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WORKFORCE ISSUES

The relationships among social capital, organisational commitment


and customer-oriented prosocial behaviour of hospital nurses
Chiu-Ping Hsu, Chia-Wen Chang, Heng-Chiang Huang and Chi-Yun Chiang

Aims. This study examines the perceptions of registered nurses of social capital, organisational commitment and customeroriented prosocial behaviour. Additionally, this study also addresses a conceptual model for testing how registered nurses
perceptions of three types of social capital influence their organisational commitment, in turn intensifying customer-oriented
prosocial behaviour, including role-prescribed customer service and extra-role customer service.
Background. Customer-oriented prosocial behaviour explains differences in job satisfaction and job performance. However,
the critical role of customer orientation in the hospital setting has yet to be explored.
Design. Survey.
Methods. The survey was conducted to obtain data from registered nurses working for a large Taiwanese medical centre,
yielding 797 usable responses and a satisfactory response rate of 867%. The partial least squares method was adopted to obtain
parameter estimates and test proposed hypotheses.
Results. The study measurements display satisfactory reliability, as well as both convergent and discriminant validities. All
hypotheses were supported. Empirical results indicate that registered nurses perceptions of social capital were significantly
impacted the extent of organisational commitment, which in turn significantly influenced customer-oriented prosocial behaviour.
Conclusion. By stimulating nursing staff commitment, health care providers can urge them to pursue organisational goals and
provide high quality customer service. To enhance organisational commitment, health care managers should endeavour to create
interpersonal interaction platforms in addition to simply offering material rewards.
Relevance to clinical practice. Nurses act as contact employees for their patient customers in the hospital, and they are
required to provide patient safety and service quality. This study shows that nurses with high organisational commitment are
willing to provide customer-oriented prosocial activities, which in turn enhances patient satisfaction.
Key words: customer-oriented prosocial behaviour, evidence-based practice, hospital nurses, organisational commitment, social
capital
Accepted for publication: 21 November 2010

Introduction
Organisational commitment served as a criterion variable for
an organisations sustaining and competitive advantage. The
degree of employee organisational commitment has implica-

Authors: Chiu-Ping Hsu, PhD Candidate, Department of


International Business, National Taiwan University, Taipei; ChiaWen Chang, PhD, Assistant Professor, Department of Business
Administration, Feng Chia University, Taichung; Heng-Chiang
Huang, PhD, Professor, Department of International Business,
National Taiwan University; Chi-Yun Chiang, PhD, Assistant
Professor, Department of Business Administration, Ming Chuan
University, Taipei, Taiwan

tions for the employee and organisation. Both employee and


organisation derive benefits from commitment employees
(Gormley & Kennerly 2010). Organisational commitment
has been shown to be a key cause of nurse job engagement
(McNeese-Smith 2001), job satisfaction (Lu et al. 2007),

Correspondence: Chiu-Ping Hsu, PhD Candidate, Department of


International Business, National Taiwan University, 8F, Building I,
College of Management, No.1, Sec. 4, Roosevelt Rd., Taipei City
106, Taiwan. Telephone: +886 2 3366 4966.
E-mail: d94724003@ntu.edu.tw

 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392


doi: 10.1111/j.1365-2702.2010.03672.x

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C-P Hsu et al.

