An-Najah National University 

Faculty of Graduate Studies 

 

LEADERSHIP STYLE AND ITS 

RELATIONSHIP TO THE LEVEL OF JOB 

SATISFACTION IN THE JENIN HEALTH 

DIRECTORATE 

 

 

By 

Haneen Zohair Yousef Obead 

 

 

 

Supervisors 

Dr. Wafaa Menawi 

Dr. Kamal Hijjazi 

 

This Thesis is Submitted in Partial Fulfillment of the Requirements for the Degree of 

Master of Public Health Management, Faculty of Graduate Studies, An-Najah National 

University, Nablus - Palestine. 

2022 





III 

 

Dedication 

I dedicate the harvest of my effort to my dear parents 

My mother, may Allah protect her 

My father, may Allah have mercy on him 

For every member of my family 

To Everyone Who helped me directly or indirectly 

 

Haneen Zohair Yousef Obead 

  



IV 

 

Acknowledgement  

I would like to sincerely thank my supervisor, Dr. Wafaa Menawi, for her continued 

understanding, positive words of encouragement and constant encouragement, and 

insightful advice in guiding me through this study. My grateful-thank also goes to my co-

supervisor, Dr. Kamal Hijjazi, for his constructive advice on revisions.  

I am grateful to the faculty members of Al-Quds Open University and the Arab American 

University who agreed to the interviews and have helped to provide feedback on my 

questionnaire, for their valuable time and advice, for their open sharing, and for providing 

me with their insightful perceptions.  

Finally, I would like to thank the Jenin Governorate Health Directorate, represented by 

its leaders, managers, and employees, for their cooperation in participating in this study 

and the different parties who helped me accomplish it. 

 

Haneen Zohair Yousef Obead 

 

  





VI 

 

Table of Contents 

Dedication ....................................................................................................................... III 

Acknowledgement .......................................................................................................... IV 

Declaration ....................................................................................................................... V 

Table of Contents ............................................................................................................ VI 

List of Tables ............................................................................................................... VIII 

List of Figures .................................................................................................................. X 

List of Appendices .......................................................................................................... XI 

Abstract .......................................................................................................................... XII 

Chapter One: Introduction and Theoretical Background .................................................. 1 

1.1 Research problem ...................................................................................................... 4 

1.2 Research questions ..................................................................................................... 6 

1.3 Research hypotheses .................................................................................................. 6 

1.4 Research objectives ................................................................................................... 7 

1.5 Research importance .................................................................................................. 7 

1.6 Definitions of terms ................................................................................................... 8 

1.7 Leadership versus management ................................................................................. 9 

1.8 Leadership styles ..................................................................................................... 10 

1.8.1 Dictatorial leadership style .................................................................................... 10 

1.8.2 Democratic leadership style .................................................................................. 11 

1.8.3 Laissez-faire leadership style ................................................................................ 12 

1.8.4 Transformational leadership style ......................................................................... 12 

1.8.5 Transactional leadership style ............................................................................... 14 

1.9 Culture and leadership style ..................................................................................... 15 

1.9.1 Factors affecting the selection of the appropriate leadership style ....................... 15 

1.10 Job satisfaction ......................................................................................................... 16 

1.10.1 Concept of job satisfaction .................................................................................. 17 

1.10.2 Importance of job satisfaction in healthcare organization .................................. 17 

1.10.3 Job satisfaction dimensions ................................................................................. 19 

1.10.4 Factors affecting job satisfaction ........................................................................ 21 

1.11 A brief summary of previous studies ....................................................................... 24 

Chapter Two: Methods ................................................................................................... 26 



VII 

 

2.1 Study design ............................................................................................................. 26 

2.2 Study population ...................................................................................................... 26 

2.3 Study sample ............................................................................................................ 27 

2.4 Instruments of study ................................................................................................ 27 

2.4.1 Validity and reliability of the questionnaire .......................................................... 28 

2.5 Research conceptual model and variables ............................................................... 29 

2.6 Study procedures ..................................................................................................... 30 

2.7 Analysis plan ........................................................................................................... 30 

2.8 Ethical approval ....................................................................................................... 31 

Chapter Three: Results .................................................................................................... 32 

3.1 Socio-demographic and practice characteristics of the employees ......................... 32 

3.2 Internal consistency composite reliability of the questionnaire .............................. 34 

3.3 Perceived managerial leadership style of the employees ........................................ 35 

3.3.1 Perceived democratic leadership style .................................................................. 35 

3.3.2 Perceived dictatorial leadership style .................................................................... 38 

3.3.3 Perceived Laissez-Faire leadership style ............................................................... 41 

3.3.4 Perceived transformational leadership style .......................................................... 43 

3.4 Job satisfaction of the employees ............................................................................ 44 

3.5 Correlation between perceived managerial leadership style and job satisfaction 

scores of the employees .................................................................................................. 44 

Chapter Four: Discussions and Conclusions .................................................................. 46 

4.1 Conclusion ............................................................................................................... 53 

4.2 Study limitations and related future vision .............................................................. 53 

4.3 Recommendations .................................................................................................... 53 

List of Abbreviations ...................................................................................................... 55 

References ....................................................................................................................... 56 

Appendices ...................................................................................................................... 67 

 ب................................................................................................................................. الملخص 

 

  



VIII 

 

List of Tables 

Table 1: Distribution of the study sample members according to their socio-demographic 

characteristics ................................................................................................... 33 

Table 2: Composite reliability and internal consistency of the different domains of the 

multi-factor leadership questionnaire ............................................................... 34 

Table 3: Composite reliability and Internal consistency of the different domains of the job 

satisfaction scale ............................................................................................... 35 

Table 4: Distribution of the opinions of the employees on the democratic leadership style

 .......................................................................................................................... 36 

Table 5: Differences in the perceived democratic leadership style scores among the 

employees ......................................................................................................... 37 

Table 6: Predictors of higher perceived democratic leadership style scores .................. 38 

Table 7: Distribution of the opinions of the employees on the dictatorial leadership style

 .......................................................................................................................... 39 

Table 8: Differences in the perceived dictatorial leadership style scores among the 

employees ......................................................................................................... 40 

Table 9: Predictors of higher perceived democratic leadership style scores .................. 41 

Table 10: Distribution of the opinions of the employees on the Laissez-Faire leadership 

style ................................................................................................................... 42 

Table 11: Summary of the reviewed studies ................................................................... 91 

Table 12: Differences in the perceived Laissez-Faire leadership style scores among the 

employees ......................................................................................................... 97 

Table 13: Predictors of higher perceived Laissez-Faire leadership style scores ............ 98 

Table 14: Distribution of the opinions of the employees on the transformational leadership 

style ................................................................................................................... 98 

Table 15: Differences in the perceived transformational leadership style scores among the 

employees ......................................................................................................... 99 

Table 16: Predictors of higher perceived transformational leadership style scores ..... 100 

Table 17: Distribution of the opinions of the employees on the transactional leadership 

style ................................................................................................................. 100 

Table 18: Differences in the perceived transactional leadership style scores among the 

employees ....................................................................................................... 101 



IX 

 

Table 19: Predictors of higher perceived transactional leadership style scores ........... 102 

Table 20: Distribution of the opinions of the employees on the job satisfaction items 102 

Table 21: Differences in the job satisfaction scores among the employees ................. 104 

Table 22: Predictors of higher job satisfaction scores .................................................. 105 

Table 23: Correlation between perceived managerial leadership style and job satisfaction 

scores of the employees .................................................................................. 106 

Table 24: Linear regression between job satisfaction scores and perceived democratic 

leadership, transformational style, and transactional leadership scores ......... 107 

 

  



X 

 

List of Figures 

Figure 1: Potential relationship between the independent and dependent variables ...... 29 

Figure 2: Relationship between the independent and dependent variables .................... 45 

 

  



XI 

 

List of Appendices 

Appendix A The questionnaire ....................................................................................... 67 

Appendix B The Arabic questionnaire ........................................................................... 76 

Appendix C Names of the arbiters for questionnaire ..................................................... 83 

Appendix D Approval of the Faculty of Graduate Studies ............................................. 87 

Appendix E Approval of the IRB ................................................................................... 88 

Appendix F Approval of the Ministry of Health ............................................................ 89 

Appendix G Formal written consent form ...................................................................... 90 

Appendix H Tables ......................................................................................................... 91 

 

 

  



XII 

 

LEADERSHIP STYLE AND ITS RELATIONSHIP TO THE LEVEL 

OF JOB SATISFACTION IN THE JENIN HEALTH 

DIRECTORATE 

By 

Haneen Zohair Yousef Obead 

Supervisors 

Dr. Wafaa Menawi 

Dr. Kamal Hijjazi 

Abstract 

Introduction: Leadership represents the backbone of the managerial process because it 

is linked to the effectiveness and efficiency of the leadership process to achieve the 

desired goals and retain employees.  

Aims: To investigate the relationship between perceived managerial leadership style of 

employees in Jenin Health Directorate and job satisfaction. 

Methods: A cross-sectional study used a questionnaire containing the multi-factor 

leadership and job satisfaction scales as the study tool. The study was conducted between 

November 3, 2021, and January 17, 2022. Scores of the groups were compared using t-

tests and analysis of variance (ANOVA) as appropriate. Multiple linear regression models 

were used to control the confounding variables, and correlations were investigated using 

Pearson's correlation coefficients.      

Result: Of the 357 employees invited, 322 returned usable questionnaires, giving a 

response rate of 90.1%. The majority (58.1%) of the employees were female, in age 

between 41 and 60 years (60.5%), had a bachelor's degree or higher (64.9%), and had an 

experience of fewer than 20 years (63.0%). The overall Cronbach's alpha of the multi-

factor leadership scale was 0.82, and the overall Cronbach's alpha of the job satisfaction 

scale was 0.90. Job satisfaction positively correlated with perceived transformational, 

democratic, and transactional leadership styles. On the other hand, job satisfaction is 

negatively correlated with a perceived dictatorial leadership style.  



