The effects of organizational commitment and structural empowerment on patient safety culture

The relationship between organizational commitment and work engagement among clinical nurses in China: A cross-sectional study

AIM

This study aims to investigate the levels of organizational commitment and work engagement among clinical nurses in tertiary hospitals and explore the relationship between them.

BACKGROUND

The nursing literature supports the idea that organizational commitment plays an important role in positively influencing job performance. However, the relationship between organizational commitment and work engagement among clinical nurses remains unclear.

METHODS

This was a cross-sectional study. A convenience sample of clinical nurses (n = 621) was selected from five tertiary hospitals in Sichuan Province of China. Survey instruments included a general information questionnaire about organizational commitment and work engagement. Univariate analysis, correlation analyses and linear regression analysis were used to examine the association between organizational commitment and work engagement.

RESULTS

The mean scores for organizational commitment and work engagement were 3.85 ± 0.59 and 4.58 ± 1.46, respectively. A moderate degree of positive correlation was found between them. Gender, monthly income and retention commitment were significantly associated with work engagement, and they accounted for 39.0% of the total variance.

CONCLUSIONS

Clinical nurses had a moderate level of organizational commitment and a high level of work engagement. Organizational commitment positively influenced work engagement; that is, organizational commitment is a significant determinant of nurses' work engagement.

IMPLICATIONS FOR NURSING MANAGEMENT

Hospital organizations should focus on assessing and strengthening nurses' organizational commitment to promote increased work engagement and, ultimately, improved quality of care. This may include, but is not limited to, increasing rest time for nurses, implementing a performance appraisal system and focusing on nurses' psychological state.

How Work-Family Conflict Influenced the Safety Performance of Subway Employees during the Initial COVID-19 Pandemic: Testing a Chained Mediation Model

This study examined the impact of work-family conflict on subway employees' safety performance during the initial wave of the COVID-19 pandemic. We proposed a chain mediation model in which job burnout and affective commitment play mediating roles in this process. Using questionnaire data from 632 Chinese subway employees during February 2020, structural equation modeling analyses were performed. The analyses showed that work-family conflict had a significant negative impact on subway employee safety performance. Moreover, job burnout completely mediated the influence of work-family conflict on safety performance, while affective commitment only partially mediated the influence of job burnout on safety performance. These findings suggest the important role played by Work-Family balance during the pandemic and contribute to a deeper understanding of the inner mechanisms. We also discussed several practical implications for organizations to reduce the negative impact of work-family conflict on safety performance.

Organizational commitment of emergency physician and its related factors: A national cross-sectional survey in China

Background

Organizational commitment is important for job performance and employee retention. However, studies on the level of organizational commitment and its related factors among emergency physicians in China are scarce. Therefore, this study aimed to identify the factors associated with organizational commitment among emergency physicians in China.

Methods

A national cross-sectional study was conducted in 2018 among emergency physicians in China. Data were collected from 10,457 emergency physicians using a standard structured anonymous questionnaire, including demographic characteristics, organizational structure factors and work environment factors. A generalized linear model was used to explore the correlation between the independent variables and organizational commitment.

Results

In this study, 55.3% of emergency physicians reported a moderate level of organizational commitment. The physicians who were male, younger than 40 years old, had a mid-level title and had a lower average monthly income were more likely to show lower organizational commitment levels. Conversely, the organizational commitment was higher among physicians who perceived that promotion is easy and the number of emergency physicians meet their daily work or had not experienced workplace violence in the last year.

Conclusions

The study showed that organizational commitment among Chinese emergency physicians was moderate and related to gender, age, monthly income, frequency of daily visits, departmental promotion mechanism and workplace violent. Targeted interventions are needed to improve the organizational commitment of emergency physicians in a comprehensive way.

Psychological Safety and Affective Commitment Among Chinese Hospital Staff: The Mediating Roles of Job Satisfaction and Job Burnout

Purpose

The affective commitment of hospital staff is important for human resources management and the sustainable development of hospitals. Psychological safety is an important factor that contributes to an emotional connection to an organization among staff, yet its functional mechanism remains unclear. This study explored how psychological safety influenced affective commitment through the mediating roles of job satisfaction and job burnout.

