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IJHCQA
32,6 Investigating power styles and
behavioural compliance for
effective hospital administration
958 An application of AHP
Received 26 February 2018
Revised 2 September 2018
Anjali Pathania and Gowhar Rasool
Accepted 8 November 2018 School of Business Studies, Central University of Jammu, Jammu, India

Abstract
Purpose – The purpose of this paper is to examine the use of power tactics by hospital administrators in
order to gain employee compliance. It attempts to understand the influence of power bases of hospital
administrators on the employee compliance using an analytic hierarchy process (AHP) technique.
Design/methodology/approach – The study adopted a mixed method technique and was conducted in
two phases. In the first phase, qualitative analysis was carried out through content analysis of the anecdotes
collected from the employees working in tertiary hospitals. Content analysis of responses aided in obtaining a
list of criteria and sub-criteria affecting employee behavioural compliance. In the second phase, quantitative
analysis was carried out using the AHP technique. While applying AHP, the issue pertaining to employee
behavioural compliance with hospital’s policies, procedures and related instructions was formulated in form
of a hierarchy of one objective, two criteria, six sub-criteria and five alternatives established through literature
review and content analysis. Furthermore, the subject matter experts were asked to conduct pairwise
comparison wherein priority rankings were achieved.
Findings – The results indicated that reward power (25 per cent) is the most significant power style exercised by
effective hospital administrators in achieving employee behavioural compliance followed by expert (24 per cent),
referent (22 per cent) and legitimate powers (17 per cent). As coercive (12 per cent) came out to be the least preferred
power style, it should be cautiously exercised by hospital administrators in the present day scenario.
Research limitations/implications – The major limitation of this study is that the sample was drawn
only from three tertiary hospitals in Jammu district that limits the generalizability of the findings in all the
hospital settings across different regions. No attempt is made in this study to understand the variations with
regard to demographics of the respondents that can be taken as a future research study. This study is
cross-sectional in nature and provides the perspective of specific time. A longitudinal study could further
provide insights into different time variations and the comparison and henceforth can be more
comprehensive, thus supporting the generalizability of this study.
Practical implications – The study empirically identifies the relative importance of exercising power
styles in order to gain employee behavioural compliance. The study helps in understanding the complex
problem of behavioural compliance in hospital setting by examining the intensity of each factor affecting
employee behavioural compliance. This knowledge is very critical in effective hospital management and
getting the work done. The priority rankings obtained for power styles can be used for developing selection
batteries and performance records of hospital administrators. As the behaviour of the employees is not static,
there may exist the inherent limitations of adopted cross-sectional design for the present study. Furthermore,
longitudinal study can be conducted at different time periods, to understand the variations in the patterns of
employee’s compliance behaviour and associated practiced power styles by hospital administrators.
Originality/value – This is perhaps the first study that has scientifically attempted to integrate the power
styles and analyzed their effective use in hospital administration. This research study has attempted to
develop an elementary base for academicians, scholars as well as management practitioners on the effective
use of power styles for achieving employee behavioural compliance in hospitals.
Keywords Analytic hierarchy process, Multi-criteria decision making, Employee behavioural compliance,
Leadership power styles
Paper type Research paper

International Journal of Health

Care Quality Assurance Introduction
Vol. 32 No. 6, 2019
pp. 958-977
Business dynamics have been witnessing interminable changes and the corporate diaspora
© Emerald Publishing Limited
0952-6862
is striving for innovative and ingenious means of edifying the employee performance
DOI 10.1108/IJHCQA-02-2018-0059 (Evans et al., 2002). However, employee’s interpretation of these unconventional strategies
largely depends on their psychological quotient. Harris (1994) discussed how the mental Power
schema of employees can be influenced by creating appropriate organizational culture that, styles and
in turn, affects employee’s sense making or response towards organizational phenomena. behavioural
Ke and Wei (2008) argued that the leader’s behaviour formed by the usage of varied power
styles contributes in shaping the organizational culture. Usage of these power styles by the compliance
leaders tends to receive varied response from employees. The employee behaviour that is of
concern to the organization is predominantly their mindful compliance to the directions 959
given by their managers in line with organizational policies and procedures. As the
discretion of compliance is subjective and employees may refuse to comply, behavioural
compliance that is characterized as “Change in conduct that is requested by another person
or group; the individual acted somehow on the grounds that others requested him or her do
as such” assumes a critical role in organizational settings (Breckler et al., 2006).
The existing literature on individual behaviour as also highlighted by theory of planned
behaviour (TPB) (Ajzen, 2005) emphasizes that individual belief, attitude, social norms,
intentions and volitional control significantly influence employee behaviour. Also, there is
extant literature on how employee behaviour is articulated and constrained by several
organizational factors like processes, rules, relations, values and culture (Smircich, 1983;
Kouzes and Posner, 1987; Harris, 1994; Sharma and Yetton, 2003; Schein, 2004). However, in
the present empirical literature, the relationship and linkages between administrator’s
actions, organizational factors, individual factors and employee behaviour have not been
tested in a hospital setting wherein policy compliance is crucial for ensuring effective service
delivery. Moreover, with an optimistic forecast regarding reforms in health care service
(WHO, 2000; Boselie, 2010; Srinivisan, 2014), the focus has shifted towards attaining
employee behavioural compliance for effective hospital management (Guthrie, 2005;
Erlandson and Ludeman, 2003). As limited research studies have been conducted to
understand the relative significance of factors influencing the employee’s behavioural
compliance specifically in the health care sector (Corby, 1992), the present study has been
conducted to examine the problem of employee’s behavioural compliance in hospitals using
an analytical hierarchy process (AHP) method. The AHP technique has been applied as a
successful tool in a similar study of achieving high employee performance by establishing
priority rankings of management styles being exercised by managers in organizations
(Albayarak and Eransal, 2004). Hence, the present study has applied multi-criteria decision
making to develop a model that delineates the structured relationship and significance of
improved employee behavioural compliance via different leadership power styles. The
choice of diverse forms of power is at the disposal of leaders in health care as they attempt to
influence doctors, patients, colleagues, depending on the role they are playing. It is vital to
exercise the right type of power singly or in combination with other powers to achieve
successful interactions and appropriate influence. Power and leadership are interlinked;
however, both are studied rarely in medical and health care settings, given the roles and
responsibilities, health care personnel have to exert leadership power appropriately to foster
patient-centred and health care organizational goals (Gabel, 2012). In the past studies of
power in the health care sector, no clear consensus has emerged among the researchers as in
which form of power or combination thereof would increase the organizational effectiveness.
This study is an attempt to bridge this gap and add to the existing research of power and
compliance specifically in the health care sector.

