An analysis of relationships among transformational leadership,job satisfaction,organizational commitment and organizational trust in two Turkish hospitals

The purpose of this study was to investigate the relationships among employee organizational commitment, organizational trust, job satisfaction and employees' perceptions of their immediate supervisors' transformational leadership behaviors in Turkey. First, this study examined the relationships among organizational commitment, organizational trust, job satisfaction and transformational leadership in two Turkish public hospitals. Second, this investigation examined how job satisfaction, organizational trust and transformational leadership affect organizational commitment. Moreover, it was aimed to investigate how organizational commitment, job satisfaction and transformational leadership affect organizational trust. A quantitative, cross‐sectional method, self‐administered questionnaire was used for this study. Eight hundred four employees from two public hospitals in Turkey were recruited for collecting data. The overall response rate was 38.14%. The measurement instruments of survey were the Job Satisfaction Survey (developed by P. Spector), the Organizational Commitment Questionnaire (developed by J. Meyer and N. Allen), the Organizational Trust Inventory‐short form (developed by L. Cummings and P. Bromiley) and the Transformational Leadership Inventory (TLI) (developed by P. M. Podsakoff). Five‐point Likert scales were used in these measurement instruments. Correlation test (the Pearson's rank test) was used to examine relationships between variables. Also, multiple regression analysis was used to determine the regressors for organizational commitment and organizational trust. There were significant relationships among overall job satisfaction, overall transformational leadership and organizational trust. Regression analyses showed that organizational trust and two job satisfaction dimensions (contingent rewards and communication) were significant predictors for organizational commitment. It was found that one transformational leadership dimension (articulating a vision), two job satisfaction dimensions (pay and supervision) and two organizational commitment dimensions (affective commitment and normative commitment) were significant regressors for organizational trust. There is a lack of research in the health organizations regarding organizational commitment, organizational trust, job satisfaction and transformational leadership. The investigator of the proposed study intends to add to the literature and intends to prove that the proposed study would be important for healthcare organizations. A number of specific measures should be undertaken to reduce factors that negatively affect organizational commitment, organizational trust and job satisfaction of hospital personnel and to improve transformational leadership behaviors of hospital administrators. Copyright © 2012 John Wiley & Sons, Ltd.     

Implementing managerial innovations in primary care: can we rank change drivers in complex adaptive organizations?

BACKGROUND: There has been much innovation in primary care in the past few decades. Although external and systemic constraints for health care organizations are relevant for their managerial evolution, there is also evidence that organizations operating under the same external pressures reach different levels of maturity. PURPOSES: Which of the internal drivers available explain and foster change? Is it possible to rank change drivers by looking at their rate of efficacy in order to define a general change management path in the relationship between managers and physicians? The study is a hypothesis-generating work, designed to discuss a framework, consistent with the complex adaptive systems literature, for more effective internal change management approaches. METHODS: We employed a qualitative approach to conduct a multiple case study in order to directly observe the evidence and to ask "key change players" for their perceptions. We studied different organizations all subject to the same external constraints in order to focus on the effects of internal change drivers. FINDINGS: According to key players' opinions, the main drivers for managerial development are characteristics of the actors involved: their motivation, leadership, and commitment; the quality of relationships among the main actors; and how the resources dedicated to manage change are used. Given these criteria, any organizational strategy and goal seems to be achievable. This is consistent with the suggestions coming from the complex adaptive system literature. MANAGERIAL IMPLICATIONS: Managers have to consider the management of the relationship with professionals as the key success factor for implementing change. Managerial leadership has to be diffused in the organization both in the vertical and horizontal dimensions. Innovations need a medium or long-term perspective to become widely applied, and this requires a strong commitment which is related to managerial stability. Resources for innovation are to be considered a critical driver for fostering the relationship between managers and professionals.     

