Examining Climate in the Context of a Changing Healthcare System; The
particular Case of an Intellectual Disability Service Provider in Ireland
Dr Juliet Mac Mahon
Dr Sarah Mac Curtain
Dr Thomas Turner
Department of Personnel and Employment Relations
Kemmy Business School
University of Limerick
Ireland
Email: juliette.mcmahon@ul.ie
Abstract
Purpose: This paper details the results of a survey based project carried out in a large
non profit making organisation in Ireland providing services to people with
intellectual disability. The paper focuses on exploring some aspects of organisational
climate and factors affecting climate in the context of Ireland. It also seeks to explore
relationships between climate dimensions and employee outcomes. There is a dearth
of organisational behaviour research with respect to healthcare organisations in
Ireland in general in spite of the sector being one of the largest employment providers
in Ireland. Research into the working lives of people employed in intellectual
disability organisations is particularly scarce Looking specifically at the provision of
intellectual disability services; there are currently over 15500 people employed in this
area in Ireland providing care and services to over 22,000 people with intellectual
disability (National Federation of Voluntary Bodies 2009).
Currently the healthcare sector in Ireland is viewed as currently being in a state of
crisis. The paper seeks to make some contribution to addressing the knowledge gap
and perhaps provide the basis for further exploration and debate in the area with
respect to Irish organisations
Methodology The survey was commissioned by an organisation providing services to
people with intellectual disability A number of climate measures were developed
through discussion with employees and managers and also utilising measures
developed through available research (Patterson et al 2005, Hatton et al 2001, 1999,
Stone et al 2004). The survey population was 600 employees across all grades and
locations. A questionnaire was distributed which consisted of items using a five point
likert scale. Employees also had the opportunity to provide qualitative comments on
the organisation. The response rate was 49.5% in organisation Regression analysis
was used to explore the relationship between organisational climate measures and
employee outcomes. Qualitative comments were also utilised as it was felt they gave
depth and richness to the overall results. Results and findings: Our findings suggest
that organizational support, perceptions of organizational fairness and trust in
supervisory management are important dimensions of organizational climate in the
intellectual disability healthcare sector. Qualitative data supports these findings and
indicates that perceived changes or threats to service can have an impact on key
variables
Key Words: organisation climate; intellectual disability; climate measures; Voluntary
organisations; employee outcomes
Introduction and context
The issue of climate has become a focus of much research in the area of healthcare
internationally (Patterson 2005, Stone 2004, Gershon e al 2004) and more particularly
the climate-employee outome-patient outcome nexus is one which has attracted a lot
of attention (Hatton et al 2001,1999) with a recognition that these issues are
inexorably linked. This research is not reflected in the context of Ireland.
According to current figures from the Census of Ireland, there are 213,000 people
employed in Ireland in health and social services making this one of the largest
employment sectors in Ireland. Looking specifically at the provision of intellectual
disability services; there are currently over 15,500 people employed in this area in
Ireland providing care and services directly to over 22,000 people intellectual
disability and their families (National Federation of Voluntary Bodies 2006).
According to the 2006 Census of Ireland over 70,000 people are reported as having
learning or intellectual disability. There is a dearth of organisational behaviour
research with respect to the working lives of people employed in Irish healthcare
organisations in spite of the sector being one of the country’s largest employment
providers. Research of this nature on people working in the intellectual disability
sector is particularly scarce reference here
The health services sector has undergone many changes in recent years due to
government policy and wider contextual changes. Many health service providers are
funded directly by the state and are vulnerable to changes in government, government
policy and availability of public funds. Ireland’s spending on healthcare provision is
ranked low among OECD countries although nominal funding to health services has
increased substantially since the early 1990s (Nolan and Nolan 2004). The sector is
reported as ‘being under severe strain’ (Quinn 2006). This is reflected in the level of
employment in organisations providing a service for those with intellectual disability
which has reduced from 17,000 in 2006 to 15,500 in 2009 (NFVB 2009). However
the number of services users directly availing of the services of these organisations
has increased. There is increasing pressure on healthcare providers from the Irish
Health Service Executive (HSE) to improve efficiency and cost effectiveness. At the
same time patient advocacy groups are demanding higher quality of care and greater
accountability. There are inherent tensions in these developments particularly from a
service provision and an employment perspective. The situation is similar to the UK
and other countries (Barman 2007, Passey et al 2000, Sparks et al 2001, Kellock et al
1998). Brito et al (2001) and Ledwith (1999) assert that the emphasis seems to be on
increasing productivity and decreasing costs regardless of the satisfaction of workers
or clients - an observation that has resonance in the current Irish context.