Literature review
Compliance management that is acting as a major challenge for organizations is defined as
the management of employees’ behaviour who may or may not be willing to follow the
organizational rules, regulation and decisions (Warkentin and Willison, 2009). In this
direction, there are several empirical studies conducted to understand the factors affecting
IJHCQA employees’ compliance in organization (Puhakainen and Siponen, 2010; Ifinedo, 2012).
32,6 Haynes et al. (1979) highlighted that behavioural compliance is the degree to which one
person adheres to the opinion of other. Rungapadiachy (1999) emphasized that compliance
is behaviour in response to the request of an influencing source. The TPB highlights the
existing relationship between belief, behavioural control and intention, attitude and actual
behaviour (Ajzen, 1985, 1991; Ajzen and Fishbein, 1980). It is argued that intentions of a
960 person are shaped by his/her attitude, their subjective norms and beliefs, which ultimately
determines individual’s behaviour. Therefore, intentions lead to performing behaviour (Bass
et al., 1999). In the employee compliance studies, compliance intention is referred to as
employee’s intention to comply with organization decisions, policies and procedure
(Bulgurcu et al., 2010; Vance et al., 2012).
Also, power is seen as a process to induce the desired behavioural change in
conformance with a predetermined plan. French and Raven (1959) explained power as the
influence in terms of psychological change that includes the change in conduct, feelings,
the state of mind, objectives, needs, values and different components that constitute the
psychological meaning of a person. French and Raven (1959) in their study identified
different sources of power, namely, legitimate power (LP), reward power (RP), coercive
power (CP), expert power (EP) and referent power.
There is plethora of literature on supervisory power, organization culture, and
individual capability; however, there are limited studies attracted towards investigating
significant influence of supervisory power, organization culture and individual capability
on employee behaviour and compliance. There are several proposed models based on
cognitive theories (Herath and Rao, 2009b; Myyry et al., 2009; Bulgurcu et al., 2010;
Johnston and Warkentin, 2010) and criminological theories (Straub, 1990; Willison and
Backhouse, 2006; D’Arcy et al., 2009; Siponen and Vance, 2010; Hu et al., 2011) in which
various organizational and individual level factors have been identified influencing
employee’s compliance with security policies.
On the basis of the literature review, there are three major theoretical voids identified and
argued, which guides towards addressing the gaps in future research studies. First, there
are several studies that indicate the relation between organizational culture and employee
compliance and many of them addressing specifically employee’s information security
compliance. Here, the issue that has not been deliberated upon is whether organization
culture directly influences or there exist other organizational and individual aspects and
related factors that mediate the influence. Moreover, there is dearth of research studies that
advances and tests the model in this direction. Second, though as highlighted in the study of
Puhakainen and Siponen (2010), the role of top management or administrators in guiding
desired employee compliance is significant, there is limited clarity and explanation on
whether this relationship holds true in hospital setting and using what ways or styles can
administrators/top management impact employee cognitive process thereby guiding
desired compliance. Here, it is notable that administrators or supervisors or top managers
are the medium through which company policies and decisions are communicated to
employees for compliance and execution.
Finally, based on our review of power styles and leadership role in influencing employee
behavioural compliance, it can be inferred that consensus has been established in the
literature that a leader in a company whether known as top management/supervisor/
manager/administrator plays a critical role in executing any initiative of the organization
via his/her influence ( Jarvenpaa and Ives, 1991; Sharma and Yetton, 2003). Therefore, in
order to fill the above research gaps, it is imperative to articulate and test the explicit role of
supervisor’s power styles in influencing organizational factors as well as individual factors
and their overall combined effects on employee compliance in a hospital setting. In the
present study, the behaviour of interest comprises employee’s mindful compliance with
organizational policies and practices through the medium of instructions and directions by Power
the hospital administrators. The attempt to address the above gaps makes a significant styles and
contribution to the existing theory and practice of hospital administration and management. behavioural
In the following section, a conceptual research model has been proposed along with
research questions in order to elucidate how hospital administrators could directly or compliance
indirectly shape employee intentions and compliance in conjunction with influencing
organizational and individual level factors. 961
Theory, research questions and conceptual diagram
The literature review reveals numerous factors influencing employee compliance. However,
it seems that consensus appear amongst three antecedents:
(1) power styles;
(2) organizational factors; and
(3) individual factors.
In context of leader’s power styles, Koslowsky and Schwarzwald, (1993) carried a research in
order to examine the use of power tactics to gain the compliance. The study analyzed the
utilization of power in distinctive settings and status conditions. The settings that were picked
in this study were work and school and the status level was manager or teacher employee or
student. The study measured the influence and use of power based on French and Raven’s six
fold power taxonomy. The results of this study also showed that individuals who are on low
status tend to use less of power to gain compliance in conflict situations. Meng et al. (2014)
investigated the relationship between leader’s power bases and member’s compliance and
satisfaction with supervision. The results from the multiple regression indicated that
30.5 per cent of the variance in attitudinal compliance was explained by legitimate and EP.
There is rapidly growing studies investigating the linkages between power styles and
employee compliance. Thus, the above exposition leads to following research question:
RQ1. What is the relative importance of leadership power styles of hospital
administrators in gaining employee’s behavioural compliance in hospital setting?
Several research studies have been conducted findings of which establish the influence of
various aspects of organizational culture on employees’ attitude that is cognitive, affective
and behavioural outcomes (Lund, 1986; Douglas et al., 2001; Schrodt, 2002). Smircich (1983)
emphasized that organizational culture instils the sense of identity and commitment
amongst employees, facilitates stable social systems and guides the employee behaviour.
There is extant literature on how employee behaviour is articulated and constrained by
several organizational factors like processes, rules, relations, values and culture (Smircich,
1983; Kouzes and Posner, 1987; Harris, 1994; Sharma and Yetton, 2003; Schein, 2004). Hence,
we develop a research question as follows:
RQ2. What are the primary organizational factors (criteria) that influence employee’s
behavioural compliance in hospital setting?
Ke and Wei (2008) researched and supported the assumption that leader’s perceived
behaviour due to their associated power styles contributes in shaping the organizational
culture and related factors. Therefore, the following research question was developed:
RQ3. How do leadership power styles of hospital administrators influence organizational
factors which can affect employee’s behavioural compliance in hospital setting?
In terms of employee’s individual behaviour is concerned, TPB (Ajzen, 2005) emphasizes that
individual belief, attitude, social norms, intentions and volitional control significantly
IJHCQA influence employee behaviour. Ifinedo (2012) conducted a study based on TPB and protection
32,6 motivation theory in which it was revealed that employee’s self-efficacy, attitude, subjective
norms, response efficacy and perceived vulnerability positively influence their security
behavioural compliance intentions. Hence, we develop the following research question:
RQ4. What are the primary individual factors (criteria) that influence employee’s
behavioural compliance in hospital setting?
962 Podsakoff and Mackenzie (1994) researched and established the influence of reward on
work attitude and employees’ commitment. Afza (2005) carried a research on prevalent
superior–subordinate relationship and satisfaction in Indian small business enterprises. The
object of this particular study was to investigate the relationship between the five power
bases defined by French and Raven with individual level factors like employee commitment,
satisfaction, trust and behavioural compliance. It was concluded in the study that reward,
expert and referent power bases are most effective in influencing subordinates. Hence, we
develop a research question as:
RQ5. How do leadership power styles of hospital administrators influence individual
factors which can affect employee’s behavioural compliance in hospital setting?
For conducting this research, the basic foundation was based on the literature review
of employee behaviour and compliance, supervisor’s power styles, organizational factors
influencing employee compliance, and further these theoretical findings were integrated
to investigate the influence of hospital administrator power styles on guiding the
desired employee belief’s and attitudes that facilitates their intention to comply as per
TPB (Ajzen, 2005), which is also depicted in a conceptual diagram as shown in Figure 1.
The present study is nowhere exodus from the prior literature; however, it only attempts
to elucidate and test how these constructs work together in influencing causal map of
employee’s behavioural compliance in a hospital setting, thereby constituting the main
contribution of this research.

