Relationship between organizational culture, leadership behavior and job satisfaction

Graduate level health professions education: how do previous work experiences influence perspectives about interprofessional collaboration?

Understanding how previous experiences with interprofessional education and collaboration inform health care provider perspectives is important for developing interprofessional interventions at the graduate level. The purpose of this study was to examine how previous work experiences of graduate level health professions students inform perspectives about interprofessional education and collaboration. Drawing from program evaluation data of two separate graduate level interprofessional education interventions based in primary care and home health care, we conducted a qualitative secondary data analysis of 75 interviews generated by focus groups and individual interviews with graduate students from 4 health professions cadres. Using directed content analysis, the team coded to capture descriptions of interprofessional education or collaboration generated from participants' previous work experiences. Coding revealed 173 discrete descriptions related to previous experiences of interprofessional education or collaboration. Three themes were identified from the analysis that informed participant perspectives: Previous educational experiences (including work-based training); previous work experiences; and organizational factors and interprofessional collaboration. Experiences varied little between professions except when aspects of professional training created unique circumstances. The study reveals important differences between graduate and undergraduate learners in health professions programs that can inform interprofessional education and collaboration intervention design.

Patient safety from executive hospital management to wards: A qualitative study identifying factors influencing implementation

AIM

To examine the journey of safety initiatives from executive hospital management to ward.

BACKGROUND

Hospital management teams are often responsible for identifying safety priorities and ensuring delivery of these.

METHOD

Naturalistic study design within a large NHS Hospital Trust. Using semi-structured interviews, focus groups and secondary data analysis, the study examines the implementation of safety initiatives.

RESULTS

While hospital management developed five safety initiatives, only one of these (falls prevention) was actually seen to permeate all layers of the organisation. Other initiatives stopped one layer down. Both middle management and ward staff added to the list of initiatives developed, resulting in 16 priorities. A range of positive and negative influences to successful implementation are identified.

CONCLUSIONS

Safety initiatives need positive reinforcement at all levels to be addressed appropriately. The research suggests that a model related to improvement science may prove useful in ensuring that priorities are addressed.

IMPLICATIONS FOR NURSING MANAGEMENT

Care should be taken to ensure that safety initiatives are successfully implemented at all levels within an organisation. Identifying priorities with staff and sharing values and priorities are a key approach to leading such initiatives.

Factors Influencing Acceptance of Personal Health Record Apps for Workplace Health Promotion: Cross-Sectional Questionnaire Study

Background

Health care technologies can help improve workers’ health and productivity by supporting workplace health promotion. A personal health record app is used to manage medical data such as results from medical checkups, which facilitates decision making for medical personnel. However, an analysis of users’ technology acceptance is required to provide appropriate services based on personal health record apps.

Objective

The purpose of this study was to analyze the factors influencing the behavioral intention of health experts and workers to use an app in workers’ health centers and to examine differences in their perception of the main variables.

Methods

The study involved health experts and workers who visited 21 workers’ health centers in Korea to verify a research model in which perceived risk was added to the unified theory of acceptance and use of technology, a representative theory of information technology acceptance. After receiving ethical approval from the Korea National Institute for Bioethics Policy, 1050 questionnaires were distributed over 7 weeks with cooperation of the Korea Occupational Safety and Health Agency. A multiple linear regression analysis and multigroup path analysis were performed to verify the hypotheses, and independent samples t tests were performed to analyze differences between workers’ and health experts’ perception of the main variables.

Results

The analysis included data from 866 respondents (687 workers and 179 health experts). Effort expectancy (beta=.08, P=.03), social influence (beta=.43, P<.001), performance expectancy (beta=.07, P=.008), and facilitating conditions (beta=.13, P<.001) exerted significant positive effects on behavioral intention, whereas perceived risk (beta=–.29, P<.001) exerted a significant negative effect on behavioral intention. Performance expectancy had a significant effect on path differences depending on gender (critical ratio=–3.38) and age (critical ratio=1.97). Workers’ mean scores for the main variables were higher relative to those of health experts for all remaining variables except perceived risk, and significant differences were observed for all remaining variables except facilitating condition.

Conclusions

Social influence exerted the strongest effect on behavioral intention to use the personal health record app. Consequently, it is necessary to coordinate health promotion activities in the workplace as well as the operational direction of community institutions such as in workers’ health centers to allow workers to manage their own health via continuous use of the app. In addition, the app should be developed based on a requirement analysis of the balance between both interest groups in consideration of differences in perspective between consumers and service providers.

Perceived organizational culture and its relationship with job satisfaction in primary hospitals of Jimma zone and Jimma town administration, correlational study

BACKGROUND

The concept of Organizational Culture (OC) which refers to the pattern of values, norms, beliefs, attitudes and assumptions may not be articulated through verbal language. However, it shapes the way people behave and the way things get done in an organization. The management of organizational culture is increasingly viewed as necessary part of health system reform. Major cultural transformation of an organization must be secured alongside structural and procedural changes in order to achieve desired quality and performances improvements in health systems. It is therefore essential to understand organizational culture, job satisfaction level of the health workers and the link between them.

METHODOLOGY

Facility based cross sectional study was conducted in four primary hospitals of Jimma zone and town administration. A self-administered questionnaire was used to collect the data. The collected data were checked for completeness, entered and documented into Epi-data version 3.1 and Exported to SPSS version 21 for analysis. Finally descriptive statistics, Paired t-test and multiple linear regression analysis were used to assess the relationship between organizational culture and job satisfaction and the results were presented using tables and charts.

RESULT

It was indicated from the finding that, the dominant existing organizational culture typology in the primary hospitals was Hierarchy culture (MS = 22.31, ±2.82).and the preferred organizational culture typology was Innovative culture (MS = 26.09, ±4.72). The health workers had low to medium level of job satisfaction where only (29.40%) of the health workers were very satisfied with their hospital physical working environment. Existing perceived clan culture had positive and significant correlation with health workers' satisfaction in relation to work relation dimension (r = .16, p < 0.002).

CONCLUSION

while acknowledging all limitation of observational study we reached to the conclusion that an employees of the respective primary hospitals would prefer to work in environment characterized by innovative and clan culture and their satisfaction level is medium so that the managers should undertake major cultural transformation and must work to improve the job satisfaction level of health workers within their respective hospitals.

