Gazdasági Ismeretek | Vezetés-szervezés » Ayodele Cole Benson - Amalgamated Leadership Model in For Profit Organizations

Source: http://www.doksinet Amalgamated  Leadership  Model  in  For  Profits    /Benson            1     ISSN  2159-­‐6743  (Online)   Amalgamated  Leadership   Model  in  For-­‐Profit   Organizations   Ayodele  Cole  Benson,  MD  DHA*       Abstract     The focus of this paper is the perceived leadership model that best suits for-profit health care organizations. General background of leadership and highlights of various leadership models provides an overview to enhance understanding of amalgamated leadership model suitable in for-profit organizations. In the current competitive marketplace, for-profit organizations are facing herculean challenge of ensuring profitability at all cost, because that determines organizational share price index on the trading floor. The quality of organizational leadership is therefore crucial to organizational survival in contemporary times.

The idea promoted in this paper is that the amalgamated leadership model is the most applicable leadership approach to ensure profitability and sustainability of vibrant organizational processes thereby improving organizational position in the marketplace. The belief is that amalgamation of various leadership styles into one purposeful model will leverage the essential elements of each leadership paradigm to the benefit of the organization. The need exists however, for cautious application of the amalgamated model because achievement of success in the use of this construct will demand that leaders strike a balance in how they employ the attributes of each constituent leadership paradigm in the amalgamation. Over use of one element in the construct may lead to stress in the workplace thereby reducing productivity and profitability.   Keywords:   Leadership,   amalgamated   leadership,   situational   leadership,   transactional   leadership,  

transformational   leadership,   health   care   organizations,   for   profit   organizations,  not  for  profit  organizations       *Doctor  of  Medicine  and  Doctor  of  Health  Administration.  Principal,  Echo-­‐Scan  Services   Correspondence:  Ayodele  Cole  Benson,  MD  DHA  Email:  benson ayodele  at  yahoo.com     www.jghcsinfo  [ISSN 2159-6743 (Online)]                                                                                JOURNAL  OF  GLOBAL  HEALTH  CARE  SYSTEMS/VOLUME  2,  NUMBER  1,  2012   Source: http://www.doksinet Amalgamated  Leadership  Model  in  For  Profits    /Benson            2   Amalgamated  Leadership   Model  in

 For-­‐Profit   Organizations   Several models of leadership exist but the style or model of leadership an executive chooses to follow depends on the organizational structural foundation and what the leader intends to achieve (Okeke, 2008). Bass (2003) described leadership as an observable set of skills and abilities The skills demonstrable as a leader’s responsibilities vary depending on the context in which the leader operates. Common leadership behaviors in an organization include (a) persuasion, when a leader wants the followers to align with organizational mission and vision; and (b) collaboration, when the leader employs participatory approach to enable the workforce implement the valued ideas they hold to organizational advantage. A leader may choose transactional tendencies of using rewards when it is immensely important to gain the buy-in of key elements in the workforce. In dealing with resisters, some leaders become autocratic as a way of enforcing organizational

mission to achieve a desired vision and to avoid losing control of essential issues in organizational change process. In this paper, the discussion will focus on the amalgamated leadership approach as the leadership model that best suits for-profit health care organizations. General background of leadership will form part of the discussion and highlights of various leadership models will provide an overview to enhance understanding of amalgamated leadership construct perceived as suitable in for-profit organizations. Background of Leadership Theories Leadership styles are important because they are patterns of behavior and personality attributes that exact direct and indirect influence on others (Northouse, 2007). According to Nahavandi (2009), three major eras form the foundation of modern leadership theories. Early leadership studies from the 1800s to the early 1940s promoted the ‘great man’ leadership theory otherwise called the trait leadership model. The major assumption of

the trait theory of leadership is that innate qualities shape human personality and behavior, suggesting that by virtue of their birth, some individuals possess special qualities that allow them to lead others. According to Hunter (2004), “leadership is who we are” (p 32), thus, supporting the assertions promoted by the early leadership trait theory. Nahavandi (2009) opined that these special characteristics innate in certain persons help to push them toward leadership regardless of the context. Kirkpatrick and Locke as cited by Nahavandi (2006) asserted that a number of leadership personal attributes increase the effectiveness of a leader. In their view, some of the attributes such as intelligence and drive cannot be acquired through learning whereas self-confidence and knowledge of industry can be learnt with time through observation and experience. Empirical research in the mid-1940s began to question the trait model emphasizing that leadership is a dynamic process that varied