Methodology
This research is an exploratory study that adopted mixed method design to analyze the
relative importance of leadership power styles in the process of gaining employee behavioural
compliance. Mixed method research helps in analyzing the question of interest through both a
qualitative or inductive and quantitative or deductive processes (Creamer and Ghoston, 2013).
This stepwise mixed method research study having an initial inductive phase of analysis was
carried with content analysis of narratives that was followed by a deductive or quantitative
component using the application of AHP. The purpose of the application of AHP was that the
flexibility of AHP allows for more accurate expression of one’s opinion on only two
alternatives rather than taking all the alternatives simultaneously (Ishizaka and Labib, 2011).
Pairwise comparisons in AHP further allow consistency check at various stages. AHP uses a

Organizational
Factors RQ2
RQ3

RQ1 Employee
Power Styles Behavioural
Compliance

Figure 1. RQ5 Individual

Conceptual diagram Factors RQ4
ratio scale, which, contrary to conventional methods using interval scales or questionnaires Power
that are inadequate to understand some forms of information like changes of emotions and styles and
behaviour (Popper, 2004; Ackroyd and Hughes, 1981). AHP has the advantage of permitting a behavioural
hierarchical structure of the criteria, which provides users with a better focus on specific
criteria and sub-criteria when allocating the weights (Franek and Kresta, 2014). One of the compliance
most distinguishing characters of AHP methodology is that it allows evaluation of
quantitative as well as qualitative criteria and alternatives on the same preference scale. In an 963
attempt to find the criteria affecting employee behavioural compliance, employees in three
tertiary hospitals in India were asked to share their experience wherein they complied with the
orders given in the organization. These narratives were collected using simple pen and paper
approach. In the process of applying AHP, as given by Saaty (1980), the narratives of the
employees was shown to subject matter experts (two HR experts, two psychologists and two
hospital administrators) and they were asked to give their responses in form of pairwise
comparisons using super decisions software.

