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October 2017 -
Volume 15, Issue 8

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From the Editor

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Original Contribution/Clinical Investigation

Immunity level to diphtheria in beta thalassemia patients
DOI: 10.5742/MEWFM.2017.93048
[pdf version]
Abdolreza Sotoodeh Jahromi, Karamatollah Rahmanian, Abdolali Sapidkar, Hassan Zabetian, Alireza Yusefi, Farshid Kafilzadeh, Mohammad Kargar, Marzieh Jamalidoust,
Abdolhossein Madani

Genetic Variants of Toll Like Receptor-4 in Patients with Premature Coronary Artery Disease, South of Iran
DOI: 10.5742/MEWFM.2017.93049
[pdf version]
Saeideh Erfanian, Mohammad Shojaei, Fatemeh Mehdizadeh, Abdolreza Sotoodeh Jahromi, Abdolhossein Madani, Mohammad Hojjat-Farsangi

Comparison of postoperative bleeding in patients undergoing coronary artery bypass surgery in two groups taking aspirin and aspirin plus CLS clopidogrel
DOI: 10.5742/MEWFM.2017.93050
[pdf version]
Ali Pooria, Hassan Teimouri, Mostafa Cheraghi, Babak Baharvand Ahmadi, Mehrdad Namdari, Reza Alipoor

Comparison of lower uterine segment thickness among nulliparous pregnant women without uterine scar and pregnant women with previous cesarean section: ultrasound study
DOI: 10.5742/MEWFM.2017.93051
[pdf version]
Taravat Fakheri, Irandokht Alimohammadi, Nazanin Farshchian, Maryam Hematti,
Anisodowleh Nankali, Farahnaz Keshavarzi, Soheil Saeidiborojeni

Effect of Environmental and Behavioral Interventions on Physiological and Behavioral Responses of Premature Neonates Candidates Admitted for Intravenous Catheter Insertion in Neonatal Intensive Care Units
DOI: 10.5742/MEWFM.2017.93052
[pdf version]
Shohreh Taheri, Maryam Marofi, Anahita Masoumpoor, Malihe Nasiri

Effect of 8 weeks Rhythmic aerobic exercise on serum Resistin and body mass index of overweight and obese women
DOI: 10.5742/MEWFM.2017.93053
[pdf version]
Khadijeh Molaei, Ahmad Shahdadi, Reza Delavar

Study of changes in leptin and body mass composition with overweight and obesity following 8 weeks of Aerobic exercise
DOI: 10.5742/MEWFM.2017.93054
[pdf version]
Khadijeh Molaei, Abbas Salehikia

A reassessment of factor structure of the Short Form Health Survey (SF-36): A comparative approach
DOI: 10.5742/MEWFM.2017.93088
[pdf version]
Vida Alizad, Manouchehr Azkhosh, Ali Asgari, Karyn Gonano

Population and Community Studies

Evaluation of seizures in pregnant women in Kerman - Iran
DOI: 10.5742/MEWFM.2017.93056
[pdf version]
Hossein Ali Ebrahimi, Elahe Arabpour, Kaveh Shafeie, Narges Khanjani

Studying the relation of quality work life with socio-economic status and general health among the employees of Tehran University of Medical Sciences (TUMS) in 2015
DOI: 10.5742/MEWFM.2017.93057
[pdf version]
Hossein Dargahi, Samereh Yaghobian, Seyedeh Hoda Mousavi, Majid Shekari Darbandi, Soheil Mokhtari, Mohsen Mohammadi, Seyede Fateme Hosseini

Factors that encourage early marriage and motherhood from the perspective of Iranian adolescent mothers: a qualitative study
DOI: 10.5742/MEWFM.2017.93058
[pdf version]
Maasoumeh Mangeli, Masoud Rayyani, Mohammad Ali Cheraghi, Batool Tirgari

The Effectiveness of Cognitive-Existential Group Therapy on Reducing Existential Anxiety in the Elderly
DOI: 10.5742/MEWFM.2017.93059
[pdf version]
Somayeh Barekati, Bahman Bahmani, Maede Naghiyaaee, Mahgam Afrasiabi, Roya Marsa

