Support for autonomy (SA)
In this study, the concept SA relates to the interpersonal work context in organisations. As shown in Fig. 1, SA is considered as a type of climatic resource within the organisation and thus reflects that it is under management control and therefore relatively manageable. Specifically, a climatic concept of SA is about employees’ perception of ‘how things are done here’ in the hospital organisation. SA embraces whether the ‘interpersonal context is ‘… autonomy-supportive when managers provide a meaningful rationale for doing the tasks, emphasize choice rather than control, and acknowledge employees’ feelings and perspective’ [15]. SA reflects employees’ perceptions of a positive and good leadership style. Based on this, SA refers to the relationship between employees and their direct leader and whether employees perceive this interpersonal context as encouraging, motivating and stimulating.
SA originally related to ideas within the domain of self-determination theory (SDT) [16]. Previous research has emphasized SDT as a highly relevant and appropriate framework when studying aspects associated with motivations in work contexts [17]. In SDT, there are two types of motivation, labelled (i) autonomous and (ii) controlled motivation. Autonomous motivation is an inner or self-determined driven type of motivation and means ‘that the person behaves with a full sense of volition and choice’ [15]. In contrast, controlled motivation is diametrical to autonomous motivation. It is an outer and non-self-determined type of motivation, meaning ‘that the person engages in an activity with an experience of pressure and control’ [15]. This study limits its focus to autonomous motivation. There are four reasons for this perspective when studying SA. First, and most fundamental, using SDT as a guiding theoretical framework, SA is closely associated with the autonomous motivation of a person [15, 18]. Second, in work contexts (which is the context of this study), autonomy is for many employees considered as desirable and a preferred aspect and something individuals often actively seek in their work role. In line with this, Amundsen states: ‘individuals who seek autonomy at work are often searching for inner motivational environments and situations that provide them the opportunity for self-determination, initiative and choice’ [19]. Third, autonomous motivation is described as the ‘highest quality of regulation’ [15] that is associated with positive outcomes. Fourth, SA is especially effective when individuals are performing complex tasks. ‘Complex tasks require creativity, deep processing of information, and information integration’ [20]. This latter aspect associated with SA is especially relevant considering the focus on IIB in this paper.
Internal market-oriented culture (IMOC)
The concept of IMOC is viewed as an ‘organisational culture purposely or intentionally directed toward employees in the organisation’ [3]. Specifically, in this study, IMOC as presented in Fig. 1 is viewed as an organisational culture resource. IMOC focuses on employees and whether there exists a culture of supportiveness within the hospital organisation. There are five reasons for focusing on a supportive organisational culture, here termed IMOC. First, culture has previously been viewed as an essential part of any organisation [4, 21], and as such, a supportive organisational culture, emphasizes values that are internal and employee focused [3, 22, 23]. Second, organisational culture is a key factor in better understanding and sustaining ‘the observable norm-based behaviour that constitutes organisational culture’ [8]. Third, managing organisational culture in health organisations, especially IMOC, is perceived as an indispensable part of health system reform [21]. Fourth, organisational culture has been linked to better performance and termed a powerful determinant for long-term organisational success [21]. This is due to its ‘ability to create a sense of identity and rules’ [21], aiding organisations, especially health organisations, in achieving their goals. Fifth, hospital employees’ knowledge about their organisational culture is an effective coping mechanism in this current fast-changing environment because knowledge can offer insights and solutions to problems health organisations are facing today [22].
Previous studies show that health organisations that focus on their organisational culture have resulted in positive outcomes, such as overall quality improvement and positive employee behaviours and attitudes [22, 24]. In addition, previous studies focusing on IMOC among frontline employees in health care found that IMOC has a positive influence on employees’ overall job satisfaction [3] and employee engagement [8]. As such, previous research has proposed organisational culture as vital in health organisations [8, 22]. Supportive organisational culture relates to tangible and visible characteristics of organisational culture. In this study, IMOC reflects hospital employees’ experience, beliefs and expectations regarding their organisational culture. As such, IMOC focuses on the relationship between the organisation and its employees, and whether employees identify the overall conditions of their organisation as motivating, inspiring and encouraging.