turnover (Castle 2006) and of organisational goal achievement, stability and innovation (Brown & Harvey 2006). Liou
and Cheng (2010) also found that creating a good organisational climate may increase nurses organisational commitment and, in turn, decrease their intention to leave. Despite
the large amount of literature on the subject, there is little
theoretical and practical understanding of the customerrelated outcomes in the hospital setting. This study attempts
to address this under-researched problem.
Patients are increasingly vital in determining the success of
health care organisations (Ford & Fottler 2007). Concerns
about quality and safety in health care and the impacts of
nurses work conditions on patient outcomes have been
growing in recent years, particularly as health care in acute
care settings has become increasingly complex (Clarke &
Aiken 2008). Administrators have recently re-focused by
meeting patient customer needs, wants and desires, not only
to achieve positive clinical outcomes, but also to achieve
superior health care experiences (Ford et al. 1997). In health
care organisations, nurses act as contact employees for their
patient customers. Nurses fulfil multiple roles simultaneously
and are required to provide quality and safe patient care
with less support (Greggs-McQuilkin 2004). When contact
employees exhibit customer-oriented behaviour or a strong
intention to meet customer needs (Brown et al. 2002), they
are more likely to serve customers passionately, in turn
enhancing customer satisfaction. According to earlier research (Lee et al. 2006) and our interview with the nurses,
this work argues that nurses who are committed to their own
health care organisations tend to comply with explicit
requirements regarding customer service and also tend to
make efforts that go beyond their job descriptions when
attempting to assist customers.
Previously, several authors have proposed multi-factors
likely to motivate organisational commitment, including the
DemandControlSupport (DCS) model, organisational justice (Rodwell et al. 2009), job satisfaction, organisational
culture and trust (Gregory et al. 2007). Recently, interpersonal
networks and interactions have begun to comprise a significant
part of nurse work environments and the establishment of
interpersonal relationships is widely believed to support
organisational competitiveness (Watson & Papamarcos
2002). Social capital has been conceptualised as a set of social
resources that resides in interpersonal relationships (Reed
et al. 2009). Previous studies demonstrate that social capital is
related to employee career success (Seibert et al. 2001), firm
value creation (Tsai & Ghoshal 1998) and sustainable
organisational advantage (Nahapiet & Ghoshal 1998).
In the field of nursing, the issue of social capital has also
been investigated since the mid-1990s. East (1998) indicated
1384

that building social capital, as a public health issue, is


critical to improve the health of residents in a disadvantaged
urban neighbourhood. Cowley and Billings (1999) similarly
suggested that social capital is important to promoting
health, and several studies also showed that social capital
has a positive influence on health (Cannuscio et al. 2003,
Carlson & Chamberlain 2003, Pearce & Smith 2003,
Kritsotakis & Garmanikow 2004). Based on a social capital
perspective, Looman and Lindeke (2005) suggested four
practical ways for nurses to promote health: (1) create
opportunities for networking through bringing people
together for health purposes, encourage repeated contacts
and storytelling; (2) diffuse community-related health
knowledge; (3) build personal stock of social capital; (4)
practice vision therapy in nursing as a new intervention to
improve child and family health. Looman (2006) further
developed and tested a scale for measuring social capital
to establish consensus and precision of communication.
Concerned specifically with enhancing the relationship in
primary care practice, DiCicco-Bloom et al. (2007) develop
a model of social capital to improve patient care outcomes
and promote organisation success. Recently, Kowalski et al.
(2010) suggested that social capital in hospitals could be
regarded as a resource helping nurses against their emotional
exhaustion.
However, despite the numerous findings reported by
researchers regarding the relationship between social capital
and health, there has been little empirical research on the
relationship between social capital and organisational commitment. This study identifies three dimensions of social
capital, examines their links to organisational commitment
and examines the role of commitment in shaping nurses
customer-oriented proclivity.

Background
The conceptual framework of this study delineates how
nurses perceptions of social capital serve to create organisation commitment and in turn enhance nurse customeroriented prosocial behaviour. Based on previous works
(Nahapiet & Ghoshal 1998, Tsai & Ghoshal 1998, Watson
& Papamarcos 2002), this study classifies social capital into
three categories, namely social interaction, trust among
nurses and shared vision. Drawing on recent marketing
research on social capital (e.g. Nahapiet & Ghoshal 1998,
Tsai & Ghoshal 1998), organisational commitment (e.g.
McNeese-Smith 2001, Castle 2006, Rodwell et al. 2009) and
customer-oriented prosocial behaviour (e.g. Bettencourt &
Brown 1997, Lee et al. 2006), this work proposes the
conceptual framework shown in Fig. 1.

 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392

Workforce issues

Prosocial behaviour of hospital nurses

Social capital

Social
interaction

Customer-oriented
Prosocial behavior
Role-prescribed
customer service

H1a (+)
H2a (+)

Trust among
nurses

H1b (+)

Organisational
commitment
H2b (+)

Extra-role
customer service

H1c (+)
Shared vision

Figure 1 Conceptual framework.