Sampling design
A theoretical sampling approach was adopted in this study. The rationale of adopting this
method was because given the exploratory nature of this study there was a need for more
flexible approach and theoretical sampling approach is based on the relevant theoretical
backdrop and insights of the researchers that provide valid reasons for selecting certain groups
and topics for detailed analysis (Glaser and Strauss, 1967; Strauss, 1987; Strauss and Corbin,
1990). Textual narratives from 40 staff members (22 males and 18 female staff) belonging to
patient care and nonpatient care departments were collected from three tertiary hospitals in
Jammu district, India. While selecting the sample size for qualitative study, the objective of
study as well as time and resource constraint was taken into consideration (Patton, 1990). The
sample size was selected so as to ensure that all possible diverse perceptions were collected
without duplication and reaching saturation (Glaser and Strauss, 1967). The sample was purely
drawn based on the availability of staff members and who agreed to be the part of the study. In
order to avoid response bias, narratives were collected within a period of two weeks. The sample
age group was between 25 and 40 years. In order to ensure the collection of high-quality
responses, researchers were present in person during the entire data collection process and
personally gave directions as well as handled all queries of the respondents (Strange et al., 2003;
Dornyei and Taguchi, 2010). During quantitative analysis using AHP, these narratives of
employees were shown to subject matter experts (two HR experts, two psychologists and two
hospital administrators) and they were asked to give their responses after reading each
narrative, thus accounting for 240 pairwise comparisons.
Phase 1: qualitative analysis. Narratives were discussed and criteria as well as
sub-criteria were identified by the authors. Furthermore, each narrative was independently
coded for the presence and absence of criteria as 1 and 0, respectively. The interpretations of
criteria and sub-criteria were discussed amongst authors and after further iterations of
revisiting literature followed by refinement and coding, two main criteria with six
sub-criteria were finalized once the value for Krippendorff’s (1970, 2004) α as 0.72 was
achieved. Krippendorff’s α coefficient of 1 indicates perfect agreement, whereas 0 indicates
chance agreement (Williams et al., 2015). Therefore, higher values indicate a better
agreement (Krippendorff, 1980). The acceptable value of K α is ⩾ 0.667, the lowest
conceivable limit (Krippendorff, 2004, p. 241).
The results of content analysis highlighted following criteria and sub-criteria.
Criteria 1: organizational aspect. Nature of work: this incorporates the quality of work to
be done by the employee. It may also include the confidentiality attached to the work, time
constraint involved as well the level of challenge involved in doing the work. Lawrence and
IJHCQA Lorsch (1969) led an investigation to figure out which sort of work is appropriate for the
32,6 market condition. Thus, this criterion determines that how the work should be designed so
that it prompts high employee behavioural compliance.
Incentives: incentives include both monetary and non-monetary forms. Monetary
incentives help in augmenting the satisfaction of employees and non-monetary impetuses
are helpful for the recognition of subordinates. These monetary and non-monetary
964 incentives help in attaining employee’s compliance (Burgess and Ratto, 2003). Employee
compliance is based on several parameters like employee attitudes, opinions and value
system. Lazear (1986) likewise contended that by adding financial incentives to employees
as a motivational catalyst would attract more engaged workers to the organization. Thomas
(2009) highlighted that giving intrinsic rewards help in improving employee engagement.
Social relations: “Social Relationships” at the workplace are characterized as
interpersonal relationships among the colleagues that help in advancing positive working
relationships as well as dealing with inadmissible behaviours. Bruk-Lee and Spector (2006)
identified that in many professional occupations interpersonal conflicts are the most
reported cause of workplace problems and also antecedent of work-related stress.
Criteria 2: individual aspect. Self-efficacy: self-efficacy is viewed as the conviction of a
person in himself for doing a particular task. Self-efficacy enables individuals in making a
difference in how they think, feel and act (Bandura, 1997). Thus, this criterion determines
how self-efficacy can be raised to positively influence employee behavioural compliance.
Trust: Kramer and Carnevale (2001) emphasized that “trust involves beliefs and
expectations that a partner’s actions will be instrumental to one’s long-term self-interest,
particularly, in circumstances in which the partner must be counted on in order to provide
unique benefits or valuable outcomes”. Thus, this criterion determines how an increased
level of trust can be imbued in employees to achieve behavioural compliance.
Attitude: attitude encapsulates the emotions that employees exhibit towards different
aspects of the workplace environment (Carpenter et al., 2009). It has been researched that there
are some elements that influence the attitude towards work, like the person-environment fit,
job characteristics, psychological contract, work relationship and leader–member exchange.
Podsakoff and Mackenzie (1994) in his research attempted to find the influence of reward on
work attitude and employees’ commitment.
Phase 2: quantitative analysis. The AHP method as given by Saaty (1980, 1990, 1994) was
applied using Super Decision software. Several studies depict that the AHP technique has
wide application (Zahedi, 1989) in areas like marketing (Wind and Saaty, 1980), accounting
(Arrington et al., 1984), behaviour (Antony and Joseph, 2017), etc. Thus, it is considered to be a
versatile technique that can be explored further and can be applied in other areas of research
as well. Over the years, researchers have shown concern and have struggled in measuring
both the physical and psychological realm of events wherein physical realm relates to
objective reality outside the person carrying out the measurement and psychological realm
relates to his/her subjective ideology. As AHP provides a coherent theory to deal with both
these aspects of physical and psychological world without compromising one or the other, it
has been extensively used for measuring physical and social domains (Saaty, 1987). Therefore,
in the present study, AHP is applied in order to analyze the relative importance of different
power styles for improving employee’s behavioural compliance in the hospital setting.
The statistical technique used in AHP in the present study is Gamma distribution-based ML
estimates as it is believed that priority weights of all power styles are equal and it is preferred
that the statistical estimates should be close to eigenvalue solution.