Concepts of health and well-being in managers: An organizational study

Global changes and new managerial challenges require new concepts of health and well-being in organizational contexts. In the South African context, health and well-being of managers have gained relevance in organizations and in management sciences. International organizations, in particular, attempt to address the increasing demand for health care and the delivery of health services to their managers. Careful and appropriate health management requires research to evaluate context-specific health concepts and strategies. The purpose and aim of this article is to assess managerial concepts on health and well-being that could be used by the organization to contribute to managerial well-being by implementing health promotion according to managerial needs. At the same time, this article contributes to salutogenetic health research that is very rare with regard to the South African organizational management research.This study is a multi-method research study conducted in a selected international organization in South Africa. However, in this article, selected qualitative findings will only be presented.This organizational study presents selected research findings on health concepts and strategies employed by managers. Findings demonstrate that the managerial concepts of health and strategies mainly refer to not only physical but also to mental and spiritual aspects, with a priority on physical health and well-being.The findings presented are based on qualitative research methods and their research criteria.This assessment serves as a foundation for new approaches to health management within the international work context in South Africa. It also contributes to a paradigm shift from pathogenetic to salutogenetic concepts of health and well-being within the South African organizational work context.The article produces new insights into the qualitative health concepts of South African managers and expatriates and contributes to promoting salutogenesis in organization within South Africa.     

Health-promoting organization and organizational effectiveness of health promotion in hospitals: a national cross-sectional survey in Taiwan

To assess the organizational health-promotion (HP) status and its effect on the organizational effectiveness of HP in a national cross-sectional survey of all hospitals above the local community hospital level in Taiwan's hospitals, questionnaires were sent to 474 hospitals, of which 162 (34.18%) hospitals returned them and were rendered valid. The results of the organizational HP status reveal that the standardized overall score achieved is 76.26, suggesting that there is considerable room for improvement. The results of correlation analysis partially support the proposition of this study, suggesting that the higher the organizational HP status, the better the self-evaluated overall organizational and administrative effectiveness of its HP. When hierarchical multiple regression was performed, support for ownership (private hospitals), hospital accreditation grades (academic medical centers) and overall score of the Organizational Health of Hospital Assessment Scale were significant predicators of self-evaluated overall organizational effectiveness (F = 11.097, p < 0.01, R(2) = 0.369). Moreover, drafted annually, HP policies and plans and the number of staff HP training activities were found to partially mediate the relation between the organizational HP status, hospital characteristics and self-evaluated overall organizational effectiveness. The results contribute to clarify the conception of health-promoting hospital organizations and to identify a number of dimensions of health-promoting organizations related to the organizational effectiveness of HP in hospitals, which could allow hospitals to establish a healthier organization and more effective HP programs. This study also supplies the research field with important data and insights that can be used in future research.     

Learning helpers: how they facilitated improvement and improved facilitation--lessons from a hospital-wide quality improvement initiative

Quality improvement is a leading approach to the difficult yet inevitable task of managing organizational change. The literature suggests that facilitators can help organizations apply improvement principles and tools but it is unclear how facilitators actually do this and how they develop their own skills. Using a case study design we therefore examined how facilitators worked with 93 improvement projects in over 1000 sessions at one Swedish university hospital where systematic process improvement was successfully established over a 5-year period. They facilitated improvement by providing a framework and methods' support for improvement efforts--relying on experiential learning rather than didactic teaching--while letting clinical teams and managers maintain control over the content of improvement projects. They developed extensive experience that they documented and could transfer between teams, so that each team could benefit from lessons learned elsewhere. They improved facilitation through participant feedback and systematic review and reflection regarding their own practice. We suggest that facilitators can help organizations manage change by assuming responsibility for demanding tasks related to improvement work, developing specialized skill and extensive experience regarding improvement, and transferring insights across the organization, while using a learning approach throughout including to their own work.     

Organizational Learning and Continuous Quality Improvement: Examining the Impact on Nursing Home Performance

Interest is growing in learning more about the ability of total quality management and continuous quality improvement (TQM/CQI) initiatives to contribute to the performance of healthcare organizations. A major factor in the successful implementation of TQM/CQI is the seminal contribution of an organization's culture. Many implementation efforts have not succeeded because of a corporate culture that failed to stress broader organizational learning. This may help to explain why some TQM/CQI programs have been unsuccessful in improving healthcare organization performance. Organizational performance variables and organizational learning orientation were assessed in a sample of 181 Canadian long-term care organizations that had implemented a formal TQM/CQI program. Categorical regression analysis shows that, in the absence of a strong corporate culture that stresses organizational learning and employee development, few performance enhancements are reported. The results of the assessment suggest that a TQM/CQI program without the backing of a strong organizational learning culture may be insufficient to achieve augmented organizational performance.     