Relationship between social capital and organisational


commitment
The concept of social capital has become increasingly
important in the discipline of nursing. A growing number
of nurse scholars have invoked the concept of social capital as
a means of investigating challenging questions raised in the
nursing literature. Social capital is discussed from three
theoretical approaches in contemporary research, and each
approach is defined differently. First, the functional approach
is centrally concerned with social capital as a social resource
for expediting collaboration and corporate action (Coleman
1988, Putnam 1993). Such a beneficial resource exerts an
influence on the development of human capital (Coleman1998), firms performance (Baker 1990) and of geographical regions (Putnam 1993). The second theoretical
approach, which is network based, views social capital as
networks of relationships with a valuable resource (Bourdieu
1986). Social capital is embedded in structure and relationships, and relationships are created through social affairs;
thus, interaction is a precondition to build and sustain social
capital (Bourdieu 1986). Recently, Grootaert et al. (2004)
have suggested a third approach, which may be considered a
multi-dimensional approach. By combining the elements of
the functional and network-based approaches, Grootaert
et al. (2004) introduced the SC-IQ concept covering six
dimensions for the purpose of measuring social capital.
There are many ways to conceptualise and operationally
define social capital. In this study, our definition of social
capital reflects the network-based approach and acknowledges social capital as a concept rooted in the structure and
content of relationships. We adopt Nahapiet and Ghoshals
(1998) view in defining social capital as the sum of actual
and potential resources within, available through and
derived from the network of relationships possessed by an
individual or social unit. Social capital thus comprises both
the network and the assets that may be mobilised through
the network (p. 243). This study thus focuses on social

capital arising from the network of relationships among


hospital nurses.
Prior research suggests that social capital is considered
critical to individual organisational commitment (Mowday
et al. 1979). Organisational commitment presents individual
psychological attachment to an organisation (Mowday et al.
1979, Gormley & Kennerly 2010). In a health care organisation involving plenty of interpersonal interactions between
nurses, we argue that social capital, as perceived by nurses, is
able to influence individual commitment to the organisation.
Drawing on a review of previous research on social capital
(Watson & Papamarcos 2002), this study classifies three
dimensions of social capital, namely social interaction, trust
among nurses and shared vision, each of which is expounded
on below.
The structural aspect of social capital refers to the social
interactions among nurses, i.e. with whom and with what
frequency they share information and hold communicative
actions. It is reasonable to expect that social interaction
relates to organisational commitment. A network of relationships provides information on what is happening in the
organisation, access to power structures, emotional support
and friendship. This should increase the persons involvement
in the affairs of the organisation and attachment to the
organisation, hence affective organisational commitment
(Bozionelos 2008). Communicative actions not only serve
to transmit information, they also serve to construct the
persons perception of meaning and reality itself. The specific
values to which an organisation appeals when justifying its
actions or laying out its plans, allow person to understand
why certain events occur, influence the persons perception of
organisation justice and permit the person to share the
communicators perspective. Communicative actions, therefore, will have affects on organisational commitment (Watson & Papamarcos 2002). Moen et al. (2008) also argued
that face-to-face interaction is beneficial for the establishment
of commitment.
Trust has become increasingly critical in influencing
organisational climate, employee performance and organisational commitment (Laschinger et al. 2008). Trust is critical
in successful social cooperation. Without an atmosphere of
trust, people are incapable and unwilling to cooperate
without strict behavioural control (Whitney 1994). Doney
and Cannon (1997) identified credibility and benevolence
as two critical elements of trust. Credibility refers to
individual belief that a trusted party (trustee) is capable of
fulfilling promised commitment, whereas benevolence
describes the inclination of the trustee to prioritise the
interests of trustors. Trust implies individual willingness
toward vulnerability (Rousseau et al. 1998) and subjective

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perceptions of norms related to reciprocity (Watson &


Papamarcos 2002). When trust exists in interpersonal relationships, individuals will expose self-vulnerability based on
the belief that their peers will not take advantage of them.
Conversely, if an individual feels vulnerable in an organisation or does not trust that their work efforts will receive
appropriate reciprocation, their organisational attachment
will be reduced (Watson & Papamarcos 2002). Laschinger
et al. (2008) also argued that trust significantly impacts
organisational commitment.
Shared vision embraces the collective goals and aspirations
of organisational members (Tsai & Ghoshal 1998) and
generally notifies members of what is considered right and
wrong (Watson & Papamarcos 2002). According to Tsai
and Ghoshal (1998), a shared vision can prevent misunderstandings in interpersonal communications and facilitate the
free exchange of ideas and resources. This study considers
shared vision as a precursor of nurse attachment to their
health care organisations. Previous works have shown that
shared vision can promote the integration of an entire
organisation (Orton & Weick 1990) and stimulate more
effective interpersonal cooperation (Starbuck 1983). Ravlin
and Meglino (1987) proposed that perceptions of organisational shared vision positively influence commitment to the
organisation. According to the above literature, we proposed
the following hypotheses:
H1a: Social interaction positively influences organisational
commitment.
H1b: Trust among nurses positively influences organisational commitment.
H1c: Shared vision positively influences organisational
commitment.

