Queen Essays

Submission Id: 2664

Title

Enhancing participant diversity during recruitment for a national COVID-19

Surveillance Study Using Stakeholder Engagement

Priority 1 (Research Category)

COVID-19

Presenters

Hazel Tapp, PhD, PhD, Michael Runyon, MD, MPH, Yhenneko Taylor, PhD

Abstract

In May 2020 A COVID-19 Community Research Partnership, a surveillance study aimed at learning about

the spread of the COVID-19 virus in local communities and among healthcare workers, began.

Recognizing the disproportionate impact of COVID-19 on low-income and racial/ethnic minority groups,

recruitment strategies that enabled diverse representation and engagement were used. We describe a

community based participatory approach to engage a stakeholder advisory board to guide recruitment

and data collection.

Study Design was a community based participatory research study. Approximately 30 participants

comprise the SAB. The study recruits participants from a large metropolitan area, and Atrium Health, a

large, vertically integrated, not-for-profit healthcare system.

Population Studied >12,000 community participants

Outcome Measures recruitment and demographics of participants

Results With SAB guidance we recruited >12,000 participants. The highly engaged stakeholders

provided valuable input to guide the development of recruitment materials (¬flyers, emails, social

media, websites, videos); use of incentives (free phones to complete the online symptom survey); and

community outreach opportunities (primary care practices in underserved neighborhoods; COVID-19

mobile testing units located in underserved communities; mask giveaway events; and the local public

school system) The SAB identified groups that the research team then partnered with to share

information about the study (Village Heart BEAT, a community-based organization aimed at improving

the health of African American and Hispanic populations; and HealthCare System employee affinity

groups serving Hispanic/Latino and African American communities). Demographics include 90%

White/Caucasian, 5% Black/African American; 3% Hispanic and 2% Asian or Pacific Islander; 38% are

healthcare workers; 67% are female.

Conclusions Use of a community stakeholder advisory board has enhanced understanding and

participation in a COVID-19 Community Research Partnership. Engaging diverse community stakeholders

early in the research process was essential for ensuring data collection efforts are patient-centered and

tailored to reach diverse communities.

Copyright of Annals of Family Medicine is the property of Annals of Family Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Submission Id: 2664

Title

Enhancing participant diversity during recruitment for a national COVID-19

Surveillance Study Using Stakeholder Engagement

Priority 1 (Research Category)

COVID-19

Presenters

Hazel Tapp, PhD, PhD, Michael Runyon, MD, MPH, Yhenneko Taylor, PhD

Abstract

In May 2020 A COVID-19 Community Research Partnership, a surveillance study aimed at learning about

the spread of the COVID-19 virus in local communities and among healthcare workers, began.

Recognizing the disproportionate impact of COVID-19 on low-income and racial/ethnic minority groups,

recruitment strategies that enabled diverse representation and engagement were used. We describe a

community based participatory approach to engage a stakeholder advisory board to guide recruitment

and data collection.

Study Design was a community based participatory research study. Approximately 30 participants

comprise the SAB. The study recruits participants from a large metropolitan area, and Atrium Health, a

large, vertically integrated, not-for-profit healthcare system.

Population Studied >12,000 community participants

Outcome Measures recruitment and demographics of participants

Results With SAB guidance we recruited >12,000 participants. The highly engaged stakeholders

provided valuable input to guide the development of recruitment materials (¬flyers, emails, social

media, websites, videos); use of incentives (free phones to complete the online symptom survey); and

community outreach opportunities (primary care practices in underserved neighborhoods; COVID-19

mobile testing units located in underserved communities; mask giveaway events; and the local public

school system) The SAB identified groups that the research team then partnered with to share

information about the study (Village Heart BEAT, a community-based organization aimed at improving

the health of African American and Hispanic populations; and HealthCare System employee affinity

groups serving Hispanic/Latino and African American communities). Demographics include 90%

White/Caucasian, 5% Black/African American; 3% Hispanic and 2% Asian or Pacific Islander; 38% are

healthcare workers; 67% are female.

Conclusions Use of a community stakeholder advisory board has enhanced understanding and

participation in a COVID-19 Community Research Partnership. Engaging diverse community stakeholders

early in the research process was essential for ensuring data collection efforts are patient-centered and

tailored to reach diverse communities.

Copyright of Annals of Family Medicine is the property of Annals of Family Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

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Enhancing the Employee Engagement: The Mediating Role

of Exchange Ideology (Meningkatkan Keterlibatan Pekerja: Peranan Perantaraan Ideologi Pertukaran)

Lianto

(Faculty of Economics and Business, Universitas Tanjungpura)

(Sekolah Tinggi Ilmu Ekonomi Widya Dharma)

Anis Eliyana

(Faculty of Economics and Business, Universitas Airlangga)

Rizky Fauzan

(Faculty of Economics and Business, Universitas Tanjungpura)

ABSTRACT

This study analyses a model that links three predictors namely workplace spirituality, self-

efficacy, and person-organization fit to employee engagement through the mediating role of

exchange ideology. Drawing on social exchange theory, researchers expected that exchange

ideology would mediate the relationship between the given antecedents and employee

engagement. This study used quantitative method to collect data and WarpPLS5.0 to analyze

the data. The results of a survey conducted among 100 employees of credit unions in West

Kalimantan, Indonesia, indicated that employees with stronger spirituality, self-efficacy, and

values compatibility engaged better at work. Researchers also found that exchange ideology

did not mediate the relationship between workplace spirituality and employee engagement

although the exchange ideology mediated the relationship between two predictors namely

self-efficacy and person-organization fit to employee engagement.

Keywords: Workplace spirituality; self-efficacy; person-organization fit; exchange ideology;

employee engagement

ABSTRAK

Kajian ini mengkaji model yang menghubungkan tiga faktor penentu, iaitu kerohanian

tempat kerja, keberkesanan kendiri, dan kesesuaian individu-organisasi untuk keterlibatan

pekerja menerusi peranan perantaraan ideologi pertukaran. Menurut teori pertukaran sosial,

peyelidik menjangkakan ideologi pertukaran menjadi pengantara dalam hubungan antara

antesedan yang diberi dan keterlibatan pekerja. Kajian ini menggunakan kaedah kuantitatif

untuk mengutip data dan perisian WarpPLS5.0 digunakan untuk menganalisis data. Hasil

kaji selidik yang dilakukan ke atas 100 orang pekerja syarikat kredit di Kalimantan Barat,

Indonesia, menunjukkan bahawa pekerja yang mempunyai kerohanian yang lebih kuat,

keberkesanan kendiri, dan keserasian nilai akan bekerja dengan lebih baik di tempat kerja.

Para penyelidik juga menemukan bahawa ideologi pertukaran tidak memainkan peranan

pengantara bagi hubungan antara kerohanian tempat kerja dengan keterlibatan pekerja

meskipun ideologi pertukaran menjadi pengantara hubungan antara dua faktor penentu,

iaitu keberkesanan kendiri dan kesesuaian nilai individu dengan nilai organisasi untuk

keterlibatan pekerja.

Kata kunci: Kerohanian tempat kerja; keberkesanan kendiri; kesesuaian nilai individu

dengan nilai organisasi; ideologi pertukaran; keterlibatan pekerja

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INTRODUCTION

One of the fundamental elements of the survival of an organization is a sustained competitive

advantage generated by the valuable, rare, inimitable, and non-substitutable resources

(Barney 1991; Ichrakie 2013). The Harvard Business Review (2015) reported that 71% of

respondents ranked employee engagement as very important to achieve organizational

success. Engaged employees look for a better way to finish their work, spend less time for

routine activities, and use resources efficiently. The employee engagement influences

effectiveness and innovation (Welch 2011), performance (Macey & Schneider 2008), and the

sustained competitive advantage (Albrecht et al. 2015; Nair & Salleh 2015). Ratanjee and

Emond (2013) stated that the engagement factor plays a vital role, for it motivates business

activity, competitive advantage, and sustainable organization. Since the introduction of Kahn

(1990), this concept has been drawing the attention of researchers, either in business,

management, industrial psychology/organization, or human resources (Albrecht et al. 2015;

Crawford, LePine & Rich 2010; Gruman & Saks 2011; Welch 2011; Wollard & Shuck 2011).

Kahn (1990) defined employee engagement as an involvement of an employee in his role

where he works and expresses himself physically, cognitively, and emotionally. The

involvement motivates loyalty within the employee so that he or she can reduce the intention

to quit (Macey & Schneider 2008). The engaged employee, who is concerned with the

success of an organization, will make a contribution that is more than what a job requires

(Mercer, Carpenter & Wyman 2007).

In adverse circumstances, workforce is becoming disengaged at fast rates. The global

level of employee engagement is in crisis “with serious and potentially lasting repercussions

for the global economy” (Mann & Harter 2016). Based on the data of 230,000 full-time and

part-time employees in 142 countries, 24 percent were actively disengaged, 63 percent were

not engaged, and only 13 percent of employees were highly engaged in their jobs (Gallup

2016). The findings indicate that at the global level, the workplace could be described more

as a source of frustration than as a place of self-realization. The grim picture of employee

engagement reminds us of the importance of a research. To improve employee engagement, a

critical and holistic research needs to be done. It is a substantial matter that today’s

organization tries to review the key driver of employee engagement (James, McKechnie &

Swanberg 2011). Responding to the lack of employee engagement, the focus of this research

is to develop an empiric model in the process of improving employee engagement.

This study contributes to the on-going discussion about the antecedents of employee

engagement through examination of exchange ideology as a mediator. This study may be

among the first research to examine exchange ideology as a mediator for the effect of

workplace spirituality, self-efficacy, and person-organization fit on the employee

engagement.

LITERATURE REVIEW

The concept of workplace spirituality urges employees to discover and apply spiritual values

(Mehta & Joshi 2010). An organization that assists employees to find the inner meaning of

their work will reach a peak of creativity, learning process, and passion in their mind

(Fawcett et al. 2008). A spiritually-minded organization helps its employees to develop and

realize the fulfilment of their great potential (Robbins & Judge 2013). Saks (2011)

emphasized the importance of including the variable of workplace spirituality as a predictor

of employee engagement and its comparison with other predictors. The concept of workplace

spirituality will enrich the model of employee engagement. In line with Saks (2011), Roof

(2015) stated that a deeper understanding of the relationship between workplace spirituality

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and employee engagement indicates that workplace spirituality plays key role as a potential

component to respond to the global decrease of engagement at the workplace. Kolodinsky,

Giacalone, and Jurkiewicz (2008) found that workplace spirituality was positively related to

job involvement, a variable that has some similarity to engagement. Previously, Mirvis

(1997) found that to engage employees with their work, organizations needed to pay attention

to the employees’ spiritual life and their collective potential. Based on the above background,

this research would relate workplace spirituality to employee engagement with the following

hypothesis:

H1 Workplace spirituality is positively related to employee engagement

Self-efficacy refers to individual beliefs in doing their work (Bandura 2012). The higher

the self-efficacy of a person, the higher the belief in his ability to achieve success. In difficult

situations, people with low self-efficacy will easily give up. Conversely, people with high

self-efficacy will try hard to overcome the obstacles he faces (Stajkovic & Luthans 1998).

