Date of Award


Document Type


Degree Name

Doctor of Philosophy


Leadership PhD

First Advisor

Shirley A. Freed

Second Advisor

Jo Manion

Third Advisor

Joan Ulloth


In the United States a large number of people are not engaged at work. The lack of engagement affects the service outcomes as well as financial bottom line of organizations. The cost of actively disengaged employees in the U.S. is about $300 billion a year. Research cites the importance of examining business units that scored high on employee engagement to learn about actions and practices that drive business outcomes.

Between 2005-2010 The Community Hospital (TCH), part of a Healthcare Corporation in Valley Town, USA (pseudonym), assessed employee engagement using Gallup’s Q12 survey. Some groups scored in the top quartile and became the sample for the study. The purpose of this study was to learn from the high-engaged teams about individual actions, practices, and workplace conditions, which contributed to high engagement. The research questions guiding the study were: How do workgroup member actions, practices, and workplace conditions contribute to high engagement? How do leaders contribute to developing high-engagement workgroups? How are the workgroup member and leader actions and practices similar or different? This study identified actions and practices that contributed to high engagement that can be expanded upon to promote high engagement at TCH in the future.

The population for this qualitative study consisted of workgroups and their leaders rated as highly engaged in the 2010 Gallup Survey. Out of 186 originally designated as members of highly engaged workgroups, 28 people were recruited and selected for the study. There were five clinical workgroups and their leaders, and two non-clinical workgroups and their leaders.

The encoding and analysis of the data began once a session had been transcribed. After a focus group or interview session, participants were asked to complete an online survey on the culture of engagement at TCH. The data were used to uncover deeper meaning in perspectives among workgroup members and their leaders on topics pertaining to the research questions. Throughout the data collection process, I kept a journal to record reflections on what I was seeing, hearing, and learning in the data collection process.

Two research areas provided the conceptual framework for this study. The first area was Social Exchange Theory (SET) that examines benefits that individuals and groups perceive themselves as deriving from interactions and relationships in their workplace. The second area was employee engagement literature, which builds from SET and describes practices and workplace conditions that facilitate engagement at the individual level, workgroup level, and organization-wide. This study expanded on employee engagement research by looking specifically at exemplars in their field who had been quantitatively rated and designated as highly engaged prior to the study.

Findings indicated that the highly engaged employees stayed engaged in part due to the high engagement of their other workgroup members. Workgroups members identified themselves as teams based on their interactions and relationships with each other at their department or work unit. Workgroup members valued, supported, and cared for each other. When leaders were attuned to their workgroups, and provided the internal support that teams needed, workgroups saw their leader as being in alignment with the team. Yet for the most part leaders were unaware of their actions and practices that either fostered or hindered the engagement of the people who directly reported to them.

Consequently, it was not surprising that employees did not think that leaders always put them first, but leaders thought they did. This was particularly true when leader responsibilities took them outside the team’s work, or business-related matters took precedence over employee concerns about providing good patient care. Interestingly, contemporary healthcare literature indicates that if leaders do not put the employee first, employees will not be able to focus on the patient as their first priority.

In addition, leaders who had large numbers of direct reports were not able to foster the interactions and practices most conducive to high engagement on teams. The sheer number of workgroups and direct reports a leader had, tended to preclude an ability to consider how to model what was happening on a highly engaged team with workgroups that were less engaged.

This study laid the foundation for my future consulting work with healthcare leaders on actions and practices that can be used to develop a high-engagement workforce at the local work unit level within hospitals. It can be done by working with leaders to establish a culture of engagement where leaders put employees first, which, in turn, allows employees to put patients first.

Subject Area

Work, Quality of work life, Employee empowerment, Medical personnel.