Literature DB >> 35480712

Prism of Employee Performance Through the Means of Internal Support: A Study of Perceived Organizational Support.

Mingxing Li1, Arif Jameel1, Zhiqiang Ma1, Hongzheng Sun1, Abid Hussain1, Sidra Mubeen2.   

Abstract

The purpose of this paper is to develop a theoretical framework for testing the perceived organizational support (POS)-employee performance relationship with a mediating effect of intrinsic motivation. To combine the concepts from perceived organizational support (POS) and employee performance, secondary data have been collected from different research papers to provide a literature-based analysis. The present study found positive relationships between POS, intrinsic motivation, and employees' performance. The study further realized the intrinsic motivation as a potential mediator between POS and performance relationship. From this framework, numerous areas of research can be pursued to be used to research and practice human resource management. The theoretical framework which is developed in this paper is based upon literature that can be proved empirically. To improve theory, research, and practice in the field of human resource management, this paper conceptualizes the concept of POS through the means of internal support.
© 2022 Li et al.

Entities:  

Keywords:  employee performance; empowerment; intrinsic motivation; organizational trust; perceived organizational support

Year:  2022        PMID: 35480712      PMCID: PMC9035458          DOI: 10.2147/PRBM.S346697

Source DB:  PubMed          Journal:  Psychol Res Behav Manag        ISSN: 1179-1578


Introduction

In today’s competitive environment employees’ needs and wants should be dealt with on a priority basis.1 The purpose of doing the same is to retain them and to make them more profitable for the organization. It is quite critical for any organization to develop such programs and policies as are attractive and alluring for employees.2 Organizations in recent times are well-aware of this very fact and becoming conscious to provide a supportive environment to their employees to retain them for a longer period.3 Taleghani et al4 are of the view that the most important cradle for obtaining competitive advantage is the role of human resources in an organization. Perryer et al5 explored and concluded that the core objective of organizations in our days is to increase their competitive advantage. This must be done through effective and efficient use of human resources. As it is difficult for competitors to imitate human resource skills and techniques used by an organization. To obtain it organizations must hire skilled and valuable employees.6 Organizations should look more appealing and attractive to employees through their management programs and policies. This will reduce the employee turnover ratio. Allen et al7 retention of employees with the appropriate knowledge, professionalism, positive attitude, and required abilities has become increasingly important for competitive organizations in the last couple of decades. Now organizations are becoming increasingly concerned and alert about retaining the employees and using them effectively to attain a long-term competitive edge.5 Mayfield and Mayfield8 indicate that for an organization’s outclass performance, valuable and experienced employees are their backbone. Therefore retention of these employees is of crucial importance for employers. By providing a working environment that is positive, supportive, and focuses on the collective effort the retention of the employees can be ensured.9 One aspect of an encouraging and helpful organization environment is defined as an employee’s perceived organizational support Riggle et al10 that is an employee’s perceived organizational support. It is an employee’s attitude that is considered by organizations very valuable. Therefore organizations should invest generously in such programs which tend to improve their employee’s perceived organizational support.11 Lynch et al12 are of the view that Perceived Organizational Support may be used by employees as an indicator of the organization’s benevolent or malevolent intent in the expression of exchange of employee effort for reward and recognition. Blau13 have laid their ideas based on “social exchange theory” and on norms of “reciprocity” respectively. They say that when an organization acts in beneficial ways to its employee then he or she has an understood obligation to reciprocate in the same manner. This leads towards more dedication and commitment of employees in achieving organizational goals.14 Eisenberger et al15 say that the extent to which the socio-emotional need is satisfied, individuals “incorporate organizational membership into their self-identity”. This serves to support the social exchange relationship, which consequently leads to increased employees performance commitment. They become connected as required by their job which leads to the growth of positive attitudes in the organization.16 Coyle-Shapiro and Conway17 based on the models of exchange relationships say that organizational supportive treatment creates a sense of commitment that encourages employees to put extraordinary efforts to make the organization achieve its objective. Liao et al18 believe that perceived organizational support is a well-thought-out process as far as positive organizational outcomes are concerned. The social exchange concept explains that employees be disposed to interchange valuable treatment that they obtain with positive work-related activities.19 The purpose of this study is to contribute to the research work linking POS to employee performance. Using secondary data, the study presents the theoretical framework of the relationship between POS and employee performance and the possible mediating effect of employee motivation on that relationship. We used a multi-dimensional POS scale to theorize these relationships.

