How Privatization and Corporatization Affect Healthcare Employees' Work Climate, Work Attitudes and Ill-health: Implications of Social Status

Abstract

Political liberalization and increased public costs have placed new demands on the Swedish public sector. Two ways of meeting these novel requirements have been to corporatize and privatize organizations. With these two organizational changes, however, comes a risk of increased insecurity and higher demands on employees; the ability to handle these changes is likely dependent on their social status within an organization. The general aim of the thesis is to contribute to the understanding of how corporatization and privatization might affect employees' work climate, work attitudes and ill-health. Special importance is placed on whether outcomes may differ depending on the employees' social status in the form of hierarchic level and gender. Questionnaire data from Swedish acute care hospitals were used in three empirical studies. Study I showed that physicians at corporatized and privatized hospitals reported more positive experiences of their work climate compared with physicians at a public administration hospital. Study II showed that privatization had more negative ramifications for a middle hierarchic level (i.e., registered nurses) who reported deterioration of work attitudes, while there were no major consequences for employees at high (physicians) or low (assistant nurses) hierarchic levels. Study III found that although the work situation for women and men physicians were somewhat comparable (i.e., the same occupation, the same organization), all of the differences that remained between the genders were to the detriment of women. The results of this thesis suggest that corporatizations and privatizations do not necessarily imply negative consequence for employees. However, the consequences appear to differ between groups with different social status. Employees whose immediate work situation is affected but who do not have sufficient resources to handle the requirements associated with an organizational change may perceive the most negative consequences.

The corporatization of healthcare organizations internationally: A scoping review of processes, impacts, and mediators

“…Corporatization reshapes the relations between clinicians and managers. Employees with “lower social status” and less “access to resources” are more likely to experience negative consequences from changing and uncertain environments (Falkenberg, 2010, p. 55). By contrast, clinical staff at the higher end of the corporatized structure reported little strain or change in their relationships.…”

“…From the perspective of managers, managerialism can be seen as a positive step through which their influence on health services as a form of production can be enhanced. In a study of Swedish hospitals, managers introduced “reporting and monitoring tools” in order to generate operational efficiency and initiated management systems designed to “reduce variation in ‘patient experience’” (Falkenberg, 2010). The upshot being that managerial authority was enhanced through the use of such tools and systems at the expense of what was once the traditional “domain of the owner‐doctors”.…”

“…Twenty-two articles used a qualitative design while 10 were quantitative; two papers were review articles(Braithwaite et al, 2011;Erny-Albrecht & Bywood, 2016).The predominant theoretical perspective was NPM, or related ideas of accountability, which informed 12 of the articles(Andrews et al, 2019;Kahancová & Szabó, 2015;Ferreira & Nunes, 2018;Ferreira & Marques, 2015;Mattei et al, 2013;Cruz & Major, 2016;Galetto et al, 2014;Wright et al, 2012;Allen et al, 2012aAllen et al, , 2012bHeins & Parry, 2011;Mosebach, 2009). Other studies concentrated on medical professionalism including impact on status, identity, and involvement in reform(Aldred, 2009;Bush et al, 2009;Falkenberg, 2010;Falkenberg et al, 2009;Hunt et al, 2019;Meghani, 2011;Turner et al, 2011;Turner et al, 2016;Uddin et al, 2020;Waring & Bishop, 2013); analyzed corporatized forms in relation to their environment using contingency or institutional theory or historical analyses(Lindlbauer et al 2016;Konda et al, 2019;Farris & Marchetti, 2017); or took an organizational governance or strategy perspective(Jankura, 2014;Kirkpatrick et al, 2017aKirkpatrick et al, , 2017bLee et al, 2008). Three articles did not have a discernible theoretical perspective(Galloway, 2008;Patena & Kaszyk, 2015;Rego et al, 2010).4.2 | Managerialism of medical work4.2.1 | ProcessesCorporatization introduces a variety of management processes for monitoring medical work.…”

Transformational Leadership and its Dimensions: Contributions in Organizational Change among Schools

“…This indicates that good working conditions may be important for engaging in transformational leadership behaviours. The importance of support structures to enable managers in the public sector to be effective have also been stressed in other studies (e.g., Berntson, Wallin, & Härenstam, 2012) Further, previous research suggest that organizational change affects employees' work climate, work attitudes and ill-health (Falkenberg, 2010). In line with these findings, the factor of 'continuous change' indicates that change may also have consequences for leadership behaviour, in the sense that transformational leadership behaviour could be hindered when the organization is in constant change.…”

Impact of Privatization on Health Sector in Kingdom of Saudi Arabia

“…The work environment and climate represent another variable in which privatization's effect has widely explore. One of the previous studies that examine this effect is a study of Falkenberg (2010) in which aims to explore the effect of privatization and corporatization on employees' work attitude and work climate. The dependent variables of his study are (work climate and employees' attitude) and the independent variable is the privatization process.…”