XIII 

 

Conclusion: The current research investigated the relationship between the perceived 

managerial leadership styles (democratic leadership, dictatorial leadership, Laissez-Faire 

leadership, transformational leadership, and transactional leadership) and the level of job 

satisfaction in Jenin Health Directorate. The findings showed that job satisfaction 

positively correlated with perceived transformational, democratic, and transactional 

leadership styles. On the other hand, job satisfaction is negatively correlated with a 

perceived dictatorial leadership style. Administrative flexibility is recommended to 

choose the most appropriate leadership style based on the nature of the circumstances and 

the existing situation and not stick to one leadership style. 

Keywords: Job Satisfaction; Leadership Style; Transformational Leadership. 

  



1 

 

Chapter One 

Introduction and Theoretical Background 

Healthcare organizations are social systems, and human resources are one of the essential 

constituents of these systems. In healthcare organizations, leadership plays a crucial role 

in retaining healthcare professionals and other workers, achieving patient satisfaction, and 

improving the quality of the work environment (Clarke, 2007). Adopting successful 

leadership remains one of the most critical issues in leading any healthcare establishment. 

Healthcare organizations are considered one of the most complex organizations from an 

administrative point of view. The efficiency, effectiveness, and enhancement of the role 

of these healthcare organizations depend mainly and decisively on the presence of 

effective leadership. Global changes and trends such as ageing and increasing dependence 

on technology require new ways and leadership styles to lead the health care team 

(Alloubani et al., 2019). This is to attain high performance and enrich the present 

capabilities to enhance the quality-of-care outcomes. As well as managing the risk and 

boosting cultural and behavioral changes. 

Leaders in hectic and complex environments must adopt, adapt, and be responsive to 

various variables and adjust their conditions by abandoning the traditional methodology 

and models. Additionally, leaders need to experiment with new, creative, and effective 

methods and patterns commensurate with developments. These methods should be 

characterized by future orientation and efficiency (Perez, 2021). Hence, it is essential in 

healthcare organizations that leaders understand and know the leadership style that is the 

most appropriate for their organizations to ensure the continuity and success of these 

organizations (Alrubaysh et al., 2022; Perez, 2021). 

It has been argued that the management of health facilities does not need a specialist with 

a scientific qualification but a leader. This leader might be an administrator, a doctor, or 

any other professional. Health facilities differ in their nature and complexities from the 

rest of the facilities because of the long working hours that subject healthcare workers to 

burnout. Additionally, healthcare workers are subject to workplace bullying, lack of 

administrative support, time-consuming organizational responsibilities, and various other 

reasons that may need special requirements. Therefore, leaders of healthcare 



2 

 

organizations need to have an exceptional nature, possess high capabilities, and have 

unique skills that enable them to understand the nature, and conditions of these 

organizations, deal with employees from various departments and specializations and deal 

with clients from outside of these organizations (Alrubaysh et al., 2022). 

It is noted that most of the criticisms directed in general towards healthcare organizations 

are criticisms related to the shortage of workers and the low level of performance which 

does not live up to the expected level as reflected by the provided services. If we look at 

the cadres working in health facilities, we find that they, like many other workers, are 

affected at work by a lot of pressures and changes that may raise their level of 

performance or vice versa. Many factors overlap and complement each other to affect the 

employees and the degree of satisfaction and performance. The role of the leadership style 

in this aspect cannot be neglected. Therefore, leaders must understand and realize that 

health workers are integral to building robust health systems that can withstand and 

compete (Specchia et al., 2021). 

Leadership is a long-term process of influencing people toward accomplishing a mission 

and particular goals of a group or an organization (Van Wart et al., 2019). The relationship 

between the leader and the employees can be translated into satisfaction or dissatisfaction. 

Leader relies on employees' feedback to improve their behavior and decisions in the 

future, as the leader is responsible for linking the employee to the job, and he is also the 

first responsible for the weak relationship of the employee with his job or place of work 

(Alloubani et al., 2019; Van Wart et al., 2019). 

Leadership styles usually refer to the different ways leaders manage organizations. 

Employees define leadership styles as the actual behavioral trends that the manager 

adopts and works within the organization (Alrubaysh et al., 2022). Leadership styles were 

considered as a set of behavioral traits that characterize the leader in the decision-making 

process and the practice. Thus, it can be said that the leadership style is the method used 

and practised depending on the leader's personal characteristics and behavioral skills, 

which will affect the orientation of employees and the decision-making process 

(Alloubani et al., 2019; Alrubaysh et al., 2022; Van Wart et al., 2019). 

Most of the references discussed the traditional leadership styles, such as autocratic, 

democratic, and laissez-faire leadership styles extensively; in addition to advanced styles, 



3 

 

namely transactional leadership, transformational leadership, ethical leadership, 

charismatic, and bureaucratic style (Alblooshi et al., 2021; Koo & Park, 2018). 

Leadership style has a significant role in guiding the management and performance of 

primary health care and public health service providers. The path and theory state that a 

leader's behaviours and traits can influence the team members' motivation, satisfaction, 

and performance. According to the path and goal theory, the used style should be 

appropriate to the situation to facilitate the subordinates' task in achieving the goals of the 

health organization (Alloubani et al., 2019; Specchia et al., 2021). 

Maintaining employees and ensuring their survival is directly related to job satisfaction 

that is achieved based on the leadership style used. For example, a previous study showed 

a strong relationship between job satisfaction for nurses and the pattern of behaviors 

followed by the nursing administration (Specchia et al., 2021). 

Job satisfaction was defined as a sense of employee achievements and successes, and it 

is generally believed that it is directly related to productivity, work performance, and 

personal well-being. Additionally, job satisfaction was described as doing the work one 

likes, doing it well, and being rewarded for own efforts (Dilig-Ruiz et al., 2018). 

Another definition of job satisfaction is how people feel about their jobs and different 

facets of their careers.’ In particular, job satisfaction stresses the link between negative 

and positive emotions that affect employees’ behavior and performance, affecting 

organizational results (Aloisio et al., 2021). 

The success of any organization in achieving its directional strategy is linked to how the 

leader manages this organization, the exercised leadership style, the successful leadership 

qualities and the ability to employ these capabilities towards constructive work in order 

to build positive human relationships among employees to achieve job satisfaction and 

thus motivate them to give and continuous achievement (De Brún et al., 2019). Therefore, 

job satisfaction directly affects the success of any organization.   

Job satisfaction is the most important factor influencing improving performance within 

the organization; just as the engine operates the machine, job satisfaction is a driver of 

morale, self-discipline, commitment, and achievement (De Brún et al., 2019; Graham & 

Woodhead, 2021). Employee satisfaction was affected by a set of determinants such as 



4 

 

salary, direct manager behavior, leadership, job security, nature of work and flexibility 

(Aloisio et al., 2021). 

Reality and experiences have proven that employee will not look for other job 

opportunities when feels safe, appreciated, and motivated in the workplace, especially 

when the job offers important opportunities for advancement. The confirmed fact is also 

that the employee will look for other opportunities to work in another place when they 

feel unsafe or unappreciated by the management and leadership of the organization in 

which works under. Therefore, leaders are required to push their employees forward by 

providing incentives and rewards and involving them in the decision-making process. 

These actions can make them feel that they are the organisation's owners and not just 

employees who receive orders and carry out instructions (Luu et al., 2019). 

In Palestine, some studies have focused on leadership styles, i.e., leadership styles in the 

Palestinian healthcare sector (Hatem H. Alsaqqa & Çağdaş E. Akyürek, 2021). One of 

these studies was conducted in Gaza Strip. In this study, doctors, paramedics, nurses, and 

administrators were included to describe their perception on the types of organizational 

culture and leadership styles in the hospitals (Hatem H. Alsaqqa & Çağdaş E. Akyürek, 

2021). The study showed that hierarchy-driven and clean cultures were at the top of the 

defined forms of organizational cultures in the hospitals included. Transactional and 

transformational styles were the most predominant leadership styles in these hospitals. 

On the other hand, some studies focused on large-scale industrial enterprises and found 

that the transactional leadership style is the most frequently used in the Palestinian 

industrial sector (As‐Sadeq & Khoury, 2006). 

The current study aims to analyze the relationship between the perceived leadership style 

and the level of job satisfaction in the Jenin health directorate. 

1.1 Research problem 

For several reasons, this study focuses on the relationship between perceived managerial 

leadership style and the level of employee job satisfaction in Jenin health directorate in 

the year 2021. One of the most prominent problems facing all kinds of organizations is 

their leaders' inability to lead these organizations (Ashford & Sitkin, 2019). 

The increase in size of organizations, especially those working in the field of health care 

services, has led to a rise in organizational complexities and a multiplicity of internal and 



5 

 

external relations for these organizations, in addition to the impact of economic, social, 

political, technological and authorities on these organizations. Adaptation to changes by 

updating research, adopting innovation and performance development will only be 

achieved through effective and wise leadership. This leadership derives its importance 

from its ability to optimally utilize the organization's resources, especially the human 

resource, which is the most important and most valuable resource in any organization 

(Alblooshi et al., 2021). 

Many issues are affected by the leadership style in health organizations, including 

employee satisfaction, which influences the whole operations in the organization and 

whether tasks are achieved effectively or not; this justifies the need for health 

organizations at the local or national level for successful leadership behavior, which in 

turn can direct workers towards achieving their goals in addition to the purposes of the 

organization (Cummings et al., 2021). 

The health care system in Palestine struggles to provide comprehensive and integrated 

quality services for all citizens through the interconnectedness of the health care system 

with other social systems like education, food production, and utilities. However, the high 

levels of unemployment, poverty, conflict, displacement, and brain drain in the region, as 

well as a shortage of staff, equipment, and sustainable finance, exacerbate the 

shortcomings of the health care system and make it more challenging for Palestinians to 

access quality health care when they need it. Health care professionals in Palestine work 

tirelessly to care for the large population. But the factors mentioned above impede the 

effectiveness of their work and prevent Palestinians from accessing quality medical care. 