tional documents (for example, performance evaluation


forms and job descriptions) (Brief & Motowidlo 1986,
Bettencourt & Brown 1997). Meanwhile, the extra-role
customer service component examines whether contact
employees exceed their explicitly required expectations, such
as providing spontaneous exceptional services during service
encounters to boost customer satisfaction (Bitner et al. 1990,
Bettencourt & Brown 1997). This study measures customeroriented prosocial behaviour as organisational assistance
provided by nurses as well as their customer-orientation
behaviour.
Previous works have argued that organisational commitment can encourage prosocial behaviour by service providers (MacKenzie et al. 1998). As Brief and Motowidlo
(1986) suggested, individuals who perceive strong bonds
with their organisations as part of their organisational role
are more inclined to engage in prosocial behaviour.
Furthermore, they are more likely to interact with customers in a prosocial manner, keeping organisational goals in
mind while doing so. As a liaison between patients and
doctors, the organisational attachment and commitment of
nurses can facilitate their empathetic, caring and patientcentred behaviour. This study indicates that the extent to
which nurses are willing to engage in customer-orientated
prosocial behaviour is strongly stimulated by their organisational commitment. Consequently, this study hypothesises the following:
H2a: Organisational commitment positively influences
role-prescribed customer service.
H2b: Organisational commitment positively influences
extra-role customer service.

Methods
Relationship between organisational commitment and
customer-oriented prosocial behaviour

Measures

Customer-oriented prosocial behaviour is regarded as the


helpful behavior of service providers directed toward an
organisation or other individuals (Bettencourt & Brown
1997, p. 41). This behaviour forms part of the organisational
role of service providers. Furthermore, service providers
displaying customer-oriented prosocial behaviour desire to
promote the welfare of the organisation they belong to (Brief
& Motowidlo 1986). In the work of Bettencourt and Brown
(1997) on contact employees, prosocial behaviour includes
both role-prescribed and extra-role customer service components. Lee et al. (2006) also agreed with Bettencourt and
Browns (1997) classifications. Role-prescribed customer
service captures the facets related to whether the required
actions of a service provider are clearly stated in organisa-

This study adapted measures from previous studies (e.g.


Smith et al. 1994, Bettencourt & Brown 1997, Leana & Pil
2006, Lee et al. 2006) to tap the concept of each construct
and made necessary modifications to fit the context of this
research. This research developed items for social capital
based on the manifestation of Smith et al. (1994), Lee et al.
(2006) and Leana and Pil (2006). Among these multi-item
scales of social capital, two items were used to assess social
interaction. Four items were respectively designed to evaluate
trust among nurses and shared vision. Moreover, another
four items were adapted to measure organisational commitment used by Lee et al. (2006). Regarding role-prescribed
customer service and extra-role customer service, this study
individually adapted two three-item scales used by Betten-

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Workforce issues

court and Brown (1997) to capture our concept of customeroriented prosocial behaviour.

Ethical considerations
This surveyed medical centre approved the study. We
composed a questionnaire, which was prefaced with a note
assuring the respondents of anonymity in their responses. All
of the participants were also informed that the survey was
only for academic purposes. Our introduction to the questionnaire discussed potential risks and stated that taking the
survey implied consent. Participants were informed that that
it was not obligatory to take part in the research (to include
the completion of the questionnaire) and that they could
cease participation at any time with no penalty whatsoever.

Data collection
A questionnaire survey was performed to gather data from
nurses in a major medical centre in northern Taiwan. The
sample consists of 1026 full-time nurses. Respondents were
required to possess two characteristics: (1) over three months
of work experience in the medical centre; (2) completion of
new employee training. A total of 919 potential respondents
were thus identified. Each of the 919 participating nurses
received a questionnaire. Anonymity was maintained in the
data collecting process. We informed all nurses of the
purposes of the study. The respondents answered in total
anonymity, with no identifying information on the survey
instruments. The nurses returned the completed questionnaires in a return envelope. We researchers do not know, nor
does the supervisor, which respondent gave which answers.
This procedure protected the identities of the respondents.
Besides, the hospitals name is being kept confidential. A gift
worth approximately US$2 was given as a reward for
participation. With the aid of top managements approval
and support of this study, 825 contacts completed and
returned the survey questionnaire. The period of data
collection was between August 2008April 2009. Among
the 825 returned questionnaires, this study obtained 797
usable responses for subsequent analysis after discarding
incomplete responses. The usable response rate was approximately 867%.