Application of AHP
AHP was applied in the following steps.
Step1: development of behavioural compliance hierarchy (Saaty, 1980) Power
Complex decision problem of improving employee’s behavioural compliance was structured styles and
into a hierarchy model as shown in Figure 2. On the basis of literature review and content behavioural
analysis, the evaluation criterion was decomposed into two criteria with three sub-criteria
each as Organizational level: nature of job, social relations and incentives and individual compliance
level: self-efficacy, trust and attitude. Also, five alternative power styles as given by French
and Raven (1959): LP, RP, CP, EP and referent power were examined. Podsakoff and 965
Schriesheim (1985) conducted field investigations based on French and Raven’s bases of
power and made recommendations for future exploration. Raven et al. (1998) in their study
attempted to measure the power influence based on theoretical conceptualization given by
French and Raven. Elias Steven (2008) revisited the 50 years of development that took place
in French and Ravens power taxonomy. Thus, from time to time, these five power bases
have been widely and extensively used by various researchers during reanalysis and
investigation of organizational power dynamics. Therefore, for the present study, the
following five power bases were examined as alternatives of the constructed AHP hierarchy.
Alternative 1: Power Style 1– legitimate power. Lunenburg Fred (2012) explained LP as
the capability of a person to influence others’ behaviour due to the position that he/she holds
in the organization. French and Raven (1959) defined LP as “Perception of an individual that
another person has the legitimate right to prescribe behaviour for him”. The effectiveness of
LP is subject to level of acceptance by the followers (Gibson et al., 2012).
Alternative 2: Power Style 2 – reward power. RP is a person’s ability to influence others’
behaviour due to the control over the resources that they want to receive. These rewards can
be in different forms like financial or nonfinancial. French and Raven (1959) defined RP as
“Perception of an individual that another person has the ability to mediate rewards for him”.
Nelson and Quick (2012) highlighted that for effective RP, the manager should be clear
about the behaviour being rewarded.
Alternative 3: Power Style 3 – coercive power. CP is the person’s capability to influence
the behaviour of others’ through means of threatening or punishing. French and Raven
(1959) defined CP as “Perception of an individual that another person has the ability to
mediate punishments for him”. CP is attached with negative effects and thus should be
used with caution.

Goal
Employee behavioral
Compliance

Criteria
Individual
Organizational
Aspect
Aspect

Sub-criteria

Nature of Social
Incentives Self Efficacy Attitude Trust
Work Relations

Alternatives
Figure 2.
Hierarchy for gaining
Expert
employee behavioural
Legitimate Power Reward Power Coercive Power Referent Power
compliance
IJHCQA Alternative 4: Power Style 4 – expert power. When knowledge, skills and abilities empower
32,6 an individual to influence others’ behaviour it is referred to as EP. French and Raven (1959)
defined EP as “Perception of an individual that another person has special knowledge or
expertness”. The effectiveness of EP depends upon credibility, trustworthiness and
relevance of the power holder (Luthans, 2011).
Alternative 5: Power Style 5 – referent power (RFP). Referent power is seen as person’s
966 capability to influence others’ behaviour due to interpersonal relations or respect that
individual bears. French and Raven (1959) defined referent power as “identification of the
individual with another person as a sense of oneness”. Referent power develops when a
person desires to be like another person because of the respect he enjoys. Leaders with a
good reputation, a certain level of charisma and attractive personality influences the
followers as they wish to get associated with such leaders (Kudisch et al., 1995).

