Leadership in Health Services

The effects of leadership competencies and quality of work on the perceived

readiness for organizational change among nurse managers
Mahmoud Al-Hussami, Sawsan Hamad, Muhammad Darawad, Mahmoud Maharmeh,
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Leadership
The effects of leadership competencies
competencies and quality of work and quality of
work
on the perceived readiness for
organizational change among
nurse managers Received 5 November 2016
Revised 4 February 2017
7 April 2017
Mahmoud Al-Hussami, Sawsan Hamad, Muhammad Darawad and Accepted 14 April 2017

Mahmoud Maharmeh
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Faculty of Nursing, University of Jordan, Amman, Jordan

Abstract
Purpose – This paper aims to set a leadership guidance program that can promote nurses’ knowledge of
leadership and, at the same time, to enhance their leadership competencies and quality of work to promote
their readiness for change in healthcare organizations.
Design/methodology/approach – A pre-experimental, one-group pretest-posttest design was utilized.
Out of 90 invited to participate in this study, 61 nurses were accepted to participate.
Findings – The statistical analyses suggested several significant differences between pre- and in-service nurse
managers about leadership competencies, quality of work and readiness for change. Yet, findings from the
background characteristics were not found to be significant and had no effects on the perceived readiness for
change.
Research limitations/implications – The present study highlights the importance of leadership
competencies and quality of work that healthcare policymakers identify for the success of organizational
change efforts.
Practical implications – Healthcare policymakers, including directors of nursing, should focus on
applications that increase leadership competencies and overall satisfaction of the nurse managers to support
the changes in hospitals and supporting learning organization. Hence, they should establish policies that
decrease the possible negative impact of planned change efforts.
Originality/value – Competent nurse managers enhance their readiness for change, which in turn helps
nurses in constructive change processes. A leadership guidance program should be set for nurse managers.
This study has important implications for hospital administrators and directors of nursing.
Keywords Leadership competencies, Quality of work, Perceived readiness of organizational change
Paper type Research paper

Background
Organizational readiness for change is a prerequisite to the successful implementation of
changes in healthcare organizations and viewed in terms of the organizational members’
beliefs, attitudes and intentions. Healthcare organizations are entering a new era marked by
unexpected changes in technology and societal demands. In addition, management of
healthcare organizations is challenging, as it faces rapid and competitive changes in many

