job sat. china 2010
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1
Job and Career Influences on the Career Commitment of Health Care
Executives: The Mediating Effect of Job Satisfaction
Introduction
The health care industry, like many other industries, has been undergoing
significant transformation and change (Kumar, Subramanian, Strandholm, 2002;
Gaynor and Hass-Wilson, 1999). Not surprisingly, as the health care industry has
changed so to have the careers of health care executives (Fahey and Myrtle, 2001). As
a result it is not uncommon to hear some health care managers say, If I knew what I
know now about this job I probably would not have entered this field in the first
place. With some reports noting that the career commitment of health care executives
is lower than other industries (Runy, 2003), this paper seeks to study the influence of
current employment contexts, job satisfaction and career experiences on the career
commitment of health care managers working in the five western states.
The literature on organizational commitment is extensive (e.g. Lee et. al, 2000;
Mathieu and Zajak, 1990), yet Goulet and Singh (2002) note there is a paucity of
research focusing on career commitment. Career commitment is defined as the
relative strength of an individuals identification with and involvement in a particular
profession or vocation (Blau, 1985; Lee et al., 2000; Mowday et al., 1982). Career
commitment has been found to be positively correlated with job satisfaction (Goulet
and Singh, 2002). They found that when employees are content with the nature of the
work itself, are satisfied with their supervisor and co-workers, and perceive current
pay policies and future opportunities for promotion, within their firm, to be adequate,
they will generally be satisfied with their jobs and thus high career commitment can
be expected. Their findings were in contrast to the work of Rhodes and Doering
(1983) who show that the effects of various antecedents on career commitment are
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mediated through job satisfaction.
There have been a few studies relevant to establishing the relation between job
satisfaction and organizational commitment. Porter et al. (1974) suggested that
satisfaction and commitment were related but distinguishable attitudes. More
specifically, they proposed that commitment represents a global evaluative link
between the employee and the organization, with job satisfaction among
commitment's specific components. Porter et al. (1974) further offered that
satisfaction would be associated with aspects of the work environment and thus would
develop more quickly than commitment, which would require a worker to make a
more global assessment of his or her relationship to the organization. Whereas the
instability and rapid formation of satisfaction would suggest it as a cause of
commitment, rather than vice versa, Bateman and Strasser (1984) note that the
validity of this perspective has not been established. Londons career motivation
model (1983) suggests that career commitment emerges from interaction between
individual characteristics, situational characteristics and career decisions and
behaviors. He suggests that the nature of the situation and the individual
characteristics affect career decisions and behaviors. Goulet and Singh (2002)
followed Londons career motivation model and consider job satisfaction is one of the
antecedents on commitment. None of these models has specifically examined the
relationship between job satisfaction and other aspects of the work environment and
thus influences a workers global assessment of his or her career.
Since one study (Runy, 2003) reported that nearly two-thirds of health care
workers reported thinking about leaving the health care field, this research examined
some of the work related factors that are believed to influence how health care
executives view their jobs, their careers and ultimately may affect their commitment
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to the career they are pursuing. In this study, the responses of 456 hospital managers
to a questionnaire designed to examine the relationship between their current work
situations, their job satisfaction and career commitment are reported. Using the
conceptual framework proposed by London (1983), this investigation builds on and
adds to the situational characteristics and career events that are believed to affect
career commitment. This framework and the work situation and career experiences to
be tested is presented in Figure 1.
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Insert Figure 1 about Here
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Influences on Career Commitment
Current Work Situation
Goulet and Singh (2002) found that a number of factors including job security,
job involvement, job satisfaction and organizational commitment would influence
career commitment. Chang (1999) observes that people bring a set of expectations to
an employment setting. Therefore, if an individuals perceived expectations for his or
her present job is fulfilled, he or she will have higher career commitment (Bedeian et
al., 1991; Farrell & Rusbult, 1981). Therefore, it is expected that,
Hypothesis 1: Health care managers who report their current job is meeting their
career expectations (MET_EXP) will have higher levels of career
commitment than workers whose current job is not meeting their
career expectations.
