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Introduction
Norway’s hospital reform began in 2002. For the hospitals and their owner (the state) to monitor activity, key performance indicators are deemed important. These are linked to activity volume, economic results and goal achievement. Hospitals report regularly on these parameters to state authorities. Managerial focus has been increasing in the public sector in the 20 years since activity-based performance was implemented (Martinussen and Magnussen, 2011). These types of changes in the hospital sector are often called New Public Management (NPM)-inspired changes or reforms (Lægreid et al., 2005). In the past decades, most European health-care organizations have been subjected to NPM reforms and increased attention to cost efficiency (Paun, 2016). Doctors with many years of work experience in the hospital sector are raising concerns that the measurements used to evaluate the quality of their job are the wrong parameters, that a heavy administrative burden takes the focus away from patient care, and that reporting adverse events can be seen as disloyal and can be punished rather than encouraged and solved (Anderson, 2012; Slagstad, 2017). The critics of the NPM influence on public health-care organizations claim that focusing on efficient “production” has been more important to health-care leaders than other goals of the NPM, such as providing a more patient-centred care based upon patient security, holistic care, transparency of important decisions and implementing of evidence-based methods (Andersson and Liff, 2012).
Disagreement on the strategy, policy, goals, quality measures, organizational values and management practice of the organization can lead to a certain kind of stress in this article defined as institutional stress. The institutional stress dimension is based on a new statistical validation of selected parts of Cooper (1981) Stress Check Scale (CSCS).
The Job Demand Resource model (JD-R model) is a theoretical framework that tries to integrate two independent research traditions relevant for our study, the stress research tradition and the motivation research tradition (Demerouti and Bakker, 2011). The aims of this study are to investigate how institutional stress, defined as job demand, autonomy, competence development and social support, here defined as motivational job resources, are related to job performance among hospital employees. We explore whether perceptions of institutional stress in a hospital region in Norway are directly or indirectly related to job performance and whether...