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JMD
37,1
40
Received 27 December 2016
Revised 16 June 2017
8 August 2017
Accepted 14 August 2017
Journal of Management
Development
Vol. 37 No. 1, 2018
pp. 40-52
© Emerald Publishing Limited
0262-1711
DOI 10.1108/JMD-12-2016-0311
The effect of employee
ability, hospital’s ethic and
leadership on job satisfaction
through employee commitment
A study on an Indonesian Type A
government hospital
Ria Mardiana Yusuf
Management Department, Hasanuddin University, Makassar, Indonesia
Abstract
Purpose – The purpose of this paper is to confirm the direct and indirect effect of employee ability, perceived
ethic, and leadership and leadership to service quality through employee commitment.
Design/methodology/approach – A survey instrument is using to collect the data and to measure the
effect of employee ability, perceived ethic, and leadership directly to the quality of inpatient health care
services was developed. This study also used the self-perception, leadership evaluation and customer
evaluation questionnaires. The effects among variables were also analysed by using the structural equation
modelling method.
Findings – The results of the analysis show that the survey instrument was reliable and valid;
the implementation of hospital ethic was more emphasised on the nurses (as a front liners); the study proved
that there is a direct and indirect effect among variables of employee ability, hospital’s ethic, and leadership to
the service quality through the employee commitment; the direct effect of employee commitment variables
against the service quality was significantly negative.
Research limitations/implications – Analyses are developed within the context of a government single
hospital of Type A. According to the time sequence of study, this field of study research considered for
purpose only (one time study), and was not conducted for experimental study.
Originality/value – This paper’s main contribution is to propose and empirically test a set of constructs that
complement the effect of employee ability, hospital’s perceived ethic, leadership on the service quality of
inpatient health care through the employee commitment direct and indirectly in the Type A hospital.
Keywords Service quality, Leadership, Employee commitment, Employee ability, Hospital’s ethic
Paper type Research paper
1. Introduction
Nobody wants to fall sick. However, to maintain one’s health condition is not an easy thing.
In addition, illness is caused by uncertain events (unpredictable) that are irregular and may
rarely occur. It also puts pressure on someone who has little financial resources and
increases economic burden on him or her. The incidence of illness is often seen as a
“disaster” (e.g., catastrophic illness) that results in economic burden on patients or their
family. The situation is unpleasant to most people because they pay for medical services
directly from their bag (out-of-pocket).
In the context of Indonesia, Mohammad (2002) stated that the implementation of
comprehensive health insurance is still hampered by several things, namely, the basic policy
of the health system and health care systems are not yet clear, the attitude of the politicians
who consider health care as a responsibility of health departments, and the low level of
public confidence towards health insurance. Health-Grades (insurance company consultant)
examined comprehensive data from 2000 to 2002 and concluded that about 195,000 deaths
in US hospitals were due to medical errors. Furthermore, errors inflate medical costs
due to longer and more costly hospital stays (Nordgren et al., 2004). Data released by
Juran Institute say that two-thirds of the cost of health insurance coverage expenditure is Job satisfaction
due to the low quality of service (Mehring and Koretz, 2004). through
PT Askes (Health Insurance, The health care insurance program known as Health Insurance employee
(ASKES), as of January 1, 2017 changed its name to the Health Insurance Administering Board
(BPJS) in accordance with Act no. 24 of 2011 concerning the Health Insurance Administering commitment
Board), one of the largest service providers and state-owned enterprises in Indonesia.
As an equal partner to health insurance companies, hospitals as health care providers play the 41
most essential role. The insurance companies act as intermediaries between participants’ health
insurance and hospitals providing health services. The involvement of a hospital as a health
care provider is undoubtedly very important, so there are various discussions on service
quality, which is explicitly measured from the satisfaction obtained using hospital services.
Services are intangible products produced by the various parties within an organisation,
including hospitals. The theory of interactive service quality mention that for the optimisation
of service, it is first necessary to optimise internal services to internal stakeholders, who will
further provide optimum services to external stakeholders (Boshoff and Gerhard, 1995).
In addition to researchers who have analysed the role of service employees as a
dimension of service quality (e.g. Parasuraman et al., 1988; Dabholkar et al., 2000), studies
that explicitly address the concept of customer orientation of service employees are
Brown et al. (2002), Donavan et al. (2004), and Hennig-Thurau and Thurau (2003). In the
context of service quality research, it has been demonstrated that the behaviour of service
employees affects the customers’ perception of the service (Bitner et al., 1990).
Specifically, researchers have identified employee-related aspects of the service as
dimensions of the customer’s service quality assessment. For example, three out of five service
quality dimensions of Parasuraman et al. (1988) directly or indirectly address the behaviour of
employees (i.e. responsiveness, assurance, and empathy) and are measured using a
multidimensional research instrument SERVQUAL. Similarly, Dabholkar et al. (2000)
identified personal attention and comfort as provided by a health care provider’s employees as
components of service quality. Therefore, a service provider gains only limited information on
the managerial action that is needed to select and train their service employees. In addition to
the theory of interactive marketing, this research paper therefore also adopts the theory of
customer orientation of service employee that stems from the theory of personal interactions
(Argyle, 1967). In this regard, the topic concerning the effect of working ability, hospital ethics,
leadership behaviour on employee commitment and quality of inpatient services in Type A
General Hospital in South Sulawesi becomes a topic of research in this paper.