The involvement of self-efficacy in this model of research is based on the following research

gap. Saks (2006) proposed that the upcoming researchers needed to take into consideration

the predictor of employee engagement that are different from variables of individual

differentiation, such as self-esteem, locus of control, and self-efficacy. Luthans and Peterson

(2002) stated that self-efficacy had a significant effect on employee engagement. It is a better

predictor of task performance than various traditional workplace attitudes (e.g. satisfaction

and organizational commitment), personality traits, level of education, training, goal setting,

and feedback interventions. Xanthopoulou et al. (2008) found that self-efficacy is a predictor

of performance through employee engagement. Self-efficacy influences learning capacity,

motivation, and individual performance since an individual will try to learn and only do

things that he or she is convinced that he or she is able to perform (Lunenburg 2011).

Albrecht and Marty (2017) also found that self-efficacy has significant positive associations

with work engagement. Building on this literature and following Saks (2006), researchers

suggest that self-efficacy is positively related to employee engagement. Therefore, the

hypothesis is:

H2 Self-efficacy is positively related to employee engagement

Person-organization fit refers to the compatibility between the value of the employee and

the value of the organization (Yaniv & Farkas 2005). The conceptualization of person-

organization fit is based on the Schneider's Attraction-Selection-Attrition framework.

According to this framework, individuals are not randomly choosing a situation, but are

deliberately looking for an interesting situation. After selecting the situation, they will be part

of the situation and live within it. In the context of person-organization fit, an organization is

a situation in which people feel attracted, chooses to be part of it, and resides in it when there

is a match, and comes out of it when there is no match (Schneider 1987). At the end of their

analysis, Macey and Schneider (2008) stated that engagement could be a consequence of the

conditions of a work environment and dispositional characteristics at a workplace, and the

interaction of these two elements. Accommodating the contingent perspective (situational

context), they proposed the concept of person-environment (organization) fit which means a

compatibility between value internalized by the employees and the value of the organization.

Research of Lovelace and Rosen (1996) proved that the person-organization fit was the

predictor of work satisfaction, stress reduction, and intention to quit. According to Lv and Xu

(2018), the interaction of a high-performance work system and psychological contract on

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employee engagement was mediated by the person-organization fit. Hence, researchers

expected that person-organization fit would be positively related to employee engagement.

H3 Person-organization fit is positively related to employee engagement

Based on Saks’s suggestion (2006) about the role of exchange ideology between

engagement and its antecedent, this research proposes an exchange ideology as a mediating

variable. The concept of this ideology, which was promoted for the first time by Eisenberger

et al. (1986), consists of a convincing idea of reciprocity between employees and an

organization. Normally, what the employees do depends on the attitude of an organization.

In the context of working, Eisenberger et al. (1986) described exchange ideology as a

continuum. On one side of the continuum, an individual’s work performance is equal to the

reinforcement by the organization. If the employees are well treated, they will work hard,

otherwise, they will not work hard. On the other side of the continuum, an individual will

work hard without concerning about what they receive from the organization. Even so, they

will work hard although they are not well treated. This means that exchange ideology reflects

on an individual’s expectation of the individual and organization exchange.

Although no specific study has yet surveyed exchange ideology as a mediator between

employee engagement and the predictors, some studies have been made to observe the topic

of social exchange in the organization (Shore et al. 2006). Bal, Kooij and De Jong (2013)

have examined the mediating role of the psychological contract that related the

developmental HRM to employee outcomes. The psychological contract, which consists of

transactional and relational contracts, has a similar meaning to the two-continuum exchange

ideology. Yeh (2012) found that relational psychological contracts (similar to a lower

continuum of exchange ideology) had a positive influence on engagement. On the other side,

the transactional psychological contracts (similar to a higher continuum of exchange

ideology) had a negative influence on employee engagement. Analogically, researchers

expected the exchange ideology would have an indirect effect that would mediate the

relationship between employee engagement and the antecedents.

An employee who recognizes his spiritual identity will consider his work as a vocation.

He will fulfill his role and duties without being too concerned with how the organization

treats him. Besides, meaningful work is a key feature of a productive work environment

(Hackman & Oldham 1980). Experience in the meaning of work can create the excitement

that connects employees better with positive perceptions (Giacalone & Jurkiewicz 2003).

Employees also need to feel that they are part of a community in the workplace. According to

Duchon and Plowman (2005), the workplace should be seen as a place to share life. When

employees feel themselves as part of the community, they will identify themselves with the

goals of the organization and strive to achieve them. If all three dimensions of workplace

spirituality are experienced by employees, it is expected to create a low exchange ideology.

Employees will work hard no matter what they get in exchange. Concerning the above

description, researchers expected that workplace spirituality would enhance employee

engagement through exchange ideology. Researchers proposed the following hypotheses:

H4 Exchange ideology mediates the relationship between workplace spirituality and

employee engagement: workplace spirituality negatively relates to exchange ideology

(4a) and exchange ideology negatively relates to employee engagement (4b).

Employees with high self-efficacy will be more optimistic and intensive to involve

themselves in the organization. They can even ignore negative feedback. On the other side,

employees who have low self-efficacy tend to reduce the effort when it gets negative

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feedback (Bandura & Cervone 1986). Here, it is clear that self-efficacy can shape the

expected exchange ideology. In other words, employees will still perform even if they do not

get recognition from the organization. Hence, researchers hoped that self-efficacy would

enhance employee engagement through exchange ideology.

H5 Exchange ideology mediates the relationship between self-efficacy and employee

engagement: self-efficacy negatively relates to exchange ideology (5a) and exchange

ideology negatively relates to employee engagement (5b).

Researchers and practitioners agree that value compatibility between employees and

organizations is the key in managing flexible and committed workforce needed in a

competitive business environment (Bowen, Ledford & Natan 1991; Kristof 1996; Sekiguchi

2004). Various empirical research findings showed that a high level of fit between the value

of employees and the organization would be followed by a variety of positive behaviors.

These variables correlated with attitudes expected in work, such as job satisfaction and

commitment (Chatman 1989; Judge 1994; Vancouver & Schmitt 1991), labor turnover

intention (Chatman 1989; O'Reilly, Chatman & Caldwell 1991; Ambrose, Arnaud &

Schminke 2008), and prosocial behaviors, such as organizational citizenship behavior

(O'Reilly & Chatman 1986) and contextual performance (Goodman & Svyantek 1999;

Sekiguchi 2004). We expect that employees who feel satisfied by value compatibility would

reciprocate lower exchange ideology resulted positive behavior. For these reasons,

researchers hypothesized the following hypothesis:

H6 Exchange ideology mediates the relationship between person-organization fit and

employee engagement: person-organization fit negatively relates to exchange ideology

(6a) and exchange ideology negatively relates to employee engagement (6b).

METHODOLOGY

SAMPLE AND DATA COLLECTION

Researchers conducted this research by distributing questionnaires to 100 employees of eight

credit unions using a multistage sampling. In West Kalimantan, there were 31 credit unions

incorporated in the Center for Legal Credit Cooperatives. Each credit union had dozens of

branches spread across the city, coastal and inland areas of West Kalimantan. All employees

in the 31 credit unions are the study’s sampling frame. From the population, the target

population was selected based on three criteria; 1) the credit unions have been in operation

for more than 20 years; 2) total assets of IDR 200 billion and above, and 3) have 50

employees or more. Based on these criteria, only 8 credit unions were selected. From this,

researchers selected the respondents proportionately to the total amount of employees which

is 100 respondents. This is in line with Ghozali’s recommendation (2008) which stated that

for Partial Least Squares analysis, the research sample ranged from 30-100 respondents. The

fundamental reason for choosing credit unions as the context of the survey was that credit

unions played a key role in developing the socio-economic life of the people in West

Kalimantan. The appreciation of human dignity from this economic organization was

expressed by a systematic program to increase the social prosperity of the people by fighting

against poverty. Credit unions also educate and train their members to have financial literacy

and understand how to manage their money professionally.

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MEASUREMENT

Workplace spirituality was measured based on a scale developed by Ashmos and Duchon

(2000). This scale was empirically developed and validated. Researchers measured the self-

efficacy using a five-item scale adopted from Schwarzer and Jerusalem (1995). The person-

organization fit was measured using a four-item scale developed by Netemeyer et al. (1997).

To measure exchange ideology, researchers adopted a scale developed by Eisenberger et al.

(1986). The employee engagement was measured using a scale adopted from Rich, Lepine

and Crawford (2010). All items were measured using five-point Likert scale with 1 for

strongly disagree to 5 for strongly agree.

ANALYSIS

We examined the hypotheses by conducting partial least squares (PLS) path modelling in

WarpPLS5.0 using the two-step process advocated by Henseler, Ringle and Sinkovics (2009).

The two-step process encompasses the outer model assessment and the inner model

assessment. In the first step, the assessment focused on the measurement models. An

evaluation of PLS estimates showed the measurement validity and reliability according to the

criteria that were associated with the reflective and formative outer model. A measurement

model was examined for the five constructs in this study. In the second step, researchers

assessed the inner model or structural model. Reliable and valid outer model assessments in

the first step were the initiation of the inner path model estimation. In line with

recommendation of Henseler et al. (2009), researchers assessed a series of indices,

encompassing R2 (the coefficient of determination), the individual path coefficients, the

values of effect size (f2) that could be considered as the partial effect of the path model, and

assessment of the predictive relevance (Q2).

RESULTS

MEASUREMENT MODEL ASSESSMENT

An assessment of the outer model focused on the effort to examine the validity and

reliabilities of indicators of the latent construct of this research. The criteria used to examine

the reflective construct were indicators of reliability, internal consistency, convergent

validity, and discriminant validity. From the PLS output (Table 1), the loading factor of all

indicators fulfil the reliability condition, except for item 9 with a loading of 0.668 and item

14 with a loading of 0.573. Based on the rule of thumb, those two items had to be eliminated.

TABLE 1. Indicator loadings for reflective construct

Construct Item Loading Scale type

Self-efficacy 4 0.826 Reflective

5 0.835 Reflective

6 0.797 Reflective

7 0.774 Reflective

8 0.74 Reflective

9 0.668 Reflective

Person-

organization fit 10 0.762 Reflective

11 0.796 Reflective

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12 0.848 Reflective

13 0.838 Reflective

Exchange

ideology 14 0.573 Reflective

15 0.803 Reflective

16 0.847 Reflective

17 0.811 Reflective

The re-examination produces output as presented in the following Table 2. It shows that

the value of the composite reliability of the three reflective constructs is very good (self-

efficacy 0.902, person-organization fit 0.885, and exchange ideology 0.880), that is, >0.70

and it fulfills the criteria of internal consistency reliability.

