human resource management and performance …human resource management and performance-related...
TRANSCRIPT
HUMAN RESOURCE MANAGEMENT AND
PERFORMANCE-RELATED WORKER SELF-
EFFICACY: THE ROLE OF THE WORKER-
ORGANIZATION RELATIONSHIP IN
PORTUGUESE HOSPITAL WORKERS.
By
Maria Helena Gonçalves Martins
Doctoral Thesis in Management
Specialization in Human Resource Management
Supervised by
Professor Maria Teresa Campos Proença
2016
i
To my parents,
for the constant reminder of what unconditional love and support are.
ii
Author’s Biography
Maria Helena Gonçalves Martins, 34 years old, has a degree in Psychology by the Uni-
versity of Minho, and an Erasmus Mundus Master in Work, Organizational and Person-
nel Psychology by the University of Coimbra (Portugal) and University of Valencia
(Spain).
Helena Martins is a lecturer in higher education since 2008, in the areas of organiza-
tional psychosociology, organizational behaviour and human resource management, as
well as communication fundamentals and personal development for healthcare profes-
sionals and managers. She currently collaborates with the Porto Polytechnic, University
of Porto and the Association of Northern Polytechnics (APNOR).
Her research has been focusing the worker-organization relationship and reciprocity in
the workplace, psychometry (namely, testing psychometric properties and validating
scales), intercultural competences and higher education pedagogy.
Helena Martins was a member of the EMIC (Erasmus Mundus Intercultural Compe-
tence) project, funded by the European Commission.
In February 2011 she finished the curricular course of the doctorate in Business and
Management Studies at FEP, with the approval of the doctoral proposal in Human Re-
source, which made her a PhD. candidate.
Parts of this doctoral work have been published and communicated in conferences and
papers.
Working Papers
Martins, H., & Proença, T. (2012, October). Minnesota Satisfaction Questionnaire –
Psychometric properties and validation in a population of Portuguese hospital work-
ers. FEP Working Paper, 471. Retrieved from
https://ideas.repec.org/p/por/fepwps/471.html
International Conferences
Oral Presentations
Martins, H., & Proença, T. (2015, April). “I’m doing my best, considering” – The re-
lationship between worker satisfaction with HRM practices and worker perception of
iii
individual performance in the healthcare sector. Paper presented at the 30th Work-
shop on Strategic Human Resource Management, Brussels, Belgium.
Martins, H., & Proença, T. (2014, September). Comprometimento Organizacional em
trabalhadores de diferentes areas num Hospital Portugues: Um estudo de caso [Or-
ganizational behaviour in workers of different áreas in a Portuguese Hospital]. Paper
presented at the IX Congresso Iberoamericano de Psicologia. Lisbon, Portugal.
Martins, H., & Proença, T. (2012, July). When the fat lady sings: Organizational
commitment in a dying Hospital. Paper presented at the GBATA Conference, New
York, USA.
National Conferences
Oral Presentations
Martins, H. (2013, October). Encosta-te a mim – Uma perspetiva (não tão) atual so-
bre a teoria da troca social nas organizações [Lean on me a (not so) current pers-
pective on social exchange theory]. Paper presented at the 2.as Jornadas de Psicolo-
gia na Universidade de Aveiro, Aveiro, Portugal.
Martins, H., & Proença, T. (2011, October). Minnesota Satisfaction Questionnaire:
Validation and evaluation pf psychometric properties in the Portuguese hospital
workers population. Paper presented at the Conferência em Investigação e Inter-
venção em Recursos Humanos, Vila do Conde, Portugal.
Proceedings
Martins, H., & Proença, T. (2015). “I’m doing my best, considering” – The relation-
ship between worker satisfaction with HRM practices and worker perception of indi-
vidual performance in the healthcare sector. Proceedings of the 30th Workshop on
Strategic Human Resource Management – EIASM (European Institute for Advanced
Studies in Management), Brussels, Belgium.
Martins, H., & Proença, T. (2011). Minnesota Satisfaction Questionnaire: Validation
and evaluation of psychometric properties in the Portuguese hospital workers popula-
tion. Proceedings of the Conferência em Investigação e Intervenção em Recursos
Humanos, Vila do Conde, Portuga.
Poster Presentations
Martins, H., & Proença, T. (2015, May). Give some to get some – Analysing the rela-
tionship between worker satisfaction with human resources management and per-
ceived individual performance in a Portuguese hospital. Poster session presented at
the 17th Congress of the European Association of Work and Organizational Psychol-
ogy (EAWOP), Oslo, Norway.
Martins, H., & Proença, T. (2015, May). Constructing and validating a scale of em-
ployee satisfaction with HRM practices in the healthcare context. Poster session pre-
iv
sented at the 17th Congress of the European Association of Work and Organizational
Psychology (EAWOP), Oslo, Norway.
Martins, H., & Proença, T. (2014, September). Validação da ECO-ANC (Escala de
Comprometimento Organizacional – Afetivo, Normativo e de Continuidade) para a
população de Trabalhadores na área da Saúde no Norte de Portugal [Validation of
the OCS (organizational Commitment Scales) for the population of healthcare wor-
kers in the north of Portugal]. Poster session presented at the 2.º Congresso da Or-
dem dos Psicólogos Portugueses e IX Congresso Iberoamericano de Psicologia, Lis-
bon, Portugal.
Proença, T. & Martins, H. (2013, May). Remember me and smile: Helping and voice
behaviours in a Portuguese decaying Hospital. Poster session presented at the
16th Congress of the European Association of Work and Organizational Psychology
(EAWOP), Munster, Germany.
Proença, T., & Martins, H. (2013, May). Helping and Voice Behaviours Scale: Valida-
tion to a sample of Portuguese hospital workers. Poster session presented at the
16th Congress of the European Association of Work and Organizational Psychology
(EAWOP), Munster, Germany.
Invited lectures
Martins, H. (2015, March). Give some to get some: The relationship between human
resources practices and organizational performance. Lecture for the course Recent
Developments in Organizational Psychology of the Erasmus Mundus Master in
Work Organizations and Personnel Psychology, University de Coimbra, Portugal.
Magazine and Newspaper Articles
Martins, H., & Proença, T. (2014). “Tudo o que eu te dou, tu me dás a mim” – Mas só
às vezes e em circunstâncias muito especiais – Uma reflexão sobre o crescente inte-
resse da Gestão de Recursos Humanos no “lado humano” dos seus trabalhadores. In-
Comunidade, 28. Retrieved
from http://www.incomunidade.com/v28/art_bl.php?art=11
Martins, H. (2014). Eu trabalho muito, mas aqui não me sabem dar valor [Anniversa-
ry special edition]. RH Magazine, jan/fev. Retrieved from http://inforh.pt/eu-
trabalho-muito-mas-aqui-nao-me-sabem-dar-valor-por-helena-martins-do-instituto-
politecnico-do-porto/
Book Chapters
Martins, H., & Proença, T. (accepted). Inside out: Challenges in Managing Human Re-
sources in the Healthcare sector. In Carla Carvalho, Lisete Mónico e Pedro Parreira
(Eds.), Organizações, Trabalho, Recursos Humanos, Saúde e Gestão.
v
Acknowledgements “Watching great people do what you love is a great way to start learning how to do it yourself”
- Amy Poehler, “Yes, please.”
“Do you know it is in your company that I have had my finest thoughts?”
- Muriel Barbery, “The elegance of the hedgehog”
To say that there are not enough words to thank the people that need to be acknowl-
edged in this process is a clear understatement. This work exists in part because of me,
and in part in spite of me; this was a long tortuous process at the personal level and if it
has come to a successful end it is not solely because of personal self determination, but
greatly because of the support and understanding that these people provided me with,
giving ever more meaning to the utmost African expression of reciprocity “Ubuntu”: I
am because you are. Thus, I would like to mention some people who were especially
important in this process.
First and foremost I must thank Professor Teresa Proença whose work ethics and team
spirit make her one of my greatest role models. Professor Teresa Proença was a relent-
less supervisor, providing feedback and fruitful discussions on different topics every
step of the way, while at the same time making sure that this was truly my process. In
the years we have worked together, Professor Teresa Proença has always made sure I
felt more as colleague than a student and, in this context, has been the best team mate I
could have hoped for and one I hope to keep working with for a long time.
This work was only prompted and made possible because Pedro Coelho, Marlene Fer-
reira and Dora Ventura all working in IPO-Porto at the time had the idea to make a
partnership with FEP and allowed for the collection of data in their institution; a big
thank you is also in order to all the staff in the HR department that collaborated with
data collection and incited the workers to collaborate as well as to every and any one of
the nearly 1000 people that responded to our questionnaire.
The African proverb “It takes a village to raise a child” is also applicable to this work. I
would like to thank my colleagues at ESTSP-IPP, especially my friend and supervisor
in the institution Artemisa Rocha Dores, for all the patience and understanding during
the toughest parts of the work: when I was swamped and when I was discouraged.
vi
These moments were not scarce during the time I worked on my thesis and their attitude
of encouragement and support, plus the sense to recognize those moments and the trust
in my work were crucial during this period. Thank you.
“Thank yous” are also in order to all my friends and colleagues in the Institutions that
collaborated with during this time, namely: Jorge Freire of FEUP for the constant and
friendly nagging to “get rid of it”, Ana Cláudia Rodrigues and Viviana Meirinhos of
ESEIG for the sheer, palpable solidarity in the process, Diogo Lamela at the time work-
ing in ESE-IPVC who always inspired me with his love and joy of research and Alex-
andra Costa of APNOR for the pragmatism, honesty and simplicity of her views on dif-
ferent matters in this process.
My students deserve a special acknowledgement for teaching me everyday more than I
can express here and for the extra motivation that keeping the privilege of being a part
of their path provided me in concluding this work.
Further, I would like to thank my PhD course colleagues, especially Beatriz Casais,
Amélia Carvalho and Alexandra Braga with whom so much of the way was shared, who
are truly my “sisters in arms”; I would like also to mention the members of the Face-
book group I created originally as a joke “Grupo de apoio às vítimas do furacão dou-
toramento” and that has since become the meeting point of over 300 people doing a
PhD or struggling with a thesis/research, thanks to whom I have realized that my per-
sonal issues and struggles with this thesis were not as uncommon as I thought, and
whose successes and support gave me hope, even when I felt I was so much over my
head.
Final words of acknowledgement go to my friends and extended family for their perse-
vering love and commitment, despite all the times I could not be with them, or I had to
cancel plans, or I was too tired/depressed to be good company. In this thank you I must
point out my parents and my sisters, Maria João and Aida, who never let me feel alone
and whose love and complicity are the best gifts I could have ever been blessed with. In
the last decade or so all the losses I have experienced in my circle of family and friends
have been due to cancer, the very disease treated in IPO-Porto; I hope that in some
small way I have paid you a tribute by conducting my research in this institution: the
memory of you accompanies me always and inspires me daily.
vii
Abstract
The search for the causal links between human resource management (HRM) and or-
ganizational performance (OP) has dominated both the academic and practitioner debate
and many authors suggest both constructs should be challenged to include multidimen-
sional approaches. Recently, literature in HRM has been marked by an increased inter-
est in worker perceptions; a growing number of authors propose that although intuitive,
the relationship between HRM and OP is not a simple one, suggesting a mediation by
workers’ attitudes, behaviours and beliefs (the “black box effect”).
Undisputedly a knowledge and people intensive field, healthcare is of crucial im-
portance in societies; yet, study on healthcare and hospitals’ HRM seems to be lacking.
This study addressed the afore mentioned conceptual problems in an individual level by
means of human resources’ issues management (HRIM, a construct encompassing tradi-
tionally considered HRM practices and issues that are not directly associated with
HRM, yet are expressions of HR policies) and performance related observations of self-
efficacy (PROSE, a proximal antecedent of worker performance, contributing to OP).
We propose a mediation effect by the worker-organization relationship (WOR), a trifec-
ta of job satisfaction, organisational commitment and organizational citizenship behav-
iour.
Structural equations modelling was used to test the hypotheses in a sample of 942
workers from a large Portuguese hospital. Results show that HRIM affects PROSE, and
this relation is mediated by the WOR. Consistently with the literature, the most signifi-
cant mediation effect in this relationship pertained to more intrinsic or emotional varia-
bles rather than extrinsic or bottom-line ones; this tendency seems to be stronger in clin-
ical rather than non-clinical workers.
This study considers some of the most prevalent issues and propositions of the literature
about the relationship between HRM and organizational outputs and provides a testable
theoretical model. The fact that employees’ satisfaction with the HR practices and is-
sues predicts attitudinal and behavioural outcomes has profound implications for re-
search and practice, namely in the hospital context.
Keywords: Social Exchange Theory, Worker-Organization Relationship, Human Resou-
rces Management, Healthcare Context, Worker Perceptions of Performance.
viii
Resumo
A busca da relação causal entre a gestão de recursos humanos (GRH) e o desempenho
organizacional (DO) tem suscitado o interesse quer de um ponto de vista teórico, quer
prático. Vários autores sugerem que estes constructos devem ser considerados de um
ponto de vista multidimensional. Recentemente o interesse no estudo das perceções dos
trabalhadores tem aumentado: cada vez mais autores defendem que embora a relação
entre GRH e DO seja intuitiva, esta não é simples, sugerindo um efeito de mediação das
atitudes, comportamentos e crenças dos trabalhadores (o “efeito caixa negra”).
A Saúde é uma área onde as pessoas e o seu conhecimento são fulcrais, sendo também
ela mesma de fundamental importância para as sociedades; porém, o estudo da GRH na
Saúde em geral e nos Hospitais em particular tem sido relativamente escasso.
Este estudo aborda os problemas concetuais referidos supra, a um nível individual, atra-
vés de dois constructos: gestão de assuntos dos recursos humanos (GARH, que engloba
quer aquilo que tradicionalmente se consideram práticas de GRH, quer assuntos que não
sendo diretamente relacionados com esta, são expressões das políticas de GRH) e per-
ceções de auto-eficicácia do desempenho individual no trabalho (PAEDIT, um antece-
dente do desempenho individual que contribui para o DO). Propõe-se um modelo que
relaciona estas duas variáveis contemplando um efeito de mediação da relação do traba-
lhador com a organização (RTO, uma medida compósita de satisfação com o trabalho,
comprometimento organizacional e comportamentos de cidadania organizacional).
Foram usados modelos de equações estruturais para testar as hipóteses numa amostra de
942 trabalhadores de um grande hospital português. Os resultados demonstram que a
GARH afeta a PAEDIT e que esta relação é mediada pela RTO. Confirmando a revisão
de literatura, verificamos que a mediação mais significativa refere-se a variáveis mais
intrínsecas ou emocionais do que extrínsecas ou monetárias; esta tendência parece ser
mais prevalente em colaboradores(as) clínicos(as) do que não–clínicos(as).
Este estudo considera alguns dos temas e propostas mais prevalentes na literatura que
relaciona a GRH com outputs organizacionais e desenvolve um modelo teórico testável.
O facto de a satisfação dos trabalhadores com a GRH ser preditor de comportamentos e
atitudes dos mesmos tem um profundo impacto quer para a investigação, quer para a
prática, nomeadamente em contexto hospitalar.
Palavras-Chave: Teoria da Troca Social, Relação do Trabalhador com a Empresa,
Gestão de Recursos Humanos, Contexto da Saúde, Perceções de Desempenho dos
Trabalhadores.
ix
Index
Author’s Biography ................................................................................................ ii
Acknowledgements .................................................................................................. v
Abstract ................................................................................................................ vii
Resumo................................................................................................................. viii
List of Figures ......................................................................................................... xii
Abbreviations ....................................................................................................... xvi
Chapter 1 – Introduction ........................................................................................ 2
1.1. Purpose & relevance of the study ............................................................................. 2
1.2. The healthcare context ............................................................................................. 3
1.3. Roadmap for this work ............................................................................................ 7
Chapter 2 – Satisfaction with Human Resources’ Issues Management ................. 10
2.1. Perceptions of Human Resources’ Issues Management .......................................... 10
2.2. Satisfaction with Human Resources’ Issues Management ...................................... 13
Chapter 3 – Worker-Organization Relationship ................................................... 17
3.1. Social Exchange Theory and Reciprocity ............................................................... 17
3.1.1. Job Satisfaction .......................................................................................................... 29
3.1.2. Organizational Commitment ..................................................................................... 31
3.1.3. Organizational Citizenship Behaviour ....................................................................... 33
Chapter 4 – Performance-Related Worker Self-Efficacy ...................................... 38
4.1. Organizational Performance in Healthcare ............................................................ 38
4.2. Organizational Performance and Human Resource ............................................... 41
4.3. Performance related worker self-efficacy ............................................................... 42
Chapter 5 – Research Questions, Models and Hypotheses .................................... 50
5.1. Research Questions and Model .............................................................................. 50
5.2. Research Hypotheses .............................................................................................. 52
5.2.1. Direct relationship between SHRIM – PROSE ........................................................... 52
5.2.2.a. Hypotheses concerning Job Satisfaction ................................................................ 54
5.2.2.b. Hypotheses concerning Organizational Commitment ........................................... 57
5.2.2.c. Hypotheses concerning Organizational Citizenship Behaviours ............................ 61
5.2.3. Hypotheses concerning the mediation of the WOR between the SHRIM-PROSE
relationship ......................................................................................................................... 65
5.3. Conclusion.............................................................................................................. 67
Chapter 6 - Research Methodology ....................................................................... 69
6.1 Research Design ...................................................................................................... 69
6.2 Data Collection Procedures ..................................................................................... 70
x
6.2.1 Pilot testing ................................................................................................................ 71
6.3 Instruments ............................................................................................................. 71
6.3.1 SHRIMQ – Satisfaction with Human Resources’ Issues Management Questionnaire 72
6.3.2 MSQ - Minnesota Satisfaction Questionnaire ............................................................ 75
6.3.3 OCS - Organizational Commitment Scales ................................................................. 76
6.3.4 HVBS - Helping and Voice Behaviours Scale ............................................................... 79
6.3.5 PROSES – Performance Related Observations of Self Efficacy Scale ......................... 80
6.4 Sampling ................................................................................................................. 82
6.5 Conclusion .............................................................................................................. 83
Chapter 7 - Data Analysis ..................................................................................... 86
7.1 Psychometric Properties of the Instruments ............................................................ 86
7.1.1 SHRIMQ – Satisfaction with Human Resources’ Issues Management Questionnaire 89
7.1.2 Minnesota Satisfaction Questionnaire – MSQ (short version) .................................. 93
7.1.3 Organizational Commitment Scales ........................................................................... 94
7.1.4 Helping and Voice Behaviours Scale .......................................................................... 97
7.1.5 PROSES – Performance Related Observations of Self Efficacy Scale ....................... 100
7.1.6. Reliability ................................................................................................................. 101
7.1.7. Common Method Variance ..................................................................................... 102
7.1.8. Synthesis .................................................................................................................. 104
7.2 Sample .................................................................................................................. 105
7.3 Exploratory Analysis of Data ................................................................................ 108
7.4 Hypotheses Testing................................................................................................ 117
7.5. Conclusion............................................................................................................ 141
Chapter 8 – Discussion ........................................................................................ 144
8.1. Instruments and exploratory results..................................................................... 144
8.3. Hypotheses concerning the SHRIM – PROSE direct relationship ........................ 151
8.4.a. Hypotheses concerning Job Satisfaction ............................................................ 152
8.4.b. Hypotheses concerning Organizational Commitment ........................................ 156
8.4.c. Hypotheses concerning Organizational Citizenship Behaviours......................... 159
8.5. Hypotheses concerning the mediation of the WOR between the SHRIM-PROSE
relationship ................................................................................................................. 161
Chapter 9 – Conclusions ..................................................................................... 166
9.1 Contributions / Implications to Practice ................................................................ 168
9.2. Limitations and future research ........................................................................... 171
References ........................................................................................................... 180
Appendix ............................................................................................................. 221
A1. Psychometric Properties of the WOR .............................................................. 222
A2. Psychometric Properties of the EWOR ............................................................ 223
Annex .................................................................................................................. 224
xi
xii
List of Figures Figure 1.1. Structure and organization of this research ................................................................................ 8 Figure 5.0 - Proposed theoretical model for the research ......................................................................... 50 Figure 5.1 – Graphic representation of hypothesis 1 of this study ............................................................. 53 Figure 5.2 – Graphic representation of hypotheses 2a1, 2a2 and 2a3 of this study .................................... 56 Figure 5.3 – Graphic representation of hypotheses 2b1, 2b2 and 2b3 of this study ................................... 60 Figure 5.4 – Graphic representation of hypotheses 2c1, 2c2 and 2c3 of this study .................................... 64 Figure 5.5 – Graphic representation of hypothesis 3 of this study ............................................................. 66 Figure 7.1 – Confirmatory factor analysis of the SHRIMQ model obtained with the exploratory factor
analysis procedures. ........................................................................................................................... 92 Figure 7.2 - Confirmatory factor analysis of the MSQ model obtained with the exploratory factor analysis
procedures.in this study. .................................................................................................................... 94 Figure 7.3 - Confirmatory factor analysis of the OCS model obtained with the exploratory factor analysis
procedures. ......................................................................................................................................... 97 Figure 7.4 - Confirmatory factor analysis of the HVB model obtained with the exploratory factor analysis
procedures. ......................................................................................................................................... 99 Figure 7.5 - Confirmatory factor analysis of the PROSE model obtained with the exploratory factor
analysis procedures. ......................................................................................................................... 101 Figure 7.6 – Respondents’ age distribution .............................................................................................. 106 Figure 7.7. Distribution of staff in different job functions (percentages). ................................................ 106 Figure 7.8 - Distribution of staff according to contract types (percentages). ........................................... 107 Figure 7.9 – Respondents’ schooling distribution .................................................................................... 108 Figure 7.10 – Structural equations model for the different dimensions of the SHRIMQ and performance
related observations of self-efficacy ................................................................................................ 123 Figure 7.11 – Structural equations model for the different dimensions of the SHRIMQ and job satisfaction
subscales .......................................................................................................................................... 125 Figure 7.12 – Structural equations model for the different dimensions of job satisfaction and performance
related observations of self-efficacy ................................................................................................ 126 Figure 7.13. Mediation model of SHRIMQ on PROSE, mediated by job satisfaction. ............................ 127 Figure 7.14 – Structural equations model for the different dimensions of the SHRIMQ and the
components of organizational commitment. .................................................................................... 128 Figure 7.15 – Structural equations model for the different components of organizational commitment and
performance related observations of self-efficacy ........................................................................... 130 Figure 7.16. Mediation model of SHRIMQ on PROSE, mediated by organizational commitment.. ....... 131 Figure 7.17. Structural equations model for the different dimensions of the SHRIMQ and the components
of helping and voice behaviors ........................................................................................................ 133 Figure 7.18 – Structural equations model for the different components of helping and voice behaviors and
performance related observations of self-efficacy ........................................................................... 134 Figure 7.19 – Mediation model of SHRIMQ on PROSE, mediated by organizational commitment.) ..... 135 Figure 7.20. Mediation model of SHRIMQ on PROSE, mediated by the worker organization relationship
(job satisfaction, organizational commitment and helping and voice behaviours). ......................... 136 Figure 7.21. Mediation model of SHRIMQ on PROSE, mediated by the emocional worker organization
relationship (intrinsic job satisfaction, affective organizational commitment and helping and voice
behaviours).. .................................................................................................................................... 137 Figure 7.22. Mediation model of SHRIMQ on PROSE, mediated by the worker organization relationship
job satisfaction, organizational commitment and helping and voice behaviours) in the clinical staff
......................................................................................................................................................... 138 Figure 7.23. Mediation model of SHRIMQ on PROSE, mediated by the worker organization relationship
(job satisfaction, organizational commitment and helping and voice behaviours) in the non-clinical
staff .................................................................................................................................................. 139
xiii
Figure 7.24. Mediation model of SHRIMQ on PROSE, mediated by the emotional worker organization
relationship (intrinsic job satisfaction, affective organizational commitment and helping and voice
behaviours) in the clinical staff ........................................................................................................ 140 Figure 7.25. Mediation model of SHRIMQ on PROSE, mediated by the emotional worker organization
relationship (intrinsic job satisfaction, affective organizational commitment and helping and voice
behaviours) in the non-clinical staff ................................................................................................ 141 Figure a.1 - Confirmatory factor analysis of the WOR model. ................................................................ 222 Figure a.1 - Confirmatory factor analysis of the EWOR model. .............................................................. 223
xiv
List of Tables Table 5.1 – Synthesis of hypotheses ........................................................................................................... 67 Table 6.1 – Indicators and construct of satisfaction with human resources’ issues management .............. 73 Table 6.2– Indicators and construct of job satisfaction .............................................................................. 76 Table 6.3 – Indicators and construct of organizational commitment .......................................................... 78 Table 6.4 – Indicators and construct of helping and voice behaviours ....................................................... 80 Table 6.5 – Indicators and construct of performance related observations of self efficacy ........................ 82 Table 7.1 - Varimax rotated component matrix based on correlations among the items of the SHRIMQ
and communalities ............................................................................................................................. 91 Table 7.2 - Goodness of fit indices obtained in the confirmatory factor analysis of the SHRIMQ ............ 92 Table 7.3 - Varimax rotated component matrix based on correlations among the items of the MSQ
communalities, and explained variance. ............................................................................................ 93 Table 7.4 - Goodness of fit indices obtained in the confirmatory factor analysis of the SHRIMQ ............ 94 Table 7.5 - Varimax rotated component matrix based on correlations among the items of the OCS and
communalities (h2). ........................................................................................................................... 96 Table 7.6 - Goodness of fit indices obtained in the confirmatory factor analysis of the OCS .................... 97 Table 7.7 - Varimax rotated component matrix based on correlations among the items of the HVBS and
communalities (h2). ........................................................................................................................... 98 Table 7.8 - Goodness of fit indices obtained in the confirmatory factor analysis of the HVBS. ................ 99 Table 7.9 - Varimax rotated component matrix based on correlations among the items of the PROSES,
communalities (h2) and explained variance. .................................................................................... 100 Table 7.10 - Goodness of fit indices obtained in the confirmatory factor analysis of the HVBS ............. 100 Table 7.11 – Average variance extracted and composite relaibility for the constructs of this study ........ 102 Table 7.12. Minimum, maximum, mean and standard deviation of the latent variables in the present study.
......................................................................................................................................................... 109 Table 7.13 – t tests concerning gender differences for all the latent constructs in our study. .................. 111 Table 7.14 – Pearson correlations of the age of respondents with the latent constructs of our study ....... 112 Table 7.15 – Means and standard deviations of the different latent constructs in the different jobs of the
respondents. ..................................................................................................................................... 113 Table 7.16 – One way anova of the differences in the latent constructs of our study regarding the different
jobs included in the sample. ............................................................................................................. 114 Table 7.17. Bonferroni post hoc comparisons results. .............................................................................. 116 Table 7.18. Normality tests using skewness and kurtoses of the latent constructs of this study .............. 120 Table 7.19 – Syntheses of hypotheses ...................................................................................................... 122 Table 7.23. - Regression estimates of the sem model for the standardized path beta coefficients regarding
the relationship of the SHRIMQ dimensions and job satisfaction. .................................................. 124 Table 7.24. - Regression estimates of the sem model for the standardized path beta coefficients regarding
the relationship of job satisfaction and PROSE. .............................................................................. 125 Table 7.25. - Regression estimates of the sem model for the standardized path beta coefficients regarding
the relationship of the SHRIMQ dimensions and the components of organizational commitment
(affective, normative and continuance commitment)....................................................................... 129 Table 7.26. - Regression estimates of the sem model for the standardized path beta coefficients regarding
the relationship of organizational commitment and prose. .............................................................. 130 Table 7.27. - Regression estimates of the sem model for the standardized path beta coefficients regarding
the relationship of the SHRIMQ dimensions and job satisfaction. .................................................. 132 Table 7.28. - Regression estimates of the sem model for the standardized path beta coefficients regarding
the relationship of job satisfaction and PROSE ............................................................................... 133 Table 7.29 - Synthesis of results concerning hypotheses ......................................................................... 142 Table A1.1 - Goodness of fit indices obtained in the confirmatory factor analysis of the WOR composite
measure ............................................................................................................................................ 222
xv
Table A1.2 – average variance extracted and composite relaibility for the WOR ................................... 222 Table A2.1 - goodness of fit indices obtained in the confirmatory factor analysis of the EWOR composite
measure ............................................................................................................................................ 223 Table A2.2 – average variance extracted and composite relaibility for the WOR ................................... 223
xvi
Abbreviations
AOC Affective Organizational Commitment
AVE Average Variance Extracted
CFA Confirmatory Factor Analysis
CFI Comparative Fit Index
COC Continuance Organizational Commitment
CR Composite Reliability
GFI Goodness of Fit Index
HR Human Resources
HRIM Human Resources’ Issues Management
HRM Human Resource Management
HVB Helping and Voice Behaviours
HVBS Helping and Voice Behaviours Scale
JS Job Satisfaction
MSQ Minnesota Satisfaction Questionnaire
NOC Normative Organizational Commitment
OC Organizational Commitment
OCB Organizational Citizenship Behaviour
OCS Organizational Commitments Scales
OP Organizational Performance
PC Psychological Contract
PROSE Performance Related Observations of Self Efficacy
PROSES Performance Related Observations of Self Efficacy Scale
RMSEA Root Mean Square Adjusted
RS Recruitment and Selection
SEM Structural Equations Model/Modelling
SET Social Exchange Theory
SHRIM Satisfaction with Human Resources’ Issues Management
SHRIMQ Satisfaction with Human Resources’ Issues Management Questionnaires
SHRM Strategic Human Resources’ Issues Management
WOR Worker-Organization Relationship
1
Chapter 1 - Introduction
“It doesn’t matter how slowly you are going, as long as you don’t stop”
- Confucius
2
Chapter 1 – Introduction
1.1. Purpose & relevance of the study
Over the past decades, research for the causal links between human resource manage-
ment (HRM) and business performance has dominated both the academic and practi-
tioner debate (Purcell & Kinnie, 2007; Kehoe & Wright, 2013): the present study aims
at contributing towards this body of knowledge.
Many authors have dedicated their careers to understanding the connection between
HRM and Organizational Performance (OP) that in some ways justifies the relevance of
HRM in companies by making return on investment in HRM clearer. Scholars and prac-
titioners have increasingly recognized the importance of effective people management
and human capital for organizational performance (Bowen & stroff, 2004; Ferreira &
Marques, 2014; Grant, 1996; Hitt, Biermant, Shimizu, & Kochhar, 2001; Nasurdin,
Ahmad & Ling, 2015). In particular, strategic human resource management (SHRM)
scholars have suggested that organizations can use performance and commitment-
oriented human resource (HR) practices to drive organizational effectiveness (Becker &
Gerhart, 1996; Dyer & Reeves, 1995; Wright, Dunford, & Snell, 2001) - a claim now
supported by a large body of field research (e.g., Delery & Doty, 1996; Huselid, 1995;
MacDuffie, 1995), as well as subsequent confirmatory reviews and meta-analyses of
this literature (e.g., Combs, Liu, Hall, & Ketchen, 2006; Wright, Gardner, Moynihan, &
Allen, 2005).
However intuitive this connection between how much a company invests and values
their human capital through HRM and how well a company can do may be, empirical
evidence has been elusive, and some authors go so far as to refer to this
“happy-productive worker hypotheses” as the Holy Grail of
HRM research (Fisher, 2003).
Although a few recent empirical studies have provided support for the claim that high-
performance HR practices work most immediately through employee attitudes and be-
haviours—such as job satisfaction, affective commitment (Cohen, 2003; Gong, Law,
Chang, & Xin, 2009; Takeuchi, Chen, & Lepak, 2009; Xerri & Brunetto, 2013), ser-
vice-oriented citizenship behaviours, turnover (Sun, Aryee, & Law, 2007), and social
exchange (Takeuchi, Lepak, Wang, & Takeuchi, 2007) – recent theoretical work on the
HR–performance causal chain suggests that these studies may oversimplify the relation-
3
ships between HR practices and employee outcomes (e.g., Bowen & Ostroff, 2004;
Nishii & Wright, 2008).
In this study we consider these claims and propose a more complex and ‘human’ en-
compassing way of linking the two elements as we explore other conceptualizations and
mediators to this connection.
We argue that the explanation for the link between HRM and OP lays, to a great extent,
in the individual point of view of the relationship between worker and organization and
in worker perceptions (Kehoe & Wright, 2013), and that herein may lay some of the
fundamental aspects of the “black box effect” - the process through which HRM prac-
tices affect behavioural outcomes (Becker & Gerhart, 1996; Nasurdin, Ahmad, & Ling,
2015). We will therefore explore the subject of the worker-organization relationship in a
reciprocity theory and social exchange theory framework (Blau, 1964; Coyle-Shapiro &
Conway, 2005; Gouldner, 1960; Homans, 1958), aiming at contributing to a better un-
derstanding of some of the psychological processes that may influence employee’s will-
ingness to contribute to the OP (e.g. Kelley & Hoffman, 1997; Gould-Williams, 2003;
Gyekie, 2005).
Variations regarding the relationships between HRM and OP across organizational
forms and industry sectors are often disregarded (Bamberger, Bacharach & Dyer, 1989).
This work aims at shedding additional light on the specificities of the healthcare con-
text.
1.2. The healthcare context
“At the heart of each and every health system, the workforce is central to advanc-
ing health” (World Health Organization [WHO], 2006)
Organizational context differentiates the healthcare sector from other sectors (Prins &
Henderickx, 2007): delivery of HRM in hospitals is a complex process throughout the
world (Townsend & Wilkinson, 2010). Worldwide, hospitals are facing many challeng-
es including increased costs, per capita decreases in government funding, technology
that delivers both less invasive surgery (consequently capacity to perform more inpa-
4
tient procedures) and the capacity to deal with more complex medical interventions;
also, healthcare systems that include hospitals have been under constant and continuing
pressure to deliver quality improvements, better accountability, consumer choice and
cost savings (Grimshaw, Rubbery, & Marchington, 2010; Kabene, Orchard, Howard,
Soriano, & Leduc, 2006).
Organizations in the healthcare sector have the social responsibility to deliver care to
citizens, which means that the work processes must be organized to meet the needs of
the clients (van Wijk, 2007). As such, it is arguable that one important area of improv-
ing and maintaining service delivery as well as facing current challenges is through the
hospital’s arguably most important assets: the people that work in hospitals, their human
resources (HR).
Over recent years, the Portuguese healthcare system - not unlike the British healthcare
system and others around the world (Kabene et al, 2006) – has been facing government
promoted consumer choice, competition among service providers, quasi-market con-
tracting and outright privatization that directly contradicts former public policies and
generates some disruption of previous practices. These managerial practices have also
had some reflections on HRM policies such as: establishment of individual contracts
(instead of collective contractual agreements), non-public hire for public hospitals,
changes in the performance appraisal system (e.g., implementation of the infamous SI-
ADAP1 system) etc. Adding to these sector specific changes, economic instability has
also proven to affect HRM in public hospitals, where career progression as been politi-
cally “frozen” and pay raises have been altogether stopped: salaries have even been cut
down in different manners.
The afore mentioned situations can be a veritable recipe for disaster in HRM, and may
lead to high levels of turnover, stress and burnout among healthcare workers (Gray &
Philips, 1996), less involvement in safety procedures and practices (Gyekye, 2005) and
even higher levels of mortality among patients (West, Guthrie, Dawson, Borrill &
Carter, 2006), which makes it paramount that we increase our knowledge concerning
HRM in the healthcare context as to better cope with situations such as these.
Around the world it is an undisputed fact that the health care sector is primarily a people
1 SIADAP stands for “Sistema Integrado de Gestão e Avaliação de Desempenho na Administração
Pública” (Integrated System for the Performance managemnet and Appraisal in Public Service).
5
oriented, labour intensive sector, since the workforce in most healthcare organizations
directly provides the services to the clients - which means that the workforce is the most
critical organizational input (Buchan, 2004; Prins & Henderickx, 2007; van Wijk, 2007;
West, Guthrie, Dawson, Borril, & Carter, 2006;). Within many health care systems
worldwide, increased attention is being focused on HRM (Kabene et al., 2006).
Human resources have been described as “the most important aspect of health care sys-
tems” (Narasimhan et al., 2004, p. 1469), “the heart of the health system in any coun-
try” (Joint Learning Initiative, as cited in Hongoro & McPake, 2004, p. 1451), and “a
critical component in health policies” (Dussault & Dubois, 2003, p.1). Thus, healthcare
organizations are highly dependent on the workforce (Dussault & Dubois, 2003). As a
result, HRM is particularly important, because HRM can encourage the performance of
the workforce (Prins & Henderickx, 2007; van Wijk, 2007), and a well motivated and
appropriately skilled and deployed workforce is crucial to the success of the delivery of
healthcare (Buchan, 2004): in recent years, it has been increasingly recognized that
HRM is important in the healthcare sector (Prins & Henderickx, 2007) as there is a rea-
sonable expectation of a strong connection between HR and health care organizations in
terms of culture but also performance.
The relationship between HR and healthcare organizations is very complex, and its
study should be encouraged (Kabene et al., 2006). This is often complicated because of
many circumstances, such as multiple employers (many healthcare workers have more
than one job in different organizations) and a very diverse workforce (including clinical
and non-clinical workers (WHO, 2000) that includes separate occupations often repre-
sented by powerful professional trade unions (Buchan, 2004; Prins & Henderickx,
2007); in the Portuguese context other political and economic factors can be included,
such as a strong organizational culture in the public sector that is very different from the
private sector, and that has managerial implications in the movement of privatization of
healthcare. Thus management of what is meant to be a joined-up healthcare experience
can be potentially confusing and subject to multiple influences (Townsend & Wilkim-
son, 2010).
Adding to these circumstances, Townsend and Wilkimson (2010) state that a range of
factors limits research in healthcare HRM. Firstly, a lack of diverse methodological ap-
proaches limits our ability to understand the complex social and institutional dynamics
6
involved in managing HR in hospitals (e.g., the vast majority of studies address only
one type of professionals or one sector/ward of the hospital). Secondly, structural and
organizational aspects of hospitals that are important in measuring performance seem to
be systematically overlooked (e.g., organizational performance is difficult to materialize
in most cases; it is hard to establish a comparison for performance even among the same
type of jobs – e.g., a nurse in intensive care vs. a nurse in ambulatory surgery; adminis-
trative assistants are usually evaluated by an administrative supervisor that does not
work with them because they are spread through different departments/wards in the in-
stitution, etc.).
