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Job autonomy, trust in leadership, and continuous improvement: An empirical study in health care

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Abstract

This research examines the influence of autonomy in day-to-day work on commitment of frontline employees to continuous improvement. Our hypothesized model links the job characteristics theory of work design that associates job autonomy with responsibility for outcomes, and the total quality management perspective that advocates empowering employees in order to generate commitment to continuous improvement. Further, as leadership is known to have a role in shaping job behaviors, and is considered important for the success of total quality management, the influence of trust in leadership on the relationship between job autonomy and commitment to continuous improvement is also examined. We test our hypotheses on data collected from individual employees working for an outpatient health care organization that is applying lean principles for managing and improving work processes. Based on our results, we present implications for organizations implementing continuous improvement initiatives such as lean, particularly in service environments such as health care.

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Authors and Affiliations

  1. Department of Business Administration, University of Illinois at Urbana-Champaign, 350 Wohlers Hall, 1206 South Sixth Street, Champaign, IL, 61820, USA

    Gopesh Anand & Dilip Chhajed

  2. Christie Clinic, 101 West University Avenue, Champaign, IL, 61820, USA

    Luis Delfin

Authors
  1. Gopesh Anand
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  2. Dilip Chhajed
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  3. Luis Delfin
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Corresponding author

Correspondence to Gopesh Anand.

Appendices

Appendix A

1.1 Scales

All items use five point scales ranging from 1 = Strongly Disagree to 5 = Strongly Agree, with an additional option for “Not Applicable”.

Commitment to continuous improvement (CI)

  1. CI1.

    Continuous Improvement helps me serve patients better.

  2. CI2.

    Continuous Improvement has led to an increase in the standardization of work practices.

  3. CI3.

    Continuous Improvement has encouraged me to question any inefficient ways of doing work.

  4. CI4.

    Continuous Improvement has encouraged me to suggest changes in ways of doing things.

  5. CI5.

    Continuous Improvement has made me more flexible in responding to unexpected situations.

Job autonomy (JA)

  1. JA1.

    My job makes full use of my skills and abilities.

  2. JA2.

    I learn new things and develop new skills at work.

  3. JA3.

    The work I do allows room for creativity.

  4. JA4.

    I feel empowered, or authorized, to make independent decisions.

Trust in leadership (LT)

  1. LT1.

    I trust the information supplied to me by the Leadership Team.

  2. LT2.

    The Leadership Team has my best interests at heart.

  3. LT3.

    The Leadership Team responds well to my concerns.

  4. LT4.

    The Leadership Team treats me with respect.

  5. LT5.

    The Leadership Team knows about the problems I face.

Note: Last item (LT5 italicized above) was deleted, based on the results of the statistical analysis for scale reliability.

Appendix B

Table 7 Regression without control variables
Full size table

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Anand, G., Chhajed, D. & Delfin, L. Job autonomy, trust in leadership, and continuous improvement: An empirical study in health care. Oper Manag Res 5, 70–80 (2012). https://doi.org/10.1007/s12063-012-0068-8

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