Physicians' professional autonomy and their organizational identification with their hospital.
Ontology highlight
ABSTRACT: Background
Managing medical professionals is challenging because professionals tend to adhere to a set of professional norms and enjoy autonomy from supervision. The aim of this paper is to study the interplay of physicians' professional identity, their organizational identity, and the role of professional autonomy in these processes of social identification.Methods
We test hypotheses generated according to social identity theory using a survey of physicians working in public hospitals in Italy in 2013.Results
Higher degrees of organizational and economic professional autonomy are correlated with higher organizational identification. Identification with the profession is positively correlated with identification with the organization.Conclusions
Although the generalizability of our results is limited, this study suggests that organizations should support the organizational and economic autonomy of their physicians to project an organizational identity that preserves the continuity of a doctor's self-concept and that is evaluated as positive by doctors. As a result, organizations will be able to foster organizational identification, which is potentially capable of inducing pro-social organizational behavior.
SUBMITTER: Salvatore D
PROVIDER: S-EPMC6186093 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:BACKGROUND: Belgian hospitals face a growing shortage of physicians and increasingly competitive market conditions. In this challenging environment hospitals are struggling to build effective hospital-physician relationships which are considered to be a critical determinant of organizational success. METHODS: Employed physicians of a University hospital were surveyed. Organizational attributes were identified through the literature and two focus groups. Variables were measured using validated questionnaires. Descriptive analyses and linear regression were used to test the model and relative importance analyses were performed. RESULTS: The selected attributes predict hospital attractiveness significantly (79.3%). The relative importance analysis revealed that hospital attractiveness is most strongly predicted by professional attributes (35.3%) and relational attributes (29.7%). In particular, professional development opportunities (18.8%), hospital prestige (16.5%), organizational support (17.2%) and leader support (9.3%) were found to be most important. Besides these non-economic aspects, the employed physicians indicated pay and financial benefits (7.4%) as a significant predictor of hospital attractiveness. Work-life balance and job security were not significantly related to hospital attractiveness. CONCLUSIONS: This study shows that initiatives aimed at strengthening physicians' positive perceptions of professional and relational aspects of practicing medicine in hospitals, while assuring satisfactory financial conditions, may offer useful avenues for increasing the level of perceived hospital attractiveness. Overall, hospitals are advised to use a differentiated approach to increase their attractiveness to physicians.
| S-EPMC4055796 | biostudies-other
Project description:ObjectivesNurses' autonomy is a complex and multi-dimensional concept that has often been overlooked. Although many studies have addressed patients' autonomy, there has been no assessment of nurses' experience of professional autonomy. The present study aimed to assess nurses' lived experiences of professional autonomy in Shiraz, Iran.MethodsThe present qualitative study was conducted in Shiraz (Iran) from January 2016 to February 2018. The target population was selected among nursing professionals employed by various hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The experiences of the participants were assessed through 14 in-depth semi-structured interviews. The response of the participants was analyzed using Van Manen's 6-step approach for interpretive phenomenology.ResultsBased on the analysis of the interviews, 4 themes, 11 categories, and 13 sub-categories were extracted. The themes were: Advocacy for patients and nurses, independence in the workplace, Involvement in professional decision-making, and Professional accountability.ConclusionDue to the intense interaction between nurses and patients, a better quality of care will be achieved if the professional autonomy of nurses is ensured. Healthcare authorities and hospital managers should provide the framework and permit the nurses to practically exercise full independence in the workplace.
| S-EPMC6722471 | biostudies-literature
Project description:Physicians in the United States are now less likely to practice in smaller, more traditional, solo practices, and more likely to practice in larger group practices. Though older theory predicts conflict between bureaucracy and professional autonomy, studies have shown that professions in general, and physicians in particular, have adapted to organizational constraints. However, much work remains in clarifying the nature of this relationship and how exactly physicians have adapted to various organizational settings. To this end, the present study examines physicians' autonomy experiences in different decision types between organization sizes. Specifically, I ask: In what kinds of decisions do doctors perceive autonomous control? How does this vary by organizational size? Using stacked "spell" data constructed from the Community Tracking Study (CTS) Physician Survey (1996-2005) (n = 16,519) I examine how physicians' perceptions of autonomy vary between solo/two physician practices, small group practices with three to ten physicians, and large practices with ten or more physicians, in two kinds of decisions: logistic-based and knowledge-based decisions. Capitalizing on the longitudinal nature of the data I estimate how changes in practice size are associated with perceptions of autonomy, accounting for previous reports of autonomy. I also test whether managed care involvement, practice ownership, and salaried employment help explain part of this relationship. I find that while physicians practicing in larger group practices reported lower levels of autonomy in logistic-based decisions, physicians in solo/two physician practices reported lower levels of autonomy in knowledge-based decisions. Managed care involvement and ownership explain some, but not all, of the associations. These findings suggest that professional adaptation to various organizational settings can lead to varying levels of perceived autonomy across different kinds of decisions.