Among the proposals for future research that address these issues in the study of the
linkage between HRM and OP in hospitals, authors have been proposing single institu-
tion studies in order to study the HRM-performance linkage, while eliminating parasite
variables that can occur when comparing hospitals (e.g., different organizational culture,
organizational policies, etc.) (Nishii & Wright, 2008; Veld, Paauwe, & Boselie, 2010).
Also, Wright and Nishii (2004) build a strong argument for making a clear distinction
between intended HR practices (those designed on a strategic level), actual – or imple-
mented – HR practices (those implemented by, for example, the direct supervisor), and
perceived HR practices (those perceived by the employees). These three realities can
have an almost separate existence: considering this may help us understand why some
HRM policies and practices that theoretically seem to make perfect sense, sometimes
backfire.
This perspective strikes an especially relevant chord in terms of organizational theory
but also research methodology, since what the manager intends to implement may be
opposite to what employees perceive and even what is actually done – this also means
that depending on the research design, studies may be looking at the same reality with
very different perspectives and results. In this study we address this issue by specifically
basing our research on employee perception, based on the Thomas Theorem: if people
define situations as real, they are real in their consequences (Merton, 1995).
All these elements explain to some extent the fact that, although healthcare is an essen-
tial service, with knowledge intensive characteristics, research about HRM in hospitals
seems to still be lacking because of contextual and methodological issues. The present
7
research addresses some of these challenges by considering using one single institution
in healthcare and including all types of hospital workers, through in an individual level
analysis.
1.3. Roadmap for this work
We will proceed with the literature review, starting with some considerations on the
satisfaction and perceptions of human resources’ issues and its paramounting im-
portance in the field of HRM; we then will discuss some essential aspects of organiza-
tional performance and performance related worker self efficacy, especially in hospitals
and healthcare. We will conclude our literature review by exploring the subject of the
worker-organization relationship in the framework of reciprocity and the social ex-
change theory, focusing on three important components of this relationship: job satis-
faction, organizational commitment and organizational citizenship behaviours.
After introducing and contextualizing our major constructs we will then formulate our
research questions, theoretical model and hypotheses before the empirical section.
In the empirical section, methodological procedures and options will be explained, data
collection procedures detailed, psychometric instruments will be shortly presented and
validated. Sample will be described prior to the results section, where results concerning
data exploration, hypotheses testing and model testing will be shown in a comprehen-
sive matter. The discussion of results closes the empirical section.
The last section of this work is the conclusion where the main ideas will be recapitulat-
ed, and implications for the practice, limitations and future research in this area are dis-
cussed.
Figure 1.1 introduces the structure and organization of this work in a graphic manner.
8
Figure 1.1. Structure and organization of this research
9
Chapter 2 – Satisfaction with Human Resources’ Issues
Management
“You argue complexity as an excuse for inaction?”
– Claire North, “The first fifteen lives of Harry August”
10
Chapter 2 – Satisfaction with Human Resources’ Issues Management
“Healthcare organizations are the most complex form of human organization.”
(Golden, 2006)
2.1. Perceptions of Human Resources’ Issues Management
Human resource management (HRM) practices have been recognized as an important
factor in developing sustainable competitive advantage across sectors (Kydd & Oppen-
heim, 1990; Lado & Wilson, 1994; Pfeffer, 1998), including the healthcare sector (Prins
& Henderickx, 2007; van Wijk, 2007).
In the case of the healthcare sector and specifically hospital workers, authors like West
el al. (2006) and Buchan (2004) discuss impactful HRM practices following Pfeffer’s
(1998) work on ‘high commitment’ or ‘high performance’ HRM practices, and suggest
that HRM that truly impacts performance in the healthcare includes both more tradition-
al/technical aspects of HRM (namely, performance appraisal/management, training,
employment security, staffing [recruitment/selection] and compensation), and also areas
of action that aren’t exactly HRM practices, but represent issues that can be highly as-
sociated with HRM policies (decentralization, participatory mechanisms, team-based
structures).
The perception of good teamwork, for instance, has been associated with safety attitudes
and innovation in postoperative outcomes (Haynes et al., 2011), whereas a significant
proportion of adverse events has been attributed to inadequate team-based skills such as
communication, leadership, situation awareness and resource utilization (Petrosoniak &
Hicks, 2013); training techniques that promote the development of shared mental mod-
els for team and task processes, address the effect of acute stress on team performance,
and integrate strategies to improve clinical reasoning and the detection of cognitive er-
rors have been proposed as a way to significantly increase team and task performance in
the health care sector (Petrosoniak & Hicks 2013). Furthermore, HRM practices are
associated with positive effects on the behaviour of healthcare staff where they enhance
autonomy and employee participation in change and innovation (Patterson et al., 2005).
This to say that although technical HRM has been increasingly regulated through stake-
holder’s expectations since it reportedly benefits administration, employee relation-
ships, and health and safety (Huselid, Jackson, & Schuler, 1997; Schuler, 1992), recent
research has concluded that technical HRM alone may not have good predictive power
11
to explain organizational performance in healthcare (Yang & Lin, 2014). HRM is com-
monly defined as a set of employee management activities, but there is no consensus
regarding which HR practices should be included in a ‘comprehensive HRM checklist’
(Boselie, Dietz, & Boon, 2005), which led us to use the expression of Human Re-
sources’ Issues Management (HRIM), as a term that clearly encompasses technical and
non technical HRM, as to promote conceptual clarity.
The work of several authors has explored what type of HRIM practices most impact
performance in the healthcare.
Nasurdin and colleagues (2015) suggest four main areas: selective hiring (the rigor of
hiring as indicated by applications per vacancy), communication (the activities that pro-
vide employees with sufficient and useful information about their work), appraisal (the
evaluation and feedback process about employees’ performance based on some prede-
termined organizational standards) and reward (all forms of financial returns, tangible
services, and benefits that an employee receives as part of an employment relationship).
Vermeeren and colleagues (2014), in a large study in the healthcare context, chose five
indicators that are often used in HRM and performance research: training and develop-
ment, performance related pay, teamwork, job design, and autonomy.
West and colleagues (2006) and Buchan (2004) explore the dimensions of impactful
HRM practices following Pfeffer’s (1998) work on ‘high commitment’ or ‘high perfor-
mance’ HRM practices, and indicate that the areas of HRM that most have an impact in
performance in the healthcare context are: performance appraisal/management, training,
decentralization, participatory mechanisms, team-based structures, employment securi-
ty, staffing (recruitment/selection) and compensation.
Although the effects of a company’s overall HR practices, or HR bundle, have been
extensively examined, the effects of employees’ overall perception of HR effectiveness
have rarely been studied (Chang, 2005). This might be due to the fact that perception is
classically a construct approached by Psychologists whereas HRM is mainly a man-
agement field.
Recently the notion emerged that the perceptions of employees regarding HRM can be
as important as the HRM practices themselves (e.g., Wright & Nishii, 2008). Empirical
12
evidence has been gathered by various authors in the past 15 years or so to explore this
idea, as we will exemplify next.
In a study with circa 2000 security workers, Boselie and van der Wiele (2002) conclud-
ed that positive perceptions of individual employees on the HRM concepts lead to a
higher level of satisfaction and less intention to leave the organization; Bowen and Os-
troff (2004) developed a study about strong HRM systems and focused on climate be-
cause of their interest in multilevel relationships, since both psychological climates as
individual-level perceptions and organizational climate2 as a shared perception at the
firm level have been positioned as mediators of the relationship between HRM practices
and performance (e.g., Ostroff & Bowen, 2000 as cited in Bowen & Ostroff, 2004).
Their work has been considered “groundbreaking in their acknowledgement of the role
employee perceptions play in translating HR practices into desired organizational out-
comes” (Nishii, Lepak, & Schneider, 2008, p. 508).
Other studies include Chang’s (2005) attempt to examine the construct of employees’
overall perception3 as one of the possible mechanisms by which the HRM influences
employees’ attitudes. Results indicated that employees may readily perceive a certain
practice to be effective if they have perceived other HR practices as effective, and their
attitudes may be strongly influenced by the consistency of their perceptions. The author
also points out that the other side of the coin is that a salient negative perception can
undermine other effective practices. We will finally point out Nishii et al.’s (2008) in-
troduction of the construct of HR attributions; these authors argue that the attributions
employees make about the reasons why management adopts certain HR practices have
consequences for their attitudes and behaviours, and ultimately, unit performance.
These authors proclaim that although a number of scholars have suggested that employ-
ees’ interpretations or attributions of HR practices are likely to play an important role in
influencing the ultimate effect of HR practices, their study is among the first to provide
2 Organizational climate is a shared perception of what the organization is like in terms of practices, poli-
cies, procedures, routines, and rewards, what is important and what behaviors are expected and rewarded
(Bowen & Ostroff, 2004) – so, although this argument meets the point that we are trying to make: that
employee and group perceptions can play an important role in organizational outcomes, the construct of
organizational climate does not fit our interests per se, in a sense that it is too wide. 3 According to Chang (2005) employee overall perception, the employee’s beliefs about diverse aspects
of HR practices, and consideration of diverse beliefs about an object in shaping an individual’s overall
attitude can be traced back to the Fishbein model (Fishbein as cited in Chang, 2005). This model has
mainly had application in customer behavior theory, depicting that when an individual holds beliefs to-
wards more than one aspect of an object, the overall attitude is influenced by a summation of the product
of each belief and evaluation regarding the belief.
13
evidence that this is the case.
Hence, employee perception of HRM practices seems to be gaining new ground and
attention from scholars with the added methodological benefit that individual measure-
ments, when done in a significant sample are statistically more robust and offer different
possibilities of studying organizational issues, due to the sheer large sample size possi-
bilities (Paauwe, 2009). This allows for the inclusion of a broader scope of practices and
other methodological procedures in variables collected by the Organization, as previ-
ously mentioned.
Thus it is fair to say that this study focuses on perceived HRM, following the Thomas
Theorem: if people define situations as real, they are real in their consequences (Merton,
1995), which is to say that if employees believe that specific HR practices are employed
in the organization, they will act according to that belief (Vermeeren et al., 2014).
2.2. Satisfaction with Human Resources’ Issues Management
In this context we are approaching the affective side of perception (Cupach, Canary &
Spitzman, 2009) by inquiring employees about their satisfaction with HRIM. By ap-
proaching the matter thusly, we expect to register not only the rational perception of
HRIM but mostly how subjects feel and relate to it in a more positive or negative mat-
ter, the side of perception that will most likely be related with how subjects construct
their relationship with the organization and how much they are willing to invest in their
job.
In the last decade scholars have been concerned with the precise nature of the mecha-
nism linking HRM and performance outcomes (the ‘black box’, i.e., the mediating link
between HRM and performance). In recent years, many suggestions have been made
regarding the nature of this ‘black box’, but many scholars emphasize the perceptions
and experiences of employees as the main linking mechanism (Boselie et al., 2005;
Bowen & Ostroff, 2004; Nishii & Wright, 2007). HR practices forge a psychological
contract between employer and employee that in turn affects these perceptions and ex-
periences (Coyle-Shapiro & Kessler, 2002).
The importance of this question is based on the rationale that prompted this study: that
attitudes are likely to precede and predict behaviours (Ajzen & Fishbien, 1980), thereby
14
suggesting that behaviours’ attitudinal antecedents are important points of focus and
measurement.
Conclusion
One of the main goals of Human Resource Management (HRM) is to increase the per-
formance of organizations (Paauwe, Wright, & Guest, 2013; Vermeeren et al., 2014).
In the last two decades, several studies on HRM and performance have been conducted
in the health care sector (El-Jardali, Tchaghchagian, & Jamal, 2009; Vasset, Marnburg,
& Furunes, 2011). In their review of health care studies, Harris et al. (2007) concluded
that HR practices are often related to patient oriented performance outcomes. They also
noted the importance of conducting additional research on the ‘black box’ issue. Fur-
thermore, many health care studies relate HRM to organizational and HR related out-
comes (Chuang, Dill, Morgan, & Konrad, 2012; Cole et al., 2005; Lee & Kang, 2012;
Scotti, Harmon, & Behson, 2007; Vermeeren et al., 2014; Weinberg, Avgar, Sugrue, &
Cooney-Miner, 2013).
HR practices provide employees with concrete evidence of the organisation’s intent to
anticipate and meet their needs (Armstrong-Stassen & Schlosser, 2010). When an or-
ganisation engages in HR practices that reflect investment in, and support of its em-
ployees, it signals that the organisation is seeking to continue a social exchange rela-
tionship with its employees (Allen, Shore, & Griffeth, 2003).
No single agreed, or fixed, list of HR practices or systems of practices exists to measure
HRM (Guest, 2011; Paauwe, 2009) and the heterogeneity of medical subcultures across
different organisations suggests that a single HRM model is unlikely to be effective
throughout the NHS, indicating the need for local development of this or any HRM
framework (Trebble, Heyworth, Clarke, Powell, & Hockey, 2014).
Thus, we chose to approach this question from the perspective of an inclusive construct
of HRIM (including technical and non technical aspects of HRM) and from the point of
view of worker perceptions, namely satisfaction with HRIM, as a more adequate way to
construe the idea at hand.
15
16
Chapter 3 –Worker-Organization Relationship
“Money can be exchanged quickly, but love takes time”
- Foa & Foa as cited in Coyle-Shapiro & Conway, 2005
“With a secret like that, at some point the secret itself becomes irrelevant.
The fact that you kept it does not.”
- Sara Gruen, “Water for elephants”
17
Chapter 3 – Worker-Organization Relationship
“The nature of the employment relationship has been an important but
amorphous topic since probably the very first time one individual struck
bargain with another, trading labour for otherwise inaccessible valued out-
comes” (Coyle-Shapiro, Shore, Taylor, & Tetrick, 2005, p.1).
In 1981, Clark (as cited in Coyle-Shapiro et al., 2005) pointed out that labour and capi-
tal are in perpetual conflict over two issues: control of the production process and the
conditions of employment. Although conflict is an intrinsic component of the relation-
ship between between labour and capital (the two sides of the employment or worker-
organization relationship) both seek contractual agreement and reconciliation. No side
wins if it completely breaks the power of the other. It is through the employment rela-
tionship, that reciprocal rights and obligations are created between the employee and the
employer. This relationship has been the main vehicle through which workers gain ac-
cess to the rights and benefits associated with employment (International Labour Con-
ference [ILC], 2005).
Thus it is almost intuitive a certain give-and-take in this relationship: that is the funda-
ment of the Social Exchange Theory (Blau, 1964; Coyle-Shapiro & Conway, 2005;
Gouldner, 1960; Homans, 1958). Social Exchange Theory (SET) has been used to ex-
amine a variety of organizationally desired outcomes and to examine how employees
view their relationships with their employer in different cultures and in different con-
tractual arrangements. Overall, the empirical evidence seems to support the universality
of social exchange as a framework for understanding the employment relationship
(Shore & Coyle-Shapiro, 2003).
3.1. Social Exchange Theory and Reciprocity
“Human social interaction is rarely guided by pure reason. Instead, in situ-
ations in which humans have the option to cooperate, to defect, or to punish
non-cooperative behaviour of another person, they quite uniformly tend to
reciprocate ‘‘good’’ deeds, reject unfair proposals, and try to enforce obe-
dience to social rules and norms in non-cooperative individuals (‘‘free-
riders’’), even if the punishment incurs costs to the punisher.” (Wischniew-
ski, Windmann, Juckel, & Brüne, 2009, p.1)
Although the seminal works on Social Exchange Theory (SET) date back from the
1960’s (e.g., Blau, 1964; Homans, 1958; Thibaut & Kelly, 1959), in the past few years
18
it has seen its popularity boost in a number of social sciences as is the example of em-
ployee relations (Coyle-Shapiro et al., 2005), project teams (Lin & Huang, 2010), psy-
chopathology and neuroscience (Wischniewski et al., 2009), tourism (Ward & Berno,
2011) and marketing (Kingshott, 2006).
Cooperation between genetically unrelated individuals is a quite unique trait in humans.
This characteristic has biological consequences, since it favours the natural selection of
individuals who exhibit it (Fehr & Rockenbach, 2004; Jensen, Call, & Tomasello,
2007), such that universally accepted rules of social exchange evolved as ‘‘the decisive
organizing principle of human society’’ (Nowak, 2006) and several studies have con-
firmed as crucial in developing and maintaining relationships (Uhl-bien & Maslyn,
2003).
SET is rooted in Barnard’s (1938) theory of equilibrium (an economic theory) and was
modified by Thibaut and Kelley (1959) for the study of the social psychology of groups.
The exchange model proposed by Barnard (1938) and later revised by March and Simon
(1958) posited that individuals exchange their contributions for certain inducements that
the organization provides. Subsequently, Blau (1964) distinguished between social and
economic exchange that differ, among other things, on the nature of the inducements
being offered by the organization; economic exchange emphasizes the financial and
more tangible aspects of the exchange while social exchange emphasizes the socio-
emotional aspects of the exchange (Shore, Tetrick, Lynch, & Barksdale, 2002). Thus,
SET focuses on the perceptions of the relative costs and benefits of relationships and
their implications for relationship satisfaction.
According to the social exchange theory (Blau, 1964), positive, beneficial actions di-
rected at employees by either the organisation and/or its representatives (e.g., supervi-
sors) contribute to the establishment of high-quality exchange relationships that create
obligations for employees to reciprocate in positive, beneficial ways (Settoon, Bennett,
& Liden, 1996). Social exchange theorists have viewed the employment relationship as
an exchange of tangible and intangible benefits (Coyle-Shapiro & Conway, 2005). As
such, it is the emphasis on the exchange of the intangible benefits that differentiates
social exchange from economic exchange. Eisenberger, Huntington, Hutchison, and
Sowa (1986) propose that fulfilling important socio-emotional needs in the workplace is
similar to fulfilling individual needs for respect, caring, and support in interpersonal
19
relationships.
SET has been in the origin of several organizational constructs such as organizational
support theory or psychological contracts.
Organisational support theory (Eisenberger et al., 1986) posits that employees develop
global beliefs concerning the extent to which their organisation values their contribution
and cares about their well-being. Employees interpret such support by the organisation
as demonstrating the organisation’s commitment to them, creating an obligation to re-
pay the organisation for its commitment and caring. Prior research has found a strong
positive relationship between perceived organizational support and affective organisa-
tional commitment (e.g., Meyer & Smith, 2000; Rhoades & Eisenberger, 2002).
Some authors state that perceived organizational support fulfills the need for self-esteem
by communicating recognition of employees’ contributions (Armeli, Eisenberger, Fa-
solo, & Lynch, 1998), the need for emotional support by signalling to employees that
the organization can be relied upon to help when required, and the need for social ap-
proval by communicating that they are adhering to organizational norms. Therefore, a
social exchange perspective on the employment relationship goes beyond the exchange
of tangible benefits to include the fulfillment of socio-emotional needs.
As Rousseau and Tijoriwala (1998) note, “central to the workings of psychological con-
tracts is the interplay between employee and employer obligations, their relative magni-
tude and contingent relations”. (p. 692).
Rousseau (1989) argues that in the exchange relationship, there is a belief “that contri-
butions will be reciprocated and that ... the actions of one party are bound to those of
another”. (p. 128). The idea of reciprocation draws on the work of Blau (1964), who
argues that the exchange partners will strive for balance in the relationship and, if im-
balance occurs, attempts will be made to restore the balance. Furthermore, Morrison and
Robinson (1997) highlight the centrality of reciprocity, by arguing that “violation [of
the psychological contract] comes not only from the organization’s presumed failure to
reciprocate goods and services as promised, but also from its presumed failure to live up
to the norms and standards of reciprocity and goodwill that govern the relationship”.
(p.248).
20
In line with Rousseau’s (1989) conceptualization, perceived obligations and the extent
to which those obligations are fulfilled represents the essence of the psychological con-
tract. Perceived obligations set behaviour within the exchange. Empirically, numerous
studies have demonstrated that employees reciprocate perceived employer contract
breach (obligations–fulfilment of obligations) by reducing their commitment to the or-
ganization (Coyle-Shapiro & Kessler, 2000), lowering their trust in the employer (Rob-
inson & Rousseau, 1994), reducing their performance (Robinson, 1996), and withdraw-
ing organizational citizenship behaviour (Robinson & Morrison, 1995). The emerging
conclusion, therefore, is that employees reciprocate treatment by the employer by ad-
justing their attitudes and behaviours Results show that the instruments adopted in this
study are valid and reliable Results show that the instruments adopted in this study are valid
and reliable accordingly (Coyle-Shapiro & Kessler, 2002).
Current employee relations literature depicts psychological contract4 to comprise of an
individual’s belief that certain promises have been made by the other party (Robinson,
1996; Rousseau, 1989, 1995) and these act as strong psychological bonds between the
parties (Anderson & Schalk, 1998) because they reflect communications of future intent
between them (Morrison & Robinson, 1997).
Despite deriving from a field outside HRM (namely, Psychology), the psychological
contract has been gaining protagonism in the HRM related literature. Contributing to
this is the usefulness of the concept for understanding what employees and employers
expect of a job and a work environment, including not only expectations of tenure or
promotion but also sense of entitlement to work-life benefits and flexible working ar-
rangements. Although it is clear that the psychological contract is a relationship be-
tween employee and employer (the organization on its agents – the leader, supervisor,
CEO, etc.), most research has been focusing on the employee side of this equation
(Coyle-Shapiro & Kessler, 2002). Because reciprocation is at the very heart of the con-
struct, psychological contracts can contribute in understanding how Organizational Pol-
icies and Practices affect employee’s attitudes, feelings and behaviors.
4 Although Argyis (1960) and Levinson, Price, Munden, and Solley (1962) are credited with using the
term “psychological contract”, subsequent contributors have conceptualized the construct in significantly
different ways (cf. Roehling, 1996; Rousseau, 1995). Briefly, the construct has evolved from mutual
expectations to reciprocal obligations yet the core idea of reciprocity in the exchange is visible throughout
this development. As Argyis notes, “the employee will maintain the high production, low grievances ... if
the foreman guarantees and respects the norms of the employee informal culture” (1960, p. 97).
21
Psychological contracts have been shown to be highly significant within the employ-
ment context because they help the employee frame the relationship and this serves to
guide their behaviour. It should be noted that the psychological contract is distinguisha-
ble from the normative contract (Rousseau, 1995) because it resides in the mind of the
individual and can therefore act as double-edged swords because it also offers the po-
tential to engender dispute and disagreement between parties (Rousseau & Mclean-
Parks, 1993). By showing the positive and negative implications of psychological con-
tracts this rapidly growing body of knowledge has been an important aspect in helping
managers to understand the employment relationship.
To ensure a lack of confusion between the individual nature of psychological contracts
and the universal nature of the need to reciprocate, Rousseau (1995) makes clear the
distinction between relational rules or norms and psychological contracts arguing that
norms are likely to come into existence when the psychological contracts of parties
overlap. Psychological contract breach may help explain the deleterious consequences
of organizational restructuring on employee health and well-being and has been associ-
ated with insomnia and psychological distress (Garcia, Bordia, Restubog, & Caines,
2015), general reorganization involving downsizing, mergers & acquisitions is associat-
ed with psychosomatic complaints (Campbell-Jamison, Worrall, & Cooper, 2001), in-
creased mental health problems (Probst, 2003) and physical health impacts such as
muscular-skeletal, cardiovascular disease and mortality (Kivimäki et al., 2006). Howev-
er, it is believed that supportive relationships may buffer the effects of reduced induce-
ments (at least in the short term).
It is undisputed that norms constitute shared expectations and values that help guide
patterns of appropriate behaviour (Joshi & Arnold, 1997; Morgan & Hunt, 1994) and
seemingly help either party attain joint relational outcomes. Although psychological
contracts assist in developing positive bonds within a relationship (Anderson & Schalk,
1998) and this constitutes strong beliefs about what both parties are obliged to for being
in the relationship (Rousseau, 1995; Rousseau & Tijoriwala, 1998) these are highly idi-
osyncratic and reside in the mind of the individual (Rousseau, 1995). From this point of
view, it would seem likely that as norms develop through socialization the parallel de-
velopment of the psychological contract will result and thus the interactive effects of
theses two constructs upon one another, as well as their conjoint impact upon govern-
ance will need to be examined.
22
Even the interaction between employees within the same firm will result in the for-
mation of the psychological contract (Llewellyn, 2001) and this could moderate the ef-
fectiveness of managing these relationships.
The literature related to employee bonds shows these to form through interaction with
their employers through its agents, supervisors, peers, and, management (Anderson &
Schalk, 1998), suggesting the avenue that is designed to investigate these multiple inter-
actions is likely to be most fruitful.
Evidence concerning the Worker-Organization Relationship has shown a positive rela-
tionship between psychological contract fulfilment and objective measures of perfor-
mance (Conway & Coyle-Shapiro, 2012), a negative relationship between PC breach
and objective performance (salary) (Chen, Tsui, & Zhong, 2008), a negative relation-
ship between PC breach and supervisory rated in-role performance (Restubog, Bordia,
Tang, & Krebs, 2010), a positive relationship between PC breach and organizational
deviance mediated by contract violation (Kiazad, Seibert, & Kraimer, 2014), a positive
relationship between contract violation and organizational deviance mediated by re-
venge cognitions (Bordia, Restubor, & Tang, 2008).
Thus, psychological contracts’ literature (e.g., Rousseau, 1995) proposes that employees
will most likely want to reciprocate the companies’ interest in their well being and de-
velopment, with higher levels of job satisfaction, organizational commitment, job in-
volvement, organizational citizenship behavior, when they have positive perceptions
regarding HRM policies and practices.
Contracts (including psychological contracts), like all social exchange are based on trust
(Doney & Cannon, 1997) and the norm of reciprocity (Gouldner, 1960; Homans, 1958;
Levi-Strauss, 1957; Malinowski, 1922; Simmel, 1950). However, these constructs can-
not simply materialize, as they evolve as a result of some form of socialization process
(Doney & Cannon, 1997; Williams, 2001).
As a social exchange relationship involves unspecified obligations, exchange partners
are required to trust the other to discharge their obligations and also to accept the norm
of reciprocity that obligates an individual to return favourable treatment. Exchange
partners can demonstrate their trustworthiness by reciprocating benefits received. As
such, social exchange relationships take time to develop as exchange partners begin to
23
demonstrate their trustworthiness and show that they accept the norm of reciprocity
governing the relationship.
Homans (as cited in Coyle-Shapiro & Conway, 2005) views social behavior as “an ex-
change of goods, material goods but also non-material ones such as the symbols of ap-
proval or prestige” (p. 606). Blau (1964) distinguishes social and economic exchange,
where the nature of the economic exchange is usually an explicit and formal one, where
each party fulfils specific obligations; social exchange, in contrast, involves unspecified
obligations: “favours that create and diffuse future obligations, not precisely specified
ones, and the nature of the return cannot be bargained about, but must be left to the dis-
cretion of the one who makes it” (Blau, 1964, p. 93). Thus, one party needs to trust the
other to discharge future obligations (i.e., reciprocate) in the initial stages of the ex-
change and it is the regular discharge of obligations that promote trust in the relation-
ship.
Gouldner (1960) made this process more explicit through his seminal work on the
“norm of reciprocity”, stating that this norm implies two demands “(1) people should
help those who have helped them and (2) people should not injure those who have
helped them”5.
According to the same author, the norm of reciprocity can be understood by examining
different elements or components of this process, including equivalency (how much of
what is returned is equivalent/proportional to what was attained), immediacy (how long
has passed between a benefit and its return, where a feeling of unfulfilled duty remains)
and interest (the reason why the other element of the dyad is in the exchange relation-
ship). The combination of these elements is arguably the base of the mechanisms
through which the stability of social systems is maintained, (Homans, 1958; Liden,
Sparrowe, & Wayne, 1997; Simmel, 1950; Thurnwald, 1932), or even, as Thurnwald
(1932) puts it “the vital principle of society”. (p.106).
The norm of reciprocity plays an important role in the development of social exchange
relationships by perpetuating the ongoing fulfilment of obligations and strengthening
5 Gouldner (1960) argues that the strength of an obligation to repay is contingent upon the value of the
benefit received. Benefits are more valued when (a) the recipient is in greater need; (b) the donor cannot
afford to (but does) give the benefit; (c) the donor provides the benefit in the absence of a motive of self
interest; and (d) the donor was not required to give the benefit. Therefore, highly valued benefits create a
stronger obligation to reciprocate.
24
indebtedness and there is some empirical evidence that a high social capital is associat-
ed with improvements in the social and economic well-being (Pretty, 2003).
Some authors go so far as to believe that this need to reciprocate and the social ex-
change practices have their fundaments in the selective evolutionary process
(Wischniewski et al., 2009). Recent research in the evolutionary neurosciences has be-
gun to unveil the factors involved in complex decision-making in situations of social
exchange. According to different authors, it seems to become increasingly clear that
humans have evolved cognitive and emotional motives that guide their behaviour to-
wards cooperation, defection, and even sanctioning of unfair behaviour (Axelrod &
Hamilton, 1981; Fehr & Fischbacher, 2004; Nowak, 2006; Trivers, 1971; Wilson,
2006). Empirical evidence deriving both from behavioural observation and brain imag-
ing studies (e.g., Quervain et al., 2004; Sanfey, Rilling, Aronson, Nystrom, & Cohen,
2003) propose that this way of dealing with reciprocity seems to be quite universal as
humans, across cultures, seem to deal with communal sharing, social ranking, imbal-
ances of equality and market pricing in very similar ways (Fiske, 1992).
Still, there is a paucity of research into individual differences in behaviour, although it
is implicitly clear that character and temperament as well as situational contingencies
influence an individual’s attitude towards cooperation or noncooperative alternatives.
Contextual information also seems to be vital for an individual’s benefit-cost evaluation
in a given situation (Wischniewski et al., 2009). For example, people who themselves
have abundant resources at hand are arguably more likely to share with others in need;
in situations in which an individual feels threatened, the likelihood of cooperating with
a stranger is probably weakened6. Like individual differences, such contextual factors
influencing decision-making during social exchange have largely been disregarded in
experimental research (Wischniewski et al., 2009). In the workplace, Coyle-Shapiro and
Kessler (2002) demonstrated that the norm of reciprocity in which the conferring of
benefits (i.e., fulfilling obligations) creates a perceived obligation on the part of the re-
6 Classic social psychological theories of intergroup relations emphasize the role of threat and competi-
tion in predicting intergroup attitudes (LeVine & Campbell, 1972; Sears, 1988), and empirical research
has consistently borne out their negative consequences in international and multicultural research (Jack-
son, Brown, Brown, & Marks, 2001; Quillian, 1995). Threat may be perceived and interpreted in a num-
ber of ways. Integrated threat theory posits that there are four fundamental threats: realistic threat, sym-
bolic threat, negative stereotypes and intergroup anxiety (Stephan & Stephan, 1996, 2000), and each of
these has been shown to be significant predictors of attitudes toward outgroups, including responses to
immigrants, ethnic minorities and national groups (Stephan, Ybarra, & Bachman, 1999; Stephan, Ybarra,
Martínez, Schwarzwald, & Tur-Kaspa, 1998).
25
cipient to reciprocate: reciprocity comes from both parties to the worker-organization
relationship. These authors propose that in reciprocating future benefits from the em-
ployer, employees seem to place trust in the employer that these benefits will be forth-
coming, confirming Rousseau’s (1989) argument on the centrality of reciprocity to our
understanding of how exchange relationships are governed.
Several other authors confirm the need to investigate individual variables, stressing that
the range of fits analysed in HRM-research needs to be supplemented by the person-
organization fit in order to include perceptions of workers and to be able to differentiate
between employee groups; this is supplemented by the notion that the assessment and
measurement of performance should focus on more proximal outcomes (Paauwe, 2009;
Paauwe & Boselie, 2005; Wall & Wood, 2005).
Trivers (1971)7 argued that it can be predicted that different forms of cooperation be-
tween non-kin individuals can be distinguished according to the directness of reciproci-
ty. Direct reciprocity implies that there are repeated interactions between the same two
individuals (or groups of individuals), and that both have resources that are attractive to
one another (Trivers, 1971) such that both parties receive direct benefit from the ex-
change (Hammerstein & Leimar, 2006), referred to as ‘‘conditional cooperation’’ (or
direct reciprocity), where the employment relationship and the worker-organization re-
lationship can be classified.
Accordingly, people tend to cooperate if their counterpart behaves in the same way and
defection by one party is seen as a legitimate reason for the other party to retaliate (Fehr
& Fischbacher, 2004). The efficacy of such reciprocity can be experienced by both par-
ties within relatively short periods of time.
In everyday life, however, indirect reciprocity (also referred to as altruism) is also prev-
alent, where the benefit may lie in improved reputation or gain in social status (Nowak,
2006) -a potential pay-off that may lie in the more distant future. Nevertheless, such
behaviour can be frequently observed, because humans are concerned about the impres-
sions other people get of them; usually, helpful deeds are approved by significant others
or the community, and hence may be suitable to help raise one’s social status (Nowak &
7 Trivers (1971) was the first to lay the theoretical groundwork for the understanding of altruistic behavior
between genetically unrelated individuals within the modern evolutionary synthesis of ‘‘inclusive fitness
theory’’.
26
Sigmund, 1998). In evolutionary terms indirect reciprocity may also serve as an ‘‘hon-
est signal’’: individuals/parties in the social exchange context who are willing to take
costs without the (direct) prospect of getting anything in return may in fact be showing
that they can afford giving away ‘‘surplus’’ resources.
Above and beyond direct and indirect reciprocity, however, cooperative behaviour can
sometimes appear to be entirely altruistic, without the prospects of ever getting anything
in return. This form of ‘‘strong’’ altruism may be less prevalent than reciprocal forms of
cooperation, since subjects are wired for giving and perceiving reciprocity (even if indi-
rect and distal) (Wischniewski et al, 2009).
In the specific context of organizations and according to Social Exchange Theory (SET)
(e.g., Blau, 1964), workers will experience a higher will to reciprocate the trust and care
that leaders may express in a relationship (Cardona & Eola, 2003; Dirks & Ferrin, 2002;
Konovsky & Pugh, 1994; Organ, 1990).
This means that although traditionally we refer to reciprocity in the context of mutual
reciprocity or restricted (direct) exchange (Ekeh, 1974), this construct includes a certain
mental “quid pro quo”, and subjects may feel obliged to reciprocate their benefactors in
different levels and this need to reciprocate may be expressed even if they cannot do it
directly, by helping others that indirectly may affect them (e.g., the children of the
“benefactors”) (Levi-Strauss, 1949).8
Thus reciprocity seems to contribute to the development of mutual obligations between
people in the long term, which helps attaining positive environmental results and ulti-
mately contributes towards organizational performance (Pretty, 2003).
Common rules, norms and sanctions operate as behaviour moderators through a system
of reinforcements and punishments that can be more or less conscientious. These ensure
the group’s interests and are complementary to the individuals’ own interests (Pretty,
2003). This is often referred to as “the rules of the game” and provides individuals with
the confidence to invest in “common good” (Pretty, 2003). Staff attitudes towards col-
8 This type of reciprocity, also referred to as “univocal reciprocity” and “generalized exchange” (Ekeh,
1974; Levi-Strauss, 1949), or even "circular exchange" (Malinowski, 1939), involves 3 or more actors
that are connected in an integrated transaction, where reciprocations are indirect and non mutual (Ekeh,
1974). Generalized trade is characterized by the lack of 1 to 1 correspondence between what 2 parties
give and receive directly from each other; this is the main difference between generalized and restricted
exchange (Wade-Benzoni, 2002).
27
laboration at work will always remain conditional on arrangements being consistent
treatment that is perceived as “fair” (Grimshaw et al., 2010)
These management decisions that define the rules of the game (or that break them, with
obvious consequences for the organization), can last for several generations in society,
as well as the organization itself. In the organizational context a “generation” can be
cohort-based9, or event-based10: it is the socialization process and/or the psychological
contract with the organization that can make it so that a group is considered a generation
in the organization (Wade-Benzoni, 2002). This concept of intergenerational behaviour
is important for organizations in a long term perspective, especially when long-term
organizational interests conflict with the immediate interest of the current generation,
that is to say, when individuals are faced with the choice of serving their own interests
or the organization’s, in cases they do not overlap (Wade-Benzoni, 2002).
Reciprocity can also reach a continuum from negative to balanced positive to general-
ized positive reciprocity (Liden et al., 1997).
Negative reciprocity can be defined as bellicose relationships that are defined for per-
sonal interests, sabotage and hatred, where each part extracts the minimum from each
other and acts in order to contradict the counterpart’s objectives. This is highly dysfunc-
tional (Liden et al., 1997).
However pertinent, it would not seem that an exclusive reliance on exchange based
frameworks would do justice to the range of norms that govern how individuals act in
their relationship with their employer and would require expanding the basis of behav-
iour beyond straightforward reciprocity; this relationship should consider the possibility
of other mediator constructs, like personality traits and attitudes (Coyle-Shapiro &
Conway, 2005).
Standard models of homo economicus suggest that human behaviour is universally
based on deliberate and controlled thinking that is free from biases, and strives to max-
imize personal benefit (i.e., subjective utility), regardless of social and emotional con-
text. This view has been challenged, following observations that human behaviour is all
9 In cohort-based generations, a group of individuals considered a generation has an initial temporal be-
ginning, giving them a certain contemporaneity status – for example, student groups are cohort-based. 10Event-based generations are created when the occurrence of a significative event leads to the differentia-
tion of generations in different organizations (e.g., change of management, buildings, etc.)
28
but logical when it comes to the distribution of resources between individuals, groups or
nations, while our introspective access to these processes is limited (Fehr & Fisch-
bacher, 2004). In reality, our behaviour in situations involving give or take is widely
guided by momentary states such as affection, empathy, or anger, as well as by general
environment interactions influencing personality traits, and gender.
