The association between work ethics and attitudes towards organizational changes among the administrative, financial and support employees of general teaching hospitals.

In order to achieve success in today's competitive world, organizations should adapt to environmental changes. On the other hand, managers should have a set of values and ethical guidelines for their administrative and organizational functions. This study aimed to investigate the association between work ethics and attitudes towards organizational changes among the administrative, financial and support employees of general teaching hospitals affiliated to Shiraz University of Medical Sciences. This was an applied, cross-sectional and descriptive-analytic study conducted in 2013. A sample of 124 employees was selected using stratified sampling proportional to size and simple random sampling methods. Data were collected using 2 questionnaires measuring the dimensions of employees' work ethics (four dimensions) and attitudes towards organizational changes (three dimensions). The collected data were analyzed using SPSS 18.0 and statistical tests, including ANOVA, independent samples t-test, and Pearson's correlation coefficient. A P < 0.05 was considered statistically significant. The maximum and minimum score of work ethic dimensions were related to being cooperative (4.60 ± 0.38) and dependable (4.29 ± 0.39) respectively. On the other hand, the maximum and minimum score of attitudes towards the various dimensions of organizational changes were related to the behavioral (3.83 ± 0.70) and the affective (3.55 ± 0.88) dimensions respectively. Furthermore, there was a significant relationship between the work ethics and education levels of the employees in this study (P = 0.003). Also, among work s dimensions, only being considerate had a significant association with attitudes towards organizational changes (P = 0.014) and their cognitive dimension (P = 0.005). To improve employees' work ethics and attitudes towards organizational changes, the following suggestions can be offered: training hospitals managers in participative management style and its application, as well as the importance of meeting the employees' needs and expectations based on their characteristics; familiarizing employees with the Islamic work ethic; educating employees on the importance of being considerate towards their colleagues and subordinates in the workplace, and reinforcing this desirable quality; and finally, clarifying the need for changes in the organization for all employees.

Introduction

Organizations work in a highly variable and dynamic environment and are constantly exposed to changes in their internal conditions or external environment. “Change” has been interpreted as a response to some of the most important behaviors or opportunities originating from outside the organization (1). Many organizations have come to believe that they should adapt themselves to a reality called “change” in order to achieve success in today's competitive world (2). In contrast to factors that strive to maintain the current situation and prevent changes from happening, there are factors that drive them, including dissatisfaction with the current state of affairs, the quest for new opportunities, and so on (3–5).

Human resources are the core of every organization, which makes human factors crucial to the success of organizational changes (6, 7). Therefore, changes can be effective only if the beliefs and attitudes of employees are challenged because employees are the main components of an organization and the study of their psychological characteristics, interactions, motivations and attitudes can be of great importance (8). The results of several studies have shown that some factors facilitating the acceptance and implementation of changes within organizations are as follows: psychological feelings of possession and ownership (9, 10), belief in one’s own abilities as well as openness of top management (11, 12), organizational commitment (13–15), trust in management (16, 17), appropriate rewards and adequate encouragement (18–22), involvement of employees in the planning and implementation of organizational changes (23), application of transformational leadership style (24–26), senior managers' support of changes (27–30), employee empowerment (31), and so on. The results of some other studies have also shown that among the reasons for employees' resistance to organizational changes are uncertainty and fear of losing professional and personal power, dissatisfaction with lack of participation in planning the changes, and the decision to implement them in a short period (32, 33). Furthermore, some researchers believe that organizational commitment, leadership styles, employees' interpretation of the actual events and their attitudes towards the process can affect their outlook (13, 34, 35).