Profile of employees working in the area of intellectual disability
There are a number of studies that examine the particular nature of the type of person
who gravitate towards work in the intellectual disability sector and the pronounced
effects that perceived negative changes can exert on these workers. Parry et al (2005)
discuss the high moral attachment of many workers in voluntary organisations (such
as those in the intellectual disability sector in Ireland) and the strong attachment they
have for the cause of the organisation. In the intellectual disability sector employees
have been found to display a strong orientation and loyalty to service users (Alatrista
and Arrowsmith 2003; Cunningham 1999; Schepers et al 2005). Such workers often
give the ethos discount (Lloyd 1993) i.e they are prepared to work for lower extrinsic
rewards in exchange for higher intrinsic rewards. However the flip side of this is that
such employees will be much more concerned with how the organisation goes about
its work and expect to be involved in decision making (Parry et al 2005:590,
Cunnigham 2000). Therefore any negative perceptions of these dimensions would
possibly have an adversetive effect on employee outcomes, as would changes
perceived to affect the lives of service users or interfere with the traditional values of
the organisation (Kellock et al, 2001). It is timely therefore to seek to explore the
relationships between climate, and employee outcomes in the sector and this theme
will be explored in the following paragraphs
Organisation Climate
Organisational climate is a concept that has received considerable attention in
healthcare and other research since the 1970’s (Anderson & West, 1998). It is
recognised in the literature that measuring climate can be problematic. The concept
remains ill defined (Field & Abelson, 1982) and issues of measurement are
exacerbated when the terms ‘climate’ and ‘culture’ are used interchangeably. (Burrell
96, Scott et al 2003). Climate however can be generally understood as a ‘surface’
manifestation of culture which reflects employees perceptions of organisation culture
(Schneider et al 1990 Gershon et al 2004) and it refers to the day-to-day practices in
the organisation, its policies and reward procedures, the “encapsulation of the
organisation’s true priorities” (Ahmed, 1998, p.31). Moran and Volkswein (1992)
provide a more comprehensive definition when they describe climate as:
“A relatively enduring characteristic of an organisation which distinguishes it from
other organisations: and (a) embodies members’ collective perceptions about their
organisation with respect to such dimensions as autonomy, trust, cohesiveness,
support, recognition, innovation and fairness; (b) is produced by member interaction
(c) serves as a basis for interpreting the situation; (d) reflects the prevalent norms
values and attitudes of the organizational culture; and (e) acts as a source of
influence for shaping behaviour” (p. 20).
This paper concerns itself solely with climate and measures of climate and utilises
measures as identified by relevant research (Gershon et al 2004, Scott et al 2003,
Patterson et al, Hatton et al 2001). While Anderson and West recognise that agreeing
upon a specific definition of climate as a general concept has proved elusive, they
argue that attempts to deconstruct the concept of climate into subdomains has helped
resolve this dilemma. For example Anderson & West, (1998) propose that
participation (e.g. involvement in decision making) and safety are important elements
of a climate for innovation while West and Richter (2007) highlight the importance of
a support climate where individuals feel free from threats and pressures. This study
draws on the Moran and Volkswein (1992)definition of climate and focuses on
perceptions of fairness, trust/safety, participation and involvement as important
domains of organisational climate in healthcare.
Organisational effects of climate
Empirical findings have found climate to exert a significant influence on
organisational performance, (Baer & Frese, 2003; Mudrack, 1989; Moss-Kanter,
1983) and important employee outcomes such as individual motivation (DeCotiis &
Summers, 1987), stress (Carter and West 1999, Rose et al 2000) turnover intent
(Hatton 1999, Aaron and Sawitzky 2006), and job satisfaction (Mathieu, Hoffman and
Farr, 1993). Furthermore there is a growing body of research in the area of healthcare
that suggest that organizational climate is associated with positive or negative patient
outcomes. Anderson, Hardy and West (1992) found climate to be associated with
innovation in patient care in their case study of the National Health Service in the UK.
A study conducted by Borrill et al (2000) of more than 500 NHS teams found that
innovative and participative climates were linked to effectiveness in delivering patient
care.
With respect to the intellectual disability area of healthcare- climate may have a
particular significance in the effective delivery of service to a particularly vulnerable
group- the service users. In this sector the importance of continuity and depth of
relationships between staff and service users cannot be over emphasised. It is
recognised that people with intellectual disability require from care givers a much
higher level of support and individual commitment than other people (Schalock et al
2002). Fisher (2004) for example highlights the critical importance of staff who are
familiar with the physical, emotional, and behavioural needs of the person. High
levels of staff turnover have long been recognized as a major problem in services for
people with intellectual disability (ID), (e.g.Aaron and Sawitzky 2006; Hatton et al
2001; Felce et al 1993; Fisher 2004) Turnover can have a particular effect the quality
of life of service users for whom continuity and familiarity are important components
of care. Because of the importance of employee commitment and continuity in the ID
sector, we explore the relationship between organisational climate and tenure intent
and commitment.
Recent developments in care initiatives aimed at improving quality of life of people
with intellectual disability such as ‘active support’ show that positive results are
contingent on a number of staff related factors (Jones et al 1999). Mansell et al (2007)
for instance have identified staff attitudes, clear management guidance, more frequent
supervision and team meetings, training and support for staff to help residents engage
in meaningful activity. Recent research (Rose and Rose 2005, Michie and Williams
2003, Hatton et al 2001, Hatton et al 1998, Borrell a et al, 1996 ) has shown that
aspects of climate such as perceptions of support/isolation, management style, job
overload can have an impact on outcomes for employees in terms of satisfaction,
stress and general distress, absenteeism and turnover- a recognised problem in the ID
sector which one is a recognised problem- all of which have a knock on effect on the
service provided to service users. Hatton et al (1999) highlight the higher than
average levels of staff stress and strain and lower levels of staff morale that permeate
the intellectual disability sector in the UK when compared to other healthcare sectors
and the consequent effect this has on important staff outcomes such as, increased
absenteeism and reduced performance.
Climate thus can have serious implications for service users in the sense that
demoralised/ stressed staff may not be able to provide the level of care required for
enhancing quality of life of service users. It is important therefore to also examine the
relationship between organisational climate and individual outcomes such as
satisfaction, stress and morale.
Methodology
By gathering data from a variety of different levels, we explore organizational
climate, in particular, employee perceptions of organizational support, perceptions of
safety/trust in colleagues, supervisory management and employee trust in senior
management. Outcome measures include important employee outcomes such as
employee stress, morale commitment and tenure intent. Data were collected from a
‘not for profit’ public sector organisation in the intellectual disability sector.
The organisation in question provides an integrated service for people with learning
and associated disabilities and employs over 600 people. Although the employees of
this organisation are paid employees, their work requires an extremely high level of
interaction and commitment to service users, which displays many elements of
volunteerism. The study was commissioned by the organisation through an appointed
committee including representatives of management, employees and trade unions.
