Organisational Factors, Fulfilment of the Psychological Contract and Quality of Patient-Care in Public Hospitals

Abstract

The study examined the impact of hospital organisations structure-related factors, namely, decentralisation, coordination and work autonomy, on perceived levels of psychological contract fulfilment of medical employees and the reported quality of patient care in not-for-profit public hospitals which are (a) attached to a teaching institution and (b) those which are only involved in providing medical services (railways non-teaching). The study was conducted on a sample of paramedical staff in both types of hospitals (N=200) in northern India dirough questionnaire method using five-point Likert-type scales. Responses of participants were statistically analysed through computation of correlation and stepwise regression analysis using SPSS programme. Results highlighted the importance of ‘co-ordination’ as the salient structural factor diat predicted perceived levels of psychological contract fulfilment and reported levels of quality of patient care in both types of hospitals. Mediator effects of perceived psychological contract fulfilment (PCF) on the relationship between the structural factors and quality of patient care through hierarchical regression analysis revealed that PCF mediated die prediction of quality of patient care by decentralisation and work autonomy only in the public (non-teaching) hospital but failed to mediate the prediction of quality of patient care by ‘coordination’ in both types of hospitals. Findings highlighted the significance of co-ordination among various specialities and departments in hospitals as the single factor that can be promoted by hospital administrators for increasing perceived contract fulfilment among their paramedical staff and their quality of patient care.