On the other hand, in addition to institutional and legal standards, managers need a set of values and ethical guidelines to perform their administrative and executive functions and facilitate adaptation to organizational changes (36). Ethics have an effective role in the prevention of corruption and tyranny in the society and workplace, and can help identify opportunities, threats, strengths and weaknesses (37). Ethical climate is one aspect of organizational climate that represents an institution’s character and, by extension, its ethics (38). Work ethics are a set of cultural norms that provide the positive foundations for doing a right and good job in the community, and are based on the belief that the work itself has an intrinsic value (39, 40). According to Miller et al., work ethics comprise attitudes and beliefs concerning work behavior and are multidimensional, secular, and consists of motivational constructs reflected in behavior; moreover, they are associated with work and work-related activities, can be learned, and refers to attitudes and beliefs, and not necessarily behavior (41). An organization’s work ethics can be investigated through its employees' perceptions of the organizational climate, their decisions when faced with ethical issues, and the level of their participation in solving those issues (42). Social participation, social justice, cultural unity and cohesion in society are correlated with adherence to work ethics in organizations (43). Moreover, employees who are optimistic about the organization's values follow work ethics more than those who are not (39). Additionally, employees are more likely to have stronger work ethics if they are more hopeful about the future of their country or organization, have more freedom in their work, and are given responsibilities commensurate with their organizational positions; likewise, closer adherence to traditional social values and optimism about the social environment seem to be other factors associated with sturdy work ethics (44). When an organization is ethically weak, it is faced with higher operation costs. Furthermore, decisions can only be effective if there is adequate knowledge and understanding of ethics in the organization (18).

The results of some studies have indicated that work ethics is also significantly related to various features of organizational administration and management, including job satisfaction, work stress, organizational commitment, organizational justice, and participative leadership style (17, 45–50). Moreover, some studies have shown that there is a significant relationship between work ethics and attitudes towards organizational changes (51–53), so that when employees have stronger work ethics, they will be more committed and make more attempts to develop the institution and contribute to organizational changes rather than resist them (8).

Considering the importance of adapting to the rapid changes in the present world and the need for studying work ethics, the association between employees' work ethics and their attitudes towards organizational changes has apparently not been adequately researched, especially in the health care industry. The present study aimed to investigate this association among the administrative, financial and support employees of general teaching hospitals affiliated to Shiraz University of Medical Sciences in 2013.

Methods

This was an applied, cross-sectional and descriptive-analytic study conducted in 2013. The study population consisted of administrative, financial and support employees of general teaching hospitals affiliated to Shiraz University of Medical Sciences. A sample of 114 employees was considered appropriate based on the findings of the Fallahzade Abarghooie study (52), assuming α = 0.05, β = 0.2 and r = 0.26. In order to increase the accuracy of this study, however, and in view of the potential loss of data, 124 employees were finally selected.

This sample was selected using stratified sampling proportional to size. For this purpose, each of the two hospitals under study was considered a stratum in which the required sample was selected out of the total number of the employees through simple random sampling using a random numbers table.

Data were collected using 2 questionnaires measuring the dimensions of employees' work ethics and attitudes towards organizational changes. The work ethics questionnaire was developed by Hill and Petty in 1995 (54) and translated and modified by Fallahzade Abarghooie in 2009 (52). It contained 46 items to assess the employees' work ethics dimensions, including 13 items on being dependable, that is, reliability and the ability to fulfill the minimum expectations for satisfactory job performance; 12 items on being ambitious, which pertains to initiative; 14 items on being considerate, indicating interpersonal skills and personal characteristics that facilitate good working relationships with colleagues; and 7 items on being cooperative, or the unconditional willingness to work with others to meet the job requirements. Fallahzade Abarghooie had confirmed the validity and reliability of this questionnaire in her study by consulting the opinions of experts and using Cronbach's alpha coefficient (α = 0.83). A five-point Likert scale was used to assess employees' work ethics, in which 5 referred to “always” and 1 to “never”.

