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Abstract
The health care industry is besieged by the public's outcry concerning rising costs. Health care management is attempting to meet the challenges through implementation of best practices from modern business organizations. The purpose of this study is to assess the impact that two of the most popular business practices--TQM and downsizing--have on the performance, satisfaction, commitment, and turnover of employees in a large health care organization.
A pre-test/post-test quasi experimental control group design was used to test the hypotheses that both TQM and downsizing had on hard (performance and turnover) and affective (job satisfaction and organizational commitment) organizational outcomes. Additionally, moderating variables of supervisor behaviors and work group climate were analyzed to determine their impact on the affective organizational outcomes. A longitudinal analysis collected baseline measures for the TOM intervention in 1991, followed by post measures in 1992 and 1993. This was followed by a two year downsizing intervention, where the baseline measures were 1993, and the post intervention data were gathered in 1994 and 1995.
The results showed mixed support for the hypothesized effects. First, although TQM did seem to have a positive effect on performance and voluntary turnover over the intervention period, there were no significant findings regarding TOM's impact on affective measures of job satisfaction and organizational commitment. Important for implementing TQM, however, was that the moderating variables of supervisor supportiveness and work group trustworthiness, which in and of themselves related to satisfaction and commitment, had a significant impact on the affective outcomes.
Second, like TQM, downsizing seemed to have a positive impact on employee performance and voluntary turnover, but, as hypothesized, had a significant negative effect on employee job satisfaction and organizational commitment. Finally, supervisor supportiveness and work group trustworthiness were shown to significantly moderate the relationship between downsizing and organizational commitment. These findings provide important practical implications and guidelines for implementing TQM and downsizing strategies in health care organizations.
