Identify the problems and underlying causes. Be sure to include relevant dates and present your narrative in chronological order of their occurrence.

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Please read the Servant Leadership case and then address the Case Study Questions below. Please use APA format as shown in the APA Template provided.

Your Case Study Paper should provide a cohesive narrative fully addressing the questions and recapping the relevant data, problems/causes and outcomes from the article.

  • You should include citations to the source article, as well as to the textbook where appropriate, throughout your paper and in a References page on the last page of your paper.
  • In-text citations should be in the format (Vanderpyl, 2012) or (Vanderpyl, 2012, p. X) when you have a quote in the sentence for which you are providing the citation.
  • Citations for the textbook are (Daft, 2018) or (Daft, 2018, p. XXX).
  • Be sure to include both sources in a Reference page on the last page of your paper. You do not need to identify and include any additional references beyond the source article and the textbook for this Case Study paper.

You should aim for 4-6 pages for Case Study assignments.

  1. Case Background: Provide a meaningful summary of the case background. This information should be addressed in a chronological and narrative format. Be sure to address each of the bullets below.
    1. Identify the problems and underlying causes. Be sure to include relevant dates and present your narrative in chronological order of their occurrence.
    2. Identify the stakeholders involved in this case (e.g., nurses union, media, clients, etc.).
    3. Describe how Cowan’s predecessor (the leader prior to Cowan’s appointment as CEO in 2001) lead and managed the organization and the outcomes of his leadership.
  2. Leadership Strategies: The article discusses four major strategies that Cowan used in leading SMHC (listed in bullets below). Choose and describe the strategy that you think was most effective and why you believe it was the strategy that worked best for Cowan in SMHC’s turnaround.
    1. Get in their face
    2. Offer to serve, rather than be served
    3. Weed the garden
    4. Give the credit away
  3. Leadership Traits and Communication Tactics: Discuss the leadership traits and the communication tactics used by Cowan (refer to textbook chapter 9) to motivate, collaborate, and innovate. Be sure to provide citations to the textbook when you use concepts from it in your discussion.
  4. Outcomes of Servant Leadership: Discuss the relational and financial outcomes of Cowan’s servant leadership to this healthcare institution, its employees, and other stakeholders (e.g., unions).
  5. Challenges of Servant Leadership: Identify and discuss the challenges that make servant leadership so difficult to implement in practice. Identify at least two of the challenging elements of this leadership style for servant leaders.



Running head: THE TITLE OF THE ASSIGNMENT Name of Assignment and Week Number by Your Name MGMT 5800 Effective Leadership Month, day, year 1 THE TITLE OF THE ASSIGNMENT 2 The Title of Your Assignment List first question or problem statement in bold. Indent (tab) five spaces (1/2”) and begin your response to first question/statement. Use 12 point font – Times New Roman, Arial or Calibri font. Citations in text are formatted with (Author[s], Year of publication) and must also be listed in the References section. List second question or problem statement in bold. Indent (tab) five spaces (1/2”) and begin your response to second question/statement. Continue as necessary until all questions/problem statements have been addressed. At end of paper, Reference list begins on a separate page. See below. THE TITLE OF THE ASSIGNMENT 3 References Chapter seven in the APA manual gives you reference examples. Everything is double-spaced and there is a hanging indent. See the model on p. 49 of the Publication Manual Author’s Last Name, Initial. (YEAR). Book title. City, State (of publisher): Name of Publisher. Journal of Healthcare Leadership Dovepress open access to scientific and medical research P erspect i ves Open Access Full Text Article Servant leadership: a case study of a Canadian health care innovator This article was published in the following Dove Press journal: Journal of Healthcare Leadership 15 February 2012 Number of times this article has been viewed Tim H Vanderpyl School of Global Leadership, Regent University, Virginia Beach, VA, USA Abstract: Both servant leadership and innovation are easier to theorize than to actually ­implement in practice. This article presents a case study of a Canadian health care executive who led a remarkable turnaround of St Michael’s Health Centre, a floundering and almost bankrupt nursing home. In less than 7 years, Kevin Cowan turned around the finances and changed numerous broken relationships into strategic alliances. Under his leadership, St Michael’s Health Centre went from being one of the most underperforming health care organizations in Canada, to one of the most innovative. This article describes some of Cowan’s strategies and argues that a servant leadership approach has a direct impact on an organization’s ability to innovate. As far as the author is aware, this is the first published article on this specific change effort, which presents a unique perspective on the topics of servant leadership and innovation. Keywords: servant leadership, innovation, Canada, health care, case study Introduction Correspondence: Tim H Vanderpyl PO Box 