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The Relationship between Employee Participation, Organisational Commitment, and Sharing and Cooperation within Healthcare Organisations Linn Lien Lømo Master’s thesis at the Department of Psychology UNIVERSITY OF OSLO 15.05.2017

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Page 1: The Relationship between Employee Participation ... · The Relationship between Employee Participation, Organisational Commitment, and Sharing and Cooperation within Healthcare Organisations

The Relationship between

Employee Participation, Organisational

Commitment, and Sharing and Cooperation

within Healthcare Organisations

Linn Lien Lømo

Master’s thesis at the Department of Psychology

UNIVERSITY OF OSLO

15.05.2017

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II

© Linn Lien Lømo

2017

The Relationship between Employee Participation, Organisational Commitment, and

Sharing and Cooperation within Healthcare Organisations

Linn Lien Lømo

http://www.duo.uio.no/

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Abstract

The aim of this study is to investigate the effect of organisational commitment and employee

participation on employees’ perception of knowledge sharing and cooperation among 1) work

groups and 2) departments within healthcare organisations in Norway. Previous research has

explored these variables by mainly focusing on inter-individual knowledge sharing and

cooperation. This study contributes to the field by applying an inter-group perspective. Data

was collected through a survey and in collaboration with Regional Centre of Knowledge

Translation in Rehabilitation (RKR) at Sunnaas Hospital. The sample consisted of 246

employees from different organisations in the South-East Health Region of Norway. The

present study tests seven propositions regarding the relationship between these variables

through structural equation modelling. The results indicate that organisational commitment

positively predicts sharing and cooperation, both among work groups (internal) and

departments (external). Employee participation has, in turn, a strong positive direct effect on

organisational commitment and by extension an indirect effect on both internal and external

sharing and cooperation. At last, employee participation also has a positive direct effect on

internal and external sharing and cooperation, over and above the effect explained through

organisational commitment. Employee participation is found to have the strongest effect on

the perceptions of sharing and cooperation, indicating this as an important focus area for

managers who wish to facilitate intra-organisational knowledge sharing and cooperation.

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Acknowledgement

In the process of writing this master’s thesis, there are several people I would like to

express my gratitude to. First of all, I would like to thank Cato Alexander Bjørkli for

supervising this thesis and for all your encouragement, readiness, stimulating discussions, and

feedback. Furthermore, a big thank you to RKR and Jan Egil Nordvik for giving me the

opportunity to write my thesis in collaboration with you and for your interest and

engagement. Additionally, I would like to express my sincere appreciation to Alexander

Garnaas for your helpful guidance and discussions on climate and methods, Pål Ulleberg for

your input on the analysis, and lastly Bård Kuvaas for providing me with a Norwegian

translation of an organisational commitment measure.

To my sister Ingvild Lien Lømo and Leonardo Carlos Ruspini: Thank you for your

much-appreciated proof-reading and input. A special thank you goes to Ingvild for all the

academic guidance you have given me throughout my studies. Your patience, humour,

precision, and wisdom have been immensely rewarding.

Finally, I would like to thank Einar, my friends, and family for all your support and

encouragement.

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Table of Content

Introduction .................................................................................................................. 1

Background ................................................................................................................... 2

Sharing and Cooperation ............................................................................................ 2

Development of Hypotheses ......................................................................................... 7

Organisational Commitment ...................................................................................... 7

Employee Participation ............................................................................................ 10

Method ......................................................................................................................... 14

The Project................................................................................................................ 14

Data Collection ......................................................................................................... 14

Sample ...................................................................................................................... 14

Measures ................................................................................................................... 15

Analysis .................................................................................................................... 17

Ethical Considerations .............................................................................................. 21

Results .......................................................................................................................... 21

Results of the Descriptive and Preliminary Analysis ............................................... 21

Hypothesis Testing – Structural Equation Model .................................................... 23

Discussion .................................................................................................................... 26

Implications .............................................................................................................. 28

Limitations ................................................................................................................ 33

Future Research ........................................................................................................ 34

Conclusion ................................................................................................................ 36

References ................................................................................................................... 37

APPENDIX 1: Measures in Norwegian .................................................................... 46

APPENDIX 2: Measurement model 1 – Path diagram ........................................... 49

APPENDIX 3: Measurement model 2 – Path diagram ........................................... 50

APPENDIX 3: Measurement model 2 - Communalities ......................................... 51

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Introduction

Current global trends in healthcare practice and research has amplified the importance

of knowledge sharing and collaboration throughout healthcare organisations. These trends

include health systems integration (e.g., Samhandlingsreformen in Norway) and the stressing

of evidence-based practice as efforts towards providing patients with the best possible care.

Health systems integration can take various forms (Armitage, Suter, Oelke, & Adair, 2009),

but it often involves a holistic patient centred approach which focuses on continuity of care

across health care providers. The goal being to ensure that patients receive the right care at the

right place to the right time (Helse- og omsorgsdepartementet, 2009; Suter, Oelke, Adair, &

Armitage, 2009). This necessitates increased collaboration and better coordination both within

and across health care providers (Blondiau, 2015; Helse- og omsorgsdepartementet, 2011).

Evidence-based practice is integral to ensure that patients receive the right care. However, the

implementation of research evidence into organisational practice is found to be quite

challenging and entails a considerable amount of time (Morris, Wooding, & Grant, 2011).

This challenge has spiked the development of a research field on knowledge translation (also

known as implementation science or research utilisation), which is the study of how to

synthesise, disseminate, exchange, and apply knowledge throughout the organisation to

ensure evidence-based practice (Graham, Straus, & Tetroe, 2013).

Both health systems integration and knowledge translation require a high degree of

collaboration and knowledge sharing among employees within an organisation. For example,

the value of one person keeping him/herself updated on research is not appropriately

leveraged unless it is shared with other employees (Cabrera & Cabrera, 2005). Research

indicates that people generally share and cooperate more with members of their own group

compared to with those who are not (Balliet, Wu, & De Dreu, 2014; Nesheim & Hunskaar,

2015; Zhu, 2016). Healthcare organisations comprise multiple groups (e.g., teams,

departments, professions), and research has established that the mere perception of group

categories can act as barriers to sharing and cooperation (Dovidio & Banfield, 2015). Hence,

an important topic for research is what can facilitate sharing and cooperation between

different groups within an organisation.

This study explores organisational commitment and employee participation as

potential facilitators of sharing and cooperation between groups. Previous research has

established positive relationships between both organisational commitment and employee

participation and individuals’ engagement in knowledge sharing (e.g., Wang & Noe, 2010;

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PREDICTORS OF INTERGROUP SHARING AND COOPERATION

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Witherspoon, Bergner, Cockrell, & Stone, 2013). However, to the author’s knowledge, no

study has investigated the effect of the combination of these variables on knowledge sharing

and cooperation in an intergroup perspective. In fact, Dovidio and Banfield (2015) state that

“the literature on intergroup cooperation is surprisingly limited” (p. 573), and more research

is needed to understand what can facilitate cooperation among groups.

The aim of this study is therefore to investigate the relationship between organisational

commitment, employee participation, and sharing and cooperation (SC) across different

groups within organisations. Specifically, this thesis addresses the following questions: can

organisational commitment and employee participation positively predict sharing and

cooperation among work groups and departments? And furthermore, is there an indirect effect

of participation on sharing and cooperation through organisational commitment? This will be

investigated in the context of the South-East Health Region in Norway (i.e., Helse Sør-Øst),

in organisations which provide rehabilitation services.

The thesis will first address the concept of sharing and cooperation, before looking

deeper into organisational commitment, and employee participation and how these constructs

can relate to SC. This leads to the suggestion of seven hypotheses which are represented in a

structural equation model and continues with an elaboration of the method applied to

investigate these. Following this is the presentation and discussion of the results, and finally,

implications, limitations and suggestions for future studies will be considered.

Background

Sharing and Cooperation

In order to properly understand how these constructs can relate to each other is it

essential to understand the constructs themselves. The following section will elaborate on

what is meant by sharing and cooperation, how this will be investigated in the present study,

and current understandings on intergroup sharing and cooperation.

Construct definition.

The focus of this thesis is to study intergroup cooperation and knowledge sharing at

two structural levels within organisations: 1) among groups within the same department (i.e.,

internal), and 2) among separate departments within the organisation (i.e., external).

Cooperation can be defined as two (or more) parties working together towards a common

interest or goal which will benefit the parties involved (Dovidio & Banfield, 2015; Ferrin,

Bligh, & Kohles, 2007; Schalk & Curşeu, 2010). Knowledge sharing is central among

cooperative behaviours (Gagné, 2009; Lin, 2007; Llopis & Foss, 2016; Sveiby & Simons,

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2002) and is defined as “the provision of task information and know-how to help others and to

collaborate with others to solve problems, develop new ideas, or implement policies or

procedures” (Wang & Noe, 2010, p. 117). Know-how resembles the more commonly used

term competency, which is the knowledge, skills, and abilities that enable people to perform a

task successfully (Soderquist, Papalexandris, Ioannou, & Prastacos, 2010)1.

A central question is whether sharing and cooperation occur to the same degree

between work groups as between departments. Previous studies have found a difference in the

amount of sharing or cooperation among employees who are members of the same work

group, compared to employees who are not (e.g., Balliet et al., 2014; Grice, Gallois, Jones,

Paulsen, & Callan, 2006; Nesheim & Hunskaar, 2015; Zhu, 2016). However, to the author’s

knowledge, there is a lack of empirical investigations on whether work groups and

departments share and cooperate to the same extent. Nevertheless, the likelihood of work

groups being closer in proximity to each other and having greater interdependency in

performing work tasks compared to departments, suggest that the prevalence of SC will be

different internally and externally.

A climate approach to the study of SC.

This study applies a climate approach to the investigation of sharing and cooperation

in organisations. Climate can be defined as employees’ perception of the work environment,

and more precisely the perception of organisational events, practices and procedures which

are supported, expected and rewarded (Kuenzi & Schminke, 2009; Patterson et al., 2005).

Furthermore, it can be seen as a manifestation of the organisation’s culture. Culture is the

underlying and unobservable basic assumptions, values, and beliefs of an organisation, while

climate is to a greater extent observable through behaviour, policies, and procedures of an

organisation, by many thought of as ‘the way we do things around here’ (Schein, 2010;

Schneider, Ehrhart, & Macey, 2013).

Several authors have applied, or argued for the usefulness of, a climate approach to the

study of knowledge sharing and collaboration (e.g., Cabrera & Cabrera, 2005; Collins &

Smith, 2006; Kettinger, Li, Davis, & Kettinger, 2015; Koritzinsky, 2015; Llopis & Foss,

2016; Patterson et al., 2005). Climates relating to SC have been measured by different

researchers. For example, Patterson et al. (2005) introduce a climate dimension called

integration in their Organisational Climate Measure (OCM). They define integration as “the

1 von Hippel (1988) defines know-how as “the accumulated practical skill or expertise that allows one to do

something smoothly and efficiently” (p. 6).