Step2: assigning priorities

The AHP process begins by developing a matrix through pairwise comparison. The matrix
A (n×n) matrix, where n is the number of criteria considered for evaluation. Every entry in
the matrix A denoted by acd represents the importance of the cth criterion relative to the dth
criterion. Thus, if acd W1, then the cth criterion is more important than the dth criterion and
vice versa. However, if both criteria have similar importance, then the value of acd is 1:
0 1 01 . . . a1n
1
a11 a12 . . . a1n a12
B a21 a22 . . . a2n C B C
. . . a2n C
B C B 1=a21 1
A¼B C¼B C: (1)
@^ A B @^
C
A
an1 an2 . . . ann 1=an1 1=aan . . . 1

Thus, paired comparisons were done to determine the relative importance of each element in
different levels of hierarchy through evaluation by SMEs. The narratives of the employees
were shown to subject matter experts (two HR experts, two psychologists and two hospital
administrators) and they were asked to give their responses after reading each narrative in
form of pairwise comparisons using super decisions software.
After constructing matrix A, the pairwise comparisons are normalized. The matrix is
calculated using the formula:
acd
acd ¼ Pn : (2)
l¼1 ald

Thus, the response matrices formed were normalized and weights depicting the priorities
were assigned as shown in Tables I–IX.
Furthermore, the criteria weight vector w is calculated by averaging the values on each
row of normalized vector A (Saaty, 1980):
 
W i ¼ Sum of cdth row=n : (3)

The consistency was checked using the eigenvalue method for verifying the rationality of
the matrix. The consistency index was calculated by the using the formula:

ðdmax n Þ
CI ¼ ; (4)
ðn1Þ

where δ is the maximum variance and n the number of priorities.

 Finally, consistency ratio (CR) is calculated using formula (Saaty, 1980): Power
styles and
CR ¼ CI=RI; (5) behavioural
where RI is the random index number as mentioned by Saaty. compliance
Thus, in the present study, CR are calculated for matrices as shown in Tables I–IX.
As shown in Table I, the values of priority vector depict that the employee’s decision of
compliance is greatly influenced by factors related to organizational aspect (53 per cent)
967
followed by factors related to individual aspect (46.6 per cent). The organizational aspect
and associated support are perceived to be the most important decisive factor for employee’s
mindful compliance in hospitals. The social exchange theory provides the foundation for the
above-revealed relationship between perceived support on account of organizational aspect
and employee’s compliant behaviour. As per this theory, as the perceived support from the

OA IA Priority vector
Table I.
OA 1 5.5 0.534188034 Criteria comparison
IA 3.5 1 0.465811966 matrix with priority
4.5 6.5 vector and
Note: Consistency ratio: 0.0 consistency ratio

OA NJ SR IN Priority vector

NJ 1 1.125 0.5 0.355935562

Table II.
SR 1.666667 1 0.333333333 0.378056491 Sub-criteria
IN 0.5 0.222222 1 0.266007946 comparison matrix
3.166667 2.347222 1.833333333 for criterion
Note: Consistency ratio: 0.04 organizational aspect

IA SE TR ATT Priority vector

SE 1 1.25 1.083333333 0.464663827 Table III.

TR 0.171429 1 0.291666667 0.199790324 Sub-criteria
ATT 1.125 0.238095 1 0.335545849 comparison matrix
2.296429 2.488095 2.375 for criterion
Note: Consistency ratio: 0.05 individual aspect

NJ LP RWP CP RFP EP Priority vector

LP 1 2 1.6 1.583333 2.5 0.308785

RWP 0.5 1 2.5 0.333333 0.183333 0.175673
CP 0.291667 0.266667 1 3 3 0.235779
Table IV.
RFP 0.333333 2 0.333333 1 2 0.174788 Alternatives
EP 0.171429 2 0.154762 0.196429 1 0.104974 comparison matrix
2.296429 7.266667 5.588095 6.113095 8.683333 for sub-criterion
Note: Consistency ratio: 0.08 nature of job
IJHCQA organization is high, it develops a sense of social exchange wherein the feeling of
32,6 reciprocating the same in form of compliance is aroused amongst the employees due to their
increased commitment, dedication and loyalty. Several empirical research studies have been
conducted that supports this relationship (Settoon et al., 1996; Eisenberger et al., 1986).
Results in Table II indicate that the social relations are the most important sub-criteria
within the organizational aspect (38 per cent) followed by the nature of job and incentives
968 relative weights of which are 36 and 27 per cent, respectively. In hospitals, the social
systems defining the quality of relationships influence employee behaviour by instilling a

SR LP RWP CP RFP EP Priority vector

LP 1 3 6 0.154762 3 0.21049
RWP 0.333333 1 9 0.142857 0.5 0.117868
CP 0.166667 0.111111 1 0.111111 0.2 0.031811
Table V.
Alternatives RFP 5 4 9 1 5 0.516804
comparison matrix EP 0.154762 2 5 0.2 1 0.123028
for sub-criterion 6.654762 10.11111 30 1.60873 9.7
social relations Note: Consistency ratio: 0.09

IN LP RWP CP RFP EP Priority vector

LP 1 0.133929 6 2 2.5 0.153607

RWP 7 1 9 8 8 0.604911
CP 0.125 0.111111 1 0.142857 0.2 0.030544
Table VI.
Alternatives RFP 0.25 0.125 4.5 1 5 0.135411
comparison matrix EP 0.2 0.125 5 0.166667 1 0.075526
for sub-criterion 8.575 1.49504 25.5 11.30952 16.7
incentives Note: Consistency ratio: 0.09

SE LP RWP CP RFP EP Priority vector

LP 1 0.5 3 1 0.125 0.101176

RWP 2 1 2 2 0.2 0.149182
CP 0.333333 0.5 1 0.5 0.111111 0.054612
Table VII.
Alternatives RFP 1 0.5 2 1 0.2 0.09858
comparison matrix EP 8 5 9 5 1 0.59645
for sub-criterion 12.33333 7.5 17 9.5 1.636111
self-efficacy Note: Consistency ratio: 0.03

