Impact of organizational climate on the self-efficacy of operating room personnel

Introduction:

Organizational climate is a set of characteristics of the work environment that are perceived directly and indirectly by employees and influence the behaviour of the organization’s employees. An appropriate organizational climate can be effective in motivating employees, improving morale and the staff’s participation in decision-making. So, it can be effective in increasing the staff’s creativity and innovation as well as productivity and self-efficacy of them. Therefore, the present study aimed to determine the association of organizational climate with the job self-efficacy of the operating room staff in the medical training centres of IUMS in 2020–2021.

Methods:

This study is descriptive and analytical research conducted in 2020–2021. The participants of this study include all the operating room. The research sample included 220 people. The data collection tools in this study are demographic characteristics form, questionnaire on organizational climate and Lyle Sussman and a job self-efficacy questionnaire by Riggs and Knight. Data analysis was performed using SPSS software through statistics of Spearman’s correlation, multiple regression model and Mann–Whitney.

Results:

More than half of the participants (50.5%) had a good organizational climate and high self-efficacy (58.2%). The results of Spearman’s rank correlation coefficient indicated that there was a significant relationship between organizational climate and self-efficacy (P<0.0001).

Conclusion:

Considering that there was a significant association between the organizational climate and self-efficacy, it is recommended that the officials of medical training centres improve the job self-efficacy and organizational climate of the operating room staff based on the conditions and rules governing the operating room by considering the following factors; knowing the organizational climate and personal characteristics of operating room staff, knowing the causes of various conflicts and knowing the ambiguities and challenges in the work environment.

Introduction

Highlights

• The present study was aimed to determine the association of organizational climate with the job self-efficacy of the operating room staff in the medical training centres.

• More than half of participants (50.5%) had a good organizational climate and high level of self-efficacy (58.2%).

• The results of Spearman’s rank correlation coefficient indicated that there was a significant relationship between organizational climate and self-efficacy.

Organizational climate refers to the common comprehension, feelings and attitudes of the members of an organization toward the basic elements of that organization. Organizational climate reflects the norms, values and attitudes which determine the organization’s culture and differentiate one organization from another¹. Since personality refers to a person’s basic characteristics ‘, the climate is also related to the stable characteristics of the organization². Organizational climate is an influential factor in the behaviour of organization members³. This issue, in turn, has a significant effect on the moral, motivation, satisfaction and willingness of employees to stay in the organization⁴. A bad organizational climate can create an environment full of suspicion and hostility that causes the failure of any cooperative and collaborative management⁵. On the other hand, a suitable organizational climate can be effective in motivating employees, improving morale and participation of people in decision-making, as well as increasing creativity and innovation and incrementing productivity⁶. Research has shown that the organizational climate has a significant effect on the behaviour of employees and their performance, as well as the effectiveness of organizations⁷. Therefore, a positive and open organizational climate provides the basis for employees’ self-efficacy⁵. Self-efficacy is a personality trait that affects the personal and work life of individuals in many ways⁸. It is reported as an important determinant for predicting performance in different work environments, especially in a demanding context⁹. Self-efficacy in clinical practice means judging the ability to manage self-care independently¹⁰. So, if health workers improve their services for self-sufficiency, they will be expected to have a higher probability of achieving their desired outcomes¹¹. Sodagar et al.¹² reported that the average self-efficacy of Iranian nurses in the clinical environment is 29.78±5.28. Self-efficacy is affected by various factors. It is believed that self-efficacy is a dynamic construct that changes over time in response to new experiences such as education, clinical and social experiences¹³. The individual’s belief in self-efficacy may strengthen or weaken their performance. It may also affect the type of activities and environments a person chooses¹⁴. The research on non-educational occupations indicates that work self-efficacy is an important predictor for Career exploration, job stability, job satisfaction and organizational commitment and work effectiveness can affect job performance through these constructs¹⁵.

