Abby Kahaleh 2007

8/8/2019 Abby Kahaleh 2007

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Original Research

The effects of work setting on pharmacists

empowerment and organizational behaviors

Abby Kahaleh, B.Pharm., Ph.D., M.S., M.P.H.a,

*,Caroline Gaither, Ph.D.b

aLECOM School of Pharmacy, Erie, PA 16509bDepartment of Social and Administrative Sciences, College of Pharmacy,

University of Michigan, Ann Arbor, MI 48109-1065

Abstract

Background: In traditional organizations, power determinantsdaccess to information,

resources, opportunity, and supportdtend to be accessible only to top management. In

todays health market, however, organizations must compete in a dynamic environment

that affects the relationship between the individuals and their organization.

Objectives: The purpose of the study was to examine the effects of work setting on

antecedents of empowerment, empowerment, and its consequences: loyalty, commit-

ment, identification, and job-turnover intention.

Methods: The study used a cross-sectional design. A model developed by Kanter is

used and extrapolated for the study. A random national sample of 1,200 pharmacistswas selected to participate in this research. Self-administered questionnaires were

mailed to the subjects home addresses. For data analyses, structural equation mod-

eling analyses were conducted to test the study model.

Results: A total of 421 usable responses (40.0%) was obtained. Most of the respondents

were white, males, and the average age was 47 years. Goodness-of-fit for the overall

model was acceptable (SRMR 0.06, RMSEA 0.07, CFI 0.91, and NNFI 0.88.)Conclusions: Consistent with theoretical considerations, the hypothesized model was

significant. Work setting affected empowerment and its consequences. Pharmacists

* Corresponding author. Ohio Northern University, Pharmacy Practice, 525 South Main

Street, Ada, OH 45810, USA. Tel.: 1 419 772 1866; fax: 1 419 772 2720.E-mail address: [email protected] (A. Kahaleh).

1551-7411/$ - see front matter 2007 Elsevier Inc. All rights reserved.

doi:10.1016/j.sapharm.2006.08.001

Research in Social and Administrative Pharmacy

3 (2007) 199e

222
mailto:[email protected]:[email protected]


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who work in independent community pharmacies were more structurally empowered

than their counterparts in hospitals or chain pharmacies. In each setting, organiza-

tional commitment and loyalty were significant predictors of job turnover intention.Increasing access to knowledge, opportunity, and support may reduce the likelihood

of job turnover among chain and hospital pharmacists.

2007 Elsevier Inc. All rights reserved.

Keywords: Empowerment; Work setting; Independent pharmacists; Chain pharmacists;

Hospital pharmacists; Loyalty; Commitment; Identification; Job-turnover intention

1. Background

In traditional organizations, power determinantsdaccess to information,

resources, opportunity, and supportdtend to be accessible only to top man-

agement.1 Employees in such organizations are adapted to being passive and

are successful in a rigid work environment. In todays health market, how-

ever, organizations must compete in a dynamic environment that affects the

relationship between the individuals and their organization.2-6 Many orga-

nizations, including heath care organizations, are restructuring their workenvironments to become more competitive by reducing their costs, decreas-

ing duplicate services, securing resources, and differentiating their services.

Organizational researchers have assumed that organizational behaviors

are entirely related to individual characteristics. More recently, organiza-

tional theorists have examined the relationship between employees and their

work environment.7-17

Strategic management theorists have focused on examining organiza-

tional behavior and its link to the success of organizational redesigning

strategies. They have noted that the success or failure of such transactionsappears to depend on the cooperation and coordination of individuals

within work units. Individuals who are empowered have greater autonomy

regarding the content of their work and are more likely to be committed to

organizational goals.4-10

Based on Kanters structural theory, organizational behaviors are consid-

ered rational responses to the work environment.1 Access to power engenders

higher commitment to organizational goals among employees. The theory

postulates that individuals respond rationally to their work environment,

their position, and to the situations that unfold in their organization.

1

If anorganization is flat, employees are more likely to be empowered and this

will benefit the organization in terms of the behaviors of employees and the

effectiveness of the organization. Based on Kanters theory, power is a struc-

tural determinant that shapes organizational behaviors among employees.1

Empowerment is acquired through access to information, ability to mobilize

resources, support, and opportunities to grow in ones job.1,10,11

200 A. Kahaleh, C. Gaither / Research in

Social and Administrative Pharmacy 3 (2007) 199e222


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There have been many studies supporting Kanters structural theory in

the business and health care arenas; 4,5,10,12-15 however, the impact of struc-

tural supports on pharmacists behaviors has not been examined. Work set-tings may affect antecedents of empowerment such as job flexibility and

visibility, structural and psychological empowerment, and consequences of

empowerment.

