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Organisational Commitment, Work Values, and Engagement of Clinical Staff for Quality Care Professor Gary E Day Professor of Health Services Management Pretext Committed staff working in organisations with strong, positive cultures provides


  1. Organisational Commitment, Work Values, and Engagement of Clinical Staff for Quality Care Professor Gary E Day Professor of Health Services Management

  2. Pretext Committed staff working in organisations with strong, positive cultures provides the best opportunity to deliver safe, quality patient care. This workshop will outline the range of organisational, professional and personal factors that can impact upon clinical staff’s ability to provide quality care. The workshop will discuss practical approaches to increasing clinical staff engagement and commitment to promote safe, quality healthcare delivery.

  3. What the research tell us Work values were positively related to job involvement and organizational commitment, and job involvement is positively related to organizational commitment. Subsequent analyses revealed that job involvement could play an important role in mediation, and that establishing a higher level of job involvement may be more important than focusing only on organizational commitment. (Ho, Oldenburg, Day and Sun, 2012)

  4. “There is no such thing as a dysfunctional organisation, because every organisation is perfectly aligned to achieve the results it gets” Jeff Lawrence

  5. As a healthcare organisation, where should our focus lay? Patient (or client) or staff?

  6. Balancing Organisational Results and Employee Engagement  Building Trust  Mastering Conflict  Achieving Commitment  Embracing Accountability  Focusing on Results (Lencioni, P. 2005)

  7. What is the culture like in your current work place?

  8. What sort of culture do you have? Is culture that important anyway? Cultures of Blame, Reaction, Consolidation, Ambition and Success (Best Practice Australia and New Zealand)

  9. Organisational values and the link to culture The importance of value congruence in building and sustaining a healthy organisational culture is confirmed by the evidence presented in the Bundaberg Hospital Inquiry. The presence of strong individual values among staff and strong espoused values in line with community expectations and backed up by legislation and ethics regimes were not, in themselves, sufficient to ensure a healthy organisational culture and prevent unethical, and possibly illegal behavior. (Casali & Day, 2010)

  10. Embedding Culture, Morale and Commitment No matter what you do (or don ’ t do)....you have an impact on morale and culture  Team norms / values  Hire by the values, hold to account according to the values, dismiss by the values  Team ritual / celebration

  11. Why understand morale? Literature points to a litany of problems when staff have poor morale:  Retention and recruitment problems  Increased absenteeism  Increased incidents and accidents, including needlestick injuries  Increased adverse outcomes  Reduction in quality of care  All of these issues cost organisations $$$

  12. Organisational Morale • Respondents who reported higher levels of:  Team interaction  Patient care provision -were more likely to have higher organisational morale  Respondents who reported lower personal morale were more likely to perceive lower organisational morale

  13. Personal Morale • Respondents who reported higher levels of:  Team interaction  Consultation  Professional recognition  and reported lower levels of:  Abuse from patients -were more likely to have higher personal morale  Respondents who reported lower organisational morale were more likely to perceive they had lower personal morale. (Day, Minichiello and Madison, 2007)

  14. Personal Morale (cont) For those respondents that indicated their ability to cope was at maintenance level , their odds were 10 fold more likely to have positive personal morale than those that worked at survival level For those respondents that indicated their ability to cope was at enhanced level , their odds were 5 fold more likely to have positive personal morale than those that worked at survival level (Day, Minichiello and Madison, 2007)

  15. Link between staff morale, organisational commitment and work climate or culture And there is also a link between organisational culture and change

  16. Unless managers define new terms and persuade employees to accept them, it is unrealistic for managers to buy into changes that alter the status quo. Strebel, P. (1996) Why do Employees Resist Change?, Harvard Business Review , May-June, pp. 86-92

  17. What are the organisational costs?  Organisational goals / outcomes  Time and cost blowouts  Non completion  Slippage  Staff instability / poor morale  Poor employee health and early exit from the labour market (Vathera & Virtanen, 2013),  Increased sick days (Hansson, Vingard, Arnetz, & Anderzen, 2008),  Significant increase in staff receiving stress-related medication in organisations that change, particularly broad simultaneous change along several dimension (Dahl, 2011), and  Adverse sleep patterns, minor psychiatric morbidity, increase in blood pressure, increased ischaemia, increase in body mass index (Ferrie, Shipley, Marmot, Stansfeld, & Smith, 1998).