Leadership in Health Services

The authors are very grateful to nurse managers for their voluntary participation. Also, they would © Emerald Publishing Limited
1751-1879
like to thank the faculty members at the University of Jordan for their suggestions. DOI 10.1108/LHS-11-2016-0058
 LHS aspects of its services. These organizations are under pressure to apply evidence-based data
to stand first and maximize their successes. A key factor to achieve a long-term
organizational success and continuous quality improvement is organizational readiness for
change. Readiness for change is defined as:
[. . .] a comprehensive attitude that is influenced simultaneously by the content, process, context,
and individuals involved and collectively reflects the extent to which an individual or a collection
of individuals is cognitively and emotionally inclined to accept, embrace, and adopt a particular
plan (Stevens, 2013, p. 326).
Besides, Weiner (2009) stated that organizational readiness for change could be achieved
when the members of an organization are committed and have efficacy to implement the
change process.
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Literature review
The importance of readiness to change is based on its power to motivate the organizational
members to initiate, exert effort and display cooperative behavior that leads to successful
implementation of change (Weiner, 2009). For instance, Madsen et al. (2005) found a strong
relationship between organizational commitment and readiness for change. Besides,
organizational commitment was the strongest predictor for readiness for change (Ingersoll et al.,
2000). Among the other factors that were found to affect employees’ readiness for change were
commitment of senior managers to the change, capability of change agents and support of the
direct managers (Cinite et al., 2009). Also, strong relationships were found between readiness to
change, job satisfaction, full-time employment and nonclinical staff role (Christl et al., 2010).
A high quality of work (QW) is important for organizations to magnetize and to retain
employees. There are strong evidences that poor QW (Al-Hussami et al., 2014; Almalki et al.,
2012; Mosadeghrad, 2013; Opollo et al., 2014; Ramesh et al., 2013; Zhao et al., 2013) has an
impact on turnover intention among employees. Similarity, high QW had an impact on work
engagement (Kanten and Sadullah, 2012), job satisfaction, organizational commitment and
team spirit (Koonmee et al., 2010; Permarupan et al., 2013). Also, high QW increased job
embeddedness and affective commitment (Zhao et al., 2013). In literature, Mosadeghrad et al.
(2011) and Mosadeghrad (2013) reported that the most important predictors of QW were
management support, disturbance handling, job proud, job security and job stress. In
addition, leadership competencies, shift working, salary, relationship with colleagues,
workload and demographic characteristics were other major predictors of QW
(Vagharseyyedin et al., 2011). Despite the positive relationship found between productivity
of nurses and their QW (Salam Zadeh et al., 2008; Nayeri et al., 2011), there is a gap in
literature regarding the impact of high QW on employees’ readiness for change.
Readiness for change can be enhanced and stimulated by purposeful interventional
programs (Backer, 1995). For instance, training opportunities for employees were found to
affect their readiness for change (Devereaux et al., 2006). Moreover, to carry out a well-
managed change, an effective leadership is required (Gill, 2002). Hence, leaders’ abilities to
motivate, communicate and build teams were found to be predictors of implementing a
successful change (Gilley et al., 2009). Also, leaders’ capabilities had a strong and positive
impact on innovation tendency (Ryan and Tipu, 2013) that influenced change initiation
processes (Talim, 2012). Further, Bommer et al. (2005) found leaders with transformational
leadership style to effectively implement changes in their organizations. Those leaders were
charismatic, visionary, risk-taking, energetic and out-of-the-box thinkers, and had abilities
for motivating others while acting as a role model and mentor to their followers (Ward,
2002). Simultaneously, managers who utilized transformational leadership had good job
 satisfaction and were more committed to their organizations (Emery and Barker, 2007; Leadership
Munir et al., 2012; Schwartz et al., 2011), and their style was strongly associated with the competencies
perception of work–life conflict and psychological well-being (Munir et al., 2012). Besides, and quality of
leaders with transformational characteristics could overcome the complex and rapidly
changing health environment (Murphy, 2005), were positive change agents (Ward, 2002),
work
had a positive attitude to implement evidence-based practice (Aarons, 2006) and positively
affected organizational culture (Shiva and Suar, 2012).
Mohammed et al. (2012) found that transformational leadership styles do not rely on
sociodemographic variables, rather it is a style that can be learned and necessitates
development of the employees to be transformational leaders, who later can affect
employees’ commitment to change (Lo et al., 2010), influence employees’ creativity
(Gumusluoglu and Ilsev, 2009; Wang et al., 2014) and improve organizational performance
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(Gumusluoglu and Ilsev, 2009; Samad, 2012).

Although previous evidences proved that transformational leaderships had abilities and
qualifications that can affect organizational development and success. Van der Voet (2014)
found that those leaders contributed little to planned organizational change. Besides, Nordin
(2011) found that transactional leadership style can better predict organizational readiness
for change.
The effects of demographic variables (e.g. gender, age and years of experience) on
readiness for change have been reported in the literature (Cunningham et al., 2002;
Hanpachern, 1997). In addition, differences in the way males and females manage their
subordinates in various situations had been documented in the work of Lewis (2000).
Sinclair and Kunda (2000) stated that female supervisors were viewed as less competent
than male supervisors in particularly management issues. Meanwhile, Fletcher et al. (2000)
mentioned in their study that female managers develop a mutual rewarding relationship
with their employees. Hanpachern (1997) revealed that readiness for change was
significantly correlated to length of stay but not associated to age and gender. However,
Cunningham et al. (2002) found that readiness for change had no relationship with both
gender and marital status. Similarly, Weber and Weber (2001) found no relationship
between readiness for change, age and work experience.
From the previously mentioned literature, readiness for change is a state of mind about
the need for change and the ability to engage in a changing process. This stage is the most
important to achieve and implement successful change innovations. Besides, leaders with
transformational competencies are more effective change agents, productive and
empowering. However, a contradiction was found in the literature regarding the impact of
this style on planned organizational change. Thus, as transformational leadership style can
be taught to the organization employees, the assumption of this study is based on the notion
that teaching employees the transformational leadership style characteristics may have an
impact on their readiness for change. Hence, this study aims to set a leadership guidance
program that can promote nurses’ knowledge of leadership and, at the same time, enhance
their leadership competencies and QW to promote their readiness for change in healthcare
organizations.