Furthermore, organizations are complex exchange systems and, as such, a number of
exchanges may be occurring simultaneously, which may have consequences for other
exchanges. An exchange does not occur in isolation nor can it be conceptualized as an
isolated event (Coyle-Shapiro & Conway, 2005), for example, if the employee-
employee exchange was observed by a supervisor or commented/noticed by others.
Feeling an obligation at work is important because it compels employees to repay ad-
vantageous treatment received from their employers (Eisenberger, Armeli, Rexwinkel,
Lynch, & Rhoades, 2001), provides guidance in self-management (Dose & Klimoski,
1995) and often precedes taking charge at work (Morrison & Phelps, 1999). Cropanza-
no and Mitchell (2005) argued that “further investigations of how exchange orientation
influences organizational relationships is of great importance.” (p. 878).
Cropanzano and Mitchell (2005) suggested that, although the norm of reciprocity is a
universally accepted principle (as posited by Gouldner, 1960), how people and cultures
apply reciprocity principles may vary. The notion of context is becoming of increasing
importance to organizational researchers (Johns, 2006; Wikhamn & Hall, 2012). Coyle-
Shapiro and Conway (2005) suggest one should see social exchange as an on going pro-
cess and not one separate moment in time and Paauwe (2009) refers that in order to fig-
ure out the nature of the relationship between HRM and OP, the employment relation-
ship must assume a more central position.
The Employee-Organization Relationship or Worker-Organization Relationship is “an
overarching term to describe the relationship between the employee and the organiza-
tion” (Shore et al., 2004, p. 292). In the worker-organization relationship literature three
constructs paramount and are often presented together in different studies, as represent-
ing desired employee responses to HR practices (Nishii et al., 2008): job satisfaction
(the relationship individuals have with the work itself and the job conditions), organiza-
29
tional commitment11 (how attached individuals are to their organization) and organiza-
tional citizenship behaviour (how individuals relate to other colleagues to profit the or-
ganization when behaviour is discretionary). We will further explore these three con-
structs in this chapter.
3.1.1. Job Satisfaction
Job satisfaction (JS) is the overall summary evaluation a person makes regarding his or
her work environment (Weiss, Dawis, England, & Lofquist, 1967); it can be defined as
positive affect towards employment (Mueller & McCloskey, 1990) and it is arguably a
fairly stable, multidimensional evaluation of how the job meets the employee’s needs,
wants, or expectations (Fisher, 2003). Locke (1976) in his well-cited definition consid-
ers job satisfaction to be “a pleasurable or positive emotional state resulting from the
appraisal of one’s job or job experiences and as a function of the perceived relationship
between what one wants from one’s job and what one perceives it as offering” (p.
1300). JS is an attitude that relates to overall attitudes towards life at work, or life satis-
faction (Ilies, Wilson, & Wagner, 2009) as well as to service quality (Schneider &
Bowen, 1985).
JS has had a key role in management research, especially because of the “happy-
productive worker hypotheses” (Fisher, 2003; Petty, McGee, & Cavender,, 1984). The
search for a relationship between job satisfaction and job performance has been referred
to as the ‘Holy Grail’ of organizational behaviour research (Weiss & Cropranzano,
1996). The idea that satisfied employees will perform their work more effectively un-
derpins many theories of performance, leadership, reward, and job design (e.g., Batt,
2002; Hackman & Oldham, 1976; Morrisey, Cordery, Girardi, & Payne, 2005; Patter-
son, Warr, & West as cited in Shipton, West, Dawson, Birdi, & Patterson, 2006). Man-
agers and lay people are thought to believe in what has been called the ‘happy–
productive worker hypothesis’ (Kluger & Tikochinsky, 2001; Ledford, 1999; Staw &
Barsade as cited in Fisher, 2003). Implicit in these expectations is the basic idea that
employees who are satisfied with their jobs are likely to be more committed to their
team and their organization, as well as more productive (Hsu & Wang, 2008; Menezes,
2012).
11 Social exchange theory has been considered a cornerstone for research on support and commitment
(Bishop et al., 2005).
30
Regardless of the success (or lack there of) of scholars in proving the connection be-
tween JS and Performance, the latter remains one of the most prominent variables in
study in business science and organizational behaviour (Spagnoli, Caetano, & Santos,
2012). JS is relevant for scholars interested in the subjective evaluation of work condi-
tions, but also for managers and researchers regarding organizational outcomes (e.g.,
organizational commitment, extra-role behaviour) and for employees, job satisfaction
has implications for subjective well being (Judge & Hulin, 1993) and life satisfaction
(Judge & Watanabe, 1993). It is assumed that Job Satisfaction has major implications as
it is a prevailing construct covering all professions, work, jobs and contexts (Spagnoli et
al., 2012).
Job satisfaction is an important dimension of employee well being in its own right but is
also a desired indicator of various dimensions of organizational success (e.g., Akdere,
2009; Brown & Lam, 2008; Culbertson, 2009; Hsu & Wang, 2008; Korunka, Scharitzer,
Carayon, & Sainfor, 2003) It is seen as a potential route to high performance (Boxall &
Purcell, 2003; Wright, Gardner, & Moynihan, 2003). Other studies found correlations
between job satisfaction and friendships among staff members (Adams & Bond 2000,
Kovner, Brewer, Wu, Cheng, & Suzuki, 2006).
In the healthcare context, studies have emerged demonstrating the relationship between
JS and quality of care. Evidence suggests that nurses’ JS affects patient satisfaction and
the quality of patient care (Aiken, Smith, & Lake, 1994; Aiken, Lake, Sochalski, &
Sloane, 1997) as well as nurses’ physical and psychological stress (Carvalho & Lopes,
2006). Regarding job satisfaction, it has been found that the more nurses are satisfied
with their job, the less likely they will leave it (Boyle, Bott, Hansen, Woods, & Taun-
ton, 1999; Chen et al., 2008; Hayes et al., 2006). Hayes et al. (2006) show that job dis-
satisfaction is reported to be strongly associated with nurse turnover and several authors
(e.g., Huang et al,, 2012: Shields & Ward, 2001; Tsai & Wu, 2010) point out that it is
also strongly associated with intent to leave: positive correlation between nurses’ JS and
retention is well established (Leveck & Jones, 1996; Molassiotis & Haberman, 1996).
Among physicians, non-monetary factors seem to be perhaps more important contrib-
utes to job satisfaction than monetary incentives (Janus, Amelungb, Gaitanidesc, &
Schwartz, 2007). Research focusing on factors related to nurse job satisfaction have
identified correlations between satisfaction and improved nurse–physician collaboration
(Rosenstein, 2002), and collaboration with medical staff (Adams & Bond, 2000; Chang,
31
Ma, Chiu, Lin, & Lee, 2009). Rafferty, Ball, and Aiken (2001) surveyed over ten thou-
sand nurses in England and found that nurses with higher interdisciplinary teamwork
scores were more likely to be satisfied with their jobs, planned to stay in them and had
lower burnout scores. Chang et al. (2009) found that collaborative interdisciplinary rela-
tionships were one of the most important predictors of job satisfaction for all healthcare
providers. Most nurse turnover models assign an important role to job satisfaction and
organizational commitment (Hayes et al., 2006) and this finding generalizes to other
employees as well (Griffeth, Hom, & Gaetner, 2000; Tett & Meyer, 1993).
A variety of correlates of job satisfaction has been investigated over the years, including
citizenship-behavior, communication and other associates of cooperative relationships.
(Shetach & Marcus, 2015).
3.1.2. Organizational Commitment
Organizational Commitment has been the target of growing attention and popularity in
the area of Organizational Psychology in the past decades (Bergman, 2006; Mathieu &
Zajac, 1990; Meyer & Allen 1997); investigation has been extensive although relatively
unsystematic (Meyer, Becker, & Vanderberghe, 2004)
Meyer et al. (2004) identify two major moments in the development of the theory rela-
tive to Organizational Commitment in the last decades: the acknowledgement that it can
assume several shapes (e.g., Meyer & Allen, 1991; Mowday, Steers, & Porter, 1979;
O’Reily & Chatman, 1985) and the consensus around the existence of several foci (such
as the organization, the job, the career, the union, etc.).
Although there is some redundancy among the several models, there are also important
differences among them (cf. Meyer & Herscovitch, 2001 for a review). The several def-
initions reflect essentially three main ideas: commitment reflecting an affective orienta-
tion (e.g., Mowday et al., 1979), the recognition of the costs of leaving the organization
(e.g., Becker, 1960) and the obligation to remain with the organization (e.g., Wiener,
1982).
Despite the fact that is was originally conceived as an one-dimensional construct (Beck-
er, 1960; Mowday et al., 1979), nowadays it is rather consensual that Organizational
Commitment is multidimensional (Bergman, 2006; Fields, 2002; Meyer & Allen, 1997);
this has important repercussions in the comprehension of the consequences and interac-
32
tions of this construct with other job attitudes (Gelatly, Meyer, & Lutchack, 2006).
It is defensible that Meyer and Allen’s (1997; Allen & Meyer, 1990) affective, norma-
tive and continuance commitment approach is the most studied and empirically support-
ed model, prevailing in the literature (Bergman, 2006; Meyer, Stanley, Herschovitch, &
Topolnytsky, 2002) and being already explored in diverse contexts and cultures, alt-
hough most studies are based in the North American reality (cf. Allen & Meyer, 1996).
About the different focus that commitment can assume in the work context, organiza-
tional commitment is the most developed construct of this nomological net (Morrow &
McElroy, 1993).
Organizational commitment is often related to but different from work engagement.
Work engagement is an affective-motivational, work-related state of fulfilment in em-
ployees that is characterized by vigour, dedication and absorption (Schaufeli & Bakker,
2004). Engaged employees have high levels of energy, are enthusiastic about their
work, and they are often fully immersed in their job so that “time flies” (Macey &
Schneider, 2008).
Some authors refer organisational characteristics as the most influential factor in devel-
oping commitment and highlight the weight of decentralisation and participation in de-
cision-making (Nijhof, Jong, & Beukhof, 1998). Iverson (1996) studies employee ac-
ceptance of organisational change and suggests that commitment should be considered
as a main determinant, and a mediator of factors in the process. Shadur, Rodwell, and
Bamber (1995) study predictors of an employee approval of lean production and find
that commitment to the company is one important element.
Despite the multiplicity of definitions and models there is a common point in the sense
that organizational commitment reflects a psychological bond with the organization
inversely related to turnover and withdrawal intentions (Allen & Meyer, 1990; Fields,
2002), although it is obviously very reductive to consider that Organizational Commit-
ment is only related to focal intentions to remain with the organization (cf. Meyer &
Allen, 1997, for a more detailed view).
There has been a growing degree of consensus among researchers that employees’
commitment to both organization and job constitutes a key factor that links between an
33
organization’s HRM practices and employees’ work behaviours and outcomes including
enhanced job performance, reduced turnover and absenteeism (e.g., Guest 1997; Meyer
& Allen, 1997; Whitener, 2001). For example, Guest (1997) lays out the clear causal
path that many other researchers in this field assume.
In the healthcare context, Chang (2005) refers that the nursing work context requires
committed workers. Concerning organizational commitment, research indicates that the
stronger nurses’ commitment to their hospital, the smaller their turnover intention
(Beecroft, Dorey, & Wenten, 2008; Tourangeau & Cranley, 2006) and commitment is
known to influence innovative behaviour (Jafri 2010). Qualitative study by O’Donohue
and Nelson (2007) of Australian nurses found that nurses redirected their focus away
from the hospital to their profession allowing them to tolerate some level of non deliv-
ery of ideological commitments by the hospital and at the same time continue to do their
best for patients. Finally, it appears that job satisfaction and organizational commitment
are crucial antecedents of nurse turnover (e.g., Hayes et al., 2006).
3.1.3. Organizational Citizenship Behaviour
Organizational Citizenship Behaviour (OCB) can be defined as an individual behaviour
that is discretionary, not contractually guaranteed and that in the aggregate promotes the
effective functioning of the organization (Organ, 1997; Smith, Organ, & Near, 1983).
Organizational Citizenship Behaviour (OCB) is discretionary in the sense that it is not
an enforceable requirement of the role or the job description, but a matter of personal
choice (such that its omission is generally not understood as punishable) and by “not
contractually guaranteed” we mean that an OCB is not directly or explicitly recognized
by the formal reward system (Organ, 1997).
For example, spontaneously helping a co-worker when he or she is in an occasional
overload of work can be considered an OCB in the sense that it is discretionary (sponta-
neous, even, in this case), it is not contractually guaranteed, as it is a punctual extra-role
activity and promotes the effective functioning of the organization, since it helps main-
tain productivity in a time of need. This behaviour would stop being considered an OCB
if (a) the person was requested by a supervisor to help the colleague or in some way the
lack of that behaviour would be punishable (e.g., being a doctor and not helping a per-
son who is having a heart attack in a social event) (b) that collaboration with the co-
34
worker was held in account for Performance Appraisal or explicitly rewarded by the
formal reward system (e.g., pay, promotions, etc.) or (c) that behaviour would be coun-
terproductive to the aggregate functioning of the company (e.g., the person’s task is
more complicated/urgent/important that his or her co-worker’s, the other co-worker is
constantly needing help and the person’s intervention masks the need for another work-
er in that job or even the co-workers ineffectiveness, etc.).
This construct, however fashionable at the moment, has been much debated over time
due to the concepts of in-role and extra-role behaviour. Although some of the original
articles referred to OCB as extra-role behaviours, further research verified that much of
the OCB’s were perceived by the workers as in-role, rather than extra-role (cf. Morri-
son, 1994) a question that inheres the very fuzziness of the concepts “role” and “job”
themselves (Organ, 1997).
In order to avoid the discussion between what employees could consider in-role or ex-
tra-role and to distance ourselves from a discussion that is not the focus of this study,
we chose to approach this subject by restricting our research to specific Extra-role Be-
haviours such as Van Dyne and LePine’s (1998) model “Helping and Voice Behav-
iours”.
According to this model, helping behaviour is defined as the proactive behaviour that
emphasizes small acts of consideration towards other co-workers, and Voice Behaviours
are the proactive behaviours that challenge the status quo in order to improve Organiza-
tional Performance. Both are seen as extra role behaviours that the employees may un-
dertake at their own time (Fields, 2002).
Extra-role behaviours include actions that protect the organisation and its property, con-
structive suggestions for improving the organisation, self-training for additional respon-
sibility, creating a favourable climate for the organisation and its surrounding environ-
ments, and cooperative activities (Katz, 1964). The definition of OCB stipulates that
these extra-role behaviours are not linked to any formal reward system, but the continu-
al demonstration of OCB over a period of time is said to positively influence the percep-
tion that colleagues and supervisors have about the employees who are exhibiting OCB
(Podsakoff, Whiting, Podsakoff, & Blume, 2009). Markoczy, Vora, and Xin (2009)
propose that it is the organisational environment that influences what types of behaviour
35
will be thought of as discretionary within the organisation. In general, extra-role behav-
iours associated with OCB ensure more efficient use of resources, liberate some of
management’s time, and support and enhance the ability of colleagues to perform their
daily tasks (Xerri & Brunetto, 2013). The consequences of organizational citizenship
behaviour can result in feelings of higher job social support from supervisors and co-
workers, that can reduce turnover intention (Chiu et al., 2009; Shader et al., 2001).
Since OCB’s have been associated with a variety of positive outcomes, many research-
ers have attempted to identify its antecedents, which include among others, job satisfac-
tion (Barnes, Ghumman, & Scott, 2013),organizational commitment (Ng & Feldman,
2011; Podsakoff, MacKenzie, & Bommer, 1996; Zhu, Newman, Miao, & Hooke, 2013),
emotional intelligence (Ramachandran, Jordan, Troth, & Lawrence, 2011), personality
(Moon, Kamdar, Mayer, & Takeuchi, 2008), perceived fairness (Deng, 2012), perceived
organizational support (Chiang & Hsieh, 2012; Duffy & Juliana, 2013), transformation-
al leadership (Podsakoff et al., 1996; Podsakoff, MacKenzie, Moorman, & Fetter, 1990;
Zhu et al., 2013), role stressors (Eatough, Chang, Miloslavic, & Johnson, 2011), em-
powerment (Jiang, Sun, & Law, 2011), leader-member exchange (Ilies, Nahrgang, &
Morgeson, 2007) and human resource practices (Nasurdin et al, 2015).
Given the unique characteristics of service organizations as opposed to manufacturing
organizations, Wang (2009) is of the opinion that the performance of OCBs is more
imperative for service organizations. Specifically, service organizations offer intangible
product to its customer, often involves interactions between service employees and cus-
tomers during service delivery, and finally, service products are often produced and
consumed simultaneously by customers (Bowen & Ford, 2002; Sun et al., 2007). In
addition to the service features, service organizations are often challenged with unique
and impulsive customers’ demands, as well as having to deal with customers from vari-
ous backgrounds and cultures (Nasurdin et al., 2015; Prentice & King, 2011).
In the healthcare context, Xerri and Brunetto (2013) applying social exchange theory as
a lens for examining the key argument that nursing employees, who are committed to
the organisation and who exhibit OCB, will be more likely to be innovative in the
workplace; these authors report that OCB is recognised as an individual-level factor that
may have a positive relationship with an organisation’s ability to successfully imple-
ment organisational strategy, as well as gain a competitive advantage. Specifically, as
36
relationships are formed within the workplace, reciprocity is developed, which provides
an environment that facilitates employees helping one another and the organisation be-
yond their expected work duties (Xerri & Brunetto, 2013).
37
Chapter 4 – Performance-Related Worker Self-Efficacy
“The one thing that doesn't abide by majority rule is a person's conscience.”
― Harper Lee, To Kill a Mockingbird
38
Chapter 4 – Performance-Related Worker Self-Efficacy
4.1. Organizational Performance in Healthcare
“In the health sector, the outputs (products) are difficult to define, since
health is a complex concept, there is no traditional health market, and
there is lack of homogeneity between the output measurements, as in
case of inpatients.“ (Ferreira & Marques, 2014)
The most crucial part in relating HRM and Organizational Performance (OP) is of
course the linkage between the two (Combs et al., 2006; Paauwe, 2009; Paauwe et al.,
2013; Vermeeren et al., 2014). Regardless, the task of relating HRM with OP has met
obstacles that are both methodological and conceptual in nature.
Although the linkage between HRM and OP seems intuitive and clear to most research-
ers, some critics have stated that the evidence for an effect of HRM on performance is
promising but only circumstantial due, for the most part, to inadequate research design
(Wall & Wood, 2005). Wall and Wood (2005) point to the fact that most research in this
area is cross-sectional, which is adequate for exploratory studies and providing clues for
future research (as well as providing evidence-based arguments for investing in costly
longitudinal designs), but not for inferring causal relationships. The authors mention
that even when the design is longitudinal seldom do studies consider the timing with the
organization’s implementation (or substantial enhancement) of HRM between the per-
formance measurement occasions, which is often translated in data collection moments
that have little to do with the kind of conclusions researchers mean to draw; finally,
these authors point to the scarcity of expereimental studies (with controls).
Adding to issues with research design, conceptual issues with defining and measuring
performance arise, since performance outcomes can be captured in a variety of ways.
Dyer and Reeves (1995) famously mention:
Financial outcomes (e.g., profits, sales, market share);
Organizational outcomes (e.g., output measures such as productivity, quality,
efficiency);
HR-related outcomes (e.g., attitudinal and behavioral impacts among employees,
such as satisfaction, commitment, intention to quit).
Hospitals and healthcare institutions in general, not unlike most organizations, are con-
39
cerned with maximizing effectiveness through the adoption of appropriate management
policies and practices. OP issues are therefore not alien to this type of institutions; un-
like most other organizations however, ‘effectiveness’ in hospitals cannot consider only
financial aspects, it is measured partly by their success in treating illness and avoiding
deaths (West et al., 2006), which makes OP in healthcare a rather controversial subject.
Crêteur, Pochet, Pouplier, and Closon (2000) have synthesized major performance crite-
ria in a Hospital retaining five rational dimensions: 1) quality of care; 2) satisfaction of
patients; 3) satisfaction of human resources; 4) efficiency; 5) financial results.
Equating two dimensions as critical and differentiated as financial results and quality of
care (especially) has been stemming a great deal of discussion in this area where ethical
questions can be raised with management issues: when healthcare decisions need to be
equated with financial issues, the question may arise that a financial value is being put
on a human life. These issues have led some authors like West et al. (2006) to prefer
using only the standardized mortality rate (ratio between the observed number of deaths
in an study population and the number of deaths would be expected, based on the case
mix of a hospital), but authors from the area of the economic evaluation of health tech-
nologies (e.g., Drummond, O’Brien, Stoddart, & Torrance, 1997) contemplate other
indexes such as the QALY (Quality Adjusted Life Years, a generic measure of disease
burden, including both the quality and the quantity of life lived; it is used in assessing
the value for money of a medical intervention) or the money saved from certain proce-
dures, depending on different approaches.
Buchan (as cited in Buchan, 2004) structured a series of other indicators that Hospitals
use in order to measure effectiveness/performance, dividing them in 3 groups:
1) "activity"/process-related (number of beds, occupied beds, outpatient visits, client
contacts), 2) staffing-related (job satisfaction - measured by attitudinal survey, acci-
dents/injuries, absence, assaults on staff, vacancy rates, overtime, turno-
ver/stability/retention, use of temporary staff) and 3) care-related (output/outcome) (pa-
tient length of stay, readmission rates, live births, mortality rates, urinary tract infec-
tions, pneumonia, shock, upper gastrointestinal bleeding, deep vein thrombosis, pres-
sure sores/ulcers, cross-infections, patient satisfaction survey).
The majority of the authors agree that using the same measures in different hospitals
40
may not be the most adequate criteria since the case mix (the type or mix of pa-
tients/diagnostics treated by a hospital or unit) might be different and hospital policies
that involve the indicators might compromise the conclusions one can draw (e.g., if you
measure mortality rates in different hospitals you might not only be measuring medical
inefficiency but also the policy to keep terminal patients in the hospital or to send them
home in their final moments) (Buchan, 2004).
Finally Porter (2010) in a paper for the New England Journal of Medicine proposed
“Value should be the preeminent goal in the health care system, because it is what ulti-
mately matters for customers (patients) and unites the interests of all system actors.“ (p.
2477). The author discusses that value must be measured directly in health care because
profitability, the proxy for value in most industries, is not a reliable indicator of value in
health care because of flawed reimbursement and lack of competition based on actual
results. For this author, value in health care depends on the actual patient health out-
comes, not the volume of services delivered and is based on the results achieved relative
to the inputs (or cost) required, and as such it encompasses efficiency. However inter-
esting this point of view may be, even the author suggests the difficulties of measuring
this construct in the current situation of affairs: most healthcare systems are organized
around the steps of treatments and specialities, not the patient per se, and value meas-
urement (including patient outcomes and an accurate balance of global costs and bene-
fits of treatments) in health care today is limited and highly imperfect.
So, on the one hand researchers and practitioners are faced with more strategic aspects
of performance and on the other hand more societal aspects of performance. Strategic
aspects of performance (based on economic rationality), emphasize outcomes such as
labour productivity, innovation, quality, efficiency gains and flexibility (Boselie et al.,
2005), whereas the more societal aspect of performance (based on relational or norma-
tive rationality) emphasize legitimacy and fairness (Paauwe, 2004) that can be opera-
tionalized through indicators like organizational citizenship behaviour, commitment,
trust, perceived security, and perceived fairness (Paauwe & Boselie, 2005). These issues
that are more or less transversal to all contexts are enhanced in the healthcare context,
where societal aspects of performance can have a potentiated effect in the way that HR
addresses and cares for patients, which in it self then reflects not only in the HR-reflect
outcomes, but also in the financial and organizational outcomes.
41
4.2. Organizational Performance and Human Resource
Central to the societal aspects of performance, arguably a more sophisticated way of
thinking about the relationship between HRM and performance, is the idea that HR
practices at the organizational level affect the attitudes and behaviour of employees at
the individual level which, in turn, affect key aggregated level behavioural or HR out-
comes such as labour productivity and turnover which, subsequently, might impact or-
ganizational or firm-level outcomes (Paauwe, 2009).
So we are in need of performance indicators that are far more proximal in terms of what
HR practices can actually affect, such as changes, for example, in employee work-
related attitudes (motivation, commitment, trust) and subsequent changes in outcomes at
organizational level (e.g., productivity and quality of services and/or products) (Paauwe,
2009). This is especially relevant when one considers that organizational performance is
a function of team performance and individual performance, which in turn is influenced
through interaction between employee ability, voluntary or discretionary effort and op-
portunities (Boxall & Macky, 2009).
Managing the workforce by means of HRM can therefore be seen as an important key to
success in hospitals. Although multiple meta-analysis seem to confirm a relationship
between HRM and performance in the for profit sector (e.g., Combs et al., 2006; Zacha-
ratos, Hershcovis, Turner, & Barling, 2007), research focusing on the added value of
HRM in hospitals remains scarce, even if some research has been confirming the basic
notion that HRM and performance within the health care sector are linked (Vermeeren
et al., 2014)12. Further analysing HRM in the health care sector has been appointed as a
productive endeavour for both researchers and practitioners to take (Vermeeren et al.,
2014).
Thus it seems better to use the concept of ‘outcomes’ instead of performance (Guest,
1997) seems especially relevant for health care organizations, as financial performance
is certainly not the only - or even primary – objective.
12 Vermeeren and colleagues (2014) have successfully related the use of HR practices to improved finan-
cial outcomes (measure: net margin), organizational outcomes (measure: client satisfaction) and HR out-
comes (measure: sickness absence) in the healthcare context; however, the impact of HR practices on HR
outcomes and organizational outcomes proved substantially larger than their impact on financial out-
comes.
42
Wright & Kehoe (2013) propose that because employees’ perceptions of HR practices
necessarily follow managers’ HR practice implementation (Nishii & Wright, 2008),
employees’ HR practice perceptions are temporally closer to, and consequently likely to
be more predictive of their attitudinal and behavioural outcomes than are HR practice
ratings as provided by managers. This idea that the workers’ performance self-
assessment can be a more immediate result of HRM contributed to our consideration of
performance related worker self-efficacy as a proximal for worker and organizational
performance in this context.
4.3. Performance related worker self-efficacy
The perception of being in control of the situation is often referred to as self-efficacy
(Bandura, 1997). Self-efficacy can be defined as a self-evaluation of one’s competence (
Bandura, 1993; van Dijk, 2009).
A considerable body of research has explored the development of individual self-
efficacy. For example, self-efficacy is dependent on performance attainments,
knowledge and skills, and comparison to relevant others (Kaufman, 2003). Self-efficacy
increase has been consistently established as a consequence of higher levels of perfor-
mance, as well as the confidence about ones’ knowledge and skills and through compar-
ison to others (van Dijk, 2009). Bandura (1997) argues that it is affected by past per-
formance, by modelling (observing others take similar actions), by persuasion and by
independent information processing of or in addition to the above. Bandura (1986) has
found that self- efficacy is strongly related to task performance and research ever since
has been confirming this finding (e.g., Bandura, 1997; Chen, Gully, & Eden, 2001; Gist
& Mitchell, 1992; Stajkovic & Luthans, 1998,).
Research has shown that self-efficacy is not only a consequence of past performance; it
is a predictor of several important work-related outcomes, including job attitudes (Saks,
1995), training proficiency (Martocchio & Judge, 1997), and job performance (Staj-
kovic & Luthans, 1998).
People differ in the areas in which they develop their efficacy and the levels at which
they develop it, even within their given pursuits. Thus, the efficacy beliefs system is not
a global trait, but a highly contextualized construct: it is a differentiated set of self-
beliefs linked to distinct realms of functioning (Pepe, Farnese, Avallone, & Vecchione,
2010) regardless of the existence of generalized self-efficacy (one’s belief in one’s
43
overall competence to effect requisite performances across a wide variety of achieve-
ment situations [Chen et al., 2001]). Various forms of task specific self-efficacy have
been researched in organisational behaviour, including computer self-efficacy (Com-
peau & Higgins, 1995), knowledge sharing (Hsu, Ju, Yen, & Chang, 2007), employee
remote work self-efficacy (Staples, Hulland, & Higgins, 1999), employee creative self-
efficacy (Tierney & Farmer 2002), front-line staff’s self-efficacy in initiating sales
(Pattni, Soutar, & Klobas 2007), entrepreneurial self-efficacy (Brazeal, Schenkel, &
Azriel, 2008), presentation self-efficacy (Tucker & McCarthy, 2001), school counsellor
self-efficacy (Sutton & Fall, 1995), student self-efficacy (Phillips & Gully, 1997) and
academic self-efficacy (Bong & Skaalvik, 2003).
Specific self-efficacy is a proximal state that positively relates to individuals’ decisions
to engage and persist in task-related behaviour (Chen et al., 2001) and has also been
pointed out as a mediator of the relationships between learning and ethical behaviour
from human resource development in corporate social responsibility activity (Sukserm
& Takahashi, 2012).
Social–cognitive theory and its central variable, self-efficacy, have been the focus of a
voluminous amount of research in psychology13 (Judge, Jackson, Shaw, Scott, & Rich,
2007). Its applicability has been described as “pervasive across contexts and domains of
human functioning” (Zimmerman & Schunk, 2003, p. 448). A primary application of
self-efficacy has been in the work domain (Bandura, 1997).
In industrial–organizational psychology, self-efficacy has been remarkably popular. In
the past years, more than 800 articles on self-efficacy have been published in organiza-
tional journals (Judge et al., 2007). Virtually every area in organizational research has
utilized self-efficacy, including training (Kozlowski et al., 2001), leadership (Chen &
Bliese, 2002), newcomer socialization and adjustment (Saks, 1995), performance evalu-
ation (Bartol, Durham, & Poon, 2001), stress (Jex, Bliese, Buzzell, & Primeau, 2001;
Schaubroeck, Jones, & Xie, 2001), political influence behaviors (Bozeman, Hochwarter,
Perrewe, & Brymer, 2001), creativity (Redmond, Mumford, & Teach, 1993), negotia-
13 Self-efficacy is the central variable of the social-cognitive theory, described as “the theory heard ‘round
the world’” (D. Smith, 2002, p. 30). Its creator, Albert Bandura, has been credited as the fourth most
influential psychologist in the history of psychology (Haggbloom, Warnick, & Warnick, 2002) and ranks
among the top five psychologists in the number of citations in psychology texts (Knapp, 1985). Accord-
ing to Judge et al. (2007), it is fair to say that self-efficacy has proven to be one of the most focal concepts
in contemporary psychology research.
44
tion (Stevens & Gist, 1997), occupational stress14 (Salanova, Peiró, & Schaufeli, 2002),
group–team processes (Feltz & Lirgg, 1998), and work-related psychological responses
such as psychological contracts, occupational commitment and turnover intention (e.g.,
Franco, Bennett, & Kanfer, 2002; Klassen & Chiu, 2011; Mulki, Lassk, & Jaramillo,
2008; Panatik, O’Driscoll, & Anderson, 2011; Shore & Tetrick, 1994). When employ-
ees feel competent in their jobs, they are more likely to commit themselves to the firm
by lending a helping hand overall to protect the benefits of the firm (Todd & Kent,
2006). A strong sense of job self- efficacy enables the employees to persevere to over-
come obstacles and make personal efforts to reach the goals of their firm (i.e., high rela-
tional contracts) (Allen-Brown, 1998). Specifically, a high level of job self-efficacy
enhances the employees’ confidence in their judgments to execute the necessary courses
of action required for the success of the firm (Allen-Brown, 1998). On the contrary,
employees with low job self-efficacy often reveal low perseverance and an absence of
long-term commitment in their job performance attainments (i.e., high transactional
contracts) (Allen-Brown, 1998; Bandura, 1986), suggesting a negative relationship be-
tween job self- efficacy and transactional contracts (Chen & Lin, 2012). Self-efficacy is
an important topic in organisational behaviour and psychology because of its relation-
ship with task performance, the difficulty of the goals that are set (often termed goal
level), goal commitment, task learning, choice and persistence of effort (Bandura 1997;
Gist & Mitchell, 1992, Locke et al., 1984; Stajkovic & Luthans, 1998).
In 1989, Landy called self-efficacy “the wave of the future” (p. 410) in work motivation
research; from interest in the concept in the past 20 years, Landy’s prevision has been
an accurate one (Judge et al., 2007).
In this area of research, perhaps the most focal variable to which self-efficacy has been
related is work-related performance (i.e., job and task performance). Meta-analytic evi-
dence suggests that self-efficacy is rather strongly related to performance (Stajkovic &
Luthans, 1998) and it has been emphasized that self-efficacy beliefs play a major role in
influencing psychological outcomes among adult workers (Lubbers, Loughlin, &
Zweig, 2005). This connection seems to be stronger concerning state or task-specific
14 For instance, it has been found that self-efficacy may act as a buffer in the presence of work stressors so
that their negative impact is reduced (Salanova, Peiró, & Schaufeli, 2002). Workers with higher levels of
self-efficacy will not perceive demands as threats, but as opportunities to overcome and develop their
skills; they will strive to obtain good results, and achievements will be interpreted as a result of their own
effort (Bandura, 2002).
45
self-efficacy rather than generalized self-efficacy (Hysong & Quinones, 1997; Stajkovic
& Luthans, 1998).
Self-efficacy beliefs contribute to motivation by influencing the challenges people pur-
sue, the effort they spend, and their perseverance in the face of obstacles as well as task-
related effort (Bandura, 1997). Self-efficacious employees have been found to experi-
ence higher levels of flow over time (Salanova, Bakker, & Llorens, 2006), while self-
efficacious students reported higher levels of engagement (Llorens, Schaufeli, Bakker,
& Salanova, 2007) and job self-efficacy seems to be a cognitive mediator between per-
ceived work quality (e.g., legal and ethical works) and psychological health (Lubbers et
al., 2005).
Further, Pierce and Gardner (2004) reviewed studies showing that organizational-based
self-esteem, namely the degree to which organizational members believe that they can
satisfy their needs by participating in roles within the organization, is strongly related to
job satisfaction and commitment. Additionally, in a recent longitudinal study among
Finnish healthcare personnel, organizational-based self-esteem turned out to be one of
the most important predictors of work engagement measured two years later (Mauno,
Kinnunen, & Rukolainen, 2007).
The concept of self-efficacy obviously bears a close resemblance to the motivational
theory of expectancy, the belief that one can attain a certain level of performance is in
itself motivational. It has been shown that intrinsically motivating work fosters enactive
mastery experiences, which are an important source of job self-efficacy (Lubbers et al.,
2005). Call and Mortimer (2001) suggest that intrinsic job quality (e.g., ethical work
environments or ethical citizenship) is an important factor in the development of work-
ers’ perceptions of job self-efficacy (Chen & Lin, 2012; Lubbers et al., 2005). Self-
efficacy is developed through social learning processes and Bandura (1986, 1997) iden-
tified four broad sources of information that influence self-efficacy (i.e., personal mas-
tery experiences (performance accomplishments), vicarious experience (modelling),
verbal persuasion, and physiological states [e.g., stress and anxiety]) (Leng, 2013).
However, a puzzling aspect of the Locke et al.’s (1984) results is the considerable suc-
cess of self-efficacy in predicting performance in contrast to the consistent failure of
effort-performance expectancy to show a positive association with performance in pre-
46
vious goal-setting studies (Mento, Cartledge, & Locke, 1980).
Further, proficient performance is partly guided by higher-order self-regulatory skills.
These include generic skills for diagnosing task demands, constructing and evaluating
alternative courses of action, setting proximal goals to guide one’s efforts, and creating
self-incentives to sustain engagement in taxing activities and to manage stress and de-
bilitating intrusive thoughts (Bandura, 2006).
In sum, perceived efficacy plays a key role in human functioning because it affects be-
haviour not only directly, but also via its impact on other determinants such as goals and
aspirations, outcome expectations, affective proclivities, and perception of impediments
and opportunities in the social environment (Bandura, 1997). Efficacy beliefs influence
whether people think erratically or strategically, optimistically or pessimistically. As
Ozer and Bandura (1990) noted, “people often fail to perform optimally even though
they know what to do and possess the requisite skills. This is because self-referent
thought mediates the translation of knowledge and abilities into proficient perfor-
mance.” (p. 473). It has been suggested that this performance gap is largely associated
with employees’ self-efficacy (Gist et al., 1991). Thus, perceptions of self-efficacy also
influence the courses of action people choose to pursue, the challenges and goals they
set for themselves and their commitment to them, how much effort they put forth in
given endeavours, the outcomes they expect their efforts to produce, how long they per-
severe in the face of obstacles, their resilience to adversity, the quality of their emotion-
al life and how much stress and depression they experience in coping with taxing envi-
ronmental demands, and the life choices they make and the accomplishments they real-
ize (Bandura, 2006). Also, empirical research has demonstrated that self-efficacy is re-
lated to a number of other work-performance measures such as adaptability to advanced
technology (Hill, Smith, & Mann, 1987), coping with career related events (Stumpf,
Brief, & Hartman, 1987), managerial idea generating (Gist, 1989), skill acquisition
(Mitchell et al., 1994), and naval performance at sea (Eden & Zuk, 1995).
One of the properties of self-efficacy is that it is domain related, in the words of Ban-
dura (2006) “One cannot be all things, which would require mastery of every realm of
human life”. (p. 307). A person can have high self-efficacy on one domain, and low
self-efficacy on another (Bandura, 1986). For example, one can have high self-efficacy
on carrying out academic tasks, but low self efficacy of job skills (e.g., Jex &
47
Gudanowski, 1992; Zajacova, Lunch, & Espenshade, 2005). People differ in the areas in
which they cultivate their efficacy and in the levels to which they develop it even within
their given pursuits. For example, a business executive may have a high sense of organ-
izational efficacy but low parenting efficacy. Thus, the efficacy belief system is highly
contextualized, as opposed to being a global trait.
Theoretically, state or task self-efficacy is related to performance in diverse rationales.
For example, theories of learned helplessness (Kuhl, 1984) support a link between posi-
tive self-evaluations and job performance. According to the model of learned helpless-
ness, when faced with unfavourable circumstances, individuals with a positive, optimis-
tic explanatory style will be less likely to display motivational deficits (i.e., lower their
effort, withdraw from task-oriented behaviours), whereas those with a pessimistic ex-
planatory style will display symptoms of helplessness (Peterson & Seligman, 1984).