Position tenure has been found to be negatively related to job satisfaction and
positively associated with career commitment (Gregersen & Black, 1992; Mathieu &
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Zajac, 1990). Research on job tenure among managers has shown that employees who
remain in the same jobs for a number of years are less satisfied with their careers than
those who are more mobile (Veiga, 1981). However, Lee et al. (2000) in their meta-
analysis did not find an association between organizational tenure and occupational
commitment. Since the health care field continues to grow and develop it is logical to
expect that job mobility would increase. Fahey and Myrtle (2001) found that health
care executives changed jobs as part of their career progression. Since changing jobs
provide individuals opportunities to learn and to grow it is expected that,
Hypothesis 2: Position tenure (LONG) has a negative relationship with career
commitment.
Darney (2003) reported that during the last decade the number of hospitals has
declined by approximately 20 percent. These changes have been accompanied by
similar changes in the number of administrative positions. As a result, the hospital
administrator turnover rate has been averaging around 15 percent (Khaliq, Walston,
and Thompson, 2006). Sieveking and Wood (1992) noted that that these changes in
the health care industry have led health care administrators to express apprehension
about the future. As a result it is believed that,
Hypothesis 3: Perceived job security (SECURE) will have a positive relationship
with career commitment.
Mathieu and Zajac (1990) found that job level was positively correlated with
organizational commitment. Aryee et al. (1994) suggest that the extent to which a
persons job is seen as contributing their career objectives will influence their career
commitment. Blau (1985) notes that individuals seek to grow on their jobs and to
meet challenges. This suggests that the position one attains in an organization reflects
a sense of movement in their career as well as a return on their career investment.
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Thus administrators in senior level positions are likely to perceive a higher expected
utility from their job, face more demanding challenges and to allow for greater
growth. Hence,
Hypothesis 4: The higher the level of the managerial position attained (MANG) in an
organization will be positively related with career commitment.
Career Experiences
Career theory emphasizes the sequence of work-role experiences over time
(Latack & Dozier, 1986). In this research, career is defined as the sequence of work-
related experience and attitudes that the individual has over the span of his or her
work life (Yan et al., 2002). This suggests that over ones work life, these career
experiences evolve over time. Career stage theory recognizes that individual careers
change throughout ones working life and that different stages are marked by different
needs, concerns, and commitments (Bowen & Hisrich, 1986). Super (1957)
characterized these stages as 1) the exploration stage; 2) the establishment stage and
3) the maintenance stage. Aryee et al. (1994) found that career commitment had a
positive relationship with skill development. Since each of the career stages reflects a
progression in the development and application of ones knowledge and skills, that the
following is expected,
Hypothesis 5: Career stage (STAGE) is related to the career commitment.
Casson and Bennison (1984) suggest that career outcomes are shaped by the
opportunities that are available within an organizational context. Gattiker and
Larwood (1988) found that the type of business a person was in influenced their
perceptions of career success. The Bureau of Labor Statistics (BLS 2006) notes that
health care is both the largest industry in the nation and the industry that will create
more jobs than any other industry sector. They report that 41 percent of all jobs in the
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health care industry were in hospitals, 22 percent in nursing and residential care
facilities and 16 percent in the offices of physicians (BLS 2006).
In spite of this growth, Runy (2003) found that the health care industry has a
work force commitment index that is well below that of other industries. She reports
that hospital workers have slightly higher work force commitment scores than
ambulatory care centers and both have commitment scores that are higher than
workers in long-term care facilities. Not surprising, Fahey and Myrtle (2001) found
that slightly more than one-third of the administrators changed their jobs. While most
job changers remained in the same service delivery sector (e.g. hospitals) one third
moved to a difference service delivery sector in the health care industry (e.g. hospital
to medical group) (Fahey and Myrtle, 2001). Since increased mobility can provide
managers with personal or career growth opportunities, it is believed that,
Hypothesis 6: Health care managers who change service delivery sectors
(SECT_CHG) (e.g. from ambulatory care to hospital administration)
will have a higher career commitment than those who did not change
their service delivery sector.
Vardi (1980) noted that most research on careers has focused on management
and professional careers and has tended to characterize career mobility in terms of
upward movement. He suggests that career mobility should extend beyond
promotions to include horizontal job movement as well. Arthur (1994) argues that as
the nature of organizations change our understanding of careers also needs to change.
While he notes that many careers will continue to reflect movement within and
between organizations, these patterns will not be as clearly defined as they have in the
past. Even so, Kanchier and Unruh (1989) found that most people tend to remain in
the same occupational category when they change jobs.