Specifically, the study model proposed examines the effects of antecedents

of empowerment, power factors, and need for achievement on empower-

ment and its consequences, commitment, loyalty, and identification among

pharmacists in different work settings.1-3,7,10,13,14,19,20

1.1. Definitions

1.1.1. Antecedents

Power factors are defined as structural elements that enhance empower-

ment, such as job visibility, relevance of the job to the organizations mis-

sion, and flexibility, the amount of discretion perceived by the

employees.1,10 Need for achievement is described as a desire to achieve chal-

lenging career goals.7

1.1.2. EmpowermentStructural empowerment is defined as access to information, resources,

opportunity, and support.1,10 Psychological empowerment has 4 dimen-

sions: meaning, competence, self-determination, and impact.13,14

1.1.3. Consequences

Organizational commitment is accepting the organizations goals and

values, putting forth effort, and wanting to remain a member.19,20 Organiza-

tional loyalty is defined as acting as a loyal booster for the organization.2

Organizational identification is described as a persons self-concept, whichcontains the same attributions as those of the organization.3,18 Job-turnover

intention is defined as intention to leave an organization voluntarily.20

2. Conceptual model

A model developed by Kanter is used and extrapolated to examine the

effects of work setting on psychological and structural empowerment and

consequences of empowerment, loyalty, commitment, identification, and job turn intention.1 The study model examines both structural and psycho-

logical empowerment among pharmacists. The comprehensive model links

structural determinants of empowerment to organizational behaviors. The

underlying rationale behind the model is that pharmacists who have access

to power factors in their work environment develop a sense of structural and

psychological empowerment, which shapes their organizational behaviors.1

201A. Kahaleh, C. Gaither / Research in



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The model has 3 important components. First, a cognitive component,

which represents the 4 dimensions of psychological empowerment. Second,

a structural component, which represent the interactions between pharma-cists and their environments, and includes access to structural determinants

of empowerment. Finally, there is a behavioral component, which represents

organizational outcomes such as commitment, identification, loyalty, and

job-turnover intention. These 3 components are important requisites of em-

powerment based on the empowerment theory. This theory posits that re-

searchers need to include all 3 components to adequately measure

empowerment.1

3. Objective

The main purpose of the study is to examine the effects of work setting on

antecedents of empowerment, empowerment, and consequences of empow-

erment. The research questions for the study are:

1. Does work setting affect the levels of power factors, need for achieve-

ment, empowerment, loyalty, commitment, identification, and job-turn-

over intention?

2. Does work setting affect the relationships between antecedents of em-

powerment, empowerment, and consequences of empowerment?

4. Methods

4.1. Research design and subjects

The study used a cross-sectional survey design. A random sample of

5,000 pharmacists and their home addresses was purchased from KM Lists,

which maintains a list of approximately 200,000 pharmacists in the U.S.

4.2. Data collection

A pretest was conducted to assess the reliability and validity of the survey

instrument on a sample from the study population. A random sample of 120

pharmacists was selected and subtracted from the purchased sample of 5,000pharmacists. This pretest sample represents 10% of the final sample. We

used summated scales to measure power factors, need for achievement, psy-

chological empowerment, structural empowerment, commitment, loyalty,

identification, and job-turnover intention. Preliminary reliability analyses

provided estimated Cronbachs coefficient alphas for all of the scales at

0.70 or higher.




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A cover letter, questionnaire, and preaddressed, postage-paid return en-

velope were mailed to home addresses of a random sample of pharmacists

nationwide. The cover letter and questionnaire were approved by the Insti-tutional Review Board of the University of Michigan. Four weeks prior to

this mailing, early notice postcards were mailed to the subjects home ad-

dresses.21-25 Two weeks after the mailing of the survey, reminder postcards

were mailed to nonrespondents. Finally, a second mailing of the question-

naire was sent to nonrespondents.