Theoretical relationships between concepts
As presented in Fig. 1, SA is assumed to have a direct impact on IIB. Previous research has shown that SA is associated with different types of positive outcomes, including job performance [20, 35]. For example, in a study by Kanat-Maymon and Reizer [20], the authors found that supervisors’ autonomy-supportive managerial style was, among other factors, positively associated with job performance in a sample of sports analysts [20]. Similarly, in a study undertaken in a healthcare setting, Gillet et al. [35] found that supervisor autonomy support was indirectly related to nurses’ job performance. Gillet et al. [35] defined job performance as nurses’ perception of their team’s quality of work. In this study, job performance refers to employees’ IIB. IIB embraces both (implicitly) a person’s cognition (that is to think or be creative) as well as the explicit manifestation of a person’s behaviour (that is to actually try out new ideas in practice).
IIB is demanding and can be characterized as a complex task to perform. Previous research suggests that a necessary foundation to deal with such complex tasks is autonomy. Maymon and Reizer state ‘complex tasks … tend to require a higher degree of … autonomy’ [20]. SA is, based on SDT, ‘posited to facilitate the needs for autonomy’ [15]. Based on this, it is assumed that when employees experience SA from their direct leader this should lead to a positive increase in employees’ IIB. Research has yet to examine this linkage in a healthcare context. However, previous research supports a positive linkage between SA and employees’ creative performance [36]. Furthermore, there is empirical evidence that autonomy of employees is associated with characteristics such as innovative behaviour [37], creative work involvement [38], creative self-efficacy and innovative activities [39]. Furthermore, a linkage between SA and IIB is also supported in the LMX (leader–member–exchange) theory. LMX theory builds on social exchange theory [40, 41]. According to LMX theory, a leader has a unique relationship with each member of the organisation [38]. A high-quality relationship between leaders and members in an organisation is suggested to have several positive outcomes, such as improved job performance. Consequently, based on LMX theory, when employees perceive the existence of a high-quality relationship of SA from their direct leader, it is reasonable to assume that this constitutes a necessary foundation and, moreover, functions as a promoting factor that positively increases employees’ IIB in organisations. Naturally, there is probably a variation in employees’ perception of SA, ranging from low to high. However, in this study it is expected that the more a direct leader provides SA to employees the more it positively increases employees’ IIB. Formally this relationship is stated in this hypothesis:
Hypothesis 1: SA is positively related to employees’ IIB
As proposed in Fig. 1, this study proposes a linkage that is made up of two sub-steps that together constitute an interconnected chain. The first step in the chain suggests a direct relationship between SA and OA. This proposes that employees’ perception of leadership style (referring to SA) is associated with employees’ attitude towards the attractiveness of the organisation that employs them. However, this specific relationship is yet to be explored, and the literature provides empirical evidence and documentation that leadership style and how the leadership role is performed are strongly associated with the employees’ perception of their organisation. For example, previous research within healthcare has revealed that the performance of management tasks and leadership style are significantly linked to the employees’ attitudes. The attitudes of employees are reflected in such as their level of job satisfaction [5], work engagement [42], turnover intentions [43] and a range of other work- and organisation-related factors. In this study, employees’ perception of OA is defined as an attitude. Consequently, the ‘list’ of types of employee attitudes influenced by leadership in organisations should also include OA. Therefore, there are good reasons to assume a direct relationship between SA and OA. This is formulated by this hypothesis:
Hypothesis 2: SA is positively related to OA
As mentioned above, the first sub-step is proposed as the relationship between SA and OA. When this first step of linkages is established (referring to SA–OA linkage) this should lead to the second step of linkage, which is between OA and IIB. As such, this study also suggests, as presented in Fig. 1, that the relationship between SA and IIB is mediated through OA. This relationship represents an additional and complementary ‘route’ of how SA promotes IIB to what was proposed in the first hypothesis. According to Reeve, SA of leaders is ‘a coherent cluster of supervisory behaviours that collectively create that interpersonal tone of support and understanding’ [44]. Consequently, when employees perceive the SA of the leader as favourable and positive, this should strengthen employees’ attitudes towards the attractiveness of the organisation that employs them. This positive attitude of employees regarding SA could be manifested in OA expressions such as: ‘this is a great place to work’ or this is a ‘great employer’. Similar to the relationship between SA and OA, no previous research has examined