A total of 600 questionnaires were distributed. Data were gathered from respondents
who worked in a number of different locations, at all levels and across a wide variety
of disciplines : administration (e.g. finance, HR, maintenance, transport, health and
safety), direct services (e.g. direct care staff in child support, autism, family support),
community disciplines (eg. Social work, psychology, physiotherapy, occupational
therapy), and senior management team. The response rate was 49.5%. Employees
were given the survey with a cover letter stressing confidentiality and a return
envelope addressed to the researchers. There was clear agreement between the
researchers and the organisation that the researchers would retain the data and would
provide no information to the organisation that would identify a particular individual.
The researchers also met with employees to assure them of confidentiality and to hear
any concerns they might have. The questionnaire consisted of items using a five point
Likert scale. Employees also had the opportunity to provide qualitative comments on
the organisation.
Measuring climate in the intellectual disability sector:
In measuring climate in general a key difficulty that itself is which measures to utilise
and which outcomes to examine. In addressing this there are many useful recent
studies which have collated and in some cases tested measures of climate and climate
outcomes in healthcare settings (Patterson et al 2005;Stone et al 2004; Gershon et al
2004; Michie and West 2004; Hatton et al 1999, 2001)
The dimensions eventually included in the organizational climate measures and
outcome measures reflect dimensions considered in general climate literature, health
care climate literature and particularly in the intellectual disability healthcare
literature most notably the work of Hatton et al and Rose and Rose 2005 and Rose
1999). We focus on the following dimensions of organizational climate:
organizational support, perceptions of trust in colleagues, supervisors and senior
management, employee involvement and perceptions of fairness.
Climate measures
Organisational safety: Four items were used to assess organizational safety (items
include: company x has supported me in times of need in the past; when things go
wrong, management will blame employees; I feel company X provides adequate
support to ensure my safety). Respondents were asked to rate on a four point Likert
scale (1 – strongly disagree, 2 – disagree, 3 agree, 4 – strongly agree). Cronbach
alpha: .82
Employee Involvement: Six items were used to measure employee perceptions of
their level of involvement in the company. Again, Respondents were asked to rate on
a four point Likert scale (1 – strongly disagree, 2 – disagree, 3 agree, 4 – strongly
agree) and items include I feel I have say in decisions that affect my work; It is
important to check with my supervisor before taking a decision; I have a say in how
my service is managed. Cronbach alpha: .84
Organizational Fairness: Five items were used to assess respondents’ perceptions of
organizational fairness. Items include the criteria used for gaining promotions are
clear to me; I believe the process for gaining promotions in company x is fair.
Cronbach’s alpha: .82
Safety/Trust in colleagues: Seven items adapted from Edmondson (1999) were used to
assess psychological safety/employee trust in supervisory management. Respondents
were asked to rate on a four point Likert scale (1 – strongly disagree, 2 – disagree, 3
agree, 4 – strongly agree) statements such as ‘If I make a mistake in my job, I am
comfortable reporting it to my colleagues’, ‘I feel I am able to bring up problems and
difficult issues when necessary with my colleagues’. This scale exhibited a
Cronbach’s alpha of .94
Safety/Trust in supervisory management: Seven items adapted from Edmondson
(1999) were used to assess psychological safety/employee trust in supervisory
management. Respondents were asked to rate on a four point Likert scale (1 –
strongly disagree, 2 – disagree, 3 agree, 4 – strongly agree) statements such as ‘If I
make a mistake in my job, I am comfortable reporting it to my supervisor’, ‘I feel I
am able to bring up problems and difficult issues when necessary with my
supervisor’. This scale exhibited a Cronbach’s alpha of 0.94
Safety/trust in senior management: The seven items adapted from Edmondson (1999)
were also used to assess employee trust in senior management. Respondents were
asked to rate on a four point Likert scale (1 – strongly disagree, 2 – disagree, 3 agree,
4 – strongly agree) statements such as ‘If I make a mistake in my job, I am
comfortable reporting it to senior management’, ‘I feel I am able to bring up problems
and difficult issues when necessary with senior management’. This scale exhibited a
Cronbach’s alpha of 0.93.
Outcome measures
Employee stress: Stress: Four items were used to measure employee stress.
Respondents were asked to rate on a four point Likert scale (1 – strongly disagree, 2 –
disagree, 3 agree, 4 – strongly agree) to statements such as ‘Sometimes I feel isolated
in my job’ and ‘I find myself worrying about work in my free time’. This scale
exhibited a Cronbach’s alpha of 0.69. why did we not use a validated scale
Employee commitment: We adapted Mowday, Steers & Porter’s (1979)
organizational commitment questionnaire (OCQ). Participants’ responses were
collected using a five-point Likert-type scale with “1 = Strongly Disagree” and “5 =
Strongly Agree” as anchors. Four items were used to measure employee commitment.
Employees were asked to rate statements such as ‘I really care about the future of my
organisation’ and ‘I am proud to tell others I work in this organisation’. This scale
exhibited a Cronbach’s alpha of 0.75. Data coding was done in such a way that a
higher score indicated a higher level of commitment.
Tenure Intent: We adapted Ramamoorthy and Flood’s (2002) tenure intent measure
using a four item scale including ‘I intend working with this organisation for the
foreseeable future and ‘I would turn a job down elsewhere with more pay in order to
stay with this organisation’. Respondents were asked to rate the items on a four point
Likert scale (1 – strongly disagree, 2 – disagree, 3 agree, 4 –strongly agree). This
scale exhibited a Cronbach’s alpha of 0.82. A higher score on this measure indicates a
greater propensity to stay with the organization.