TABLE 2. Indicator loadings and composite reliability for reflective

construct

Construct Item Loading Scale type Composite

Reliability

Self-efficacy 4 0.843 Reflective 0.902

5 0.827 Reflective

6 0.826 Reflective

7 0.774 Reflective

8 0.753 Reflective

Person-

organization fit 10 0.762 Reflective 0.885

11 0.796 Reflective

12 0.848 Reflective

13 0.838 Reflective

Exchange

ideology 15 0.802 Reflective 0.880

16 0.880 Reflective

17 0.844 Reflective

Assessing the convergent validity and discriminant validity, Table 3 shows the value of

AVE which is given in the diagonals. The value of the AVE is also very good (engagement

self-efficacy 0.648, person-organization fit 0.659, and exchange ideology 0.710), that is more

than 0.50 and therefore fulfilled the requirement of convergent validity. Table 3 summarizes

the result of analysis to show discriminant validity. It indicates that the value of the square

root of the AVE of each latent variable is larger than the square of the correlations. Fornell-

Larcker criteria for discriminant validity postulates that a latent variable should share larger

variance with its indicator instead of other latent variables. The square root of the AVE for

self-efficacy is 0.805, the person-organization fit is 0.812 and exchange ideology is 0.843;

this is higher than the value above and below them. This condition shows that the

discriminant validity of the three predictors fulfill the requirements.

TABLE 3. Correlation among construct scores (root of AVE in diagonals)

Construct WS SE POF EI EE

AVE = 0.573 AVE = 0.648 AVE = 0.659 AVE = 0.710 AVE = 0.741

Workplace spirituality (WS) 0.757 0.452 0.444 -0.297 0.554

Self-efficacy (SE) 0.452 0.805 0.601 -0.376 0.534

Person-organization fit (POF) 0.444 0.601 0.812 -0.414 0.566

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Exchange ideology (EI) -0.297 -0.376 -0.414 0.843 -0.315

Employee Engagement (EE) 0.554 0.534 0.566 -0.315 0.861

Compared to the reflective construct, the evaluation of formative construct is performed

by assessing the reliability and collinearity of the indicators. The parameter of indicator

reliability is the significant weight achieved by the resampling process. Meanwhile, the

parameter for collinearity is the value of the variance inflation factor (VIF). The referential

value for collinearity is VIF <5 or ideally according to some literature, VIF <2.5 – 3.3. To

evaluate the formative construct in this research, the following Table 4 shows the result of the

formative construct analysis of this survey, that is, workplace spirituality and employee

engagement based on loading indicator compared to other relevant criteria. From the table, it

can be seen that all indicators of the formative construct of workplace spirituality and

employee engagement have a significant weight value where ρ-value <0.001. So, all

formative indicators of this research have fulfilled the reliability’s requirements. The VIF

value of the two constructs also shows that the score <2.5. This indicates that there are no

problems of multicollinearity.

TABLE 4. Indicator weights for formative construct

Construct Workplace

spirituality

Employee

engagement SE ρ-value VIF WLS

Workplace

spirituality 1

0.390 0.000 0.090 <0.001 1.148 1

Workplace

spirituality 2

0.474 0.000 0.088 <0.001 1.362 1

Workplace

spirituality 3

0.452 0.000 0.088 <0.001 1.301 1

Employee

engagement 1

0.000 0.399 0.090 <0.001 2.318 1

Employee

engagement 2

0.000 0.403 0.090 <0.001 2.402 1

Employee

engagement 3

0.000 0.357 0.091 <0.001 1.520 1

Notes: P values < 0.05 and VIFs < 2.5 are desirable for formative indicators; VIF = indicator variance inflation

factor;WLS = indivator weight-loading sign (-1 = Simpson's paradox in l.v.)

STRUCTURAL MODEL ASSESSMENT

The output diagram as shown in Figure 1 shows us that the variance of exchange ideology is

influenced by variance value of workplace spirituality, engagement self-efficacy, and person-

organization fit which is 24.8%. This is indicated by the value of R2 that is 0.248. The result

of the estimation explains that the contribution of the three exogenous constructs

simultaneously is categorized as small. Besides, the variances of the latent endogenous

construct of employee engagement are influenced and can be explained by the variances of

workplace spirituality, self-efficacy, person-organization fit, and exchange ideology which

reach 50.6%. This is indicated by the value of R2 of 0.506. The value of such influence is

classified into a strong and substantial category. The result describes that the contribution of

the four predictors of employee engagement simultaneously is categorized as large or

substantial (≥0.45).

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Figure 1 indicates that workplace spirituality, on one hand, was significantly related to

employee engagement (β= 0.279, ρ= 0.002, f2= 0.157), which supported Hypothesis 1.

However, on the other hand, workplace spirituality is not significantly related to exchange

ideology (ρ= 0.201, NS), failing to support Hypothesis 4a. This signifies that exchange

ideology could not be a mediator for the relationship between workplace spirituality and

employee engagement. This analysis discovered both a positive relationship between self-

efficacy and employee engagement (β= 0.225, ρ= 0.009, f2= 0.128), and a negative

association between self-efficacy and exchange ideology (β= -0.175, ρ= 0.034, f2= 0.072),

which supported Hypotheses 2 and 5a. This research also found a positive significant

relationship between person-organization fit and employee engagement (β= 0.246, ρ= 0.005,

f2= 0.144), and a negative association between person-organization fit and exchange ideology

(β= -0.317, ρ<0.001, f2= 0.147), which gave support for Hypotheses 3 and 6a. Moreover, the

exchange ideology is negatively related to employee engagement (β= -0.163, ρ= 0.046, f2=

0.077), which confirmed Hypothesis 4b, 5b, and 6b. According to Zhao, Lynch, and Chen

(2010), the requirement to establish mediation was a significant indirect effect. The following

Table 5 summarizes the P-value and indirect effect of this research.

TABLE 5. ρ-values of indirect effect for paths with 2 segments

Construct Employee

engagement ρ-value

Workplace spirituality 0.013 0.105

Self-efficacy 0.029 0.048

Person-organization fit 0.052 0.036

Table 5 reveals that exchange ideology did not mediate the relationship between

workplace spirituality and employee engagement (non-significant in ρ-value=0.105).

However, these results confirmed the expected indirect effect through exchange ideology as a

mediator for relationships between self-efficacy and employee engagement (significant in ρ-

Workplace

Spirituality

(F)3i

Self-efficacy

(R)5i

Person-

Orgnization Fit

(R)4i

Exchange

Ideology

(R)3i

Employee

Engagement

(F)3i

β= -0.082

ρ= 0.201

f2= 0.029

β= -0.175

ρ= 0.034

f2= 0.072

β= -0.317

ρ<0.001

f2= 0.147

β= 0.279

ρ= 0.002

f2= 0.157

β= 0.225

ρ= 0.009

f2= 0.128

β= 0.246

ρ= 0.005

f2= 0.144

β= -0.163

ρ= 0.046

f2= 0.077

R2 = 0.248

R2 = 0.506

FIGURE 1. Hypothesized model and results

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value=0.048) and between person-organization fit and employee engagement (significant in

ρ-value = 0.036).

In assessing the effect of a particular independent variable on a dependent variable,

Figure 1 demonstrates the score of the effect size (f2) for each predictor. It indicates the

contribution of each predictor for the criterion variables’ coefficient (R2) in the model. R2 of

exchange ideology (0.248) derives from the contribution of workplace spirituality (0.029),

self-efficacy (0.072), and person-organization fit (0.147). The result of R2 (0.506) of

employee engagement is an accumulation of the contribution of workplace spirituality

(0.157), engagement self-efficacy (0.128), person-organization fit (0.144), and exchange

ideology (0.077). The predictive relevance of this research model can be traced from the Q-

square (Q2) on each dependent variable. The model has predictive relevance if Q2 > 0. The

output estimated by PLS shows that the exchange ideology (Q2= 0.247) and employee

engagement (Q2= 0.505) have predictive relevance.

DISCUSSION AND CONCLUSION

The results of this research showed that the three predictors were significantly related to

employee engagement. Two out of three predictors of the model, such as self-efficacy and

person-organization fit, influenced the employee engagement through exchange ideology as a

mediator. The weak connection between the spiritual dimension and employees’ perception

of what they should give to and what they should get from the organization might cause the

insignificant influence on the two constructs. The values of spirituality were still perceived as

a very personal one. Meanwhile, exchange ideology was linked strictly to the rights and

duties, a formal regulation of contribution and compensation, and the hierarchy of needs of

the employees. The gap of spiritual dimension and employees’ rights and duties caused the

above condition, although the employees hold the values of spirituality respectively, and at

the same time they hold the exchange ideology up to a certain level. These findings were not

in line with most of the workplace spirituality researches that discovered the various positive

impacts of spirituality on the organizational behavior (Burack 1999; Fawcett et al. 2008;

Freshman 1999; Korac-Kakabadse 2002; Leigh 1997; Metha & Joshi 2010; Pawar 2008;

Robbins & Judge 2013; Wagner-Marsh & Conely 1999).

Self-efficacy related significantly to exchange ideology. The employees needed to have

self-efficacy in their abilities to engage in their work and organization. Based on the previous

researches on self-efficacy, this result was in line with most of the researches on the outcome

of self-efficacy of all disciplines. According to the findings of a number of researchers

(Bandura 1989; Bandura & Cervone 1983; Lunenburg 2011; Luthans & Peterson 2002;

Mensah & Lebbaeus 2013; Propst & Koestler 1998; Xanthopoulou et al. 2008), self-efficacy

was a strong predictor of the various positive organizational behaviors.

Person-organization fit also related significantly to exchange ideology. If an employee’s

compatibility of values with the organizational culture was high, the exchange-ideology of an

employee’s behavior would be low. The implication of this finding is that in the process of

recruitment and selection, the organization should consider the behavior and values of the

candidates which are in accordance with the organizational culture. This finding was in line

with the previous researches done by researchers and practitioners who were in consensus

that the values compatibility between employees and organization was an important key to

develop the flexible and committed workforce needed by the competitive business

environment (Bowen et al. 1991; Kristof 1996; Sekiguchi 2004).

Workplace spirituality related significantly to employee engagement. If the implication

of the spirituality’s values at the workplace was higher and stronger, the employee

engagement would increase. The employees needed to be aware of their inner dimension and

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meaning of their work. They also need to be a member of a bigger community of work. The

implication of spiritual elements will increase employee engagement in work and

organization. This finding was in line with Word (2012) that found significant relationship

between workplace spirituality and job involvement and meta-analysis of Dent, Higgins, and

Wharff (2005) which found that spirituality had an intimate relationship to productivity. The

spirituality element supported the idea that each individual has an inherent need for work that

will bring meaning for him (Chalofsky & Krishna 2009).

Self-efficacy related significantly to employee engagement. If the workers are confident

that their ability to integrate into their work is strong, the level of engagement would also be

also high. Considering the process of enhancing the engagement of an employee in his or her

work and organization, the employees are convinced that it is necessary to prepare a space for

those who are really engaged in their work. This essential need is strengthened from

psychology perspective that emphasized the importance of self-confidence as an intrinsic

motivation to reach an achievement (Seligman & Csikszentmihalyi 2000). This finding was

in line with various research studies which found that self-efficacy related to engagement

(Luthans & Peterson 2002; Rich et al. 2010) and performance (Xanthopoulou et al. 2010).

