V. Meeting Today’s Healthcare Challenges through Innovations in Employment Relations and Information

The Role of Participatory Union Leadership and Union Commitment throughout an Organizational Change Process in a Healthcare Setting

Julie Sadler 
Pennsylvania State University

Abstract

This paper, using survey data, investigates the relationship between union members’ views about union leaders’ participatory style, commitment to the union, and commitment to the nursing home. Understanding these relationships during a change process is important for multiple theoretical and practical reasons. Unfortunately, relatively little research has been done on the role unions play in orchestrating change processes. This omission is particularly concerning as unionization efforts within healthcare are increasing and the U.S. healthcare system is in flux. This paper is part of an ongoing project investigating the outcomes associated with the adoption of electronic medical recording in nursing homes.

Introduction

In this paper I investigate the relationship between union members’ views about the participatory style of union leadership, commitment to the union, and commitment to the nursing home. Understanding the relationship between union leadership, union commitment, and organizational commitment in a nursing home setting during a change process is important for multiple theoretical and practical reasons. From a theoretical perspective, there is relatively little research on the role unions play in orchestrating an organizational change process (Iverson 1996). This omission is particularly concerning as unionization efforts within healthcare are on the rise and are increasingly successful (Clark et al. 2001, Clark and Clark 2003), and U.S. healthcare is a system in flux, marked by extreme change. The system is encountering increasing scrutiny regarding quality of care and costs, with many political, industry, and civic actors mandating significant changes (Price and Mueller, 1981a, 1981b; Tai, Bame, and Robinson 1998; Yin and Yang 2002; Hayes et al. 2006).

This study addresses these questions and investigates the intersections between an employee’s relationship with the union, his or her employer, and commitment to the organization, with implications for the change process discussed (Iverson 1996). This paper is part of an ongoing research project documenting and explaining the outcomes of a change process, specifically the adoption of electronic medical recording (EMR) in nursing homes.

How organizations manage and plan for change has been the subject of many research studies and practitioner-oriented articles. Unfortunately, there has been minimal investigation about the role unions play in fostering readiness, acceptance, and implementation of change in an employing organization. One notable exception is Iverson’s 1996 study in an Australian hospital undergoing large-scale change. He developed and tested a causal model, predicting acceptance of organizational change, directly from organizational commitment and environmental variables and indirectly (via organizational commitment) from personal variables, job-related variables, and environmental variables.¹ Of particular relevance to the present study, he found that union membership negatively and significantly related to organizational commitment, and organizational commitment in turn significantly related to acceptance of change. Additionally, Iverson found that union membership had a negative and significant direct relationship with acceptance of change.

Similar to Iverson’s 1996 study, this study investigates the relationship between job-related variables on organizational commitment. Consistent with the larger body of research on organizational commitment, job-related variables are expected to have a positive and significant relationship with organizational commitment. However, I deviate from Iverson by focusing not on the union member/nonmember distinction but rather on members’ relationship with the union, meaning their view of union leaders’ participatory style and members’ commitment to the union, and how these union-related variables relate to organizational commitment. Similar to CEOs and managers in employment-based settings, formal union leaders (presidents and workplace representatives) are responsible for day-to-day operations and long-term strategic planning. These leaders, as elected agents of the union, are charged with representing the interests of the membership and directing union activities, and they are the face of the union to the membership and management counterparts. Members, in their interactions with union leaders, collect information and form opinions and attitudes regarding the leadership’s competence and the level of consideration directed at the membership (Eisenberger et al. 2002). Unfortunately, union leadership has received relatively little attention within academic literature. This exclusion has been raised by a variety of researchers some of which have explored union leadership (Kahn and Tannenbaum 1957; Nicholson 1976; Strauss 1977; Nicholson, Ursell, and Lubbock 1981; Fullagar, McCoy, and Shull 1992; Fullagar, Gallagher, Gordon, and Clark 1995; Parks et al. 1995; Skarlicki and Latham 1996, 1997; Kelly 1998; Greene, Black, and Ackers 2000; Kaminski, Kaufman, Graubarth, and Robins 2000; Metochi 2002; Sadler 2007).