Employee Morale: Six items were used to assess employee morale. These include the
fulfilment I get from working with service users has increased; the fulfilment I get
from working in western care has increased, overall general morale. Cronbach alpha:
.72
Employee satisfaction:
Eight items were used to assess employee satisfaction- including satisfaction with
physical working conditions, work life balance pay and benefits, work itself, security
of employment, communication.
Controls: We controlled for experience of challenging behaviour (How often have you
experienced challenging behaviour in the last three months 1- not occurred, 2 – rarely,
3 – occasionally, 4 – often, 5 – very often).
Descriptive Statistics
In order to place the results of the analysis of climate measures in an organisational
context an overview of the initial findings of respondents’ perceptions of the
organisation are briefly presented here
There were clear indications from the study that staff at Organisation x have a strong
emotional attachment to the organisation, what it has achieved, and the service it
continues to provide. Respondents were asked to identify what aspects of work were
very important to them in the organisation and 87% of respondents indicated that
supporting people with disability was very important to them with 78% indicating
overall job satisfaction and 60% indicating that the values of the organisation were
important to them 78% of respondents reported security of employment as very
important- and 58% reported pay and benefits as very important.
A number of questions relating to changes in work as perceived by the respondents
were asked. 60% of employees felt there had been an increase in a sense of ‘them and
us’ divide within the organisation. 77% felt that work had intensified. 60% felt that
overall morale had decreased in the organisation and 43% felt that the fulfilment they
got from working with service users was the same 58% of employees were
dissatisfied with the level of communication between senior management and
employees while a clear majority were satisfied with pay and benefits (86%) and job
security (83%). There were indications of low levels of trust in senior management
(65%), high levels of trust in colleagues and high levels of trust in supervisors 88%.
With respect to well being 50% of respondents felt that they were expected to do
much in a day. 46% of respondents indicated that they work issues do concern them in
their free time. 49% of employees reported feeling ‘isolated’ in the job and this rose
sharply for certain categories of employee- peaking in respect of those regularly
exposed to challenging behaviour in community based houses.
Mean scores, standard deviations and correlations for all measures are shown in Table
1. The correlations were all in the hypothesised directions and were not so strong as to
suggest that respondents were unable to discriminate between the constructs
(Christiansen, Lovejoy, Szynmanski & Lang, 1996).
Table 1: Means and Correlations for Main Study Variables
Mean
1
2
3
4
2.86
1
1.challenging
behaviour
2.56
-.31** 1
2.Org support
2.6
-.10
.60**
1
3.Org fairness
2.14
-.07
.60**
.52**
1
4.Employee involve
3.50
.12
.07
.11
.15*
5. PS colleagues
3.28
-.13
.39**
.39**
.38**
6.PS supervisor
2.37
-.18*
.68**
.51**
.61*
7.PS senior mgnt
2.91
.25**
-.39** -.32** -.25**
8.Stress inside
2.6
.33**
-.28** -.28** -.16**
9.Stress
3.41
.13
.50**
.54**
.41**
10.Commitment
2.84
-.17*
.30**
.32**
.33**
11.tenure intent
5
6
7
8
1
.47**
.21**
-.12
-.01
.09
.38
1
.41**
-.37**
-.28**
.33**
.26**
1
-28**
-.12
.42**
.32**
1
.53**
-.46*
-.34*
.39**
.47**
-.41*
-.37*
1.7
-.18*
.46**
.40**
.34**
.06
.28**
12 Morale
2.88
-.21** .60**
.61**
.48**
.10
.36**
13 satisfaction
Note***** Correlation is significant at the 0.001 level : Correlation is significant at
the 0.01 level. ,*: Correlation is significant at the 0.05level
Findings
Regression analysis was then employed to examine relationships between climate
variables and outcome measures Table 2 and Table 3 below portray the significant
relationships that emerged from the regression analysis.
Table 2: Regression Analyses testing direct influence of organizational climate on
potential consequences for the organisation and employee (n = 331)
_____________________________________________________________________
Outcome measures
Predictor
org commitment
tenure intent
lifestress
morale
Challenging beh
ns
ns
-.20** ns
ns
Org support
.31***
ns
-30**
.43***
Org fairness
.26***
ns
ns
ns
Empl involvement
ns
ns
ns
ns
Psychological safety ns
ns
ns
.
ns
colleagues
PS supervisor
ns
ns
-.30***
.20*
PS senior
ns
ns
ns
.ns
management
R
.61***
.45***
.54***
.71***
Adj R²
.33
.15
.25
.48
___________________________________________________________________
Table 3: Regression Analyses testing direct influence of organizational climate on
potential consequences for the organisation and employee (n = 331)
_____________________________________________________________________
Outcome Measures
Predictor
satisfaction
stress 2
(stress from work content)
Challenging beh
ns
ns
Org support
.34***
-.26**
Org fairness
.31***
ns
Empl involvement
ns
ns
Trust in colleagues
ns
ns
.
Trust in supervisor
ns
-.30***
.
Trust in senior
management
ns
ns
R
.71***
.55***
Adj R²
.48
.26
_______________________________________________________________
We predicted that organizational climate (support, trust/safety, involvement and
perceptions of organizational fairness would be positively associated with
organisational commitment, morale, satisfaction and tenure intent and negatively
associated with employee stress. As can be seen in Tables 2 and 3 this is partially
supported. Certain dimensions of organizational climate are significantly related with
all outcomes. Others are not significantly related to any of the above outcomes. As
can be seen in table 2 and 3 above organizational support is significantly related to all
outcome measures except tenure intent (positively associated with commitment,
morale and satisfaction and negatively associated with stress). Trust in supervision is
significantly associated with employee morale and stress and in the hypothesised
directions. Perceptions of organizational fairness were positively and significantly
associated with employee commitment and satisfaction. Trust in colleagues, senior
management and employee involvement were not significantly associated with any of
the outcome measures. While there are significant correlations between safety/trust in
senior management and employee involvement and all the outcome variables, these
relationships are no longer significant when enter into the model with other climate
variables. Safety/trust in colleagues was not significantly related to any of the
outcome variables.