To grant the sustainability of the Palestinian health system in its different components 

(health services, human resources, health information, medicines and health technology, 

health finance, and governance, appropriate adoption of leadership style is needed. 

In general, no study in Palestine is similar to our current study. It is also important to note 

that this study focuses on 5 leadership styles and their relationship to the level of job 

satisfaction which was not addressed in any previous study.   

The study problem crystallizes in the analysis of the relationship between perceived 

managerial leadership style and the level of job satisfaction in the Jenin Health Directorate 

as a comprehensive sample to be generalizable and representative to highlight the effect 

of appropriate leadership style that maintains job satisfaction among health care providers 



6 

 

in Palestine who are subjected to the frequent salary cuts due to financial crisis in 

Palestine. 

1.2 Research questions 

• What is the perceived managerial leadership style distribution in the Jenin Health 

Directorate? 

• What is the overall job satisfaction among employees of the Jenin Health 

Directorate? 

• What is the relationship between employees' socio-demographic and practice 

variables in Jenin Health Directorate and their perceived managerial leadership 

styles?  

• What is the relationship between employees' socio-demographic and practice 

variables in Jenin Health Directorate and their job satisfaction?  

• What is the relationship between perceived managerial leadership styles and 

employees' job satisfaction levels in Jenin Health Directorate?  

• Are there differences in the strength of the relationship between perceived 

managerial leadership styles (democratic, dictatorial, laissez-faire, 

transformational, and transactional leadership) and the level of job satisfaction in 

the Jenin Health Directorate? 

1.3 Research hypotheses 

• H1 There is no statistically significant relationship at the significance level (α<0.05) 

between perceived managerial democratic leadership style and the level of job 

satisfaction in Jenin Health Directorate. 

• H2 There is no statistically significant relationship at the significance level (α<0.05) 

between perceived managerial dictatorial leadership style and the level of job 

satisfaction in the Jenin Health Directorate. 

• H3 There is no statistically significant relationship at the significance level (α<0.05) 

between perceived managerial Laissez-Faire leadership style and the level of job 

satisfaction in the Jenin Health Directorate. 

• H4 There is no statistically significant relationship at the significance level (α<0.05) 

between perceived managerial transformational leadership style and the level of job 

satisfaction in the Jenin Health Directorate.  



7 

 

• H5 There is no statistically significant relationship at the significance level (α<0.05) 

between perceived managerial transactional leadership style and the level of job 

satisfaction in the Jenin Health Directorate.  

• H6 There are no statistically significant differences at the significance level (α<0.05) 

in the strength of the relationship between perceived managerial leadership styles 

(democratic, dictatorial, laissez-faire, transformational, and transactional leadership) 

and the level of job satisfaction in Jenin Health Directorate. 

1.4 Research objectives 

• To find the distribution of perceived managerial leadership styles in the Jenin 

health directorate. 

• To investigate the relationship at the significance level (α<0.05) between socio-

demographic and practice variables of employees in Jenin Health Directorate and 

their perceived managerial leadership styles. 

• To determine the overall job satisfaction among employees of the Jenin Health 

Directorate. 

• To investigate the relationship at the significance level (α<0.05) between socio-

demographic and practice variables of employees in Jenin Health Directorate and 

their job satisfaction. 

• To investigate the relationship at the significance level (α<0.05) between 

employees perceived managerial leadership styles in Jenin Health Directorate and 

their job satisfaction. 

1.5 Research importance  

The importance of this study lies in shedding light on critical factors: the prevailing 

leadership styles in health organizations in Palestine and the level of job satisfaction 

among the employees. The complex and chaotic environment in Palestine has a social and 

psychological impact, and these conditions affect the availability of sufficient and 

qualified staff and sufficient equipment that meet the health needs of Palestinian patients. 

The healthcare system in Palestine strives to provide comprehensive and integrated 

quality services to all citizens through the synergy between the healthcare system and 

other social systems. So, adopting an appropriate administrative leadership style plays an 

influential and unique role in the keeping sustainability of the Palestinian health system 

with its various components. The leadership style followed plays effective public 



8 

 

management and human resources in particular. The researcher decided to study the 

relationship between perceived managerial leadership styles and the level of job 

satisfaction in Jenin Health Directorate as a representative sample of the health sector in 

Palestine due to the need for an appropriate leadership style capable of effectively and 

efficiently managing health care organizations and their components. 

The importance of this study also lies in its focus on five leadership styles (democratic, 

dictatorial, laissez-faire, transactional, and transformational leadership) for managers and 

their relationship to the job satisfaction of subordinates in the health sector, specifically 

in the Jenin Health Directorate. This wasn't addressed previously in studies that focused 

on one or some of these patterns without others, which gives the study importance in 

addressing the subject. 

Therefore, this study is of great importance, and it is the first of its kind, as it deals with 

a group of leadership styles that still need research to reach valuable results, especially 

with the scarcity of studies and field research that deal with this issue at the regional and 

local levels, specifically at the level of Palestine. 

The theoretical importance of this study lies in its scientific addition that will present. 

Thus the study becomes Proof dependent on the public domain. This importance is 

demonstrated by clarifying the problem, defining the old studies that dealt with it, and 

thus comparing what those studies presented and the addition included in this study. So 

this study can provide significant results and recommendations for health managers, 

leaders, and policymakers, specifically in the government sector, and draw the attention 

of officials to the need for the adoption most suitable leadership style in managing tasks 

and achieving the health directorate’s directional strategies as well as attainment of 

qualified health care providers. 

1.6 Definitions of terms 

In this subsection, the researcher defined the main terms mentioned in the current study. 

• Perception: The term "perception" is derived from the Latin terms perceptio, and 

percipio. Longman Dictionary of Contemporary English defines perception as "a) the 

way you think about something and your understanding of what it is." b) the way that 

you notice things with your senses of sight, hearing etc.; c) the natural ability to 

understand or notice things quickly.”, But in philosophy, psychology, and cognitive 



9 

 

science Perception is defined as the process of being aware of or comprehending 

sensory information (Pageaux, 2016). 

• Leadership: is the process of facilitating individual and collective efforts and 

influencing others to achieve common goals. Leadership represents a process, while 

the leader refers to an individual (Sweeney et al., 2019). 

• Leadership style is the method or methodology adopted by the leader within the 

organization to influence subordinates and lead them to achieve the organization's 

goals and strategic plans efficiently and effectively (Fries et al., 2021). 

The term leadership styles used in the current study were defined through a 

questionnaire that dealt with (5) leadership styles (dictatorial leadership, democratic 

leadership, transactional leadership, transformational leadership, and Laissez-Faire 

leadership). Each of these styles included 10 statements/questions, which relied on 

the five-point Likert scale; each question has five possible answers (Strongly 

disagree, Disagree, Neutral, Agree, Strongly Agree) and is scaled from 1 - 5. The 

individual chooses the answer that suits his perception so that each answer is given a 

score from 1-5.  

• Job satisfaction: A result of employee perceptions of how well their work provides 

things that are considered necessary. Job satisfaction is an affective or emotional 

response to various aspects of one’s work (Dilig-Ruiz et al., 2018). 

The same is true for job satisfaction, where this term was also referred to through a 

special questionnaire to determine the level of job satisfaction, which included 24 

questions. Also, the five-point Likert scale was relied on, which consists of 5 answers 

ranging from strongly agree to strongly disagree with a rating of 1 = (strongly 

disagree), indicating the lowest score. A 5 = (strongly agree) rating indicates the 

highest job satisfaction score. 

1.7 Leadership versus management 

Despite the close interrelationship and significant overlap between the concept of 

leadership and management, this does not mean that they are the same thing. Leadership 

and management differ from a scientific and applied point of view. All Studies and 

research have confirmed that management and leadership differ, but the main problem 

remains that determining the degree of overlap between these two concepts is still thorny, 



10 

 

as distinguishing between the two terms is not easy (Nienaber, 2010). Finding people in 

managerial and leadership positions is possible, but we cannot consider them real 

managers or leaders (Gifford et al., 2018). Leadership seeks to achieve practical goals and 

management; although there are points of agreement between them, they are also 

different. It has been argued that the manager only manages and supervises, while the 

leader creates and innovates (Gifford et al., 2018; Nienaber, 2010). The manager does 

things right, accepts the status quo, and tries to implement the goals set by the leaders, 

while the leader challenges the conditions and the status quo to the point of taking risks 

even if the result is a failure. 

The manager's primary goal is to implement the laws and regulations of the organization 

in a routine and repetitive manner, starting from the planning stage until the final stages 

of implementing the work, and the results are only the indicator that adopts while the 

leader is a creative person. The leader creates, renews, adds, and improves the 

organization, the staff, and himself (Gifford et al., 2018; Nienaber, 2010). 

1.8 Leadership styles 

1.8.1 Dictatorial leadership style 

Dictatorial or autocratic leadership are the most common names for this style, and there 

are other less-known names, such as authoritarian leadership and military leadership 

(Mulenga et al., 2018). This style is considered one of the most negative leadership styles 

in management, and the Chinese environment is an incubator for such a style. The leader 

is unique in making decisions without participating, discussing, or even delegating some 

decisions or powers to his subordinates (Aydin & Özmutaf, 2021; Mulenga et al., 2018). 

