Change management in the healthcare sector:

are employees likely to stay?

The relationship between High-involvement work practices and Turnover intentions:

exploring the mediating role of Change readiness and the moderating role of
Transformational leadership

Bachelor thesis Human Resource Studies (Personeelwetenschappen)

Tilburg University – Tilburg School of Social and Behavioral Sciences

Author: Sophie M.A. van den Dungen – SNR: 2000260

1st supervisor: S. Kilroy
2nd supervisor: R. Steegh
June 2019
Project theme: HRM, well-being and performance: case study nurses
Abstract
This study explored whether high-involvement work practices (HIWPs) impact on employee
perceptions of change readiness and turnover intentions in a changing organizational
environment. This study aimed to develop new theoretical insights in the ‘black box’ debate of
Human Resource Management (HRM), by investigating the mediating role of change readiness
in the relationship between HIWPs and turnover intentions. In addition, this study investigated
whether transformational leadership (TL) moderates the relationship between HIWPs and
change readiness. Questionnaires were distributed among 2,244 healthcare employees in a
Canadian psychiatric hospital. Data from 883 healthcare employees were used. Multiple linear
regression analyses were conducted using the PROCESS macro in SPSS. Findings revealed
that perceived HIWPs were significantly and negatively related to turnover intentions, and
significantly and positively related to change readiness. Change readiness was found to partially
mediate the relationship between HIWPs and turnover intentions. However, TL did not
moderate the relationship between HIWPs and change readiness. The role of TL was further
investigated in a post-hoc analysis, using the PROCESS macro in SPSS. The post-hoc analysis
revealed interesting significant findings, which are discussed in the discussion section. The
study findings point towards the importance of change management in healthcare, and two
potentially effective strategies for organizations to safeguard employees’ readiness to change
and to address the personnel shortage in healthcare. Theoretical and practical implications of
the findings are discussed to improve understanding of whether and how HIWPs and TL
influence change readiness and turnover intentions.

Key words: turnover intentions, high-involvement work practices, change readiness,

transformational leadership, strategic HR, change management.

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Table of Contents
Theoretical Framework .............................................................................................................. 7

The relationship between high-involvement work practices and turnover intentions............ 9

The relationship between high-involvement work practices and change readiness ............... 9

The mediating role of change readiness ............................................................................... 11

The moderating role of transformational leadership ............................................................ 13

Method...................................................................................................................................... 15

Results ...................................................................................................................................... 19

Descriptive Statistics ............................................................................................................ 19

Factor Analysis ..................................................................................................................... 21

Test of Hypotheses ............................................................................................................... 21

Discussion ................................................................................................................................ 25

Theoretical implications ....................................................................................................... 25

Practical implications ........................................................................................................... 28

Limitations and Future research ........................................................................................... 29

References ................................................................................................................................ 31

Appendix .................................................................................................................................. 44

Appendix A – Cover letter for questionnaire ....................................................................... 44

Appendix B – Questionnaire items ...................................................................................... 46

Appendix C – Descriptive statistics of respondents ............................................................. 48

Appendix D – Output Factor Analyses and Reliability Analyses ........................................ 49

Appendix E – Results of post-hoc analyses in PROCESS ................................................... 55

Appendix F – PROCESS Model 7 (moderated mediation) (Hayes, 2018) .......................... 56

Appendix G – Post-hoc analysis PROCESS Model 4 (Hayes, 2018) .................................. 61

Appendix H – Interviews with HR professionals in healthcare ........................................... 66

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Introduction
For many years, a worldwide challenge facing organizations in the healthcare sector is the
increasing turnover rates among nurses (e.g. Dewanto & Wardhani, 2018). This trend is likely
to pose a threat for the chances of survival for healthcare organizations (Lavoie-Tremblay,
O’Brien-Pallas, Gélinas, Desforges, & Marchionni, 2008). The prognosed nursing shortage for
the upcoming two decades is at least a half to one million in the United States (Salam, 2016).
In other countries in the Western world, healthcare organizations face an equivalent
contemporary problem (Lavoie-Tremblay et al., 2008). In Canada, a nursing shortage of 60,000
could arise in 2022 if no interventions are implemented to reduce the turnover rates (Jobs
Canada Fairs, 2018). In the Netherlands, an increase of 100,000 unfilled healthcare jobs are
forecasted for 2022 (Ministry of Health, Welfare & Sport, 2018). A sufficient ratio of patients
and healthcare professionals is a precondition for safeguarding the quality of care delivered
(e.g. Gardulf et al., 2005). Therefore, turnover intentions among employees are a potential
threat to the performance and survival of healthcare organizations.
At the same time, change has become an inevitable reality in both public and private
sectors (e.g. Gelaidan, Al-Swidi, & Mabkhot, 2018; Neves, Almeida, & Velez, 2018).
Considering today’s dynamic environment, change and continuous adaptation is key for
organizations to overcome external challenges, remain competitive, and ultimately survive
(Gelaidan et al., 2018). Healthcare organizations have been subject to internal changes in order
to improve efficiency and respond to external challenges such as personnel shortages (Dubois,
Bentein, Mansour, Gilbert, & Bédard, 2014; Weiner, Amick, & Lee, 2008). Success rates of
organizational change are below 30 percent (see review of Al-Haddad & Kotnour, 2015).
Employees’ attitudes towards change are considered to play a role in determining either success
or failure of reorganization initiatives in healthcare (Dubois et al., 2014).
An important element that could hamper the success of change is the lack of an
organization’s ability to create a sense of change readiness among employees (Cinite, Duxbury,
& Higgins, 2009). Change readiness is the cognitive precursor for behaviours that are in favour
of, or resisting change (Armenakis, Harris, & Mossholder, 1993). Although contributing
elements towards employees’ acceptance of change have been widely studied (see e.g the meta-
analysis of Oreg, Vakola, & Armenakis, 2011), there is on-going debate about change
management strategies to safeguard employees’ readiness to change, and to address the
shortage issue in healthcare. Indeed, the decisions of employees to leave the organization as a
result of change could be reduced by means of intervention (Morrell, Loan-Clarke, &
Wilkinson, 2004). One of the reasons to leave might be attributable to the high change rates

4
that organizations are subject to nowadays, thereby stimulating employees’ “change fatigue –
a perception that too much change is taking place.” (Bernerth, Walker, & Harris, 2011, p. 322).
Negative experiences of change are found to increase the likelihood among healthcare
employees to leave the organization (Josephson, Lindberg, Voss, Alfredsson, & Vingard,
2008).
Human Resource Management (HRM) is acknowledged to play a significant role in
change management (Kew & Stredwick, 2016). Change management is: “an enabling
framework for managing the people side of change.” (Hiatt & Creasey, 2012, p. 7). In
Armstrong’s (1999) guidelines for managing change, HR’s role is to shape an organizational
environment in favour of change such as enabling employee participation. In addition, the
strategic role of HRM has become crucial in today’s organizational environment (Mitchell,
Obeidat, & Bray, 2013). Strategic HRM (SHRM) concerns a specific set of planned HR
practices intended to positively impact organizational performance outcomes, and is referred to
in the literature as high-performance work practices, commitment-based practices, innovative
employment practices, and high-involvement work practices (e.g. Gittell, Seidner, & Wimbush,
2010; Jiang, Takeuchi, & Lepak, 2013).
There is an evolving trend in previous empirical research to focus on the role of strategic
HR practices in the HRM-performance relationship (e.g. Richardson & Vandenberg, 2005),
suggesting that these sets of mutually reinforcing, synergistic HR practices facilitate employee
involvement (e.g. MacDuffie, 1995; Guthrie, Spell, & Nyamori, 2002). For years, the focus has
been on identifying underlying mechanisms in the HRM-performance relationship, thereby
striving for developed insights into the so-called ‘black box’ debate in HRM (Peccei & van de
Voorde, 2014). However, the influence of SHRM practices and the potentially intervening role
of employees’ attitudinal perceptions to change in the HRM-performance relationship have
rarely been explored. Nevertheless, in Canadian healthcare, a high-involvement approach is
considered to improve employees’ perceptions of the work environment, which could reduce
turnover rates (Dastmalchian & Steinke, 2017). Moreover, high-involvement work practices
(HIWPs) are found to have beneficial outcomes for organizations and employees, such as
increased productivity and lower turnover rates (e.g. Doucet, Lapalme, Simard, & Tremblay,
2014; Paré & Tremblay, 2007). HIWPs are a specific set of HR practices providing employees
with more power, information, recognition, and knowledge, with the aim of increasing
employee involvement (Lawler, 1986).
Empirical evidence shows that high levels of change readiness are associated with
greater employee effort and investment in change processes, which contributes to successful

5
change outcomes (Kotter, 1995; Weiner et al., 2008). Furthermore, acceptance of change is
found to be negatively associated with employees’ turnover intentions (Wanberg & Banas,
2000). Since turnover intentions are acknowledged as a form of change resistance (Armenakis
& Bedeian, 1999), a lack of change readiness may result in increased turnover intentions.
Therefore, change readiness may function as a mediating mechanism in the HRM-performance
relationship.
In addition, empirical evidence is found wanting in terms of how strategic HR practices
impact on individuals’ reactions to the implementation of an organizational change, and how
supervisors are able to influence this process (Neves et al., 2018). Change management research
regards leadership to play a decisive role in organizational change processes (e.g. Gelaidan &
Ahmed, 2013; Gelaidan et al., 2018). According to Kavanagh and Ashkanasy (2006), effective
leadership is one of the most important strategies to create acceptance of change among
individuals. Prior research demonstrated that several forms of change deliver more successful
outcomes when “leadership, management and HRM practices are integrated” (Fugate, 2012, p.
200). In particular, transformational leadership (TL) seems to play an important strategic role
in change processes (Avolio, Bass, & Jung, 1999; Oreg & Berson, 2011). TL behaviours
increase employees’ awareness of the organization’s valued outcomes, and encourage
employees to achieve performance goals such as target outcomes of change (e.g. Bass, 1985).
Moreover, signal consistency originating from an organization’s structure and leadership
behaviours is considered important to bring about successful change (e.g. Nadler & Tushman,
1990). In practice, however, line and ward managers in healthcare are responsible for
implementing HR practices and conveying signals to employees (Townsend, Wilkinson, &
Allan, 2012). Therefore, the relationship between employee perceptions of HIWPs and change
readiness may be influenced by the line managers’ leadership style used to implement the
HIWPs (i.e. HRM process model, Nishii & Wright, 2008). However, empirical research which
explores the interaction between HIWPs and TL behaviours as complementary change
management strategies in the SHRM-performance relationship is lacking.
Based on the aforementioned research gaps, the aim of the present study is to provide
HR, line, and ward managers with insight into change management by investigating how and
under what circumstances HIWPs may be an effective SHRM-tool for healthcare organizations
to safeguard employees’ change readiness and turnover intentions. In an attempt to fill the
research gap in the understanding of possible mechanisms and conditions that interfere in the
HRM-performance relationship, this study aims to contribute to existing literature on change
management and the black box debate in HRM. Furthermore, the research call of Veld, Paauwe,

6
and Boselie (2010) is addressed by investigating the moderating role of TL in creating a
strategic HR climate to foster employees’ change attitudes. The following research question is
proposed: Do high-involvement work practices indirectly predict turnover intentions via
change readiness, and is this indirect effect moderated by transformational leadership?