How can leadership influence the quality of care in a health-care organization?

Objective

This study focuses on how leadership could influence the quality of care in a health-care organization.

Methods

The concept of leadership and quality are analyzed. In addition, issues concerning how leadership can influence quality of care through the effect on the organizational culture and the engagement of both nurses and patients are discussed.

Results

Leadership is the pivotal factor in the improvement of quality through the effect on the organizational culture and the engagement of both nurses and patients.

Conclusions

Leadership can influence the quality of care directly and indirectly. The organization and the leaders should know the importance of effective leadership to a better work environment, facilitate the implementation of the new mode of nursing, and provide best services to the patients.

Organisational culture, leadership behaviour and job satisfaction in the Vietnam context

Purpose

The purpose of this paper is to challenge the influence of organisational culture types on leadership behaviour and job satisfaction. The theory of culture was divided into four characteristics, namely, clan, hierarchy, adhocracy and market.

Design/methodology/approach

A purposive questionnaire was adapted to collect surveys from 294 working people in several sector organisations in Vietnam. The questionnaire included two main parts. The first part comprising demographic questions. The second part included three constituted scales to evaluate organisational culture types, leadership behaviour and job satisfaction. Correlation and linear regression analysis were adapted to use to challenge connections among variables.

Findings

Hierarchy culture negatively connected to relationship-oriented leadership behaviour. Adhocracy culture positively affected job satisfaction. Clan and market cultures insignificantly predicted leadership style and job satisfaction.

Research limitations/implications

The research is structured in 294 working people in various Vietnamese sector organisations. This small sample is unlikely to represent the popularity of the findings. Further research should collect samples in more organisations and industries in Vietnam to improve the efficiency of the results. The research findings may support leaders and superiors to choose a proper organisational culture that will reduce employee dissatisfaction.

Originality/value

The research is conducive to the studies on organisational culture, especially the association between leadership behaviour and job satisfaction in Vietnamese sector organisations

The experience of culturally diverse faculty in academic environments: A multi-country scoping review

Evidence supports that the way people work together influences how they perceive the working environment and retention. With increasing migration among health professionals, it is important to better understand the experiences of multi-national faculty in higher education. This scoping review aims to provide a global perspective on the experiences of faculty from diverse cultural backgrounds and explore strategies that promote faculty diversity and contribute to the organizational culture of academic workplaces. CINHAL, PUBMED, and PsycInfo were searched for original studies that examined perspectives of diverse faculty across the world. Seventeen eligible studies were reviewed using PRISMA guidelines. Three themes were extracted: Descriptions of cultural diversity among faculty in the academic workplace, Factors that increase retention among faculty from diverse cultural backgrounds, and Strategies for building an academic culture that values faculty diversity. Faculty reported difficult experiences that limit recruitment and retention of diverse faculty, thus contribute to the lack of faculty diversity and faculty shortages. Expatriate faculty have similar experiences in feeling a lack of support in promoting their professional growth. Still, diversity can also be a positive organizational factor when the commitment of school leaders creates a harmonious work culture for all faculty that fosters and values diversity.

Nurses' perceptions of the sustainability of a standardised assessment for preventing complications in a ICU: a qualitative study

Background: Quality improvement projects have been widely adopted to prevent complications in the ICU. Objective: This paper describes nurses' perceptions of implementation strategies and the potential sustainability of a practice change intervention to prevent complications in a Malaysian ICU. Design: A participatory action research using five focus group discussions were undertaken with 19 nurses in a single ICU in regional Malaysia. Focus group transcripts were analysed using thematic analysis. Results: The main themes derived from the interviews were: [1] Empowering staff to embrace evidence-based practices; [2] Staff knowledge, attitudes, and beliefs that impact on behaviour; and [3] management support and leadership are influential in staff behaviours (acceptance & perseverance of change process). Discussion: Resistance to change was recognized as a barrier to adopting evidence based recommendations. There is a need to improve nurses' knowledge, attitude and awareness of the importance of assessment for VAP, CRBSI and PIs in the ICU.

Linking hospital culture to the training performance of residents: The roles of leader-member exchange and transactional leadership style

BACKGROUND

Hospital culture is a crucial aspect of residents' training. However, the mechanisms related to stakeholder culture (SC) and teacher-resident interaction remain unclear. The study investigated the relationship between hospital culture and training performance of residents. Also, it explored the mediating effect of teacher-resident exchange and the moderating effect of the teacher's transactional leadership style within a Chinese context.

METHODS

Based on stakeholder and leadership member exchange theories, we constructed a composite model. Data were collected from 296 residents from five tertiary hospitals in China. Hierarchical moderated regression analyses were used to test the hypotheses.

RESULTS

(a) Both the employee-orientation culture (EOC) (β = .14, P ≤ .05) and patient-orientation culture (POC) (β = .47, P ≤ .001) in the hospital were significantly related to residents' training performance. (b) Teacher-resident exchange fully mediated the relationship between EOC and training performance and partially mediated the relationship between POC and training performance. (c) The moderating role of transactional leadership style (TLS) in the relationship between EOC and leader-member exchange (LMX) (β = -.17, P ≤ .05) was negative; it was not significant in the interaction between POC and TLS (β = .06, P > .1).

CONCLUSION

The results suggest that trainers should consider the value of multiple cultures and ensure balance among stakeholders rather than focusing on a single one. Furthermore, a positive interaction improves teacher-student relationship and training performance. Most importantly, educational departments should pay attention to establishing assessment tools, using rewards and incentives in residents' training.

Unravelling the role of leadership in motivation of health workers in a Moroccan public hospital: a realist evaluation

OBJECTIVES

This study aimed at opening the black box of the relationship between leadership and motivation of health workers by focusing on a high-performance hospital in Morocco.

DESIGN

We adopted the realist evaluation approach and used the case study design to test the initial programme theory we formulated on the basis of a scoping review on complex leadership. We used the Intervention-Context-Actors-Mechanism-Outcome Configuration as a heuristic tool to identify plausible causal configurations.