Literature Review

This section aims to develop a conceptual framework of POS, employee intrinsic motivation, and performance (See Figure 1). This framework comprises of two parts: dimensions of POS and the mediating role of intrinsic motivation between POS and employee performance relationship.
Figure 1

Theoretical framework.

Theoretical framework.

Perceived Organizational Support

Eisenberger et al15 are the first ones to present the idea of perceived organizational support. He defined it as an endowment of a supportive and caring environment at the workplace. In the contemporary competitive environment perceived organizational support has gained tremendous importance for the organizations. Perceived organizational support can be defined by way of a belief of the employees that the organization gives due consideration to their Well-being, welfare and value their contributions to the organization.20 Social exchange theory is employed to better understand the reciprocal relationship that exists inside the organization between employees and the organization.13 Perceived organizational support is based upon this reciprocal relationship which involves the inclination of the organization to fulfill the socio-emotional needs of the employees. Wayne et al21 explain the social exchange relationship. He says when the organization shows supportive and positive behavior toward employees’ contributions, cares about their well-being and treats them impartially. Employees expect a high level of support and consequently feel obliged to respond. Perceived organizational support guarantees to the employees22 that the organization will provide necessary support and will not leave them alone in stressful situations. It also includes organization stands behind them, it backs them through every thick and thin. Rhoades and Eisenberger23 are certain that the “perceived organizational support” as being the result of “organizational support theory”. They further say that perceived organizational support is centered upon the idea that the organization and employees enjoy exchange relations. According to the result of research done by Davidson et al24 to gain competitive advantage organizations are seeking quality employees. At the same time, they are facing the challenge of employees turnover as a result of more attractive packages from competitors. The only solution in this situation is retaining the employees by enhancing their perceived organizational support. Research carried out by Ballinger et al25 agrees on the one point that organizations should look more attractive by their supportive and caring environment toward their employees. This is the only way to survive and sustain in an ever-increasing competitive environment. Perceived organizational support prevails in an organization through many aspects.

Perceived Organizational Support and Supervisory Support

POS is characterized as the extent to which the employees perceive that their supervisor thinks about their career well-being and their personal needs. To what extent do they give due consideration to their contribution to the organization and create a supportive environment for them.26 Organizational support theory explains that an organization shows its concern towards its employees through its agents who create a cooperative situation and develops facilities for employees on the behalf of the organization.14 The result of the research done by Sluss et al27,28 indicates that there exists a positive correlation between supervisory support and perceived organizational support. Supervisory support has been proved as a predictor and outcome of perceived organizational support and there exists a strong connecting link between the two. Lee29 explains the leader-member exchange as a relationship between leader and employee which is a part of perceived organizational support. Research done by Ballinger et al25 points toward that supervisor support is like a social relation and when there is a greater value of social relationships for the employees they will reciprocate with positive behaviors that benefit the organization. As a matter of the fact, perception of supervisors’ support is positively related to subordinates’ perceived organizational support. Sluss et al27 specify the leader-member exchange and perceived organizational support in the conclusion of their research. It is strongly influenced by the organization through its agents because the leader is thought to be an agent of the organization who can bring the employees and management on the same page. Leaders influence the organization’s decision-making. These researches also determined that when there is a strong leader-member relation this leads towards a high and positive perception of organizational support among the employees. Both POS and leader-member exchange are based upon social exchange relations. They categorically stated that in an exchange relationship when a leader provides something valuable to its employees then it became inevitable for employees to reciprocate it with even more zeal and zest. Settoon et al19 put forward their results based upon the Social exchange theory. They say that the employees maintain an affiliation with the organization and the supervisor. These results were also confirmed by some other research done by Wayne et al21,30 Employees are involved in continuing exchange relationships both with the organization as a whole and their immediate supervisor to deliver them positive repercussions. Previous studies31 also bear testimony to the very fact that when the employees found greater Perceived Supervisory Support within their working environment this also increases their Perceived organizational support. The result is obvious ie increase in performance. Therefore this can be concluded that when perceived supervisory support increases the perceived organizational support will also be increased because supervisory support is one aspect of perceived organizational support. Organizational support theory designates that supervisors’ constructive treatment results in increased Perceived organizational support, which makes it obligatory for the employees to help the organization in meeting its goals. They show more commitment, more positive behavior, and a more enthusiastic attitude toward the organization.32