Theoretical Framework
The high-involvement management approach is recognized as particularly important in the
context of organizational change (Boxall & Macky, 2009). This approach is concerned with
employee involvement in organizational processes beyond the scope of original job
descriptions, in order to stimulate them to be pro-active, flexible, and collaborative (Wood, Van
Veldhoven, & Croon, 2012). An increasing amount of organizations apply the high-
involvement approach to improve performance outcomes (Kizilos, Cummings, & Cummings,
2013). HIWPs could be characterized as a more soft approach in terms of HRM, promoting
employee development, participation, and trust, in contrast to the hard HRM approach, which
focuses on quantitative performance outcomes (Townsend et al., 2012; Tremblay, Cloutier,
Simard, Chênevert, & Vandenberghe 2010).
According to the PIRK-model by Lawler (1986), the foundation for employee
involvement consists of four principles: Power, Information, Rewards, and Knowledge, which
together form a system of HIWPs. In order to become involved, employees must have power
in decision-making (P), possess the requisite information to make decisions (I), receive social
recognition for contributions (R), and possess knowledge (K) that enables them to participate
in decision-making (e.g. Doucet et al., 2014).
The Power principle in HIWPs is represented by autonomy practices, which entail
components of empowerment and control in relation to decision-making (Kizilos et al., 2013).
These HR practices provide employees the opportunity to be of greater influence in work-
related processes, increasing their sense of ownership (Paré & Tremblay, 2007).
The Information principle is represented by top-down and bottom-up practices. Top-
down concerns information-sharing about the organization’s goals and development (Kizilos et
al., 2013). Bottom-up concerns practices that take information and suggestions from lower-
level employees into account (Tremblay et al., 2010).
The Reward principle concerns the social recognition employees receive as appreciation
for their contributions to organizational outcomes (Kizilos et al., 2013). Few empirical studies
involved non-monetary recognition practices in the relationship between HRM systems and

7
organizational attitudes (Tremblay et al., 2010). However, Brun and Dugas (2008) indicated
that, regardless of profession, the need for employee recognition is recognized in the literature,
e.g. in order to retain employees (Saunderson, 2004). Furthermore, social recognition could
signal to employees that their contribution is valued by the organization (e.g. Wayne, Shore, &
Liden, 1997), and has been negatively associated with turnover intentions (Paré & Tremblay,
2007).
The Knowledge principle in HIWPs is represented by development opportunities,
enabling employees to better perform their work and signal that the organization considers
human resources as a valuable set of knowledge, skills, and abilities to reach high performance
outcomes (e.g. Kizilos et al., 2013; Paré & Tremblay, 2007).
According to Lawler (1986), high-involvement of employees could only be reached if
all four principles are enhanced altogether. HIWPs are mutually reinforcing and interact
synergistically (e.g. MacDuffie, 1995; Vandenberg, Richardson, & Eastman, 1999). Moreover,
integrated HRM bundles are considered a system of complementarities for which the
performance effects are greater than the sum of individual parts (e.g. Appelbaum, Bailey, Berg,
& Kalleberg, 2000). Therefore, in order to take maximum advantage of employee involvement,
all four principles of the PIRK-model should be perceived in high levels by employees (e.g.
Kilroy, Flood, Bosak, & Chênevert, 2017). Therefore, this study investigates the impact of the
complete set of HIWPs on turnover intentions and change readiness.
Turnover intention is defined as: “the extent to which an employee plans to leave the
organization” (Lacity, Lyer, & Rudramuniyaiah, 2008, p. 228). According to the theory of
reasoned action “the best single predictor of an individual’s behaviour will be a measure of the
intention to perform that behaviour” (Fishbein & Ajzen, 1975, p. 369). Moreover, previous
empirical evidence showed a positive relationship between turnover intentions and actual
turnover (e.g. Byrne, 2005).
Change readiness concerns an individual’s “beliefs, attitudes, and intentions regarding
the extent to which changes are needed and the organization’s capacity to successfully make
those changes” (Armenakis et al., 1993, p. 681). Literature underlines that change readiness is
regarded as an important precursor of successful change implementation (see Weiner et al.,
2008, for an overview).

8
The relationship between high-involvement work practices and turnover intentions
The negative relationship between HIWPs and turnover intentions can be explained based on
the postulations of Social Exchange Theory (SET) (Blau, 1964). SET states that within the
employer-employee relationship, perceived favourable outcomes are reciprocated from both
perspectives (Rhoades & Eisenberger, 2002). It is expected that employees’ perceived HIWPs
initiate loyalty behaviours towards the organization to reciprocate the positive resource
investment and involvement opportunities they received from the organization (Blau, 1964;
Gouldner, 1960). These loyalty behaviours constitute behaviours in favour of the organization,
such as lower intentions to leave the organization.
Several studies found support for the notion that HR practices enhance organizational
effectiveness by reducing employee turnover intentions (e.g. Bartram, Casimir, Djurkovic,
Leggat, & Stanton, 2012). This study expects that when employees perceive high levels of
HIWPs by means of participation, information, social recognition, and development practices,
they are likely to reciprocate with lower behavioural intentions to leave the organization. Thus,
HIWPs may function as resource-enhancing organizational structure, instrumental in achieving
a high-quality exchange relationship between organizational management and employees. The
following hypothesis is proposed:
Hypothesis 1. High-involvement work practices will be negatively related to turnover
intentions.

The relationship between high-involvement work practices and change readiness

Employees play a significant role in the successful implementation of any organizational
change (Kotter, 1995). The daily work context relates to the way change is managed and how
employees perceive and react upon change (van Dam, Oreg, & Schyns, 2008). Former research
identified three characteristics of change processes that are likely to relieve employees’
resistance to change: information provision, opportunities to participate in decision-making,
and trust in the change vision (Bordia, Hunt, Paulsen, Tourish, & DiFonzo, 2004; Oreg, 2006).
Also, healthcare professionals’ change willingness seems to be fostered by high levels of
perceived autonomy in their work, since low levels of autonomy are associated with low levels
of change support (Tummers, 2011). Since HIWPs are part of the daily work characteristics,
HIWPs are also expected to influence employees’ perceptions of change.
Situations of change are likely to be perceived as demanding and stressful for employees
(Cunningham, 2006; Shin, Taylor, & Seo, 2012). According to Conservation of Resources
(COR) theory, individuals value stability and try to minimize their resource loss when

9
confronted with a stressful or demanding situation at work (Otto & Dalbert, 2012; Hobfoll,
1989). Individuals with sufficient pools of resources are better able to deal with demands at
work, therefore are better able to protect themselves from negative consequences of resource
loss (Lee & Ashforth, 1996; Hobfoll, 1989). Within an employee’s resource pool, resources are
differentiated into four types: object (e.g. tools), personal (e.g. personal traits), energy (e.g.
knowledge and development), and condition resources (e.g. social support) (Hobfoll, 2011).
This study considers HIWPs as conditional organizational resource (i.e. job resource) for
employees by facilitating the conditions to become involved in organizational process, which
could contribute to a positive resource gain-cycle in other areas. For instance, HIWPs may
provide employees with information and development opportunities (i.e. energy resources) to
increase understanding of the reasons and consequences of a change process, enabling them to
gain a clearer picture of what is expected from them. In addition, autonomy and social
recognition practices involved in HIWPs can facilitate a personal resource gain in the sense that
employees’ self-esteem may improve.
Moreover, according to the resource investment principle, the more resources
individuals possess, the less vulnerable they are to resource loss, and the more capable they are
to perceive resource gains (e.g. Hobfoll, 2011). By the same token, resource gains in the form
of HIWPs could help to overcome feelings of change-related stress, forming a personal resource
pool to cope with change-related stress and thereby improving employees’ attitudes towards
change (e.g. Shin et al., 2012). In other words, employees’ change readiness could be fostered
by the resource-building principle of HIWPs, which delivers employees a personal, energized
attitudinal resource pool towards change. This reasoning is in line with COR’s proposition that
resources exist in caravans (Hobfoll, 1988). According to the concept of resource caravan
passageways, organizations could either create ecologies that support, enrich, and protect
employees’ resources, or ecologies that hamper and obstruct their resources (e.g. Hobfoll,
2011). This study considers HIWPs as representing aspects of “resource caravan-creating and
sustaining organizational ecologies” (Hobfoll, 2011, p. 118) that enhance and protect
employees’ resources in times of change.
Furthermore, employees’ competencies and skills could make a unique contribution to
organizational change processes (Doorewaard & Benschop, 2003). This is in line with the
human resource-based view, which states that organizations could gain a sustained competitive
advantage based on the extent to which they possess an employee pool with valuable, rare,
inimitable, and non-substitutable competencies and skills (Barney, Wright, & Ketchen, 2001).
Doorewaard and Benschop (2003) stressed the importance of HR practices that provide

10
employees with empowerment, opportunities to participate, and information and
communication patterns, together fostering employees’ competencies required for successful
change. These type of practices are involved in HIWPs and may impact employees’ attitudinal
reactions to change in such a way that HIWPs deliver the required communication, motivation
and participation structures to bring about successful change outcomes (Doorewaard &
Benschop, 2003).
In sum, in the context of this study HIWPs are considered as a set of conditional
organizational resources aiming to facilitate employees with power, information, recognition,
and knowledge, thereby providing them with an adequate amount of resources to cope with
demanding change situations. As a consequence, employees’ change readiness is likely to
increase. The following hypothesis is proposed:
Hypothesis 2. High-involvement work practices will be positively related to change
readiness.

The mediating role of change readiness

Uncertainty is rife during organizational change (e.g. Bordia et al., 2004). Morrell et al. (2004)
studied the turnover decisions of nurses from the National Health Service and found that in case
of poor change management, the experienced shock by employees correlates with higher
turnover intentions. Bastien’s (1987) study on employees’ reactions to mergers showed that
moving from a well-known towards an unknown organizational context is associated with a
fear of resource loss. The associated loss of resources in such change situations is likely to be
perceived as a demanding cost of change for individuals, which increases their likelihood to
show unwishful behaviour to the organization, and could result in higher turnover rates
(Bouckenooghe, 2010; Cunningham, 2006).
According to the Job Demands-Resources (JD-R) model, perceived resources are
assumed to initiate a motivational process among employees and function as a facilitator
towards the achievement of organizational goals (Demerouti, Bakker, Nachreiner, & Schaufeli,
2001). In this regard, HIWPs can be perceived as a resource which initiates a motivational
process, providing employees with motivation to face change successfully without the expense
of valuable personal and energy resources, and subsequently delivering positive organizational
outcomes (Demerouti et al., 2001; Hobfoll, 2011). For instance, supportive HR practices
(participation in decision making, fairness of rewards, and opportunities to grow) are positively
related to employees’ perceived organizational support, which in turn is negatively related to
turnover (Allen, Shore, & Griffeth, 2003). Neves (2009) states that employees’ change

11
readiness impacts on individual behavioural intentions: employees’ turnover intentions are
reduced as a consequence of increased understanding of the change purpose.
Although studies investigated the relationship between employees’ reactions to change
and turnover (e.g. Fugate, Kinicki, & Prussia, 2008; Wanberg & Banas, 2000), the role of
individual behavioural intentions in relation to HRM and change outcomes has rarely been
explored. An exception is the study conducted by Neves et al. (2018), which found evidence
for a mediating role of affective commitment to change in the negative relationship between
commitment-based HR practices and the intention to resist future change.
Based on the aforementioned considerations, it is expected that higher levels of HIWPs
will increase employees’ levels of change readiness, which in turn will reduce turnover
intentions. The following hypothesis is proposed:
Hypothesis 3. Change readiness will positively mediate the relationship between high-
involvement work practices and turnover intentions.

Transformational leadership
TL comprises behaviours of leaders aiming to increase awareness among employees of the
organization’s valued outcomes, and encouraging and motivating them to achieve performance
goals (Bass, 1985; Podsakoff, MacKenzie, Moorman, & Fetter, 1990). TL behaviours serve the
goal of motivating employees to identify with the leader’s vision, to let go of self-interest, and
put the organization’s interests first (McKnight, 2013). TL is a multi-dimensional construct,
consisting of four behavioural components: idealized influence, inspirational motivation,
intellectual stimulation, and individualized consideration (e.g. Bass & Riggio, 2006).
According to Bass and Riggio (2006), idealized influence involves showing moral and
ethical behaviour that enables transformational leaders to act as role model for employees.
Second, inspirational motivation concerns behaviours of motivating and inspiring employees
to get them involved in the envisioned future state of the organization. Transformational leaders
inspire employees by means of clearly communicated expectations about the goals and vision.
Third, transformational leaders stimulate employees to be creative, innovative, and to think ‘out
of the box’. Ideas from employees that challenge the status quo are not criticized by
transformational leaders (Avolio, Bass, & Jung, 1997). Fourth, individualized consideration is
practiced by fulfilling the role as coach to pay attention to individuals’ needs for growth and
achievement, and providing support (Bass & Riggio, 2006).