| S-EPMC3898537 | biostudies-literature
Project description:BackgroundThe concept of organizational vision has been little explored in the health-care services research literature. To address this knowledge gap in the literature, the present study examines the factors that may promote organizational vision integration (OVI), which refers to the employees' use of organizational vision as a guiding framework in their work. The roles of organizational commitment (OC), leadership autonomy support (LAS), and organizational culture in relation to hospital employees' OVI are examined.MethodsHospital employees were surveyed. Partial least-squares structural equation modeling was performed using SmartPLS 3 software to test the proposed hypotheses statistically. A bootstrapping test was used to identify the mediating effects.ResultsThe main findings show that: (i) OC is the most powerful factor in promoting employees' OVI (β = 0.26), while organizational culture (represented by the concept of internal market-oriented culture) and LAS showed significantly less and almost equal impact (β = 0.16 and β = 0.15, respectively). In total, OC, organizational culture and LAS explain 25% of the variance in the concept of OVI. (ii) LAS and organizational culture both significantly contribute to employees' OC (β = 0.35 and β = 0.29, respectively) and in total explain nearly 40% (R2 = 0.38) of the variance in the concept of OC. (iii) The relationships between organizational culture, LAS, and OVI are mediated through OC, and (iv) LAS mediates the relationship between organizational culture and OVI, and that between organizational culture and OC.ConclusionsTo promote hospital employees' OVI effectively, hospital managers should focus particularly on their employees' OC. Specifically, they should strengthen their employees' OC through building a strong employee-focused organizational culture and ensuring that leaders practice LAS. This contributes to promoting hospital employees' OVI.
| S-EPMC8729017 | biostudies-literature
Project description:Although several studies have empirically supported the distinction between organizational identification (OI) and affective commitment (AC), there is still disagreement regarding how they are related. Precisely, little attention has been given to the direction of causality between these two constructs and as to why they have common antecedents and outcomes. This research was designed to fill these gaps. Using a cross-lagged panel design with two measurement times, Study 1 examined the directionality of the relationship between OI and AC, and showed that OI is positively related to temporal change in AC, confirming the antecedence of OI on AC. Using a cross-sectional design, Study 2 investigated the mediating role of OI in the relationship between three work experiences (i.e., perceived organizational support, leader-member exchange, and job autonomy) and AC, and found that OI partially mediates the influence of work experiences on AC. Finally, Study 3 examined longitudinally how OI and AC combine in the prediction of actual turnover, and showed that AC totally mediates the relationship between OI and turnover. Overall, these findings suggest that favorable work experiences operate via OI to increase employees' AC that, in turn, decreases employee turnover.
| S-EPMC4395289 | biostudies-literature
Project description:ImportanceAlthough misalignment of values between physicians and their organization is associated with increased risk of burnout, actionable organizational factors that contribute to perceived values alignment are poorly understood.ObjectiveTo evaluate the association between the leadership behaviors of immediate supervisors and physicians' perception of personal-organizational values alignment.Design, setting, and participantsThis survey study of faculty physicians and physician leaders at Stanford University School of Medicine was conducted from April 1 to May 13, 2019. The survey included assessments of perceived personal-organizational values alignment, professional fulfillment, and burnout. Physicians also evaluated the leadership behaviors of their immediate supervisor (eg, division chief) using a standardized assessment. Data analysis was performed from May to December 2020.Main outcomes and measuresAssociation between mean leadership behavior score (range, 0-10) of each supervisor and the mean personal-organizational values alignment scores (range, 0-12) for the physicians in their work unit.ResultsOf 1924 physicians eligible to participate, 1285 (67%) returned surveys. Among these, 651 (51%) were women and 729 (57%) were aged 40 years or older. Among the 117 physician leaders evaluated, 66 (56%) had their leadership behavior independently evaluated by at least 5 physicians and were included in analyses. The mean (SD) personal-organizational values alignment score on the 0 to 12 scale was 6.19 (3.21). As the proportion of work effort devoted to clinical care increased, values alignment scores decreased. Personal-organizational values alignment scores demonstrated an inverse correlation with burnout (r = -0.39; P < .001) and a positive correlation with professional fulfillment (r = 0.52; P < .001). The aggregate leader behavior score of the 66 leaders evaluated correlated with the mean values alignment score for physicians in their work unit (r = 0.53; P < .001). Aggregate leader behavior score was associated with 21.6% of the variation in personal-organizational values alignment scores between work units. After adjusting for age, gender, academic rank, work hours, physician-leader gender concordance, and time devoted to clinical care, each 1-point increase in leadership score of immediate supervisor was associated with a 0.56-point (95% CI, 0.46-0.66; P < .001) increase in personal-organizational values alignment score.Conclusions and relevanceThis survey study's results suggest that physicians experience their organization through the prism of their work unit leader. Organizational efforts to improve values alignment should attend to the development of first-line physician leaders.
