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Aims. This study examines the perceptions of registered nurses of social capital, organisational commitment and customeroriented prosocial behaviour. Additionally, this study also addresses a conceptual model for testing how registered nurses
perceptions of three types of social capital influence their organisational commitment, in turn intensifying customer-oriented
prosocial behaviour, including role-prescribed customer service and extra-role customer service.
Background. Customer-oriented prosocial behaviour explains differences in job satisfaction and job performance. However,
the critical role of customer orientation in the hospital setting has yet to be explored.
Design. Survey.
Methods. The survey was conducted to obtain data from registered nurses working for a large Taiwanese medical centre,
yielding 797 usable responses and a satisfactory response rate of 867%. The partial least squares method was adopted to obtain
parameter estimates and test proposed hypotheses.
Results. The study measurements display satisfactory reliability, as well as both convergent and discriminant validities. All
hypotheses were supported. Empirical results indicate that registered nurses perceptions of social capital were significantly
impacted the extent of organisational commitment, which in turn significantly influenced customer-oriented prosocial behaviour.
Conclusion. By stimulating nursing staff commitment, health care providers can urge them to pursue organisational goals and
provide high quality customer service. To enhance organisational commitment, health care managers should endeavour to create
interpersonal interaction platforms in addition to simply offering material rewards.
Relevance to clinical practice. Nurses act as contact employees for their patient customers in the hospital, and they are
required to provide patient safety and service quality. This study shows that nurses with high organisational commitment are
willing to provide customer-oriented prosocial activities, which in turn enhances patient satisfaction.
Key words: customer-oriented prosocial behaviour, evidence-based practice, hospital nurses, organisational commitment, social
capital
Accepted for publication: 21 November 2010
Introduction
Organisational commitment served as a criterion variable for
an organisations sustaining and competitive advantage. The
degree of employee organisational commitment has implica-
1383
turnover (Castle 2006) and of organisational goal achievement, stability and innovation (Brown & Harvey 2006). Liou
and Cheng (2010) also found that creating a good organisational climate may increase nurses organisational commitment and, in turn, decrease their intention to leave. Despite
the large amount of literature on the subject, there is little
theoretical and practical understanding of the customerrelated outcomes in the hospital setting. This study attempts
to address this under-researched problem.
Patients are increasingly vital in determining the success of
health care organisations (Ford & Fottler 2007). Concerns
about quality and safety in health care and the impacts of
nurses work conditions on patient outcomes have been
growing in recent years, particularly as health care in acute
care settings has become increasingly complex (Clarke &
Aiken 2008). Administrators have recently re-focused by
meeting patient customer needs, wants and desires, not only
to achieve positive clinical outcomes, but also to achieve
superior health care experiences (Ford et al. 1997). In health
care organisations, nurses act as contact employees for their
patient customers. Nurses fulfil multiple roles simultaneously
and are required to provide quality and safe patient care
with less support (Greggs-McQuilkin 2004). When contact
employees exhibit customer-oriented behaviour or a strong
intention to meet customer needs (Brown et al. 2002), they
are more likely to serve customers passionately, in turn
enhancing customer satisfaction. According to earlier research (Lee et al. 2006) and our interview with the nurses,
this work argues that nurses who are committed to their own
health care organisations tend to comply with explicit
requirements regarding customer service and also tend to
make efforts that go beyond their job descriptions when
attempting to assist customers.
Previously, several authors have proposed multi-factors
likely to motivate organisational commitment, including the
DemandControlSupport (DCS) model, organisational justice (Rodwell et al. 2009), job satisfaction, organisational
culture and trust (Gregory et al. 2007). Recently, interpersonal
networks and interactions have begun to comprise a significant
part of nurse work environments and the establishment of
interpersonal relationships is widely believed to support
organisational competitiveness (Watson & Papamarcos
2002). Social capital has been conceptualised as a set of social
resources that resides in interpersonal relationships (Reed
et al. 2009). Previous studies demonstrate that social capital is
related to employee career success (Seibert et al. 2001), firm
value creation (Tsai & Ghoshal 1998) and sustainable
organisational advantage (Nahapiet & Ghoshal 1998).
In the field of nursing, the issue of social capital has also
been investigated since the mid-1990s. East (1998) indicated
1384
Background
The conceptual framework of this study delineates how
nurses perceptions of social capital serve to create organisation commitment and in turn enhance nurse customeroriented prosocial behaviour. Based on previous works
(Nahapiet & Ghoshal 1998, Tsai & Ghoshal 1998, Watson
& Papamarcos 2002), this study classifies social capital into
three categories, namely social interaction, trust among
nurses and shared vision. Drawing on recent marketing
research on social capital (e.g. Nahapiet & Ghoshal 1998,
Tsai & Ghoshal 1998), organisational commitment (e.g.
McNeese-Smith 2001, Castle 2006, Rodwell et al. 2009) and
customer-oriented prosocial behaviour (e.g. Bettencourt &
Brown 1997, Lee et al. 2006), this work proposes the
conceptual framework shown in Fig. 1.