4.3. Study variables

4.3.1. Power factors and structural empowermentThe subjects were asked about their access to power factors in their work-

place. Power factors are structural elements that facilitate empowerment. A

job with more flexibility and visibility allows easier access to knowledge, op-

portunity, support, and resources.1 Five-point Likert scales were used to

measure flexibility and visibility. Results of the reliability analyses showed

that for flexibility Cronbachs a 0.78.Structural empowerment is defined as having access to structural determi-

nants. Specifically, subjects were asked to evaluate how much knowledge

they have about their organizations, opportunity to advance in their careers,support they receive from their supervisors, and resources that are available

to them to get the job done.1

Five-point Likert scales were used to measure knowledge, opportunity,

support, and resources.1,10 Results of the reliability tests showed that Cron-

bachs alphas for the scales were as follows: knowledge (a 0.86), opportu-nity (a 0.89), support (a 0.92), and resources (a 0.72).

4.3.2. Need for achievement

Pharmacists were given a list of items that measured their level ofachievement. For instance, they were asked to rank items that measured

their need to improve their performance and to perform better than their co-

workers.7 A 7-point Likert scale was used to measure need for achievement

(a 0.60).

4.3.3. Psychological empowerment

Psychological empowerment is defined as the cognitive status that enables

managerial interventions to be effective among pharmacists. Subjects were

asked to rate their levels of competence and self-determination. Also, theywere asked to evaluate how meaningful their jobs are to them and how

much they affect their organizations.13,14 Seven-point Likert scales were

used to measure various components of psychological empowerment. Re-

sults of the reliability analyses showed that Cronbachs alphas for the scales

were as follows: competence (a 0.92), meaning (a 0.92), self-determina-tion (a 0.90), and impact (a 0.88).




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4.3.4. Consequences of empowerment

Subjects were asked to rate their commitment to their employers and how

much they identified with their organizations.3,20

In addition, subjects wereasked to evaluate their loyalty toward their organizations and the likelihood

of them leaving their employers.2,20 A 7-point Likert scale was used to mea-

sure consequences of empowerment. Results of the reliability analyses

showed that Cronbachs alphas for the scales were as follows: loyalty

(a 0.91), commitment (a 0.87), identification (a 0.88), and job-turn-over intention (a 0.91).

4.4. Analysis plan

Data were managed and analyzed with SPSS 9.0.26,27 Analyses of vari-

ances were conducted to examine the effects of the pharmacists work setting

on psychological and structural empowerment. These statistical analyses

enable researchers to examine the effects of work setting on the levels of

empowerment. The analysis focuses on differences in the levels of empower-

ment between independent, chain, and hospital pharmacists. Posthoc (Tukey)

tests were performed to compare means among groups and to determine any

significant differences between the means.Structural equation modeling using LISREL 8.026 was conducted to test

the overall theoretical model. The structural equation technique allows

researchers to obtain precise estimates of the parameters by including the

error measurements of the instruments. Structural equations model can be

divided into 2 specific models. 26 The first is the measurement model or con-

firmatory factor analysis model, which can be used to test for convergent

validity and to examine the linear relationships between the observed vari-

ables or indicators and the latent variables or the unobserved constructs.

The second is the structural model, which evaluates the relationshipsbetween dependent and independent latent variables.26

Moment matrices included in the structural equation modeling analyses

were covariance matrices. Indicators were computed by averaging every

other item within each scale. The method of parameter estimation was the

maximum likelihood. Calculated lambdas (li) represent factor loadings of

the observed variables on the latent variables in the hypothesized model.

The error variances in the observed variables are represented by theta-

deltas (qdi). High factor loadings and low error variances are sensibly fa-

vored. There were no negative error variances and no correlations weregreater than 1. The composite reliability is calculated by dividing the factor

loadings squared by the sum of the loadings squared plus the error vari-

ances. Composite reliabilities were calculated using the following formula:

r Sli2

var:xj=Sli

2var:

xjSqdi




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Satisfactory model fits are indicated by nonsignificant chi-square tests, stan-

dardized root mean square residual (SRMR) and root square error of ap-

proximation (RMSEA) values less than 0.08, comparative fit index (CFI),normed fit indices (NFI), and nonnormed fit index (NNFI) values that

exceed 0.90.26 The data were split by practice setting for the final path anal-

yses. Due to sample size limitations, the models for each practice setting

were estimated with lambdas set to 1 and error variances set to zero.

5. Results

Surveys were mailed to 1,200 pharmacists nationwide. After 5 mailingsconsisting of 2 surveys, 2 reminder postcards, and a survey of nonrespon-

dents, 447 pharmacists responded for an overall response rate of 42.4%.