| S-EPMC7873777 | biostudies-literature
Project description:BACKGROUND:In contrast to other countries, the appearance of locum physicians as independent contractors constitutes a rather new phenomenon in the German health care system and emerged out of a growing economization and shortage of medical staff in the hospital sector. Locums are a special type of self-employed professionals who are only temporally embedded in organisational contexts of hospitals, and this might have consequences for their professional practice. Therefore, questions arise regarding how locums perceive their ethical duties as medical professionals. METHODS:In this first qualitative study on German locum physicians, the locums' own perspective is complemented by the viewpoint of permanently employed physician colleagues. Eighteen semi-structured interviews were conducted in 2014 to explore the professional practice of locum physicians from both groups' perspectives with respect to doctor-patient-relationship, cooperation with colleagues and physicians' role in society. The data were analysed using qualitative content analysis, including a deductive application and an inductive development of codes. The results were related to key tenets of medical professionalism with respect to the question: how far do locums fulfil their ethical duties towards patients, colleagues and the society? RESULTS:The study indicates that although ethical requirements are met broadly, difficulties remain with respect to close doctor-patient contact and the sustainability of hiring locums as a remedy in times of staff shortage. CONCLUSIONS:Further qualitative and quantitative research on locum physicians' professional practice, including patient perspectives and economic health care system analyses, is needed to better understand the ethical impact of hiring independent contractors in the hospital sector.
| S-EPMC5941762 | biostudies-literature
Project description:To address women's underrepresentation in high-status positions, many organizations have committed to gender equality. But is women's professional success viewed less positively when organizations commit to women's advancement? Do equality commitments have positive effects on evaluations of successful men? We fielded a survey experiment with a national probability sample in Germany (N = 3229) that varied employees' gender and their organization's commitment to equality. Respondents read about a recently promoted employee and rated how decisive of a role they thought intelligence and effort played in getting the employee promoted from 1 "Not at all decisive" to 7 "Very decisive" and the fairness of the promotion from 1 "Very unfair" to 7 "Very fair." When organizations committed to women's advancement rather than uniform performance standards, people believed intelligence and effort were less decisive in women's promotions, but that intelligence was more decisive in men's promotions. People viewed women's promotions as least fair and men's as most fair in organizations committed to women's advancement. However, women's promotions were still viewed more positively than men's in all conditions and on all outcomes, suggesting people believed that organizations had double standards for success that required women to be smarter and work harder to be promoted, especially in organizations that did not make equality commitments.
| S-EPMC10982289 | biostudies-literature
Project description:BACKGROUND:Professional competency is a fundamental concept in nursing, which has a direct relationship with quality improvement of patient care and public health. Organizational commitment as a kind of affective attachment or sense of loyalty to the organization is an effective factor for professional competency. OBJECTIVE:This study was conducted to evaluate the nurses´ professional competency and their organizational commitment as well as the relationship between these two concepts. METHODS AND MATERIALS:This descriptive-analytic study was conducted at the hospitals affiliated with a University of Medical Sciences, in the southeast of Iran in 2016. The sample included 230 nurses who were selected using stratified random sampling. Data were gathered by three questionnaires including socio-demographic information, competency inventory for registered nurse (CIRN) and Allen Meyer's organizational commitment. RESULTS:Results showed that professional competency (Mean±SD: 2.82±0.53, range: 1.56-4.00) and organizational commitment (Mean±SD: 72.80±4.95, range: 58-81) of the nurses were at moderate levels. There was no statistically significant correlation between professional competency and organizational commitment (ρ = 0.02; p = 0.74). There were significant differences in professional competency based on marital status (p = 0.03) and work experience (p<0.001). CONCLUSION:The results highlighted that the nurses needed to be more competent and committed to their organizations. Developing professional competency and organizational commitment is vital, but not easy. This study suggests that human resource managers should pursue appropriate strategies to enhance the professional competency and organizational commitment of their nursing staff. It is necessary to conduct more comprehensive studies for exploring the status and gaps in the human resource management of healthcare in different cultures and contexts.
| S-EPMC5678726 | biostudies-literature
Project description:In 2013, Kenya transitioned into a devolved system of government with a central government and 47 semi-autonomous county governments. In this paper, we report early experiences of devolution in the Kenyan health sector, with a focus on public county hospitals. Specifically, we examine changes in hospital autonomy as a result of devolution, and how these have affected hospital functioning.We used a qualitative case study approach to examine the level of autonomy that hospitals had over key management functions and how this had affected hospital functioning in three county hospitals in coastal Kenya. We collected data by in-depth interviews of county health managers and hospital managers in the case study hospitals (n = 21). We adopted the framework proposed by Chawla et al (1995) to examine the autonomy that hospitals had over five management domains (strategic management, finance, procurement, human resource, and administration), and how these influenced hospital functioning.Devolution had resulted in a substantial reduction in the autonomy of county hospitals over the five key functions examined. This resulted in weakened hospital management and leadership, reduced community participation in hospital affairs, compromised quality of services, reduced motivation among hospital staff, non-alignment of county and hospital priorities, staff insubordination, and compromised quality of care.Increasing the autonomy of county hospitals in Kenya will improve their functioning. County governments should develop legislation that give hospitals greater control over resources and key management functions.
| S-EPMC5542634 | biostudies-other