Longitudinal Associations between Organizational Change, Work-Unit Social Capital, and Employee Exit from the Work Unit among Public Healthcare Workers: A Mediation Analysis

By Jensen, Johan Høy; Flachs, Esben Meulengracht et al. | Scandinavian Journal of Work, Environment & Health, January 1, 2019 | Go to article overview

Longitudinal Associations between Organizational Change, Work-Unit Social Capital, and Employee Exit from the Work Unit among Public Healthcare Workers: A Mediation Analysis


Jensen, Johan Høy, Flachs, Esben Meulengracht, Skakon, Janne, Rod, Naja Hulvej, Bonde, Jens Peter, Scandinavian Journal of Work, Environment & Health


Restructuring of workplaces is widely performed to keep up with increasing demands for productivity and cost-efficiency. However, there seems to be a downside to organizational changes in terms of poor employee health and well-being (1-6). Elevated rates of employee exit (ie, turnover) from the workplace following reorganization have been reported consistently in the literature (7-13), and studies suggest that organizational changes may have a dual impact on employee exit and health (11, 14). Specifically, quarterly employee-exit rates increased from 3.1% to 3.4% after implementation of new healthcare workflows (9), and - relative to no change - excess employee-exit rates of 15-50% have been demonstrated in the years following merger, splitup, relocation, change of management, and >3 changes performed simultaneously in the healthcare sector (11, 12). Such higher employee-exit rates have been associated with adverse psychosocial outcomes among the remaining employees as well as high replacement costs and loss of productivity (15).

Social capital refers to the "resources that are accessed by individuals as a result of their membership of a net work or a group" (16) and manifests as trust, reciprocity and social cohesion within a group of co-workers (16). The literature on workplace social capital in the context of reorganization is limited. However, since the workplace can be seen as having social dimensions among coworkers, it is reasonable to assume that reorganizations disrupt work-related social networks and friendship ties in a work unit. Employees can perceive such processes as being unfair, lowering their attachment to the workplace (17-20). This is supported by findings of a 4% decrease in trust of management after reorganization involving change of top management (21) as well as distributive justice partially mediating the association between trust and intention to quit in the context of downsizing (20).

Low social capital has been linked to a higher risk of mental-health problems (22, 23), sickness absence (24-26), early retirement (12), and poor self-rated health (27). A study found that self-reported poor health was associated with a 2.3-fold higher "risk" of intention to quit, whereas good collaboration among colleagues as well as trustworthiness and support from managers were associated with 60-80% lower chance of intention to quit (28). Indeed, the associations of workplace social capital on the pathway between organizational changes and employee exit from the workplace remain unclear.

We aimed to investigate the hypothesized (objective a) prospective associations between organizational changes and low work-unit social capital, (objective b) the association between low social capital and higher rates of employee exit from the work unit (EFW), and (objective c) work-unit social capital as a mediator on the associations between organizational changes and higher rates of subsequent EFW (figure 1). In this study, EFW refers to an employee terminating employment in a work unit regardless of the reason. A mediator refers to a factor that explains the impact of an exposure on a given outcome (29). Such mediation may highlight social capital as a target of intervention to prevent adverse effects of organizational changes.

Methods

Study design and data collection

This longitudinal study was based on the Well-being in Hospital Employees (WHALE) cohort (30) and examined the associations between work-unit organizational change in the last six months of 2013, work-unit social capital in March 2014, and employee EFW during 2014.

The source population comprised 37 720 employees from the Capital Region of Denmark who were invited to complete a work-environment questionnaire in March 2014 (response rate: 84%). From April through June 2016, we distributed a survey to the managers of all 2696 work units to collect data on six types of organizational changes occurring in the last six months of 2013 (response rate: 59%). …

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