Examining Leaderships’ Role on Employees’ Motivation, Retention, and Organizational Performance in Healthcare Centres within Saudi Arabia
Literature Review
Leadership, Organizational Performance and Ability, Motivation, Opportunity (AMO) Model
Leadership is intricate in view of the fact that it is examined in diverse manners that involve dissimilar explanations (Naile & Selesho, 2014). It permits managers to influence employee behavior in the firm. Hence, motivated employees are considered as one of the vital and leading upshots of effective leadership. According to Gooraki, Noroozi, Marhamati and Behzadi (2013), leadership style is deemed as the widely discussed area in management, particularly in metropolitan healthcare centers, which has affected more than a few managers and employees.
Mccarthy, Covella, Kaifi & Corcoran (2017) analyzed the role of leadership in relation to employee retention. These researchers discussed the essential role that the association between employee and leaders act in affecting the imminent career decisions of an employee. In the domain of critical care unit in healthcare centres, Roy and Brunet (2005) examined the role of leadership in prevailing over employees’ turnover. For leaders within the healthcare units, employee turnover is a major problem because of the decreasing number of employees in Western states and an escalated necessity for serious care services as the people age. Leaders steering in the Intensive Care Unit (ICU) need to comprehend and tackle the matter of staff turnover as it is of key significance. As stated by Roy and Brunet (2005), considering this problem with a systematized and proof-based method that deals with collaboration and cooperation will not just enhance retention but will also play a great role to make such units a very competitive and enviable workplace.
Khan and Bukhari (2016) analyzed the influences of leadership style on the performance of healthcare centres based in Karachi, Pakistan. The main intention of the research was to investigate the impact of leadership characteristics and behavior on performance of healthcare centres. The results indicated that as compared to transformational leadership style, transactional leadership characteristic was more appropriate in stimulating and improving performance in hospitals.
The structure of AMO, stands for ability, motivation and opportunity, has been essentially acknowledged for elucidating the association flanked by human resource management and performance (Boxall & Purcell, 2003). As mentioned by Boselie (2010), Marín-García (2013) and Choi (2014), in accordance with this model, employees do well when they possess the capabilities, they possess enough motivation, and their work surroundings offer opportunities to take part. Based on AMO model, Kundu and Gahlawat (2018) scrutinized the varied performance results linked to the elements of high-performance work systems. For that, the researchers considered 204 organizations based in India and gathered primary data from 563 workers. They revealed that insights of employees concerning the applicability of ability-enriching, motivation-boosting, and opportunity-improving human resource practices bring about enhanced organization performance and greater affective commitment. The outcome further showed that affective commitment completely arbitrates the association of opportunity-improving HR practices with organization performance and partly arbitrates the associations of ability-enriching and motivation-boosting HR practices with the performance of an organization.
Impact of AMO on Employee Attitude and Employee Behavior
Three HRM elements that influence the level of an employee performance are motivation, ability and opportunity to take part. These HRM elements have an effect on high performance for both employees as well as firms and are essential to be examined. Guest, Michie, Sheehan and Conway (2000) conducted a survey that included two thousand workplaces and acquired the opinions of nearly 28 thousand employees. The results of the study revealed that there is a great relationship between HRM and employee attitudes together with the performance of an organization. Some pragmatic research studies, e.g. Gong, Law, Chang and Xin (2009); Takeuchi, Chen and Lepak (2009) have given verification for the statement that high-performance HR practices work directly via employee attitudes and behaviors, for instance, job satisfaction and affective commitment.
As stated by Boxall and Purcell (2003) and Nishii and Wright (2008), there is a great association between HR practices, employees’ attitude and behavior and their upshots. Hence, employees are positively organized when HR practices have a constructive influence on employees’ attitude and behavior. If an employee likes his or her tasks and responsibilities and is enthusiastic to put a great deal of energy in his/her work, then he/she does not want to leave the organization, which can be deemed as a positive employee effect.
