Abstract
BACKGROUND:
Al-Zahraa Teaching Hospital, one of the most important hospitals in Iraq, is currently facing extensive organizational problems. One reason for these problems is the lack of attention to the voice of the employees, which can be due to a lack of designing an appropriate model for this phenomenon.
MATERIALS AND METHODS:
Accordingly, the present interpretive, qualitative, and exploratory research mainly aimed at designing a voice pattern for the employees in Al-Zahraa Teaching Hospital in Iraq. The field data were analyzed using the grounded data analysis method in the ATLAS.ti 8 software. The research experts included 17 academic experts, managers, and medical, health, and nursing staff of Al-Zahraa Teaching Hospital in Iraq, who were selected by the purposive sampling method. The sample size was determined based on the data saturation method.
RESULT:
The research results revealed that the voice of employees can provide managers with a thorough and multi-dimensional understanding of the organization’s situation.
CONCLUSION:
Based on the findings of the present study, individual and organizational characteristics are the elements that affect the voice of employees.
Keywords: Educational hospital, employees’ voice, grounded method, leadership style, organizational levels
Introduction
Hospitals are among the most important service organizations for the health needs of societies. In this respect, the voice of the employees is of great importance because of certain issues. Environmental pressure, special mental conditions, and floating working hours are a small part of the hospital’s working environment, which was extensive effects on the quality of life of its employees.[1] Al-Zahraa Teaching Hospital of Iraq, one of the most important hospitals in Iraq, is now encountering extensive organizational problems for different reasons, including the lack of attention to the voice of the employees. Such shortcomings can result from a lack of designing a suitable model for this process. In this regard, the employees’ ideas and opinions can solve many organizational problems and reflect their interests and demands on the organizational management. Employees will often experience stress, dissatisfaction, job frustrations, and isolation in their organization if they do not feel the desire to present their ideas, opinions, and information to the organization for any reason. Such an issue will lower the level of trust between individuals and their commitment to the organization, thereby lowering the employees’ level of performance. Hence, designing an employee voice model in this organization can break the employees’ silence, eventually moving the organization toward innovation and creativity and solving organizational problems and development. One gap in the field of the voice of employees is the lack of comprehensive research regarding model design, identification of causes, consequences, and strategies, considering the causal and intervening conditions. Considering the mentioned explanations and the presented subject plan, the current study sought to design a voice model for the employees at Al-Zahraa Teaching Hospital in Iraq.
Dimensions of Employees’ Voice
Organizational policy and employee voice
With the increasing understanding of organizational policy and resource usage, the resources available to employees will gradually decrease, and employees will decrease their voice behavior. Hence, individual perceptions of organizational policies negatively affect employee voice.[2]
Organizational self-efficacy and employee voice
Employees should believe in their skills and competencies and know that they can successfully apply them to contribute to voice.[3]
Organizational interaction, effectiveness, and employee voice
Wang et al. (2020) demonstrated that the interaction of employees stimulates organizational effectiveness. Employees with adequate information (about the organization’s performance) and opportunities to participate in decision-making are highly engaged in their work. This attraction helps them enhance the overall effectiveness of the organization.[4]
Leadership style and employee voice
Three negative implicit beliefs in the organization’s leaders are the main reason for the reduction of voice in the organization. The first one is that the employees have personal interests and cannot be trusted, such that their thoughts and opinions cannot be trusted. The second implicit belief is that management has the most information about essential organizational issues. Therefore, the task of the management group is to manage and give orders rather than pay attention to the expression of unimportant opinions. The third implicit belief is a state in which the consensus is a sign of the organization’s health, and at the same time, disagreement and opposition should be avoided.[5]
Organizational behavior and employee voice
Employee voice is considered an important issue in organizational behavior literature, where voice is the expression of employees’ desires and choices to convey their opinions to management for the benefit of the organization.[6] According to organizational behavior researchers, voice is a primary behavioral role of employees. The organizational voice expresses ideas about improving the current work process. Therefore, organizational voice is different from organizational silence.[7]
Human resource management and employee voice
Human resource managers often assume that voice mechanisms can align the goals of employees and the organization through increased commitment and engagement. Voice may create long-term positive attitudes since employees understand the power of influencing decisions, regardless of whether the employee’s voice affects the decision outcome. Voice is a challenging, prosocial, and organizational citizenship behavior that helps improve the organization and manage human resources by changing existing methods.[8]
Organizational culture and employee voice
Leaders of organizations should provide the necessary platforms and allow employees to present their opinions and suggestions. This important example of organizational participation is defined as the voice of employees.[9] Figure 1 presents the pattern of different dimensions of employees’ voices in the organization.
Figure 1.
Dimensions of employees’ voice in the organization based on research literature
Materials and Methods
Study design and setting
This interpretive, qualitative, and exploratory research is also considered a practical-developmental study. Based on the primary raw data, the researcher extracts preliminary categories related to the issue under investigation by asking questions about the data. In addition, it compares cases, events, and other states of the phenomena to obtain similarities and differences. In the next stage (axial coding), the researcher focuses on one of the categories, investigates it (the main phenomenon), and then relates other categories to it.[10] These categories include causal conditions (causes of the main phenomenon), strategies (actions or interactions that are performed to control, manage, deal with, and respond to the main phenomenon), background (specific background conditions effective in strategies), intervening conditions (the conditions of the general framework that are effective in strategies), and consequences (regarding the application of strategies).[11]
Study participants and sampling
The field data were analyzed using the grounded data analysis method in the ATLAS.ti 8 software. The research experts included 17 academic experts, managers, and medical, health, and nursing staff of Al-Zahraa Teaching Hospital in Iraq. They were chosen by purposive sampling, and the sample size was estimated according to the data saturation method. Table 1 provides the personnel position of the experts at Al-Zahraa Hospital in Iraq.