Perceived Organizational Support and Organizational Trust

Perceived organizational support also prevails in an organization through organization trust. According to Gouldner33 the defining feature of organizational trust is the norm of exchange relationships. Here the employees perceive that their organization trusts them in carrying out their duties. They return it by showing high performance and loyalty toward the organization. Porter et al34 recommended in these words, “Where there is trust there is the feeling that others will not take advantage of another”. To carry out organizational functions appropriately trust plays a vital role. It is not only necessary rather inevitable for the organization to maintain trust-based relationships. Baumeister and Leary35 concluded in their research that to improve and boost the quality of work-life, trust relationships are direly needed. They provide the necessary support, inclination, persistence, and meaning to the organizational members. Social exchange relationships and perceived organizational support can be structured and strengthened through the development of trust among the organizational members. In today’s competitive environment organizations are continuously developing the cooperative environment and feelings of collaboration among their employees in the work setting.36 Where the collective actions and teamwork prevail organizations are also extending their parameters of trust for improving and refining the values of employees which they create. Trust is a characteristic of perceived organizational support and is positively correlated37 towards it. Perceived organizational support guarantees that employees will be rewarded for their positive contributions. It ensures good consequences in the wake of risk-taking, initiative-taking, spontaneous and simultaneous response. It all results in the belief that organizations have a high level of acceptance for mistakes and have trust in their employees. Therefore employees ought to be all the more eager to respond to high perceived organizational support not only with expanded performance as well as with risk-taking.38,39 It gives bigger potential adjustments to the organization because they realize that the organization has trust in them. Perceived organizational support tends to be related to reasonable risk-taking.40 As a result of a resultant conviction, there will be lesser retribution for failure after taking efforts to help the organization to meet its goals. This tendency leads the positive organizational trust towards its employees because trust is a trait of perceived organizational support. Dineen et al41 have concluded in their study that the organization and its representatives develop the beliefs of reliability, guidance, and behavioral veracity among their employees. They want to maintain an image of cooperation and assistance among them.42 So, the employees become honest, and they feel at ease while discussing difficulties at work with the concerned department or the person.

Perceived Organizational Support and Empowerment

Empowerment is a part of perceived organizational support, according to the Porter et al34 it has become compulsory for organizations to improve their efficiency and performance to respond the rapidly changing business conditions. This is the only way to remain successful in a competitive environment. In the global competition following the trend of empowerment of the employees is vital43 for attaining the long-term competitive advantage and to improve the organizational performance. Perceived organizational support flourishes among the employees when they are empowered. In the context of Bandura44 theory of self-efficacy, Conger and Kanungo45 explain the concept of empowerment. Agreeing with Bandura’s model they defined empowerment as “empowerment refers to a process whereby an individual’s belief in his or her self-efficacy is enhanced”. They agree to the version of empowerment as a set of conditions necessary for intrinsic task motivation. It is an instinct in human beings to remain independent and to enhance their autonomy to influence and control their environment. They continuously strive for attaining empowerment. Tulloch46 defined in his research the original meanings of empowering as “authorize, give power to”. Empowerment can be defined as a concept of symmetrical power47,48 which enhances the cooperation and increase the power of each person in the organization. Senior experienced individuals within the organization are called mentors. They give advice and developmental support to junior employees. Russell and Adams49 define the concept of empowerment as an interactional relationship between an experienced employee and a less experienced peer. Theorists Kanter50 and Parker et al51 explained that when a person becomes empowered in decision-making and in performing his duties he feels freedom and authority. Empowerment means not just delegation of power and giving the authority of decision-making to those who are at the lower level in the organizational hierarchy. Rather empowerment is all about trust, motivation, the authority of decision making and ultimately creating an environment of shared deliberation. Eisenberger et al52,53 recognized empowerment as a major chunk of perceived organizational support and a positive correlation between high autonomy and increased perceived organizational support. When an organization trusts in its employee to decide wisely on their own, to perform their jobs, and assist the organization in meeting its goals they reciprocate. Perceived organizational support is related to trust which is considered an important element in social exchange relationships.54,55 When trust prevails within organization employees are given more authority to control their environment. They affect their job outcomes with positive behavior. This explains that the organization shows its trust in employees by empowering them. The employees reciprocate it by showing higher performance and in this way, the perceived organizational support formed through empowerment strengthens the social exchange relationships within organizations. The environment that is shared by employees and their organization can be related mainly to term perceived organizational support. Employees view it as a perceived measure for organizational support in their professional behavior. Empowerment however refers to actual changes in one’s role and authority, which is to be expected in the level of authority.56