Attitudes of employees are deemed as one of the significant proximal variables in the arbitrating phase of the HRM performance association (Almutawa, Muenjohn & Zhang, 2016). The researchers addressed organizational commitment, however attitude of employees is mostly outlined with regard to job satisfaction and organizational commitment. They targeted to examine the arbitrating influence of the AMO model on the association between HRM system and commitment of employees. The researchers analyzed that if employees realize that the HRM practices certainly influence their ability, motivation, and opportunity to take part, then such practices have an effect on affective commitment of employees. Further, Almutawa, Muenjohn and Zhang (2016) determined that there is a great constructive influence of observed AMO enrichment on the attitude of employees characterized by affective commitment. Pare and Tremblay (2007) believed that to forecast the behavior of employees, organizational commitment is deemed more constant as compared to job satisfaction.
Former pragmatic research studies have put forward a horde of attitudinal variables as forecasters of intention of nurses to leave comprising job satisfaction, work engagement, and organizational commitment (Galletta, Portoghese, & Battistelli, 2011; Carter & Tourangeau, 2012). Among medical practitioners, job satisfaction and optimism is a prevailing matter all over the world (Huby, Gerry, McKinstry, Porter, Shaw & Wrate, 2002). Raised doctor turnover is brought about by poor job satisfaction that undesirably influences healthcare job satisfaction. Thus, a healthcare leader can develop employees who are valuable, motivated and pleased by creating a background that stimulates job satisfaction.
Yusuf (2018) analyzed the influence of employee capability, ethos of hospital and leadership on job satisfaction by means of employee commitment. The execution of hospital ethos had given more emphasis on the nurses. Survey was carried out and it was found that there is a direct and indirect influence among variables of employee capability, ethos of hospital, and leadership as a result of the employee commitment.
For the recognition of elements of a High Performance Work System (HPWS), the AMO model is appropriate (Boselie and Paauwe 2004; Boxall and Purcell, 2008). So as to explain the association between HR practices and organization citizenship behavior (OCB), it is required to find a way to pinpoint the diverse elements of HR, and hence probably diverse influences of the HR system on OCB. According to Appelbaum, Bailey, Berg and Kalleberg (2000), on the capacity of employees that constructively arbitrates the association between HRM and organization performance, it is discretionary effort - the degree of effort individuals could give if they needed to, but over and above the least needed. Gong, Chang and Cheung (2010) researched the upshot of HPWS on OCB among managers. In order to explain this association, these researchers use social exchange theory. They got pragmatic proof to back the positive association between HPWS and OCB at group level.
With the intention of improving organizational performance and efficiency, several organizations are motivated to plan and implement High Performance Work Practices (HPWPs). Sarikwal and Gupta (2013) focused on IT industry. To make certain enhanced performance of particular employees and organizations, HPWPs may be initiated on individual basis or in arrays, referred to as ‘bundles’ of practices. To elucidate the HPWPs, Sarikwal and Gupta (2013) used AMO model and put forward that HPWPs improve the ability and skills of employees to carry out their work, motivating them to do extremely well and the opportunity to take part could bring about positive results for the firm. Sustainable employee performance is built by the contribution of these three elements. Sarikwal and Gupta (2013) scrutinized the influence of HPWP on OCB of the employees that comprises such specific behaviors that are over and above the responsibilities and is, as a result, discretionary and indirectly acknowledged by the official reward system, however they are valuable to the organization and play a great role with regard to performance and competitive advantage. The researchers, after analyzing the influence of HPWP on OCB of the employees, investigated its influence on turnover intentions among the employees. The results of the study revealed that the execution of HPWP in IT firms hold a great positive association with OCB of employees. Also, the association of HPWP and OCB with intention to leave is quite trivial.
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According to Banken (2010), HR practices targeted at strengthening ability of employees, motivation and opportunity to take part have a nontrivial negative influence on turnover intention. The results of the study indicated that employees have less intention to leave the firm if HR practices pointed at boosting their motivation and opportunity to take part. Previous researches also supported these results (De Lange, De Witte & Notelaers, 2008; Eddleston, 2008). Banken (2010) stated that the mentioned HR practices revolve around the motivation of employees and opportunity to take part and that is why there is negative influence of these HR practices on turnover intention. The motivation and participation of employees would be enhanced by considering these practices, however this would eventually bring about less turnover intentions. The upshots also accentuated that it is important for employers to develop their HR practices in a manner to upsurge the motivation and opportunity to take part amid their employees.
