Purpose of the Paper: The purpose of this study is to provide healthcare organizations with a new perspective for developing strategies to enrich their human resource capabilities and improve their performance outcomes. The focus of this study is on leveraging the synergy between organizational management strategies and environmental design interventions.
Background: This paper proposes a framework for linking the built environment with the human resource management system of healthcare organizations. The framework focuses on the impact of the built environment regarding job attitudes and behaviors of healthcare workers. Research from the disciplines of strategic human resource management, resource-based view of firms, evidence-based design, and green building are utilized to develop the framework.
Theoretical Framework: The positive influence of human resource practices on job attitudes and behaviors of employees is one mechanism to improve organizational performance outcomes. Organizational psychologists suggest that human resource practices are effective because they convey that the organization values employee contributions and cares about their well-being. Attention to employee socio-emotional needs can be reciprocated with higher levels of motivation and commitment toward the organization. In line with these findings, healthcare environmental studies imply that physical settings and features can have a positive influence on job attitudes and the behavior of caregivers by providing for their physical and socio-emotional needs.
Conclusions: Adding the physical environment as a complementary resource to the array of human resource practices creates synergy in improving caregivers' job attitudes and behaviors and enhances the human capital of healthcare firms.
Keywords: Staff, evidence-based design, interdisciplinary, modeling, perceived organizational support
Corporations can be seen as business entities that form the economic system of a society. Corporations can also be viewed as social artifacts composed of institutionalized activities. As such, when it comes to enterprises, the term sustainability represents two separate but interrelated concepts: (1) creating an enduring competitive advantage for companies to stay in business and (2) meeting their responsibilities toward the sustainable development of the society in which they conduct their activities. As suggested by Baumgartner and Ebner (2010), Dyllick and Hockerts (2002), and Khan (1995), to succeed in these two aspects organizations need to obtain and use a wide array of resources, including economic, social, and ecological capital. This article deals with the first aspect of corporate sustainability, which is the way organizational resources are used for creating an enduring competitive advantage.
One approach for study of sustainability of competitive advantages is the resource-based view (RBV) of firms first proposed by Wernerfelt (1984). He described how creating the bundle of valuable resources can result in a competitive advantage for organizations and argued that differences in firm performance come from the differences in the resources they own. As advocates of RBV, Wright, McMahan, and McWilliams (1994) suggest that in order for an organization to have an enduring competitive advantage, it has to acquire different types of capital (economic, social, and ecological) and combine them to create value-generating resources often referred to as an organizational resource bundle.
Organizational resource bundles contribute to performance advantage to the extent that they are rare, costly to imitate, and nonsubstitutable (Armstrong & Shimizu, 2007; Barney, 1991; Dyllick & Hockerts, 2002; Sirmon, Hitt, & Gove, 2008). According to Barney (1991), the firm's competitors should not possess the same resource bundle, not be able to easily recreate its value, nor be able to generate the same outcome by using an alternative resource bundle. This paper proposes a model for linking the human resource management system of organizations with their facilities for enhancing the three characteristics described above to increase the sustainability of competitive advantages. The proposed framework focuses on the influence of physical features of the work environment on job attitudes of healthcare professionals and is developed by adopting key findings from studies on strategic human resource management, resource-based view of firms, evidence-based design, and green buildings.
Healthcare organizations should give attention to the synergy between organizational management intervention and environmental design interventions. Limiting expenses and ensuring quality services are each imperative to a healthcare organization's corporate sustainability. According to the American Hospital Association (AHA), approximately 60 cents of every dollar of expenditures goes to caregivers and other hospital workers. Human resource-related expenses are higher than other essential expenses, including medications, devices, and other supplies, as well as improvements to treatment facilities, installation or upgrades of health information technologies, utilities, and liability coverage (American Hospital Association, 2011). As a result, human resource-related expenses are primary targets of cost-containment strategies when funding becomes limited. However, as Filipova (2011) notes, strategies that require lowering stafflevels may not ultimately be worth the tradeoffand organizations must find alternative ways to optimize expenditures without sacrificing the quality of service. From an organizational management viewpoint, this study provides healthcare organizations with an alternative perspective for developing cost-avoidance strategies based on managerial and architectural design solutions to improve employees' job attitudes and enrich organizational capabilities.
Another important characteristic of healthcare organizations is that healthcare service delivery is physically and emotionally demanding for caregivers, and because of that, these organizations experience severe challenges in terms of employee burnout, strain, job satisfaction, absenteeism, and turnover. Such challenges highlight the importance of recognizing an employees' socio-emotional needs as a critical cost-avoidance strategy and emphasize the role of the built environment in achieving that objective.
