Influence of Psychological Empowerment on Organizational Commitment among Medical Employees in a Hospital Setting

Introduction: people within organizations are a key factor for efficiency. Thus employee empowerment has become a popular management strategy. The study aimed to investigate the relationship between psychological empowerment and organizational commitment among medical staff of a hospital in Zahedan city. Methods: This cross sectional study was carried out in 2013. A random sample of 172 medical employees in Khatam-ol-Anbia hospital at Zahedan city was selected and responded to items of the questionnaires using a 7-point Likert scale ranging from 1 to 7. For measuring psychological empowerment and organizational commitment, Mishra & Spreitzer’s scale and Meyer and Allen’s questionnaire were used. A higher score means a higher degree of psychological empowerment or organizational commitment. Analysis was carried out using SPSS. Results: The level of organizational commitment and psychological empowerment significantly were higher than average. There was a significant positive relationship between employees’ empowerment and their commitment to organization. Psychological empowerment was a significant predictor of organizational commitment (β = .524). Out of the five dimensions of empowerment three dimensions are significant predictors of commitment and explain 37.1% of the variance in commitment. Conclusions: Due to The positive influence of psychological empowerment on organizational commitment, programs for in-service education should focus on facilitating psychological empowerment to improve and increase organizational commitment. Also, since impact of employees psychological empowerment on organizational commitment partially supported, there are other variables that influence the organizational commitment.


INTRODUCTION
People within organizations are the key factor for survival in a highly competitive environment and a main factor in the efficiency of their organizations [1]. yet, in our time employees in organizations report feeling isolated, undervalued, dehumanized, and exploited [2]. Regarding this issues, one of the most useful techniques to raise staff productivity and the best use of capabilities and capacities of individuals and groups in line with organizational objectives is empowerment [3,4].
In recent years many efforts have been made to improve organizations that mostly focused on areas such as reduction of hierarchy and bureaucracy, forming dynamic groups, participation in decision-making at the lowest level of organization and in other words empowerment of employees [1].Thus, employee empowerment has become a popular management strategy in today's human resource management and a trend in all organizations [5] and in recent years, more than 70% of organizations have adopted some kind of empowerment initiative in their workforce [6].
Empowerment is defined as individual beliefs of employees about their role in relation to the organization [6]. Between the two concepts of empowerment, structural and psychological [7], this research is focusing on psychological empowerment. Psychological empowerment refers to a set of psychological states that are necessary for individuals to feel a sense of control in relation to their work role [7,8]. It is revealed in the five feelings of meaning, competence, self-determination, confidence, and impact [6]. This psychological perspective views empowerment as organic or bottom-up processing in which empowerment is achieved only when psychological states produce a perception of empowerment within the employee. It is not the conditions of the work context but the reactions of the employee to these conditions that in turn, influence their organizational behavior [9].
Organizational commitment is a psychological state that describes the relationship of employees with the organization for which they work and that has deductions for their decision to continue with the organization [16]. Organizational commitment is considered as a key determinant of organizational outcomes such as performance [17,18]; controllable absenteeism [19] and organizational citizenship behavior [20]. For this reason, employee commitment continues to be one of the most exciting topics for both executives and researchers [21].
However, despite the numerous researches on the relationship between psychological empowerment and organizational commitment in various organizational settings, doing research on these topics in hospitals in Iran seems to be still necessary because firstly the results of different empowerment studies conducted in different settings are inconsistent. For example, Moynihan and Pandy found a significant negative correlation between employees' empowerment and organizational commitment [22] and Mastracci found a significant positive correlation between employees' empowerment and organizational commitment [23]. Bhatnagar [24] and Chen and Chen [25] in their studies concluded that some of the empowerment dimensions were positively related to organizational commitment and some other dimensions were negatively or not related to organizational commitment. Secondly due to different culture and organizational structure the results of those studies are not applicable in an eastern society like Iran. Thirdly a hospital is an institution which has the most influential and important role in society [26]. Fourthly hospitals in Iran currently facing many issues in employees' commitment to the organization [27]. And finally in past no similar study has conducted on medical staff as a group in Iran. Therefore, little is known regarding if and how psychological empowerment is related to organizational commitment and the mechanism of this relationship is not clear in the context in Iran.
Based on this rationale, the study aims to investigate the actual picture of the relationships between psychological empowerment and its five dimensions with organizational commitment among medical staff of Khatam-ol-AnbiaHospital in Zahedan city in I.R. Iran.

