Figure 1 illustrates the conceptual model. As noted in the introduction, the overall aim of this study is to contribute to research on employees’ individual innovative behaviour (IIB) in healthcare setting.
Figure 1 indicates two distinct types of factors that have an impact on IIB: (i) personal characteristics and (ii) organizational characteristics. Two personal characteristics are represented in Figure 1: (i) individual creativity (IC) and (ii) PsyCap. PsyCap is assumed to be linked directly to both IIB and IC as well as indirectly to IIB through IC. The organizational characteristics represented in Figure 1 of the conceptual model are labelled ‘leadership autonomy support’ (LAS). LAS is expected to have multiple effects. Specifically, it is assumed that LAS has a direct impact on IIB, IC and PsyCap. Moreover, the linkage between LAS and IIB is expected to be mediated through IC and PsyCap. In addition, the link between LAS and IC is expected to be mediated through PsyCap. All the hypotheses leading this study have been summarized below in Table 1. In the following sections, the concepts and linkages between them, as depicted in Figure 1, are explained in more detail.
Table 1 Hypotheses leading these study
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Hypothesis
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Hypothesized relationships
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H1
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IC is positively related to IIB.
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H2a
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PsyCap is positively related to employees’ IIB.
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H2b
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PsyCap is positively related to employees’ IC.
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H2c
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The relationship between PsyCap and IIB is mediated by IC.
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H3a
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LAS is positively related to IC.
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H3b
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LAS is positively related to employees’ IIB
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H3c
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The relationship between LAS and employees’ IIB is mediated by their IC.
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H3d
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LAS is positively related to employees’ PsyCap.
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H3e
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The relationship between LAS and IIB is mediated by PsyCap.
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H3f
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The relationship between LAS and employees’ IC is mediated by PsyCap.
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Note: IC = Individual creativity, IIB = Individual innovative behaviour, PsyCap = Psychological capital, LAS = Leadership autonomy support.
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Individual innovative behaviour
According to Fuglsang, innovation is ‘a difficult phenomenon to define and study, and there is no consensus about how to define innovation’ [11]. One of the earliest definitions of innovation was that of Schumpeter. Schumpeter refers to innovation as a ‘new combination’ of services, work processes, products and markets [12]. In the literature, an innovation can refer to a ‘new product or service, a new production process, or a new structure or administrative system’ [13]. These diverse definitions of innovation exemplify the potential variety of differences between various types of innovation. Simply stated, innovation can manifest everywhere in an organization. However, this study limits its focus to innovations relevant to individual employees. The innovation type evaluated in this study is IIB in healthcare settings. IIB concerns the implementation of innovations of potential benefit to employee performance. IIB relates to the behaviour of employees and their ability to adopt and use new and useful ideas in their work environment [14]. As such, IIB is doing something new that represents a behavioural change or discontinuity relative to the ordinary organizational pattern of behaviour in the past. Consequently, the domain of IIB is related to everyday employee practices, and such innovations are implicitly ‘a function of learning and knowledge creation, integrated into daily work practices’ [15]. Furthermore, there is no explicit focus on the timing of implementation. Innovation may be implemented either as a one-time change (e.g. for a specific patient or situation) or more permanently (e.g. a new procedure that is extended to all future patients). Innovation in a one-time situation is analogous to what the literature terms an ad hoc innovation [16]. Similar to ad hoc innovation, IIB may include some temporary innovations. However, the concept of IIB can include ‘some element that can be repeated in new situations’ [17], to be implemented and generalized more permanently. Consequently, the concept of IIB in this study is open to a wide range of changes relevant to employee performance. Thus, IIB embraces and reflects a ‘… specific form of change-oriented activity’ [18] that is explicitly manifested in employees’ ‘implementation of new and useful ideas within a work-role’ [18]. Below, some significant factors suggested to have an impact on IIB are addressed.
Individual creativity
As shown in the conceptual model in Figure 1, IC is one of two personal characteristics suggested to have an impact on IIB. IC as a personal characteristic reflects the idea that creativity is heterogeneous and distributed across individuals in organizations. Creativity is flexible and dynamic; it varies from one employee to another. Therefore, IC is an individual resource or capability to be creative. Based on this, and specifically for this study, IC is defined as the individual employee’s ‘production of novel, useful ideas or problem solutions. IC refers to both the process of idea generation or problem solving and the actual idea or solution’ [19]. Creativity is sometimes used synonymously with innovation. However, in this study, we separate the concept of IC from that of IIB. Shalley et al. support this distinction, stating: ‘it important to distinguish creativity from innovation. Creativity refers to the development of novel, potentially useful ideas. Although employees might share these ideas with others, only when the ideas are successfully implemented at the organization or unit level would they be considered innovation’ [20]. As the above definition suggests, IC refers to the production and development of potentially useful and novel ideas. Consequently, IC describes processes and individual cognitive thoughts (referring to creative thinking) and potential associated activities such as (1) defining the problem to be solved, (2) collecting information, (3) generating ideas and (4) evaluating ideas [21]. In contrast to IC, the concept of IIB relates to behaviour, specifically referring to the behavioural implementation of creative ideas. Consequently, there is a natural distinction between IC and IIB, although the two concepts are closely linked or interdependent.