2. Literature review
2.1 Theoretical background
Investigating organisational commitment is important and useful to organisation leaders as
organisational commitment has been found to affect other organisational outcomes, including
turnover intentions (Sims and Kroeck dan, 1994) and company sales and profitability
(Benkhoff, 1997). Its importance and usefulness underlie the proliferation of studies that
investigate the determinants of organisational commitment (e.g. personal attributes, job
characteristics and work experience – the three broad categories of determinants of
organisational commitment proposed in Steers’ (1977) model in Johnston et al. (1990)). Other
determinants found to have an effect on organisational commitment include job satisfaction
(Mackenzie, 1998) and socialisation tactics or practices (Allen and Meyer, 1990; Ashfort et al.,
2007; Buchanan, 1974). There is also evidence that employees’ personal belief in work ethics
had a direct effect on organisational commitment (Ashfort et al., 2007).
As ethical values may vary from one person to another, it may be necessary for leaders in
organisations to adopt certain measures to inculcate certain ethical values among employees in
order to manage organisational outcomes. This study investigates the links between
JMD organisational ethics and two measures of organisational outcomes. Specifically, it investigates
37,1 whether top management supports for ethical behaviour and the ethical climate in the
organisation, and the link between ethical behaviour and career success is associated with
different levels of job satisfaction and also with different levels of organisational commitment.
The findings of this study can contribute to the understanding of how organisational ethics
may be used as a means to generate favourable organisational outcomes.
42 The link between organisational ethics and job satisfaction can be explained by the
organisational justice theory and cognitive dissonance theory. The salient points
are summarised below (see also Koh and Boo, 2004; Viswesvaran et al., 1998). According
to the organisational justice theory, the concept of organisational justice is central to
understanding a wide range of human attitudes and behaviours in organisations.
The underlying premise is that the justice perceptions of employees affect their job attitudes
and organisational outcomes. Leigh et al. for example, concluded that employees look more
to the broader organisational environment than to their particular role in attributing their
satisfaction to their job. In particular, perceptions of organisational justice affect job
attitudes, such as job satisfaction and turnover intention.
On the conceptual front, fairness heuristic states that perceptions of fairness in one area
affect perceptions of fairness in another area. In the context of this study, it means that
employees who perceive their organisations to be ethical are also likely to perceive their
organisations as being fair to them. This, in turn, is likely to enhance employee’s job
satisfaction. Hence, organisational ethics and job satisfaction are expected to be positively
linked. More generally, justice judgements affect attitudes, behaviour and decisions across a
wide variety of social contexts and they also play an important role in how employees
respond to organisational outcomes and organisational procedures and process.
In view of the above, if employees perceive strong top management support for ethical
behaviour, a favourable ethical climate, and a strong association between ethical behaviour
and career success in the organisation, then they are also likely to have a higher level of job
satisfaction. The converse is also true. According to the cognitive dissonance theory, first
proposed by Festinger, individuals strive to minimise dissonance in their environment.
Similar concepts include the balance theory, the congruity principle and the discrepancy
theory. Empirical evidence has shown the operation of the cognitive dissonance theory in
finance and marketing. In a nutshell, continued dissonance results in distress and
dissatisfaction with the situation (Viswesvaran et al., 1998). Essentially, employees desire
consistency between their ethical value system and the ethical climate of their organisation.
Assuming that employees generally strive to be individually ethical, dissonance results if
these employees perceive little top management support for ethical behaviour, an
unfavourable ethical climate in their organisation, and/or little association between ethical
behaviour and career success. This dissonance will, in turn, reduce job satisfaction.
Further, top management sets the organisational climate for, and serves as a referent
group to, employees. Thus, any discrepancy between employees’ internal standards of
ethics and their perceptions of top management will result in a moral conflict and cognitive
dissonance (Dozier and Miceli, 1985). This again reduces job satisfaction. More recently,
Viswesvaran et al. (1998) found that the lack of an ethical fit (i.e. ethical incongruence)
between employees and their organisation can result in distress and job dissatisfaction,
among other things. To summarise, a positive link between organisational ethics and job
satisfaction is expected. That is, a higher level of ethics is expected to be associated with a
higher level of job satisfaction in organisations.
The definition by Brown et al. (2002) is based on Bandura’s social learning theory,
according to which nearly anything that can be learned through personal experience can
also be learned by observing the behaviours of others and the consequences of these
behaviours. Thus, leaders are influencing their followers by acting as role models of ethical
conduct and being the object of identification and emulation to followers. Punishments and Job satisfaction
effects can facilitate learning in an anticipatory manner and signal about the benefits and through
costs of selected (un)ethical behaviours. This social learning process has an important role employee
regarding the ethical behaviours in an organisation, and therefore it can also be thought to
have an impact on the ethical organisational culture. commitment
Employees’ attitudes towards ethicality are susceptible to environmental effects. Therefore
leadership behaviour can have an effect on the organisational culture and organisation’s 43
members’ behaviour. Ethical leadership has been, accordingly, found to be positively
associated with employees’ ethical decision making, prosocial behaviour, satisfaction,
motivation and commitment to the organisation, and negatively associated with harmful
behaviour. Ethical leadership also predicts employee trust and satisfaction with the leader
(Brown et al., 2002) and increases employee commitment and their willingness to report
problems to management (Brown et al., 2002). Jordan, et al. discovered that when employees
were treated fairly, they were more committed to their organisation and unethical conduct in
the organisation decreased. In addition, organisational justice, including fair treatment of
employees, is related to a 13-48 per cent lower rate of sickness absences (Elovainio et al., 2002)
and to higher work satisfaction (Tatum and Eberlin, 2008).
The literature covering different factors that affect (ethical) leadership is in its full extent
beyond the scope of this study. Some essential findings are discussed next. When ethical
leadership has been studied in relation to background variables, several studies have not found
differences between men and women. However, those studies that have found gender differences
showed that female managers have proven to be more ethical in decision-making processes
( for reviews, see Ford and Richardson, 1997; O’Fallon and Butterfield, 2005). Results have also
shown that cognitive moral development is positively correlated with age, education, and work
experience. Study results concerning the effects of moral development on ethical decision making
are, however, mixed (O’Fallon and Butterfield, 2005). According to some studies, the line of
business and size of the organisation are associated with ethical decision making, but the results
are somewhat contradictory (Ford and Richardson, 1997; O’Fallon and Butterfield, 2005).
Some differences in ethical decision making have also been found between different
managerial levels. Lower level managers are focussing more on internal relations and employee
interactions, whereas higher level managers can affect organisational finance and implement
ethical behaviours into the organisation. In upper management, the focus is also more on
external stakeholders, contacts and strategic management. Middle level managers can face
additional pressures in ethical decision making, as they are acting in between executives and
employees, arbitrating their possibly conflicting expectations. Some studies have shown that
practitioners in later career stages display higher ethical judgement, and that the ability to
identify unethical behaviour increases with work experience. It has also been found that higher
level managers are less likely to detect ethical problems in their organisation, and that lower
level managers are more pessimistic about the ethicality of their organisation.