According to Bartram, Casimir, Djurkovic, Leggat, and Stanton (2012), HPWPs have a direct influence on the intention of nurses to leave, plus it also acts as mediator in the association flanked by emotional workforce and a state of emotional and physical tiredness triggered by an extended phase of stress and annoyance. HPWPs and intention of nurses to leave have been investigated by Gkorezis, Georgiou and Theodorou (2018) and they backed the role that HPWPs perform in lessening the intention of nurses to leave the hospital. With the intention of elucidating this association, the researchers revealed the arbitrating role of an emerging, albeit significant, undesirable attitude that is organizational cynicism. Gkorezis, Georgiou and Theodorou (2018) explained this association by representing that HPWPs are liable to improve cynical attitudes of nurses with regard to the hospital and, consequently, lessen their intention to leave. In other words, hospitals which do not carry out such modern practices activate organizational cynicism of nurses which, sequentially, increases their intention to leave.
Impact of Democratic Leadership Styles on the Relationship of AMO and Employee Attitude
Democratic leadership style has a tendency to enrich accountability, flexibility, and elevated morale that will give rise to enhanced performance of employees (Zervas and David 2013; Iheriohanma, Wokoma and Nwokorie 2014). In accordance with these researchers, democratic leadership style has a tendency to improve determination and motivation of employees plus cultivate recognition and retention of employees in a firm. It indicates that in democratic leadership, the employees experience contentment with the belief and confidence put in them which give them the certainty to build a great association, commonality, and elevated determination (Izidor & Iheriohanma, 2015).
With the aim of improving quality procedures in the domain of healthcare and nursing, a vital role is performed by leadership styles (Sfantou, Laliotis, Patelarou, Pistolla, Matalliotakis and Patelarou, 2017). As stated by Ata (2009), Molero, Cuadrado, Navas and Morales (2007) determined that in accordance with the team of nurses, democratic leadership style is considered as the most commonly used leadership style utilized by the lead nurses, after that transformational leadership style comes at number 2. However, autocratic leadership style is the one that is employed least commonly. On the work performance of health workforces at Federal Medical Centre, the influence of diverse leadership is investigated by Mawoli and Haruna (2013). The researchers identified that the leadership style that has a great influence on the work performance of health personnel is democratic leadership style; on the other hand, on the work performance of health workers, both autocratic as well as laissez-faire leadership styles have nontrivial influence.
Mayo clinic, established by Dr. William Mayo and his family, is a nonprofitmaking organization and offers most advanced and leading-edge healthcare research services all over the world. According to an article published by St. Thomas University (2014), the Mayo clinic does well by employing democratic leadership values. This hospital and its research facility appeals one of the most excellent intellectuals in the health discipline seeing that it gives them opportunities to work cooperatively amongst fellows on democratic groups. However, it has been analyzed that in the healthcare centre, the processes needed often require an autocratic leadership style, but Mayo clinic cannot turn out well without democratic leaders.
Dorgham and Al-Mahmoud (2013) carried out a research study amongst critical care nurses to analyze leadership styles and independence of making decisions in the field of medicine. These researchers employed an explanatory cross-sectional correlation research design. The research was carried out in the domain of Egypt and Saudi Arabia and the considered hospitals were Tanta Main University Hospital and King Fahd Hospital of the University (KFHU). The goal of the research was to evaluate influential leadership styles, level of independence to make verdicts amid critical care nurses and association flanked by leadership style and decision-making autonomy. Results of the study showed that in both the countries, most of the head nurses working in Intensive Care Units (ICUs) hold democratic and authoritarian leadership styles.