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extent of interdepartmental trust and cooperation” within an organisation (p. 386).

Furthermore, Sveiby and Simons (2002) have developed a scale aimed at measuring a

collaborative climate. Their scale suggests that an important aspect of a collaborative climate

is the sharing of knowledge among leaders, work groups, employees, and in the organisation

as a whole. This is also supported by an interview study conducted in the Norwegian police,

which led Koritzinsky (2015) to propose that an integral part of a cooperative climate is,

along with trust, the sharing of information and competence among units/work groups.

Accordingly, a climate for sharing and cooperation is here defined as the degree of trust,

cooperation, and knowledge sharing among different work groups (internal) and departments

(external) within an organisation.

The climate literature is characterised by disagreements on what the phenomenon

encompasses, its’ theoretical conceptualisation and operationalisation. Most of these debates

are too extensive to address in this thesis. For a more thorough review, see Kuenzi and

Schminke (2009). However, some distinctions should be addressed here. First, there is a

distinction between psychological climate and organisational climate, where the former

denotes an individual’s perception and the latter describes a shared perception of the work

environment among a group of people (Feldman & O'Neill, 2014; Kuenzi & Schminke, 2009;

Ostroff & Schulte, 2014; West & Richter, 2011)2. Second, some researchers focus on a

general/molar climate which tries to capture a wide range of characteristics associated with

the work environment, while others on a specific/focused climate. Schneider et al. (2011a)

defend the latter approach. They argue that a focus on a climate for something specific, such

as a behaviour or a strategic outcome, will better predict the achievement of the outcome of

interest. Third, there are some differences in the operationalisation of climate and how it is

related to individual behaviour. In line with Schneider et al. (2011a), some researchers ask

respondents to what degree specific behaviours occur throughout the organisation. They

theorise that the perception of the behaviour’s occurrence will predict individual’s

engagement in the behaviour. Other researchers (e.g., Kettinger et al., 2015; Riordan,

Vandenberg, & Richardson, 2005) ask respondents of the prevalence of factors within the

organisation which are thought to facilitate the occurrence of the behaviour of interest (e.g.,

rewards, training), and not the prevalence of the behaviour itself. Taken together, these three

2 There is a debate regarding whether psychological climate and organisational climate constitutes conceptually

different constructs, or are the same construct but referring to different levels of analysis. I choose to treat

climate as a construct with different levels of analysis, and refer the reader to James et al. (2008) and Schneider,

Ehrhart, and Macey (2011a) for other interpretations.

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distinctions are issues which researchers need to clarify when studying climate (Kuenzi &

Schminke, 2009).

The research on climates for knowledge sharing and cooperation previously presented

(i.e., Koritzinsky, 2015; Patterson et al., 2005; Sveiby & Simons, 2002) has prompted

responses about the behaviour itself, rather than facilitators. In line with this, the current study

measures a specific climate for sharing and cooperation through seeking responses about the

behaviour itself. Furthermore, this study applies a psychological climate approach. The

rationale for such an approach is that individuals’ willingness to share and cooperate with

other work groups and departments increases if they perceive SC as high, due to a perceived

norm for sharing and cooperation (Gagné, 2009; Kettinger et al., 2015; Llopis & Foss, 2016;

Mc Manus, Ragab, Arisha, & Mulhall, 2016; Tohidinia & Mosakhani, 2010).

Intergroup relations.

As previously mentioned, research has established that people share and cooperate

more with members of their own group rather than with non-members. To understand this

phenomenon, researchers have focused on the process of social categorisation (e.g., Dovidio

& Banfield, 2015; Tajfel & Turner, 1979).

Social categorisation denotes the process of perceiving individuals as members of

different groups, and in particular as members of either ingroup or outgroup. Social

categorisation simplifies our social world by invoking cognitive schemas and stereotypes, as

well as providing us with a framework for self-reference. As suggested by social identity

theory (Tajfel & Turner, 1979), people have both a personal and a social identity. The social

identity entails “those aspects of an individual’s self-image that derive from the social

categories to which he perceives himself as belonging” (Tajfel & Turner, 1979, p. 40). Thus,

one’s membership in a social category provides us with an understanding of ourselves as

individuals and group-members.

The mere categorisation of outgroup/ingroup influences how members of different

groups perceive and interact with each other and gives rise to different biases. People are

found to be more competitive and less cooperative when interacting as group-members rather

than individuals, termed the interindividual-intergroup discontinuity effect (Wildschut &

Insko, 2007). People display an ingroup bias: a tendency to favour the ingroup, and a

preference and inclination to trust, cooperate, and share with ingroup members rather than

outgroup members (Balliet et al., 2014; Dovidio & Banfield, 2015; Nesheim & Hunskaar,

2015; Tajfel & Turner, 1979). Furthermore, people tend to exaggerate differences between

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groups, while members of the same group tend to be perceived as more similar to each other.

This is particularly the case for outgroup members (termed the outgroup homogeneity effect).

This effect has also been related to a propensity to perceive outgroups more negatively

(Gaertner & Dovidio, 2000; Vala & Costa-Lopes, 2015). In short, ingroup bias and the

outgroup homogeneity effect are examples of intergroup biases rooted in social categorisation

that serve as barriers to intergroup cooperation and sharing (Dovidio & Banfield, 2015; Vala

& Costa-Lopes, 2015).

In order to decrease intergroup bias and enable cooperation, researchers have proposed

changing the impact of social categorisation as a possible solution (Gaertner & Dovidio,

2000; Vala & Costa-Lopes, 2015). One strategy is to recategorise group boundaries, as to

include the differing groups within one superordinate group whom members of both groups

can identify with, while still acknowledging their original group memberships (i.e., producing

a dual identity). Gaertner and Dovidio (2000) make use of this approach when they propose

their Common Ingroup Identity Model as a particularly useful strategy to enhance intergroup

cooperation (Dovidio & Banfield, 2015). Their model suggests that by inducing a

superordinate category inclusive of both groups, “the process that produces cognitive,

affective, and evaluative benefits of in-group members become extended to those who were

previously viewed as members of a different group” (Dovidio & Banfield, 2015, p. 567).

Hence, this model capitalises on ingroup favouritism to enhance cooperation.

Following this, the Common Ingroup Identity Model implies that if employees

experience high identification with a superordinate category, such as the organisation, then

this identification should positively affect the level of sharing and cooperation among

subgroups included in the category, such as departments and work groups.

In the organisational psychology literature, both the concepts of organisational

identification (OI) and organisational commitment (OC) address employees’ identification

with his/her organisation. Some researchers argue that these are separate constructs, while

others use them interchangeably (Riketta, 2005). Riketta (2005) has investigated the empirical

distinction between OI and OC by comparing meta-analytical results from the two most used

scales of OI3 with the two most used scales of OC4 on different work-related outcomes and

demographic variables. He found that OC correlated highly (.79 and .90) with the two

3 Organizational Identification Questionnaire (OIC) by Cheney (1983) and the Mael Scale by Mael and Tetrick

(1992) 4 Organizational Commitment Questionnaire by Mowday, Steers, and Porter (1979) and Affective Commitment

Scale by Meyer and colleagues (1991, 1993)

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measures of OI, which questions the discriminant validity of the measures. Moreover, he

investigated if there was a significant difference in the estimated correlations between OI

measures, compared to OC measures, and eleven demographic and work-related variables.

The results displayed that OI produced significantly different correlations, compared to OC,

for only five variables. Four of these five variables were more strongly correlated with OC

than OI. In conclusion, organisational identification and organisational commitment measures

seem to be highly correlated and display similar correlations with other work-related

variables. In the instances they display significantly different correlations, OC generally

produces stronger correlations with other variables. This could be due to OC being

conceptualised as a wider construct, which includes OI as well as other aspects (e.g.,

willingness to act in favour of the organisation), and is, as a consequence, more strongly

related to different variables (Riketta, 2005; Riketta & Van Dick, 2005).

Taken together, the implications of the Common Ingroup Identity Model and the

findings of OC’s relatedness to OI makes it interesting to investigate if employees’

organisational commitment is associated with climates for sharing and cooperation across

work groups and departments.

Development of Hypotheses

Organisational Commitment

Construct definition.

Organisational commitment is a longstanding concept in organisational psychology

describing an employee’s attachment to one’s organisation. Different conceptualisations of

commitment emerged during the 1960-70’s, while the most influential conceptualisations of

organisational commitment were provided by researchers such as Porter, Mowday and Steers

during the 1970-80’s (e.g., Mowday, Porter, & Steers, 1982; Mowday et al., 1979; Steers,

1977), and by Meyer and Allen from the 1990’s and onward (e.g., Meyer & Allen, 1991,

1997; Meyer, Allen, & Smith, 1993). Fifty years later there is still debate regarding what

constitutes organisational commitment (Klein, Becker, & Meyer, 2009; Meyer, 2016;

Solinger, van Olffen, & Roe, 2008).

Porter, Mowday, and Steers described OC as an individual’s degree of involvement in

and identification with an organisation, which is manifested as a) an internalisation of the

organisation’s values and goals, b) a willingness to exert effort for the organisation and c) a

desire to remain in the organisation (Mowday et al., 1979; Steers, 1977).

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In contrast to Porter and colleagues’ view of OC as a unitary construct, Meyer and

Allen (1991) suggested that OC consists of three components: affective, continuance and

normative commitment. The components represent different psychological states regarding

one’s membership in an organisation. Specifically, affective commitment (AC) is defined as

“the employee’s emotional attachment to, identification with, and involvement in the

organization” (Meyer & Allen, 1991, p. 67) and refers to a desire to remain within the

organisation. Continuance commitment (CC) on the other hand refers to a need to maintain

membership because of the perceived costs of leaving the organisation. Finally, normative

commitment (NC) concerns a feeling of obligation to remain in the organisation, that is the

‘right thing to do’ (Meyer & Allen, 1991). The three-component framework was the

prevailing view on OC at the beginning of the 21st century and has consequently been widely

researched. Several studies have found stronger correlates between AC and work-related

outcomes, compared to the other two components (Judge & Kammeyer-Mueller, 2012;

Mercurio, 2015; Meyer, Stanley, Herscovitch, & Topolnytsky, 2002; Solinger et al., 2008).