The organization of this paper begins with a review of the literature related to job satisfaction as well as the influence of the built environment on employees' job attitudes. The theoretical background of the study is described after a review of job satisfaction theories. This section explains how firms' resources contribute to the sustainability of competitive advantages and identifies the significance of human resources. Moreover, the mechanism through which human resource practices influence performance outcomes at individual and organizational level is described. How the built environment functions in a similar manner is also discussed. To demonstrate this, a framework for linking the human resource management system of organizations to the built environment is proposed. Next, different elements of the model are explained and the hypothesized relationships between them are discussed. The contribution of this study to the existing literature on corporate sustainability is also presented.
A traditional theory for understanding job satisfaction is Maslow's hierarchical model of human needs. The model suggests a five-level hierarchy spanning from physiological needs, safety, and social needs to self-esteem and self-actualization. Maslow's work was adopted by Herzberg (1959), who developed a two-factor job satisfaction theory. Herzberg suggests that satisfaction and dissatisfaction are two separate, or at times, unrelated constructs which are influenced by different factors. Whereas job satisfaction is mostly influenced by factors intrinsic to the nature and experience of the work (e.g., the work itself, achievement, recognition, and responsibility), job dissatisfaction results from factors outside the job (e.g., organizational policy, supervision, salary, interpersonal relations and working conditions). Herzberg (1959) calls these hygiene factors.
According to Spector (1997), these two models became less popular with an increase in the emphasis on underlying cognitive processes of job satisfaction rather than underlying needs. For example, Hulin and Judge (2003) proposed that job satisfaction is a multidimensional psychological response of individuals to their job and has cognitive (evaluative), affective (emotional), and behavioral components. Affective and cognitive indicators of job satisfaction are also addressed in other definitions of job satisfaction (e.g., Brief & Weiss, 2002; Davis, 2004; Harrison, Newman, & Roth, 2006; Hulin & Judge, 2003). Affective Event Theory, developed by Weiss and Cropanzano (1996), includes affective and cognitive components. The authors emphasize that job satisfaction is a positive or negative evaluative judgment about one's job, and is a combination of the person's beliefs about his or her job, and partly results from his or her emotional experiences at work. They suggest that long-term behaviors, such as turnover and retirement stem from stability features and the structure of the job environment, while short-term behaviors, such as lateness or helping others stem from spontaneous job events. As the literature on environmental psychology suggests, as a stable feature and structure of job environment, the built environment may influence long-term behaviors of employees.
Multidimensional studies on job satisfaction, such as those conducted by Locke (1969) and Skalli, Theodossiou, and Vasileiou (2008) show that by placing new values on different facets of the job, a person may maintain his or her satisfaction when certain aspects of it change. Studies of workers' attitudes conducted by organizational psychologists often support this concept. For example, Greenberg (1989) found that employees attempted to compensate for financial underpayments by altering their perceptions of the physical environment where they were working. More specifically, he concluded that when employees were underpaid, they expressed higher levels of satisfaction with their work environment, showing that they were trying to cognitively alter their perceptions of the physical work environment (Greenberg, 2011).
Although the built environment theoretically fits as a factor of job satisfaction, it is absent in the research conducted for healthcare settings. In their review of the 21 studies related to hospital nurses' job satisfaction, 14 of which were carried out in the United States, Utriainen and Kyngas (2009) found interpersonal relationships (e.g., with other members of the nursing staffand with medical staff) and patient care (e.g., seeing patients get better and patient satisfaction) as two themes most significant to nurses' job satisfaction. In addition to these two factors, Utriainen and Kyngas (2009) also state that organizing nursing work (e.g., work-family relationship, working time, balanced workload, autonomy) is another significant predictor of nurses' well being at work. In an earlier but more comprehensive study reviewing more than 50 studies of job satisfaction among nurses, Lu et al. (2005) listed factors such as working conditions, social interaction, and job security as complementary sources of job satisfaction.
To identify the relationships of specific variables with nurses' job satisfaction two meta-analyses were conducted by Blegen (1993) and Zangaro and Soeken (2007). Blegen's (1993) analysis of nurses working in patient care settings found that job satisfaction had the strongest correlation with job stress (r = -0.61), and was moderately correlated with communication with supervisor (r = 0.44), autonomy (r = 0.42), and communication with peers (r = 0.44). Similarly, Zangaro and Soeken (2007) indicated that job satisfaction had the strongest negative correlation with job stress (r = -0.43), and the strongest positive correlation with nurse-physician collaboration (r = 0.37). They also found that autonomy had a moderately positive correlation with job satisfaction (r = 0.39).
As stated, the built environment is notably absent among the factors that influence job satisfaction in studies of healthcare professionals. A review of the literature related to healthcare environmental design suggests that the built environment is not listed among the direct sources of job satisfaction because of its indirect influence through other factors such as job stress and improvements in working conditions. The following section introduces and summarizes the literature on the indirect influence.
Influence of Environmental Design on Job Attitudes
The link between the built environment and human behavior is a key concept of environmental psychology for understanding how the behavior and development of people are influenced by their physical environments (Holahan, 1986). This body of research constitutes an important part of the literature related to architectural and urban design theories, and is often used to support informed decision-making by design professionals. Gibson (2008) argues that ecological psychology is a pivotal, but underused body of work when considering the organization-physical space relationships.
