Internal Customer Service in Healthcare: A Servant Leadership Model

Complex organizational structures that include partnerships between diverse internal and external stakeholders with competing interests and needs can present unique customer service challenges. A solution that is suitable for one customer may be unacceptable to another.  Liaising between internal and external customers often feels like refereeing a zero-sum game.  This article explores these relationships and seeks to offer insight into how to successfully navigate these situations as a leader or influencer.

February 12, 2020

Aaron Harmon

Program Director

Aaron Harmon has more than 15 years of behavioral healthcare experience in the inpatient psychiatric hospital setting. Since 2014, he has served as Program Director for a 10-bed gero-psychiatric unit and intensive outpatient program at Fulton County Health Center (FCHC), a rural critical access hospital located in Wauseon, Ohio.

Who is the Internal Customer?

The internal customer is any stakeholder with whom you interact through the course of your work that has a professional interest in the care that you provide and who is not the patient, client, or family that you serve. These stakeholders include representatives of your contracting agency, other healthcare agents, or agencies within the community who rely on you or those you rely on for continuity and coordination of care and services. Internal customers may even include representatives within different elements of your agency if your mission is expressly administrative or supportive.

Internal customers may not have the same goals and objectives as your employer or your external customers (i.e. the patient, client, or family) and their agendas may be unaligned. For example, internal/external customers could have competing interests regarding the level or degree of program participation, admission, discharge, cost, and the community resources needed. Conflicts arise when agendas are not well aligned in the presence of competing interests or where there is competition for limited time or resources.

As employees of a contracting agency, you have a responsibility to achieve the contracted mission efficiently and cost-effectively. As healthcare providers, you must advocate for and serve your external customer (client/patient/family). As members of a care network that relies on other departments and agencies within the community outside of your direct control, you must work within the confines of available resources.

“The consequence of this is that there is a myriad of institutions, groups, and individuals, all with their own cultures, beliefs, and values. Leaders in health and social care, therefore, have to find ways to meet the needs of these diverse communities and forge alliances that use the most appropriate assets of each to meet shared goals. This is illustrated best in primary care, where the duty of providing some services is shared between healthcare providers, local authorities, and local patient organizations.” (Waterman, 2011).

Intrapersonal interactions take place at each step along the way, and each provides an opportunity for not only conflict but also leadership.

Leadership Styles

When most people think of leadership, they think in terms of “top-down” or hierarchal strategies. This type of leadership is sometimes necessary, but this approach requires absolute authority and the power to enforce mandates and therefore does not work well in every environment. Morale is important, but it is not necessarily critical to achieving the mission. Absolute authority works well in emergencies, but it does not exist in collaborative environments.

“Traditionally, leadership is conceptualized as top-down influence from leaders with power (i.e. formally appointed individuals who are high in the organizational hierarchy) to those who hold lower positions in the bureaucracy.  It is also known as vertical leadership since important decisions are made by a single “heroic” leader and influence is unilateral [76].  In fact, the layman’s notion of leadership is commonly framed in terms of the vertical leadership model.” (Shek, 2015).

In modern business and healthcare settings, various stakeholders share elements of power and control.  Cooperation is critical and buy-in must be earned or negotiated.  If any party steps away from the table, it often impacts the mission of all other stakeholders, and the most vulnerable suffer.  In healthcare, this is typically the patient.

Enter the Servant Leader

The servant-leader sees their role as supportive and best achieves the mission by empowering others to leverage their various strengths and abilities.  While the servant leader may hold absolute power within their team, they rarely need to call upon it.  In this way, the servant leader learns to be flexible and is well equipped to adapt when dynamics change through collaboration with other teams.

“Servant leadership employs a different approach by considering the followers’ needs and collaborating with them to achieve organizational goals.  This style is based very much on mutual trust and empowerment of followers and so is likely to be best suited to moving groups forward in organizations of multidisciplinary teams or groups of professionals…” (Isis, 2004). 

The Servant Leader’s Role in Customer Service

The servant leadership model is very well suited for internal customer service due to its collaborative approach and reliance on the development of mutual trust and respect.

According to Shek (2015), research indicates that fundamental elements of servant leadership include the following competencies:

  1. Vision
  2. Honesty
  3. Integrity
  4. Trust
  5. Service
  6. Modeling
  7. Pioneering
  8. Appreciation of others
  9. Empowering

The core principle of these skills and the underlying theme of servant leadership is the emphasis on relationship building. Strong relationships are possible due to the leader’s apparent genuine concern and desire for the success, personal growth, and wellbeing of his or her partners. The successful servant leader achieves those relationships while keeping a close eye on the organization’s overall mission and objectives. When competing needs create insurmountable challenges, the servant leader approaches the situation with honesty, integrity, empathy, and respect. The result of this approach is fundamentally strong relationships with followers built on mutual trust.

Finally, servant leadership leaves little room for fragile personal egos.

“Servant leaders stand out in their willingness to serve and value others without rancour or the need to be defensive, even if provoked.  Their sole interest is in developing those whom they lead and those with whom they collaborate.” (Waterman, 2011).

Successful servant leadership leads to greater trust and better relationships with employees and internal and external clients.  It works well where other approaches such as “top-down” leadership do not, but it is not without its limits. Servant leadership is, in some ways, the antithesis of absolute authority because it relies on partnership rather than unwavering obedience. It is therefore ill-suited to situations where rapid transitions rely on absolute obedience, such as ad hoc teams working in emergencies.

Servant leadership is not merely a leadership style. It is a mindset and a culture that must be continuously endorsed and reinforced through the leader’s deeds, actions, and attitudes. It takes time to establish the necessary relationships and build the trust upon which servant leadership relies.

While it is not suited for every environment, this approach is well suited for multidisciplinary collaboratives and diverse teams. The servant-leader employs these same principles when collaborating with external agencies and teams through intentional, thoughtful relationship building. The servant-leader views the leadership role as supportive rather than authoritative and relishes the success of the team rather than the individual accomplishment. Servant leaders achieve their mission when all or most parties share in elements of this success.



Isis, L. H. (2004). The servant leader. Nursing Management (through 2013), 11(3), 20-4. Retrieved from

Shek, D. T. L., Chung, P. P. Y., & Leung, H. (2015). How unique is the service leadership model? A comparison with contemporary leadership approaches. International Journal on Disability and Human Development, 14(3), 217-231. doi:

Waterman, H. (2011). Principles of ‘servant leadership’ and how they can enhance practice. Nursing Management (through 2013), 17(9), 24-6. Retrieved from