Another example is control theory (Lord & Manges, 1987) that predicts that when indi-
viduals perform below their expectations, they exert additional effort to obtain the per-
formance goal, reduce their standard level (lower their aspirations), or withdraw from
the task entirely (Judge & Bono, 2001)
The relationship between work or performance related self efficacy and worker perfor-
mance has been proven to be indirect and moderated by individual factors (e.g., person-
ality [Locke et al., 1984]), task complexity and locus of performance (Stajkovic & Lu-
thans, 1998).
Conclusion
Considering that HRM refers to management practices that aim to enhance the perfor-
mance of the organization, by improving the performance of the workforce (Boxall,
Purcell, 2003; Michie & West, 2004), it is fair to say that employee performance is an
important issue in organizations today.
Efficacy beliefs influence people’s thoughts and behaviors, and impact other determi-
nants such as the goals and aspirations individuals choose to pursue, their resilience to
adversity, commitment to goals, effort, outcomes and perseverance. This trend can be
seen in organizational settings as well. People spend a lot of time in the workplace, ex-
pending much energy, emotions and hopes (Pepe et al., 2010).
48
Despite the growing attention paid to psychological processes by both researchers and
practitioners, previous studies in the area of strategic human resource management
tended to focus on examining the effectiveness of organizational-level human resource
practices and their links with firm performance.
It is now increasingly recognized, however, that the true effectiveness of firms’ human
resource policies and practices should be evaluated from employees’ behavioural and
psychological outcomes (Lam, Chen, & Takeuchi, 2009; Park, Mitsuhashi, Fey, &
Björkman, 2003). Clearly, greater effort needs to be made to explore the mechanisms by
which the HRIM policies and practices of establishments influence employees’ behav-
iours and outcomes. Specifically, we need to shed more light on employees’ psycholog-
ical processes by addressing the central part of hypothetical sequences, that is, the pro-
cess by which work practices affect employee attitudes, which eventually influence em-
ployee work behaviour.
This study, therefore, looks at micro-level employees’ behaviour and attempts to exam-
ine how employees’ evaluations of organizational HRIM practices affect their perfor-
mance related self-efficacy; in this study we propose that this relationship can also be
mediated by the more complex construct of the Worker-Organization Relationship,
which we will explore in the next chapter.
49
Chapter 5 – Research Questions, Models and Hypotheses
“Would it save you a lot of time if I just gave up and went mad now?”
- Douglas Adams, “The hitchhikers guide to the galaxy” (Vol. I)
50
Chapter 5 – Research Questions, Models and Hypotheses
In this chapter, research questions are presented and the research model is proposed;
also we aim at explaining the research objectives and hypotheses.
5.1. Research Questions and Model
In this work we aim at testing a structure of the HRM-PROSE relationship at an indi-
vidual level of analysis. Considering Performance Related Observations of Self-
Efficacy (PROSE) as proxy for individual performance, which contributes to OP (espe-
cially in the health care sector [Boxall & Macky, 2009]), we want to know if SHRIM
predicts PROSE, if SHRIM predicts WOR, and finally, if the relationship between
SHRIM and PROSE is mediated by the overall Worker-Organization Relationship
(WOR) as is proposed by our literature review (e.g., Boselie et al., 2005; Bowen & Os-
troff, 2004; Kehoe & Wright, 2013: Nishii & Wright, 2008).
Figure 5.0–The proposed theoretical model for the research
We propose different models in which these relationships may occur, using the con-
structs in figure 5.0 separately and together, which allows us to consider the influence
of each construct as well as the interactions that may occur between variables. Namely,
we want to know if the constructs in the model will act as predictors of the outcome
51
variables separately and then together in the model, as to test different facets of the un-
derlying theory and make sure the model has no redundant variables. The different
manners we propose these variables relate with each other are clarified in the hypothe-
ses section of this work.
52
5.2. Research Hypotheses
Our research hypotheses are formulated as follows: direct relationship of SHRIM and
PROSE, hypotheses concerning each of the components of the WOR and their individu-
al relationship with SHRIM and WOR, and finally we hypothesize that the composite
measure of the WOR mediates the relationship between SHRIM and PROSE.
5.2.1. Direct relationship between SHRIM – PROSE
The importance of HRM as a competitive tool and the relationship between HRM with
organizational performance has been the subject of systematic research (Becker & Ger-
hart, 1996; Delery & Doty, 1996; Huselid, 1995). Cascio (1992) has suggested that con-
temporary organizations must gain competitive advantage through effective utilization
of their HR. Researchers have also identified and examined certain HRM practices as
crucial to developing organizational competitive advantage (Pfeffer & Veiga, 1999).
Some previous research has examined self-efficacy as an outcome that is driven by or-
ganizational care, training, education, and ethics (McAllister & Bigley, 2002), implying
a potential influence of perceived corporate citizenship on job self-efficacy. Existing
literature indicates that psychological contracts may vary due to the changes taking
place at the business corporations (Bellou, 2007). When employees realize that their
firm is unreliable and does not uphold their reciprocity, for example when it is ignorant
about their career development, performs consumer fraud, or cheats its business partner,
they are less likely to maintain their employment relationship with the firm in the long
run (e.g., Schwepker, 2001; Valentine & Barnett, 2003), consequently weakening rela-
tional contracts and enhancing transactional contracts (e.g., to have no commitment to
the firm and only remain in the firm for a short time) (Chen & Lin, 2012).
As a mirror of the organization’s reliability and the rule of reciprocity, the organiza-
tion’s ethical citizenship (e.g., integrity) is reflected in how well it lives up to its obliga-
tions to employees (Thompson & Hart, 2006). In this sense, the misconduct by the or-
ganization often discourages relational contracts (e.g., psychological contract violation)
among an organization’s workforce (Thompson & Hart, 2006), and can result in less
commitment and efforts from workers (i.e., strong transactional contacts) (e.g., Appel-
baum, Deguire, & Lay, 2005; Jaramillo, Mulki, & Solomon, 2006), and weak relational
contracts with, for example, strong intention to find another job (e.g., Hart, 2005; Jara-
millo et al., 2006). Collectively, work environments historically fraught with ethical
53
conflict inherently lead employees to question their personal competency, eventually
devastating job self-efficacy (Chen & Lin, 2012).
Job self-efficacy expectations are directly associated with ethical perceptions of em-
ployees to have successfully navigated past work situations and circumstances provided
by their firm (e.g., Jones, 1986). In other words, if ethical cues about the firm provided
a history of trust in the organization (e.g., treat business partners fairly), then self-
efficacy will be elevated. Conversely, job self-efficacy will be attenuated if the work
environment provided by the firm reveals the questionable likelihood of success (e.g.,
fraudulent business practices).
Organizational policies and practices increasingly influence its employees. As proposed
in social exchange theory (Blau, 1964), employees receive inducements for their contri-
butions (Tsui, Pearce, Porter, & Tripoli, 1997) in the form of HRM practices, to which
they reciprocate by exhibiting positive or negative behaviours depending on the attribu-
tions they make about the reasons why management adopts such HR practices (Nishii,
Lepak, & Schneider, 2008, p. 503). Likewise, in another laboratory experiment (Probst,
2002) it was found that the threat of layoffs resulted in a lower quality of performance
and in a greater violation of safety rules.
Following the preceding rationales concerning the effect of job self-efficacy on psycho-
logical contracts, this study further hypothesizes that such job self-efficacy is driven by
employee satisfaction with HRIM practices, which leads us to our next hypothesis:
H1. SHRIM predicts PROSE
Figure 5.1 – Graphic representation of hypothesis 1 of this study
54
5.2.2.a. Hypotheses concerning Job Satisfaction
In recent years, many suggestions have been made regarding the nature of the so-called
‘black box’, but many scholars emphasize the perceptions and experiences of employees
as the main linking mechanism (Boselie et al., 2005; Bowen & Ostroff, 2004; Nishii &
Wright, 2008). Perceived HR practices forge a psychological contract between employ-
er and employee that in turn affects these perceptions and experiences (El-Jardali et al.,
2009). Janus et al. (2007) suggest that non-monetary factors are important determinants
of physician job satisfaction, perhaps more important than monetary incentives that may
augment or reduce physicians’ base incomes.
Bamford and Griffin (2008) showed that high-satisfaction levels of participants with
HRIM reflected the intrinsic interest of the jobs and the quality of personal relationships
within multi-professional teams in the healthcare sector, reducing turnover15.
Gyekye (2005) found a positive association between job satisfaction and safety climate
and reminds us that it is on record that when workers’ basic needs are met consistently,
the workers express job satisfaction, which lead us to formulate the following hypothe-
sis:
H2.a1 SHRIM is a predictor of job satisfaction.
Psychological contracts’ literature (e.g., Rousseau, 1995) proposes that employees will
most likely want to reciprocate the companies’ interest in their well being and develop-
ment, with higher levels of job satisfaction, organizational commitment and organiza-
tional citizenship behaviours (among others, e.g., job involvement), when they have
positive perceptions regarding HRM policies and practices (Coyle-Shapiro & Kessler,
2002).
SET argues that when employees and supervisors/managers develop good workplace
relationships, a reciprocal arrangement develops that not only benefits the individuals
involved but also benefits the organisation as a whole (Cole, Schaninger, & Harris
2007). Xerri (2013) supports the idea that using SET as a theoretical lens, it is expected
that under ideal conditions, the outcome of effective workplace relationships will be that
15 High turnover in health facilities can impact negatively on the capacity to meet patient needs and health
care quality. The direct impact usually incurs extra personnel costs including recruiting, selection, and
training costs. Turnover also has negative impacts on the cohesiveness of the work unit, causes increased
burdens for the remaining staff, decreases work satisfaction, and further impacts the quality of patient
care (Hayes et al., 2006).
55
workers feel supported and therefore they develop a desire to give back to the organisa-
tion.
There seems to be a general trend in considering the employees’ perceptions and cogni-
tions as an antecedent of employee attitudes, behaviours and even performance.
Regardless of the (lack of) empirical evidence between JS and OP, Job Satisfaction re-
mains one of the key constructs studied in relation with OP. Meta-analyses find individ-
ual job satisfaction and job performance to be positively correlated (Petty et al., 1984;
Judge et al., 2001) and in general, JS is seen as a rout to high performance (Boxall &
Purcell, 2003; Wright et al., 2003) and in the healthcare context, studies have emerged
demonstrating the relationship between JS and quality of care (e.g., Aiken et al., 1994;
Aiken et al., 1997).
Job satisfaction is also highly associated with personal mastery experiences, which are
one of the social learning processes by which self-efficacy, is developed (Bandura,
1986, 1997). Hence we propose that:
H2.a2 Job Satisfaction predicts PROSE
A more extensive use of HR practices leads to more satisfied employees. This greater
satisfaction ‘reflects’ on the clients, as satisfied employees will do more for them (Ver-
meeren, Kuipers, & Steijn, 2011). Moreover, satisfied workers are less likely to call in
sick than less satisfied workers (Vermeeren et al., 2014)
The use of HR practices is related to improved financial outcomes, organizational out-
comes and HR outcomes (Vermeeren et al., 2014). Vermeeren and colleagues (2014)
showed that HR practices have a substantially larger impact on HR outcomes and or-
ganizational outcomes have than on financial outcomes. Employee attitudes especially
job satisfaction, are seen as an important element in the ‘black box’ between HRM and
performance, more specifically, in line with the assumption, our research proposes that:
H2.a3 The different facets of Job Satisfaction mediate the relationship
between SHRIM and PROSE.
56
Figure 5.2 – Graphic representation of hypotheses 2a1, 2a2 and 2a3 of this study
57
5.2.2.b. Hypotheses concerning Organizational Commitment
Specifically, social exchange theory suggests that individuals are drawn to participate
and invest in rewarding relationships, after which they become bound to return benefits
or favours to their partners in exchange (Blau, 1983). High-performance HR practices,
if implemented effectively, are likely to cause employees to perceive that their exchange
relationship with the organization is characterized by a supportive environment based
on investments in employee skills, regular unbiased performance feedback, availability
of fair and attractive rewards for performance—including compensation and advance-
ment opportunities—and mutual efforts toward meaningful goals (which employees
may have helped in developing (Wright et al., 2003). In return, employees are likely to
feel an obligation to the organization’s goals and so develop an affective bond with the
organization itself—which may be expressed as affective commitment (Cohen, 2003).
Other factors like the perception of justice in access to training is considered an im-
portant factor of the development of a strong corporate culture and has been positively
related with organizational commitment (Bartlett & Kang, 2004; Ehrhardt, Miller,
Freeman, & Hom, 2011). Past studies have shown that giving employees an opportunity
to learn develops a higher level of commitment among employees, compared to job se-
curity, monetary benefits, and job satisfaction (McNeese-Smith, 2001)16. In terms of
SHRIM related with training, other studies found that a training program that is effec-
tive may also lead to employees forming an opinion that their organization demonstrates
a willingness to invest in them, since the organization cares about them, which encour-
ages a higher level of commitment among employees toward their organization (Brunet-
to, Farr-Wharton, & Shacklock, 2012), and that this trend happens in different cultural
subsets (Ahmad & Bakar, 2003; Bartlett, 2001).
Gyekye (2005) reminds us that “it is on record that when workers’ basic needs are met
consistently and the workers express stronger feelings of allegiance and loyalty to their
organisations” (p. 292).
H2.b1 Satisfaction with HRIM is a predictor of organizational commit-
ment.
Rhoades, Eisenber, and Armeli (2001) suggest that employees who are affectively
16 Further, it has been found that employee commitment levels are high when they are given training
opportunities and, hence, they display a higher rate of training participation (Bartlett, 2001; Dhar, 2015).
58
committed to their organisation are considered to usually be dedicated and loyal to the
organisation. A sense of belonging is commonly associated with an employee’s emo-
tional attachment to the organisation, and such employees have a tendency to be in-
volved in organisational activities, are willing to work towards the attainment of organi-
sational goals and feel they should remain with the organisation. Employees who want
to remain with the organisation might also be more inclined than those who need to be
with the organisation to maximise their performance and to help others when required
(Meyer, Allen, and Gellatly 1990). In summary, employees who are affectively commit-
ted to the organisation are inherently led to be concerned about the organisation’s well
being (Xerri & Brunetto, 2013). Affective commitment has been demonstrated to relate
strongly and consistently to desired work outcomes, such as low absenteeism and organ-
izational citizenship behaviours (Meyer et al., 2002). Similar findings exist in different
occupational contexts (e.g., Brunetto et al., 2012; Ehrhardt et al., 2011) which leads us
to that by generating satisfaction with training programs accessible to employees, em-
ployees feel the organizations has a desire to invest in them, thus increasing their com-
mitment level.
Xerri and Brunetto (2013) suggest that employees who perceive to be managed with
high-performance HR practices are likely to express increased affective commitment
toward the organization based on a sort of obligatory reciprocation in their exchange
relationship (social exchange theory); employees’ increased levels of commitment are
then likely to affect important work behaviours since the attitudinal response of in-
creased affective commitment alone is not likely to provide a balance in the benefits
received by each party in the exchange relationship (i.e., the employees and the organi-
zation). Some further contribution on the part of employees would be required to level
the field, given the relatively large organizational investment and great number of em-
ployee benefits associated with a high-performance HR system.
Also, employees who are committed to an organization are likely to more naturally be-
have in ways that reflect this affective bond. Committed employees are likely to act in
ways that are in the best interest of the employer—specifically, through demonstrating,
in their work behaviours, a personal connection and devotion to the organization’s ac-
tivities and goals (Mowday, Porter, & Steers, 1982).
Organizational commitment has been proven to have a positive relationship with the
59
quality of service offered to customers (Chan, Ng, & Gian, 2011). This suggests that
when employees develop a higher level of commitment toward their organization, they
tend to perform well by providing better quality service leading to customer satisfaction
and positive word of mouth publicity.
Although research in this matter has focused mainly affective commitment, based on the
SET framework, we extend the premise to the other two types of commitment and pro-
pose that:
H2.b2 Organizational Commitment predicts PROSE.
There has been a growing degree of consensus among researchers that employees’
commitment to both organization and job constitutes a key factor that links between an
organization’s HRM practices and employees’ work behaviours and outcomes including
enhanced job performance, reduced turnover and absenteeism (e.g., Guest 1997; Meyer
& Allen 1997; Whitener 2001).
There has been a growing degree of consensus among researchers that employees’
commitment to both organization and job constitutes a key factor that links between an
organization’s HRIM practices, employees’ work behaviours and outcomes including
enhanced job performance, reduced turnover and absenteeism (e.g., Guest 1997; Meyer
& Allen 1997; Whitener 2001). For example, Guest (1997) lays out the clear causal path
that many other researchers in this field assume. Human resource systems are estab-
lished; they influence workplace practice; employee attitudes change with increased
work commitment; and there is a consequent effect on work behaviour and this in turn
feeds through to the performance of the work unit and eventually of the firm (Dhar,
2015).
Affective commitment in particular has been shown to be affected by employees’ work
and organizational experiences (e.g., HR practices) (Meyer et al., 2002).
As mentioned earlier, our study presumes that employees’ work commitment would
play an important role in mediating the relationship between HRM practices and em-
ployees’ work behaviours and outcomes. In particular, we assume that employees’ Sat-
isfaction with HRIM would influence the three components of organizational commit-
ment, which would eventually affect employees’ self-efficacy:
60
H2.b3 The relationship between SHRIM and PROSE is mediated by the
different components of Organizational Commitment.
Figure 5.3 – Graphic representation of hypotheses 2b1, 2b2 and 2b3 of this study
61
5.2.2.c. Hypotheses concerning Organizational Citizenship Behaviours
As previously mentioned, OCB refers to the activities and behaviour of employees that
go beyond the call of duty; such behaviour is often thought to be a result of effective
workplace relationships (Coyle-Shapiro & Kessler, 2002).
Several studies have been linking SHRIM with OCB. Edmondson & Lei (2014) refer
that psychological safety in the workplace is one of the critical factors that enables peo-
ple both to speak up about concerns at work and learn from errors. Low psychological
safety generates perceptions that an organisation is toxic, unfair and set in its ways and
in such working contexts, people will ‘keep their heads down’, ‘keep their mouths shut’
and ‘turn a blind eye’ as a rational response to danger (Wilde, 2014).
The underlying explanatory mechanism adopted to explain why individuals engage in
OCB as extra-role behaviour is based on social exchange (Blau, 1964) and the norm of
reciprocity (Gouldner, 1960). In other words, positive beneficial actions directed at em-
ployees by the organization create an impetus for employees to reciprocate in positive
ways through their attitudes and/or behaviours. Although empirical evidence supports
the relationship between JS and OCB (Bateman & Organ, 1983; Motowidlo & Van
Scotter, 1986; Smith et al., 1983), Moorman (1991) concludes that this relationship may
be a consequence of the underpinning concept of fairness, which subsequently prompt-
ed researchers to directly examine the role of organizational justice (Coyle-Shapiro et
al., 2011) and in our case leads us to consider the antecedent power of SHRIM in this
relationship.
Specifically, high-performance HRM practices can nurture a relational employment
relationship, leading to internalization of organizational values and goals. This, in turn,
would induce employees to engage in greater OCBs. However, conceptual and empiri-
cal work explaining the mechanism by which high-performance HRM practices relate to
OCBs remains scarce (Nasurdin et al., 2015).
Emerging empirical research suggests that the type of relationship an individual per-
ceives one has with one’s employer has important consequences for how the individual
contributes to that relationship (Irving & Gellatly, 2001; O’Leary-Kelly & Schenk,
1999). Van Dyne and Ang (1998) found that perceived employer obligations was posi-
62
tively related to the helping dimension of OCB in a sample of professional Singaporean
employees. Drawing on Barnard’s (1938) idea of ‘net anticipated satisfactions’, per-
ceived employer obligations reflect anticipated benefits arising from the exchange rela-
tionship and it is the anticipation of future benefits that may motivate behaviour. Rec-
ognizing the reciprocal nature of the interplay between the employer and employees,
employees may engage in OCB as a way of increasing the likelihood that the employer,
over the longer term will fulfil its promises (Coyle-Shapiro, 2002).
The empirical evidence is strongly supportive in demonstrating a positive relationship
between organizational inducements and employee attitudes and behaviour (Irving &
Gellatly, 2001; Rhoades & Eisenberger, 2002). As employees will attempt to match
their contributions with the inducements provided by the employer, one would expect
employees’ who perceived greater inducements to reciprocate by engaging in OCB
(Coyle-Shapiro & Dhensa, 2011).
In the meantime, an important way for linking SHRIM and OCB is through inferences
drawn from how their firm treats people (e.g., McAllister & Bigley, 2002). When a firm
treats various employees ethically17, the employees are encouraged to strive for a long-
term employment relationship with the firm, suggesting a positive relationship between
perceived ethical firm behaviour and relational contracts (Schwepker, 2001). On the
other hand, employees prefer to keep a short-term relationship with their firm if the firm
treats others unethically (Grover, 1993), suggesting a negative relationship between
perceived ethical firm behaviour and transactional contracts. It is understandable that
employees feel they may be mistreated by their firm one day if they see that the firm
often treats others unethically, and therefore may not trust the organization (Coyle-
Shapiro et al., 2011).
We are thus lead to the following hypothesis:
H2.c1 SHRIM predicts OCB.
Relationships based on mutual commitment (and therefore trust and reciprocity) influ-
ence OCB in two ways: first, by directly affecting the degree to which individuals en-
gage in OCB and secondly, by influencing how an individual conceptualizes the bound-
17 Schwepker (2001) suggests this perception of ethic with impact in outcomes doesn’t solely focus em-
ployees but also other stakeholders.
63
aries of their job, which in turn, affects the extent to which individuals engage in citi-
zenship behaviour. Coyle-Shapiro et al. (2011) propose that this finding is consistent
with Organ’s (1988) reciprocation thesis and Morrison’s (1994) role definition argu-
ment and consequently, the two perspectives complement each other and together pre-
sent a better foundation for understanding OCB than either alone.
The difference between the two perspectives lies in how individuals respond to a rela-
tionship based on mutual commitment. Consistent with Organ (1990), individuals en-
gage in OCB as a form of reciprocity based on organizational treatment and also con-
sistent with Morrison (1994), individuals enlarge their job responsibilities by incorpo-
rating those behaviours into their job. Taylor and Tepper (1999) in their empirical in-
vestigation of the relationship between organizational justice and mentoring label Mor-
rison’s (1994) explanation as a role enlargement process and Organ’s (1990) as a role
maintenance process. An alternative way of integrating the two perspectives is to extend
our conceptualization of reciprocity beyond the current focus on employee attitudes and
behaviour. The psychological contract literature suggests that employees may recipro-
cate employer treatment through a cognitive dimension; that is, adjusting their obliga-
tions to their employer (Coyle-Shapiro & Kessler, 2002). Recent empirical evidence
also suggests that employees reciprocate perceived organizational support by enhancing
their felt obligation to care about the organization’s welfare and to help the organization
achieve its objectives (Eisenberger et al., 2001).
Further, Coyle-Shapiro and colleagues (2011) found that OCB significantly predicts job
performance in accordance to previous studies (MacKenzie, Podsakoff, & Fetter, 1991;
Organ, 1988) that elaborated the fact that OCB improves the ability of co-workers and
managers to perform their jobs through more efficient planning, scheduling and prob-
lem-solving and contribution to service quality (Hui, Lee, Rousseau, 2004). This impact
of worker behaviours has an added impact to OP when we consider that organizations
that foster good citizenship behaviours are more attractive places to work and are able to
hire and retain the best people (George & Bettenhausen, 1990).
Thus we propose the following hypothesis:
H2.c2 OCB predicts PROSE
OCB’s have been found to significantly moderate the relationship between HRM prac-
64
tices and job performance. This has been supported in studies of Purcell, Kinnie,
Hutchinson, Rayton, and Swart (2003) that says that the critical factor in the relation-
ship between HRM and performance is the way through which HRM policies can shape
discretionary behaviour, that is, the choices people often make about the way to do their
work, which are neither expected nor required, and therefore cannot officially be re-
warded or punished by the organization for their presence or absence of it, which gets
translated into improved organizational and individual performance.
Reciprocity thus seems to contribute to the development of mutual obligations between
people in the long term, which helps attaining positive environmental results and ulti-
mately contributes towards organizational performance (Pretty, 2003). It is thus clear
that the need to reciprocate may depend on the relationship that the worker has previ-
ously established with the organization, leading us to our third hypotheses concerning
OCB:
H2.c3 The relationship between SHRIM and PROSE is mediated by
OCB.
Figure 5.4 – Graphic representation of hypotheses 2c1, 2c2 and 2c3 of this study
65
5.2.3. Hypotheses concerning the mediation of the WOR between the SHRIM-PROSE
relationship
Social exchange theorists have viewed the employment relationship as an exchange of
loyalty and effort in return for organizational inducements (Rhoades & Eisenberger,
2002). Forms of inducements can include wages, fringe benefits, nature of the job,
working conditions (March & Simon, 1958) as well as socioemotional benefits (Armeli
et al., 1998). Eisenberger et al. (2001) argue, based on the norm of reciprocity, employ-
ees are motivated to compensate beneficial treatment by acting in ways that support the
organization (Coyle-Shapiro, 2002).
Several authors, propose that the relationship between HRM and performance is not
direct, but mediated by the so called “black box effect” and an important interpretation
of the ‘black box’ implies that employee attitudes will mediate the link between HRM
and performance (MacDuffie, 1995).
Macduffie (1995) argues that HRM practices can influence the psychological contract
between employees and their employing organization; specifically, HRM practices that
are considered supportive and rewarding will be perceived as inducements provided by
the employer, which in turn, establishes a high-quality employment relationship
(Nasurdin et al., 2015).
Wikhamn and Hall (2012) propose that in a labour market that regulates the employ-
ment relationship, employees may feel reciprocating care and attention by the organiza-
tion is expected to be, and/or is more valuable if, directed towards performance rather
than the organization per se - thus, obligation is more associated with role performance.
Wikhamn and Hall’s (2012) results support the idea that performance-based attitudes
are outcomes of reciprocation and that obligation governs the nature of the exchange in
social relationships between employees and their organizations (Wikhamn & Hall,
2012).
Perceived employer obligations define the parameters of the relationship and signal to
the employee the potential inducements that may be exchanged over the course of the
relationship. As such, perceived promises signal the organization’s future intent and
their willingness to invest in the relationship. However, the realization of these obliga-
66
tions is not unconditional but rather predicated on employees’ fulfilling their side of the
exchange. The nature of some obligations may be on going during the relationship and
temporarily discharged periodically as the relationship progresses. For example, an ob-
ligation to keep skills up to date may be temporarily fulfilled when an individual is giv-
en additional training but the obligation to continue to update skills in the future may
exist. In addition, the nature of the exchange involves the contingent interplay between
the individual and his/her employer. Therefore, an individual’s behaviour should be
influenced by the anticipation of fulfilled promises, as the ‘actual’ fulfillment of those
promises is contingent upon the employee’s contributions (Coyle-Shapiro, 2002).
Thus we propose that:
H3. The relationship between SHRIM and PROSES is mediated by the
overall Worker-Organization Relationship
Figure 5.5 – Graphic representation of hypothesis 3 of this study
67
5.3. Conclusion
Table 5.1 summarizes the hypotheses formulated in this chapter.
Table 5.1 – Synthesis of hypotheses
Hypotheses
Number Hypotheses
H1. SHRIM predicts PROSE
H2.a1 SHRIM predicts Job Satisfaction
H2.a2 Job Satisfaction predicts PROSE
H2.a3 The different facets of Job Satisfaction mediate the relationship be-
tween SHRIM and PROSE.
H2.b1 SHRIM predicts Organizational Commitment
H2.b2 Organizational Commitment predicts PROSE
H2.b3 The relationship between SHRIM and PROSE is mediated by the dif-
ferent components of Organizational Commitment.
H2.c1 SHRIM predicts Organizational Citizenship Behaviours
H2.c2 Organizational Citizenship Behaviours predict PROSE
H2.c3 The relationship between SHRIM and PROSE is mediated by Organi-
zational Citizenship Behaviours.
H3. The relationship between SHRIM and the PROSE is mediated by the
overall Worker-Organization Relationship
68
Chapter 6 - Research Methodology
“Don’t panic.”
- Douglas Adams, “The hitchhikers guide to the galaxy” (Vol. I)
69
Chapter 6 - Research Methodology
In this chapter we aim to explain the methodology used in carrying out the empirical
approach, as to respond the research questions and testing the hypotheses that have been
proposed in the literature review section later in the Results section. Questionnaire de-
sign as well as the main constructs and scales are explored, followed by an exploration
of the collected data and the hypotheses testing.
Many authors support the notion that the epistemological positioning will have a deci-
sive influence on the design a researcher implements (Thietart, 2001). Whereas pure
positivism contends that only the scientific method using quantitative data can produce
real scientific knowledge, constructivists maintain that the study of individuals and their
institutions requires specific methods, different from those developed by the natural
sciences. These views have led to the development of two perspectives seen as antago-
nistic: the quantitative and qualitative approach (Thietart, 2001), but “research ap-
proaches are not systematically attached to a particular paradigm” (Thietart, 2001,
pp. 115). Thus in this study we developed a mainly quantitative approach to test a con-
structivist theory, choosing a research design that uses quantitative methods to assess
latent (unobservable) constructs.
6.1 Research Design
In order to test the theoretical model of the mediated relationship of satisfaction with
human resource issues with performance related self-efficacy, we had to develop a few
constructs.
Abstract constructs such as these cannot be directly measured, which means that re-
searchers need to find a way to measure these latent constructs with psychometric in-
struments or scales. We privileged the use of pre-existing and widely validated psycho-
metric scales; however, our two main constructs (satisfaction with human resource prac-
tices and related issues and performance related self-efficacy) seemed to be lacking a
corresponding scale, which lead us to construct specific instruments for both constructs,
based on our literature review.
Structural equations modelling (SEM) is the adequate methodology to assess the rela-
tionships proposed by the previously presented model. This methodology allows us to
estimate multiple interrelated dependency relationships between variables that are ob-
served and latent (variables that are impossible to observe directly), as well as assessing
70
the theoretical relationships in a specified model (Byrne, 2010). SEM is an extension of
the general linear model that enables a researcher to test a set of regression equations
simultaneously. SEM software can test traditional models, but it also permits examina-
tion of more complex relationships and models, such as confirmatory factor analysis.
According to Maroco (2010) other advantages of the uses of SEM include clear and
testable assumptions underlying the statistical analyses, overall tests of model fit and
individual parameter estimate simultaneous tests; regression coefficients, means, and
variances may be compared simultaneously, even across multiple between-subjects
groups, measurement and confirmatory factor analysis models can be used to purge er-
rors, making estimated relationships among latent variables less contaminated by meas-
urement error, which is especially important in social sciences where latent variables are
common.
According to Hooper, Coughlan, and Muller (2008), SEM has become one of the tech-
niques of choice for researchers across disciplines and increasingly is a ‘must’ for re-
searchers in the social sciences where assessing whether a specified model ‘fits’ the data
is one of the most important steps in structural equation modelling (Yuan, 2005).
Data collection was attained through a self-responding questionnaire, since each set of
questions composes the measurement of each latent variable or construct. Questionnaire
design involved an exhaustive and detailed work in order to respond to the proposed
research model. Latent variables, factors or constructs are variables that are not directly
observed and their “existence” is shown to us by the way they manifest in items that are
indicative or – as the name indicates - manifest (Maroco, 2010). The latent variables in
this work are: satisfaction with human resource practices and related issues, job satisfac-
tion, helping and voice behaviours, organizational commitment and performance related
self-efficacy.
6.2 Data Collection Procedures
As a data collection procedure object, the questionnaire is an important tool in the re-
search process; as such, it is important to explain its relevance and role. The question-
naire is a communication mean between the researcher and the subjects, that aims at
introducing a series of similar questions to all respondents (Brace, 2008). The main ad-
vantages of using this method are its versatility, uniform measurement across subjects;
whereas the disadvantages lie with a possible low response rate (Brace, 2008; Hill &
71
Hill, 2005). In our research, data was collected during the month of January of 2012 in
a large a Hospital in the north of Portugal that employs circa 2000 workers, using both
paper and electronic format. Paper format was distributed among workers that preferred
this method or that did not have access to the intranet of the institution with envelopes
so that responses could be sealed and anonymity ensured. Electronic questionnaires
were divulged in the Hospital’s intranet.
The questionnaire is comprised of six parts (cf. Annex 1): 1) sociodemographic charac-
teristics of the subject, 2) perceptions of performance related self-efficacy, 3) satisfac-
tion with human resource, practices and related issues, 4) job satisfaction, 5) organiza-
tional commitment and 6) helping and voice behaviours. Each of these sections will be
explained in detail in section 6.3.
6.2.1 Pilot testing
According to Brace (2008), doing a pilot test should be an integral part of the process,
even if the questionnaire includes questions or items previously used in other studies.
Brace (2008) makes the point that questionnaires are hardly ever optimized for the pop-
ulation in case in their first version, so it is relevant that a few subjects from the sample
are allowed to survey the questionnaire so that the researcher may do the necessary al-
terations to ensure that subjects are truly responding what was originally meant
(Ghiglione & Matalon, 1997).
In our study we conducted a cognitive pilot test (Brace, 2008), since we used the ques-
tionnaire in a small subset of subjects that were then invited to do a talked reflection in
the contents and adequacy of items and item order, as to maximize comprehension of
the intended constructs; this allowed us to realize if there were any issues with vocabu-
lary or controversial or difficult questions.
There were no considerable issues in the pilot testing phase, safe for a few adjustments,
that were mainly in terms of format, not substance, and permitted us to advance to the
next stage of research expecting higher levels of reliability and validity of constructs
(Brace, 2008).
6.3 Instruments
While selecting the instruments we considered the recommendations for the psychomet-
ric evaluation of measures used in organizational research by Meyer and Allen (1997).
72
These authors proclaim that scales should have acceptable internal validity; a minimum
.70 alpha is considered, although as Cortina (1993) has noted, measures with more
items will typically yield higher coefficient alpha values than those with fewer items,
other things being equal.
This means it is preferable to choose smaller scales, given comparable alpha values and
construct validity estimates. Scales should also be relatively stable across time, and
items that measure one construct should not correlate highly with items intended to
measure unrelated constructs, and correlate with other constructs that are expected theo-
retically, that is to say, convergent and discriminant validity should be considered
(Fields, 2002).
Concerning two of the constructs of this study and given that no scale in our literature
review matched our exact needs for this work, one scale was developed considering the
existing literature: SHRIMQ (Satisfaction with Human Resources’ Issues Management
Questionnaire) and another was adapted to match our specific needs: PROSES (Perfor-
mance Related Observations of Self-Efficacy Scale). WOR is design as a composite
measure of Job Satisfaction (assessed using the MSQ Weiss, Dawis, England, &
Lofquist’s [1967] MSQ), Organizational Commitment (assessed via Meyer and Allen’s
[1991] OCS] and Organizational Citizenship Behaviour (assessed with Van Dyne and
LePine’s [1998] HVBS).
6.3.1 SHRIMQ – Satisfaction with Human Resources’ Issues Management Questionnaire
Satisfaction with Human Resources’ Issues Management is a construct that encom-
passes both human resources practices and management but also issues that are not tra-
ditionally and directly associated with the HRM, but are nonetheless expressions of HR
policies, such as teamwork, inter-department cooperation and even information sharing.
This construct came about during our review of the literature where several authors
mentioned different issues that impact human resources performance, encompassing
both areas that traditionally are HRM (e.g., staffing, performance appraisal) and areas
that were not directly related, but are still in the HRM’s “jurisdiction” latu sensu (e.g.,
interdepartmental cooperation, information sharing, teamwork). Because this construct
is apparently very context specific, it was necessary to construct a scale to assess it for
this specific study.
Thus, a scale was developed based on West el al.’s (2006) and Buchan’s (2004) work
73
on the impact of good HRM practices in healthcare organizations, namely hospitals.
The authors explore these dimensions of impactful HRM practices following Pfeffer’s
(1998) work on ‘high commitment’ or ‘high performance’ HRM practices, and indicate
that the areas of HRM that truly have an impact in performance in the healthcare con-
text are: performance appraisal/management, training, decentralization, participatory
mechanisms, team-based structures, employment security, staffing (recruit-
ment/selection) and compensation.
Since the work conducted by the authors was designed at an organizational level and we
are operating in a more individual level of analysis, in order to develop our question-
naire we started out by considering these conceptual dimensions, and then tried to create
items that would fit in the Portuguese Hospital context, as well as including some char-
acteristics mentioned in the literature (e.g., Buchan, 2004; Paauwe, 2009; West et al.,
2006) as relevant to hospital workers, namely issues with cooperation among teams and
information sharing.
The final set of items was the result of this review and the talked discussion process
with hospital workers from our sample, resulting in a 24 item long, five-point (from
“very dissatisfied” [1] to “very satisfied” [5]) Likert-type original scale, shown in table
6.1.
Table 6.1 – Indicators and construct of Satisfaction with Human Resources’ Issues Management
Construct Satisfaction with Human Resources’ Issues Management
Authors Developed based on the reviews by Buchan (2004); Paauwe (2008);
West et al. (2006)
Dimension Item
number Item
Recruitment and Se-
lection (Staffing)
1 The way people are chosen to work in this hospital
2 The way people are chosen to work in this
ward/department
3 The way I was chosen to work in this Hospital
24 The way I was integrated in the department/institution.
Training 4 The quality and themes of the trainings the Hospital pro-
vides for me
74
5 The quantity of the trainings the Hospital provides for me
Performance apprais-
al/management
6 The way my performance appraisal occurred (SIADAP or
other)
7 The way that generally performance appraisal occurs (SI-
ADAP or other)
8 The results of my performance appraisal (SIADAP or
other)
9 The general results of performance appraisal (SIADAP or
other)
Information/ Commu-
nication
10 The way generic information relative to the Hospital is
conveyed to co-workers by the leaders
11 The way generic information directly/professionally relat-
ed with me is conveyed to co-workers by the leaders
12 The way information relative to the Hospital circulates
among colleagues
13 The way information relative to the Ward/department
circulates among colleagues.