On the other hand, one of the most important sustainable areas of health in human societies is the one related to health and treatment, which is directly associated with human health and has a crucial role in maintaining and restoring health to human society. The hospital is also one of the most important components of the healthcare system and is considered its central core. Nowadays, effective management of hospitals is regarded as one of the main challenges of the health and treatment system in every country¹⁶. Besides, if the hospitals are not able to acquire and support their manpower in any reason, they will face problems in performing their important duties. So, it is mandatory for hospital managers to strengthen the morale of employees to provide better services by creating a suitable organizational climate¹⁷. On the other hand, the operating room is one of the most vital departments in the hospitals that is considered as the heart of the hospital. Since the most expenses are spent in operating rooms, it has the most important role in improving the quality and increasing the efficiency and performance of the hospital. Besides, largest share of the hospital’s income is also provided from this department¹⁸. Surgical nurses care for the patient during surgical procedures .during this stage, patients have specific needs that should be provided by nurses in the field of surgery. Professional nurses in this unit either directly perform many cares themselves or supervise their proper functioning by others¹⁹. Nurses with higher self-efficacy perceptions provide better performance and quality care than nurses with lower self-efficacy. Increasing self-efficacy reduces the gap between theory and practice and greater work commitment and perseverance in facing of problems. Therefore, strengthening and paying attention to the characteristics of self-efficacy in the performance of employees requires identifying the factors that predict or determine it²⁰. Therefore, improving the performance of human resources management in hospitals can bring more response to the needs of the covered community in addition to improving hospital outcomes such as patient safety and reducing patient mortality²¹. This requires attention to the empowerment of employees; organizations with capable employees have better performance and job satisfaction²². Also, operating room managers have close and direct relations with superiors, personnel under supervision and patients and the results of their activities have a significant impact on improving the health and improving quality of care of patients²³.

Considering the importance and consequences of the organizational climate and its effect on the self-efficacy of individuals in an organization from one side, and the limitation of studies done in the field of medicine, especially the operating room from the other side, and also trying to have a safe Surgery, all members of the surgical team are required to give their best performance. All these could be achieved by strengthening the sense of self-efficacy among surgical staff. The present study is aimed to investigate the association between the organizational climate and the self-efficacy of operating room staff in the medical training centres of IUMS in 2020–2021.

Methods

The present study was conducted based on a cross-sectional analysis approach. Our study is in accordance with the STROCSS 2021 guidelines²⁴. The research population consisted of the operating room staff of IUMS (surgical technologists and anesthesiologists with the associate, bachelor’s and master’s degrees. The total number of operating room staff was 640. To determine the sample size, the following formula was used.

$$n=p+1+\frac{z_{\frac{\alpha }{\mathrm{۲}}}^2(1-R^2)}{\mathrm{\Delta }{r}_j^2}$$

Two hundred twenty operating room staff (110 surgical technologists and 110 anesthesiologists) were selected by randomized cluster techniques. The inclusion criteria in the study was to have a valid academic degree in the field of operating room and anaesthesiology as well as being agree to participate in the research and completing the questionnaires. Data collection tools included demographic characteristics form, organizational climate questionnaires of Sam Deep and Lyle Sussman and job self-efficacy questionnaire of Riggs and Knight.

The questionnaire of demographic data including age (in years), sex (male and female), education (associate, bachelor, master), marital status (single, married, divorced, deceased spouse), income (enough, not enough), field of study (operating room, anaesthesiology), type of employment (permanent, corporate, contractual, under -a-contract), work experience (by year) and shift work (morning, evening, night, rotational shiftwork). Organizational climate questionnaires of Sam Deep and Lyle Sussman consisted of 20 questions. This questionnaire was scored on a 5-point Likert scale (fully disagree=0, disagree=1, no idea= 2, agree=3, entirely agree=4). The minimum and maximum scores of the questionnaire are zero and 80 respectively. A score between 0 and 27 shows a weak organizational climate, a score of 28–40 shows an average organizational climate and a score above 40 shows a strong organizational climate. This questionnaire was evaluated from psychometrical point of view in Iran by Heidarinejad and colleagues in 2013 and its Cronbach’s alpha coefficient was calculated as 0.87²⁵. In this study, the reliability of this questionnaire was measured by the test-retest method and its Cronbach’s alpha coefficient was calculated as 0.90%.

Riggs and Knight’s occupational self-efficacy questionnaire consisted of 31 questions based on a 5-point Likert scale (fully disagree=1, disagree=2, no idea=3, agree=4 and entirely agree=5). The score of this questionnaire ranged from 31 to 155. Scores of 93 and above show high self-efficacy and less than 93 show low self-efficacy. In 2008, this questionnaire was psychometrically evaluated by Sai and Noami in Iran and Cronbach’s alpha coefficient was calculated as 0.88²⁶. In this study, the reliability of this questionnaire was measured by the test-retest method and its Cronbach’s alpha coefficient was calculated as 91%. To perform the research, the researcher referred to the research site and provided the demographic characteristic form and questionnaires to the employees. The forms and questionnaires were completed by them and then collected on the same day. Spearman’s Rank correlation coefficient was used to evaluate the association between organizational climate and self-efficacy. Besides, to evaluate the association of demographic variables and organizational climate and self-efficacy, independent t-tests and one-way analysis of variance were used, respectively. The significance level was considered as 5%. Before analyzing the data, the studied variables were checked for the normality of their distribution to determine the appropriate method (non-parametric statistics) for testing the research hypotheses. So, the Kolmogorov–Smirnov test was used in this regard. SPSS version 14 software was used for data analysis, so first, univariate analysis was performed to select the candidate variables to be included in the multiple regression model using the Mann–Whitney test, then variables with a lower P value or equal to 0.25 were entered into the multiple models as important variables and finally variables with P value less than 0.05 were considered statistically significant.

