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An analysis of the relationships among job satisfaction, organizational trust, and organizational commitment in an acute care hospital

Dissertation
Author: Jr. Bobbie M. Tanner
Abstract:
The purpose of this study was to examine the relationship among specific job attitudes held by a cross section of employees of an acute care hospital, and to understand and communicate how these attitudes and their interrelationships within the hospital may strengthen the strategic planning effort of hospital leadership in relation to human resources management. Increasing awareness of the issues and conducting assessments related to employees' perceptions of job satisfaction, organizational trust, and organizational commitment may provide hospital management valuable insight as to how well employees feel they "fit" in a hospital organization and whether they are satisfied to the extent that they plan to remain in their jobs. Three research instruments were administered to a sample of 120 individuals from a single hospital. These surveys were the Job Satisfaction Survey (Spector, 1985); the Organizational Trust Inventory (Cummings & Bromiley, 1996); and the Employee Commitment Scales (Meyer & Allen, 1991). A moderately strong to strong positive correlation was found to exist among each of the variables, with the exception being the relationships between continuance commitment and job satisfaction and between continuance commitment and organizational trust. Therefore, the null hypothesis was rejected for five of the seven research hypotheses. The issue of continuance commitment in relation to job satisfaction and organizational trust may reflect an attitude among the employees in the sample that there are other job alternatives available in the vicinity. Therefore, the type of commitment based on the cost that employees place on leaving the organization, which is often associated with low perceived alternatives and high personal sacrifice, does not appear to be a significant factor in this case. It seems more likely that their commitment to the organization is based on other values, such as good pay, close kinship with their coworkers, good working relationships with supervisors and management, and a satisfactory job "fit." The opportunity exists for further research among other hospitals toward developing a broader sense of how these particular variables are related and how the research results might be best applied toward the organization's overall performance improvement and strategic planning efforts.

v Table of Contents

List of Tables....................................................................................................................vii List of Figures..................................................................................................................viii CHAPTER 1: INTRODUCTION........................................................................................1 Definitions............................................................................................................................7 Collaboration............................................................................................................7 Job Satisfaction........................................................................................................8 Organizational Trust................................................................................................9 Organizational Commitment..................................................................................12 Relationship Among Organizational Commitment, Trust, and Job Satisfaction...............13 Organization of the Study..................................................................................................15 Purpose of the Study and Research Questions...................................................................17 Study Setting......................................................................................................................18 Methods..............................................................................................................................19 Significance of the Study...................................................................................................20 CHAPTER 2: LITERATURE REVIEW...........................................................................24 Job Satisfaction..................................................................................................................25 Factors Influencing Job Satisfaction......................................................................25 Benefits of Job Satisfaction...................................................................................29 Organizational Trust..........................................................................................................30 How Trust Forms...................................................................................................31 Why Trust is Necessary.........................................................................................32 The Impact of Trust...............................................................................................33 Organizational Commitment..............................................................................................35 Factors Influencing Organizational Commitment.................................................37 Impact of Organizational Commitment.................................................................38 Relationships Among Job Satisfaction, Organizational Trust, and Organizational Commitment.............................................................................38 Summary............................................................................................................................39 CHAPTER 3: RESEARCH METHODOLOGY...............................................................41 Research Design.................................................................................................................44 Sampling............................................................................................................................47 Measurement......................................................................................................................49 Administration...................................................................................................................51 Data Analysis.....................................................................................................................52 Summary............................................................................................................................53 CHAPTER 4: DATA ANALYSIS....................................................................................55 Descriptive Statistics..........................................................................................................57 Reliability...........................................................................................................................62 Correlations........................................................................................................................62 Summary............................................................................................................................73