2.2 Previous study

Koh and Boo (2004) in their paper “Organisational ethics and employee satisfaction and
commitment” examined the relationships between organisational ethics and organisational
outcomes. In particular, it investigates if a higher level of top management supports ethical
behaviour, a more favourable ethical climate in the organisation, and a stronger association
between ethical behaviour and career success that can lead to a higher level of job satisfaction
as well as greater organisational commitment. Decision tree results indicate significance and
positive effect of both organisational ethics and job satisfaction on organisational
commitment. They also indicate significance and positive links between ethical culture
constructs and job satisfaction. However, no significance relationship between ethical climate
and job satisfaction is observed. This may not be surprising as ethical culture comprises
JMD control mechanisms that specifically aim at influencing organisational outcomes, while ethical
37,1 climate is associated with attitudes and perceptive values that may or may not affect
behaviour. The practical implication to organisational leaders is that organisational ethics can
be used as a means to generate favourable organisational outcomes. Some possibilities on
enhancing organisational ethics have been suggested in an earlier section.
Dion (2012) in his paper “Are ethical theories relevant for ethical leadership?”
investigated if ethical theories could be connected to some leadership approaches. In the
44 paper, eight leadership approaches are selected: directive leadership, self-leadership,
authentic leadership, transactional leadership, shared leadership, charismatic leadership,
servant leadership, transformational leadership. Five western ethical theories (philosophical
egoism, utilitarianism, Kantianism, ethics of virtue, ethics of responsibility) are analysed to
see to what extent their basic concepts could be connected to one or the other leadership
approach. A given ethical theory (such as philosophical egoism) could be suitable to the
components of various leadership approaches. Ethical leadership does not imply that a
given leadership approach is reflecting only one ethical theory. Rather, ethical leadership
implies that for different reasons, various leadership approaches could agree with the same
ethical theory. This is what we could call the “moral flexibility of leadership approaches”.
The main aim of the present study is to discover whether the managers’ self-evaluations of
their ethical leadership style are associated with their assessments of the ethical organisational
culture (measured with an eight-dimensional Corporate Ethical Virtues-model) (Huhtala et al.,
2013). It aims to hypothesise that the more ethical the managers evaluate their own leadership
style to be, the higher evaluations they give on the ethical culture of their organisation.
The underlying assumption is that ethical managers can enhance the ethical culture by
behaving in accordance with their own values. This quantitative research was based on a
questionnaire study with 902 respondents throughout Finland. A linear regression analysis
was conducted to examine how ethical leadership was related to ethical organisational culture.
Managers who appraised their own leadership style as ethical also evaluated the ethical
culture of their organisations more positively. The result implies that an ethically behaving
leader can develop the culture of his/her organisation towards more ethical practices.
The results also showed that differences in evaluating both ethical leadership and culture
emerged concerning background variables.

