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.
Funder
Belgian Directorate-General for Development Cooperation
Reference160 articles.
1. George A , Scott K , Govender V . A health policy and systems research reader on human resources for health. Geneva: World Health Organisation, 2017.
2. Dieleman M , Gerretsen B , van der Wilt GJ . Human resource management interventions to improve health workers' performance in low and middle income countries: a realist review. Health Res Policy Syst 2009;7.doi:10.1186/1478-4505-7-7
3. WHO . The world health report 2006: working together for health. Geneva: World Health Organization, 2006.
4. WHO . Health workforce requirements for universal health coverage and the sustainable development goals. (human resources for health observer, 17, report no: 9241511400). Geneva: World Health Organization, 2016.
5. How can we achieve and maintain high-quality performance of health workers in low-resource settings?
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