TRANSFORMATIONAL LEADERSHIP STYLE AND ORGANIZATIONAL CULTURE ON ORGANIZATIONAL CITIZENSHIP BEHAVIOR AND EMPLOYEES’ PERFORMANCE: STUDY IN MOTHERS AND CHILDREN HOSPITALS

Purpose – This research aims to test and analyze the influence of transformational leadership style and organizational culture on organizational citizenship behavior (OCB) and employees’ performance in mothers and children hospitals in Indonesia, particularly in East Java Province. Design/Methodology/Approach – The research samples are 89, i.e. 89 nurses and midwives who work in 3 mothers and children hospitals in East Java. The sampling technique uses a population study. The analysis data method used is path analysis. Findings – The research results conclude that: (1) the transformational leadership style significantly influences OCB; (2) the organizational culture significantly influences OCB; (3) the transformational leadership significantly influences employees’ performance; (4) the organizational culture insignificantly influences employees’ performance, and (5) OCB significantly influences nurses’ performance in mothers and child hospitals in East Java. 
Originality/value – This study is among the few studies that take into account the influence of transformational leadership style and organizational culture on organizational citizenship behavior, particularly within the context of the nurse working in mother and children hospitals.


INTRODUCTION
Mothers and children hospitals have important roles in the world of health, both in big cities and small cities. They are able to provide best services for all society and to give special offers for outpatient and inpatient services, especially for mothers and children. Mothers and children hospitals' success relies on their human resources. One of them is the role of nurses who provide health services to patients both mothers and children. Nurses must have ethics by being polite, always smiling, and being sympathetic. With good ethics, a nurse is expected to be able to establish a more intimate relationship with the patients. Attitudes, behaviors, responsibilities, and cleverness of the nurses in working can be set as benchmarks of nurses' performance. Many factors influence nurses' performance levels theoretically and empirically, i.e. transformational leadership style, organizational culture, and organizational citizenship behavior (OCB). Therefore, this research tries to analyze the influence of transformational leadership style and organizational culture to OCB and employees' performance, especially nurses and midwives in mothers and children hospitals in East Java.

Transformational Leadership Style
Anoraga (2009) defines leadership style as someone's ability or style to influence other people. Transformational leaders changes the followers' awareness of problems by helping them to face past problems with new ways, and they are able to stimulate, generate, and inspire the followers to take extra efforts to achieve group goals. Jung et al. (2008) state that leaders with idealized Influence demonstrate heightened concerns and cognizance of followers' needs and generate a sense of shared risk-taking. Cummings et al. (2010) observed that regardless of style, "leaders who practiced relational and transformational styles had better quality outcomes than those who demonstrated autocracy". Organizational Culture Schein (1992) states that organizational culture is a group of basic assumptions.
Organizational culture functions to give directions to organization members about what to watch out, the meaning of something to achieve, how about the reaction and action in certain situations. Understanding and managing organizational culture are not only directed to find an explanation about organization's success phenomena, but also can be used to develop organization to be more effective. Organizational Citizenship Behavior (OCB) Organ et al. (2006) defines OCB as a behavior which is an individual choice and initiative; it is not related to organization formal reward system but in aggregate it raises organization effectiveness. In other words, Organizational Citizenship Behavior (OCB) is an employee's behavior voluntarily, not a forced behavior to things that promote the interests of the company. Lambert (2006) defines OCB as behavior that goes beyond the basic requirements of the job, is to a large extent discretionary, and is of benefit to the organization. Organizational Citizenship Behaviour (OCB) also can defined as the organizational activities that the employees engage in voluntarily without the expectation to get any rewards (Lewis, 2010).