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The moderating role of transformational leadership
In the light of organizational change, transformational leaders have proven to engage in a three-
phase change process: recognize the need for change, generate a new vision for the
organization, and subsequently institutionalize the change (Eisenbach, Watson, & Pillai, 1999).
This study takes a configurational approach to link the SHRM-system of HIWPs to TL when
testing for the moderating effect of TL on the HIWPs-change readiness relationship.
Within a configurational approach, a pattern of multiple independent variables are taken
together to represent one independent variable in the relationship with a dependent variable
(Delery & Doty, 1996). By taking this approach, the vertical fit can be optimized: the
congruence of the organizational HR-system with other organizational characteristics, such as
leadership (Delery & Doty, 1996). The four TL behaviours constitute a strategic configuration
of leadership, which can be linked to employees’ perceptions of the total set of perceived
HIWPs in the strategic climate, thereby conforming to Delery and Doty’s (1996)
implementation requirements.
First, transformational leaders positively stimulate employee participation in change
processes (Bass & Riggio, 2006; Gelaidan et al., 2018). Autonomy practices involved in HIWPs
facilitate an organizational structure to participate in decision-making processes (Lawler,
1986). Kotter (1995) states that employees’ motivation to accept change is fostered by means
of involving them in the change process in such a way that they understand the change. When
leaders motivate and inspire employees with a clearly communicated vision, the positive
influence of autonomy practices on employees’ change readiness is likely to be strengthened.
Second, idealized influence and inspirational motivation may complement the
information principle of HIWPs, since top-down information practices strive towards
awareness and internalization of organizational goals among employees (Meyer & Allen,
1997). In addition, individualized consideration corresponds to an organization’s openness to
employee feedback (bottom-up). Therefore, perceived proper information top-down and
bottom-up, combined with a clear envisioned, communicated organizational future state and
individualized consideration may strengthen the positive relationship between HIWPs and
change readiness.
Third, transformational leaders offer individualized consideration to employees,
meaning personal needs are recognized by supervisors (Bass & Riggio, 2006). Social
recognition from supervisors is likely to guide employees’ perceptions of recognition by the
whole organization (Eisenberger et al., 2010). Recognition practices in HIWPs deliver similar
social recognition to employees and are incorporated into the formal organizational structure

13
(Doucet et al., 2014). The combination of these two sources of recognition perceived by
employees may strengthen the positive effect of the perceived set of HIWPs on change
readiness by creating an even more prominent culture of recognition (Brun & Dugas, 2008).
Finally, individualized consideration corresponds to development opportunities
provided in the HIWPs structure (Avolio et al., 1997). Transformational leaders stimulate
employees to be creative and innovative (Bass & Riggio, 2006). Therefore, they could motivate
employees to use development opportunities, thereby strengthening the positive effect of
perceived HIWPs on change readiness.
Moreover, Kotter (2001) defines management as facilitating stability and consistency
within the organizational structure, and leadership as coping with changing circumstances by
guiding and aligning employees through organizational change. HIWPs represent the
management as a facilitating process of organizing, planning, and controlling, whereas
leadership is a process of providing direction, aligning employees, and motivating employees
to accept change (e.g. Kotter, 2001). Keller (2006) found that initiating structure together with
TL behaviours may form a valuable combination to achieve high performance outcomes.
Moreover, achieving successful change implementation is often featured by “a hybrid
combining elements of lower-level participation and direction from top management”
(Fernandez & Rainey, 2006, p. 171). Transformational leaders are likely to complement the
structure provided by HIWPs, by strengthening the positive relationship between HIWPs and
change readiness.
Furthermore, Haggerty and Wright’s signalling theory (2009) states that HRM can be
regarded as signals that organizational management sends to employees, rather than practices
(Townsend et al., 2012). Due to the fact that line and ward managers are responsible for
implementing strategic HR policies in healthcare, line managers play a significant role in
determining which and in what way HIWPs are signalled to and perceived by employees
(Townsend et al., 2012). Moreover, according to upper echelons theory (Hambrick & Mason,
1984), managers’ personal behavioural characteristics determine which strategic choices they
make and how employees are affected (Oppong, 2014). In other words: based on the line
manager’s judgement of the usefulness of HIWPs, it is decided whether and how the practices
are implemented and actually perceived by employees on the work floor. Therefore, the extent
to which employees’ change readiness is fostered by HIWPs is likely to be influenced by line
managers’ leadership behaviours when implementing practices on the work floor.

14
 To gain a complete understanding of employees’ reactions to change, the role of
strategic HIWPs and the role played by leaders should be taken into account at the same time.
Perceived TL could represent a condition in support of employee resource gains from HIWPs,
by strengthening the positive relationship between HIWPs and change readiness. Based on the
aforementioned considerations, the following hypothesis is proposed:
Hypothesis 4. Transformational leadership will moderate the relationship between
high-involvement work practices and change readiness such that the positive relationship
between high-involvement work practices and change readiness becomes stronger under the
condition of high rather than low levels of transformational leadership.

High-involvement work + Change readiness - Turnover intentions

practices
+

Transformational
leadership

Figure 1. Conceptual model

Method
Sample
The study population comprised of 2,244 French-speaking healthcare employees in a Canadian
psychiatric hospital, who were being exposed to a reorganization of healthcare services.
Participants were approached via convenience sampling, meaning data was collected by using
the researchers’ network.
In total, 995 respondents from 2,244 employees returned the questionnaire, yielding a
response rate of 44%. Not all questions were filled out by the respondents. After screening and
cleaning the data, the final sample consisted of 883 employees. The socio-demographic
characteristics of the respondents were as follows: 68% were women, 13% were below 30
years, 33% between 30-45 years, 41% between 46-55 years, and 12% over 55 years. 72% were
full-time employees, 9% had been working for the hospital for less than 2 years, 12% for 2-5
years, 11% for 6-10 years, 20% for 11-20 years, and 48% for more than 20 years. Appendix C
shows an extensive overview of the descriptive statistics of the respondents.

15
Study design
Data used in this study originate from a cross-sectional data collection that took place in 2011.
Consequently, secondary data analysis was employed for this study. The data were part of a
larger investigation on employee perceptions of the hospital’s work climate. Questionnaires
were used to gather quantitative data among healthcare employees. Employees from all staff
categories were invited to participate, since the perspective of healthcare employees in general
was of interest in this study. Data collection was on individual level. The focus in this study
was on the following concepts: high-involvement work practices, change readiness,
transformational leadership, and turnover intentions.

Measures
To measure all concepts, respondents were asked to report their level of agreement with several
statements on a seven-point Likert scale, ranging from “strongly disagree” (1) to “strongly
agree” (7).
High-involvement work practices. HIWPs were measured with items corresponding to
the four component PIRK-model (Lawler, 1986). The power component was represented by
three items measuring employees’ perceived autonomy from the psychological empowerment
scale developed by Spreitzer (1995). A sample item is: “I have great freedom of action in
carrying out my work”.
Inspired by Tremblay et al. (2010), the information-sharing component was measured
by five items, adopted from the scale of Lawler, Mohrman, and Ledford (1995). Three items
were used to measure the view on bottom-up information-sharing. Two items evaluated the
view on top-down information-sharing. A sample item for bottom-up information-sharing is:
“Employees’ opinions are regularly sought”. A sample item for top-down information-sharing
is: “Employees are regularly informed of new services, programs and/or products offered by
our hospital”.
The reward component was measured by three items based on Tremblay, Guay, Simard,
and Chênevert (2000), measuring perceptions of non-monetary recognition. A sample item is:
“Exceptional employee contributions are recognized by the institution”.
The knowledge component was measured by three items indicating employees’
perception of training and development practices, inspired by Tremblay et al. (2000). A sample
item is: “In this organization, various professional development activities are offered to
employees (e.g. coaching, training)”. Scale reliability for all individual PIRK-components
together forming HIWPs were considered as ‘good’ to ‘excellent’ (αempowerment = .83, αinformation

16
= .91, αrewards = .91, αknowledge = .85). Previous research showed that HIWPs are treated as one
global construct, having an even stronger effect on performance when considered as one
construct rather than separate practices in isolation (Vandenberg et al., 1999; Guerrero &
Barraud-Didier, 2004). Therefore, in this study HIWPs was treated as a second-order latent
factor. Overall scale reliability of HIWPs was considered ‘excellent’ (α = .90).
Change readiness. Four items from the scale of Collerette and Schneider (1996) were
used to measure employees’ level of change readiness. A sample item is: “I am ready to
continue the effort to implement the new operating modes”. Scale reliability was considered
‘good’ (α = .89).
Turnover intentions. Employees’ intentions to leave the hospital were measured with
the three-item scale of Meyer, Allen and Smith (1993). A sample item is: “I often think about
leaving the hospital”. Scale reliability was considered ‘good’ (α = .81).
Transformational leadership. TL was measured with a nine-item scale, inspired by the
Multifactor Leadership Questionnaire originally developed by Bass and Avolio (1990). The
four behavioural components of TL were represented, i.e. idealized influence, inspirational
motivation, intellectual stimulation, and individualized consideration, as identified by factor
analytic studies (e.g. Bass, 1985; Avolio et al., 1997). A sample item is: “My immediate
supervisor encourages me to see situations from a different angle”. Scale reliability was
considered ‘excellent’ (α = .91).
Control variables. In order to rule out alternative explanations for the findings, a number
of control variables were included in this study: gender, age, job status (full-time, part-time, on-
call), and organizational tenure. These variables were represented by a single-item measure in
the questionnaire. Gender represented a dichotomous variable, and was recoded into a dummy
variable (0 = male, 1 = female). Age, job status, and organizational tenure were measured as
categorical variables with four, three, and five response categories, respectively. Therefore, age
was recoded into three dummy variables with ‘46-55 years’ as reference category, job status
into two dummy variables with ‘full-time’ as reference category, and organizational tenure into
four dummy variables with ‘> 20 years’ as reference category.
Previous studies showed that age and organizational tenure were found to negatively
impact on turnover intentions (see meta-analysis Cotton & Tuttle, 1986). Moreover, Samad
(2006) found that the older someone is and the longer someone works for an organization, the
lower their intentions to leave. In addition, women were found to be more likely to leave than
men (Cotton & Tuttle, 1986), and job status is linked to employees’ psychological states such
as thoughts about leaving (Jourdain & Chênevert, 2010). A study among nurses showed that a

17
full-time job status (rather than part-time) was associated with lower intentions to leave the
organization (Rahnfeld, Wendsche, Ihle, Müller, & Kliegel, 2016).
Furthermore, tenure is considered to influence employees’ perceptions of the
organization’s HR system: the longer someone works for an organization, the less likely they
are to have a positive view of the HR system (Nishii, Lepak, & Schneider, 2008). Moreover,
age and tenure often have been negatively related to change acceptance, meaning that older and
longer tenured employees are less likely to accept change (see Oreg et al., 2011). Studies report
inconsistent findings about the relationship between gender and employees’ acceptance of
change (Oreg et al., 2011). Therefore, the control variables were chosen.

Procedure
The purpose of the data collection was to identify engaging work place factors for employees,
which could be helpful to implement in support of the reorganization. Approval by the ethics
committee was obtained before the hospital was approached. After approval of the HR director,
employees were approached to participate voluntarily in the study by receiving a cover letter
and a questionnaire (Appendix A-B). Since the sample comprised of French-speaking
respondents, questionnaires were only available in French. The cover letter incorporated
information about the topic and purpose of the study, and the data collection procedure.
Respondents were asked to insert the questionnaire in the return envelope after completion. In
addition, confidentiality and anonymity were guaranteed.

Statistical Analysis
First, descriptive statistics were used to inspect the means, standard deviations, minima, and
maxima for all study items. No outliers were detected, and missing values were identified. One
item of TL needed to be recoded, since it was reverse scored in the questionnaire.
Second, several assumptions for linear regression analysis were tested. Assumptions for
homoscedasticity, linearity, and independence of residuals were checked for all variables,
showing an appropriate pattern. Histograms were inspected to assess the distribution of the
variables. A distribution slightly differing from normal appeared for the three independent study
variables: HIWPs, change readiness, and TL. However, the outcome variable turnover
intentions showed a distribution that deviated from normal. Nevertheless, linear regression is
recognized as a test robust enough to deal with small deviations from normality in the
distribution.

18
 The sample size constituted 883 respondents. Based on Tabachnick and Fidell’s (2013)
equation (N > 50 + 8m), with m representing the number of independent variables, this study
met the assumption for required sample size (N), since the outcome is: N > 74. The sample size
of 883 respondents implies that the assumption was met.
To check for multicollinearity, a correlation matrix was created to inspect the
correlations between the independent variables. The matrix showed correlations below .7,
meaning there was no reason for suspecting any multicollinearity.
In order to test the proposed hypotheses, linear regression analysis in IBM SPSS
Statistics (version 24) was applied, using the PROCESS macro of Hayes (version 3.0, 2018). A
moderated mediation model (model 7) was used to test for all hypotheses outlined in the
conceptual model (Figure 1). Model 7 allowed for testing the indirect mediating and conditional
effects, simultaneously. In comparison to a standard multiple regression, the beneficial feature
of PROCESS is that it gives more accurate results, since all hypotheses could be tested for at
the same time.

Results
Descriptive Statistics
Means (M), standard deviations (SD), reliability coefficients (Cronbach’s α), and Pearson
correlations (r) of the study variables are shown in the correlation matrix in Table 2. Pearson
correlations concern indicators of the strength and direction of a relationship between two
continuous variables without providing any evidence of causality (Pallant, 2016). For HIWPs,
the correlation matrix shows a positive significant correlation with change readiness (r = .434,
p < .01), and a negative significant correlation with turnover intentions (r = -.205, p < .01). In
addition, HIWPs is positive and significantly correlated with TL (r = .485, p < .01).
Furthermore, for change readiness the correlation matrix displays a negative significant
correlation with turnover intentions (r = -.215, p < .01), and a positive significant correlation
with TL (r = .319, p < .01). Besides, TL is negative and significantly correlated with turnover
intentions (r = -.142, p < .01).
The matrix shows that gender was positive and significantly correlated to HIWPs and
TL. In addition, age, job status, and organizational tenure were significantly correlated with
turnover intentions. Thus, based on these significant correlations, it was decided to include the
control variables in the regression analysis, since they may affect the proposed relationships.

