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Quality of Work Life and Organizational Performance: The Mediating Role of

Employee Commitment

Article  in  Journal of Health Management · September 2015

DOI: 10.1177/0972063415589236

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Article

Quality of Work Life and Journal of Health Management

17(3) 263–273
Organizational Performance: © 2015 Indian Institute of
Health Management Research
The Mediating Role of Employee SAGE Publications
sagepub.in/home.nav
Commitment DOI: 10.1177/0972063415589236
http://jhm.sagepub.com

Tanaya Nayak1
Chandan Kumar Sahoo1

Abstract
Background
The quality movement in health care has recognized better quality of work life (QWL) of employees as
an important rubric for a health care organization’s performance. Health care employees are the front
lines of the health care delivery system. However, studies on the QWL of private health care unit’s
employees are limited.
Methodology
This research investigates the relationship between QWL, organizational performance (OP) and
employee commitment (EC). A self-designed questionnaire was distributed to 300 health care employees.
Out of which only 205 valid responses were received resulting in a response rate of 68 per cent from
the survey. The data were analyzed using SPSS 20.
Results
The findings show that EC acts as a partial and a significant mediator in the relationship between QWL
and OP. Mediation analysis was also conducted for each dimension of QWL, EC and OP to reinforce
the results.
Conclusions and Recommendations
Findings can be used by health care units’ managers and policy makers to design and implement appro-
priate initiatives to improve QWL. Better QWL is the key to attract and retain qualified and motivated
employees and can possibly lead to enhanced quality of services in health care organizations.

Keywords
Quality of work life, employee commitment, organizational performance, health care

1
School of Management, National Institute of Technology, Rourkela, Odisha, India.

Corresponding author:
Chandan Kumar Sahoo, School of Management, National Institute of Technology, Rourkela 769 008, Odisha, India.
E-mail: sahooc@nitrkl.ac.in

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264 Journal of Health Management 17(3)

Introduction
The winds of globalization have catalyzed the intensity of competition, leading to changes in strategy
and structure of health care organizations. In this dynamic environment, the doctrine to emerge as a
leader is ‘Quality’, from quality of service for the customers to quality of work life (QWL) for the
employees. The quality of service aids in creating value, customer satisfaction and customer retention,
whereas the QWL is the foundation of well-being of employees and leads to better performance. Health
care employees are the front lines of the health care delivery system. They play an important role in the
safe and healthy recovery of patients, but their well-being is often ignored. They regularly deal with
challenging and crucial tasks that exert intensive physical and psychological pressure on them.
Specifically, heavy workload, workplace hazards, occupational stress (OS) and exposure to unpleasant
emotions of illness and death are critical factors that pose a threat to their well-being (Mosadeghrad,
Ferlie & Rosenberg, 2011). As these employees are responsible for the health care outcomes, such issues
may affect the quality of service as well as organizational performance (OP). This concern has induced
significant research in developed countries in pursuit of solutions for promoting health care employees’
well-being and QWL (Lowe, 2004). However, organizational efforts towards better QWL are less popular
in the health care sector of developing countries such as India and there is also lack of evidence for
designing relevant intervention programmes for the employees.

Theoritical Background and Hypotheses

Quality of Work Life

QWL as a multidimensional construct covers the physical, social, psychological and environmental
dimensions of an employee. It is the result of an examination that each person conducts by comparing
his own desires, hopes and expectations with what he perceives as reality (Argentero, Miglioretti &
Angilletta, 2007). Saraji and Dargahi (2006) stated QWL for health care employees as a comprehensive,
department-wide programme designed to improve employee satisfaction, strengthening workplace learn-
ing and in helping employees to manage change and transition in a better way. Likewise, Brooks and
Anderson (2005) defined nursing QWL as the degree to which the registered nurses are able to satisfy
important personal needs through their experience at work while achieving organizational goals. Several
dimensions have been proposed by researchers to measure QWL. We take the following dimensions for
the study.
Work environment (WE) is referred as healthy if the work setting takes a strategic and comprehensive
approach to provide the physical, cultural, psychological work conditions that maximize the health, safety
and well-being of employees (Grimes & Robert, 2010). They aid in enhanced motivation, productivity and
performance in both individuals and organizations, and provide support for best practices in quality patient
care. Lee and Harrison (2000) suggests taking the opinions of employees regarding their satisfaction with
WE to measure their perceived QWL. Previous research on WE and QWL is indicative of a significant and
positive relationship between a healthy WE and QWL (Sirgy, Efraty, Siegel & Lee, 2001).
Occupational stress (OS) is a state of disequilibrium in the system of variables that connect people
to their environment, which affects the normal levels of well-being. The health care employees are
trained to deal with physically and mentally challenging workplace activities, but stress takes a toll
when there are additional stressors like lack of family support, conflict at work, inadequate staffing,
poor teamwork, lack of training and poor supervision (Kane, 2009; Saha, Sinha & Bhavsar, 2011).

