International Journal of Workplace Health ManagementExploring the link between organisational justice and job satisfaction and performancein Ghanaian hospitals: Do demographic factors play a mediating role?Gordon Abekah-Nkrumah Roger Ayimbillah Atinga
Article information:To cite this document:Gordon Abekah-Nkrumah Roger Ayimbillah Atinga , (2013),"Exploring the link between organisationaljustice and job satisfaction and performance in Ghanaian hospitals", International Journal of WorkplaceHealth Management, Vol. 6 Iss 3 pp. 189 - 204Permanent link to this document:http://dx.doi.org/10.1108/IJWHM-04-2011-0011
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Exploring the link betweenorganisational justice and jobsatisfaction and performance
in Ghanaian hospitalsDo demographic factors play a mediating role?
Gordon Abekah-Nkrumah and Roger Ayimbillah AtingaDepartment of Public Administration and Health Services Management,
University of Ghana Business School, Legon, Ghana
Abstract
Purpose – The purpose of this paper is to examine whether organisational justice (distributivejustice, procedural justice and interactional justice) predicts job satisfaction and performance of healthprofessionals and whether the demographic characteristics of hospital employees mediate the relationshipbetween workplace justice and job satisfaction and performance.Design/methodology/approach – Questionnaires were administered to a sample of 300respondents in seven hospitals using convenient sampling. Hypotheses were tested using multipleand hierarchical regression models.Findings – The paper established that distributive justice, procedural justice and interactional justicepredict job satisfaction and performance of health professionals. However, their demographiccharacteristics are shown to partially mediate the relationship between organisational justice and jobsatisfaction but not performance.Originality/value – Granted that other studies exist, this is one of the few that focuses on hospitalsand probably the first of its kind in Ghanaian hospitals. Thus the findings could be essential for policyand practice and also generate further discourse that may improve the extant literature and ourunderstanding of the subject.
Keywords Justice, Job satisfaction, Performance, Workplace, Ghana, Fairness
Paper type Research paper
IntroductionThe need for managers to maintain fairness in organisations has been emphasised by anumber of writers (Liao and Rupp, 2005; Suliman, 2007). Organisations cannot succeedin achieving their objectives without management commitment in exercisingworkplace justice. Organisational justice may be defined as an employee’sperception of fairness and equal treatment within an organisation. In the context oforganisational management, fairness and equal treatment have been shown to have animportant effect on human resource management. Latham and Pinder (2005) observedthat when employees perceive they are treated fairly, they become committed with lowturnover intentions. Extant literature also demonstrate a significant relationshipbetween organisational justice and employees work performance (Lind et al., 1990;Philips et al., 2001; Alder and Tompkins, 1997), job satisfaction (Cropanzano et al., 2001;Moorman, 1991; McFarlin and Sweeney, 1992), commitment to work (Folger andKonovsky, 1989) and employee behaviour in organisations (Moorman, 1991). On thecontrary, lower levels of organisational justice engender employee dissatisfaction,resentment and even bitterness against the organisation (Homans, 1982; Bies and
The current issue and full text archive of this journal is available atwww.emeraldinsight.com/1753-8351.htm
Received 2 April 2011Revised 13 October 2011
Accepted 11 May 2012
International Journal of WorkplaceHealth Management
Vol. 6 No. 3, 2013pp. 189-204
r Emerald Group Publishing Limited1753-8351
DOI 10.1108/IJWHM-04-2011-0011
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Moag, 1986; Rae and Subramaniam, 2008). This has the tendency to create hostility andsocial loathing which can degenerate into loss of confidence in the organisation leadingto workplace defiance (Dietz et al., 2003). Perceived injustices can also result in poorquality of work (Cowherd and Levine, 1992) and weak solidarity among employees(Pfeffer and Langton, 1993).