Creativity is most often described as a necessary ‘input’ to innovation. Slåtten and Mehmetoglu, emphasizing the importance of creativity, characterized it as a ‘primary source’ [22] of innovative behaviour. Gilmartin illustrates the criticality of creativity by describing it as ‘the fuel of innovation’ [23]. The ‘foundation of innovation ideas is creativity’ [24]. Previous research has found a positive link between creativity and innovation at the individual level [22]. In line with previous research, this study sought a positive association between IC and IIB. This leads to the following hypothesis:
Hypothesis 1: IC is positively related to IIB.
Psychological capital
PsyCap in Figure 1 is the second personal characteristic that may influence IIB. The PsyCap construct is drawn from positive psychology, and concerns ‘who you are’ as a person [25]. More precisely, PsyCap focuses on the positive aspects and strengths of individuals and labels them collectively as positive psychological resources [26] for the innovative process. Luthans et al described PsyCap as a higher order construct, which encompasses four first-order positive psychological resources: (i) hope, (ii) self-efficacy, (iii) resilience and (iv) optimism [26]. All four resources included in PsyCap are state-like resources [25]. The hope dimension in PsyCap is a motivational state that describes the extent to which one can progress when facing obstacles. Self-efficacy is individual confidence in one’s ability to perform tasks successfully. Resilience refers to the capability to manage setbacks, pursue objectives and achieve good results. Optimism is a person’s positive assessment of the future [27]. This defines PsyCap consistent with previous research as an individual’s positive psychological state of development characterized by (1) having confidence (self-efficacy) to take on challenging tasks and put in the necessary effort to succeed at them; (2) having a positive feeling (optimism) about future success; (3) persevering towards goals, and when necessary redirecting paths to goals (hope) to succeed; and (4) when beset by problems and adversity, bouncing back, sustaining or increasing one’s efforts (resilience) to attain success [27].
Previous research has associated individual PsyCap with work related performance, including IIB. For example, Slåtten et al. found that PsyCap among service sales employees was positively associated with innovative behaviour [28]. In another study, Abbas and Usman found a positive link between PsyCap and supervisor-rated innovative performance among employees employed in a range of fields [29]. Research has also found that the individual components and resources of PsyCap are linked to innovative behaviour. For example, research has linked the single PsyCap component of self-efficacy to innovative activities [30] and creative performance [31]. Although this study focuses on the collective impact of all (four) resources of PsyCap and does not examine the impact of single components, it supports the assumption of a link between PsyCap and IIB. In line with most previous research, it is expected that PsyCap in such settings will ‘provide a necessary repository of psychological resources that help effectively innovative work-related ideas’ [29]. Based on this, the following hypothesis is proposed:
Hypothesis 2a: PsyCap is positively related to employees’ IIB.
Although it has been suggested that PsyCap has a direct impact on IIB, it is also reasonable to assume that PsyCap has an additional direct impact on IC. Previous research has revealed that IC is linked to personal factors [32]. In this study, PsyCap reflects these individual factors. Specifically, it is expected that PsyCap is not limited to its positive impact on an individual employee’s adoption of an innovation (referring to IIB) but also of triggering creativity (referring to IC). It is important to remember that IC in the previous discussion was described in terms such as ‘primary source’ ([22] and ‘foundation of innovation’ [24]. Simply and directly stated, without creative thoughts, no innovative behaviour will occur. Gilmartin supports this assumption, stating, ‘creativity is the basic building block of invention and thus innovation’ [23].
Each of the four resources of PsyCap is a potential enabler and helps to trigger IC. Creative thinking is not a quick fix but often involves extensive and intensive cognitive and mental work. It is reasonable to assume that the mental work of IC entails some form of learning process of at least four steps. First, a person must be aware of a problem or challenge that needs to be solved. Second, a person must be interested and motivated to explore the nature of the problem (‘What is the real problem to be solved here?’). Third, potential solutions are identified. In this part, there may be several and sometimes even competing solutions, each with its specific obstacles. Fourth, among the list of alternative solutions, one must finally evaluate and identify the most appropriate and practical solution. Based on this four-step IC process, it is easy to imagine that IC is a relatively demanding mental/cognitive process that can be frustrating, time-consuming and stressful. However, a person’s PsyCap resources can boost IC. PsyCap is a core resource to achieve IC because it represents ‘one’s positive appraisal of circumstances and probability for success based on motivated effort and perseverance’ [26].
