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“One possible reason why HRM has a limited impact on employee well-being is that the rate of adoption of more advanced or progressive HR practices by organizations is, in reality, quite low. Its impact, therefore, like the impact of either weak medicine or poison - depending on one’s point of view - tends necessarily to be quite limited.” Peccei (2004, p. 10).

1.1  Overview of the Study

Organizational commitment and job satisfaction are the most prominent individual outcomes of human resources management (HRM) practices in the organizational research (Boon, Den Hartog, Boselie, & Paauwe, 2011; Boon & Kalshoven, 2014; Gould-Williams et al., 2014; Gould-Williams, Mostafa, & Bottomley, 2015; Gould‐Williams, 2004; Marescaux, De Winne, & Sels, 2013). In the long-held debate over the HRM-performance model, the major focus has been on the organizational outcomes of HRM practices (Beer, Eisenstat, & Foote, 2009; Purcell & Kinnie, 2007). Little attention has been given to the individual outcomes of HRM practices, notwithstanding a few exceptions (Gould-Williams et al., 2014; Gould-Williams et al., 2015; Kooij et al., 2013; Van De Voorde, Paauwe, & Van Veldhoven, 2012; Wood, 2008). Even most of those works, which have focused on individual outcomes of HRM practices, emphasized them as means towards performance enhancement rather than as ends in themselves (Guest, 2002). This fact highlights the need for studies of the individual outcomes of HRM practices as ends in themselves, not as a means for something else. As part of the current debate, such studies would make crucial contributions in filling in the missing link in the HRM-performance model.

Moreover, organizations need to ensure that their employees are satisfied and committed in order to be in top performance mode (e. g., Alfes, Shantz, & Truss, 2012; Camilleri & Van Der Heijden, 2007). But what really matters in getting someone committed needs to be identified. Most scholars assert that positive worker attitudes emanate from employees’ perceptions that their employer is committed to them (e. g., Eisenberger, Fasolo, & DavisLaMastro, 1990; Gould-Williams & Davies, 2005). For instance, Gould-Williams and Davies (2005) suggest that managers need to convey a consistent signal through HRM practices, management trust, and resource allocation, so that employees reciprocate this via a positive worker attitude. In view of the social exchange theory, employees’ commitment to the organization derives from their perceptions of the employers’ commitment to and support of them (e. g., Bakhshi, Sharma, & Kumar, 2011; Blau, 1964; DeCotiis & Summers, 1987; Homans, 1958). It is also suggested that employees interpret organizational actions such as HRM practices and the trustworthiness of management as indicative of the organization’s commitment to them (e. g., Gould-Williams & Davies, 2005; Snape & Redman, 2010; Somers & Birnbaum, 2000). “High-commitment” HR systems have the tendency to shape employee behaviors and attitudes by evolving “psychological links” between organizational and employee goals (Arthur, 1994; Gould-Williams, 2004; Walton, 1985). In the view of Arthur (1994), managers using high-commitment HRM practices wish to see committed employees who can be trusted to use their discretion in discharging duties in ways that are consistent with organizational goals. In the same vein, Gould-Williams and Davies (2005) claim that organizations adopting a “soft” or high-commitment approach to HRM try to enhance worker performance by empowering, developing, and trusting workers to achieve organizational goals on the basis of mutuality of interests. Implied by this argument is that high-commitment HRM practices are those that signal management’s trust in employees, whereby employees reciprocate their perceptions in their own commitment to the organization. 

Organizational commitment is thus a function of such variables as the characteristics of the job performed by the workers, the characteristics of the organizations in which the tasks are performed, and the characteristics of the workers who perform the tasks (e. g., Allen & Meyer, 1990; Glisson & Durick, 1988; Gould-Williams et al., 2014; Gould-Williams & Mohamed, 2010). Thus, the causes of organizational commitment are quite diverse in nature and origin (Bashir & Ramay, 2008). This reminds us of the recent debate in the field of public administration that is about public service motivation (PSM), which drives the behavior of the worker who performs the task. Perry and Hondeghem (2008, p. 3) claim that PSM is “individual motives that are largely, but not exclusively, altruistic and are grounded in public institutions.”  In line with this, scholars suggest that over and above the role of HRM practices and the resultant employees’ job satisfaction, PSM plays a significant role in building employees’ organizational commitment (e. g., Gould-Williams et al., 2014; Gould-Williams et al., 2015; Pandey, Wright, & Moynihan, 2008). However, the use of a comprehensive model in which both HRM practices and PSM take leading roles in the process of building employees’ organizational commitment is scant in the literature, particularly with regard to sub-Saharan Africa.