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Nayak and Sahoo 265

Stress is known to cause emotional turbulence, thus affecting employees’ health, attrition rate, injury,
infection rates and distort them from giving holistic care to patients (Shirey, 2006). Findings indicate
that there exists an inverse relationship between job stress and QWL. Employees with high QWL tend
to have lower job stress and poor QWL can lead to stressful working conditions as well as negative
health outcomes (Mosadeghrad et al., 2011).
Opportunities for development (OD) include work roles and opportunities available to an employee
in the organization to develop skills, knowledge, qualifications, experience, etc. With the rising educa-
tional level and occupational aspirations, employees want their organizations to provide them with
ample scope and direction to experience career growth and professional development. Organizations
are widely using employee assistance programmes, career counselling, cross-functional training, behav-
ioural training, career development and personal development in order to help the employees utilize
their skills and competencies for optimum performance (Srivastava, Geetika & Singh, 2010). In return,
it provides employee retention, staff morale, practice efficiency, job competency and better QWL
(Farjad & Varnous, 2013; Gesme, Towle & Wiseman, 2010). The commitment of an organization to
invest in employee development can improve QWL to a level that emotionally binds them to the
organization and encourages them to stay on.
Social support (SS) refers to an employee’s perception regarding the quality of relationships with his
supervisor, co-workers and family and the support received from them. A supervisor has an important
role to play in structuring the WE along with the fulfilment of social and emotional needs of the employees.
He should responsibly use the power, encourage healthy confrontation, creative thinking, benchmarking
practices and high-quality standards. The support received from co-workers can be emotional, such as,
the action of caring or listening sympathetically, providing tangible assistance, such as, help with a work
task (Jenkins & Elliot, 2004). It can promote well-being by meeting the important human needs of secu-
rity, social contact, approval, belongings and affection. Throughout the working life, the employee
encounters with many people who provide both negative and positive experiences. It is viewed that posi-
tive interactions and support in the workplace can alleviate depression and stress, provide solutions for
work problems and lead to increased QWL (Dolan, García, Cabezas & Tzafrir, 2008).
Compensation and rewards (CR) are the measures of how much an organization can satisfy its
employees’ work values, aspirations, their personal ideals and hope for progress. They may include
monetary rewards, such as, competitive salaries, performance bonuses and scarce skills remunerations,
as well as the non-monetary rewards or fringe benefits, such as, extended leave, promotions, childcare
facilities and recreation (Mokoka, Oosthuizen & Ehlers, 2010). They act as pull factors to attract and
retain talent, enhance competitive advantage and increase employee loyalty. Researchers have also found
a significant relationship between compensation, rewards and QWL (Saraji & Dargahi, 2006).
Work-life balance (WLB) refers to creating synergy by a harmonious relationship between ‘work’
(career and ambition) and ‘lifestyle’ (health, pleasure, leisure, family and spiritual dimensions). Greenhaus
and Powell (2006) divided WLB into three components, namely, time balance, involvement balance and
satisfaction balance. WLB practices can boost staff morale, focus on work, job satisfaction, loyalty and
productivity and reduce stress, conflicts and absenteeism.

Impact of QWL on Organizational Performance

OP can be defined as the ability of an organization to attain its goals and objectives by optimum utiliza-
tion of resources. There is a plethora of literature stating that organizations providing desirable QWL for
its employees can achieve better human resource productivity and performance (Korunka, Hoonakker &

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266 Journal of Health Management 17(3)

Carayon, 2008). A study conducted by May, Lau and Johnson (1999) indicated that the companies,
which had high QWL gained better profitability and higher growth compared to other companies. Better
QWL is about being sensitive to the employees’ physiological and socio-emotional needs in a holistic
manner, which stimulates job satisfaction and enhances organizational productivity and efficiency
(Ruzevicius, 2007; Schneider, Hanges, Smith & Salvaggio, 2003). QWL also helps in developing jobs
and working conditions that are excellent for employees as well as for the economic health of the organi-
zation. Employees who are satisfied with the working environment are both loyal to the organization and
capable of providing better quality of care. The above discussion provides ample evidences to establish
the relationship between QWL and OP. But when we put the spotlight on health care organizations, this
relationship is of critical importance. Nayeri, Salehi and Noghabi (2011) investigated the relationship
between the QWL and productivity among nurses and suggested managers to design appropriate strate-
gies for promoting QWL to enhance productivity in hospitals.