Perceived Organizational Support and Mentoring

Mentoring is different from supervisory support as Supervisory support is a perception of the employees about their superiors’ concern towards their well-being.57 How supervisors value employees’ contributions, and how much they are supportive towards them.14 Whereas mentoring is an interactive exchange relationship between high experienced and low experienced employees and it is thought to be important for peers’ socialization. While studying the characteristics of perceived organizational support Dreher and Ash,58 found mentoring as an important attribute of perceived organizational support which supports the social exchange relationships in the organization. When Dreher and Cox59 studied supportive properties of mentoring relationships from both the perspective of the mentor and the peers this strongly supports social exchange theory. They found that the degree of reciprocity, as well as the support that peers obtain from their mentors, leads towards peers’ satisfaction with their mentors. Having a mentor has become compulsory for the organization to sustain itself in the global competition.60 Employees’ performance positively grows when the mentors play a significant role to socialize them and it works as a major feature of perceived organizational support. Scandura61 describes that mentoring provides opportunities to less experienced employees. It enables them to obtain useful skills for their career advancement and to increase their job performance. They have access to organizational resources. Now they know about the clear span of control and line of authority within the organization. Mentoring helps the employees to cope with career stress. It provides the opportunities to acquire new skills, knowledge, and abilities that are necessary for career growth. Ragins and Cotton62 agree that in mentoring process persuasive individuals who have advanced experience and knowledge in the work environment support other employees’ careers. They explain the mentor as an advisor and trusted guide by the organization who helps the other, especially to those who are at lower rank through his vast experience and skills. Allen et al63 found empirical evidence that mentoring creates an environment of initiation and socialization which leads toward increased employee performance. Mentoring creates feelings of identification with the organization. The employees feel positive psychological feelings about their career and reciprocate with higher performance. According to the study of Baugh and Scandura64 employees with a mentor show more career promotions, earn higher returns, and are more satisfied than employees without a mentor. Mentoring is a part of perceived organization support that is an informal relationship in an organization.65 The aim of mentoring is to disseminate the knowledge and skills from a higher to a lower level for the profitability of the organization. It provides advancement opportunities at the lower levels and employees feel an association with the organization and perceive their organization more supportive.

Perceived Organizational Support and Employee Motivation

Fletcher66 defines motivation as; “Motivation is the inner urge that moves or prompts a person to action”. Self Determination Theory (SDT) suggests that there are two sorts of inspirations or motivators affecting employee motivation.67 These are called internal and external motivation. External rewards which characterize the external motivation are connected with the pay framework, compensation system, and different packages of remuneration.68 For example a high rate of the pay scale, incidental benefits, and rewards. Despite that this sort of motivation is seen as an imperative one, many researchers contend that external motivation is insufficient. Motivation is surmised from a deliberate analysis of how individual, task, and natural qualities impact behavior, conduct, and job performance. Joshua-Amadi69 presented an inspiring definition of intrinsic motivation, Motivation is here defined as the driving force within individuals that influences their choices of behavior in performing tasks to achieve desired goals or expectations. Internal motivation is requisite to motivate the employees internally for enhancing their performance and to keep them satisfied at work. On the other hand, external motivation helps only for the retention of the employees. Over thirty years of investigative study has proved that “intrinsic motivation” directs to enhanced tenacity, performance, and gratification in a diversity of jobs in several domains (eg, educational, behavioral well-being, and institutional) than “extrinsic motivation”.70,71 The theory also suggests that the espousal of “intrinsic motivation” over “extrinsic motivation” rests on the gratification of three essential psychological wants for “autonomy, competence, and relatedness”. SDT emphasizes inspirations and recommends that people have fundamental psychological wants for “autonomy, competence, and relatedness”. The study has proposed that humans are more probably to stick with, and have an advanced qualitative performance on doings that fulfill these wants.72,73 In self-determination theory, “autonomy” relates to the desire to self-organize an individual’s activities, when one can easily follow the activity and experiences “volitional” in doing so.71 The necessity for capability infers that persons are inclined to be efficient in their connections with the surroundings and when they do an action74 which is alike to the notion of “self-efficacy”.75 The requirement for relatedness35 is the need to feel associated and backed by important individuals, for instance a boss, parents, mentors, or colleagues. According to Mosley et al76 the employees will be satisfied with their organization and enjoy their work when they will be internally motivated. Internal motivation is associated with the employees’ willingness to meet the challenges, to take the risks and new initiatives for the organization. Gagné and Deci77 claimed that a supportive work setting should boost self-determined motivation at the related level (ie, work motivation). Henceforth et al78 explored the role of POS (ie, the extent to which workers believe that their institution values their job and cares about their well-being in the prediction of employees’ motivation rendering to SDT. In a study of a sample of 881 pilots employed for a business airline company, Gagné et al78 proved that POS was optimistically associated with self-determined motivation. Tremblay et al79 also unearthed that both POS and work climate were positively connected to self-determined work motivation.