As characterized by absolute centralization, the employee is often forced to follow the 

methodology and policy of the leader and implement orders, even if they conflict with his 

convictions, for fear of punishment so that all administrative operations end with him 

(Aydin & Özmutaf, 2021). The human relations curve is very low in this pattern; the work 

environment is full of negativity and indifference, where there is a lack of mutual trust 

between the leader and the followers, as the dictatorial leader’s attention focused on 

achievement size instead of focusing on efficiency or quality of the content (Lake et al., 

2019). The great neglect of human relations among members of the organization 

contributes to the spread of hostility which could target the leader or the organization he 



11 

 

represents (Wei & Watson, 2019). Low employee morale and low self-motivation for 

work also decrease productivity, worker turnover, and absenteeism.  

Ultimately, dictatorial leadership is not considered one of the desirable patterns 

nowadays. Still, there are some situations and cases where the dictatorial style is the most 

appropriate and successful method, for example, in emergencies requiring firmness and 

severity in autocracy. Dictatorial leadership is considered ideal in cases where the nature 

of work is homogeneous, so all employees are subject to unified rules, instructions, and 

procedures for implementing work. In some organizations, leaders face lazy subordinates, 

so only this method suits them (Gifford et al., 2018). 

1.8.2 Democratic leadership style  

Leaders in democratic leadership or participatory leadership depend on respect for 

individuals and participation, where employees present their ideas and opinions related 

to work, set plans and goals, and make decisions (Idelji-Tehrani & Al-Jawad, 2019). The 

leader in the democratic style takes into account the needs and desires of the employees 

and gives attention to all followers without any bias; in addition, the democratic leader 

considers that moral incentives are no less important than material incentives. 

In contrast to dictatorial leadership, democratic leadership is very concerned with the 

human aspect and human relations. One of the most important features or positive 

phenomena of democratic leadership is that it focuses on achieving the general interest of 

the organization and all working individuals; it is collective, participatory leadership. 

Therefore, it depends on actual participation between the leader and followers in all 

administrative areas, from planning, organization, and follow-up (Idelji-Tehrani & Al-

Jawad, 2019). This reduces the level of dependence on the leader in all matters related to 

work, and this, in turn, stimulates the employees’ abilities to be creative, innovative and 

initiative and helps in their cooperation to achieve common goals and interests.  

The democratic leadership style has drawbacks when the organisation's followers do not 

have sufficient qualifications and experience to enable them to participate in decision-

making; this can lead to team members feeling that their ideas are being ignored, which 

may reduce employee satisfaction and morale (Joshi, 2019). Other problems of 

democratic leadership are that it needs a full-time manager to follow up on activities. One 

of the advantages of this style is that the morale is high among employees in organizations 



12 

 

that adopt the democratic style, as well as the advantage of cooperation between 

management and employees, which improves performance significantly and increases 

Productivity and job satisfaction (Joshi, 2019). In general, democratic leadership works 

better in organizations characterized by the presence of employees who have experiences 

and the desire to share their experiences and knowledge to achieve common goals (Idelji-

Tehrani & Al-Jawad, 2019). 

1.8.3 Laissez-faire leadership style 

The leader here gives absolute freedom to the followers to make decisions, set goals, and 

implement methods, and provides general notes and information instead of giving specific 

directions or a real effort to follow up on the work of individuals or assign tasks to the 

group he leads (Magbity et al., 2020). 

Laissez-faire leaders abdicate control and accountability. The leader here does not 

actively participate in organizational operations or meetings, does not issue orders, and 

only responds when a minimum degree of knowledge and guidance is necessary (Pahi et 

al., 2020). One of this type's most prominent negative features is low performance and 

productivity. Failure to clearly define responsibilities and duties causes chaos and loss for 

employees, leading to a decrease in the motivation and enthusiasm of individuals and a 

reduction in the level of performance and innovation (Pahi et al., 2020). 

Furthermore, Absolute freedom impels some employees’ control over their colleagues at 

work, leading to weak relations and communications between employees (Magbity et al., 

2020; Pahi et al., 2020). 

Despite the previous flaws in this style, studies have proven satisfactory results if certain 

conditions contribute significantly to the success of this style of leadership; for example, 

the presence of employees with a high degree of experience and knowledge at work 

enables the leader to delegate authority to them (Magbity et al., 2020; Pahi et al., 2020). 

It can be said that this pattern can be more successful in scientific institutions as the 

employees' excellent great skills and the nature of work do not need the leader’s constant 

intervention (Pahi et al., 2020). 

1.8.4 Transformational leadership style  

This model is more suitable for application in collective societies, especially in Asian 

societies such as Indonesia and other Asian countries. However, this type of leadership 



13 

 

originated in the United States, a country based on the principle of individualism (Deng 

et al., 2022). 

Transformational leadership is a modern style; the leader has a clear and long-term vision 

for the future and specific goals known to all; transformational leadership depends on 

mutual admiration, a shared vision, and the creative interchange of ideas (Bass, 1999; 

Deng et al., 2022). Some consider transformational leadership ethical leadership, as it 

adopts a set of moral values such as justice, equality, and humanity. It also works to 

expand subordinates’ interests and motivates them to look beyond their interests to 

achieve the general interest of the organization (Bass, 1999). 

In addition to the above, it adopts a new philosophy by inspiring and motivating 

employees to achieve high levels of performance, greater than they expect, so 

transformational leadership tends towards change, development, and innovation, whether 

at the level of individuals, groups, or the status of the organization, therefore, it is 

considered a continuous process practised by the leader over his subordinates (Deng et 

al., 2022). 

Transformational leadership has four dimensions: 

• Idealized influence: The leader in this dimension represents an ideal model for 

workers by defining and following standards of behavior of an ethical nature in the 

organization, and here the leader gives priority to the needs of workers, preferring the 

public interest over his interest (Hayati et al., 2014). 

• Inspirational motivation: In this dimension, the leader defines the organization’s 

vision with clarity and transparency to make it achievable. The leader inspires 

employees, raises their morale, and encourages them to achieve and challenge (Hayati 

et al., 2014). Transformational leaders in this dimension build confidence among the 

followers in the ability to overcome difficulties and obstacles and evoke team spirit 

through idealism. These behaviors define expectations for followers and describe the 

method of commitment necessary to achieve organizational goals. 

• Intellectual stimulation: In which the transformational leader constantly searches for 

new ideas to solve work problems and supports new creative models for task 

performance (Hayati et al., 2014). In addition, the leader's ability to make his 

employees address outstanding problems in new and creative ways by identifying the 

organisation's strengths, weaknesses, opportunities, and threats. 



14 

 

• Individualized Consideration: Here, the leader considers the individual differences 

between the workers to distribute the tasks based on their abilities, specializations, and 

personal preparation (Hayati et al., 2014). The leader considers them an essential 

practical, effective element of the organization, so they give great attention to the needs 

and requirements of the employees. 

1.8.5 Transactional leadership style 

Transactional leadership is based on a reciprocal process between the leader and 

subordinates (Deng et al., 2020). This style is a series of mutual interests and benefits 

shared between the leader and the followers and between the followers themselves as 

well. The relationship between the leader and the employees or the followers is based on 

a fundamental principle: a reward for work and production, punishment for non-

commitment to work, and low productivity (Deng et al., 2020). The leader here 

determines the performance expected of them to obtain incentives and rewards and also 

the punishment in the event of a failure in performance and achievement (Deng et al., 

2019). 

Finally, when comparing transformational leadership and transactional leadership, we 

note that transactional leadership is appropriate for organizations and companies that are 

characterized by stability environment and routine procedures, while transformational 

leadership is more effective in organizations that are exposed to rapid and continuous 

change (Deng et al., 2019; Deng et al., 2020). 

Transactional leadership includes four essential elements or dimensions:  

• Contingent reward is a contract or agreement between the leader and the 

subordinates. The leader grants the reward in return for the performance and 

achievement of the subordinates. The leader sets standards and goals and provides the 

necessary resources, support, and attention, to subordinates' commitment to 

performance and required expectations (Deng et al., 2019). 

• Contingent punishment: In this dimension, the subordinate is punished for failing to 

comply with the implementation conditions (Deng et al., 2019). 

• Management-by-Exception (active): After the leader sets the standards and works 

goals, he monitors and follows up on the workers’ performance with great accuracy 

and does not wait for problems to escalate (Deng et al., 2019). But he intervenes in the 



15 

 

event of any error or deviation, takes corrective measures immediately to prevent the 

recurrence of these mistakes or problems, provides advice and support for 

subordinates, and may punish the negligent employees at work. 

• Management-By-Exception (passive): The leader here is described as passive, as he 

waits for problems to occur and exacerbate to intervene (Deng et al., 2019). 

1.9 Culture and leadership style  

The concept of leadership includes many styles, while the degree of use and spread of 

these styles varies with different countries and cultures worldwide. The desired style in a 

particular culture or country may be undesirable in another (Specchia et al., 2021). 

Leadership and its patterns are directly related to the culture of countries and the peoples' 

principles, beliefs, and perceptions; for example, over a long period, women did not have 

the right to assume leadership positions in many countries of the world, and this is actually 

what the great man’s theory of leadership indicated (Kanat-Maymon et al., 2020). 

Today, the situation has changed dramatically, as women occupy many leadership 

positions in various fields, and the number is still increasing. More than ever, women 

today are strong in education, sports, politics, business, trade, and many other fields, 

including leadership positions in healthcare management (Mathad et al., 2019). 

In developing countries, for example, leaders are chosen based on a set of determinants 

that are usually related to the culture and social behavior prevailing in these countries, 

such as the degree of kinship, family, favoritism and nepotism, self-interest, and in many 

cases the leader is appointed based on specialization, but the truth and experiences have 

proven Specialization alone is not sufficient for a person to be a leader. Leadership is a 

more profound concept than that and requires many skills, abilities, and qualifications, 

and specialization alone is not sufficient for a leader to succeed in many developing 

countries. The expertise and external leaders of developed countries are also used in many 

companies and projects due to the low level of their leaders and their lack of leadership 

ability (Williams-Elegbe, 2018). 