from situation to situation. The promoters of the situational era in leadership studies believed that leadership could be learned and not simply an innate privilege. Thus, the impact of behavior in leadership effectiveness came to the fore in those days. The behavioral leadership theory emerged in the late 1940s. Further studies in the subject led to the emergence of the contingency leadership model in mid-1960s. Nahavandi (2009) opined that the major assumption of the contingency theory is that the requirements of situation influence the personality, style, or behavior of effective leaders. More recent leadership models that grew from the 1970s include the transactional theory, the charismatic model, transformational model, and currently, beyond the transformational model   www.jghcsinfo  [ISSN 2159-6743 (Online)]                                                                

               JOURNAL  OF  GLOBAL  HEALTH  CARE  SYSTEMS/VOLUME  2,  NUMBER  1,  2012   Source: http://www.doksinet Amalgamated  Leadership  Model  in  For  Profits    /Benson            3   (Nahavandi, 2009). Leadership is an interesting enigma Though many changes in the styles of leadership have emerged over the years, the one constant is that the need and ability to lead is the required in all styles. Current belief promoted by leadership researchers is that leadership is a mixture of experience, character, education, and genetics. Therefore, there may be a correlation between the present understanding and the assertion of the behavioral leadership theories that emphasizes the assumption that leadership is essentially learned as opposed to an leadership being an innate attribute as suggested by the trait era (Nahavandi, 2006). Leadership and Power Following the trait era of leadership

and the subsequent influence era, the power theory emerged in which leadership was synonymous with use of power. According to Yukl (2010), power involves the ability of an individual to influence another party called the target. Sometimes the target refers to one or more persons and potential influence could be over things, events or attitudes, and behavior. Acoording to Tichy (2002), power is one of the most written about topics in the field of social sciences. However, power conveys several meanings to different individuals depending on their leaning in the spectrum of leadership models. What power means to an autocrat is different from what it means to a charismatictransformational leader Power, exercised appropriately and productively leads to organizational growth but when used destructively could create chaos and mayhem. Immelt, serving as the chief executive officer of GE exercised power in a participative manner using his position to seek ideas from senior team managers in

weekly meetings even though eventually he makes every decision alone taking leverage on employees inputs (Tichy, 2002). His experience according to Tichy (2002), shows that when a leader uses power to collaborate effectively with followers without inconsistencies he gains tremendous support and achieve team cohesion. However, inappropriate use of leadership power can give rise to leadership stress. According to Boyatzis and Mckee (cited in Krakoff, 2007), "Power stress is part of the experience that results from the exercise of influence and sense of responsibility associated with leadership positions." These authors asserted that when leadership faces continued scrutiny and evaluation they tend to encounter more stress. According to Tichy (2002), an individual who believes he cannot positively change the course of event could use resistance to try to manipulate the situation. This becomes a power tussle that creates stress for the leader Effective Leadership Model in a

For-Profit Organization The drive for financial gains in for-profit organizations to satisfy the aspirations of board members and shareholders calls for an amalgamation of leadership approach. An integrative leadership, according to Avolio (2007) is a combination of the transactional, the transformational leadership styles and more. The contingency model of leadership promoted in the 1960s emphasized the belief that there is no best way to lead; indicating that element of situation affects the leadership style adopted by a leader. The contingency theories in a sense is embracing of other leadership models and is significantly flexible to adapt to changing situations at the same time applying the principles of contemporary leadership models (Yukl, 2006). A common assertion in management arena is that employees are the best organizational assets (Longest, Rakish & Darr, 2000). Irrespective of other investments made into running an organization, it takes working well with the

employees to harness all resources to actualize desired objectives of the organization. Effective management of human resources (HR) is therefore central to organizational success. Management of HR in environments with compromised socio-economic circumstances such as the current global economic downturn calls for transactional leadership where the leaders influence their followers by resorting to the application of rewards and sanctions. The high tendency of migration of health care professionals in search of better conditions of service requires the reward approaches of transactional leadership to enhance motivation and staff retention. The HR system also calls for transformational leadership whereby visionary leaders, goal setters and change agents can influence the “attitudes, beliefs and motives” (Antonakis & House, 2002, p. 8) of their followers to higher aspirations   www.jghcsinfo  [ISSN 2159-6743 (Online)]                    