19
Table 1. Means, Standard Deviations, reliability coefficients, and Pearson correlations for all study variables (N = 883)
Variables Means SD 1 2 3 4 5 6 7 8
1. Gender(a) 1
2. Age(b) -.103** 1
3. Job status(c) .074* -.334** 1
4. Organizational tenure(d) -.107** .566** -.416** 1
5. High-involvement work practices 3.92 1.08 .099** .050 .022 -.125** 1 (0.90)
6. Turnover intentions 2.46 1.67 -.010 -.172** .135** -.159** -.205** 1 (0.81)
7. Change readiness 4.39 1.26 .049 .058 .021 -.053 .434** -.215** 1 (0..89)
8. Transformational leadership 4.23 1.33 .089** -.010 .009 -.133** .485** -.142** .319** 1 (0.91)
Notes:
(a) Dummy variable, with women as reference category.
(b) Dummy variable, with 46-55 years as reference category.
(c) Dummy variable, with full-time as reference category.
(d) Dummy variable, with > 20 years as reference category.
* p < .05 (two-tailed); ** p < .01 (two-tailed)

20
Factor Analysis
All study constructs were measured with well-established and validated scales. Construct
validity was tested in SPSS using exploratory factor analysis to ensure validity and
measurement consistency. First, assumptions for Principal Axis Factoring were checked. The
Kaiser-Meyer-Olkin measure of sampling adequacy should be .6 or higher, and Bartlett’s test
of sphericity should be significant (p < .05) (Pallant, 2016).
Both Varimax and Oblimin rotations were tested for in the factor analysis. Since only
very small differences were found between the two types of rotations, it was decided to use
Varimax. The reasoning behind this decision stems from the notion that Varimax allows for
easier interpretation of rotation differences. Factors have been chosen based on eigenvalues >
1. Scree plots were inspected and theoretical reasoning was applied in order to make validated
decisions which items to include in the scales. It was expected that all items load onto their
respective construct, thereby representing one factor.
Scale reliability was evaluated using reliability analysis in SPSS. COTAN’s guidelines
for internal consistency reliability were used to interpret the Cronbach’s α-values. Cronbach’s
α < 0.7 is considered ‘insufficient’, 0.7 < α < 0.8 ‘sufficient’, and α > 0.8 ‘good’ (Everts,
Sijtsma, Lucassen, & Meijer, 2010). Appendix D displays the factor analyses and reliability
analyses for all developed scales.

Test of Hypotheses
Hypotheses 1-4 were tested using the PROCESS extension in SPSS (Hayes, 2018). The
moderated mediation model (model 7) allowed to test for all hypotheses simultaneously.
Additionally, a simple mediation analysis was performed (model 4) to test for the mediation
effect separately (Hypothesis 3). In both models, the analyses controlled for the dummy
variables of gender, age, job status, and organizational tenure, since regression analysis allowed
to test for variables with two response categories only.
Table 2 displays the findings of the analysis acquired by model 7 in Hayes’ PROCESS
macro. Model 1 shows the findings in relation to the mediator, i.e. change readiness, as outcome
variable. The R2 of the first model was .215 (F(13, 843) = 15.163, p < .01). In the full model
(Model 2), findings concerning turnover intentions as outcome variable are displayed. The R2
of the second model was .129 (F(12, 844) = 8.762, p < .01). In addition, Table 2 displays the
unstandardized regression coefficients (B), standard errors (SE), and t-values for the study
variables.

21
The relationship between HIWPs and Turnover intentions
Hypothesis 1 proposed that HIWPs will be negatively related to turnover intentions. The results
of the analysis showed that the HIWPs were negative and significantly associated with turnover
intentions (B = -.242, SE = .064, p < .01). Therefore, Hypothesis 1 is supported, indicating that
higher levels of HIWPs are associated with lower levels of turnover intentions.

The mediating effect of Change readiness

Hypothesis 2 proposed a positive direct effect between HIWPs and change readiness, and
Hypothesis 3 a mediating effect of change readiness in the HIWPs-turnover intentions
relationship. The requirements by Mackinnon, Fairchild, and Fritz (2007) to test for mediation
are discussed below.
First, to establish mediation, the independent variable (HIWPs) must be significantly
associated with the mediating variable (change readiness). Table 2 show that HIWPs were
positive and significantly associated with change readiness (B = .426, SE = .050, p < .01),
thereby confirming Hypothesis 2.
In addition, the mediating variable must be significantly associated with the dependent
variable (turnover intentions), both in presence and absence of HIWPs. Change readiness was
negative and significantly associated with turnover intentions (B = -.224, SE = .053, p < .01).
Thus, Mackinnon et al.’s (2007) requirements for mediation were satisfied.
PROCESS found the indirect effect of HIWPs on turnover intentions through change
readiness to be significant (B = -.095, SE = .026, 95% CI [-.152; -.050]). The direct effect
between HIWPs and turnover intentions remained significant and negative in the presence of
change readiness, implying a partial mediating effect of change readiness. Therefore, support
was provided for Hypothesis 3.

The moderating effect of Transformational leadership

Hypothesis 4 proposed a positive moderating effect of TL on the relationship between HIWPs
and change readiness, in such a way that the positive effect of HIWPs on change readiness
would be strengthened under high rather than low levels of TL. As displayed in Table 2, the
relationship between TL and change readiness was positive and significant (B = .136, SE =
.038, p < .01). However, the interaction effect of HIWPs and TL was non-significant (B = -
.011, SE = .030, p < .05). Hence, results indicated that TL did not moderate the relationship
between HIWPs and change readiness. Therefore, Hypothesis 4 was rejected.

22
Table 2. Conditional direct and indirect effect of HIWPs on Turnover intentions, mediated by
Change readiness and moderated by Transformational leadership.
Predictor variable B SE t R2
Model 1: F(13, 843) = 15.163** .215**
The main effect on the mediator variable:
Change readiness
High-involvement work practices (HIWPs) .426** .050 8.459
Transformational leadership (TL) .136** .038 3.608
HIWPs x TL -.011 .030 -.360
Gender (0 = men, 1 = women) -.005 .086 -.056
Age
< 30 -.064 .175 -.368
30-45 -.138 .102 -1.357
55+ .134 .129 1.033
Job status
Part-time .006 .106 .059
On-call basis .077 .131 .588
Tenure
< 2 years -.051 .173 -.296
2-5 years .151 .153 .982
6-10 years -.104 .150 -.689
11-20 years .016 .114 .138
Constant 4.429** .089 49.901
Model 2: F (12, 844) = 8.762** .129**
The main effect on the dependent variable:
Turnover intentions
Change readiness -.224** .053 -4.216
HIWPs -.242** .064 -3.779
Gender (0 = men, 1 = women) -.088 .120 -.737
Age
< 30 .881** .252 3.501
30-45 .362** .134 2.689
55+ .467** .170 2.756
Job status
Part-time .223 .156 1.436
On-call basis .183 .220 .831
Tenure
< 2 years .328 .274 1.197
2-5 years .324 .237 1.369
6-10 years -.039 .188 -.208
11-20 years .175 .149 1.179
Constant 3.044** .263 11.579

23
 Moderated mediation analysis
Bootstrap results of the conditional indirect effect of HIWPs on Turnover intentions at values
of the moderator (Transformational leadership):
Boot indirect effect Boot SE LLCI 95% ULCI 95%
-1.326 -.099 .029 -.164 -.049
(-1 SD)
0.00 -.095 .026 -.152 -.050
+.1.326 -.092 .025 -.148 -.050
(+1 SD)
Index of moderated mediation
.002 .007 -.010 .018
Notes: N = 883. Bootstrap sample size = 5000. LLCI = Lower Limit Confidence Interval;
ULCI = Upper Limit Confidence Interval.
* p < .05 (two-tailed); ** p < .01 (two-tailed).

B = -.242**

B = .426** B = -.224**
High-involvement work Change readiness Turnover intentions
practices

B = -.011

Transformational
leadership

Figure 2. Results
* p < .05 (two-tailed); ** p < .01 (two-tailed).

Post-hoc analysis
A post-hoc analysis was performed to further investigate the role of TL and change readiness.
TL was positive and significantly related to change readiness (B = .136, SE = .038, p < .01).
The simple mediation test showed that the relationship between TL and turnover intentions was
partially mediated by change readiness. Findings are displayed in Appendix E-G.

24
Discussion
With the goal of safeguarding employees’ turnover intentions in healthcare, the aim of the
present study was to develop insight into the effect of strategic change management by
exploring the mediating role of change readiness in the HIWPs-turnover intentions relationship.
Additionally, this study tested for the moderating role of TL in the relationship between HIWPs
and change readiness. Evidence points towards a direct negative relationship between HIWPs
and turnover intentions, and a partial mediation of change readiness in the HIWPs-turnover
intentions relationship, but lacks support for the moderating effect of TL in the relationship
between HIWPs and change readiness. The findings entail some important implications for
theory and practice, which will be explained in greater detail in the following sections.

Theoretical implications
In the light of today’s dynamic environment, organizations in the healthcare sector face
challenges in successfully implementing changes (Chênevert, Kilroy, & Bosak, 2019). To
prepare and motivate individual employees for change, it is critical for higher and middle
management to understand how employees’ change readiness could be fostered (Madsen,
Miller, & John, 2005). In addition, the prognosed shortage of healthcare employees forces
management to think of strategic interventions to lower employees’ turnover intentions
(Dewanto & Wardhani, 2018).
In support of previous empirical evidence (e.g. Neves, 2009), this study shows that
change readiness is negatively associated with turnover intentions among individual healthcare
employees. In addition, this study confirmed previous findings on the beneficial effects of
HIWPs on performance outcomes (e.g. Doucet et al, 2014; Guthrie, 2001) by providing
evidence for a significant negative association between HIWPs and turnover intentions. Debate
is on-going about several strategies to increase change readiness and reduce turnover intentions
among employees. Individual employees are of significant influence in change processes, since
the extent to which they lend legitimacy to a change effort and “marshal the resources and
emotional support required to induce organizational members to change” (Fernandez, &
Rainey, 2006, p. 171), may determine whether the outcomes of a change process are worthwhile
for the organization (Kotter, 1995). Several strategies have been used in organizations to induce
higher levels of change readiness among employees. For instance, training and development
activities have been implemented in order to foster employees’ understanding of change
processes (e.g. Samaranayake & Takemura, 2017). This study investigated the role of HIWPs
as a strategy to foster change readiness.

25
 Previous attempts to unravel the black box debate rarely investigated the mediating role
of employees’ perceptions of change in the HRM-performance relationship in a changing
organizational environment. This study fills a void in this area and extends insights into the
black box debate by elucidating the mediating role of change readiness in the HIWPs-
performance relationship in a healthcare context. Change readiness was found to partially
mediate the relationship between strategic HRM (i.e. HIWPs) and turnover intentions. Thus,
the findings recognize a significant contribution of HIWPs as change management strategy to
induce higher levels of change readiness and lower levels of turnover intentions among
healthcare employees. Therefore, this study extends understanding of the performance-
contributing capacity of strategic HR systems (i.e. HIWPs) in the change management
literature.
In line with previously formulated ideas by Bowen and Ostroff (2004), HIWPs have
been found to serve a communicative function of the organization’s strategic goals and vision
for the future. The findings extend the propositions of COR theory in the context of change,
suggesting that perceived HIWPs could develop a sufficient resource pool for employees to
effectively deal with change-related resources loss (Hobfoll, 1989). In addition, support is
provided for the JD-R model, by highlighting the ability of HIWPs to initiate a motivational
process to help employees cope with potential demands and psychological costs that come
along with change (Demerouti et al., 2001). Thus, HIWPs act as resource-building SHRM-
intervention providing employees with the opportunity to develop a sufficient pool of resources
by participating in decision-making, being informed of organizational processes, receiving
recognition, and developing knowledge and skills (Lawler, 1986). These practices are helpful
in adapting to change in several ways. First, empowerment provides employees the opportunity
to have influence on the way their department is organized as a result of the reorganization
(Kappelman & Richards, 1996). Second, information practices (bottom-up and top-down) can
help employees in getting to understand the reasons for change and to develop a clear picture
of the consequences on the work floor. Third, social recognition can signal towards employees
that they are still recognized to be of added value for the organization, although the organization
moves into new direction. Lastly, development opportunities are particularly relevant to help
employees in learning skills that are required for the changed work situation.
Kotter’s eight-step model emphasized the importance of empowering employees to test
new ideas and procedures as a result of organizational change (Appelbaum, Habashy, Malo, &
Shafiq, 2012). To help increase employees’ change readiness, preparation in terms of training
and mentoring is considered an essential task for management (Appelbaum et al., 2012). Clear