Employees' Performance
According to Simamora (2010), employees' performance is employees' levels to achieve work requirements. Indicators to measure employees' performance are work quantity, work quality, honesty, adherence, initiative, and intelligence (Ruky, 2006 Organizational culture influences OCB. The relationship is explained by Badawy et al (2016) who shows that there is a positive correlation among four types of organizational culture, work satisfaction, and OCB. Thus, the hypothesis is as follows: H2: Organizational culture influences significantly to organizational citizenship behavior of the employees in mothers and children hospitals in East Java.
Transformational leadership style influences employees' performance. The relationship is explained by Roscahyo and Prijati (2013) who show that simultaneously the influence of leadership style which consists of autocratic, democratic, and free control to employees' performance is significant; also Moiuddin (2017) explains that the appropriate leadership will be able to increase employees' performance. Therefore, the hypothesis is as follows: H3: Transformational leadership style influences significantly to employees' performance in mothers and children hospitals in East Java.
Organizational performance influences employees' performance. The relationship is explained by Awadh and Saad (2013) who show that a strong culture of an organization based on manager and leader helps in increasing performance level. Thus, the hypothesis is as follows: H4: Transformational leadership style influences significantly to employees' performance in mothers and children hospital in East Java.
OCB influences employees' performance. The relationship is explained by Al-Masahneh (2015) who concludes that organizational citizenship behavior (OCB) influences positively to employees' performance in Greater Amman Municipality. Therefore, the hypothesis is as follows: H5: OCB influences significantly to employees' performance in mothers and children hospitals in East Java.

METHOD
This is an explanatory research, which further will analyze causal relations among variables by hypothesis test set previously. The population of this research is all nurses and midwives who work in 3 mothers and children hospitals in East Java Province of Indonesia, i.e. Lamongan City, Malang City, and Gresik City, that is 89 nurses. The sample of this research is 89 employees in mother and children hospitals. The sampling technique is population study. Analysis data method used is path analysis with SPSS Version 22.0 program.

Validity and Reliability Test Result
Validity and reliability test for each variable is shown in Table 1 and Table 2 Table 2 shows coefficient score of Alpha Cronbach of each research variable is more than 0.6 (Alpha Cronbach > 0.6) so it can be concluded that the variables used or investigated, namely transformational leadership style, organizational culture, organizational citizenship behavior, and employees' performance, are reliable to be further analyzed.

Path Analysis Results
Path analysis results are shown in Table 3 and Picture 2.

Hypothesis Test Results
Hypothesis test results of the research are shown in the following Table 4.

First Hypothesis
Variable of transformational leadership style (X1) positively and significantly influences OCB (Y1), with significance score 0.000 which means sig. 0.05 and regression path coefficient score is 0.610. This means transformational leadership style significantly influences OCB of employees in mothers and children hospitals in East Java, so the first hypothesis is proven to be true.

Second hypothesis
Variable of organizational culture (X2) positively and significantly influences OCB (Y1), with significance score 0.000 which means sig. < 0.05 and the regression path coefficient score is 0.318. This means organizational culture significantly influences OCB of employees in mother and children hospitals in East Java, so the second hypothesis proposed is proven to be true.

Third Hypothesis
Variable of transformational leadership style (X1) positively and significantly influences employees' performance (Y2), with significance score 0.002 which means sig. < 0.05 and regression path coefficient score is 0.258. This means transformational leadership style significantly influence employees' performance in mothers and children hospitals in East Java, so the third hypothesis proposed is proven to be true.

Fourth Hypothesis
Variable of organizational culture (X2) negatively but non-significantly influences employees performance with significance score 0.492 which means sig. > 0.05 and regression path coefficient score is -0.032. This means organizational culture non-significantly influences employees' performance in mothers and children hospitals in East Java, so the fourth hypothesis proposed is not proven to be true.

Fifth Hypothesis
Variable of OCB (Y1) positively and significantly influences employees performance (Y2) with significance score 0.000 which means sig. < 0.05 and regression path coefficient score is 0.713. This means organizational citizenship behavior significantly influences employees' performance in mothers and children hospitals in East Java, so the fifth hypothesis proposed is proven to be true.