1.9.1 Factors affecting the selection of the appropriate leadership style 

The leader’s choice of a particular leadership model depends on several factors related to 

the organization's environment, situations related to the leader, and subordinates. The 

surrounding environment, such as society's culture and economic, political, and social 



16 

 

conditions, clearly influence the leader’s behavior and leadership style (Musinguzi et al., 

2018). Each organization has its own goals, culture, standards, organizational climate, 

organizational structure, competitors, philosophy, mission, and vision, and all these 

variables affect the choice of leadership style; also, the size of the organization, whether 

it is within the private or public sector, affects the style that the leader will use with 

subordinates. Sometimes the organization needs a different leadership style at each stage 

of its development that is commensurate with the nature of the stage (Musinguzi et al., 

2018). 

Factors related to the nature of the situation that affects the type of leadership style used 

and the variables associated with the nature of the situation include clarity of tasks, 

methods, and procedures, the difficulty of work, work style, and routine, all of which 

affect leadership (Khan et al., 2020). Another factor that also impacts the leadership style 

that will be used is (the leader himself) the style that a leader adopts depends on a mix of 

their beliefs, ideas, Standards, norms, orientation, and values. The ability of subordinates 

to face situations and take administrative decisions, and their degree of responsibility, all 

of these factors affect directly or indirectly the optimal leadership style chosen by the 

leader (Khan et al., 2020). 

Studies and research show that no leadership style is valid for all situations and cases, no 

positive and practical style that the leader can adopt in different situations or 

environments, and no style that suits all subordinates. The matter is relative and not that 

simple (Musinguzi et al., 2018). So, the leader needs to consider how he will choose the 

leadership style that meets the employee's needs and achieves the organisation's goals. 

1.10 Job satisfaction  

Job satisfaction is an essential topic in various institutions and organisations' 

administrative and organizational aspects because it affects and is also affected. It is an 

independent variable that affects the behavior and performance of employees and the 

form of communication (formal, informal). Sometimes job satisfaction is a dependent 

variable that is also affected by factors such as incentives, rewards, salary, organizational 

structure and other factors (van Diepen et al., 2020). 

The concept of job satisfaction is considered one of the most complex and ambiguous 

concepts because it is an emotional state related to human emotions, feelings and 



17 

 

behaviors that change according to the situation (van Diepen et al., 2020). Accordingly, 

the level of job satisfaction determines the level of performance of the organization. 

Therefore, any organisation's effectiveness is linked to its employees' performance 

through their satisfaction with work. 

1.10.1 Concept of job satisfaction  

As we mentioned earlier, job satisfaction is related to feelings that are difficult to explain 

because they change with changing situations. For this reason, there is no agreement on 

defining a specific definition of satisfaction; some consider job satisfaction as an internal 

state linked to an individual’s sense of achievement, whether quantitative or qualitative. 

Others referred to the definition as a good mood or pleasure condition arising from work 

experience or evaluation of one's job (Specchia et al., 2021). 

Generally, employee job satisfaction may be defined in various ways; nonetheless, they 

all consider job satisfaction as a consequence or behavior that an individual contributes 

to the workplace (Dilig-Ruiz et al., 2018). Finally, it can be said that job satisfaction is 

the result of the individual’s interaction with his job. And it is a reflection of the extent of 

the satisfaction that he derives from his work, his belonging, and his interaction with the 

members of the group and with an environment, whether it is internal or external and thus 

refers to a set of functional feelings or psychological state about How does a person feel 

about his job (Dilig-Ruiz et al., 2018; Specchia et al., 2021). 

1.10.2 Importance of job satisfaction in healthcare organization  

We cannot ignore the vital role of job satisfaction, as it is a key factor in influencing the 

performance of employees, which in turn will be reflected in the organisation's 

performance as a whole (Dilig-Ruiz et al., 2018). Many reasons tell us why organizations 

should care about achieving job satisfaction for their employees, whether the focus and 

attention are at the level of the organization or individuals working in it. 

Indeed, employee satisfaction reflects a good style of leadership. Job satisfaction can also 

be considered a strong indicator of employees' emotional well-being and psychological 

health, reflecting the reality of organizational performance. It has been linked to greater 

productivity, loyalty, creativity, and devotion to the organization. All the above reasons 

are sufficient to understand and justify (Dilig-Ruiz et al., 2018; Specchia et al., 2021). 



18 

 

In general, recent research and surveys indicate that the level of job satisfaction is low in 

various sectors in most countries of the world, including the health sector as well, and this 

constitutes a great danger due to the specificity and sensitivity of this sector (Dilig-Ruiz 

et al., 2018). 

The health sector is the lifeblood of any country, and it performs a substantial and vital 

role in serving people by providing the health services they need and maintaining their 

lives within a healthy environment free from pests and diseases. Therefore, the volume 

of responsibilities and tasks performed by employees in the health sector is vast, which 

means that healthcare workers are considered the most effective crucial element. The 

quality of health services is directly affected by the level of satisfaction of workers in the 

healthcare organization (Specchia et al., 2021). 

Achieving a high level of job satisfaction among the employees of health organizations 

is of great importance at the levels of individuals and also at the level of the organization. 

For example, at the level of individuals from a psychological point of view, studies have 

proven that an employee who is satisfied with his work is considered a balanced and 

happy person and has a high sense of self-fulfilment (Dilig-Ruiz et al., 2018). 

When the employee feels job satisfaction, this means a more remarkable ability to adapt 

to the work environment, creativity, innovation, and excellence, and more desire for 

career development. In addition to his feeling of satisfaction with life in general, as the 

material and immaterial benefits provided by the job to employees help meet the 

requirements of life, Thus, this will undoubtedly lead to an increase in the loyalty and 

affiliation of employees to the organization in which they work (Dilig-Ruiz et al., 2018; 

Specchia et al., 2021). 

On the other hand, the opposite is also true; it is noted that job dissatisfaction at work is 

linked to several phenomena at the level of individuals, including mental illnesses and 

heart diseases. Many studies and research have proven a direct link between the level of 

job satisfaction and the state of physical and mental exhaustion that many employees are 

exposed to, especially in companies and institutions that require extra effort and fatigue 

and whose employees are exposed to severe work pressure, including health institutions 

and hospitals (Dilig-Ruiz et al., 2018). At the level of organizations, the employees’ job 

satisfaction is also reflected positively on the organization in many aspects. For example, 

whenever the level of job satisfaction increases, it leads to an increase in the level of 



19 

 

effectiveness and efficiency at work because the satisfied employee is interested in his 

performance level. Therefore, he will be more focused on achieving the best performance. 

Also, job satisfaction is related to improved performance, productivity, and reduced 

absenteeism. Several studies have demonstrated that whenever the degree of job 

satisfaction increases, the turnover rate tends to decrease, impacting employees' desire to 

learn new skills and their commitment to long-term organizational success (Dilig-Ruiz et 

al., 2018). 

One of the consequences of feeling dissatisfied with employees leads them to do some 

behaviors and actions that affect the quality and stability of the organization’s 

performance, such as frequent complaints and grumbling and sometimes rebellion or 

distance and withdrawal from work, whether by repeated absence without a health excuse 

or a particular excuse, especially in work that requires attendance. This leads to a 

permanent increase in the costs incurred by the organization, whether the costs of holidays 

and vacations or the costs of lack of productivity (Whether training or recruitment costs 

for new employees) that require a replacement employee for the absent employee (Liu et 

al., 2019). 

In the end, human resource has tremendous importance in organizations, despite the 

modern technology that significantly facilitates the work. However, this resource remains 

an essential resource for the organization. It is the organisation's first and foremost 

supporter in drawing strategies and plans, setting goals, and following up on their 

implementation, and it is the cornerstone for the success of any organization. Therefore, 

organizations are supposed to seek It strives to achieve job satisfaction for this human 

resource and to fully satisfy the needs of workers at work to ensure its success and 

distinction (Liu et al., 2019). 

1.10.3 Job satisfaction dimensions 

Job satisfaction is known to be influenced by the working conditions/environments, 

relationship with co-workers, wages and salaries, incentives and promotions, appraisal of 

the annual performance, and relationship with managers (Specchia et al., 2021). 

1.10.3.1 Work environment and conditions  

The physical working conditions are affected by ventilation, lighting, humidity, heat and 

noise. Cleanliness depends on the degree of individual acceptance and satisfaction with 



20 

 

the work environment, as these conditions affect some behavioral phenomena of working 

individuals, such as turnover rates, absences, accident rates, and diseases (Kinzl et al., 

2005). The better the material working conditions, the greater the satisfaction of 

individuals with work. 

1.10.3.2 Relationship with co-workers 

The positive relationship of the working individual with the work group satisfies his social 

needs and achieves an exchange of benefits between them (Lorber & Skela Savič, 2012). 

So the work in the organization gives individuals the opportunity to interact and 

communicate with others; the satisfaction of individuals with their work will be high and 

vice versa. It is worth mentioning in this regard that the strength of the relationship 

between the individual's satisfaction with his work and his relationship with others 

depends on the degree of his preference for affiliation and the strength of his social need. 

1.10.3.3 Wages and salaries 

Wages are essential to satisfying working individuals' physical and social needs (Hsiao 

& Lin, 2018). Many studies indicated that there is a positive relationship between the 

level of income and job satisfaction. The higher the income level of working individuals, 

the higher their satisfaction with work and vice versa. 

1.10.3.4 Incentive and promotions 

 It is not enough for workers to feel the achievement at the highest levels, but they also 

need the presence of an external party that recognizes and appreciates these achievements. 

Promotion is the essential type of recognition of the value of the effort made, as promotion 

leads to an increase in the benefits accruing to employees, whether by increasing their 

salaries or through improving their social status at work and outside the work (Specchia 

et al., 2021). 