26
communication regarding the change in combination with high-involvement of employees are
able to mitigate the stress that organizational change can cause, and to show that the
organization values its employees (e.g. Madsen, 2003). HIWPs are able to provide employees
with such sufficient pools of resources and opportunities. Therefore, employees become better
able to understand and prepare for change-related resource loss, and thus more likely to believe
in the organization’s capacity to successfully manage change (i.e. change readiness).
The finding that HIWPs lead to lower turnover intentions via change readiness can also
be interpreted from a Social Exchange perspective (Blau, 1964). HIWPs are perceived as a sign
of support and care for employees, and this favourable treatment can be reciprocated with
heightened change readiness and lower turnover intentions.
This study also contributes to the existing literature on change-leadership. From a
configurational perspective, this study aimed to develop an understanding of when HIWPs are
more or less likely to lead to higher change readiness. The moderating role of TL is investigated
as reflecting a contextual enhancing factor of the relationship between the strategic change
HIWPs-system and change readiness. Contrary to expectations, the moderating effect of TL
was not confirmed. This implies that TL undermines the role of HIWPs. Nevertheless, the post-
hoc analysis provided evidence for a partial mediation of change readiness in the relationship
between TL and turnover intentions.
The non-significant moderating effect of TL and the subsequent significant findings of
the post-hoc analysis could be further discussed in terms of the Change-leadership theory (e.g.
Kotter, 1995). With regards to change-leadership, TL can be perceived as being able to improve
employees’ understanding and ownership of a change process directly, and so serving a
motivating function in support of change (Herold, Fedor, Caldwell, & Liu, 2008). Moreover, it
seems realistic to assume that TL and HIWPs are considered synonyms in relation to their role
in organizational change, since the definitions of both the TL behaviours and HIWPs’ PIRK-
principles imply to aim at employee involvement (Bass & Riggio, 2006; Lawler, 1986).
Although former research argued in favour of leadership to play a significant role in
managing change (e.g. Kavanagh & Ashkanasy, 2006), findings show that the effects of HIWPs
on both change readiness and turnover intentions are stronger than the effects of TL. In
conclusion, this study contributes to the literature by pointing to the predominant role of SHRM,
thereby shedding a new light on the on-going discussion in the change management literature.

27
Practical implications
From a practical viewpoint, the value of the findings are three-fold. In the first place, the
findings could act as practical guide for HR and line managers in choosing a strategy to
effectively implement change. This study shows the benefit of HIWPs when approaching a
change implementation in healthcare. When making considerations about the appropriate
change management tools, this study pleads for implementation of HIWPs instead of educating
ward and line managers in healthcare to show TL behaviours towards employees. Therefore,
line managers are supported to implement HIWPs in order to assure that employees become
involved in the on-going businesses of the organization, and to develop their understanding of
changing circumstances. This high-involvement approach in SHRM is likely to pay off in terms
of increased employee change readiness and decreased turnover intentions.
Second, the findings indicate that HIWPs and TL behaviours do not interact in such a
way that they deliver additional benefits in terms of improved employee attitudes to change.
This suggests that line and ward managers either need to adjust their leadership style towards
TL behaviours, or enable employees to participate in HIWPs, in order to positively align
employees’ attitudes towards change and to reduce their behavioural intentions to leave the
organization. This study shows both strategies could work in change management, but shows a
stronger effect of HIWPs than TL. As concrete starting point, this study provides line managers
with a conceptual framework to evaluate which high-involvement areas are already represented
on the work floor, and which areas could be added to create a high-involvement work system
composing of a mutually reinforcing set of HIWPs that act synergistically and deliver
performance effects that are greater than the sum of its individual parts (Appelbaum et al.,
2000).
Finally, inspired by practical experience in healthcare, due to HR devolution, HR
managers seem to have limited influence on the actual implementation of HIWPs by line
managers. The role of HR managers is to facilitate an inspiring, supportive climate for line
managers to actually implement HIWPs. However, it depends on the line managers’ decision
and actions whether HIWPs are actually perceived by employees. Moreover, in contrast to HR
managers, line managers interact with employees within their department on a daily basis.
Therefore, practitioners recommend to invest in the development of TL behaviours among line
and ward managers in healthcare. In addition, this study recommends HR managers to look for
candidates with potential TL characteristics in recruitment and selection processes.

28
Limitations and Future research
A number of limitations for this study are worth noting. First, due to the cross-sectional design,
making inferences about causal relationships is impossible (Pallant, 2016). The study variables
are measured at one point in time. Therefore, nothing can be stated about how effects develop
over time. For instance, it remains unclear whether an employee perceives high levels of change
readiness as a result of highly perceived HIWPs, or if highly perceived HIWPs are a result of
high levels of change readiness. Future research should use longitudinal design in order to gain
insight into temporal relationships and to draw conclusions about causality. Preferably a three-
wave longitudinal design should be used for testing mediation (Cole & Maxwell, 2003).
Second, the findings’ generalizability is limited, because the sample was composed of
employees from a single healthcare organization. This type of convenience sampling could
result in a non-representative sample of the study population (Mullinix, Leeper, Druckman, &
Freese, 2015). Replication of findings in other healthcare organizations would be useful to gain
a more reliable picture of the entire healthcare population. Moreover, future research should
investigate the relationships in other countries for the reason that employee perceptions of
change, HRM, and leadership might differ across cultures (e.g. Fu & Yukl, 2000; Farndale &
Sanders, 2017; Hofstede, 2011; Kwantes & Boglarsky, 2007).
In addition, findings are based on self-reported measurement by employees. Single-level
designs raise the probability of self-report response bias, meaning that employees’ subjective
answers could differ from reality. However, the employee perspective is recognized as the most
valid perspective from which to measure the extent to which HIWPs are actually perceived
(Nishii et al., 2008). It is recommended for future research to use a multilevel design in which
multiple perspectives could be combined to see whether manager and employee perceptions are
aligned.
Furthermore, the level of turnover intentions might be undermined by the social
desirability bias: “individuals' tendencies to overreport socially desirable personal
characteristics and to underreport socially undesirable characteristics.” (Arnold, Feldman, &
Purbhoo, 1985, p. 955). However, steps were taken to ensure anonymity, which was also
explained in the cover letter.
Finally, it is recommended to use an objective outcome variable to increase the findings’
reliability. Replacing turnover intentions with actual turnover rates is a suggestion for future
research to apply in investigation of the HRM-performance relationship. Nevertheless,
awareness of employees’ turnover intentions are regarded valuable since it enables management
to evaluate policies and take decisive action before intentions translate into actual turnover.

29
Conclusion
This study investigated the mediating role of change readiness in the relationship between
HIWPs and turnover intentions, and the influence of TL on the relationship between HIWPs
and change readiness. HIWPs were found to relate both direct and indirectly via change
readiness, negatively to employees’ turnover intentions. Though, support lacks for the
moderated indirect effect of TL. This study provides extraordinary theoretical insight into how
the synergistic functioning of HIWPs works in inducing higher levels of change readiness and
safeguarding turnover intentions among employees in the context of change. HIWPs represents
an effective change approach in SHRM to achieve beneficial employee attitudes and
behavioural outcomes. With the help of a post-hoc analysis, this study creates awareness among
managers that employees’ attitudinal and behavioural outcomes are positively influenced by
both the structure of HIWPs and behaviours of transformational leaders.

30
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43
Appendix
Appendix A – Cover letter for questionnaire

SONDAGE SUR LE CLIMAT ORGANISATIONNEL

HÔPITAL LOUIS-HIPPOLYTE LAFONTAINE

Madame, Monsieur,

La mobilisation et la santé du personnel représentent actuellement un objet de préoccupation majeur dans

le réseau de la santé au Québec. C’est pourquoi l'Hôpital Louis-Hippolyte Lafontaine, en collaboration
avec Denis Chênevert, professeur agrégé au HEC Montréal, mène une étude sur le climat organisationnel.
Cette étude vise à cerner les facteurs liés à l’environnement de travail qui mobilisent les employés et qui
affectent leur santé psychologique au travail. Les résultats issus du diagnostic seront utilisés par l'Hôpital
Louis-Hippolyte Lafontaine afin de mettre en place des actions visant à soutenir le personnel dans la
réorganisation des soins et services cliniques.

Nous sollicitons donc votre collaboration pour remplir le questionnaire ci-joint. L’exercice devrait vous
prendre environ 30 minutes. Une fois complété, veuillez insérer le questionnaire dans l’enveloppe de
retour et conserver l'un des deux numéros qui se situent au bas de cette page. Ce numéro vous permettra
de participer au tirage de 7 billets de la Super Loterie de la fondation de l'Hôpital Louis-Hippolyte
Lafontaine.

Les informations recueillies resteront strictement confidentielles. Aucune personne de votre établissement
n’aura accès à ces données, la compilation et l'analyse des données étant réalisées par une firme externe.
Il est important de souligner que la valeur d’une telle recherche tient à votre participation : plus vous être
nombreux à participer, plus les résultats seront représentatifs de notre milieu de travail.

En vous remerciant pour votre précieuse collaboration, veuillez agréer, Madame, Monsieur, l’expression
de nos sentiments les meilleurs.

Denis Chênevert Geneviève Jourdain Sylvie Desmarais

Professeur agrégé HEC Étudiante au doctorat HEC Directrice RH

Pour toute question concernant ce sondage, vous pouvez contacter Philippe Rivard , conseiller en développement
et formation des ressources humaines , au (514) 251-4000 poste 2426.

44
Cover letter translated from French to English
Dear,

The mobilization and health of staff are currently a major concern in the Quebec health system.
That's why Hôpital Louis-Hippolyte Lafontaine, in collaboration with Denis Chênevert,
associate professor at HEC Montréal, is conducting a study on organizational climate. The
purpose of this study is to identify workplace factors that engage employees and affect their
psychological health at work. The results of the diagnosis will be used by the Louis-Hippolyte
Lafontaine Hospital to implement actions to support staff in the reorganization of clinical care
and services.

We therefore request your cooperation to complete the enclosed questionnaire. The exercise
should take you about 30 minutes. Once completed, please insert the questionnaire into the
return envelope and keep one of the two numbers at the bottom of this page. This issue will
allow you to participate in the draw of 7 Super Lottery tickets from the Louis-Hippolyte
Lafontaine Hospital Foundation.

The information collected will remain strictly confidential. No one in your institution will have
access to this data, as the compilation and analysis of the data is done by an external firm. It is
important to note that the value of such research is your participation: the more you participate,
the more the results will be representative of your workplace.

Thanking you for your precious collaboration, please accept, Madam, Sir, the expression of our
best feelings.

45
Appendix B – Questionnaire items

Scale construction of high-involvement work practices (HIWPs)

Composed of items based on the PIRK-principle:
Power
2. I choose the way I organize my working time myself.
7. I have a lot of autonomy in the organization of my tasks.
10. I have great freedom of action in carrying out my work.

Information
103. Employees are regularly informed of major projects that concern our hospital
(e.g. investments, new technologies).
104. Employees are regularly informed of new services, programs and/or products
offered by our hospital.
105. Employees’ opinions are regularly sought.
106. Employees frequently receive feedback on their suggestions.
107. Employee suggestions are generally taken seriously.

Rewards
94. The organization values and rewards excellence.
95. In general, my organization congratulates those who exceed expectations.
96. Exceptional employee contributions are recognized by the organization (e.g. at
ceremonies or meetings, through an internal journal, congratulatory letter, prizes or
gifts, etc.).

Knowledge
97. In this organization, various professional development activities are offered to
employees (e.g. coaching, training).
98. The development of employees’ skills outside this organization is valued (e.g., refresher
courses, academic or professional certifications).
99. This organization provides us with the necessary resources to improve our skills (e.g.
time, funding, work planning).

46
Scale construction of turnover intentions
81. I am likely to leave the hospital by next year.
82. I often think about leaving the hospital.
83. I may be looking for a job in another hospital.

Scale construction of change readiness

26. I support the objectives of the ongoing organizational changes.
27. The means used to implement the changes in progress are adequate.
28. At this stage of implementation, I believe that the new operating procedures will be
effective.
29. I am ready to continue the effort to implement the new operating modes.

Scale construction of transformational leadership (TL)

My immediate supervisor…
108. Is a (role) model for me.
109. Leads by example.
110. Shows me ideas that help me question my ways of doing things.
111. Encourages me to see situations from a different angle.
112. Does not hesitate to question the things I take for granted.
113. Is an inspiration to me.
115. Knows where we are going.
119. Has a clear idea where our unit or service will be in 5 years.
120. DOES NOT have a clear vision of the goals we need to achieve*

*Item was reverse scored in the questionnaire. Therefore, the item was recoded in SPSS.

