Leader–member exchange and organizational climate effects on clinician turnover intentions

Impact of decentralized management on sickness absence in hospitals: a two-wave cohort study of frontline managers in Danish hospital wards

BACKGROUND

This study explores the impact of decentralized management on the sickness absence among healthcare professionals. Sickness absence is a reliable indicator of employees' wellbeing and it is linked to management quality. However, the influence of decentralized management on sickness absence has not been adequately studied.

METHODS

The research design combined a two-wave, web-survey of frontline managers in two Danish university hospitals with administrative data on sickness absence at the ward-level. The first and second wave included data from 163165 and 137 frontline managers linked to 121 wards and 108 wards. Data was analysed using an ordinal logistic regression model.

RESULTS

Wards where frontline managers had the highest level of decentralised decision authority compared to none showed lower odds of ward-level sickness absence (ORcrude: 0.20, 95% CI: 0.05-0.87). A very high extent of cross-functional decision authority showed lower odds of sickness absence (ORcrude: 0.08, 95% CI: 0.01-0.49). Overall, the results showed a clear data trend, although not all results were statistically significant.

CONCLUSION

Higher levels of decentralized management in wards were positively associated with lower risks of sickness absence in hospital wards. The study supports future research on how to empower decision autonomy at the frontline level of management.

Managers' Micro-Communities Matter: The Impact of Clinical Supervision Team on Therapist Perception of the Organization

Positive organizational climate - employee perceptions of their work environment and the impact of this environment on well-being and functioning - is associated with desirable organizational and client-level outcomes in mental health organizations. Clinical supervisors are well-positioned to impact organizational climate, as they serve as intermediaries between higher-level administrators who drive the policies and procedures and the therapists impacted by such decisions. This cross-sectional study examined the role of clinical supervisors as drivers of therapist perceptions of organizational climate within supervisory teams. Specifically, the present study investigated: (1) shared perceptions of organizational climate among therapists on the same supervisory team; (2) predictors of therapist climate perceptions. Eighty-six therapists were supervised by 22 supervisors. Indices of interrater agreement and interrater reliability of therapists on the same supervisory team were examined to determine shared or distinct perceptions of organizational climate. Multi-level models were used to examine whether supervisor attitudes towards evidence-based practices and therapist perceptions of supervisor communication predicted perceived organizational climate. Results showed perceptions of organizational cohesion and autonomy were shared among therapists on the same supervisory team and distinct from therapists on different supervisory teams. Therapist perceptions of their supervisor's communication was positively associated with perceptions of organizational cohesion and autonomy. These findings align with emerging evidence that middle managers shape their employees' experience of their work environment through communication strategies. These findings also point to the potential for intervening at lower organizational levels to improve overall organizational climate.

Sustaining the collaborative chronic care model in outpatient mental health: a matrixed multiple case study

BACKGROUND

Sustaining evidence-based practices (EBPs) is crucial to ensuring care quality and addressing health disparities. Approaches to identifying factors related to sustainability are critically needed. One such approach is Matrixed Multiple Case Study (MMCS), which identifies factors and their combinations that influence implementation. We applied MMCS to identify factors related to the sustainability of the evidence-based Collaborative Chronic Care Model (CCM) at nine Department of Veterans Affairs (VA) outpatient mental health clinics, 3-4 years after implementation support had concluded.

METHODS

We conducted a directed content analysis of 30 provider interviews, using 6 CCM elements and 4 Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) domains as codes. Based on CCM code summaries, we designated each site as high/medium/low sustainability. We used i-PARIHS code summaries to identify relevant factors for each site, the extent of their presence, and the type of influence they had on sustainability (enabling/neutral/hindering/unclear). We organized these data into a sortable matrix and assessed sustainability-related cross-site trends.

RESULTS

CCM sustainability status was distributed among the sites, with three sites each being high, medium, and low. Twenty-five factors were identified from the i-PARIHS code summaries, of which 3 exhibited strong trends by sustainability status (relevant i-PARIHS domain in square brackets): "Collaborativeness/Teamwork [Recipients]," "Staff/Leadership turnover [Recipients]," and "Having a consistent/strong internal facilitator [Facilitation]" during and after active implementation. At most high-sustainability sites only, (i) "Having a knowledgeable/helpful external facilitator [Facilitation]" was variably present and enabled sustainability when present, while (ii) "Clarity about what CCM comprises [Innovation]," "Interdisciplinary coordination [Recipients]," and "Adequate clinic space for CCM team members [Context]" were somewhat or less present with mixed influences on sustainability.

