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Behavioral Integrity, Engagement, Organizational Citizenship Behavior, and Service Quality in a Healthcare Setting

EXECUTIVE SUMMARY In response to increased competition and outcomes transparency, healthcare delivery organizations must rely on their employees to provide superior care quality and patient service. Healthcare managers seeking to motivate employees to this end have an abundance of leadership theories, many of which are broad and overlapping, on which to base their initiatives. In this study, we looked at a relatively narrow construct: behavioral integrity (BI)—that is, the extent to which employees view their managers’ words and actions as congruent (whether they “walk their talk”). We collected data from self-reported surveys completed by 3,605 employees of a large, integrated, religiously affiliated healthcare system in the mid-Atlantic region of the United States. Using correlational and hierarchical regression, we tested whether employees who perceived their direct managers as exhibiting more BI were more engaged in their jobs; reported their coworkers as performing more organizational citizenship behaviors; and had more favorable views both of the service quality of their unit and hospital or other entity in which they worked. We found positive relationships between perceived BI and all of those desirable outcomes. Employee engagement also was positively related to individuals’ perceptions of their unit’s organizational citizenship, as evidenced by discretionary effort, and with their perceptions of the quality of care delivered by both unit and organizational entity. Engagement partially mediated the relationships between BI and those variables. We discuss the implications for individual managers seeking practical advice for self-improvement as well as for organizations striving to improve employee engagement and performance through leadership development.