vi CHAPTER 5: CONCLUSIONS AND RECOMMENDATIONS.....................................76 Conclusions........................................................................................................................76 Limitations.........................................................................................................................79 Delimitations......................................................................................................................80 Suggestions for Further Study...........................................................................................81 Recommendations for Hospital Leadership.......................................................................81 Opportunities......................................................................................................................83 REFERENCES..................................................................................................................86 APPENDIXES...................................................................................................................96 A. The Job Satisfaction Survey.............................................................................96 B. The Organizational Trust Inventory (Short Form).........................................100 C. The Employee Commitment Scales...............................................................101 D. Study Invitation..............................................................................................103 E. Saybrook Graduate School and Research Center Informed Consent For Participants of Research Projects......................................................104 F. Letters of Permission......................................................................................106 G. Survey Cover Letter.......................................................................................111 H. Bar Charts of Job Satisfaction Survey Responses.........................................112

vii List of Tables

Table 1: Steps of the Research Project.............................................................................46 Table 2: Research Questions, Hypotheses, and Expected Outcomes...............................56 Table 3: Job Satisfaction Scores.......................................................................................58 Table 4: Measures of Reliability.......................................................................................62 Table 5: Pearson Correlations to Job Satisfaction............................................................69 Table 6: Pearson Correlations to Organizational Trust.....................................................73 Table 7: Summary of Hypothesis Testing........................................................................75

viii List of Figures

Figure 1: Suggested Relationships Among Organizational Trust, Job Satisfaction, and Organizational Commitment.......................................15 Figure 2: Job Satisfaction Score.........................................................................................59 Figure 3: Organizational Trust Score..................................................................................60 Figure 4: Affective Commitment Score..............................................................................60 Figure 5: Continuance Commitment Score.........................................................................61 Figure 6: Normative Commitment Score............................................................................61 Figure 7: Scatter Plot of Organizational Trust and Job Satisfaction...................................64 Figure 8: Scatter Plot of Affective Commitment and Job Satisfaction...............................65 Figure 9: Scatter Plot of Continuance Commitment and Job Satisfaction..........................66 Figure 10: Scatter Plot of Normative Commitment and Job Satisfaction.............................68 Figure 11: Scatter Plot of Affective Commitment and Organizational Trust.......................70 Figure 12: Scatter Plot of Continuance Commitment and Organizational Trust..................71 Figure 13: Scatter Plot of Normative Commitment and Organizational Trust.....................72

1 Chapter 1: Introduction

In the process of assessing healthcare employees’ perceptions of job satisfaction, organizational trust, and organizational commitment, hospital leadership must consider a multitude of factors and issues that come into play, such as hospital culture, quality of management, effectiveness of communication, job design, pay, and benefits, to name just a few. The intent of this study is to focus on the importance of these three specific factors to provide a better understanding of their interrelatedness, as well as how they can be used as indicators of general employee satisfaction and then incorporated into the organization’s strategic planning effort. By identifying how and why the well-being of employees is influenced by the above factors, the healthcare leadership team will be better prepared to react to future employee performance (Hanson & Miller, 2002). The survey tools employed in this study were selected partially for their ease of use by hospital human resources departments as an ongoing barometer of job satisfaction, trust, and commitment. Using the results of the initial survey, the HR department at Albemarle Hospital will be able to gauge employee attitudes moving forward and proactively plan on ways and means to attract and keep a motivated, satisfied, and productive workforce. Hospital chief executive officers face major challenges, including predicting and planning for changes in state and federal legislation, addressing healthcare funding, advancing technology, dealing with competition from managed care companies, and keeping the hospital staffed in critical areas (Gaynor & Haas-Wilson, 1999). In short, the transformation of the healthcare delivery system requires leadership to reduce healthcare costs while increasing both quality of care and access to services. As a result, many healthcare organizations have articulated new strategic directions that focus on better