The questionnaire on attitudes towards organizational changes was developed by Dunham et al (55) and translated and modified by Fallahzade Abarghooie in 2009 (52). It consisted of 18 items to measure the employees' attitudes towards organizational changes, including 6 items on the cognitive dimension, that is, the employees’ opinions about the advantages, disadvantages, necessity and usefulness of organizational changes; 6 items on the affective dimension, referring to the employees' feelings towards organizational changes; and 6 items on the behavioral dimension, indicating actions which would be taken in the future, or had been taken for or against organizational changes. Fallahzade Abarghooie had confirmed the validity and reliability of this questionnaire in his study through consulting the opinions of experts and using Cronbach's alpha coefficient (α = 0.82). A five-point Likert scale was used to measure the employees' attitudes towards organizational changes, in which 5 referred to “strongly agree” and 1 to “strongly disagree”.

Furthermore, respondents were asked about their demographic characteristics such as sex, age, education level, job experience, and service unit.

An approval for conducting this study was obtained from the ethical committee of Shiraz University of Medical Sciences. Moreover, informed consent was obtained from all employees participating in this study and all of them were assured of the confidentiality of their responses.

SPSS 18.0 and some statistical tests including ANOVA, independent samples t-test, as well as Pearson’s correlation coefficient were used to analyze the collected data. A P < 0.05 was considered statistically significant.

Results

The results showed that most studied employees were male (n = 87, 70.2%), in the 30 – 40 year old age group (n = 56, 45.2%), had academic degrees (n = 57, 46%), had less than 10 years job experience (n = 68, 52.4%), and were working in the support unit (n = 76, 61.3%) (Table 1).

Table 1.

Demographic characteristics of the employees in this study

Variables		Frequency (%)
Sex	Male	87 (70.2)
	Female	37 (29.8)
	Total	124 (100)
Age	< 30	48 (38.7)
	30 – 40	56 (45.2)
	> 40	20 (16.1)
	Total	124 (100)
Education level	Less than high school Diploma	21 (16.9)
	Diploma	49 (37.1)
	Academic degrees	57 (46)
	Total	124 (100)
Job experience	< 10	68 (52.4)
	10 – 20	45 (38.7)
	> 20	11 (8.9)
	Total	124 (100)
Service unit	Administrative	36 (29)
	Financial	12 (9.7)
	Support	76 (61.3)
	Total	124 (100)

The mean score of the employees' work ethics was 4.41 ± 0.34 and the maximum and minimum score of their dimensions were related to being cooperative (4.60 ± 0.38) and being dependable (4.29 ± 0.39) respectively. Moreover, the mean score of their attitudes towards organizational changes was 3.72 ± 0.60 and the maximum and minimum score of their dimensions were related to the behavioral dimension (3.83 ± 0.70) and the affective dimension (3.55 ± 0.88) respectively (Table 2).

Table 2.

The mean and SD of work ethics, attitudes towards organizational changes and their dimensions in the employees in this study

Variables	Dimensions	Mean ± SD
Work ethics	Dependable	4.29 ± 0.39
	Ambitious	4.32 ± 0.46
	Considerate	4.51 ± 0.36
	Cooperative	4.60 ± 0.38
	Total	4.41 ± 0.34
Attitudes towards Organizational changes	Affective	3.55 ± 0.88
	Cognitive	3.77 ± 0.67
	Behavioral	3.83 ± 0.70
	Total	3.72 ± 0.60

The results showed that there was no significant relationship between the employees' work ethics and attitudes towards organizational changes, and sex, age, job experience, and service unit (P > 0.05). However, there was an indirect association between their work ethics and education level (P = 0.003), that is, an increase in the education level resulted in a decrease in work ethics.

The Pearson’s correlation test results showed that only being considerate had a significant association with attitudes towards organizational changes (P = 0.014) and their cognitive dimension (P = 0.005) (Table 3).

Table 3.