SETTINGS

Since 2000, the Ministry of Health in Morocco initiated many reforms in the frame of the governmental deconcentration process called 'advanced regionalisation'. The implementation of these reforms is hampered by inadequate human resource management capacities of local health system managers. Yet, the National 'Concours Qualité', a national quality assurance programme implemented since 2007, demonstrated that there are many islands of excellence. We explore how leadership may play a role in explaining these islands of excellence.

PARTICIPANTS

We carried out a document review, 18 individual interviews and 3 group discussions (with doctors, administrators and nurses), and non-participant observations during a 2-week field visit in January-February 2018.

RESULTS

We confirmed that effective leaders adopt an appropriate mix of transactional, transformational and distributed leadership styles that fits the mission, goals, organisational culture and nature of tasks of the organisation and the individual characteristics of the personnel when organisational culture is conducive. Leadership effectiveness is conditioned by the degree of responsiveness to the basic psychological needs of autonomy, competence and relatedness, perceived organisational support and perceived supervisor support. Transactional and overcontrolling leadership behaviour decreased the satisfaction of the need for autonomy and mutual respect. By distributing leadership responsibilities, complex leaders create an enabling environment for collective efficacy and creative problem solving.

CONCLUSIONS

We found indications that in the Moroccan context, well-performing hospitals could be characterised by a good fit between leadership styles, organisational characteristics and individual staff attributes.

The effect of leadership on public service motivation: a multiple embedded case study in Morocco

OBJECTIVES

We aimed at exploring the underlying mechanisms and contextual conditions by which leadership may influence 'public service motivation' of health providers in Moroccan hospitals.

DESIGN

We used the realist evaluation (RE) approach in the following steps: eliciting the initial programme theory, designing the study, carrying out the data collection, doing the data analysis and synthesis. In practice, we adopted a multiple embedded case study design.

SETTINGS

We used purposive sampling to select hospitals representing extreme cases displaying contrasting leadership practices and organisational performance scores using data from the Ministry of Health quality assurance programmes from 2011 to 2016.

PARTICIPANTS

We carried out, on average, 17 individual in-depth interviews in 4 hospitals as well as 7 focus group discussions and 8 group discussions with different cadres (administrators, nurses and doctors). We collected relevant documents (eg, performance audit, human resource availability) and carried out observations.

RESULTS

Comparing the Intervention-Context-Actor-Mechanism-Outcome configurations across the hospitals allowed us to confirm and refine our following programme theory: "Complex leaders, applying an appropriate mix of transactional, transformational and distributed leadership styles that fit organisational and individuals characteristics [I] can increase public service motivation, organisational commitment and extra role behaviours [O] by increasing perceived supervisor support and perceived organizational support and satisfying staff basic psychological needs [M], if the organisational culture is conducive and in the absence of perceived organisational politics [C]".

CONCLUSIONS

In hospitals, the archetype of complex professional bureaucracies, leaders need to be able to balance between different leadership styles according to the staff's profile, the nature of tasks and the organisational culture if they want to enhance public service motivation, intrinsic motivation and organisational commitment.

The Role of Leadership in the Knowledge Management and Innovation Processes in a Modern Organization

The ability to create innovations is one of the most important sources of a competitive advantage forevery modern organization, region, and state. In today’s context as a particularly significant problem arises the issue of the role of leaders in organizing effective knowledge management and innovation processes. Although the topic of leadership was analyzed quite extensively in the second half of the 20th century, in the 21st century, it is recognized that organizations of this age need a new quality of leadership, as the organizations themselves and their environments are undergoing profound changes. This paper analyzes the changing approaches to leadership and its role in a modern organization, focusing on the concept of innovative leadership and its peculiarities in order to identify the components of this phenomenon and their links to knowledge management and innovation processes. After analyzing significant aspects of this topic, identified were the relationships between innovative leadership, knowledge management, and innovation performance, as well as an integral theoretical model of innovative leadership, knowledge management, and innovation performance for driving continuous innovation performance has been developed.

A Feasibility Study Of Administering The Electronic Research And Development Culture Index To The Multidisciplinary Workforce In A UK Teaching Hospital

Purpose

The study aims were: (i) to convert the Research and Development Culture Index (a validated rating instrument for assessing the strength of organizational Research and Development culture) into electronic format (eR&DCI), and (ii) to test the format and assess the feasibility of administering it to the multidisciplinary (allied health professionals, doctors and nurses) workforce in a National Health Service Hospital (NHS) in the United Kingdom (UK) by trialing it with the workforce of the tertiary Children’s Hospital within the organization.

Population and methods

The eR&DCI was emailed to all professional staff (n=907) in the Children’s Hospital. Data were analyzed using IBM SPSS Statistics 22.

Results

The eR&DCI was completed by 155 respondents (doctors n=38 (24.52%), nurses n=79 (50.96%) and allied health professionals (AHPs) n=38 (24.52%)). The response rate varied by professional group: responses were received from 79 out of 700 nurses (11%); 38 out of 132 doctors (29%) and 38 out of 76 AHPs (50%). Index scores demonstrated a positive research culture within the multidisciplinary workforce. Survey responses demonstrated differences between the professions related to research training and engagement in formal research activities.

Conclusion

This is the first study to assess the feasibility of assessing the strength of an organization’s multidisciplinary workforce research and development (R&D) culture by surveying that workforce using the eR&DCI. We converted the index to “Online Surveys” and successfully administered it to the entire multidisciplinary workforce in the Children’s Hospital. We met our criteria for feasibility: ability to administer the survey and a response rate comparable with similar studies. Uptake could have been increased by also offering the option of the paper-based index for self-administration. Results of the survey are informing delivery of the research strategy in the Children’s Hospital. This methodology has potential application in other healthcare contexts.

Using the Plan, Do, Study, Act cycle to enhance a patient feedback system for older adults

Patient feedback about healthcare experiences has gained increasing attention as an essential and meaningful source of information for identifying gaps and developing effective action plans for improving the quality of care. As experiences differ across patient groups, flexible and responsive feedback systems are essential. The population of older adults is growing rapidly; it constitutes an increasing proportion of the NHS client base. This group wants to have a say in their care and their views are critical in any performance assessment of a modern healthcare system. Nevertheless, collecting feedback data from older adults presents unique challenges, due to chronic conditions and comorbidities involving vision, hearing, speech and cognitive processing. In addition, nurses often find it difficult to act on feedback data in order to make quality improvements. This difficulty is associated with poor leadership, absence of explicit targets and an action plan, and the nature of clinical change required. This article offers insight into the development of a local innovation centred on enhancing the feedback system in a medical rehabilitation ward for older adults. A model for improvement in the form of the Plan, Do, Study, Act (PDSA) cycle provided a structured learning approach to facilitate the planning, testing, analysing and refining of the feedback system.