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In their study of the career patterns of health care executives, Fahey and
Myrtle (2001) identified four different job change patterns. The most common pattern
was one of multiple changes between different sectors of the health care industry.
They found that while most job changes did not lead to a career change, nearly 40
percent of them indicated that their job change was also a career change. Since,
Shamir and Arthur (1989) found that career change was strongly related to job
change, the following is suggested,
Hypothesis 7: The job change patterns (PATTERNS) of health care managers is
positively related career commitment.
Research suggests that most people tend to remain in the same occupational
category when they change jobs (Kanchier and Unruh, 1989; Fahey and Myrtle,
2001). Since Rhodes and Doering (1983) view a career change as movement to a new
occupation that is not part of a typical career progression, a change from one industry
(e.g. banking) to another (e.g. health care) is likely to involve, or to be described as a
career change. Because Cherniss (1991) and Chang (1999) found that persons who
changed their career were less committed to their present careers than were those who
had not changed their careers, it is hypothesized that,
Hypothesis 8: Managers, who moved from a management position in non-health care
industry (ANOTHER_) to one in the health care industry, will have
lower career commitment than managers who have not held a
management job outside the health care industry.
Hall (1971) suggests career commitment was influenced by the extent to
which a person feels they are competent and successful in their career role. Ayree and
Tan (1992) found that there was a significant and positive relationship between career
satisfaction and career commitment. Ng, Eby and Sorensen (2005) point out that
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people assess their career success through a number of different mechanisms
including their satisfaction with their careers and how their career has progressed
relative to others. Thus,
Hypothesis 9: Career satisfaction (SATISFY) will have a positive association with
the career commitment.
The Role of Job Satisfaction as a Mediator Variable
Career commitment has been found to be positively correlated with job
satisfaction (Goulet and Singh, 2002). When employees are content with the nature of
the work itself, are satisfied with their supervisor and co-workers, and perceive
current pay policies and future opportunities for promotion, within their organization,
to be adequate, they will generally be satisfied with their current jobs and thus high
commitment can be expected. Some studies show that the effects of various
antecedents on career commitment are mediated through job satisfaction (Rhodes and
Doering, 1983). Similarly, Farrell and Rusbult (1981) described job satisfaction as an
intervening variable to be a function of rewards and costs associated with the job,
with job commitment resulting from job satisfaction, investments, and alternatives.
Rusbult and Farrell (1983) found support for their model in a longitudinal
investigation with nurses and accountants and, thus, identified satisfaction as an
antecedent of commitment. However, the Rusbult and Farrell (1983) model is based
on a behaviorally oriented commitment, whereas the present research takes an
attitudinal focus. However, others find that job satisfaction doesnt mediate the effects
of other antecedents on commitment; rather these antecedents influence career
commitment directly (Goulet and Singh, 2002).
Hypothesis 10: Job satisfaction (JOBSAT) has a positive relationship with the career
commitment.
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Hypothesis 11: Job satisfaction (JOBSAT) also mediates the association of current
work situation and career experiences with career commitment.
Control Variables
A number of demographic and individual characteristics have been found to
influence the needs and expectations a person seeks from the job, their satisfaction
with their work and ultimately their career commitment. For instance, education has
been found to have a positive relationship with career change (Cabral, et al., 1985);
ones career identity, goals and values (Colarelli and Bishop, 1990); career success
(Melamed, 1996). Since most health care managers are college educated and many
have advanced degrees we will use education as one of our control variables.
The relationship between gender and career commitment has not been
consistently demonstrated. For instance, Judge et al. (1995) report that gender has
been found to be a factor in the levels of career attainment, with women having lower
levels of career success than men. However, Korabik and Rosin (1995) note that
while women are perceived to be less career oriented than men, and that women with
dependent children are even less likely to be committed to their careers than women
who are childless, they did not find these factors to be associated with a reduced
commitment to their work or to their organizations. On the other hand, Melamed
(1996) pointed out that marriage, home roles and responsibilities reduced a womans
work experience and ultimately her career success. Since many women work in
health care organizations as nurses and health care providers and, as a result hold
many supervisory and management positions in different health care organizations,
we will control for gender in our analysis of career commitment.