Methods

A battery of surveys were administered to all medical staff (n = 267) in a local second-grade comprehensive hospital. The surveys included the Psychological Safety Scale, Affective Commitment Scale, Minnesota Satisfaction Questionnaire, Maslach Burnout Inventory–Human Service Survey, and Perceived Organizational Support Scale.

Results

Job satisfaction and job burnout fully mediated the relationship between psychological safety and affective commitment among hospital staff. In addition, perceived organizational support moderated the mediating path via job burnout, and the indirect effect of job burnout decreased when perceived organizational support increased.

Conclusion

Psychological safety may enhance the affective commitment of hospital staff through improving job satisfaction or reducing job burnout. Perceived organizational support may counteract the deleterious effect of job burnout on affective commitment. Effective strategies to improve affective commitment among hospital staff may require consideration of job burnout and job satisfaction.

Organizational Commitment and Intention to Leave of Nurses in Portuguese Hospitals

Intention to leave is influenced by the commitment and individual and structural factors. It is a critical dimension in health systems due to the shortage of professionals and the potential impact on the quality of care. The present paper: (i) characterizes organizational commitment and intention to leave; (ii) analyzes the relationship between structural factors (such as, work environment and nurse staffing), individual factors (age), and nurses’ organizational commitments and intention to leave; and (iii) analyzes the differences in the intention to leave and in the organizational commitment according to service specialty, nurses’ specialization, and contractual relationship in Portuguese public hospitals. A cross-sectional study was conducted with a sample of 850 nurses from 12 public hospitals units. The results show a high affective and continuance commitment of nurses with the hospital, and a reduced tendency of the intention to leave. A significant positive association was also found between the intent to leave and individual/structural factors. Organizational commitment and intention to leave levels are satisfactory, despite the influence of several factors, such as nurse staffing, work environment, or other opportunities for professional development. The results identify particularly sensitive areas that, through adequate health and management policies, can reduce nurses’ intentions to leave and promote the sustainability of the health system.

How does job mobility relate to work commitment among rural healthcare workers? a cross-sectional study in western China

Background

Rural healthcare workers (RHWs) are the core of the rural health system. The antecedents of turnover of RHWs have been well studied, but little is known about the consequences of job mobilities among RWHs. This study aimed to identify the association between job mobility and the work commitment of RHWs in China.

Methods

Based on a three-stage random sampling method, a cross-sectional survey was conducted in 11 western provinces in China. A total of 3783 RHWs, consisting of 2245 doctors and 1538 nurses, were included in our study. Confirmatory factor analysis, Pearson’s chi-squared test, one-way ANOVA, linear regression analysis, and binary logistic regression analysis were performed for data analyses.

Results

46.3% of RHWs reported the experience of job mobility in the past. Work commitment of RHWs was not very high; specifically, the mean scores of pride in, concern for, and dedication to work were 3.54, 3.81, and 3.61 (out of a maximum of 5), respectively, and 29.9% presented turnover intent. RHWs’ overall experience of job mobility in the past was significantly associated with an increased odds of having the turnover intent. With respect to the last job mobilities of RHWs, the last job changes that occurred in the last 3 years, especially these lateral (i.e., job changes between two healthcare institutions at the same hierarchical level) and upward (i.e., job changes from a healthcare institution at a lower hierarchical level to current institution) mobilities, were significantly associated with a high level of work commitment (i.e., pride in, concern for, and dedication to work) among RHWs. However, the lateral mobilities in the last four to 5 years and the downward mobilities (i.e., job changes from a healthcare institution at a higher hierarchical level to current institution) 6 years ago or more significantly increased the odds of having turnover intent among RHWs, and RHWs whose last job changes were other mobilities (i.e., job changes from a non-healthcare institution to a healthcare institution) in the last four to 5 years reported had a significantly low level of pride in and concern for work and an increased odds of having the turnover intent.

Conclusions

The study suggests that the overall experience of job mobility in the past is a threat to RHWs’ work commitment to their current healthcare institutions. The honeymoon-hangover pattern exists in the association between a single job change and RHWs’ work commitment. Managers of rural healthcare institutions should pay more attention to these RHWs with the experience of job mobility to enhance their work commitment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07166-w.