Nurse educators' perceived organizational factors affecting their psychological empowerment: An exploratory qualitative study

BACKGROUND

Organizational culture affects nurse educators' psychological empowerment. Limited research exists on the organizational culture and psychological empowerment in nursing educational environments and about the type of organizational factors affecting nurse educators' psychological empowerment.

AIM

To explore nurse educators' perceived organizational factors that affect their psychological empowerment.

METHODS

A qualitative descriptive exploratory study was drawn from a larger sequential exploratory-mixed-methods study. Semi-structured interviews were conducted with 12 educators with both clinical and educational experience. The data were analyzed using thematic analysis.

RESULTS

We generated three themes: poor organizational structure, dynamics of educators-academic administrators' relations, and educational tools and physical environment. The educators perceived factors were poor organizational structure, lack of collaboration across institutions and regulatory bodies, condescending attitudes of administrators and educators toward novice educators, limited teaching aids and scholarly resources, poorly defined roles, and underdeveloped and inconsistent curricula.

CONCLUSIONS

The identified organizational factors should be addressed to enhance educators' psychological empowerment so that they can effectively teach students. Emphasis should be placed on developing collaboration among educators, academic administrators, and regulatory bodies to address these factors. Further quantitative research is warranted to assess the degree and strength of association of these factors with psychological empowerment.

Strategic elements of residency training in China: transactional leadership, self-efficacy, and employee-orientation culture

BACKGROUND

The standardized training of resident physicians in China is significant and robust. During the training, clinical teachers act as leaders. The training taking place in public hospitals requires a transactional leadership style (TLS), but existing research studies seldom analyze how to promote residents' performance from this perspective.

METHODS

Two hundred and ninety six new residents undertaking standardized training were recruited from five tertiary hospitals in two provinces of China. Hierarchical moderated and mediated regression analyses were used to test the hypotheses. The hypotheses include that TLS is positively related to the training performance; mediating effect of self-efficacy and moderating effect of employee-orientation organizational culture (EOC) are significant.

RESULTS

(1) Two kinds of teachers' TLS, punishment and reward, have significant positive influence on residents' performance. (2) Self-efficacy of residents partly mediates the positive relationship. (3) EOC moderates the relationship between the punitive behavior of clinical teachers with TLS and the self-efficacy of the residents.

CONCLUSIONS

Empirical evidence has shown the positive relationship between teachers' TLS and residents' performance outcomes in China. Teachers can enhance training performance by promoting self-efficacy of residents. This study also advances our understanding of EOC by examining the demonstrated moderating effects of cultural background in the relationship between teachers' TLS and the self-efficacy of residents.

Validation of the nurse leadership and organizational culture (N-LOC) questionnaire

Background

Leadership style and organizational culture have often been studied independently in nursing research despite abundant evidence that the two factors both influence employee outcomes. Moreover, diverse theoretical typology and measuring instruments challenges generalizability of findings. Employees from different cultural, geographical, occupational settings were also reported to have varying interpretation on organizational culture and leadership style underlying constructs. This study aims to validate the Nursing Leadership and Organizational Culture (N-LOC) questionnaire, based on the two commonly used theoretical frameworks: Multifactor Leadership Theory and Competing Values Framework, on its applicability in an Asian hospital setting.

Methods

All full-time nurses from two distinctive Asian hospitals (H1: n = 295 and H2: n = 1146) were invited to participate in this questionnaire study. Exploratory factor analysis (EFA) was carried out when confirmatory factor analysis (CFA) fit indices were not satisfactory after model refinement to explore the actual underlying construct in sampled population. Part-time and outsourced nurses were excluded. 93 nurses from H1 were randomly selected for test-retest reliability 4 weeks post initial survey. Scale internal consistency, convergent and discriminant validity were also assessed.

Results

CFA results indicated that the proposed CVF organizational culture 4-factor structure was applicable to our sample but not the MLQ leadership 3-factor/9-factor structure. EFA revealed a 2-factor leadership style construct for our sample, named Confucius transformational and Laissez-Faire passive leadership. Transformational leadership traits already embedded in Confucius cultural values (self-sacrifice, stresses collective mission, instills pride) did not apply, the new Confucius transformational construct which resembles LMX theory paternalistic leadership style is deemed more suitable in an Asian context. A final 14-item 2-factor leadership and 13-item 4-factor organizational culture construct was yielded with satisfactory fit indices (CFI, TLI > 0.95, RMSEA < 0.08), internal consistency (Cronbach’s alpha > 0.7), test-retest reliability (ICC > 0.4) and convergent and discriminant validity.

Conclusion

A reliable N-LOC organizational culture and leadership questionnaire (N-LOC) has been validated in an Asian nurse context. Study results demonstrated the importance of scale validation in cross-cultural adaptation, as underlying scale constructs may change with specific cultural and contextual factors. Future studies are encouraged to test the adaptation of this scale in other cultural and occupational settings.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4290-z) contains supplementary material, which is available to authorized users.

The interrelationships among organizational culture and service quality under different levels of competitive intensity

Purpose

This study aims to investigate the interrelationships among organizational culture and service quality by applying the SERVQUAL instrument under different levels of competitive intensity in the shipping industry context.

Design/methodology/approach

This study used the questionnaire investigation method to evaluate the hypothesized relationships. The authors utilized widely accepted and validated instruments as identified in the literature to measure the constructs under examination. The sample consisted of 684 shipping organizations located in Greece. The factorial structures of the constructs were identified through exploratory and confirmatory factor analyses, while the examined relationships were established through regression analyses.

Findings

The findings argue in favor of a parsimonious three-dimensional structure of the SERVQUAL instrument in the shipping industry context, illustrate the associations among the different types of organizational culture and the dimensions of service quality and explicate how the former impacts the latter. Moreover, the findings showed that the above-mentioned interrelationships are conditioned by the varying levels of competitive intensity.