261, Coaldale, Alberta, Canada T1M1M3 Tel +1 403 360 6971 Email submit your manuscript | Dovepress Both servant leadership and innovation are easier to theorize than they are to actually live out or execute. It is much easier to talk about serving or innovating, than it is to actually serve or innovate. Canadians tend to shy away from talking about ­themselves. Describing this tendency of Canadian leadership, Walker explains, “our style is effective, a quiet exercise of leadership with no flash or ostentation, but charisma. It is solid and trustworthy, humble and collaborative, attentive, and based on values.”1 While not directed at him, this quotation accurately describes Kevin Cowan. This paper adds to the literature on both innovation and servant leadership by presenting a case study of a true Canadian innovator and servant leader who embodies innovative Canadian leadership. Servant leadership as a leadership theory was originally proposed in an essay written in 1970 by Greenleaf.2 In this essay, Greenleaf pondered the leadership of Leo, a character in the mythical story Journey to the East, written by Herman Hesse. Leo is the servant of a group travelling across the desert. He does everything for the travellers, and serves in any way needed. But when Leo disappears, the group realizes that Leo was actually their leader. He led through his serving. Greenleaf pondered this paradox and wrote that the test of servant leadership is to ask “[d]o those served grow as persons; do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants?”2 Blanchard and Hodges expanded on Greenleaf’s writings and wrote that “servant leaders look at leadership as an act of service.”3 Servant leadership is not soft leadership; rather, it is a viable and perhaps necessary form of leadership that can generate exceptional results. This paper Journal of Healthcare Leadership 2012:4 9–16 © 2012 Vanderpyl, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 9 Dovepress Vanderpyl presents an example of a servant leader and tells the story of the remarkable change effort he led. Kevin Cowan is the former CEO of St Michael’s Health Centre (SMHC) in Lethbridge, Alberta, Canada. From 2001 to 2008, Cowan led an effort that changed this health care organization from one that was underperforming and on the verge of bankruptcy, to a thriving and innovative organization that set numerous precedents in Canadian health care. This article describes the strategies used by Cowan in this change effort. These are not grandiose theories but, rather, simple strategies that have become folklore in the organization. By “simple,” I mean that they are practical and attainable to the majority of everyday managers. The simplest strategies are sometimes the most ingenious, when mixed with hard work and an intentional and intelligent methodology for implementing them. The research for this article was conducted through the author’s personal observations of Cowan’s legacy and folklore as an employee at SMHC (now Covenant Health) from 2009 to the present. The author interviewed seven former counterparts of Cowan, including the former board chairman and six of Cowan’s former direct reports. These interviewees also provided feedback on early drafts of this article. The author reviewed every newspaper article published about Cowan and SMHC in The Lethbridge Herald (the local newspaper) from 2000 to 2008. As far as the author is aware, this is the first published research article describing this change effort. Where possible, publically accessible direct evidence of the information below is cited appropriately. Background Early organizational challenges In 1929, the Sisters of St Martha bought an old hospital in the prairie town of Lethbridge, Alberta, Canada and, in 1931, they built St Michael’s Hospital on the outskirts of this town.4 It was run by the sisters for 56 years, and then turned over to professional managers in 1985. While originally run on private donations and support, like most Canadian hospitals, it continually became more reliant on government tax dollars.5 In this way, St Michael’s Hospital found that it slowly forfeited its autonomy as it slowly grew more dependent on government funding to operate. The Catholic hospital also immediately generated an ongoing dispute over the existence of a Catholic hospital in a city with many non-Catholics; a dispute that carried on for many decades.5 Further, the provincial government built a new hospital a few blocks away, which enraged another dispute and incited 10 submit your manuscript | Dovepress competition that carried on for many decades. This dispute culminated in the demolition of St Michael’s Hospital in 1997, against the wishes of its leaders, staff, and many ­community members. The Canadian health care system is primarily publicly funded, but relies on many private for-profit and nonprofit health care providers to provide services. These providers are given service contracts by government agencies and provide services within those contracts. By the 1990s, St Michael’s Hospital was solely reliant on the provincially funded ­Chinook Health Region (CHR) for funding. (The CHR merged with all other Alberta health regions to form Alberta Health Services in 2009; this same year, SMHC merged with ten other Catholic health care organizations to form Covenant Health. Cowan initially took on the role of vice president and then consultant in this new ­organization.) After the hospital was demolished, the organization rebranded itself as SMHC. SMHC took over a nursing home and began forging its identity in seniors care. Partly to pacify the