Perceived Organizational Support and Employee Performance

Monetary and non-monetary results of employees’ efforts consider being as employee performance which has a direct effect upon the performance and achievement of the organization. The employee’s outcomes and endeavors which they make at work are thought to be their performance. According to Cardy and Leonard80 in the performance management process performance evaluation has a distinctive position because it evaluates the actual performance outcomes. Organizational programs and policies have a direct effect on the performance of its employees and on the performance of the organization itself. Delery and Doty81 argue that in the integrative perspective of strategic human resource management configurations and patterns of human resource activities contrary to single activities are essential in meeting the organizational long term and short term objectives. The aggregate value of direct and indirect behavior and contributions of employees to an organization is considered as employee performance.82 When employees fulfill their assigned responsibilities, duties, and tasks they fulfill their in-role performance83,84 because these are formally mentioned in their job description and this is directly linked with individual tasks and productivity. Employee performance is influenced by POS and employee engagement and is directly related to organizational performance. As employee performance is a behavioral outcome and when an organization gives proper attention and recognition to the employees’ work and contribution their performance is seen to be more flourished. Stamper and Johlke9 find evidence that POS positively influences the improvement of employee performance. Allen et al7 says that the assessment of excellence of employee achievement according to the organization’s expectations is called employee performance. According to the results of research conducted by Eisenberger et al15 the behaviors and treatments of organizations towards their employees affect their employee’s performance. Jamal85 describes job performance as a role that an individual can achieve effectively and efficiently with available resources and through overcoming the normal constraints. They also explain it as a set of behaviors through which the employees help in the attainment of the organization’s goals. Perceived organizational support and employee performance

Mediating Effect of Employee Motivation Between Perceived Organizational Support and Employee Performance Relationship

Perceived organizational support is correlated to motivation is based on the idea that perceived organizational support would satisfy the emotional needs of the employees by providing a caring and supportive environment.86 Employees are motivated to present positive work-related behaviors when perceived organizational support makes them feel highly associated with the organization. Intrinsic motivation has been unearthed to mediate the relationships of perceived organizational support and work-related attitudes. When workers think that their company value and respect them, they start enjoying the work more, and they feel more motivated to take the initiative.87,88 Perceived organizational support affects employee performance indirectly.89 When employees see support and care from the organization, the organization addresses their need for association and offers them a sense of belonging they become emotionally involved in an organization which results in enhanced performance. Perceived organizational support in the conclusion of the study undertaken by Shore et al38 is positively linked with many considerations. This includes employees’ positive behaviors, professional attitudes, and better outcomes such as organizational commitment and enhanced employee performance at the workplace.90 When employees see their companies value their inputs and are concerned about their well-being they react in more positive manners and they feel the motivation to perform their task. Erdogan and Enders,91 concluded in their study that perceived organizational support at the broadest level, is consistently associated with increased job performance through employees’ intrinsic motivation. Employees show increased performance, innovation, and carefulness in performing their job responsibilities for the organization when they perceive a higher level of organizational support. Empirical studies found motivation as a mediator in performance relationships and other variables.92 For example between climate and employee, performance motivation exist as a crucial mediating variable. Numerous other researchers found a mediating effect of motivation between context influences creativity and organizational performance.93