Originality/value

Although much research and writing has occurred on the topics of service quality and organizational culture, relatively less is known about their interrelationships, that is how a company’s culture relates to the service quality offered especially under different levels of competitive intensity. Thus, the current study aims to fill in this gap in the literature and empirically address the need to look at the interrelationships among the theoretical constructs under examination.

The role of organizational attractiveness in an internal market-oriented culture (IMOC): a study of hospital frontline employees

Background

Hospitals need to understand how to reduce their frontline employees’ turnover rate as well as how to positively engage them and improve their service. Central to these issues, we find, is the employees’ perception of their organization’s attractiveness. This objective of this paper is to clarify how the role of organizational attractiveness relates to frontline employees’ perception of their internal market-oriented culture as well as their turnover rate, engagement, and service quality. To our knowledge, no previous research has explored the role of organizational attractiveness from a frontline employee perspective in health-service organizations.

Methods

The conceptual framework we developed was tested in a quantitative study. We sent a questionnaire to nurses in several public hospitals in Norway. We then analyzed the data with confirmatory factor analysis and structural equation modeling in Stata. Further, we performed multi-group comparisons to test heterogeneity in personal characteristics. The indirect effects were tested by mediator analyses.

Results

We made three main findings. First, organizational attractiveness has a significant positive effect on frontline employees’ engagement (β = 0.833) as well as on the service quality they provide to hospital patients (β = 0.472). Additionally, it significantly lowers their turnover rate (β = − 0.729). Second, the ‘internal market-oriented culture’ (IMOC) has a significantly positive effect on organizational attractiveness (β = 0.587) and explains a total of 35% of the variance in organizational attractiveness. Third, organizational attractiveness fully mediates the relationship between “internal market-oriented culture” (IMOC) and frontline employees’ engagement and the service quality they provide to patients, and it partially mediates the relationship with the turnover rate.

Conclusions

This study proves that organizational attractiveness is vital for hospital managers to focus on, as it affects employees’ perception of whether the organizations is a great place to work. It reveals the need for those same managers to develop an internal market-oriented culture (IMOC) directed toward hospital frontline employees, as it has both a direct effect on organizational attractiveness and an indirect effect on employees’ engagement, turnover intention, and service quality.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4144-8) contains supplementary material, which is available to authorized users.

Challenges facing healthcare leadership in attaining accreditation of teaching hospitals

PURPOSE

This paper aims to examine the challenges faced by health-care leadership in teaching hospitals in attaining accreditation for their institutions.

DESIGN/METHODOLOGY/APPROACH

This paper is based on a study of current literature on health-care leadership, hospital accreditation and quality of patient care and identifies the challenges facing health-care leadership in attaining accreditation for teaching hospitals.

FINDINGS

Based on a review and analysis of literature, infrastructure, finance, legal support, workforce recruitment and training, documentation and technology are identified as challenges faced by health-care leadership in teaching hospitals. The key challenges facing health-care leadership with respect to medical education and clinical research are found to be integration of education into hospital operations, compliance with all regulatory and professional requirements and adequacy of resources in executing research programs.

ORIGINALITY/VALUE

This study draws the attention of health-care leadership in teaching hospitals on the challenges they face in obtaining accreditation for their institutions so that they may develop appropriate strategies to overcome them.

Hypothesis Testing of CNA Perceptions of Organizational Culture in Long Term Care

This commentary for the special issue on research that went wrong describes a study that explored factors that contribute to variability within Certified Nursing Assistants (CNAs) on organizational safety culture. We know from previous research that CNAs provide most direct care in nursing homes and that direct care workers often experience agency culture differently from agency management (Wolf et al., 2014). We were looking for factors that nursing homes could alter to improve the culture for CNAs, and thus, residents. We conducted a secondary analysis of data collected via a multi-component paper survey of CNAs employed in long term care. We used results from the Nursing Home Survey on Patient Safety Culture and primary shift, type of unit, and years as a CNA to identify modifiable characteristics that would explain variability in the perceptions of patient safety culture. The final sample included n = 106 from three nursing homes. Dimension scores were compared using bivariate tests appropriate to the scale and ordinal logistic regression. Despite support in the literature for the hypothesis, we found few significant differences on the total scale within groups. Differences in perceptions have implications for quality of care and the experiences of residents within nursing homes.

Individual and Occupational Differences in Perceived Organisational Culture of a Central Hospital in Vietnam

Many hospitals in developing countries, including Vietnam, are facing the challenges of increasingly noncommunicable diseases and the financial autonomy policy from the government. To adapt to this new context requires understanding and changing the current organisational culture of the hospitals. However, little has been known about this in resource-constrained healthcare settings. The objectives of this study were to examine the four characteristics of the organisational culture and test selected individual and occupational differences in the organisational culture of a Vietnam central hospital. In a cross-sectional study using the Organisation Culture Assessment Instrument (OCAI) with the Competing Value Framework (CVF), including 4 factors, Clan, Adhocracy, Hierarchy, and Market, health workers currently working at Quang Nam General Hospital were interviewed. The results indicated the current cultural model was more internally focused with two dominant cultures, Clan and Hierarchy, while, for the desired model, the Clan culture was the most expected one. Comparing between the current and desired pattern, the down trend was found for all types of culture, except the Clan culture, and there were significant differences by domains of organisational culture. Furthermore, the current and desired models were differently distributed by key individual characteristics. These differences have raised a number of interesting directions for future research. They also suggest that, to build a hospital organisational culture to suit both current and future contexts as per employees' assessment and expectation, it is important to take individual and institutional variations into account.

Interprofessional team member's satisfaction: a mixed methods study of a Chilean hospital

INTRODUCTION

The health organizations of today are highly complex and specialized. Given this scenario, there is a need for health professionals to work collaboratively within interprofessional work teams to ensure quality and safe care. To strengthen interprofessional teamwork, it is imperative that health organizations enhance strategic human resources management by promoting team member satisfaction.

OBJECTIVE

To analyze the satisfaction of members in interprofessional teams and to explore interpersonal relationships, leadership, and team climate in a hospital context.