The correlation between work ethics, attitudes towards organizational changes and their dimensions in the employees in this study

Dimensions of attitudes towards organizational changes	Affective	Cognitive	Behavioral	Attitudes towards organizational changes (total)
Dimensions of work ethics
Dependable	r = 0.059	r = 0.110	r = 0.058	r = 0.092
	P = 0.516	P = 0.225	P = 0.520	P = 0.307
Ambitious	r = −0.010	r = 0.007	r = −0.100	r = −0.041
	P = 0.910	P = 0.938	P = 0.267	P = 0.647
Considerate	r = 0.121	r = 0.253	r = 0.162	r = 0.220
	P = 0.182	P = 0.005	P = 0.079	P = 0.014
Cooperative	r = −0.013	r = 0.102	r = 0.049	r = 0.050
	P = 0.884	P = 0.258	P = 0.588	P = 0.576
Work ethics (total)	r = 0.053	r = 0.139	r = 0.048	r = 0.096
	P = 0.538	P = 0.123	P = 0.597	P = 0.286

Discussion

The present study aimed to investigate the association between work ethics and attitudes towards organizational changes among the administrative, financial and support employees of general teaching hospitals affiliated to Shiraz University of Medical Sciences in 2013. The maximum and minimum score of work ethics dimensions were related to being cooperative and being dependable respectively. The maximum and minimum score of attitudes towards the various dimensions of organizational changes were related to the behavioral dimension and the affective dimension respectively. There was also a significant relationship between the work ethics and education level of the employees. On the other hand, among work ethics dimensions, only being considerate had a significant association with attitudes towards organizational changes and their cognitive dimension.

The results of the present study showed that among the work ethics dimensions, being dependable has the lowest mean score. This may be due to the mismatch between the employees' fields of study and education levels and their occupations and salaries. Another reason may be lack of variety and repetitive assignments, lack of employees' proper understanding of the job and not receiving appropriate feedback about their work. All this can result in a decrease in employees’ self-confidence, job satisfaction, involvement, and motivation to perform their tasks well.

On the other hand, the maximum score of work ethics dimensions was related to being cooperative. It should be noted that employees gradually become familiar with their jobs and workplaces and get more accustomed to them, and as a result, feel accountable for all issues related to their jobs. They try to make comments and suggestions about problems in their work groups, and also consider their colleagues' suggestions and comments in order to perform their duties well. Accomplishing predetermined tasks collaboratively and in partnership with other colleagues can decrease individuals' workloads and responsibilities. Nowadays, jobs have become more complex and specialized, and therefore cooperation within organizations is absolutely necessary, as the only way to do things more efficiently is to foster collaboration and participation.

The results of Moidfar's study showed that the maximum and minimum mean scores among work ethics dimensions are related to being cooperative and being dependable respectively (39), which confirms the current study results. In the study by Fallahzade Abarghooie, however, the highest mean score among work ethics dimensions was related to being considerate (52), which is inconsistent with the results of the present study.

In the present study, the affective dimension of attitudes towards organizational changes had the lowest mean score. This may be due to the fact that when employees get accustomed to their jobs, they will not accept changes easily. In this case, most people feel like they do not have the capacity to deal with new organizational changes and cannot adapt. It is part of human nature to initially oppose new ideas when they are used to doing things in a certain way. Lack of security and fear of losing their positions are the main reasons why people dislike change and feel that it will lead to inability and failure to do the job (33, 56).

The results of the present study also showed that the behavioral dimension of attitudes towards organizational changes has the maximum mean score. This is probably due to the fact that individuals feel responsible for their work, and they also need to maintain their positions in the organization on account of various economic, social and psychological reasons. Therefore, they inevitably adapt to organizational changes and respond to them appropriately. Fallahzade Abarghooie demonstrated through her study that the cognitive dimension of attitudes towards organizational changes has the maximum mean score (52), which does not confirm the results of the present study. Rahmanseresht and Moghadam's study showed that the managers' interpretation of actual events and their attitudes towards the process of organizational changes affect their decisions to accept or reject these changes (35).

Furthermore, the results of the present study showed that there is an indirect relationship between education and work ethics, that is, an increase in the employees’ education level leads to a decrease in the mean of work ethics. The reason for this can be that employees with higher education have more expectations of the job, such as benefits and salaries. When these expectations cannot be met, especially in the public sector, employees feel discouraged, which may result in a decrease in their dependability and ambition.