the specific association between OA and IIB as a type of job performance. However, the literature supports OA to be linked to the employee’s job performance. For example, in a study undertaken in healthcare settings, Slåtten et al. [8] found that OA was positively significantly associated with job performance. Job performance was in this study reflected in the level of service quality provided to hospital patients and employees’ work engagement [8]. Moreover, Fortune 100 Best Companies to Work For also suggests there should be a linkage between OA and job performance, stating: ‘employees who say they have a great place to work (or what this study labels as OA) were four times more likely to say they’re willing to give extra to get the job done’ [45]. Social cognitive theory (SCT) also provides theoretical underpinnings to assume an association between OA and IIB. SCT suggests that ‘… beliefs and motivations are formed on valuable judgments’ [46]. Based on this assumption from SCT there are good reasons to expect that when employees judge OA more positively it should strengthen employees’ motivation to perform IIB. The discussion above suggests OA is functioning as a common link or a mediator between SA and IIB. Specifically, it means when employees perceive SA of leaders more positively this should lead to more positive attitudes towards OA of employees. Next, when OA increases, this should strengthen employees’ motivation to make more use of their capability to experiment with novel ideas and to find creative solutions when performing their work role thus causing a positive increase in IIB of employees. This chain of linkages can formally be stated in this hypothesis:
Hypothesis 3: OA mediates the relationship between SA and employees’ IIB
Figure 1 also suggests that IMOC has a direct impact on SA. Simultaneously, SA is assumed to function as a mediator between IMOC and both OA and IIB. The idea for both these relationships assumes that there must be some fundamental premises in place that are capable of cultivating and promoting SA that simultaneously in the next round are capable to have an impact on both the perception of OA and employees’ level of IIB. This ‘engine’ or must-be-factor that triggers and initiates this ‘domino effect’ is suggested to be IMOC. IMOC is, as also mentioned in the previous discussion, defined and described in terms of being a type of organisational culture. Previous research has well documented and emphasized the fundamental importance and role of organisational culture in organisations. Organisational culture is said to ‘pervade all aspects of organisational life’ [4]. When focusing on culture in organisation one looks at ‘more fundamental characteristics of organisation’ [47]. The importance of organisational culture lies in its proposition as a ‘critical first step towards creating a satisfactory work environment’ [4]. For example, organisational culture ‘provides the rules for behaviour within organisations’ [5]. These ‘rules’, stemming from organisational culture, are transferred to all organisational members. The transmission is not limited to only include employees. It also embraces the managers and leaders of the organisation and function as guiding principles of what is appropriate behaviour and how to practise their work role as managers or leaders. There is a linkage between organisational culture and leadership behaviour. As Banaszak-Holl et al. stated: ‘organisational culture provides a key mechanism by which top management integrate managerial actions’ [4]. Previous research supports well a positive association between organisational culture and leadership behaviour. This positive relationship is also found in healthcare research [5, 48]. Consequently, parallel to findings in previous research, there are good reasons to expect organisational culture in this study to represent the concept of IMOC, to be positively associated with the SA of leaders. This leads to the following hypothesis:
Hypothesis 4: IMOC is positively related to SA
As mentioned in the discussion above, IMOC in an organisation provides directions and behavioural codes of conduct for the SA of organisations’ leaders. Consequently, when IMOC positively increases the level of SA of leaders, this should also next lead to a positive increase both in employees’ perception of OA and employees’ IIB in an organisation. Specifically, in this study, it is expected that the stronger the existence of IMOC in an organisation is, the more positively it drives SA of leaders and in the next round both OA and IIB of employees. Accordingly, IMOC functions as an initial promoting factor to employees’ perception of OA and level of IIB that works through the mechanism encompassed by leaders’ SA. Consequently, it is expected that SA has a mediating role between IMOC and both OA and IIB. Based on the aforementioned discussion, the following two hypotheses are proposed:
Hypothesis 5: SA mediates the relationship between IMOC and OA
Hypothesis 6: SA mediates the relationship between IMOC and employees’ IIB
