Healthcare Manager’s Perception of How Empowerment is
Experienced Working Among Their Employees
Debra R. Wilson, PhD
Certified Professional and Organizational Coach
Abstract. Empowerment is a concept used to describe an employee’s level of authority to make
autonomous decisions within an organization. While empowerment has been studied and discussed from
an employee’s perspective, it has not been fully addressed from the manager’s perspective. As
expectations within public healthcare are changing, it is important to understand how managers in
various leadership capacities feel about their role in the empowerment process and how this perception
plays a part in their ability to empower their staff. While empowerment has been studied and discussed
from an employee’s perspective, it has not been addressed from the manager’s perspective. In this
researcher’s study, a generic qualitative methodology was used to understand how a managers’
perception of empowerment was experienced working among their employees. The results of this study
provide a detailed discovery of how managers within a public health agency perceive empowerment and
how they experience empowerment working in a changing healthcare environment among their
employees. Three key themes were identified in the study: (a) public influence, (b) professional growth,
and (c) personal feelings. The research added value to Empowerment Theory by exploring how the
concepts of empowerment influence current management practices.
Keywords: empowerment; management, public influence, professional growth, personal feelings.
People who join organizations with a commitment to service become frustrated when they are
constrained by institutional and organizational barriers (Paarlberg & Lavigna, 2010). Quality
improvements happen in public health delivery when leadership is committed to empowering
employees that are close to the issues to make changes (Davis, Mah, Joly, Zelek, Riley, Verma &
Fisher, 2014). Public service is rooted in the beliefs, values and attitudes that extend beyond
self-interest and toward organization goals (Paarlberg & Lavigna, 2010). Management’s attitude
about employee empowerment has a vital impact in how empowerment is implemented within
organizations (Ghosh, Shuck, & Petrosko, 2012). An employee’s perception of an organization
is related to job satisfaction, organizational performance, and helps to protect the public
perception of the organization to external stakeholders (White, Vanc & Stafford, 2010). Early
research focused on empowerment as a managerial practice of delegating authority. More resent
research seeks to understand the effect that leadership has on employee’s empowerment
(Ravazadeh & Ravazadeh, 2013). The purpose of this study is to discover how managers within
public healthcare perceive empowerment and how they experience empowerment in their work
Background of the Study
Empowerment is a concept that dates back to the 1980’s and it is a construct that links
individual’s strengths and competencies, natural helping systems and proactive behaviors to
social policy and social change (Rappaport, 1981, 1984). The Empowerment Theory conveys a
psychological sense of personal control and actual social influence, political power and legal
rights (Rappaport, 1987). Managers need employees in order to meet goals and objectives;
therefore, effectively leveraging and managing in public sector involves understanding what will
motivate employees to produce positive outcomes (Paarlberg & Lavigna, 2010). An employee’s
perception of an organization is related to job satisfaction, organizational performance, and helps
to protect the public perception of the organization to external stakeholders (White, Vanc &
Public service is rooted in the beliefs, values and attitudes that extend beyond self-interest and
toward organization goals (Paarlberg & Lavigna, 2010). It is important to understand how the
manager feels about their role in the empowerment process and how this perception plays a part
in their ability to empower staff. Management’s attitude about employee empowerment has a
vital impact in how empowerment is implemented within organizations (Ghosh, Shuck, &
Petrosko, 2012). Early research focused on empowerment as a managerial practice of delegating
authority. This study discovered how managers in various roles within a public sector health
department perceive empowerment, how their perception compares to that of their organization,
how they believe empowerment influences performance and satisfaction, and finally, how they
perceive empowerment impacting the organization.
Rationale of the Study
The concept of empowerment not only requires individual power, but also includes the necessary
training, credit and information in order to be successful in making responsible job-related
decisions (Hossein, Saleh, Iman, & Jaafar, 2012). As the theory of empowerment was postulated
by Rappaport, it proposed empowerment as a process and a mechanism by which organizations,
people and communities obtain relevance (Rappaport, 1987). In this researcher’s study, a
generic qualitative methodology was used to understand how a managers’ perception of
empowerment was experienced working among their employees. The sample came out of a
public healthcare setting, where a County public health department is faced with the challenges
now impacting healthcare where performance is being measured by outcomes as opposed to just
patient care. The research was designed to understand how healthcare managers perceive
empowerment playing a part in how they set goals and objectives and how they experience
empowerment working among their employees. The purpose of the research is to understand
how managers construct work environments based upon their perceptions of how empowerment
is actually experienced in their work place.