Solinger et al. (2008) offer a different perspective on OC. In line with other

researchers (e.g., Judge & Kammeyer-Mueller, 2012; Mowday et al., 1979; Riketta, 2005;

Schleicher, Hansen, & Fox, 2011), they conceptualise organisational commitment as an

individual’s attitude towards one’s organisation. The authors argue that in the three-

component framework by Meyer and Allen, only the affective component of commitment

does in fact model an attitude towards the organisation as a target. Continuance and normative

commitment, on the other hand, represent attitudes towards a behaviour. That is, staying or

leaving the organisation. In their seminal article, Solinger et al. (2008) review the literature on

OC and utilise Eagly and Chaiken’s (1993) composite attitude-behaviour model to better

understand the construct. Based on this, they provide an attitudinal definition of OC including

an affective, cognitive and behavioural component, which will be applied in this thesis:

Organizational commitment is an attitude of an employee vis-à-vis the organization, reflected

in a combination of affect (emotional attachment, identification), cognition (identification and

internalization of its goals, norms, and values), and action readiness (a generalized behavioral

pledge to serve and enhance the organization’s interests) (p. 80).

This definition offers an inclusive approach to defining OC, building on earlier

conceptualisations of OC which has emphasised identification with the organisation and

willingness to act in favour of the organisation. These attributes of commitment can be

beneficial for a climate of sharing and cooperation for several reasons.

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Organisational commitment’s relationship with sharing and cooperation

As previously discussed and in line with the Common Ingroup Identity Model, high

identification with the organisation invoke a perception of all employees being part of the

ingroup. Ingroup favouritism consequently increases the likelihood of trust, sharing, and

cooperation among members of different work groups or departments. This is supported in a

recent study by Zhu (2016). She found that employees’ identification with the organisation

negatively predicted team-level ingroup bias (β= −0.36) and knowledge sharing disparity (i.e.,

employees sharing with ones’ own team members rather than with other teams) (β= −0.33).

Second, OC involves a willingness to act in favour of the organisation and help to

achieve its goals. A primary goal in healthcare organisations is to give patients the best

possible care. Sharing and collaboration across work groups and departments are behaviours

aiding the achievement of such a goal. Several researchers have additionally conceptualised

knowledge sharing as a kind of organisational citizenship behaviour (OCB) (e.g. Cabrera &

Cabrera, 2005; Casimir, Lee, & Loon, 2012; Gagné, 2009) and argued that OC positively

predicts OCB, and thus also knowledge sharing. For example, by increasing employees’

altruistic spirit (Han, Chiang, & Chang, 2010).

In addition to these arguments, there is empirical evidence supporting the relation

between OC and related outcomes such as knowledge sharing and cooperation. In a study of

75 employees in a nursing department, Carson, Carson, Yallapragada, and Roe (2001) found

that organisational commitment positively predicted across-department cooperation (β=.35).

Several other studies have established a positive effect of OC on knowledge sharing (e.g. Han

et al., 2010; Lin, 2007; Wang & Noe, 2010), as well as a meta-analysis by Witherspoon et al.

(2013) who found a sample size weighted corrected correlation of r=.28.

These empirical findings and the preceding arguments of OC prompting 1)

organisational level ingroup bias, 2) effort to achieve organisational goals and 3)

organisational citizenship behaviour, suggest that organisational commitment is positively

related to internal and external SC. Consequently, the following hypotheses are proposed:

H1a: There is a positive direct effect of organisational commitment on the perception

of internal sharing and cooperation.

H1b: There is a positive direct effect of organisational commitment on the perception

of external sharing and cooperation.

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Employee Participation

Grice et al. (2006) suggests that managers should invest in strategies which invoke

identification with a superordinate level, such as the organisation, in order to enhance

information sharing and communication across different work groups. One such strategy is to

provide employees with the opportunity to voice their opinions and influence decision-

making. This is also known as employee participation or involvement, empowerment,

industrial democracy and voice among other terms. For simplicity, this thesis applies

employee participation as an umbrella term for initiatives which aim to engage employees in

decision-making (Busck, Knudsen, & Lind, 2010; Wilkinson & Dundon, 2010).

Construct definition.

Employee participation has both theoretical and political traditions, the latter being

particularly true for Norway. Both domains share to a great extent a common understanding

of what the term comprises. The academics Dietz, Wilkinson, and Redman (2010) describe

employee participation as “employer-sanctioned schemes that extend to employee

collectivities a ‘voice’ in organisational decision-making in a manner that allows employees

to exercise significant influence over the processes and outcomes of decision-making” (p.

247). From a policy perspective, a white paper to the Norwegian Ministry of Labour defines

participation as “any action that enables employees to influence the decision-making

processes at any level in the organisation, from the determination of the organisation’s overall

goal to the ongoing decisions related to the individual’s daily work and effort” (NOU 2010:1,

2010, p. 15, own translation). Following these definitions, it is clear that participation can

involve a range of initiatives introduced by the employer which can vary in terms of depth,

scope and level.

Depth, or the power possessed by the employee as Busck et al. (2010) calls it, refers to

the degree of influence employees can exercise (Wilkinson & Dundon, 2010). The power can

range from receiving information (shallow depth), being consulted on decisions, joint

decision-making, to self-determination (greater depth). Several authors do not regard mere

information as participation (e.g., Dietz et al., 2010; Strauss, 2006). According to them,

participation must include some form of influence. Information can nevertheless be seen as a

prerequisite for participation. That is, to be able to influence decisions, employees need to

have adequate information on the matter (Riordan et al., 2005).

Scope refers to the kind of matters employees can influence, which can vary across

operational, tactical and strategical domains (Busck et al., 2010). For example, it can range

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from influencing the coordination of work tasks to more extensive issues such as determining

long-term goals for the organisation. Finally, level refers to the hierarchical level on which

participation takes place (e.g., the individual, work group, department, corporate level).

Participation initiatives are characterised not only according to their depth, scope and

level. They can also differ in form. Form describes the kind of initiatives implemented to

engage employees. These can vary greatly, from formalised procedures, like employee

representatives, focus groups or electronic suggestion-box, to everyday face-to-face

interaction between employee and manager. A particular important distinction is between

direct and indirect participation. Direct participation entails situations where employees are

involved themselves, while indirect participation denotes processes where employees are

represented by an elected representative or union (Dietz et al., 2010). The focus of this thesis

is direct participation.

In summary, employee participation concerns a range of initiatives aimed at engaging

employees and shifting decision-making power from solely the employer to the employees. In

this study, I take a climate perspective on direct employee participation, because of interest in

the perception of the facilitation (i.e., information) and the presence of participation initiatives

on a general basis, and not the potential effect of single initiatives (Tesluk, Vance, & Mathieu,

1999). Hence, this climate approach tries to capture varying depths and scope of participation

at several levels in the employee’s organisation.

Employee participation’s relationship with organisational commitment.

As previously argued, organisational commitment should have a positive impact on

sharing and cooperation within organisations. Employee participation can, in turn, be an

expedient management strategy to increase organisational commitment. For example, a study

by Tesluk et al. (1999) revealed that individuals’ perception of a participative climate

positively predicted employees’ organisational commitment (β=,41). Furthermore, a meta-

analysis by Kooij, Jansen, Dikkers, and De Lange (2010), which included 19 studies of the

relationship between participation and OC found a mean true score correlation of .52.

Participation was the strongest correlate, together with internal promotion, compared to ten

other HR practices included in the analysis. By informing employees of the state of the

organisation and prominent decisions being made, employees’ understanding can be increased

(Wilkinson & Dundon, 2010). Moreover, if employees are generally encouraged to influence

or make decisions, it can increase their sense of responsibility toward the decisions and the

fate of the organisation. This can further create a psychological ownership and attachment

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towards the organisation, and by extension increased organisational commitment. This is

supported in a study by Han et al. (2010), who found that participation in decision-making

positively predicted employees’ experience of psychological ownership towards the

organisation. Psychological ownership further predicted employees’ organisational

commitment and in turn knowledge sharing behaviour through the indirect effect of OC.

Based on the findings above, one can thus assume that employees’ perception of participation

will affect their commitment to the organisation, which again will affect the level of sharing

and cooperation in the organisation. Accordingly, the following hypotheses are proposed:

H2: There is a positive direct effect of employee participation on employees’ level of

organisational commitment.

H3a: There is a positive indirect effect of employee participation on the perception of

internal sharing and cooperation through organisational commitment.

H3b: There is a positive indirect effect of employee participation on the perception of

external sharing and cooperation through organisational commitment.

Employee participation’s direct relationship with sharing and cooperation.

In addition to an indirect effect through organisational commitment, it is conceivable

that employee participation affects sharing and cooperation directly. Several researchers have

theorised that for a behaviour to occur, employees need to have the motivation, opportunity

and capability to engage in the behaviour (e.g., Argote, McEvily, & Reagans, 2003; Michie,

van Stralen, & West, 2011). Organisational commitment can be argued to positively influence

employees’ motivation to share and cooperate across work groups and departments. Employee

participation can, on the other hand, be beneficial to increase employees’ opportunity and

capability to engage in SC. Cabrera and Cabrera (2005) assert, based on social capital theory,

that employee participation can increase employees’ opportunity to engage in knowledge

sharing. The argument here being that participation can increase social ties between

employees as well as shared language and narratives, and these factors will in turn increase

employees’ opportunity to share knowledge because it brings employees closer together and

creates a climate for knowledge sharing. Shared language and narratives can also increase

employees’ capability to cooperate and share knowledge, by increasing employees’

knowledge of how to efficiently communicate with each other. Hence, employee participation

can facilitate employees’ motivation through enhancing OC, opportunity, and capability to

engage in sharing and cooperation with other work groups and departments.

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Furthermore, it is possible to look at the dynamics of SC from a social exchange

perspective (Zhu, 2016). By giving employees the opportunity to take part in decisions,

management displays trust and recognition of subordinates’ competence (Cabrera & Cabrera,

2005), as well as providing them with information. By receiving information from

management, employees might be more willing to share their information and knowledge

with the rest of the organisation. This notion is supported by Lin (2007). He found that the

positive effect of employee participation on the degree of knowledge sharing was stronger for

individuals high in exchange ideology (i.e., strong belief in the norm of reciprocity).

In summary, when employees are provided with information, their motivation to share

information with the rest of the organisation may increase, as well as their opportunity and

capability to engage in sharing and cooperation. A climate for participation can thus facilitate

a climate for sharing and cooperation. Additionally, employee participation involves open

communication between employees and employer. It decreases status barriers and creates an

egalitarian work environment, all of which are theorised to encourage sharing of knowledge

(Cabrera & Cabrera, 2005). As a result, the following hypotheses are formed:

H4a: There is a positive direct effect of employee participation on the perception of

internal sharing and cooperation over and above the indirect effect through OC.