Judge et al. (1995) note that married individuals achieve higher levels of
objective success than their unmarried counterparts. Melamed (1996) notes that while
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Variables and Measurement
Education (EDU) was a measure that asked respondents to indicate their highest
educational level (1=less than baccalaureate, 2=baccalaureate, 3=masters,
4=doctorate).
Gender was coded as 0=female, 1=male
Ethnicity (ETHNIC) was measured as 1=Asian, 2=Black, 3=Caucasian, 4=Hispanic,
5=Other. Because of the small number of minority respondents, the measure was
recorded with 0=Minority, 1=Non-Minority.
Dependents (CHILD) were measured as the actual number of children at home.
Married (MARRY) was coded as 0=not married, 1=married.
Met Expectations (MET_EXP) measures the extent to which the current job meets
the respondents career expectations. Following an approach used by Hrebiniak and
Alutto (1972) we constructed a met expectations measure (Cronbach 0.87) by
computing the absolute magnitude of the difference between two scales. The first
scale asked the respondents a set of questions about the importance of selected items,
derived from the Job Satisfaction Survey (Spector, 1985), in deciding to enter the
health care. These items were rated using a 5 point scale ranging from 1=not
important, 5=very important. Later in the survey, respondents were presented with
these items again and asked to indicate their satisfaction with these items on their
current job with 1=not satisfied and 5=very satisfied.
Job satisfaction (JOBSAT) was measured using 10 items from the Job Diagnostic
Survey developed by Hackman and Oldham, (1974). In this research, healthcare
executives rate their satisfaction on a scale from 1 = very dissatisfied to 5 = very
satisfied. Items included autonomy, challenge, and professional growth. By using
principle component factor analysis, we found that these items formed one factor,
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which explains 53.8 percent of the total variance. The internal reliability Cronbach
is 0.90. Factor loading structure can be found in Table 1
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Insert Table 1 about Here
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Position Tenure (LONG) was obtained from a question asking how long the
respondent had held his or her current position.
Job Security (SECURE) was obtained from a question asking them to indicate how
secure they felt in their current position (1=quite insecure, 5=very secure).
Management Level (MANG) was based on the position title provided by the
respondents. The lead investigators separately coded the 19 different job titles
provided by the respondents into 5 management levels (1=supervisory level, 2= lower
level managemente.g. department head, 3=mid-level managemente.g. director,
4=senior levele.g. COO and 5=executive levele.g. CEO). In the several
instances were there some disagreement as to the proper level, it was resolved by
identifying the sector the respondent worked in and comparing their reported job titles
to the job titles by level that are commonly used in that industry sector.
Career Stage (STAGE) was based on the respondents selection of the career stage
that best described their view of their career. Respondents were provided with a
description of three different career stages (establishment, advancement and
maintenance) and then were asked to indicate the career stage they felt they had
achieved.
SectorChange (SECT_CHG)was determined by comparing the sector the
respondent was currently employed in (hospital, ambulatory care, long term care, and
other health care) with the sector of their first health care job. If the current sector
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was different from their initial employment sector, this difference was recorded as a
sector change (0=no change in sector, 1=change in sector).
Career Patterns (PATTERN) were based on the different career patterns noted by
Fahey and Myrtle (2001). They identified 4 different patterns (traditional, change of
sector, back and forth movement between two sectors and, multiple sector moves).
The survey instrument described these 4 patterns and respondents were asked to
identify the pattern that characterized their career.
Industry Change (ANOTHER_) as part of the questionnaire, respondents were asked
if they held a management position in another industry prior to their entering the
health care field (1=yes, 0=no).
Career Satisfaction (SATISFY) was based on a scale created by the summation of
responses to two questions about their careers (Cronbach 0.68). The first asked
respondents to rate their satisfaction with their career progression (1=very dissatisfied,
5=very satisfied) and the second asked that they consider the satisfaction of their
career progression relative to others with similar backgrounds (1=very much worse,
5=very much better).
Career Commitment (COMMIT)was measured using a scale initially developed by
Blau (1985). Sample items used in this research include "if I could do it all over
again, I would choose a management career in healthcare; I would recommend a
healthcare management career to others; If I could get a management job outside of
healthcare that paid the same as my current job, I would probably take it (reversed
scored). These measures were assessed using a five-point scale (ranging from 1 =
strongly disagree to 5 = strongly agree). The total score of career commitment ranged
from 3 to 15 (Cronbach 0.74).