Prior to the study, the researcher assumed that employee's psychological empowerment,
competence, performance and satisfaction was centered on their perception of their leader's role
in their empowerment (Zhu, 2012). The research question for this study asked, “How do
healthcare managers perceive empowerment and how do they experience empowerment in their
work environment among their employees?”
Methodology of the Study
The strategy to use a generic qualitative methodology is based on the lack of knowledge
surrounding how managers perceive empowerment playing a role in their job performance. A
healthcare managers’ job performance includes meeting the changing demands within
healthcare, to include results-driven expectations, cost effectiveness, employee validation and
job retention as well as patient satisfaction. A generic qualitative methodology is preferred when
there is an interest in understanding a particular phenomenon from multiple perspectives,
including how individuals feel about and experience that particular phenomenon.
The study used a generic qualitative inquiry with semi-structured interviews to gather data.
The interviews were guided by 7-10 open-ended research questions aligned to discover how
managers perceive empowerment playing a role in obtaining expected organizational results as
well as validation and retention of subordinate staff. A theoretical thematic analysis was
conducted to analyze the data and the findings are presented using text, tables and visual models
(Breakwell, Hammond, & Fife-Schaw, 2004; Madill & Gough, 2008).
A purposeful, non-probability sampling strategy seemed appropriate for this study because
the researcher intended to obtain insight directly from the manger’s point of view and to learn
about their perceptions only. The selection criterion was based upon the management
classification with a public County Department Human Resource system.
Data Analysis of the Study
The sample consisted of eight managers from various Bureaus within a County Health
Department. The targeted sample consisted of at least those participants classified in Bargaining
Unit X (General Management) or Unit Y (Executive Management) within a County Human
Resource system. The sample participants were “at-will” employees who are responsible for
managing, supervising, evaluating and determining goal and objective constructs within their
area of responsibility.
The research question for this study asked, “How do healthcare managers perceive
empowerment and how do they experience empowerment in their work environment among their
employees?”The purpose of the study was to use the generic qualitative inquiry research design
to understand how the Health Care managers’ perception of empowerment is experienced
working among their staff and how these perceptions mutually influence job performance and
overall satisfaction. The intent was to use the flexibility of this research design to provide a rich
and comprehensive account of a complex data set of information.
Table 1: Demographic Characteristics
Identifier Age Gender Race Years in Role Role
Participant 1 50-59 F Asian American 1-10 Finance Mgr.
Participant 2 55-64 M Caucasian 11-20 Operations Mgr.
Participant 3 50-59 F Hispanic 1-10 Analyst Mgr.
Participant 4 60-69 M Caucasian 1-10 Executive Mgr.
Participant 5 30-39 F Hispanic 11-20 Executive Mgr.
Participant 6 50-59 F Hispanic 11-20 Finance Mgr.
Participant 7 60-69 F Caucasian 1-10 Executive Mgr.
Participant 8 50-59 F African American 1-10 Analyst Mgr.
Table One reflects the demographic characteristics of the participants for this study.
Although the sample size was relatively small and therefore prevents transfer of these
findings outside of this context, the sample was diverse. Each of the eight participants is
described and referred to throughout the study using the numbers given to them by the
researcher. They are presented below in order as presented in the Table One.
Participant 1 is a Finance Manager with the primary leadership role to manage the budget for
the Bureau within the Health Department.
Participant 2 is an Operations Manager primarily responsible for the oversite of the
infrastructure, space and utilization for the department.
Participant 3 is a Management Analyst primarily responsible for handling contracts, managing a
program and participating in budget control.
Participant 4 is in an executive management position responsible for establishing new
programs, overseeing policies, ensuring compliance and collaborating with County Stakeholders.
Participant 5 is in an executive management position responsible for enforcing programs,
overseeing bureaus, ensuring compliance and collaborating with County Stakeholders.