It is very crucial to maintain fairness in healthcare organisations to stimulatequality of care. Achieving this would require managers with multiplicity of skills tomanage the different professional groups who have diverse needs, orientation andidiosyncrasies. The challenge of maintaining fairness and equal treatment in hospitalsmust, however, be acknowledged. Attention is often focused on tangible factors such asremuneration to the neglect of equally more important intangible ones such as equaltreatment for all. This has the potential to diminish the morale of employees therebyaffecting their output. Maintaining equal treatment among the different cadre of healthprofessionals could further be exacerbated especially in developing countries likeGhana where societal values in certain instances tend to influence organisationalmanagement. For example, a study by Gyekye and Salminen (2005) on responsibilityassignment at the workplace in Ghana and Finland found that, the workplaceenvironment in the former is characterised by a hierarchical system based oninequality, paternalism and submission to authority. They argued that the influenceof the Ghanaian subculture on workplace practice and decision making tends to bepreponderated by managers who are sometimes autocratic and did not collaborate orconsult with subordinates (Gyekye and Salminen, 2005). Thus, subordinates are oftencompelled to accept certain managerial decisions even if such decisions are not in theirinterest. Another study in Ghana and Uganda discovered that organisational justice ispositively related to organisational effectiveness though there were human factorswithin the two countries with concomitant effect on organisational effectiveness(Acquaah and Tukamushaba, 2009).
Findings of these two studies albeit crucial are generalised and do not necessarilybroaden our knowledge on workplace fairness, in the hospital setup. Thus the dearthof empirical studies on organisational justice within the hospital setting in Ghanaprovides a unique research opportunity for the execution of this study. This papertherefore seeks to examine the influence of the facets of organisational justice on jobsatisfaction and performance of health workers and whether their demographiccharacteristics mediates the relationship between organisational justice and jobsatisfaction and performance. The first part of the paper introduces the theoreticalframework of organisational justice and its composite elements, distributive,procedural and interactional justice. The rest of the paper is structured to describethe methodology of the study, empirical results, discussion and policy implications.
Theoretical frameworkOrganisational justice is described as employees’ perception of how an organisationtreats them with fairness (Campbell and Finch, 2004). A highly leveraged approachto understanding the concept was suggested by Moorman (1991), who observed thatorganisational justice is concerned with employees’ determination of how they havebeen fairly treated on the job and the manner in which such determinants influenceother work-related variables. Different theories have been propounded to explainthe concept of organisational justice. The equity theories (Adams, 1965; Organ andMoorman, 1993; Konovsky and Pugh, 1994), social exchange theory (Homans, 1961),relative deprivation theory (Martin, 1981), justice motive theory (Lerner, 1977) and the
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justice judgement model (Leventhal, 1976) are all fundamental to understandingorganisational justice and its significance in the workplace. Based on these theories,three components of organisational justice have been identified in the literature:distributive justice, procedural justice and interactional justice. Although manyorganisational theorists have placed emphasis on distributive and procedural justice asyardstick for determining fairness and better employee performance (Gilliland, 1993;Schmitt and Dorfel, 1999; Andrews and Kacmar, 2001; Aryee et al., 2004; Lam et al.,2002; Fearne et al., 2005), the interactional aspect is also essential in explaining the linkbetween managers and subordinates as well as performance. These three componentsare further discussed as follows.
Distributive justiceHoman (1961) refers to distributive justice as the allocation of resources. Others,however, contend that it represents employee perception of fairness of the outcomethat they receive from the organisation (Folger and Cropanzano, 1998). Leventhal(1976) suggested that outcome may be distributed according to need, equity orcontribution. Thus individual employees are able to establish the extent of fairness ofsuch distribution through comparison with others (Adams, 1965; Cropanzano andGreeberg, 1997; Campbell and Finch, 2004). Studies have shown that distributivejustice manifest in several areas such as decisions relating to pay and promotion(Folger and Greeberg, 1985; Folger and Konovsky, 1989), courtroom pronouncements(Thibaut and Walker, 1975) as well as citizens’ assessment of certain decisions arrivedat by government representatives, justices of the courts and police officers (Tyler andCaine, 1981; Tyler and Folger, 1980). Distributive justice is often considered importantbecause unfair distribution of outcome could have dire consequences includingdisputes, distrust, disrespect and other social problems among employees and theirmanagers (Suliman, 2007). Moreover unfair allocation of resources or opportunitiesdiminishes employee morale, since perceived input does not commensurate with theoutput they receive from the organisation. In distributing organisational outcomesamongst employees in the context where discretion is permitted, there may be thetemptation for management to tilt their decisions in favour of certain demographicgroup of employees. However, Rawls (1999) contends that individual characteristicssuch as place of birth, social status and family influences come as a matter of luckand should therefore not be given space to influence the benefits that an individual isexpected to receive in life. He maintained that the aim of distributive justice is tosubmerge the influence of these characteristics so that resources can be fairlydistributed to everyone’s satisfaction.