Self-efficacy creates positive environment based on high self-confidence and this would lead

employees to be engaged more in their work in order to improve their performance. On the

other hand, if good performance is achieved, self-confidence of the employees will be

strengthened (Salanova, Llorens & Schaufeli 2011).

Person-organization fit related significantly to the employee engagement. If the

employee’s perceived compatibility of their values and the organization’s value was high and

strong, their will and effort to be engaged in work would also be strong. In the process of

enhancing employee engagement, organizations need to pay attention to the organizational

climate that enables employees to achieve congruence so there will be a balance between the

values of the workers and the corporate culture. This finding strengthened the previous

researches about the impact of person-organization fit (Ambrose et al. 2008; Chatman 1989;

Goodman & Svyantek 1999; Judge 1994; O’Reilly & Chatman 1986; O’Reilly et al. 1991;

Rich et al. 2010; Sekiguchi 2004; Vancouver & Schmitt 1991; Verquer, Beehr & Wagner

2003).

Exchange ideology is found to be related significantly to employee engagement. This

finding contributes to the novelty of the model of employee engagement development. This

research discovered that exchange ideology could be the mediator that linked self-efficacy

and person-organization fit to employee engagement. This contribution is important because

most of the previous researchers suggest exchange ideology as a moderating variable (Ahn,

Lee & Yun 2016; Eisenberger et al. 1986; He et al. 2014; Ladd & Henry 2000; Orpen 1994;

Pazy & Ganzah 2010; Redman & Snape 2005; Scott & Colquitt 2007; Takeuchi, Yun &

Wong 2011; Witt 1991, 1992; Witt & Broach 1993; Witt, Kacmar & Andrews 2001). Only a

few researchers that posit this construct in the mediating role (Ravlin et al. 2012). Through

the mediation of exchange ideology, this research explains the relationship between employee

engagement and its predictors.

MANAGERIAL IMPLICATIONS

In the process of improving sustained competitive advantage through the development of

employee engagement, organizations need to create the climate that accommodates

workplace spirituality. An employee who experiences the spiritual dimension of his work will

find the meaning of work for his life and feel that he is a member of a community. Such a

person will easily engage in work. Besides preparing a special space for the spiritual

development that motivates the employees to be more engaged, the organization needs to

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develop self-efficacy of each employee. High self-efficacy in the ability to be engaged in

work will strengthen all the efforts for better employee engagement. Employees will

persevere to face difficulties in work, interpersonal communications, and temporary limits of

the organization. Although each employee has his own way to achieve the value of

compatibility, the organization need to build a harmonious coherence between the value

within an employee and the organizational culture. The employees need continuous training

and socialization in order to strengthen the coherent values between the employees and the

organization. In this way, both the employees and the organization can walk together,

motivated by their shared values.

LIMITATIONS AND AVENUES FOR FUTURE RESEARCH

The result of the research, in general, confirmed the significant interrelationship of the

constructs, however, the explanatory power of this model is still at the moderate level. This

shows that the possibility of other predictors for explaining employee engagement.

The insignificant relationship between workplace spirituality and exchange ideology

might take place because of the dimension of workplace spirituality developed in the context

of Western culture of and way of thinking need to be contextualized in Eastern culture. It is

necessary to develop the basic idea of workplace spirituality considering the Sitz im Leben of

Indonesian (Asian) culture. Indonesian society has a local wisdom consisting of a series of

values in traditional spirituality which needs to be explored. Further research will be needed

to understand the workplace spirituality of Indonesians in the Eastern culture and way of

thinking. Such research can be done by using mixed methods or a triangulation method.

Future research needs to develop a more complex model of research so that the

explanatory power of the applied model can be improved. The complexity of a phenomenon

and reality is triggered by many potential variables as predictors. Future research can

consider the development of the research model that involves other constructs, such as

organizational commitment, perceived justice, perceived organizational support, and work-

life balance.

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Lianto (corresponding author)

Faculty of Economics and Business

Universitas Tanjungpura

Jl. Prof. Hadari Nawawi Pontianak

78124 Kalimantan Barat, INDONESIA.

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Sekolah Tinggi Ilmu Ekonomi Widya Dharma

Jl. H.O.S. Cokroaminoto 445, Pontianak, 78117 INDONESIA.

E-Mail: [email protected]

Anis Eliyana

Faculty of Economics and Business

Universitas Airlangga

Jl. Airlangga 4-6, Surabaya, 60286 INDONESIA.

E-Mail: [email protected]

Rizky Fauzan

Faculty of Economics and Business

Universitas Tanjungpura

Jl. Prof. Hadari Nawawi Pontianak

78124, Kalimantan Barat, INDONESIA.

E-Mail: [email protected]

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Employee Responsibilities and Rights Journal https://doi.org/10.1007/s10672-022-09420-7

1 3

Workplace Bullying, Engagement and Employability: Moderating Role of Organization‑Based Self‑Esteem

Nimmi P. M.1  · Geetha Jose2 · Maria Tresita Paul Vincent3  · Anjali John4

Accepted: 12 July 2022 © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, corrected publication 2022

Abstract The present research paper aims to examine the influence of workplace bullying on employee work outcomes in terms of employee engagement and perceived internal employ- ability. The paper also analyses the moderating role of organization-based self-esteem (OBSE) in the relationship between workplace bullying and employee work outcomes. The authors relied on cross-sectional data from teaching faculty across universities and colleges in South India to validate hypotheses empirically. The proposed model was tested using Warp-PLS and PROCESS macro in SPSS. The study reported a significant negative influ- ence of workplace bullying on perceived internal employability and employee engagement. The study also found that OBSE positively moderated the negative relationship between workplace bullying and employee work outcomes in terms of engaging employees and per- ceived employability. The unique aspect of this research is that it is the first time the mod- erating role of OBSE is discussed in bullying literature. The study puts across OBSE as a positive organization related construct that can nullify the negative impacts of workplace bullying. OBSE is a crucial resource in annualizing the negative effect of bullying in the workplace. Policymakers should imbibe OBSE as a crucial factor in the policies and ethics of their organization for enhancing employee engagement and employability.

Keywords Workplace bullying · Perceived internal employability · Employee engagement · Organization-based self-esteem · Indian faculty

* Nimmi P. M. [email protected]

Geetha Jose [email protected]

Maria Tresita Paul Vincent [email protected]

Anjali John [email protected]

1 SCMS Cochin School of Business, Kochi, Kerala, India 2 Bharata Mata Institute of Management, Kochi, India 3 Sardar Vallabhbhai Patel International School of Textiles & Management, Coimbatore,

Tamil Nadu, India 4 Marthoma College of Management, Perumbavoor, India

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Introduction

Daily interactions in the workplace establish critical grounds based on which organiza- tional members are respected or not as respected. These interactions are also vital aspects that transfer the sense of belongingness and worth to the members (Nguyen et al., 2019). This unique sense of significance derived from interactions is at the heart of the human experience and psychological needs (Rogers & Ashforth, 2017). During such social exchanges, negative interactions may occur like workplace bullying, incivility, abu- sive supervision, deviance, harassment, emotional abuse, and social undermining (Mao et al., 2019; Jacobsen et al., 2018). Amongst these, even after 30 years of research, bul- lying remains a prominent issue that workplaces must solve (Agarwala, 2018; Krishna & Soumyaja, 2020). Workplace bullying is established as a serious work demand and has received much attention in the organizational psychology and behaviour literature in the last decade (Agarwala, 2018; Arshad & Ismail, 2018; Bartlett & Bartlett, 2011; Conway et al., 2021; Gardner et al., 2016; Glambek et al., 2018; Gupta, 2013; Hogh et al., 2021; Nielsen & Einarsen, 2012; Rai & Agarwal, 2017; Tuckey et al., 2017; Verkuil et al., 2015).

In India, teaching as a profession is considered noble; despite this, ‘Indian academia’ reports a high rate of workplace bullying (Agarwala, 2018; Gupta, 2013; Krishna & Soumyaja, 2020). Workplace bullying is described as a category of harassing behaviour that employees may be subjected to at any stage of their career, regardless of their member- ship in a protected class based on gender, ethnicity, age, etc. (Leymann, 1990). The reper- cussion of workplace bullying in academia is often reflected in the behaviour towards other stakeholders in an immediate environment like students. This vicious spillover effect may also be reflected in other work outcomes (Krishna & Soumyaja, 2020). However, research examining outcomes of workplace bullying literature in Indian academia is comparatively less (Agarwala, 2018; Gupta, 2013; Krishna & Soumyaja, 2020). Recent research identi- fied that the literature on workplace bullying in India lacks studies on the antecedents and consequences of workplace bullying at the national, societal, and cultural levels, emphasiz- ing future research in this direction (Gupta et al., 2020). Given these gaps in bullying lit- erature in Indian academia, the present study is a modest attempt to address how workplace bullying influences work outcomes among Indian academics.

Adverse effects of bullying affect the organizational sustainability of higher educational institutions (Muazzam et  al., 2020). Organizational sustainability is associated with how engaged/associated employees are with their work and organization (Glavas, 2012; Zayed et  al., 2020). Activities that demoralize employees’ enthusiasm for the organization can negatively impact organizational sustainability and growth. Moreover, workplace victimi- zation can lead to absence of employees, reduced morale and motivation, and reduced pro- ductivity (Law et al., 2011). Although studies on workplace bullying and adverse work out- comes, like turnover intention (Coetzee & van Dyk, 2018), workplace incivility (Meires, 2018), and deviant behaviours (Sarwar et al., 2020), have yielded an understanding of the negative impact of bullying. The impact of workplace bullying and its relationship with positive work outcomes remain underexplored (Rai & Agarwal, 2017). While workplace bullying can have profound consequences in the work purview, it is vital to comprehend further workplace bullying and its interactions with positive outcomes in the work domain, like employee engagement and internal employability.

Sustainable growth of organizations is achieved by developing human resources and hav- ing a positive mindset at work. A highly engaged workforce is quintessential for the success of an organization. Commitment and belongingness towards the organization are evident while

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assessing employees’ perceived internal employability as it indicates whether employees plan to continue with the organization (Nimmi et  al., 2020). From an employee perspective, an optimum balance between resources and demands is essential for a sustainable career.

Perceived internal employability is an indicator of increased productivity and higher reten- tion of employees (Sánchez-Manjavacas et al., 2014). A greater sense of employability is asso- ciated with career satisfaction and wellbeing (Gowan, 2012). Employees with higher internal employability perceptions are confident that they are competent and competitive. Referred to as employees’ alignment of current and future career prospects within the company, perceived employability is affected by individual differences. External realities relating to work and work environment help to nurture or hinder perceived internal employability (Cerdin et al., 2020). Uncertainties and contingencies at work results in less cognitive resources for employ- ees which can negatively impact their internal employability perceptions (Cerdin et al., 2020).