Mediating Effects of Employee Commitment

Organizational commitment is defined as an individual’s relative ability and involvement in a certain
organization. Allen and Meyer (1997) proposed three types of commitment, namely, affective, continu-
ance and normative. Employees often evaluate the organizational efforts to recognize their meaningful
contribution. A positive evaluation can increase motivation, influence behaviour at workplace and
guarantee his permanence in the organization without considering the circumstances (Steyrer, Schiffinger
& Lang, 2008). Employees who are committed are more adaptable, productive, have a sense of respon-
sibility and are not financial liabilities to the organization (Demir, 2012). Several literatures show a
significant relationship between QWL and employee commitment (EC) (Farjad & Varnous, 2013;
Huang, Lawler & Lei, 2007).
The literature mentioned above clearly depicts that there is a great deal of research exploring the
relationship between any two of the three variables (QWL, EC, OP). The purpose of the current study is
to establish a relationship between the three variables by investigating the mediating role of EC. Based
on the foregoing, we hypothesize that:

H1: EC will mediate the relationship between QWL and OP.

H1a: EC will mediate the relationship between WE and OP.
H1b: EC will mediate the relationship between OS and OP.
H1c: EC will mediate the relationship between opportunities for development (OD) and OP.
H1d: EC will mediate the relationship between SS and OP.
H1e: EC will mediate the relationship between CR and OP.
H1f: EC will mediate the relationship between WLB and OP.

Methods

Sample
A descriptive research design was used in this study. The research was performed in 30 private health
care organizations (i.e., hospitals, nursing homes) providing varying levels and types of care. All the
health care organizations were located at Cuttack and Bhubaneswar in Odisha. All the nurses, supportive

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Nayak and Sahoo 267

and paramedical employees active on the organization’s payroll at the time of the study were eligible to
participate in this research. A self-designed questionnaire was distributed to 300 health care employees. Out
of which only 205 valid responses were received resulting in a response rate of 68 per cent from the survey.
The respondents included 85 (41.5 per cent) males and 120 (58.5 per cent) females. Most of the respondents
were aged between 20–30 years (48.8 per cent) followed by 31–40 years (34.1 per cent), 41–50 years (14.6
per cent) and 51–60 years (2.4 per cent). Sixty-one per cent of the respondents were married and 39 per cent
of the respondents were single. Most of the respondents were nurses (51.2 per cent) followed by pharma-
cists (26.8 per cent), radiologists (14.6 per cent) and pathologists (7.3 per cent). The majority of the respond-
ents had work experience of 5–10 years (36.6 per cent) followed by 0–5 years (34.1 per cent), 11–15 years
(22 per cent), 16–20 years (4.9 per cent) and 21 and above (2.4 per cent).

Tools/Measures
A self-designed questionnaire was used for the survey of health care employees. The initial selection of
items included in the instrument was done by extensive review of literature. The researcher then refined
these items to consider issues of accuracy, relevance, readability, grammar and meet the local context
and the multicultural environment of the health care employees of Cuttack and Bhubaneswar in Odisha.
QWL was measured using a 43-item questionnaire which represented six dimensions of QWL. The six
dimensions used to measure QWL are WE (7 questions, a = 0.80), OS (8 questions, a = 0.76), OD (6
items, a = 0.74), SS (9 questions, a = 0.77), CR (5 questions, a = 0.75) and WLB (5 questions, a = 0.83).
EC was measured using 12 items (a = 0.81). OP was measured using 10 items (a = 0.72). All the scales
used in the present study displayed adequate levels of reliability (a ranged from 0.72 to 0.83). Employees
were asked to respond in a way that best described their feelings using a 5-point Likert’s scales with 1
indicating strongly disagree, 2 disagree, 3 neutral, 4 agree and 5 strongly agree.

Procedure
As organizations and its employees were diverse, so the survey was customized to best fit each of the
organizations. It was felt that a varied approach would be more feasible for the organizations and that this
would help maximize response rates. Participation was granted through prior appointments and consent
via phone calls to the organization. The researcher visited the health care organization to administer the
questionnaires. The participants were advised regarding the voluntary nature of participation. The hospi-
tal managers were reminded about the study by phone call or visit. The data collected are analyzed by
different statistical tools like descriptive statistics, Pearson correlation, multiple regressions using SPSS
version 20 for Windows and Sobel test.