Post-mortem Distribution of Morphine in Cadavers Body Fluids
DOI: 10.5742/MEWFM.2017.93060
[pdf version]
Ramin Elmi, Mitra Akbari, Jaber Gharehdaghi, Ardeshir Sheikhazadi, Saeed Padidar, Shirin Elmi

Application of Social Networks to Support Students' Language Learning Skills in Blended Approach
DOI: 10.5742/MEWFM.2017.93061
[pdf version]
Fatemeh Jafarkhani, Zahra Jamebozorg, Maryam Brahman

The Relationship between Chronic Pain and Obesity: The Mediating Role of Anxiety
DOI: 10.5742/MEWFM.2017.93062
[pdf version]
Leila Shateri, Hamid Shamsipour, Zahra Hoshyari, Elnaz Mousavi, Leila Saleck, Faezeh Ojagh

Implementation status of moral codes among nurses
DOI: 10.5742/MEWFM.2017.93063
[pdf version]
Maryam Ban, Hojat Zareh Houshyari Khah, Marzieh Ghassemi, Sajedeh Mousaviasl, Mohammad Khavasi, Narjes Asadi, Mohammad Amin Harizavi, Saeedeh Elhami

The comparison of quality of life, self-efficacy and resiliency in infertile and fertile women
DOI: 10.5742/MEWFM.2017.93064
[pdf version]
Mahya Shamsi Sani, Mohammadreza Tamannaeifar

Brain MRI Findings in Children (2-4 years old) with Autism

DOI: 10.5742/MEWFM.2017.93055
[pdf version]
Mohammad Hasan Mohammadi, Farah Ashraf Zadeh, Javad Akhondian, Maryam Hojjati,
Mehdi Momennezhad

Reviews

TECTA gene function and hearing: a review

DOI: 10.5742/MEWFM.2017.93065
[pdf version]
Morteza Hashemzadeh-Chaleshtori, Fahimeh Moradi, Raziyeh Karami-Eshkaftaki,
Samira Asgharzade

Mandibular canal & its incisive branch: A CBCT study
DOI: 10.5742/MEWFM.2017.93066
[pdf version]
Sina Haghanifar, Ehsan Moudi, Ali Bijani, Somayyehsadat Lavasani, Ahmadreza Lameh

The role of Astronomy education in daily life
DOI: 10.5742/MEWFM.2017.93067
[pdf version]
Ashrafoalsadat Shekarbaghani

Human brain functional connectivity in resting-state fMRI data across the range of weeks
DOI: 10.5742/MEWFM.2017.93068
[pdf version]
Nasrin Borumandnia, Hamid Alavi Majd, Farid Zayeri, Ahmad Reza Baghestani,
Mohammad Tabatabaee, Fariborz Faegh

International Health Affairs

A brief review of the components of national strategies for suicide prevention suggested by the World Health Organization
DOI: 10.5742/MEWFM.2017.93069
[pdf version]
Mohsen Rezaeian

Education and Training

Evaluating the Process of Recruiting Faculty Members in Universities and Higher Education and Research Institutes Affiliated to Ministry of Health and Medical Education in Iran
DOI: 10.5742/MEWFM.2017.93070
[pdf version]
Abdolreza Gilavand

Comparison of spiritual well-being and social health among the students attending group and individual religious rites
DOI: 10.5742/MEWFM.2017.93071
[pdf version]
Masoud Nikfarjam, Saeid Heidari-Soureshjani, Abolfazl Khoshdel, Parisa Asmand, Forouzan Ganji

A Comparative Study of Motivation for Major Choices between Nursing and Midwifery Students at Bushehr University of Medical Sciences
DOI: 10.5742/MEWFM.2017.93072
[pdf version]
Farzaneh Norouzi, Shahnaz Pouladi, Razieh Bagherzadeh

Clinical Research and Methods

Barriers to the management of ventilator-associated pneumonia: A qualitative study of critical care nurses' experiences
DOI: 10.5742/MEWFM.2017.93073
[pdf version]
Fereshteh Rashnou, Tahereh Toulabi, Shirin Hasanvand, Mohammad Javad Tarrahi