Participant 6 is a Finance Manager responsible for managing and preparing the budget.
Participant 7 is an executive manager responsible for oversight of a bureau.
Participant 8 is a Management Analyst responsible for an accounting department and managing
Data Collection: Themes
Primary data was collected through one-on-one, semi-structured and open-ended question
interviews with management level employees of a county health department. The raw data was
analyzed by the researcher in order to capture both verbal and non-verbal sentiments and
gestures. After each transcribed interview, the researcher developed an initial coding analysis to
synthesize and capture emerging themes through data saturation. Three major high-level/over-
arching themes emerged: (a) public influence, (b) professional growth, and (c) personal feelings.
The themes were used to code, reorganize and to further analyze the primary data. The
researcher used coding to discover the secondary data in the study, which was grouped and
clustered where relevant.
Within the secondary data, the researcher’s analysis and NVivo Plus software, resulted in six
sub-themes that emerged: (a) organization, (b) community, (c) transference, (d) performance, (e)
self-worth and (f) satisfaction. Figure 3 was developed by the researcher to illustrate these sub-
themes and how they relate to the primary themes. The themes were used to code, reorganize
and to further analyze the primary data. Research findings are presented in summary format and
organized by the primary and secondary emergent themes in the following paragraphs.
Figure 3. Empowerment Perception Sub-Themes
In order to identify the textual/structural descriptions of the themes, the researcher used
NVivo 11 Plus Software to analyze the variables within the interview responses that
interchanged and connected in the study. NVivo helped the researcher to discover 30 variables
of coding references. The researcher grouped the variables into clusters to support the high-
level/overarching themes and the secondary themes of the study.
Public influence in context for the study encompassed the organization and the community.
The organization was defined as (a) authority, (b) system, (c) structure, (d) County Board of
Supervisors, and, (e) the Health Department. The participant’s perception of empowerment and
how it is experienced working in the Health Department among their employees is influenced
and impacted by the organization’s expectations, directives, and support. Public influence also
included the community. Community was defined as (a) the patients, (b) the County
stakeholders and (c) the residents of the participant County. The nodes within the Public
Influence sub-theme included the following: control, expectation, authority, resources, tools and
support (Figure 4).
Figure 4. Public Influence - Nodes Clustered by Word Similarity
Professional growth in context for this study, encompassed transference and job performance.
Transference was described as (a) accountability, (b) authority, (c) control, (c) independence, (e)
micro-management, (f) promotion, (g) respect and (h) trust (Figure 5). Job performance was
described as (a) accountability, (b) manage, (c) performance measurements, and (d) strategic
planning. Five out of the eight participants described their perception of empowerment and in
describing how it is experienced. Participants discussed the changes in healthcare and how these
changes have an impact on their perception of how the organization defined empowerment and
how the organization’s definition compared or confirmed their personal definition of
empowerment. The nodes within the Professional Growth sub-theme included the following:
control, performance, authority, manage, respect, and trust (Figure 5).
Figure 5. Professional Growth - Nodes Clustered by Word Similarity
Personal feelings in the context of the study encompassed self-worth and job satisfaction.
Six out of eight participants related to empowerment in the as (a) value, (b) worth, (c) respect,
and (d) trust (Figure 6). Personal feelings regarding the participant’s overall job satisfaction
were expressed as (a) empowerment and (b) satisfaction. When asked how managers perceive
how empowerment has affected job satisfaction, the researcher obtained different responses. The
nodes within the Personal Feelings sub-theme included the following: empowerment, trust,
value, worth, respect, and satisfaction (Figure 6).
Figure 6. Personal Feelings - Nodes Clustered by Word Similarity
Findings from this study and other related studies implicated that empowerment plays a vital
role in the work performance of employees (Gilbert et al., 2010; Gill et al., 2012; Kim et al.,
2013; Proenca, 2014). As the researcher entered study, there was an assumption that employee's
psychological empowerment, competence, performance and satisfaction was centered on their
perception of their leader's role in their empowerment (Zhu, 2012). The study findings indicated
that empowerment had an impact on transference, job performance, self-worth, and job
satisfaction for healthcare managers as they experience empowerment working among their
employees. The study findings also revealed that organization and community have an impact
on the perception of empowerment and how it is experienced working within a county health
department. Data collection from interviews and analyses supported the conclusion that
empowerment had a valid impact on managers’ perception and experience.