Employee engagement can be defined as a “positive, active, work-related psychological state operationalized by the maintenance, intensity, and direction of cognitive, emotional, and behavioral energy” (Shuck et al., 2017, p. 269). Kahn conceptualizes engagement as harness- ing selves in one’s work roles cognitively, physically, and emotionally, driving in-role behav- iours (May et al., 2004). The psychological conditions of meanigfulness,safety and availability has to be met for engaging the employees (Kahn, 1990). Research revealed that psychological conditions influence the overall employee engagements. (Allen & Rogelberg, 2013). Engage- ment creates a psychological connectedness with employees’ work, and engaged employees encompass high levels of energy and are enthusiastic about their work. They also often get fully engrossed in their work and execute their role and responsibilities at a higher quality level. In organisations harmful social stressors like workplace bullying causes disengage- ment and disrupts the organisational productivity, increased intent to quit and decreased employee performance (Trépanier et al., 2013; Serban et al., 2022). Thus, when the psycho- logical conditions are not met in the organizations, it can affect the employee’s psychological health. Employee disengagement is a prominent indicator of such poor psychological health in employees.

Resource theory literature (Hobfoll, 2012) highlights the importance of resource caravans and resource passageways for a sustainable career. Bullying is characterized as a job demand that drains out the positive resources in an employee. More and more resources are needed to buffer the drain of resources. Theoretically, the study draws from the conservation of resources theory to decipher how workplace bullying negatively influences employee engagement and internal employability and how an organizational resource could mitigate this negative effect. The study proposes that developing organization-based self-esteem can potentially protect employees from the detrimental effects of bullying. Practically, this study provides insights into mitigating the adverse effects of bullying in the workplace and how organizations can play a role. The purpose of our paper is thus two-fold. First, to see if bullying negatively pre- dicts employee engagement and perceived internal employability among academics in India as a case. Second, to look into whether OBSE moderates the negative relationships between the above said variables.

Theoretical Framework

Our study is positioned on the conservation of resource theory (COR theory). Accord- ing to COR theory, “people strive to retain, protect, and build resources and that what is threatening to them is the potential or actual loss of these valued resources, Hobfoll (1989,

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p.513)”. COR theory introduces resource passageways, representing how the external envi- ronment, including work and non-work environment, can promote or hinder one’s resource gain. In this study, we place bullying as a job demand. The job demand ought to have a depleting role on job resources. At a work setting, employee engagement and perceived internal employability are considered an outcome of resource perceptions. The study pro- poses that bullying as a job demand depletes the job resources and negatively impacts engagement and internal employability. The study then places OBSE as a resource pas- sageway instigated within an employee by the organization. Thus, developed self-esteem in employees protects and safeguard them against incivility experienced by them at the workplace.

Literature Review and Hypothesis Development

Workplace Bullying and Employee Engagement

Personnel engagement is conceptualized as “the harnessing of organization members’ to their work roles; i.e., in engagement, people express and employ physically, cognitively, and emotionally during role performances (Kahn, 1990, 694)”. Engagement is about the willingness to invest oneself and expend an open effort to help the employer succeed. Employee engagement consists of three facets: trait engagement, behaviour engagement, and psychological state engagement (Macey & Schneider, 2008). Employee engagement is a crucial competitive advantage factor in human resource management practices (Albrecht et al., 2015). Saks (2019), in his study on the antecedents and consequences of employee engagement, stated a positive and significant relationship of employee engagement with job performance, organization commitment, and organizational citizenship behaviour. Employee engagement can be better understood by understanding the sources creating employee engagement.

The COR theory gets aligned with this perspective. The demands and resources employees collect in the organization play a vital role in engaging them. This is because employees’ intrinsic and extrinsic motivation gets strongly influenced by these demands and resources, which results in their engagement level (Nazir & Islam, 2017; Tesi, 2021). Workplace bullying covers a set of negative behaviours aimed toward an individual at the workplace (Einarsen et  al., 2009). Bullying acts as a job demand that drains out the resources of an employee and negatively impacts the positive job outcomes of employees. Workplace bullying is primarily defined as “repetitive acts of harassment, such as social isolation and verbal abuse, which one or more perpetrators commit over an extended period (six months or more)” (Einarsen et al., 2020, p.22). There are a series of negative consequences of workplace bullying (Coetzee & van Dyk, 2018; Meires, 2018; Sarwar et al., 2020). Engagement with work or organization is the result of actual or anticipated resource gain enhancing energetic resources. The washout of resources due to bullying can reduce engagement with the organization. Based on previous empirical findings (e.g., Ein- arsen et al., 2018; Meriläinen et al., 2019; Park & Ono, 2017), based on the above discus- sions, we hypothesize that workplace bullying is negatively related to engagement, espe- cially employee engagement.

H1: Workplace bullying negatively predicts employee engagement

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Workplace Bullying and Perceived Internal Employability

Employability perception is defined as an individual’s perception of his or her chances of attaining and maintaining employment (Vanhercke et al., 2014). Assessing employability perceptions is essential as employees’ perceptions rather than reality activate their cogni- tions and behaviours (Vanhercke et al., 2014; Nimmi et al., 2020). There are two dimen- sions of perceived employability, namely, perceived internal employability and perceived external employability. According to Rothwell and Arnold (2007), internal employability is the perceived value of the occupation with the current employer or within the labour market. In contrast, external employability reflects the perceived value of employment in the external labour market.

Research reveal that, employability is a key job resource, impacting the subjective career success and job performance within organizations. (Bozionelos et  al., 2016). The COR theory places perceived employability as a vital resource (Kirves, 2014) to enable an individual to adapt to the changing work environment (Baruch, 2014; Baruch & Rousseau, 2019) and as an individual coping mechanism for job security and a sustainable career (Donald et  al., 2020). Perceived employability is considered an outcome of interactions between structural factors (Job market and Organisational) and internal factors (Bernt- son, 2008). Several factors like training, work experience, interpersonal relationships, and constructs like, protean career attitude, and spirituality affect the employability perceptions of a person (Cortellazzo et al., 2020; Groot & Van Den Brink, 2000; Nimmi et al., 2020; Nimmi et  al., 2021). Organizational factors like HRM practices are associated with per- ceived internal employability (Akkermans et  al., 2020). Perceived internal employability explains organizational outcomes like desired commitment, loyalty, adaptability, and pro- ductivity (Sánchez-Manjavacas et  al., 2014). It is an indicator of enhanced commitment towards the organization and output of developmental activities provided by the organi- zation. However, work demands like workplace bullying, which deplete resources, have a detrimental effect on internal employability as different bullying activities manifest into different adverse outcomes. Bullying depletes the resources like self-esteem, self-con- fidence, physical and mental health, trust in the organization and colleagues (Krishna & Soumyaja, 2020). As these resources see a downfall, workplace bullying can be detrimen- tal to the internal employability perceptions of individuals and job insecurity (Krishna & Soumyaja, 2020). Thus, we hypothesize that,

H2: Workplace bullying negatively predicts perceived internal employability.

The Moderating Role of OBSE

Pierce et al. (1989) introduced the concept of organization-based self-esteem as a multi- faceted phenomenon. Organization-based self-esteem (OBSE) is defined as “the degree to which an individual believes him/herself to be capable, significant, and worthy as an organizational member.” The concept elaborates self-esteem, which has been stud- ied in the individual context, to an organizational context where one’s self-evaluation of his/her worthiness as an organizational member is assessed. High OBSE indicates individuals consider themselves as essential and competent enough to be employable in that particular organization (Pierce & Gardner, 2004) and are highly satisfied with the treatment in the particular organization. OBSE is a self-concept (personal resource)

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developed at the individual level, based on social exchange within the organization. According to Xanthopoulou et al. (2007), personal resources moderate the link between job demands and work outcomes. In this context, employees who enjoy a stronger sense of self-esteem can be expected to exhibit a stronger sense of performance than their low self-esteem counterparts (Paul V & Devi, 2018, 2020).

Recent research has revealed that psychological empowerment substantially affects employee engagement (Joo et  al., 2019). OBSE is an essential psychological empow- erment resource for employees. In the organizational context, people with high self- esteem or high levels of OBSE may be less responsive to adverse effects than employees with low levels of OBSE (Hui & Lee, 2000). When threatened by a hostile work atmos- phere, employees with high OBSE may cope more than employees having low OBSE (Arshadi & Damiri, 2013). The theoretical explanation for the moderating role of OBSE comes from its role as a resource passageway. First is that OBSE acts as a resource cara- van passageway helps to maintain resource caravan by compensating for resources lost at the job (Hobfoll, 2012). OBSE moderates the relationship as ‘resource passageway function’ as it can diminish the side effects of adverse workplace habits. So OBSE helps an individual to cope up with the negative impacts of workplace bullying. Based on the assumptions we propose,

H3: OBSE positively moderates the negative relationship between Workplace bul- lying and employee engagement; such that the negative relationship between work- place bullying and employee engagement is weaker for those who are high in OBSE. H4: OBSE positively moderates the negative relationship between Workplace bullying and perceived internal employability; such that the negative relationship between work- place bullying and internal employability is weaker for those who are high in OBSE.

So based on the propositions a theoretical model was framed, depicted in Fig.  1 which was theoretically tested,

Methodology

Methods and Participants

The core aim of this study was to investigate the linkage between workplace bullying with employee engagement and employability. It also examined how OBSE moderates the relationship mentioned above among university teachers.

The population of the study constitutes permanent teachers employed with recog- nised Indian universities and their affiliated colleges spread across Kerala and Tamil Nadu, in South India. Convenience sampling was chosen for the study considering the special interventions of Covid 19 pandemic. The methodological rigour followed in this study can subdue the apprehensions of choosing convenience sampling method in this cross-sectional study. Limiting respondents to the above criteria made OBSE, employee engagement, and employability relevant issues for the individual. An online survey was floated through the mail. Participants were assured strict academic usage of collected data and anonymity of their responses. Screening 269 reverted responses, nine were cast off due to incompletion, resulting in a sample size of 260.

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Measures

Perceived Internal Employability was assessed via 4-items based on the scale devel- oped by Rothwell and Arnold (2007). The perceived value of occupation in the current organization (internal employability) with four items. A sample item was “Even if there was downsizing in this organization, I am confident that I would be retained.”

Organisation Based Self-Esteem was assessed with a ten-item scale developed by Pierce et al. (1989). A sample item was “I am taken seriously around here”.

Employee engagement was assessed using a UWES -9 developed by Schaufeli et al. (2006) containing 9 items. A sample item is “I feel happy when I am working intensely”.

Workplace bullying was assessed using a Short Negative Acts Questionnaire contain- ing 9 items developed by Notelaers, Hoel, van der Heijden and Einarsen et al. (2018). A sample item is “in the past six months I experienced persistent criticism about my work and effort”.

Control Variables

Gender, total experience, years of experience in the current organization were controlled in the study as previous studies have denoted the impact of these variables on outcome variables (Pierce et al., 1989; Donald et al., 2019).