H4b: There is a positive direct effect of employee participation on the perception of

external sharing and cooperation over and above the indirect effect through OC.

In sum, this thesis proposes seven hypotheses in total which are displayed in Figure 1.

Figure 1. Graphical representation of the hypothesised relations among the variables

Note: Hypotheses 3a and 3b are not displayed in the figure, but concerns the paths from Participation OC Internal SC

and Participation OC External SC respectively.

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Method

The Project

This study is conducted in collaboration with the Regional Centre of Knowledge

Translation in Rehabilitation (RKR) at Sunnaas Hospital, represented by Jan Egil Nordvik as

contact person. The aim of the overall project is to investigate 1) attitudes and behaviours

related to evidence-based practice and knowledge translation, 2) perceptions of sharing and

cooperation, and 3) participation, and 4) employees’ degree of organisational commitment.

This is investigated among health care personnel working in rehabilitation in the South-East

Health Region in Norway. The current thesis focuses on the perception of sharing and

cooperation, participation and degree of organisational commitment. Thus, questions

regarding evidence-based practice and knowledge translation are not included in this specific

study.

Data Collection

The data was collected in collaboration with RKR through a survey distributed to

different institutions in the region. We distributed the survey by two different channels during

November 2016. First, all subscribers of RKR’s monthly newsletter received an invitation to

participate in the study by e-mail (1113 subscribers). Additionally, an e-mail was sent to 106

managers of different rehabilitation institutions, asking them to share our request for

participants throughout their organisation. The survey was completed electronically by

following a link to the questionnaire through the software Enalyzer, provided by RKR. The

period of data collection was four weeks.

Sample

The sample consists of 246 respondents from 74 different organisations. 151 of the

newsletter subscribers completed the whole questionnaire, while 176 subscribers did not fully

complete it. 18 of these 176 completed the questionnaire to such a degree it was possible to

include their answers in further analysis (some demographic variables were missing). The

remaining 158 replies were discarded. 69 respondents completed the questionnaire by the link

distributed to rehabilitation managers. Additionally, there were 69 incomplete answers from

this distribution channel. 7 of these were completed to such a degree they could be retained

for later analysis. Together, this sums up to 246 respondents, 77.2 % women and 20.3 % men

(2.4% did not provide gender). 74.8% of the respondents worked in specialist health service

(i.e., spesialisthelsetjenesten), 22% in primary or municipal health service and 3.3% worked

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in other health services. The majority worked as health care professionals (65 %), while

22.7% worked in management or administration, 9.8% in other professions and 2.4% did not

provide profession. Due to the uncertainty in the number of distributed requests by the

managers, it was not possible to calculate an accurate response rate for this study.

Measures

This study applies four different scales aimed at measuring the constructs of interest:

Internal sharing and cooperation, External sharing and cooperation, Organisational

Commitment and Participation. A table of all the measures with its associated items in

Norwegian is displayed in Appendix 1. Two of the measures have been piloted in a study of

the Norwegian Police. The measure of organisational commitment was developed for this

study. All negatively worded items have been reversed coded for the analysis. The measures’

degree of internal consistency was investigated by calculating their respective Cronbach’s

alpha, where a value of α ≥ .70 denotes acceptable reliability (Hair, Black, Babin, &

Anderson, 2014).

Sharing and cooperation.

The items measuring internal and external sharing and cooperation stems from

Koritzinsky (2015), who proposed an extension of Patterson et al.’s (2005) integration scale5

to include items concerning knowledge sharing. The two scales consist of 12 items each,

where the content of the items is overlapping, except for the structural reference to either

sharing and cooperation between work groups (internal) or departments (external). The scales

apply a 5-point Likert scale response format, ranging from definitely false (1) to definitely

true (5). Example items are: “Collaboration between the groups in this department is very

effective” (internal) and “People are prepared to share information across different

departments in this organisation” (external). Cronbach’s alpha was estimated to be α=.91 for

internal and α=.92 for external SC, thus displaying satisfactory reliability.

Organisational commitment.

To the author’s knowledge, no organisational commitment scale has been developed to

operationalise Solinger et al.’s (2008) conceptualisation of organisational commitment as a

tripartite attitude consisting of affective, cognitive and behavioural information.6

Consequently, a scale was developed by combining items from two established measures: the

5 The Organisational Climate Measure has been translated into Norwegian and validated by Bernstrøm, Lone,

Bjørkli, Ulleberg, and Hoff (2013). 6 Except for a 3-item scale aimed at longitudinal studies (Solinger, Hofmans, & Olffen, 2015).

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Affective Commitment Scale (ACS) by Meyer, Allen and Smith (1993) and the

Organisational Commitment Questionnaire (OCQ) by Mowday et al. (1979). The Norwegian

translation of the ACS was provided by Bård Kuvaas, while the Norwegian translation of the

OCQ was taken and adjusted from Stavne (2015). To the author’s knowledge, none of these

translations have been back-translated.

As defined earlier, organisational commitment is:

an attitude of an employee vis-à-vis the organization, reflected in a combination of affect

(emotional attachment, identification), cognition (identification and internalization of its goals,

norms, and values), and action readiness (a generalized behavioral pledge to serve and

enhance the organization’s interests) (Solinger et al., 2008, p. 80).

Three items aimed at measuring affect were chosen from the ACS. These were selected based

on 1) the items’ content alignment with the conceptual definition and 2) an inspection of

several factor analyses of the ACS performed by Kuvaas and Dysvik on Norwegian samples

(Kuvaas, 2006a, 2006b, 2007; Kuvaas & Dysvik, 2010a, 2010b). The three items which

consistently displayed the highest loadings in these factor analyses were chosen. An example

item is: “I do not feel a strong sense of "belonging" to my organisation.” (reversed). To

measure cognition, two items were chosen from the OCQ, while one item from the ACS was

reformulated to tap cognition rather than affect (i.e., “I really feel as if this organisation’s

problems are my own” was changed to “I really perceive this organisation’s problems as my

own”). An example item taken from the OCQ is: “I find that my values and the

organisation’s values are very similar”. Finally, three items from the OCQ were chosen to

reflect action readiness. An example is: “I am willing to put in a great deal of effort beyond

that normally expected in order to help this organisation be successful”. The items reflecting

cognition and action readiness were chosen based on their contents’ alignment with the

conceptual definition.

The interest of this study is to investigate the effect of organisational commitment as

an overall attitude, and not necessarily the effect of the different subcomponents. As a

consequence, I follow Solinger et al.’s (2015) recommendation and treat the scale as a

unidimensional summary measure of organisational commitment where affective, cognitive,

and behavioural information is mixed. The 9-item scale (shown in Appendix 1) uses a 5-point

Likert scale response format where 1 represents strongly disagree, and 5 strongly agree. The

scale displayed acceptable reliability with α=.79.

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Employee participation.

The measure of participation is based on a 6-item measure of employee participation,

as introduced in Burke (2014). This scale has been translated by the Work and Organisational

Psychology research group at the Department of Psychology, at the University of Oslo. It was

furthermore extended with seven items to cover what Wilkinson and Dundon (2010) refer to

as different depths of participation (i.e., information, communication, consultation, co-

determination, control). Consequently, the participation scale applied in this study consisted

of 13 statements rated on a 5-point Likert scale ranging from definitely false (1) to definitely

true (5). Example items are: “Subordinates have an opportunity to contribute to the setting of

their department’s goals” and “Department changes are jointly planned between the

manager and members of the department”7. Cronbach’s alpha for this scale was α=.92,

demonstrating satisfactory reliability.

Analysis

Preliminary analysis.

Data screening, preliminary and descriptive analysis were conducted with the software

SPSS 24.0. Data screening and preliminary analysis are further elaborated below, while the

descriptive analysis is presented in the results.

There were no missing data for any of the indicators to be included in the hypotheses

testing. In accordance with Kline’s (2016) recommendations, the data was evaluated for

normality. None of the indicators displayed skewness or kurtosis values larger than the

guiding values of severe skewness (|>3,0|) and problematic kurtosis (|>10,0|) (Kline, 2016).

Most values ranged between +/- 1, and the largest skewness value was 1,07 and for kurtosis

2,48. Linearity was investigated by inspecting the scatter plots between the sum scores of

each construct. Collinearity was investigated by calculating the explained variance (R2)

between each variable and all the rest (Kline, 2016). Both were found to be satisfactory. It

was, therefore, concluded the data was suitable for further analysis.

Considering that the measures applied in this study are relatively new, I decided to do

a preliminary exploratory factor analysis (EFA) before testing the hypotheses through a SEM-

analysis. The EFA is useful to get an initial picture of the dimensionality of the different

measures, as well as convergent and discriminant validity. Ideally, this should be done by

7 The majority of the items in this scale are concerned with participation at the departmental level. Spence

Laschinger, Finegan, and Wilk (2009) have found that unit-level empowerment predicts employees’

organisational commitment, demonstrating that perceptions of events at the departmental level can affect

attitudes targeted at the whole organisation.

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randomly splitting the sample in two and do an EFA on one part, and a confirmatory factor

analysis (CFA) on the other. However, considering the sample size (N=246) in this study, it

was not feasible to split it because the separate samples would be too small and as a

consequence, the results from the EFA and CFA would be questionable.

In addition to evaluating if the constructs were conceptually distinct, it was also

examined whether it is a meaningful difference in the level of SC internally and externally.

This was investigated through a one-sample t-test, testing the null hypothesis that the mean

difference between the sum scores of internal and external SC equals zero.

Structural Equation Modelling.

The hypotheses were investigated using structural equation modelling (SEM). SEM-

analysis can be thought of as a combination of different statistical techniques, such as factor

analysis and multiple regression analysis (Hair et al., 2014). SEM is a useful tool to test

multiple relationships between latent variables simultaneously. Moreover, by the use of SEM,

it is possible to achieve better estimates of the effect sizes between constructs, because one

controls for the unique variance in indicators not attributable to their common latent factor

(Kline, 2016). The SEM-analysis was conducted with the software AMOS 24.0, with

maximum likelihood estimation and bootstrapping of the estimates to obtain the 95%

confidence interval of the indirect effects.

There are different variations of SEM, but most often it includes specifying and testing

a measurement model and a structural model, which together make up the theorised model

one wishes to investigate. The first step is to specify the measurement model, which is to

ascribe the relationship between the different indicators and the latent factors (i.e., which

indicators load on which factors). This is known as a confirmatory factor analysis. Second, if

the measurement model fits the observed data well, one continues to specify the structural

model, which is to determine the relation between the latent factors (i.e., one’s hypotheses).