Generally, studies conducted at the organizational level indicate that HRM practices affect organizational outcomes by shaping employee behaviors and attitudes (e. g., Huselid, 1995; Snape & Redman, 2010). Particularly, high-commitment HRM practices increase organizational effectiveness via empowerment, trust, and involvement of employees in the organization (Edgar & Geare, 2005; Gould-Williams et al., 2015; Gould‐Williams, 2004; Wood & De Menezes, 1998). 

More specifically, the work of Mostafa and Gould-Williams (2014) clearly indicates that the mere adoption of high performance HR practices does not lead to desirable employee outcomes; rather, they suggest the mediation effect of person-organization fit. The study is appealing in the context of the current debate for dealing with the relationship between HR practices and employee outcomes in a setting similar to the present study – that is, the Egyptian public sector. While most of the studies have focused on the relationship between HRM practices and measures of organizational effectiveness, only a few studies (e. g., GouldWilliams et al., 2015; Mostafa & Gould-Williams, 2014) have explored the role of HRM practices in this model, and none have explored the implication for countries in sub-Saharan

Africa (Debrah & Budhwar, 2004). Using “Contextually based Human Resource Theory”, Paauwe (2004) and Paauwe and Boselie (2007) argue that the particular political, historical, socio-cultural, and legal context hugely affects the design and implementation of HR practice. To understand the behavior of people in organizations, there is a need to take account of the knowledge of societies, of their language, their concepts, their values, their culture, which could be achieved through conducting studies in various contexts (Brewster, Tregaskis, Hegewisch, & Mayne, 2000; Hofstede, 1980). Consistent with this argument, the present study enables us to see the universal theories of HRM practices, PSM, job satisfaction and organizational commitment in light of the Ethiopian perspective. In line with this, there is a need to investigate the relationship between HRM practices, public services motivation, job satisfaction, and employee commitment in one model in Ethiopia, which is a large and typical representative of a sub-Saharan African country. The present thesis sees the various configurations of these four constructs and works towards answering the following basic research questions:

•      Does job satisfaction mediate the relationship between HRM practices and employees’ organizational commitment? 

•      To what extent is the relationship between HRM practices and job satisfaction moderated by public service motivation?

•      To what extent is the relationship between public services motivation and employees’ organizational commitment mediated by job satisfaction?

1.2  Conceptual Model of the Thesis

1.2.1. HRM practices, job satisfaction, and organizational commitment

HRM practice is believed to be the major determinant of employees’ organizational commitment (e. g., Boon & Kalshoven, 2014; Edgar & Geare, 2005; Gould‐Williams, 2004; Mostafa & Gould-Williams, 2014). However, the mechanism through which it influences employees’ organizational commitment is not as linear as some scholars report (Meyer & Smith, 2000). For Meyer and Smith (2000), the relation between HRM practices and employees’ organizational commitment is more of an indirect than direct nature, as it is believed to act through other variables. The most susceptible way that HRM practice is believed to affect employees’ organizational commitment is through employees’ job satisfaction. Job satisfaction is a work-related attitude that is more quickly developed but less stable than employees’ organizational commitment (Orth, Robins, & Widaman, 2012; Porter, Steers, Mowday, & Boulian, 1974). 

Due to the immediate nature of job satisfaction, as an outcome of HRM practices for employees, one may expect a more direct influence on job satisfaction than on employees’ organizational commitment. Hence, the effect of HRM practices on employees’ organizational commitment is more significant when it is through job satisfaction than when it is direct. Such a non-linear model of HRM practices to employees’ organizational commitment has not yet been empirically tested. Hence, we address the current model through testing the assumption that workers’ level of job satisfaction fully mediates the influence of HRM practices on employees’ organizational commitment. Though these variables are very well studied in the Western (Porter et al., 1974; Steijn & Leisink, 2006), Asian, and Middle East contexts (GouldWilliams & Mohamed, 2010; Taylor, 2014), they are not well addressed in the sub-Saharan Africa context, specifically for the health sector. Thus, the rationale of the study is to extend this long held theory of the West, Asia, and the Middle East to a sub-Saharan Africa context.