Procedural justiceProcedural justice entails employee perception of motives, methods, mechanism andprocesses used in determining outcomes (Folger and Cropanzano, 1998) or moreprecisely fairness of the procedure involved in making decisions (Folger and Greeberg,1985). Procedural justice is widely recognised as an important issue in anyorganisational setting (Tang and Sarsfield-Baldwin, 1996; Mossholder et al., 1998).As suggested by Brockner and Siegel (1996) positive individual views on the processesand procedures involved in determining outcome are associated with higher levelsof trust in the organisation and its managers. Conversely studies have establishedthe negative ramifications of non-observance of procedural justice. Indeed, the wordsof Lin and Tyler (1988) are insightful in this context: “organisations that ignore
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procedural justice concerns run the risk of engendering negative organisationalattitudes, dissatisfaction with organisational outcomes of decisions, non-compliancewith rules and procedures, and in some instances low performance”. A conceptualapproach to understanding the issue of procedural justice was provided by Tyler andBies (1990), who identified five factors that shape employee’s perception of proceduraljustice in an organisation:
. tolerating the opinion of employees;
. decision making based on an approach that is consistent;
. impartiality;
. effective feedback; and
. explanation of decisions taken.
Interactional justiceElovainio et al. (2001) referred to interactional justice as relational justice. Bies andMoag (1986) on their part portray interactive justice as the manner of treatment thatemployees receive from their managers. Free flow of information within theorganisation also describes interactional justice. Communication between managersand their employees enjoins the former to take into consideration the concerns of thelatter, listening to their needs and displaying empathy and understanding towardsthem. When managers exhibit considerable amount of care towards their employees,it serves as a morale booster bridging the manager-subordinate gap and leadingsteadily to higher performance. Suliman (2007) categorised inter-relational justice asfairness, employee-employee relationship and organisation-employee relationship.Suliman continued that an employee’s perception of how fair a decision or an outcomeis has the tendency to influence his or her behaviour and performance. Employee-employer relationship is concerned with effective flow of communication betweenemployees and their managers. In healthcare, multiple channels of communicationare important due to numerous treatment errors that may occur as a result ofineffective interaction among teams of healthcare providers in the hospital (Kohn et al.,1999; Coiera, 2000). In certain instances communication gaps exist amongst healthprofessionals through non-sharing of information. The consequence of which isinefficiency and ineffectiveness of service delivery (Borrill et al., 2001). It is argued thatthe degree in which information is transmitted and received effectively throughcommunication plays a key part in accomplishing work results (Rakich et al., 1992).Tang and Sarsfield-Baldwin (1996) particularly placed emphasis on communicationbetween the manager and the employee by maintaining that establishing a workplaceenvironment that is transparent, honest and responsive to all employees creates a senseof ownership. In sum, communication provides employees and managers with vitalinformation needed to make decisions. Figure 1 is a framework conceptualisingmeasures of the facets of organisational justice.
The importance of maintaining fairness in organisational management is to createtrust between managers and employees. The trust between employees and theirmanagers could stimulate job satisfaction and performance (Suliman, 2007). Indeedstudies have concluded that job satisfaction plays a greater role in influencingemployee behaviour and work outcomes. Lum et al. (1998) identified the configurationof job satisfaction to encompass: work, pay, quality of work, supervision,
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organisational commitment, participation and organisational climate. Theoretically,organisational justice (distributive justice, procedural justice and interactional justice)influences an employee’s performance and satisfaction. However, the link betweenorganisational justice and employee satisfaction and performance could be mediatedby certain socio-demographic characteristics. For example, variables like job tenureand experience on the job have been shown to be significant mediating factors of jobsatisfaction (Kavanaugh et al., 2006). Additionally, Rawls (1999) identified place ofbirth, social status and family influences as possible moderating factors. In this study,we used factors such as age, education, professional background and hospital tenureas moderating variables of organisational justice and employee satisfaction andperformance. The rationale for focusing on these variables is that due to thepaternalistic subculture in the Ghanaian work place, age could easily be a factor foreliciting compliance from subordinates and perhaps perpetuating unfairness andinequality. Additionally, in the hospital environment in Ghana, a person’s professionalassociation (i.e. medical, paramedical, support staff, etc.), educational level and hospitaltenure may interact to determine preferential treatment. From the foregoing discussionwe hypothesise as follows:
H1. Staff perception of organisational justice (distributive, procedural andinteractional justice) influences their satisfaction with job and self-perceivedperformance.