2.3 Relationship
Work ability, employee commitment and service quality. Robbins (1996) suggested that the
ability is the capacity of a person to work, which was formed among others by education,
training, work experience and work ethic. This capability is suspected as the process of
enriching a person’s ability to work. The term of commitment has been used to describe
such diverse phenomena as the willingness of social actors to give their energy and loyalty
to social systems (Kanter, 1968), an awareness of the impossibility of choosing a different
social identity or of rejecting a particular expectation, under force of penalty, the
organisational identification or organisational involvement. On the other hand, Martin and
Nicholls in Mullins (1995) stated that there are three main pillars of building a model of
employee commitment to the company or management, namely:
(1) a sense of belonging to the organisation;
(2) a sense of excitement in the job; and
(3) confidence in management.
Kaldenberg et al. (1995) found that differences in ability (experience and expertise) are in
close association with the employee’s commitment to the company, management or
organisation, while Mowday et al. (1982) in Johnston et al. (1990), found that there are three
factors that are considered the antecedent of organisational commitment. Based on the Job satisfaction
above discussion, the following hypotheses are constructed: through
H1. The thought that work ability of employees has a significant direct effect on employee
service quality. commitment
H2. Suspected that work ability of employees has significant indirect effects on service
quality through employee commitment. 45
Hospital’s ethics, employee commitment and service quality. Studies related to the effect of
institutional ethics on employee commitment have been carried out. Among them is Murphy’s
(1995) study, which states that today’s CEOs of the world’s leading companies have announced
their commitment through the statement of value of each company. The statement of value is
nothing but the statement of ethics. Weaver (1999) also found that the higher commitment of
top management leadership towards ethics leads to the implementation of the ethics
programme to be run by the company. The same thing was expressed also by Robbins (1996)
that the “code of ethics require a commitment from top management”.
Robbins (1996) conducted a survey of some of the world’s major companies, including
Exxon, Sara Lee, Du Pont, Bank of Boston, and Wisconsin Electric Power in the USA. Large
companies are following three main points in their code of conduct: be a dependable
organisation citizen, do not do anything unlawful or improper that will harm the
organisation; and be good to the customer.
Based on the above discussion, the following hypotheses are constructed:
H3. Alleged that the hospital ethics have a significant direct impact on service quality.
H4. Alleged that the hospital ethics have a significant indirect effect on service quality
through employee commitment.
Behaviour leadership, employee commitment and service quality. The effect of leadership
behaviour on the commitment of employees is clearly suggested by Yukl (1998) in the model of
power and effect. In the model, it is illustrated that situational factors of the supporting leadership
behaviours will lead to positive and negative impacts on their subordinates. The positive impact
is due to the formation of commitment and obedience from subordinates, whereas the negative
impact is due to resistance to behaviours that have demonstrated leadership.
Smith (1996) also found that leadership behaviour has a positive and significant effect on
the employee commitment. Smith’s findings are in accordance to the results of Buchanan
(1974), who found that managers in business or government environment constantly
contribute to the institution and always try to fulfil their promise to encourage greater
commitment from their subordinates.
From the company’s viewpoint, success comes with increasing the quality of corporate
intangibles (including service quality) and productivity, which will increase sales and
profits. Judging from the customer side, the only measure of corporate success is service
quality. Therefore, according to Yukl (1998), leadership behaviour indirectly affects
service quality which is a review of success or failure of a company from the customer side.
This opinion is also reinforced by Smith (1996), who found that leadership behaviour has
a positive effect on productivity.
Thus, it can be said that there is a relationship between leadership behaviour and
service quality. Then, we have the following hypothesis:
H5. Alleged that service quality has a significant direct effect on leadership behaviour.
H6. Alleged that service quality has significance indirect effects on leadership behaviour
through employee commitment.
JMD Employee and service quality commitment. Research related to employee commitment and its
37,1 effect on service quality has been mostly performed by experts, including Butler and
Dynan in 1988 (in Natalisa, 1999). The results of their study of the First Pennsylvania Bank
found that in order to improve the quality of service provided to the customer, the bank
restructured its framework of corporate culture and employee commitment. Dubinsky and
Hartley (1986) in Johnston et al. (1990) found that employee commitment will greatly affect
46 the behaviour of employees, including the behaviour of a service that can give satisfaction to
the company’s stakeholders.
Another finding states that employees who have high commitment to the company and
the intention not to leave the company will overcome their stress (Begley and Czajka, 1993)
and will perform satisfactorily. Currivan found that there is a reciprocal relationship
between employee commitment and the satisfaction achieved by both internal and
external corporate stakeholders (Lincoln and Kalleberg, 1990). Thus, these studies reinforce
the impact of employee commitment on quality services that satisfy the company’s
stakeholders. However, this limits the review of this research paper on the deterministic
effect of employee commitment on service quality.
Thus, we have the following hypotheses:
H7. Suspected that employee commitment has a significant direct effect on
service quality.
To conclude this section, a construct of a causal effect between variables depicted in the
conceptual framework of this research paper is given in Figure 1.