MATERIALS AND METHODS
This cross sectional study was carried out in spring 2013. The population of the study was 308 medical employees (i.e all of staff that involved in patients' care such as physicians and nurses) in Khatam-ol-Anbia hospital at Zahedan city. Using cochran formula for sample size calculation in finite populations the sample was made up of 172 of medical employees selected by simple random sampling technique. The participants completed the questionnaires anonymously. Finally, 150 questionnaires (88.2%) were correctly filled out and gathered for analysis.
In this study, in the first piece of the questionnaire respondents gave their demographic data. For measuring psychological empowerment, Mishra & Spreitzer's scale was used. Spreitzer demonstrated the internal consistency and test-retest reliability of the dimensions of psychological empowerment in a work context [7].
Volume 61 Meaning refers to work value of a work objective, judged in connection with individuals' own ideals or standards. Competence or self efficacy contains an individual's belief in his or her capability to do activities with skills. Self determination or selection is an individual's sense of having an option in starting and regulating procedures. Impact discloses the feeling that a person thinks he can influence the outcomes of an assignment. Finally, the sense of confidence means that the staff is sure to be behaved fairly [6]. Organizational commitment was measured using a shortened form of the Meyer and Allen's organizational commitment questionnaire [19], with 5 items. The Allen & Meyer's organizational commitment questionnaire (OCQ) was selected for this study as it is a widely-used, reliable and validated scale of organizational commitment [16].
Participants responded to items of the two questionnaires using a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The total score ranges from 15 to 105 for psychological empowerment and from 5 to 35 for organizational commitment questionnaires respectively. A higher score means a higher degree of psychological empowerment or organizational commitment.
The statements of original questionnaires were translated into Farsi. Three experts in the field inspected the questionnaire to ascertain its consensual validity and the wording of statements was also simplified. Lastly a pilot test was conducted with 30 respondents and final adjustment was made accordingly. Reliability of the questionnaires was 0.822 for psychological empowerment questionnaire (meaning = 0.726, competence = 0.740, self-determination = 0.750, confidence = 0.815 and impact = 0.749), and 0.782 for organizational commitment scale using Cronbach's alpha coefficient. According to Hair et al. Cronbach's alpha coefficients equal to or more than .7 has adequate reliability [28].
Descriptive statistics (mean and standard deviation) were used to study the distribution of data. One-sample t-test, correlation, simple regression and multiple regressions were used to analyze data. A one-sample t-test was performed to compare the sample mean to the mean of the similar previous study [29]. Pearson's correlation coefficient was achieved to measure how variables are related. Simple linear regression was conducted to study the impact of psychological empowerment on organizational commitment. Stepwise multiple regression analysis was conducted to determine whether each dimensions of psychological empowerment affects organizational commitment. Total psychological empowerment and its five dimensions served as independent and organizational commitment as dependent variables in regression analyses. Assumption of normality, and multicollinearity were checked. Analysis was carried out using SPSS for Windows (version16.0). P values less than 0.05 were considered statistically significant.

RESULTS
The results show the mean age of the respondents was 30.17  7.6 years. 79.3 percent of them were females and the rest were males. 70.7% of the participants were married and 29.3% were single. 10.7% of subjects had a high school diploma. 89.3% of them had a college level education. Table 1 shows that the mean of organizational commitment, psychological empowerment and the five dimensions of psychological empowerment were on the higher side. One-sample t-test implies that these means are significantly higher than the average of the similar previous study. The highest and lowest mean were in competence and confidence dimensions respectively (Table 1). In the table 2, internal correlation of research variables have been provided. The highest and lowest correlations with organizational commitment were observed in meaning and competence dimensions respectively. As it is observable there were significant positive correlations between psychological empowerment and its dimensions with organizational commitment. Hence it can be assessed in a regression model precisely. To investigate these preliminary findings further, simple and Stepwise multiple regression were applied between dependent variable and independent variables. The results of Simple regression indicated a significant positive impact of employees' empowerment on their commitment to the organization. Psychological empowerment was a significant predictor of organizational commitment (β = .524, F = 55.89, p= .000). Then stepwise multiple regressions were applied to determine the role of the five dimensions of psychological empowerment on predicting organizational commitment. Results of final step have been presented in table 3.It show that three dimensions of empowerment (Meaning, Self determination, and confidence) are significant predictors of commitment and all the three entered dimensions in model together explain 37.1% of the variance in commitment. Meanwhile, out of them meaning has the strongest influence (β=.435, P=0.000) on commitment.