Results

Descriptive Statistics and Correlations

Descriptive statistics, such as, mean and standard deviation are used to describe the variables under
study. The mean reveals the central value for each variable which lies between 3.1 and 3.6 in this study.
Health care employees rated their overall QWL, EC and OP at moderate levels.The value of standard

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268 Journal of Health Management 17(3)

Table 1. Mean, Standard Deviations and Correlations

Variables Mean Std. Deviation QWL EC OP

WE 3.41 1.30 0.532** 0.536** 0.581**
OS 3.65 1.42 –0.349** –0.467** –0.469**
OD 3.39 1.01 0.372** 0.320** 0.485**
SS 3.17 1.30 0.590** 0.506** 0.576**
CR 3.48 1.215 0.361** 0.448** 0.452**
WLB 3.68 1.116 0.572** 0.382** 0.452**
QWL 3.39 0.961 – 0.437** 0.631**
EC 3.29 1.26 – – 0.478**
OP 3.36 1.05 – – –
Source: Authors’ own.
Note: **Correlation is significant at the 0.01 level (2-tailed).

deviation for all variables is between 0.3 and 1.4. Correlation analysis is used to determine the relation-
ship between QWL, EC and OP. As expected, all the QWL dimensions positively correlated with QWL
except OS, which was negatively and significantly correlated. In addition, QWL was positively corre-
lated with EC and OP. Finally, EC was also positively correlated with OP. Table 1 shows the overall
results of mean, standard deviations and correlation between variables of the study.

Mediation Analysis
Mediation analysis was carried out to assess the mediating effect of EC on the relationship between
QWL and OP. To test the mediation, the procedure suggested by Baron and Kenny (1986) was adopted;
the steps have been stated below:

1. The independent and dependent variable must be significantly related

2. The independent and mediating variable must be significantly related
3. The mediator and dependent variable must be significantly related and
4. The independent variable must have no effect on the dependent variable when the mediator is held
constant (full mediation) or should become significantly smaller (partial mediation).

In the literature, several mediation test methods are used to assess the significance of mediation
effects among variables. This study uses the Sobel test, which is used frequently and known to create the
most reliable results (Simsek, 2007). Jose (2013) developed a macro for the users of Microsoft Excel
called MedGraph-3 program, which was utilized to apply the Sobel test.
Results (see Table 2) indicate QWL was positively and significantly related to the OP (b = 0.631, p <
0.001), QWL was positively and significantly related to EC (b = 0.437, p < 0.001) and EC was posi-
tively and significantly related to the OP (b = 0.250, p < 0.001). Thus, the steps one, two, three of the
mediation analysis were supported. Furthermore, results show that after EC was taken into account the
beta weight for QWL dropped from the initial level of 0.631 to 0.521, albeit still significant. Thus, EC
satisfied the requirements of a partial mediator in the relationship between QWL and OP. To further

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Nayak and Sahoo 269

Table 2. Mediating Effects of Employee Commitment between QWL and Organizational Performance

Employee
Commitment 0.478**
.437**
(.250**)

Quality of Organisational
Work Life Performance
.631** (.521**)

Multiple Regression Results:

Independent variable (quality of work life), dependent variable (organizational performance), mediator variable
(employee commitment)
Mediation Steps B Std. Error Beta t value Sig.
1 0.693 0.060 0.631 11.581 0.000
2 0.576 0.083 0.437 6.915 0.000
3 0.398 0.051 0.478 7.752 0.000
4 0.573 0.064 0.521 8.979 0.000
Sobel Test Results:
Mediation Type Z Score Direct Effect Indirect Effect Total Effect Sig.
Partial 3.67 0.521 0.110 0.631 0.000
Source: Authors’ own.

assess the significance of the mediation, a Sobel test (z = 3.67, p < 0.001) was obtained. Thus, our propo-
sition H1 was partially supported.
The mediation tests were also conducted by replacing only the independent variable QWL in the
model, with any one of its dimensions (WE, OS, OD, SS, CR and WLB). It was observed that all the six
dimensions satisfied the four conditions of the mediation test. The beta value for each dimension reduced
significantly when EC was included in the model. Table 3 represents the beta values of regressions for
each dimension and Z value of Sobel test, which are significant. Thus, the EC also acts as a partial
mediator in the relationship between WE and OP (H1a), OS and OP (H1b), OD and OP (H1c), SS and
OP (H1d), CR and OP (H1e) and WLB and OP (H1f). Therefore, our propositions H1a, H1b, H1c, H1d,
H1e and H1f were also partially supported.

