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Privatizing health care in times of new public management: Investigating the role of psychological empowerment using cluster analysis
Stockholm University, Faculty of Social Sciences, Department of Psychology.
Stockholm University, Faculty of Social Sciences, Department of Psychology.
Stockholm University, Faculty of Social Sciences, Department of Psychology.
Stockholm University, Faculty of Social Sciences, Department of Psychology.
2013 (English)In: PsyCh Journal, ISSN 2046-0252, Vol. 2, no 3, 190-208 p.Article in journal (Refereed) Published
Abstract [en]

Although privatization within health care is usually justified using arguments based on efficiency and productivity, the empirical investigations underpinning such arguments are few and ambiguous in their results. Presenting a new theoretical and analytical approach to this research field, we argue that psychological empowerment, reflecting individuals' intrinsic change motivation state, is a crucial prerequisite for the transformation of a nonprofit health care organization to a for-profit one. The general aims of this study were to explore empowerment cognitions during a privatization, to relate these to a selection of key work-related outcome variables, and to identify the effects of privatization in terms of individual level changes in empowerment after privatization. A sample of health care workers (n = 210) provided survey longitudinal data that were analyzed using cluster analysis. Eight clusters were identified at both pre- and postprivatization with each cluster mirroring specific empowerment patterns: Empowered, In Control, Quasi-Empowered, Competent/Normed, Reference, Underused, Misfit, and Powerless. The clusters discriminated on positive work attitudes, mental health complaints, and turnover intentions. The analysis also revealed the complexity of privatization in that a homogenization as well as a differentiation tendency was observed, thereby implicating both socio-structural equality and inequality effects. The results highlighted the relevance of allocating importance to health care workers' psychological empowerment during the privatization process, and of viewing such organizational transformations not as simple shifts in the state of affairs, but as nonlinear processes involving dynamic changes in individual perceptions over time.

Place, publisher, year, edition, pages
John Wiley & Sons, 2013. Vol. 2, no 3, 190-208 p.
Keyword [en]
cluster analysis, longitudinal design, person-oriented approach, privatization, psychological empowerment
National Category
Psychology
Research subject
Psychology
Identifiers
URN: urn:nbn:se:su:diva-97179DOI: 10.1002/pchj.37OAI: oai:DiVA.org:su-97179DiVA: diva2:676201
Available from: 2013-12-05 Created: 2013-12-05 Last updated: 2014-04-04Bibliographically approved
In thesis
1. Arbetsvillkor i privat och offentlig sjukvård: Implikationer för personalens attityder och hälsa
Open this publication in new window or tab >>Arbetsvillkor i privat och offentlig sjukvård: Implikationer för personalens attityder och hälsa
2014 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[en]
Working conditions in private and public health care : Implications for personnel attitudes and health
Abstract [sv]

Omvandlingen av sjukvården mot marknadisering och nya driftsformer har huvudsakligen genomförts utifrån ekonomiska och politiska föresatser om ökad effektivitet och vårdkvalitet. Goda arbetsvillkor för personalen är en viktig förutsättning för förverkligandet av dessa mål. Givet det oklara kunskapsläget kring psykologiska implikationer av omställningen i välfärdssektorns styrning var syftet med avhandlingen att studera olika aspekter av arbetsvillkor samt arbetsrelaterade attityder och hälsa i privat, bolagiserad och förvaltningsdriven sjukvård. Det gjordes genom att undersöka hur krav och resurser i arbetet förhåller sig till uppkomsten och utbredningen av utbrändhet hos sjuksköterskor, betydelsen av kontroll i och över arbetet för de anställdas arbetstrivsel samt hur motivationsbaserade kognitioner av bemyndigande hos vårdpersonal förändras vid privatisering och relaterar till attityder och hälsa. De empiriska studierna inkluderade såväl tvärsnittliga som longitudinella enkätdata från tre svenska akutsjukhus med olika driftsform. Resultaten visade högre nivåer av utbrändhet hos sjuksköterskor i privat jämfört med förvaltningsdrivet sjukhus. För arbetstrivsel fanns ingen nivåskillnad mellan de tre driftsformerna. Krav i arbetet hängde samman med högre utbrändhetsnivåer och lägre arbetstrivsel. Flera resurser var förenade med lägre grad av utbrändhet medan kontroll hängde samman med högre trivsel. Vid en förändring från bolagiserad till privat driftsform var vårdpersonalens bemyndigande relativt stabilt. Dock fanns efter privatiseringen en tendens till standardisering då graden av bemyndigande blev mer lika. Likaså skedde en statusmässig differentiering i bemyndigande mellan yrkesgrupperna genom att flera med låg status fick mindre bemyndigande. Sammantaget pekar avhandlingen på fler likheter än skillnader mellan driftsformerna vilket antyder att driftsform tycks ha mindre betydelse för såväl nivå som betydelse av arbetsvillkor för personalens attityder och hälsa.

Abstract [en]

The shift in health care towards marketization and new types of ownership has mainly been carried out for financial and political reasons aimed at increasing care efficiency and quality. Good working conditions for the personnel are essential for these goals. However, knowledge of the implications at the individual level is still limited. Considering this, the aim of this thesis was to study working conditions, work-related attitudes and health in private for-profit (PFP), private non-profit (PNP), and publicly administered (PA) hospitals in three empirical studies. This was done by investigating how demands and resources at work predict the development of burnout, how control within and over work relate to employee job satisfaction, and how perceptions of empowerment change in connection with privatization and relate to attitudes and health. The empirical studies include cross-sectional and longitudinal questionnaire data from three Swedish acute care hospitals with different ownership types. The results showed higher levels of burnout among nurses at the PFP hospital than those at the PA hospital. There was no difference in levels of job satisfaction among the ownership types. Demands were associated with higher burnout levels and lower job satisfaction. Several job resources were associated with lower burnout, while control was related to higher job satisfaction. In a change from PNP to PFP, employees’ empowerment levels remained relatively stable. However, there was a tendency towards standardization as their degrees of empowerment became more similar after privatization. Also, a status-related differentiation in empowerment occurred among the occupational groups as some with low status experienced less empowerment. Altogether, the findings show more similarities than differences among the ownership types, suggesting that ownership is of less importance for both the levels and the impact of working conditions on attitudes and health.

Place, publisher, year, edition, pages
Stockholm: Psykologiska institutionen, Stockholms universitet, 2014. 92 p.
Keyword
Marketization, health care, ownership type, privatization, work climate, work-related attitudes, health, Marknadisering, sjukvård, driftsform, privatisering, arbetsklimat, arbetsrelaterade attityder, hälsa
National Category
Applied Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:su:diva-102413 (URN)978-91-7447-884-6 (ISBN)
Public defence
2014-05-09, David Magnussonsalen (U31), Frescati Hagväg 8, Stockholm, 10:00 (Swedish)
Opponent
Supervisors
Note

At the time of the doctoral defence, the following paper was unpublishd and had a status as follows: Paper 2: Manuscript.

Available from: 2014-04-15 Created: 2014-04-04 Last updated: 2014-04-22Bibliographically approved

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