Implications of the Study
The study findings indicated that the way managers perceive empowerment plays a
significant role in their performance. Not only does empowerment play a significant role in their
performance, study findings indicated that empowerment plays a significant role in the way they
experience it working among with employees. The results of the study were a wide range of
responses to semi-structured interview questions. The themes that emerged from the study
revealed that participant’s perception and experience are closely associated by their position of
authority and who they feel that they are responsible to. The emerging themes indicated that
managers’ perceive empowerment based upon their responsibility and not based upon the needs
of their employees. The participants in executive management positions perceived
empowerment from the vantage point of their level of authority and responsibility to the Health
Department. The primary themes that emerged from their interviews were their perceptions and
feelings of empowerment as influenced or impacted by (a) organization, (b) community. The
secondary theme was how empowerment was experienced working among their employee and
(c) transference. The remaining five participants are in mid-level management positions within
the health department and the primary themes that emerged in their interviews were (a) job
performance, (b) self-worth and (c) job satisfaction.
Implications for Government Manager Empowerment
In this study, some participants stated that the lack of empowerment negatively affected job
performance, self-worth and job satisfaction. Some participants felt that public influence
impacts professional growth and personal feelings. Other participants felt that public influence
drives empowerment. There is an apparent disparity between the organization’s perception of
empowerment and the health care managers’ perception. This disparity negatively affects job
satisfaction, job performance of managers and affects their ability to transfer empowerment to
their employees. An employee’s perception of an organization is related to job satisfaction, the
performance of an organization, the achievement of organizational goals and impacts the
organization’s reputation to external stakeholders (Men & Stacks, 2013).
Empowerment may need to become an integral component of the health department’s current
strategic planning model. For mid-level managers in the health department, it is evident from
this study’s findings that more resources need to be distributed to empowering them in the areas
of (a) hiring staff, (b) disciplining staff, (c) pursuing technology advancements, (d) budget
management, and (e) decision-making modalities. The Health Department would benefit from
building upon the existing leadership initiative by including empowerment as a foundational
Limitations of the Study
This research was conducted in one geographical location. There have been objections raised
in the past about the validity and reliability of qualitative research – both because of smaller
sample sizes and reliance on the personal commentaries of those experiencing the topic
The sample of participants within this study represented different levels of leadership within
the health department. As such, participant’s vantage points influenced how they perceived
empowerment and how it was experienced working among their employees.
Site-specific focus and context associated with generic qualitative research. This study
occurred in one specific County Health Department, which limits the perspective to one
County department in a decentralized County.
The sample size was relatively small which limited data collection. There were only eight
managers interviewed for this study. This may not fully represent sufficient data to meet a
saturation of information. Employee feedback was not considered in this study.
Short-term evaluation. Data was collected over a period of 12 weeks. This indicates that
only immediate perceptions and feelings were assessed for the study. Implications of
changes to perception in the advent of proposed organizational changes were not assessed.
Recommendations for Future Research
This research focused on exploring the perceptions and experiences of management
empowerment in a county health department. There is no known research in a public sector
health department that explores this concept so it would be important to have further studies with
larger sample sizes in a public sector, in the private sector and from the perspective of the
organization, the community and the employee. This research focused on a select group of
managers in a specific County Health Department so it would be interesting to conduct similar
studies in a private hospital and compare the results between government and private hospitals to
see if there are any notable differences. For example, would there be more of an inclination to
transfer empowerment to employees in a private setting than there is in a government setting?
Further research is also needed to conduct similar studies in other departments within the same
County and compare the results between the health department and other departments to see if
there are any notable differences. In addition, within the same setting, the County Health
Department, further research is needed to ascertain what happens to managers if are given more
empowerment over a long period of time. Do managers’ job performance, self-worth and job
satisfaction improve when provided with more “trust” to act independently? Finally, research is
also needed to conduct similar studies among the employees of the Health Department to
compare the results between the managers’ feelings and the employee’s feelings about
empowerment and how it is actually experienced.