3. Methodology
The sample was drawn from nurses, doctors and patients in health care, by using a
cross-sectional and explanatory research design. A questionnaire was conducted on 320
respondents (including internal (160 respondent) and external (160 respondent) stakeholders of
the hospital) using 24 indicators. The survey included questions on employee ability,
implementations of perceived ethics, leadership style, as well as commitment and satisfaction
due to their services. The structural equation modelling was also used by the researchers to test
the hypothesis.

Work
ability

H1

H2

H4
Hospital Employee Service
ethics commitment quality
Figure 1. H7
Conceptual framework H3
among work ability,
hospital ethics, and
leadership behaviour H6
through employee
commitment on Leadership H5
service quality behaviour
To test the validity and reliability of data, a goodness-of-fit (GOF) test was applied to the Job satisfaction
suitability index of each construct or variable models were built. The GOF test was applied through
to the construct of the following variables: working ability, hospital ethics, leadership employee
behaviour, commitment to employee and service quality. The results showed (as discussed
below) that all variables met the criteria of the GOF index. commitment

4. Analysis result 47
After an appropriate measurement model has been established, the next step is to test the
full structural model. Structural equation modelling is a tool for testing the causal
relationship among the latent variables, explaining the causal effects and assigning the
explained and unexplained variance. The relationships hypothesised were tested using
AMOS to complete the standardized parameter estimates and t-values. The structural
equation modelling confirms this conceptual model perfectly because of causal relationships
among these variables. The result is summarised in Table I.

5. Discussion
This study analysed the direct and indirect effects of variables, i.e. work ability, ethics
hospitals and hospital leadership behaviour, on service quality through employee
commitment. The results obtained proved that the variables have a significant effect on
service quality through employee commitment (Table II).
From the aspect of workability, Luthans stated that an employee's sense of capability
would psychologically affect the employee’s thinking power. Furthermore, the power of
thought will encourage the cognitive state of employees and can help them improve their
performance (Bell and Kozlowsky, 2002). This is not only evidenced by the value of path
coefficients from work ability to service quality and employee commitment which is 0.35 and
0.10, respectively, with the positive direction, but also by the value of CR, which is equal to
2.828 and is greater than the value in the t table (1.96).
These findings support the findings of Mowday, Steers and Porter, and Johnston ( Johnston
et al., 1990), who found that there are three factors that are the antecedent of a person’s

Hypothesis Loading factor (λ) Critical ratio (t hitung) Probability ( p) Description

Table I.
H1 0.354 2.112 0.000 Significance Parameter estimation
H2 0.102 2.828 0.000 Significance regression weights
H3 0.094 2.258 0.000 Significance overall work ability,
H4 0.518 2.888 0.000 Significance hospital ethics,
H5 0.707 3.922 0.000 Significance leadership behaviour,
H6 0.072 2.004 0.000 Significance employee commitment
H7 −0.538 2.664 0.000 Significance and service quality

Criterion Cut-off value Model result Model evaluation

Table II.
χ2 Lower value expected 141.295 Good Goodness of fit index
Probability ⩾ 0.05 0.238 Good work capability
CMIN/df ⩽ 2.00 1.580 Good construct model
GFI ⩾ 0.90 0.927 Good effects, hospital ethics,
TLI ⩾0.95 0.980 Good leadership behaviour,
CFI ⩾ 0.95 0.984 Good employee commitment
RMSEA ⩽ 0.08 0.060 Good and service quality
JMD commitment. The three factors of employee commitment variable as follows, a person, non
37,1 organizational and organizational. Of these factors, associated with the ability to work is the effect
of factors in a person. On testing the hypothesis that the effect of the hospital ethics of employee
commitment on breadth of our customers, we find that there is a significance direct effect of the
hospital ethics on commitment of employees. This is evidenced by the acquisition value of the
path coefficient, which is equal to 0.52, and the t-test value (CR) W2.0, which is equal to 2.888, and
48 0.094 with CR 2.258. This indicates that the commitment of paramedics that consists of frontliners,
doctors and nurses and hospital patients are affected ethics. These findings are consistent with
previous studies concerning the relationship between ethics and commitment stating that it
contains ethical values that greatly affect the attitudes and behaviours of a person, or even the
organisation as a whole (Murphy, 1995; Weaver, 1999; Sims and Kroeck dan, 1994; Robbins, 1996).
The hypothesis suggests that the behaviour of top management leadership of the
Government General Hospital Type A in South Sulawesi has a significance effect on
commitment and service quality. Test results of this hypothesis suggest that the top
leadership behaviour directly affects the hospital significance to the commitment and
service quality with the path coefficients of 0.072 and 0.71. This result is evidenced by the
acquisition of the CRW2.0, and a large loading factor, i.e. 2.004 and 3.922, greater than 2.0.
The results of this study are consistent with the findings stating that there is a relationship
between leadership and commitment and performance of their subordinates (Bass, 1990;
Yukl, 1985) as well as the success of an organisation.
The results of an analysis of employee commitment to the department of Type A in
South Sulawesi and its effect on service quality demonstrate the significance of direct effect,
but the results are inversely proportional. Namely the path coefficients of −0.54, and the
value of CR ¼ 2.664. Allegations that the commitment of employees (paramedics and
frontliners) in the General Hospital Type A in South Sulawesi has a significance effect on
service quality have been proven through testing hypotheses. Based on hypothesis testing,
the test results indicate the receipt of allegations stating that there is a significant direct
effect of employee commitment on service quality, although the effect coefficient has a
negative value, which is equal to −0.54. The significance of these effects is marked by the
acquisition of CR values W2.0 in all segments of the respondents, as well as t-test values
(CR) which are greater than t table (1.645), which amount to 2.953.
The three groups of variables that consist of employee ability, hospital’s ethic and
leadership will explain the relationship between employee commitments to service quality.
This statement describes the diversity of influence of predictors of employee commitment
variables as finding by Bateman and Strasser (1984) and Glisson and Durick (1988). It seems
that the findings or results of the analysis on the relationship between employee commitment
and service quality support the findings of Curry et al.(1986), (Glisson and Durick, 1988).
The explanation for the findings in this paper will be directed based on the point of view
of Glisson and Durick (1988), as follows:

(1) Based on the point of view of groups of variables that describe the characteristics of
work to employees and employee characteristics, we found that among the four
indicators of building employee commitment, it turns out there are two indicators
that have less value to the category (below the median on average), which is believed
indicator and indicator values.
(2) Another cause is the lack of time spent (particularly doctors) in treating patients in
the department of Type A in South Sulawesi. As is well known, the paramedics and
frontliners (especially physicians) are faced with various interests, including
interests of patients (of which not a few) that should they handle every day, the
interests of the institution which is a place where paramedics and frontliners find a
shelter, as well as their personal interests.
 (3) Based on the variable characteristics of the company’s point of view, the findings in Job satisfaction
this dissertation also produces something different from previous findings. One of the through
main characteristics inherent in the character of the hospital cannot refuse patients. employee
Figure 2 shows a path diagram of the research model of work ability, hospital ethics,
and leadership behaviour on service quality through the commitment of hospital staff. commitment

49
6. Limitation of the research

(1) The comparison of customer expectations regarding health services with the reality
of the services received makes this study a one time sequence of study, with a
cross-sectional design. The assessment of service quality is based on the paradigm
of service performance received by the customer.
(2) Based on the research that is longitudinal, measuring service quality and
dissatisfaction with health services provided in the hospital will use the paradigm
of expectancy disconfirmatiom, the assessment based on the comparison of
expectations and the reality of the health services received by the customer on
being in the hospital.
(3) Measurement of work ability in this study is based on the measurement of
employee perceptions and customer perceptions, where the objectivity of the
measurement is somewhat dubious (because there are too many factors that can
affect their judgements).
(4) Therefore, in the context of future research, it would be nice if assessments on work
ability conducted by the leaders direct the authorities to assess the performance of
its employees.
(5) This study is a case study of one hospital that would make the generalisation of
the aspects of the findings questionable. So, further research should use multiple
Type A government-owned hospitals that may represent aspects of the
generalisation of the findings.

Work
ability

0.35

0.10

0.52
Hospital Employee Service
ethics commitment quality
–0.54 Figure 2.
0.094
Path diagram of the
effect among work
ability, hospital ethics
0.072 and leadership
0.71
behaviour through
Leadership employee commitment
behaviour on service quality
JMD 7. Conclusion
37,1 (1) In general, the study found that there was a significant direct and indirect effect of the
variables, i.e. work ability of employees, perceived ethics, hospital leadership behaviour,
on employee commitment and service quality based on the assessments and
perceptions of internal stakeholders, i.e. paramedic (doctors), frontliners (nurses), and
external stakeholders, in Type A government hospital in Indonesia.
50 (2) Significant indirect effects of the ability of employees, hospital ethics, and leadership
behaviours on service quality have been found based on the assessment of internal
stakeholders in the hospital, which include paramedic (doctors) and frontliners
(nurses), as well as external stakeholders (hospital’s inpatient).
(3) Finally, we found that the employee commitment has a direct significant negative
effect on service quality, which is evidenced by the value of path coefficient of −0.538.
The results of this study are not uncommon, as some previous studies stated a positive
relationship between employee commitment and service quality. To end this
research paper, the author would like to conclude that the findings in point 3 are
different from previous findings, i.e. character of hospital management shows that
physicians are faced with a variety of interests, like the benefit of patients (of which not
a few) that they must deal with every day, the interests of the institution which is a
place where paramedics and frontliners find a shelter, as well as their personal interests;
one of the main characteristics inherented in the character of the hospital is that it
cannot refuse a patient, so if the demand for services exceeds the capacity of service
available, it will cause the workload to be incompatible with the available capacity;
frontliners, paramedics and hospital staff, in general, on the one hand, stated that they
have a high commitment to the hospital, whilst, on the other hand, they feel burdened
by their work. This situation will result in the service delivered to be less than optimal
and would ultimately have an impact on service quality.