Researchers evaluate different estimates produced by the SEM-analysis to assess how

well the theorised model (i.e., the measurement and structural model) represents the observed

data. Specifically, one evaluates the global fit of the overall model by inspecting a range of

goodness-of-fit indices, as well as assessing local fit by examining residuals, modification

indices and the size and significance of parameter estimates (e.g., factor loadings and

regression coefficients) (Brown, 2015; Hair et al., 2014; Kline, 2016). Based on an overall

evaluation of global and local fit, the researcher chooses to retain, modify or reject the model.

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Goodness-of-fit (GOF) indices are estimates of global fit, which indicate how well the

specified model is able to reproduce the observed covariance matrix among the items (Hair et

al., 2014). In this study, I will apply the following indices: Chi-square, CFI, RMSEA and

SRMR as recommended by Brown (2015) and Kline (2016).

Chi-square (χ2) is an absolute fit index which assesses whether the specified model is

significantly different from the observed covariance matrix. A non-significant chi-square

(p>.05) indicates good fit. A limitation with χ2 is its sensitivity to large sample sizes and

greater number of indicators, where one or both will inflate the χ2 and make it more difficult

to achieve good model fit (i.e., non-significant result) (Hair et al., 2014). Hair et al. (2014)

offer guidelines, based on simulation studies, for different GOF indices across different model

situations. They state that for models containing more than 30 indicators and N<250 a

significant p-value for χ2 is expected, which is the case in this study.

The Comparative Fit Index (CFI) compares how well the specified model fits the data

relative to a null model where all indicators are uncorrelated. The index ranges from 0-1,

where values closer to 1 indicate better fit. Following Hair et al. (2014) model-specific

guidelines (i.e., N<250, number of indicators >30) a CFI above .92 suggests good fit.

Finally, both the Root Mean Square Error of Approximation (RMSEA) and the

Standardised Root Mean Residual (SRMR) are absolute fit indices which are scaled as

badness-of-fit statistics, where higher values indicate poor fit and values close to zero denote

better fit. RMSEA should be less than .08 together with a CFI above .92 to indicate good fit

(Hair et al., 2014). RMSEA is often reported with 90% confidence interval (Brown, 2015).

The SRMR uses the residuals (i.e., the difference between the estimated and observed

covariance) to compute the average standardised residual as a measure of how well the overall

model fits the data. SRMR should be below .09 (together with CFI>.92) 8 to indicate good fit

(Hair et al., 2014).

The standardised covariance residuals are also a useful statistic to discover local poor-

fit. It is important to investigate local fit in addition to global fit because the global fit indices

do not reveal whether some part of the model has poor fit. In large samples, the standardised

covariance residual approximates a standardised normal distribution; thus less than 5 % of the

residuals should fall outside the range of -2 to +2 (Kline, 2016). Any residual with an absolute

8 Several researchers apply stricter values for the CFI (≥.95), RMSEA (≤.06) and SRMR (≤.08) to indicate good

fit (e.g., Schreiber, Nora, Stage, Barlow, & King, 2006), however these are general guidelines and not model-

specific.

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value above 4 raises serious concerns (Hair et al., 2014). By inspecting the standardised

residuals, it is possible to detect if specific indicators are problematic.

Finally, the estimated parameters of the model should be inspected. In the

measurement model, the factor loadings should be statistically significant, in the predicted

direction and of a considerable size. That is, factor loadings should be above .50, and ideally

.70 or higher (Hair et al., 2014).

Reliability and Validity.

In SEM-analysis, internal consistency is estimated by calculating the scales composite

reliability (CR). CR is the ratio of explained variance over total variance (Kline, 2016). CR

values of .70 and higher are regarded as acceptable reliability (Hair et al., 2014).

To support construct validity the items aimed at measuring a particular construct

should share a substantial amount of variance (i.e., convergent validity), and the construct

should be distinct from other constructs (i.e., discriminant validity). Thus, items should load

highly on one factor, and constructs should not be highly correlated (e.g., >.85) (Kline, 2005).

Composite reliability is also a measure of a scale’s convergent validity. To assess

discriminant validity, one can investigate whether specifying all items belonging to two

factors to load on a single factor produces a significantly different fit (i.e., Chi-square) than

the model with two factors. Discriminant validity is supported if the two-factor model fits

significantly better than the one-factor model. Contrary, discriminant validity is not supported

if there is no significant difference between the models or if the one-factor model provides

significantly better fit (Hair et al., 2014).

Sample Size.

There are different recommendations regarding suitable sample size for conducting

exploratory factor analysis: some researchers recommend absolute thresholds (N>50, N>100

and N≥300), while others suggest ratios of 5, 10 or 20 times as many observations as

variables. Hair et al. (2014) recommend a minimum of 5:1, which is the case in this study, but

a bigger ratio (e.g., 10:1) is preferable. Thus, a sample size of N=246 meet only the minimum

requirement and, consequently, the results should be interpreted with caution.

Required sample size is also a debated topic within SEM. Just as for EFA, different

thresholds (most often N>200) and ratios have been suggested. However, simulation studies

have shown that required sample size is sensitive to: the degree of normality, missing data,

estimation method, model complexity (i.e., number of indicators, factors and parameters

estimated), magnitude of factor loadings, and path coefficients (Hair et al., 2014; Wolf,

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Harrington, Clark, & Miller, 2013). Based on the screening of the data there is no indication

of non-normality and no missing data. Together with a large set of indicators per latent

variable, few latent variables and N>200, a N=246 can be regarded as an adequate sample

size to apply SEM-analysis in this study (Hair et al., 2014).

Ethical Considerations

The study is reported to and approved by the Data Protection Official at the University

Hospital of Oslo. The invitation e-mail contained information about: the purpose of the study,

the storage of data, voluntary participation, that reporting of the results would only be at

aggregate levels, and their individual responses would thus not be disclosed. It was

communicated that by continuing the survey, the respondent gave their informed consent.

There were no known benefits or detriments of participating in the study.

Results

Results of the Descriptive and Preliminary Analysis

The means, standard deviations, Cronbach’s alpha and inter-correlations between the

sum scores of every construct are presented in Table 2. The results displayed moderate to

large correlations among all the constructs. Internal sharing and cooperation had the largest

mean, while external SC displayed the lowest of the four constructs. All the constructs’

averages were above the response scale centre (3), indicating a positive degree of internal and

external sharing and cooperation, participation, and organisational commitment in the sample.

Table 2

Mean, standard deviation, Cronbach's alpha and zero-order correlations for all constructs

Construct Mean SD Α 1. 2. 3. 4.

1. Internal Sharing & Cooperation 4.06 .61 .91 1

2. External Sharing & Cooperation 3.60 .66 .92 .57** 1

3. Employee Participation 3.72 .63 .92 .57** .59** 1 4. Organisational Commitment 3.62 .56 .79 .46** .48** .55** 1

** Correlation is significant at the 0.01 level (2-tailed).

The exploratory factor analysis was conducted with maximum likelihood as extraction

method and with promax rotation9. There are different criteria to assess the number of

underlying factors. Horn’s (1965) parallel analysis is widely recommended (Hayton, Allen, &

Scarpello, 2004; Patil, Singh, Mishra, & Donavan, 2008), and this analysis was conducted

9 Before performing the factor analysis, I calculated the Kaiser-Meyer-Olkin Measure of Sampling Adequacy

(KMO= .93) and the Bartlett's Test of Sphericity (which was significant), both of which supported the suitability

of conducting a factor analysis on the data.

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following Hayton et al.’s (2004) procedure10. The parallel analysis revealed five underlying

factors, which was one more than expected. The pattern matrix containing five factors is

shown in Table 3. Several of the items on internal and external SC, in particular the reversed

items, loaded on a separate factor. The content of these items concerned mistrust and conflict,

opposites of trust and cooperation. Additionally, the items Par_2 and OC_B_8 did not load

strongly on any factor. Overall however, most items loaded on a single factor and together

with other items aimed at measuring the same construct.

The mean difference in SC internally and externally was .46 (SD=.59). The two-tailed

t-test of difference in means was statistically significant (t(245)=12.17, p<.01), supporting

that on average there is a higher degree of SC internally compared to externally.

Table 3

Exploratory factor analysis: Pattern Matrix

Items Factors

Items Factors

1 2 3 4 5 1 2 3 4 5

IntSC_1 .63 Par_1 .57

IntSC_2 .43 Par_2

IntSC_3_R .61 Par_3_R .56

IntSC_4 .69 Par_4 .85

IntSC_5_R .71 Par_5 .80

IntSC_6 .69 Par_6 .88

IntSC_7 .63 Par_7 .64

IntSC_8_R .47 Par_8 .91

IntSC_9 .73 Par_9 .64

IntSC_10 .82 Par_10 .50

IntSC_11 .87 Par_11 .75

IntSC_12 .76 Par_12 .74

ExtSC_1 .58 Par_13 .42

ExtSC_2 .44 .31 OC_C_1 .61

ExtSC_3_R .68 OC_B_2 .65

ExtSC_4 .82 OC_A_3R .37

ExtSC_5_R .57 OC_C_4 .45

ExtSC_6 .62 OC_B_5 .81

ExtSC_7 .65 OC_A_6R .51

ExtSC_8_R .44 .44 OC_C_7 .52

ExtSC_9 .82 OC_B_8

ExtSC_10 .77 OC_A_9R .50

ExtSC_11 .89

ExtSC_12 .69 Note. Extraction Method: Maximum Likelihood. Rotation Method: Promax with Kaiser Normalization.

Factor loadings below .30 are not displayed.

10 Generated 100 random datasets and estimated eigenvalues with ML estimation, rather than 50 datasets as

Hayton et al. (2004) describes.

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Hypothesis Testing – Structural Equation Model

Measurement model.

The first CFA containing all items specified to their respective latent factors (model

1), did not entirely meet the criteria set for good model fit, as displayed in Table 4. A path

diagram of the initial measurement model can be found in Appendix 2. The Chi-square was,

as expected due to sample size and number of indicators, significant. Both RMSEA and

SRMR were acceptable. However, the CFI was too low.

Several respecifications were made to attain good model fit for the measurement

model. These were done step by step, to check improvement in the Chi-square. Several items

from the OC scale and one item from the participation scale displayed low factor loadings

(<.5). Par_2, which was also problematic in the EFA, was dropped. Three items from the OC

scale were also excluded, each aimed at measuring cognitive, affective and behavioural

information respectively. This left one item (OC_A_3R) with a loading of .45 in the model,

this item was however retained because of content validity concerns.

The reversed items in both the internal and external SC scales displayed several high

standardised covariance residuals (absolute value above 3). Together with the results from the

EFA, where five of these items loaded on a single separate factor, it was decided to exclude

these items from the measurement model. Additionally, Par_13 displayed several standardised

covariance residuals above 3 and was, as a result, excluded from the model.