Table 1.
Study samples
| Row | Experts’ personnel position | Frequency |
|---|---|---|
| 1 | Head of the unit | 7 |
| 2 | Assistant hospital manager | 1 |
| 3 | Director of the unit | 19 |
| 4 | Total | 17 |
Data collection tool and technique
The research experts included 17 academic experts, managers, and medical, health, and nursing staff of Al-Zahraa Teaching Hospital in Iraq. They were chosen by purposive sampling, and the sample size was estimated according to the data saturation method. Table 1 provides the personnel position of the experts at Al-Zahraa Hospital in Iraq. First, open coding and then central and secondary coding were implemented, focusing on causal conditions, axial phenomenon, background conditions, intervening conditions, and strategy and consequence identification. The results obtained are presented in the appendix section. Eventually, after implementing selective coding, the researchers set the paradigm model of the research [Figure 2]. The field data were analyzed using the grounded data analysis method in the ATLAS.ti 8 software. The research experts included 17 academic experts, managers, and medical, health, and nursing staff of Al-Zahraa Teaching Hospital in Iraq. They were chosen by purposive sampling, and the sample size was estimated according to the data saturation method. Table 1 provides the personnel position of the experts at Al-Zahraa Hospital in Iraq. The validity and reliability of this study were confirmed based on the obtained Cronbach’s alpha coefficients (i.e., 85%), factor loadings, content validity index (CVI), and construct validity index. Calculations for these criteria are provided in the appendix section. The content validity ratio (CVR) was applied to estimate the validity of the data. The CVR was determined by providing a tailor-made questionnaire to eight experts in this field. According to the table proposed for this purpose, the acceptable CVR value was considered to be 0.75. After computing the CVR, the number 0.92 was obtained, indicating that all the obtained indexes had the required validity.
Figure 2.
Paradigmatic model of employee voice in the hospital
Ethical consideration
According to the research topic and the nature of the participants, there are no specific ethical considerations in the research.
Result
First, open coding and then central and secondary coding were implemented, focusing on causal conditions, axial phenomenon, background conditions, intervening conditions, and strategy and consequence identification. The results obtained are presented in the appendix section. Eventually, after implementing selective coding, the researchers set the paradigm model of the research [Figure 2].
Discussion
Overall, 18 final codes were extracted in the open coding stage. Based on the analysis of the next stage (i.e., axial coding), these codes were categorized into individual and organizational outcomes. Individual consequences included four codes for reducing stress, frustration, and isolation among employees, creating motivation in employees, job satisfaction among organizational employees, and increasing loyalty and organizational commitment. Corresponding to the mentioned codes, organizational consequences (including 12 codes) prevent the occurrence of organizational problems. In addition, these codes improve the work environment, build trust in the organization, increase the innovation and creativity of employees, and enhance organizational performance. Other codes included retaining competent employees, increasing the level of interaction between employees and managers, better solving organizational problems, discovering organizational mistakes, increasing employees’ job enthusiasm, optimizing organizational policies, reducing organizational risk, and improving the hospital’s actions. The remaining codes were upbringing happy human resources, using the capabilities and knowledge of hospital employees, and creating organizational transparency. The results of the conducted studies revealed that employees are motivated, and their attitudes and behaviors change when supervisors or managers ask subordinates for their opinions in their decisions and respect their wishes or needs. The first issue in presenting the model of employees’ voice is to investigate the conditions affecting this phenomenon.
Conclusion
Based on the findings of the present study, individual and organizational characteristics are the elements that affect the voice of employees. These conditions work by affecting the voice of the employees. In addition, the voice of the employees affects the strategies and mechanisms. A series of factors accompany this impact as interfering factors, which are classified as environmental factors. The strategies influenced by these factors include society’s culture, the environment with high levels of uncertainty, and the learning organization. This strategy will only happen under background conditions. Among the most essential contextual factors in this research are the diversity of the workforce, the level of maturity of employees, collaborative leadership style, cultural intelligence, the alignment of the goals of employees and managers, and the ability of managers. Certainly, the consequence of the phenomenon of the voice of employees is a significant point mentioned in the form of individual and organizational consequences in this study.
Theoretical and practical participation
To our knowledge, the grounded data method has not been used to identify the variables of the voice pattern of employees in Iraq. Causal conditions, intervening conditions, background conditions, the main phenomenon, strategies, actions, and consequences of employees’ voices were detected as the major voices of employee variables. From this viewpoint, the research presented in the field of employees’ voices provides a more comprehensive insight than the literature. Further, the researchers’ approach toward the phenomenon of the voice pattern of employees is multi-dimensional, considering the nature of the research methodology and the use of a qualitative approach. This issue has received less attention in previous studies in this field.
Limitations and recommendation
Despite the efforts made in this research, this study faced some limitations. Part of the limitation is related to its identification method. This research was performed at Al-Zahraa Teaching Hospital in Iraq. Thus, the generalizability of the study results requires further research regarding cultural, economic, weather, and social differences with other provinces. Also, one of the limitations of the grounded data theory is the limitation in the theoretical generalizability of the findings, as the findings of this study rely on the views and experiences of a limited number of individuals.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
The researchers express their gratitude to the management and staff of Al-Zahraa Hospital, who cooperated in the research process.
Funding Statement
Nil.
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