Assessment of the Psychometric Properties of the Organisational Commitment Scale for Physicians in Pakistan

This study assesses the psychometric properties of Allen and Meyer's three-component model of organizational commitment focusing on physicians in Pakistan and explores the determinants of each form of commitment. The cross-sectional study implemented a self-reported questionnaire at a hospital in Pakistan. Data were collected from 478 permanently employed physicians. This study offers evidence for the generalizability of this model to the health sector, particularly for physicians. Age, experience, and qualification explained the higher commitment levels. This study suggests adjustments to the commitment scale for physicians. Hospital administrations should formulate effective strategies at individual levels to enhance commitment.

The Relationship between Achievement Motivation and Job Performance among Chinese Physicians: A Conditional Process Analysis

Background

To explore the relationship between achievement motivation and job performance among physicians, this study investigated the impacts of different personality traits on job performance among the physicians.

Methods

This cross-sectional study was conducted in 2017 and 1,523 physicians from eight tertiary grade A hospitals in Harbin, China. The type of data collected included the achievement motivation of the physicians, job performance, organizational commitment, personality traits, and other demographic variables. To assess and compare the demographic data, independent t-test and ANOVA were applied. Further, Pearson correlation coefficients were used to evaluate the correlation among the variables. Moderated mediation analysis was performed to test the correlation among the job performance, achievement motivation, organizational commitment, neuroticism, extraversion, openness, agreeableness, and conscientiousness.

Results

Achievement motivation directly influences job performance and organizational commitment partially mediates the direct effects of achievement motivation on job performance. Additionally, our findings demonstrated that agreeableness and conscientiousness moderate the strength of the relationships between achievement motivation and job performance mediated by organizational commitment.

Conclusion

We propose that hospital managers should pay attention to the personal growth of the physicians and improve their organizational commitment via creating a positive working climate and training for career planning and education. Moreover, managers should identify conscientiousness and agreeableness individuals and increase their responsibilities geared towards improving the performance of the organization.

The Association Between Health Care Staff Engagement and Patient Safety Outcomes: A Systematic Review and Meta-Analysis

OBJECTIVES

Despite decades of research, improving health care safety remains a global priority. Individual studies have demonstrated links between staff engagement and care quality, but until now, any relationship between engagement and patient safety outcomes has been more speculative. This systematic review and meta-analysis therefore assessed this relationship and explored if the way these variables were defined and measured had any differential effect.

METHODS

After systematic searches of Medline, CINAHL, PsycInfo, Embase, Cochrane Library, and National Institute for Health Research Journals databases, narrative and random-effects meta-analyses were completed, with pooled effect sizes expressed as Pearson r.

RESULTS

Fourteen studies met the inclusion criteria, 11 of which were suitable for meta-analysis. Meta-analyses indicated a small but consistent, statistically significant relationship between staff engagement and patient safety (all outcomes; 11 studies; r = 0.22; 95% confidence interval [CI], 0.07 to 0.36; n = 30,490) and 2 patient safety outcome categories: patient safety culture (7 studies; r = 0.22; 95% CI, 0.01 to 0.41; n = 27,857) and errors/adverse events (4 studies; r = -0.20; 95% CI, -0.26 to -0.13; n = 2633). The specific approach to conceptualizing engagement did not affect the strength of the findings.

CONCLUSIONS

This is the first review to demonstrate a significant relationship between engagement and both safety culture scores and errors/adverse events. Despite a limited and evolving evidence base, we cautiously conclude that increasing staff engagement could be an effective means of enhancing patient safety. Further research is needed to determine causality and clarify the nature of the staff engagement/patient safety relationship at individual and unit/workgroup levels.

Staff Working Life and Older Persons' Satisfaction With Care: A Multilevel, Correlational Design

BACKGROUND

The importance of staff working life for staff well-being has been demonstrated in several studies; less research has focused on staff working life and older persons' satisfaction with care.

PURPOSE

The study aim was to study relationships between 1) staff assessments of their structural conditions/empowerment in elderly care, psychological empowerment, and job satisfaction and (2) older persons' satisfaction with care.