Organizational capacity for community development in regional health authorities: a conceptual model

The value of community development (CD) practices is well documented in the health promotion literature; it is a foundational strategy outlined in the Ottawa Charter for Health Promotion. Despite the importance of collaborative action with communities to enhance individual and community health and well-being, there exists a major gap between the evidence for CD and the actual extent to which CD is carried out by health organizations. In this paper it is argued that the gap exists because we have failed to turn the evaluative gaze inward-to examine the capacity of health organizations themselves to facilitate CD processes. This study was designed to explicate key elements that contribute to organizational capacity for community development (OC-CD). Twenty-two front-line CD workers and managers responsible for CD initiatives from five regional health authorities in Alberta, Canada, were interviewed. Based on the study findings, a multidimensional model for conceptualizing OC-CD is presented. Central to the model are four inter-related dimensions: (i) organizational commitment to CD, rooted in particular values and beliefs, leadership and shared understanding of CD; (ii) supportive structures and systems, such as job design, flexible planning processes, evaluation mechanisms and collaborative processes; (iii) allocation of resources for CD; and (iv) working relationships and processes that model CD within the health organization. These four dimensions contribute to successful CD practice in numerous ways, but perhaps most importantly by supporting the empowerment and autonomy of the pivotal organizational player in health promotion practice: the front-line worker.     

Knowledge sharing networks related to hospital quality measurement and reporting

BACKGROUND: With the growing momentum toward hospital quality reporting by public payers, hospitals face increasing pressures to improve their medical record documentation and administrative data coding performance. The literature on "professional complex systems" has put forth various strategies for improving the performance of professional organizations. In doing so, it has emphasized the importance of creating effective structures for knowledge sharing and organizational learning. This study integrates knowledge networks and professional organizations literatures to develop hypotheses related to knowledge sharing network effectiveness in professional organizations. PURPOSE: Correspondingly, this study explores the relationship between the organizational knowledge sharing structure related to quality and hospital coding performance related to quality. Simultaneously, this study seeks to identify other organizational characteristics associated with coding for quality measurement. The purpose is to identify strategies not only for improving hospital coding performance but also for the organization to adapt to the changing environment. METHODS: An exploratory and comparative research design is used. The sample is composed of four hospitals, two showing "good-coding" performance for quality measurement and two showing "poor-coding" performance. Interviews and surveys are conducted with administrators and staff in the quality, medical staff, and coding subgroups in each facility. Survey data are subjected to social network analysis to examine knowledge sharing structures. FINDINGS AND IMPLICATIONS: This study finds that good-coding performance is systematically associated with a knowledge sharing network structure rich in brokerage and hierarchy (with leaders connecting different professional subgroups to each other and to the external environment) rather than in density (where everyone is directly connected to everyone else). From a health care management perspective, this study suggests that to improve hospital coding performance, senior administrators must undertake proactive and unceasing efforts to coordinate knowledge exchange across physician and coding subgroups and connect these subgroups with the changing external environment.     

医学科技创新与医院管理方式变革的关系研究

医学科技创新会促进医院管理观念、管理方法与管理组织等发生变革；而型管理观念的培育、创新型管理方法的实施和创新管理组织的构建又会反极大地激励医学科技创新。两者之间存在着一种内在的相辅相成、相互促进的关系，促进它们之间良性循环的形成是现代医院管理的重要目标。     