According to Fig. 1, IMOC is assumed to have a direct impact on IIB. Previous research has indicated that in health organisations where there is a supportive organisational culture, which is directed towards employees, it can potentially be a source of competitive advantage [49]. Scott et al. [50] argued that ‘structural changes alone do not deliver anticipated improvements in quality and performance in health care’. Consequently, organisational culture should play a key to improvements in quality and performance for health organisations. For example, Hogan and Coote [51] explored the role of organisational culture in professional service firms and found the organisational culture to be a key variable in fostering IIB at work. Similarly, Homburg and Pflesser [47] found the organisational culture to be directly related to the performance of employees. In this study, performance refers to employees’ IIB, which encompasses both the production of novel ideas and the implementation of those novel ideas in a specific work role. Consequently, there are good reasons to assume that an organisational culture that supports new ideas or new ways of accomplishing a work task have the potential to foster employees’ IIB directly. On the basis of this the following hypothesis is suggested:
Hypothesis 7: IMOC is positively related to employees’ IIB
Furthermore, it is also assumed that the relationship between IMOC and IIB is mediated through OA. As seen in Fig. 1, such a relationship represents an indirect and supplementary route of linkages of how IMOC promotes IIB compared with what was proposed in the previous hypothesis (referring to Hypothesis 7). There are two sub-steps that in common constitute this interconnected chain of linkage. The first step assumes that IMOC is having a direct impact on OA. As mentioned in the previous discussion, the concept of OA refers to employees’ attitude and whether employees perceive the hospital organisation as an attractive organisation to be employed in. It is reasonable to assume that organisational culture, in this study reflected in IMOC, is having a significant impact on employees’ perception of OA. According to Leekha and Sharma, organisational culture is one of the most preferred organisational attributes [52]. Previous research supports well that employee perception of organisational culture is related to employees’ attitudes [5, 22, 53, 54]. A previous study using the concept of IMOC in a healthcare setting has shown that IMOC is directly linked to hospital employees’ perception of OA [8] as well as to employees’ satisfaction [3]. Consequently, in line with previous research on the impact of organisational culture, and especially those using the IMOC construct, there are good reasons to expect that IMOC is related to OA. This leads to the following hypothesis:
Hypothesis 8: IMOC is positively related to OA
Furthermore, and this leads to the second step of linkage between IMOC, OA and IIB, when employees perceive the organisation as attractive, stemming from IMOC, it is also reasonable to assume that this positive attitude (embraced in OA) next will motivate and engage employees to devote both more time and use more mental or physical capacity and generally be more willing to work in such a way that it benefits the interest of their hospital organisation. This idea and reasoning about logic are analogous to what was suggested in Hypothesis 3 regarding the impact of SA on OA and IIB. Specifically, based on SCT [46] IMOC (similar to SA) is capable of positively driving employees’ perception of OA and next strengthen employees’ motivation to perform IIB. To the authors’ knowledge, no previous research has examined this exact relationship in health services research. However, previous research undertaken in hospital settings has identified OA as a mediator between IMOC and aspects of work-role performance such as employee engagement and service quality provision [8]. Consequently, in line with this research, it is assumed that OA is functioning as a mediator between IMOC and IIB. This leads to the following final hypothesis:
Hypothesis 9: OA mediates the relationship between IMOC and employees’ IIB
All the suggested hypotheses guiding this study are summarized in Table 1.
Table 1
Hypotheses leading this study
Hypothesized relationships
|
H1
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SA is positively related to employees’ IIB
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H2
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SA is positively related to OA
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H3
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OA mediates the relationship between SA and employees’ IIB
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H4
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IMOC is positively related to SA
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H5
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SA mediates the relationship between IMOC and OA
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H6
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SA mediates the relationship between IMOC and employees’ IIB
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H7
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IMOC is positively related to employees’ IIB
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H8
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IMOC is positively related to OA
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H9
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OA mediates the relationship between IMOC and employees’ IIB
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Note: SA Support for Autonomy, IIB Individual Innovative Behavior, OA Organizational Attractiveness, IMOC Internal Market-Oriented Culture |