47
Appendix C – Descriptive statistics of respondents
Table 1. Descriptive statistics of respondents

Variable N Percentage

Gender 879
Male 283 32.2%
Female 596 67.8%

Age 879
< 30 years 119 13.2%
30-45 years 291 33.1%
46-55 years 360 41.0%
55 + 109 12.4%

Job status 867

Full-time 623 71.9%
Part-time 166 19.1%
On-call basis 78 9.0%

Organizational tenure 880

< 2 years 82 9.3%
2-5 years 103 11.7%
6-10 years 100 11.4%
11-20 years 174 19.8%
> 20 years 421 47.8%

Staff category 883

Nursing and cardiorespiratory staff 180 20.4%
Para technical, service and auxiliary business 257 29.1%
Office, technicians and administrative professionals 160 18.1%
Technicians and professionals of health/social services 215 24.3%
Supervisory staff (e.g. senior, senior managers) 71 8.0%

Department 828
Nursing care 264 31.9%
Professional services 240 29.0%
Rehabilitation and residential services 136 16.4%
Administrative services 98 11.8%
Human Resources 77 9.3%
Research and teaching 13 1.6%

Notes: N = number of respondents

48
Appendix D – Output Factor Analyses and Reliability Analyses
Scale analysis: High-involvement work practices (HIWPs)

Table 2. Factor analysis HIWPs

Total Variance Explained
Initial Eigenvalues Extraction Sums of Squared Loadings Rotation Sums of Squared Loadings
Factor Total % of Variance Cumulative % Total % of Variance Cumulative % Total % of Variance Cumulative %
1 6.535 46.676 46.676 6.236 44.542 44.542 3.333 23.810 23.810
2 2.028 14.486 61.162 1.674 11.954 56.496 2.354 16.818 40.627
3 1.269 9.062 70.224 1.009 7.209 63.704 1.984 14.174 54.801
4 1.010 7.211 77.435 .704 5.031 68.735 1.951 13.934 68.735
5 .721 5.150 82.585
6 .401 2.868 85.453
7 .376 2.689 88.142
8 .359 2.563 90.705
9 .312 2.230 92.935
10 .302 2.157 95.092
11 .248 1.769 96.861
12 .178 1.270 98.131
13 .139 .991 99.122
14 .123 .878 100.000
Notes: Extraction Method: Principal Axis Factoring. Varimax rotation.

49
 Figure 1. Scree plot HIWPs

Table 2. Reliability analysis HIWPs

Reliability Statistics
Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items
.904 .904 14

Notes: N = number

50
Scale analysis: Change readiness

Table 3. Factor analysis change readiness

Total Variance Explained
Initial Eigenvalues Extraction Sums of Squared Loadings
Factor Total % of Variance Cumulative % Total % of Variance Cumulative %
1 2.999 74.976 74.976 2.670 66.749 66.749
2 .415 10.377 85.352
3 .342 8.544 93.896
4 .244 6.104 100.000
Notes: Extraction Method: Principal Axis Factoring. Varimax rotation.

Figure 2. Scree plot change readiness

Table 4. Reliability analysis change readiness

Reliability Statistics
Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items
.889 .890 4
Notes: N = number

51
Scale analysis: Transformational leadership (TL)

Table 4. Factor analysis TL

Total Variance Explained
Initial Eigenvalues Extraction Sums of Squared Loadings Rotation Sums of Squared Loadings
Factor Total % of Variance Cumulative % Total % of Variance Cumulative % Total % of Variance Cumulative %
1 5.509 61.212 61.212 5.226 58.066 58.066 3.793 42.149 42.149
2 1.019 11.323 72.536 .504 5.605 63.670 1.937 21.521 63.670
3 .746 8.288 80.824
4 .571 6.345 87.168
5 .381 4.230 91.398
6 .307 3.408 94.806
7 .210 2.329 97.135
8 .140 1.553 98.688
9 .118 1.312 100.000
Notes: Extraction Method: Principal Axis Factoring. Varimax rotation.

52
 Figure 3. Scree plot TL

Table 5. Reliability analysis TL

Reliability Statistics
Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items
.914 .914 9
Notes: N = number

53
Scale analysis: Turnover intentions

Table 6. Factor analysis turnover intentions

Total Variance Explained
Initial Eigenvalues Extraction Sums of Squared Loadings
Factor Total % of Variance Cumulative % Total % of Variance Cumulative %
1 2.187 72.915 72.915 1.798 59.946 59.946
2 .480 15.986 88.901
3 .333 11.099 100.000
Notes: Extraction Method: Principal Axis Factoring. Varimax rotation.

Figure 4. Scree plot turnover intentions

Table 7. Reliability analysis turnover intentions

Reliability Statistics
Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items
.814 .814 3
Notes: N = number

54
 Appendix E – Results of post-hoc analyses in PROCESS
The results indicated a positive significant relationship of transformational leadership with
change readiness (B = .299, SE = .035, p < .01) and turnover intentions (B = -.117, SE = .051,
p < .05). Change readiness was also negative and significantly related to turnover intentions (B
= -.270, SE = .052, p < .01). Although the results indicated a weakened negative indirect effect
of transformational leadership on turnover intentions through change readiness, the relationship
remained significant (B = -.081, SE = .018, 95% CI [-.119; -.048]). Therefore, evidence
indicated the presence of a partial mediation effect of change readiness in the relationship
between transformational leadership and turnover intentions (Figure 3).

B = -.117*

B = .299** B = -.270**
Transformational Change readiness Turnover intentions
leadership

Figure 3. Results post-hoc analysis

* p < .05 (two-tailed); ** p < .01 (two-tailed).

Additionally, model 4 was used to test for the relationship between HIWPs and change
readiness without any moderating effects. The results provided evidence for a positive
significant relationship between HIWPs and change readiness (B = .509, SE = .043, p < .01). In
addition, the relationship between change readiness and turnover intentions was found negative
and significant (B = -.224, SE = .053, p < .01). Results showed a negative significant direct
effect of HIWPs on turnover intentions (B = -.242, SE = .064, p < .01). The indirect effect of
HIWPs on turnover intentions through change readiness was found to be lower, but still
significant (B = -.114, SE = .029, 95% CI [-.177; -.061]). In accordance with the analysis of
model 7, the test for simple mediation showed evidence for partial mediation of change
readiness in the relationship between HIWPs and turnover intentions. Thus, both model the
moderated mediation, and the simple mediation model provided support for Hypothesis 3.

55
Appendix F – PROCESS Model 7 (moderated mediation) (Hayes, 2018)

Run MATRIX procedure:

************* PROCESS Procedure for SPSS Release 2.16.1 ******************

Written by Andrew F. Hayes, Ph.D. www.afhayes.com

Documentation available in Hayes (2013). www.guilford.com/p/hayes3

**************************************************************************
Model = 7
Y = Turnover
X = HIWPs_ne
M = Change_R
W = Tr.Leade

Statistical Controls:
CONTROL= Q155 Agebelow Age30unt Age55plu Jobstatu Jobsta_1 OrgTenbe
OrgTen2t OrgTen6t OrgTen11

Sample size
857

**************************************************************************
Outcome: Change_R

Model Summary
R R-sq MSE F df1 df2 p
,4641 ,2154 1,2750 15,1632 13,0000 843,0000 ,0000

Model
coeff se t p LLCI ULCI
constant 4,4289 ,0888 49,9006 ,0000 4,2547 4,6031
HIWPs_ne ,4264 ,0504 8,4585 ,0000 ,3274 ,5253
Tr.Leade ,1363 ,0378 3,6075 ,0003 ,0621 ,2104
int_1 -,0108 ,0300 -,3600 ,7189 -,0697 ,0481
Q155 -,0048 ,0856 -,0561 ,9553 -,1728 ,1632
Agebelow -,0643 ,1746 -,3682 ,7128 -,4070 ,2784
Age30unt -,1383 ,1019 -1,3566 ,1753 -,3383 ,0618
Age55plu ,1335 ,1292 1,0328 ,3020 -,1202 ,3871
Jobstatu ,0063 ,1062 ,0590 ,9530 -,2022 ,2147
Jobsta_1 ,0771 ,1312 ,5877 ,5569 -,1804 ,3346
OrgTenbe -,0513 ,1734 -,2960 ,7673 -,3916 ,2890
OrgTen2t ,1506 ,1534 ,9815 ,3266 -,1505 ,4516
OrgTen6t -,1035 ,1504 -,6886 ,4913 -,3986 ,1916
OrgTen11 ,0157 ,1142 ,1379 ,8904 -,2084 ,2399

Covariance matrix of regression parameter estimates

Columns 1 - 12
constant HIWPs_ne Tr.Leade int_1 Q155 Agebelow

56
Age30unt Age55plu Jobstatu Jobsta_1 OrgTenbe
constant ,0079 ,0003 -,0002 -,0009 -,0046 -,0014
-,0020 -,0041 -,0024 -,0010 -,0011
HIWPs_ne ,0003 ,0025 -,0011 -,0002 -,0005 ,0002
,0002 -,0003 ,0003 ,0004 -,0011
Tr.Leade -,0002 -,0011 ,0014 ,0000 ,0000 -,0004
,0001 ,0003 -,0001 -,0001 ,0003
int_1 -,0009 -,0002 ,0000 ,0009 ,0002 ,0008
,0004 ,0003 ,0005 ,0000 -,0010
Q155 -,0046 -,0005 ,0000 ,0002 ,0073 -,0009
-,0009 ,0002 ,0004 ,0006 -,0005
Agebelow -,0014 ,0002 -,0004 ,0008 -,0009 ,0305
,0066 ,0012 -,0001 -,0047 -,0185
Age30unt -,0020 ,0002 ,0001 ,0004 -,0009 ,0066
,0104 ,0031 ,0000 -,0010 -,0045
Age55plu -,0041 -,0003 ,0003 ,0003 ,0002 ,0012
,0031 ,0167 ,0021 -,0001 ,0024
Jobstatu -,0024 ,0003 -,0001 ,0005 ,0004 -,0001
,0000 ,0021 ,0113 ,0036 -,0025
Jobsta_1 -,0010 ,0004 -,0001 ,0000 ,0006 -,0047
-,0010 -,0001 ,0036 ,0172 -,0031
OrgTenbe -,0011 -,0011 ,0003 -,0010 -,0005 -,0185
-,0045 ,0024 -,0025 -,0031 ,0301
OrgTen2t -,0015 -,0008 ,0006 -,0003 -,0010 -,0118
-,0032 ,0019 -,0026 -,0049 ,0137
OrgTen6t -,0013 ,0001 ,0004 -,0002 -,0013 -,0073
-,0045 ,0005 -,0005 -,0016 ,0087
OrgTen11 -,0022 -,0005 ,0000 ,0001 ,0000 -,0009
-,0044 -,0001 -,0012 -,0010 ,0047
Columns 13 - 14
OrgTen6t OrgTen11
constant -,0013 -,0022
HIWPs_ne ,0001 -,0005
Tr.Leade ,0004 ,0000
int_1 -,0002 ,0001
Q155 -,0013 ,0000
Agebelow -,0073 -,0009
Age30unt -,0045 -,0044
Age55plu ,0005 -,0001
Jobstatu -,0005 -,0012
Jobsta_1 -,0016 -,0010
OrgTenbe ,0087 ,0047
OrgTen2t ,0075 ,0046
OrgTen6t ,0226 ,0049
OrgTen11 ,0049 ,0130

Product terms key:

int_1 HIWPs_ne X Tr.Leade

**************************************************************************

57
Outcome: Turnover

Model Summary
R R-sq MSE F df1 df2 p
,3587 ,1287 2,4472 8,7621 12,0000 844,0000 ,0000

Model
coeff se t p LLCI ULCI
constant 3,0441 ,2629 11,5788 ,0000 2,5281 3,5601
Change_R -,2239 ,0531 -4,2160 ,0000 -,3281 -,1196
HIWPs_ne -,2416 ,0639 -3,7791 ,0002 -,3671 -,1161
Q155 -,0884 ,1198 -,7374 ,4611 -,3236 ,1469
Agebelow ,8810 ,2516 3,5010 ,0005 ,3871 1,3748
Age30unt ,3616 ,1345 2,6889 ,0073 ,0977 ,6256
Age55plu ,4672 ,1695 2,7561 ,0060 ,1345 ,7998
Jobstatu ,2234 ,1556 1,4355 ,1515 -,0821 ,5289
Jobsta_1 ,1828 ,2199 ,8313 ,4060 -,2488 ,6144
OrgTenbe ,3277 ,2737 1,1970 ,2317 -,2096 ,8649
OrgTen2t ,3242 ,2369 1,3685 ,1715 -,1408 ,7892
OrgTen6t -,0391 ,1877 -,2083 ,8351 -,4075 ,3293
OrgTen11 ,1754 ,1488 1,1792 ,2387 -,1166 ,4674