Previous research has revealed that the four resources or ‘ingredients’ of PsyCap, both individually and collectively, are associated with IC [33, 34]. For example, previous research has linked the hope resource of PsyCap to a person’s will to perform creative exploration [35]. Luthans et al. explicitly stated that hopeful employees ‘tend to be creative’ [35]. Similarly, in regard to optimism Rego et al. found that optimistic people tend to be more creative than their less optimistic counterparts [36]. Research on the other two resources of PsyCap, self-efficacy and resilience, has also found them to be positively linked to the aspect of creativity (see e.g. [30, 31, 37]). Consequently, the four resources of PsyCap are all potentially associated with IC. Scarce research has examined the impact of PsyCap on employees’ IC in a healthcare setting, making this study a unique contribution to health services research. Based on previous research, it is expected that the ‘combined motivational effects of the four dimensions’ [33] of PsyCap will be positively associated with employees’ IC. The assumption about this relationship can be summarized in the following hypothesis:
Hypothesis 2b: PsyCap is positively related to employees’ IC.
The two aforementioned hypotheses propose that PsyCap has a direct impact on employees’ IIB and IC. However, as shown in Figure 1 and summarized in Table 1, it is also expected that the relationship between PsyCap and IIB is mediated by IC. This assumption represents a third alternative way in which PsyCap may be linked to IIB. The main argument for this third route of impact is in the core role IC seems to have in IIB. As emphasized above, IC in the literature is described as a ‘primary source’ [22] and the ‘foundation of innovation’ [24]. This implies that from an individual employee perspective, IC is a necessary precondition for IIB. Based on this core role of IC, an increase in employee IC because of a positive shift or change in their PsyCap (as suggested in hypothesis 2b) may encourage employees to experiment with and apply creative ideas if they see a benefit to their work. Consequently, IC is expected to mediate between PsyCap and IIB. This leads to the following hypothesis:
Hypothesis 2c: The relationship between PsyCap and IIB is mediated by IC.
Leadership autonomy support
In the conceptual model in Figure 1, LAS represents organizational characteristics. In general, leadership is an essential organizational variable because it influences employees’ psychological attributes (e.g. PsyCap) and their creative performance [38] in constructs such as IC and IIB. LAS may affect motivation in work contexts [39]. This motivation is interesting for two reasons. First, as mentioned above, IC and IIB are relatively stressful and demans action. Second, IC and IIB can both be described as ‘extra-role behaviour’ because they are normally not a direct obligation, nor are they explicitly stated in formal contracts or job descriptions. Therefore, creative performance in terms of IC and IIB can be described as voluntary hard work that employees want to do but do not have to. Consequently, employees need a certain level of interest, or more precisely, motivation to be creative and innovative. This latter aspect of employee motivation is interesting and especially relevant to the concept of LAS. The ideas in this concept originally come from self-determination theory (SDT) [40]. SDT focuses on factors that facilitate motivation in humans. In SDT, the inner or self-determined driven type of motivation is emphasized as the ideal type. In SDT, it is labelled ‘autonomous motivation’, which describes a person who ‘behaves with a full sense of volition and choice’ [41]. In the literature, autonomous motivation is described as the ‘highest quality of regulation’ [41], and is closely linked to LAS [41, 42]. Hence, LAS is of special interest to the overall aim of this study.
In this study, LAS refers to employees’ perceptions of the quality of their interpersonal relationship with their leader. The domain and focus of LAS is the interpersonal work context and whether employees perceive their leader as one who stimulates, motivates and encourages them to work autonomously. Leaders that are autonomy-supportive provide ‘a meaningful rationale for doing the task, emphasise choice … and acknowledge employees’ feelings and perspective’ [41]. The ‘goodness’ and ‘well-being’ of autonomy-supportive leaders become very clear if it is contrasted with the opposite—non-autonomy-supportive leaders. In an organization with non-autonomy-supportive leaders, employees have minimal or zero freedom, are controlled at every step of the way, and their leaders give orders and provide detailed recipes of how the work should be done. Not surprisingly, employees most often feel that non-autonomy-supportive leaders decrease their inner motivation while autonomy-supportive leaders increase it. Therefore, because autonomy at work and autonomy-supportive leaders are closely associated with employees’ inner motivation, they are most often appreciated and sought by employees. Individuals who seek autonomy at work ‘are often searching for inner motivational environments and situations that provide them the opportunity of self-determination, initiative and choice’ [43].
