- Top of page
- What is already known about this topic
- The study
- Conflict of interest
- Author contributions
Employees of long-term care organizations are persistently pressured in their practice environments to meet competing demands within turbulent healthcare systems (Stone et al. 2003, Marck 2004, 2006, Shannon & French 2005, Johnson et al. 2006). They are witnessing a call from politicians, health policy analysts and scholars for improved efficiency and effectiveness. This gives nurses and other employees the challenging task of improving efficiency and effectiveness together (Appelbaum & Batt 1994), but some might be tempted to lean back and hitchhike on the work of others (Kerr 1983, Organ 1988). Cooperative, solidary behaviour is seen as one of the most important success factors in organizations (Wickens 1995) and understanding the factors influencing it in long-term care organizations is thus crucial. Following Katz (1964), dependence on voluntary participation and willingness to cooperate is interpreted herein as solidarity in nurses’ and other employees’ behaviour. Employee solidarity concerns employee behaviour that has an overall positive effect on the functioning of the organization and that cannot be enforced by the employment contract (Organ & Lingl 1995). Solidary behaviour between nurses, managers and other professionals occurs if employees in organizations contribute to the success of the team or organization, are prepared to help others in need, resist the temptation to let other members do most of the work, share responsibilities and are prepared to apologize for mistakes (Lindenberg 1998). Research has shown that it is related to employees’ resistance to organizational change (Torenvlied & Velner 1998) and short-term absenteeism (Sanders & Hoekstra 1998, Sanders 2004).
The notion of solidarity among nurses, managers and others in long-term care organizations is relatively new. In these organizations, employees work interdependently to deliver care. The nature of work in health care is characterized by increasing levels of interdependence (Gittell et al. 2000, Kaissi et al. 2003). Involvement of various nurses in healthcare delivery does not guarantee coordinated teamwork (Pearson 1983). Unfortunately, nurses, managers and other professionals in long-term care settings do not always work well together, which can negatively affect the quality of patient care and services (Kvarnstrom 2008). It is important to realize that nurses in long-term care settings have considerable autonomy, which is different from other industries. One problem is that they have to simultaneously manage the teamwork process and their individual tasks (Lingard et al. 2004). Such conditions may raise the potential for confusion, errors and delays (van Maanen & Barley 1984). Solidarity among nurses, managers and other professionals may encourage to value the contributions others make and consider the impact of their actions, reinforcing the inclination to act with regard for the overall work process.
Traditional research has studied solidarity among employees in conflict with management or in the enforcement of local work group norms (Roethlisberger & Dickson 1939, Seashore 1954, Blau 1955, 1964, Homans 1974). We are particularly interested in how organizational characteristics influence solidarity, i.e., cooperative behaviour characterized by reciprocity (Gouldner 1960, Hechter 1987) and the purpose of our study is to identify such characteristics in long-term care organizations in the Netherlands. We expect that differences in solidarity can in part be explained by them. In line with previous research, we define solidarity as behaving agreeably with other employees even when not convenient or formally described (Sanders et al. 2002).
Relationships in organizations are institutionally embedded, that is, they are influenced by the institutions that give the formal and informal rules and communication patterns that govern interaction between healthcare professionals (North 1990). Informal and formal exchanges of information in organizations complement the organization’s formal rules. For instance, employers often make use of social networks and informal social control to develop and maintain cooperative relations with and between employees (Flap et al. 1998). We, therefore, expect an organization’s informal and formal exchange of information patterns to be related to solidarity.
Empirical research shows that leadership style is highly effective in terms of commitment and motivation (Lowe et al. 1996). Although the relationship between leadership style and the supervisor–employee relationship has been studied (Podsakoff et al. 1990, 1993, 1996a, 1996b, Graen & Uhl-Bien 1995), research on the relationship between leadership styles and solidarity behaviour is rare, especially in long-term care organizations. Den Hartog et al. (1997) have studied three management styles: transformational, transactional and passive. ‘Transformational’ leaders ask followers to transcend their own self-interests for the good of the group, organization or society, and to consider long-term rather than momentary needs with respect to developing themselves. Transformational leaders upset the status quo and existing rule structures, replacing them with a ‘new order’ (Ferlie & Shortell 2001). Because transformational leaders ask employees to transcend self-interest for the good of the group, we expect them to be positively related to solidarity. ‘Transactional’ leaders build expectations by setting specific performance targets with their employees (Avolio & Bass 2002). Transactional leadership refers to ‘the exchange relationship between leaders and followers to meet their own self-interest’ (Bass 1990, p. 10). This type of leadership can be considered as effective as well, although the performance related to this leadership is lower than the one related to transformational leadership. ‘Passive’ leaders tend to react only after problems have become serious enough to take corrective action, and often avoid making decisions at all (Avolio & Bass 1999). While transactional leaders focus on own self-interests of employees, passive leaders are reactive in nature, and transformational leaders ask followers to transcend their own self-interests for the good of the group, we only expect a relationship between transformational leadership and solidarity.
Every organization has a culture that constitutes the expected, supported and accepted way of behaving. Cultural norms are mostly unwritten and tell employees how things ‘really are’. They influence everyone’s perception of the organization from the chief executive to the service worker. ‘Hierarchical’ and ‘centralized’ cultures by means of authority chains are vertical organizational structures (Taplin 1995). An organization’s hierarchy refers to how structured and inflexible its operation is and the extent to which authority is delegated to lower levels. We expect the inflexibility of a hierarchical culture and strong high-level authority to negatively affect solidarity among employees.
Employee solidarity reportedly improves organizations’ effectiveness and efficiency. Research shows that centralization, hierarchical culture, formal and informal exchange of information and leadership style are organizational characteristics affecting solidarity.
The impact of these organizational characteristics on solidarity in (long-term) healthcare settings is lacking. The aim of this study was to identify organizational characteristics explaining employee solidarity in the long-term care sector.