Based on the modification indices, some error terms of items which had similarly

worded phrases and/or were in consecutive order were allowed to covary. The reason for this

was that it was plausible they shared some unique variance due to their similarity.

A path diagram of the respecified measurement model (model 2) is shown in

Appendix 3 and the model’s respective communalities are presented in Appendix 4. Table 4

presents the GOF indices for this model (model 2), where the values of CFI, RMSEA and

Table 4

Measurement model Goodness of Fit statistics

Model χ2 df χ2/df CFI

RMSEA

[CI1] SRMR Comments

1 2141.73**

983

2.18 .825

.069

[.065-.073]

.069 All items are included

2 1022.90** 580 1.76 .920 .056

[.050-.061]

.054 Items: Par_2, Par_13, OC_C_4,

OC_A_6R, OC_8_B, IntSC_3_R,

IntSC_5_R, IntSC_8_R, ExtSC_3_R,

ExtSC_5_R are excluded ** Chi-square significant at the 0.01 level. 1 90 % confidence interval of the RMSEA

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SRMR indicate good fit. It was possible to continue modifying the model to get an even better

overall fit, however, with new modifications the results can become more specific to the

sample rather than representing theoretical assumptions. As MacCallum, Roznowski, and

Necowitz (1992) cautioned “when an initial model fits well, it is probably unwise to modify it

to achieve even better fit because the modifications may simply be fitting small idiosyncratic

characteristics of the sample” (p. 501).

Reliability and validity.

Composite reliability (CR) was above .70 for all constructs: Participation CR= .92,

organisational commitment CR= .83, internal SC CR= .91 and external SC CR= .93. Thus,

reliability and convergent validity were satisfactory for all scales. A Chi-square significant

difference test was conducted for every pair of constructs, comparing a one-factor model to a

two-factor model. All the two-factor models (i.e., keeping the constructs separated) displayed

significantly better fit than the one-factor models (i.e., merging items from two factors to one

factor). This supported discriminant validity between all constructs.

Structural model.

After demonstrating acceptable fit for the measurement model, the next step in SEM is

to specify the structural model. That is, to introduce the paths among the latent variables as

specified in the hypotheses. The complete theorised model, with its measurement and

structural elements, is displayed in Figure 2. The estimates between the latent variables are

interpreted as standardised regression coefficients (β), the estimates between the latent

variables and the indicators are factor loadings and the estimates connected to the double-

headed arrows are correlations.

The structural model produced the same GOF indices as the respecified measurement

model (model 2), as presented in table 5. Thus, the overall model fit the observed data well

and was therefore retained.

Table 5

Structural model Goodness of Fit statistics

Model χ2 df χ2/df CFI

RMSEA

[CI1] SRMR Comments

2 1022,90**

580

1,76 ,920

,056

[,050-,061]

,054 Items: Par_2, Par_13, OC_C_4,

OC_A_6R, OC_8_B, IntSC_3_R,

IntSC_5_R, IntSC_8_R, ExtSC_3_R,

ExtSC_5_R are excluded.

** Chi-square significant at the .01 level. 1 90 % confidence interval of the RMSEA

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Figure 2. Structural model path diagram Note: Estimation method: Maximum Likelihood. Displaying standardised coefficients.

Circles represents latent variables (factors), while rectangles represent observed variables (indicators). Circles with e**

denotes error variance, and circles with d* denotes disturbance terms. Disturbance are other variables which affect the latent

variables, but which are not accounted for in the model.

Table 6 displays the direct, indirect, and total effects, as well as explained variance,

between the latent variables. All the effects were found significant (p <.05) and in the

predicted direction, thus all the hypotheses were supported. There was a significant positive

direct effect of organisational commitment on both internal (H1a: β=.29) as well as external

(H1b: β=.22) sharing and cooperation. Employee participation did positively predict

organisational commitment (H2: β=.69). Additionally, there was a significant positive indirect

effect of participation, through organisational commitment, on internal (H3a: β= .20, CI=.08-

.35) and external sharing and cooperation (H3b: β=.15, CI=.03-.31). Finally, as suggested,

participation had a significant positive direct effect on internal (H4a: β=.38) and external SC

(H4b: β=.47) over and above the effect that could be explained trough organisational

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commitment. The variation in participation and organisational commitment explained

together 38% of the variation in internal SC and 41% of the variation in external SC.

Table 6

Estimates of direct, indirect and total effects between latent variables and explained variance

Relationship Direct

effect1

Standard

Error of b

Indirect effect

by OC1

95% CI of the

indirect effect1

Total

effect1

Explained

variance (R2)

OCIntSC .29**

(.20)

.06

OCExtSC .22*

(.22)

.09

ParOC .69**

(.77)

.09

.47

ParIntSC .38**

(.29)

.07

.20**

(.16)

.08-.35

(.06-.29)

.58**

(.45)

.38

ParExtSC .47**

(.52)

.10

.15*

(.17)

.03-.31

(.04-.35)

.62**

(.68)

.41

Note. Par=Participation, OC= Organisational commitment, IntSC= Internal sharing and cooperation, ExtSC= External

sharing and cooperation, CI= Confidence interval 1 Displaying standardised coefficients: β, numbers in parentheses are the unstandardised coefficients: b

* Coefficient is significant at the 0.05 level.

** Coefficient is significant at the 0.01 level.

Discussion

The aim of this study was to explore the relationship between organisational

commitment, employee participation, and knowledge sharing and cooperation among

different groups within organisations. This was examined in a Norwegian healthcare setting.

Specifically, the thesis investigated whether organisational commitment and employee

participation could predict internal and external SC directly and if there was an indirect effect

of participation through organisational commitment. Seven concrete hypotheses were derived

and presented in a structural equation model.

The first hypotheses concerned organisational commitment’s relationship to internal

and external SC. Hypothesis 1a stated that OC would positively and directly predict internal

SC, while hypothesis 1b suggested the same for external SC. The analysis produced positive

and significant regression coefficients, and as a consequence, both hypotheses were retained.

This result suggests that employees who are highly committed to their organisation also

regard within-organisation sharing and cooperation as high.

The second hypothesis proposed that a climate for participation would positively

predict employees’ organisational commitment. The results displayed a positive significant

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regression coefficient. Consequently, hypothesis 2 was also retained. Participation explained

almost half the variation in OC. This is a large effect size, which might question the

distinctiveness of the constructs. Nonetheless, the test for discriminant validity indicated the

constructs are conceptually distinct, and the items are articulated quite differently and differ in

content. Moreover, the results are in accordance with previous research which has found

strong effect sizes between participation and OC (e.g., Kooij et al., 2010; Tesluk et al., 1999).

Hence, employees’ organisational commitment is closely related to whether employees feel

informed, included and empowered in decision-making by management.

The third hypotheses suggested employee participation would positively predict

internal (hypothesis 3a) and external (hypothesis 3b) SC through its effect on organisational

commitment. The confidence intervals of the indirect effects displayed a small variation in the

estimates produced by the bootstrap procedure and did not include zero. However, the lower

bound estimate of the indirect effect for external SC tended to zero. Still, both hypotheses

were retained, due to significant effect sizes in the predicted direction and confidence

intervals which did not include zero. Taken together, this indicates that continuous

involvement of employees can facilitate sharing and cooperation internally and externally

because such a participative climate seems to increase employees’ OC, which in turn affects

SC positively. In other words, this suggests OC as a potential mediator in the relationship

between participation and SC11.

Finally, employee participation also had a positive direct effect on both internal and

external SC, while controlling for OC. This was asserted in hypothesis 4a and 4b respectively.

The results displayed a surprisingly large positive direct effect on internal SC, and even more

so for external SC. Both effect sizes were significant, leading to the retention of the

hypotheses. Thus, employees’ perception of a climate for participation is strongly associated

to their apprehension of SC between departments, as well as within their department. In total,

employee participation and organisational commitment explained a substantial proportion of

variance in both internal and external sharing and cooperation.

In summary, the findings indicate that organisational commitment positively

influences internal and external SC and that OC is in turn predicted by employee

participation. There is additionally a positive direct and indirect effect of participation on

internal and external SC. In conclusion, all the hypotheses are retained, and the inspection of

11 Kline (2016, p. 135) asserts that the “use of the term mediation should be reserved for designs that feature time

precedence”, because one should demonstrate that a change in one variable produces a change in the other. If

this is not the case one should use the term indirect effect, which is applied in this study.

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global and local fit support the retention of the theorised model. The magnitude of the effect

sizes (β and R2) indicates there is a strong relationship between the variables. This is

particularly the case for employee participation’s direct effect on OC and internal and external

SC. Remarkably, employee participation is an even stronger predictor of internal and external

SC than organisational commitment. These findings have interesting theoretical and practical

implications.

Implications

Theoretical implications.

Overall, this study contributes to psychological research by increasing our knowledge

of what can facilitate intergroup sharing and cooperation in organisations. Previous research,

which has included participation and organisational commitment variables, has focused on

these two variables as predictors of individuals’ intention to share and knowledge sharing

behaviour. This study provides evidence that the positive effect of these variables can be

extended to the perception of sharing and cooperation among work groups and departments in

organisations. The findings furthermore broaden our theoretical, conceptual, and operational

understanding of sharing and cooperation, organisational commitment, and employee

participation, which will be addressed accordingly.

Sharing and cooperation.

The results support that there is a difference in the perception of internal and external

SC, both conceptually and in degree. In regards to the latter, the t-test indicates that

employees report significantly more sharing and cooperation internally than externally. In

other words, the findings suggest we tend to share and cooperate more with other work groups

in our department than we do with other departments in the organisation. The exploratory

factor analysis and the test for discriminant validity support that the constructs are

conceptually different, yet correlated. However, the analysis discovered some problems with

the reversed items in both scales, which led to the exclusion of five items in the SEM-

analysis. These items were negatively worded and concerned topics such as

conflict/mistrust/hostility. Hence, a relevant question becomes whether the items represent a

separate construct or is a methodological artefact (i.e., a product of how the items are

articulated). According to Brown (2015), EFA often produces a two-factor solution of a

construct which aims to be unidimensional, where reversed items are singled out as a separate

factor. The two factors are then a result of the method rather than representing different

dimensions. In this study’s case, the reversed items in both the internal and external scales

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loaded on a fifth factor. Yet, another item also cross-loaded on the fifth factor in the EFA

(ExtSC_2). This item was not negatively worded, but concerned conflict. One cannot

conclude whether the findings regarding these items are a result of the method or represent a

different construct concerning conflict/mistrust/hostility. The removal of these items has

nevertheless implications for how one should interpret the findings. By inspecting the

remaining items in Model 2, none seem to concern trust. That is, the outcome variables in the

structural model measure the perceived sharing of information, competence and cooperation

among work groups and departments, and not trust which was included in Patterson et al.’s

(2005) original measure. The above findings imply that further research into the construct is

needed, potentially by investigating if the same factor solution is reproduced if one rewrites

the items to a positive wording.

