Good management: It can be a matter of life and death

Hospitals are large and complex institutions designed to provide optimum clinical care. Of course, patient-facing staff must to be at the top of their game. But they depend on administrative support, effective coordination and engaging leadership.

Dr John McWilliams

Poor management can be detrimental to medical outcomes. (People can die.)

It can also result in clinical workers quitting their jobs or reducing their hours, contributing to a growing global shortage of good hospital staff.

We are all familiar with formal written contracts.

We enter in to one when we take a job.

The contract specifies what will be expected of us and what we can expect in return.

But there are things expected that are never made explicit, until the expectations are violated.

The psychological contract is tacit, and based on social exchange and norms of reciprocity. (If you scratch my back, I will scratch yours.)

The sort of tacit expectations employees may have include loyalty, training and development, career progression, convivial work, respect, reciprocity, fairness and equity.

Breach of such expectations has been shown to reduce job satisfaction and commitment.

Perceived organizational justice can moderate the effect of contract breaches. It can be:

  • distributive (perceived fairness of allocation of outcomes)
  • procedural (perceived fairness of employer’s decision-making process in allocating outcomes)
  • informational (perceived adequacy and honesty of explanations provided by the employer)
  • interpersonal (perceived sincerity and respect with which an employee is treated).

In previous research, procedural fairness has been linked to job satisfaction and emotional commitment.

It influences the quality of relationship between the employee and the organization.

A lack of justice leads to perception that breaches of psychological contracts are deliberate.

There is a need for more research on justice in organizational life.

The aim of our research was to investigate the relationships between psychological contract fulfilment, and four aspects of justice on organizational commitment, psychological distress and job satisfaction, among hospital clinicians.

We surveyed clinicians (physicians) in a large hospital.

Our results indicated that, whereas the perceived obligations of the psychological contract were linked to organizational commitment, breaches were not linked to any of the outcomes.

However interactions between breaches and distributive justice did have a significant effect on organizational commitment.

Job satisfaction was positively predicted by the interaction between breach and informational justice.

Lack of procedural justice also individually predicted increased psychological distress highlighting the importance of organizations having fair decision making processes, particularly because they reflect the extent to which employees are valued.

Read the paper here.

Ellershaw, Julia, Stean, Peter, McWilliams, John & Dufour, Yvon (2014) Promises in psychological contract drive commitment for clinicians, Clinical Governance: An International Journal, Vol. 19, No. 2. 2014, pp 153-165.

Dr John McWilliams

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