Research hypotheses

H1. Nurse managers who receive the educational program will show improved
knowledge abilities in leadership.
 LHS H2. Nurse managers who report high level of leadership competencies and high level of
quality of work will report higher level of change readiness than those who report
low level of leadership competenices and quality of work.
H3. Gender, age, years of experience and yearly income can affect nurses’ perceived
readiness for change.

Study design
A pre-experimental, one-group pretest–posttest design was utilized to assess the effect of
leadership competencies and QW for readiness of change and the effects of the leadership
program on improving leadership competencies and QW. This study involved measuring
leadership competencies, QW and readiness for change after implementation of a leadership
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educational program. In this study, the participants served as their own control, and
comparisons were made before and after the intervention in relation to the knowledge of
leadership. The difference between pretest and posttest scores was assumed to be owing to
the effect of the intervention (Polit and Beck, 2012).

Setting
Similar to other developed countries, health care in Jordan is divided into two sectors: public
and private. The public sector comprises the majority (66 per cent) of bed capacity in the
country, but only 48 per cent of the nursing workforce is working in this sector. Therefore,
the sample of this study was selected from both public and private hospitals in Amman, the
capital of Jordan. These hospitals were randomly selected from a list that contained the
largest hospitals in Amman that contained 300 beds and more.

Sample and sampling techniques

The target population was the nurse managers working in hospitals located in Amman, and
responsible for the direct operation of nursing units and linked directly to nurses who
provide bedside nursing care. Sixty-one nurses accepted to participate out of 90 nurse
managers (response rate = 67 per cent) invited to voluntarily participate in this study.
Participants were recruited from the population of nurse managers who met the eligibility
criteria. The eligible subjects in this study were nurses who have acquired a bachelor’s or
master’s degree in nursing, and being a manager responsible for the operation of a nursing
unit for at least one year in this position, and with anticipated availability over the entire
duration of the program.

Sample size
Calculating sample size was considered by the researchers to acquire adequate power to
detect differences between the scores of leadership competencies, QW and readiness to
change for one interventional group. The authors had determined the risk of type 1 error as
0.05 (2-tailed), a power of 0.80 and a medium effect size using G* power software (Faul et al.,
2007). The calculation showed that the required sample size was 60 participants.

Ethical consideration
Prior to data collection, approval from the designated hospitals was obtained. Participants
were asked to sign written consent forms for participation. Confidentiality of the
participants was ensured throughout the study. Data were secured correctly and saved in
the principal researcher’s personal computer. Moreover, the data were coded by numbers
 with no names to maintain confidentiality, and no one except the principal researcher had an Leadership
access to it. Participants were instructed that participation in the study was voluntary, and competencies
that they could withdraw from the study without any penalties.
and quality of
Instruments
work
The pre-testing questionnaire consisted of two parts. The first part required participants to
complete demographic details, which included age, gender, years of nursing experience,
marital status and yearly income. The second section asked participants to answer
knowledge questions regarding leadership. A total of 100 multiple-choice questions were
used, each of which has four alternatives choices and only one correct answer covering a
wide range of concepts and principles of leadership, ideal leader, leadership competencies,
leadership blockage, organizational change, work-related variables and organizational
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change. The posttest questionnaire consisted of the knowledge questions regarding