Organisational commitment.

This study contributes to intergroup theory by providing empirical support to the

Common Ingroup Identity Model. As previously presented, different intergroup biases rooted

in social categorisation often act as barriers to intergroup sharing and cooperation. As a

remedy, the Common Ingroup Identity Model asserts that identification with a superordinate

category should enhance cooperation between groups included in the category. The current

study found that identification with the organisation, measured by organisational

commitment, positively predicted sharing and cooperation among groups within the

organisation, which concur with the model’s proposition. Additionally, the findings are in line

with previous research (e.g., Kooij et al., 2010), concluding that employee participation is

strongly related to employees’ organisational commitment. This finding is important as

organisational commitment has been shown to be related to a range of other work-related

variables, such as turnover intention, motivation, and job performance, in addition to SC

(Schleicher et al., 2011).

A new measure of organisational commitment, which aimed to measure Solinger et

al.’s (2008) conceptualisation of OC, was proposed and given preliminary support in this

study. The original measure was a combination of nine items taken from the ACS (Meyer et

al., 1993) and OCQ (Mowday et al., 1979). The scale displayed good reliability. However, in

the CFA three items were dropped due to low factor loadings and one item with a low factor

loading was retained due to content validity concerns. Hence, further testing and development

of the scale is desirable to strengthen its convergent validity. This should include a proposal

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of several new items, including items which are not negatively worded for the affective

component.

Employee participation.

In the development of the hypotheses for this study, it was expected that organisational

commitment would be integral in enhancing sharing and cooperation across different groups

in an organisation. The results display a somewhat different picture. Organisational

commitment does have a positive effect on sharing and cooperation. However, the effect of

employee participation is even greater. Hence, participation explains a significant portion of

the variance in SC beyond what can be explained by increased organisational commitment.

How can we make sense of this?

A direct effect of participation on internal and external SC was already anticipated in

the development of this study. As previously discussed, participation can increase employees’

opportunity and capability to engage in sharing and cooperation due to increased social ties

and shared language and narratives. Moreover, when management display information and

willingness to cooperate with subordinates, it can in turn increase subordinates’ willingness to

share their knowledge and cooperate with the rest of the organisation. In a similar vein,

leaders might model behaviours and attitudes which promote sharing and cooperation when

they involve employees in decision-making. Examples of such are: openness, trust,

willingness to share information and power, and to cooperate to reach good decisions. These

attitudes and behaviours might inspire, or convey an expectation, to employees to act in a

similar fashion when interacting with other organisational members. Thus, a possible

explanation for the strong direct effect is that leaders set an example which employees follow.

Actual employee participation entails that subordinates truly can influence decisions

being made in the organisation. This implies that management needs to be open to change

(Birkelund, 2006). Participation can be regarded as a process of continuous development as

management prompts input, dialogue and co-determination with employees to reach

decisions. The point here being that for an organisation to initiate successful employee

participation, it has to be open to learning and development. Hence, actual participation can

be seen as closely related to an organisation’s climate for learning and development (see

Rasmussen and Nielsen (2011) for a discussion linking these phenomena). Whether learning

and development is a prerequisite, a result or an integrated part of participation is beyond the

scope of this study. However, regardless of this, an organisation’s encouragement of learning

and development could positively influence employees to share their knowledge and

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collaborate with others in the organisation (Hsu, 2006; Taylor & Wright, 2004). Hence,

another plausible explanation for the direct effect of participation on the perception of SC

could be the confounding effect of an organisation’s encouragement of learning and

development. Still, more research on this topic is needed.

Finally, one should consider the possibility of the strong effect being caused by the

method applied. In this study, both the employee participation scale and the two SC scales are

measures of climate asking how ‘things are generally done’ in their department/organisation,

rather than asking what the respondents’ themselves do (viz., referent shift) (Kuenzi &

Schminke, 2009). Besides, they both apply common scale anchors and additionally, all three

scales include questions regarding information. However, the SC scales prompt responses on

sharing of information between work groups/departments, while the participation scale

concerns information sharing between management and subordinates. Hence, the similarities

in wording, common scale anchors and to some degree the content of the items, might inflate

the effect between employee participation and internal and external sharing and cooperation.

Practical implications.

This study has a clear implication for practice: To facilitate internal and external

knowledge sharing and cooperation in one’s organisation, managers should focus on

providing employees with opportunities for direct participation. Specifically, this means

managers should work to keep employees informed, especially on matters affecting their job,

but also on matters generally involving the organisation and its future. Moreover, managers

should open up for two-way communication and let subordinates take part in decision-

making. Vertical communication and the sharing of power can inspire horizontal

communication and increase employees sense of responsibility to share and cooperate in order

to achieve goals. Additionally, a greater sense of involvement in the organisation can increase

employees’ psychological ownership toward their organisation and in turn organisational

commitment, which is beneficial for SC. At last, managers need to be open for change and

development following employees’ involvement. This study adds to previous research

establishing the importance of employee participation in healthcare organisations (West,

Topakas, & Dawson, 2014).

Research has repeatedly found a relationship between the type of culture or climate

leaders emphasise and the kind of goals and performance organisations achieve (Schneider,

Ehrhart, & Macey, 2011b; West et al., 2014). As previously mentioned, health systems

integration and knowledge translation conceptually require that employees collaborate and

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share throughout their organisation. Hence, it is essential that managers, at all levels in the

organisation, work to facilitate a climate for participation to achieve the goals set by the

Coordination reform (i.e., Samhandlingsreformen) and to ensure evidence-based practice.

Norway is perhaps in a unique position when it comes to employee participation in the

workplace. Norway’s tradition of regulating and deliberate development of work life, which

has come to be known as the Nordic model, has emphasised employee participation and

development as expedient ideals in work life (Gustavsen, 2011). Rights and obligations

regarding both direct and indirect participation are legally established in the Norwegian Work

Environment Act (Working Environment Act, 2005, e.g., § 2-3., § 4-2., and § 8). There are

additionally institutions which have the task of supervising the enforcement of specific

statutory measures, particularly regarding indirect participation (e.g., the Norwegian Labour

Inspection Authority). Thus, there are external factors which incentivise managers to

encourage employee participation. Still, direct participation is to a large degree dependent on

the particular manager’s willingness to engage subordinates in decision-making. Empirical

evidence indicates the healthcare sector in Norway has some potential for improvement in this

field. A report published by Fafo in 2009 established that, among different sectors in

Norwegian industry, the healthcare sector reported the lowest degree of employee

participation (NOU 2010:1, 2010). Furthermore, in the South-East Health Region’s employee

satisfaction survey of 2015, employee participation received the second lowest rating among

the 18 work-environmental factors included in the survey (Helse Sør-Øst, 2015). Even though

work life in Norway can be characterised by an emphasis on employee participation, this still

needs to be translated into the actions of individual managers and should be of particular

focus to healthcare managers.

In light of these traditions and political regulations, a climate for participation might

be more accepted and expected in Norway compared to other cultures. In national culture

studies, Norway scores low on power distance and high on feminine values (Hofstede &

Hofstede, 2005). That is, we value egalitarianism, decentralisation, cooperation and dialogue

(Hofstede & Hofstede, 2005). The implications derived from this study might not apply to

other cultures. Especially, employee participation is not likely to produce the same effect in

cultures with high power distance, such as Russia and China, where subordinates accept and

expect inequality in power and decisions being made centrally (Hofstede & Hofstede, 2005).

Hence, the applicability of this study’s findings might be restricted to countries which are

comparable to Norway in terms of culture and health care system.

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Limitations

The present study has some limitations that need to be addressed. First, this is a cross-

sectional study where all variables are measured at the same time. In consequence, it is not

possible to draw causal inferences regarding the relationship among the variables. The study

provides evidence of a positive association between employee participation, OC, and internal

and external SC. However, the causal relationship between these can be different than what

this thesis hypothesises, or other variables not included in the study might explain the positive

association. There is no remedy for this limitation post hoc, which means that further research

is needed to establish causality.

Second, there is the potential existence of common method variance (CMV). The

focus of this study is individual psychological variables (i.e., perceptions and attitudes). This

prompts the use of self-report measures, as the individual is presumably the best source of

information on these matters. Self-report measures do however display an increased risk of

CMV because the same person report on both the predictor and criterion variable. This can

distort the real effect between the variables, because factors related to the respondent or the

questionnaire might systematically affect the covariation among variables (Podsakoff,

MacKenzie, Lee, & Podsakoff, 2003). An often-cited source of CMV is social desirability,

which can affect the respondents scoring of organisational commitment. The participation and

SC scales are, on the other hand, articulated as referent shift (i.e., asks of the behaviour and

intentions of people in the department/organisation, rather than about own actions/intentions),

which can be thought to limit social desirability. However, in accordance with social identity

theory, people seek to maintain a positive social identity (Tajfel & Turner, 1979). Hence, it is

possible that social desirability can be extended to reporting about the groups which one

identify with, and not only about oneself (also termed leniency bias (Podsakoff et al., 2003)).

Thus, an alternative explanation for our findings might be that employees who are highly

committed to the organisation, also report high participation and SC in the organisation, to

preserve a positive social identity. In order to at least not prime this effect, the OC scale was

the final measure presented to the respondents before demographic variables.

Third, this study makes some implicit assumptions about the relationship between

organisational events and employees’ perceptions, but do not actually measure these events.

In the development of the hypotheses, employee participation and organisational commitment

is argued to increase employees’ motivation, opportunity and capability to share and

cooperate internally and externally. Hence, it is assumed that participation and OC will

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facilitate actual sharing and cooperation, which in turn will increase the employee’s

perception of SC. The increased perception of SC is further thought to motivate the employee

to engage in SC due to normative pressure. Thus, this study assumes a positive reinforcing

feedback loop between actual SC and the perception of SC. However, a measure of actual SC

is not obtained and such a relationship is not empirically investigated. Consequently, this

study cannot conclude whether the perception of SC is related to the actual degree of SC.

There is, however, research on other specific climates in healthcare (e.g., safety climate),

which has established that climate affects employees’ motivation and in turn behaviour,

which again predicts the relevant outcome (e.g., accidents) (Neal & Griffin, 2006), thus

supporting parts of the above assumption.

Finally, the generalisability of the findings needs to be addressed. Even though it was

not possible to calculate an accurate response rate, it was presumably quite low (at best 20%).