Of the 447 responses, 421 were usable questionnaires. Three responses out

of the 421 were completed on the phone or sent electronically. Out of the

1,200 pharmacists that were mailed the surveys, 83 of them were nonreach-

able, 31 were noneligible, and 32 indicated that the survey was nonapplica-

ble to their work status. Therefore, the usable response rate is 40.0%.

5.1. Description of respondents

Table 1 provides the demographic and job-related variables for the respon-

dents. Most of the respondents were white, males, and the average age of the

study population was 47 years. The majority of them had 1 or more children

and the mean graduation date was the late 1970s. Most of the respondents did

not complete a residency, had full-time jobs, worked in pharmacy-related

jobs for 20 years on average, and worked in large entities.

The majority of the respondents were staff in community pharmacies. On

average, pharmacists worked for current employers for at least a decade andhad 5 different employers throughout their careers. Most of the respondents

indicated having an average or above average salaries and benefits based on

their qualifications and job experiences.

5.2. Antecedents of empowerment

Job flexibility, job visibility, and need for achievement were measured

among pharmacists. Results of the study showed that the levels of job flex-

ibility and visibility were moderate. The majority of the respondents indi-cated that in their current jobs they have flexibility in contacting the

people they need to be in touch with and that they have autonomy in deter-

mining how they do their own work. Approximately 30% of the respon-

dents said that they set their own work hours and get around

bureaucratic regulations. Most of the respondents stated that they consider

their work-related activities to be visible within the organization.




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Need for achievement among pharmacists was moderately high. Almost

all of the respondents agreed that they try very hard to improve prior

work performance. The majority of the respondents agreed that they do

their best work when their job assignments are difficult, try to perform better

Table 1

Description of respondents

Variable Mean (SD) Number PercentAge 47(12)

60 years 65 15

Gender

Male 232 56

Race/ethnicity

White Caucasian 345 86

Other 56 14

Number of children

1 or more 242 61

None 155 39

Years since graduation 23(15)

Degrees earned

B.S. 354 84

Pharm.D. 71 16

Completed a residency 73 18

Number of employers

for the first 5 years

!2 employers 226 56

Between the 6th and 10th years

!2 employers 132 38

Between the 11th and present

!2 employers 129 41

Work setting

Chain 113 36

Hospital 81 26

Independent 55 17Othera 69 21

Primary position

Staff 175 56

Manager 80 25

Owner 19 6

Assistant manager/director 12 4

Otherb 29 9

a Home care, infusion, mail order, industry, government, academia, and nuclear pharmacy.b Medical affairs, consultant.




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5.4. Consequences of empowerment

Loyalty, commitment, identification, and job-turnover intention were mea-sured among pharmacists. Results showed that the levels of consequences of

empowerment were moderate. Respondents ranked loyalty as the highest fol-

lowed by commitment, identification, and job-turnover intention (Table 2).

5.5. Analyses of variance

Results of the analyses of variance on the effects of work setting on psy-

chological empowerment and structural empowerment, and their respective

components are shown in Tables 3 and 4. Examining the effects of work set-ting on psychological empowerment revealed that pharmacists who worked

in independent settings had a significantly higher level of psychological

empowerment than those who worked in hospitals or chain pharmacies.

Table 3

The effects of pharmacists work setting on psychological empowerment (N 418)

Psychological empowerment

Groups

a

Mean difference Standard error Significance

b

Model1-2 0.67 0.12 0.00b F 10.89, Sig. 0.00b

1-3 0.55 0.12 0.00b

2-3 0.11 0.11 0.74

I. Meaning

Groupsa Mean difference Standard error Significanceb Model

1-2 0.24 0.15 0.40 F 2.31, Sig. 0.071-3 0.38 0.14 0.04b

2-3 0.14 0.13 0.70

II. Competence


1-2 0.28 0.12 0.09 F 2.34, Sig. 0.07

1-3 0.07 0.11 0.92

2-3 0.21 0.10 0.18

III. Self-determination


1-2 0.77 0.18 0.00b F 11.2, Sig. 0.00b

1-3 0.87 0.17 0.00b

2-3 0.10 0.16 0.92

IV. Impact


1-2 1.38 0.22 0.00b F 13.6, Sig. 0.00b

1-3 0.89 0.21 0.00b

2-3 0.48 0.19 0.06

a Group 1 Independent pharmacists, Group 2Hospital pharmacists, Group 3Chainpharmacists. Groups 1-2, 1-3, 2-3 comparisons between groups 1 and 2, 1 and 3, 2 and 3.b Significant level P < .05.