1.2.2. HRM practices, PSM, and job satisfaction

The debate about PSM is no longer about whether it exists or not. It is rather about whether the role of high-commitment HRM practices is more important than employees’ own predisposed desire to serve others (PSM) in making them satisfied with their job. In this regard, just as many scholars claim that HRM practices have the tendency to result in better job satisfaction (Boon & Kalshoven, 2014), there are scholars who believe that HRM practices may have a negative repercussion on employees’ attitudes (Barker, 1993; Guest, 2002). These are basically seen as two contradicting views about HRM practices’ outcomes for employees: the optimistic versus pessimistic views. The optimistic view posits that when employees feel that HRM practices are highly exercised, they feel more empowered, responsible, trusted, and developed (Snape & Redman, 2010). The more favorable the perception of employees about the HRM practices, the better their level of job satisfaction is. The pessimists, on the other hand, believe that if employees’ perception is that more progressive HRM practices such as high-commitment HRM practices are in place, they feel more prone to being exploited due to the closer supervision and systematic exploitation that comes about with the widely practiced HRM (Guest, 2002; Sewell & Wilkinson, 1992). 

There also is a third position, which claims that HRM practices should not have any effect on employees’ job satisfaction (Peccei, 2004; Peccei & Rosenthal, 2001). This view is termed skeptical, as the reason for the skepticism is the possibility of a moderation effect by some other variables that are more due to the individual employee than to the HRM practices. From the recent literature, it is apparent that PSM has attracted huge attention from scholars, and it is believed to have a close positive association with job satisfaction (Andersen & Kjeldsen, 2013; Taylor, 2014). Thus, employees with varying degrees of PSM may exhibit different levels of job satisfaction regardless of their perception of the prevailing HRM practices. Since employees with a high level of PSM are motivated by opportunities to serve the public interest, they need no or little reason to be satisfied with their job (Homberg, McCarthy, & Tabvuma, 2015; Vandenabeele, 2009). From this, we can infer that there is the possibility for PSM (the need to serve the public interest) to have a moderation role in the relationship between HRM practices and job satisfaction, such that at a higher level of employees’ PSM, a better perception of the prevailing HRM practices is associated with higher job satisfaction. At lower PSM, however, the employees’ perception of HRM practices may not have any effect on job satisfaction.

1.2.3. PSM, job satisfaction, and organizational commitment 

The long-held debate about the association between job satisfaction and organizational commitment has not yet culminated, particularly regarding the causal sequence of the constructs (e. g., Bateman & Strasser, 1984; Curry, Wakefield, Price, & Mueller, 1986; Porter et al., 1974; Veličković et al., 2014). There is no doubt that the two constructs have a significant positive relation, except for the interaction effect of job satisfaction with PSM on employees’ organizational commitment, which deserves research. The relation between PSM and job satisfaction itself is not yet clearly demarcated (Giauque, Ritz, Varone, Anderfuhren-Biget, & Waldner, 2011), notwithstanding the study by Taylor (2014), which claims a positive relation that goes from PSM to job satisfaction. However, according to Giauque et al. (2011), some public service orientations of employees may contribute to expectations that are incompatible with the working conditions of the organizations, which may lead the employees to experience negative effects on their psychological well-being. Here, one can see that there are some controversial reports about the relation between PSM and job satisfaction.

In our present model, though we study the direct associations of HRM practices and PSM with job satisfaction and employees’ organizational commitment, our focus is more on the regenerative and interactive effects of the constructs on employees’ organizational commitment. In the first place, we have ascertained that most research shows that job satisfaction is a more immediate effect of HRM practices and PSM (Andersen & Kjeldsen, 2013; Ray & Ray, 2011). Finally, in a more comprehensive phase of the study, the integrated impact of HRM practices, job satisfaction, and PSM on employees’ organizational commitment is tested. For a visual illustration of the study, see Figure 1.1 below.

1.3  Overview of the Research Context

Ethiopia is in east-central Africa, bordered on the west by Sudan, the east by Somalia and Djibouti, the south by Kenya, and the northeast by Eritrea. The country hosts a population of nearly 96.6 million people (CIA, 2015). See Figure 1.1a below for geographical details. 

As opposed to developed nation-states, human resource management (HRM) in Ethiopia is sub-optimal, as modern HRM concepts and practices are lacking and human resource (HR) functions are generally limited to traditional personnel administration tasks (Berhan, 2008). In the view of Berhan (2008), as the result of limited efforts to modernize HR functions as a strategic resource in the health sector and the limited investment into HRM capacity development, existing human resources department staff in HRM and leadership feature limited technical skills and experience. According to Berhan (2008), the Ethiopian health sector is known for an inadequate human resources structure and staffing at all levels, with limited capacity and practices in strategic and operational human resources planning and budgeting. For instance, human resources information systems are not fully functional to support HR planning and development, supportive supervision, performance monitoring and improvement. Ethiopia in general and its health sector in particular have major HR management challenges, including staff shortage, urban/rural and regional disparities, poor motivation, retention, and performance (FMOH, 2015), which is very different from developed nation-states.   