                                                           JOURNAL  OF  GLOBAL  HEALTH  CARE  SYSTEMS/VOLUME  2,  NUMBER  1,  2012   Source: http://www.doksinet Amalgamated  Leadership  Model  in  For  Profits    /Benson            4   Attributes of Transformational Leadership in an Amalgamated Model Leaders are responsible for initiating action and connecting with their followers. Health care leaders just like in the general industry, inspire, create commitment, act as role models and evoke the highest level of commitment and competence possible from the team (Newman, 1997). The transformational leader exhibits charisma, empathy, vision, and inspiration (Mannarelli, 2006). The supportive, participative and achievement-oriented leadership are some of the other attributes of the modern day charismatic transformational

leadership behavior (Aviolo & Yammarino, 2002). One of the situational factors that impacts leadership effectiveness in for-profit organization is the nature of the group or followers. It is obvious then that an organization in which workforce morale and enthusiasm is low, the level of innovation will also be low or non-existent because interest to participate in challenging tasks or brainstorming is not present. According to Krames (2005), one of the authentic leadership attributes emphasized by Welch at GE is that strong leaders have infectious enthusiasm that acts as a force multiplier to stimulate the workforce to increase organizational capabilities. A core attribute of transformational leadership is the ability to engage with followers in such a way that they surpass their expectations and raise the morality of each other (Burns, 1978). Transformational leaders therefore, possess high ability to motivate their followers According to Hunter (2004), job motivators stimulate

workers enthusiasm to put out more energy and zeal in doing their jobs. In other words, motivation enhances organizational spirit Citing the research carried out by Herzberg (n.d), Hunter (2004) listed motivational elements to include recognition, praise, appreciation, opportunity for growth, and job satisfaction. In organizations in which these abound, the spirit of the workforce for innovation is high. Attributes of Transactional Leadership in an Amalgamated Model Transactional leadership model involves the practice of management-by-exception and contingent reward (Burns, 1978). Transactional leaders set performance standards and do performance reviews for their followers. A transactional leader focuses more on a series of transactions to achieve organizational objectives. Thus, transactional leadership serves as more popular leadership model in for-profit organizations in which the driving force of leadership decisions is to achieve increases in organizational earnings. The

transactional leaders exchange benefits with their subordinates and clarify a sense of duty with rewards and punishments to reach goals (Bass, 1997; Nahavandi, 2009). In this case, the ultimate goal is to grow the organization and make profit for stakeholders regardless of the process of its attainment. Transactional leaders obtain results by making, and fulfilling promises. They recognize good results with pay increases, and advancement for employees who perform well. By contrast, employees who do not do good work receive penalties (Burns, 1978). However, in large corporations with many arms of activity that a leader must coordinate, such transactional leadership according to Burns is a prescription for mediocrity. The author stressed that this is particularly true if the leader relies heavily on passive management-by-exception, intervening with the workforce only when procedures and standards for accomplishing tasks are not being met. Moreover, whether the promise of rewards or the

avoidance of penalties motivates the employees depends on whether the leader has control of the rewards or penalties, and on whether the employees want the rewards or fear the penalties. Therefore, transactional leadership approach alone may not suit for-profit health care organizations in which quality of service delivery and sustainability matter significantly in the quest to increase organizational profit. A combination with other leadership models in an amalgamation will provide an avenue to eliminate the deficiencies inherent in the transactional model while using its good attributes to ensure organizational profitability. Attributes of Participatory Leadership in an Amalgamated Model According to Hamm (2006), one of the cardinal functions of leadership is to promote change, stressing that providing the roadmap for change is a fundamental leadership requirement. Yukl (2010) describes participatory leadership as delegation of decision-making and empowerment of subordinates in an

organization in such a manner that they have the opportunity to determine their work roles, accomplish meaningful work, and influence important events. Therefore, this type of leadership   www.jghcsinfo  [ISSN 2159-6743 (Online)]                                                                                JOURNAL  OF  GLOBAL  HEALTH  CARE  SYSTEMS/VOLUME  2,  NUMBER  1,  2012   Source: http://www.doksinet Amalgamated  Leadership  Model  in  For  Profits    /Benson            5   approach can be adopted in all types of organizational settings including large health care systems. Yukl elaborates that participative leadership involves the use of various decision procedures that permits followers’ some influence over the leader’s decisions. This power sharing approach to leadership