H2. Characteristics of hospital staff (age, education, profession and hospital tenure)are likely to moderate the effect of organisational justice on employee’s self-perceived performance and job satisfaction.
The context of healthcare in GhanaHealthcare in Ghana is provided largely by the government through tertiary referralhospitals, district hospitals, community health centres and clinics but missionhospitals and clinics also play an important role. There are also private for profits
Organisationaljustice
Distributivejustice
Proceduraljustice
Interactionaljustice
Fairness of outcome
No favouritism in resourceallocation
Fairness of decision making
Employee involvement indecision making
Tolerance of employee views
Caring
Employee-employee communication
Manager-employee communication
Figure 1.Measures of the facets
of organisational justice
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hospitals but they provide o2 per cent of health services in the country. The GhanaHealth Service (GHS) regulates the activities of public hospitals. Over the last twodecades, efforts of the GHS to ensure that patients have access to quality care is marredby distributional imbalances of health professionals across the country characterisedby large health worker-population ratio. In 2009 for instance, one doctor wasresponsible for a population of 11,929 (Ghana Health Service, 2009). Most of the trainedhealth professionals are working in the cities and towns to the disadvantage of ruralareas. Generally, an estimated 65 per cent of doctors and 40 per cent of nurses work inGreater Accra and Kumasi, though 33 per cent of the population of Ghana lives in thesecities (Awofeso, 2010). Unlike nurses, doctors are virtually not part of healthcaredelivery in rural health facilities. Coverage of health facilities has also been relativelylow especially in rural and deprived areas with undesirable consequence to therealisation of the right to healthcare and improved health outcomes.
Administration of health service in Ghana is highly decentralised in a top-downstructure comprising five levels: national, regional, district, sub-district andcommunity (Ackon, 2003). The Central Ministry of Health (MOH) is the governingbody with the mandate to formulate policies for the health sector, determine prioritiesfor resource allocation, monitor the performances of health sector agencies (GHS,teaching hospitals, regulatory bodies and privately owned health institutions) andengages in mobilisation of funds for the health sector. The regional hospitals serve astertiary referral centres of district health facilities. The present decentralisation ofhealth services aims at facilitating decentralised planning and management ofhealthcare. The decentralised strategy empowers the district health administrationsto plan and implement their own policies within the framework of the nationalpolicy goals.
MethodsA total of seven hospitals from two regions (Greater Accra and Eastern) were selectedto participate in the study (see Table I for description of the characteristics of thehospitals). The hospitals selected represent a convenient sample because the inclusioncriterion was based on geographical accessibility. In each hospital at least 40respondents excluding management staff were conveniently selected to completethe study questionnaire. Though the selection of respondents was done conveniently,only those who had worked in the hospitals for more than six months were considered.This was done to garner the relevant information from those with relatively fair
Characteristics Minimum Maximum
Bed complement 37 120Average annual admissions 1,523 2,877Average daily OPD attendance 116 250Number of doctors 3 11Number of nurses 20 77Number of midwives 6 10Other allied health staff 12 23Number of casual staff 14 25
Note: Minimum and maximum values are the range of values representing hospitals with fewernumber of each characteristic to those with highest numbers
Table I.Summary descriptionof the characteristicsof the hospitals
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knowledge of the management system of the hospitals. Data were collected throughpersonal interviews with respondents in the health facilities. The researchers firstapproached the respondents and explained the purpose of the study to them to obtaintheir consent. Upon explaining the intention of the study, the respondents were giventhe option to decide whether to decline or participate. Those who consented toparticipate were assured anonymity and confidentiality of the information provided.Owing to the fact that the issue being investigated was quite sensitive, respondentswere given the questionnaire to complete and return them to the researchers.