One of the most extensive bodies of work and knowledge base on the relationship between the physical design of buildings and key organizational outcomes exists in the healthcare design domain, which is commonly known as evidence-based design (EBD). In essence, the focus of EBD is the influence of architectural and interior design of healthcare facilities on key outcomes such as patient safety (e.g., hospital-acquired infections, medical errors, and falls), patient outcomes (e.g., pain, stress, length of stay, and the perceived quality of care), and staffoutcomes (e.g., injury, stress, work effectiveness, and satisfaction). For instance, Ulrich et al. (2008) conducted a comprehensive evaluation of the scientific research on evidence-based healthcare design, and one of their conclusions was that well-designed physical settings play an important role in making hospitals a better workplace. Berry et al. (2004) also note that healthcare facility design has a critical role in earning employee commitment, and that "facilities tell employees a great deal about management's concern for them" (p. 5). Other studies, such as Coile's (2002) forecast of healthcare trends, also point to the effectiveness of healthcare facility design in employee recruitment and retention.
Berry and Parish (2008) studied differences in nurses' perceptions of their job, hospital, and building features six months before and six months after the opening of a new hospital wing and found significant differences in employees' perceptions of quality of patient rooms, safety, pleasantness, quality of workspace, job stress, job satisfaction, and service quality. Another beforeafter study of nurses in single-room maternity care versus traditional birth settings by Janssen, Harris, Soolsma, Klein, and Seymour (2001) found that nurses working in new units reported better scores for room size, lighting, and noise levels and also reported higher job satisfaction. Furthermore, studies that examined different facets of job satisfaction, such as those conducted by Kotzer and Arellana (2008), Kotzer, Koepping, and LeDuc (2006), Susan et al. (2003), suggest that nurses are generally not satisfied with their physical work environment and as a result, the built environment can be a source of job dissatisfaction. These findings follow the basic principles of the two-factor theory regarding job satisfaction because negative extrinsic factors, such as working condition (including workplace), can cause job dissatisfaction.
Altogether, this collective body of work provides compelling evidence that improving attributes of the built environment can enhance the general job satisfaction of nurses. However, as Djukic and Kovner (2009) note, a review of job satisfaction models does not provide significant evidence for supporting the idea that the built environment has a strong direct effect on enhancing nurses' job satisfaction. These authors examined the effect of multiple combined features of the physical work environment on nurses' job satisfaction and controlled for multiple covariates of satisfaction. The general conclusion they made was that the effect of the physical work environment on job satisfaction is not direct and is probably mediated through other factors such as work attributes and job attitudes that directly impact satisfaction. This paper describes how these mediating variables can be used to study the interaction between human resource practices and the built environment. To accomplish that, an examination of the theoretical background of the model is required.
Firm's Resources and Sustainability of Competitive Advantage
As previously identified, in order to be a competitive advantage, an organizational resource needs to be rare, costly to imitate, and nonsubstitutable. Barney (1991) notes that in generating values from organizational resources, complex phenomena are often involved. He maintains that to ensure the sustainability of competitive advantages, the link between a firm's resources and competitive advantage should not be fully understood by competitors. Barney, Wright, and Ketchen (2001) argue that building strategies on intangible assets that meet such criteria result in higher performance than building strategies only on tangible assets that are easy to imitate by competitors, such as natural resources and technology.
In addition to the characteristics of organizational resources, the process needed for achieving a sustainable competitive advantage is well documented. For example, Makadok (2000) points out two distinct causal mechanisms where an enduring competitive advantage can be created from resources. The first mechanism is called resource-picking and refers to obtaining outstanding resources. An alternative mechanism is called capability-building, that focuses on enhancing the productivity of existing organizational resources. Makadok (2000) also points to the synergy that may occur when a newly obtained resource achieves higher productivity when combined with pre-existing resources.
Importance of Human Resources and Human Resource Management System
The literature related to resource-based view (RBV) of firms considers the stock of employees' knowledge, skills, and abilities (Barney, 1991; Wright, Dunford, & Snell, 2001) as well as their motivation and loyalty (Dyllick & Hockerts, 2002) to be a part of the human capital of organizations. Additionally, formal and informal relations among employees and between employees and the organization are considered to be part of social capital of organizations. Wright et al. (2001) note that RBV shifted emphasis away from external factors of competitive advantage toward internal firm resources mentioned above; as such it brought legitimacy to the human resource's assertion that people are strategically important to firm success.
