The effect of leadership on public service motivation: a multiple embedded case study in Morocco

Abstract

ObjectivesWe aimed at exploring the underlying mechanisms and contextual conditions by which leadership may influence ‘public service motivation’ of health providers in Moroccan hospitals.DesignWe used the realist evaluation (RE) approach in the following steps: eliciting the initial programme theory, designing the study, carrying out the data collection, doing the data analysis and synthesis. In practice, we adopted a multiple embedded case study design.SettingsWe used purposive sampling to select hospitals representing extreme cases displaying contrasting leadership practices and organisational performance scores using data from the Ministry of Health quality assurance programmes from 2011 to 2016.ParticipantsWe carried out, on average, 17 individual in-depth interviews in 4 hospitals as well as 7 focus group discussions and 8 group discussions with different cadres (administrators, nurses and doctors). We collected relevant documents (eg, performance audit, human resource availability) and carried out observations.ResultsComparing the Intervention-Context-Actor-Mechanism-Outcome configurations across the hospitals allowed us to confirm and refine our following programme theory: “Complex leaders, applying an appropriate mix of transactional, transformational and distributed leadership styles that fit organisational and individuals characteristics [I] can increase public service motivation, organisational commitment and extra role behaviours [O] by increasing perceived supervisor support and perceived organizational support and satisfying staff basic psychological needs [M], if the organisational culture is conducive and in the absence of perceived organisational politics [C]”.ConclusionsIn hospitals, the archetype of complex professional bureaucracies, leaders need to be able to balance between different leadership styles according to the staff’s profile, the nature of tasks and the organisational culture if they want to enhance public service motivation, intrinsic motivation and organisational commitment.

How does social support affect public service motivation of healthcare workers in China: the mediating effect of job stress

“…Supervisor support and coworker support may be the most important social support factors affecting workers’ PSM. With sufficient supervisor support, workers feel they are important members of the organization and realize that their goals fit organizational goals [ 18 ]. They will thus be more involved in their work and demonstrate more altruistic behavior, dedication, and organizational citizenship behavior—the concrete manifestations of PSM.…”

“…For many employees, especially new workers, reciprocal modulation of the relationship between them and their supervisors is very important. While working hard, they also want to be recognized and rewarded by their supervisors and organization [ 18 ]. If their efforts elicit a positive response from supervisors, PSM is strengthened and they will work harder.…”

Programme theory and linked intervention strategy for large-scale change to improve hospital care in a low and middle-income country - A Study Pre-Protocol

“…Others focused on large scale change in LMIC have focused on the politics and governance of such change or employed Realistic Evaluation as a central strategy to explore hospitals’ management 120 , 121 . Work in the latter arena has contributed significantly to thinking on the effects of hospital management on improvement and change processes 122 , 123 and on the evolution of specific service delivery platforms 99 . In HIC the UK NHS Institute for Innovation and Improvement presents a more practical guide to large scale change interventions 7 and there have been efforts to learn from the UK’s Collaborations for Leadership in Applied Health Research and Care and geographically widespread service improvement interventions 124 , 125 .…”

Unravelling the role of leadership in motivation of health workers in a Moroccan public hospital: a realist evaluation

“…The overall PhD study aimed at (1) describing how complex leadership is being conceptualised and applied in healthcare; (2) unravelling the underlying processes that link leadership to health workers’ motivation, the organisational characteristics and contextual conditions within which these processes are enabled or hindered; (3) exploring how the notion of public service motivation is defined by health workers, exploring the differences in the definition by cadre and identifying the factors that may influence PSM. For further details, see previous works 39 78 79. Indeed, the general design of the larger PhD study is a multiple embedded case study that proved appropriate in testing and refining theoretical propositions guided by the RE cycle presented in figure 3.…”