TR LP RWP CP RFP EP Priority vector

LP 1 2 5 0.166667 0.154762 0.128674

RWP 0.5 1 5 0.333333 0.154762 0.108038
CP 0.2 0.142857 1 0.291667 0.126984 0.043183
Table VIII. RFP 6 3 3 1 0.2 0.248396
Alternatives EP 5 4 7 3 1 0.471709
comparison matrix for 12.7 10.14286 21 4.791667 1.636508
sub-criterion trust Note: Consistency ratio: 0.09
sense of belongingness and higher motivation. In a study with related results, conducted by Power
Smircich (1983), it was concluded that the organizational culture facilitates stable social styles and
systems and guides the employee behaviour. behavioural
Table III clearly depicts that self-efficacy (46 per cent) is the most important
sub-criteria with individual aspect that affects employee’s behavioural compliance followed compliance
by attitude of the employee (36 per cent) and trust factor (20 per cent). In hospitals, the
employees who have a higher level of self-efficacy and positive attitude are usually the ones 969
who are highly motivated and indicate the tendency of better compliance. Ifinedo (2012) in the
study based on the TPB and protection motivation theory also inferred similar results that
employee’s self-efficacy, attitude towards compliance, subjective norms, response efficacy and
perceived vulnerability positively influence their security behavioural compliance intentions.
Results in Table IV depict that LP is the most effective power style in influencing
nature of the job (31 per cent) followed by CP (24 per cent), RP (18 per cent), referent power
(17 per cent) and EP (10 per cent).
Table V depicts that referent power is the most effective power style in influencing
social relations (52 per cent) followed by LP (21 per cent), EP (12 per cent), RP (12 per cent)
and CP (3 per cent).
Table VI depicts that RP is the most effective power style in influencing employee
incentives (60 per cent) followed by LP (15 per cent), referent power (14 per cent), EP
(8 per cent) and CP (3 per cent).
Table VII depicts that EP is the most effective power style in influencing self-efficacy
(60 per cent) followed by RP (15 per cent), LP (10 per cent), referent power (10 per cent) and
CP (5 per cent).
Table VIII depicts that EP is the most effective power style in influencing trust
(47 per cent) followed by referent power (25 per cent), LP (13 per cent), RP (11 per cent) and
CP (4 per cent).
Table IX depicts that RP is the most effective power style in influencing attitude
(38 per cent) followed by CP (31 per cent), referent power (14 per cent), EP (10 per cent) and
LP (6 per cent).

Step 3: result calculation

Each power style was given priority rankings depending upon paired comparisons of
criteria and sub-criteria. Furthermore, global vectors of the relative weights were calculated
for each sub-criteria as well as alternatives by multiplying the respective priority vector
with the category weight in question as shown in Tables X–XII.
After calculating the global vectors, the final rankings of alternatives were calculated
to determine their importance in achieving employee’s behavioural compliance as shown
in Table XIII.
As depicted in Table XIII, RP exercised by hospital administrator was found to be the
most crucial power style in order to achieve employee behavioural compliance (25 per cent).

ATT LP RWP CP RFP EP Priority vector

LP 1 0.2 0.2 0.333333 0.5 0.058048

RWP 5 1 2 3 3 0.383816
CP 5 0.5 1 4 3 0.311341
RFP 3 0.333333 0.25 1 2 0.143632 Table IX.
EP 2 0.333333 0.333333 0.5 1 0.103164 Alternatives
16 2.366667 3.783333 8.833333 9.5 comparison matrix for
Note: Consistency ratio: 0.04 sub-criterion attitude
IJHCQA This could be mainly due to the reason that in a hospital, an employee seeks a job with main
32,6 intention to earn and, thus, in case rewards are attached in any form (monetary or
non-monetary) for rule following, the chances of employee’s mindful compliance with
organizational decisions, policies and procedures increase. Podsakoff and Mackenzie (1994)
established the similar conclusion that RP positively influences employee’s work attitude
and commitment, thereby increasing the compliance intention. EP (24 per cent) was ranked
970 as 2nd best alternative for facilitating employee compliance. These findings are in
agreement with results of the study conducted by Afza, (2005) in Indian small business
enterprises wherein it was concluded that reward followed by EP are most effective in
influencing subordinates. Referent power (22 per cent), LP (17 per cent) and CP (12 per cent)
are perceived as less important in facilitating employee compliance and ranked as 3rd,
4th and 5th, respectively.

Discussion and findings

The study of leadership power and behavioural compliance provides important information
that could be harnessed to improve the delivery of health care services across multiple
levels. The study of leadership power and behavioural compliance and the relationship
between them provides hindsight for medical educators and practitioners who would

Table X. OA (0.53)
Global vector of
sub-criteria NJ 0.190137
for category SR 0.201953
organizational aspect IN 0.142098

Table XI. IA (0.47)

Global vector
of sub-criteria SE 0.216446
for category TR 0.093065
individual aspect ATT 0.156301