  18. What are the organisational costs? More importantly: Poorly managed change can have negative patient outcomes, including increased length of stay and mortality rates (Timmers, Hulstaert & Leenen, 2014).

  19. Gaining Trust and Getting the Best out of People  Involvement  Be clear about what is negotiable  Leadership is about influence, Influence is about relationships  Lead everyone differently

  20. Getting Stakeholder Buy-In  Engagement and feedback  Real consultation  Be realistic about what you can promise

  21. Embedding Culture, Morale and Commitment No matter what you do (or don ’ t do)....you have an impact on morale and culture

  22. Embedding Culture, Morale and Commitment  Team norms / values  Hire by the values, hold to account according to the values, fire by the values  Team ritual / celebration

  23. What is needed is Change and Transition Change is external (policy, practice, structure) Transition is internal (psychological reorientation before change can work) Bridges, W. and Bridges, S. (2000) Leading Transition: A new Model for Change, Leader to Leader, 16, Spring.

  24. 26 Organisations of the Future  Persistent sense of urgency  Teamwork at the top  People who can create and communicate vision  Broad-based empowerment  Delegated management for excellent short-term performance  No unnecessary interdependence  An adaptive corporate culture (Kotter, J.P. 1996, Leading Change. Harvard Business School Press, Boston.)

  25. Professor Gary E Day E-mail: g.day@griffith.edu.au Twitter: @GaryDay64

  26. References  Casali & Day (2010) Treating an Unhealthy Organisational Culture: Implications for the Bundaberg Hospital Inquiry for Managerial Decision Making, Australian Health Review, 34, p73-92.  Dahl, M.S. (2010) Organisational Change and Employee Stress. Available from: http://www.wiwi.uni-jena.de/eic/files/WS%2010%20JERS%20Dahl.pdf  Day, G.E., Minichiello, V. and Madison, J. (2007) Nursing morale: predictive variables among a sample of registered nurses in Australia, Journal of Nursing Management, 15 (3), 274-284.  Day, G.E., Minichielle, V. and Madison, J. (2007) Self ‐ reported perceptions of Registered Nurses working in Australian hospitals, Journal of Nursing Management, 15(4), 403-413.  Ferrie, J.E., Shipley, M.J., Stansfeld, S.A. and Marmot, M.G. (2002) Effects of chronic job insecurity and change in job security on self reported health, minor psychiatric morbidity, physiological measures, and health related behaviours in British civil servants: the Whitehall II study. Journal of Epidemiology and Community Health, 56, 450-454.  Hansson, A.-S., Vingaard, E., Arnetz, B., & Anderzen, I. (2008). Organizational change, health, and sick leave among health care employees: A longitudinal study measuring stress markers, individual, and work site factors. Work & Stress, 22(1), 69 ฀ 80.  Ho, C-C., Oldenburg, B., Day, G.E. and Sun, J. (2012). Work Values, Job Involvement, and Organizational Commitment in Taiwanese Nurses. International Journal of Psychology and Behavioral Sciences, 2(3), 64-70.  Kotter, J.P. (1996) Leading Change. Harvard Business School Press, Boston  Lencioni, P. (2005) Overcoming the Five Dysfunctions of a Team, Jossey-Bass  Scholtes, P. (1988) The Team Handbook, Joiner  Strebel, P. (1996) Why do Employees Resist Change?, Harvard Business Review , May-June, pp. 86-92  Timmers, T.K., Hulstaert, P.F. and Leenen, L.P. (2014). Patient outcomes can be associated with organizational changes: a quality improvement case study. Critical Care Nursing Quarterly, 37(1), 125-134.

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