The importance of human resources in creating a sustainable competitive advantage is part of the strategic leadership and management literature. Hitt and Duane (2002) looked at human capital through the lens of RBV and pointed out that human capital is significant in terms of creating competitive advantages because it is often the firm's most unique resource and the mechanisms used for creating and managing it are likely to be complex. The importance of a human resource management system as a mechanism for creating competitive advantage from human capital is also documented. Regarding imitability of organizational resources, Barney (1991), Wright et al. (2001), and Becker and Gerhart (1996) point to the importance of the human resource management system as an invisible asset embedded in the organization. Barney et al. (2001) further argue that human resource management systems and routines that develop over time can be unique to a particular firm and may contribute to the creation of a specific human capital pool.
Human Resource Management and Firm's Performance
The relationship between human resource management and a firm's performance is studied in the Strategic Human Resource Management (SHRM) field of organizational theory, which according to Wright et al. (2001) is devoted to exploring the role of human resources in supporting business strategies. The impact of human resource practices on business growth, financial performance, and workers' productivity is also shown in the SHRM literature (Evans & Davis, 2005; Gittell, Seidner, & Wimbush, 2010). Furthermore, an important question and the subject of many studies in organizational theory has been the mechanism through which the effect of human resource practices is transferred to performance outcomes. Different mediating variables have been studied, including functional flexibility, behavioral flexibility, relational coordination, flexibility in personnel skills, shared goals, shared knowledge, mutual respect, enhanced communication, improved social exchange, organizational citizenship behavior, work satisfaction, lower job stress, and quality of information (Beltrán-Martín, Roca-Puig, Escrig-Tena, & Bou-Llusar, 2008; Evans & Davis, 2005; Gittell et al., 2010; Kalleberg, Marsden, Reynolds, & Knoke, 2006; Messersmith & Guthrie, 2010; Preuss, 2003; Takeuchi, Chen, & Lepak, 2009; Tyagi & Sawhney, 2010). Gittel et al. (2010) note that these mediating variables can be classified into two general pathways: (a) changes in employees' knowledge, skills, and abilities; and (b) changes in employees' attitudes (e.g., motivation and commitment) and behaviors (e.g., discretionary efforts). They also note that these two pathways are not mutually exclusive and human resource management can contribute to performance through both pathways.
The Mechanism for Influence of Human Resource Management
Researchers such as Huselid (1995); Becker and Gerhart (1996); Evans and Davis (2005); and Takeuchi, Lepak, Heli, and Takeuchi (2007) studied the attitudinal and behavioral pathway and note that one explanation for why human resource practices, such as incentive compensation and employee involvement and empowerment, are effective is because they carry the message that the organization values their contributions, cares about their well-being, and in general supports them. What these authors suggest is very similar to the findings of studies in the broader area of strategic human resource management conducted by researchers such as Eisenberger, Armeli, Rexwinkel, Lynch, and Rhoades (2001) and Eisenberger, Huntington, Hutchison, and Sowa (1986), who showed the positive influence of human resource practices on Perceived Organizational Support (POS). According to Eisenberger et al. (1986) POS is "an experiencebased attribution concerning the benevolent or malevolent intent of the organization's policies, norms, procedures, and actions as they affect employees" (p. 42). An overview of social exchange theory is required to understand the mediating role of POS.
According to Cropanzano and Mitchell (2005), social exchange theory is one of the most influential conceptual paradigms for understanding workplace behaviors. These authors explain that social exchange in this theory refers to a series of interactions between two sides of a relationship with a potential to generate obligations. As Gouldner (1960) put it, obligation is created as a result of the norm of reciprocity that obliges the return of favorable treatment. Cropanzo and Mitchell (2005) also explain that norms of exchange are the guidelines used in exchange processes and one of the best-known rules of exchange is reciprocity or repayment in kind. Eisenberger et al. (2001) suggest that the reciprocity norm may apply to the relationship between employees and employer by obliging employees to return advantageous treatment they receive by acting in ways valued by the organization.
In summary, social exchange theory suggests that employees consider the organization as an entity with which they have exchange relationships to explain why human resource practices have positive influence on employees' attitudes. The reciprocity norm explains that as the organization gives special attention to employees' needs, a sense of obligation is developed in employees to care about the welfare of the organization and help it achieve its goals (Eisenberger et al., 2001; Eisenberger, Aselage, Sucharski, & Jones, 2004; Hellman, Fuqua, & Worley, 2006; Wayne, Shore, & Liden, 1997). In this study, the concept is adopted to add architectural and physical features of the workplace to the array of resources used in the exchange relationship between employees and their employer.
The proposed framework focuses on the influence of physical features of the work environment on employees' job attitudes. In reviewing the literature related to the influence of environmental design on job satisfaction of healthcare workers, it was the effect of physical work environment on job satisfaction is mediated through other factors that directly impact satisfaction. This statement is consistent with what Ulrich, Zimring, Quan, Joseph, and Choudhary (2004) posit in their study regarding the role of the physical environment, suggesting that design solutions such as improved ventilation, ergonomic design, better designed nursing stations, improved lighting, and floor plans can reduce staffstress and improve their health and safety, the factors that are known to be positively related to job satisfaction.