leadership, and another section asked the sample participants regarding leadership
competencies, QW and organizational readiness to change. To evaluate participants’
perceptions of their leadership competencies, nurse managers were asked to respond to 21
descriptive elements of transformational, transactional and laissez-faire behaviors developed
by Bass and Avolio (1992). Respondents were requested to fill out a self-rating in which they
evaluated how frequently, or to what degree, they believed they engage in specific behaviors
toward their subordinates, using a five-point scale (1 = not at all; 2 = once in a while; 3 =
sometimes; 4 = fairly often; 5 = frequently, if not always). Kanste et al. (2006) investigated
the psychometric properties for the Multifactor Leadership Questionnaire among nurses in
Finland and reported high Cronbach alpha coefficient for leadership subscales ranging from
0.78 to 0.94. However, the Cronbach alpha coefficient for the current study of leadership
subscale was 0.81.
In an attempt to measure the QW of the participants, six items were adopted from Brooke
et al. (1988). QW is thought to explain various behaviors of nurses and can be explained in
terms of their emotional state resulting from perceived work environment. All items were
responded on a five-point Likert scale (1 = strongly disagree; 5 = strongly agree). The
validity and reliability of scale have been demonstrated in previous studies such as Brooke
et al. (1988) and achieved an acceptable reliability level with a Cronbach’s alpha of 0.90. For
the current study, the result of this subscale’s Cronbach alpha was 0.86.
The dependent variable, organizational readiness for change, was measured by a 10-item
Likert scale adopted from Hanpachern’s readiness for change questionnaire (Hanpachern
et al., 1998). Participants were asked to circle one of five numbers on a Likert scale (1 = very
unlikely; 5 = very likely). The authors found the Cronbach’s alpha of the scale was 0.82,
which indicates a good internal consistency. The scores ranged from 10 to 50, with higher
scores indicating higher perceived readiness for change. The Cronbach’s alpha for these
items was found to be reliable at 0.75 (Yoon and Thye, 2002). However, the current study
results found the measurement was reliable at 0.71.
The clarity, feasibility and understandability of the measurements were ascertained by a
pre-pilot work before being administered to the participants. A panel of three nurses holding
PhD degrees who were specialized in nursing administration reviewed the English version
of the instrument and the educational program; then, the panel were asked to identify
ambiguous information and to comment on ease of reading and presentation. A pilot study
was carried out to ascertain the clarity and understandability of the instrument before being
introduced to the participants in terms of the suitability of the intervention to the study
sample, cost-effectiveness and the ease of integrating the program into the clinical setting.
 LHS The data collection procedure
Self-reported questionnaires were handed by the researchers to the participants before and
after the completion of the leadership educational program. Data were collected in the
classrooms where the program was carried out over a period of three weeks and was divided
into three sessions. The first session was a pre-intervention, the second session focused on
the leadership and management program and the third section included the post-
intervention and focused on introducing the posttest and getting feedback from the study
participants.

The leadership and management educational program

The program was designed for mid to senior clinical nurse managers aspiring to manage
large departments and systems of care. The program was based on the Ministry of Health
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care criteria for performance, and guided by the leadership and management principles
adopted from the work of Northouse (2013), Roussel (2013) and Liebler and McConnell
(2012), presenting a unique opportunity to engage in nursing leadership and management.
The program focused on enhancing and understanding leadership and management
through developing self-awareness and providing individuals with the core skills and
knowledge needed to effectively lead and manage individuals to increase the managers’
ability to lead with greater confidence and with broader range of capabilities such as
measuring, monitoring and improving the nurse managers for organizational change.
The program involved three sessions. The first session was a pre-intervention (pre-
program), which focused on introducing the program and introducing the pretest for
participants. The second session included action learning and participants required to put
the learning into practice in the following modules: appraisal skills, assertiveness, coaching
skills, coaching to support change, dealing with difficult people, innovation, leading,
managing, dealing with change, managing absence and implementing leadership action
plan. The researchers used a variety of educational methods, including handouts of the
program, PowerPoint slides, group discussions and prepared templates for exercises. At the
end of the interventional program, each participant wrote an action plan that enhanced
effective leadership competencies and readiness for change. The third section included the
post-intervention and focused on introducing the posttest and getting feedback from the
study participants regarding their experiences in this program.