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A further examination of the effects of work setting on meaning, compe-

tence, self-determination, and impact was conducted. Pharmacists who

worked in independent settings had significantly higher levels of self-

determination and impact than those who worked in hospitals or chain

pharmacies.

Examining the effects of work setting on structural empowerment re-

vealed that pharmacists who worked in independent settings had a signifi-

cantly higher level of structural empowerment than those who worked in

hospitals or chain pharmacies. A further examination of the effects ofwork setting on opportunity, knowledge, support, and resources was

conducted. Results showed that pharmacists who worked in independent

settings had a significantly higher level of knowledge and support than those

who worked in hospitals or chain pharmacies. In addition, pharmacists who

worked in independent settings had significantly higher levels of opportunity

than did those who worked in chain pharmacies. Also, pharmacists who

Table 4

The effects of pharmacists work setting on structural empowerment (N 418)

Structural empowermentGroupsa Mean difference Standard error Significanceb Model

1-2 0.53 0.10 0.00b F 21.74, Sig. 0.00b

1-3 0.73 0.09 0.00b

2-3 0.20 0.08 0.09

I. Opportunity


1-2 0.26 0.13 0.19 F 16.55, Sig. 0.00b

1-3 0.73 0.12 0.00b

2-3 0.46 0.11 0.00b

II. Knowledge


1-2 0.80 0.11 0.00b F 25.46, Sig. 0.00b

1-3 0.82 0.10 0.00b

2-3 0.01 0.09 0.99

III. Support


1-2 0.50 0.14 0.00b F 9.12, Sig. 0.00b

1-3 0.62 0.13 0.00b

2-3 0.12 0.12 0.72

IV. Resources


1-2 0.28 0.16 0.27 F 1.74, Sig. 0.151-3 0.32 0.15 0.13

2-3 0.03 0.13 0.99

a Group 1 Independent pharmacists, Group 2Hospital pharmacists, Group 3Chainpharmacists. Groups 1-2, 1-3, 2-3 comparisons between groups 1 and 2, 1 and 3, 2 and 3.b Significant level P < .05.




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worked in a hospital setting had significantly higher levels of opportunity

than did their counterparts in chain pharmacies.

5.6. Structural equation modeling

Results of testing the overall measurement model of the structural equa-

tion analyses are shown in Table 5. Similar to Cronbachs alpha coefficients,

the values of composite reliabilities range from 0 to 1 and high values are

favored.26 Examining the factor loadings of the observed variables showed

that most of the lambdas (li) were high, which is indicative of convergent

validity. Most theta-deltas (qdi) were low to moderate indicating low mea-

surement errors.

Since the chi-square test is sensitive to sample size (c2 626.46, df 172,P < .05), 4 descriptive goodness-of-fit indexes were examined to provide ad-ditional information about the fit of the model: SRMR 0.06,RMSEA 0.07, CFI 0.91, and NNFI 0.88. The values of the good-ness-of-fit indices for SRMR, RMSEA, and CFI of the hypothesized model

are indicative of an acceptable model fit.

Table 5

Confirmatory analysis of antecedents and consequences of pharmacists empowerment

(N 412)

Parameter Estimatea (error variances) Composite reliability

l1 0.86 (0.25) L1L2 0.89l2 0.94 (0.12)

l3 0.89 (0.21) L3L4 0.78l4 0.71 (0.50)

l5 0.85 (0.28) L5L7 0.71l6 0.17 (0.97)

l7 0.89 (0.21)

l8 0.94 (0.11) L8L9 0.90l9 0.88 (0.22)

l10 0.74 (0.46) L10L13 0.68l11 0.70 (0.51)

l12 0.67 (0.55)

l13 0.19 (0.97)

l14 0.41 (0.83) L14L17 0.72l15 0.84 (0.29)

l16 0.72 (0.48)

l17

0.49 (0.76)

l18 0.74 (0.45) L18L19 0.60l19 0.54 (0.71)

l20 0.79 (0.38) L20L21 0.68l21 0.64 (0.59)

a Standardized estimates: c2 580.26; df 161; P 0.0; Root mean square error of approx-imation (RMSEA) 0.07; Standardized root mean square residual (SRMR) 0.06; Non-normed fit index (NNFI) 0.88; Comparative fit index (CFI) 0.91.