This study considers POS as another important mediating variable in the relationship between architectural or physical features of the workplace and job attitudes. As Eisenberger et al. (1986) note, employees have a tendency to assign humanlike characteristics to their organization, and because of this personification, they view favorable or unfavorable treatment as an indication that the organization favors or disfavors them. Rhoades and Eisenberger (2002) suggest that resources voluntarily provided by the organization are welcomed as indications the organization values and respects its employees and cares about their well-being. For example, when a hospital increases the ventilation rate or installs High-Efficiency Particulate Air (HEPA) filters to improve indoor air quality and potentially reduce airborne infections, it may be perceived by employees as a voluntary action showing the organization's mindset in putting higher emphasis on their needs, especially when they know that other facilities do not go beyond minimum requirements set by occupational health and safety codes. Providing a healthy environment with a high indoor environmental quality offers substantial inducements to employees that can be reciprocated with higher levels of motivation and commitment towards the organization. Accordingly, the first hypothesis is:
Hypothesis 1: Perceived organizational support mediates the relationship between architectural or physical features of the workplace and job attitudes.
Perceived organizational support is influenced by both human resource management system and environmental design, and because of that it can be studied to understand the role of environmental design in management of human resources. According to Wicker (1992), physical objects along with people are the main components of small-scale social systems that impact activities within specifiable time and place boundaries. He calls these small-scale social systems "behavior settings." This study uses Wicker's (1992) argument regarding the influence of physical settings on occupants' attitudes and behaviors and focuses on the attitudinal and behavioral pathway that influences organizational performance. Principles of Affective Event Theory also suggest that as a stable feature and structure of job environment, the built environment may influence long-term behavior of employees.
As Table 1 shows, a negative message to employees is sent when an organization has a weak human resource management system, where employees are not involved in decisionmaking, do not receive adequate training, and are not compensated based on their performance. If the organization also fails to provide a high-quality work environment ("BE"), the combined negative environmental factors will have a detrimental effect on employees' attitudes (cell 1 in Table 1). In contrast, when the organization has a strong human resource management system, and at the same time provides a high-quality built environment, the combined positive factors will have a synergistic effect on improving employees' attitudes (cell 4 in Table 1). Finally, in a situation when one factor is high and the other one is low, they neutralize each other, assuming that they have similar effect (cells 2 and 3 in Table 1). However, the existing literature does not suggest a strong direct effect for the built environment, specifically when it is compared with the bundle of human resource practices. As such, the second hypothesis is:
Hypothesis 2: Satisfaction with architectural or physical features of the workplace moderates the relationship between human resource management system and perceived organizational support.
Elements of the Model
Figure 1 shows a general framework linking human resource management practices and architecture features to employee- and organizational-level performance outcomes, through individual and collective measures of attitudinal and behavioral variables.
High-Performance Work System and Architectural Features
High-Performance Work System (HPWS) consist of practices related to selection and staffing, training, employee involvement and empowerment, reward and compensation, performance measurement and appraisal, and career planning and promotion. HPWS practices incorporated in the model shown in Figure 1 are adapted from the study by Garman, McAlearney, Harrison, Song, and McHugh (2011), where they developed a conceptual model of HPWS practices for healthcare organizations on the basis of prior research.
The architectural features shown in Figure 1 are adopted from the evaluation of the scientific research on evidence-based healthcare design by Ulrich et al. (2008), as well as green building features identified by the U.S. Green Building Council's (USGBC) Leadership in Engineering and Design (LEED) for healthcare. Well-being and health are important criteria associated with the green building movement (Kibert, 2008). For office buildings and workplaces in general, using green-building features can send the message to employees that senior management cares about their wellbeing and health. For example, green building techniques such as improving indoor environmental quality may decrease physiological health issues (e.g., asthma and respiratory allergies) and psychological health problems (e.g., strain and anxiety) (Cirla, 2005; Corr, 2000; Fisk, 2000; Goe et al., 2004; Joseph, 2006a; Rashid & Zimring, 2008; Ulrich et al., 2008).
In a study of physiological health issues, Smedbold et al. (2002) analyzed clinical data for 115 females who worked at 36 geriatric nursing departments and concluded that poor indoor environmental quality, such as high temperature, low relative humidity, and low carbon dioxide levels may affect the nasal mucosa of nursing personnel and cause nasal mucosal swelling. Regarding psychological health problems, in a study of 141 nurses in a university hospital, Alimoglu and Donmez (2005) found that at least three hours a day exposure to natural light can lead to less stress and higher satisfaction at work. Furthermore, Pati, Harvey, and Barach's (2008) study of relationships between exterior views and stress among 32 nurses on 19 different units at two hospitals found that visual relief improved short-term alertness and sharpened the focus of nurses, which in turn may enhance their job satisfaction and long-term retention. Fjeld and Bonnevie (2002) also examined the impact of installing 23 groups of green plants along with full spectrum fluorescent bulbs in examination rooms of a radiology ward. The rooms had no windows or natural light and were used by 48 employees. The research found 10% reductions in sick leave, 32% in fatigue, and 45% in headaches after the intervention, all statistically significant.
