5. Discussion
Katz and Kahn (1978) defined leadership as “an influential increment over and above compliance with routine directives of
the organization” (p. 528). Implied in this definition is that leadership is context bound but offers unique explanatory power beyond
characteristics of the context. Avolio (2007), Hackman and Wageman (2007), Vroom and Jago (2007), and Yukl (2013) are
among leadership researchers who are more direct in asserting that context and particular conditions are essential elements to
understanding the influence of leadership. In this study, we measured servant leadership in the particular context of a multihospital
system and under varying conditions of organizational structure. The results indicate that direct relationships exist between
servant leadership and nurse collaboration, creativity, and job satisfaction. In turn, nurse job satisfaction is associated
with patient satisfaction in the form of patient satisfaction with nursing, satisfaction with pain management, and in a willingness
to recommend the caregiving facility.
Moreover, the relationships of servant leadership with creativity and with patient satisfaction mediated through job satisfaction
were moderated by organizational structure such that the associations were enhanced under conditions of high levels of organizational
structure. However, an examination of Figs. 2 and 3 indicates that although high levels of structure enhance the
relationships of servant leadership with both nurse job satisfaction and creativity, the effects differ by outcome. High levels of
structure combined with high levels of servant leadership yield the highest level of satisfaction, while the lowest levels of satisfaction
result from combining high levels of structure with low levels of servant leadership or low levels of structure with high
levels of servant leadership. Alternatively, high levels of structure uniformly relate to lower levels of creative behavior, an overall
effect that is buffered slightly with high levels of servant leadership. Together, the findings support the hypothesized effect of