The qualitative data
A large amount of qualitative data were also collected to supplement the quantitative
data. Whilst analysis of the quantitative data established the key variables associated
with aspects of climate, the qualitative data provided insights into the perceived or felt
effects of these key variables on the working lives of employees. The qualitative data
also highlighted the perceived effects of change to the organisation and employees
There was a large volume of feedback which indicated the high levels of commitment
of employees to the services. However this was tempered by feelings that things had
changed in a negative fashion
“I love my job and the service users but it feels so different from ten years ago.
I used to feel valued but not any more”
“Overall I love my job. The service users make it worthwhile – not
management. They have a no hands on approach so we feel isolated from
them”
I enjoy my work. I love my family of service users. I enjoy chatting, laughing
with and listening to them. They have taught me so much. *** has done so
much but please bring back the fun”
Far less happy place to be. At my place of work morale very low and worsening
It has so many good staff that make so much happen. I am proud to work with
them and know them. We need senior management who focus on service users
and staffs best interests and stop running the association as if it was a profit
making multinational. It is so sad
The relationship between contextual pressures, percieved changes and managerial
style was also highlighted as a factor by respondents
Demands have increased with no additional support/staff
I feel the focus of management has changed from the service user to the
business side of the association and this is reflected in the type of managers
that are being employed
The effects of changes driven by context was articulated by employees
The type of management in *** has changed from service user focus to a
business and budget focus. This has to be a factor in management but should
not be the sole focus.
I loved working in ** – it was a people’s organisation – now it has become a
huge business, its top heavy. The service users, the people we are here for are
forgotten to a certain extent. Business and caring for people needs to be gelled
together – senior management need to change its attitude, outlook and get
reconnected with the reason they are employed in ** – the service users
Feel that a very business like atmosphere has taken effect – not the best when
working with people. “ We want results and we want them now”,
For many staff changes in the structure had resulted in a sense of isolation and a
perception of lack of support from management
I think there should be more opportunities to meet and talk with colleagues in
services. When you work alone most of the time you can feel isolated and
stressed- just talking it out and comparing experiences could be helpful.
Across the service there was a high level of feedback indicating that trust was a
serious issue
Very low trust at present..staff insecure, worried about positions/contracts
There is very poor levels of trust between staff and senior management. This is
something that has developed in recent years
As a front line staff member I do not feel able to trust senior management.
There was also a strong indication that staff did not feel supported by senior
management
Lack of communication at management level causes huge problems for
workers on the ground.
I love working in the disability section and feel let down by ***. There are
never any opportunities to meet and discuss with management or even just to
chat and get to know them. I feel un valued and not respected. The job
extremely difficult and concerns are not listened
Higher management seem not to have any personal input i.e. visiting centres
and residences, these visits would boost morale and ensure they have hands
on experience of what is going on
Feedback on supervisory support was mixed with people indicating high to low levels
perceptions of support
Get no support from line manager, undermines my role…take staff for granted
I am very lucky to have a good relationship with my supervisor where we can
both be open and honest. However, some of my peers do not have this
relationship
There was evidence from both staff and supervisors that there was significant pressure
on the supervisory level of management
I do feel that pressure is put on my supervisor to make changes in my
workplace without regard to her or our opinions
Senior house parents should not be rostered like other staff as they are
constantly occupied with phone calls and office work. In a service with only
two staff this means that one person is left to do all the work and look after 5
service users of which 2 have difficult behaviour. Very draining and tiring
Most supervisors have too many people reporting to them and do not have
adequate time to spend on developing their staff
My manager has too much to deal with and she cannot see beyond the budget
or how to do things more practically
There was also evidence that managers themselves felt under increased pressure due
to changes :
My job has changed and I manage more than one service and due to high
levels of staffing need due to challenging behaviour I am regularly the fall guy
and end up working double shifts and days and nights. A lot of my time is
spent trying to cover rosters on a day-to-day basis. Due to high levels of s/l
and absenteeism also vacant posts
Workload is regularly increased for team managers to such an extent if I fall
behind I stay behind – I myself am seriously considering changing to a less
responsible job, less wages but benefits less stress, less imposing phone calls
to me outside of work. I often receive phone calls when off duty and before
7am and after 11pm.
Overall then the picture of organisation x from the qualitative data was one where
staff displayed a high level of emotional attachment to the organisation, what it has
achieved, and the service it continues to provide. There is also evidence that a strong
spirit of collegiality continues to exist within teams. However here are also very
strong indications from the data that staff perceive a low trust relationship between
senior management and employees and decreased morale particularly in respect of
frontline staff and a very definite ‘them and us’ culture has developed within the
organisation. Contextual changes were identified by many employees and managers
as a factor negatively affecting the climate of the organisation.
Discussion
Our findings suggest that organizational support, perceptions of organizational
fairness and safety/trust in supervisory management are important dimensions of
organizational climate in the intellectual disability sector. All three dimensions of
climate were significantly related to important employee outcomes such as morale,
satisfaction, commitment and employee stress. These findings support the climate and
healthcare literature and more specifically literature relating to the intellectual
disability sector (Patterson et al 2005, Gershon et al 2004, Scott et al 2003, Hatton et
al 1999).
Our findings also suggest that the level of safety/trust in supervisors has a significant
effect on employee well being on a daily basis. Safety/trust in one’s supervisor was
significantly related to employee stress and morale. This finding is consistent with
studies carried out by Purcell (2004), Connell et al, (2003) and Helliwell and Huang
(2005) suggesting that supervisors play a pivotal role in determining employee well
being and behaviour. It also supports Tan and Tan (2000) who argue that trust in
supervision is more likely to be related to proximal variables such as employee
attitudes and behaviours. Perceptions of fairness were also significantly related to
individual outcomes in this study, namely employee commitment and satisfaction.