Attention to employees' health and well-being is particularly important in healthcare settings where employees are exposed to higher health and safety-related risks at work. Workers in hospitals have to deal with patients and often use many highly toxic chemicals (e.g., pesticides, cleaners, and disinfectants). The literature review by Ulrich et al. (2008) suggests that sick building syndrome (SBS) is generally high in hospitals buildings and health-related complaints are higher in hospitals with SBS. Moreover, according to the U.S. Bureau of Labor Statistics (2007), the rate of occupational injuries and illnesses in hospitals is 8.1 cases per 100 full-time workers, which is about 80% higher than the rate for all of the private industry (4.6 cases per 100 full-time workers).
Job Attitudes, Emotions, and Feelings
As Figure 1 shows, attitudinal variables are the first group of outcomes in the series of mediating variables between the built environment and organizational performance outcomes. Attitudinal outcomes are also the key to understanding the interaction between the built environment and human resource management system. The influence of these two factors on behavioral variables and organizational performance is transferred through attitudinal variables.
A review of the literature related to EBD suggests that nurses report higher job satisfaction when physical features of the work environment, including lighting, view, and unit layout, are improved (e.g., Alimoglu & Donmez, 2005; Janssen, Harris, Soolsma, Klein, & Seymour, 2001). To understand how this happens, this study suggests that the impact of POS and jobrelated anxiety should be a topic of additional research. The relationship between POS and attitudinal and behavioral outcomes has been considered in the SHRM literature. Rhoades and Eisenberger's (2002) meta-analysis found that the relationship between POS and job satisfaction is significant (r = 0.59). In another meta-analysis, Riggle, Edmondson, and Hansen (2009) concluded that job satisfaction exhibits a strong positive relationship with POS (r = 0.61). Consistent with these findings, in her crosssectional survey of 656 nurses in 100 facilities in midwestern states of the United States, Filipova (2011) found that POS positively predicted nurse job satisfaction.
Job-related anxiety is the second attitudinal outcome that mediates the relationship between the built environment and job satisfaction. The negative effect of physical stressors in the workplace such as noise, light, heat, vibrations, and chemical and toxic substances are studied in the EBD and green building literature, suggesting that environmental intervention through architectural design can play an important role in reducing employees' anxiety and increasing job satisfaction (e.g., Alimoglu & Donmez, 2005; Ampt, Harris, & Maxwell, 2008; Bayo, Janssen et al., 2001; Joseph & Ulrich, 2007; Shumaker & Pequegnat 1989; Tyson, Lambert, & Beattie, 2002).
Hypothesis 3: There is a direct negative relationship between the perceived quality of the built environment and nurses' job-related anxiety and depression
In addition to this direct negative relationship between the quality of the built environment and job-related anxiety and depression, the literature related to organizational support theory suggests that POS may reduce job-related anxiety because it conveys to employees that the organization will provide resources such as physical assistance and emotional support (e.g., Hochwarter, et al., 2006; Wallace, et al., 2009; Witt & Carlson, 2006). To investigate the role of POS in the relationship between the quality of the work environment and job-related anxiety the following hypothesis is suggested for further consideration in future studies:
Hypothesis 4: Perceived organizational support mediates part of the relationship between the perceived quality of the built environment and nurses' job-related anxiety and depression.
Another important attitudinal variable incorporated in the model is organizational commitment. Social exchange theorists such as Eisenberger et al. (1986) suggest that employees are prone to exchange their commitment for the supports they receive from their employers. This idea is supported in the meta-analysis study by Rhoades and Eisenberger (2002) as they found a significant and positive relationship between POS and desire to remain (r = 0.59). The meta-analysis by Riggle et al. (2009) also shows that overall organizational commitment has a strong positive relationship (r = 0.71) with POS. In summary, as social exchange theory suggests, providing a highquality work environment has the potential to be perceived by employees as an indicator of the benevolent intent of the organization and may create an affective bond between employees and the organization. In this regard, the following two hypotheses are suggested for future studies:
Hypothesis 5: There is a positive relationship between the perceived quality of the built environment and nurses' organizational commitment.
Hypothesis 6: Perceived organizational support mediates the relationship between the perceived quality of the built environment and nurses' organizational commitment.
The effect of the built environment and the human resource management system on behavioral outcomes is transferred through attitudinal variables. As such, the next group of variables in the framework shown in Figure 1 is individual-level behavioral outcomes. The influence of improvement in work attitudes on employees' performance has been investigated by both organizational psychologists and healthcare environmental researchers.