Organisation Bases Self-Esteem

Workplace Bullying

Employee Engagement

Perceived Internal Employability

Fig. 1 Proposed theoretical model

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Data Analysis Strategy

The Warp PLS was used to conduct confirmatory factor analysis (CFA), examining adopted study measures’ measurement model and validity. Thus, confirming the discri- minant and convergent validity of the instrument items. Subsequently, using the PRO- CESS macro in SPSS 23.0 (Hayes, 2013) with 5000 bootstrapped samples following Preacher and Hayes (2008), the structural equation model (SEM) was performed to test the hypothesized moderation model. Out of 260 respondents, 161 were female, and 99 were male. Also, 35% of teachers were below 25 years, 26% were between 26 and 35 years, 21% were between 36 and 45 years, 7% were between 46 and 55 years, and the remaining 11% were above the age of 55 years.

Further analysis was done in two stages. In the first stage, Harmon’s single factor test was applied to check for common method bias. Initial descriptive tests were conducted using SPSS software. Then the reliability and validity of the scales were assured. The reli- ability of the scales was assessed using Cron-Bach alpha values. In the second stage of the study, the hypotheses were tested using structural equation modelling using Warp-PLS. The moderation effects were assessed using SPSS Macro- Hayes Model Template 1.

Results and Analysis

Descriptive Statistics

The fit of the proposed model depicted in Fig. 1 was tested with Warp-PLS v.6.0 statisti- cal software (Kock, 2015). Each of the constructs like Bullying, OBSE are represented by latent factors. And each latent factors were assessed using specific scale items. Fit Indices are provided in Table. 1, which permits an acceptable fit for the model.

The mean, standard deviation, and correlations (Table 2) indicated a reliable correlation for the variables under study.

The convergent and discriminant validity was assessed using average extracted vari- ance (AVE) and maximum shared variance (MSV); which found to be above thresh- old levels and approves validity and reliability tests for the measures (Table.  3). The

Table 1 Fit indices

Fit Index Value Threshold limit

Average path coefficient (APC) 0.350 P < 0.001 Average R-squared (ARS) 0.276 P < 0.001 Average adjusted R-squared (AARS) 0.261 P < 0.001 Average block VIF (AVIF) 3.34 acceptable if <= 5, ideally <= 3.3 Average full collinearity VIF (AFVIF) 2.00 acceptable if <= 5, ideally <= 3.3 Tenenhaus GoF (GoF) 0.443 small > = 0.1, medium > = 0.25, large > = 0.36 Sympson’s paradox ratio (SPR) 0.750 acceptable if > = 0.7, ideally = 1 R-squared contribution ratio (RSCR) 0.950 acceptable if > = 0.9, ideally = 1 Nonlinear bivariate causality direction ratio

(NLBCDR) 0.750 acceptable if > = 0.7

Statistical suppression ratio (SSR) 0.720 acceptable if > = 0.7

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reliability of the constructs (Cron-Bach values) was above the accepted threshold (Workplace Bullying – 0.87, OBSE – 0.89, Perceived Internal Employability – 0.87, Employee Engagement – 0.86).

Hypothesis Testing

In order to assess the direct effects, path analysis was conducted with workplace bully- ing as the predictor and employee engagement and perceived internal employability as outcomes in Warp-PLS. The direct effects were assessed from the structural model. The study found a significant negative effect of workplace bullying on employee engagement (−0.269**) and employability (−0.312**). So, hypothesis 1 and 2 are accepted.

To test the moderating hypotheses, PROCESS method (Preacher and Hayes (2004, 2008)) was used as indirect effect can be deducted from it. Bootstrapping procedure was followed with around 5000 samples to give 95% confidence interval (CI) with indirect effect estimates. The codes for moderation analysis were captured from SPSS – Hayes Macro output and graphical representation were created with MS- Excel. Lastly, regarding the moderating hypotheses, H3 and H4, the indirect outcome of workplace bullying on per- ceived internal employability was significant for OBSE (beta = 0.318**) and on employee engagement was significant for OBSE (beta = 0.468**). The positive moderating role of OBSE is represented in the Figs. 2 and 3. Further Tables 4 and 5 depicts the interaction effect of Work place Bullying on Internal employability and Employee engagement. The direct effect of Bullying on Engagement and Internal Employability in the presence of OBSE as well interaction (moderation effect) effect is evident from the tables.

Table 2 Correlation table

**. Correlation is significant at the 0.01 level (2-tailed) *. Correlation is significant at the 0.05 level (2-tailed)

1 2 3 4 5 6 7 Mean S.D

1. Bullying 1.932 0.787 2. Perceived Employability −.165* 3.842 749 3. OBSE −.428** .573** 4.146 0.721 4. Engagement −.269** .721** .696** 4.04 0.818 5. Gender −.093 .085 .002 .163 na na 6. Total experience −.251* .042 .263** .232* .034 8.581 6.931 7. Experience in current Organization −.102 .143 .052 .199* .142 .531** 3.901 3.991

Table 3 Measurement model statistics

Constructs Type CR AVE Cronbach VIF

1.Workplace Bullying Reflective 0.902 0.708 0.877 1.293 2. Perceived Employability Reflective 0.871 0.677 0.814 2.093 3. OBSE Reflective 0.924 0.754 0.889 2.331 4. Engagement Reflective 0.91 0.717 0.867 2.313

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Discussion

The purpose of this paper was two-fold. First, to see whether workplace bullying has a det- rimental effect on internal employability perceptions and employee engagement. Second, to see whether OBSE has a positive effect on the above-mentioned relationships. We found support for H1 (workplace bullying negatively predicts employee engagement) and H2

Fig. 2 Moderating role of OBSE in Bullying – Engagement

Fig. 3 Moderating role of OBSE in Bullying – Employability

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(workplace bullying negatively predicts perceived internal employability). The moderating hypothesis put forward was also accepted. That means OBSE moderated the relationship of workplace bullying with employee engagement as well as perceived internal employability. Our study was in response to a call by Park and Ono (2017) on more representation of reports from the impact of bullying on employees belonging to different cultures and occu- pations. The support to H1 addresses calls by Park and Ono, 2017 and Rai and Agarwal, 2017 on the under-representation of the effects of workplace bullying in different cultural contexts and also the organization-level outcomes of workplace bullying.

Our findings of the detrimental effect of workplace bullying on engagement and employability are in line with the JD-R theory claiming the negative impact of workplace bullying on work outcomes. The potential explanation of the negative impact of workplace bullying is that bullying could act as a workplace demand that can mitigate the energy and resources of the individual. This drain of resources may lead to a decreased level of engagement within the organization activities as well as perceiving low internal employ- ability. The moderating role of OBSE is very much evident from the regression coefficient and Figs. 2 and 3. For those employees who have high OBSE, even when facing bullying experiences their engagement at work and internal employability seems to be high. This means the adverse effects of bullying are buffered by the high OBSE levels.

Theoretical Implications

The study looks into the impact of workplace bullying on important work outcomes from a multi-theoretic perspective. Major factors that reflect the sustainability of an organization are the internal employability and engagement of its employees. The study is the first among to look into the impact of bullying on employability. The study is significant from a socio-cul- tural perspective as India has a collectivist culture with high power distance (Hofstede, 1980). A negative association was found in lieu of the JD-R model and COR model. Prior research on workplace bullying has not checked the buffering role of OBSE. The most significant

Table 4 Interaction effect of OBSE and bullying on employee engagement

Dependent Variable: Employee engagement

Predictor Beta SE t p LLCI ULCI

Constant 1.32 1.01 1.3 0.03 0.68 3.34 Bullying −0.22 0.34 −0.65 0.05 −0.84 −0.25 OBSE 0.63 0.23 2.62 0.0002 0.36 0.89 Bullying*OBSE 0.46 0.08 0.244 0.04 0.27 0.85

Table 5 Interaction effect of OBSE and bullying on perceived internal employability

Dependent Variable: Perceived Internal Employability

Predictor Beta SE t p LLCI ULCI

Constant 1.49 1.07 1.38 0.17 1.18 2.23 Bullying −0.21 0.36 −0.27 0.05 −0.78 −0.31 OBSE 0.61 0.32 2.39 0.01 0.36 0.88 Bullying*OBSE 0.32 0.08 0.97 0.03 0.27 0.64

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theoretical implication of our study comes from the moderating role of OBSE. Organization based self-esteem acts as a source passage that alleviates the negative impacts of bullying in workplace domain. OBSE is an unswerving reflection of the self-perceived value that an indi- viduals have in an organisational enviornment. Employees who perceive high OBSE, perceive themselves as important in the organisation and find meaning in the work they do. This is reflected in their future employment perceptions within the organisation. This will be directly reflected in their behaviours which is in lieu with the policies of the organisation and valued within organization. It is believed that these may result in employees’ deriving intrinsic satis- faction, coupled with reinforcing their self-esteem (Pierce et al., 1989).

Practical Implications

The deleterious effects of workplace bullying may reflect on the sustainable growth of organi- zations. The cues from the employees who perceive bullying shall be seriously taken up by HR managers and supervisors to support them and help them relieve the negative emotions. The study calls for interventions conducted at the organization level that can convey the value system within the organization and restrain individuals from bullying manifestations. It is per- tinent to develop a work culture that nurtures creativity as well as employability rather than mitigating them. The study also voices the need to develop a harmonious relationship at work. Such an atmosphere is necessary to ensure employees that their jobs are not at stake. The importance of developing OBSE in an organization is conveyed through the article by looking into the buffering role of OBSE on the negative impacts of workplace bullying. The effects of employer brand image regarding their warmth and competence on employee engagement is influenced by their employee characteristics (e.g., experience and role) (Davies et al., 2018). Thus, organizations should provide the teachers with a supportive environment (Gallagher et al., 2021) through OBSE to enhance their positive affirmations with their role and experi- ence accumulation, to enhance their brand image and employee engagement.

Limitations and Future Research

Future research could include observer ratings to examine how much they predict incremental variance over and above self-reports, which could be collected at multiple time points. Like- wise, a longitudinal research design to attain more knowledge on causal relationships. Cultural differences may exist in academic settings in different countries, so the validation of models in different nations is a possibility. Also, another scope is to capture the difference in outcome on temporary and permanent employees who are subjected to bullying. Various personal and organization level moderators could be considered to buffer the negative impacts of bullying. Further studies also could come up with how bullying impacts external employability and turnover intentions.

Conclusion

In conclusion, our study and model constitute an important step toward understanding the outcomes of workplace bullying. The study also investigated the moderating role of OBSE in the relationship of bullying at the workplace to that of employee engagement,

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and employability. We found that OBSE positively moderates both the relationships. This research work adds to the research on workplace bullying and organizational outcomes in academia. We also provide implications of our findings for employees in academics.

Declarations

Conflict of Interest There is no conflict of Interest between the authors.