Partial Determination Coefficient Calculation Results
The score of squared multiple correlation (R 2 ) for OCB variable is 0.759. This means 75.9% of variation in OCB (Y1) possessed by employees in mothers and children hospitals in East Java. It can be explained by transformational leadership style (X1) and organizational experience (X2). The score of squared multiple correlation (R 2 ) for employees' performance variable is 0.830. This means 83% of variation in employees' performance (Y2) in mother and children hospitals in East Java can be explained by variables of transformational leadership style (X1), organizational culture (X2), and OCB (Y1).

Direct and Indirect Influence Analysis
Direct and indirect influences are shown in Table 5 as follows.  Directly there is a positive and significant influence og organizational culture variable (X2) to OCB (Y1) that is 0.318 with significance 0.000.
Directly there is a positive and significant influence of transformational leadership style variable (X2) to employees' performance (Y2) that is 0.258 with significance 0.002.
Directly there is a negative but notsignificant influence of organizational culture variable (X2) to employees' performance (Y2) that is -0.032 with significance 0.492.
Directly there is a positive and significant influence of OCB variable (Y 1 ) to employees' performance (Y2) that is 0.713 with significance 0.000.
Indirectly there is a positive influence of transformational leadership style variable (X1) to employees' performance (Y2) via OCB (Y1) that is 0.610 x 0.713 = 0.435 in which the influence is significant. This shows that organizational citizenship behavior (OCB) as an intervening variable plays a role to strengthen and enlarge the influence of transformational leadership style (X1) to employees' performance (Y2).
Indirectly there is a positive influence of organizational culture variable (X2) to employees' performance (Y2) via OCB (Y1) that is 0.318 x 0.713 = 0.227 in which the influence is significant. This shows that organizational citizenship behavior (OCB) as an intervening variable plays a role to strengthen and enlarge the influence of organizational culture (X2) to employees' performance (Y2).

The Influence of Transformational Leadership Style to OCB
The first hypothesis is proven or acceptable that transformational leadership style significantly influences organizational citizenship behavior (OCB) of employees in mothers and children hospitals in East Java. This is shown by the number of regression path coefficient of transformational leadership style variable (X1) to OCB (Y1) that is 0.610 (Sig. = 0.000; significant). The contribution of transformational leadership style variable to OCB of employees in mothers and children hospitals can be seen from partial determination coefficient score (r 2 ) = 0.441 so the contribution is 44.1%. Meanwhile, the relation of (r) transformational leadership variable with OCB is 0.664 with significance 0.000 (table  3). Based on this correlation score, it shows that the relation between transformational leadership style and OCB is quite close (very close if almost 1).
According to the results of descriptive analysis of the transformational leadership style variable, it shows that in average transformational leadership style in mother and children hospitals in East Java is good, with average score (mean) of transformational leadership style variable 3.803. This means that respondents give good rating to the transformational leadership style in mothers and children hospitals in East Java.
These research results, which show that transformational leadership style significantly influences OCB of employees in mother and children hospitals in East Java, empirically support by Malik et al (2016) research results which conclude that there is a strong and positive relationship between leadership style and OCB, leadership style significantly contributes to the OCB enhancement, the democratic leadership style stimulates more OCB for employees. Another reaesarch by Jiang et al

