Mediators and moderators of the relationship between IP&Ps and middle managers’ commitment to innovation implementation in health care organizations

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Aim 2 uses qualitative data to explore mediators and moderators of the relationship between IP&Ps and middle managers’ commitment to innovation implementation in health care organizations that extant research has identified as potentially important (Rhoades & Eisenberger, 2002). The theory of perceived organizational support, for example, suggests potential mediators and moderators of the relationship; these mediators and moderators are described in detail below. I also identify potential mediators and moderators of the

relationship between IP&Ps and middle managers’ commitment to HDC implementation that emerged from Aim 2 analyses but were not proposed by the theory of perceived

organizational support. The mechanisms and boundary conditions for the relationship

between IP&Ps and middle managers’ commitment in health care organizations currently are poorly understood; understanding mediators and moderators will provide a nuanced

understanding of how and under what conditions IP&Ps influence middle managers’ commitment. Further, understanding mediators and moderators of the relationship between IP&Ps and middle managers’ commitment will allow practitioners to promote middle managers’ commitment and implementation effectiveness in health care organizations.

The relationship between IP&Ps and middle managers’ commitment to innovation implementation in health care organizations may depend on the conditions under which IP&Ps are offered. Moderators of the relationship between IP&Ps and middle managers’ commitment to innovation implementation in health care organizations may include (1) whether IP&Ps are under top managers’ control and (2) whether middle managers perceive top managers to be agents of the organization (figure 3). The theory of perceived

organizational support suggests that IP&Ps are more highly valued if they are offered based on discretionary choice rather than circumstances beyond the donor’s control (Eisenberger et

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al., 1986; Rhoades & Eisenberger, 2002). For example, if an organization is obligated by law to provide the IP&Ps, middle managers may not feel that the favorable treatment is as worthy of reciprocation than if IP&Ps were offered based on organizational policy. Indeed,

Eisenberger and colleagues (1997) found that perceived organizational support among employees in a variety of organizations depended upon whether the policies and practices were offered based on the organization’s discretion or in response to external constraints. Employees who perceive their organization as supportive may be more likely to reciprocate with greater effort toward meeting organizational goals such as innovation implementation (Eisenberger et al., 1986), so middle managers who believe that IP&Ps are offered based on the organization’s discretion may exhibit greater commitment to innovation implementation.

The theory of perceived organizational support posits that IP&Ps are more highly valued if employees identify top managers as agents of a benevolent organization as opposed to idiosyncratic actors. Three studies involving employees in a variety of organizations demonstrated that perceived organizational support depended upon the extent to which employees identified top managers with the organization (Eisenberger, Stinglhamber, Vandenberghe, Sucharski, & Rhoades, 2002). That is, employees who believed that top managers acted on behalf of the organization were more likely to believe that help was available to them if they had a problem than employees who believed that top managers’ actions were based on their personal discretion. Since employees who perceive their organization as supportive may be more likely to reciprocate with greater effort toward meeting organizational goals such as innovation implementation (Eisenberger et al., 1986), middle managers who perceive top managers to be agents of their organization may exhibit greater commitment to innovation implementation.

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Potential mediators of the relationship between IP&Ps and middle managers’ commitment to innovation implementation in health care organizations include (1) job involvement (identification with and interest in the specific work one performs), (2) job- related affect (job satisfaction and general mood), and (3) strain (aversive psychological and psychosomatic reactions) (Rhoades & Eisenberger, 2002) (figure 3). Middle managers may experience increased commitment to innovation implementation because IP&Ps increase their job involvement. For example, a middle manager who receives incentives for implementing an innovation may find that he or she is more interested in innovation

implementation than a middle manager who does not receive incentives for implementing the innovation. Indeed, Eisenberger and colleagues (1999) found that financial incentives for meeting a performance standard were associated with greater perceived competence; in turn, perceived competence was associated with greater task interest.

Increased commitment to innovation implementation might also be related to job affect. Middle managers who have access to training resources may feel more competent, enhancing positive mood. Indeed, in a study of perceived organizational support among postal workers, Eisenberger and colleagues (2001) found that positive mood mediated the relationship between perceived organizational support and commitment to the organization.

Middle managers may also experience increased commitment to innovation

implementation because IP&Ps decrease strain associated with innovation implementation. Having access to human resources, for example, may give middle managers the ability to commit to innovation implementation by ameliorating some of the strain associated with their work, giving them the opportunity to engage in activities that demonstrate commitment to innovation implementation. Indeed, Cropanzano and colleagues (1997) found that

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perceived organizational support predicted strains such as fatigue and burnout. Implementing quality improvement initiatives is extremely demanding of employees and organizations— cognitively, emotionally, physically, and spiritually (Shortell et al., 1998). Middle managers who have access to supportive IP&Ps may experience a decrease in these strains, thereby increasing commitment to innovation implementation.

CHAPTER 4