has close semblance to the transformational leadership approach of empowering followers to attain beyond their usual capacity. In this sense, it fosters team play in accomplishing desired objectives Certain drawbacks with participative leadership include the possibility of creating unhealthy competition within the organization. Leadership with a high need for achievement may be reluctant to delegate responsibilities. Similarly, delegation of power may suffer setbacks by a feeling of indifference by subordinates’ or when the necessary expertise to carry out sensitive tasks is lacking in the followers (Nahavandi, 2009). Certainly, delegation of responsibilities may not be feasible in all leadership decisionmaking and tasks It is important for participatory leaders to establish a protocol of responsibilities that has possibility for delegation to subordinates and how to carry out such delegation to avoid unintended consequences of delegation. To ensure successful delegation in

participatory leadership Yukl (2010) provides elaborate guidelines of what to delegate and how to delegate that guarantees improvement in productivity. Yukl stressed that although research on delegation is still very limited, considerable agreement exists in the practitioner literature about when and how to apply delegation effectively. Guidelines for Delegation provided by Yukl, (2010) p. 108 • Delegate tasks that can be done better by a subordinate • Delegate urgent tasks not deemed high priority • Delegate tasks relevant to subordinate’s training and career • Delegate tasks of appropriate difficulty • Delegate tasks that do not impinge on the manager’s role How to Delegate Effectively • Specify responsibilities clearly. • Provide adequate authority and specify limits of discretion. • Specify reporting requirements. • Ensure subordinate acceptance of responsibilities. • Inform others who need to know. • Monitor progress in appropriate ways. • Arrange for

the subordinate to receive necessary information. • Provide support and assistance, but avoid reverse delegation. • Make mistakes a learning experience. Attributes of Contingency Leadership in an Amalgamated Model In the contingency leadership model described by Fiedler (cited in Nahavandi, 2009), the basic premise is that leadership effectiveness is a function of the match between the leader’s style and the leadership situation. The primary assumption of the contingency paradigm is that the personal attributes, style, or behavior of effective leaders depends on the demands of the situation in which the leaders find themselves. Therefore, the contingency model promotes the thought that there is no one best way to lead, but the situation and the various relevant contextual issues determine which style or behavior leaders adopt (Nahavandi, 2009). According to Nahavandi, Fiedler’s central idea is that if the leader’s style matches the situation, the leader will be effective and

conversely if there is a mismatch between a situation and the leadership approach, the leader will not be effective. Northouse (2007) however, sees a demerit in the contingency leadership approach, as it does not advocate for specific leadership training to handle specific organizational situations. It does seem however, that contingency leadership approach would be more useful in for-profit organizations than not-for-profit health care organizations. Whereas the for-profit organizations may well accommodate the constant switch in leadership style to grow organizational income, the not-for-profit and government owned organizations adopt more structured forms of leadership approaches that best provides outstanding quality in service delivery without serious consideration for profit making. According to Nahavandi (2009), three elements impact on the effectiveness of the situational leader: (a) The relationship between the leader and the followers. (b) The   www.jghcsinfo  [ISSN

2159-6743 (Online)]                                                                                JOURNAL  OF  GLOBAL  HEALTH  CARE  SYSTEMS/VOLUME  2,  NUMBER  1,  2012   Source: http://www.doksinet Amalgamated  Leadership  Model  in  For  Profits    /Benson            6   amount of structure of the task. (c) The position power of the leader The three elements combine to define the amount of control the leader has over the situation (p. 72) At one end of the spectrum, good leader–member relations, a highly structured task, and high position power enable the leader to exercise control over the situation and the leadership influence receives positive appraisal. In the middle of the continuum are situations in which the leader and the followers do not get along so well, or the task is

nonspecific. In such situations, the leader does not possess full control over the situation and the leadership context is more difficult. At the other end of the situational control continuum, the leader–member relations are poor, the task is non-specific, and the leader has little power. The result is organizational chaos in which no one is indeed seen to be in control Reasons for Effectiveness of the Amalgamated Model The United States business environment has principally two divisions, for-profit and nonprofit sectors, a segmentation based on legal organization and the core values upheld by each sector. In the current competitive marketplace, for-profit organizations are facing herculean challenge of ensuring profitability at all cost because that determines organizational share price index on the trading floor. The quality of organizational leadership is therefore crucial to organizational survival in contemporary times. Health care staff in an industry that is constantly