Statistical analysis
Statistical analysis was carried out using Statistical Package for Social Sciences (SPSS)
version 21.0 (SPSS, 2013). Data entry was double-checked by the researchers and verified for
outliers and missing data. Descriptive statistics including the frequency distribution and
percentages, means and standard deviations were used to analyze the sample
characteristics. Inferential statistics such as paired-samples t-test and independent-sample t-
test were used to examine the differences between two related group means. All statistical
procedures were performed at a = 0.01, 2-tailed.

Results
The sample participants of the study consisted of 61 nurse managers, 34 (55.7 per cent) of
them were female and 25 (41 per cent) held a master’s degree in nursing. The mean age of the
nurses was 27.8 years (SD = 3.9), ranging from 22 to 42 years. The majority of the nurses
were married (n = 32; 52 per cent) and had a nursing experience as a nurse manager ranging
from 1 to 15 years (M = 5.29; SD = 3.20; Table I).
 Variables Range Mean (SD) Median % (n)
Leadership
competencies
Gender Female and quality of
Male 44.3 (27)
Female 55.7 (34) work
Marital status Married
Single 44.3 (27)
Married 52.6 (32)
Divorced 03.3 (02)
Age in years 22-42 27.00 (3.9)
Experience in years 1-15 05.29 (3.2)
Monthly income 230-1100 590.0 (173)
Leadership competencies 47-91 73 (11.09) 75.00
Quality of work 8-22 17 (3.11) 17.00
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Perceived readiness for change 28-49 37 (4.53) 38.00 Table I.

Sample
Note: N = 61 characteristics

For the purpose of testing H1, paired t-test using a

 = 0.01 (2-tailed) has been implemented.
Nurse managers showed good improvement of knowledge of leadership and management
(knowledge posttest) after implementing the leadership program (M = 82.7/100, SD = 8.5,
R = 73-100), and confirmed statistically significant difference (t = 32.56, df = 60, p < 0.001),
which suggests the efficiency and effectiveness of the program. Therefore, H1 was
supported (Table II).
Before testing H2, the mean scores for leadership competencies (M = 73) and the mean
score of QW (M = 17) were used as cutoff scores for competent nurse managers and high
QW. Then, the normality of leadership competences and QW were tested for normality
using skewness values. The results showed that the scores were normally distributed, and
Levene’s test (Munro, 2012) for equality of variances was used to test the homogeneity of
variances of the same variables, and it was found that the test is not significant for
leadership competences (p = 0.91) and QW (p = 0.18). Thus, the assumption of homogeneity
of variances was met and an independent t-test was carried out. The results showed a
statistically significant difference in scoring of perceived readiness for change among
participants regarding leadership competences and QW [t (59) = 2.85, p = 0.006; t (59) = 2.48,
p = 0.016, respectively]. However, participants who scored high in leadership competences
and high in QW were significantly percieved to have a higher readiness for change (M =
39.39, SD = 4.20; M = 39.14, SD = 3.79, respectively) than those whom scored low in
leadership competencies and QW. So, leaders’ competencies and high QW had strong
impact on organizational readiness for change. Therefore, H2 was supported (M = 36.25,
SD = 4.37; M = 36.34, SD = 5.00, respectively; Table III).

