As there is considerable emphasis on the provision of patient-centered service in all aspects of health care , growing research attention is being devoted to factors contributing to providing high- quality service . Empirical evidence shows that, to the extent that nurses are able to deliver high-quality care and service, patients are more likely to generate favorable evaluations of service encounters and experience higher satisfaction [3, 4], which, in turn, affects organizational effectiveness and performance . Therefore, nurses’ service behaviors have critical implications for hospitals.
The service behavior of nurses is composed of moral philosophy with core values, including the consideration of the patient’s wants, needs, and preferences . Hence, nursing has been considered to be an “ethical laden practice” . Nevertheless, previous researchers have neglected the ethical aspects of nursing service practices . Therefore, researchers should explore the promotion factors of nurse’ service behavior from the ethical aspects in hospitals, such as ethical climate.
Additionally, previous studies on customer service behavior focused on two types of employee behavior, including in-role behavior and extra-role behavior [9–11]. The in-role service behavior refers to the required or expected customer service behavior that stem from hidden rules in the workplace or from clear duties and responsibilities expressed in company regulations, such as job descriptions and key performance indicators . While the extra-role service behavior is the employee’ informal behavior that goes beyond the formal job requirements in serving customers [11, 13]. Both of the above-mentioned types of service behaviors are discretionary. They all have a strong flavor of service orientation that involves satisfying customers’ work-related problems. Thus, it is critical that researcher should consider both of the two types of service behavior when study the antecedents, outcomes and mechanism of service behavior, because they may have different impact results and paths [12, 14].
Ethical climate and service behavior
Defined by Victor and Cullen [15, 16], ethical climate is “the shared perceptions of what ethically correct behavior is and how ethical issues should be handled,” and they believed that ethical climate can influence employee behavior . Based on the theory proposed by Rodney et al. , ethical climate in the health care field means the “implicit and explicit values that drive healthcare delivery and shape the workplaces in which care is delivered” . According to Numminen et al. , the definition of the ethical climate of nursing is the perceptions of nurses about dealing with ethical issues in the workplace. Nursing practice is carried out in a social framework in which environmental factors and interpersonal relationships interact each other . Therefore, the climate of the work environment is crucial for nurses’ behavior and nursing practice . As a kind of the organizational climate, the ethical climate significantly affects the professional and ethical practice of nurses, and as a result, it should be attached importance to in evaluating nurses’ service behaviors.
According to the level of moral development of the work group (egoism, benevolence and principled), Victor and Cullen [15, 16] developed a typology of ethical climates that the locus of analysis was used for final decisions (individual, local and cosmopolitan). Building on this typology, the five most common climate types in the research process include “caring” (employees’ behaviors and decisions should focus on the well-being of others),“law and code” (whether employees’ behavior and decisions are contrary to legal norms or principles)༌“rules” (employees should consider whether their behaviors and decisions disobey company rules and regulations)༌“instrumental” (organizations provide a climate concerning employees’ self-interest), and “independent” (organizations provide a climate that employee can act or make decisions depending on their personal ethical beliefs) [21, 22].
However, the literature is largely silent on how organizational ethical climate affects nurses to imply service behaviors. According to the current literature, the ethical climate not only affects which issues organizational members consider to be ethics-related, but also plays a decisive role in the generation of moral standards that organization members can understand, weigh and solve these problems . On one hand, the ethical climate works through formal culture. Formal culture refers to the aspects such as leadership, structures, reward systems, policies, decision-making processes and socialization mechanisms . This therefore suggests that the ethical climate may play a role in facilitating employees’ in-role service behavior. On the other hand, the ethical climate also plays an important role by the informal atmosphere, such as in languages, role models, behavioral norms, rituals, and historical anecdotes [19, 23], which suggests that the ethical climate will lead to a higher level of extra-role service behavior. In the year of 1975, Schneider strongly believed that because of the diversity of climate types that exist within an organization, it is imperative that researchers focus on those dimensions of climate that are associated with specific variables, rather than focusing on the climate in general . However, evidence specific to the effect of different ethical climate types on nurses’ in-role service behaviors and extra-role service behaviors remains limited.
Hospital ownership and service behavior
In recent ten years, private hospitals in China have developed rapidly, but they are in fact designated as the supplement of public hospitals . Because public hospitals account for the majority of hospitals in China, and they play the vital roles in keeping citizen’s health and responding to emergency public health crisis, such as the COVID-19 pandemic. Of course, the public hospitals in China have significant medical resource advantages, public hospitals are in a better position to recruit health care workers and provide services . In China, most private hospitals are primarily profit-driven, and for this reason, it makes sense that private hospital services are largely determined by the market. Private hospitals adopt the marketing concept and seek to attract patients by concerning patients’ satisfaction and providing consumer-oriented services . In addition, there are different employment contracts for nurses in public and private hospitals, such as permanent contract, fixed term contract, and agency employment contract . Various contract types not only present different salary and compensation systems, but also different job requirements for nurses to stay in their organizations. Therefore, nurses in different ownership hospitals may act differently in nursing service behaviors.
Additionally, the difference of hospital ownership implies potentially different resources, operation modes and climates. The issue as to whether hospital ownership has an impact on the quality of nursing service has long been a serious concern . Some researchers argue that nurses in public hospitals perform better than those in private hospitals [28, 29]. However, others argue the reverse conclusions . Since the nurses’ service behavior contains the moral philosophy with core values that considering patient’s wants, needs, and preferences , ethical climate may be the direct and effective explanations of service behavior, and can clarify the mixed associations between hospital ownership and nursing service behavior. The hospital ownership may moderate the relationships between ethical climate and nurses’ service behavior, especially in China. Considering hospital ownership has both the theoretical and practical contributions in the study of ethical climate and service behavior, that help researchers find a key factor for service behavior research and inspire nursing managers to propose down-to-earth managerial solutions.