14 The way information relative to the Hospital circulates
among colleagues/in the Hospital/ among my peers
Team-based structures
/ cooperation
15 The way my team works
16 The way teams in general work in the hospital
17 The way the team(s) I integrate work
Interdepartmental
communication/ in-
formation sharing
18 The ways different departments/wards cooperate with
each other
19 The way general information is shared among
wards/departments
20 The way information about the patients is shared among
different departments/wards
Compensation
21 The package of pay benefits I am offered
22 The package of pay benefits this Hospital generally offers.
23 The remuneration and compensation system I’, included
in (CAP or CIT)
75
6.3.2 MSQ - Minnesota Satisfaction Questionnaire
Job Satisfaction was assessed using the short version of the MSQ - Minnesota Satisfac-
tion Questionnaire (Weiss, Dawis, England, & Lofquist, 1967), with 20 items. A 5-point
Likert-type scale was used with choices that range from “very dissatisfied with this as-
pect of my job” (1) to “very satisfied with this aspect of my job” (5).
Fields (2002) mentions that over the years, and in several different investigations where
the MSQ was used, different factor solutions were found and refers to Mathieu and
Farr’s (1991) work where four factors emerged (satisfaction with working conditions,
satisfaction with leadership, satisfaction with responsibility and satisfaction with extrin-
sic rewards) and Moorman’s (1993) work where two factors (one assessing satisfaction
with intrinsic aspects of the job and the other assessing satisfaction with extrinsic as-
pects) yield. Spector (1997), however solely mentions two factors solutions from previ-
ous studies for the short version of the MSQ, reporting to the main tendency of the
scale.
To assess Job Satisfaction we considered using several scales, from various articles and
Fields’s (2002) work, choosing the Minnesota Satisfaction Questionnaire – Short Ver-
sion (Weiss et al., 1967), since it presents several advantages: it is a well known and
stable over the time instrument; previous researches had yielded coefficient alpha values
ranging from .85 to .91; is a 20 item scale (in comparison with the 72 items of the JDI –
Job Descriptive Index, for example) and the MSQ has been widely studied and validat-
ed (cf. Mathiew & Farr, 1991; Moorman, 1993).
The translated version of Weiss et al.´s (1967) 20 item scale proposed by Martins
(2008) was used. Martins (2008) started with the translation of the instrument to Portu-
guese, followed by a backtranslation by an Englishman proficient in the Portuguese
language, so to compare the original and the back translated items, therefore ensuring
the reliability of the adaptation. After this process, a pilot study was conducted with a
small group of workers of an industrial company, where the talked reflection around the
scale leads to small final adjustments in terms of language; the same version of the in-
strument was further used in research by Sousa, Cruz and Martins (2011) and Martins
and Proença (2012), with good psychometric properties and high reliability values
(above α= 0.70)
76
Table 6.2– Indicators and construct of Job Satisfaction
Construct Job Satisfaction
Authors Weiss, Dawis, England & Lofquist (1967)
Dimension Item num-
ber Item
Intrinsic Job Satisfac-
tion
1 Being able to keep busy all the time.
2 The feeling of accomplishment I get from the job.
3 The chance to do things for other people.
4 The chance to work alone on the job.
5 The chance to be “somebody” in the community.
8 The way my job provides for steady employment.
10 The chance to do different things from time to time.
12 The chance to tell people what to do.
13 The chance to do something that makes use of my
abilities.
14 Being able to do things that don’t go against my
conscience.
16 The freedom to use my own judgment.
20 The chance to try my own methods of doing the job.
Extrinsic Job Satisfac-
tion
6 The way my boss handles his/her workers.
7 The competence of my supervisor in making deci-
sions.
9 The way company policies are put into practice.
11 The praise I get for doing a good job
18 The chances for advancement on this job.
19 The praise I get for doing a good job.
General Job Satisfac-
tion
15 The way my co-workers get along with each other.
17 The working conditions.
6.3.3 OCS - Organizational Commitment Scales
Employees’ levels of commitment to their organization were measured using the revised
version of Meyer and Allen’s (1997) 19 item scale: Affective, Normative and Continu-
ance Commitment Scales (Meyer & Allen, 1997). A 7-point Likert-type scale was used
for measuring respondents’ level of agreement with each statement (from 1—strongly
disagree to 7—strongly agree). In the authors’ version, the Affective Commitment Sub-
scale contains 6 items, such as “I would be very happy to spend the rest of my career in
this organization”, the Normative Commitment Subscale integrates 6 items, such as “I’d
feel guilty if I left my organization now” and the Continuance Commitment Subscale
integrates 7 items, such as “I believe I have too few options to consider leaving this or-
ganization”.
77
Meyer and Allen’s (1997) model was the most referenced in the literature consulted,
and the most used in relational studies (Allen & Meyer, 1990).
Hence, the 19 item version of this instrument (Meyer & Allen, 1997) was chosen, in
conformity with the above mentioned model (cf. table 6.3). This measure has the ad-
vantage of discriminating and dealing with the different dimensions of commitment
instead of measuring essentially one kind (usually affective commitment), and had pre-
viously reported alpha values of .77<<.88 for Affective Commitment, .65<<.86 for
Normative Commitment, .64<<.86 for Continuance Commitment (Fields, 2002).
In Portugal, this scale has been previously used in researches developed by Ferreira
(2005) and Martins (2008).
Ferreira (2005) analyzed the relation between individual and organizational characteris-
tics and Organizational Commitment in a sample of doctors and nurses in six different
hospitals, as well as if these relations were mediated by the management model (tradi-
tional, corporate or private) and by the professional group. This author used a version of
the original Meyer and Allen (1997) scales with a total of 23 items, reporting a good
internal consistency for the three components.
Martins (2008) analyzed the impact of the promotion of Accreditation of Prior Learning
(APL) Processes by organizations in the worker-organization relationship, namely in
terms of Organizational Commitment, Organizational Citizenship Behaviors and Job
Satisfaction. This author used the 19 item revised version of this instrument (Meyer &
Allen, 1997) in a sample of 135 workers of two major industrial companies in the north
of Portugal.
In this study we used Martins’ (2008) version, which was developed with a process of
translation, backtranslation, pilot study with talked reflection and an assessment of the
psychometric properties of the instrument. The analysis of the instrument was furthered
by Martins, Rebelo and Tomás (2012) with a confirmatory factor analysis, with good
results regarding the instrument’s psychometric properties.
78
Table 6.3 – Indicators and construct of Organizational Commitment (items marked with * are
reverse score items)
Construct Organizational Commitment
Authors Meyer and Allen (1997)
Dimension Item num-
ber Item
Affective Commitment
1 This organization has a great deal of personal mean-
ing to me.
2 I do not feel a strong sense of belonging in my or-
ganization.*
3 I would be very happy to spend the rest of my career
in this organization.
6 I really feel as if this organization’s problems are my
own.
9 I do not feel emotionally attached to this organiza-
tion.*
16 I do not feel “part of the family” at my organiza-
tion.*
Normative Commitment
4 Even if it were to my advantage, I do not feel it
would be right to leave my organization now.
5 I would not leave my organization right now because
I have a sense of obligation to the people in it.
10 I owe a great deal to this organization.
11 This organization deserves my loyalty.
12 I do not feel any obligation to remain with my cur-
rent employer.*
17 I would feel guilty if I left my organization now.
Continuous Commitment
7 One of the few negative consequences of leaving this
organization would be the scarcity of available alter-
natives.
8 One of the major reasons I continue to work for this
organization is that leaving would require a consid-
erable personal sacrifice; another organization may
not match the overall benefits I have here.
13 It would be very difficult to leave this organization
now, even if I wanted to.
14 I believe that I have too few options to consider leav-
ing this organization.
15 If I had not put so much of myself into this organiza-
tion, I might consider working elsewhere.
18 Right now, staying with my organization is a matter
of necessity as much as desire.
19 Too much of my life would be disrupted if I decided
I wanted to leave my organization now.
79
6.3.4 HVBS - Helping and Voice Behaviours Scale
Extra-Role Organizational Citizenship Behaviour was assessed using the 13-item Help-
ing and Voice Behaviours Scale (Van Dyne & LePine, 1998). Responses to all items
were assessed on 7-point Likert-type scales (1 -strongly disagree to 7 - strongly agree).
The Helping Behaviours original subscale contains 7 items such as “I volunteer to do
things for this work group” and the Voice Behaviours subscale integrates 6 items, such
as “I develop and make recommendations concerning issues that affect this work
group”.
The Helping and Voice Behaviours Scale (Van Dyne & LePine, 1998) was chosen for
several reasons for this study. First of all, and bearing in mind the nature of our investi-
gation we found it preferable to use scales that could be applied directly to the subjects
and not involve other participants for practicality reasons, given our sample size and the
fact that several workers work in more than one service of the Hospital (e.g. doctors) or
work in different areas from their supervisors (e.g. administrative staff). In that sense we
eliminated a priori all the scales that were supposed to be only responded by supervisors
or co-workers (e.g., Smith et al., 1983 Organizational Citizenship Behaviour scale). The
fact that the scale is rather specific also allows us to stray from the current theoretical
and methodological controversies in this area (regarding what employees actually con-
sider to be “in-role” or “extra-role” behaviours, and therefore a citizenship behaviour or
their implied duty, inhering the very fuzziness of the concepts “role” and “job” them-
selves (Morrison, 1994; Organ, 1997).
This scale is more parsimonious than most (13 items, cf. table 6.4) and reported very
good coefficient alpha values by other researchers of 85<<.95 for helping behaviours
and .82<<.96 for voice behaviours (Fields, 2002).
The Portuguese version of the instrument used in this study was the one developed by
(Martins, 2008), using the same method referred for the other adapted scales with trans-
lation, back-translation by a native speaker with good knowledge of Portuguese, pilot
study with talked reflection and an assessment of the scale’s psychometric properties
with good results. This version has been further used in research (e.g. Proença & Mar-
tins, 2013).
80
Table 6.4 – Indicators and construct of Helping and Voice Behaviours
6.3.5 PROSES – Performance Related Observations of Self Efficacy Scale
Bandura (2006), in his “Guide for constructing self-efficacy scales”, considered that
“there is no all-purpose measure of perceived self-efficacy. The “one measure fits all”
approach usually has limited explanatory and predictive value because most of the items
in an all-purpose test may have little or no relevance to the domain of functioning.”
Construct Helping and Voice Behaviours
Authors Van Dyne and LePine (1998)
Dimension Item num-
ber Item
Helping Behaviours
1 I help to orientate new employees in this group
3 I help others in this group to learn about the work.
4 I attend functions that help the work group.
5 I assist others in this group with their work for the
benefit the work group.
8 I help others in this group with their work responsi-
bilities
10 I volunteer to do things for my work group.
Voice Behaviours
2 I speak up in this group with ideas for new projects
or changes in procedures.
6 I communicate my opinions about work issues to
others in this group, even if my opinion is different
and others disagree with me.
7 I speak up and encourage others in this group to get
involved in issues that affect this group.
9 I get involved to benefit this work group.
11 I develop and make recommendations about matters
concerning issues that affect this work group.
12 I keep myself well informed about issues where my
opinion might be useful to this work group.
13 I get involved in matters which affect the quality of
life in this group.
81
(p.30).
Thus, although Chen et al. (2001) produced a “New General Self Efficacy Scale”, con-
stituted of a parsimonious 8 items, we considered that an adjustment needed to be made
to the specific type of self-efficacy we were assessing, given the fact that this is a highly
context-specific construct. Thus we adjusted the 5 items that we considered to be most
relatable to performance and adapted the “New General Self Efficacy Scale” as the Per-
formance Related Observations of Self Efficacy Scale (PROSES) that includes the items
described in table 6.5.
As jobs become broader and more complex, measuring dispositional constructs that can
predict motivational reactions and behaviors across a variety of work domains becomes
increasingly important (e.g., Judge et al., 1997; Judge, Erez, & Bono, 1998; Chen et al.,
2001).
Specific self-efficacy has been shown to be an important predictor of performance
across different studies and settings (Stajkovic & Luthans, 1998); arguments have been
made that the effects of self-efficacy on performance may be partly a bandwidth issue,
as self-efficacy matters more in the presence of distal variables for task performance
than global job performance. This notion fits rather well with the bandwidth–fidelity
debate (e.g., Cronbach & Gleser, 1966), which would suggest that self-efficacy, given
its relatively task-specific nature, is likely to be a stronger predictor of narrow perfor-
mance measures such as task performance (Judge et al., 2007).
82
Table 6.5 – Indicators and construct of Performance Related Observations of Self Efficacy
6.4 Sampling
Any empirical research encompasses data collection (Hill & Hill, 2005). In this re-
search, the population in study is composed by all types of individuals that work for a
hospital; these encompass clinical and non clinical staff.
Given the dimension of the population, difficulties with data collection and the need to
eliminate other possible parasite variables from our results such as organizational cul-
ture or hospital case mix, we chose to work with a single institution.
We used a convenience sample, in the sense that only one institution was considered in
our study and participants were not enrolled via a randomized approach, but rather on
availability and volunteering to respond. However, there are some sampling issues that
one must always consider when deciding how many subjects suffice in a research. Hill
and Hill (2005) propose a few rules of thumb for determining the minimum dimension
of a sample so that an adequate statistical analysis may be developed. Thus we consid-
ered that in this research more than one statistical analysis was bound to be applied, and
we took into consideration that in researches where the number of independent (or ex-
ogenous, in the case of structural equations modelling) variables is K, the minimum size
(N) of the sample must be 15K, and when multiple regression analysis is used 50K must
Construct Performance Related Observations of Self Efficacy
Authors Adapted from Bandura (2006) and Chen, Gully, and Eden (2001)
Dimension Item num-
ber Item
1 In my opinion, I contribute to the success of the Or-
ganization
2 I think I’m having a good performance in the Organ-
ization
3 I think I’m a good worker
4 On average I feel that I work harder than my col-
leagues
5 I feel that I have the right conditions to do my best in
this organization
83
be considered in order for the test results to be generalizable. In our case, 200 subjects
was the minimum sample threshold.
Where structural equations modelling is considered, different authors suggest diverse
sample sizes, varying between 5 and 20 subjects per scale item (observable or manifest
variable) (cf. Schumacker & Lomax, 2010 for a comprehensive view on this matter).
Since we use many different questionnaires, we considered our longest questionnaire
(SHRIMQ - 24 items). Using the most demanding criteria, our sample should be com-
posed of a minimum of 480 subjects and using the least demanding criteria, 120 sub-
jects.
A convenience sampling method was used, where both paper and electronic question-
naires were distributed among all workers, and information was conveyed in the Hospi-
tal’s intranet. Paper questionnaires were distributed among workers that preferred this
method or that did not have access to the intranet of the institution. Envelopes were de-
livered with the questionnaires, so that responses could be sealed and anonymity en-
sured. From the circa 2000 workers of the Hospital at the time, 942 subjects replied,
composing a 48.3% response rate.
6.5 Conclusion
The constructs in our study are considerably abstract, which makes the use of SEM ap-
propriate to assess and evaluate the relationships suggested by our model. SEM meth-
odology allows us to estimate multiple interrelated dependency relationships between
variables that might be latent or observable (Byrne, 2010; Klein, 2011; Maroco, 2010;
Schumaker & Lomax, 2010). Thus, SEM allows us to observe how independent (exog-
enous) variables may explain the dependent (endogenous) variables, as well as their
relative importance, by giving us all the indicators associated with a certain phenome-
non (Klein, 2011). The process begins with formulating a theoretical model that estab-
lishes relationships between a set of variables and this must be duly based in theory
(Maroco, 2010). In this chapter a detailed review of the literature concerning the scales
used to assess the constructs of our model was presented, which allowed us to choose
the most appropriate models for our study. These instruments were either new (although
based in pre-existing scales) or the Portuguese version of previously used instruments,
which made it necessary to validate their structure and content.
Self-reporting scales were our data collection method, since the different sets of ques-
84
tions enable the assessment of each construct or latent variable. Questionnaire design
involved and exhaustive preparation in order to allow for a precise, reliable, adequate
and valid data collection as to permit the evaluation of the pre-established theoretical
model. Our convenience sampling allowed for a response rate of circa 48.3%.
85
Chapter 7 - Data Analysis
“Atticus told me to delete the adjectives and I’d have the facts”
- Harper Lee, “To kill a mocking bird”
86
Chapter 7 - Data Analysis
In this chapter, the psychometric properties (validity and reliability) of the chosen scales
are assessed, followed by an exploratory analysis of the data and finally structural equa-
tions modelling is used to test the hypotheses. The results consider the indications of
Hair, Black, and Anderson (2009), and are presented in such a way that results are ac-
companied by the explanation of our options in data analysis, as to permit a better un-
derstanding of these.
7.1 Psychometric Properties of the Instruments
Assessing the psychometric properties of instruments/scales aims at ensuring the quality
of the measurement of latent variables in the study and represents an essential part of
the best effort to ensure that the right constructs are being focused, and that the empiri-
cal indicators represent a certain construct (Hair et al., 2009). Instrument-related proce-
dures in this study include construct validity and reliability testing.
Latent constructs, unlike observed variables (e.g. height, weight, speed, etc.), are inac-
cessible to direct measurement and therefore require the use of psychometric instru-
ments. These instruments – usually scales or questionnaires – are comprised of different
items that contribute to our understanding of the subject’s level and perception of said
construct (Maroco, 2010).
Construct validity estimates the ability of an instrument to measure the underlying con-
struct of interest (Ellenbecker & Byleckie, 2005). Exploratory factor analysis (EFA) has
traditionally been employed by researchers as a tool to determine the number of under-
lying dimensions in a data set by grouping together variables that are correlated
(Tabachnik & Fidell, 2007).
Factor analysis is a multivariate analysis procedure that attempts to identify any under-
lying “factors” (or “components”, when the extraction method is principal components
analysis) that are responsible for the covariation among a group of independent varia-
bles. The goals of a factor analysis are typically to reduce the number of variables used
to explain a relationship or to determine which variables show a relationship amongst
each other. Like a regression model, a factor is a linear combination of a group of varia-
87
bles (items) combined to represent a scale measure of a concept or construct. To suc-
cessfully use a factor analysis, though, the variables must represent indicators of some
common underlying dimension or concept such that they can be grouped together theo-
retically as well as mathematically.
Psychometric instruments can be self or other-reporting, but the vast majority of them
are self-reporting scales (Fields, 2002).
Concerning the exploratory factor analysis (EFA), and according to Hair et al. (2009),
the following results were reported: Keiser-Meyer-Olkin (KMO) indicator and Bartlet’s
test of sphericity; factor loadings, communalities and explained variance.
The KMO indicator and Bartlet’s test of sphericity are preliminary measurements that
ensure the researcher that scales are fit for factor analysis since correlations between the
variables is neither excessive nor lacking. According to Hair et al. (2009), the KMO
should be above 0.8 and Bartlet’s test should be significant. According to Hair et al.
(2009), three criteria should be observed when considering whether to retain or elimi-
nate items in a scale: factor loadings below 0.3 in any factor or component, communali-
ties below 0.5, and the lack of contribution of the item to the internal consistency or
reliability of the scale.
In our study, principal factors extraction with varimax rotation was performed on the 20
items from the MSQ (Weiss et al., 1967), on the 19 items of the Affective, Normative
and Continuance Commitment Scale (Meyer & Allen, 1997) as well as the 24 items of
the SHRIMQ and the 5 items of the PROSES. Oblique rotation was used on the 13
items of the Helping and Voice Behaviours Scale (Van Dyne & LePine, 1998): theory
suggests that good citizenship is demonstrated by high levels of both substantive cate-
gories (Van Dyne, Graham, & Dienesch, 1994), thus, Helping and Voice Behaviours
should be positively correlated rather than orthogonally related, as is the present case
(r=.78, p<.01).
Principal components extraction was used prior to confirmatory factor analysis to esti-
mate number of factors, presence of outliers, absence of multicollinearity and factorabil-
ity of the correlation matrices (Tabachnick & Fidell, 2007). The principal components
analysis was, therefore, used as an initial step of the Factor Analysis that produced the
prevailing results, since the purpose of our work was a “theoretical solution uncontami-
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nated by unique and error variability" and we had designed our study “on the basis of
underlying constructs [...] expected to produce scores in the observed variables”
(Tabachnik & Fidell, 2007, p. 635).
Confirmatory Factor Analysis (CFA), ensued the EFA procedures. We decided to use
CFA procedures in order to ensure that the measurement models of the scale had a good
fit with the sample and to check for the possibility of better fit of other factor solutions.
According to the indications provided by Maroco (2010), the following results were
reported: factor structure including regression weights and correlations between the la-
tent variables; model chi-square and relative/normed chi square (χ2/degrees of freedom),
degrees of freedom; root mean square error of approximation (RMSEA) and it’s higher
and lower confidence intervals, Goodness of fit index (GFI) and comparative fit index
(CFI).
The Chi-Square value is the traditional measure for evaluating overall model fit and,
“assesses the magnitude of discrepancy between the sample and fitted covariances ma-
trices” (Hu & Bentler, 1999, p. 2). A good model fit would provide an insignificant re-
sult at a 0.05 threshold, thus the Chi-Square statistic is often referred to as either a ‘bad-
ness of fit’ or a ‘lack of fit’ measure (Kline, 2011). Due to the restrictiveness of the
Model Chi-Square, researchers have sought alternative indices to assess model fit. One
example of a statistic that minimises the impact of sample size on the Model Chi-Square
is Wheaton, Muthen, Alwin, and Summers’s (1977) relative/normed chi-square (χ2/df).
Although there is no consensus regarding an acceptable ratio for this statistic, recom-
mendations range from as high as 5.0 (Wheaton et al., 1977) to as low as 2.0 (Tabach-
nick & Fidell, 2007). The root mean square of approximation (RMSEA) tells us how
well the model, with unknown but optimally chosen parameter estimates would fit the
population’s covariance matrix (Byrne, 2010). In recent years it has become regarded as
“one of the most informative fit indices” due to its sensitivity to the number of estimat-
ed parameters in the model. In other words, the RMSEA favours parsimony in that it
will choose the model with the lesser number of parameters. A cut-off value close to .06
(Hu & Bentler, 1999) or a stringent upper limit of 0.07 (Steiger, 2007) seems to be the
general consensus amongst authorities in this area. The Goodness-of-Fit statistic (GFI)
calculates the proportion of variance that is accounted for by the estimated population
covariance (Tabachnick & Fidell, 2007). This statistic ranges from 0 to and traditionally
an omnibus cut-off point of 0.90 has been recommended for the GFI. The Comparative
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Fit Index (Bentler, 1990) is a revised form of the NFI which takes into account sample
size (Byrne, 2010) that performs well even when sample size is small (Tabachnick &
Fidell, 2007); today this index is included in all SEM programs and is one of the most
popularly reported fit indices due to being one of the measures least effected by sample
size (Fan, Thompson, & Wang, 1999). A value of CFI ≥ 0.95 is presently recognised as
indicative of good fit (Hu & Bentler, 1999).
Reliability was assessed using Cronbach’s alpha, a widely used measurement of internal
consistency for psychometric instruments; this indicator assesses how much a set of
items is measuring the same construct (Maroco, 2010).
Because SEM was used to conduct a CFA and further the analysis on the validity of the
scales, average variance extracted (AVE) and composite reliability (CR) were also held
in account: AVE assesses convergent validity, that is to say AVE tests if the items that
define each construct load properly in that same construct, i.e. does the latent variable
account for its variance (Maroco, 2010); CR is a different measure for internal con-
sistency, when SEM is used to assess validity: CR indicates how much the items of the
scale are reflexive of the latent variable (Fornell & Lacker, 1984).
7.1.1 SHRIMQ – Satisfaction with Human Resources’ Issues Management Questionnaire
Concerning the SHRIMQ, the hypothesized dimensions were almost integrally proven
to be valid in the present sample: of the eight originally constructed dimensions 6 were
verified as designed and 2 dimensions (team-based structure and team-based coopera-
tion) fused into a single one (teamwork). Thus, seven components were extracted using
principal components analysis with varimax rotation, accounting for 77.4% of the vari-
ance. Communality values tended to be high, well above the cut off point of 0.32
(Tabachnick & Fidell, 2007) for inclusion of a variable in interpretation of a factor. Two
items were removed from the analysis since they either loaded very closely in more than
one factor (with a difference lesser than .01). Loadings of variables on factors and
communalities are shown in table 7.1, as well as the explained variance of each sub-
scales. Variables are ordered and grouped by size of loading to facilitate interpretation.
90
Subscales were named according to what had been designed originally, since very few
changes resulted from the analysis (none in most cases) and apart from the two afore
mentioned dimensions that fused, no items shifted subscales. Thus, scales were named:
1. Satisfaction with Information (referring to the satisfaction with the way information that
does not concern patients is conveyed in the organization);
2. Satisfaction with performance appraisal (regarding satisfaction with the process and re-
sults of performance appraisal in the organization);
3. Satisfaction with pay (considering satisfaction with compensation and benefits the or-
ganization offers);
4. Satisfaction with service cooperation (regarding satisfaction with the way different de-
partments or services cooperate and share information that is general or concerns pa-
tients);
5. Satisfaction with recruitment and selection (concerning satisfaction with staffing prac-
tices);
6. Satisfaction with teamwork (satisfaction with the way respondents’ teams work);
7. Satisfaction with training (satisfaction with the contents and quantity of training offered
by the Hospital).
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Table 7.1 - Varimax rotated component matrix based on correlations among the items of the SHRIMQ and communalities (h2).
1 2 3 4 5 6 7 h2
12. The way information relative to the Hospital circulates among colleagues. 0.82 0.13 0.12 0.17 0.13 0.07 0.15 0.71
13. The way information relative to the Ward/department circulates among colleagues. 0.79 0.10 0.09 0.15 0.08 0.27 0.14 0.76
14. The way information relative to the Hospital circulates among colleagues/in the
Hospital/ among my peers 0.75 0.14 0.11 0.24 0.12 0.14 0.09 0.47
11. The way generic information directly/professionally related with me is conveyed to
co-workers by the leaders. 0.72 0.30 0.16 0.16 0.17 0.14 0.09 0.86
10. The way generic information relative to the Hospital is conveyed to co-workers by
the leaders. 0.69 0.33 0.10 0.17 0.16 0.11 0.15 0.86
8. The results of my performance appraisal (SIADAP or other). 0.16 0.88 0.06 0.05 0.11 0.06 0.08 0.82
9. The general results of performance appraisal (SIADAP or other). 0.15 0.86 0.13 0.11 0.13 0.06 0.07 0.82
6. The way my performance appraisal occurred (SIADAP or other). 0.21 0.86 0.10 0.07 0.09 0.04 0.14 0.83
7. The way that generally performance appraisal occurs (SIADAP or other). 0.21 0.84 0.13 0.10 0.14 0.07 0.15 0.82
22. The package of pay benefits this Hospital generally offers. 0.10 0.11 0.89 0.11 0.08 0.05 0.05 0.69
21. The package of pay benefits I am offered. 0.14 0.13 0.88 0.14 0.10 0.06 0.07 0.71
23. The remuneration and compensation system I’m, included in (CAP or CIT). 0.15 0.12 0.83 0.08 0.02 -0.01 0.12 0.77
19. The way general information is shared among wards/departments. 0.32 0.10 0.12 0.81 0.13 0.11 0.12 0.76
18. The ways different departments/wards cooperate with each other. 0.17 0.10 0.13 0.81 0.09 0.22 0.08 0.70
20. The way information about the patients is shared among different depart-
ments/wards. 0.21 0.09 0.11 0.76 0.17 0.05 0.18 0.87
2. The way people are chosen to work in this ward/department. 0.15 0.15 0.20 0.11 0.78 0.24 0.02 0.86
1. The way people are chosen to work in this hospital. 0.16 0.18 0.18 0.16 0.77 -0.06 0.06 0.77
3. The way I was chosen to work in this Hospital. 0.12 0.08 -0.12 0.08 0.63 0.13 0.12 0.82
15. The way my team works. 0.24 0.07 0.05 0.17 0.11 0.87 0.05 0.71
17. The way the team(s) I integrate work. 0.24 0.11 0.03 0.15 0.17 0.85 0.10 0.85
4. The quality and themes of the trainings the Hospital provides for me. 0.21 0.19 0.12 0.15 0.16 0.09 0.84 0.84
5. The quantity of the trainings the Hospital provides for me. 0.23 0.19 0.13 0.20 0.05 0.07 0.84 0.74
% of Variance accounted for 15.9% 15.6% 11.5% 10.3% 8.5% 8.1% 7.5%
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We then proceeded to the confirmatory procedures that yielded the goodness of fit indi-
ces values obtained for this model structure indicating satisfactory values for all the
estimated indices (table 7.2).
Table 7.2 - Goodness of fit indices obtained in the confirmatory factor analysis of the SHRIMQ
2 df. 2/df GFI CFI RMSEA Confidence
interval (90%)
Structure derived from the
exploratory analysis
(22 items)
930.01** 188 4.95 .92 .94 .065 .06-.07
*p<0.05 ; ** p<0.01; *** p≤0.001
Figure 7.1 – Confirmatory Factor Analysis of the SHRIMQ model obtained with the exploratory factor analy-
sis procedures.
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7.1.2 Minnesota Satisfaction Questionnaire – MSQ (short version)
Regarding the MSQ, two factors were extracted using principal components analysis
with varimax rotation, accounting for 58.73% of the variance. Communality values
tended to be high, with a cut off point of 0.32 (Tabachnick & Fidell, 2007) for inclusion
of a variable in interpretation of a factor. Eleven of the twenty variables loaded very
closely in both factors (with a difference lesser than .01) or had communalities below
the cut-off point, which led us to eliminate them from the analysis. Loadings of varia-
bles on factors and communalities are shown in table 7.3. Variables are ordered and
grouped by size of loading to facilitate interpretation.
Table 7.3 - Varimax rotated component matrix based on correlations among the items of the
MSQ, communalities (h2), and explained variance.
Intrinsic Extrinsic h2
3. The chance to do things for other people. 0.79 -0.11 0.41
2. The feeling of accomplishment I get from the job. 0.78 0.12 0.62
4. The chance to work alone on the job. 0.77 0.17 0.63
5. The chance to be “somebody” in the community. 0.74 0.13 0.62
1. Being able to keep busy all the time. 0.62 0.17 0.56
16. The freedom to use my own judgment. 0.60 0.33 0.39
14. Being able to do things that don’t go against my conscience. 0.58 0.24 0.47
19. The praise I get for doing a good job. 0.08 0.89 0.78
18. The chances for advancement on this job. 0.20 0.86 0.80
% of Variance accounted for 38.78% 19.95%
We named the two factors intrinsic satisfaction (concerning the nature of the job tasks
themselves and how people feel about the work they do, e.g., “the chance to do some-
thing that makes use of my abilities”), and extrinsic satisfaction (referring to aspects of
work that have little to do with the job tasks or the work itself, e.g., “The relationship
between pay and the amount of work I do”) according to the content of the items and to
what has been most commonly mentioned in the literature as the results of the factor
analysis of the short version of the MSQ, here used (Spector, 1997).
94
Confirmatory procedures yielded the goodness of fit indices values obtained for this
model structure indicating satisfactory values for all the estimated indices (table 7.4).
Table 7.4 - Goodness of fit indices obtained in the confirmatory factor analysis of the SHRIMQ
2 df. 2/df GFI CFI RMSEA Confidence
interval (90%)
MSQ structure derived
from the exploratory
analysis
(22 items)
214.80** 26 8.26 .95 .93 .09 .08-.10
** p <.01
Figure 7.2 - Confirmatory Factor Analysis of the MSQ model obtained with the exploratory factor analysis
procedures.in this study.
7.1.3 Organizational Commitment Scales
The 19 items comprising the scale were subjected to an exploratory factor analysis, with
principal components analysis. Three factors, accounting for 57.82% of the total vari-
ance were extracted and rotated to a varimax criterion. The items and their factor load-
95
ings are reported in table 7.5. In view of the fact that the reverse score items clustered in
dissonance with the remaining scale (given by values of corrected item-total statistics,
ranging between 0.187 and -0.149) we were led to eliminate all the reverse score items
present in this scale18. One of the items in the Continuance Commitment Scale (“15. If I
hadn’t given so much of myself to this company, I would consider working for another
company”) and another from the Affective Commitment Scale (“6. I feel this organiza-
tion’s problems as my own.”) were also eliminated due to low communalities.
Taken together, our results regarding this scale suggest that each of the psychological
states identified in the literature as “commitment” to the organization can be reliably
measured. The independence of the scores of the Continuance Commitment Scale from
the ones on the other two measures was expected. The significant relationship between
Affective Organizational Commitment and Normative Organizational Commitment had
already been suggested by Allen and Meyer (1990) and Bergman (2006) and is replicat-
ed in the Portuguese Hospital Workers population, where items from both scales ap-
peared mixed, suggesting that feelings of obligation to maintain membership in the or-
ganization, although not identical to feelings of desire, may be meaningfully linked.
18 The reversed score items present in the original scale, eliminated from this factorial solution are: “2. I
do not feel a strong sense of belonging in my organization.”, “9. I do not feel emotionally attached to this
organization.”; “12. I do not feel any obligation to remain with my current employer” “16. I do not feel
“part of the family” at my organization”.
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Table 7.5 - Varimax rotated component matrix based on correlations among the items of the
OCS and communalities (h2).
1 2 3 h2
1. This organization has a great deal of personal meaning to
me. 0.83 0.02 0.06 0.61
11. This organization deserves my loyalty. 0.76 0.07 0.20 0.72
3. I would be very happy to spend the rest of my career in
this organization. 0.73 0.01 0.24 0.61
10. I owe a great deal to this organization. 0.61 0.17 0.23 0.68
14. I believe that I have too few options to consider leaving
this organization. 0.07 0.82 -0.10 0.59
7. One of the few negative consequences of leaving this
organization would be the scarcity of available alternatives. -0.20 0.72 0.00 0.45
13. It would be very difficult to leave this organization
now, even if I wanted to. 0.35 0.60 0.14 0.62
8. One of the major reasons I continue to work for this or-
ganization is that leaving would require a considerable
personal sacrifice; another organization may not match the
overall benefits I have here. 0.06 0.59 0.34 0.56
19. Too much of my life would be disrupted if I decided I
wanted to leave my organization now. 0.24 0.57 0.27 0.46
5. I would not leave my organization right now because I
have a sense of obligation to the people in it. 0.27 0.08 0.80 0.50
17. I would feel guilty if I left my organization now. 0.10 0.12 0.76 0.69
4. Even if it were to my advantage, I do not feel it would be
right to leave my organization now. 0.41 0.11 0.65 0.46
% of Variance accounted for 33.09% 15.97% 8.81%
Confirmatory procedures yielded the goodness of fit indices values obtained for this
model structure indicating satisfactory values for all the estimated indices (table 7.6).
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Table 7.6 - Goodness of fit indices obtained in the confirmatory factor analysis of the OCS
2 df. 2/df GFI CFI RMSEA Confidence
interval (90%)
OCS structure derived
from the exploratory
analysis
(22 items)
350.84** 48 7.31 .95 .91 .08 .07-.09
** p <.01
Figure 7.3 - Confirmatory Factor Analysis of the OCS model obtained with the exploratory factor analysis
procedures.
7.1.4 Helping and Voice Behaviours Scale
Self-report responses of employees to the 13 item-scale were factor-analysed using
principal components analysis. We specified oblique rotation for the analysis of this
scale since we verified that the dimensions (Helping Behaviours and Voice Behaviours)
98
were positively correlated rather than orthogonally related (r=.78, p<.01), confirming
what was mentioned by the authors of the scale in the seminal articles (LePine & Van
Dyne, 1998; Van Dyne & Le Pine, 1998).
Three items , for loading in both factors simultaneously; table 7.7 lists the 10 remaining
items, their factor loadings, communalities and explained variances. Factor 1 contains
six Helping Behaviour items, representing the proactive behaviour that emphasizes
small acts of consideration to other co-workers; Factor 2 contains four items, represent-
ing Voice Behaviours, the proactive behaviours that express a challenge the status quo
in order to improve Organizational Performance.
Table 7.7 - Varimax rotated component matrix based on correlations among the items of the
HVB and communalities (h2).
1 2 h2
13. I get involved in matters which affect the quality of life in this
group. 1.00 -0.15 0.77
12. I keep myself well informed about issues where my opinion might
be useful to this work group. 0.92 -0.07 0.70
11. I develop and make recommendations about matters concerning
issues that affect this work group. 0.75 0.17 0.74
10. I volunteer to do things for my work group. 0.74 0.16 0.65
9. I get involved to benefit this work group. 0.69 0.25 0.64
7. I speak up and encourage others in this group to get involved in
issues that affect this group. 0.56 0.29 0.62
3. I help others in this group to learn about the work. -0.09 0.94 0.55
4. I attend functions that help the work group. 0.02 0.87 0.59
5. I assist others in this group with their work for the benefit the work
group. 0.15 0.77 0.65
2. I speak up in this group with ideas for new projects or changes in
procedures. 0.12 0.69 0.70
% of Variance accounted for 65.98% 8.39%
In summary, the results of the exploratory factor analysis generally support the two sub-
stantive components originally predicted by the authors of the scale (Helping and Voice
99
Behaviours), although the distribution of the items across the two factors did not follow
the exact original pattern proposed by the authors.
Confirmatory procedures yielded the goodness of fit indices values obtained for this
model structure indicating satisfactory values for all the estimated indices (table 7.8).
Table 7.8 - Goodness of fit indices obtained in the confirmatory factor analysis of the HVBS.
2 df. 2/df GFI CFI RMSEA Confidence
interval (90%)
HVB structure derived
from the exploratory
analysis
(22 items)
243.62** 31 7.86 .95 .97 .09 .08-.10
** p <.01
Figure 7.4 - Confirmatory Factor Analysis of the HVB model obtained with the exploratory factor analysis
procedures.
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7.1.5 PROSES – Performance Related Observations of Self Efficacy Scale
The 5 items comprising the scale were subjected to an exploratory factor analysis, with
principal components analysis. Three factors, accounting for 83.38% of the total vari-
ance were extracted and rotated to a varimax criterion. The items and their factor load-
ings are reported in table 7.9. Two items were removed from the analysis, one because
of loading in more than one dimension and another because it loaded in a single item
factor and was therefore unacceptable in a latent variable model (Maroco, 2010).