Result

Based on the data presented in the above Table 1, the P value of each of the variables is less than 0.05 (less than the significance level). So, the distribution of variables is not normal and variables are tested and analyzed with non-parametric tests.

Table 1.

The statistical test for determining the normality of research variables.

Variable	Mean	Standard deviation	Kolmogorov–Smirnov statistic	P value
Organizational climate	40.28	13.08	0.062	0.041
Self-efficacy	94.09	8.53	0.096	<0.0001

Table 2 showsthat 220 individuals from operating room staff of medical education centres affiliated with the Iran University of Medical Sciences participated in this study. One hundred ten people (50.0%) were operating room specialists, and the rest 110 (50.0%), were anesthesiologists. 46.4% of participants were in the age range of 22–29, and most were female (87.4%). 87.3% had a bachelor’s degree, 47.2% were recruitment of manpower plan, 75.0% had insufficient income, 16.4% had work experience of 1–5 years and 93.6% had rotational shiftwork. Besides, study’s frequency of single and married individuals was equal (50.0%).

Table 2.

Frequency distribution of research samples according to demographic indicators.

Variables	Mean±SD or frequency (%)
Age	30.79±6.59
Work experience	8.49±6.62
Sex
Male	25 (11.4)
Female	87.7 (193)
Marital status
Single	110 (50.0)
Married	110 (50.0)
Field
Surgery room	110 (50.0)
Intelligence	110 (50.0)
Level of education
Associate degree	19 (8.6)
Masters	192 (87.3)
M.Sc	9 (4.1)
Income
Enough	55 (25.0)
Not enough	165 (75.0)
Employment status
Official	57 (25.9)
Treaty	4 (1.8)
Contractual	22 (10.0)
Plan	104 (47.2)
Corporate	33 (15.0)
Shift work
Morning	13 (5.9)
Night	1 (0.5)
Circulation	206 (93.6)

The data presented in Table 3 revealed that most studied samples (50.5%) had a strong organizational climate. Besides, most of them had a high level of self-efficacy (58.2) (Table 4). The results of Spearman’s rank correlation coefficient demonstrated that the association between organizational climate and self-efficacy was significant (P<0.0001) (Table 5).

Table 3.

Frequency distribution of research samples based on the organizational climate.

Organizational climate	Frequency	Percentage
Weak	31	14.1
Moderate	78	35.5
Strong	111	50.5
Total	220	100.0
Mean±SD	13.08±40.28

Table 4.

Frequency distribution of research samples based on their self-efficacy.

Self-efficacy	Frequency	Percentage
Low self-efficacy (Score <93)	92	41.8
High self-efficacy (Scores 93 and above)	128	58.2
Total	220	100.0
Mean±SD	8.53±94.09

Table 5.

Association of organizational climate and the self-efficacy of operating room staff.

Variable	Mean±SD	Test statistic
Organizational climate	13.08±40.28	r=0.166
Self-efficacy	8.53±94.09	P=0.013

The results of Table 6 show that there is a significant relationship between the income variable and the organizational climate and self-efficacy (P<0.05). Therefore, on the condition that other variables remain constant, the organizational climate in operating room employees whose salaries were sufficient will increase by 8.65% compared to employees whose salaries were not sufficient (P<0.001) and on the condition that other variables remain constant, self-efficacy in operating room employees whose salaries were sufficient will increase by 3/38% compared with employees whose salaries were not sufficient (P<0.011).

Table 6.

The results of examining the relationship (multiple regression) of organizational climate and self-efficacy with demographic variables.

