Social capital in healthcare A resource for sustainable engagement in organizational improvement work

Social capital, work engagement, working conditions, and leadership are concepts that have been studied previously, but there is lack of knowledge about what processes promote sustainable organizational improvement work in hospitals, and specifically, what leads healthcare professionals to engage in clinical developments. The overall aim of this thesis is to increase knowledge of how social capital and engagement contribute to organizational improvement work in hospitals and how social capital and engagement are created during organizational improvement work. In Study I, the aim was to assess dimensions of engagement among healthcare professionals and to investigate how these are related to work conditions during organizational redesign of care processes. In Study II, the aim was to assess working conditions and social capital association with intention to leave, and to investigate if social capital moderates the association between job demands and intention to leave. Study III aimed to investigate the importance of social capital for job satisfaction, work engagement, and engagement in clinical improvements among healthcare professionals. In Study IV, the aim was to explore whether qualities of leadership have impact on social capital among employees in hospital settings over time, and if so, what those qualities are. The empirical material is based on data from one research program including three research projects. Data were collected by a questionnaire at three times over a period of two years, and all studies are quantitative. The studies are based on a hospital cohort including five hospitals. In Study II, cross-sectional data were analysed. In studies I, III, and IV, longitudinal data were analysed. The results show that improved working conditions and employees’ attitudes to engagement in improvement work are associated with and have importance for healthcare professionals’ work engagement and clinical engagement in improving care processes (Study I). Job demands, social capital, and other job resources are associated with healthcare professionals’ intention to leave their jobs, whereas high levels of social capital are associated with low levels of intention to leave (Study II). Increased social capital predicted healthcare professionals’ job satisfaction, work engagement, and engagement in patient safety (Study III). Leadership is shown to be important for healthcare professionals’ social capital, and levels of leadership quality correlate with levels of social capital over time (Study IV). In conclusion, social capital, increased job resources, and decreased job demands are important conditions for healthcare professionals’ engagement in organizational improvement work. To develop social capital, leadership quality is an important precondition. Social capital can be regarded as a resource for sustainable organizational improvement work in healthcare, because of its importance for healthcare professionals’ engagement, job satisfaction, and intention to leave.