The questionnaire designed for the study was divided into two parts. The first partcontained information on demographic characteristics of the respondents – age,education, profession and hospital tenure while the second part looked at employees’perception of organisational justice (distributive, procedural and interactional justice).A total of five items each were used to measure distributive and procedural justicewhile interactional justice was measured using six items. The last part consisted of thedependent variables (job satisfaction and workplace performance). Job satisfaction wasmeasured by a single question which asked respondents to rate their overallsatisfaction with job in the hospital. On the other hand performance of employees inthe workplace was assessed using self-performance rating (SPR) since it was difficultgetting access to any objective performance assessment from the hospitals thatparticipated in the survey. Pevious studies have also used SPR (see Furnham andStringfield, 1998; Suliman, 2007). Responses to questions used in measuringorganisational justice and the dependent variables were captured on a five-pointLikert scale, 1 being the least and 5 the highest. A total of 300 questionnaires werereceived out of 350 questionnaires distributed. However, 247 of them, representing71 per cent were found to be useful because the rest were either partially completedor unanswered.
AnalysisThe SPSS software version 16.0 was used to analyse the data. A simple w2 analysis wasused to test association between the individual items of each of the facets oforganisational justice and the dependent variables (job satisfaction and self-perceivedperformance). The results showed that of all the items tested, only one item under eachfacet was significantly associated with the dependent variables. Thus each of the facetsof organisational justice (distributional, procedural and interactional) was representedby the single items that were reported to be statistically significant. The itemsextracted to represent each facet were regressed against the dependent variables to testthe first hypothesis. Hierarchical regression model was then computed to test themediating effects of the demographic characteristics in the second hypothesis. Furtheranalysis was conducted using Bivariate correlations to examine possible correlationsamong the dimensions of organisational justice, job satisfaction and performance.
ResultsCorrelation matrix of the variables used for the study is presented in Table I. It isevident that all the variables, distributive justice (DIJ), procedural justice (PRJ),interactional justice (INJ), job satisfaction (JSAT) and performance (PERF) arepositively correlated and statistically significant, except performance which isnegatively and significantly correlated with distributive, procedural, interactional andperformance. However, distributive justice tends to be more important in predictingjob satisfaction (r¼ 0.65) and performance (r¼�0.60). Similarly, procedural and
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interactional justice are more important in explaining job satisfaction (r¼ 0.42 andr¼ 0.40, respectively). Further, results from Table II shows a high level of correlationbetween procedural justice and interactional justice (r¼ 0.53).
To test the first hypothesis, the elements of organisational justice (distributive,procedural and interactional) were regressed against the dependent variables ( jobsatisfaction and performance). As reported in Tables III and IV the estimatedregression models are statistically significant at po0.001. The variance of thedependent variable (job satisfaction) was explained by 55 per cent as shown inTable III. Results from Table III further demonstrate significant influence ofdistributive, procedural and interactional justice on job satisfaction at po0.001.This was further supported by the correlation coefficients that yielded a positivesignificant relationship between distributive, procedural and interactional justice andjob satisfaction (r¼ 0.65, r¼ 0.42 and r¼ 0.40, respectively). A rank order of theparameter estimates of the standardised beta values suggests that distributive justicegreatly influence job satisfaction. This is followed in order of importance byinteractional justice and procedural justice.
Similarly, there exists a significant relationship between the facets of organisationaljustice (distributive, procedural and interactional) and self-perceived performance atpo0.001 (Table IV). The explanatory power of the dependent variable (self-perceivedperformance) yielded 49 per cent as indicated by the adjusted R2-value. These resultsconfirm H1: that organisational justice (distributive, procedural and interactionaljustice) significantly influences job satisfaction and self-perceived performance.