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(b630.46), commitment (b640.35), and identification (b65 0.17) on job-turnover intention are depicted in the model. Results showed that the

effects of psychological empowerment on loyalty, commitment, and identi-

fication among independent pharmacists were stronger than those among

hospital or chain pharmacists (Fig. 1)

Most of the goodness-of-fit statistics indicate that the model has an over-

all acceptable fit.26 Specifically, the fit statistics were: chi-square 31.22

(P .00), RMSEA 0.16, SRMR 0.09, GFI 0.91, NFI 0.91, andthe CFI 0.94.

5.6.2. Hospital pharmacists empowerment

The effects of power factors and need for achievement on psychological

empowerment (g11 0.62, g21 0.63) and structural empowerment(g12 0.23, g22 0.15) and the effects of psychological empowerment andstructural empowerment on loyalty (b31 0.25, b32 0.45), commitment(b41 0.04, b42 0.41), and identification (b51 0.34, b52 0.43) are shown.

Finally, the effects of loyalty (b630.19), commitment (b640.44), andidentification (b650.06) on job-turnover intention are depicted in themodel (Fig. 2).

The goodness-of-fit statistics indicate, with the exception of the RMSEA

value, that the model has an overall acceptable fit.26 Specifically, the fit sta-

tistics were as follows: chi-square 28.31 (P .00), RMSEA 0.12,SRMR 0.06, GFI 0.94, NFI 0.93, and the CFI 0.95.

Fig. 1. Model of independent pharmacists empowerment.




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5.6.3. Chain pharmacists empowerment

The effects of power factors and need for achievement on psychological

empowerment (g11 0.30, g21 0.46) and structural empowerment(g12 0.37, g22 0.26) and the effects of psychological empowerment andstructural empowerment on loyalty (b31 0.18, b32 0.46), commitment(b410.03, b42 0.56), and identification (b51 0.16, b52 0.50) areshown. Finally, the effects of loyalty (b630.17), commitment

(b640.34), and identification (b650.07) on job-turnover intentionare depicted in the model (Fig. 3).The goodness-of-fit statistics indicate, with the exception of the RMSEA

value, that the model has an overall acceptable fit.26 Specifically, the fit sta-

tistics were as follows: chi-square 33.77 (P .00), RMSEA 0.12,SRMR 0.07, GFI 0.94, NFI 0.92, and the CFI 0.95.

6. Discussion

Consistent with previous research in nursing, structural empowerment

had the following 4 distinct factors: support, opportunity, knowledge, and

resources.10 Similarly, psychological empowerment had the following 4 dis-

tinct factors: meaning, competence, self-determination, and impact.

Examining the effects of work setting on psychological empowerment re-

vealedthat pharmacists whoworkedin independent settings hada significantly

Fig. 2. Model of hospital pharmacists empowerment.




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higher level of psychological empowerment than those who worked in hospi-

tals or chain pharmacies. A further examination of the effects of work setting

on meaning, competence, self-determination, and impact was conducted.

Pharmacists who worked in independent settings had significantly higher

levels of self-determination and impact than those who worked in hospitals

or chain pharmacies.

Examining the effects of work setting on structural empowerment re-vealed that pharmacists who worked in independent settings had a signifi-

cantly higher level of structural empowerment than those who worked in

hospitals or chain pharmacies. A further examination of the effects of

work setting on opportunity, knowledge, support, and resources was con-

ducted. Pharmacists who worked in independent settings had a significantly

higher level of knowledge and support than those who worked in hospitals

or chain pharmacies. In addition, pharmacists who worked in independent

settings had significantly higher levels of opportunity than did those who

worked in chain pharmacies. Also, pharmacists who worked in a hospitalsetting had significantly higher levels of opportunity than did their counter-

parts in chain pharmacies.

Work settings in independently owned, hospital, and chain pharmacies

had significant effects on both psychological and structural empowerment.

Findings suggest that pharmacists who worked in independent settings

had a significantly higher level of psychological empowerment, based on

Fig. 3. Model of chain pharmacists empowerment.




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Fig.

4.

Confirmatoryfact

oranalysis.




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self-determination and impact, than those who worked in hospital or chain

settings. Independent pharmacists also had a significantly higher level of

meaning, which is defined as the congruence between an individuals values,beliefs, organizational behaviors, and work requirements, than those who

worked in chains.

Since independent pharmacies are separate entities and their owners are

pharmacists, one might argue that pharmacists are more likely to treat other

pharmacists who work with them as professionals and allow them to have

more autonomy and freedom in their jobs. In turn, those pharmacists work-

ing under such a manager would perceive that they have more impact in

their organizations.