METHODOLOGY

This study is an explanatory sequential mixed methods (quantitative/qualitative) study of 53 teams (409 professionals) at a university hospital in Santiago, Chile. The first phase involved quantitative surveys with team members examining team satisfaction, transformational leadership, and team climate. Social network analysis was used to identify interactions among team members (cohesion and centrality). The second phase involved interviews with 15 professionals belonging to teams with the highest and lowest team satisfaction scores. Findings of both phases were integrated.

RESULTS

Significant associations were found among variables, and the linear regression model showed that team climate (β = 0.26) was a better predictor of team satisfaction than team leadership (β = 0.17). Registered nurse was perceived as the profession with the highest score on the transformational leadership measure (mean = 64), followed by the physician (mean = 33). Team networks with the highest and lowest score of team satisfaction showed differences in cohesion and centrality measures. Analysis of interviews identified five themes: attributes of interprofessional work; collaboration, communication, and social interaction; interprofessional team innovation; shared leadership; and interpersonal relationship interface work/social. Integration of findings revealed that team member satisfaction requires participation and communication, common goals and commitment for patient-centered care, clear roles and objectives to support collaborative work, and the presence of a transformational leader to strengthen well-being, dialog, and innovation.

CONCLUSIONS

Results have the potential to contribute to the planning and decision-making in the field of human resources, providing elements to promote the management of health teams and support team member satisfaction. In turn, this could lead to job permanence especially where the local health needs are more urgent.

Job satisfaction of nurses with master of nursing degrees in Poland: quantitative and qualitative analysis

BACKGROUND

Understanding the issue of job satisfaction of nurses with master of nursing degrees may help develop organisational changes necessary for better functioning of health care institutions. This study aimed to evaluate the level of job satisfaction among holders of Masters of Nursing degrees employed at health care institutions and to ascertain its determinants.

METHODS

The cross-sectional study was carried out in randomly selected health care institutions in Poland using the Misener Nurse Practitioner Job Satisfaction Survey and an original survey questionnaire with two open-ended questions. Quantitative data were analysed using descriptive and summary statistics.

RESULTS

The participants gave highest satisfaction ratings to their relationships with direct superiors and other nurses, as well as their social contacts at work. The lowest ratings were given to the pension scheme and factors connected with remuneration. A highly statistically significant relationship was found between the job classification and the level of professional satisfaction (p < 0.001). Qualitative analysis of responses to the two open-ended questions supported Herzberg's Two-Factor theory: internal factors promoted satisfaction, whilst external ones caused dissatisfaction.

CONCLUSIONS

Managers of nurses should strengthen the areas that contribute to higher employee satisfaction, particularly interpersonal relationships, by commendation and recognition of work effects.

Health workers' perceptions of private-not-for-profit health facilities' organizational culture and its influence on retention in Uganda

BACKGROUND

An in-depth understanding of how organizational culture is experienced by health workers (HWs), and influences their decisions to leave their jobs is a fundamental, yet under-examined, basis for forming effective retention strategies. This research examined HWs' working experiences and perceptions of organisational culture within private-not-for-profit, largely mission-based hospitals, and how this influenced retention.

METHODS

Thirty-two HWs, including managers, in 19 health facilities in Uganda were interviewed using a semi-structured topic guide. Interview transcripts were analysed using thematic content analysis.

RESULTS

Interviews showed that the organizational culture was predominantly hierarchical, with non-participative management styles which emphasized control and efficiency. HWs and managers held different perceptions of the organizational culture. While the managers valued results and performance, HWs valued team work, recognition and participative management.

CONCLUSIONS

The findings of this study indicate that organizational culture influences retention of HWs in health facilities and provide a useful context to inform health care managers in the PNFP sub-sector in Uganda and similar contexts. To improve retention of HWs, a gradual shift in organizational culture will be necessary, focussing on the values, beliefs and perceptions which have the greatest influence on observable behaviour.

Variables associated with work performance in multidisciplinary mental health teams

OBJECTIVES

This study investigates work performance among 79 mental health teams in Quebec (Canada). We hypothesized that work performance was positively associated with the use of standardized clinical tools and clinical approaches, integration strategies, "clan culture," and mental health funding per capita.

METHODS

Work performance was measured using an adapted version of the Work Role Questionnaire. Variables were organized into four key areas: (1) team attributes, (2) organizational culture, (3) inter-organizational interactions, and (4) external environment.

RESULTS

Work performance was associated with two types of organizational culture (clan and hierarchy) and with two team attributes (use of standardized clinical tools and approaches).

DISCUSSION AND CONCLUSION

This study was innovative in identifying associations between work performance and best practices, justifying their implementation. Recommendations are provided to develop organizational cultures promoting a greater focus on the external environment and integration strategies that strengthen external focus, service effectiveness, and innovation.

Antecedents of Relationship Conflict in Cross-Functional Project Teams

Relationship conflict is a pervasive phenomenon in cross-functional project teams. Although previous studies have demonstrated the dysfunctional effect of relationship conflict, the direct drivers of relationship conflict in cross-functional project teams remain unclear. To address this gap, a literature review and an advisory group discussion were performed to identify the antecedents of the relationship conflict framework. Afterward, a structural equation model (SEM) was used to confirm the influence of such antecedents on relationship conflict. Intrapersonal diversity, uncertain project task, organizational culture diversity, and inappropriate behavior positively influence relationship conflict. These findings help researchers better understand the drivers of relationship conflict as well as open a gateway for practitioners to control and manage relationship conflict for a successful cross-functional project.

The Impact of Organizational Commitment and Nursing Organizational Culture on Job Satisfaction in Korean American Registered Nurses

PURPOSE

This study aimed to describe the perceived level of organizational commitment and organizational culture of Korean American Registered Nurses (KARNs) and to investigate predictors of job satisfaction.

DESIGN

A total of 163 KARNs working in U.S. hospitals responded to a Web survey. Descriptive analysis, t test, analysis of variance, and stepwise regressions were used for data analysis.

RESULTS

KARNs reported moderate levels of job satisfaction (3.5 ± 0.58). Job satisfaction was positively correlated with both organizational commitment ( r = .85, p < .001) and culture ( r = .66, p < .001). KARNs who were aged ≥50, married, hospital-employed, had longer nursing experience, and experienced turnover at least once were more likely to report higher job satisfaction compared with other nurses. Organizational commitment, culture, marital status, and workplace were significant predictors of and explained 76.8% of the variance in job satisfaction.