Sample and Procedure
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Twenty seven hundred and ninety nine questionnaires were mailed out to
members of the American College of Healthcare Executives (ACHE) residing 5
western states (Arizona, California, Nevada, Oregon and Washington). Six hundred
and forty-three responses were received (22.9%) and after eliminating those who were
retired or were students, a sample of 456 respondents who were currently employed in
the hospital or health systems industry was obtained. A comparison of the age and
gender differences of the ACHE members the survey was mailed to and those
responding did not reveal any marked differences between the two groups. The
average age of the ACHE members in the mailed sample was 47.66 years compared to
an average age of 48.13 for the respondents. Forty-one percent of the ACHE
members in the mailed sample were female compared to 41.4 percent of the
respondents who identified themselves as female in their responses. These results
suggest the demographic characteristics of those sampled were quite similar to those
who responded to the survey.
Statistical Methods
Path analysis was conducted to test the hypothetical models, as shown in Figure
1. Path analysis determines whether our theoretical model successfully accounts for
the actual relationships observed in the sample data. Path analysis dealt with models
with manifest (observed) variables. Several modifications to the original theoretical
model were conducted to test whether the model chi-squire statistics improved if a
given path were added to the model (MacCallum et al., 1992). The modification
procedures continued till an acceptable fit is obtained.
We reviewed several fit statistics to assess our revised model. The RMSEA and
the normed fit index (NFI) were reported. We also examined the goodness-of-fit index
(GFI), and the comparative fit index (CFI). Standardized path coefficients were
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reported to determine which independent variable has the largest effect on career
commitment.
Data and Descriptive Analysis
Two hundred and thirty-five (235) of the 456 respondents in this study were male
(52%). Of these, 297 were married (65%) and 196 had children (48%). Most
respondents (367) were White (82%); with 39 reporting their race as Black (9%), 23
were Asian (5%), 10 were Hispanic (2%) and 9 were other racial categories (2%).
The average age was 48.13. Three hundred and sixty-five respondents (80%) had
masters degrees, 44 had bachelor degrees (10%) and 36 had doctoral degrees (8%).
Upon entering the most frequently mentioned position held was nursing (62) and
the first sector most people (345 individuals) worked was the hospital/health system.
The positions held by respondents included senior management (CEO, CIO, CFO,
CMO, CNO, and COO) 38% (n = 172), 43% in middle management positions
(Assistant Administrator, Director, Department Head) (n= 195), 10% held first line
management positions (n = 47) and 4% (n = 20) were in staff roles. On average, they
have been in their current position for 5.5 years (s.d. 5.80343).
Most respondents (218 individuals) characterized their career as traditional, i.e.,
remain in the same sector they started their careers in, while 76 indicated that their
careers had multiple changes, (i.e., movement among multiple sectors). Most (41%, n
= 183) felt secure in their current position although 17% (n = 77) were not. Most
(36%, n = 164) said they were very satisfied with their careers while 16% (n = 73)
were not. While most said they would choose this career again, less than half (48%)
indicated they would remain in the field even if they could get a similar job
elsewhere.
Results
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The model in Figure 2 summarizes the direct relationships between individual
variables, current work situation, career experiences and career commitment. None of
the individual characteristics were found to have statistically significant relationships
with career commitment, and were not further modeled. Since some studies have also
reported similar results, the lack of a relationship between these demographic
characteristics and career commitment is not surprising. However, the lack of a
statistically significant relationship between education and career commitment is
interesting. It is probably due to the fact that many respondents are college graduates
or have advanced degrees.
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Insert Figure 2 about Here
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Based on previous research, the researchers expected that all of the current work
situation measures would have a statistically significant direct relationship with career
commitment. As shown in the model in Figure 2, two measures, job security
(SECURE), and management level (MANG), were found to have a statistically
significant association with career commitment. Hence support for Hypotheses 2 and
4, and 10 were found. Although the relationship between position tenure (LONG) and
career commitment was not statistically significant, it was in the predicted direction.
On the other hand the extent to which the current job fulfilled career expectations
(MET_EXP) was neither statistically significant or in the expected direction. Thus
support for Hypotheses 1 and 2 not found.