Covariance matrix of regression parameter estimates

Columns 1 - 12
constant Change_R HIWPs_ne Q155 Agebelow Age30unt
Age55plu Jobstatu Jobsta_1 OrgTenbe OrgTen2t
constant ,0691 -,0126 ,0071 -,0084 -,0072 -,0057
-,0024 -,0032 ,0008 ,0016 -,0026
Change_R -,0126 ,0028 -,0015 -,0002 ,0009 ,0003
-,0007 ,0004 -,0004 -,0006 ,0001
HIWPs_ne ,0071 -,0015 ,0041 -,0006 ,0009 -,0001
-,0006 ,0001 ,0013 -,0039 -,0026
Q155 -,0084 -,0002 -,0006 ,0144 -,0004 ,0000
,0005 ,0000 ,0004 -,0028 -,0015
Agebelow -,0072 ,0009 ,0009 -,0004 ,0633 ,0127
,0068 -,0015 -,0067 -,0321 -,0240
Age30unt -,0057 ,0003 -,0001 ,0000 ,0127 ,0181
,0069 -,0017 -,0012 -,0079 -,0080
Age55plu -,0024 -,0007 -,0006 ,0005 ,0068 ,0069
,0287 -,0028 -,0016 ,0008 -,0002
Jobstatu -,0032 ,0004 ,0001 ,0000 -,0015 -,0017
-,0028 ,0242 ,0064 -,0062 -,0043
Jobsta_1 ,0008 -,0004 ,0013 ,0004 -,0067 -,0012
-,0016 ,0064 ,0484 -,0153 -,0154
OrgTenbe ,0016 -,0006 -,0039 -,0028 -,0321 -,0079
,0008 -,0062 -,0153 ,0749 ,0267
OrgTen2t -,0026 ,0001 -,0026 -,0015 -,0240 -,0080
-,0002 -,0043 -,0154 ,0267 ,0561
OrgTen6t ,0004 -,0005 ,0003 -,0023 -,0142 -,0065
-,0026 -,0029 -,0059 ,0160 ,0144
OrgTen11 -,0041 ,0002 -,0006 -,0005 -,0032 -,0061

58
-,0019 -,0025 -,0012 ,0088 ,0086
Columns 13 - 13
OrgTen11
constant -,0041
Change_R ,0002
HIWPs_ne -,0006
Q155 -,0005
Agebelow -,0032
Age30unt -,0061
Age55plu -,0019
Jobstatu -,0025
Jobsta_1 -,0012
OrgTenbe ,0088
OrgTen2t ,0086
OrgTen6t ,0078
OrgTen11 ,0221

******************** DIRECT AND INDIRECT EFFECTS *************************

Direct effect of X on Y
Effect SE t p LLCI ULCI
-,2416 ,0639 -3,7791 ,0002 -,3671 -,1161

Conditional indirect effect(s) of X on Y at values of the moderator(s):

Mediator
Tr.Leade Effect Boot SE BootLLCI BootULCI
Change_R -1,3257 -,0987 ,0293 -,1641 -,0490
Change_R ,0000 -,0954 ,0255 -,1516 -,0503
Change_R 1,3257 -,0922 ,0246 -,1477 -,0500

Values for quantitative moderators are the mean and plus/minus one SD from
mean.
Values for dichotomous moderators are the two values of the moderator.

******************** INDEX OF MODERATED MEDIATION ************************

Mediator
Index SE(Boot) BootLLCI BootULCI
Change_R ,0024 ,0069 -,0096 ,0176

******************** ANALYSIS NOTES AND WARNINGS *************************

Number of bootstrap samples for bias corrected bootstrap confidence

intervals:
5000

Level of confidence for all confidence intervals in output:

95,00

NOTE: The following variables were mean centered prior to analysis:

59
 HIWPs_ne Tr.Leade

NOTE: Some cases were deleted due to missing data. The number of such cases
was:
26

NOTE: All standard errors for continuous outcome models are based on the HC3
estimator

------ END MATRIX -----

60
Appendix G – Post-hoc analysis PROCESS Model 4 (Hayes, 2018)

Run MATRIX procedure:

************* PROCESS Procedure for SPSS Release 2.16.1 ******************

Written by Andrew F. Hayes, Ph.D. www.afhayes.com

Documentation available in Hayes (2013). www.guilford.com/p/hayes3

**************************************************************************
Model = 4
Y = Turnover
X = Tr.Leade
M = Change_R

Statistical Controls:
CONTROL= Q155 Agebelow Age30unt Age55plu Jobstatu Jobsta_1 OrgTenbe
OrgTen2t OrgTen6t OrgTen11

Sample size
857

**************************************************************************
Outcome: Change_R

Model Summary
R R-sq MSE F df1 df2 p
,3485 ,1215 1,4243 8,2249 11,0000 845,0000 ,0000

Model
coeff se t p LLCI ULCI
constant 3,1084 ,1736 17,9092 ,0000 2,7677 3,4491
Tr.Leade ,2987 ,0352 8,4826 ,0000 ,2296 ,3678
Q155 ,0376 ,0908 ,4145 ,6786 -,1406 ,2158
Agebelow -,1572 ,1743 -,9019 ,3674 -,4994 ,1849
Age30unt -,1898 ,1082 -1,7549 ,0796 -,4021 ,0225
Age55plu ,2302 ,1376 1,6728 ,0947 -,0399 ,5003
Jobstatu ,0277 ,1116 ,2479 ,8043 -,1913 ,2466
Jobsta_1 ,0301 ,1394 ,2161 ,8290 -,2435 ,3038
OrgTenbe ,1586 ,1746 ,9082 ,3640 -,1841 ,5013
OrgTen2t ,2585 ,1560 1,6568 ,0979 -,0477 ,5647
OrgTen6t -,1111 ,1578 -,7043 ,4814 -,4208 ,1985
OrgTen11 ,0367 ,1248 ,2942 ,7687 -,2083 ,2817

Covariance matrix of regression parameter estimates

constant Tr.Leade Q155 Agebelow Age30unt Age55plu
Jobstatu Jobsta_1 OrgTenbe OrgTen2t OrgTen6t
constant ,0301 -,0053 -,0038 ,0001 -,0029 -,0047
-,0020 -,0008 -,0004 -,0028 -,0032
Tr.Leade -,0053 ,0012 -,0002 -,0002 ,0002 ,0001

61
,0000 -,0001 -,0004 ,0002 ,0004
Q155 -,0038 -,0002 ,0082 -,0013 -,0007 -,0004
-,0001 ,0005 -,0008 -,0010 -,0017
Agebelow ,0001 -,0002 -,0013 ,0304 ,0074 ,0016
-,0009 -,0047 -,0176 -,0123 -,0072
Age30unt -,0029 ,0002 -,0007 ,0074 ,0117 ,0035
-,0001 -,0011 -,0045 -,0039 -,0048
Age55plu -,0047 ,0001 -,0004 ,0016 ,0035 ,0189
,0016 ,0000 ,0027 ,0021 ,0014
Jobstatu -,0020 ,0000 -,0001 -,0009 -,0001 ,0016
,0124 ,0040 -,0020 -,0022 -,0010
Jobsta_1 -,0008 -,0001 ,0005 -,0047 -,0011 ,0000
,0040 ,0194 -,0042 -,0052 -,0021
OrgTenbe -,0004 -,0004 -,0008 -,0176 -,0045 ,0027
-,0020 -,0042 ,0305 ,0141 ,0095
OrgTen2t -,0028 ,0002 -,0010 -,0123 -,0039 ,0021
-,0022 -,0052 ,0141 ,0243 ,0084
OrgTen6t -,0032 ,0004 -,0017 -,0072 -,0048 ,0014
-,0010 -,0021 ,0095 ,0084 ,0249
OrgTen11 -,0010 -,0002 -,0004 -,0020 -,0053 ,0001
-,0015 -,0008 ,0057 ,0056 ,0058

**************************************************************************
Outcome: Turnover

Model Summary
R R-sq MSE F df1 df2 p
,3432 ,1178 2,4778 8,3843 12,0000 844,0000 ,0000

Model
coeff se t p LLCI ULCI
constant 3,7596 ,2726 13,7895 ,0000 3,2245 4,2947
Change_R -,2700 ,0521 -5,1809 ,0000 -,3723 -,1677
Tr.Leade -,1174 ,0508 -2,3123 ,0210 -,2171 -,0177
Q155 -,0992 ,1191 -,8330 ,4051 -,3330 ,1346
Agebelow ,9201 ,2566 3,5862 ,0004 ,4165 1,4237
Age30unt ,3755 ,1369 2,7428 ,0062 ,1068 ,6441
Age55plu ,4281 ,1680 2,5486 ,0110 ,0984 ,7578
Jobstatu ,2065 ,1568 1,3166 ,1883 -,1013 ,5143
Jobsta_1 ,2053 ,2256 ,9100 ,3631 -,2375 ,6481
OrgTenbe ,2450 ,2817 ,8699 ,3846 -,3079 ,7980
OrgTen2t ,2936 ,2387 1,2302 ,2190 -,1749 ,7621
OrgTen6t -,0360 ,1913 -,1882 ,8508 -,4115 ,3395
OrgTen11 ,1727 ,1490 1,1592 ,2467 -,1197 ,4651

Covariance matrix of regression parameter estimates

Columns 1 - 12
constant Change_R Tr.Leade Q155 Agebelow Age30unt
Age55plu Jobstatu Jobsta_1 OrgTenbe OrgTen2t
constant ,0743 -,0077 -,0065 -,0074 -,0111 -,0071
-,0024 -,0047 -,0038 ,0159 ,0072

62
Change_R -,0077 ,0027 -,0010 -,0005 ,0014 ,0002
-,0010 ,0002 -,0004 -,0011 -,0001
Tr.Leade -,0065 -,0010 ,0026 ,0001 ,0003 ,0005
,0004 ,0005 ,0011 -,0028 -,0019
Q155 -,0074 -,0005 ,0001 ,0142 ,0001 -,0001
,0001 ,0000 ,0004 -,0034 -,0021
Agebelow -,0111 ,0014 ,0003 ,0001 ,0658 ,0132
,0070 -,0008 -,0067 -,0350 -,0254
Age30unt -,0071 ,0002 ,0005 -,0001 ,0132 ,0187
,0070 -,0015 -,0008 -,0090 -,0087
Age55plu -,0024 -,0010 ,0004 ,0001 ,0070 ,0070
,0282 -,0025 -,0010 -,0004 -,0010
Jobstatu -,0047 ,0002 ,0005 ,0000 -,0008 -,0015
-,0025 ,0246 ,0065 -,0071 -,0048
Jobsta_1 -,0038 -,0004 ,0011 ,0004 -,0067 -,0008
-,0010 ,0065 ,0509 -,0148 -,0161
OrgTenbe ,0159 -,0011 -,0028 -,0034 -,0350 -,0090
-,0004 -,0071 -,0148 ,0794 ,0280
OrgTen2t ,0072 -,0001 -,0019 -,0021 -,0254 -,0087
-,0010 -,0048 -,0161 ,0280 ,0570
OrgTen6t ,0004 -,0003 -,0001 -,0027 -,0152 -,0073
-,0029 -,0030 -,0059 ,0172 ,0152
OrgTen11 -,0014 ,0004 -,0009 -,0003 -,0032 -,0062
-,0025 -,0024 -,0011 ,0089 ,0086
Columns 13 - 13
OrgTen11
constant -,0014
Change_R ,0004
Tr.Leade -,0009
Q155 -,0003
Agebelow -,0032
Age30unt -,0062
Age55plu -,0025
Jobstatu -,0024
Jobsta_1 -,0011
OrgTenbe ,0089
OrgTen2t ,0086
OrgTen6t ,0079
OrgTen11 ,0222

************************** TOTAL EFFECT MODEL ****************************

Outcome: Turnover

Model Summary
R R-sq MSE F df1 df2 p
,2842 ,0808 2,5787 5,9027 11,0000 845,0000 ,0000

Model
coeff se t p LLCI ULCI
constant 2,9203 ,2340 12,4784 ,0000 2,4610 3,3797
Tr.Leade -,1981 ,0482 -4,1112 ,0000 -,2926 -,1035

63
Q155 -,1094 ,1212 -,9023 ,3672 -,3473 ,1286
Agebelow ,9625 ,2561 3,7591 ,0002 ,4600 1,4651
Age30unt ,4267 ,1401 3,0464 ,0024 ,1518 ,7016
Age55plu ,3659 ,1673 2,1869 ,0290 ,0375 ,6944
Jobstatu ,1990 ,1592 1,2502 ,2116 -,1134 ,5114
Jobsta_1 ,1972 ,2323 ,8488 ,3962 -,2588 ,6531
OrgTenbe ,2022 ,2835 ,7132 ,4759 -,3543 ,7588
OrgTen2t ,2238 ,2403 ,9313 ,3520 -,2479 ,6956
OrgTen6t -,0060 ,1977 -,0303 ,9758 -,3941 ,3821
OrgTen11 ,1628 ,1513 1,0760 ,2822 -,1342 ,4597