Knowledge scores n Mean SD t df p-value

Table II.
Pretest 61 50.7 9.2 32.5 60 0.000**
Paired t-test of the
Posttest 61 82.7 8.5
knowledge scores on
Notes: **Significant at a
 = 0.01 (2-tailed); -sample t-test of the leadership competencies and quality of work the pretest and
(n = 61) posttest (n = 61)
 LHS Furthermore, demographic variables of the participants were tested using independent-
sample t-test. The results showed no significant differences in scoring of perceived readiness
for change among female and male nurses [t (59) = 0.15, p = 0.881]. Furthermore, results
revealed no statistically significant differences at a  = 0.05 (2-tailed) between young and
older nurse managers, novice and senior nurse managers and low- and high-income nurse
managers regarding perceived readiness for change [t (59) = 1.10, p = 0.275; t (59) = 1.64, p =
0.105; t (59) = 0.814, p = 0.419, respectively]. These results advocate that participants differ
to a greater degree than what would be expected by chance, and these differences are
suggested to be owing to implementation of the leadership program. Therefore, H3 was not
supported (Table IV).

Discussion
As the first study of its kind in Jordan, the current study aimed to initiate the leadership
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guidance program to advance nurse managers’ leadership knowledge and enhance

leadership competencies and QW. This study also aimed to enhance nurse leaders’ readiness
for change in healthcare institutions. Of concern, nurses’ average of knowledge regarding
leadership was 50.7 per cent, which is considered low average compared to 84 per cent in a
study carried out by Hsu et al. (2011). Also, such low average of knowledge does not support
nurses in performing their role as nurse leaders, which may decrease the quality of

Group n Mean SD t df p-value

Leadership
Table III. Competent 33 39.39 4.20 2.85 59 0.006**
Independent-sample Incompetent 28 36.25 4.37
t-test of the
Quality of work
leadership Satisfied 35 39.14 3.79 2.48 59 0.010**
competencies and Unsatisfied 26 36.34 5.00
quality of work
(n = 61) Note: **Significant at a
 = 0.01 (2-tailed)