The present study places the union leader in a change agent role and assesses the importance of participatory union leadership in promoting commitment to the employing organization. In contrast to autocratic or directive style, participatory or empowering leadership theory emphasizes frequent consultation, communication, and consideration demonstrated by the leader toward the followers, culminating in shared goal setting and joint decision-making (Arnold et al. 2000). Interestingly, much of the work in the larger body of research on organizational change processes tends to be divorced from the broader leadership research and focuses on more specific strategies or practical steps to follow (Harold et al. 2008). Recently, research has focused more on the role of the change agent, specifically the leadership behaviors and style embodied by managers throughout the change process (Harold et al. 2008). This study builds off of Iverson’s (1996) causal framework that identified organizational commitment as a predictor of change acceptance and adapts Harold’s work on the importance of a change agent’s leadership style on commitment to change. I pose four hypotheses (see below), one of them being that a member’s view of a union leader’s participatory leadership style will have a positive relationship on organizational commitment.²

Unlike union leadership, union commitment has received a relatively high amount of empirical attention. Multiple models and theoretical paradigms exist for union commitment (Gordon et al. 1980; Fullagar and Barling 1989; Bamberger, Kluger, and Suchard 1999; Thacker, Fields, and Tetrick 1989; Fullagar and Barling 1991; Kelloway, Catano, and Southwell 1992; Fullagar et al. 1994; Sverke and Kuruvilla 1995; Catano, Cole, and Hebert 1995; Bayazit, Hammer, and Wazeter 2004; Fullagar et al. 2004). Based on organizational commitment research, union commitment has traditionally been referred to as an attitudinal and behavioral variable relating to the “relative strength of the individual's identification with, and involvement in, a particular organization” (Mowday, Steers, and Porter 1979:226). More specifically, organizational and subsequently union commitment has been characterized by three related factors: an acceptance of, and strong belief in, the organization’s goals and values; a strong desire to maintain membership with the organization; and a willingness to exert considerable effort toward the accomplishment of the organization’s goals (Mowday et al. 1979). Researchers have explored the potential tension between being a loyal or committed union member while also being a loyal or committed employee (Fukami and Larson 1984; Angle and Perry 1986; Bamberger, Kluger, and Suchard 1999; Cohen 2005).

Why the inclusion of union commitment in the present study? Aside from an interest in the larger debate about competing or enhancing forms of commitment, I argue that those members who have a strong attachment to the union simultaneously have a strong connection to their fellow employees. Union commitment is the attachment and identification that a member has toward the organization as a whole. The union is composed of union leaders as well as fellow union members and co-workers. This strong positive bond to fellow employees may translate to having a strong attachment to the employing organization. While it is important to note that other researchers have suggested that organizational commitment predicts union commitment (Bamberger, Kluger, and Suchard 1999), my third hypothesis is that union commitment will positively and significantly relate to organizational commitment.

Beyond testing for a positive and significant relationship between participatory union leadership and union commitment, I hypothesize that adding union-related variables to the model will explain a significant amount of additional variance in organizational commitment. Below is a summary of these preliminary hypotheses. Future papers will identify hypotheses relating background variables, job-related variables, union-related variables, organizational commitment to preparedness for change, and outcomes of the change process. Additionally, future analyses will attempt to disentangle more complex, indirect, or causal relationships.

Hypothesis 1. Job-related variables will positively relate to a union member’s commitment to the nursing home (organizational commitment).

Hypothesis 2. A member’s view of the union leader’s participatory style will positively relate to his or her commitment to the nursing home (organizational commitment).

Hypothesis 3. A member’s commitment to the union will positively relate to his or her commitment to the nursing home (organizational commitment).

Hypothesis 4. The inclusion of union-related variables will explain a significant amount of additional variance in commitment to the nursing home organizational commitment.

Methodology

Sample Selection and Description

As part of a New York State–funded pilot project, nursing home owners volunteered to participate in a longitudinal study investigating the factors that aid in the successful adoption of electronic record-keeping systems. From fall 2007 through summer 2008, a pre-implementation phone survey was administered by the Survey Research Institute at Cornell University. Twenty nursing home facilities were included in the project, with 1,241 survey participants in the first phase of the longitudinal study. Of those participants, 938 are union members. Removing participants with relatively high amounts of missing information as well as outliers resulted in a sample size of 905 union members. The response rate across the nursing home facilities varied between 30% and 50%. From fall 2008 through spring 2009, the electronic record-keeping system will be implemented. A post-implementation phone survey will be administered by the Cornell Survey Research Institute. See Lipsky, Avgar, and Lamare (2009) for more background information on the project.

Survey Measure

Most items used in the survey came from published research and citations are available upon request.

 Background variables: The current study included gender, age, educational level, and the number of years the union member has worked in the nursing home. For gender, males were coded 0 and females were coded 1. Educational level was measured on a 7-point scale, with 1 “less than high school” and 7 “doctoral degree.”