Table 7.9 - Varimax rotated component matrix based on correlations among the items of the
PROSES, communalities (h2) and explained variance.
1 h2
2. I think I’m having a good performance in the Organization 0.94 0.75
3. I think I’m a good worker 0.93 0.89
1. In my opinion, I contribute to the success of the Organization 0.87 0.86
% of Variance accounted for 83.38%
Confirmatory procedures yielded the goodness of fit indices values obtained for this
model structure indicating satisfactory values for all the estimated indices (table 7.10).
Table 7.10 - Goodness of fit indices obtained in the confirmatory factor analysis of the HVBS
2 df. 2/df GFI CFI RMSEA Confidence
interval (90%)
PROSES structure derived
from the exploratory analysis
(22 items)
22.17** 2 11.08 .98 .99 .10 .07-.14
** p <.01
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Figure 7.5 - Confirmatory Factor Analysis of the PROSE model obtained with the exploratory factor analysis
procedures.
7.1.6. Reliability
All the scales and its dimensions presented high levels of reliability, with values of
α=0.92 for the SHRIMQ (subscales: information (5 items) α= 0.90, performance ap-
praisal (4 items) α=0.93, service cooperation (3 items) α= 0.84, recruitment and selec-
tion (3 items) α= 0.68, teamwork (2 items) α= 0.86, pay (3 items) α= 0.89, training
(2 items) α= 0.84), α=0.82 for the MSQ (subscales: intrinsic job satisfaction (7 items)
α= 0.84, extrinsic job satisfaction (2 items) α= 0.77), α= 0.80 for the affective, norma-
tive and continuance organizational commitment scales (subscales: affective organiza-
tional commitment (4 items) α= 0.76, normative organizational commitment (3 items)
α= 0.73, continuance organizational commitment (5 items) α=0.72), α= 0.94 for the
helping and voice Behaviours scale (subscales: voice behaviours scales (6 items)
α= 0.93, helping behaviours scale (4 items)) and α= 0.90 for the performance related
observations of self-efficacy.
As expected, from the obtained alpha scores and considering Ra and Kim’s (2013) con-
clusions that the difference between alpha values and CR is relatively inconsequential
for practical applications, composite reliability and average variance extracted values of
scales and subscales were good to very good. Results are shown in table 7.11.
102
Table 7.11 – Average Variance Extracted and Composite Relaibility for the constructs of this
study
Scale CR AVE
SHRIMQ 0.91 0.85
SHRIMQ – Information 0.90 0.64
SHRIMQ - Performance Appraisal 0.93 0.91
SHRIMQ - Service Cooperation 0.84 0.78
SHRIMQ - Recruitment And Selection 0.70 0.54
SHRIMQ – Teamwork 0.86 0.82
SHRIMQ – Pay 0.89 0.85
SHRIMQ – Training 0.84 0.79
MSQ 0.68 0.57
MSQ - Extrinsic Job Satisfaction 0.79 0.71
MSQ - Intrinsic Job Satisfaction 0.84 0.70
OCS 0.69 0.57
OCS - Affective Organizational Commitment 0.77 0.61
OCS - Normative Organizational Commitment 0.74 0.60
OCS - Continuance Organizational Commitment 0.84 0.70
HVBS 0.99 0.99
HVBS - Helping 0.89 0.84
HVBS - Voice 0.93 0.90
PROSE 0.90 0.88
All CR values are above the cut point value of 0.7, safe for the OCS and the MSQ
which were 1 and 2 centesimal points respectively below the reference value and can be
considered in the acceptable range; all AVE values are above the cut-point of 0.5
(Maroco, 2010; Hair, 2009).
7.1.7. Common Method Variance
Because all data are self-reported and collected through the same questionnaire during
the same period of time with cross-sectional research design, common method variance
(variance that is attributed to the measurement method rather than the constructs of in-
terest) may cause systematic measurement error and further bias the estimates of the
true relationship among theoretical constructs. Method variance can either inflate or
deflate observed relationships between constructs, thus leading to both Type I and Type
II errors (Podsakoff, MacKenzie, Lee, & Podsakoff, 2003; Podsakoff & Organ, 1986).
Harman’s single-factor test and confirmatory factor analysis, post hoc statistical tests,
were conducted to test the presence of common method effect in all scales except
PROSES, since this is in itself a single-factor measure, due to the parcimony of the
items that compose it (3 items).
103
All the variables of each questionnaire were entered into an exploratory factor analysis,
using unrotated principal components factor analysis; if a substantial amount of com-
mon method variance is present, either (a) a single factor would emerge from the factor
analysis, or (b) one general factor would account for the majority of the covariance
among the variables (e.g., Podsakoff et al., 2003; Podsakoff & Organ,1986; Steensma,
Tihanyi, Lyles, & Dhanaraj, 2005). Moreover, all variables of the different measure-
ment models were loaded on one factor to examine the fit of the confirmatory factor
analysis model. If common method variance is largely responsible for the relationship
among the variables, the one-factor CFA model should fit the data well (Mossholder,
Bennett, Kemery,& Wesolowski, 1998).
7. 1.7.1 Common Method Variance analysis of the SHRIMQ
The unrotated principal component factor analysis revealed the presence of seven dis-
tinct factors with eigenvalue greater than 1.0, accounting for 77.43% of the variance
rather than a single factor; when a single factor is considered the total variance ex-
plained accounts for 37.2%. Thus, no general factor is apparent.
The confirmatory factor analysis showed that the single-factor model did not fit the data
well, χ2 (230)= 6811.84, p>.001, GFI=0.57; CFI= 0.49; RMSEA = 018.
While the results of these analyses do not preclude the possibility of common method
variance, they do suggest that common method variance is not of great concern and thus
is unlikely to confound the interpretations of results.
7. 1.7.2 Common Method Variance analysis of the Minnesota Satisfaction Questionnaire –
MSQ (short version)
The unrotated principal component factor analysis revealed the presence of two distinct
factors with eigenvalue greater than 1.0, accounting for 58.73% of the variance rather
than a single factor; when a single factor is considered the total variance explained ac-
counts for 43.25%. Thus, no general factor is apparent.
The confirmatory factor analysis showed that the single-factor model did not fit the data
well, χ2 (35)= 729.60, p>.001, GFI=0.85; CFI= 0.76; RMSEA = 015.
While the results of these analyses do not preclude the possibility of common method
variance, they do suggest that common method variance is not of great concern and thus
is unlikely to confound the interpretations of results.
104
7. 1.7.3 Common Method Variance analysis of the Organizational Commitment Scales
The unrotated principal component factor analysis revealed the presence of three dis-
tinct factors with eigenvalue greater than 1.0, accounting for 57.87% of the variance
rather than a single factor; when a single factor is considered the total variance ex-
plained accounts for 33.09%. Thus, no general factor is apparent.
The confirmatory factor analysis showed that the single-factor model did not fit the data
well, χ2 (65)= 1458.07, p>.001, GFI=0.76; CFI= 0.57; RMSEA = 015.
While the results of these analyses do not preclude the possibility of common method
variance, they do suggest that common method variance is not of great concern and thus
is unlikely to confound the interpretations of results.
7. 1.7.4 Common Method Variance analysis of the Helping and Voice Behaviours Scale
The unrotated principal component factor analysis revealed the presence of three dis-
tinct factors with eigenvalue greater than 1.0, accounting for 74.37% of the variance
rather than a single factor; when a single factor is considered the total variance ex-
plained accounts for 65.98%. Thus, since the value of the first factor is above 50%a
general factor can be considered, which makes the confirmatory factor analysis para-
mount to determine the existence of common method variance.
The confirmatory factor analysis showed that the single-factor model did not fit the data
well, with χ2 (44)= 938.35, p>.001, GFI=0.82; CFI= 0.88; RMSEA = 015.
While the results of these analyses do not preclude the possibility of common method
variance, they do suggest that common method variance is not of great concern and thus
is unlikely to confound the interpretations of results.
7.1.8. Synthesis
The purpose of this section was to validate the scales that assess the five latent con-
structs of the model. We developed an exploratory and confirmatory factor analysis and
the then assess the reliability of the instruments. In total, five scales were assessed, con-
cerning the five constructs:
105
Satisfaction with Human Resources’ Issues Management Questionnaire
(SHRIMQ) – the scale presented very good results, and two items were elimi-
nated from the original set;
Minnesota Satisfaction Questionnaire – short version (MSQ)– eleven items were
eliminated, but the remaining set shows good psychometric properties and the
resulting model is consistent with the literature;
Organizational Commitment Scales (OCS)– the scale presented very good re-
sults that are consistent with previous research; seven items were eliminated due
to low communalities;
Helping and Voice Behaviours Scale (HVBS) – three items were eliminated
from this scale for loading in both factors simultaneously; the final set of items
presents very good psychometric properties.
Performance Related Observations of Performance Scale (PROSES) – this con-
struct presents very good results; 2 items were eliminated.
The exploratory factor analysis was conducted using principal components analysis
with eigenvalues above 1; this was ensued by a confirmatory factor analysis.
The results of the analysis are consistent with the theoretical literature of the constructs.
7.2 Sample
Sample is composed of a total of 942 subjects, with ages of respondents varying be-
tween 20 and 66 years old (mode=28 and M= 38.5; standard deviation= 9.6). Age dis-
tribution in our sample is shown in figure 7.6.
106
Figure 7.6 – Respondents’ age distribution
Most respondents are female (80.3%; 16.9% male respondents; 2.2% missing).
In terms of job, the distribution of staff per job group is shown in Figure 7.7.
Figure 7.7. Distribution of staff in different job functions (percentages).
Seniority values range between less than a year to up to 39 years (mode=3, mean=12.38
Nurses42%
Helpers28%
Allied healthcare technicians
10%
Doctors6%
Administrative Staff10%
Superior Technician
4%
other0%
107
years, standard deviation= 8.46), where a significant amount of workers (71%) have an
effective contract (hired with no predetermined ending date of the bond with the organi-
zation).
Figure 7.8 - Distribution of staff according to contract types (percentages).
When it comes to schooling, 17% of subjects have a school level inferior to the manda-
tory Portuguese level (9th year), 28.8% attended or graduated from middle school,
42.8% attended or graduated from College and 19.7% have post-graduate schooling
(Specializations, Masters Degree, etc.).
Effective Contract
80%
Temporary Contract
(fixed/certain ending date)
6%
Temporary Contract
(uncertain ending date)13%
Temporary Workers
0%
Other1%
108
Figure 7.9 – Respondents’ schooling distribution
7.3 Exploratory Analysis of Data
As one can observe in table 7.12, almost all scales have results that range from mini-
mum to maximum values and those that do not include the minimum response value
have a minimum value that does not reach the second Likert-point; almost all scales
report values above the mean point of the scale, save for latent variables referring to pay
or extrinsic satisfaction.
Regarding the SHRIMQ and its subscales, workers seem to be satisfied with the HR
policies in general, except in terms of pay, in which the average is below the mean point
of the scale (3). Extrinsic satisfaction, in consonance with satisfaction with pay stands
below the scale’s mean point, but the same cannot be said for intrinsic satisfaction.
The higher levels of organizational commitment refer to affective commitment (com-
mitment based on emotional ties the employee develops with the organization primarily
via positive work experiences), followed by the continuance commitment (commitment
based on the perceived costs, both economic and social, of leaving the organization) and
finally the normative commitment (perceived obligation towards the organization, root-
ed in the norms of reciprocity).
109
Both helping and voice behaviours and performance related observations of self-
efficacy have high mean values, but this might be due to the social desirability bias, the
tendency of survey respondents to answer questions in a manner that will be viewed
favourably by others (Fisher, 1993).
Table 7.12. Minimum, maximum, mean and standard deviation of the latent variables in the
present study.
Min Max M SD
SHRIMQ – Information 1.00 5.00 3.42 0.69
SHRIMQ – Performance Appraisal 1.00 5.00 3.30 0.79
SHRIMQ – Service Cooperation 1.00 5.00 3.33 0.65
SHRIMQ – Recruitment and Selection 1.00 5.00 3.56 0.61
SHRIMQ – Teamwork 1.00 5.00 3.77 0.75
SHRIMQ – Pay 1.00 5.00 2.25 0.85
SHRIMQ – Training 1.00 5.00 3.55 0.84
Global SHRIMQ 1.00 4.88 3,29 0.51
Intrinsic Job Satisfaction 1,29 5.00 3.90 0.59
Extrinsic Job Satisfaction 1.00 5.00 2.29 0.96
Global Job Satisfaction 1.22 5.00 3.54 0.57
Affective Organizational Commitment 1,50 7.00 5.30 1.05
Normative Organizational Commitment 1.00 7.00 3.98 1.40
Continuance Organizational Commitment 1.00 7.00 4.60 1.14
Global Organizational Commitment 1.00 7.00 4.68 0.90
Voice Behaviours 1,67 7.00 5.65 0.90
Helping Behaviours 1.00 7.00 5.59 0.98
Global Helping and Voice Behaviours 1.50 7.00 5.63 0.68
PROSES 1.00 5.00 4.52 0.56
Our sample presents some gender differences concerning our constructs. As one can
observe in tables 7.12 and 7.13, women present values that are significantly higher than
men concerning satisfaction with performance appraisal, service cooperation, recruit-
110
ment and selection, training and global satisfaction with human Resources’ Issues man-
agement. Also, women reported higher levels of intrinsic job satisfactions and global
job satisfaction, as well as normative, continuance and global organizational commit-
ment. Finally, women in our sample reported significantly higher levels of global help-
ing and voice behaviours.
111
Table 7.13 – t tests concerning gender differences for all the latent constructs in our study.
male
female
M SD
M SD
df t
SHRIMQ – Information 3.33 0.74 3.44 0.68 913 -1.77
SHRIMQ – Perfor-
mance Appraisal 3.18 0.84 3.33 0.77 913 -2.15*
SHRIMQ – Service
Cooperation 3.20 0.66 3.35 0.64 913 -2.75**
SHRIMQ – Recruit-
ment and Selection 3.44 0.67 3.58 0.59 211,52 -2.52*
SHRIMQ – Teamwork 3.78 0.77 3.78 0.74 913 -0.06
SHRIMQ – Pay 2.22 0.87 2.26 0.85 913 -0.50
SHRIMQ – Training 3.35 0.88 3.59 0.83 913 -3.24**
Global SHRIMQ 3.19 0.54 3.31 0.49 913 -2.71**
Intrinsic Job Satisfac-
tion 3.72 0.70 3.94 0.56 202,84 -3.68***
Extrinsic Job Satisfac-
tion 2.18 0.97 2.30 0.95 225,20 -1.34
Global Job Satisfaction 3.38 0.66 3.57 0.54 913 -3.93***
Affective Organization-
al Commitment 5.18 1.06 5.31 1.04 913 -1.44
Normative Organiza-
tional Commitment 3.72 1.44 4.02 1.39 913 -2.42*
Continuance Organiza-
tional Commitment 4.34 1.23 4.65 1.11 913 -3.17**
Global Organizational
Commitment 4.47 0.85 4.71 0.90 913 -3.20***
Voice Behaviours 5.56 0.97 5.67 0.87 913 -1.44
Helping Behaviours 5.52 1.07 5.62 0.95 913 -1.09
Global Helping and
Voice Behaviours 5.55 0.96 5.65 0.85 913 -1.26
PROSES 4.47 0.59 4.53 0.53 913 -1.28
*p<0.05 ; ** p<0.01; *** p≤0.001
Age seems to correlate with the dimensions of our study as well. As one can observe in
table 7.14, age correlates positively with satisfaction with pay and training, but also
with extrinsic and global job satisfaction. Age correlates positively with affective, nor-
mative and global organizational commitment. Respondents seem to increase their help-
ing and voice behaviours separately and taken together with age as well.
112
Table 7.14 – Pearson correlations of the age of respondents with the latent constructs of our
study
Age
SHRIMQ – Information -0.001
SHRIMQ – Performance Appraisal -0.03
SHRIMQ – Service Cooperation 0.01
SHRIMQ – Recruitment and Selection 0.06
SHRIMQ – Teamwork 0.06
SHRIMQ – Pay 0.10**
SHRIMQ – Training -0.08*
Global SHRIMQ 0.02
Intrinsic Job Satisfaction 0.04
Extrinsic Job Satisfaction 0.18***
Global Job Satisfaction 0.09**
Affective Organizational Commitment 0.17***
Normative Organizational Commitment 0.20***
Continuance Organizational Commitment -0.004
Global Organizational Commitment 0.14***
Voice Behaviours 0.08*
Helping Behaviours 0.08*
Global Helping and Voice Behaviours 0.08*
PROSES 0.01
*p<0.05 ; ** p<0.01; *** p≤0.001
Finally, we decided to look into the differences in the different latent constructs regard-
ing all the different jobs included in our sample.
113
Table 7.15 – Means and Standard Deviations of the different latent constructs in the different jobs of the respondents.
Nurses
(N=363)
Helpers
(N=247)
Allied
Healthcare
Technicians
(N=85)
Medical Doc-
tors
(N=49=
Technical
Assistants
(89)
Superior
Technician
(N=35)
M SD M SD M SD M SD M SD M SD
SHRIMQ – Information 3.43 0.70 3.52 0.62 3.20 0.67 3.46 0.76 3.44 0.79 3.38 0.79
SHRIMQ – Performance Appraisal 3.34 0.72 3.44 0.77 3.14 0.75 3.15 0.57 3.07 1.03 3.11 0.93
SHRIMQ – Service Cooperation 3.35 0.69 3.34 0.59 3.14 0.55 3.57 0.65 3.35 0.60 3.16 0.72
SHRIMQ – Recruitment and Selection 3.53 0.58 3.59 0.58 3.60 0.59 3.72 0.67 3.56 0.71 3.71 0.65
SHRIMQ – Teamwork 3.80 0.73 3.73 0.73 3.82 0.59 4.07 0.59 3.82 0.82 3.76 0.83
SHRIMQ – Pay 2.02 0.80 2.42 0.86 2.13 0.85 2.74 0.80 2.51 0.72 2.46 0.96
SHRIMQ – Training 3.66 0.82 3.78 0.68 3.02 0.86 3.52 0.71 3.21 0.82 3.21 0.90
Global SHRIMQ 3.28 0.49 3.38 0.48 3.13 0.46 3.42 0.47 3.26 0.56 3.24 0.57
Intrinsic Job Satisfaction 3.90 0.56 3.97 0.57 3.83 0.49 4.10 0.56 3.79 0.74 3.92 0.64
Extrinsic Job Satisfaction 2.03 0.86 2.48 0.97 2.12 0.93 3.09 0.85 2.47 0.83 2.40 1.04
Global Job Satisfaction 3.48 0.52 3.64 0.55 3.45 0.50 3.87 0.52 3.50 0.67 3.58 0.62
Affective Organizational Commitment 5.19 1.01 5.57 0.97 5.03 1.10 5.28 0.93 5.29 1.19 5.42 1.13
Normative Organizational Commitment 3.60 1.30 4.48 1.28 3.78 1.32 4.12 1.47 4.11 1.42 3.85 1.51
Continuance Organizational Commitment 4.42 1.10 5.01 1.00 4.65 1.10 4.00 1.24 4.61 1.18 4.13 1.08
Global Organizational Commitment 4.47 0.82 5.06 0.83 4.56 0.88 4.45 0.83 4.71 0.99 4.49 0.81
Voice Behaviours 5.69 0.81 5.59 0.95 5.59 0.81 5.74 0.82 5.60 1.05 5.89 0.97
Helping Behaviours 5.61 0.95 5.57 1.02 5.64 0.81 5.74 0.84 5.41 1.17 5.92 1.00
Global Helping and Voice Behaviours 5.66 0.82 5.58 0.74 5.61 0.68 5.74 0.79 5.53 1.06 5.90 0.95
PROSES 4.56 0.49 4.51 0.55 4.53 0.47 4.43 0.54 4.46 0.67 4.59 0.51
114
Table 7.16 – One way ANOVA of the differences in the latent constructs of our study regarding
the different jobs included in the sample.
df SS MS F
SHRIMQ – Information
Between Groups 863 7.40 1.23 2.59**
Within Groups 6 412.03 0.48
SHRIMQ – Performance Ap-
praisal
Between Groups 863 15.53 2.59 4.26***
Within Groups 6 524.51 0.61
SHRIMQ – Service Cooperation
Between Groups 863 7.80 1.30 3.18***
Within Groups 6 352.73 0.41
SHRIMQ – Recruitment and Se-
lection
Between Groups 863 3.03 0.51 1.38
Within Groups 6 315.75 0.37
SHRIMQ – Teamwork
Between Groups 863 5.47 0.91 1.72
Within Groups 6 456.64 0.53
SHRIMQ – Pay
Between Groups 863 49.14 8.19 12.17***
Within Groups 6 580.78 0.67
SHRIMQ – Training
Between Groups 863 57.25 9.54 15.46***
Within Groups 6 532.77 0.62
Global SHRIMQ
Between Groups 863 5.61 0.94 3.83***
Within Groups 6 210.96 0.24
Intrinsic Job Satisfaction
Between Groups 863 5.15 0.86 2.56**
Within Groups 6 289.46 0.34
Extrinsic Job Satisfaction
Between Groups 863 70.96 11.83 14.55***
Within Groups 6 701.41 0.81
Global Job Satisfaction
Between Groups 863 10.32 1.72 5.67***
Within Groups 6 261.73 0.30
Affective Organizational Com-
mitment
Between Groups 863 30.35 5.06 4.78***
Within Groups 6 912.36 1.06
Normative Organizational Com-
mitment
Between Groups 863 121.06 20.18 11.41***
Within Groups 6 1525.87 1.77
Continuance Organizational
115
Commitment
Between Groups 863 82.30 13.72 11.45***
Within Groups 6 1033.47 1.20
Global Organizational Commit-
ment
Between Groups 863 57.77 9.63 13.42***
Within Groups 6 619.20 0.72
Voice Behaviours
Between Groups 863 6.14 1.02 1.30
Within Groups 6 680.88 0.79
Helping Behaviours
Between Groups 863 10.26 1.71 1.78
Within Groups 6 829.44 0.96
Global Helping and Voice Behav-
iours
Between Groups 863 6.89 1.15 1.50
Within Groups 6 660.42 0.77
PROSES
Between Groups 863 1.57 0.26 0.92
Within Groups 6 244.68 0.28
*p<0.05 ; ** p<0.01; *** p≤0.001
Post-hoc tests showed that 14 out of the 19 latent constructs yielded significant F’s. In
table 7.17, we are able to observe the comparison of averages indicated as significant by
the Bonferroni post hoc comparison test. Groups being compared are organized with
highest value to the left of lowest value.
116
Table 7.17. Bonferroni post hoc comparisons results.
Latent construct Job M Job M
SHRIMQ – Information Helpers 3.52 Allied Healthcare Profes-
sionals 3.20
SHRIMQ – Performance
Appraisal
Helpers 3.44 Allied Healthcare Profes-
sionals 3.14
Helpers 3.44 Technical Assitants 3.07
SHRIMQ – Service Coop-
eration Medical Doctors 3.57 Helpers 3.35
SHRIMQ – Recruitment
and Selection Non significant F
SHRIMQ – Teamwork Non significant F
SHRIMQ – Pay
Helpers 2.42 Nurses 2.02
Medical Doctors 2.74 Nurses 2.02
Technical Assitants 2.51 Nurses 2.02
Medical Doctors 2.74 Allied Healthcare Profes-
sionals 2.13
Technical Assitants 2.51 Allied Healthcare Profes-
sionals 2.13
SHRIMQ – Training
Nurses 3.66 Technical Assitants 3.21
Nurses 3.66 Superior Technicians 3.21
Helpers 3.78 Nurses 3.66
Helpers 3.78 Allied Healthcare Profes-
sionals 3.02
Helpers 3.78 Technical Assitants 3.21
Helpers 3.78 Superior Technicians 3.21
Helpers 3.78 Medical Doctors 3.52
Global SHRIMQ
Helpers 3.38 Allied Healthcare Profes-
sionals 3.13
Medical Doctors 3.42 Allied Healthcare Profes-
sionals 3.13
Intrinsic Job Satisfaction Medical Doctors 4.10 Technical Assistants 3.79
Extrinsic Job Satisfaction
Helpers 2.48 Nurses 2.03
Technical Assistants 2.47 Nurses 2.03
Helpers 2.48 Allied Healthcare Profes-
sionals 2.12
Medical Doctors 3.09 Nurses 2.03
Medical Doctors 3.09 Helpers 2.48
Medical Doctors 3.09 Allied Healthcare Profes-
sionals 2.12
Medical Doctors 3.09 Technical Assitants 2.47
117
Medical Doctors 3.09 Superior Technicians 2.40
Global Job Satisfaction
Medical Doctors 3.87 Nurses 3.48
Medical Doctors 3.87 Allied Healthcare Profes-
sionals 3.45
Medical Doctors 3.87 Technical Assitants 3.50
Affective Organizational
Commitment
Helpers 5.57 Nurses 5.19
Helpers 5.57 Allied Healthcare Profes-
sionals 5.19
Normative Organizational
Commitment
Helpers 4.48 Nurses 3.60
Allied Healthcare Pro-
fessionals 3.78 Nurses 3.60
Continuance Organization-
al Commitment
Helpers 5.01 Nurses 4.42
Helpers 5.01 Medical Doctors 4.00
Helpers 5.01 Superior Technicians 4.13
Allied Healthcare Pro-
fessionals 4.65 Medical Doctors 4.00
Technical Assitants 4.61 Medical Doctors 4.00
Global Organizational
Commitment
Helpers 5.06 Nurses 4.47
Helpers 5.06 Allied Healthcare Profes-
sionals 4.56
Helpers 5.06 Medical Doctors 4.45
Helpers 5.06 Technical Assitants 4.71
Helpers 5.06 Superior Technicians 4.49
Voice Behaviours Non significant F
Helping Behaviours Non significant F
Global Helping and Voice
Behaviours Non significant F
PROSES Non significant F
7.4 Hypotheses Testing
We tested our hypotheses using structural equations modelling (SEM) since all our hy-
potheses included complex latent variables and SEM has been proven to report some
advantages when compared to traditional methods that include calculating the total
scores of global scales and their dimensions and disregard measurement errors for the
larger part.
In this study we used moderation and mediation models using bootstrapping19, regres-
19 Bootstrapping is a method for deriving robust estimates of standard errors and confidence
intervals for estimates such as the mean, median, proportion, odds ratio, correlation coefficient
or regression coefficient. It may also be used for constructing hypothesis tests. Bootstrapping is
most useful as an alternative to parametric estimates when the assumptions of those methods are
118
sion models and path analysis to test hypotheses.
Statistical assumptions underlying SEM
As with all statistical methodologies, structural equation modelling requires that certain
underlying assumptions be satisfied to ensure accurate inferences. These assumptions
pertain to the intersection of the data and the estimation method. The major assumptions
associated with structural equation modelling are multivariate normality, completely
random missing data, sufficiently large sample size, and correct model specification
(Kaplan, 2009).
Missing data
Often in social sciences there is a problem with missing data/missing values (Hair et al.,
2009; Tabachnik & Fidel, 2007). The topic of how to analyse data sets with missing
observations is complicated (Kline, 2011). Ideally researchers would work with data
sets that encompassed no missing data, but in the real worlds this is often impossible.
Kline (2011) refers that if data loss pattern is ignorable (that is to say, data is missing at
random and not following any specific systematic pattern), data may be replaced using
single our multiple imputation methods.
In our study we began by analysing the missing values and realizing if there were cases
and subjects that had more than 20% of data missing, which is one of the methods pro-
posed by Tabachnik and Fidel (2007) to determine if data is missing at random or not.
We found 23 subjects that failed to reply to more than 20% of the questionnaire and
chose to eliminate them from our sample. The remaining cases and subjects had missing
data with no visible pattern, which led us to replace data using the “series mean” option
of SPSS.
Thus missing data was dealt with using SPSS’s “replace with mean” method and the
data set was complete for the SEM analysis.
Multivariate normal distribution of data
When the estimation methods are maximum likelihood or generalized least squares, the
observed variables must follow a multivariate normal distribution. When the normality
in doubt (as in the case of regression models with heteroscedastic residuals fit to small samples),
or where parametric inference is impossible or requires very complicated formulas for the calcu-
lation of standard errors (as in the case of computing confidence intervals for the median, quar-
tiles, and other percentiles).
119
assumption is met, ML and GLS have properties of consistency (the parameters esti-
mate tends to the real value when sample size increases) and asymptotic null bias (pa-
rameter estimates are unbiased to larger samples, i.e., they do not over or underestimate
populational parameters) (Maroco, 2010).
Normality can be tested using normality tests such as the Shapiro-Wilk (for small sam-
ple sizes) or the Kolmogorov-Smirnov (for large sample sizes), but since these are espe-
cially sensitive to small variations in the sample they have a high probability of incur-
ring in Type I error (concluding that the variable is not normal, when in fact it is). Al-
ternatively, sample kurtoses and skewness are often used as indicators of a normal dis-
tribution (Maroco, 2010).
When kurtoses and skewness of the observed variables yield values equal or close to
zero, one can conclude that the assumption of multivariate normality is plausible
(Maroco, 2010).
Regardless, Kline (2011) points out the fact that for values of skewness under 3 and
kurtoses under 10 the violation of the multivariate normal distribution of data assump-
tion is not severe and that the methods above mentioned may still be used without con-
cern.
As one may observe in the following table (table 7.18), this is the case for all latent var-
iables in our study, which leads us to conclude that this assumption is met.
120
Table 7.18. Normality tests using skewness and kurtoses of the latent constructs of this study
Skewness Kurtosis
Statistic Std. Error Statistic
Std.
Error
SHRIMQ – Information -0.54 0.08 0.59 0.16
SHRIMQ – Performance Appraisal -0.54 0.08 0.65 0.16
SHRIMQ – Service Cooperation -0.37 0.08 0.32 0.16
SHRIMQ – Recruitment and Selection -0.40 0.08 0.81 0.16
SHRIMQ – Teamwork -0.86 0.08 1.18 0.16
SHRIMQ – Pay 0.28 0.08 -0.50 0.16
SHRIMQ – Training -0.67 0.08 0.39 0.16
Global SHRIMQ -0.36 0.08 0.37 0.16
Intrinsic Job Satisfaction -0.74 0.08 1.23 0.16
Extrinsic Job Satisfaction 0.27 0.08 -0.79 0.16
Global Job Satisfaction -0.52 0.08 -0.01 0.16
Affective Organizational Commitment -0.06 0.08 -0.42 0.16
Normative Organizational Commitment -0.39 0.08 0.11 0.16
Continuance Organizational Commitment -0.59 0.08 0.35 0.16
Global Organizational Commitment -0.90 0.08 1.73 0.16
Voice Behaviours -1.59 0.08 5.96 0.16
Helping Behaviours -0.47 0.08 0.65 0.16
Global Helping and Voice Behaviours -0.65 0.08 -0.72 0.16
PROSES 0.42 0.08 0.99 0.16
Sufficiently large sample size
“It is generally true that SEM is a large-sample technique” (Kline, 2011, p. 11). The
minimum sample size for any given study is not easily calculated, since there are many
estimation methods. Methods vary from the “N:q” rule (especially useful when using
the maximum likelihood method), where “N” is the number of cases and “q” is the
121
number of parameters that require statistical estimates; Jackson (as cited in Kline, 2011)
suggests that an ideal ratio would be 20:1. Recommended sample size may also concern
more absolute terms. Ding, Velicer, and Harlow (as cited in Schumaker & Lomax,
2010) recommend a minimum of 100 to 150 subjects as the minimum satisfactory sam-
ple size when conducting structural equations models. Kline (2011) refers that 200 is a
very common N in studies using SEM, however, Hu, Bentler, and Kano (1992) indicat-
ed that this calculation should consider the number of variables and indicate a value of
10 to 20 subjects per observed variable/questionnaire item, but the absolute acceptable
minimum would be 5 subjects per item/observed variable (Bentler & Chu as cited in
Schumaker & Lomax, 2010).
Our sample is composed of 942 subjects which largely surpasses the absolute methods’
prescriptions, and taken together there are a total of 83 items in our instruments, which
means that the ratio of subjects/observed variables or items in this study is roughly
11,35 subjects per item, which also is within the range of the sample size indications.
Correct model specification
Model specification refers to the formal design of the theoretical model that tests the
research questions and reflects a priori the assumptions of the theoretical framework
being studied. In SEM, it is assumed that relationships are always designed from “cause
to effect” and that the variance of exogenous variables that is unexplained by endoge-
nous variables is due to disturbances (errors associated to latent variables). These indi-
cations were considered when designing our model.
Synthesis
We have dealt with all of the above-mentioned assumptions to SEM and concluded that
the data were fit for this statistical technique. Further we had already established the
quality of the measurement models when we conducted the validation of the instru-
ments using confirmatory factor analysis. Thus we could proceed with the analysis to
test our hypotheses.
122
Synthesis of Hypothesis
Table 7.19 – Syntheses of hypotheses
Hypotheses
Number
H1. SHRIM predicts PROSE
H2.a1 SHRIM predicts Job Satisfaction
H2.a2 Job Satisfaction predicts PROSE
H2.a3 The different facets of Job Satisfaction mediate the relationship be-
tween SHRIM and PROSE.
H2.b1 SHRIM predicts Organizational Commitment
H2.b2 Organizational Commitment predicts PROSE
H2.b3 The relationship between SHRIM and PROSE is mediated by the dif-
ferent components of Organizational Commitment.
H2.c1 SHRIM predicts Organizational Citizenship Behaviours
H2.c2 Organizational Citizenship Behaviours predict PROSE
H2.c3 The relationship between SHRIM and PROSE is mediated by Organi-
zational Citizenship Behaviours.
H3. The relationship between SHRIM and the PROSE is mediated by the
overall Worker-Organization Relationship
H1. SHRIM predicts PROSE
Standardized path beta coefficients regarding PROSE revealed that satisfaction with
recruitment and selection->PROSE is the most significant path (BProse.RS=0.22,
SE=0.05, βPROSE. RS =0.22, p<0.001), followed by satisfaction with pay/compensation-
>PROSE (BPROSE.Pay=-0.23, SE=0.03, βPROSE.Pay=-0.15, p<0.001) and satisfaction with
teamwork ->PROSE (BPROSE.Teamwork=0.09, SE=0.04, βPROSE.Teamwork=0.07, p=0.05); the
remainder trajectories were non-significant.
Hence, we can conclude that Hypotheses 2 is partially confirmed, namely in the cases of
satisfaction with recruitment and selection, satisfaction with pay and satisfaction with
teamwork.
123
Figure 7.10 – Structural equations model for the different dimensions of the SHRIMQ and Performance Re-
lated Observations of Self-Efficacy (χ2/df=4.20; CFI=0.92; GFI=0.95; PGFI=0.78; RMSEA=0.06; p>0.01; CI
90% ]0.05; 0.0.06]
H2.a1 SHRIM predicts Job Satisfaction
Standardized path beta coefficients regarding intrinsic job satisfaction and dimensions
of the SHRIMQ revealed the existence of significance in the paths of intrinsic job satis-
faction and training, teamwork, recruitment and selection and information, as is observ-
able in table 7.23. Extrinsic job satisfaction seems to be affected by the levels of satis-
faction with pay and R&S practices, as is clear in table 7.23.
124
Table 7.23. Regression estimates of the SEM model for the standardized path beta coefficients
regarding the relationship of the SHRIMQ dimensions and Job Satisfaction.
Path B SE β p
Intrinsic Job Satisfac-
tion <--- Satisfaction with Training 0.12 0.02 0.06* 0.01
Intrinsic Job Satisfac-
tion <--- Satisfaction with Pay 0.05 0.02 0.02 0.18
Intrinsic Job Satisfac-
tion <---
Satisfaction with
Teamwork 0.21 0.03 0.13*** 0.00
Intrinsic Job Satisfac-
tion <---
Satisfaction with Re-
cruitment and Selection 0.21 0.04 0.17*** 0.00
Intrinsic Job Satisfac-
tion <---
Satisfaction with Satis-
faction with Interde-
partmental Cooperation
0.08 0.04 0.06 0.09
Intrinsic Job Satisfac-
tion <---
Satisfaction with Per-
formance Appraisal 0.02 0.02 0.01 0.61
Intrinsic Job Satisfac-
tion <---
Satisfaction with Infor-
mation 0.24 0.04 0.18*** 0.00
Extrinsic Job Satisfac-
tion <---
Satisfaction with Infor-
mation -0.02 0.06 -0.03 0.67
Extrinsic Job Satisfac-
tion <---
Satisfaction with Per-
formance Appraisal 0.03 0.04 0.03 0.37
Extrinsic Job Satisfac-
tion <---
Satisfaction with Satis-
faction with Interde-
partmental Cooperation
0.00 0.06 0.00 0.96
Extrinsic Job Satisfac-
tion <---
Satisfaction with Re-
cruitment and Selection 0.11 ,06 0.16*** 0.00
Extrinsic Job Satisfac-
tion <---
Satisfaction with
Teamwork -0.01 0.04 -0.01 0.83
Extrinsic Job Satisfac-
tion <--- Satisfaction with Pay 0.80 0.04 0.79*** 0.00
Extrinsic Job Satisfac-
tion <---
Satisfaction with Train-
ing 0.01 0.04 0.01 0.74
*p<0.05 ; ** p<0.01; *** p≤0.001
125
Figure 7.11 – Structural equations model for the different dimensions of the SHRIMQ and Job Satisfaction
subscales (χ2/df=4.20; CFI=0.92; GFI=0.95; PGFI=0.78; RMSEA=0.06; p>0.01; CI 90% ]0.05; 0.0.06]
H2.a2 Job Satisfaction predicts PROSE
Standardized path beta coefficients regarding the effects of job satisfaction on PROSE
indicated very significant paths of both the extrinsic and intrinsic dimensions of job
satisfaction with this endogenous variable, as is observable in table 7.24.
Table 7.24. Regression estimates of the SEM model for the standardized path beta coefficients
regarding the relationship of Job Satisfaction and PROSE.