METHODS

A multilevel, cross-sectional, and correlational design was applied using questionnaire data on working life (1021 staff members) and unit-level data (40 elderly care units) on older persons' satisfaction with care.

RESULTS

Statistically significant relationships were found between all 3 working life variables and older persons' satisfaction with care. Furthermore, the results revealed an indirect/mediating effect of job satisfaction between structural empowerment and satisfaction with care, but not for psychological empowerment.

CONCLUSIONS

Staff structural empowerment, psychological empowerment, and job satisfaction are linked to older persons' satisfaction with care.

Structural empowerment of nurses in the hospital setting

OBJECTIVE

to measure the level of structural empowerment of nurses working in a university hospital.

METHOD

a descriptive, analytical, and cross-sectional study, carried out with 237 nurses, who developed care and management activities. Data collection took place through a self-administered questionnaire with questions on the personal and professional characterization and the Work Effectiveness Conditions Questionnaire II. Data analysis used descriptive and inferential statistics.

RESULTS

it was identified that nurses have a moderate level of structural empowerment (18.06±SD 0.9). The greatest value was obtained in the Opportunity dimension (4.08±SD 0.8), followed by the Resources (3.17±SD 0.8) and Informal power (3,04±SD 0.9) dimensions; while the scores of Support (2.67±SD 1.0), Formal power (2.59±SD 0.9), and Information (2.51±SD 0.9) were lower.

CONCLUSION

the level of structural empowerment of the nurses was moderate, which means partial access to opportunities, resources, support, and information of the institution.

Organizational commitment among physicians: A systematic literature review

PURPOSE

Physicians work increasingly in larger organizations across different health care delivery systems. This systematic review examines the published empirical literature on organizational commitment among physicians within an international context.

DESIGN

A systematic, PRISMA-guided review examining studies of organizational commitment among physicians published over time. Four article databases and a combination of appropriate search terms aided in identifying relevant articles.

FINDINGS

Key findings include: (a) physicians, regardless of country, personal characteristics, type of job, or place of employment generally have lower levels of organizational commitment than other health care workers; (b) work- and job-related variables, particular age and job satisfaction, shape physicians' organizational commitment; and (c) organizational commitment and the factors that shape it are similar across physicians working in different health systems.Review implications: Organizational commitment should remain central for researchers to study in most health systems internationally. Larger samples, longitudinal research, and greater use of theory are design improvements that will strengthen the extant research. The findings imply that if healthcare organizations create workplaces that make physicians feel in control, do not overwhelm them with work, provide a supportive culture, enhance their ability to give input, and keep them job satisfied, they may gain enhanced organizational commitment.Originality and value: To our knowledge, this is the first review of research examining organizational commitment among physicians. It is a resource for researchers and managers interested in learning more about aligning physician thinking and behavior with health care organizations.

Continuing medical education and work commitment among rural healthcare workers: a cross-sectional study in 11 western provinces in China

OBJECTIVES

Continuing medical education (CME) and work commitment are important for rural healthcare workers (RHWs) and rural medical work. The significant association between continuing education and work commitment has been reported in many studies from several different industries. However, very few studies have analysed the association of CME with work commitment among healthcare workers, let alone among RHWs. This study aimed to identify the significance of CME for the work commitment of RHWs (doctors and nurses) in China.

DESIGN AND SETTING

The cross-sectional study interviewed RHWs from 11 western provinces in China.

PARTICIPANTS

In total, 4118 RHWs, consisting of 2490 doctors and 1628 nurses who were working clinically, were included in the study.

PRIMARY OUTCOME MEASURES

Work commitment (ie, the relative importance of work to one's sense of self) focussing on the affective component was the dependent variable, and it included four subdomains: pride, concern, and dedication, extracted by exploratory factor analysis of a 5-point Likert scale, and turnover intent, measured by a dichotomous question. CME (ie, a variety of educational and training activities to maintain, develop or increase knowledge, skills and professional performance and relationships) was the independent variable, including three subdomains: opportunity, participation and expectation, measured by three dichotomous questions.