 Job-related variables: For the purposes of the present study, job-related variables encompass traditional and nontraditional job characteristics, general job satisfaction, trust in the nursing home administration, job-related stress, and relationship with supervisor. A 5-point Likert scale was used to measure each item, with 1 “strongly disagree” and 5 “strongly agree.”

Traditional job characteristics include job security (1 item), skill development opportunities (5 items and an  = 0.74), job variety (1 item), job discretion (1 item), and team-orientation of the unit (1 item). Nontraditional or specific items related to the healthcare arena include the nursing home’s approach to resident-centered care (1 item) and adequacy of staffing levels (2 items,  = 0.74). General job satisfaction was measured with 3 items ( = 0.84). Trust in the nursing home administration was measured with 2 items ( = 0.80). Job-related stress was measured with 2 items ( = 0.69). Relationship with the supervisor was measured with 5 items ( = 0.76).

 Union-related variables: Participants were asked to answer questions based on the union leader they felt was

most influential in formulating their views about the union. The members’ view of the union leadership was measured with 11 items adapted for the union context ( = 0.93) from the Empowering Leadership Questionnaire (Arnold, Arad, Rhoades, and Drasgo 2000). Union commitment was measured with a total of 6 items ( = 0.91), four from Mael and Tetrick (1992) and two from Gordon et al. (1980).

 Organizational commitment: Organizational commitment was assessed with 7 items ( = 0.75).

Results

The sample comprises 92% females, with 56% having at least some college credit or higher, an average age of 48 years, with 9 years of experience working at the nursing home. While many of the variables are significantly correlated, collinearity statistics did not raise concerns about the correlations amongst the regressors. (See Table 1 for full descriptive statistics).

TABLE 1
Descriptive Statistics

The multiple regression model explaining organizational commitment from background variables, job-related variables, and union-related variables was significant and explained 57% of the variance. Many of the regressors significantly and positively related to organizational commitment. Age of the union member, years worked at the nursing home, general job satisfaction, job-related stress, relationship with the supervisor, opportunity for skill development, trust in the nursing home administration, appropriate or adequate staffing levels, and union commitment all positively and significantly related to commitment to the nursing home. However, members’ view of the participatory nature of union leadership did not significantly relate to organizational commitment. The variables with the strongest relationship to organizational commitment were general job satisfaction (Beta coefficient = 0.33), followed by trust in the nursing home administration (Beta coefficient = 0.26). Interestingly, the simple correlation results suggested that members’ view of the participatory nature of union leadership was positively and significantly related to organizational commitment (Spearman Rho = 0.28, p <= 0.01).

TABLE 2
Multiple Regression Results for Model Explaining Commitment to the Nursing Home from Background Variables, Job-Related Variables, and Union-Related Variables

N = 905, **p <= 0.01, *p <= 0.05, R = 0.76, R-squared = 0.58, adjusted R-squared = 0.57, standard error = 0.46, F 17,887 = 70.51, p <= 0.01.

Table 3 reports the results of a series of hierarchical ordinary least squares regression analyses designed to explore the relative contributions of the background variables, job-related variables, and union-related variables. The results included in Table 3 are from a hierarchical regression analysis where union-related variables were entered last. While divergent theoretical rationale exist for when to included the union-related and job-related variables in a hierarchical regression equation, I have used the more conservative approach here.

Focusing on the addition of the union-related variables, the fourth column (Model 4) reports the results after adding union-related variables to the model. Adding these two variables to the model accounted for an additional 1% of the variance, with union commitment positively and significantly relating to organizational commitment. When adding union commitment and union leadership to the model in the final step, union leadership was not significantly related to organizational commitment. The age of the employee, years worked in the nursing home, job-related stress, opportunity for skill development, appropriate staffing levels, general job satisfaction, relationship with supervisor, and trust in the nursing home administration positively and significantly related to organizational commitment. Additionally, the change in the F-statistic was not significant, meaning that adding the two union-related variables did not explain a significant amount of additional variance in organizational commitment.

Summary

Based on the preliminary analyses, general support for Hypothesis 1 was found in the amount of additional variance in organizational commitment explained by adding job-related variables to both hierarchical regression analyses. Interestingly, some of the job-related variables were not significantly related to organizational commitment. Specifically, job variety, team orientation of the unit, discretion, and job security were not significantly related to organizational commitment. Given that, I suggest that Hypothesis 1 was partially supported.