Path B SE β p
PROSE <--- Intrinsic Job Satisfaction 0.43 0.0
6 7.84***
0.0
0
PROSE <--- Extrinsic Job Satisfaction -0.10 0.0
2 -4.51***
0.0
0
*p<0.05 ; ** p<0.01; *** p≤0.001
126
Figure 7.12 – Structural equations model for the different dimensions of job satisfaction and performance
related observations of self-efficacy (χ2/df=5.02; CFI=0.96; GFI=0.96; PGFI=0.62; RMSEA=0.07; p>0.01; CI
90% ]0.06; 0.07]
H2.a3 The relationship between SHRIM and PROSE is mediated by the different facets
of Job Satisfaction.
The indirect (mediated) effect of SHRIM on PROSE is ,087. That is, due to the indirect
(mediated) effect of SHRIM on PROSE, when SHRIM goes up by 1, PROSE goes up
by 0,087. This is in addition to any direct (unmediated) effect that SHRIM may have on
PROSE.
127
Figure 7.13. Mediation model of SHRIM on PROSE, mediated by job satisfaction. (χ2/df=4.55; CFI=0.90;
GFI=0.87; PGFI=0.76; RMSEA=0.06; p>0.01; CI 90% ]0.06; 0.06])
128
H2.b1 SHRIM predicts Organizational Commitment
Significance was found for the paths of some of the SHRIMQ dimensions in all the
components of organizational commitment.
Thus, concerning affective commitment, all dimensions of the SHRIMQ seem to act as
predictors of this endogenous variable, except for performance appraisal; normative
organizational commitment seems to be predicted by satisfaction with recruitment and
selection and compensation, whereas continuance commitment seems to be affected
only by satisfaction with teamwork.
Figure 7.14 – Structural equations model for the different dimensions of the SHRIMQ and the components of
Organizational Commitment (χ2/df=4.33; CFI=0.90; GFI=0.88; PGFI=0.72; RMSEA=0.06; p>0.01; CI 90%
]0.06; 0.06]).
129
Table 7.25. Regression estimates of the SEM model for the standardized path beta coefficients
regarding the relationship of the SHRIMQ dimensions and the components of organizational
commitment (affective, normative and continuance commitment).
Path B SE Β p
COC <--- Satisfaction with Training 0.12 0.08 1.44 0.15
COC <--- Satisfaction with Pay -0.01 0.07 -0.10 0.92
COC <--- Satisfaction with Teamwork 0.19 0.09 2.06* 0.04
COC <--- Satisfaction with Recruitment
and Selection 0.13 0.13 0.98 0.33
COC <--- Satisfaction with Service Coop-
eration -0.02 0.14 -0.18 0.86
COC <--- Satisfaction with Performance
Appraisal 0.03 0.09 0.30 0.77
COC <--- Satisfaction with Information -0.05 0.14 -0.36 0.72
AOC <--- Satisfaction with Training 0.17 0.07 2.63** 0.01
AOC <--- Satisfaction with Pay 0.10 0.05 2.00* 0.05
AOC <--- Satisfaction with Recruitment
and Selection 0.47 0.10 4.77*** 0.00
AOC <--- Satisfaction with Service Coop-
eration 0.27 0.11 2.55** 0.01
AOC <--- Satisfaction with Performance
Appraisal 0.04 0.07 0.61 0.55
AOC <--- Satisfaction with Information 0.26 0.10 2.52** 0.01
NOC <--- Satisfaction with Training 0.06 0.06 1.12 0.27
NOC <--- Satisfaction with Pay 0.24 0.05 5.12*** 0.00
NOC <--- Satisfaction with Teamwork -0.01 0.06 -0,09 0.93
NOC <--- Satisfaction with Recruitment
and Selection 0.27 0.09 3.07** 0.00
NOC <--- Satisfaction with Service Coop-
eration 0.18 0.09 1.90 0.06
NOC <--- Satisfaction with Performance
Appraisal 0.05 0.06 0.89 0.37
NOC <--- Satisfaction with Information 0.10 .10 1.04 0.30
*p<0.05 ; ** p<0.01; *** p≤0.001
130
H2.b2 Organizational Commitment predicts PROSE.
Standardized path beta coefficients regarding the effects of organizational commitment
on PROSE indicated a very significant path for affective organizational commitment on
PROSE, but not the remaining components of organizational commitment, as is observ-
able in table 7.26.
Table 7.26. Regression estimates of the SEM model for the standardized path beta coefficients
regarding the relationship of Organizational Commitment and PROSE.
Path B SE β P
PROSE <--- NOC -0.08 0.04 -2.16 0.03
PROSE <--- AOC 0.18 0.03 5.47*** 0.00
PROSE <--- COC 0.00 0.02 -0.19 0.85
*p<0.05 ; ** p<0.01; *** p≤0.001
Figure 7.15 – Structural equations model for the different components of organizational commitment and
Performance Related Observations of Self-Efficacy (χ2/df=7.04; CFI=0.90; GFI=0.92; PGFI=0.64;
RMSEA=0.08; p>0.01; CI 90% ]0.07; 0.09])
131
H2.b3 The relationship between SHRIM and PROSE is mediated by the different com-
ponents of Organizational Commitment.
The indirect (mediated) effect of SHRIM on PROSE is 0.13. That is, due to the indirect
(mediated) effect of SHRIM on PROSE, when SHRIM goes up by 1, PROSE goes up
by 0.13. This is in addition to any direct (unmediated) effect that SHRIM may have on
PROSE.
Figure 7.16. Mediation model of SHRIMQ on PROSE, mediated by organizational commitment. (χ2/df=3.04;
CFI=0.91; GFI=0.88; PGFI=0.77; RMSEA=0.06; p>0.01; CI 90% ]0.05; 0.06]).
H2.c1 SHRIM predicts Organizational Citizenship Behaviours
Standardized path beta coefficients regarding helping behaviours and dimensions of the
SHRIMQ revealed the existence of significance in the paths of helping behaviours and
satisfaction with pay and information, as is observable in table 7.27. Voice behaviours
seem to be affected by the levels of satisfaction with pay and teamwork, as is clear in
table 7.27.
132
Table 7.27. Regression estimates of the SEM model for the standardized path beta coefficients
regarding the relationship of the SHRIMQ dimensions and Job Satisfaction.
Path B SE β p
Helping Behav-
iors <--- Satisfaction with Information -0.01 0.05 -0.14 0.89
Helping Behav-
iors <--- Satisfaction with Pay -0.19 0.04 -4.59*** 0.00
Helping Behav-
iors <--- Satisfaction with Teamwork 0.18 0.06 3.06*** 0.00
Helping Behav-
iors <---
Satisfaction with Recruitment
and Selecion 0.22 0.08 2.76** 0.01
Helping Behav-
iors <---
Satisfaction with Service Co-
operation 0.20 0.08 2.37* 0.02
Helping Behav-
iors <---
Satisfaction with Performance
Appraisal -0.06 0.05 -1.09 0.28
Helping Behav-
iors <--- Satisfaction with Information 0.29 0.09 3.30*** 0.00
Helping Behav-
iors <--- Satisfaction with Training -0.02 0.05 -0.30 0.76
Voice Behaviors <--- Satisfaction with Pay -0.16 0.04 -3.83*** 0.00
Voice Behaviors <--- Satisfaction with Teamwork 0.26 0.06 4.37*** 0.00
Voice Behaviors <--- Satisfaction with Recruitment
and Selection 0.26 0.08 3.27*** 0.00
Voice Behaviors <--- Satisfaction with Service Co-
operation 0.22 0.08 2.61** 0.01
Voice Behaviors <--- Satisfaction with Performance
Appraisal -0.11 0.05 -2.13* 0.03
Voice Behaviors <--- Satisfaction with Information 0.28 0.09 3.20*** 0.00
*p<0.05 ; ** p<0.01; *** p≤0.001
133
Figure 7.17. Structural equations model for the different dimensions of the SHRIMQ and the components of
Helping and Voice Behaviors (χ2/df=5.77; CFI=0.90; GFI=0.87; PGFI=0.71; RMSEA=0.07; p>0.01; CI 90%
]0.07; 0.07]
H2.c2 Organizational Citizenship Behaviours predict PROSE
Standardized path beta coefficients regarding the effects of helping and voice behav-
iours on PROSE indicated very significant paths of both dimensions with this endoge-
nous variable, as is observable in table 7.28, although voice behaviours present a higher
level of significance than does helping behaviours.
Table 7.28. Regression estimates of the SEM model for the standardized path beta coefficients
regarding the relationship of Job Satisfaction and PROSE.
Path B SE β p
PROSE <--- Helping Behaviors 0.10 0.05 2.11* 0.04
PROSE <--- Voice Behaviors 0.13 0.05 2.73** 0.01
*p<0.05 ; ** p<0.01; *** p≤0.001
134
Figure 7.18 – Structural equations model for the different components of helping and voice behaviors and
Performance Related Observations of Self-Efficacy (χ2/df=8.91; CFI=0.95; GFI=0.91; PGFI=0.62;
RMSEA=0.09; p>0.01; CI 90% ]0.08; 0.1]
H2.c3 The relationship between SHRIM and PROSE is mediated by Organizational
Citizenship Behaviours.
The indirect (mediated) effect of SHRIM on PROSE is 0.17. That is, due to the indirect
(mediated) effect of SHRIM on PROSE, when SHRIM goes up by 1, PROSE goes up
by 0.17. This is in addition to any direct (unmediated) effect that SHRIM may have on
PROSE.
135
Figure 7.19 – Mediation model of SHRIMQ on PROSE, mediated by organizational commitment. (χ2/df=5.14;
CFI=0.90; GFI=0.86; PGFI=0.75; RMSEA=0.07; p>0.01; CI 90% ]0.06; 0.07])
H3. The relationship between SHRIM and the PROSE is mediated by the overall
Worker-Organization Relationship
The indirect (mediated) effect of SHRIM on PROSE is 0.37. That is, due to the indirect
(mediated) effect of SHRIM on PROSE, when SHRIM goes up by 1, PROSE goes up
by 0.37. This is in addition to any direct (unmediated) effect that SHRIM may have on
PROSE.
136
Figure 7.20. Mediation model of SHRIMQ on PROSE, mediated by the Worker Organization Relationship
(job satisfaction, organizational commitment and helping and voice behaviours) (χ2/df=3.82; CFI=0.87;
GFI=0.81; PGFI=0.75; RMSEA=0.06; p>0.01; CI 90% ]0.05; 0.06]).
After testing all hypotheses and in view of the results in hypotheses H1a to H2.c3 we
wondered if instead of considering the entire worker organization model we had theoret-
ically construed, the actual mediator might be the more emotional element present in
this relationship conceptually composed of intrinsic satisfaction, affective organization-
al commitment and helping and voice behaviours, proceeding to test this hypotheses, as
is shown if figure 7.21.
The indirect (mediated) effect of SHRIM on PROSE is 0.20. That is, due to the indirect
(mediated) effect of SHRIM on PROSE, when SHRIM goes up by 1, PROSE goes up
by 0.20. This is in addition to any direct (unmediated) effect that SHRIM may have on
PROSE.
137
Figure 7.21. Mediation model of SHRIMQ on PROSE, mediated by the Emocional Worker Organization
Relationship (intrinsic job satisfaction, affective organizational commitment and helping and voice behav-
iours). (χ2/df=3.64; CFI=0.91; GFI=0.84; PGFI=0.85; RMSEA=0.05; p=0.004; CI 90% ]0.05; 0.06]).
According to the questions raised during the literature review we were also curious to
see if the model fit the subjects according to their professional groups. In this task we
were faced with a setback because not all the professional groups had enough subjects
to run the SEM model we had come up with.
In this context we divided the professions in clinical and non clinical to run the original
models.
138
Figure 7.22. Mediation model of SHRIMQ on PROSE, mediated by the Worker Organization Relationship
(job satisfaction, organizational commitment and helping and voice behaviours) in the clinical staff
(χ2/df=2.91; CFI=0.86; GFI=0.79; PGFI=0.73; RMSEA=0.03; p>0.01; CI 90% ]0.03; 0.03]).
The indirect (mediated) effect of SHRIM on PROSE on the clinical staff is 0.30. That
is, due to the indirect (mediated) effect of SHRIM on PROSE, when SHRIM goes up by
1, PROSE goes up by 0.30. This is in addition to any direct (unmediated) effect that
SHRIM may have on PROSE.
139
Figure 7.23. Mediation model of SHRIMQ on PROSE, mediated by the Worker Organization Relationship
(job satisfaction, organizational commitment and helping and voice behaviours) in the non-clinical staff
(χ2/df=2.91; CFI=0.86; GFI=0.79; PGFI=0.73; RMSEA=0.03; p>0.01; CI 90% ]0.03; 0.03]).
The indirect (mediated) effect of SHRIM on PROSE on the non-clinical staff is 0.45.
That is, due to the indirect (mediated) effect of SHRIM on PROSE, when SHRIM goes
up by 1, PROSE goes up by 0.45. This is in addition to any direct (unmediated) effect
that SHRIM may have on PROSE.
140
Figure 7.24. Mediation model of SHRIMQ on PROSE, mediated by the Emotional Worker Organization Rela-
tionship (intrinsic job satisfaction, affective organizational commitment and helping and voice behaviours). in
the clinical staff ( (χ2/df=2.82; CFI=0.90; GFI=0.83; PGFI=0.75; RMSEA=0.03; p>0.01; CI 90% ]0.03; 0.03]).
The indirect (mediated) effect of SHRIM on PROSE on the non-clinical staff is 0.18.
That is, due to the indirect (mediated) effect of SHRIM on PROSE, when SHRIM goes
up by 1, PROSE goes up by 0.18. This is in addition to any direct (unmediated) effect
that SHRIM may have on PROSE.
141
Figure 7.25. Mediation model of SHRIMQ on PROSE, mediated by the Emotional Worker Organization Rela-
tionship (intrinsic job satisfaction, affective organizational commitment and helping and voice behaviours). in
the non-clinical staff ( (χ2/df=2.82; CFI=0.90; GFI=0.83; PGFI=0.75; RMSEA=0.03; p>0.01; CI 90% ]0.03;
0.03]).
The indirect (mediated) effect of SHRIM on PROSE on the non-clinical staff is 0.22.
That is, due to the indirect (mediated) effect of SHRIM on PROSE, when SHRIM goes
up by 1, PROSE goes up by 0.22. This is in addition to any direct (unmediated) effect
that SHRIM may have on PROSE.
7.5. Conclusion
In this chapter we analysed some crucial aspects that led to the test of the previously
proposed theoretical relationships. We started by analysing the reliability and validity of
the scales used in this study. We proceeded by doing an exploratory analysis of data,
and then presented our data analysis, testing hypotheses and the proposed model.
Generally speaking it is adequate to say that the measurement model presents good
properties and the structural models confirmed either completely or partially our hy-
potheses, while maintaining good fit properties.
142
Table 7.29 Synthesis of results concerning hypotheses
Hypotheses
Number Status
H1. SHRIM predicts PROSE Partially Con-
firmed
H2.a1 SHRIM predicts Job Satisfaction Partially Con-
firmed
H2.a2 Job Satisfaction predicts PROSE Confirmed
H2.a3 The different facets of Job Satisfaction mediate the
relationship between SHRIM and PROSE. Confirmed
H2.b1 SHRIM predicts Organizational Commitment Partially Con-
firmed
H2.b2 Organizational Commitment predicts PROSE Partially Con-
firmed
H2.b3
The relationship between SHRIM and PROSE is
mediated by the different components of Organiza-
tional Commitment.
Confirmed
H2.c1 SHRIM predicts Organizational Citizenship Behav-
iours
Partially Con-
firmed
H2.c2 Organizational Citizenship Behaviours predict
PROSE Confirmed
H2.c3
The relationship between SHRIM and PROSE is
mediated by Organizational Citizenship Behav-
iours.
Confirmed
H3.
The relationship between SHRIM and the PROSE
is mediated by the overall Worker-Organization
Relationship
Confirmed
Additionally we tested:
H3.1
The relationship between SHRIM and the PROSE
is mediated by the Emotional Worker-Organization
Relationship
Confirmed
H3.2
There is a difference between clinical and non-
clinical staff in the way the relationship between
SHRIM and the PROSE is mediated by the overall
Worker-Organization Relationship
Confirmed
H3.3
There is a difference between clinical and non-
clinical staff in the way the relationship between
SHRIM and the PROSE is mediated by the Emo-
tional Worker-Organization Relationship
Confirmed
143
Chapter 8 - Discussion
“So how, children, does the brain, which lives without a spark of light, build for us a world full
of light?” – Anthony Doerr, “All the light we cannot see”
144
Chapter 8 – Discussion
In this section we present the discussion of the research results. We will begin by dis-
cussing each of the psychometric assessment of the instruments, then proceed to analyse
the different sets of hypotheses considering their partial or complete confirmation, since
none of our hypotheses were rejected.
8.1. Instruments and exploratory results
The results section begins by addressing the important issue of the validity and reliabil-
ity of the instruments used to collect data (Fields, 2002). Whenever possible we chose
to use previously validated scales that had a history of validity and reliability in the Por-
tuguese population, which meant we used the MSQ to measure job satisfaction, the
OCS to measure organizational commitment and HVBS to measure organizational citi-
zenship behaviours. When the constructs we were trying to assess were either very con-
text specific or new in the literature review, new instruments were created, based on
other existing measures. We created the SHRIMQ to assess satisfaction with human
resources’ issues management and adapted PROSES to assess performance related self-
efficacy.
Results show that the instruments adopted in this study are valid and reliable, which is
to say they are fit to use in our sample. The afore mentioned instruments required some
rearrangements (namely, items from the affective and normative commitment scales got
mixed up together, as is frequent in the literature [e.g. Bergman, 2006] and the same
happened to items from the helping and voice behaviour scales). Items were dropped
from all three instruments due to low communalities and/or simultaneous factor load-
ings (Hair et al., 2009; Maroco, 2010; Tabachnik & Fidel, 2007).
The scales we developed and adapted for this study proved also to be valid and reliable,
although some adjustments also were made, concerning items with low communalities
that needed to be dropped in order to ensure the appropriate psychometric values (Hair
et al., 2009; Maroco, 2010; Tabachnik & Fidel, 2007).
These findings constitute an added value to the literature since the existence of and reli-
able and validated instruments is often an issue when conducting research. The availa-
bility of such measures allows for the researchers to collect data with confidence that
the constructs they are trying to assess are actually the ones being measured, so that the
145
inferences and conclusions drawn upon these can be done with the appropriate rigour
(Fields, 2002).
Our sample is nearly 1000 subjects, encompassing all types of hospital workers, which
steps beyond the traditional preponderance of research on physicians, nurses and admin-
istrators (Bartunek, 2014) to include clinical and non clinical staff such as multiple
types of therapists, pharmacists, laboratory technicians, and so forth who also contribute
largely to the successful delivery of healthcare directly or indirectly speaking.
This hospital has a population of workers who is mostly young as can be observed in
figure 7.6, which is in consonance with seniority in the hospital having a mode of 3
years and an average of 12.38 years. Most workers have a tenured contract (effective
contract in the Portuguese framework terms), which might permit issues like job insecu-
rity to be eschewed. Most workers have an undergraduate degree and most workers are
female, as is usual in the literature on healthcare workers.
In the exploratory analysis of the constructs results in the population it became at once
clear that scales have results that range from minimum to maximum values, which
means that all the Likert points were used and that the scales are not biased.
Almost all scales report values above the mean point of the scale, save for pay or extrin-
sic satisfaction, which means that hospital workers are most dissatisfied about their
compensation packages.
Affective commitment (commitment based on emotional ties the employee develops
with the organization primarily via positive work experiences), harnesses the highest
levels in the population as one would expect from the type of commitment that has been
most studied in the OC family in the healthcare context (Kehoe & Wright, 2013).
Takeuchi & Takeuchi (2013) discussed if the commitment in healthcare workers would
concern more the organization or the job and concluded that for Japanese healthcare
workers the improvement of job quality is a consequence of the affective commitment
with the organization itself. High levels of affective commitment therefore are in line
with the culture of excellence and the good reputation that the surveyed hospital enjoys.
Continuance commitment (commitment based on the perceived costs, both economic
and social, of leaving the organization) was the second highest in this set and finally the
normative commitment (perceived obligation towards the organization, rooted in the
146
norms of reciprocity). The fact that continuance commitment is the second in rank is not
great news as it can be a clear reflection of the tough economic times experienced in
2012 and the shortage of jobs, namely in the healthcare sector - employees who are high
in continuance commitment are committed to stay with a given employer, regardless of
their emotional detachment, because they have significant organization-specific invest-
ments, too few options for alternative employment, or both (Boichuk & Menguc, 2013).
High levels of continuance commitment have been associated with discouragement to
improve job quality in Japanese healthcare workers (Takeuchi & Takeuchi, 2013).
Both helping and voice behaviours and performance related observations of self-
efficacy have high mean values, which is in itself an indicator, although it can be
somewhat inflated by the social desirability bias, the tendency of survey respondents to
answer questions in a manner that will be viewed favourably by others (Fisher, 1993).
Regardless, this population views itself as performing organizational citizenship behav-
iours and having a good self-efficacy. OCB’s seem to be more important in service or-
ganizations than non-service (Wang, 2009) and have been perceived as related to a myr-
iad of positive outcomes (cf. p. 58 of this work).
Performance related self-efficacy, as was established in the literature review, is a signif-
icant antecedent of both job performance (Stajkovic & Luthans, 1998) as well as the
general attitude of resourcefulness and resilience in workers (Allen-Brown, 1998; Saks,
1995), which in the health care context is especially important given the amount of
stress induced pathologies in healthcare workers (Bakker et al., 2001) and occupational
stress consequences for patients mentioned in the literature (e.g., Blatnik & Lesnicar,
2006; West et al., 2006).
Women in our sample present values that are significantly higher than men’s concerning
satisfaction with performance appraisal, service cooperation, recruitment and selection,
training and global satisfaction with human resources’ issues management.
Smith (2002) reflects that women intensive environments are more prone to having
women in job authority positions, especially in the public sector, as is the case. Smith
(2002) adds that at a meso-level majority-group gatekeepers are positioned at the entry
ports and promotional ladders of jobs/organizations or establishments are typically
charged with the responsibility of making the types of decisions that often lead to the
perpetuation of their group in power, even if this might not be done on purpose or con-
147
scientiously. This type of discrimination happens because the people who fit with the
majority and with job authority tend to share values and attitudes more easily and natu-
rally than others from the exogroup (Smith, 2002). These findings are in accordance
with the areas of HRIM with which women are more satisfied than men (e.g., perfor-
mance appraisal, recruitment and selection, etc.).
Men and women had similar levels of satisfaction with information and teamwork;
these two areas where colleagues tend to play a bigger role than a more distal figure of
“the organization” and more traditional “HRM”. There were also no significant differ-
ences concerning the expression of (dis)satisfaction regarding pay, probably because
dissatisfaction had a higher power than any gender bias in this case. This finding is con-
sistent with Settles, Cortina, and Miner’s (2012) work, who mention that equal dissatis-
faction concerning pay may be a reflection of equal financial responsibilities of both
men and women regarding their dependents and their needs and who add that perhaps
other worker characteristics different from gender (and in their case also marital status)
might be influencing job dissatisfaction (e.g., job inputs, task characteristics).
Also, women reported higher levels of intrinsic job satisfactions and global job satisfac-
tion. These findings are in accordance with the literature on gender differences in job
satisfaction, according to Clark (1997) who proposes that the notion of relative well-
being is especially relative to workers' expectations. An identical man and woman with
the same jobs and expectations would report identical job satisfaction, but the authors
sustains that women's expectations are lower than men's which leads to a higher level of
satisfaction. Kidder (2002) refers also that this tendency may be due to the fact that
women focus on different aspects of work in arriving at a given level of job satisfaction.
Women also report higher normative, continuance and global organizational commit-
ment values, but bare no differences with their male counterparts concerning affective
organizational commitment. Gender differences in organizational commitment are
strongly associated with differences in the psychological contract (Scandura & Lankau,
1997) and to how the organization meets one’s needs. Thus, women seem to develop a
greater sense of loyalty and moral indebtedness with the organization in question than
their male counterparts (NOC), while perceiving lesser alternatives to their current job
(COC). Affective commitment, which reflects how much employees “like” the organi-
zation bears no difference between male and female workers.
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Helping and voice behaviours showed no significant gender differences, indicating a
similar reporting of OCB’s. This is an interesting result in the sense that these results
come from self-reporting measures. Research indicates that women are perceived by
others as performing more helping type of OCB’s, whereas men are perceived as more
active voice actors, and that these OCB’s tend to be more engaged by their correspond-
ing gender association (Kidder, 2002). Kidder (2002), however, proposes that it is not
only gender that matters, and proposes that gender orientation and gender-type occupa-
tion (the dominant [in terms of numerical superiority] Is key. Gender in any occupation
tends to be associated with the type of behaviours that are expected from those profes-
sions; the nursing profession, for instance it is clearly a stereotypically “female” occu-
pation, and the same can be said for the vast majority of health care related jobs). Thus,
although it is possible that gendered identities may be involved also in terms of self-
reported performance of OCB’s, the gender-type occupation may be playing a more
predominant role than the individual gender identity, which is in line with Kidder’s
(2002) findings.
In a meta-analysis on gender differences and similarities, Hyde (2005) made another
argument for the lack of gender differences in findings: the fact that we may be attrib-
uting too much importance to gender differences where other factors may be of more
importance, stating that males and females are similar in most but not all psychological
variables. The author also proposed that claims of gender differences in the workplace
may cause harm in numerous realms, including women’s opportunities, especially since,
these claims are not consistent with the vast majority of scientific data (Hyde, 2005),
which may constitute fodder or thought in this matter.
In our sample, PROSE was also indifferent to gender differences, indicating that one’s
perception of one’s self-efficacy might be immune to gender differences as well.
Age correlates positively with satisfaction with pay and extrinsic job satisfaction. This
can be due to the fact that older workers tend to be better paid and compensated in gen-
eral than their younger and less experienced counterparts.
Older workers are less satisfied with training offered by the organization, which might
indicate that the organization attends to training needs of newcomers in a more effective
fashion than their older workers.
149
Age is also positively associated with all forms of commitment except continuance
commitment. It would be expectable that in general the longer a person stays with an
organization the more they are likely to feel attached to it (Meyer & Allen, 1997). How-
ever it is a bit surprising that COC did not correlate significantly with age since the ten-
dency is that the older workers get, the less alternatives they tend perceive to their cur-
rent jobs (COC). In this case we believe these results might be due to a comprehension
that there is mobility and a high demand for professionals in this area, and that experi-
ence is an advantage in this specific sector.
Helping and voice behaviours are positively correlated with respondents’ age. This
might be due to the fact that respondents that are older and more confident of their role
in the organization are more fearless to speak out (voice behaviours) and more confident
to help others (helping behaviours)
PROSE is not correlated with age at all, which can mean that this is a measure that is
immune to age and life experience, and might point to its intrinsic value as an assess-
ment of the respondents’ self-efficacy concerning their own observations of perfor-
mance.
Some differences emerged from the group comparisons we conducted and although they
may seem plentiful, only 48 group differences out of the 126 possible combinations
occurred. These differences reveal some patterns that have to do with the highest and
lowest ranking jobs in terms of status in the hospital and that also reflect the highest and
lowest amount of training, pay, etc.
Helpers seem to be the most satisfied with HRIM in general: they are happier with in-
formation and performance appraisal than allied healthcare professionals and in the last
case also than technical assistants.
Helpers are more satisfied with training than all their counterparts, which can be due to
the fact that this job category has less training and academic background in general, and
therefore may feel any training as better than their more educated peers.
Medical doctors are more extrinsically satisfied with their job than all other workers,
which is consistent with the fact that generally speaking they are the best-paid position
in the Hospital.
150
Helpers in general show higher levels of organizational commitment than their col-
leagues, which might be due both to the nature of the job that entails the highest level of
contact with patients, which might influence AOC, since it permits a higher tangibility
of results and the importance of their work and the organizations work, but also due to
the low level of training and high unemployment rates at the time: workers may feel that
they have less alternatives (higher COC) and that they feel have a bigger loyalty debt to
the organization for giving them an opportunity to work (NOC).
Helpers also report conducting higher levels of Helping and Voice Behaviours than all
other workers. These might be subject to some desirability bias, where helpers may feel
that they are expected to do more helping and voice behaviours than others, or it might
be due to the nature of the work, where more comradry might be developed, hence more
helping behaviours and more voice behaviours.
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8.3. Hypotheses concerning the SHRIM – PROSE direct relationship
Figure 5.1 – Graphic representation of hypotheses 1 of this study
Hypothesis 2 of this study was partially confirmed. Strong HR practices have consist-
ently been associated with important attitudinal and behavioural employee outcomes.
Specifically, substantial evidence based on previous empirical work in the SHRM realm
supports the relationship between high-performance HR practices and organizational
performance, and a smaller amount of evidence based on more recent studies has begun
to point to a link between high-performance HR practices and employee outcomes;
however, both these streams of work have largely depended on the use of managerial
reports of HR practice use (Kehoe & Wright, 2013).
As discussed earlier, a variety of reasons explain why managers’ reported HR practice
use may not relate in expected ways to desired employee outcomes (Bowen & Ostroff,
2004; Nishii & Wright, 2008) and as seen before, PROSE is the most adequate and ac-
curate performance related indicator we could find.
As such, an examination of the role of employees’ perceptions of HR practice, specifi-
cally SHRIM, use in determining positive outcomes represented an important need in
the literature (Kehoe & Wright, 2013) and, thus, a key contribution of the present study
In our study we verified that 3 out of the 7 dimensions of SHRIMQ predicted PROSE.
Satisfaction with information, performance appraisal, service cooperation and training
do not seem to predict PROSE; unlike satisfaction with recruitment and selection, satis-
faction with pay and satisfaction with teamwork, which is to say satisfaction with the
way people begin the psychological contract, satisfaction with financial and tangible
compensation and satisfaction with how people get along in their work environment
dictate how much PROSE an employee will have.
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8.4.a. Hypotheses concerning Job Satisfaction
Figure 5.2 – Graphic representation of hypotheses 2a1, 2a2 and 2a3 of this study
Hypothesis 2.a1 was partially confirmed. The connection between SHRIM and JS is an
intuitive one. However, this study demonstrated that not all aspects of SHRIM predict
JS which on the one side is a sign of construct differentiation and on the other is an in-
dicator of specific areas managers can act upon as to promote JS.
Thus, extrinsic job satisfaction seems to be predicted by the levels of satisfaction with
pay and RS practices.
The strong connection between extrinsic satisfaction and satisfaction with pay is not
only expected as the lack of such a connection would be illogical and could point to
failures in the construction of the scales. Since extrinsic job satisfaction refers to exter-
nal compensations that derive from the workers job and pay is in itself an external com-
pensation for people’s job, this connection is self-explanatory. The connection with ex-
trinsic JS and Satisfaction with RS, however requires a less “on the nose” framework.
Satisfaction with RS may dictate how happy subjects are with the way their psychologi-
cal contract was established, and how their expectations regarding the employment rela-
tionship were established and set. Hence, satisfaction with the way psychological con-
tract was established may dictate how extrinsically happy workers are, since it can also
153
be related with how happy they are with the way the organization is meeting those same
expectations.
Intrinsic job satisfaction is predicted by satisfaction with training, teamwork, recruit-
ment and selection and information in this sample.
Intrinsic job satisfaction might be in consonance with SHRIM since it may lead to a
perception that workers have better conditions to do the job they are performing, allow-
ing them to have the desired impact in the community and the “pleasure of a job well
done” and increasing intrinsic motivation (Bonenberger, Aikins, Akweongo, 2014;
Deci, Koestner, & Ryan, 1999). Also, job satisfaction has been consistently associated
with general life satisfaction (Tennison, 1996) which might means that workers might
that have a general inclination for satisfaction in life might also indicate higher satisfac-
tion with job and SRHIM. Lu, Barriball, Zhanga, and While (2012), in a systematic re-
view of the literature point to the fact that in the nursing population the working condi-
tions are a major antecedent of job satisfaction.
Satisfaction with training might be a predictor of intrinsic JS in the sense that workers
are happiest with the training they consider most useful to them (Schmidt, 2007)) and
that might lead to their better competencies in doing their job, thus augmenting intrinsic
job satisfaction. Using the same rational, satisfaction with teamwork and information
sharing can be associated with the feeling that workers will be better able to do their job
more efficiently and more impactfuly when they have those aids, thus augmenting their
feeling of intrinsic job satisfaction.
Satisfaction with RS as the starting point of the psychological contract might also influ-
ence intrinsic job satisfaction, as it also conveys the organization’s policies and values
concerning the type of people and sought-after characteristics of their staff (Cole et al,
2007). The more employees are happy with this type of practices, the more they will
express intrinsic satisfaction.
Previous research had already associated job satisfaction with non monetary elements of
the employment relationship: Janus and colleagues (2007) suggest that non-monetary
factors are important determinants of physician job satisfaction, perhaps more important
than monetary incentives that may augment or reduce physicians’ base incomes. Factor
analysis revealed seven principal factors of which decision-making and recognition,
154
continuous education and job security, administrative tasks and collegial relationships
were highly significant, specialized technology and patient contact were significant and
research and teaching and international exchange were not significant in contributing to
physician job satisfaction. Kalisch, Lee, and Rochman (2010) demonstrate that within
nursing teams on acute care patient units, a higher level of teamwork and perceptions of
adequate staffing leads to greater job satisfaction with current position and occupation.
Hypothesis 2.a2 was confirmed. Both intrinsic and extrinsic job satisfaction are signifi-
cant in predicting PROSE, although intrinsic job satisfaction has a positive relationship
with PROSE, whereas extrinsic job satisfaction has a negative one.
Results regarding intrinsic satisfaction are pretty much what was expected and had been
substantiated in chapter 5, when the hypothesis was formulated. Previous research had
found satisfied workers to be more actively engaged in activities that are considered as
facilitative to organisational goals than their dissatisfied work colleagues (Arye et al,
2002), and this makes sense especially in the case of intrinsic job satisfaction which
Herzberg (1966) termed as focusing on achievement, recognition, responsibility, ad-
vancement, growth, and the work itself. Bandura’s (2006) social learning theory states
that experiences of mastery bring about a higher motivation to replicate behaviours.
Thus, if an employee is experiencing a higher sense of enjoyment deriving from their
work it will probably be associated with a higher level of self-efficacy and mastery.
Still according to Herzberg (1966) extrinsic or hygiene factors are supervision, working
conditions, co-workers, pay, policies and procedures, job security, status, and personal
life and concerning Lu et al. (2012) working conditions are among the most important
antecedents of JS in nurses.
In our case, extrinsic satisfaction contains 2 different items that concern being praised
for one’s job and the chances for advancement in one’s job. Our results indicate that
employees that aren’t getting as much praise and that have less of a chance to advance
in their careers in the organization tend to feel that they are doing a better job. This can
be a result of poor praising practices in the organization (the way a praise is conducted
can be good or not) and that when employees are less focused on their career advance-
ments they tend to pay more attention to the job itself (Pink, 2011).
155
Results can also be analysed using the self-determination theory framework (Deci &
Ryan, 1985). In this framework, people are seen as active organisms, with evolved
tendencies toward growing, mastering ambient challenges, and integrating new experi-
ences into a coherent sense of self. These natural developmental tendencies have a dia-
lectical relationship with the environment, which is to say that they require on-going
social nutriments and supports, namely responding to the human need for basic psycho-
logical needs for autonomy, competence, and relatedness (Ryan & Deci, 2000). Thus
motivation is self-determined but is influenced by the environment. In our study re-
spondents show that a high level of intrinsic satisfaction is related with better PROSE,
which is consistent with this theory, and results regarding the negative relationship be-
tween extrinsic satisfaction and PROSE can be interpreted in the sense that more self-
determined subjects (those depending less on external factors) tend to have a higher
performance related self-efficacy.
Hypothesis 2.a3 was confirmed. Employee attitudes, especially job satisfaction, are seen
as an important element in the ‘black box’ between HRM and performance. Vermeeren
and colleagues (2011) remind us that a more extensive use of HR practices leads to
more satisfied employees and this greater satisfaction ‘reflects’ on the clients, as satis-
fied employees will do more for them. Moreover, satisfied workers are less likely to call
in sick than less satisfied workers (Vermeeren et al., 2014).
Our results reflect these ideas that are also generally supported in the literature as was
mentioned in the literature review and the chapter on research questions, models and
hypotheses. As such this study meets the findings of a great number of studies that have
consistently found strong and positive relationships between job satisfaction and pro-
ductive organisational behaviours (Gyekye, 2005).
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8.4.b. Hypotheses concerning Organizational Commitment
Figure 5.3 – Graphic representation of hypotheses 2b1, 2b2 and 2b3 of this study
Hypothesis 2.b1 was partially confirmed. Our results show that affective commitment is
predicted by all dimensions of the SHRIMQ except for performance appraisal; norma-
tive organizational commitment seems to be predicted by satisfaction with staffing and
compensation, and continuance commitment seems to be affected only by satisfaction
with teamwork.
Organizational commitment, the bond between a worker and the organization, be it af-
fective, normative or continuance, is, according to social exchange theory the direct
result of individuals understanding a relationship as rewarding, in the sense that they
become bound to return benefits or favours to their partners in exchange (Blau, 1983).
Previous research had already concluded that individual HRM practices or bundles
thereof play a positive role in the development of OC (Appelbaum, Bailey, Berg, &
Kalleberg, 2000; Gould-Williams, 2003); our study confirms these findings through the
lens of HRIM perception.
Although not originally hypothesized it is not completely surprising to see that in the
healthcare sector, affective commitment is predicted by more dimensions of HRIM,
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since this variable is more frequently associated with other variables in this work setting
(Buchan, 2004; West et al., 2006).
Thus, affective commitment is predicted by all variables of SHRIM except performance
appraisal; this can be due to the fact that there is no consistent performance appraisal
practice for all the groups of workers in the Portuguese Hospital Setting (nurses are
evaluated via a report every three years, some doctors and allied healthcare technicians
aren’t appraised at all, and administrative staff is subject to SIADAP). It seems however
clear that the more people are satisfied with HRIM, the more they identify with organi-
zation and want to remain because of affective issues.