2 performance, heightened efficiency, and improving their capabilities to deal with ongoing change. All of these initiatives are best achieved with a dedicated, satisfied, and committed staff because they each depend on employee performance to move forward successfully. A key player in hospital operations, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), states on its website that it is an “independent, not for profit organization whose comprehensive system of standards for measuring healthcare quality help form, to a considerable extent, the guiding principles of most hospitals” (JCAHO, 2006, p. 2). Its tremendous power over the flow of public dollars is based on current law that says hospitals accredited by JCAHO are automatically eligible for Medicare reimbursement. Though often regarded as a “watchdog” agency, JCAHO functions as if it were responsible primarily to the hospitals it regulates by requiring accredited institutions to measure their own management and leadership performance as evidenced by their ability to remain in substantial compliance with all standards. “JCAHO standards address an organization’s performance in key functional areas. Each standard is presented as a series of Elements of Performance—expectations that establish the broad framework that JCAHO surveyors use to evaluate a facility’s performance” (O’Leary, 2007, p. 1). Some of the standards refer to environmental issues as part of the Environment of Care standard, but the standards relevant to this study are part of the Human Resources and Leadership standards, which include financial performance. These standards impose a need for hospitals to be ready for regular audits and remain in compliance at all times. To achieve this readiness status, hospital leadership strives to attract and retain employees at all levels of the organization who are satisfied in the jobs they perform and are committed to the organization’s mission and goals. Without these

3 key components of job satisfaction, organizational trust, and organizational commitment firmly in place, the hospital’s ability to maintain applicable standards may be in jeopardy to the extent that related problems might be observable during a survey. Most factors contributing to low levels of job satisfaction, organizational trust, and organizational commitment can be linked to management practices within the organization. Dissatisfaction in any of these areas tends to be higher in work settings where employees feel they are undervalued, unappreciated, unimportant, and otherwise excluded from reasonable consideration as part of the organizational team (Shouksmith, 1994). Findings of an investigation by Ingersoll, Olsan, Drew-Cates, DeVinney, and Davies (2002) suggest that, among other factors, the organizational environment in which clinical staff performs their jobs directly affects their attitudes related to job satisfaction, organizational commitment, and plans for continuing their employment. Research suggests that a significant relationship exists between employee satisfaction and patients’ perceptions of the quality of care received in the hospital, measured in terms of their intent to return and to recommend the hospital to others (Atkins, Marshall, & Javalgi, 1996). Employee dissatisfaction can negatively affect quality of care and have an adverse effect on patient loyalty and thus hospital profitability (Ford et al., 2006). Therefore, hospital leadership should routinely and consistently measure employee satisfaction as a means of gauging the quality of patient care. When negative issues are noted as a result of these monitoring efforts, the management team should engage the human resources department to develop and implement measures or programs to promote a work environment that is conducive to achieving and maintaining a high level of job satisfaction, mutual trust, and commitment.

4 Due to leadership and financial issues, many hospitals have been acquired by larger chains more adept at streamlining their operations, reaping the greatest benefits from their resources, and achieving a competitive advantage. Sager, Deol, and Socolar (1997) predicted that hospitals with greater financial resources and a more stable financial footing were likely to stay open and resist takeovers. A study funded by the Robert Wood Johnson Foundation reviewed hospital closings and mergers in 52 cities from 1936 through 1980 and found that smaller, nonteaching hospitals; hospitals with lower occupancy rates; and hospitals with weak financial standing were most likely to close. The resulting pressure on hospital leadership to provide high-quality services while controlling costs, building a strong financial base, keeping census figures high, and maintaining a reputation for excellence has resulted in highly complex and sophisticated management environments throughout the healthcare industry. One of the most effective ways of transforming and sustaining an ailing healthcare system is to invest in its human capital, for an organization’s people represent the most valuable component of the organization and what Pralahad and Hamel (1990) call an organization’s best source for creating sustainable competitive advantage. For example, hospitals could periodically gather quantitative information to measure employee satisfaction and commitment (Press, 2005). Hospitals could use this information to create a work environment that promotes job satisfaction and employee retention over the long term (Home Care Associates Training Institute, 1997; Chassin, 1997). Healthcare organizations might also help improve their employees’ overall performance by building and sustaining a creative, trusting, and committed workforce (De Brabandere, 2005). Meyer and Herscovitch’s (2001) general model of commitment,