There are several interconnected reasons why LAS should have a direct impact on both employees’ IC and employees’ IIB. First, LAS potentially ‘fuels’ employees with an inner motivation that increases their interest and leads them to focus on their work performance. Previous research supports the view that autonomy support is linked to employee motivation in work contexts. Second, because LAS is associated with positive motivation, it is reasonable to assume that employees also become more engaged and dedicated, which increases their IC and their IIB. Consequently, by this reasoning, employees’ perceptions of LAS function in tandem with their motivation by promoting IC and IIB. The importance of motivation for creativity and innovation is supported in the componential theory of creativity. By this theory, the motivation of an individual is suggested to be a primary mechanism that affects the creativity of an individual [44]. Furthermore, the creativity of an individual is noted as an predecessor for IIB at work, as the generation of ideas (creatitivity) is a necessary step towards the implementation (innovation) of ideas [45, 46]. As noted by Hocine and Zhang, ‘people are most creative when they feel motivated’ [47]. Previous research suggests that autonomy-supportive leaders have an impact on employee performance [44, 47]. Frese and Zapf, for example, found that the more leaders encouraged and supported employees in organizations, the more it promoted new ideas, creativity and the implementation of those ideas [48]. In an empirical study by Slåtten including 345 hospitality employees, the author found that their perceived autonomy influenced both their creative self-efficacy and innovative behaviour [30]. In this paper, the authors suggest that autonomy is a ‘¼ “key factor” and is critical for developing a person’s creative self-efficacy’ [30]. Previous research has also revealed that when employees experience the opposite of autonomy at work—controlling behaviour from their leader—this has a detrimental impact on creativity and innovation [49]. Consequently, based on previous research, there are several good reasons to assume that when employees perceive LAS in a positive way it will have a positive impact on both IC and IIB. This reasoning leads to the following hypotheses:
Hypothesis 3a: LAS is positively related to IC.
Hypothesis 3b: LAS is positively related to IIB.
Shalley et al. state that ‘the presence of … creative ideas increases the likelihood that other employees will apply the ideas in their own work’ [20]. This statement—like the present study—stresses the importance of IC in achieving IIB. Consequently, creative thinking (or IC) is a precursor for creative acting (or IIB). On the other hand, as previously mentioned, there are studies revealing that autonomy is positively associated with innovative behaviour [45] and creative work involvement [46]. However, in these studies, the impact of autonomy is limited because they do not include both IC and IIB in the same study. Therefore, considering the core role of IC, the true pattern of linkages in the impact of autonomy on IC and IIB has not been fully investigated. In contrast, this study separates IC (as a cognitive concept) from IIB (as a behavioural concept), thus providing a more comprehensive test for mechanisms operating between LAS, IC and IIB. Previous research has yet to explore the linkages between these three concepts. Being creative is demanding for employees and it entails abilities such as ‘deep processing of information, and information integration’ [50]. Thus, being creative is a complex task. Such ‘complex tasks or quality-type tasks tend to require a higher degree of engangement and autonomy’ [50]. LAS is, therefore, a leadership tool that may increase employees’ IC. Based on this, when employees perceive the LAS to be good it should encourage them and stimulate their IC. However, LAS is not limited to raising employees’ creative thinking skills. It is also reasonable to assume that LAS, in the next round can fuel employees with the necessary authority and freedom to transform their creative thoughts (IC) into real action and behaviour (IIB). This is because implementing creative thoughts may benefit work performance. This reasoning assumes that IC acts as the common denominator between LAS and IIB. Specifically, IC is expected to mediate the relationship between LAS and IIB. This leads to the following hypothesis on the pattern of linkages:
Hypothesis 3c: The relationship between LAS and employees’ IIB is mediated by their IC.
Because of leaders’ and managers’ formal roles in organizations, they significantly influence their subordinates [51]. Slåtten et al. describe this influence as ‘among the most dominant factors’ [52). Leadership is a significant or ‘impactful’ part of an organizational work environment and ‘resource theorists view the work environment as a key management resource that interacts with other resources’ [53] such as the resources that comprise PsyCap. As discussed in relation to hypotheses 3a and 3b, leadership is expected to affect employees’ IC and IIB. Below, it is suggested that this relationship also works through the impact of LAS (an organizational characteristic) on PsyCap (a personal characteristic) as shown in Figure 1 and summarized in Table 1. Consequently, this represents an alternative and complementary route in the pattern of linkages associated with IC and IIB.