transforming alongside changes in demographic variables requires motivation and encouragement to ensure continuity with service delivery at top quality and profitability to stakeholders. An amalgamation of leadership models that encompasses a blend of participative, contingency, transactional, and transformational leadership models will be most useful to address the issues involved. Burns (1978) presented leadership as the process of mobilizing people with obvious common interests in an effort to achieve goals held by both leaders and followers. The most basic idea one gleans from the statements made by notable authors in leadership and management theories is that a leader is a team player. The transformational leadership theory and the participatory leadership seem to address the obvious place of team collaboration in leadership more than other leadership theories. Hence, a transformational leader provides relevant team cohesion in an amalgamated construct. Flexibility in leadership

is equally essential for organizational success, thus the contingency approach provides such flexibility in an amalgamated model to ensure that various organizational situations receives commensurate leadership attention to address issues as they occur. Change is a constant phenomenon in organizational processes; it is common knowledge that resistance occurs at times of change, which could affect productivity. The transactional approach of reward and sanctions becomes a useful tool at such times when a buy-in by the workforce is necessary for organizational survival and profitability.   www.jghcsinfo  [ISSN 2159-6743 (Online)]                                                                                JOURNAL  OF  GLOBAL  HEALTH  CARE  SYSTEMS/VOLUME  2,  NUMBER  1,  2012   Source: http://www.doksinet Amalgamated

 Leadership  Model  in  For  Profits    /Benson            7   *Vision *Innovation *Charisma *Contextual *Flexibility *Match *Team spirit *Delegation *Empowers For-profit organization *Rewards *Motivates *Sanctions Increased Productivity Increased Profitability Conclusion Figure 1. Illustration of relationships among constructs Note. The diagram illustrates the various strengths of each leadership model brought into amalgamation to ensure effective leadership in a for-profit organization with ultimate result of increased productivity and profitability. Cautions in the Application of Amalgamated Leadership Burns (1978) decried the lack of focal governing concept of leadership, attributing the multiplicity of models in part because “scholars have worked in separate disciplines and sub-disciplines in pursuit of different and often unrelated questions

and problems” (p. 3) To achieve success in the application of amalgamated leadership theory, leaders must aim to strike a balance in how they employ the attributes of each leadership paradigm. Over use of the transactional approach may lead to stress in the workplace thereby reducing productivity. According to Parker and DeCotiis as cited in Chen and Silverthone (2005) transactional leadership can create organizational environments that serves as breeding grounds for job dissatisfaction and job stress. Transformational leadership, on the other hand, has lower association with stress and job burnout (Gill, Flaschner, & Shachar, 2006). Transformational leadership empowers followers to be leaders and incorporates followers in the creation and implementation of a vision. Because of this empowerment, followers have a greater level of job satisfaction and motivation (Gill, et al. 2006), and subsequently lower job stress. Clawson (1999) asserted attributes that separates

transformational from transactional leaders includes the observation that transformational leaders are more likely to be proactive in approaching issues than the reactionary tendency common with transactional leaders. Transformational leaders are more creative, novel and innovative in their ideas than reforming or conservative in ideology thus less inhibited by quest for solutions as is common with transactional leadership (Clawson). However, the delegation of responsibilities and empowerment of followers inherent in the transformational and   www.jghcsinfo  [ISSN 2159-6743 (Online)]                                                                                JOURNAL  OF  GLOBAL  HEALTH  CARE  SYSTEMS/VOLUME  2,  NUMBER  1,  2012   Source: http://www.doksinet Amalgamated  Leadership  Model  in  For  Profits