In the organizational psychology literature, several meta-analyses exist that link attitudinal variables to behavioral variables such as in-role performance and extra-role performance (e.g., Blegen, 1993; Combs, Liu, Hall, & Ketchen, 2006; Harrison et al., 2006; Meyer, Stanley, Herscovitch, & Topolnytsky, 2002; Riggle, Edmondson, & Hansen, 2009; Tett & Meyer, 1993; Zangaro & Soeken, 2007). In-role performance, also known as focal performance or role behavior, refers to work behaviors that are prescribed by formal job roles (e.g., administering medication and updating patient records, providing instructions for care at home) and extra-role performance, also known as contextual performance, refers to discretionary work behaviors that are beyond one's formal job roles (e.g., staying late to help patients, making suggestions to improve the overall quality of the care provided in the department). For example, the meta-analysis by Harrison et al. (2006) of studies published between 1983 and 2004 found that organizational commitment is negatively correlated with turnover (r = -0.22), and job satisfaction is positively correlated with focal performance (r = 0.30). Furthermore, the Meyer et al. (2002) meta-analysis of 155 studies involving 50,146 employees found that affective organizational commitment is positively correlated (r = 0.32) with organizational citizenship behavior.
The impact of the built environment on behavioral outcomes of nonphysician staffand physicians has been studied by healthcare environmental researchers. For example, Joseph (2006b) suggests that spatial transparency (i.e., being able to see and hear what others are doing from individual workspace or when moving around their workspace) may promote teamwork and enhance communication as it provides more opportunities to interact with team members. In their theoretical framework capturing the current domain of EBD in healthcare, Ulrich, Berry, Quan, and Parish (2010) point out the influence of the built environment on participant outcomes, including nonphysician staffand physicians. More specifically, they posit there are converging findings from multiple rigorous studies indicating that safety enhancement solutions reduce absenteeism among nurses. Among nonphysician staffoutcomes, Ulrich et al. (2010) suggest job-related injuries, workspace social support, and teamwork within units as topics for future research.
Performance outcomes compose the final element of the proposed framework. In a comparative study of 77 nurses working in single-occupancy versus multi-occupancy rooms in acute care environments, Chaudhury, Mahmood, and Valente (2006) found that nurses favor single occupancy rooms with regard to ease of patient examination and interaction with or accommodation of family members. Moreover, France et al. (2009) surveyed clinicians working in a children's hospital replaced with a family-centered care designed facility and found that the percentage of nurses who gave higher ratings on efficiency of work flow increased by 12%. They also found that the percentage of nurses that gave better ratings on the effect of unit layout on patient monitoring increased by 22%. As Ulrich et al. (2008) note, these examples demonstrate that the architecture and interior design of healthcare facilities have influence on staffout comes such as medical errors, work effectiveness, and communication with patients and families. The conceptual framework for an EBD domain in healthcare provides a list of organizational outcomes for future studies, where the impact of audio and visual environments, as well as safety enhancements on facility costs, revenue, and market share are suggested areas for future research.
Considerations for Future Studies
In their study of environmental sources of satisfaction among hospital patients, Harris, McBride, Ross, and Curtis (2002) distinguished between three relevant dimensions of the physical environment, including relatively permanent characteristics such as the spatial layout of a hospital and room size (architectural features); less permanent elements such as furnishings, colors, and artwork (interior design features); and ambient features such as lighting, noise levels, odors and temperature. The same three dimensions should be considered in the study of caregivers. The key consideration for assessments involving POS is defining the high-quality work environment, because in addition to indoor environmental quality features (e.g., thermal comfort and indoor air quality), other attributes of the built environment influence one's perception of the quality of workplace, such as a feeling of connection to the natural world, feeling of cleanliness, and the amount of privacy afforded by the building. Measuring these criteria is challenging as individuals' perception and responses to their impacts may be contradictory or change over time.
To address this issue, judgmental measures, where respondents use survey questionnaires to rate various physical features, are commonly used for measuring the perceived quality of the built environment. For an employee-level analysis, the perspective adopted in this study, this approach is advantageous because some direct physical measures do not translate into employees' perceptions of the environment (Michael, Beard, Choi, Farquhar, & Carlson, 2006). For example, a physical measure of the size and number of indoor plants is not sufficient for evaluating the "connection to the natural world" regarding indoor spaces, given that an individual's perception may depend on factors such as the spatial arrangement of the plants. Judgmental measures may be more helpful when it comes to such attributes as feelings of cleanliness that vary from person to person. However, as Araya et al. (2006) note, it is important to control for individual characteristics, such as age and gender, to ensure the variance of outcome variables is explained by place-based (i.e., different medical departments) rather than individual differences. It is also important to note that the subjective nature of judgmental measures brings into question whether the findings actually represent the quality of the built environment. If measuring actual quality of the built environment is needed, judgmental measures should be supplemented with objective data audit measures collected by trained individuals.