Pharmacists who worked in independent settings had significantly higherlevels of structural empowerment than their counterparts in hospitals or

chain pharmacies. Specifically, independent pharmacists had significantly

higher levels of opportunity, knowledge, and support.

As mentioned earlier, perhaps pharmacists who own the independent

pharmacies, as opposed to those in chain pharmacies or in hospital settings,

collaborate with their colleagues and treat them as peers rather than as em-

ployees. That being said, however, results of this study indicate that the

work setting did not affect the pharmacists level of access to resources.

This finding indicates that lacking needed supplies, handling excessivepaperwork, and working short of adequate personnel are common work

conditions among pharmacies in all work settings.

The subgroup analyses based on the work settings independent, hospital,

and chain showed similar patterns with regard to the theoretical path model.

Almost all the paths were significant. There were, however, some differences

among the 3 groups with regard to the effects of identification on job-turn-

over intention and the effects of psychological empowerment on commit-

ment. Unlike hospital and chain settings, the independent work setting

resulted in a significant effect of psychological empowerment on organiza-tional commitment. It is likely that independent pharmacists have higher

levels of psychological empowerment, which in turn significantly affected or-

ganizational commitment. Unlike hospital and chain pharmacists, identifi-

cation was positively related to job-turnover intention. However,

identification did not significantly affect job-turnover intention among inde-

pendent pharmacists.

6.1. Implications of the study

6.1.1. Implications for pharmacy research

These findings suggest that future research in pharmacy needs to include

external as well as internal factors when examining pharmacists organiza-

tional behavior. Results of the study provide additional evidence supporting

Kanters theory that structures of the organization and work setting have an

impact on pharmacists organizational behaviors. A unique contribution of




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the present study to pharmacy administration literature is examining the ef-

fects of work setting on a comprehensive model that includes antecedents

and consequences of empowerment.Many researchers focused on examining the relationship between em-

powerment and organizational behaviors among nurses.4,5,10 Findings of

these studies supported Kanters structural theory.1 Specifically, the results

showed that nurses had low scores on empowerment and conditions of work

effectiveness. Researchers concluded that unless these conditions are

changed, nurses will more likely be less motivated, lack initiative, and be

less committed to their organizations.4,5,10 Health care administrators and

policy makers need to focus on the effectiveness of pharmacists work envi-

ronment. Recruiting qualified pharmacists as well as retaining them is essen-tial for succeeding in todays health care market. Specifically, through

increasing access to opportunity, knowledge, support, and resources, man-

agers can provide the key structural elements to empower pharmacists

and ultimately enhance the quality of patient care.

Based on the findings of this study, there is enough empirical evidence to

support that empowerment differs based on work setting. Further research

is needed to identify critical environmental factors that impinge on empow-

erment and organizational behaviors among pharmacists. Perhaps these en-

vironmental factors could be identified by interviewing pharmacists indifferent settings.

6.1.2. Implications for pharmacy education

Presently, it is common for pharmacy schools to offer their entry-level

students courses on health care administration, management, and market-

ing. Offering pharmacy students additional courses on organizational be-

haviors would be beneficial for pharmacists and their supervisors.

In addition to individual models, pharmacy students need to understandthe effects of environmental factors that influence their behaviors as well as

the behaviors of their supervisors. They would also benefit from being able

to recognize different types of work settings. Hierarchical organizations, for

instance, tend to foster authoritative styles of management whereas flat or-

ganizations tend to be more persuasive and allow their subordinates more

discretion. Having access to this information would be helpful to pharma-

cists in selecting their jobs, having positive relationships with their future

employers.

Finally, a deeper understanding of the effects of work setting on struc-tural determinants of organizational behaviors would enable educators, pol-

icy makers, and future leaders of the pharmacy profession to enhance the

quality of work life among pharmacists. The structuralist view, which

focuses on the effects of work environment on organizational behaviors,

provides guidance to decision makers in implementing policies that would

positively influence pharmacists organizational behaviors.




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6.1.3. Implications for pharmacy practice

Knowledge about values and goals of top management needs to be

clearly communicated to pharmacists, specifically in chain and hospital set-tings. Organizational goals and objectives need to be based on shared values

between management and pharmacists. Feedback on achieving these objec-

tives and administrative support for pharmacists must be actively distrib-

uted to assure collaboration between pharmacists and management.

Pharmacists need to have access to adequate resources to be able to ac-

complish their goals. Pharmacists in this study often worked without an ad-

equate number of pharmacy technicians, thereby decreasing the quality of

services. This shortage of personnel may lead to a decrease in patient coun-

seling services and an increase in potential medication errors. To enhancethe quality of patient care, pharmacists need to be involved in decisions

regarding resources and personnel that are important to their practice.