   /Benson            8   participative models of leadership must be applied with caution to avoid conflict of interests in an organization and breeding of unhealthy competition in organizational processes. Whereas contingency approach to leadership is good for flexibility in decision-making, overuse might create instability and confusion with respect to organizational polices in the workplace. Conclusion The discussion focused on the perceived leadership model that best suits for-profit health care organizations. General background of leadership and highlights of various leadership models provided an overview to enhance understanding of amalgamated leadership model suitable in for-profit organizations. A notable observation from the discussion is that leadership styles are important because of their direct and indirect influence on followers. The belief however, that no best way to lead is evident from the deficiencies of each leadership paradigm; thus the

amalgamated leadership model composed of essential elements of major leadership approaches and theorems will enhance profitability and sustainability of organizational processes in a for-profit setting.   www.jghcsinfo  [ISSN 2159-6743 (Online)]                                                                                JOURNAL  OF  GLOBAL  HEALTH  CARE  SYSTEMS/VOLUME  2,  NUMBER  1,  2012   Source: http://www.doksinet Amalgamated  Leadership  Model  in  For  Profits    /Benson            9   References Abbasi, S. M, Hollman, K W, & Hayes, R D (2008, January-February) Bad bosses and how not to be one. Informational Management Journal, 42, 52-56 Retrieved February 8, 2008, from the EBSCOhost database. Antonakis, J. & House, R J, (2002) The full-range leadership theory: The

way forward In B J Avolio & F. J Yammarino (Eds) Transformational and charismatic leadership: The road ahead New York: Elsevier Avolio, B.J, & Yammarino, FJ (2002) Transformational and charismatic leadership: The road ahead (pp334) New York: Elsevier Avolio, B. (2007) Promoting More Integrative Strategies for Leadership Theory-Building American Psychologist, 62(1), 25-33. Retrieved January 27, 2008, from Academic Search Premier database Burns, J. M (1978) Leadership New York: Harper & Row Chen, J., & Silverthorne, C (2005) Leadership effectiveness, leadership style and employee readiness Leadership & Organization Development Journal, 26(3/4), 280-288. Retrieved February 21, 2008, from ProQuest database. Clawson, J. G (1999) Level 3 leadership: Getting below the surface Upper Saddle River, NJ: Prentice-Hall Gill, A. S, Flaschner, A B, & Shachar, M (2006) Mitigating stress and burnout by implementing transformational-leadership. International Journal of

Contemporary Hospitality Management, 18(6), 469481 Retrieved February 21, 2008, from ProQuest database Jossey-Bass (2003). Business and management series San Francisco: John Wiley and Sons Hunter, J. (2004) The world’s most powerful leadership principle: How to become a servant leader New York, NY: Crown Publishing Group. Krakoff, P. (2007) Leadership power stress: (Part I) Sources Retrieved, February 21, 2008. From http://wwwzeromillioncom/business/Leadership-Power-Stress-Sourceshtml Krames, J. (2005) Jack Welch and the 4E`s of leadership: How to put GE`s leadership formula to work in your organization. New York: McGraw-Hill Companies Krause, T. (2007) The effective safety leader: Personality, values and emotional commitment Occupational Hazards,69(9),24. Retrieved January 29, 2008, from ABI/INFORM Global database Kumuyi, W. F (2007, December) The functions of a servant-leader New African, 469, 30-31 Retrieved January 29, 2008, from Research Library database. Longest, B. B, Rakich,

J S, & Darr, K (Eds) (2000) Managing health services organizations and systems (4th ed.) Baltimore, Maryland: Health Professions Press Mannarelli, T. (2006, December) Accounting for leadership: Charismatic, transformational leadership Accountacny Ireland, 38, 1-6. Retrieved January 31, 2008, from the Gale Powersearch database Maxwell, J. (1999) The 21 indispensable qualities of a leader: becoming the person others will want to follow Tennessee: Thomas Nelson. Nahavandi, A. (2006) The art and science of leadership New Jersey: Pearson Education Nahavandi, A. (2009) The art and science of leadership (5th ed) Upper Saddle River, NJ: Pearson Prentice Hall. Northouse, P. G (2007) Leadership: Theory and practice (4th ed) Thousand Oaks, CA: Sage Publications. Tichy, N.(2002) The cycle of leadership: How great leaders teach their companies to win New York: HarperCollins Publishers. Yukl, G (2006) Leadership in organizations (6th edition). Upper Saddle River: Pearson Yukl, A. (2010)

Leadership in organizations (7th ed) Upper Saddle River, NJ: Pearson Education, Inc. Zalesnik, A. (1992, March-April) Managers and leaders-are they different? Harvard Business Review, March-April, 15-24.   www.jghcsinfo  [ISSN 2159-6743 (Online)]                                                                                JOURNAL  OF  GLOBAL  HEALTH  CARE  SYSTEMS/VOLUME  2,  NUMBER  1,  2012