5 which was partly based on Meyer and Allen’s (1991) three-component model of affective commitment, continuance commitment, and normative commitment, presents the core essence of commitment as the “sense of being bound to a course of action of relevance to a particular target” (p.314). There is now a trend toward fostering work environments that enhance perceptions of empowerment and organizational trust to generate positive effects such as creativity, motivation, and cooperation in organizational members and, thus, increase organizational effectiveness (Laschinger, Finegan, Shamian, &Casier, 2000). The findings of Laschinger et al. support Kanter’s (1993) notion that power begets power in that powerful managers are more likely to share their power with their coworkers and, thus, increase the trust and productivity of their organizational units. Kanter (1993) stated, “Those with sufficient power are able to accomplish the tasks required to achieve organizational goals. These individuals have the ability to empower those around them and thus create an effective work unit within the organization” (p. 285). Renewed interest in organizational trust and commitment in the healthcare industry has focused on leveraging interrelationships and collaboration throughout the organization to improve overall performance. Eisenberg, Bowman, and Foster (2001) asserted that the tradition of evidence-based decision-making needs to be applied to healthcare management, as it has been applied in the past in the clinical function, in order to show how environment, organizational trust, and organizational culture can affect the quality of patient care. Because the highest possible quality of patient care is the primary goal of any healthcare organization (and is mandated by all associated regulatory agencies and the JCAHO), hospital leadership needs to look toward proven synthesizing strategies to increase employee job satisfaction. Leaders also should implement

6 interventions that promote effective recruitment and staff retention as a means of achieving this goal. Research conducted by Kreitzer et al. (1997) on health professionals pointed out “the connection between a healthier work environment, employee well-being, and organizational performance. Hospitals that provide these work conditions show improvement in staff recruitment and retention as well as patient outcomes” (p. 37). The industry-wide commitment to creating a satisfying work environment has led to a tremendous growth in the use of outside consultants to help in identifying, evaluating, and improving the quality of the healthcare work environment because this is a key part of the solution for managing the quality of patient care. The healthcare organization must foster a caring, sharing, and supportive work environment to build and retain a committed, trusting, satisfied, and equally supportive work force. Achieving these desired outcomes also requires a strong commitment to interdepartmental cooperation. This, too, requires that hospitals retain their best staff at all levels of the organization and that each employee handles his or her particular aspects of the program. Because hospitals are complex and diverse systems, effecting sustainable improvements requires buy-in and active participation from all organizational members throughout the system. Across all levels of the hospital, employees are expected to adapt to changing roles, to seek opportunities for improvement that transcend functional boundaries, and to examine past practices in healthcare and best practices in other industries in the interest of continuing quality improvement and innovativeness (Laffel & Blumenthal, 1989). JCAHO standards similarly have posited that strong organizational leadership and maintaining a culture of excellence in the hospital are primary factors for improving

7 employee-organization relationships in the industry (JCAHO, 2003). JCAHO asserted that successful healthcare facilities are places where people of diverse backgrounds want to work because they feel they are an important part of the organization’s mission. Such cultures are believed to foster supportive and inclusive behavior at all levels.

Definitions

It was important to define four terms as they were intended for purposes of this study: collaboration, job satisfaction, organizational trust, and organizational commitment. These definitions are followed by a discussion of the relationship among job satisfaction, organizational trust, and organizational commitment. Collaboration. Collaboration at work refers to interdependent action among coworkers within and across levels of the organization under study. It involves cooperation among disciplines, including exchanging ideas, building creative teams from several departments to resolve work performance issues, utilizing innovative methods and technologies, striving to achieve common goals, and orchestrating a deliberate transformation toward a culture that supports a nonpunitive environment and interdisciplinary problem-solving (Cousins, 2004). The intensity of this interdependence is magnified substantially in a medical hospital when lifesaving procedures are almost always being called upon throughout a routine workday. Traditionally, healthcare facilities have been known for departmentalizing to the extent that professionals and nonprofessionals are virtually isolated within their specific functions and lack clear understanding of what other departments do. This perceived independence among departments often results in inefficiency and fragmentation of