Methods

To combine the concepts from POS and employee performance secondary data has been employed that is collected from different research papers to provide a literature-based analysis. Firstly, we performed a computer search of the PsycINFO databases, beginning with the introduction of the POS construct. We searched for all published articles and books containing the terms POS in their title or abstract having relationships with other factors. Second, we carried out a computer search of Web of Science’s citation index for all articles POS. The amalgamations of different theories include social exchange theory,13 the theory of self-efficacy,94 self-determination theory,71 and organizational support theory15 help to construct a theoretical framework. These methods enabled us to explore the relationships among POS, intrinsic motivation, and employees’ performance and provide enough data to combine all those dimensions which are part of POS in a single paper.

Practical Implications

The current results show that managers’ own POS has central implications for the acuities and accomplishment of their juniors. Based on our results, junior’s supportive treatment and its constructive results may create, at least in part, from the “supportive treatment” that managers get from the company. In common with earlier organizational support theory, our study findings recommend that promising exchange relations between a worker and a company may cause in good treatment of managers, colleagues, juniors, or clients, relying on the level of the worker in the company and the kind of work kept by the worker. Workers at virtually any stage of the company may respond to perceived organizational support by aiding colleagues or managers.95 Moreover, the current research findings propose that managers make use of the prospect to respond by offering juniors a “supportive treatment”, with significant results for juniors’ perceived organizational support and performance. The forthcoming study could take measures of supportive actions offered to juniors (eg, optimistic feedback, coaching, and presence in making a decision) to inspect precisely what actions the manager exercises in response to perceived organizational support that direct juniors to have improved insights of manager support. The optimistic connection amid managers’ perceived organizational support and juniors’ perceived organizational support and performance recommends that institutions may wish to foster manager perceived organizational support. An earlier study connecting managers implies that few of the antecedents of perceived organizational support for lower cadre workers and managers are the same, including higher cadre worker’s supportive treatment, promising job experiences (eg, training, development, and promotion prospects), and reward expectations.96 Other job experiences established important to the perceived organizational support of lower cadre workers may also be imperative to managers. For instance, having a voice, or the chance to put contribute to the “decision-making” of the institution and independence in functioning one’s job responsibilities were discovered to be two of the substantially linked antecedents of perceived organizational support.87 Thus, institutions that handle managers in ways that give them “voice and autonomy” may interject substantively to managers’ insights of institutional support. The forthcoming study could also take into consideration the dispositional features of the manager that influence the connection amid managers’ perceived organizational support and juniors’ performance. For example, the association amid perceived organizational support and a felt duty to repay the institution was found to be bigger among workers with an eminent exchange ideology.26 Thus, managers with a high exchange ideology may feel a sturdier duty to treat their juniors supportively under conditions of high POS, with a corresponding influence on their treatment of workers. In return, it will increase the performance of both employees and their supervisors.

Limitations and Future Work

There are some limitations to this study. First, this paper provides a theoretical base and in the future, it can be tested empirically. Second, it is also observed that most of the studies are predominantly conducted in developed countries with only a few from Asian countries. To approve and support the rationality or otherwise of these outcomes it is therefore suggested, that research be conducted in other developing countries. Third, employee motivation is used as a potential mediator in this study, future research should employ other mediators or moderators such as employee commitment, and psychological empowerment.

Conclusion

In conclusion, our research findings recommend that “organizational support theory” could be extended to take in support providing to juniors as a way by which managers share beneficial handling from the institute. Taken together, the current research findings interpose to a better understanding of the role of POS, manager supported motivation in the prediction of employee performance. More precisely, institutional and supervisory factors, together with individual features, are involved in predicting performance. As employee performance is the key concern for every organization; organizations and trainers should support supervisory staff to strengthen their POS and level of motivation in their professional activities. Employee motivation supported by the supervisors’ in the company valued their input and cared about their welfare were unearthed linked to juniors’ acuities of support by the manager, which, in return, was associated to juniors’ perceived organizational support, and performance. Therefore, the institute’s “supportive treatment” of managers may have value for enhancing the perceived organizational support and performance of juniors.
  25 in total

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Journal:  J Appl Psychol       Date:  2007-03

9.  Linking Transformational Leadership with Nurse-Assessed Adverse Patient Outcomes and the Quality of Care: Assessing the Role of Job Satisfaction and Structural Empowerment.

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