Ramin Ravangard ( Department of Health Services Management, Shiraz University of Medical Sciences, Shiraz, Iran. )
Heshmat Asadi ( School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. )
Mohammad Khammarnia ( Student Research Committee, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran. )
Objective: To determine the relationship between psychological empowerment and readiness for organisational change among primary healthcare workers in Iran.
Methods: This descriptive-analytical cross-sectional study comprised 64 primary health workers in Noorabad, western Iran, and was conducted in 2012. A multi-stage cluster sampling was used for the study. Information was collected using two validated questionnaires related to psychological empowerment and readiness for organisational changes. Data was analysed using SPSS 16.
Results: Overall, 33 (51%) health workers were men and 31 (49%) were women. The attitude towards organisational change had significant relationships with impact, education level and job experience, and the behaviour towards organisational change had a significant relationship with competence (p<0.05).
Conclusion: Psychological empowerment could raise the readiness for organisational changes. Health centre managers should pay more attention to their primary healthcare workers and their empowerment.
Keywords: Psychological empowerment, Organisational changes, Primary healthcare worker. (JPMA 64: 537; 2014).
In the 21st century, the structure of organisations is changing because of certain factors such as increased customer expectations, globalisation and rapid changes in technology. Accordingly, organisations are required to study the customer needs and respond to the changing needs. Additionally, the organisations need to be modified and adapted to such changes in order to survive among their competitors.1,2 Considering these global developments, many organisations have moved to the increased organisational learning and empowerment programmes. Some of these programmes are related to the factors affecting people\'s feelings and overcoming internal and external obstacles using individuals\' learning and empowerment.3 Nowadays, those organisations are successful in which employees collectively strive to improve their capability and their managers provide suitable conditions for empowerment.4
Empowerment is a tool through which managers are able to manage organisations effectively with specifications such as having a variety of networks influencing individuals and community as well as communication networks. Furthermore, it could minimise distance between staff and managers, reduce organisational dependency and using information technology. Empowerment through motivated and powerful employees allow the managers to act quickly and appropriately in a dynamic and competitive environment. It also gives the organisation competitive advantages, thereby increasing productivity.5 Empowerment means to give power to the people. However, the empowerment of individuals is not a long-term personal characteristic which becomes evident in various locations. Empowerment is a recognition that can be gotten at the workplace.6
Although the concept of empowerment has been part of management and psychology literature since the late 1980s and early 1990s, but historical studies reveal that it has been introduced even before that.7 In preliminary studies, four dimensions had been considered for empowerment. However, over time and with increased attention to this issue, another dimension was added and now, psychological empowerment has five dimensions, including meaning (an opportunity that people feel they pursue important and valued career goals); competence (the degree to which a person can do his/her job successfully); self-determination (having a sense of freedom and independence in selecting the necessary activities to perform job duties); trust (the proper relationships between managers and subordinates); and impact (the degree to which a person can affect the results of other persons\' jobs).8,9 Empowerment is rooted in the motivation needs of individuals. Any strategy which encourages the employees to go for self-efficiency can result in empowerment. Moreover, psychological empowerment has been defined as a job intrinsic motivation that increases the employees\' empowerment.9 A study on employees\' empowerment showed that psychological empowerment had relationship with employees\' performance.10 The results of a study conducted in Iran showed that organisations with higher mean of psychological empowerment had higher efficiency than other organizations.11 Moreover, the organizations with higher employees\' meaning, competence, self-determination, impact and trust in colleagues had higher organisational learning.4
Because of the need for change in today\'s dynamic environment, it seems that change management is a necessary skill for managers and employees alike. According to studies, many of change barriers are rooted in the readiness for organizational changes. Readiness to accept the organisational change is a new issue of organisational management which has two main dimensions: attitude and behaviour. Attitude includes two parts: attitude towards the changes in the whole organisation and attitude towards individual changes. The two parts together have a great effect on changing people\'s attitudes. Moreover, the individuals\' behaviour derives from their attitude towards the topic. Overall, the adoption of a positive attitude and positive behaviour towards changes can be considered as the dimensions of the readiness for organisational changes. The adoption of a positive attitude towards changes means that employees have a positive viewpoint on changes. The adoption of a positive behaviour towards changes means that employees prefer organisational benefits to personal benefits and they easily adjust themselves to the new status. In organizations where individuals accept the changes in terms of both attitude and behaviour, the organisational changes are facilitated.12,13
Healthcare organisations are considered the most important among service organisations in a society which should adapt to their changing environment in order to provide high quality services. Some experts believe that Iran\'s health system needs are changing. In addition, many patients, doctors, nurses, staff, and administrators who work in this system believe that there is a great gap between the current health system and what it should be. Therefore, the current health system should act in accordance with the available changes to achieve the national goals.14
Primary healthcare is the most important service in the Iranian health system which is run by primary healthcare workers in rural areas. These personnel, over a period of two years of passing theoretical and practical training, begin to provide primary healthcare in their respective villages and are responsible for serving large groups of villagers,15 a population of over 20 million people in more than 60000 villages across Iran.16 There were a few studies on the relationship between psychological empowerment and readiness for organisational changes. This study aimed to determine this relationship among the primary healthcare workers in western Iran in order to investigate the effect of employees\' empowerment on their readiness for organisational changes.