1.10.3.5 Annual performance appraisal  

The annual performance appraisal helps improve communication between employees and 

the organization by identifying strengths, weaknesses, and shortcomings, which usually 

leads to better and more accurate metrics, thus improving performance results (Abdullah 

et al., 2021; Karem et al., 2019). This whole performance appraisal process aims to 



21 

 

improve how a team or organization operates to achieve higher levels of customer 

satisfaction, which is reflected in employee satisfaction. 

1.10.3.6 Relationship with managers  

A good relationship between employees and managers is one of the most critical factors 

in achieving job satisfaction (Duan et al., 2019). This relationship manifests in positive 

and effective communication between managers and employees, especially with their 

direct managers. An atmosphere of mutual respect prevails between them, motivating 

employees to provide the best performance. 

1.10.4 Factors affecting job satisfaction 

Human resource has great importance in the organization, which imposes on 

organizations the need to know and understand the nature and needs of their employees 

in all respects. Therefore, all organizations must know the most important reasons and 

factors that may affect job satisfaction or dissatisfaction. In general, most research and 

studies indicate that four main factors affect employee satisfaction: personal factors, 

physical factors, and organizational factors (Halcomb et al., 2018). 

1.10.4.1 Personal factor  

Personal factors are related to the individuals themselves, for example, gender, age, years 

of experience, and level of education. These factors are considered personal factors whose 

impact on job satisfaction varies from person to person (Halcomb et al., 2018). The 

relationship between gender and job satisfaction is not stable because it depends on the 

discrimination ratio between both sexes by the management at work. Often, a woman’s 

performance and experience are compared to men’s performance and experience based 

on social beliefs and perceptions that favor men’s performance over women’s 

performance at work and not based on actual performance or final results. So, these 

negative phenomena towards women’s work ultimately affect their satisfaction with their 

work, especially in high positions, where priority is given to men in heading these 

positions, so when the discrimination between women and men increases in the 

workplace, job satisfaction of women will decrease (Halcomb et al., 2018). 

Concerning the age factor, the results of studies and research, in general, showed that the 

relationship between job satisfaction and age is relatively small. It was noted that job 

satisfaction increases with increasing age, while it decreases among employees during the 



22 

 

middle age period (Halcomb et al., 2018; Zhang et al., 2020). The explanation may be 

that the achievements and ambitions of the employee in his first life are higher and more 

significant than the available reality, resulting in job dissatisfaction. However, with 

increased age, the individual becomes more mature, realistic, and less ideal, so the degree 

of his ambitions decreases, and he is satisfied with the actual reality, which results in 

increased satisfaction career. 

About years of experience or elapsed time at work, much research has shown that job 

satisfaction is relatively common in the first years, then decreases gradually in the fifth 

and eighth years, and then rises again with increasing the period that the individual spends 

at work, and the morale is very low, after twenty years or vice versa. It may also be at its 

peak, varying from one person to another. Concerning education, several aspects must be 

considered before discussing a comprehensive generalization. For example, when 

discussing education, we must study the organization’s policy regarding promotion 

because it dramatically affects employee satisfaction (Halcomb et al., 2018). Therefore, 

with the high level of education and the decrease in opportunities for advancement and 

promotion, the employee will certainly feel very frustrated, and the level of job 

satisfaction will decrease. The dissatisfaction and lack of appreciation will increase even 

more when the right employee is placed in the wrong place so that it does not match the 

level of his educational qualifications or his abilities and technical skills. 

1.10.4.2 Physical factors 

The workplace and the work environment are among the most psychological and physical 

factors affecting employees. Several physical factors, either internal or external, affect 

the degree of job satisfaction. The indoor working environment, including the workplace 

space, level of cleanliness, lighting and ventilation, air conditioning, humidity, heat, and 

noise, affects the degree of personal acceptance of the work environment (Halcomb et al., 

2018). The presence of entertainment used by the worker during breaks permanence, the 

external work environment and the factors surrounding the organization have an 

influencing role in the level of satisfaction. 

1.10.4.3 Organizational and occupational factors 

It includes the organizational structure, procedures, decisions, supervision, the degree of 

control imposed on employees and their activities, the leadership styles used, in addition 



23 

 

to the wages and salaries system and its gradation, bonuses, and material or moral 

incentives that the organization provides to employees, growth opportunities, the 

relationship between colleagues, the relationship with managers, work conditions and 

environment, work content and other factors that lead Job satisfaction or dissatisfaction 

(Zhang et al., 2020). Among the most critical organizational factors or dominant factors 

that affect job satisfaction: The work nature or job itself; for example, is this job 

compatible with the employee’s academic qualifications, and is it commensurate with his 

abilities, talents, and preparations? Does this job achieve the desired social status for the 

employee inside or outside the organization? Does this job enable the employee to use 

the skills and experiences he possesses and development of innovation and creativity, or 

does this job obliterate innovation, creativity, and a spirit of enthusiasm? In general, the 

nature of work affects job satisfaction (Halcomb et al., 2018; Zhang et al., 2020). 

When an employee's job is seen to be vital, their degree of satisfaction rises. Work 

difficulties and challenges allow people to put their talents, knowledge, and intellect to 

use in dealing with the intricacies of their profession. According to some research, 

intelligence and work satisfaction have a negative relationship. Generally, many problems 

arise in the workplace when the employee feels that his job is unimportant, uninteresting, 

or devoid of a challenge, so if the job lacks the perceived element of interest, it may cause 

dissatisfaction among the intelligent person. Individuals feel job satisfaction when they 

do the work they love, which motivates them to master the work and provide everything 

they can to achieve the best results (Halcomb et al., 2018). 

The leadership style also has a significant role in job satisfaction or dissatisfaction, for 

example in democratic leadership, the leader uses an open-door policy with subordinates, 

and this, in turn, increases harmony and understanding between the leader and 

subordinates and increases the opportunity for employees to accept and be satisfied with 

the changes that may occur in the organization. In addition to that, this style ensures the 

participation of effective employees of all levels, It raises the level of loyalty and mutual 

trust between the leader and the workers, and this contributes to raising productivity and 

achieving job satisfaction. On the contrary, dictatorial leadership limits employees’ 

participation and freedom and permanent dependence on the leader, and this causes a state 

of psychological instability for the individual due to punishment and the strict style of 

dictatorial leadership (Musinguzi et al., 2018). 



24 

 

Previous studies had shown that employees were more satisfied with their jobs when their 

boss exhibited transformational leadership style conduct as opposed to transactional 

leadership style activity (Musinguzi et al., 2018). On the other hand, transformative 

leadership is positively associated with work satisfaction, and it is evident that raising the 

level of job satisfaction requires adopting the appropriate leadership behavior or style, so 

different leadership styles have different impacts on job satisfaction (Musinguzi et al., 

2018). 

Salary and wages are critical factors in achieving happiness and meeting the necessary 

needs of individuals. So determining the worker's wages and paying attention to 

developing a wise and fair wage policy is one of the factors for the success of personnel 

management policies and programs in organizations, so job satisfaction is the state of 

reaching financial recovery (Akinwale & George, 2020). Regarding promotions and 

growth opportunities, whenever the employee feels that his performance is appreciated, 

he becomes more satisfied with his work and thus, his efficiency increases at work 

(Akinwale & George, 2020; Musinguzi et al., 2018). 

The content of the work in terms of the responsibilities and powers granted to the 

employee and the degree of diversity of tasks is significant. For example, the greater the 

powers granted to the employee, the greater his sense of his importance as an individual 

working in the organization; thus, this feeling translates into satisfaction with work and 

the organization. This result is consistent with Herzberg's theory regarding the driving 

factors represented by job enrichment, where employees with higher positions want to 

give them independence and provide some additional elements for job enrichment, such 

as feedback and setting diverse and challenging tasks for them. Therefore, satisfying this 

desire through job redesign leads to an increase in the satisfaction rate they have (Sobaih 

& Hasanein, 2020). In addition, the diversity of tasks reduces the severity of the boredom 

arising from routine work and contributes to job satisfaction. 

1.11 A brief summary of previous studies 

Many previous studies dealt with the topic of "leadership styles and their relationship to 

the level of job satisfaction" and dealt with it from different angles and aspects. The 

current study will present several studies that have benefited concerning its most 

prominent features (see table 11) in appendix H, commenting on the essential aspects of 

agreement and disagreement and clarifying the scientific gap discussed in the current 



25 

 

study. It is worth noting that the studies that will be discussed have been applied and 

completed between 2015 and 2022, whether locally or around the world, indicating their 

temporal and geographical diversity. 



 

Chapter Two 

Methods 

The methodology includes the theoretical and philosophical assumptions upon which 

research is based and the implications for the method or methods adopted; the methods 

specifically refer to the techniques and procedures used to obtain and analyze data. In this 

chapter, the methods used in the study include the study design, study population, study 

sample, Instruments of study and validation indicators, analysis plan, study procedures, 

and ethical approval. 

2.1 Study design 

According to the study problem and its objectives, and through the questions that this 

study seeks to answer, the cross-sectional descriptive study has been relied upon, which 

provides data for describing the status of phenomena or relationships among phenomena-

related variables at a fixed point in time. 

2.2 Study population 

Corona pandemic, the repeated strike of health workers such as doctors, nurses, and 

contract employees, forced the researcher to choose the Jenin Health Directorate, where 

works to identify leadership style and their relationship to the level of job satisfaction as 

the first comprehensive research at the level of the directorate to avoid delays and 

obstacles in the implementation of the study. 

The population refers to all the elements of the study or elements being investigated. The 

research population included all the Jenin Governorate Health Directorate employees 

(doctors, administrators, nurses and midwifery, laboratory technicians, radiology 

technicians, and pharmacists), who were 357 at the time of the study.  

The study included inclusion and exclusion criteria, which are as follows:  

• Inclusion criteria: workers of Jenin Health Directorate. 