Hierarchical regression models were estimated to test the second hypothesis. In thefirst step of the hierarchical regression the independent measures of organisational
R2 0.556Adjusted R2 0.550SE 0.478Analysis of variance
df Mean squareRegression 69.480 3 23.160Residual 55.532 243 0.229F¼ 101.344 Sig. F¼ 0.000Equation variables Standardized b t Significance of tConstant �1.405 0.161Distributive justice 0.586 13.488 0.000Procedural justice 0.210 4.126 0.000Interactional justice 0.214 4.238 0.000
Table III.Regression model, jobsatisfaction is thedependent variable
M SD Scale DIJ PRJ INJ JSAT PERF
DIJ 1.45 0.59 1-5 1PRJ 1.74 0.97 1-5 0.17** 1INJ 2.69 0.99 1-5 0.13* 0.53** 1JSAT 1.56 0.71 1-5 0.65** 0.42** 0.40** 1PERF 4.42 0.73 1-5 �0.60** �0.42** �0.39** �0.95** 1
Notes: *,**Significant at po0.05 and 0.01 levels, respectively
Table II.Means, standarddeviations andcorrelation matrix
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justice (distributive, procedural and interactional) were regressed against thedependent variables (job satisfaction and self-perceived performance). In the secondstep, the demographic characteristics (age, education, profession and hospital tenure)under analysis were then added to the original model to determine the moderatingeffect. As can be seen in Table V, adding the demographic characteristics to the fullregression model on the dependent variable (job satisfaction) yielded a minusculepercentage change of 0.4 per cent (0.55�0.54¼ 0.004). Further, there appears to beslight changes in the predictive values of distributive, procedural and interactionaljustice when the employee’s characteristics were introduced (F¼ 43.230; po0.01). It isalso demonstrated in Table VI that an addition of the employee characteristics to theoriginal regression did not yield any change in the variance of the dependent variable(self-perceive performance) as indicated by the adjusted R2-values. However, changeswere noticed in the overall original regression model with the introduction of thedemographic characteristics (F¼ 34.394; po0.01). Additionally, the parameterestimates of the standardised b values for distributive, procedural and interactionaljustice are all reported to be changed. Overall the results suggest that respondents’characteristics explain just 0.4 per cent of their evaluation of job satisfaction and0 per cent of their assessment of self-perceived performance. This indeed limits theburden of support for the second hypothesis (Table VII).
R2 0.494Adjusted R2 0.487SE 0.525Analysis of variance
df Mean squareRegression 65.185 3 21.728Residual 66.864 243 0.275F¼ 78.966 Sig. F¼ 0.000Equation variables Standardized b t Significance of tConstant 50.800 0.000Distributive justice �0.539 �11.630 0.000Procedural justice �0.218 �4.019 0.000Interactional justice �0.201 �3.715 0.000
Table IV.Regression model, self-
perceived performance isthe dependent variable
Variables Step I independent effect Step 2 moderating effect
Distributive justice 0.586* 0.592*Procedural justice 0.210* 0.213*Interactional justice 0.214* 0.218*Age �0.009Education �0.045Profession 0.010Hospital tenure 0.027R2 0.556 0.559Adjusted R2R 0.550 0.546SE 0.478 0.480F 101.344 43.230df 3 7
Notes: Dependent variable: job satisfaction. Entries are b’s. *po0.01
Table V.Hierarchical regression
model
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DiscussionEnsuring fairness and equity in managing the various categories of employees in anyorganisation such as that of the hospital could constitute a great challenge. It istherefore not surprising that many organisational researchers have placed premiumon empirical work on organisational justice (Theo and Lim, 2001). An exhibition offairness and the creation of a healthy work environment for the different categories ofhealthcare workers is paramount and indeed essential to maximising productivity.This study in one breadth sought to examine how the facets of organisational justicepredict job satisfaction and performance in Ghanaian hospitals. The study furthersought to investigate the degree to which certain socio-demographic characteristics(age, education, profession and hospital tenure) of hospital employees mediate the linkbetween organisational justice and job satisfaction and performance. The resultsconfirm the findings of previous studies that distributive, procedural and interactionaljustices are significant predictors of job satisfaction and workplace performance(Suliman, 2007). This is further confirmed by the inter-item correlations that showed ahigh level of positive correlations between the three dimensions of organisationaljustice and job satisfaction. Of greater interest is the fact that distributive justice hasappeared in this study as a stronger and perhaps the most important predictor of jobsatisfaction than the other two dimensions (Clemmer, 1993; McFarlin and Sweeney,1992). Findings of the study further provide support for an earlier study by Lee (2000)that established significant positive influence of distributive and procedural justice onjob satisfaction. A possible reason is that health professionals would expect to be givena fair share in the allocation of resources within the hospital. Thus when healthmanagers treat them in a rude and degrading manner, they may feel dissatisfied andthis may eventually affect their work output.
