Changing to improve? Organizational change and change-oriented leadership in hospitals

Work engagement of hospital workers in times of pressure: do nonclinical hospital workers react differently from their well-studied clinical colleagues?

PURPOSE

While prevalence and value of nonclinical hospital workers, like quality or education professionals, increase, their work engagement is understudied. Work engagement of nonclinical and clinical hospital workers is critical considering the pressure of major challenges in healthcare. The pandemic was a natural experiment for this.

DESIGN/METHODOLOGY/APPROACH

We conducted an observational survey study among all nonclinical and clinical hospital workers of the Jeroen Bosch Hospital, the Netherlands. In an employee satisfaction survey, we measured work engagement under acute pressure (just after the first COVID-19 wave in July 2020) and chronic pressure (within the second COVID-19 wave in November 2020) and to what extent psychological demands and co-worker support were related to work engagement.

FINDINGS

For all hospital staff, "average" levels of work engagement were found under acute (response rate 53.9%, mean 3.94(0.81)) and chronic pressure (response rate 34.0%, mean 3.88(0.95)). Under acute pressure, nonclinical hospital workers scored lower on the subcategory dedication than clinical workers (mean 4.28(1.05) vs mean 4.45(0.99), p < 0.001). Under chronic pressure, no differences were found. For both nonclinical and clinical hospital workers, co-worker support was positively related to overall work engagement (beta 0.309 and 0.372). Psychological demands were positively related to work engagement for nonclinical hospital workers (beta 0.130), whereas in clinical hospital workers, psychological demands were negatively related to vigor (beta -0.082).

PRACTICAL IMPLICATIONS

Hospitals face times of pressure. Fostering co-worker support under pressure may be vital for hospital management.

ORIGINALITY/VALUE

Work engagement of nonclinical hospital workers is understudied.

Nurse middle managers' proactive work behavior: antecedents and consequences on innovative work behavior and job performance

PURPOSE

Healthcare organizations require more proactive behaviors from nursing professionals. However, nurse managers' proactivity has rarely been analyzed in the literature and little is known about the antecedents and consequences of their proactive behavior at work. This study examines the relationships between job characteristics (i.e. job autonomy and job variety), psychological empowerment, proactive work behavior and job effectiveness indicators (i.e. innovative work behavior, job performance). We tested a model in which psychological empowerment and proactive work behavior sequentially mediate the relationship between job characteristics and job effectiveness.

DESIGN/METHODOLOGY/APPROACH

A cross-sectional study was conducted among nurse middle managers from a French hospital (N = 321). A hypothetical model was developed based on existing theory. Structural equation modeling was used to test the hypotheses.

FINDINGS

Results show that psychological empowerment and proactive work behavior fully mediate the relationship between job characteristics and innovative work behavior, and partially mediate the relationship between job characteristics and job performance.

ORIGINALITY/VALUE

This study provides insights for understanding how job characteristics can contribute to fostering the proactivity of nurse middle managers and how their proactive work behavior can be positively related to innovative work behavior and job performance. Findings raise several implications for hospital administrators and upper management seeking new ways to enhance nurse middle managers' proactive work behavior and push further their effectiveness at work.

Leadership effectiveness through coaching: Authentic and change-oriented leadership

There has been an increasing shift towards individually owned leader development programs within organizations. Whilst leadership coaching is one of these and is gaining in popularity, the mechanisms of its effect remain poorly understood. We develop and investigate a model in which leadership coaching enhances leader effectiveness through coaching's positive effect on authentic and change-oriented leadership behaviours as well as self-efficacy. To assess the model, multi-source data were collected for organizational leaders (N = 70) pre- and post-coaching. To investigate mechanisms of coaching's effect, relations between latent change scores were assessed in structural equation modelling using partial least squares indicating that after accounting for base-line scores, coaching-related increases in authentic leadership behaviour has the largest total effect on leadership effectiveness.