Conclusion of the Study
The perception of empowerment influences job satisfaction and leads to job involvement to
the degree those employees feel empowered to handle job-related issues (Gill et al., 2012). This
study used a generic qualitative methodology to understand how a managers’ perception of
empowerment was experienced working among their employees. The study findings indicated
that the way managers perceive empowerment plays a significant role in their performance. Not
only does empowerment play a significant role in their performance, study findings indicated
that empowerment plays a significant role in the way they experience it working among with
employees. Study findings indicated that three major themes emerged in the study (a) public
influence, (b) professional growth and (c) personal feelings. Although there are several key
limitations identified in advance of and after this study’s conclusion, findings from this study and
other related studies implicated that empowerment plays a vital role in the work performance of
employees (Gilbert et al., 2010; Gill et al., 2012; Kim & Kim 2013; Proenca, 2014).
Breakwell, G.M., Hammond, S. & Fife-Schaw, C. (2004). Research methods in psychology.
(2nd ed.). London, UK: Safe Publications.
Davis, M., Mah, E., Joly, B., Zelek, M., Riley, W., Verma, P., & Fisher, S. (2014). Creating
quality improvement culture in public health agencies. American Journal of Public Health,
Gilbert, S., Laschinger, H., & Leiter, M. (2010). The mediating effect of burnout on the
relationship between structural empowerment and organizational citizenship behaviors.
Journal of Nursing Management, 18(19), 229-348.
Gill, A., Sharma, S., Mathur, N. & Bhutani, S. (2012). The effects of job satisfaction and work
experience on employee-desire for empowerment: A comparative study in Canada and India.
International Journal of Management, 29(1), 190-200.
Ghosh, A.K. (2013). Employee empowerment: a strategic tool to obtain sustainable competitive
advantage. International Journal of Management, 30(3), 95-107.
Ghosh, R., Shuck, B. & Petrosko, J. (2012). Emotional intelligence and organizational learning
in work teams. Journal of Management Development, 31(6), 603-619.
Hossein, R., Saleh, P. Iman, A., & Jaafar, A. (2012). An analysis of the empowerment level of
employees and it’s relation to organizational factors. International Journal of Business and
Social Science, 3(15), 255-263.
Kim, T. & Kim, M. (2013). Leaders' moral competence and employee outcomes: The effects of
psychological empowerment and person-supervisor fit. Journal of Business Ethics, 112(1),
Men, L. & Stacks, D. (2013). The impact of leadership style and employee empowerment on
perceived organizational reputation. Journal of Communication Management, 17(2), 171-
Merriam, S.B. (1998). Qualitative research and case study applications in education. San
Merriam, S. (2009). Qualitative Research: A guide to design and implementation. San
Francisco, CA.: Jossey-Bass
Paarlberg, L. & Lavigna, B. (2010). Transformational leadership and public service motivation:
driving individual and organizational performance. Public Administration Review, 70(5),
Proenca, J. (2014). Perceived organizational support as a moderator for empowerment practices.
Academy of Business Research Journal, (1), 139-153.
Rappaport, J. (1981). In praise of paradox: A social policy of empowerment over prevention.
American Journal of Community Psychology, 9, 1-25.
Rappaport, J. (1984). Studies in empowerment: Introduction to the issue. Prevention in Human
Services, 3, 1-7.
Rappaport, J. (1987). Terms of empowerment/exemplars of prevention: Toward a theory for
community psychology. American Journal of Community Psychology, 15(2), 121-148.
Ravazadeh, N. & Ravazadeh, A. (2013). The effect of transformational leadership on staff
empowerment. International Journal of Business and Social Science, 4(10), 165-158.
White, C., Vanc, A., & Stafford, G. (2010). Internal communication, information satisfaction,
and sense of community: The effect of personal influence. Journal of Public Relations
Research, 22(1), 65-84.
Zhu, W., Sosik, J.J., Riggio, R.E., & Yang, B. (2012). Relationships between transformational
and active transactional leadership and followers’ organizational identification: The role of