Group n Mean SD t df p value

Gender
Male 27 37.85 4.64 0.15 59 0.881
Female 34 38.02 4.50
Age
Old 38 38.44 4.56 1.10 59 0.275
Young 23 37.13 4.46
Experience
Senior 25 39.08 4.01 1.64 59 0.105
Table IV. Novice 36 37.16 4.75
Student t-test of the
Income
demographic factors High 29 38.44 5.35 0.84 59 0.410
on perceived Low 32 37.50 3.66
readiness for change
(n = 61) Note: *Significant at a
 = 0.05 (2-tailed)
 leadership in their institutions (Armenakis and Harris, 2009). However, being exposed to Leadership
such leadership training courses can enhance nurse managers’ abilities in managing unit competencies
operations and inspiring staff (Contino, 2004), which was reflected in the posttest of this
study, where the average score increased to 82.7 per cent. Therefore, frequent refreshment
and quality of
courses are recommended in this regard. work
Participants’ readiness for change was found to be moderate (75.8 per cent). If compared to
the literature (El Haddad et al., 2013; Walker and Campbell, 2013; Wolff et al., 2010), this figure
seems to be acceptable and reflects an open perspective. However, knowing that this figure was
obtained after receiving a training course indicates the importance of such training courses in
broadening nurse managers’ perspective toward accepting change in their units (Devereaux
et al., 2006; Weiner, 2009). Such an implication could have the potential to improve the quality
of patient care in their institutions (Armenakis and Harris, 2009). Another interesting finding of
this study was that there was no difference in nurse managers’ perceived readiness for change
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based on their demographic characteristics. Similar findings were found among Australian
nurses (Walker and Campbell, 2013). However, this was in contrast to what was reported
among academic nurses, where there were significant differences regarding demographic
variables (such as number of children, marital status and highest degree held) and who had
more perceived readiness for change than their counterparts (Goodrich, 2013). This may
indicate that the nature of a concept like readiness for change constitutes the interaction of the
whole components of work environment (Stevens, 2013).
Comparable to the literature, nurse managers who showed more leadership competencies
had more perceived readiness for change. The same result was reported among senior nurse
managers in Canada (Cinite et al., 2009). This might be attributed to the confidence among
those nurses by being prepared with such competencies, which will reduce their fear of
change in their units (Nordin, 2011). However, Gilley et al. (2009) stated that successful
organizational change mandates having leaders who can motivate, communicate and build
teams. Therefore, training courses such as the one provided in this study might be embedded
in healthcare institutions’ continuing education programs, which can promote managers’
leadership competencies and produce institutions that welcome change toward better quality
of patients care (Talim, 2012). Such quality can be achieved through competent leaders who
can promote their employees’ commitment to change (Lo et al., 2010), creativity (Wang et al.,
2014) and organizational performance (Al-Hussami et al., 2014; Samad, 2012).
Similarly, nurse managers who reported more satisfaction with their work reported
having more perceived readiness for change. The same finding was found among general
practice nursing staff in Australia (Christl et al., 2010). Similarly, a high correlation was found
between satisfaction with leadership and perceived readiness for change among healthcare
providers working both in medical centers and outpatient departments in the USA (Helfrich
et al., 2011). Such findings invite healthcare administrators to promote the QW environment
for nurse managers, which will produce satisfied nurses who are open to change through
their commitment to their organization (Madsen et al., 2005; Saleh et al., 2014).
The current study has numerous practical implications for the directors of nursing and
hospital administrators facing organizational change. Hence, the administrative team
should establish policies and procedures that decrease the possible negative impact of
planned change efforts. Indeed, attention must be given to nurse managers by providing
program development in regard to leadership competencies to improve their leadership
abilities to adjust nurses to the change process. Also, the present study showed that QW
enhances the perceived readiness for change. In the world of healthcare work today, nurse
managers are required to be competent to increase nurses’ satisfaction to cope with change.
Therefore, developing those competencies might help to improve work readiness for change.
 LHS Another implication for this study is that the nurse managers should be competent leaders
to match with employees’ satisfaction. However, during the process of change, the leaders
should be able to lead by example. Consecutively, nurse managers should build the guiding
team, get the vision right, communicate for buy-in, empower action, create short-term wins
and make change stick to improve the change programs.
The intention of this study was to add to the body of knowledge by using longstanding
measures of leadership competencies and QW to test their effects on perceived readiness for
change. The strength of this research for the decision-makers is the use of interventional
design to identify the effects of leadership competencies and the finding that the leadership
program can enhance the abilities of managers for readiness for change.
The limitations of the study include a consideration of the views and experiences of
nurses who did not enroll in the leadership program and complete the survey, although all
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nurse managers working in Amman were invited to do so. Another limitation is that the
participants in this study were mainly from hospitals in Amman, so the findings cannot be
generalized to all nurse managers in Jordan. The fact that nurses were required to complete
the posttest questionnaire with regards to the knowledge while undertaking their normal
busy duties might have affected how they completed the questionnaire, because they were
distracted with their professional responsibilities and thus may not have given accurate
information.
Future research studies are recommended to undertake comparable studies in time and
place to examine the influence of other factors such as organizational commitment,
perceived organizational support and organizational culture on perceived readiness for
change. Also, future researchers may select different measures or indeed commit to drawing
up new surveys that may better reflect the globalization of healthcare to track the influence
of the preceding factors on readiness for change.

Conclusion
This study provides an explanation of the research and the selection of a pre-experimental
design to assess the effects of leadership competencies and QW on perceived readiness of
change. These findings lead to a conclusion that the leadership course may enhance the
readiness of nurse managers for change. Moreover, healthcare policymakers should focus on
applications that increase leadership competencies and overall satisfaction of the nurse
managers to support the changes in hospitals and supporting learning organization.

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Corresponding author
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Mahmoud Al-Hussami can be contacted at: [email protected]

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