Clinical Risk Index for Neonates II score for the prediction of mortality risk in premature neonates with very low birth weight
DOI: 10.5742/MEWFM.2017.93074
[pdf version]
Azadeh Jafrasteh, Parastoo Baharvand, Fatemeh Karami

Effect of pre-colporrhaphic physiotherapy on the outcomes of women with pelvic organ prolapse
DOI: 10.5742/MEWFM.2017.93075
[pdf version]
Mahnaz Yavangi, Tahereh Mahmoodvand, Saeid Heidari-Soureshjani

The effect of Hypertonic Dextrose injection on the control of pains associated with knee osteoarthritis
DOI: 10.5742/MEWFM.2017.93076
[pdf version]
Mahshid Ghasemi, Faranak Behnaz, Mohammadreza Minator Sajjadi, Reza Zandi,
Masoud Hashemi

Evaluation of Psycho-Social Factors Influential on Emotional Divorce among Attendants to Social Emergency Services
DOI: 10.5742/MEWFM.2017.93077
[pdf version]
Farangis Soltanian

Models and Systems of Health Care

Organizational Justice and Trust Perceptions: A Comparison of Nurses in public and private hospitals
DOI: 10.5742/MEWFM.2017.93078
[pdf version]
Mahboobeh Rajabi, Zahra Esmaeli Abdar, Leila Agoush

Case series and Case reports

Evaluation of Blood Levels of Leptin Hormone Before and After the Treatment with Metformin
DOI: 10.5742/MEWFM.2017.93079
[pdf version]
Elham Jafarpour

Etiology, Epidemiologic Characteristics and Clinical Pattern of Children with Febrile Convulsion Admitted to Hospitals of Germi and Parsabad towns in 2016
DOI: 10.5742/MEWFM.2017.93080
[pdf version]
Mehri SeyedJavadi, Roghayeh Naseri, Shohreh Moshfeghi, Irandokht Allahyari, Vahid Izadi, Raheleh Mohammadi,

Faculty development

The comparison of the effect of two different teaching methods of role-playing and video feedback on learning Cardiopulmonary Resuscitation (CPR)
DOI: 10.5742/MEWFM.2017.93081
[pdf version]
Yasamin Hacham Bachari, Leila Fahkarzadeh, Abdol Ali Shariati

Office based family medicine

Effectiveness of Group Counseling With Acceptance and Commitment Therapy Approach on Couples' Marital Adjustment
DOI: 10.5742/MEWFM.2017.93082
[pdf version]
Arash Ziapour, Fatmeh Mahmoodi, Fatemeh Dehghan, Seyed Mehdi Hoseini Mehdi Abadi,
Edris Azami, Mohsen Rezaei


Middle East Quality Improvement Program
(MEQUIP QI&CPD)

Chief Editor -
Abdulrazak Abyad MD, MPH, MBA, AGSF, AFCHSE

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October 2017 - Volume 15, Issue 8

Organizational Justice and Trust Perceptions: A Comparison of Nurses in public and private hospitals


Mahboobeh Rajabi
(1)
Zahra Esmaeli Abdar
(2)
Leila Agoush
(3)

(1) Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
(2) Alborz University of Medical Sciences, Karaj, Iran
(3) Iran University of Medical Sciences, Tehran, Iran


Correspondence:
Leila Agoush
Iran University of Medical Sciences, Tehran,
Iran

Abstract

Background:
Hospital organizational environment influences nurses’ behaviors, attitudes and work quality. Organizational justice and trust are important organizational factors which have significant effects on the organizational and individual work outcomes.

Objectives: The aim of this study was to investigate perceived organizational justice and organizational trust and their relationship in nurses of public and private hospitals in north of Iran and to compare these two groups of nurses.

Methods: The study population included 322 nurses working in six public and private hospitals selected though stratified and simple random sampling. Perceived organizational justice was assessed through Niehoff and Moorman questionnaire and Elonenet et. al questionnaire was used to assess the perceived institutional trust.