8 services rendered to the patient. In actuality, every department in a hospital is, by necessity, linked through a supportive structure that requires a high degree of cooperation on everyone’s part. This occurs due to the increasing scope and complexity of clinical and nonclinical problems occurring in the typical hospital; administrators now routinely combine the efforts of professionals from different disciplines in an effort to broaden the scope of expertise brought to focus on an issue. It is the responsibility of leadership to encourage such interdisciplinary participation and the mutual trust that supports it (Mitchell & Crittenden, 2000). Research has supported the view that a strong sense of trust enables this cooperative behavior (Gambetta, 1990) and promotes effective responses to critical situations (Rousseau, Sitkin, Burt, & Camerer, 1998). Trust also can be a significant factor in determining job satisfaction as it relates to other aspects of the job (Spector, 1997). Generally speaking, employees are more supportive of and committed to the institutions they work for when overall trust is relatively high (Brockner, Siegel, Daly, Martin, & Tyler, 1997). Likewise, a high level of trust in the organization’s leadership often translates to strong support for the decisions they make, which in turn builds commitment within a trusting environment (Carnevale & Wechsler, 1992). Job satisfaction. Job satisfaction typically is defined as the extent to which individuals are satisfied with their jobs or how they feel about different aspects of their jobs (Agho, Mueller, & Price, 1993; Cranny, Smith, & Stone, 1992). Variables that have been shown to positively affect job satisfaction include job level, tenure, and salary (Chet, Ryan, Schmeider, Parra, & Smith, 1998); employee empowerment (Kirkman & Rosen, 1997); and skill variety and type of skills needed (Hackman & Oldham, 1975). Gender also has been shown to be related to job satisfaction (Voyandoff, 1980).

9 However, the effects of gender on job satisfaction vary with the level at which an individual works. Research by Stern and Shapiro (1975) found that professional women such as clinical psychologists, social workers, and healthcare workers experienced lower levels of job satisfaction than their male counterparts. Among nonprofessionals, on the other hand, the reverse was true (Miller, 1980). Job satisfaction is an attitude based on employee perceptions (negative or positive) of their jobs or work environments (Pool, 1997; Reilly, Chatman, & Caldwell, 1991). Most explanations of job satisfaction have been dominated by the person-environment fit paradigm (Brief, 1998; Kristof, 1996; Mottaz, 1985). Simply stated, the more a person’s work environment fulfills his or her needs, values, or personal characteristics, the greater the degree of job satisfaction. This “fit” also might include both trust and commitment factors among the determinants of overall employee satisfaction with his or her job. Organizational trust. Organizational trust has been identified as an important element in building a successful organization. Doney, Cannon, and Mullen (1998) defined it as “a willingness to rely on another party and to take action in circumstances where such action makes one vulnerable to the other party” (p. 605). This definition encompasses the risk that is a precondition of trust and the belief and behavioral consequences of trust. Bhattacharya, DeVinney, and Pillutla (1998) defined trust in a similar manner: “Trust is an expectancy of positive (or non-negative) outcomes that one can receive based on the expected action of another party in an interaction characterized by uncertainty” (p. 463). From an organizational perspective, the higher the intraorganizational trust, the more satisfied and productive the employees tend to be (Schnake, 1991). Based on his research, Schnake also argued that although employees’