References
Allen, N.J. and Meyer, J.P. (1990), “The measurement and antecedents of affective, continuance, and normative
commitment to the organization”, Journal of Occupational Psychology, Vol. 63 No. 1, pp. 1-18.
Argyle, M. (1967), The Psychology of Interpersonal Behavior, Penguin, Baltimore, MD.
Ashfort, B.E., Sluss, D.M. and aks, A.M. (2007), “Socialization tactics, proactive behaviour, and
newcomer learning: integrating socialization model”, Journal of Vocational Behavior, Vol. 70
No. 1, pp. 447-462.
Bass, B.M (1990), “From transformational leadership: learning to share the vision”, Copyright of
Organizational Dynamics property of Elsevier Science Publishing Company Inc., available at:
www.discovery.com/leadership/references_files/Bass%20
Bateman, T.S. and Strasser, S. (1984), “A longitudinal analysis of the antecedents of organizational
commitment”, Academy of Management Journal, Vol. 27, pp. 95-112.
Begley, T.M. and Czajka, J.M. (1993), “Panel analysis of the moderating effects of commitment on job
satisfaction, intent to quit, and health following organizational change”, Journal of Applied
Psychology, Vol. 78 No. 1, pp. 552-556.
Bell, B.S. and Kozlowski, S.W.J. (2002), “Goal orientation and ability: interactive effects on
self-efficacy, performance, and knowledge”, Journal of Applied Psychology, Vol. 87 No. 3,
pp. 497-505.
Benkhoff, B. (1997), “Ignoring commitment is costly: new approaches establish the missing link
between commitment and performance”, Human Relations, Vol. 50 No. 6, pp. 701-726.
Bitner, M.J., Booms, B.H. and Tetreault, M.S. (1990), “The service encounter: diagnosing favorable and
unfavorable incidents”, Journal of Marketing, Vol. 54 No. 1, pp. 71-84.
Boshoff, C. and Gerhard, M. (1995), “A causal model to evaluate the relationship among supervision, Job satisfaction
role stress, organizational commitment, and internal service quality”, European Journal of through
Marketing, Vol. 29 No. 2, pp. 23-42.
employee
Brown, T.J., Mowen, J.C., Donavan, D.T. and Licata, J.W. (2002), “The customer orientation of service
workers: personality trait influences on self and supervisor performance ratings”, Journal of commitment
Marketing Research, Vol. 39 No. 1, pp. 110-119.
Buchanan, B. (1974), “Building organization commitment: the socialization of managers in work 51
organizations”, Administrative Science Quarterly, Vol. 22 No. 1, pp. 533-546.
Curry, J., Wakefield, D., Price, J. and Mueller, C. (1986), “On the causal ordering of job satisfaction and
organizational commitment”, Academy of Management Journal, Vol. 29 No. 4, pp. 847-858.
Dabholkar, P.A., Sheperd, C.D. and Thorpe, D.I. (2000), “A comprehensive framework for service
quality: an investigation of critical conceptual and measurement issues through a longitudinal
study”, Journal of Retailing, Vol. 76 No. 2, pp. 139-173.
Dion, M. (2012), “Are ethical theories relevant for ethical leadership?”, Leadership & Organization
Development Journal, Vol. 33 No. 1, pp. 4-24.
Donavan, D.T., Brown, T.J. and Mowen, J.C. (2004), “Internal benefits of service-worker customer
orientation: job satisfaction, commitment, and organizational citizenship behaviors”, Journal of
Marketing, Vol. 68 No. 1, pp. 128-145.
Dozier, J.B. and Miceli, M.P. (1985), “Potential predictors of whistle-blowing: a prosocial behavior
perspective”, Academy of Management Review, Vol. 10 No. 4, pp. 823-836.
Dubinsky, A.J. and Hartley, S.W. (1986), “Antecedents of retail salesperson performance:
a path-analytic perspective”, Journal of Business Research, Vol. 14, pp. 253-268.
Elovainio, M., Kivima-ki, M. and Vahtera, J. (2002), “Organizational justice: evidence of a new
psychosocial predictor of health”, American Journal of Public Health, Vol. 92 No. 1, pp. 105-108.
Ford, R.C. and Richardson, S. (1997), “Methods of measuring patient satisfaction in health care
organization”, Health Care Management Review, Vol. 22 No. 1, pp. 74-89.
Glisson, C. and Durick, M. (1988), “Predictors of job satisfaction and organizational commitment in
human service organizations”, Administrative Quarterly, Vol. 33, pp. 61-81.
Hennig-Thurau, T. and Thurau, C. (2003), “Customer orientation of service employees – toward a
conceptual framework of a key relationship marketing construct”, Journal of Relationship
Marketing, Vol. 2 No. 1, pp. 1-32.
Huhtala, M., Kangas, M., Lämsä, A.M. and Feldt, T. (2013), “Ethical managers in ethical organisations?
The leadership-culture connection among Finnish managers”, Leadership & Organization
