Is Organizational Justice Associated with Perceived Quality of Care and Affective Comitment? - A Multilevel Study

Abstract

According to The Swedish National Board of Health and Welfare 2016, the regions are facing an imbalance between the demand and the supply of dental staff.

Aim: The present study aimed to investigate whether a central job resource, i.e., organizational justice at the clinical unit level, is associated with staff’s perceptions of care quality and affective commitment to the workplace. Methods: The study adopted a cross-sectional multilevel design. All staff from public dental health services of four county councils in Sweden (a large convenience sample) were invited to participate in an electronic survey and a response rate of 75% was obtained. The study was approved by the Regional Ethics Board in Southern Sweden and informed consent was obtained from respondents. The present study included non-managerial dental nurses, hygienists and dentists working in general practice from units with at least five respondents (n=900 from 68 units). A set of Level-2 random intercept models were built to predict individual-level affective organizational commitment and perceived quality of care from unit-level organizational justice. At an aggregated level organizational justice can be understood as a climatic factor of how the group as a whole is treated regarding justice. The study design controlled for the potential confounding of group size, gender, age and occupation.

Results: The results of the empty model showed substantial between- unit variation for both affective commitment (Intra- class correlation, ICC-1 = 0.17) and quality of care (ICC-1 = 0.12). The overall results showed that the shared perception of organizational justice at the clinical unit level was significantly associated with perceived quality of care and organizational affective commitment (p<0.001). No significant between-unit variance in affective commitment was left to explain after the introduction of unit-level justice.

Conclusions: In the population studied, the results indicate a potential for enhancing affective organizational commitment and opportunities for quality care delivery by promoting organizational justice at the clinical unit level. This could be part of a strategy for preventing future staff turnover.