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R E S E A R CH B R I E F

Learning environments, reliability enhancing work practices, employee engagement, and safety climate in VA cardiac catheterization laboratories

Heather M. Gilmartin PhD, NP1,2 | Edward Hess MS1 | Candice Mueller BA3 |

Brigid Connelly BA1 | Mary E. Plomondon PhD, MSPH3 |

Stephen W. Waldo MD1,3,4,5 | Catherine Battaglia PhD, RN1,2

1Denver/Seattle Center of Innovation for

Veteran-Centered and Value Driven Care,

VHA Eastern Colorado Healthcare System,

Aurora, Colorado, USA

2Department of Health Systems, Management

and Policy, University of Colorado, School of

Public Health, Aurora, Colorado, USA

3CART Program, Office of Quality and Patient

Safety, Veterans Health Administration,

Washington, District of Columbia, USA

4Department of Medicine, Cardiology Section,

Rocky Mountain Regional VA Medical Center,

Aurora, Colorado, USA

5Department of Medicine, Division of

Cardiology, University of Colorado, Aurora,

Colorado, USA

Correspondence

Heather M. Gilmartin, Denver/Seattle Center

of Innovation for Veteran-Centered and Value

Driven Care, VHA Eastern Colorado

Healthcare System, 1700 N. Wheeling Street,

Aurora, CO 80045, USA.

Email: [email protected]

Funding information

Dr Heather M. Gilmartin is supported by

Career Development Award Number

1IK2HX002587-01A1 from the United States

Department of Veterans Affairs Health

Services Research & Development Service of

the VA Office of Research and Development.

Abstract

Objective: To characterize the relationship between learning environments (the edu-

cational approaches, cultural context, and settings in which teaching and learning

happen) and reliability enhancing work practices (hiring, training, decision making)

with employee engagement, retention, and safety climate.

Data source: We collected data using the Learning Environment and High Reliability

Practices Survey (LEHRs) from 231 physicians, nurses, and technicians at 67 Veterans

Affairs cardiac catheterization laboratories who care for high-risk Veterans.

Study design: The association between the average LEHRs score and employee job

satisfaction, burnout, intent to leave, turnover, and safety climate were modeled in

separate linear mixed effect models adjusting for other covariates.

Data collection: Participants responded to a web-only survey from August through

September 2020.

Principal findings: There was a significant association between higher average LEHRs

scores and (1) higher job satisfaction (2) lower burnout, (3) lower intent to leave,

(4) lower cath lab turnover in the previous 12 months, and (5) higher perceived safety

climate.

Conclusions: Learning environments and use of reliability enhancing work practices

are potential new avenues to support satisfaction and safety climate while lowering

burnout, intent to leave, and turnover in a diverse US health care workforce that

serves a vulnerable and marginalized population.

K E YWORD S

high reliability organization, learning health system, Veterans, workforce

What is known on this topic

• Health care organizations and their employees benefit from adopting learning health

practices.

The funding organization played no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the

manuscript; and decision to submit the manuscript for publication. The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of

Veterans Affairs.

DOI: 10.1111/1475-6773.13907

Health Services Research

Published 2022. This article is a U.S. Government work and is in the public domain in the USA.

Health Serv Res. 2022;57:385–391. wileyonlinelibrary.com/journal/hesr 385

• Learning health practices include the creation of supportive learning environments and use

of reliability enhancing work practices.

• The impact of learning health practices on workforce engagement and retention are not

clear.

What this study adds

• This study identified associations between supportive learning environments, reliability

enhancing work practices, and engagement, retention, and safety climate in the largest inte-

grated health care system in the United States.

• Policy makers can use this evidence to inform program planning and decision making regard-

ing high reliability organization and learning health system transformations.

• Facility, department, and unit leaders can use the Learning Environment and High Reliability

Practices Survey to provide insights into areas of strength and opportunities for improve-

ment that can lead to meaningful change.

1 | INTRODUCTION

Health care organizations and their employees can benefit from

adopting learning health practices.1 A learning health system, per the

National Academy of Medicine, harnesses data and analytics to learn

from every patient and return the knowledge to clinicians to imple-

ment with high reliability (i.e., error free).2 Transforming health care

organizations into learning health systems requires an understanding

of learning environments and reliability enhancing work practices to

realize the benefits for employees, patients, and population health.3,4

Learning environments are the educational approaches (e.g., online

vs. unit-based trainings), cultural context (e.g., ways of thinking, working),

and settings in which teaching and learning happen.5 Learning envi-

ronments differ from individual learning for they support individuals

to collectively analyze and interpret experiences. Staff who work in

supportive learning environments, the ideal learning environment, are

encouraged to discuss and debate alternative ways of getting work

done, share information about what does and does not work, experi-

ment with new ways of working, and are given time for reflection and

improvement.1,6

Health care organizations are increasingly emulating high reliabil-

ity organizations to improve safety, quality, and efficiency. High reli-

ability organizations are guided by the following five key principles:

deference to expertise, reluctance to simplify, sensitivity to opera-

tions, commitment to resilience, and preoccupation with failure.7 High

reliability in health care is achieved through a combination of specific

reliability enhancing work practices to detect and adapt to unex-

pected events. Reliability enhancing work practices include hiring

employees based on their willingness to learn new skills, the ability to

work with others, and the ability to communicate. Additional practices

include training programs for new hires in communication and inter-

personal skills, informal education sessions, and employee forums to

discuss improvements and decisions that affect work and care

delivery.6

Learning environments and reliability enhancing work practices

can positively impact staff engagement, peer-to-peer interactions, and

knowledge sharing by creating processes and forums where people

feel safe to speak about concerns or new ways of working.1,6,8 The lit-

erature has touted the benefits of learning environments and reliabil-

ity enhancing work practices on quality of care, costs, and patient

safety9–15 However, these studies are limited to case-study

approaches, small, homogenous samples, and do not include outcomes

from a diverse US health care workforce that serves vulnerable and

marginalized populations.

In this study, we aim to characterize the relationship between

learning environments and reliability enhancing work practices with

health care employee engagement, retention, and safety climate in

Veterans Affairs (VA) cardiac catheterization laboratories (cath labs).

Employee engagement is conceptualized as a positive, work-related

mindset that includes feelings of vigor and dedication and absorption

in one's work.16 Engagement can be viewed as the direct opposite of

burnout, for the two constructs are conceptualized as two ends of a

single continuum.16 Retention, or workforce length of employment, is

a recruitment strategy, as it avoids the high costs of turnover and loss

of institutional memory, provides continuity of care for patients, and

contributes to unit and organizational stability.17 Safety climate

reflects team members' perceptions or attitudes about the organiza-

tional safety culture in which they work.16 Theories and studies of

engagement suggest that engaged employees have a higher probabil-

ity of displaying safety-related attitudes and behaviors that define

safety climate.18,19 Additional studies suggest that health care work-

force engagement and retention decrease costs associated with illness

and injury of patients and lost time from work.20,21

In this study, we examined the 81 VA cath labs staffed by multi-

disciplinary teams that provide life-saving coronary procedures to

over 40,000 high-risk and vulnerable veterans annually. In the context

of cath labs, supportive learning environments are those where the

interventional cardiology team or unit leaders foster psychological

safety and encourage open discussion and debate during team meet-

ings, experiment frequently with new ways of working, and provide

time and structure for reflection through postprocedural briefings.

Cath labs that have adopted reliability enhancing work practices are

386 GILMARTIN ET AL.Health Services Research

those that interview and hire staff for their procedural knowledge and

their willingness to try new skills and their ability to communicate.

These cath labs develop preceptor programs that teach relationship

and communication skills and use daily huddles as forums for group

learning, problem solving, and decision making.

Guided by the five high reliability organization principles,7 the Learn-

ing Organization Model10 and the Reliability Enhancing Work Practice

and Patient Safety Model,6 we administered a previously validated survey

to VA cath lab staff.22 Two hypotheses were assessed: whether learning

environments that are highly supportive and use reliability enhancing

work practices are (a) associated with higher employee engagement

and retention and (b) are associated with higher safety climate scores.

2 | METHODS

2.1 | Data sources

From August through September 2020, we invited 902 physicians,

nurses, and technicians at the 81 VA cath labs to participate in

the web-based Learning Environment and High Reliability Practices

Survey (LEHRs), an independent survey not affiliated with the

annual VA All Employee Survey. All full-time and part-time cath lab

employees, fellows, consultants, and interventional cardiology physi-

cians identified by cath lab management were eligible to participate.

Cath lab employees that did not provide direct patient care were

excluded.22 The LEHRs consist of 27-items from the Learning Organi-

zation Survey-27,1 31 items from the Reliability Enhancing Work

Practices Survey,6 10 demographic questions, and 5 employee

engagement, retention, and safety climate questions. The survey

items, recruitment methods, and psychometric properties of the

LEHRs were pilot tested in VA cath labs in 2018.22

2.2 | Variables

The Learning Organization Survey-271 items measure facets of the

five high reliability organization principles. These include the support-

ive learning environment items which ask if people value new ideas,

are open to new ways of working, and make time for reflection. The

learning practices items ask if newly hired employees receive ade-

quate training, if debriefs occur regularly, and if performance is com-

pared to best-in-class organizations. The leadership items ask if

management listens attentively and invites input (Data S1).

The Reliability Enhancing Work Practices Survey assesses the

presence of reliability enhancing work practices, respectful interac-

tion, mindful organizing, affective commitment, and organizational cit-

izenship behaviors.6 The reliability enhancing work practice items

query hiring practices, communication and relationship trainings, and TABLE 1 Respondent demographics

N (%)

VA cath labs represented (N = 81) 67 (83)

Employees 232 (26)

Role

Nurse 146 (93)

Interventional cardiologist 27 (12)

Technician 42 (18)

Other 17 (7)

Supervisory role 58 (25)

Gender

Female 127 (55)

Male 100 (43)

Race

White 173 (75)

Asian, Pacific Islander 24 (10)

Other 18 (7)

Black 14 (6)

Native American 3 (1)

Mean (years)

Age 48

Years in health care 21

Years in VA 7

Years in current cath lab 5

Abbreviation: VA, Veterans Health Administration.

TABLE 2 Highest and lower scoring LEHR scales and example survey items

Survey scales

Example survey items (1–7 ascending Likert scale)

Mean

(SD)

Affective commitment I do feel a strong sense of

belonging to my lab

5.4 (1.4)

Supportive learning

environment

This lab engages in productive

conflict and debate during

discussion

5.3 (1.4)

Mindful organizing When a patient crisis occurs,

we rapidly pool our

expertise to resolve it

5.3 (1.3)

Respectful interaction The employees in this lab are

trustworthy

5.1 (1.4)

Organizational

citizenship

The employees in this lab help

make others more

productive

5.0 (1.5)

Leadership reinforces

learning

My supervisor listens

attentively

4.8 (1.7)

Learning processes This lab regularly conducts

postaudits, after-action

reviews, and debriefings

4.5 (1.4)

Reliability enhancing

work practices

Employees are hired based on

their ability to work with

others

4.5 (1.4)

Abbreviation: LEHRs, Learning Environment and High Reliability Practices

Survey.