Development Journal, Vol. 34 No. 3, pp. 250-270, available at: https://doi.org/10.1108/
01437731311326684
Johnston, M.W., Parasuraman, A., Futrell, C.M. and Black, W.C. (1990), “A longitudinal
assessment of the impact of selected organizational influences on salespeople’s
organizational commitment during early employment”, Journal of Marketing Research,
Vol. 27 No. 2, pp. 333-344.
Kaldenberg, D.O., Becker, B.W. and Zvonkovic, A. (1995), “Work and commitment among
young professionals: a. study of male and female dentist”, Human Relation, Vol. 48 No. 1,
pp. 1355-1377.
Kanter (1968), “Commitment and social organization: a study on commitment mechanism in utopian
communities”, American Sociological Review, Vol. 33 No. 1, pp. 499-517.
Koh, H.C. and Boo, E.H.Y. (2004), “Organisational ethics and employee satisfaction and commitment”,
Management Decision, Vol. 42 No. 5, pp. 677-693.
Lincoln, J.R. and Kalleberg, A.L. (1990), Culture, Control and Commitment: A Study of Work
Organization and Work Orientations in the United States and Japan, Cambridge University
Press, Cambridge.
Luthans, F. (1998), Organizational Behavior, 8th ed., Irwin McGraw-Hill, NJ.
JMD Mackenzie, F. (1998), Land, Ecology and Resistance in Kenya, 1880-1952, Edinburgh University Press,
37,1 Edinburgh.
Mehring, J. and Koretz, G. (2004), “Healthcare: how good?”, Business Week, 28 February, pp. 1-16.
Mohammad, K. (2002), “Why healthcare insurance not yet sold out”, Kompas, 20 November, p. 31.
Mullins, L.J. (1995), Management and Organizational Behaviour, 3rd ed., Pitman Publishing, London.
Murphy, P.E. (1995), “Corporate ethics statements: current status and future prospects”, Journal of
52 Business Ethics, Vol. 14 No. 1, pp. 575-587.
Natalisa, D. (1999), “Pengaruh Komitmen Manajemen Terhadap Kualitas Layanan Untuk
Meningkatkan Kepuasan Pelanggan Maskapai Penerbangan Domestik”, PhD thesis,
Post Graduate Program, Airlangga University, Surabaya.
Nordgren, L.D., Johnson, T., Kirschbaum, M. and Peterson, M.L. (2004), “Medical errors: excess hospital
costs and lengths of stay”, Journal for Healthcare Quality, Vol. 26 No. 2, pp. 42-48.
O’Fallon, M.J. and Butterfield, K.D. (2005), “A review of the empirical ethical decision-making
literature: 1996-2003”, Journal of Business Ethics, Vol. 59 No. 1, pp. 375-413.
Parasuraman, A., Zeithaml, V.A. and dan Berry, L.L. (1988), “A conceptual model of service quality and
its implications for future research”, Journal of Marketing, Vol. 64 No. 1, pp. 41-50.
Robbins, S.P. (1996), Organizational Behavior, Concepts, Controversies, Applications, 7th ed., Prentice
Hall Inc., Englewood Cliffs, NJ.
Sims, R.L. and Kroeck dan, K.L. (1994), “The influence of ethical employee satisfaction, commitment,
and turnover”, Journal of Business Ethics, Vol. 13 No. 1, pp. 939-947.
Smith, D.M. (1996), “Increasing employee productivity, job satisfaction, and organizational
commitment”, Hospital & Health Services Administration, pp. 160-174.
Steers, R.M. (1977), “Antecedents and outcomes of organisational commitment”, Administrative Science
Quarterly, Vol. 22 No. 1, pp. 46-56.
Tatum, B.C. and Eberlin, R.J. (2008), “The relationship between organizational justice and conflict
style”, Business Strategy Series, Vol. 9 No. 6, pp. 297-305.
Viswesvaran, C., Desphande, S.P. and Joseph, J. (1998), “Job satisfaction as a function of top
management support for ethical behavior: a study of Indian managers”, Journal of Business
Ethic, Vol. 9 No. 1, pp. 63-70.
Weaver, G.W., Trevino, L.K. and Cochran, P.L. (1999), “Corporate ethics programs as control systems:
influences of executive commitment and environmental factors”, Academy of Management
Journal, Vol. 42 No. 1, pp. 41-57.
Yukl, G. (1998), Leadership in Organization, Translation, Prehallindo, Prentice Hall, Amstrerdam.

Further reading
Currivan, D.B. (2000), “The causal order of job and organizational commitment in models of employee
turnover”, Human Resource Management Review, Vol. 9 No. 4, pp. 495-524.
Jordan, J., Brown, M.E., Trevino, L.K. and Finkelstein, S. (2006), “Someone to look up to: executive-follower
ethical reasoning and perception of ethical leadership”, Journal of Management, Vol. 20 No. 10,
pp. 1-12.
Smith, P.B., Peterson, M., Misumi, J. and Bond, M. (1992), “A cross-cultural test of the Japanese PM.
leadership theory”, Applied Psychology: An International Review, Vol. 41 No. 1, pp. 5-19.

Corresponding author
Ria Mardiana Yusuf can be contacted at: ria.unhas.jp@gmail.com

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