Workforce issues
Social capital
Social
interaction
Customer-oriented
Prosocial behavior
Role-prescribed
customer service
H1a (+)
H2a (+)
Trust among
nurses
H1b (+)
Organisational
commitment
H2b (+)
Extra-role
customer service
H1c (+)
Shared vision
1385
Methods
Relationship between organisational commitment and
customer-oriented prosocial behaviour
Measures
1386
Workforce issues
court and Brown (1997) to capture our concept of customeroriented prosocial behaviour.
Ethical considerations
This surveyed medical centre approved the study. We
composed a questionnaire, which was prefaced with a note
assuring the respondents of anonymity in their responses. All
of the participants were also informed that the survey was
only for academic purposes. Our introduction to the questionnaire discussed potential risks and stated that taking the
survey implied consent. Participants were informed that that
it was not obligatory to take part in the research (to include
the completion of the questionnaire) and that they could
cease participation at any time with no penalty whatsoever.
Data collection
A questionnaire survey was performed to gather data from
nurses in a major medical centre in northern Taiwan. The
sample consists of 1026 full-time nurses. Respondents were
required to possess two characteristics: (1) over three months
of work experience in the medical centre; (2) completion of
new employee training. A total of 919 potential respondents
were thus identified. Each of the 919 participating nurses
received a questionnaire. Anonymity was maintained in the
data collecting process. We informed all nurses of the
purposes of the study. The respondents answered in total
anonymity, with no identifying information on the survey
instruments. The nurses returned the completed questionnaires in a return envelope. We researchers do not know, nor
does the supervisor, which respondent gave which answers.
This procedure protected the identities of the respondents.
Besides, the hospitals name is being kept confidential. A gift
worth approximately US$2 was given as a reward for
participation. With the aid of top managements approval
and support of this study, 825 contacts completed and
returned the survey questionnaire. The period of data
collection was between August 2008April 2009. Among
the 825 returned questionnaires, this study obtained 797
usable responses for subsequent analysis after discarding
incomplete responses. The usable response rate was approximately 867%.
Results
Sample profile
Most respondents in this survey were 2630 years old
(787%) and female (984%). Moreover, 534% of the nurses
Number
11
784
2
14
984
03
107
627
28
25
5
5
134
787
35
31
06
06
5
304
426
47
15
06
381
534
59
19
534
258
6
67
322
08
1387
Standardise
item loading
Social interaction
SI1
090*
SI2
088*
Trust among nurses
T1
088*
T2
088*
T3
092*
T4
092*
Shared vision
SV1
091*
SV2
093*
SV3
093*
SV4
091*
Organisational commitment
OC1
083*
OC2
085*
OC3
087*
OC4
089*
Role-prescribed customer service
RP1
093*
PR2
096*
PR3
093*
Extra-role customer service
ER1
087*
ER2
084*
ER3
085*
CR
AVE
089
080
095
081
096
084
092
074
096
088
089
073
details, see Table 2), all exceeding the recommended threshold value of 07 suggested by Hulland (1999). Second, this
study used the composite scale reliability (CR) and average
variances extracted (AVE) to assess the internal consistency
of constructs. While CR is analogous to the Cronbachs
alpha, the AVE denotes the amount of variance captured by
the measure of a construct relative to random measurement
error (Fornell & Larcker 1981). Table 2 shows that the
Discussion
This study identified support for the proposed comprehensive
model using nurses as a sample. Particularly, this study has
made contributions in the following ways. First, relationship
is considered an asset for those involved in the social action
field (Baker 1990) and social capital is generally embedded in
interpersonal relationships (Coleman 1988). Social capital is
Table 3 Square roots of average variance extracted (AVE) and correlation matrix
#
Construct
1
2
3
4
5
6
Social interaction
Trust among nurses
Shared vision
Organisation commitment
Role-prescribed customer service
Extra-role customer service
089
053
053
045
023
031
09
082
061
041
043
092
063
036
041
086
039
054
094
075
085
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Workforce issues
Hypothesis
Standardised
Coefficients
t-value
Expected
Sign
Results
013*
027**
034***
034***
054***
197
300
367
591
907
+
+
+
+
+
Supported
Supported
Supported
Supported
Supported
1389
Conclusion
This study showed that the three types of social capital
perceived by nurses could influence their organisational
commitment. Furthermore, this study examined the key
influences on nurse customer-oriented prosocial behaviour
and found that highly committed nurses pursued certain goals
advocated by the organisation. Highly committed nurses are
generally closely engaged in customer-oriented prosocial
behaviour, including role-prescribed and extra-role customer
services.
Acknowledgements
The authors appreciate the editor and two anonymous
reviewers for comments made on an earlier draft of this
article.
Contributions
Study design: CPH, HCH; data collection and analysis: CPH,
CWC and manuscript preparation: CPH, CWC, HCH, CYC.
Conflict of interest
We declare that we have no conflict of interest.
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