• Exclusion criteria: Those who are not related to the Jenin Health Directorate 

 



27 

 

2.3 Study sample 

Since the study population is relatively small and very stratified, this research study 

utilized a comprehensive sampling approach by inviting all 357 employees of the 

Directorate to participate in the survey, including all employees in various departments 

and specialities (doctors, nurses & midwifery, administrators & health services, 

pharmacists, laboratory technicians, and radiology technicians). 

The Statistics & human resources Department in the Health Directorate of Jenin 

Governorate provided employees-related information. 

The questionnaire was distributed to the study sample through field visits to all workers 

inside the Directorate and its health centers inside and outside the city, including 

outpatient clinics in the villages and Provinces of Jenin Governorate, estimated at 58 

clinics. 

2.4 Instruments of study  

Data resources in this study can be divided into primary (direct) and secondary (Indirect) 

resources. 

• Primary data: Questionnaires were the main instruments of this study; the 

questionnaires were designed keeping in view the study’s objective. It was kept as 

concise as possible as a short questionnaire with conceptually clear and concise 

statements desired by both respondents and the researcher. 

• Secondary data: Includes books and scientific papers from CINAHL, ScienceDirect, 

ProQuest, Scopus, and Google Scholar. 

Within the framework of the field study and to test the assumed relationship between the 

two research variables (leadership styles and job satisfaction), a questionnaire was chosen 

as a tool to measure leadership style and its relationship to the level of job satisfaction in 

the Jenin Health Directorate. A questionnaire was prepared by reviewing several studies 

that dealt with the same topic as our current study, where several executive steps were 

taken to ensure the tool's validity and stability; the validity of the study tool was examined 

by content validity and internal consistency validity (Antonakis et al., 2003; Kirkbride, 

2006; Saleem, 2015; Spector, 1997). The questionnaire consisted of two main sections. 

See appendices (A and B). 



28 

 

• First Section 

It is related to the socio-demographic and job-related factors of the respondents 

(gender, age, job title, supervisory title, academic qualification, years of experience, 

and salary). 

• Second Section 

Related to the questionnaire's axes and consists of two main fields: the first field 

refers to leadership styles and includes 48 phrases/questions distributed over five 

leadership styles indicated below under the subtitle of the first field.  

• First field  

1. Part 1: Democratic leadership from questions (1-10) 

2. Part 2: Dictatorial leadership from questions (11-20) 

3. Part 3: Laissez-Faire leadership from questions (21-30) 

4. Part 4: Transformational leadership from questions (31-40) 

5. Part 5: Transactional leadership from questions (41-48) 

• Second Field 

It consists of 25 phrases/questions to measure the level of job satisfaction in the Jenin 

Health Directorate from questions (49-73). A 5-point Likert-type scale was used to 

assume that the strength/intensity of the experience is linear, i.e., on a continuum 

from strongly disagree to strongly agree. Respondents were offered a choice of one 

to five, were responses to the neutral point being neither agree nor disagree, whereby 

one refers to strongly disagree, two refers to disagree, three refers to neutral, four 

refers to agree, and finally, five refers to strongly agree.  

2.4.1 Validity and reliability of the questionnaire  

The validity of the study tool (Questionnaire) was examined by content validity and 

internal consistency validity. A group of four multidisciplinary experts judged the content 

validity; the questionnaire has been modified based on their feedback and suggestions, 

see appendix (C). The experts were academicians affiliated with two universities (Al 

Quds Open University and Arab American University).  

A pilot study was conducted on 5% of the sample size in the Health Directorate of Jenin, 

and it was excluded from the study. This action was to determine the clarity of the 

questionnaire, explore the appropriateness of the study instruments, the clarity of 



29 

 

meanings and scales, and the time taken to fill the questionnaire. In addition, to expecting 

a response rate. 

Pearson correlation matrix to indicate the relation between domains of leadership style 

and the total degree for job satisfaction domains have been done and shown a statistically 

significant relationship. Therefore, it is possible to judge the validity of the domains with 

statistical significance, thus reassuring its application. 

2.5 Research conceptual model and variables 

Following a literature review, the conceptual model shown in Figure 1 was used to 

investigate the relationships between perceived managerial leadership styles (democratic, 

dictatorial, laissez-faire, transformational, and transformational), sociodemographic 

variables (gender, age, profession, rank, educational level, length of experience, and 

salary), and the level of job satisfaction of the employees of Jenin Health Directorate. In 

this study, perceived leadership styles were the independent variables, and job satisfaction 

was the dependent variable. The socio-demographic characteristics of the workers were 

used as control variables.  

Figure 1  

Potential relationship between the independent and dependent variables 

 

 



30 

 

2.6 Study procedures 

The following steps were followed: 

− Initially, a research proposal for the current study was prepared, and the study tool 

(questionnaire) was presented to the experts and a group of arbitrators, then submitted 

on 16 June 2021. 

− Official approvals were obtained from the Faculty of Graduate Studies and IRB at A-

Najah National University and official authorities to facilitate carrying out the field 

study by distributing questionnaires to collect data between 20 June 2021 and 18 

August 2021; see appendices (D, E and F). 

− A review of previous studies and theoretical frameworks in the field of research to 

build the theoretical framework for the current study has been issued. 

− A pilot study was conducted on 17 September 2021 to ensure the validity and 

reliability of the study tool. 

− The study tool was applied to the study sample, and the data were collected, analyzed, 

and converted into information through special tables between 3 November 2021 and 

17 January 2022.  

− Finally, Interpreting and discussing results and formulating recommendations, 

proposals, and conclusions. 

2.7 Analysis plan  

All data were checked, coded, and entered into a database, and statistical data analysis 

was conducted using the Statistical Package for Social Science (SPSS) software version 

20. The internal consistency of the items in the multi-factor leadership and job satisfaction 

scales was measured using Cronbach's alpha. The data were assessed for normality of 

distribution using absolute skewness and kurtosis. The data were normally distributed 

when the absolute kurtosis was between ‐7 to +7, and the absolute skewness was between 

2 and +2 (Kim, 2013). Because the data were normally distributed, the scores of the 

groups were compared using Student’s t-tests or analysis of variance (ANOVA) as 

appropriate. To control for confounding variables, multiple linear regression models were 

used. All variables were retained in the multiple linear regression models. Correlations 

were investigated using Pearson’s correlation coefficients. In this study, a p-value of < 

0.05 indicated statistical significance.       



31 

 

2.8 Ethical approval  

To conduct the current study within research ethics, official approvals were obtained from 

the Faculty of Graduate Studies and IRB at A-Najah National University and official 

authorities, see appendices (D, E, and F). The participants also received a written 

informed consent form (see Appendix G). They were informed that their participation 

would be voluntary. Furthermore, the confidentiality and anonymity of the participants 

were guaranteed. They were also informed of the possibility of their withdrawal from the 

study at any time without any punishment. Moreover, data security was ensured and only 

used for research purposes, and the questionnaires were coded by serial numbers and kept 

in a locked cabinet. 

  



32 

 

Chapter Three 

Results 

3.1 Socio-demographic and practice characteristics of the employees 

In this study, the questionnaire was distributed to the 357 employees of the Jenin Health 

Directorate. Of those, 322 employees returned usable questionnaires, giving a response 

rate of 90.1%. The socio-demographic and practice characteristics of employees are 

shown in Table 1. In this study, the majority (58.1%) of the employees were female, aged 

between 41 and 60 years (60.5%), had a bachelor’s degree or higher (64.9%), and had an 

experience of less than 20 years (67.4%). 

On the other hand, 26.4% of the employees were nurses/midwives, 7.1% were 

pharmacists, and 28.6% were management/health service providers. Of the Jenin Health 

Directorate employees who participated in this study, (37.0%) earned 5000 NIS and more. 

Details of the socio-demographic and practice characteristics of participants are shown in 

Table 1. 

 

 

 

 

 

 

 

 

 

 

 

 



33 

 

Table 1  

Distribution of the study sample members according to their socio-demographic characteristics 

Variable n % 

Gender    

Male 135 41.9 

Female 187 58.1 

Age (years)    

22-30 49 15.2 

31-40 78 24.2 

41-50 137 42.5 

51-60 58 18.0 

Profession    

Physician 63 19.6 

Allied medical and clinical profession 59 18.3 

Pharmacist 23 7.1 

Nurse/midwife 85 26.4 

Management/health services 92 28.6 

Rank    

Director 8 2.5 

Head of department 25 7.8 

Head of division 38 11.8 

Employee 22 6.8 

Unclassified employee 229 71.1 

Educational level    

Primary education 19 5.9 

Secondary education 18 5.6 

Diploma 76 23.6 

Bachelor's degree 179 55.6 

Master or PhD 30 9.3 

Length of experience (years)    

≤5 60 18.6 

6-11 73 22.7 

12-19 84 26.1 

≥ 20 105 32.6 

Salary (NIS)    

< 2000 27 8.4 

2000-2900 23 7.1 

3000-3900 55 17.1 

4000-4900 98 30.4 

≥ 5000 119 37.0 

Note. NIS: New Israeli Shekel, PhD: Doctor of Philosophy  



34 

 

3.2 Internal consistency composite reliability of the questionnaire 

In this study, the internal consistency and the composite reliability of the items included 

in the questionnaire were tested using Cronbach’s alpha and average variance extracted. 

The values of Cronbach’s alpha, average variance extracted, and composite reliability of 

the different domains of the multi-factor leadership scale are shown in Table 2. The 

composite reliability of the different domains was > 0.80, indicating that the scale was 

reliable. The overall Cronbach’s alpha was 0.82, indicating that the scale was internally 

consistent.  