10 attitudes about the organization relative to job satisfaction, commitment, trust, and perceived equity may not be closely linked to productivity, they are strongly correlated with their willingness to give back to the organization, which is needed to achieve high productivity and quality performance. This altruistic behavior on the part of the employee, according to Schnake, promotes the most effective functioning of the organization. Based on the researcher’s personal and professional experience, organizational trust is based on certain communicative behaviors such as honesty and openness and is influenced by three variables: competence, integrity, and rapport. Competence is evaluated based on the quality of the ability and expertise of the partner in the given area (Shockley-Zalabak, Ellis, & Winograd, 2000). Integrity involves honesty, commitment, adherence to a set of principles, acting fairly and honoring agreements, and practicing an appropriate level of disclosure. Rapport is the depth of the relationship, the shared vision, and purpose and direction, as well as the understanding of roles and responsibilities within the relationship, including an understanding of work styles, strengths, and weaknesses (Cufaude, 1999). Organizational trust provides the basis for employee motivation, effective team-building, open communication, and employee retention. When trust is a “guiding principle in the corporate culture, it provides a firm foundation from which to build job satisfaction and committed staff” (DeFrank & Ivancevich, 1998, p. 58). Healthcare managers who have been involved in the JCAHO presurvey preparation process are generally aware that the significance of the trust placed upon leadership by the entire organization to focus the appropriate amount of resources on the survey process is second, perhaps, only to the level of trust that leadership places on each

11 employee to do his or her share in preparing for such surveys. This duality of trust is an important factor because, in order for trust to become part of the organization’s working culture, it has to be part of a continuous loop among staff and management throughout every department. Several management researchers have agreed that a sharing of trust among members of an organization at all levels contributes significantly to the development and nurturing of trust throughout the workplace (Kouzes & Posner, 1993; Lewicki & Bunker, 1996; Rotter, 1967, 1971). When trust becomes less than a back-and-forth commitment, there is the potential for a decrease in employees’ job satisfaction and commitment to the task at hand and to the organization as a whole. According to Gardner (1990) and Rotter (1980), mutual trust is central to forming cooperative relationships throughout all societies; this includes those societies that exist within organizations. In the limited context of a healthcare organization, a breakdown in the circle of trust may not pose a significant problem when it involves a very small number of employees, but it can be extremely damaging if it begins to create a pervasive environment of distrust and uncertainty and negatively affects interpersonal and interdisciplinary collaboration. While it is important that an organization’s employees trust each others’ abilities and believe they share mutual support, especially in a care-giving environment, the researcher believes it is crucial that employees also trust that leadership has the ability and commitment to make the decisions that are best for them as individuals and that are right for the organization. Likewise, management needs the trust of employees to maintain a creative, satisfied, and productive workforce. When employees do not have to worry about the competence of their organization’s decision-makers, they are more likely to concentrate on doing their part in helping the organization achieve its goals.

12 Organization commitment. Employees’ commitment to the organization can take various forms, and the antecedents and consequences of each form can be quite different (Mathieu & Zajac, 1990; Meyer & Allen, 1991). Meyer and Allen (1991) identified and developed measures of three forms of organizational commitment: affective, continuance, and normative. Affective commitment reflects an emotional attachment to, identification with, and involvement in the organization. For example, the researcher’s experience at numerous healthcare facilities indicates that community-based hospitals tend to employ hourly-wage workers from the surrounding neighborhoods. They and their family members receive medical care and treatment at the same hospital or its neighborhood clinics. In fact, multiple family members are often employed at the hospital, sometimes covering two or more generations. A strong sense of belonging and loyalty to the organization exist in such a community setting. Continuance commitment is based on the perceived costs associated with discontinuing employment with the organization. Many healthcare institutions are among the largest and steadiest source of employment in their communities and are heavily relied upon to provide both full- and part-time income to local families. Hospitals are typically regarded as stable income providers, especially for local residents. Continuance commitment is significant for these employees in that seeking employment elsewhere may involve a longer commute or may present other perceived risks or financial output that could be avoided by working locally. Finally, normative commitment reflects a sense of obligation on the part of the employee to maintain membership in the organization. Hospitals are centers of community activity. They support community events, are usually well publicized in the