CONCLUSION

This study provides evidence to help nursing managers and health policy makers develop educational programs aimed at enhancing job satisfaction and retention of KARNs.

Values-Based Leadership Effectiveness in Culturally Diverse Workplaces

Purpose

The extant literature is replete with suggestions, findings, etc., about how best to manage or lead a culturally diverse workforce. However, very few studies have focused explicitly on leading with values in a workplace that may be fraught with disparate cultural value systems. In this paper we assess, conceptually, the relative effectiveness of values-based leadership (VBL) in culturally diverse workplaces and attempt to provide an answer to the questions: What factors determine the effectiveness of VBL in culturally diverse workplaces and what is the probability that VBL will be effective in a culturally diverse workplace?

Design/methodology/approach

We explore VBL within the context of two models. The first model assesses the relative effectiveness of VBL in culturally diverse workplaces from a deterministic perspective. The second model assesses VBL effectiveness from a probabilistic perspective. At the core of the deterministic model is the notion that the relative effectiveness of VBL can be determined by the cultural recompositioning of a firm's workforce. At the core of the second model is the notion that the likelihood of VBL effectiveness can be derived when conditions are created by the interface of the ethnic identity salience of culturally diverse workers and the organizational culture of the firm.

Findings

A conceptual finding from the deterministic model is that the relative effectiveness of VBL is determined by the historical level of cultural diversity in a firm’s workforce and the rate at which cultural recompositioning takes place in its workforce. A question addressed by the probabilistic model is: What factors create conditions for assessing the likelihood of VBL effectiveness? A conceptual finding from the probabilistic model is that the strength of a firm’s organizational culture and the ethnic identity salience of culturally diverse workers are two major factors that create these conditions.

Research limitations/implications

One of the major theoretical implications/contributions is the deterministic and probabilistic models introduce new variables (i.e., historically level of cultural diversity in the workforce, rate of cultural recomposition, strength of workers’ ethnic identity salience, and strength of organizational culture) that have the potential to enhance our understanding of VBL by adding to the list of possible determinants of its effectiveness as well as the conditions under which it is likely to be effective. One limitation is the conceptual nature of the models. Empirical validation of the models will be required to test the veracity of the propositions derived from them.

Practical implications

A major implication for practice is the need for leaders to develop a values management strategy. Such a strategy entails developing or having a strong set of core values for the organization, clearly communicating those values, and having reward and management systems to reinforce those values. This strategy implies that once implemented the tendency for culturally distinct workers (incoming and existing) to identify with their own values will decrease and the tendency for them to identify with the values of the organization will increase.

Originality/value

Prior studies have not fully explored the conditions under which VBL is likely to be effective in culturally diverse workplaces. Since diversity in the workplace is considered one of the main challenges for human resource management, the models we discuss address a very timely issue and provide a framework that leaders in organizations around the globe might use to better understand and manage the relationships described in the models. This under-explored topic represents a major gap in the literature. Helping to narrow this gap is an important contribution that our conceptual study makes to the literature related to this topic.

Burnout, Engagement, and Organizational Culture: Differences between Physicians and Nurses

BACKGROUND:

Burnout results from a prolonged response to chronic emotional and interpersonal workplace stressors. The focus of research has been widened to job engagement.

AIM:

Purpose of the study was to examine associations between burnout, job engagement, work demands, and organisational culture (OC) and to demonstrate differences between physicians and nurses working in general hospital in Skopje, Republic of Macedonia.

MATERIAL AND METHODS:

Maslach Burnout Inventory and Utrecht Work Engagement Scale were used for assessment of burnout and job engagement. Work demands and OC were measured with Hospital Experience Scale and Competing Values Framework, respectively.

RESULTS:

Higher scores of dedication, hierarchy OC, and organizational work demands were found in physicians. Nurses demonstrated higher scores of clan OC. Burnout negatively correlated with clan and market OC in physicians and nurses. Job engagement positively correlated with clan and market OC in nurses. Different work demands were related to different dimensions of burnout and/or job engagement. Our findings support job demands-resources (JD-R) model (Demerouti and Bakker).

CONCLUSIONS:

Data obtained can be used in implementation of specific organizational interventions in the hospital setting. Providing adequate JD-R interaction can lead to prevention of burnout in health professionals (HPs) and contribute positively to better job engagement in HPs and higher quality of patient care.

A path analysis study of retention of healthcare professionals in urban India using health information technology

BACKGROUND

Healthcare information technology (HIT) applications are being ubiquitously adopted globally and have been indicated to have effects on certain dimensions of recruitment and retention of healthcare professionals. Retention of healthcare professionals is affected by their job satisfaction (JS), commitment to the organization and intention to stay (ITS) that are interlinked with each other and influenced by many factors related to job, personal, organization, etc. The objectives of the current study were to determine if HIT was one among the factors and, if so, propose a probable retention model that incorporates implementation and use of HIT as a strategy.

METHODS

This was a cross-sectional survey study covering 20 hospitals from urban areas of India. The sample (n = 586) consisted of doctors, nurses, paramedics and hospital administrators. Data was collected through a structured questionnaire. Factors affecting job satisfaction were determined. Technology acceptance by the healthcare professionals was also determined. Interactions between the factors were predicted using a path analysis model.

RESULTS

The overall satisfaction rate of the respondents was 51 %. Based on factor analysis method, 10 factors were identified for JS and 9 factors for ITS. Availability and use of information technology was one factor that affected JS. The need for implementing technology influenced ITS through work environment and career growth. Also, the study indicated that nearly 70 % of the respondents had awareness of HIT, but only 40 % used them. The importance of providing training for HIT applications was stressed by many respondents.

CONCLUSION

The results are in agreement with literature studies exploring job satisfaction and retention among healthcare professionals. Our study documented a relatively medium level of job satisfaction among the healthcare professionals in the urban area. Information technology was found to be one among the factors that can plausibly influence their job satisfaction and intention to stay. Based on the results of the study, a retention strategy has been suggested that utilizes implementation of HIT and provision of training to influence the retention of healthcare workers.