Covariance matrix of regression parameter estimates

constant Tr.Leade Q155 Agebelow Age30unt Age55plu
Jobstatu Jobsta_1 OrgTenbe OrgTen2t OrgTen6t
constant ,0548 -,0099 -,0087 -,0084 -,0073 -,0058
-,0034 -,0048 ,0140 ,0075 -,0009
Tr.Leade -,0099 ,0023 -,0001 ,0013 ,0008 ,0002
,0005 ,0009 -,0035 -,0022 -,0002
Q155 -,0087 -,0001 ,0147 -,0004 -,0004 -,0001
-,0004 ,0003 -,0035 -,0018 -,0026
Agebelow -,0084 ,0013 -,0004 ,0656 ,0132 ,0078
-,0018 -,0076 -,0345 -,0256 -,0141
Age30unt -,0073 ,0008 -,0004 ,0132 ,0196 ,0071
-,0014 -,0011 -,0090 -,0087 -,0066
Age55plu -,0058 ,0002 -,0001 ,0078 ,0071 ,0280
-,0025 -,0010 -,0015 -,0011 -,0028
Jobstatu -,0034 ,0005 -,0004 -,0018 -,0014 -,0025
,0253 ,0075 -,0074 -,0049 -,0035
Jobsta_1 -,0048 ,0009 ,0003 -,0076 -,0011 -,0010
,0075 ,0540 -,0156 -,0162 -,0063
OrgTenbe ,0140 -,0035 -,0035 -,0345 -,0090 -,0015
-,0074 -,0156 ,0804 ,0286 ,0171
OrgTen2t ,0075 -,0022 -,0018 -,0256 -,0087 -,0011
-,0049 -,0162 ,0286 ,0578 ,0149
OrgTen6t -,0009 -,0002 -,0026 -,0141 -,0066 -,0028
-,0035 -,0063 ,0171 ,0149 ,0391
OrgTen11 -,0010 -,0007 -,0001 -,0037 -,0062 -,0021
-,0026 -,0008 ,0095 ,0091 ,0080

***************** TOTAL, DIRECT, AND INDIRECT EFFECTS ********************

Total effect of X on Y
Effect SE t p LLCI ULCI
-,1981 ,0482 -4,1112 ,0000 -,2926 -,1035

Direct effect of X on Y
Effect SE t p LLCI ULCI
-,1174 ,0508 -2,3123 ,0210 -,2171 -,0177

Indirect effect of X on Y
Effect Boot SE BootLLCI BootULCI

64
Change_R -,0807 ,0180 -,1188 -,0483

Partially standardized indirect effect of X on Y

Effect Boot SE BootLLCI BootULCI
Change_R -,0496 ,0110 -,0731 -,0299

Completely standardized indirect effect of X on Y

Effect Boot SE BootLLCI BootULCI
Change_R -,0648 ,0144 -,0960 -,0390

Ratio of indirect to total effect of X on Y

Effect Boot SE BootLLCI BootULCI
Change_R ,4072 ,1620 ,2185 ,8489

Ratio of indirect to direct effect of X on Y

Effect Boot SE BootLLCI BootULCI
Change_R ,6869 265,1012 ,2645 4,2802

Normal theory tests for indirect effect

Effect se Z p
-,0807 ,0183 -4,3992 ,0000

******************** ANALYSIS NOTES AND WARNINGS *************************

Number of bootstrap samples for bias corrected bootstrap confidence

intervals:
5000

Level of confidence for all confidence intervals in output:

95,00

NOTE: Some cases were deleted due to missing data. The number of such cases
was:
26

NOTE: All standard errors for continuous outcome models are based on the HC3
estimator

------ END MATRIX -----

65
Appendix H – Interviews with HR professionals in healthcare
In two separate interviews in a Dutch clinical hospital in North-Brabant, the Netherlands, one
HR manager and one HR advisor shared their thoughts about the study findings and linked this
to their own experiences in healthcare. Below, the findings are summarized for each interview
separately. To ensure anonymity and confidentiality, names of the respondents and the hospital
are not provided.

Interview 1: HR manager
• Responsible for strategic, tactical, and operational HR policy.
• Manager of the HR department (45 employees).

Future perspective on healthcare

The shortage of healthcare employees is recognized by the HR manager. She shared her
concerns about the increasing need for care. According to her insights, it has been forecasted
that within 10-15 years, 30 percent of the population needs to work in healthcare, which makes
a personnel shortage inevitable. Although this concerns a complicated long-term process, the
hospital’s Executive Board aims to change the primary care processes to act upon the external
challenges. The main focus in this change process is to move from traditional to modern care.
Instead of the passive, traditional care system in which people are used to come to the
hospital to receive care, the modern system aims at increasing self-reliance of patients and
smartly organized care processes. For instance, the smart-watch release might facilitate a
system in which patients’ body functions are constantly measured and send forward to
healthcare institutions (e.g. physiotherapists, general practitioners, and healthcare
professionals). The HR manager expects that healthcare policies will be shaped in such a way
that patients receive a signal from their watch that informs them about their health status. For
instance, when a unhealthy heart rate is detected. Although the implications for the work place
are yet hardly to grasp for both management and employees, the HR manager argued that this
change process implies that healthcare employees will fulfil a different role in the future. A
central question for employees is: “how do you interact with your patients in the future?”.

High-involvement work practices on the work floor

The HR manager pointed out that the high-involvement work practices (HIWPs) are not being
introduced systematically, but step-by-step in the form of small “experiments” on departmental

66
levels. This in order to initiate some sort of “movement” towards a widely shared involvement
climate. The high-involvement experiments are centred around the aforementioned change
process. The HR manager recognized the presence of some components of Lawler’s (1986)
PIRK-model on the work floor. On departmental level, experiments are carried out in which
employees are involved in practices such as the freedom to organize work schedules, to work
from home (autonomy), and group consultations for decision-making processes in relation to
change (empowerment). For instance, employees engage in dialogue sessions in their
department to discuss in what way they can increase “patient direction” (in Dutch: eigen regie
van de patiënt). In addition, the hospital signals that involvement is highly appreciated by means
of providing a platform for ideas that are being developed by employees (rewards). In
exceptional circumstances, an employee receives a monetary bonus as reward for such an idea,
if it works well in practice (e.g. process improvement).

Employee survey
Recently, an employee survey has been carried out to measure work experiences.
Unfortunately, there appears a division among employees’ vision and reactions to the high-
involvement work “experiments”: some are engaged, whereas others seem to lose connection
with the strategy and do not understand what purpose HIWPs serve. The survey findings
revealed that employees perceive the extent of autonomy and development opportunities as
quite positive in general. However, the hospital is searching for ways to make trainings less
compelling and more attractive. Further, turnover intentions were increased in comparison to
the year before.

Changing circumstances and employee retention

It is important to find a new structure in healthcare that enables the movement to a modern
customized healthcare system. The HR manager expects that the role of hospitals would be to
organize the network around a patient in such a way that customized care can be delivered. This
desired move towards a new healthcare system puts pressure on all stakeholders in healthcare.
In practice, this already resulted in approximately 30 employees who quit their job, because the
potential move towards a new system caused feelings of anxiety and stress. In contrast to other
hospitals in the region, this hospital does not provide so-called retention bonuses (blijfpremies)
to employees who stay over the years. Instead, the focus is on investing in HIWPs. HR invests
in a program to improve the design of work in order to increase efficiency and pleasure at work
for employees. In addition, the focus is on improving managers’ transformational leadership

67
behaviours. Therefore, the HR manager was surprised about the non-significant finding of the
moderating effect of transformational leadership. However, she recognized the significant
direct effect of transformational leadership on change readiness. In the hospital, the HR
manager perceives a difference in leadership style among line managers. Some of them are the
more traditional transactional type of leader who is results-oriented and focusing on controlling,
whereas others are showing transformational leadership behaviours such as enabling and
coaching employees to be pro-active and participate in decision-making processes. In practice,
she experiences that the transactional type of managers experience more resistance to change
within their team in comparison to the transformational type of managers.

Practical advice
The HR manager stressed that the role of HR is to facilitate a supportive climate for line and
ward managers in which they are inspired to implement HIWPs in their departments. In other
words: the role of HR is preconditional and HR managers act as coaches to support managers
in the implementation process. She thinks there is a link between the type of leadership style of
line managers on the one hand, and the actual implementation of HIWPs on the other hand. For
instance, some line managers are flexible in their way of approaching employees and provide
them with autonomy to arrange work schedules in their department. This type of autonomy is
involved in HIWPs and this organizational structure becomes reality depending on the line
manager’s actions to act upon those work practices.
Since the influence of the HR department and the strategically formulated HIWPs on
the work floor is limited, the HR manager advised to rather invest in the development process
of transformational leadership behaviours among ward and line managers. Ultimately, line and
ward managers are the actors who implement the HIWPs to foster employees’ acceptance of
change and lower their turnover intentions.

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Interview 2: Advisor personnel services

Managing change in a tight labour market

The advisor of personnel services (hereafter: HR advisor) started off with sharing her
experiences of change management. She stressed the on-going developments that the hospital
is being exposed to at the moment. Currently, the hospital is moving from a generalist
perspective towards more tailor-made agreements between the hospital and individual
employees. Central in this change is the personalized individual attention and encouragement
of employee development. The HR advisor explained that this policy is associated with the
occurring issue of the tight labour market. Previously, the hospital could afford to offer a
“standard” vacancy, whereas today it offers a special one: “nursing career traveller” (in Dutch:
verpleegkundig loopbaanreiziger), in order to fulfil candidates’ interests and commit them to
the hospital. In addition, the hospital has introduced an Innovation department to think of new
ways of working and organizing in the healthcare sector. The hospital aims to increase
efficiency and attractiveness for potential employees among the healthcare population.

HR devolution
According to the HR advisor, there is a movement of activities with respect to HR practices
(i.e. HIWPs) from the HR department to the line managers and employees, whereby employee
self-determination is put central. For that reason, the HR advisor mentioned that she considers
the role of line and ward managers (i.e. leaders) as the most crucial in the work environment to
get employees along with the change. She considers HR’s role to be facilitative and making
sure that the process of involving employees is steered at the right direction. A line manager is
in touch with employees on a daily basis, and is therefore in the position to keep track of the
interaction processes on the work floor and employees’ reactions to change and involvement
opportunities, and can act upon the situation if necessary.
In addition, line and ward managers appear to play a major role in translation of policies
to actually implemented work practices in their department or team. The HR advisor considers
the HR department to be supportive in this translation process. In addition, she perceives the
implementation of work practices and changing policies on the work floor as a rather arduous
process. This may be due to the fact that the hospital is quite hierarchical in nature. Therefore,
with regards to HIWPs and change programs, her recommendation is to start bottom-up with
small initiatives to implement work practices and introduce small changes in order to achieve
the greater goal of increased employee involvement and change acceptance.

69
Communicating the change
Furthermore, the HR advisor pointed out that there appears to be a difference amongst
employees’ preferences in the way they wish to be approached. With regards to change, it is
important to keep this in mind. Some employees wish to be informed face-to-face, whereas
other employees are satisfied with a digital approach via the Intranet webpage of the hospital.
When a change is being introduced on departmental level, HR regularly attends a meeting to
ensure that the message is communicated clearly. The HR advisor stressed that the Intranet
serves as instrumental facilitator of communication towards employees about change processes,
and does not form the primary information channel to introduce change.
Moreover, in relation to change, the HR advisor considers communication as one of the
most important practices involved in HIWPs to ensure that employees are willing to stay in the
hospital. She argued that if, e.g. due to a reorganization, a nurse cannot keep on working for the
department where he or she is currently part of, but the hospital aims to retain this employee by
offering another job position, timely and transparent communication appears to determine
whether the employee will stay or leave. If the employee is not informed about other
opportunities in the hospital after the reorganization, feelings of uncertainty and job insecurity
may lead to low levels of change readiness and an increased chance that the employee leaves.
The respondent told that, in such a case, she believes that timely communication and
information provision are likely to increase change readiness and lower turnover intentions.
Thus, she confirmed the positive influence of some work practices involved in HIWPs on
employees’ change readiness, and the negative influence of some work practices on employees’
turnover intentions.

How to prepare for the future?

Lastly, the HR advisor expressed her curiosity in the way other hospitals deal with external
challenges and future change. She wonders how the HR department of the hospital needs to
prepare for the future. The hospital engages in conversations with organizations such as the
Police and Royal Dutch Airlines (i.e. KLM), and finds out that, although in a different context,
such organizations seem to deal with comparable external challenges that arise due to the
changing population.

70