GILMARTIN ET AL. 387Health Services Research

F IGURE 1 Mixed effect linear regression models: Average Learning Environment and High Reliability Practices Survey (LEHRs) score as a function of job satisfaction, burnout, intent to leave, safety climate, or turnover. Low: Average LEHRs score below the reference category (dotted line) and with confidence intervals that exclude the reference value. High: Average LEHRs score above the reference category (dotted line) and with confidence intervals that exclude the reference value. Results from five separate linear mixed effect models are presented. Each model has the average of the eight LEHRs scales as the response and includes either (A) job satisfaction, (B) burnout, (C) intent to leave, (D) safety climate, or (E) turnover as the predictor of interest plotted on the x-axis. Each model also adjusted for age, gender, race, role, supervisor status, time in VA cath lab (dichotomized at 3 years) and time in cath lab (dichotomized at 3 years) and a random intercept for site

388 GILMARTIN ET AL.Health Services Research

opportunities for decision making. The respectful interaction items

query honesty, trust, and mutual respect within teams. The mindful

organizing items query if teams talk openly about mistakes and ways

to learn from them. The affective commitment items query feelings of

emotional attachment to a team. The organizational citizenship items

query behaviors helpful, but not required by an employer, such as

making others more productive (Data S1).

Demographic items included age, role, education, gender, race,

ethnicity, years in health care, years in VA, years in the cath lab, and

supervisory status. Survey nonresponse bias was assessed by calculat-

ing the number of respondents divided by the number of staff invited

to participate from the 23 Veteran Integrated Service Networks

(VISN). Employee engagement was assessed through two items: “Con- sidering everything, how satisfied are you with your job” (5-point

Likert scale, “Very dissatisfied” to “Very satisfied”) and “I feel burned out from my work” (7-point Likert scale, “Never” to “Everyday”). Retention was assessed through one item: “If I were able, I would

leave my current job” (5-point Likert scale, “Strongly disagree” to

“Strongly agree”). Turnover was assessed through one item: “We have

had ____ cath lab staff leave in the last 12 months” (“Choose one:

0, 1–2, 4–6, 7+”). Safety climate was assessed through one item:

“I would feel perfectly safe being treated in this cath lab” (5-point

Likert scale, “Strongly disagree” to “Strongly agree”).

2.3 | Statistical methods

To characterize the national cross-sectional survey data, we calculated

descriptive, correlational, and reliability estimates. To assess the asso-

ciation between average LEHRs score and each of the employee

engagement, retention, and safety climate measures, a linear mixed-

effect regression model was fit with average LEHRs score as the

response variable, a given measure of interest (e.g., burnout) as the

predictor of interest, adjusting for age, gender, race, role, years in VA

cath lab, and years in cath lab, plus a random intercept for site. The

predictors of main interest were modeled categorically. The depen-

dent variable in all five models was the average LEHRs score, an aver-

age of the eight LEHRs scales (Data S1). The reference category for

job satisfaction was 3 (neutral), burnout was 1 (never), intent to leave

was 3 (neutral), turnover was 0 (no turnover), and safety climate was

3 (neutral). The overall significance of each of the five models was cal-

culated using a type II analysis of variance (ANOVA). Alpha was set at

0.05. Analyses were conducted in R version 4.0.3 (R Core Team

2020). This study was deemed an exempt, nonhuman subjects

research study by the Colorado Multiple Institutional Review Board

(17-1153).

3 | RESULTS

We received responses from 67 of the 81 (83%) VA cath labs. In total,

232 of 902 eligible employees completed surveys (26% response

rate). Of those, 146 (63%) were nurses, 42 (18%) were technicians,

27 (12%) were interventional cardiologists, and 17 (7%) were other

(e.g., fellows, electrophysiologists). A supervisory role was reported by

58 (25%) of respondents. The sample was split between females

(n = 127; 55%) and males (n = 100, 43%) and was predominantly

White (n = 173; 75%). The mean age was 48 with a mean of 21 years

in health care, 7 years in the VA, and 5 years in their current cath lab

(Table 1). The average VISN nonresponse rate was 73% (Mode: 77)

with a range from 85% nonresponse in VISN 17 (VA Heart of Texas

Health Care Network) to 41% nonresponse in VISN 20 (Sierra Pacific

Network) (Data S2).

The highest scoring survey scales across the sample was for affec-

tive commitment (mean 5.4, SD 1.4) followed by supportive learning

environment (mean 5.3, SD 1.4), mindful organizing (mean 5.3, SD

1.3), respectful interaction (mean 5.1, SD 1.4), and organizational citi-

zenship (mean 5.0, SD 1.5). The lower scoring scales were leadership

that reinforces learning (mean 4.8, 1.7), learning processes and prac-

tices (mean 4.5, SD 1.4), and reliability enhancing work practices

(mean 4.5, SD 1.4) (Table 2). These items assess themes outlined in

four of the five high reliability organization philosophies as follows:

deference to expertise, commitment to resiliency, sensitivity to opera-

tions, and preoccupation with failure.7

Overall, respondents indicated they were satisfied with their job

(mean 4.1, SD 1.1) and experienced burnout about once a month or

less (mean 3.2, 1.8). They disagreed they would leave their current job

if able (mean 2.2, SD 1.3) and reported an average of one nurse (mean

1, SD 0.8), technician and/or nonphysician having left their cath lab in

the last 12 months. On average, respondents indicated they would

feel safe being treated in their cath lab as a patient (mean 4.2, SD 1.0).

3.1 | Learning environments, reliability enhancing work practices, employee engagement, retention, and safety climate

Overall, there was a statistically significant association between the

predictors of interest (e.g., job satisfaction) and average LEHRs score.

Specifically, higher average LEHRs scores were associated with higher

job satisfaction (Chi-square 260.6, DF 4, p < 0.001), lower burnout

(Chi-square 49.2, DF 6, p < 0.001), lower intent to leave (Chi-square

85.4, DF 4, p < 0.001), lower cath lab turnover (Chi-square 23.9, DF

3, p < 0.001) in the previous 12 months, and higher perceived safety

climate (Chi-square 156.8, DF 4, p < 0.001). A regression table for the

burnout model is shown in Data S3. Results from all five models are

shown graphically in Figure 1.

4 | DISCUSSION

In this national survey study, cath lab learning environments that were

perceived as highly supportive and used reliability enhancing work

practices were associated with higher employee engagement, reten-

tion, and safety climate scores. The creation of learning environments

and use of reliability enhancing work practices are thus potential new

GILMARTIN ET AL. 389Health Services Research

avenues to support positive feelings and achievement of flow at work,

retention of valued staff, and patient safety in a diverse US health

care workforce that serve a vulnerable and marginalized population.

These findings are in alignment with research that demonstrated reli-

ability enhancing work practices, respectful interaction, and mindful

organizing can foster highly reliable performance in the form of fewer

medication errors and patient falls.6

The analysis that identified the higher and lower scoring LEHRs

items indicated that across cath labs, many staff reported considerable

personal meaning from their work, emotional attachment, and a

strong sense of belonging to their cath lab team (i.e., affective com-

mitment). The cath labs in this study also reported they engaged in

productive conflict and debate during discussion (i.e., supportive

learning environments) and rapidly pooled their expertise during crises

(i.e., mindful organizing). However, some cath labs indicated that

debriefs were not regularly conducted (i.e., learning processes), and

employees were not hired based on their ability to work with others

(i.e., reliability enhancing work practices). Suggesting there are labs

that have integrated best practices, while there are also opportunities

for improvement.

Engaged staff are less likely to experience burnout, which is known

to negatively impact quality and patient safety.19 Effective staff engage-

ment interventions23–25 and characteristics of engaged staff have been

identified.26 It is time for organizations to look beyond individual,

deficit-based interventions that address burnout (e.g., meditation,27

digital-based mental health interventions),23 retention (e.g., continuing

education),28 and specific patient safety issues (e.g., fall prevention pro-

grams).19 Organizations should consider systematic, learning health care-

based interventions, such as hiring and training for the five high reliability

principles,6,29 job crafting,30 relational coordination,31,32 and leadership

focused interventions (e.g., coaching).33,34 In practical terms, the individ-

ual LEHRs items provide insights into areas of strength and opportunities

for improvement that can be presented to teams to prompt discussion.

Group interventions to change a team toward learning and high reliability

could lead to increased engagement and well-being, though this requires

further research.24,29

This study should be interpreted in the context of several limitations.

First, cross sectional data show an association, not causality. Second, the

study design of only VA cath labs limits generalizability to only VA cath

labs. We do note that our sample was diverse in VA VISNs and occupa-

tions. Third, we did not analyze the impact of individual LEHRs items on

the outcomes of interest. Future work can explore these relationships in

other high-risk settings. Fifth, we received fewer responses (26%

response rate) than the previous study (40% response rate) and a lower

response rate than the 2020 VA All Employee Survey (69%). The nonre-

sponse rates across VISNs did not vary greatly. We attribute the low

response rate to the larger pool of staff invited to participate in the 2020

versus 2018 study, the absence of national support and incentives that

enhance participation in the VA All Employee Survey, and the administra-

tion of the survey during the COVID-19 pandemic. Many cath lab staff

were reassigned to other units or were preoccupied with clinical care

during COVID-19 and were not responding to research surveys.35 Last,

we used a self-reported measure of perceived patient safety versus

quantifiable patient outcomes. Though studies have demonstrated posi-

tive relationships between safety climate and outcomes at the hospital-

unit level,6,36 use of cath lab patient data would have strengthened this

outcome.

In summary, system versus individual methods that support work-

force engagement and retention are needed to ensure the well-being

of the health care workforce and patient safety. Implications of this

work include the potential for supportive learning environments and

reliability enhancing work practices to address the high rates of

employee burnout, turnover, and patient safety concerns reported

across health care settings. Moving forward, it is important to under-

stand how these environments were created, which practices were

implemented in VA cath labs, and if these findings are generalizable

across health care settings and populations. This line of inquiry holds

potential to identify tangible interventions for health care organiza-

tions and teams who seek to transform their work setting into sup-

portive learning environments within high reliability organizations and

learning health systems.

ACKNOWLEDGMENTS

We would like to thank the VA staff who participated in the survey.

CONFLICT OF INTEREST

The authors report no conflict of interest regarding this study.

AUTHOR CONTRIBUTIONS

All authors jointly designed the study, conducted data collection, and

drafted the article, reviewed, edited, and approved the final manu-

script draft.

DATA AVAILABILITY STATEMENT

Data Access, Responsibility, and Analysis: Dr Heather M. Gilmartin and

Mr. Edward Hess had full access to all the data in the study and take

responsibility for the integrity of the data and the accuracy of the data

analysis. Dr Heather M. Gilmartin and Mr. Edward Hess of the

Denver/Seattle Center of Innovation for Veteran-Centered and Value

Driven Care conducted and are responsible for the data analysis. Data

Sharing Statement: The data that support the findings of this study are

available from the corresponding author upon reasonable request,

though will be subject to the stringent data privacy rules of the VA

Healthcare System and United States Government.

ORCID

Heather M. Gilmartin https://orcid.org/0000-0002-0264-4059

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SUPPORTING INFORMATION

Additional supporting information may be found in the online version

of the article at the publisher's website.

How to cite this article: Gilmartin HM, Hess E, Mueller C,

et al. Learning environments, reliability enhancing work

practices, employee engagement, and safety climate in VA

cardiac catheterization laboratories. Health Serv Res. 2022;

57(2):385-391. doi:10.1111/1475-6773.13907

GILMARTIN ET AL. 391Health Services Research

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