RESULTS

Of the 4118 respondents, 91.2% reported insufficient opportunities for CME, 21.3% had never participated in CME and 83.3% had a high expectation of CME. The mean scores of pride in, concern for and dedication to work were 3.54, 3.81 and 3.61 (out of a maximum of 5), respectively, and 30.6% presented turnover intent. After adjusting for gender, age, marriage, education, technical title, income and type of rural healthcare organisation, the multivariate analyses suggested that there was a significant positive association between CME and work commitment among RHWs. RHWs who had a significant high-level work commitment were those who reported a sufficient opportunity for CME (β and 95% CI for pride in, concern for and dedication to work: 0.33, 0.23 to 0.43; 0.19, 0.09 to 0.28; and 0.25, 0.15 to 0.35), had participated in CME (β and 95% CI for pride in, concern for and dedication to work: 0.11, 0.04 to 0.19; 0.09, 0.02 to 0.15; and 0.10, 0.03 to 0.17) and had a high expectation of CME (β and 95% CI for pride in, concern for and dedication to work: 0.22, 0.15 to 0.30; 0.21, 0.13 to 0.28; and 0.28, 0.20 to 0.36), and having sufficient opportunities for CME significantly increased the odds of having no turnover intent (OR and 95% CI: 1.70, 1.26 to 2.28). Age, marriage, education, technical title, income and type of rural healthcare organisation were significantly associated with the work commitment of RHWs. Differences were observed between rural doctors and nurses in the association of CME with work commitment.

CONCLUSIONS

CME has a significant positive association with the work commitment of RHWs in China. RHWs' work commitment should be further improved in future rural health workforce management. In addition, governments, healthcare organisations and professional associations should establish a professional and complete CME system in China to provide sufficient opportunities for CME for RHWs, encourage them to participate and meet their expectations.

Improving patient safety in two French hospitals: why teamwork training is not enough

PURPOSE

The persistent challenges that healthcare organizations face as they strive to keep patients safe attests to a need for continued attention. To contribute to better understanding the issues currently defying patient safety initiatives, this paper reports on a study examining the aftermath of implementing a national team training program in two hospital units in France.

DESIGN/METHODOLOGY/APPROACH

Data were drawn from a longitudinal qualitative study analyzing the implementation of a French patient safety program aimed at improving teamwork in hospitals. Data collection took place over a four-year period (2015-2019) in two urban hospitals in France and included multiple interviews with 31 participants and 150 h of observations.

FINDINGS

Despite explicit efforts to improve inter-professional teamwork, three main obstacles interfered with healthcare professionals' attempts at safeguarding patients: perspectival variations in what constituted "patient safety", a paradoxical injunction to do more with less and conflicting organizational priorities.

ORIGINALITY/VALUE

This paper exposes patient safety as misleadingly consensual and identifies a lack of alignment between stakeholders in the complex system that is a hospital. This ultimately interferes with patient safety objectives and highlights that even well-equipped, frontline actors cannot achieve long-term results without more systemic organizational changes.

Association between organizational citizenship behavior and patient safety culture from nurses' perspectives: a descriptive correlational study

Background

Nurses play a key role in providing patient safety. It is known that patient safety requires the improvement of patient safety culture, which can be a difficult process. One of the current challenges of hospitals is to explore the ways to improve patient safety culture. Organizational citizenship behaviors are one of the factors, which can develop organizational culture including safety culture; however, its role is not well established.

Methods

In this cross-sectional study, a stratified random sample of 214 nurses was selected from a largest teaching hospital in west of Iran. The institutional research board approved the study protocol. Data were collected using three self-report questionnaires: demographic information; hospital survey on patient safety culture (HSPSC); and organizational citizenship behaviors questionnaire. Data were analyzed using Spearman’s correlation coefficient test in SPSS (α < 0.05).

Results

Organizational citizenship behaviors were found to be at an intermediate level (56.84 ± 16.22). However, some of its dimensions, including sportsmanship, civic virtue, and courtesy, were at weak levels (< 50%). The mean percentage of positive responses to the patient safety culture was 49.00 ± 14.01. The patient safety culture had significant positive correlations with organizational citizenship behaviors (r = 0.349, P = 0.001) and dimensions of altruism (r = 0.255, P = 0.001), civic virtue (r = 0.434, P = 0.001), and courtesy (r = 0.214, P = 0.001).