Results
Sample profile
Most respondents in this survey were 2630 years old
(787%) and female (984%). Moreover, 534% of the nurses

Prosocial behaviour of hospital nurses


Table 1 Sample demographics
Characteristic
Gender
Male
Female
NA
Age
2025
2630
3135
3640
>40
NA
Highest level of education
HS diploma
Associate
BS/BSN
Masters
NA
Marital status
Single
Married
NA

Number

11
784
2

14
984
03

107
627
28
25
5
5

134
787
35
31
06
06

5
304
426
47
15

06
381
534
59
19

534
258
6

67
322
08

NA, not available; BSN, Bachelors of Science/Nursing.

had BS/BSN degrees. Also, 67% of nurses who were surveyed


were single. Table 1 details the demographics of the sample
population.

Testing the model


This study employed the partial least squares (PLS) Graph
v3.0 program to estimate the parameters in the measurement
and structural models. PLS path modelling is component
based. It requires less stringent assumptions related to
measurement levels of the manifest variables, multivariate
normality and sample size (Hulland 1999, Chin et al. 2003)
than does the covariance-based approach to structural
equation modelling (e.g. LISREL). We adopted the two-stage
approach suggested by Hulland (1999), comprising both
measurement and structural models. The former reflects the
reliability and validity of the study measurements. The latter,
on the other hand, illustrates the statistical support provided
for the hypothetical relationships among constructs. Such
relationships are used as a basis for discussion and identifying
managerial implications.
To address the adequacy of the measurement model, this
study assesses the reliability, convergent validity and discriminant validity of individual items (Hulland 1999). First, the
item loadings that reflect the extent to which each construct is
tapped by the study measures range from 083096 (for

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Table 2 Items and measurement model
Construct/items

Standardise
item loading

Social interaction
SI1
090*
SI2
088*
Trust among nurses
T1
088*
T2
088*
T3
092*
T4
092*
Shared vision
SV1
091*
SV2
093*
SV3
093*
SV4
091*
Organisational commitment
OC1
083*
OC2
085*
OC3
087*
OC4
089*
Role-prescribed customer service
RP1
093*
PR2
096*
PR3
093*
Extra-role customer service
ER1
087*
ER2
084*
ER3
085*

CR

AVE

089

080

095

081

096

084

092

074

096

088

089

073

AVE, average variance extracted; CR, composite reliability.


*p < 0001.

We obtained responses using five-point Likert scales, anchored by
1 = strongly disagree and 5 = strongly agree.

details, see Table 2), all exceeding the recommended threshold value of 07 suggested by Hulland (1999). Second, this
study used the composite scale reliability (CR) and average
variances extracted (AVE) to assess the internal consistency
of constructs. While CR is analogous to the Cronbachs
alpha, the AVE denotes the amount of variance captured by
the measure of a construct relative to random measurement
error (Fornell & Larcker 1981). Table 2 shows that the

estimates of the CRs ranged from 089096 in this study,


significantly exceeding the value of 07 recommended by
Hulland (1999). The estimates of AVEs were found to exceed
05 (range from 073088) and all lay within the acceptable
range stipulated by Hulland (1999), thus achieving significant
convergent validity. All item loadings, CRs and AVEs are
supported to indicate high reliability and convergent validity.
According to Hulland (1999), this study checks for discriminant validity by examining whether the square roots of the
AVE for these constructs are larger than any other value of
their individual intercorrelated coefficients. Table 3 shows
that the square root of the AVE for each construct along the
diagonal line is higher than any other value of its correlated
coefficients in the lower triangle area. This result clearly
demonstrates discriminant validity. Overall, these statistics
reveal that the construct measurements are sufficiently strong
to enable subsequent structural model estimation.
The sign and significance level of each estimated path,
according to the PLS bootstrapping method, is shown in
Table 4. This study found that social interaction, trust among
nurses and shared vision positively and significantly impact
organisational commitment and respectively have b coefficients of 013, 027 and 034, supporting H1a, H1b and H1c.
Also, organisational commitment positively and significantly
impacts role-prescribed customer service (b = 034), leading
to H2a being supported. Moreover, organisational commitment strongly and positively influences extra-role customer
service (b = 054). As expected, support was found for H2b.
Table 4 summarises the studys results and shows how they
support the hypotheses.