Results: Perceived organizational justice and institutional trust of nurses in private hospitals were better than nurses in public hospitals. There was a significant positive relationship between perceived organizational justice and perceived institutional trust and this relationship was more significant in nurses of private hospitals. Organizational justice explained approximately 60% and 50% of the total variance of trust in respectively private and public hospitals. Among three dimensions of organizational justice, procedural justice had a greater relationship with institutional trust and it was a better predictor of nurses’ trust in comparison to distributive and interactional justice in both types of hospitals. Also nurses’ perceptions of organizational justice and trust were not significantly different based on sex, age group, job tenure, employment status, and education level in both types of hospitals.

Conclusion: According to the results, in order to improve organizational trust, it is necessary that hospital managers develop organizational justice. In this way, the resulted positive individual and organizational outcomes can significantly affect the quality of nurses’ services and patients’ satisfaction.

Key words: Organizational justice, Institutional Trust, Nurses, public hospital, private hospital


BACKGROUND

Nurses are the healthcare providers whose main duties are caring, disease prevention and health promotion of patients (1). Beside these clinical activities they have managerial activities for coordinating the unit’s tasks and condition (2). Nurses are the most numerous members of medical care teams and as frontline health workers have the closest contact with patients (3). Therefore, the nurses’ services have great effect on the quality of care, patients’ satisfaction, shaping the image of hospital care in viewpoint of patients and hospital performance and effectiveness (1, 4). Many hospitals’ managers have realized that the quality of nursing services is the key to their organization efficiency and effectiveness (5). So hospital managers should pay special attention to these greatest parts of the care team.

Employees’ attitude toward their jobs and organization is the most important factor that affects their productivity and performance and managers’ behaviors affect employees’ attitudes, beliefs and behaviors (6, 7). Managers’ fair treatment as one of the important and critical needs of employees in organization is crucial in shaping employees’ attitudes because the norms and values of fairness make a critical trait of behavior in organizations (7, 8).

Organizational justice interprets the role of fairness in the workplace and the way employees determine they have been treated fairly and how these determinations influence their work related variables (9). Organizational justice has three distinct dimensions (distributive justice, procedural justice, interactional justice) which are related but differentially affect employees’ work-related attitudes and behaviors (10). Distributive justice is based on the employees’ perceptions of fairness of outcomes due to their input and in comparison to their peers within an organization (11). Distributive justice includes different organizational factors such as promotions, rewards, work schedules, shift assignments, performance evaluations and punishments (12). Procedural justice relates to employees’ perceptions of fairness of the methods and processes which are used to make decisions like payment, reward, promotion, evaluation, disciplinary actions etc. in the organization (13). Having stronger procedural justice perceptions, the procedures are necessary to be consistent across time and persons, bias suppression, accurate, correct, ethical and representative of employees’ need (14). Interactional justice as the third dimension of organizational justice refers to employees’ fairness perceptions of interpersonal treatment of mangers in the organization. Interactional justice reflects the politeness, honesty, respect, dignity and sensitivity of authorities’ treatment toward individuals in their interactions, decision making and outcomes allocation (15, 16, 17). Employees’ perceptions of justice relate to important individual and organizational consequences like job performance, citizenship behavior, job satisfaction, evaluation of supervisor, commitment and conflict solving (18). Nevertheless some studies showed employees’ perceptions of injustice caused negative personal issues like psychiatric disorders, sickness absence and poor self-rated health status and negative organizational issues like low levels of commitment, satisfaction and productivity, weak cooperation, turn over, anti-normative behaviors, disharmony and tension-stress (18, 19, 20, 21). As organizational justice is essential for impressive management and is a key variable to improve ef¬fectiveness in an organization and predict its success (14). managers should be sensitive to the factors that affect their employees’ justice perceptions.

Studies showed one of the employees’ attitudes that was affected by perceptions of fairness in organization is trust. The history of trust issue refers to the creation of earliest human society. Trust is the basis and requirement of all social relationships like organizational relations (22). Trust is mostly considered as a singular construct but it affects the organizational performance, procedures and structures in social or organizational context which makes it a complicated multidimensional construct. Trust as a part of organizational culture and values reflects in different behaviors of employees (23). So organizational trust is essential for creating an effective organization.