On the other hand, employees with lower education levels usually have fewer job opportunities (57–59), and this can cause them to try hard to perform their tasks with more dependability and ambition in order to maintain their organizational positions. Furthermore, higher education and achievement of better positions is usually detrimental to friendships and intimate relationships with colleagues and subordinates. The reduction in employees' relationships and communication can lead to a decrease in offering opinions and suggestions, using others' comments and ideas, and getting involved in work teams. The results of the studies by Pieri (48), Moidfar (39), ter Bogt et al. (60), Kavian (61), Yousef (45), Hill (62), and Abboushi (63) confirm the findings of the present study as well.

Moreover, the present study demonstrated that attitudes towards organizational changes do not have any significant association with employees' education level and job experience. The results of Sajadikhah's study (64) are also consistent with this finding, although the studies of Calhoun et al. (32) and Grimm and Smith (65) do not confirm these results.

The results of the current study showed that the age and job experience of the employees do not have any significant association with work ethics. The results of Tavasoli and Najar Nahavandi's study (40) also confirm this finding. However, the results of the studies of Jadari (66), Pieri (48), Kavian (61), Yousef (45), and Abboushi's (63) are not consistent with the results of the present study.

There was no significant relationship between employees' age and job experience and their attitudes towards organizational changes in the present study. The results of the studies by Sajadikhah (64) and Karimian et al. (67) are consistent with this finding, although Calhoun et al. (32) have achieved different results. In addition, the results of the present study showed that there is no significant association between work ethics and attitudes towards organizational changes. On the contrary, Fallahzade Abarghooie (52), Nazarpouri (68), Gharamaleki (69), Rashidi (53), and Yousef (51) found a significant relationship between these two.

In general, the discrepancies between the present study and the other studies mentioned above can be due to the differences in the settings, samples and target populations.

Furthermore, the results of the current study indicated that there is a significant relationship between attitudes towards organizational changes and their cognitive dimension and being considerate. The reason may be that employees who have good relations with others usually have positive character traits that help them accept others' ideas and suggestions and prefer others' needs and wants over their own, and are overall better at collaboration and cooperation with others, etc. Therefore, such employees are more inclined to adapt to the changes in their organization and environment as they do not believe that environmental and organizational changes have destructive and counterproductive effects on their social life, and consequently can maintain a good interaction with others. Results of the studies by Week et al. (70), Schwepker Jr. (71), Yousef (45), and Yousef (51) also confirm the current study results in this regard.

The limitations of the present study were the use of a single method (i.e. a questionnaire) for data collection, as well as its cross-sectional design, as it is difficult to determine causal relationships in a cross-sectional study. In conclusion, the current study results revealed that there is a significant relationship between work ethics and employees' education level. On the other hand, attitudes towards organizational changes and their cognitive dimension had a significant association with being considerate. To improve the employees' work ethics (especially their consideration for their colleagues) and attitudes towards organizational changes (their cognition of the necessity and usefulness of organizational changes in particular), the following suggestions can be offered:

Training hospital managers in participative management style and its application can increase the possibility of employees' involvement in organizational decision-making, whereby the employees' commitment to implement those decisions will be increased and their reaction to the changes will be positive. Likewise, orientation and training courses should be provided for employees in order to familiarize them with the Islamic work ethics and demonstrate the importance of being considerate towards their colleagues and subordinates in the workplace, and attempts should be made to strengthen this desirable quality in them. Furthermore, briefings and training courses can be offered in hospitals to educate employees and familiarize them with the concept of organizational changes and clarify the necessity of these changes for employees. Thus, employees’ attitudes towards these changes will be positive and they will show less resistance. Other measures that can be suggested to improve work ethics in organizations are raising hospital managers' familiarity with employees' characteristics, needs and expectations, especially those of employees with higher education levels, and providing appropriate rewards based on these features. Finally, it is recommended to conduct further research on other types of hospitals and employees, even hospital managers and administrators, and compare the results with the findings of the present study.