This supports the organisational justice literature where perceptions of fairness and
justice affected attitudes and commitment levels towards the organisation (Masterson,
2001). Finally organisational support was found to be significantly related to all
outcome variables except tenure intent – this supports much of the healthcare
literature that highlights the importance of organisational support in terms of
employee wellbeing and commitment (Laschinger et al, 2000). The qualitative data
provide insight into the perceived effects of these variables on the working lives of
staff and the effect that contextual changes can exert. The descriptive and qualitative
data clearly indicated a decrease in morale and trust in senior management as well as
increases in work pressure, sense of isolation and a growing distance between staff
and senior management. There were indications from staff that the organisation was
moving towards a more budget driven, private sector type organisation and staff
expressed concerns for the service users in this regard.
When looking into the practical implications it is important to revisit the measures of
trust used. Psychological safety was a key component of these measures. These
include items measuring sense of safety in confiding, seeking advice and reporting
mistakes and perceptions of how individuals who make mistakes in the past have been
treated. In the health care sector these measures have a particular significance given
the nature of the work and the possible legal and other consequences of mistakes.
Other components of psychological safety such as sense of respect and support have
also been highlighted by Edmondson (1999) and Hatton (2001) as critical factors in
healthcare in general. A sense of support is specifically highlighted by Hatton (2001)
as crucial for staff working with challenging behaviour in the ID sector.
While the present study clearly confirms the findings of previous research there are a
number of inconsistencies. Tenure intent in particular did not emerge as significantly
associated with any of the climate dimensions in the regression analysis- and indeed
turnover in the organisation was very low. This is not surprising when the context of
the particular organisation is taken into consideration. There are few employment
opportunities or alternatives in the region and the nature of the work would be
considered quite specialised in the Irish context. Employee involvement did not
emerge as significant in the regression analysis which is surprising given the literature
regarding the importance traditionally placed by employees in this sector/type of work
in having a voice in how the organisation operates (Parry et al 2005, Cunnigham
2000, Kellock et al 2001). However it should be noted that involvement did emerge as
significantly correlated with the outcome variables in isolation (see Table 1) but this
variable is no longer significant in the presence of the other climate dimensions.
Therefore it may be slightly inaccurate to say it is not significant but it is fair to say
that other dimensions override its significance.
Conclusion
The findings suggest that the three most important dimensions of climate in this
organisation are organisational support, trust in supervision and perceptions of
organisational fairness and that all three dimensions of climate were significantly
related to important employee outcomes such as morale, satisfaction, commitment and
employee stress. This is supported by the large amount of qualitative feedback given
by the respondents. The qualitative data highlighted the perceived and felt effects of
these variables by individuals in the organisation and also highlighted the effect of
externally exerted pressures for change on the climate of the organisation. The
findings are not surprising given the particular nature of the work involved in such an
organisation- where employees are often faced with difficult demanding work and
challenging behaviour and may rely heavily on organisational and managerial
support.
There are obviously a number of limitations in a study such as this most obviously
that the results are based on a single site case study and there might be variations
across organisations in different locations within Ireland. Given the preliminary
nature of this study, further research needs to be conducted. We would advocate the
use of longitudinal designs in future studies as a limitation of this study is the cross
sectional nature of the data, thereby making causal predictions impossible. Another
limitation is common method variance as the data were gathered using self report
questionnaire. However recent work done by Wall et al (2004) suggest that subjective
measures are equally valid as objective measures. Spector (1994) has also defended
the
use
of
self-report
in
research.
Given
the
dearth
of
organisation
behaviour/employment relations and HR research on the healthcare sector in Ireland,
the study may provide a useful platform for further investigation. Such research
would be timely given the importance of this sector in terms of employment provision
in Ireland and indeed current debates (Quinn 2006) surrounding the quality of service
delivery in healthcare organisations
References
Ahmed, P.K. (1998). Culture and climate for innovation. European Journal of
Innovation Management, 1, 1, 30-43.
Alatrista, J and Arrowsmith J (2003) Managing employee commitment in the not-forprofit sector, Personnel Review Vol. 33 No. 5, 2004 pp. 536-548
Anderson, N.R., & West, M.A. (1998). Measuring climate for work group innovation;
development and validation of the team climate inventory. Journal of Organisational
Behaviour, 19, 3, 235-259.
Anderson, N.R., Hardy & West, M.A. (1992). Team climates for innovation,
MRC/ESRC, Social and Applied Psychology Unit, University of Sheffield, Memo
1430.
Baer, M., & Frese, M. (2003). Innovation is not enough: Climates for initiative and
psychological safety, process innovations, and firm performance. Journal of
Organisational Behaviour, 24, 45-69.
Barman, E. (2007), What is the Bottom Line for Nonprofit Organizations? A History
of Measurement in the British Voluntary Sector, Voluntas- international journal for
voluntary and non profit organisations Vol. 18, No.2 june 2007 pp101-115
Borrill, C., West, M.A., Shapiro, D. and Rees, A. (2000). Team working and
effectiveness in health care. British Journal of Health Care, 6, 8, 364-371.
Borrill C., Wall T. D., West M. A., Hardy G. E., Shapiro D. A., Carter A., Golya D.
A. & Haynes C. E. (1996), Mental Health of the Workforce in NHS Trusts: Phase 1
Final Report, Institute of Work Psychology, Sheffield.