13 area, and are identified positively for providing healthcare services for the local population. Normative commitment is evident among hospital employees in that they are generally proud of their role in providing vital services to their communities and identify closely with all of the successes of the institution. Relationship Among Organizational Commitment, Trust, and Job Satisfaction Acknowledging the complexity and the multifaceted nature of antecedents involved in organizational commitment, trust, and job satisfaction, it also is important that organizational leaders understand the dynamics of the relationships among these variables. Empirical research has indicated that there is a low correlation between job satisfaction, commitment, and the intention to leave an organization, which suggests that no direct relationship exists. There are satisfied, committed employees who decide to leave, and dissatisfied, ambivalent employees who steadfastly remain at their jobs (Nunn, 2000, p. 21). Other factors might weigh in the decision to stay or to leave, and these factors may be both work related and personal. Mobley, Griffeth, Hand, and Meglino (1979) concluded that only a weak negative correlation exists between job satisfaction and voluntary turnover. For example, employees may lack alternatives to staying with their present job situation, or other types of barriers and commitments may affect their decision to stay. Steers and Mowday (1981) posited that a relationship between the level of job satisfaction and turnover intention may be influenced by an employee’s efforts to stay with his or her job and try to change the elements of the job that are dissatisfiers. This suggests that an employee might have strong commitment to an organization although he or she is unsatisfied with certain aspects of his or her specific job.

14 Kovach (1977) maintained that “job satisfaction is recognized as a component of organizational commitment” (p. 73), while other researchers have clearly stated that job satisfaction is a predictor of organizational commitment (Porter, Steers, Mowday, & Boulian, 1974; Price, 1977; Spector, 1997). Whether job satisfaction is a component of or a predictor of organizational commitment, the differences between organizational commitment and job satisfaction can be viewed in various ways (Mowday, Porter, & Steers, 1982). Job satisfaction is more of a response to a specific job or aspect of a job, while commitment is a more global response (Weiner, 1982). Organizational commitment may be more indicative of an employee’s attachment to the organization, as opposed to specific tasks, environment, or job location (Mowday et al., 1982). In fact, an employee’s emotional attachment to an organization may engender a stronger personal commitment and enable the employee to experience a sense of belonging (Allen & Meyer, 1990; Meyer & Herscovitch, 2001; Mowday et al., 1982). The significance of harboring feelings of belonging or being a part of a hospital team is that such feelings of attachment reinforce a desire to participate and contribute at one’s highest level of performance. Here, then, is the value of understanding the relationship among job satisfaction, organizational trust, and organizational commitment. Taken individually, each is an important ingredient in organizational development. But the integration of all three is the way to achieve sustainable organizational success (see Figure 1). This study will further examine the relationship among these three variables, including demographic data that may be influential in job satisfaction, trust, and commitment decisions.

Full document contains 164 pages
Abstract: The purpose of this study was to examine the relationship among specific job attitudes held by a cross section of employees of an acute care hospital, and to understand and communicate how these attitudes and their interrelationships within the hospital may strengthen the strategic planning effort of hospital leadership in relation to human resources management. Increasing awareness of the issues and conducting assessments related to employees' perceptions of job satisfaction, organizational trust, and organizational commitment may provide hospital management valuable insight as to how well employees feel they "fit" in a hospital organization and whether they are satisfied to the extent that they plan to remain in their jobs. Three research instruments were administered to a sample of 120 individuals from a single hospital. These surveys were the Job Satisfaction Survey (Spector, 1985); the Organizational Trust Inventory (Cummings & Bromiley, 1996); and the Employee Commitment Scales (Meyer & Allen, 1991). A moderately strong to strong positive correlation was found to exist among each of the variables, with the exception being the relationships between continuance commitment and job satisfaction and between continuance commitment and organizational trust. Therefore, the null hypothesis was rejected for five of the seven research hypotheses. The issue of continuance commitment in relation to job satisfaction and organizational trust may reflect an attitude among the employees in the sample that there are other job alternatives available in the vicinity. Therefore, the type of commitment based on the cost that employees place on leaving the organization, which is often associated with low perceived alternatives and high personal sacrifice, does not appear to be a significant factor in this case. It seems more likely that their commitment to the organization is based on other values, such as good pay, close kinship with their coworkers, good working relationships with supervisors and management, and a satisfactory job "fit." The opportunity exists for further research among other hospitals toward developing a broader sense of how these particular variables are related and how the research results might be best applied toward the organization's overall performance improvement and strategic planning efforts.