SMHC community supporters, CHR agreed to build a long-term and palliative care facility on the old St Michael’s Hospital site, which opened in 2000. CHR then leased it to the SMHC organization with a funding agreement for SMHC to provide services. Throughout the 1990s, SMHC and CHR continually battled over funding arrangements. SMHC finally appealed to the Alberta Minister of Health to settle this dispute, but he ruled against SMHC in August 1998.6 CHR served notice a few weeks later that it was terminating its funding arrangement with SMHC, which would have dissolved the SMHC organization. The SMHC board scrambled to appease CHR leaders and negotiated a suitable arrangement that kept the organization alive. In late 1998, the SMHC board also separated from their long-time chief executive officer (CEO). In an interview before he left, he stated he was relieved to be laid off, and that “I no longer have to put up with a lot of the garbage handed around here the last while.”7 An interim CEO took his place while the board searched for a replacement. By 2000, SMHC may have been one of the worst places to work in Canada in terms of labor relations, employee morale, and management style. This is a subjective observation but one that was reiterated by a number of people who worked there. In May 2000, the licensed practical nurses (LPNs) and health care aides went on strike at SMHC. Few people at the facility seemed excited about providing seniors care and they longingly dreamed of the days of providing acute care as a renowned hospital. Journal of Healthcare Leadership 2012:4 Dovepress The Cowan era Cowan originally trained as a registered nurse (RN) in Ontario, Canada. He worked in a number of Ontario hospitals in nursing and nurse management roles in his early career. He also completed a master of health administration degree. Through a personal connection, he was recruited to Drumheller, Alberta, in the mid-1990s to run a rural nonprofit organization that supported people with disabilities. This organization was on the verge of bankruptcy and had numerous staffing, financial, and cultural issues. Cowan led an organizational change effort that changed this organization from a dysfunctional to a thriving one, and his reputation as a change leader grew in the Alberta nonprofit community. The SMHC board recruited Cowan in late 2000 and he started as CEO in January 2001. SMHC at this time had approximately 300 employees, an annual budget of CAD$10 million, and a projected annual deficit of CAD$350,000. The headline in The Lethbridge Herald (the only local daily newspaper) read “Deficit, upkeep are challenges facing new St Michael’s boss,” illustrating the tough path ahead of him as the new leader.8 SMHC’s combative atmosphere filtered into the adversarial relationships with its unions. A few weeks after Cowan started, the local paper published complaints about SMHC from the president of the local nurses’ union.9 In addition, the staffing models at SMHC were set up in an inefficient manner for the number of residents, layout of the building, and funding arrangements with CHR. It could not maintain its level of staffing without substantial changes. Starting in the fall of 2001, Cowan and the management team began using LPNs and health care aides for some tasks rather than RNs. The RN union took great exception to this and filed hundreds of grievances against SMHC between 2001 and 2002. Cowan and the board of SMHC advanced all of these grievances to a precedent setting arbitration. The local newspaper continually published reports ­criticizing Cowan and the management at SMHC. In ­February 2001, an editorial stated that “the centre is dangerously ­understaffed, and in a situation like that lives hang in the balance.”10 In September 2001, regarding the proposed ­staffing changes, it wrote that “the move will place RNs in professional ­jeopardy” and quoted the nurses’ union leader as saying that “I think what is really offensive is the misrepresentation to the public that St Mike’s and the CHR are not acknowledging they are providing lesser or unskilled hands to this vulnerable population.”11 An LPN took exception to this comment and in a letter to the editor, wrote that “I take offence to her continually Journal of Healthcare Leadership 2012:4 A case study of a Canadian health care innovator telling people that I am an unskilled provider … there is a place in the medical field for all of us.”12 Aside from the one lonely letter to the editor, there was no positive local media coverage of SMHC from 2000 to 2004. Cowan and the Chairman of the SMHC Board published a letter to the public on October 6, 2001 in The Lethbridge Herald.13 The editor forced SMHC to pay to publish this letter. The letter sought to clarify some of the comments and criticisms being made. Shortly after this ­letter, on November 1, 2001 the nurses’ union received a court injunction through the Alberta Court of Queen’s Bench. This injunction stopped the staffing changes until an arbitrator could rule on the grievances. The front page of The Lethbridge Herald proclaimed the headline “St Mike’s RNs block changes” in a large font.14 One story quoted the local union leader as saying that “Quite honestly, we see what’s happening in Lethbridge as a beachhead in terms of longterm care policy, so we’re doing everything we can because it has consequences for the rest of the province.”15 Another biased editor wrote that “the Herald receives calls periodically from the families of patients of St Michael’s. Often, those callers complain of inadequate care. Their loved one isn’t