The literature defines the concept of PsyCap as ‘an individual’s positive psychological state’ [27]. The definition of it as a ‘psychological state’ implies that PsyCap is not static or fixed but flexible and dynamic. Consequently, the individual resources that comprise PsyCap change according to certain factors. Luthans et al. support this idea by stating that PsyCap is ‘open to development and can be managed for effective work performance’ [25]. By this line of reasoning, it is expected that LAS can positively ‘develop’ or ‘manage’ employees’ PsyCap. Current research has yet to examine this specific relationship in a healthcare setting. Although very little research has been undertaken, previous research indicates a relationship between LAS and PsyCap. First, when employees perceive the LAS in their organization to be positive it reflects a perception of an autonomous work environment. As discussed above, an autonomous work environment (of which LAS is a part) is positively associated with PsyCap. For example, in a study by Choi including 331 employees in a Korean automotive parts manufacturing company, the author found a significant and strong link between autonomous work environments and employees’ PsyCap (b = 0.586) [53]. Interestingly, in this article the author describes an autonomous work environment as partly a place that ‘gives employees choices and encourages employees to take personal initiative’ [53]. Moreover, to capture employees’ perceptions of autonomy the author’s questionnaire used items that assessed ‘a subordinate’s perceptions of the degree of autonomy supportiveness provided by their supervisors’ [53]. This way of describing and capturing autonomous work environments is to a large extent similar to how the concept of LAS is used in this study. Stated in another way: Choi provided support for this study’s expectation of a positive association between LAS and PsyCap [53]. Second, although the impact of LAS has not been specifically considered, previous research found that positive leadership (e.g. authentic leadership) and supportive organizational climate are positively associated with PsyCap [28, 54]. Consequently, based on the highly relevant research of Choi [53], it is expected in this study that LAS, as a positive environmental resource in organizations, has a positive impact on employees’ PsyCap. Therefore, the following hypothesis is proposed:
Hypothesis 3d: LAS is positively related to employees’ PsyCap.
Innovative behaviour is influenced by both ‘personal and external determinants’ [55]. As argued throughout the discussion of the previous hypothesis, both PsyCap and IC—two personal determinants (or personal characteristics)—are assumed to be positively associated with IIB. Moreover, in the discussion of hypothesis 3d, it was argued that LAS, as an external determinant (or organizational characteristic) develops and increases the ‘reservoir’ of employee PsyCap resources. Based on this reasoning and assumption, it is reasonable to assume that PsyCap plays a mediating role in the relationship between LAS and IIB. Specifically, when employees’ reservoirs of PsyCap increase because of a positive development stemming from LAS, this should increase their IIB. The authors are not aware of any previous study that has specifically tested the interplay between these variables in healthcare settings. However, a previous study has found that PsyCap mediates the relationship between positive leadership and innovative behaviour. For example, in a study of sales-people, it was found that employees’ PsyCap mediated the relationship between positive perceptions of the authentic leadership style and innovative behaviour [28]. Furthermore, Choi found that PsyCap fully mediates the relationship between an autonomous work environment (of which LAS is a part) and employees’ self-directed behaviour (a concept that is strongly related to the concept of IIB in this study) [53]. Thus, given its prominent role reported in the literature, PsyCap is expected to mediate the relationship between LAS and IIB. This prompts the following hypothesis:
Hypothesis 3e: The relationship between LAS and IIB is mediated by PsyCap.
A similar mediating pattern of linkages with PsyCap is predicted between LAS and IC. In this study, IC is defined as a cognitive concept. As noted several times in this paper, creativity is fundamental as the first step to innovation [22, 23, 20]. The logic of this is simply stated: If an individual has no creative thoughts (IC) no innovation will occur (IIB). However, as stated in hypothesis 2b, PsyCap can fuel IC. Similarly, as argued in hypothesis 3d, LAS can fuel PsyCap. In combination, these relationships indicate mediation or what can be described as a ‘domino effect’ that starts with perceptions of LAS, works through PsyCap and has an impact on IC. Scarse previous research has examined this assumption in a healthcare setting. However, support for the hypothesized mediating relationship can be found in published studies. Gupta and Singh found in their study that PsyCap fully mediates the relationship between leadership and creativity [56]. Similarly, Zubair and Kamal found that PsyCap mediates the relationship between the authentic leadership style and creativeness [57]. In line with previous research, it is assumed that PsyCap mediates the relationship between LAS and IC. This leads to the following and final hypothesis in this study:
Hypothesis 3f: The relationship between LAS and employees’ IC is mediated by PsyCap.