Reforming for trust and professionalism in municipal healthcare services: implications for human resource management

BACKGROUND

Many countries face an increasing demand for home-based healthcare services, and consequently experience a mismatch between expectations and available financial and human resources. It is therefore important to utilize human resources more efficiently, while at the same time offer jobs that attract the professionals they need. This article reports a study of the development and piloting of a new organizational model for home-based healthcare services in a Norwegian municipality, which addresses the need to provide efficient services and enhance trust and professionalism within healthcare services by improving work autonomy and involvement of employees.

METHODS

The research project this article draws its empirical material from was commissioned by the municipality piloting the new organizational model and executed in collaboration with the municipality based on an evaluative trailing research (ETR) design. The data consists of interviews with key personnel and knowledge exchange between researchers and the involved actors in the pilot project. 20 semi-structured interviews involving a total of 34 informants were conducted. The analysis emphasises how different employee groups and management perceived and experienced various aspects of the work situation, as they were introduced to working and managing within the new organizational model. The aim is to shed light on how these employees and managers feel about it, interpret it, and respond to it.

RESULTS

Overall, the results indicate that the model holds potential for realizing the benefits it aims for. However, there were also challenges that need resolving for the model to fulfil this potential. Central elements include clarification of roles and responsibilities for employees and managers, competence specification and development, and development of structures for inter-professional cross-team collaboration and information provision.

CONCLUSIONS

Trust reform initiatives may be a strategy for fostering high-involvement work systems. To achieve this, sufficient attention must be paid to ensuring structures for information exchange and knowledge development in the early phases of implementation, or preferably prior to implementation. The theoretical model applied in this study could potentially be a useful managerial tool in preparing for and implementing trust reforms in healthcare services.

A Multilevel Study of Change-Oriented Leadership and Commitment: The Moderating Effect of Group Emotional Contagion

Purpose

The purpose of this study is to explore the effects of change-oriented leadership on employee change commitment, and the underlying cross-level mediating and moderating effects.

Design and Methodology

Multilevel analysis of data from 583 respondents in 55 major manufacturing firms in China from 2021, reveals that change-oriented leadership explains the significant variance in change commitment. Based on Emotions as Social Information Theory and Social Exchange Theory, this study investigates the relationship between change-oriented leadership and change commitment fully mediated by emotion regulation.

Findings

This study also confirms that positive group emotional contagion has moderating effects on the relationship between change-oriented leadership and emotion regulation. In addition, negative group emotional contagion has moderating effects on the relationship between emotion regulation and change commitment. Furthermore, the moderated mediation of negative group emotional contagion is identified.

Originality and Value

This study makes a unique contribution through its multilevel approach to examining the relationship between leadership, emotion, and commitment during organizational change.

Competence Development and Collaborative Climate as Antecedents of Job Performance, Job Commitment and Uncertainty: Validation of a Theoretical Model across Four Hospitals

Knowledge is lacking regarding how organizational factors are associated with uncertainty in patient treatment. Thus, the aim of the current study was to investigate how competence development and collaborative climate relates to job performance and job commitment, and further whether job performance and job commitment relate to uncertainty. Additionally, we examined whether these associations differed between four different hospitals. We applied data from 6445 hospital workers who provided care to patients. Basic statistics and structural equation modelling (SEM) were used to test the validity of the theoretical model developed in the study and the hypothesized associations. All hypothesized paths between the latent variables were significant and in accordance with the model across the four hospitals. The current study has implications for practical human resource management and indicates that competence development should be strengthened at the individual level and collaborative climate should be strengthened at the ward level. Strengthening competence development and collaborative climate can increase job performance and job commitment of individual workers and reduce uncertainty during care in hospital settings.

Strategic leadership and management factors driving sustainability in health-care organizations in Thailand

Purpose

This empirical study aims to identify the essential strategic leadership and management factors underlying sustainability in healthcare. It also examines which factors drive sustainability performance outcomes (SPO) in health-care organizations, an analysis lacking to date. It provides a strategic leadership and management perspective toward sustainable healthcare, responding to the United Nations Sustainable Development Goals.

Design/methodology/approach

The investigation adopted Sustainable Leadership as its research framework. Using a cross-sectional survey, 543 employees working in health-care and pharmaceutical companies in Thailand voluntarily provided responses. Factor analyses and structural equation modeling were employed.