Relationship of organizational culture, teamwork and job satisfaction in interprofessional teams

BACKGROUND

Team effectiveness is often explained on the basis of input-process-output (IPO) models. According to these models a relationship between organizational culture (input = I), interprofessional teamwork (process = P) and job satisfaction (output = O) is postulated. The aim of this study was to examine the relationship between these three aspects using structural analysis.

METHODS

A multi-center cross-sectional study with a survey of 272 employees was conducted in fifteen rehabilitation clinics with different indication fields in Germany. Structural equation modeling (SEM) was carried out using AMOS software version 20.0 (maximum-likelihood method).

RESULTS

Of 661 questionnaires sent out to members of the health care teams in the medical rehabilitation clinics, 275 were returned (41.6%). Three questionnaires were excluded (missing data greater than 30%), yielding a total of 272 employees that could be analyzed. The confirmatory models were supported by the data. The results showed that 35% of job satisfaction is predicted by a structural equation model that includes both organizational culture and teamwork. The comparison of this predictive IPO model (organizational culture (I), interprofessional teamwork (P), job satisfaction (O)) and the predictive IO model (organizational culture (I), job satisfaction (O)) showed that the effect of organizational culture is completely mediated by interprofessional teamwork. The global fit indices are a little better for the IO model (TLI: .967, CFI: .972, RMSEA .052) than for the IPO model (TLI: .934, CFI: .943, RMSEA: .61), but the prediction of job satisfaction is better in the IPO model (R(2) = 35%) than in the IO model (R(2) = 24%).

CONCLUSIONS

Our study results underpin the importance of interprofessional teamwork in health care organizations. To enhance interprofessional teamwork, team interventions can be recommended and should be supported. Further studies investigating the organizational culture and its impact on interprofessional teamwork and team effectiveness in health care are important.

Head nurses’ decision-making when managing ethical dilemmas

Purpose

– The purpose of this paper is to characterize issues related to head nurses’ decision making when managing ethical dilemmas.

Design/methodology/approach

– The study is qualitative descriptive, in which researchers stay close to the data. The data were collected in the format of unstructured written reflections. Inductive conventional latent qualitative content analysis was applied to the data.

Findings

– The issues of head nurses’ management of decision making in ethical dilemmas relate to the following aspects: taking risks in deviating from the formalities, balancing power and humaneness, maintaining the professional hierarchy, managing resistance to change, managing with limited options, and experiencing the decline of nurse’s professional and/or human dignity.

Research limitations/implications

– Reflections in written form were preferred to semi-structured interviews and the researchers were unable to contact the participants directly and to ask additional questions. All the reflections were produced in a language other than English.

Practical implications

– The issues of head nurses’ management of decision making in ethical dilemmas reveal the gap between societal expectations and the opportunities to improve nursing leadership in health care organizations.

Social implications

– The issues of head nurses’ decision making when managing ethical dilemmas are related to contexts that reflect the attitudes of society and health care system toward nursing management.

Originality/value

– The study adds to the understanding of issues of the management of decision making in ethical dilemmas. It is an ongoing systematic process that encourages head nurses to learn from practice and manage the quality of care by empowering themselves and nurses to take responsibility for leadership.

Organizational culture in general hospitals and its relationship with job satisfaction

Introduction: Organizational culture is formed via communication, resolving conflicts, team work and interconnection. The aim of the study was to present the connections between organizational culture and job satisfaction indicators. Methods: A quantitative descriptive approach was used. The study included nursing employees and medical practitioners in six Slovenian hospitals. A 30 per cent quota sample was used, with a response rate of 35.2 % (n = 310). The Organization Culture Assessment Instrument (OCAI) (α = 0,818) and Index of Work Satisfaction (α = 0,921) questionnaires were used. The data was processed with SPSS 20.0 statistical software by using the t-test, single variance analysis, correlation, factor and regression analysis. Results: The greatest total average value among employees of both job groups with regard to organizational culture was the market (x = 28.21) and hierarchy (x = 27.57). Job satisfaction indicators (collaboration, leadership, decision-making, autonomy) can be explained in 20 % of cases with adhocracy organizational culture (β = 0.318, p < 0.001), market (β = 0.219, p < 0.001) and clan (β = 0.161, p = 0.006). Discussion and conclusion: In Slovenian hospitals, control over work, abiding by the rules and attaining, goals prevails. An overview of the literature reveals the influence of culture on satisfaction. Other factors affecting satisfaction, including stress and abuse of hierarchical power, should be studied.

The Influence of Organizational Culture on Job Satisfaction of Administrative Employees at a Public Hospital

The case study aims in outlining the organizational culture that exists at a General Hospital of Larissa in Greece, measuring the satisfaction which the administrative employees of the hospital acquire through their job and correlating these two variables.

The total population of the survey was the 100 administrative employees that work in General Hospital of Larissa. The survey was conducted during May and June 2013. The research tools used were the questionnaires developed by Cameron and Quinn (1999) and Spector (1994).

Regarding the organizational culture, the survey revealed that the dominant culture in a General Hospital of Larissa is the culture of Hierarchy, while the desired culture differs from the derailing one. On the other hand, the participants appear to have low levels of job satisfaction, mainly regarding their satisfaction by their rewards. Finally, the study proved statistically that the organizational culture of General Hospital of Larissa does not seriously influences the job satisfaction of the administrative employees of the hospital.

The culture of an emergency department: an ethnographic study

In an environment of change and social interaction, hospital emergency departments create a unique sub-culture within healthcare. Patient-centered care, stressful situations, social gaps within the department, pressure to perform, teamwork, and maintaining a work-life balance were examined as influences that have developed this culture into its current state. The study aim was to examine the culture in an emergency department. The sample consisted of 34 employees working in an emergency department, level II trauma center, located in the Southeastern United States. An ethnographic approach was used to gather data from the perspective of the cultural insider. Data revealed identification of four categories that included cognitive, environmental, linguistic, and social attributes that described the culture. Promoting a culture that values the staff is essential in building an environment that fosters the satisfaction and retention of staff. Findings suggest that efforts be directed at improving workflow and processes. Development and training opportunities are needed to improve relationships to promote safer, more efficient patient care. Removing barriers and improving processes will impact patient safety, efficiency, and cost-effectiveness. Findings show that culture is influenced and created by multiple elements.