In employee-level studies, individual-level characteristics such as age, tenure, education, and personality traits should be considered as well. For example, according to Djukic and Kovner (2009), age, educational level, and tenure might be positively related to autonomy and negatively related to job stress, both of which are important predictors of job satisfaction. Additionally, Rhoades and Eisenberger (2002) note that positive or negative affectivity alter the way employees interpret organizational treatment as benevolent or malevolent.
Contribution to Literature
In describing the characteristics of resources in creating competitive advantage, the importance of a human resource management system as an invisible asset embedded in the operational system of the organization has been presented. In addition, as a human resource management system develops over time, it becomes unique to a particular firm and creates a specific human capital pool. The proposed framework suggests that as a behavior setting that offers substantial inducements to employees, the built environment can be added to the array of human resource management tools for enhancing the complexity and uniqueness of the mechanism from which the human capital pool of the firm is created. Furthermore, the principles of RBV suggest that the value generated by a rare, unique, and complex resource pool is difficult for competitors to imitate or reproduce.
This study demonstrates that the built environment, combined with the human resource management system, can be used for internal development of resources and for extending current organizational capabilities. By accepting the role of the built environment as a human resource management tool, an extensive body of the knowledge in human resource management literature becomes available to healthcare environmental researchers that can be used for strengthening the case for investing in facility design.
More specifically, in line with the statement on enriching organizational capabilities by Sirmon et al. (2008), this study suggests that the physical environment (i.e., facilities) can be added as a complementary resource to the current resource bundle (i.e., human resource management practices) for enriching organizational capabilities (i.e., improving employees' job attitudes and behaviors) and creating synergy. The proposed framework adopts the concept of the synergy proposed by Makadok (2001), because it suggests that organizations can achieve higher productivity when they use their human resource management system in combination with their facilities. Furthermore, in line with the argument made by Hamilton, Orr, and Raboin (2008), and Zimring, Augenbroe, Malone, and Sadler (2008), the proposed framework offers a mechanism for leveraging the synergy between organizational management interventions and environmental design interventions.
Implications for Practice
* Differences in firm performance originate from differences in the resources they own. To have an enduring competitive advantage, firms need to obtain a wide array of resources, including economic, social, and ecological capital, and combine them to create a valueadding resource bundle. The value generated by a rare, unique, and complex resource pool is difficult for competitors to imitate or reproduce.
* Human capital and the human resource management system can be significant sources for a competitive advantage. Human capital (the stock of employees' knowledge, skills, and abilities, as well as their motivation and loyalty) is often the firm's most unique resource and the mechanism involved with creating and managing it is likely to be complex. Human resource management routines developed over time are embedded in the operational system of the organization and are unique to each firm.
* Human resource management efforts to improve job attitude and employee behavior can have a positive impact on the performance outcomes of the organization. Studies regarding this attitudinal and behavioral pathway suggest that human resource management practices are effective because they send a message to employees that the organization values their contributions and cares about their well-being. Employees can develop a sense of obligation, care about the welfare of the organization, and help it achieve its goals when the organization gives attention to employee needs.
* Because caregivers are exposed to higher health and safety-related risks, attention to their health and well-being is particularly important. Providing a healthy environment with a high indoor environmental quality offers substantial inducements to employees that can be reciprocated with higher levels of motivation and commitment towards the organization.
* As a behavior setting that offers substantial inducements to employees, healthcare firms should add the built environment to the array of human resource management tools for enhancing their human capital.
Organizational resource bundles contribute to performance advantage to the extent that they are rare, costly to imitate, and nonsubstitutable.
Although the built environment theoretically fits as a factor of job satisfaction, it is absent in the research conducted for healthcare settings.
In addition to the characteristics of organizational resources, the process needed for achieving a sustainable competitive advantage is well documented.
The proposed framework focuses on the influence of physical features of the work environment on employees' job attitudes.
Attention to employees' health and well-being is particularly important in healthcare settings where employees are exposed to higher health and safetyrelated risks at work.
This study demonstrates that the built environment, combined with the human resource management system, can be used for internal development of resources and for extending current organizational capabilities.
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Hessam Sadatsafavi, MA, and John Walewski, PhD
Author Affiliations: Mr. Sadatsafavi is a PhD Candidate in the Zachry Department of Civil Engineering at Texas A&M University. Dr. Walewski is an Assistant Professor in the Zachry Department of Civil Engineering at Texas A&M University.
Corresponding Author: Hessam Sadatsafavi, MA, PhD Candidate, Zachry Department of Civil Engineering, Texas A&M University, 3136 TAMU, CE/TTI Building, College Station, TX 77843-3136; email@example.com
Acknowledgments: The authors are grateful for thoughtful comments and suggestions provided by Dr. Mardelle Shepley. The authors also gratefully acknowledge one of the reviewers for pointing out considerations for defining and measuring high-quality work environment.
Preferred Citation: Sadatsafavi, H., & Walewski, J. (2013). Corporate sustainability: The environmental design and human resource management interface in healthcare settings. Health Environments Research & Design Journal 6(2), pp 98-118.…