The Influence of Organizational Culture and OCB
The second hypothesis is proven and acceptable that organizational culture variable significantly influences organizational citizenship behavior (OCB) of employees in mothers and children hospitals in East Java. This is shown in Table 4 which explains that the number of regression path coefficient of organizational culture variable (X2) to OCB (Y1) is 0.318 (sig. = 0.000; significant). The contribution of organizational culture variable to OCB can be seen by partial determination coefficient score (r 2 ) = (0.356) so the contribution is 35.6%. Meanwhile, the relation of (r) organizational culture with OCB is 0.597 with significance 0.000 (Table 3). Based on this correlation score, it shows that the relation between organizational culture and OCB is quite close (very close if almost 1).
According to the results of descriptive analysis of the organizational culture variable, it shows that in average organizational culture in mother and children hospitals in East Java is good, with average score (mean) of organizational culture variable 3.447. This means that respondents give good rating to the organizational culture in mothers and children hospitals in East Java.
These research results, which show that organizational culture significantly influences OCB of employees in mother and children hospitals in East Java, empirically support by Mohanty and Rath (2012) The third hypothesis is proven or acceptable that transformational leadership style significantly influences organizational culture of employees in mothers and children hospitals in East Java. This is shown in Table 4 which explains that the number of regression path coefficient of transformational leadership style variable (X1) to employees' performance (Y2) that is 0.258 (Sig. = 0.002; significant). The contribution of transformational leadership style variable to organizational culture can be seen from partial determination coefficient score (r 2 ) = 0.109 so the contribution is 10.9%. Meanwhile, the relation of (r) transformational leadership variable with employees' performance is 0.330 with significance 0.002 (table 3). Based on this correlation score, it shows that the relation between transformational leadership style and employees' performance is quite close (very close if almost 1).
According to the results of descriptive analysis of the employees' performance variable, it shows that in average employees' performance in mother and children hospitals in East Java is high, with average score (mean) of employees' performance variable 4.264. This means that respondents judge that the performance of employees is good or very high.
These research results, which show that transformational leadership style significantly influences employees' performance of employees in mother and children hospitals in East Java, empirically support Roscahyo and Prijati (2013) and also Mohiuddin (2017). One of Roscahyo and Prijati (2013) research results is simultaneously shows that the influence of leadership style, which consists of autocratic, democratic, and free control, together to the employees' performance is significant. Meanwhile, Mohiuddin (2017) research results conclude a proof of literature which shows that transformational leadership approach has a more profitable result in the worker execution than transactional where the concentration is in the leaders' hands. The finding also in line with Liao and Chuang (2007) (2008) and Wang et al (2011). The effect of transformational leadership on rated performance was also mediated by the interaction of identification and means efficacy, as well as partially mediated by the interaction of self-efficacy and means efficacy. The point is the proper leadership style will be able to improve employees' performance (Walumbwa et al., 2008). There is direct relationship between leadership and performance (in-role and OCB) (Vigoda, 2007).

The Influence of Organizational Culture to Employees' Performance
The fourth hypothesis is not proven and unacceptable that organizational culture variable significantly influences employees' performance in mothers and children hospitals in East Java. This is shown in Table 4 which explains that the number of regression path coefficient of organizational culture variable (X2) to employees' performance (Y2) in mothers and children hospitals in East Java is -0.032 (sig. = 0.492 not-significant). These research results, which show that organizational culture does not significantly influence OCB employees' performance in mother and children hospitals in East Java, empirically does not support Awadh and Saad (2013) research results which conclude that a strong culture of an organization based on ,manager and leader helps in improving performance level. organizational culture influences employees' performance. This finding also opposite with Kim andYu (2004), Jacobs et al. (2013) and Xenikou and Simosi (2006) research. The organizational culture was found to impact a variety of organizational processes and performance (Kim and Yu, 2004). It varies across hospitals and over time, and this variation is at least in part associated in consistent and predictable ways with a variety of organizational characteristics and routine measures of performance (Jacobs et al., 2013). Moreover a path analysis showed that the achievement and adaptive cultural orientations had a direct effect on performance (Xenikou and Simosi, 2006).