Discussion
This study identified support for the proposed comprehensive
model using nurses as a sample. Particularly, this study has
made contributions in the following ways. First, relationship
is considered an asset for those involved in the social action
field (Baker 1990) and social capital is generally embedded in
interpersonal relationships (Coleman 1988). Social capital is

Table 3 Square roots of average variance extracted (AVE) and correlation matrix
#

Construct

1
2
3
4
5
6

Social interaction
Trust among nurses
Shared vision
Organisation commitment
Role-prescribed customer service
Extra-role customer service

089
053
053
045
023
031

09
082
061
041
043

092
063
036
041

086
039
054

094
075

085

Diagonal elements in bold are the square roots of the AVE.

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Prosocial behaviour of hospital nurses

Table 4 Results of partial least squares analysis

Hypothesis

Standardised
Coefficients

t-value

Expected
Sign

Results

H1a: Social interaction Organisation commitment


H1b: Trust among nurses Organisation commitment
H1c: Shared vision Organisation commitment
H2a: Organisation commitment Role-prescribed customer service
H2b: Organisation commitment Extra-role customer service

013*
027**
034***
034***
054***

197
300
367
591
907

+
+
+
+
+

Supported
Supported
Supported
Supported
Supported

*p < 005, **p < 001, ***p < 0001.

connected with employee attachment to the organisation.


This connection, however, is only partly understood. This
lack of understanding is more pronounced in hospital
settings. This empirical study proposes that social capital is
critical in augmenting nurse organisational commitment. The
study findings indicate that, for health care organisations,
interpersonal interaction facilitates interpersonal networking
for individuals with similar working experiences and thus
satisfies nurses needs for social support or approval as well as
a sense of attachment. This result has considerable managerial implications, because it suggests that greater health care
manager efforts and resources should be dedicated to
improving the design of interpersonal interaction platforms,
in addition to simply offering material rewards.
Second, social capital is demonstrated to elicit emotional
connections among members, increasing cohesion between
these like-minded people and the organisation. Among the
three dimensions of social capital, the findings of this study
reveal that shared vision has a higher predictive power.
Generally, shared vision can provide a foundation for
organisational norm. Coleman (1988) stated that when a
norm exists and is effective, it constitutes a powerful, though
sometimes fragile, form of social capital. Hospital executives
thus must establish a shared vision among nurses to foster
organisational commitment.
Third, this study applied the concept of customeroriented prosocial behaviour in health care management.
Empirically, this work found that nurses with high commitment tend to engage in customer-oriented prosocial
activities, including role-prescribed customer service
(namely they do what is explicitly required in job descriptions and other prescriptive rules) and extra-role customer
service (namely they are willing to go beyond the call of
duty to help customers). Health care administrators and
managers should increase their efforts to develop organisational commitment to encourage nursing staff to pursue
organisational goals and serve customers passionately.
Owing to the importance of organisational commitment,
health care managers should also shift from a transactional

orientation to a focus on relationship building. While the


former focuses on achieving short-term goals, the latter
emphasises the importance of relationship building in
achieving long-term goals. Massive future managerial
challenges exist as health care providers formulate relationship-oriented strategies.
Despite the above contributions, we acknowledge the
limitations of this study and stress the need for caution in
interpreting the results. First, the data for this study were
collected cross-sectionally and hypothesis testing with such
survey design may produce measurable associations between
variables. The directions of influence among variables of this
study were hypothesised in accordance with the theoretical
foundations and practices in the nursing setting. Further
research could re-examine the possibility of reversed hypothesised relationships among variables or could use longitudinal
data to re-examine our research framework. Moreover,
despite the rigorous attention to detail aimed at ensuring
the credibility and appropriateness of the collected data, the
potential for single source bias exists for this study as the
nurses were the primary source of information. Third,
previous studies have observed that patient customers significantly determine the success of health care organisations
(Ford & Fottler 2007). Bitner et al. (1990) empirically found
that unsatisfactory encounters result from employee unwillingness to respond to service failure. To maintain customer
satisfaction, hospital administrators should examine what
factors are likely to lead to higher nurses motivation to deal
with patient complaints and pursue service recovery. This
opens up a new area for researchers. Further researchers
should consider that nurses will have negative feelings when
facing customer complaints or correcting service failures for
which others are responsible. The organisational conditions
likely to attenuate the negative feelings of nurses remain a
researchable issue. Finally, further research is necessary to
examine the consequences of customer-orientated prosocial
behaviour of nurses, such as organisational profits, customer
satisfaction and customer loyalty.