Although the Ethiopian government and private sector worked hard and achieved much in the area of health infrastructure construction and mid-level health professionals training, it does not appear that medical doctors’ retention mechanisms are sorted out, to date (Berhan, 2008; Hartwig et al., 2008; Lindelow & Serneels, 2006). For instance, in “20 years’ period (1987-2006), 73.2% of Ethiopian medical doctors left the public sector mainly due to attractive remuneration in overseas countries and local NGOs/private sectors” (Berhan, 2008, p. 3). The brain drain is so severe in Ethiopia that the nation's health minister has claimed that there are more Ethiopian doctors in Chicago than in his own country. Though globalization has both positive and negative influences on health systems in developing countries, for countries like Ethiopia, its impact is more negative than positive. Even though globalization enhances access to new technologies and less costly drugs, it also promotes the out-migration of physicians and nurses from countries with low incomes for health professionals to countries offering higher incomes for the same professional positions. Thus, globalization takes out the brains that are needed to innovate and utilize the modern technologies to deliver a high-quality health care service. For developing countries, which is very different for their developed counterparts, the effect of globalization is an exchange of a critical resource (HR) for non-critical resources (technologies and drugs). 

There are also major gaps in performance management and accountability in the health sector, where strong systems and practices are required to link performance goal-setting with monitoring and improvement, and with regular performance appraisal, rewards, and professional development needs (Berhan, 2008; Lindelow &Serneels, 2006). 

The above implies that it is imperative to investigate health workers’ perceptions of the prevailing HRM practices in such an under-researched context, and to test whether these perceptions might explain individual outcomes, such as public service motivation, job satisfaction, and organizational commitment. Findings in this area would enable the subSaharan Africa health sectors to draw lesson, from the developed nation-states regarding practices that help to retain and attract the qualified talent needed to bring local health care to a higher level.

Figure 1.1a Map of Present Ethiopia, Taken from the CIA World Fact Book

1.4  Methodology 

The thesis explores the relationships between HRM practices, job satisfaction, PSM, and employees’ organizational commitment. This is done by investigating the relationship of HRM practices with job satisfaction, PSM, and employees’ organizational commitment in two empirical studies and the relationship of PSM and employees’ organizational commitment in another study. In addition, the study investigates the relationships of employees’ organizational commitment and job satisfaction with demographic variables such as age, gender, sectoral tenure, educational qualification, salary, job category, marital status, and sector of employment kept constant. In the course of the current thesis, we controlled for the demographic variables since they were known to have some associations with the constructs of the thesis.

1.4.1. Research design 

A quantitative research design was deemed appropriate, primarily because of the nature of the subject and in order to allow for the precise and objective measurement of the dimensions of the constructs involved, such as HRM practices, job satisfaction, PSM, and employees’ organizational commitment, as experienced by the respondents. A cross-sectional survey method is chosen because it allows the study of associations between variables of interest in such a limited period of time and on people whose nature of work is not convenient for a longitudinal survey. Although it is not valid to establish causal relations, this suffices to investigate the strengths and quality of relations between variables using a cross-sectional survey technique (Hair, Black, Babin, & Anderson, 2010). Given the challenges of respondents’ unwillingness to engage in such an extra role of cooperating with researchers and the fact that most respondents are physicians who obviously are busy with patient care, the questionnaire method of data collection was considered appropriate. In this way a substantial amount of data could be obtained from a large number of employees in a relatively short period of time. This allowed for mobilization of four instruments such as HRM practice, job satisfaction, public service motivation, and employees’ organizational commitment in a single data collection session. 

1.4.2. Sampling and data collection 

The survey was targeted at Ethiopian health workers in permanent employment. There is a total of 51 hospitals in Addis Ababa, from which 3 hospitals were randomly chosen as a sample following a lottery method. A letter was sent to the medical directors of the three randomly selected hospitals in Addis Ababa, seeking permission to run a survey on their employees. After permission was obtained from the three hospitals, data were collected via a paper-based survey questionnaire. The questionnaire was distributed to all (1,100) permanent health workers in the three hospitals. To satisfy the hospitals’ research ethical guidelines, we were expected to submit the research proposal including the questionnaire for the Institutional Review Board (IRB) to approve and issue ethical clearance, which took about three weeks. The researcher together with the field work assistants then approached the respondents one by one to get the questionnaire filled. 

Though a total of 231 responses were obtained, due to missing values 7, 4, and 19 responses were discarded in study 1, 2, and 3 respectively. Based on an estimated total number of people approached, the response rate was determined to be about 21%. A majority of the survey respondents held a line staff position (83%

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