being bathed regularly or is left to eat a meal alone.”16 In December 2001, The Lethbridge Herald labeled this dispute as the most contentious issue of the year in Lethbridge.17 Initial progress In February 2003, after hearing numerous arguments about the permitted scope of practice for LPNs and the staffing model of SMHC, the arbitrator sided with SMHC in all aspects of the arbitration. This allowed LPNs to work at their full scope of practice (72% of the scope of a RN). This ruling was precedent setting and allowed numerous other Canadian health care organizations to begin using LPNs in their facilities as well. But the arbitrator, while awarding the win to SMHC, described the relationship between the parties as “dysfunctional.” In the conclusion of his ruling, he wrote: “Given the time, emotion, and expense which has gone into these proceedings … I strongly urge the parties to earnestly seek to attain the objective of ‘harmonious relationships’ set out in the Preamble of the Collective Agreement.”18 While not binding in a legal sense, his observation illustrates the difficulties of leading in this culture. After numerous biased and scathing articles on SMHC in 2001 and 2002, The Lethbridge Herald did not publish a single article about the arbitrator’s decision, despite its nationwide impact. It is interesting to note that SMHC did not issue a press release or attempt to broadcast its win. This would have been a great time to publicly flaunt submit your manuscript | Dovepress 11 Dovepress Vanderpyl the win for Cowan, but he chose not to, an excellent sign that a servant leader was leading SMHC. In 2002, SMHC developed an independent arm of its organization, the St Michael’s Housing Association (SMHA) to build new independent living facilities. SMHA procured funds to build and open Martha’s House on the property adjacent to SMHC. This facility required private funding and innovative methods of procuring those funds, and the profits could be used to finance community endeavors that would otherwise not be funded by government initiatives. This facility gave SMHC additional financial stability and lessened its overall dependence on CHR for all funding. In 2005, Cowan successfully negotiated a package deal to return the Geriatric Community Rehabilitation and Bridges Program as well as the Post Acute Rehabilitation Program to the SMHC organization. In 2008, SMHC built and opened St Therese Villa, a Designated Assisted Living (DAL) facility for seniors. This facility has become a template of seniors care in Alberta and many new DAL facilities in Alberta and Saskatchewan are now modeled after it. It was designed and developed by both SMHC and CHR through a mutual partnership. The above is only a brief history of the organization, and there are numerous other stories that illustrate the dysfunctional culture Cowan inherited. This was not an easy time, but Cowan began refocusing the organization on the future, while cleaning up the mess of the past. This dichotomous approach was difficult for Cowan both personally and professionally. He was attacked from all sides and often felt like a lonely sailor in a sea of discontent and aggressiveness. The rest of this paper describes specific strategies he used to change this culture while somehow finding time and opportunities to develop two innovative health care facilities that have become oftmimicked standards for seniors care in Western Canada. Tangible solutions Innovation is cumbersome and difficult to implement. After all, if it was easy, everyone would be doing it, and it would not be innovation. It would have been easy for Cowan to give up on innovation when he first started and instead spend the first 5 years of his tenure attempting to fix the culture and focus only on the present. He did not hire expensive consultants, or conduct exhaustive engagement surveys, or release a fancy new training program. Instead, Cowan focused on the present and future simultaneously. He did not reminisce about the past; he focused on the future and what SMHC could become. Cowan used four specific strategies to implement these changes: (1) “get in their face”; (2) “offer 12 submit your manuscript | Dovepress to serve, rather than be served”; (3) “weed the garden”; and (4) “give the credit away.” These strategies are intertwined with a servant leadership approach and provide anecdotal evidence that authentic servant leadership may be a key to invoking innovative organizational change. “Get in their face” Forging alliances is an essential aspect of positive turbulence. This positive turbulence is needed to forge a climate of innovation that embraces forward-moving change.19 Cowan forged these alliances through hundreds of conversations over a cup of coffee. Whether it was an adversarial union leader, an unhappy resident or family member, or a jaded leader at CHR, Cowan’s strategy was to “get in their face.” When a person first hears this phrase, it sounds slightly offensive (was he trying to pick a fight?), but it becomes more intentional and useful when studied further. Cowan did not avoid his enemies and criticizers; rather, he would find the enemy and sit down with that person over coffee to hear their side. It is easier to hate a nameless enemy “over there,” than it is to hate someone sitting in an office sharing coffee with you. These meetings slowly turned adversarial relationships to amiable ones. Cowan would intentionally spend about 95% of the time talking about the person and what they needed. He would learn about their interests, their …
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