Different scholars have looked differently at trust concept and provide different definitions for it. For example Mayer et al define trust as “the willingness of one party to be vulnerable to the actions of another party based on the expectation that the other party will perform a particular action important to the trustor, irrespective of the ability to monitor or control that other party” (24). However, some key words constantly appear in the most of scholars’ definitions that are belief, willingness and vulnerability (25). Trust takes shape at different level in organizations and the trust referent can be an individual, group, organization or system. Trust can be established between the employee and both the supervisor and the organization (26). Organizational trust includes both interpersonal and impersonal trust. Interpersonal trust contains horizontal and vertical factors. Horizontal trust refers to trust between co-workers and vertical trust refers to trust between employees and their supervisor or managers. Organizational trust also includes systematic trust, when employees feel confidence toward the organizational system and functions. This impersonal dimension of trust is often named as institutional trust (27). Institutional trust basis is the organization’s roles, systems and reputation (28). It defines trust of employees on different aspects of organization, such as strategy, vision, procedures, communication, human resources, practices and technological and commercial ability (27).

Researchers found that trust, as an important component of professional life, has different consequences for both employees and organization. Trust can predict employees’ reactions, behaviors and performance. It also has a great role in various organizational processes and outcomes such as organizational commitment, commitment to leaders’ decisions, organizational citizenship behaviors, job performance, innovation, problem solving, long term stability, managing organizational dynamics, promote cooperation between employees and organizations, reducing the rate of resignation and turnover, organizational health and productivity and well-being of their members, (27, 29; 30 31, 32, 33, 34, 35). Organizational factors such as structure, human resource policies, procedures and organizational culture affect employees’ trust (36). So organizational factors should be considered by managers because they can use them to enhance trust perceptions. For example, improving the work environment in a way that inspires fair and safe system structures can increase employees’ trust in management(37).

Employees constantly monitor the activities of their organization to know if they should trust their organization or not (3). So if the process of payment and resource allocation, decision making, interpersonal interaction and leadership are considered to be fair in their point of view they would know their organization and their manager deserve their trust. Institute of Medicine (IOM) also has emphasized enhancement of working relationships and trust, clear and respectful communication and teamwork to improve quality of care (38). So hospital managers should determine their employees’ level of justice perceptions and trust and try to eliminate the factors that cause the perceptions of injustice which can lead to mistrust perceptions in an organization.

OBJECTIVES

The work condition can be different in private and public hospitals which can affect the employees’ attitudes in various ways. Therefore, in the current study we investigated the phenomenon of organizational justice and institutional trust perceptions among nurses in private and public hospitals; the way organizational justice dimensions affect nurses’ trust and the power of organizational justice in predicting institutional trust.

METHODS

1. Setting and sample
This cross-sectional study was performed among nurses of 3 private and 3 public hospitals affiliated to Rasht University of Medical Sciences, Iran. Among nurses of these hospitals 322 were captured by the Cochran formula. To determine the sample size in each hospital and select nurses of each unit for answering the questionnaires stratified sampling and simple random sampling were used.

2. Study instruments and data collection
Three dimensions of organizational justice (distributive, interactional, procedural justice) were measured by Moorman and Nihouf on a five grade Likert scoring questionnaire. For assessing institutional trust, Ellonen et al (2008) questionnaire in a five-grade ikert scoring system was used (27). This questionnaire, with a few modifications, was adapted from trustee’s characteristics, which Mayer et al (1995) and McKnight et al (2002) have mentioned (24, 39). Institutional trust dimensions included situational normality, vision, strategy, communication, and structural assurance. The questionnaire’s reliability was confirmed via Cronbach’s alpha, 89% for organizational justice and 86% for institutional trust.