Brito, P., Galin, P., and Novick, M. (2001) Labour Relations, Employment Conditions
and Participation in the Health Sector, Workshop on Global Health Workforce
Strategy, Annecy, France, 9-12 December 2000
Burrell, G. (1996) Normal Science, Paradigms, Metaphors, Discourses and
Genealogies of Analysis. In Handbook of Organization Studies, edited by S. Clegg,
C. Hardy, and W. Nord, pp. 642–58. London: Sage.
Carter, A. and West, M. (1999). Sharing the burden: Team work in health care
settings, In J. Firth-Cozens and R. Payne (eds), Stress in Health Professionals:
Psychological and organisational causes and interventions. Chicester: John Wilet &
Sons, pp 191-202.
Central Statistics office (2007) Census Reports 2006 Census, Dublin Central Statistics
office (www.cso.ie)
Christiansen, N.D., Lovejoy, M.C., Szymanski, J. and Lang, A. (1996), Evaluating the
structural validity of hierarchical models: An illustrative example using the social
problem-solving inventory, Educational and Psychological measurement, Vol 56 no
4, pp. 600-625.
Connell, J., Ferres, N. and Travaglione, T. (2003), “Engendering trust in managersubordinate relationships”, Personnel Review, Vol 32 No 5, pp. 569-587.
Cunningham, I (1999) Human Resource Management in the Voluntary Sector,
Challenges and Opportunities, Public Money and Management, April-June pp19-24
Cunningham, I (2000) Sweet charity! Managing employee commitment in the UK
voluntary sector, Employee Relations Vol 23, No. 3
DeCotiis, T.A., & Summers, T.P. (1987). A path analysis of a model of the
antecedents and consequences of organisational commitment. Human Relations, 40,
445-471.
Edmondson, A.C. (1999), Psychological safety and learning behaviour in work teams,
Administrative Science Quarterly, Vol.44, pp. 350-384.
Felce D, Lowe K, Beswick J. (1993) Staff turnover in ordinary housing services for
people with severe or profound mental handicaps. Journal of Intellectual Disability
Research, Apr; 37 ( Pt 2):143-52
Fisher, K. (2004) Nursing Care of Special Populations: Issues in Caring
for Elderly People With Mental Retardation, Nursing Forum Volume 39, No. 1,
January-March, 2004
Gershon, R.M., Stone, P.W., Bakken, S., Larson, E. (2004) Measurement of
Organisation Culture and Climate in Healthcare, Journal of Nursing Administration,
2004 Jan; Vol. 34 Issue 1 pp:33-40.
Helliwell, J.F. and Huang, H. (2005), “How’s the Job? Well being and social capital
in the workplace”, Paper presented at the Annual Meetings of the Canadian
Economics Association, May 27-29.
Hatton, C., Emerson, E., Rivers, M mason, H., Swarbrick, R, Mason, L Kiernan, C.,
reeves, D., and Alborz A., (2001) Factors Associated With Intended Staff Turnover
And Job Search Behaviour in Services for People with Intellectual Disability, Journal
of Intellectual Disability Research, Vol. 45 issue 3 pp 258-270
Hatton, C., Emerson, E., Rivers, M., Mason, H., Swarbrick, R., Kiernan, C., Reeves,
D., and Alborz A., (1999) Factors Associated With Job Stress and Work Satisfaction
in Services For People With Intellectual Disability, Journal of Intellectual Disability
Research, Volume 43 Issue 4, Page 253, August.
Hatton C., Rivers M., Mason H., Mason L., Kiernan C., Emerson E., Alborz A. &
Reeves D. (1999) Staff Stressors and Staff Outcomes in Services for Adults With
Intellectual Disabilities: The Staff Stressor Questionnaire. Research in Developmental
Disabilities 20, 269–85.
Hatton C., Rivers M., Mason H., Mason L., Emerson E.,
Kiernan C., Reeves D. & Alborz A. (1999) Organizational culture and staff outcomes
in services for people with intellectual disabilities. Journal of Intellectual
Disability Research 43, pp ; 206-218.
James, L., Demaree, R. & Wolf, G. (1993). An assessment of within group inter-rater
agreement. Journal of Applied Psychology, 78, 306-309.
James, L., Demaree, R. & Wolf, G. (1984). Estimating within-group interrater
agreement. Journal of Applied Psychology, 78, 306-310.
James, L. R., James, L. A., & Ashe, D. K. (1990). The meaning of organizations: the
role of cognition and values. In B. Schneider (Ed.), Organizational climate and
culture (pp. 40–129). San Francisco, CA: Jossey-Bass.
James, L. R., & Jones, A. P. (1974). Organizational climate: a review of theory and
research. Psychological Bulletin, 81, 1096–1112.
Jones, E., Perry, J., Lowe K., Felce D., Toogood S. , Dunstan F., Allen D., Pagler
J. (1999) Opportunity and the promotion of activity among adults with severe
intellectual disability living in community residences: the impact of training staff in
active support, Journal of Intellectual Disability Research 43 (3), 164–178.
Kellock Hay, G., Beattie, R.S., Livingstone, R. and Munro, P. (2001) Change, HRM
and the Voluntary Sector, Employee Relations, Vol. 23, No. 3, pp 240-245
Ledwith, F (1999) Policy Contradictions and Collaboration in Community Mental
Health Services in Britain, International Journal of Public Sector Management,
Vol. 12 No. 3, 1999, pp. 236-248.
Laschinger, H. and Finegan, J. (2000) Organisational trust and empowerment in
restructured healthcare settings: Effects on nurse commitment, Journal of Nursing
Administration, 30, 9, 413-425.