Decentralization of the decision-making processes, which pertain to phar-

macists job activities, needs to be implemented to create more productive

work environments in chain and hospital settings. Increasing pharmacists

professional responsibilities without involving them in decision-making pro-

cesses decreases their productivity and increases the likelihood of job

turnover.

6.2. Limitations

Despite the fact that the sample size was sufficient to conduct the statis-

tical analyses, the response rate, nonetheless, was modest. Second, the re-

search has a cross-sectional design; it is not possible to make definite

cause and effect conclusions without the use of longitudinal research. Third,

given the small number of pharmacy owners who responded to the survey,

researchers were unable to conduct separate analyses for pharmacy owners.

Finally, given the fact that a mail survey was used as a method to collectdata, it is not possible to be certain that all the surveys were completed

by the study sample. However, given the level of information and details

that the respondents had to know about their jobs and work environment,

the likelihood of this occurrence is very small.

6.3. Future research

Researchers may build on the study findings and conduct a longitudinal

study that examines pharmacists organizational behaviors at different worksettings. This would enable researchers to make definite conclusions on the

causal relationships between work settings, empowerment, and its conse-

quences. Recent pharmacy graduates might be tracked and their levels of

empowerment throughout their careers could be examined.

Additional research is also warranted on the role that pharmacy owners

play within their organizations. Researchers may stratify study samples




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based on position and test a model that captures the influence of owning

a pharmacy on empowerment.

7. Conclusions

Consistent with theoretical considerations, almost all the paths for the

structural equation modeling among the subgroups were significant. Results

of the study revealed that work setting had a significant effect on empower-

ment and its consequences. Pharmacists who worked in independent settings

had significantly higher levels of structural empowerment than their coun-terparts in hospitals or chain pharmacies. Specifically, independent pharma-

cists had significantly higher levels of opportunity, knowledge, and support.

Also, unlike hospital or chain pharmacists, structural and psychological em-

powerment had significant effects on loyalty, commitment, and identifica-

tion. Finally, loyalty among independent pharmacists significantly reduced

job-turnover intention.

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Appendix 1

Pharmacists structural empowerment

I. Opportunitya

Item

Having challenging work

Having the chance to gain new skills on the job

Having access to training programs for learning new things

Having a chance to work closely with their boss

Knowing how the organization works

Doing tasks that use all your skills and knowledge

Having the chance to advance to better jobs

Being rewarded for a job well done

Having the chance to develop individual friendshipsHaving the chance to utilize tuition reimbursement

II. Knowledgeb

Item

Relationship between the work in your unit to the work of the organization

How other people in positions like yours do their jobs

Values and goals of management

How salary and promotion decisions are made for people in positions like yours

This years plans for your unit work

What patients think of the work of your unit

What other departments think of the work of your unitIII. Supportc

Item

Having specific information about things that they did well

Receiving comments on things that they could improve

Getting helpful hints or problem-solving advice

Receiving suggestions about job possibilities open to them

Discussing their further training or education

Getting help in gaining access to people who can help to get the job done

Obtaining materials and supplies needed to get the job done

Getting help when theres a work crisis

IV. Resourcesd

Item

Lacking needed supplies

Handling excessive paperwork

Working short of adequate personnel resources

Getting money for themselves

Getting promotions for themselves

a 1Not at all, 5A lot.b 1No knowledge, 5Know almost everything.c 1None, 5A lot.d 1None; 5A lot.




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Appendix 2

Pharmacists psychological empowerment

I. Meaning

Item

Work is important to them

Job activities are personally meaningful to them

Caring about what they do on the job

Work that they do is meaningful to them

II. Competence

Item

Their confidence in their abilities to do their jobs

Their jobs are within the scope of their abilities

Their assurance about their capabilities to perform their work activities

They have mastered the skills necessary to do their jobs

III. Self-determination

Item

Having significant autonomy in determining how they do their jobs

Being able to decide on their own how to go aboutdoing their jobs

Having considerable opportunity for independence and freedom

Having a chance to use personal initiative in carrying out their work

IV. Impact

ItemHaving a large impact on what happens in their departments

Having a great deal of control over what happens in their departments

Having significant influence over what happens in their department

Making their opinions count in departmental decision-making process

1 Strongly disagree; 7 Strongly agree.



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