A taxonomy of health networks and systems: bringing order out of chaos

OBJECTIVE: To use existing theory and data for empirical development of a taxonomy that identifies clusters of organizations sharing common strategic/structural features. DATA SOURCES: Data from the 1994 and 1995 American Hospital Association Annual Surveys, which provide extensive data on hospital involvement in hospital-led health networks and systems. STUDY DESIGN: Theories of organization behavior and industrial organization economics were used to identify three strategic/structural dimensions: differentiation, which refers to the number of different products/services along a healthcare continuum; integration, which refers to mechanisms used to achieve unity of effort across organizational components; and centralization, which relates to the extent to which activities take place at centralized versus dispersed locations. These dimensions were applied to three components of the health service/product continuum: hospital services, physician arrangements, and provider-based insurance activities. DATA EXTRACTION METHODS: We identified 295 health systems and 274 health networks across the United States in 1994, and 297 health systems and 306 health networks in 1995 using AHA data. Empirical measures aggregated individual hospital data to the health network and system level. PRINCIPAL FINDINGS: We identified a reliable, internally valid, and stable four-cluster solution for health networks and a five-cluster solution for health systems. We found that differentiation and centralization were particularly important in distinguishing unique clusters of organizations. High differentiation typically occurred with low centralization, which suggests that a broader scope of activity is more difficult to centrally coordinate. Integration was also important, but we found that health networks and systems typically engaged in both ownership-based and contractual-based integration or they were not integrated at all. CONCLUSIONS: Overall, we were able to classify approximately 70 percent of hospital-led health networks and 90 percent of hospital-led health systems into well-defined organizational clusters. Given the widespread perception that organizational change in healthcare has been chaotic, our research suggests that important and meaningful similarities exist across many evolving organizations. The resulting taxonomy provides a new lexicon for researchers, policymakers, and healthcare executives for characterizing key strategic and structural features of evolving organizations. The taxonomy also provides a framework for future inquiry about the relationships between organizational strategy, structure, and performance, and for assessing policy issues, such as Medicare Provider Sponsored Organizations, antitrust, and insurance regulation.     

医院员工工作价值观与组织承诺关系的实证研究

目的 了解医院员工工作价值观与组织承诺的现况。比较不同个人特征的员工在工作价值观与组织承诺上的差异．探讨员工工作价值观与组织承诺的关系。方法 以上海市某医院在职员工为研究对象，进行问卷调查。结果 医院员工的个体特征在工作价值观和组织承诺上有显著差异、工作价值观与组织承诺存在显著正相关、工作价值观对组织承诺具有显著的预测力。结论 医院管理者要通过鼓励临床业务部门员工参政议政、关怀和引导青年医务人员、畅通沟通渠道、提高员工的福利待遇等途径来提升员工的组织承诺。     

Hospital-physician integration: case studies of community hospitals.

Hospitals are attempting more meaningfully to involve physicians in management as one approach to increasing the efficiency and effectiveness of their operations. The purpose of this research was to explore the relationship between the structure of the medical staff organization, the extent to which physicians are integrated into hospital decision making and the hospital's financial performance. A measure of hospital-physician integration was developed based on Alexander et al's (1986) dimensions of hospital-physician integration which were based on Scott's (1982) organizational models, ie, autonomous, heteronomous and conjoint. A multiple case study design, which comprised eight community non-teaching hospitals over 200 beds located in the Province of Ontario, Canada, was used to examine the relationship between variables. Study results suggest that there is variation among community hospitals on both contextual and organization factors. Hospitals with high levels of hospital-physician integration were located in highly populated areas, had formulated and implemented a strategic plan, had highly structured medical staff organizations, and had no budgetary deficit. In contrast, hospitals with moderate or low levels of integration were more likely to be located in lowly populated areas, had little planning activity, had a moderately structured medical staff organization, and had deficit budgeting. Suggested areas for future research include examining the role of the Board of Trustees in determining physicians' organizational roles and identifying differences in commitments, characteristics, and motivations of physicians working in rural versus urban hospitals and their impact on integrative strategies.     

Rethinking how to measure organizational culture in the hospital setting. The Hospital Culture Scale

Like all organizations, health care delivery systems must be concerned with understanding the implicit beliefs, values, and assumptions extant within the organization that ubiquitously motivate and shape the behavior of participating members. The Hospital Culture Scale (HCS) was designed as a way to assess the unique culture of hospital organizations. The HCS demonstrated high discriminant validity and reliability when applied to all members (patients, nurses, and physicians) of this particular organization. Data provided from different hospital organizations indicated that the HCS could differentiate between a variety of hospitals. Physicians, nurses, and patients were also compared. Although there was agreement between nurses and patients on how scale items are used, there were disagreements when these organizational members were compared to physicians. Differences between hospital members on the overall perception of hospital culture were found. The implications and utility of the HCS are discussed.     