There are several characteristics of the sample which indicate its representativeness. The

sample covered a range of organisations in the South-East Health Region in Norway, and the

proportion of women and managers/administrative staff in the sample corresponds with

national statistics (75% and 18%, compared to 77% and 23% in the sample respectively)

(SSB, 2017a, 2017b). The majority were healthcare professionals in different professions

(e.g., physiotherapy, clinical psychology) and worked in specialist health services. These

characteristics were expected because the survey aimed to target employees working in

rehabilitation. However, it is possible that the respondents who chose to participate in this

study share some characteristics, compared to those who did not respond. Witherspoon et al.

(2013) suggest the knowledge sharing literature might suffer from what they call a

cooperation bias. That is, those who volunteer to respond to surveys might be particularly

cooperative and inclined to share knowledge. Hence, it is conceivable that those who have

agreed to participate in the study is generally more cooperative, prosocial, or positive people,

which in turn might influence how they respond to the questionnaire. This poses a potential

threat to the study’s generalisability. It is not possible to establish post hoc if this is the case.

Yet, with a greater number of respondents (i.e., higher response rate), one could also expect a

greater variability in personal characteristics among the respondents, reflecting the healthcare

population to a better degree.

Future Research

This study opens up for several avenues for future research, both as a result of its

limitations and its findings. Some of these have already been proposed regarding the

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operationalisation of OC and SC. Furthermore, future studies should investigate these

variables longitudinally to assess the causality between the variables and the potential

mediating effect of OC. Such a study would also benefit from including measures of the

actual degree of SC internally and externally to assess if actual and perceived SC positively

reinforces one another. This could, for example, be done through observation or assessment of

the frequency of SC behaviour in internal communication channels. This might, however,

require the researcher to focus on fewer organisations as it would demand considerable

resources.

The findings of this study indicate that employee participation strongly affects sharing

and cooperation internally and externally. Further research should look deeper into the

mechanisms producing this strong effect, for instance by introducing other potential mediators

or by conducting qualitative investigations. Furthermore, it would be interesting to explore

whether all participation initiatives facilitate SC. For example, extreme forms of participation,

such as self-managed teams, could potentially have an adverse effect on internal and external

SC, because the team might fail to see the priorities of the entire organisation.

In this study’s sample, departments and work groups are organised differently. Some

are organised according to profession (e.g., one department for nursing, one for

physiotherapy), while others according to the patient group they are serving (e.g., adults vs.

children, or physical injuries vs. psychological illness). The distinction in how departments

and work groups are organised is not included in the current analysis. However, inter-

professional collaboration and sharing are often problematised in the healthcare sector (e.g.,

Blondiau, 2015; Ferlie, Fitzgerald, Wood, & Hawkins, 2005). As such, an interesting avenue

of future research would be to investigate if organisational commitment and employee

participation facilitate inter-professional knowledge sharing and cooperation. Alternatively,

one can investigate if the relationships found in this study apply to other contexts or

industries.

At last a closing remark: this study has focused on how individuals’ perceptions and

attitudes can affect their willingness to share and cooperate across work groups and

departments. However, several other factors can impact internal and external SC. For

example, Riege (2005) have hypothesised three-dozen individual, organisational and

technological barriers to knowledge sharing throughout the organisation. New insights can be

achieved through applying a more systemic approach in future studies of knowledge sharing

and cooperation across groups within organisations.

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Conclusion

Intra-organisational knowledge sharing and cooperation has gained importance to

healthcare organisations the last decade due to the focus on health systems integration and

evidence-based practice. To provide more knowledge on how sharing and cooperation can be

facilitated among work groups and departments, this study aimed to investigate the predictive

power of organisational commitment and employee participation. The results provide new

insights into the relationships between these variables, particularly considering that previous

research has largely applied an individual or within-group perspective in the study of these.

This study extends prior research by providing empirical evidence of the positive effect of

employee participation and organisational commitment on the perception of intergroup

sharing and cooperation. More precisely, the results indicate that participation has a

substantial direct effect on the level of sharing and cooperation internally, and even more so

externally. Furthermore, employee participation has a positive impact on employees’

organisational commitment, which is also beneficial to SC. Thus, managers in healthcare

organisations who wish to facilitate SC should provide employees with information and

opportunities to voice their opinion or make decisions on a general basis.

Hopefully, this thesis inspires researchers to further explore the relationships

discovered in this study. Future studies would benefit from investigating the potential

mediating effect of OC, and other variables, in a longitudinal design to further understand the

strong association between employee participation and internal and external sharing and

cooperation.

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37

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APPENDIX 1: Measures in Norwegian

Construct Item name Item statement

Internal sharing

and

cooperation/

Intern deling og

samarbeid

IntSC_1 Folk er innstilt på å dele informasjon på tvers av gruppene her på

avdelingen

IntSC_2 Det er svært lite konflikt mellom gruppene her på avdelingen

IntSC_3_R Folk er mistenksomme overfor andre grupper her på avdelingen

IntSC_4 Det er svært effektivt samarbeid mellom gruppene her på

avdelingen

IntSC_5_R Det er lite respekt mellom noen av gruppene her på avdelingen

IntSC_6 Folk er svært innstilt på å dele på kompetanse mellom gruppene

her på avdelingen

IntSC_7 Folk er svært innstilte på å dele på personer med

fagkompetanse/kompetansepersoner mellom gruppene her på

avdelingen

IntSC_8_R Det er mye konflikt om deling av kompetanse mellom gruppene

på denne avdelingen

IntSC_9 Det er effektiv deling av informasjon på tvers av gruppene her på

avdelingen

IntSC_10 Her deler vi mye informasjon på tvers av gruppene på avdelingen

IntSC_11 Det er stor grad av samarbeid mellom gruppene her på avdelingen

IntSC_12 Folk er innstilte på å samarbeide på tvers av gruppene her på

avdelingen

External

sharing and

cooperation/

Ekstern deling

og samarbeid

ExtSC_1 Folk er innstilt på å dele informasjon på tvers av avdelingene her i

organisasjonen

ExtSC_2 Det er svært lite konflikt mellom avdelingene her i

organisasjonen

ExtSC_3_R Folk er mistenksomme overfor andre avdelinger her i

organisasjonen

ExtSC_4 Det er svært effektivt samarbeid mellom avdelingene her i

organisasjonen

ExtSC_5_R Det er lite respekt mellom noen av avdelingene her i

organisasjonen

ExtSC_6 Folk er svært innstilte på å dele på kompetanse mellom

avdelinger her i organisasjonen

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Construct Item name Item statement

ExtSC_7 Folk er svært innstilte på å dele på personer med

fagkompetanse/kompetansepersoner mellom avdelingene her i

organisasjonen

ExtSC_8_R Det er mye konflikt om deling av kompetanse mellom

avdelingene her i organisasjonen

ExtSC_9 Det er effektiv deling av informasjon på tvers av avdelingene her

i organisasjonen

ExtSC_10 Her deler vi mye informasjon på tvers av avdelingene i

organisasjonen

ExtSC_11 Det er stor grad av samarbeid mellom avdelingene her i

organisasjonen

ExtSC_12 Folk er innstilte på å samarbeide på tvers av avdelingene her i

organisasjonen

Participation/

Medvirkning

Par_1 Medarbeidere gis mulighet til å påvirke de mål avdelingen setter

seg

Par_2 Medarbeidere deler sine tanker og meninger med hverandre

Par_3 Medarbeidere i denne avdelingen mottar sjelden tilstrekkelig

informasjon i forkant av endringer

Par_4 Medarbeidere gis anledning til å påvirke den generelle retningen

til avdelingen

Par_5 Nærmeste leder og underordnede evaluerer i fellesskap hvordan

arbeidsoppgaver utføres

Par_6 Det er en effektiv kommunikasjonskanal mellom ledelsen og de

ansatte i denne avdelingen

Par_7 Medarbeidere har anledning til å påvirke hverandres

arbeidsmålsetninger

Par_8 Endringer som har innvirkning på avdelingen blir planlagt i

fellesskap mellom ledere og medarbeidere

Par_9 Medarbeidere har anledning til å påvirke hvordan kollegaer

utfører sine arbeidsoppgaver

Par_10 Medarbeidere drøfter i fellesskap med kollegaer hvordan

arbeidsoppgaver utføres

Par_11 Medarbeidere mottar tilstrekkelig informasjon til at de kan gjøre

seg opp en mening om beslutninger som treffes

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Construct Item name Item statement

Par_12 Ledelsen er tilstrekkelig informert om saker som er viktige for

denne avdelingen

Par_13 Medarbeidere diskuterer forslag til forbedringer i hvordan

arbeidet utføres med hverandre

Organisational

commitment/

Organisasjons-

forplikelse

OC_C_1 Jeg opplever at mine verdier og organisasjonens verdier er svært

like

OC_B_2 Jeg er villig til å gjøre en innsats ut over det som normalt

forventes, for å bidra til at denne organisasjonen skal lykkes

OC_A_3R Jeg føler meg ikke som en ”del av familien” i denne

organisasjonen

OC_C_4 Jeg opplever virkelig at denne organisasjonens problemer er mine

egne

OC_B_5 Denne organisasjonen inspirerer meg til å yte mitt aller beste

OC_A_6R Jeg er ikke "følelsesmessig knyttet" til denne organisasjonen

OC_C_7 Jeg er stolt av å kunne si til andre at jeg er en del av denne

organisasjonen

OC_B_8 Jeg ville akseptert nesten hvilken som helst arbeidsoppgave så

lenge jeg fikk fortsette å arbeide for denne organisasjonen

OC_A_9R Jeg har ingen sterk følelse av tilhørighet til denne organisasjonen

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APPENDIX 2: Measurement model 1 – Path diagram

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APPENDIX 3: Measurement model 2 – Path diagram

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APPENDIX 3: Measurement model 2 - Communalities

Item Communalities

Par_1 0,51

Par_3_R 0,44

Par_4 0,58

Par_5 0,61

Par_6 0,68

Par_7 0,44

Par_8 0,66

Par_9 0,31

Par_10 0,32

Par_11 0,61

Par_12 0,61

OC_C_1 0,61

OC_B_2 0,37

OC_A_3R 0,20

OC_B_5 0,65

OC_C_7 0,53

OC_A_9R 0,38

IntSC_1 0,49

IntSC_2 0,30

IntSC_4 0,55

IntSC_6 0,59

IntSC_7 0,45

IntSC_9 0,63

IntSC_10 0,72

IntSC_11 0,70

IntSC_12 0,57

ExtSC_1 0,60

ExtSC_2 0,34

ExtSC_4 0,66

ExtSC_6 0,61

ExtSC_7 0,54

ExtSC_8_R 0,41

ExtSC_9 0,52

ExtSC_10 0,63

ExtSC_11 0,73

ExtSC_12 0,56