Using a sample of 973 healthcare workers, we investigated the relationship between social support, job stress and PSM in Chinese public hospitals. Overall, we found comprehensive but mixed support for our initial hypotheses. Supervisor support and coworker support significantly increased PSM among healthcare workers. Challenge stress and hindrance stress were negatively associated with PSM. Supervisor support and coworker support diminished hindrance stress and challenge stress, respectively, among Chinese healthcare workers. Challenge stress and hindrance stress significantly mediated the indirect effects of coworker support and supervisor support, respectively, on PSM. The present findings should prove useful for academic researchers and practitioners.
4.1. Theoretical Implications
Our first key finding is that social support and job stress are predictors of PSM of healthcare workers, which adds to the evidence from antecedent research on PSM. Social support, especially supervisor support and coworker support, has been used to explain a wide range of individual values, attitudes and behaviors, such as affective commitment [31] and presenteeism [32]. However, very few studies have investigated the relationship between social support and PSM. Our study provides empirical evidence of the positive effects of supervisor and coworker support on PSM. However, multi-group analysis showed that the impact of coworker support on PSM is weaker than that of supervisor support.
Challenge stress and hindrance stress had a significantly direct negative effect on PSM of healthcare workers, which differs in part from our previous hypothesis and research findings. Previous studies reported that challenge stress has a positive effect on individuals, e.g., by encouraging workers to learn and to overcome obstacles, thus benefiting career development [14, 33]. We assumed that challenge stress was positively related to PSM; however, the present findings show that challenge stress has a significant negative effect on PSM and that the effect is as strong as that of hindrance stress. This interesting finding might be due to the complex working environment for healthcare workers. To our knowledge, the workload of healthcare workers in China is heavy: many are pressured to work 10 or more hours almost every day and always with high efficiency and in a state of tension [34].
Although no studies have examined the relationship between hindrance stress and PSM, the adverse effects of job stress, especially hindrance stress, on the individual and organization have been widely discussed in many studies based on JD-R theory. These effects include burnout [35], increased presenteeism [33], and increased turnover intention [36]. Hindrance stress includes demands that are viewed by managers as unnecessary impediments to personal growth and goal attainment, and by employees as insurmountable [14]. The present analysis of data from 973 healthcare workers employed in Chinese public hospitals provides direct evidence of the negative effect of hindrance stress on PSM.
Our findings show that supervisor support and coworker support had significant negative effects on hindrance stress and challenge stress of healthcare workers, respectively, which supports our previous hypotheses. The relationship between social support and job stress is multipath [37]. Previous studies often investigated social support and job stress in the same research model but failed to explain either how social support affects job stress or the differential effects of supervisor support and coworker support. Consequently, to complement these previous findings, we investigated separately the relationships between supervisor support and hindrance stress, and between coworker support and challenge stress. Our results suggest that supervisor support lessens the hindrance stress of healthcare workers, because they feel they are taken seriously by their supervisors and that the work environment is fair.
Another important finding of this study is that while hindrance stress and challenge stress directly affected PSM, hindrance stress also mediated the effects of supervisor support, and challenge stress mediated the effects of coworker support, on PSM. Because of the limited data on the antecedents of PSM, previous studies did not consider mediators between social support and PSM. Our results shed light on how supervisor and coworker support affect PSM through hindrance stress and challenge stress, as described in JD-R theory. Hindrance stress and challenge stress are the individual's psychological reactions to job demands. Supervisor support and coworker support are important organizational resources provided to workers and help workers to meet their work demands, while reducing job stress and increasing PSM.
4.2. Implications for Management
Our findings have a number of important practical implications for managers of public hospitals who hope to reduce job stress and promote PSM among healthcare workers and improve healthcare quality.
Firstly, managers of public hospitals should be mindful of the intense job stress of healthcare workers and undertake interventions targeting challenge stress and hindrance stress. Challenge stress can be managed by ensuring reasonable workloads, rational shift arrangements, and appropriate time pressure and by balancing worker rights and responsibilities. Hindrance stress can be improved by developing a fair organizational climate, scientific performance assessment standards, clear job responsibilities, and a concrete employee growth scheme [38]. In addition, public hospitals should consider interventions that help relieve employee job stress, such as psychological counselling, physical exercise, recreational activities, and lectures on mental health.
Secondly, public hospital managers should encourage and assist supervisors in their leadership functions, e.g., by urging supervisors to (1) care about the work and life of subordinates and assist them whenever possible, (2) identify and acknowledge the strengths and accomplishments of workers and encourage and recognize their efforts, and (3) make workers' jobs as interesting as possible [39]. Public hospitals should develop training courses for supervisors, on topics such as leadership, strategic management, and communication management.
Thirdly, managers of public hospitals should emphasize coworker support and good employee relationships. For instance, a system of group activities in public hospitals could be developed in order to enhance coworker support. Such a system could include training activities and outward-bound activities and might prevent conflicts and improve career development.
4.3. Limitations and Future Research
This study is not without limitations. Firstly, the study was cross-sectional. Thus, the relationships between social support, job stress and PSM cannot be assumed to be causal and should be further examined in a cohort in a future longitudinal study. Secondly, we only recruited healthcare workers from Chinese public hospitals and excluded those from private hospitals, which limits the generalizability and robustness of our conclusions. Social support, job stress and PSM differ somewhat between public sector and private sector employees [40]. Therefore, to verify our hypotheses and models, future studies should investigate healthcare workers from private hospitals. Thirdly, our study considered only the effects of work-related dimensions of social support, which were mostly limited to job stress and PSM. Although the scale including supervisor support and coworker support dimensions could be used to adequately test social support, other dimensions of social support might be important in job stress and PSM. Future studies should examine how the support of family, friends and spouses affects job stress and PSM of healthcare workers. Fourthly, our study want to explain the potential psychological process of employees working in public sectors under the combined effect of job demands and job resources. However, JD-R theory proposed that social support and job stress not only affect employees’ motivation, but also significantly affect their burnout and job performance. On the basis of the results of the current study, future studies should integrate more psychological outcome variables in our research model. Finally, our sample comprises healthcare workers in a developing East Asian country and does not include healthcare workers from countries with other cultures and different levels of development. Future studies should examine whether the present findings are consistent across cultures and stages of economic development.