Dependent variable	Independent variable	Coefficients (95% CI)	P value
Organizational climate	Age	−0.15 (−0.51, 0.21)	0.402
	Marital status
	Single	Ref
	Married	3.57 (−0.29, 7.44)	0.070
	Income
	Not enough	Ref
	Enough	8.65 (4.68, 12.62)	<0.001
	Employment status
	Official	Ref
	Unofficial	−4.05 (−9.02, 0.93)	0.111
Self-efficacy	Income
	Not enough	Ref
	Enough	3.38 (0.77, 5.98)	0.011
	Employment status
	Official	Ref
	Unofficial	−0.99 (−3.56, 1.58)	0.449

Discussion

The results of the present study revealed that most of the studied samples (50.5%) had a strong organizational climate. This achievement was in line with the findings of the researches by Hashemi et al.²⁷, Bigdeli et al.²⁵, Mahmoudi and Khushinani and colleagues. However, the results of this study was in contrast with the findings of the studies by Karimi et al.²⁶, Mahmoudi pati et al.²⁸, Dargahi et al.¹⁶, Salam et al.²⁹, Shirani et al.³⁰, Aghaei Barzabad et al.³¹, Heydarinejad et al.³². Yamin Firozi et al.³³ and Delgoshai et al.². were inconsistent. It seems that the strong organizational climate in the operating room cab be resulted from appropriate planning of the staff incentive and reward programs, improving the awareness of people to the role they play in the organization, improving the awareness of people to the duties of their colleagues, as well as giving individual responsibilities to people in line with the objectives that organization follows. Besides, the findings revealed that most of the studied samples (58.2%) had high self-efficacy. This result is nosistent with the findings of the studies done by Biranvand et al.¹³, Handiani et al.³⁴, Pour Vakhshori et al.³⁵, Hosseini et al.³⁶ and Azadi et al.³⁷. But the results of this study were inconsistent with the findings of the study by Naboureh et al.³⁸. It seems that higher levels of self-efficacy of the operating room staff can be resulted from the career variety and job specialization appropriate to the job, work ethic, responsibility and interest in working among the operating room staff and the provision of a suitable platform for decision-making and provision of healthcare services suitable to the patients’ conditions.

The data also revealed that, the association between organizational climate and self-efficacy is significant (P<0.0001). This finding was consistent with the findings achieved by Miller & Woher³⁹, Meristo and Eisenschmidt⁴⁰ and Haron et al.⁴¹. It seems that the favourable organizational climate led to loyalty and strengthening of cooperation between the staff and has influenced their performance and service delivery and improved the self-efficacy of them. Moreover, the clarity of the goals and plans of the organization, transparency of performance appraisal and payment system, availability of working groups in the organization and support them lead the employees to be confident in doing their jobs. So, the self-confidence of the employees in doing their jobs improves as well as their courage to face problems. All these factor cause them to make new decisions to do something, turn to learning new things. As a consequence, further failures make employees to work harder and trust their abilities, such a way they don’t give up easily and rely on their abilities.

The results also revealed a significant relationship between organizational climate and income variables (P<0.0001). This finding is consistent with the studies done by Fouladvand⁴², Radad et al.⁴³ ,and saffari et al.⁴⁴, which indicated that the association between the organizational climate and the staff’s income was significant. It seems that when the level of satisfaction of people with the amount of salary and benefits based on their competence and actual performance is higher, their understanding of the organizational environment and their job position will be better and stronger.

The results also indicated that work self-efficacy had a significant association with income (P<0.0001), which was consistent with the data achieved by Fardzade et al.⁴⁵ and Zahed et al.⁴⁶. It seems that if the amount of rewards that a person receives from the organization is higher, their desire to provide appropriate healthcare services and improve their ability to manage care services independently increases.

Research limitations

1. Lack of time for employees to answer the questionnaires due to the high volume of work. In order to control this limitation, the questionnaires will be delivered to them at the beginning of the work shift and delivered at the end of the work shift.

2. The psychological conditions of the employees when answering the questionnaires. This restriction was out of control.

Conclusion

The study’s results indicated that the organizational climate of the operating rooms in the medical education centres of Iran University of Medical Sciences was strong and the operating room staff had high self-efficacy. Besides, the association between organizational climate and self-efficacy was significant. Based on the data achieved from this study, it is recommended that the managers of medical training centres, according to the conditions and laws governing the operating room, provide the basis for improving the organizational climate and removing the existing weaknesses of the operating room through understanding the organizational climate and personality characteristics of the operating room staff, comprehension of various conflicts causes, ambiguities and challenges in their work environment. On the other hand, it is recommended to improve the work self-efficacy of operating room staff using methods such as performance appreciation of the staff, competency-based feedback, improving the level of knowledge and awareness and delegation according to staff’s skills.

Ethical approval

This article is a part of the master’s thesis of the operating room field of study which was done at the Iran University of Medical Sciences with ethical code IR.IUMS.REC.1399.583. Ethical approval was taken from Student Research Committee of Iran University of Medical Sciences.

Consent

Written informed consent was obtained from the participant for publication in this study.

Sources of funding

The authors declare no sources of funding.

Conflicts of interest disclosure

The authors declare that they have no conflict of interest.

Provenance and peer review

Not commissioned, externally peer-reviewed.