Subjects and Methods
The descriptive analytical cross-sectional study was conducted in Noorabad, a city in the west of Iran, during 2012. Norabad is a strategic city in Lorestan province and has a large rural population. The study population included all the 470 primary healthcare workers of the Noorabad Health Centre. Because of the distance between some of the villages and countryside to the center and the problem of access to all health workers, multi-stage cluster sampling was used to determine the final sample size. On the basis of the number of primary healthcare workers, we used the following formula: comparison of two mean in population; the used parametres were: Z1-a2 (Confidence level)=0.95, 1-b (study power)=0.80. According to previous studies, psychological empowerment was m1=70+8.2, and Organisational change was m2=66+9.1.11,13 Subsequently, 64 persons were required.
Considering that Noorabad contains 9 regions, each region was taken as a cluster in which 10 villages were randomly selected and their health houses were selected as the sampling unit. Therefore, all primary healthcare workers in theses health houses were selected. Then, two validated questionnaires were distributed among the participants.
Psychological empowerment questionnaire, including 19 questions assessing the status of five dimensions: meaning, competence, self-determined, trust and impact. Five-point likert scale was used to assess the participants\' empowerment whereby 1 referred to \'strongly disagree\' and 5 to \'strongly agree\'. This questionnaire was designed by Spreitzer et al.17 The study questionnaire reliability has been confirmed using Cronbach\'s alpha (a=0.89).9
The second questionnaire, readiness for organisational changes, included 8 questions to examine the participant\'s attitudes and behaviour towards organisational changes. This questionnaire was designed by Rangriz and has seven-point scale whereby 1 refers to \'strongly disagree\' and 7 as \'strongly agree\'. The reliability of the questionnaire was confirmed using Cranach\'s alpha (a=0.93).13 SPSS 16 was used for statistical analysis. Independent-Samples T-Test and One-way analysis of variance (ANOVA) were used for relationship between demographic variables and psychological empowerment and the readiness for organisational changes. Pearson Correlation was used for relationship between psychological empowerment and the readiness for organisational changes, while multiple linear regression were used for variables affecting attitude and behaviour towards organisational changes. P<0.05 was considered statistically significant.
The study was conducted to determine the relationship between psychological empowerment and readiness for organisational changes among primary healthcare workers. The results showed that psychological empowerment had significant relationships with the readiness for organizational changes, competence and impact, and their increase could result in increasing the acceptance of organisational changes. Moreover, empowerment had significant and positive correlation with attitude and behaviour towards accepting organisational changes (p<0.05). A study concluded that job motivation and self-learning can positively influence support of readiness for organisational changes. In addition, psychological empowerment affects organisational commitment and thereby affects readiness for organisational changes.18 Another study believed that organisational citizenship behaviour (OCB) had a significant and positive relationship with the readiness for organisational changes; higher OCB resulted in more readiness for organisational changes.13 Other studies also confirm this result.19-21 The results of the present study are in line with those of other studies.
There was a significant relationship between the behaviour towards the acceptance of organisational changes and competence. Increasing the level of competence in employees can ensure full compliance, create high expectations, produce high performances and increase flexibility in the workplace. Therefore, increased competence improves employees\' acceptance of changes. An earlier study confirms the result.22
Moreover, meaning had effect on the readiness for organisational changes. A study had concluded that there was a strong significant relationship between organisational learning and meaning.22 If the sense of meaning increases among the employees and they place more values on their work and their vision becomes more congruent with what they do in their jobs, their organisational learning will increase.
On the other hand, self- determination and trust had no effect on the acceptance of organisational changes. However, the results of some studies showed that self-determination and trust increase the employees\' job satisfaction and organisational learning.22-24 Therefore, the result in this, section was inconsistent with the other studies; perhaps because of the nature of the health workers job in which they usually lack the required freedom and independence.
In the current study, impact had a significant relationship with attitude, but insignificant with behaviour towards accepting organisational changes. The results of some studies have shown that employees who feel impact try to dominate their external environment instead of exhibiting reactive behaviour and increasing their learning in order to influence organisational plans and programmes.21 Moreover, it can be concluded that this factor can change the attitude towards the acceptance of organisational changes. However, it cannot lead to changes in behaviour perhaps because of its low power for changing the attitude into potential behaviour. Managers should pay attention to this factor for increasing productivity in health organisations
There was no significant relationship between psychological empowerment and demographic variables. A study believed that psychological empowerment did not have any significant relationships with age and education level.23 However, some studies concluded that gender, education level and job experience had statistically significant relationships with psychological empowerment.2,3 The results of the present study are consistent with one study.23 It is believed that all employees were aware of the importance of being empowered in their jobs and they paid great attention to it.
Moreover, readiness for organisational changes had relationship with health workers\' education level and job experience so that those who had a diploma had a better attitude towards accepting organisational changes than the rest. A study confirms this result.25 The results of Multiple Linear Regression also showed that health workers with job experience of over 15 years had lower attitudes towards the acceptance of organisational changes than those with 10 to 15 years job experience. Having more job experience led to decrease in attitude towards the acceptance of organisational changes. This result is consistent with an earlier study.26
There was a positive and significant relationship between psychological empowerment and the readiness for organisational changes. Since changes in healthcare organisations seem to be necessary, it is recommended that health centre managers should pay more attention to the health workers and other healthcare employees\' empowerment. By doing so, healthcare organisations can keep pace with the rapid growth of medical sciences and, consequently, improve community health and welfare by providing quality services.
We are grateful to the heads and primary healthcare workers of Noorabad Health Center for their cooperation.
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