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Conclusion
This study showed that the three types of social capital
perceived by nurses could influence their organisational
commitment. Furthermore, this study examined the key
influences on nurse customer-oriented prosocial behaviour
and found that highly committed nurses pursued certain goals
advocated by the organisation. Highly committed nurses are
generally closely engaged in customer-oriented prosocial
behaviour, including role-prescribed and extra-role customer
services.

Relevance to clinical practice


Organisational commitment means the strength of an
individuals identification with and involvement in a particular organisation (Porter et al. 1974, p. 604). It is important
for hospitals because nurses with higher levels of organisational commitment would devote themselves to the hospitals
and work harder. Organisational commitment may take a
long time to develop and this study points out the importance
of social capital (social interaction, trust among nurses and
shared vision) in facilitating the organisational commitment
of nurses.
Healthcare service usually requires nurses to cooperate on a
group basis to follow a seamless care-providing process. Every
nurse assumes particular duty-fulfilling responsibilities and
helps their colleagues to cultivate teamwork; where social
interaction and trust among nurses are critical. Managers
could design some activities for nurses, such as group training
events and occasions for experience and knowledge sharing,
thus encouraging nurses to interact frequently, openly and
amicably. A supportive climate may induce a positive emotion,
reduce a nurses suspicion of partners and foster cooperative
behaviour.

To complete certain tasks successfully, nursing services in


different departments must be synchronised. In such situations, a clearly held shared vision could effectively guide
nurses to collaborate on the best direction and the collective
goals. The administrators should draw up a well-defined
vision and communicate it to the nurses. To encourage all
nurses to identify with and internalise the hospitals vision,
the administrators could illustrate and remind the nurses of
the vision regularly.
Our findings indicate that nurses with higher levels of
organisational commitment would likely exhibit role-prescribed as well as extra-role customer service behaviour.
Such behaviour could improve the efficiency and effectiveness of healthcare service process and boost patient
satisfaction. To cultivate a climate of customer-oriented
prosocial behaviour, managers need to offer some incentives. The managers could praise publicly those who
perform well and provide motivations such as monetary
award. In the end, such incentive-driven prosocial behaviour
may lead to improved organisational performance.

Acknowledgements
The authors appreciate the editor and two anonymous
reviewers for comments made on an earlier draft of this
article.

Contributions
Study design: CPH, HCH; data collection and analysis: CPH,
CWC and manuscript preparation: CPH, CWC, HCH, CYC.

Conflict of interest
We declare that we have no conflict of interest.

References
Baker WE (1990) Market networks and
corporate behavior. American Journal
of Sociology 96, 589625.
Bettencourt LA & Brown SW (1997) Contact employees: relationships among
workplace fairness, job satisfaction and
prosocial service behaviors. Journal of
Retailing 73, 3961.
Bitner MJ, Booms BH & Tetreault MS
(1990) The service encounter: diagnosing favorable and unfavorable
incidents. Journal of Marketing 54,
7184.

1390

Bourdieu P (1986) The forms of capital. In


Handbook of Theory and Research for
the Sociology of Education (Richardson
JG ed.). Greenwood, New York, pp.
241258.
Bozionelos N (2008) Intra-organizational
network resources: how they relate to
career success and organizational commitment. Personnel Review 37, 249
263.
Brief AP & Motowidlo SJ (1986) Prosocial
organizational behaviors. Academy of
Management Review 11, 710725.

Brown DR & Harvey DF (2006) An Experiential Approach to Organization


Development. Pearson Prentice Hall,
Upper Saddle River, N. J.
Brown TJ, Mowen JC, Donavan DT &
Licata JW (2002) The customer orientation of service workers: personality
trait effects on self-and supervisor performance ratings. Journal of Marketing
Research 39, 110119.
Cannuscio C, Block J & Kawachi I (2003)
Social capital and successful aging: the