In both public and private schools based in Lahore, the influence of democratic and autocratic leadership style on job satisfaction has been investigated by Bhatti, Maitlo, Shaikh & Hashmi (2012). The researchers developed and endorsed a set of questionnaire in which 23 variables were included with the purpose of achieving their research objective. The type of entire questions was close-ended. The total gathered data was 205 and it was obtained from different teachers of both the schools. Considering the teachers from public and private schools that included both male and female teaching staff, the researchers targeted to determine the association flanked by leadership style and job satisfaction. Results revealed that there is a positive association between leadership style and job satisfaction. The researchers also analyzed that employees prefer to work in unrestricted environment where they can share and interchange their opinions. In addition, in case if something wrong happens, employees inform their leaders courageously and valiantly. Eventually, a feeling of ownership is created among the employees that boosts their job satisfaction.
Impact of Professional Identity on the Relationship Between AMO and Employee Attitude and on the Relationship Between Employee Attitude and Employee Behavior
Professional identity is a notion that has caught the attention of a number of organizations for enhanced understanding of the attitudes of employees and results associated with the work. According to Fagermoen (2010), it alludes to the attitudes, principles, understanding and expertise distributed within a professional unit and allied with the professional responsibilities carried out by them. Adam (2011) considered that it is an element of total identity of an individual and boosted by his or her position within the group, associations with others and the elucidations of experience. In the domain of healthcare, in general it is the professional self-perception of nurses concerning their nursing capabilities (Cowin, Maree, Rhonda & Herbert, 2008). It facilitates staff nurses to continue their job and occupation for extended period. Moola (2017) analyzed the progress of a professional identity as noticed by student nurses of Saudi Arabia. When revealed to clinical realisms, the professional identity of Saudi student nurses may possibly swing or even crumble. Primarily, a self-identity has to be integrated with novel prospects and altered within a social background to shape a professional identity.
The influence of professional identification on employee attitude with respect to his or her job (that is, job satisfaction and organizational commitment) has been scrutinized by Loi, Hang-yue and Foley (2004). The researchers also studied the regulating functions of gender and organizational period on these associations. In accordance with the results of the research study, it was exposed that (a) on both job satisfaction as well as organizational commitment, professional identification has a strong influence, (b) the association of professional identification with job satisfaction and organizational commitment is controlled by the gender, (c) organizational span controlled the association of professional identification with employee satisfaction with his/her job along with career satisfaction.
In addition, organizational commitment is considered as another job attitude relevant to professional identification. Loi, Hang-yue and Foley (2004) referred organizational commitment to the affective element under three-element commitment model which was offered by Allen and Meyer in 1990. The model comprised (i) the emotional affection to (ii) identification with, and (iii) participation of employees in, the firm. An upshot of professional identification is organizational commitment in view of the fact that professional organizations give the ways essential to share a professional identity and to work as a professional. Further, as stated by Bamber and Iyer (2002), professional identification of Big 5 auditing firms has a great impact on their organizational identification.
In line with Hwang, Lou, Han, Cao, Kim and Li (2009) and Celik and Hisar (2012), nurses having strong professional identity perform their job amicably with the professional ethics and moral codes, and are effectively mindful regarding their roles. It is likely to suppose that the progress of professional identity may possibly increase the understanding and expertise of nurses and the capacity to put into operation, that in response, may possibly boost their job satisfaction. Above and beyond, it can be supposed that appropriate growth of professional identity can boost employee independence, increase their confidence, belief and knack to communicate in an efficient way, all of which have a tendency to foster job satisfaction (Deppoliti 2008; Sharbaugh 2009). It can protect nurse against mistreatment, self-effacement and biasedness in the place of work, as a result, professional identity can support in increasing employee retention (Gault, Shapcott, Luthi & Reid, 2017). Professional Identity and Turnover Intention among Staff Nurses in Different Sectorial Hospitals has been observed by Hassan and Elhosany (2017). The researchers considered two different hospitals and gathered data from 457 staff nurses. Statistical results of the study revealed that there has a strong association between professional identity and age of staff nurses and years of experience.
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