Table 2  

Composite reliability and internal consistency of the different domains of the multi-factor 

leadership questionnaire  

# Domain 
Number of 

items 
Cronbach’s alpha 

Average 

variance 

extracted 

Composite 

reliability 

1 
Democratic leadership 

style 
10 0.87 0.50 0.83 

2 Dictator leadership style 10 0.82 0.85 0.91 

3 
Laissez-faire leadership 

style 
10 0.52 0.54 0.85 

4 
Transformational 

leadership 
10 0.92 1.11 0.93 

5 Transactional leadership 8 0.73 0.49 0.87 

6 Overall 48 0.82     

 

The values of Cronbach’s alpha, average variance extracted, and composite reliability of 

the different domains of the job satisfaction scale are shown in Table 3. The composite 

reliability of the different domains was > 0.80, indicating that the scale was reliable. The 

overall Cronbach’s alpha was 0.90, indicating that the scale was internally consistent. 

 

 

 

 

 

 

 

 



35 

 

Table 3 

Composite reliability and Internal consistency of the different domains of the job satisfaction 

scale 

# Domain 
Number 

of items 

Cronbach’s 

alpha 

Average 

variance 

extracted 

Composite 

reliability 

1 
Work environment and 

conditions 
6 0.75 0.50 0.83 

2 Relationship with co-workers 4 0.67 0.40 0.80 

3 Wages and salaries 3 0.88 0.48 0.93 

4 Incentives and promotions 2 0.68 0.31 0.87 

5 Annual performance appraisal 6 0.81 0.53 0.82 

6 Relationship with managers 4 0.85 0.56 0.90 

7 Overall 25 0.9     

 

3.3 Perceived managerial leadership style of the employees   

3.3.1 Perceived democratic leadership style  

When the employees were asked to express their opinions on the democratic leadership 

style, the distribution of their opinions are shown in Table 4. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



36 

 

Table 4 

 Distribution of the opinions of the employees on the democratic leadership style 

   SD D N A SA 

# Statement n % n % n % n % n % 

1 

Your manager takes into 

account individual 

differences when allocating 

work tasks 

31 9.6 43 13.4 41 12.7 136 42.2 71 22.0 

2 

Your manager encourages 

you to take the initiative 

and develops your 

creativity and innovation  

56 17.4 61 18.9 75 23.3 90 28.0 40 12.4 

3 

Your manager asks for your 

opinions and suggestions 

regarding the work 

43 13.4 69 21.4 56 17.4 99 30.7 55 17.1 

4 
Your manager attends your 

social occasions  
37 11.5 27 8.4 95 29.5 104 32.3 59 18.3 

5 

Adequate authorities are 

given to you to solve a work 

problem  

25 7.8 35 10.9 41 12.7 157 48.8 64 19.9 

6 

Your manager shares you in 

decision- making process, 

but the last decision is for 

him.  

20 6.2 43 13.4 48 14.9 142 44.1 69 21.4 

7 

Your manager allows you 

to rotate work or swap tasks 

between you and your co-

workers  

24 7.5 32 9.9 49 15.2 154 47.8 63 19.6 

8 

Your manager allows 

collaboration between you 

and your co-workers  

13 4.0 13 4.0 53 16.5 161 50.0 82 25.5 

9 

The manager uses praise to 

support your psychological 

and human needs  

29 9.0 56 17.4 61 18.9 110 34.2 66 20.5 

10 

The manager conducts 

meetings to exchange ideas 

and decisions about work 

problems  

44 13.7 58 18.0 53 16.5 114 35.4 53 16.5 

Note. SD: Strongly disagree, D: Disagree, N: Neutral, A: Agree, SA: Strongly agree 

 

This study’s mean perceived democratic leadership style score was 34.4 ± 8.1. 

Additionally, the scores were significantly higher for employees who were male, directors 

or heads of departments, had a bachelor’s degree or higher, and earned 4000 NIS or more. 

Details of the differences in the perceived democratic leadership style scores are shown 

in Table 5.  



37 

 

Table 5  

Differences in the perceived democratic leadership style scores among the employees 

Variable n % Mean SD p-value 

Gender       

Male 135 41.9 36.6 8.2 
< 0.001 

Female 187 58.1 32.9 7.8 

Age (years)       

22-30 49 15.2 34.2 7.5 

0.309 
31-40 78 24.2 35.2 8.8 

41-50 137 42.5 33.6 7.7 

51-60 58 18.0 35.7 8.6 

Profession       

Physician 63 19.6 36.5 7.5 

0.118 

Allied medical and clinical profession 59 18.3 33.9 7.7 

Pharmacist 23 7.1 33.3 9.2 

Nurse/midwife 85 26.4 35.0 7.4 

Management/health services 92 28.6 33.2 9.0 

Rank       

Director 8 2.5 40.6 4.5 

0.022 

Head of department 25 7.8 38.3 7.6 

Head of division 38 11.8 33.9 7.8 

Employee 22 6.8 34.4 10.3 

Unclassified employee 229 71.1 33.9 8.0 

Educational level       

Primary education 19 5.9 30.2 9.5 

0.007 

Secondary education 18 5.6 31.3 8.1 

Diploma 76 23.6 33.2 8.4 

Bachelor's degree 179 55.6 35.7 7.6 

Master or PhD 30 9.3 34.9 8.1 

Length of experience (years)       

≤5 60 18.6 32.6 8.1 

0.204 
6-11 73 22.7 35.6 8.6 

12-19 84 26.1 34.5 7.9 

≥ 20 105 32.6 34.6 7.9 

Salary (NIS)       

< 2000 27 8.4 30.4 8.4 

0.041 

2000-2900 23 7.1 33.7 9.3 

3000-3900 55 17.1 33.5 8.0 

4000-4900 98 30.4 35.0 7.9 

≥ 5000 119 37.0 35.5 7.9 

Note. NIS: New Israeli Shekel, PhD: Doctor of Philosophy  

 

 

 



38 

 

To control the confounding variables and to identify the variables that could predict 

higher perceived democratic leadership style scores, a multiple linear regression was 

used. The model showed that higher perceived democratic leadership style scores could 

be predicted by being male in gender, as shown in Table 6. 

Table 6 

 Predictors of higher perceived democratic leadership style scores 

Variable UC SE SC t p-value 

Gender -3.43 0.90 -0.21 -3.79 < 0.001 

Age -0.05 0.75 -0.01 -0.07 0.944 

Profession -0.18 0.37 -0.03 -0.50 0.618 

Rank -0.61 0.45 -0.08 -1.36 0.174 

Education 1.26 0.73 0.15 1.73 0.084 

Experience 0.30 0.70 0.04 0.42 0.672 

Salary -0.13 0.65 -0.02 -0.19 0.847 
Note. SC: standardized coefficients, SE: standard error, UC: unstandardized coefficients   

 

3.3.2 Perceived dictatorial leadership style  

When the employees were asked to express their opinions on the democratic leadership style, the 

distribution of their opinions are shown in Table 7. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



39 

 

Table 7  

Distribution of the opinions of the employees on the dictatorial leadership style 

   SD D N A SA 

# Statement n % n % n % n % n % 

1 

The manager is committed to 

carrying out the work 

according to the rules and 

routine laws 

7 2.2 13 4.0 41 12.7 189 58.7 72 22.4 

2 

The manager refuses to 

delegate powers that could 

be delegated in his absence 

25 7.8 80 24.8 131 40.7 69 21.4 17 5.3 

3 

The manager follows the 

approach of tight control and 

close follow-up of workflow 

13 4.0 59 18.3 66 20.5 147 45.7 37 11.5 

4 

The manager relies on their 

official authority to compel 

you to carry out work orders 

and instructions. 

19 5.9 69 21.4 66 20.5 110 34.2 58 18.0 

5 

The manager tracks your 

mistakes while overlooking 

the mistakes of your closest 

co-workers or praising them 

60 18.6 108 33.5 79 24.5 38 11.8 37 11.5 

6 

The manager follows the 

method of punishment in the 

event of a mistake or failure 

to act 

37 11.5 93 28.9 84 26.1 74 23.0 34 10.6 

7 
The manager at the only one 

who makes decisions 
41 12.7 101 31.4 66 20.5 83 25.8 31 9.6 

8 

The manager ignores your 

personal needs and desires to 

work 

46 14.3 110 34.2 56 17.4 71 22.0 39 12.1 

9 

The manager often ignores 

your opinions and 

suggestions regarding to 

work unless they align with 

their personal vision 

41 12.7 101 31.4 70 21.7 75 23.3 35 10.9 

10 

The manage limits your 

freedom to participate in 

scientific seminars or work 

related to training workshops 

to complete daily tasks in the 

required time 

42 13.0 93 28.9 87 27.0 52 16.1 48 14.9 

Note. SD: Strongly disagree, D: Disagree, N: Neutral, A: Agree, SA: Strongly agree 

 

This study's mean perceived dictatorial leadership style score was 30.7 ± 7.1. 

Additionally, the scores were significantly higher for female employees with lower 

education and less than 3000 NIS. Details of the differences in the perceived dictatorial 

leadership style scores are shown in Table 8.  

 



40 

 

Table 8  

Differences in the perceived dictatorial leadership style scores among the employees  

Variable n % Mean SD p-value 

Gender       

Male 135 41.9 29.0 7.3 
< 0.001 

Female 187 58.1 32.0 6.7 

Age (years)       

22-30 49 15.2 30.5 6.9 

0.799 
31-40 78 24.2 30.4 6.9 

41-50 137 42.5 31.2 7.1 

51-60 58 18.0 30.3 7.6 

Profession       

Physician 63 19.6 28.6 6.3 

0.107 

Allied medical and clinical 
profession 

59 18.3 30.8 6.9 

Pharmacist 23 7.1 32.0 9.4 

Nurse/midwife 85 26.4 31.5 6.7 

Management/health services 92 28.6 31.1 7.3 

Rank       

Director 8 2.5 30.6 7.4 

0.065 

Head of department 25 7.8 26.7 7.4 

Head of division 38 11.8 30.8 8.1 

Employee 22 6.8 31.5 6.6 

Unclassified employee 229 71.1 31.1 6.9 

Educational level       

Primary education 19 5.9 33.6 8.1 

0.00