Findings

The results revealed an emergent research model and identified 20 unidimensional strategic leadership and management factors toward sustainability in healthcare. The findings indicate significant positive effects on SPO in health-care organizations. Significant factors include human resource management/development, ethics, quality, environment and social responsibility, and stakeholder considerations.

Research limitations/implications

The study was conducted in one country. Future studies should examine these relationships in diverse contexts. In practice, health-care firms should foster significant strategic leadership and management practices to improve performance outcomes for sustainability in healthcare.

Originality/value

This paper is the first empirical, multidisciplinary study with a focus on strategic leadership, health-care management and organizational sustainability. It identifies a proxy for measuring the effects of essential strategic leadership and managerial factors for sustainability in pharmaceutical health-care companies. It advances our currently limited knowledge and provides managerial implications for improving performance outcomes toward sustainable healthcare.

How Human Resources Index, Relational Justice, and Perceived Productivity Change after Reorganization at a Hospital in Sweden That Uses a Structured Support Model for Systematic Work Environment Management

To facilitate systematic work environment management, which should be a natural part of business development, a structured support model was developed. The Stamina model has previously been used in Swedish municipalities, showing positive results. The aim was to study how the Human Resources Index (HRI), relational justice, short-term recovery and perceived productivity changed in a recently reorganised perioperative setting in a hospital in Sweden that uses a structured support model for systematic work environment management. A longitudinal design that took measurements at four time points was used in a sample of 500 employees in a perioperative hospital department. The results for the overall sample indicated a positive trend in the HRI (Mt1 = 48.5, SDt1 = 22.5; Mt3 = 56.7, SDt1 = 21.2; p < 0.001). Perceived health-related production loss (Mdt1 = 2, IQR = 3; Mdt3 = 0, IQR = 3; p < 0.001) and perceived work environment-related production loss (Mdt1 = 2, IQR = 3; Mdt3 = 0, IQR = 4; p < 0.001) showed major improvements. Short-term recovery showed a minor improvement (Mt1 = 2.61, SDt1 = 1.33; Mt3 = 2.65, SDt3 = 1.22; p = 0.872). In conclusion, the implementation of the Stamina model, of which the HRI constitutes an important part, seems to be a helpful tool to follow-up on work environment processes, and minimise production losses due to health and work environment-related issues.

Reducing the waitlist of referred patients in a medical specialist outpatient clinic: an observational study

PURPOSE

Long waitlists in outpatient clinics are a widely recognised problem. The purpose of this paper is to describe and report the impact of a waitlist reduction strategy for an epilepsy clinic.

DESIGN/METHODOLOGY/APPROACH

This observational study described the local impact of a methodical approach to tackling a long waiting list, using targeted strategies supported by a modest additional budget. The interventions were described using the template for intervention description and replication (TIDieR).

FINDINGS

Over an eight-month period, the waitlist for the epilepsy clinic was reduced from 599 to 24 patients without increasing the number of days until the next available appointment. Most referrals were removed from the waitlist without an appointment. Auditing revealed a high proportion of patients no longer required the service or referrals remained on the waitlist due to administration error. A short-term increase in clinic capacity of 51 extra appointments met the needs of the remaining waiting patients. The additional project funding invested in this process was AUD $10,500 and a time-limited amount of extra work was absorbed by using existing clinic resources.

PRACTICAL IMPLICATIONS

This waitlist reduction strategy resulted in a very small waitlist for the epilepsy clinic, which is now well placed to trial further interventions with the aim of sustaining the service with minimal waiting times. Not every referral on the waitlist, particularly the very long waiters, required an appointment. Other outpatient clinics may be able to apply this process to reduce their waitlists using a modest budget.

ORIGINALITY/VALUE

Although there are reports of successful waitlist reduction, few report the intervention in detail. Use of the TIDieR in reporting enables the intervention to be appraised or adapted to other settings where long waitlists are problematic. Considerations related to implementation of policy are discussed and in this case, a locally led and executed change management strategy was a key to achieving the result.