Thursday, September 08, 2005

Reinventing the Wheel (Doh!) : The Organizational Justice / Fairness Literature

I just managed to stumble across an entire literature/ area of inquiry in psychology, sociology and management science that is very relevant to the issues discussed on Health Care Renewal, but which so far has hardly been applied to health care.
The area is called organizational justice or organizational fairness.
It is usually divided into three parts:
Distributive Justice- "the fairness of what one receives as the result of an allocation decision."
Procedural Justice- " the perceived fairness of formal decision-making processses," that can be broken down into dimensions such as consistency, bias suppression, representativeness, correctability, accuracy, and ethicality.
Interactional Justice- "the fairness of interpersonal treatment that one receives from a decision maker"
( Definitions come from Schminke M et al. The effect of organizational structure on perceptions of procedural fairness. J Appl Psychol 2000; 85: 294-304. See abstract here.)
There are widely used survey instruments designed to assess these different aspects. For example, the Moorman scale for procedural justice asks whether decision making procedures are meant to:
1. collect accurate information necessary for decision-making
2. provide opportunities to appeal or challenge decisions
3. have all sides affected by the decision represented
4. generate standards so decisions are made consistently
5. hear the concerns of those affected by the decisions
6. provide useful feedback regarding the decision and its implementation
7. allow requests for clarification or additional information
And the scale for interactional justice asks whether the leader:
1. considered your viewpoint
2. could suppress personal bias
3. provided timely feedback about decision and its implications
4. treated you with respect and kindness
5. showed concern for your rights
6. dealt with you truthfully.
Workers who perceive that such organizational justice is lacking have been shown to have less job satisfaction, organizational commitment, cooperation, and citizenship behavior, lower job performance, and are more likely to leave, steal, file a grievance, engage in conflict, and experience stress. (See summary in Schminke above.)
There are over 350 related publications in the PsychLit database on organizational justice or fairness. However, I could find only two articles on organizational justice or fairness in health care organizations.
One study in Finland assessed the cross-sectional relationship between organizational fairness and physicians psychological distress. Both procedural and interactional fairness were strongly negatively correlated with psychological stress in male, but not female physicians. (Sutinen R et al. Organizational fairness and psychological distress in hospital physicians. Scand J Pub Health 2002; 30: 209-215. Abstract available here.)
One study in Canada assessed the relationship between organizational fairness and hospital nurses' perceptions of respect. Interactional fairness was strongly related to respect. It is notable that less than half the nurses gave a positive response to each component of the fairness scale (e.g., my manager treats me with respect, my manager discusses implications of decisions, etc.) (Laschinger HKS. Hospital nurses' perceptions of respect and organizational justice. JONA 2004; 34: 354-364. See abstract here.)
Amazingly, when one staggers briefly out of the world of health care, and blinks one's eyes, there is another world where people actually worry about concepts like organizational justice.
Based on the anecdotes we have reported in Health Care Renewal, I suspect that if someone were to do the studies, they would find that many health care professionals perceive a lack of organizational justice, and that their perceptions will correlate with their dissatisfaction and demoralization (and likely poor quality of care, decreased access, and increased costs.)
It would be nice if health care managers got the idea that they should make open, honest fair decisions, and treat their employees fairly and with respect.

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