Discussions and Conclusions

The article makes a major contribution in establishing the relationship between QWL, EC and OP.
Although previous researchers have already suggested a relationship between QWL and EC (Daud,
2010; Glifford, Zammuto & Goodman, 2002; Hsu & Kernon, 2006), EC and OP (Al-Ahmadi, 2009),
QWL and OP (An, Yom & Ruggiero, 2011; Rastegari, Khani, Ghalriz & Eslamian, 2010), the relation-
ship between the three variables taken together was not tested empirically earlier.

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 Table 3. Mediating Effects of Employee Commitment between Each Dimensions of QWL and Organizational Performance

Dependent Variable = Organizational Performance, Mediator Variable = Employee Commitment

Independent Variable Work Environment Occupational Stress Opportunities for Development
Mediation Steps 1 2 3 4 1 2 3 4 1 2 3 4
b 0.469 0.52 0.398 0.368 –0.347 –0.415 0.398 –0.233 0.506 0.401 0.398 0.386
Std. Error 0.046 0.057 0.051 0.053 0.046 0.055 0.051 0.049 0.064 0.083 0.051 0.062
Beta 0.581 0.536 0.478 0.456 –0.469 –0.467 0.478 –0.315 0.485 0.32 0.478 0.37
p value 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000
Z score 3.28 (p < 0.01) –4.16 (p < 0.001) 3.75 (p < 0.001)
Mediation Type Partial Partial Partial
Independent Variable Social Support Compensation and Rewards Work-Life Balance
Mediation Steps 1 2 3 4 1 2 3 4 1 2 3 4
b 0.465 0.491 0.398 0.362 0.393 0.468 0.398 0.362 0.428 0.434 0.398 0.362
Std. Error 0.046 0.059 0.051 0.052 0.054 0.066 0.051 0.052 0.059 0.074 0.051 0.052
Beta 0.576 0.506 0.478 0.449 0.452 0.448 0.478 0.449 0.452 0.382 0.478 0.449
p value 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000

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Z score 3.50 (p < 0.001) 4.20 (p < 0.001) 3.75 (p < 0.001)
Mediation Type Partial Partial Partial
Source: Authors’ own.
Nayak and Sahoo 271

The results of the mediation analysis show that EC partially mediates the relationship between QWL
and OP. This implies the improvement in OP due to QWL is partially due to the effect of EC. Health care
organizations should consider the EC aspect in order to maximize the effect of QWL on OP. Not only the
overall relationship among variables is explored but also the individual effect of each dimension of QWL
is conceptualized and empirically tested to get a holistic picture of the phenomenon.
The article also advances the work in the field of QWL by examining the relationship between the
dimensions of QWL with EC and OP. WE significantly affects EC and OP. The same is also true for other
dimensions of QWL like OS, OD, SS, CR and WLB. A healthy WE is safe, empowering, satisfying and
encourages professionalism, accountability, transparency, involvement, efficiency and effectiveness
among employees. Low OS will motivate to perform well and lead to better QWL. OD can develop a
positive and realistic self-worth along with a self-perceived sense of growth and development. SS will
facilitate employees to manage difficulties and give room for speaking their heart, thus enabling them to
enjoy their job and workplace. Fair CR aim to attract and retain talent and positively trigger employee
satisfaction. Work life balance helps employees to prioritize between work life and thus, reducing stress
and harmonizing life.
The results of this study may provide insights to help decision-makers in identifying key workplace
factors that affect the QWL of employees. These identified factors may contribute to their initiatives for
developing strategies that would address and improve employees’ QWL within health care organiza-
tions. The study suggests that paying attention to the different dimensions of QWL which are related to
employees’ WE, OS, OD, SS, CR, and WLB would result in achieving higher EC and also OP. Thus,
better QWL is the key to attract and retain qualified and motivated employees and can possibly lead to
enhanced quality of services in health care organizations.

Limitations
The study was not conducted without limitations. This study only concentrated on the health care sector.
Therefore, the results of this study may not be generalized to all types of organizations that have different
dimensions which might affect employees’ perceptions towards QWL, EC and OP. Future researchers
could widen the scope of this study by including employees from other industries and perform a com-
parative study across different industries. This was a quantitative study, therefore, the results provided
only numerical descriptions rather than qualitative aspects of human perception.

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