Normative organizational behaviour, the moral obligation to remain in the organization
and the feeling of loyalty is predicted by satisfaction with RS, which can be construed
as the origin of the social contract. The RS moment is the arguably first direct contact
with the organization for most workers and it is fair to say that expectations are created
essentially in this moment. Pay is also a predictor of the NOC, arguably because people
feel more grateful towards the organization the more they feel obliged by the organiza-
tion.
Continuance organization behaviour is only predicted by the satisfaction with team-
work, which can be a reflection of the feeling of importance and uniqueness of teams in
healthcare. All other elements of SHRIM are more or less replicable in different hospi-
tals, however teams are often felt as the more variable influential element in Hospitals.
Previous research had also found in a field experiment (Probst, 2003) that organisational
restructuring affected employees’ perceptions of job security and had consequences on
organisational commitment, turnover and psychological well being.
Hypothesis 2.b2 was partially confirmed. Only affective commitment seems to predict
PROSE. This might be explained by the fact that affective commitment has to do with a
personal identification with the organization and its values. The higher a person is affec-
tively committed to the organization they work for the more likely they are to feel that
they are doing because not only are they willing to go beyond what their job is strictu
sensu, but also the more effortless this attitude is.
158
Previous research had also referred that low organizational commitment (and low job
satisfaction) led workers to carry out withdrawal behaviours and are also more likely to
experience job insecurity and to react more negatively to it (Hartley, Jacobson,
Klandermans, & van Vuuren, 1991), which can contribute to the explanation of why
affective organizational commitment predicts PROSE.
Hypothesis 2.b3 was partially confirmed. This hypothesis is confirmed regarding affec-
tive organizational behaviour, but not the other types of commitment.
Kehoe and Wright (2013) had already developed some work that indicated the im-
portance of affective organizational commitment as a mediator having demonstrated
significant relationships between employees’ HR practice perceptions and affective
commitment, as well as important behavioural outcomes. These authors, not unlike us,
based their explanation for this on a sequence consistent with social exchange theory,
and suggested that employees’ perceptions of high-performance HR practice use likely
affect employees’ behaviours to at least some extent through their effect on an im-
portant attitudinal outcome—that is, affective commitment, which is significant:
“Whereas previous work in this area has acknowledged the importance of social ex-
change processes in the sequence by which HR practices affect employee behaviours, to
date, little if any work has theoretically and empirically addressed the role of attitudes in
creating the context necessary for desirable behaviours to consistently emerge from the
implementation of a high-performance HR system” (Kehoe & Wright, 2013, p.368).
This hypothesis is not estrange to other recent research works, such as the one devel-
oped by Xerri (2013) where employees’ Satisfaction with HRM was assumed to influ-
ence organizational commitment and job involvement, which would eventually affect
employees’ turnover intentions and job quality, thus reflecting a mediated relationship
that relates to our own findings.
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8.4.c. Hypotheses concerning Organizational Citizenship Behaviours
Figure 5.4 – Graphic representation of hypotheses 2c1, 2c2 and 2c3 of this study
Hypothesis 2.c1 was partially confirmed. Satisfaction with pay is inversely related with
both helping and voice behaviours, suggesting that it is the workers that are least satis-
fied with pay that are more vocal concerning the status quo of the institution (voice be-
haviours) and that help others more in order to help the organization. Workers that are
less satisfied with pay may feel that they have less to lose and therefore be more prompt
to break the silence in the situations that they feel need to change. Also workers that feel
less satisfied with pay may convey their efforts to their colleagues and create alternative
sources of extrinsic satisfaction in the workplace, e.g., via more helping behaviours in
the workplace.
Further, extra-role organizational citizenship helping behaviours are also predicted by
satisfaction with information: workers that are happiest with the way information is
conveyed in their organization may feel more confident engaging in helping behaviours,
because they will not be afraid of “stepping on any toes” or being misinterpreted in their
deeds.
Extra-role organizational citizenship voice behaviours are also predicted by satisfaction
with teamwork, which may mean that workers that are more satisfied with their team
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and colleagues may also be more willing to engage in the voluntary communication
efforts directed at challenging the status quo of a work unit through the suggestion of
creative and promotive solutions (Van Dyne & LePine 1998). This is definitely another
form of engaging in reciprocity and expressing social exchange, with their colleagues
and indirectly with their organization.
These findings are in tune with others, such as Kehoe and Wright (2013) whose findings
reflect the importance of employees’ aggregated perceptions of HR practices as they are
employed throughout a job group above and beyond the individual-level mechanisms
through which HR practices may affect individuals’ outcomes, including organizational
citizenship behaviours.
Hypothesis 2.c2 was confirmed. Consistent with Organ (1990), individuals engage in
OCB as a form of reciprocity based on organizational treatment and also consistent with
Morrison (1994), individuals enlarge their job responsibilities by incorporating those
behaviours into their job. Engaging in helping and voice behaviours might also leave
workers feeling that they are doing something beyond themselves and increase their
self-esteem which can influence their performance and especially their self-efficacy.
Hypothesis 2.c3 was confirmed. Workers that are more satisfied with the HRIM also
have a higher PROSE, but this relationship is mediated by the OCB’s. That is to say that
workers OCB offers them a higher sense of accomplishment that also translates to high-
er PROSE.
Concerning voice behaviours, this finding is consistent in the sense that it has been re-
ported that Whistle-blowers are more likely to be highly educated, show good job per-
formance and hold higher-level positions (Miceli & Near, 1988). Potential costs associ-
ated with voice include the potential to initiate interpersonal conflict, the fear of nega-
tive feedback, and the risk of being perceived as a troublemaker (LePine & Van Dyne
1998).
Helping behaviours, more consistently associated with civic virtue OCB seem to play
also a role in mediating SHRIM and PROSE, which was equally expected.
161
According to research reports, perceptions of organisational climate tend to influence
interactions among workers, shape their affective responses to the work environment,
affect their levels of motivation and impact their skill training activities (Gyekye, 2005).
When workers are happiest with the way they are treated by the organization, they will
be most willing to go beyond their job obligations and to help others as well as feel con-
fident that they can voice their opinions and challenge the status quo. In the health care
sector, Organizational citizenship behaviour also plays an important part by allowing
workers the discretion to respond to the needs of patients, particularly needs which are
outside the conventional scope of an employee’s work (Organ, Podsakoff, & MacKen-
zie, 2006).
8.5. Hypotheses concerning the mediation of the WOR between the SHRIM-
PROSE relationship
Figure 5.5 – Graphic representation of hypothesis 3 of this study
Hypothesis 3 was confirmed. As noted above, employees’ attitudinal and behavioural
responses to an HR system depend on the HR practices that employees perceive to exist
162
in their work context (Bowen & Ostroff, 2004); our work shows that there is a mediator
effect of the worker-organization relationship between the afore mentioned components
The psychological contract literature suggests that employees may reciprocate employer
treatment through a cognitive dimension; that is, adjusting their obligations to their em-
ployer (Coyle-Shapiro & Kessler, 2002). Recent empirical evidence also suggests that
employees reciprocate perceived organizational support by enhancing their felt obliga-
tion to care about the organization’s welfare and to help the organization achieve its
objectives (Eisenberger et al., 2001).
It appears that perceptions of procedural and interactional justice are important to the
development of a relationship based on mutual commitment. Therefore, organizations
need to effectively manage their treatment of employees at the level of formal proce-
dures as well as how managers interact with employees at the interpersonal level. To the
extent organizations can manage their relationship with employees, they are more likely
to engage in OCB regardless of whether they categorise those behaviours as in-role or
extra-role (Coyle-Shapiro et al., 2011).
The abilities, motivation and opportunity (AMO) theory is regarded to be the heart of
strategic HRM in the sense that organizations seeking to improve performance should
develop HRM policies in the domains of resourcing, development, compensation and
incentives, involvement and job design that are expected to positively shape discretion-
ary behaviour (Boxall & Purcell, 2003; Lepak et al., 2006). HRM outcomes such as
employee skills, attitudes and behaviours mediate HRM policies and discretionary be-
haviour (Purcell et al., 2003).
We furthered our final hypotheses by testing the mediation model excluding extrinsic
job satisfaction and the continuance and normative organizational commitment, general-
ly associated with more tangible aspects of the WOR. We found that most of this effect
was due to intangible and affective-related aspects, from a self-determination theory
framework (Deci & Ryan, 1985), our results confirm that variables that are more direct-
ly related with fulfilling the psychological needs for autonomy, competence, and relat-
edness tend to mediate more effectively the relationship between SHRIM and PROSE.
When we compared clinical and non clinical staff, the global model the mediated effect
of the WOR on the relationship between SHRIM and PROSE was stronger on non clin-
163
ical rather than clinical staff; however, the portion of this mediation that was explained
by intangible variables was higher in clinical staff (0.18 in 0.30 is 60%) than in non
clinical staff (0.22 in 0.40 is 48.89%). This is coherent with the scarce literature we
could find on the difference between clinical vs. non-clinical staff in hospitals.
Thus it seems that the profile of non clinical workers is more similar to the profile of
workers in other areas than the clinical workers; this means that clinical workers will be
more sensible to HRIM measures that promote intrinsic satisfaction such as decentrali-
zation, participatory mechanisms, team-based structures (West et al., 2006; Buchan,
2004) and even autonomy and employee participation seem to affect change and inno-
vation involvement of clinical staff (Patterson et al., 2005). Studies done with clinical
workers (mostly doctors and nurses) are known for confirming the notion that these
workers bear a stronger commitment to their patients and their careers rather than their
organization (Takeuchi & Takeuchi, 2013; O’Donohue & Nelson, 2007), which might
indicate that although the impact of Satisfaction with HRIM on Prose mediated by the
WOR is significant (0.22), there might be other variables in these specific workers that
can be considered, such as the working conditions regarding the time and resources to
actually provide care and the opportunities for their professional development and learn-
ing (Janus et al, 2007).
These findings are also coherent with what workers consider to be ethical behaviour in
healthcare, thus adding to the importance of the way institutions treat their patients in
the way their clinical staff relates with the organization itself (Schwepker, 2001; Valen-
tine & Barnett, 2003 Schwepker, 2001; Valentine & Barnett, 2003).
The scarcity of literature in the matter of clinical vs. non clinical staff reinforces the idea
that there is a gap in the literature when considering hospital staff as whole and in a
more holistic view of HRM in Hospitals to accompany the more holistic philosophy of
Healthcare that has slowly but steadily been replacing the biomedical model of
healthcare (e.g. Engel, 1977; Erlich, Kendall, Frey, Denton & Kisely, 2015).
Conclusion
From a theoretical perspective, our findings represent a departure from most existing
164
HRM research in this vein. Specifically, empirical work in this area has tended to treat
the employee outcomes of HR practices as employees’ responses to consistently imple-
mented, predetermined management techniques (for an exception, see Liao, Toya, Le-
pak, & Hong, 2009). However, the current findings suggest that employees’ perceptions
of and reactions to HR practices may in fact be influenced by their perceptions and feel-
ing concerning such practices, and that these have a reflection on employees’ perfor-
mance related self-efficacy. Our results are consistent with the existing literature on
psychological contract, social exchange theory and reciprocity theory frameworks,
which strengthen the importance of the way organizations treat their workers, not only
from an intrinsic value and ethical point of view, but also as a way to promote their own
success.
Further, our results showed some nuances of the effect of SHRIM in the WOR and
PROSE that can be specific to healthcare workers and might shed some light concerning
the best HRIM strategies in this setting.
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Chapter 9 - Conclusions
“One reason why we rush so quickly to the vulgar satisfaction of judgement, and love to revel in
our righteous outrage, is that it spares us from the impotent pain of empathy, and the harder,
messier work of understanding”
– Tim Kreider, “We learn nothing”.
166
Chapter 9 – Conclusions
This study proposed to tackle some of the literature’s trends and concerns regarding
HRM research in the healthcare sector. Our conceptual approach used a single hospital,
as to avoid variances that may derive from organizational culture, management model,
policies and case mix, in accordance to recommendations found in the literature
(e.g., Nishii & Wright, 2008; Veld et al., 2010).
Thus the question of how HRM impacts performance was approached from an individ-
ualistic and proximal perspective. In this context, we considered that worker’s percep-
tions have been more directly associated with HR outcomes than the HRM practices
themselves (e.g., Boselie & van der Wiele, 2002; Bowen & Ostroff, 2004; Chang, 2005;
Wright & Nishii, 2004; Nishii et al., 2008) and we used the terminology HRIM to re-
duce ambiguity between different ways of perceiving HRM, and make a clear statement
that a more encompassing rather than more “technical” approach was intended, includ-
ing traditional and strategic HRM as well as issues that concern people from a not so
“macro” level (teamwork, communication across the organization, etc.). Also, perfor-
mance related self-efficacy was used as a proxy for individual performance. Individual
performance has an especially significant contribution to organizational performance in
the healthcare context (Boxall & Macky, 2009; Vermeeren et al., 2014) and is more or
less unanimously considered a consequent of self-efficacy (Bandura, 2006; Locke et al.,
1984; Mento et al., 1980). Since it is now increasingly recognized that the actual effec-
tiveness of firms’ human resource policies and practices should be evaluated from em-
ployees’ behavioural and psychological outcomes (Lam et al., 2009; Park et al., 2003),
and considering the Thomas Theorem (if people define situations as real, they are real in
their consequences) (Merton, 1995) we also took that perspective.
We analysed this relationship in the framework of the social exchange theory and reci-
procity theory, considering a mediation effect of the worker-organization relationship
expressed by a composite measure of job satisfaction, organizational commitment and
organizational citizenship behaviour. Although the relevance of these psychological
variables has been widely recognized, the role of HRM practices in these mediating
mechanisms has been underexplored (Tremblay, Cloutier, Simard, Chênevert, & Van-
denberghe, 2010). According to these theories, expressions of positive affect and con-
167
cern for others create a feeling of indebtedness and a corresponding sense of obligation
to respond positively in return. Workers who are satisfied with HRIM will then perceive
a higher level of organisational concern health care and support, because HR practices
provide employees with concrete evidence of the organisation’s intent to anticipate and
meet their needs (Armstrong-Stassen & Schlosser, 2010). Satisfaction with HRIM cre-
ates a sense of indebtedness and a need to reciprocate in terms that will benefit their
organisations/management (cf. Kehoe & Wright, 2013).
Health professions have been growing in number in most western countries during the
last few decades (Lega & DePietro, 2005). It may be argued that due to this growth in
number and importance of healthcare, there has never been a greater need to introduce
effective strategies for HRM in the sector for individual clinicians and other workers to
transform quality and productivity in healthcare and hospitals (Trebble et al., 2014).
Results in this study support our theoretical model, and all the proposed hypotheses
were partly or totally supported. These conclusions are in line with Liua, Martineaub,
Chenc, Zhana, and Tang’s (2006) work, that assuming HRM policies and practices are
aligned with appropriate health service objectives, improved HRM and leads to im-
proved health outcomes. Furthermore the results are in line with Xerri and Brunetto’s
(2013) conclusion that, if healthcare managers want to promote commitment, then the
first step is to embed effective workplace relationships, namely the worker-organization
relationship, even if the impact of SHRIM is stronger in non clinical than in clinical
staff.
We furthered our hypotheses by testing the mediation effect of the emotional worker
organization relationship (comprised of the less tangible and more affective elements in
the constructs that comprise the WOR) between SHRIM and PROSE. Results show that
the more affective portion of the indicators has a stronger mediation effect than the
more “bottom-line” constructs (namely, extrinsic satisfaction and continuance organiza-
tional commitment). The EWOR seems to have a stronger impact in the clinical workers
than in the non-clinical workers, and meets perfectly what the literature has been sug-
gesting regarding the surmounting importance of non-monetary factors in different
types of clinical workers (doctors, nurses, etc.) (e.g., Rafferty et al, 2001; Rosenstein,
2002; Janus et al, 2007), supporting the notion that HRIM in hospitals must go beyond
the bottom line issues when trying to retain/motivate their clinical workers.
168
9.1 Contributions / Implications to Practice
Studying HRM in the health care sector and its effect on performance has both practical
and academic relevance (Kabene et al., 2006). There are obviously many more groups
in addition to physicians, nurses and administrators (the three groups on which the pre-
ponderance of studies of HRM in healthcare is focused [Bartunek, 2011]) whose collab-
oration is necessary for successful healthcare delivery. These include, among others,
dieticians, multiple types of therapists, pharmacists, laboratory technicians and so forth;
this study included all the professional groups involved in the hospitalization experience
and thus directly and indirectly contributing to healthcare and quality of life in patients
(for instance, the importance of intergroup collaboration in the service of quality im-
provement in healthcare has been amply advocated by authors like Bartunek [2011]).
To date, the bulk of research on SET has been based on North American samples, with
little understanding whether the theory transcends cultural contexts in its ability to ex-
plain and effectively predict. Thus, in order to expand our knowledge in this area, we
examined SET in a Portuguese sample. Our results confirmed the applicability of SET
in a Portuguese context and make a contribution to the literature by extending empirical
research on SET and its applications in a non-U.S. environment.
Our work emphasizes the importance of developing supportive relationships in the
workplace in a HRIM level, through providing favourable discretionary treatment, real-
istic promise making and minimising occurrence of contract breach and violation (in-
creasing fulfilment). A possible implication of this finding is that in the Portuguese con-
text, HRM practices need to be implemented in such a way as to increase employees’
perceptions of fitting into their organizations, which eventually leads to the enhance-
ment of their AOC as well as of their retention and job quality improvements.
Complementary research findings along this line of argument in both social psychology
(e.g., Van Maanen & Schein, 1979) and the organisational literature (Kelley & Hoff-
man, 1997) have confirmed that one type of prosocial behaviour facilitates other types
of prosocial behaviours due to the personal values acquired through the socialisation
process. Thus relative to their dissatisfied colleagues, satisfied workers are more likely
to promote a good work environment and follow rules as complying with safety-related
practices (Gyekie, 2005). In fact, it is also possible that employees dissatisfied with
their job and not committed with the organization, achieve poor performance and fur-
169
thermore, they tend to carry out withdrawal behaviours and are also the ones more like-
ly to experience job insecurity and to react more negatively to it (Hartley et al., 1991).
From a practical standpoint, our findings point to the need for organizations to move
beyond a simple focus on the effective design or selection of an HR system/best prac-
tices, to include an emphasis on consistent implementation of and communication about
HR practices or others. Further, our findings bring about the importance of a good rela-
tionship with the organization and conceptualized to include co-workers (e.g. the OCB
scale focuses mainly on the relationship between workers and co-workers) and supervi-
sors (e.g. different items in the JS, OC and OCB scale refer specifically to supervi-
sor/leaders), brings us also to the importance of a good relationship between the work-
ers and their leaders, especially in the context of reciprocity and social exchange theory.
Further, it seems clear that SHRIM is connected to PROSE, and studies show that high-
er self efficacy is associated with a greater sense of success and well being (e.g. Ban-
dura, 2006, Leng, 2013). Although there is little research on the impact of HRIM on the
health and wellbeing of workers, results have been showing that positive experience of
work relationships leads to lowered blood pressure and heart rate, strengthened immune
system and healthier cortisol levels (Heaphy & Dutton, 2008) which mitigate damaging
health consequences of organizational responses to turbulence (e.g., an economic crisis)
with health enhancing social support and positive interactions at work.
With increasing competition, the conventional HRM that is practiced by almost every
organization no longer provides a competitive advantage. HR departments need to de-
sign their activities strategically to help achieve organizational goals. In other words,
with strategic HRM becoming an integral part of the HRM system, it is no longer
enough for a company to focus solely on traditional technical HRM (Yang & Lin,
2014). In our study, we go beyond the context of technical/traditional HRM and SHRM
and introduce the concept of HRIM, which is closer to the idea of People Management
than Human Resource. This broader scope permits a more humancentric approach of
management, or including issues that despite being recognized as crucial for organiza-
tions (e.g. teamwork) are often overlooked by the HRM department.
In the healthcare context, these results can have an impact not only in in-role and extra-
role performance, but also in worker retention. Kovner et al. (2007) report that up to
170
13% of new nurses consider leaving their jobs within one year and indeed, most nurse
turnover models assign an important role to job satisfaction and organizational com-
mitment (Hayes et al., 2006). Moreover, this finding generalizes to employees other
than nurses as well (Griffeth et al., 2000; Tett & Meyer, 1993).
Considering the fact that not only the WOR has a significant mediation impact on the
relationship between HRIM and PROSE, but the emotional WOR has the most signifi-
cant part of this mediation power, our findings are in agreement with Janus and col-
leagues’ (2007) suggestion that the political discussion around salary increases for phy-
sicians should be broadened – or even shifted – to include a strategic redesign of non-
monetary factors contributing to physician job satisfaction, and we propose that this
shift is applicable to healthcare workers in general, especially clinical workers.
Our research suggests that a special focus should be given to ward managers, workers
who are often the “face of the organization” to their co-workers, but who are non the
less not in the centre of the decision making process. We suggest that actions to em-
power these workers and make them feel a part of the decision process should be under-
taken, as to ensure that the way they feel and communicate organizational decisions and
policies be as positive as possible, in order to elicit positive reciprocity from the remain-
ing colleagues, especially the ones they lead. Ironically, despite a rather bleak picture of
the role of ward managers, these managers are a highly committed and dedicated group
of professionals whose loyalty to the patient and their team has remained resolute
(Takeuchi & Takeuchi, 2013). Research by several authors (e.g. Hutchinson & Purcell,
2010; Takeuchi & Takeuchi, 2013) reveals that workers’ commitment to the organiza-
tion, while quite high, is lower than the commitment to their team, their profession and
to patient care. The danger is that if healthcare front-line managers continue to have
such heavy workloads and contradictory expectations (focus on performance and “num-
bers” vs. focus on people and team relationships) placed upon them, organisational
commitment may start to erode, and looking after their own “patch” is the best they can
be expected to achieve.
HR practices and higher-level performance outcomes have been supported by previous
research, pointing to its established importance for an effective and strategic HRM ap-
proach (Kehoe & Wright, 2013).
171
9.2. Limitations and future research
“The very notion of limits presupposes something beyond them”
– Nabokov, “Lolita”
“Whatever the problem, be part of the solution. Don’t just sit around raising questions and
pointing out obstacles.”
– Tina Fey, “Bossypants”
As with most research, the results of this study should be interpreted with consideration
of several limitations.
Firstly, the study was conducted at a single organization, which limits the generalizabil-
ity of its results. The cross-sectional nature of the study does not allow for any conclu-
sions regarding causal relationships. Although the analyses show that our proposed rela-
tionships exist within the cross-sectional data set, we are not able to claim a causal rela-
tionship from these results.
Cross-sectional research is a cost-effective starting point for establishing that two or
more variables are related, and the absence of a cross-sectional relationship would send
warning signals that more costly longitudinal work might not be justified (Wall &
Wood, 2005). Also, cross-sectional work often allows the use of much larger samples
and hence augments generalizability. However, for reasons that are well known, cross-
sectional studies provide a weak foundation for causal inference, for which longitudinal
research designs are to be preferred (Wall & Wood, 2005). Future research would bene-
fit from testing the present study’s model within a longitudinal design.
Self-reported measures have been commonly and successfully used in an extensive
body of research in organisational behaviour and HRM (e.g., Gyekye, 2005); in this
work, all variables were assessed via self-report. This raises the concern for common
method bias and common variance (independent, mediating and dependent variables
were measured simultaneously). Measures have been taken to reduce this concern. For
example, respondents were informed that participation is voluntary and fully anony-
mous (Wikhamn & Hall, 2012). Further, the Harman single-factor test was conducted in
all the multiple factor scales to eschew this suspect successfully.
Regardless of the common method bias, researchers in the area of organizational behav-
172
iour have found epidemiologic reports to be faulty, biased and deficient because of poor
documentation (Parker, Carl, French, & Martin, 1994; Veazie, Landen, Bender, &
Amandus, 1994); however, research reports in different areas have found a direct corre-
spondence between self reported and objective measures (e.g., Gyekye, 2005). Although
most studies utilize manager rating of OCBs, the self-reported measures sometimes
used to assess sales-related performance and have been consistent with managers’ eval-
uations (Organ 1988). In fact, several behaviours could be known only to individuals
(Allen, Barnard, Rush, & Russell 2000), whereas supervisors may be aware of only a
portion of these behaviours (Moorman 1991). Allen et al. (2000) found a relatively high
correlation between employees’ and supervisors’ evaluations. Although OCB self-rating
may inflate relationships, this problem has not been as serious as some have suggested
(Organ & Ryan, 1995). There is substantial evidence that the relationship between em-
ployee attitudes and OCB is not a function of common-method variance (Organ & Ryan
1995).
One must consider, however, that several authors have pointed out the problematic issue
of measuring performance through self-report questionnaires (Sverke, Hellgren, &
Naswall, 2002), since there is empirical evidence that individuals tend to overrate their
performance and that ratings (Ford & Noe, 1987). Therefore, it must be underlined that
the promising results obtained in this study should be replicated in future research em-
ploying multiple measures of job performance, distinct from self report ratings, follow-
ing the methodology proposed by Chirumbolo and Areni (2005).
This study relied on employee self-reports of employee outcomes; although it is defen-
sible that more accurate reports of performance might have been obtained through de-
partmental records or managers, the fact remains that we were unable to obtain depart-
mental or managerial reports for those professionals who had performance appraisal
systems. Further, the vast majority of our sample is comprised of professionals who, at
the time we collected data, did not have objective performance indicators, and had
widely different performance appraisal systems; for example, when this study was con-
ducted, doctors did not have a performance appraisal system at all.
Finally, one may argue that our sample is from the public sector and this setting may be
unique enough to limit the external validity of the findings. However, we would argue
that the norm of reciprocity might produce stronger effects in other contexts as public
173
sector employees may be constrained from adopting a stronger reciprocity norm. One
such constraint may be employees’ commitment to the public service and what employ-
ees contribute or decide not to contribute may have direct implications for the delivery
of service to public users (Coyle-Shapiro & Kessler, 2002).
FUTURE RESEARCH
The results of our study indicate that employees’ perceptions about the management of
their Hospital likely affect individual-level attitudinal and behavioural outcomes, there-
by suggesting that to maximize the positive effects of an HR system, managers should
employ HR practices consistently across a job group and ensure that all employees are
aware of the practices in use (Kehoe & Wright, 2013).
Current findings suggest that employees’ perceptions of and reactions to HR practices
may in fact be influenced by their perceptions and apparent experiences of their co-
workers as well—thereby pointing to a need for scholars to focus on employees’ aggre-
gate perceptions of HR practice use throughout a job group or department. It can be
interesting to understand if there is a nesting effect and use a hierarchical modelling
approach to this question, where the group might have some influence on the way each
employee perceives the HRIM, beyond what managers are communicating. Conse-
quently, whereas a reader of traditional SHRM research might conclude that effective
HR policy is essential in eliciting desired aggregate outcomes, the current findings sug-
gest that a group of employees’ individual outcomes are likely affected by the way that
the individuals in the group perceive the group to be managed as a whole.
The use of a multilevel approach with consideration of relationships at the job group
and individual levels can also be a direction for future research. Specifically, by consid-
ering HR practice perceptions at the job group level, authors may capture important
variance in this variable based on a relevant organizational boundary that acknowledges
the contextual influences affecting the formation of perceptions at the individual level.
Furthermore, by considering proximal outcomes of employees’ aggregate HR percep-
tions, authors may be able to demonstrate if although individuals develop their own ex-
change relationships with an organization, choosing and enacting their work behaviours
accordingly, they develop these relationships and enact these behaviours in the presence
174
of co-workers with whom they are likely to share frequent experiences and interactions.
Kehoe and Wright (2013) have found that although individuals’ differences in affective
commitment significantly predicted their behavioural outcomes, the job group mean of
affective commitment fully mediated the relationship between aggregate HR percep-
tions and both individual organizational citizenship behaviour and intent to remain with
the organization, even after accounting for these effects—thus demonstrating the im-
portance of identifying and accounting for the appropriate contextual effects in the study
of HR practices and outcomes. Future research should consider these findings and build
on the idea that organizations are complex synergetic systems where interaction is fun-
damental.
The medical team is altogether more individualistic, as compared to the nursing and
other teams, which is due to the basic nature of medical versus nursing roles and as-
signments. Lai et al. (2013), who studied the team cultural perspective in relation to
organizational citizenship behaviour in work groups, found that team collectivism and
individualism were found to moderate the OCB–performance rating relationship. It is
therefore speculated here that doctors, whose work is individualistic by nature, may
basically function within a non-supportive team of doctors, but will experience, in this
case and according to the research results, low satisfaction with their jobs. High cooper-
ation with the nursing team is hereby shown to inspire a supportive, friendly and coop-
erative working relationship among the team of doctors; and that, in turn, is shown to
influence their feelings of greater job satisfaction (Shetach & Marcus, 2012). Bearing
these findings in mind, it could be interesting to see if an intervention designed to pro-
mote a higher interaction of doctors and other types of hospital workers – a true focus
on the multidisciplinary model might produce the same effects.
According to Aselage and Eisenberger (2003), the exchange, or reciprocation, in social
relationships becomes stronger when both partners are willing to provide resources val-
uable to the other. Whereas employees value beneficial treatment, employers seek loyal-
ty and dedication (Coyle-Shapiro & Shore, 2007; Eisenberger et al., 2001). But which
of the two parties starts first? Research discusses mostly organizations as initiators: pos-
itive actions directed at employees by the organization are argued to contribute to the
establishment of high-quality exchange relationships (Eisenberger et al., 2001). Empiri-
cal evidence supports this sequential order of reciprocation and most notably, these ex-
175
changes have been used to explain the positive consequences that ensue when employ-
ees respond to perceived organizational support (for a review, see Rhoades & Eisen-
berger, 2002; Wikhamn & Hall, 2012). But is this accurate? It would be interesting to
understand exactly how does the reciprocity chain reaction get initiated and what factors
– of any – contribute to the initialization by workers in this relationship.
Perceived employer obligations define the parameters of the relationship and signal to
the employee the potential inducements that may be exchanged over the course of the
relationship. As such, perceived promises signal the organization’s future intent and
their willingness to invest in the relationship. However, the realization of these obliga-
tions is not unconditional but rather predicated on employees’ fulfilling their side of the
exchange. The nature of some obligations may be ongoing during the relationship and
temporarily discharged periodically as the relationship progresses. For example, an ob-
ligation to keep skills up to date may be temporarily fulfilled when an individual is giv-
en additional training but the obligation to continue to update skills in the future may
exist. In addition, the nature of the exchange involves the contingent interplay between
the individual and his/her employer. Therefore, an individual’s behaviour should be
influenced by the anticipation of fulfilled promises, as the ‘actual’ fulfilment of those
promises is contingent upon the employee’s contributions (Coyle-Shapiro, 2002).
Such a reciprocation process is highly dependent upon the perceptions of each part and
each part’s sense of indebtedness, and can therefore not necessarily be balanced: it is
possible that the leader may trust the worker, and the worker does not trust the
employee (e.g., Brower, Schoorman, & Tan, 2000; Mayer, David, & Schoorman, 1995),
or even if the leader trusts the worker in a reciprocal manner, this does not mean that
both trusts have the same level (Cardona & Eola, 2003). The circumstances and conse-
quences of this (in)balance should be a valuable source of information for research and
practice in organizations.
Research shows that trust partially mediates the effects of the fulfilment of both compo-
nents of the psychological contract on employees’ affective commitment (El Akremi,
Coyle-Shapiro, & El Bedoui, 2011), future research should consider this variable in the
WOR.
The consideration of emotions is rare as is the impact of WOR on employee health
176
(Robbins, Ford, & Tetrick, 2012). Especially in a sector as sensible to this issue and so
strongly associated with work-related conditions such as stress and burnout, the impact
of the WOR and emotions in the health of workers is not only an interesting but relevant
theme for organizations in the sense that it could reduce absenteeism, withdrawal and
even turnover.
A high-performance HR–organizational citizenship behaviour linkage is likely better
explained indirectly, through the impact of high-performance HR practices on employ-
ees’ affective commitment predicted by social exchange theory (Kehoe & Wright,
2013). Specifically, as Scholl (1981) suggested, commitment serves to maintain behav-
ioural direction in the absence of rewards. Thus, employees who are committed to the
organization are likely to be eager to contribute to the organization’s goals and are more
likely than others to extend their efforts beyond their required task performance to fur-
ther the effectiveness of the organization, even if they do not expect to be directly re-
warded for this behaviour on the basis of formal HR practices. Organizational citizen-
ship behaviours provide a straightforward means for committed employees to make
such optional contributions to the firm. For these reasons—in addition to support from
previous research demonstrating a positive relationship between affective commitment
and organizational citizenship behaviour (for a review, see Podsakoff et al., 2000), it
could be interesting to realize if there is a causality relationship between these two vari-
ables and if these in turn have an effect on organizational performance in healthcare.
The issue of organizational performance in healthcare is something we believe could
also be an interesting one to tackle. Namely we believe a longitudinal study should be
conducted where different indicators of hospital performance (self-efficacy, patient sat-
isfaction, numeric performance indicators) are collected and related so that it becomes
clear how they relate to each other, which is useful for managers, because it allows for
better decisions when enhancing performance, but also for researchers, because it
broadens the type of conclusions and inferences one can make from research in this
field.
Huang et al. (2012) suggest, on the basis of their findings, that hospitals can increase
organizational citizenship behaviours by influencing an organization’s ethical climate,
job satisfaction, and organizational commitment. They focus on the "climate types" of
caring, law and code and rules climate, satisfaction with co-workers, and affective
177
commitment and normative commitment. These authors argue that caring, law/code and
rules climate (e.g. how much an organization will keep their promises, or in other
words, keep their end of the bargain in the social exchange, maintaining the rules of
reciprocity) increase organizational citizenship behaviour, while preventing organiza-
tions from developing the type of instrumental climate and continuance commitment
that decreases it (Shetach & Marcus, 2015). Blau (1964) viewed ideological rewards as
effective inducements because “helping to advance cherished ideals is intrinsically re-
warding” (p.239) and Thompson & Bunderson (2003) ideological currency as “credible
commitments to pursue a valued cause or principle (not limited to self interest) that are
implicitly exchanged at the nexus of the individual-organization relationship” (p.576).
Given the extensive literature we were to discover after our data collection with regards
to ethical behaviour in the organization and the way this directly connects to reciprocity
and SET in the WOR, we suggest that future research tries to find if the perception of
ethical behaviour and ethical policies in itself actually have an impact on the different
aspects of the WOR and if consequently they affect any aspect of performance (organi-
zational, individual, worker self-efficacy, etc.).
Regardless, some authors such as Gardner, Moyniham, Park, and Wright (2001) and
Purcell and Hutchinson (2007) argue that in the HRM–performance causal chain, it is
not just HRM outcomes that affect organizational performance, but there may exist a
serial causation from employee skills, to attitudes and then to behaviour that finally af-
fect individual performance and organizational performance at large.
This might mean that decentralisation can give health service managers more control
over managing their staff. In some cases this may lead to improved HR outcomes and
ultimately better health service provision. However, this is not always the case and in
fact decentralisation may actually lead to worse health service provision through the
inappropriate use of HRM actions (Liu et al., 2006). Research on the impact of decen-
tralization on the WOR would be a valuable asset for future research.
We did not empirically examine the antecedents of variability in employees’ percep-
tions of HR practices. Although we emphasize the likely importance of consistent and
effective HR practice implementation in shaping employees’ HR practice perceptions,
empirical work is needed examining the relative significance of potential antecedents.
178
Conclusion
Employee satisfaction remains a major concern in business today (Boichuck & Menguk, 2013);
in this work, we demonstrated the importance of employees’ satisfaction with the HR
practices used to manage their people in predicting attitudinal and behavioural out-
comes—an oversight in the majority of previous research. Second, we shed light on the
relationships between attitudinal and behavioural outcomes — a set of relationships that
previous work in this area had left vague or unspecified (Kehoe & Wright, 2003). Third,
we presented findings that suggest a variety of fruitful areas for future research in the
field of HRM in the healthcare sector. We are hopeful that future research in this area
will acknowledge and attempt to inform the gaps between organizations’ HR policies
and employees’ HR practice experiences and perceptions; employees cannot wilfully
respond to practices they do not perceive.
In general, the pattern was that better staff experiences are associated with better out-
comes for employees and probably patients, which is consistent with previous findings
(e.g. Trebble, Heyworth, Clarke, Powell, & Hockey, 2014). These outcomes represent
employee attitudes and behaviours that are likely to affect performance across a variety
of organizational settings; that is, high levels of employee satisfaction with HRIM af-
fects the way workers relate to the organization, which in turn affects their performance
related self-efficacy, a variable strongly associated with performance, which is likely to
benefit performance outcomes across industries, business strategies, and cultures—all of
which points to the generalizability of these outcomes in terms of importance and rele-
vance across many contexts, especially in the services industry where the human factor
is paramount.
179
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180
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Appendix
- Additional statistical information
222
A1. Psychometric Properties of the WOR
Table A1.1 - Goodness of fit indices obtained in the confirmatory factor analysis of the WOR
composite measure
2 df. 2/df GFI CFI RMSEA Confidence
interval (90%)
WOR structure 6740.97** 1281 5.26 .86 .88 .04 .038-.040
** p <.01
Figure A.1 - Confirmatory Factor Analysis of the WOR model.
Table A1.2 – Average Variance Extracted and Composite Relaibility for the WOR
Scale CR AVE
WOR 0.82 0.66
223
A2. Psychometric Properties of the EWOR
Table A2.1 - Goodness of fit indices obtained in the confirmatory factor analysis of the EWOR
composite measure
2 df. 2/df GFI CFI RMSEA Confidence
interval (90%)
EWOR structure 4428.83** 741 5.98 .88 .90 .042 .041-.043
** p <.01
Figure A.1 - Confirmatory Factor Analysis of the EWOR model.
Table A2.2 – Average Variance Extracted and Composite Relaibility for the WOR
Scale CR AVE
EWOR 0.82 0.50
224
Annex
- Questionnaire
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“If you have built castles in the air, your work need not be lost; that is where they should be.
Now put the foundations under them.”
- Henry David Thoreau, “Walden”