Only two of the career experiences were found to have a statistically
significant relationship with career commitment. As expected, the respondents
satisfaction with their career (SATISFY) was positively associated with career
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commitment. The relationship between changes from one management position to
another in a different sector of the health care field (SECT_CHG) was also
statistically significant. Thus Hypothesis 6 and Hypothesis 9 were supported.
Contrary to the investigators expectations, a statistically significant relationship
between ones career stage (STAGE), their career pattern (PATTERN) and career
commitment was not found. Thus hypotheses 5 and 7 were not supported. The
variable of holding a management position in another field (ANOTHER) did not show
significant association with career commitment although it was in the hypothesized
direction thus Hypothesis 8 was also not supported.
Lastly, Job Satisfaction was found to have a statistically significant
relationship with Career Commitment. Thus, Hypothesis 10 was also supported.
To obtain a parsimonious model, only significant variables were further examined
for testing the mediator role of job satisfaction on career commitment. After several
modifications, a revised model was obtained (Figure 3). All standardized coefficients
in
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Insert Figure 3 about Here
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the model are statistically significant at p
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commitment independent of job satisfaction. These relationships have a goodness of
fit statistic (GFI=0.95; RMSEA=0.04, and NFI=0.98, CFI=0.98) suggesting that this
model provides a good fit for the data explaining the career commitment of healthcare
managers.
Discussion
These results suggest that a persons commitment to their career is a function of
several different influences. Certainly ones personal situation may play a role for
some although in this research it does not emerge as a significant influence. This is
consistent with findings from other industries where education, gender and ethnicity
do not appear to have a direct influence on career commitment. Inasmuch as most
health care managers, especially at the more senior levels, have advanced degrees in
management, the influence of education may provide them with greater flexibility in
responding to the opportunities that the diversification of the health care industry
appears to be creating. As others have noted, careers are changing and thus perhaps
our view of our career and the degree of commitment to those choices is changing as
well.
These changes in the health care industry may explain the lack of relationships
between gender, marital status, dependents, ethnicity and career commitment. Fahey
and Myrtle (2001) found that while female managers had different career patterns
than males, there was no difference in their satisfaction with their careers, or their
satisfaction with their career progression relative to others. With increased mobility
between different sectors of the health care industry, coupled with the overall growth
of the industry, it is possible that these changing career opportunities may influence
the lack of differences in their commitment to their careers. These changes in the
industry may also provide more career alternatives to managers who are married, have
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dependents, or may be a member of a minority group.
In contrast to the expected lack of relationships between individual
characteristics and career commitment, several statistically significant predictors of
career commitment emerged from the situational influence and career experience
categories. Job satisfaction was found to have a positive relationship with career
commitment. Career satisfaction and job security express themselves partly through
job satisfaction on career commitment. Contrary to previous research, neither
position tenure nor the extent to which the current job met the career expectations of
the respondent was predictors of career commitment in the unmediated model.
However, in the mediated model, tenure emerged as a predictor of job satisfaction
while met expectations did not.
In addition to these situational influences, it was hypothesized that different
career experiences would have an influence on career commitment. In the
unmediated model, sector change and career satisfaction were found to have a
statistically significant relationship with career commitment. In the mediated model
sector change was found to have a direct effect on career commitment. This is
consistent with the researchers belief that changing employment sectors (e. g. moving
from an administrative position in long term care to an administrative position in an
ambulatory care setting) would increase career options and hence lead to increased
career commitment.
While the investigators also believed that satisfaction with ones career would
have a direct effect on career commitment, this study also found that job satisfaction
mediated the influence of career satisfaction on career commitment. This finding
helps clarify the relationships between career satisfaction, job satisfaction and career
commitment. It also underscores the complexity of the patterns of experiences that
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influences career commitment. In the health care field the organizational and
interorganizational changes that are occurring appear to be creating opportunities for
people to find career satisfaction by moving into other sectors and new challenges.
This increased mobility, as measured by the patterning of changes across different
health care sectors, increases ones satisfaction with their jobs and ultimately their
career commitment.
Neither career stage, career pattern and industry change were found to
influence career commitment. A post-hoc analysis found that only respondents in the
maintenance stage of their career had a positive association with career commitment.
However, neither this stage nor the other two career stage measures were found to
have statistically significant associations with career commitment. A similar post-hoc
analysis of career pattern and career commitment found that respondents with
traditional careers were associated with lower levels of career commitment than were
those who either made a single sector change or who moved between multiple sectors.