Lloyd T., (1993) The Charity Business, London, John Murray
Mansell, J., Beadle Brown, J., Whelton, B. Beckett, C., Hutchinson, A. ( 2007) Effect
of Service Structure and Organization on Staff Care Practices in Small Community
Homes for People with Intellectual Disabilities, Journal of Applied Research in
Intellectual Disabilities
Mathieu, JE, Hoffman, DA and Farr, JL (1993) Job perception – job satisfaction
relationships: an empirical comparison of three competing theories, Organizational
Behaviour and Human Decision Processes, 56, 370-387
Michie, S., and Williams, S., (2003), Reducing Work Related Psychological Ill Health
and Sickness Absence: a Systematic Literature Review, Occupational and
Environmental Medicine 2003; 60:3-9
Michie, S. and West, M. (2004), “Managing people and performance : An evidence
based framework applied to health service organizations”, International Journal of
Management Reviews, Vol 5/6 no2, pp. 91-111
Moran, E.T., & Volkswein, J.F. (1992). The cultural approach to the formation of
organisational climate. Human Relations, 45, 19-48.
Moss-Kanter, R. (1983). The Change Masters: Innovation for Productivity in the
American Corporation. New York: Simon & Schuster.
Mudrack, P.E. (1989). Group cohesiveness and productivity: A closer look. Human
Relations, 42, 771-786.
National federation
(www.fedvol.ie)
of
Voluntary Bodies
(2006)
Annual
Report,
Dublin
Nolan, B and Nolan, A., (2004) Ireland’s Healthcare System: Some Issues and
Challenges, Research Programme on "Health Services, Health Inequalities and Health
and Social Gain", Working Paper No. 14, ESRI, ISSC & University of Ulster, Dublin,
November
Parry, E., Kelliher, C, Mills, T., and Tyson, S. (2005) Comparing HRM in the
Voluntary and Public Sectors, Personnel Review, Volume 34, No. 5. Pp588-602
Passey, A., Hems, L, and Jas, P., (2000) The Voluntary Sector Almanac 2000, NCVO
Publications, London.
Patterson, M.G., West, M.A., Schackelton, V.J., Dawson, J.F., Lawthom, R., Maitlis,
S., Robinson, D.L., and Wallace, A., (2005) Validating the Organizational Climate
Measure: Links to Managerial Practices, Productivity and Innovation, Journal of
Organizational Behavior Vol 26, 379–408
Purcell, J. (2004), “The HRM-Performance link: Why, how and when does people
management impact on organizational performance?”, 12th Annual John Lovett
Memorial Lecture, University of Limerick.
Quinn, E. (2006) Managed Migration and the Labour Market: The Health Sector in
Ireland, Report prepared for the European Commission Directorate-General Justice,
Freedom and Security and published by the ESRI, Dublin, July 2006
Rose D, and Rose J., (2005) Staff in Services for People with Intellectual Disabilities:
the Impact of Stress on Attributions of Challenging Behaviour, Journal of Intellectual
Disability Research, volume 49 part 11., pp 827- 838 November 2005
Rose, J., Jones, C., and Elliott, J.L. (2000) Differences in Stress Levels Between
Managers and Direct Care Staff in Group Homes, Journal of Applied Research in
Intellectual Disabilities, Volume 13 issue 4.page 276 December
Rose J. (1999) Stress and Residential Staff who Work With People Who Have an
Intellectual Disability: A Factor Analytic Study. Journal of Intellectual Disability
Research 43, 268–78.
Schalock, R. L. Brown I., Brown, R. , Cummins R.A., Felce D., Matikka, L, Keith
K.D., and Parmenter T., (2002) Conceptualization, Measurement, and Application of
Quality of Life for Persons With Intellectual Disabilities: Report of an International
Panel of Experts. Mental retardation, Volume 40, No. 6, pp457-470, December 2002
Schneider, B. (1990). Organizational Climate and Culture. San Fransico: Jossey
Bass.
Shrout, P.E., & Fleiss, J.L. (1979). Intraclass correlations: Uses in assessing rater
reliability. Psychology Bulletin, 86, 420-428.
Scott T., Mannion R., Davies H., Marshall M., (2003), The quantitative
measurement of organizational culture in health care: a review of the available
instruments. (Methods). Health Services Research. June 2003 Vol. 38, Issue 3 p923957
Sparks K, Faragher, B., and Cooper, G.L. (2001), Well-Being and Occupational
Health in the 21st Century Workplace, Journal of Occupational and Organisational
Psychology 74, pp 489-509
Spector, P.E. (1994), Using Self-Report Questionnaires in OB Research: A Comment
on the Use of a Controversial Method”, Journal of Organizational Behavior, Vol. 15,
No. 5 , pp. 385-392
Stancliffe R.J., Harman A. D., Toogood S., McVilly K. R (2007) Australian
Implementation and Evaluation of Active Support Journal of Applied Research in
Intellectual Disabilities 20 (3), 211–227.
Stone P.W., Harrison M.I., Feldman P., Linzer M., Peng T., Doblin D., ScottCawiezel J., Warren N., Williams E.S. (2004) Organizational Climate of Staff
Working Conditions and Safety—An Integrative Model, NY. Columbia University
School of Nursing,
Tan, H.H. and Tan, C.S. (2000), “Toward the differentiation of trust in supervisor and
trust in organization”, Genetic, Social and General Psychology Monographs, Vol 126
no 2, pp. 241-260.
Verbeke, W., Volgering, M., & Hessels, M. (1998). Exploring the conceptual
expansion within the field of organisational behaviour: Organisational climate and
organisational culture. Journal of Management Studies, 35, 303-329.
Wall, T.D., Michie, J., Patterson, M., Wood, S.J., Sheehan, M., Clegg, C. and West,
M. (2004), On the validity of subjective measures of company performance,
Personnel Psychology, Vol 57, pp.95-118.
West, M. and Richter A. W., (2007) “Climates and Cultures For Innovation and
Creativity at Work” in J. Zhou and Shalley, C. (eds) Handbook of Organisational
Creativity , London, CRC Press