Perceived organizational problems in health care: a pilot test of the structured problem and success inventory

Our objective was to test whether the Structured Problem and Success Inventory (SPI) instrument could capture mental representations of organizational and work-related problems as described by individuals working in health care organizations and to test whether these representations varied according to organizational position. A convenience sample (n = 56) of middle managers (n = 20), lower-level managers (n = 20), and staff (n = 16) from health care organizations in Stockholm (Sweden) attending organizational development courses during 2003-2004 was recruited. Participants used the SPI to describe the 3 most pressing organizational and work-related problems. Data were systematically reviewed to identify problem categories and themes. One hundred sixty-four problems were described, clustered into 13 problem categories. Generally, middle managers focused on organizational factors and managerial responsibilities, whereas lower-level managers and staff focused on operational issues and what others did or ought to do. Furthermore, we observed similarities and variation in perceptions and their association with respondents' position within an organization. Our results support the need for further evaluation of the SPI as a promising tool for health care organizations. Collecting structured inventories of organizational and work-related problems from multiple perspectives may assist in the development of shared understandings of organizational challenges and lead to more effective and efficient processes of solution planning and implementation.     

The ethic of "the organizational good": is doing the right thing enough?

An organization whose members are acculturated to behave morally according to specified principles practices "the organizational good." "The organizational good" is the soul of an organization; it should not change. If the Board of Directors, Chief Executive Officer, managers, and members reinforce ethical principles by modeling them, an organization can thrive; if not, the organization may become ethically bankrupt. It is the premise of this article that the increasingly common errant behavior of some organizations and their Chief Executive Officers today is because they do not practice the ethic of "the organizational good."     

Hospital managers’ need for information in decision-making – An interview study in nine European countries

Assessments of new health technologies in Europe are often made at the hospital level. However, the guidelines for health technology assessment (HTA), e.g. the EUnetHTA Core Model, are produced by national HTA organizations and focus on decision-making at the national level. This paper describes the results of an interview study with European hospital managers about their need for information when deciding about investments in new treatments. The study is part of the AdHopHTA project. Face-to-face, structured interviews were conducted with 53 hospital managers from nine European countries. The hospital managers identified the clinical, economic, safety and organizational aspects of new treatments as being the most relevant for decision-making. With regard to economic aspects, the hospital managers typically had a narrower focus on budget impact and reimbursement. In addition to the information included in traditional HTAs, hospital managers sometimes needed information on the political and strategic aspects of new treatments, in particular the relationship between the treatment and the strategic goals of the hospital. If further studies are able to verify our results, guidelines for hospital-based HTA should be altered to reflect the information needs of hospital managers when deciding about investments in new treatments.     

以学习力提升竞争力探索医院永续发展之路--无锡市第二人民医院构建学习型组织的实践与探索

构建学习型医院,是现代医院实现可持续发展的必然要求,是许多医院管理者关注和正在探索的重要课题.文章解析无锡市第二人民医院应用学习型组织理论指导医院管理,构建学习型医院的实践和探索.介绍了该院在倡导个体学习、营造学习氛围、创新学习载体、丰富学习形式、建立保障机制等方面的做法和体会.     

Establishing a culture of perinatal safety in a community hospital

While unsafe behavior of frontline hospital staff, primarily physicians and nurses, is sometimes the proximal cause of adverse events, the critical importance of system‐wide, hospital organizational factors is now being acknowledged(1,2). These organizational factors create the “safety culture” that influences the occurrence of these proximal failures.(3) The concept of safety culture originated in high‐reliability organization theory, which was largely developed by a group of social scientists at the University of California at Berkeley who studied high‐risk organizations that have achieved very low accident and error rates, for example, aircraft carrier flight decks, nuclear power plants and air‐traffic control systems.(4–6) Safety culture refers to the enduring and shared beliefs and practices of organization members regarding the organization's willingness to detect and learn from errors.(7)     

公立医院组织文化与医院绩效的关联性研究

研究分析了我国公立综合性医院的文化现状及其与6大医院绩效指标间的关联,结果发现,制度规范、社会责任和竞争意识文化评分最高,授权、组织协调和能力发展评分最低,且不同级别、不同地区医院间差异不显著;关联性分析显示,多个组织文化维度对医院绩效指标有显著关联,且管理者与非管理者之间这种文化-绩效的关联性存在一定差异.