NJ (0.19) SR (0.20) IN (0.14) SE (0.22) TR (0.09) ATT (0.16) Overall rank

Table XII. LP 0.058711 0.042509 0.021827 0.021899 0.011975 0.009073 0.165995

Overall rank and RWP 0.033402 0.023804 0.085957 0.03229 0.010055 0.059991 0.245498
global vectors of CP 0.04483 0.006424 0.00434 0.011821 0.004019 0.048663 0.120097
alternatives for RFP 0.033234 0.10437 0.019242 0.021337 0.023117 0.02245 0.223749
each sub-criterion EP 0.019959 0.024846 0.010732 0.129099 0.0439 0.016125 0.244661

Leadership power styles Final priority weight Rank

Table XIII. Legitimate power 0.165995 4

Ranks of leadership Reward power 0.245498 1
power styles affecting Coercive power 0.120097 5
employee behavioural Referent power 0.223749 3
compliance Expert power 0.244661 2
implement these research insights to achieve wider health care goals. The purpose of the Power
study was to analyze the mechanism of voluntary employee behaviour compliance with the styles and
possible influence of administrator’s power styles in hospitals. The close examination of behavioural
usage of power styles by hospitals administrators revealed the significance of usage of
appropriate power tactics in gaining employee compliance. Priority rankings for each power compliance
style were calculated from hierarchy of two criteria, six sub-criteria and five alternatives.
After paired comparison between criteria and sub-criteria as well as paired comparisons of 971
alternatives for each criterion, priority rankings were established. The summary of findings
is as follows (Table XIV ).
The content analysis of the anecdotes revealed that in the health care sector two main
criteria affect employee behavioural compliance, namely organizational aspect criteria that
further comprise three sub-criteria, namely nature of work, incentives and social relations;
and individual aspect criteria with comprise three sub-criteria, namely self-efficacy, trust
and attitude. Furthermore, the application of the AHP technique depicted that in the health
care sector self-efficacy is the most important criterion for improving the employee
behavioural compliance and trust is least important. It also revealed that in terms of
self-efficacy, EP paramount other power styles in achieving improved employee behavioural
compliance. The application of AHP also revealed that RP can be viewed as most effective
and CP as least effective in achieving behavioural compliance. However, it was observed
that reward being most important was very closely followed by EP and referent power that
can be important styles to be exercised for improving behavioural compliance in hospitals.
This result is in agreement with the study conducted by Afza, (2005) in Indian small
business enterprises in which it was concluded that reward, expert and referent power bases
are most effective in influencing subordinates. However, the results of the study deviate
from the findings of research conducted by Elias (2007) to understand compliance of
university students wherein the results revealed that EP was rated as most appropriate
bases of power for professors to use. The possible reason for this deviation could be because
of different places of study in both the research studies. The place of study in Steven’s
research was university wherein the student takes admission with an intention to gain
knowledge, whereas in the present research the place of study is a hospital as a workplace
where employees seek a job with main intention to earn. That is the probable reason why EP
superseded RP in the case of research conducted by Elias (2007). The present study also
highlighted that CP has the least contribution towards attaining employee behavioural
compliance and thus should be exercised carefully.

Conclusion and implications

The findings of the study revealed that for effective hospital management, self-efficacy is
the most important criterion for improving the employee behavioural compliance and trust
is least important. Thus, hospital administrators should develop strategies for improving
employee’s self-efficacy by encouraging the use of idiosyncratic EP. Strategic
implementation of knowledge sharing platforms within the hospitals could help in
boosting the self-efficacy. In terms of power styles, RP should be exercised more, followed
by expert and referent power for achieving improved employee behavioural compliance in
hospitals. As coercive style seems to be least significant in today’s scenario for achieving
employee behavioural compliance, along these lines it ought to be seldom and mindfully
utilized by hospitals administrators.
The study empirically identifies the relative importance of exercising power styles in
order to gain employee behavioural compliance. The study helps in understanding the
complex problem of behavioural compliance in hospital setting by examining the intensity
of the effect of each factor affecting employee behavioural compliance. This knowledge is
very critical in effective hospital management and getting the work done. The priority
IJHCQA
32,6

972

Table XIV.
Summary of findings (continued )
 Power
styles and
behavioural
compliance

973

Table XIV.

rankings obtained for power styles can be used for developing selection batteries and
performance records of hospital administrators. As researchers predict good prospects and
emerging scenario for health care, the implementation of results of the study can assume an
instrumental part in accomplishing the goals. The findings of the study further enrich the
existing knowledge domain and contribute to the existing theory of how leader–member
linkages can be managed using power styles with consensus on foundation theories of
planned behaviour and social exchange theory.

Limitations and future scope of study

The major limitation of this study was that the sample was drawn only from three tertiary
hospitals in Jammu district that limits the generalizability of the findings in all the hospital
settings. No attempt has been made in this study to understand the variations in responses
with regard to demographics of the respondents that can be taken as a future research
study. Furthermore, this paper has discussed results in comparison to limited number of
previous studies in order to identify deviations and agreements between the findings of this
study and past literature that can be further strengthened. The research has a wide scope
and, thus, can be further extended in other allied service sectors as well.

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Further reading
Boyatzis, R.E. (1982), The Competent Manager: A Model for Effective Performance, Wiley,
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pp. 69-79.
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organisational performance: review and suggestion for future research”, Human Performance,
Vol. 10 No. 2, pp. 133-151.
Popper, K. (1959/2004), The Logic of Scientific Discovery, Routledge and Taylor & Francis, London.

Corresponding author
Gowhar Rasool can be contacted at: gowhar2@gmail.com

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