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DISCUSSION
In the current study effects of psychological empowerment and its dimensions on organizational commitment were examined. The findings indicated that employees' psychological empowerment and organizational commitment were significantly higher than mean. The study showed that only three dimensions of psychological empowerment significantly influenced organizational commitment.
In line with some other studies [30][31][32][33] and inconsistent with others ones [21,34,35], in our study staffs' psychological empowerment was higher than average. Yet some plans to raise employees' perceptions of empowerment need to be initiated. Because empowerment is not an enduring personality trait generalizable across all situations, but rather a set of cognitions shaped and changed by a work environment [36], based on questionnaire items, the management can help to build an atmosphere and organizational culture of open communication that permit personnel to express their views, take in to account others' opinions, and support questioning and feedback that increase employee empowerment especially in Self determination, Impact and Confidence dimensions. In this regard, also designing and implementing programs for the hospital managers to take on new roles as coaches and facilitators, can also improve the level of employees' psychological empowerment. In turn, such a culture and arrangement contributes to nurturing organizational commitment.
Consistent with the findings in earlier studies [11,37,38] all dimensions of psychological empowerment showed positive and significant relationships with organizational commitment ( Table  2). It can be concluded that the more psychologically be empowered an employee; the more likely he/she will be committed to the organization.
Similar to other researches [37,39,40] the results of the study (β = 0.524, p value = .000) clarify that the psychological empowerment as a whole has a positive impact on organizational commitment. However, despite the correlation of all aspects of psychological empowerment with organizational commitment (Table 2), and in congruent with other studies [21,29,30,38] that found only two or three dimensions predicted organizational commitment, in our study only three of the five dimensions namely the meaning, self determination and confidence predicted organizational commitment. The possible reason for why competence and impact dimensions of psychological empowerment does not significantly influence the level of organizational commitment could be cultural differences and should be investigated in further research.
In other words, the respondents approved that their organizational commitment will increase if the type of work they perform inherently possesses certain intrinsically motivating characteristics, remarkably skill variety, task significance, and feedback. If hospital employees feel the task is meaningful and is adding value to them, they would be more committed. In addition organizational commitment will increase when they are given the autonomy to make decisions about work processes. They also give their commitment to the hospital when they are confident that the management rates their contributions and feel secured and supported in the organization.
The three aforementioned dimensions together explain 37.1% of variance of commitment (F=28.75, p≤0.009) that indicate there are other factors as well as psychological empowerment that affect the organizational commitment.
Among the three factors of psychological empowerment (table 3), meaning (β=.435 p=.000) had the strongest effect on respondents' organizational commitment. It means that the sense of employees about the meaningfulness of their duties is the most important for predicting organizational commitment. This result is consistent with work of Jha [21].
In conclusion, this study will help the hospital setting in improving their employees' commitment to the organization and also contribute in literature. Although mean of the respondents' empowerment and commitment were higher than average, yet there are opportunities for improvement in all five dimensions of psychological empowerment especially in confidence, Impact and Self determination dimensions. Therefore hospital management can identify and continue innovative policies in order to raise employees' empowerment and in turn their commitment so that hospital can provide safe, effective and high quality care for the patients. Since the three dimensions of empowerment only explain 37.1% of variance of commitment, it can be concluded that impact of employees psychological empowerment on organizational commitment partially supported and there are other variables besides empowerment that influence the organizational commitment.
There are a few limitations in the study. The research was a questionnaire based one and depended on respondents' understanding. Study data were collected from a single hospital. Therefore, findings may not be generalized to other healthcare settings without caution.
Replication of this research in other hospitals and healthcare setting can help to validate the current results. In addition further studies are required to study what variables moderate or mediate the impact of empowerment on commitment.