Conclusion

Our findings proposed the hypothesis that OCB has a statistical significant impact on PSC. Low levels of civic virtue, sportsmanship and courtesy behaviors may be indicative low nurses’ interest in participating in organizational affairs and nurses’ low attention to measures that prevent harm to their organization. It is recommended that nursing managers focus more on these dimensions, identifying influintioal factors and taking appropriate management measures to promote these behaviors. If our findings are confirmed in future studies, nursing managers can consider the development of organizational citizenship behaviors as one of the managerial approaches for promoting a patient safety culture.

Multilevel Analysis of Individual, Organizational, and Regional Factors Associated With Patient Safety Culture: A Cross-Sectional Study of Maternal and Child Health Institutions in China

Supplemental digital content is available in the text.

The aim of this study was to assess patient safety culture (PSC) in maternal and child health (MCH) institutions in China and its individual, organizational, and regional variations.

Exploring the differential impact of individual and organizational factors on organizational commitment of physicians and nurses

BACKGROUND

Physician and nursing shortages in acute and critical care settings require research on factors which might drive their commitment, an important predictor of absenteeism and turnover. However, the degree to which the commitment of a physician or a nurse is driven by individual or organizational characteristics in hospitals remains unclear. In addition, there is a need for a greater understanding of how antecedent-commitment relationships differ between both occupational groups. Based on recent findings in the literature and the results of a pilot study, we investigate the degree to which selected individual and organizational characteristics might enhance an employee's affective commitment working in the field of neonatal intensive care. Moreover, our aim is to examine the different antecedent-commitment relationships across the occupational groups of nurses and physicians.

METHODS

Information about individual factors affecting organizational commitment was derived from self-administered staff questionnaires, while additional information about organizational structures was taken from hospital quality reports and a self-administered survey completed by hospital department heads. Overall, 1486 nurses and 540 physicians from 66 Neonatal Intensive Care Units participated in the study. We used multilevel modeling to account for different levels of analysis.

RESULTS

Although organizational characteristics can explain differences in an employee's commitment, the differences can be largely explained by his or her individual characteristics and work experiences. Regarding occupational differences, individual support by leaders and colleagues was shown to influence organizational commitment more strongly in the physicians' group. In contrast, the degree of autonomy in the units and perceived quality of care had a larger impact on the nurses' organizational commitment.

CONCLUSIONS

With the growing number of hospitals facing an acute shortage of highly-skilled labor, effective strategies on the individual and organizational levels have to be considered to enhance an employee's commitment to his or her organization. Regarding occupational differences in antecedent-commitment relationships, more specific management actions should be undertaken to correspond to different needs and aspirations of nurses and physicians.

TRIAL REGISTRATION

German Clinical Trials Register ( DRKS00004589 , date of trial registration: 15.05.2013).

How to improve healthcare? Identify, nurture and embed individuals and teams with "deep smarts"

Purpose Unlocking and transferring skills and capabilities in individuals to the teams they work within, and across, is the key to positive organisational development and improved patient care. Using the "deep smarts" model, the purpose of this paper is to examine these issues. Design/methodology/approach The "deep smarts" model is described, reviewed and proposed as a way of transferring knowledge and capabilities within healthcare organisations. Findings Effective healthcare delivery is achieved through, and continues to require, integrative care involving numerous, dispersed service providers. In the space of overlapping organisational boundaries, there is a need for "deep smarts" people who act as "boundary spanners". These are critical integrative, networking roles employing clinical, organisational and people skills across multiple settings. Research limitations/implications Studies evaluating the barriers and enablers to the application of the deep smarts model and 13 knowledge development strategies proposed are required. Such future research will empirically and contemporary ground our understanding of organisational development in modern complex healthcare settings. Practical implications An organisation with "deep smarts" people - in managerial, auxiliary and clinical positions - has a greater capacity for integration and achieving improved patient-centred care. Originality/value In total, 13 developmental strategies, to transfer individual capabilities into organisational capability, are proposed. These strategies are applicable to different contexts and challenges faced by individuals and teams in complex healthcare organisations.