Variable Step I independent effect Step 2 moderating effect
Distributive justice �0.539* �0.545*Procedural justice �0.218* �0.211*Interactional justice �0.201* �0.212*Age 0.030Education 0.050Profession �0.013Hospital tenure �0.070R2 0.494 0.502Adjusted R2 0.487 0.487SE 0.525 0.525F 78.966 34.394df 3 7
Notes: Dependent variable: self-perceived performance. Entries are b’s. *po0.01
Table VI.Hierarchical regressionmodel
Variables DIJ PRJ INJ JSAT PERF
Rank of means 5(1.45) 3(1.74) 2(2.69) 4(1.56) 1(4.42)Variance extracted 0.35 0.93 0.99 0.51 0.54
Table VII.Rank order of means andvariance extracted fromthe variables
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Another important finding is that an employee’s performance in the hospital isreported to be the outcome of perceived fairness. Put in other words, the elements oforganisational justice are related to task performance. This finding is largely atvariance with Fernandes and Awamleh (2006) whose study involving nationals andnon-nationals of UAE reported that none of the three dimensions of organisationaljustice significantly impacted on self-perceived performance for the latter. However,the correlation coefficients illustrate negative significant relationships betweenperformance and distributive justice (r¼�0.60), between performance and proceduraljustice (r¼�0.42) and between performance and interactional justice (r¼�0.39).Generally, these findings confirm the importance that health professionals attach tofairness and equal treatment in the management of hospitals. Considering the fact thatGhana like other developing countries face chronic shortage of health professionalsthrough emigration to developed countries (Anarfi et al., 2010) a very transparent,fair and honest leadership as well as a more participatory approach to hospitalmanagement is required. This together with other measures could go a long way toattract and retain health professionals in the country.
Previously published literature suggests that socio-demographic characteristics insome instances confound the relationship between organisational justice and jobsatisfaction and performance. In this study, findings indicate that the demographiccharacteristics (age, education, profession and hospital tenure) of the respondentsprovide a minuscule mediating effect on the link between organisational justice and jobsatisfaction. However, such characteristics have no mediating effect on the relationshipbetween organisational justice variables and self-perceived performance. This may notbe surprising since health professionals in Ghana (especially doctors and nurses) tendto have different reasons for working in the health sector (Anarfi et al., 2010). Thus,health workers may not be motivated to work by virtue of age, education, professionalgroup and years of professional experience but by other such as financial gains,affection for the job and others.
Implications and conclusionIt is undoubtedly clear that the absence of managerial fairness can lead to employeedissatisfaction and therefore turnover (Bies and Moag, 1986; Rae and Subramaniam,2008). In the context of a developing country such as Ghana, this study provides aninitial exploratory insight on how health professionals’ perception of fairnesscorrelates with their level of job satisfaction and therefore performance. In this regard,while meeting the expectations of every health professional in the hospital is notalways possible, maintaining a high level of fairness in the day to day businessesof health managers is an important factor that can raise the level of healthprofessionals job satisfaction. Health managers can achieve fairness through theapplication of effective distributive techniques in allocating resources to the variouscategories of health professionals. What needs to be noted is that health managers areconstantly dealing with a heterogeneous work force, each staking out claims to begiven equal opportunities as well as equal treatment. Thus, it will be in the interest ofmanagement to put in place policies and mechanisms that ensure fair distribution ofresources for the benefit of all and sundry.
Additionally, this study demonstrates the importance of procedural justice as ameasure of satisfaction and commitment to work (Fernandes and Awamleh, 2006;Aryee et al., 2004; Suliman, 2007). In the Ghanaian context, organisational decisionmaking often times is a preserve of management (Gyekye and Salminen, 2005).