The Influence of Organizational Citizenship Behavior to Employees' Performance
The fifth hypothesis is proven or acceptable that organizational citizenship behavior (OCB) significantly influences organizational culture of employees in mothers and children hospitals in East Java. This is shown in Table 4 which explains that the number of regression path coefficient of organizational citizenship behavior (OCB) variable (Y1) to employees' performance (Y2) that is 0.713 (Sig. = 0.000 significant). The contribution of organizational citizenship behavior (OCB) variable to organizational culture can be seen from partial determination coefficient score (r 2 ) = 0.441 so the contribution is 44.1%. Meanwhile, the relation of (r) transformational leadership variable with employees' performance is 0.664 with significance 0.000 (Table 3). Based on this correlation score, it shows that the relation between transformational leadership style and employees' performance is close (very close if almost 1).
According to the results of descriptive analysis of the OCB variable, it shows that in average OCB in mother and children hospitals in East Java is high, with average score (mean) of employees' performance variable 4.013. This means that respondents give good rating to the OCB of the employees in mothers and children hospitals in East Java. Based on partial determination coefficient score (r 2 ), it shows that transformational leadership style dominantly influences employees' performance in mothers and children hospitals in East Java compared to organizational culture in which transformational leadership style has partial determination coefficient score (r 2 ) 0.441 whereas organizational culture has 0.356 (Table 3).
Among transformational leadership style, organizational culture, and OCB, it can be concluded that OCB is a variable which dominantly influences employees' performance in mothers and children hospitals in East Java, where OCB has the biggest influence to employees' performance.
OCB has partial determination coefficient score (r 2 ) that is 0.441 while partial determination coefficient score (r 2 ) of transformational leadership style is 0.109; and partial determination coefficient score (r 2 ) of organizational culture is 0.006 (Table 3). The findings of this research are OCB variable is an intervening variable which is important because it can strengthen (enlarge) the influence of transformational leadership style and organizational culture to the employees' performance in mothers and children hospitals in East Java, from the insignificant influence to significant influence.
These research results, which show that OCB significantly influences employees' performance of employees in mother and children hospitals in East Java, empirically support Al-Mahasneh (2015) research results which that OCB positively influences employees' performance in Greater Oman Municipality. Bommer et al (2007) found that high individual-level OCB yielded greater significant increases in job performance ratings. Moreover this research finding supported the previous research done by Bell (2004) that argued there is a direct positive relation between the OCB of the employee who is directly interact with the customer and the customer perception towards the service quality performances. Another study done by Castro et al. (2004) is also proved the influence of OCB to the perception of customer regarding the service quality performances. Chiang andHsieh (2012), Dyah et.al (2016);Podsakoff et.al (2009), Purnama (2013 were also proved OCB positively influenced job performance. OCB has positive effect on the supervisor's evaluation of the individual performance, both directly and indirectly, through the impact OCB had on the supervisor's fondness of individual (Vilela et al., 2008). This means that the perception of employees to OCB has positive and significant influence to employees' performance. OCB affects volume and quality of work, relationship between coworkers as the dependent variables and relationship between staffs and their superintendent. or it may be due to more work-related reasons such as the manager's belief that OCB plays a significant role in the organization's overall success, or perception of OCB as a form of employee commitment due to its voluntary nature (Organ et al., 2006).

CONCLUSIONS
Based on the research results analysis of the influence of transformational leadership style and organizational culture to OCB and employees' performance, it can be concluded that: (1) the transformational leadership style significantly influences OCB; (2) the transformational leadership influences significantly to employee's performance; (3) the organizational culture insignificantly influences employee's performance; (4) OCB significantly influences employees' performance ; (5) transformational leadership style and organization culture indirectly influences employees performance significantly via OCB; (6) OCB is an intervening variable which is able to strengthen the relationship or influence of transformational leader and organizational culture to nurses' performance in mothers and children hospitals in East Java.
Based on the above conclusion, it is suggested to the mothers and children hospitals in East Java for always strengthen OCB spirit of the nurses, for instance by motivating and supporting nurses' nature of helping, raising nursing self-awareness, increasing nurses' sportsmanship, raising mutual respect, and also giving responsibility and authority to the employees namely nurses and midwives for improving the job quality.