Neither of these differences were statistically significant however. It can be
conjectured that reliance on a traditional career in an ever changing industry may
produce a degree of insecurity with ones career choice and hence commitment to
ones career.
Unfortunately, ACHE does not collect data from individuals who elect to terminate
their membership (Personal correspondence, February, 2009), thus the authors are
unable to examine this relationship.
The study found that job satisfaction mediated the influences between the
length of time a respondent held their current position and their career pattern. Job
satisfaction partially mediated the influence between perceptions of job security and
ones satisfaction with their career. Both of these measures also had a direct influence
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21
on career commitment. Last, sector change had a direct influence on career
commitment. Consistent with Goulet and Singh (2002) this research found job
satisfaction to contribute to variations in career commitment. Consistent with Lee et
al. (2000) and contrary to the investigators expectations, position tenure did not have
a direct influence on career commitment. However, in contrast with Gregersen &
Black, (1992); and Mathieu & Zajac, (1990) a negative relationship between position
tenure and job satisfaction was not found. Nor did the research reveal a relationship
between position tenure and career commitment. These results suggest that mobility
between sectors and the length of time in ones position may have a positive influence
on job satisfaction and ultimately career commitment.
The findings suggest that factors influencing the career commitment of health
care managers are varied and are influenced by a number of different conditions.
Perhaps part of the explanation can be found in the nature of transformations that are
occurring in the industry. While the industry has experienced consolidation and
integration it has also experienced growthgrowth that is expected to continue for
some time. These two changes, the growth of the industry and the blurring of
mobility barriers between sectors, may be providing health care managers with more
and perhaps different job and career opportunities than has been the case in the past.
Unfortunately the cross-sectional nature of this study does not allow us to test for
these influences.
As the largest and perhaps one of the most occupationally diverse industries,
health care provides an excellent laboratory to study the changing nature of
occupations. While this research offers some insights into the factors affecting the
career commitment of health care executives, the sample was limited to respondents
who were members of the American College of Healthcare Executives, and thus may
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22
not represent the views of all managers in the health care sector. Since ACHE
membership involves testing and continuing educational achievement it is possible
that they may be more career-involved than non-members. Inasmuch as the
respondents are very highly educated with most having advanced degrees, these
factors may limit the generalizability of these findings. However, membership in
ACHE is increasingly occupationally diverse, thus suggesting that these relationships
may not be limited to this sample.
These limitations notwithstanding, with the continuing growth and evolution of
the field, longitudinal studies of how these changes are influencing professional and
managerial careers, seem very appropriate. Perhaps these findings will offer a point of
departure for future studies.
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23
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Table 1: Factor Loading Structure of Job Satisfaction
Component Matrixa
Satisfaction with autonomy in current position .680
Satisfaction with challenge in current position .778
Satisfaction with responsibility in current position .784
Satisfaction with advancement opportunity in current position .667
Satisfaction with prestige in current position .691
Satisfaction with creativity in current position .780
Satisfaction with job security in current position .547
Satisfaction with professional growth in current position .803
Satisfaction with nature of work in current position .790Satisfaction with content of work in current position .777
Extraction Method: Principal Component Analysisa
1 component extracted.
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1
Figure 1: A Conceptual framework of the Determinants of Career Commitment (Path
diagram)
Current Work Situation
Met Expectations Position Tenure Job Security Management Level
Career Experiences
Career Stage Changed Service
Sectors
Mobility Pattern Changed Industry Career Satisfaction
Career CommitmentJob Satisfaction
Controls
Education Gender Marital Status Dependents Ethnicity
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Job and Career Influences on the Career Commitment of Health Care Executives:
The Mediating Effect of Job Satisfaction
Duan-rung Chen, Ph.D
Associate Professor
Graduate Institute of Health Care Organization Administration
College of Public Health
National Taiwan University
Taipei, [email protected]
Robert C. Myrtle, DPA
Professor of Health Administration, and
Professor of Gerontology
School of Policy, Planning, and Development
University of Southern California
Los Angeles, California, 90089-0626
Caroline H. Liu, Ph.DNational Central Library
Taipei, Taiwan
Daniel F. Fahey, MPH, Ph.D
Professor of Health Services Administration
Department of Health Science
California State University
San Bernardino, California