RESULTS

Most nurses were female, between 20-30 years old and had less than 10 years job tenure. About 98% of them had bachelor degree and 55.28% were contractually employed (Table 1). Mean score of organizational justice perceptions of private hospitals’ nurses was 3.27 (out of 5) and mean score of organizational justice perceptions of public hospitals’ nurses was 3.08 (out of 5). Among the three dimensions of organizational justice the highest mean score referred to interactional justice in both public and private hospitals. The mean score of organizational justice perceptions showed that nurses slightly agreed with organizational justice. Mean score of institutional trust perceptions of nurses of private and public hospitals were 3.08 and 2.88 (out of 5) (Table 2). The findings showed there was a significant positive relationship between organizational justice and its dimensions with institutional trust (P < 0.05). Also procedural justice was more strongly and positively related to institutional trust (Table 3). According to the Multiple Linear regression results organizational justice was significant predictors of institutional trust although its power was different in public and private hospitals. Organizational justice explained approximately 60% of the total variance of institutional trust in private hospitals and about 50% in public hospitals.

In public hospitals three dimension of organizational justice could predict the institutional trust but in private hospitals only distributive and procedural justice had the power of institutional trust prediction so interactional justice was omitted from the model. Procedural justice had stronger predictive power for institutional trust than did distributive and interactional justice in both types of hospitals (Table 4).

Also there were no differences between sex, age, job tenure, educational level and employment status in Nurses’ perceptions of organizational justice and trust of nurse in private and public hospitals (P> 0.05).

Table 1: Demographic and professional characteristics of nurses


Table 2: Descriptive statistics of organizational justice and institutional trust


Table 3: Relationship between organizational justice and its components with institutional trust


Click here for
Table 4: Regression components of organizational justice and institutional trust

DISCUSSION

The results of this study indicated the mean score of organizational justice and institutional trust perceptions of nurses from private hospitals was more than nurses of public hospitals. The mean score comparison of organizational justice components showed the score of interactional justice is more than the score of procedural justice and distributive justice in both types of hospitals. Also consistent with some other studies our results showed organizational justice and all its three dimensions had a significant relationship with institutional trust (16, 40, 41) and organizational justice was a significant predictor of institutional trust in both types of hospitals. Among the three dimensions of organizational justice procedural justice was more strongly and positively related to institutional trust and had stronger predictive power for institutional trust in both types of hospitals.

Trust implies that justice perceptions could improve trust toward subordinates (42). Organizational structure, strategy, procedures and communications with employees influence employees’ perceptions of trust (43, 44). So managers can engineer trust perceptions by actions and procedures that inspire a justice pattern of organization (45). If employees believe in justice of organizational outcomes they will trust in management and their decision making (46). Procedural justice refers to the way that an organization manages the tasks, enacts policies and allocates the resources (18). Fairness of Procedures assures employees that each outcome is the result of a certain action regardless of individual opinions or organizational mistakes. This provides evidence of the leaders’ consistency and integrity and helps reduce ambiguity (44). Procedural justice also reflects the respect of an organization for the rights and dignity of its employees (47). So procedural justice shows to employees that fairness is organization rule and they will recognize it is deserving of their trust (18). Researchers have demonstrated that procedural justice helps reduce the effects of unequal outcomes because the processes which are used to determine outcomes may be more important to an individual than the received outcomes. So if employees perceive fair procedures have been used in determining the outcomes they receive, trust in the leader and the organization will be affective (46). In this study procedural justice had the most influence of the three variables of organizational justice on institutional trust.

Interactional justice refers to the way that management behaves toward the employees and the quality of their interpersonal treatment and communication. Interactional justice also determines the integrity and benevolence of management (15, 16). In this study mean score of interactional justice perceptions of nurses in both types of hospitals was highest among the three components of organizational justice which can describe the quality of management communication.

In the organizational theory and organizational behavior realm, organizational justice and trust are two of the essential concepts and practices in every organization. According to the results, the nurses’ organizational justice perceptions could strengthen their institutional trust perceptions. So hospital management should try to improve nurses’ organizational justice perceptions to enhance their organizational trust perceptions. They should plan to enhance fair perceptions of nurses by fair payment system, fair procedures and enough information about system procedures and suitable communication and behavior with staff.

Acknowledgements
The authors would like to thank all nurses who participated in our study for their kind cooperation. Also we appreciate Maryam Asadinejad, Sanaz Zoghtalab and Seid Mirmasoad Zakipoor for their sincere assistance.

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