CONCLUSIONS

MMCS revealed that CCM sustainability in VA outpatient mental health clinics may be related most strongly to provider collaboration, knowledge retention during staff/leadership transitions, and availability of skilled internal facilitators. These findings have informed a subsequent CCM implementation trial that prospectively examines whether enhancing the above-mentioned factors within implementation facilitation improves sustainability. MMCS is a systematic approach to multi-site examination that can be used to investigate sustainability-related factors applicable to other EBPs and across multiple contexts.

The Effect of Transformational, Transactional, and Laissez-Faire Leadership Styles on Employees' Level of Performance: The Case of Hospital in Oromia Region, Ethiopia

Purpose

Poor performance of health service providers has a negative impact on the ability of health systems to produce desired outcomes. Lack of suitable and impactful leadership hinders employee performance in terms of providing a high standard of care. There is a paucity of evidence on the effect of leadership style on employee performance in the current study setting. Hence, this study sought to assess the effect of leadership styles on employee performance in hospitals in the Oromia region, Ethiopia, from August 1 to October, 30, 2021.

Methods

A cross-sectional study was conducted using a sample of 41 hospitals and 412 employees, selected by stratified sampling from hospitals in the Oromia region. The data were collected using self-administered questionnaires. They were then coded and entered into the Epi-Info-7.2. software, and exported to SPSS-20 for analysis. The participants' characteristics were analyzed and summarized using descriptive statistics. Employee performance was rated as low, average or high, and estimated by proportion along with a 95% confidence interval (CI). The association between leadership styles and the level of employee performance was modelled using ordinal logistic regression. The magnitude of association was estimated by odds ratio with a 95% CI. Statistical significance was set at p < 0.05.

Results

Employees had an increased odds of being a high performer when they experienced the following leadership styles: transformational with idealized influence (AOR=1.70; 95% CI: 1.12, 2.64), intellectual stimulation (AOR=1.60; 95% CI: 1.04, 2.48), laissez-faire approach (AOR=2.49; 95% CI: 1.71,3.62), effectiveness in terms of frequently fulfilling employees' job-related needs (AOR=2.09; 95% CI: 1.20,3.63), and the exertion of extra effort in motivating them (AOR=2.11; 95% CI: 1.22, 3.68).

Conclusion

Among leadership styles, transformational with idealized influence and intellectual stimulation, laissez-faire approaches were significantly associated with employee performance. However, transactional leadership was not significantly associated with employee performance.

Engaging to innovate: an investigation into the implications of engagement at work on innovative behaviors in healthcare organizations

PURPOSE

Organizational innovation relies on the employees' active participation in improving extant processes and practices. In particular, it has been argued that employees' engagement triggers innovation-oriented behaviors at work. Nevertheless, there is a paucity of evidence of the implications of work engagement on the health professionals' innovation propensity. The article intends to push forward what we currently know about this issue, providing some food for thought to scholars and practitioners.

DESIGN/METHODOLOGY/APPROACH

A path analysis based on ordinary least square (OLS) regression and 10,000 bootstrap samples was designed to investigate the direct and indirect implications of employees' engagement on innovative behaviors at work in a large sample of health professionals operating in Europe. The quality of employee-manager relationships and the organizational climate were included as mediating variables affecting the relationship between work engagement and propensity to innovation-oriented behaviors.

FINDINGS

The research findings highlighted that being engaged at work fosters the willingness of health professionals to partake in the improvement of organizational processes and practices. The positive implications of employees' engagement on innovative behaviors at work are catalyzed by good employee-manager relationships and a positive organizational climate.

PRACTICAL IMPLICATIONS

Healthcare organizations should uphold the health professional's engagement to enhance their innovation potential. Targeted interventions are needed to merge work engagement with the enhancement of the organizational environment in which health professionals accomplish their activities. A positive organizational climate enacts an empowering work environment, which further incentivizes innovation.

ORIGINALITY/VALUE

The article adopts a micro-level perspective to investigate the triggers of innovative behaviors among healthcare professionals, providing evidence which is relevant for theory and practice.