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Even when decision making is open, participation may still be limited and tiltedtowards top- and middle-level managers partly due to the paternalistic culture. Thefindings of this study suggest that achieving fairness in procedures of decision makingis contingent upon maintaining inclusive healthcare governance. This is likely to haltsubordinates negative perceptions about certain management decisions affectingthem. Managers need to understand and incorporate the viewpoint of employees indecisions rather than doing so just on their own observation. Decisions relating to jobschedules, professional development and policy changes are important to many healthprofessionals to the extent that ignoring their participation in such decisions can leadto poor commitment and dissatisfaction. An inclusive approach to decision makingmay therefore be an appropriate mechanism of bringing fairness and avoidingnon-compliance to implementation of decisions. Given the findings of the study, healthmanagers need to always ask themselves series of questions when taking decisionswithout the involvement of their subordinates. Will the outcome of such decision beaccepted? What will be the consequences of exclusive decision making? Are we likelyto get the commitment of health professionals to perform clinical task when we chooseto ignore their participation in decision making? These may serve as the antidotesfor opening the frontiers of decision making to all categories of health professionals.The use of the open door policy involving suggestion boxes, meetings, surveys andother participatory methods could be important enhancers of procedures of decisionmaking (Kappelman and Prybutok, 1995).
An essential component of workplace performance is healthy employees’ attitudetowards each other and the encouragement of vertical and horizontal communicationwithin the organisation. It is therefore not surprising that this study conforms to extantliterature that interactional justice is a vital component of organisational justice(Mikula et al., 1990; Bies and Moag, 1986; Wiili-Peltola et al., 2007). This calls for healthmanagers to bridge barriers to communication among staff while at the same timeestablishing closer relationship with subordinates. Job satisfaction and commitmentis enhanced when interaction between health professionals and hospital managers issuch that the former is able to communicate freely with the latter concerning theirwell-being and other problems confronting them. Further, it is important to state thatfostering interaction among health professionals strengthens teamwork. Hospitalsunlike other corporate bodies offer peculiar services. An error in treatment can costhuman live. Thus effective communication is essential for problem solving. It is onlylogical to assume that a higher level of interaction among clinical staff will lead to amutually beneficial relationship amongst them.
The mediating effect of the demographic characteristics on job satisfaction albeitinfinitesimal remains an important finding. In our view, it suggests that managersshould not place total emphasis on maintaining fairness to the neglect of thedemographic variables which are equally important. Health managers seeking toameliorate the deteriorating effect of justice on job satisfaction should ensure thatevery employee is recognised, valued and respected irrespective of the age, level ofeducational qualification, professional background and years of service in the hospital.There is the possibility that health professionals may judge overall fairness ofmanagement to be good and therefore satisfied with job once they are recognised andrespected at all occasions.
Existing literature on organisational justice have in many ways investigated thephenomenon on teachers, the police and judges as well as the business environment(see Folger and Konovsky, 1989; Tyler and Folger, 1980; Dailey and Kirk, 1992;
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Theo and Lim, 2001). Very few studies have explored the concept of organisationaljustice in the context of healthcare management especially in developing countries. Inthis regard, while further empirical evidence is required, the findings of the presentstudy provide an important step towards integrating distributive justice, proceduraljustice and interactional justice to mainstream healthcare management.
LimitationsA limitation of the study is the use of convenient sampling procedure to selecthospitals and respondents. Additionally, the use of self-perceived performanceas a proxy measure of task performance in the hospitals could also be problematicthough not uncommon in the literature (see e.g. Furnham and Stringfield, 1998;Suliman, 2007). There is the possibility that in self-rating performance, employeescould be bias in their decisions and this could invariably affect the reliability ofestimates. In spite of this, we believe that the limitations mentioned are not enough toinvalidate the findings of the study and thus a major departure from what is currentlyacceptable in the literature.
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Comrey, A. and Lee, H. (1991), A First Course in Factor Analysis, Lawrence Erlbaum Associates,Hillsdale, NJ.
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Vroom, V.H. and Philip, W.Y. (1973), Leadership and Decision Making, University of PittsburghPress, Pittsburgh, PA.
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