TABLE 3
Organizational Commitment Hierarchical Regression Analysis with Union-Related
Variables Entered Last: Standardized Coefficients and Change in R-Squared

As for Hypothesis 2, minimal support was found for a direct relationship between a member’s view of the union leader’s participatory style and a member’s commitment to the organization. When union-related variables were added last to the hierarchical regression model, union leadership was not significantly related to organizational commitment. Interestingly, when union-related variables were added to the model immediately after the background variables, both union leadership and union commitment were positively and significantly related to organizational commitment. However, as soon as some of the job-related variables were included in the model, union leader’s participatory style was no longer significantly related to organizational commitment. It may be that the relationship between union leader’s participatory style has an indirect or more complex relationship with organizational commitment than initially investigated. Related to the larger set of questions of the ongoing project, it may be that union leader’s participatory style has a direct effect on preparedness for change and outcomes of the EMR implementation in the nursing homes.

Hypothesis 3 was supported in that union commitment positively and significantly related to organizational commitment across the multiple models. These findings suggest that higher union commitment, while holding the other variables constant, is related to higher organizational commitment. Additional research is needed to determine if union commitment has positive, indirect relationships as well as a positive, direct relationship to organizational commitment. As mentioned above, the causal relationship may be reversed or more complex than initially investigated and further analysis is needed. Related to the larger study, the impact union commitment has on preparedness for change and the outcomes of the EMR technology implementation may be more complex and indirect.

Hypothesis 4 was minimally supported in the present set of analyses. Adding the union-related variables to the model did not explain a significant amount of additional variance in organizational commitment when background variables and job-related variables were already in the model. Interestingly, when union-related variables were added to the model immediately after background data, they did explain a significant amount of additional variance in organizational commitment. However, the more conservative and appropriate interpretation of the results suggests that Hypothesis 4 was not supported. As noted, union-related variables may have a more complicated relationship with organizational commitment than initially investigated. Additionally, the amount of variance explained by the union variables may be significant when investigating preparedness for technological change and the outcomes of change.

Additional Analysis

While it was not initially hypothesized, the interplay between a member’s view of the participatory leadership style of the union leadership and his or her commitment to the union were explored. Specifically, I included an interaction term between the member’s view of the union leader’s participatory style and the member’s commitment to the union in the regression equation explaining organizational commitment. Table 4 presents the results of the multiple regression equation when including the interaction term. The multiple regression model explaining organizational commitment from background variables, job-related variables, and union-related variables and the interaction between union commitment and union leadership was significant and explained 57% of the variance. A similar pattern of results emerged as in the initial multiple regression model (i.e., without the interaction term) with the notable expectation that the interaction between union commitment and union leadership emerged positively and significantly related to organizational commitment.

TABLE 4
Multiple Regression Results for Model Explaining Commitment to the
Nursing Home from Background Variables, Job-Related Variables, and
Union-Related Variables including Interaction Term

The lower-order terms of participatory union leadership and union commitment were negatively and significantly related to organization commitment, but interpretation of the lower-order terms of an interaction is complex; as such, focusing on the nature of the interaction term is appropriate.

To understand the nature of the interaction between union leadership and union commitment on organizational commitment, I plotted the interaction (see Figure 1). These results suggest that when union commitment is low, having high amounts of participatory union leadership results in lower organizational commitment. However, when a member experiences low amounts of participatory union leadership and union commitment is low, the result is a relatively high organizational commitment. Conversely, when union commitment is high and a member experiences low amounts of participatory union leadership, the result is relatively low organizational commitment. Yet, when a union member experiences high amounts of participatory union leadership and union commitment is high, the result is relatively high organizational commitment.

FIGURE 1
Interaction Effect of Union Leadership and Union Commitment on
Organizational Commitment

Stated another way, there are two ways an employer may experience relatively high amounts of organizational commitment: having low levels of commitment to the union and low levels of participatory union leadership, and having high levels of commitment to the union and high levels of participatory union leadership. Two projections stem from the interaction results related to the ongoing project concerning the implementation of EMR technology in nursing homes:

Projection 1. Union members who have low commitment to the union and experience low levels of participatory union leadership will be more prepared for the technological change and are more likely to experience positive outcomes of it.

Projection 2. Union members who have high commitment to the union and experience high levels of participatory union leadership will be more prepared for the technological change and are more likely to experience positive outcomes of it.

1. Organizational commitment has traditionally been referred to as an attitudinal and behavioral variable relating to the “relative strength of the individual's identification with, and involvement in, a particular organization” (Mowday et al., 1979, pg. 226).
   

2. It may be that union leadership style also affects a member’s commitment to the union, which in turn may affect commitment to the organization. This causal path will be explored in future analyses.

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