 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392

Workforce issues
role of senior housing. Annals of
Internal Medicine 135, 395399.
Carlson ED & Chamberlain RM (2003)
Social capital, health and health disparities. Journal of Nursing Scholarship
35, 325331.
Castle NG (2006) Organizational commitment and turnover of nursing home
administrators. Health Care Management Review 31, 156165.
Chin WW, Marcolin BL & Newsted PR
(2003) A partial least squares latent
variable modeling approach for measuring interaction effects: results from a
Monte Carlo simulation study and an
electronic-mail emotion/adoption study.
Information Systems Research 14, 189
217.
Clarke SP & Aiken LH (2008) An international hospital outcomes research
agenda focused on nursing: lessons
from a decade of collaboration. Journal
of Clinical Nursing 17, 33173323.
Coleman JS (1988) Social capital in the
creation of human capital. American
Journal of Sociology 94, 95120.
Cowley S & Billings JR (1999) Resources
revisited: salutogenesis from a lay perspective. Journal of Advanced Nursing
29, 9941004.
DiCicco-Bloom B, Frederickson K, OMalley D, Shaw E, Crosson JC & Looney
JA (2007) Developing a model of social
capital: relationship in primary care.
Advances in Nursing Science 30, E13
E24.
Doney PM & Cannon JP (1997) An examination of the nature of trust in
buyerseller relationships. Journal of
Marketing 61, 3551.
East L (1998) The quality of social relationships as a public health issue:
exploring the relationship between
health and community in a disadvantaged neighbourhood. Health and
Social Care in the Community 6, 189
195.
Ford RC & Fottler MD (2007) Creating
customer-focused health care organizations. Health Care Management Review 32, 1833.
Ford RC, Bach SA & Fotler MD (1997)
Methods of measuring patient satisfaction in health care organizations.
Health Care Management Review 22,
7489.
Fornell C & Larcker DF (1981) Evaluating
structural equation models with unob-

Prosocial behaviour of hospital nurses


servable variables and measurement
error. Journal of Marketing Research
18, 3950.
Gormley DK & Kennerly S (2010) Influence
of work role and perceptions of climate
on faculty organizational commitment.
Journal of Professional Nursing 26,
108115.
Greggs-McQuilkin D (2004) The stressful
world of nursing. Medsurg Nursing 13,
141189.
Gregory DM, Way CY, LeFort S, Barrett
BJ & Parfrey PS (2007) Predictors of
registered nurses organizational commitment and intent to stay. Health
Care Management Review 32, 119
127.
Grootaert C, Narayan D, Jones VN &
Woolcock M (2004) Measuring Social
Capital: An Integrated Questionnaire.
World Bank Social Capital Thematic
Group, Washington.
Hulland J (1999) Use of partial least squares
(PLS) in strategic management research:
a review of four recent studies. Strategic
Management Journal 20, 195204.
Kowalski C, Ommen O, Driller E, Ernstmann N, Wirtz MA, Kohler T & Pfaff
H (2010) Burnout in nurses-the relationship between social capital in hospitals and emotional exhaustion.
Journal of Clinical Nursing 19, 1654
1663.
Kritsotakis G & Garmanikow E (2004)
What is social capital and how does it
relate to health? International Journal
of Nursing Studies 41, 4350.
Laschinger HKS, Finegan J & Shamian J
(2008) The impact of workplace
empowerment, organizational trust on
staff nurses work satisfaction and
organizational commitment. Health
Care Management Review 33, 723.
Leana CR & Pil FK (2006) Social capital
and organizational performance: evidence from urban public schools.
Organization Science 17, 353416.
Lee YK, Nam JH, Park DH & Lee KA
(2006) What factors influence customer-oriented prosocial behavior of
customer-contact
employees?
The
Journal of Services Marketing 20, 251
264.
Liou SR & Cheng CY (2010) Organisational climate, organisational commitment and intention to leave amongst
hospital nurses in Taiwan. Journal of
Clinical Nursing 19, 16351644.

 2011 Blackwell Publishing Ltd, Journal of Clinical Nursing, 20, 13831392

Looman WS (2006) Developing and testing


of the social capital scale for families of
children with special health care needs.
Research in Nursing & Health 29, 325
336.
Looman WS & Lindeke LL (2005) Health
and social context: social capitals utility as a construct for nursing and health
promotion. Journal of Pediatric Health
Care 19, 9094.
Lu KY, Chang LC & Wu HL (2007) Relationships between professional commitment, job satisfaction and work
stress in public health nurses in Taiwan.
Journal of Professional Nursing 23,
110116.
MacKenzie SB, Podsakoff PM & Ahearne
M (1998) Some possible antecedents
and consequences of in-role and extrarole salesperson performance. Journal
of Marketing 62, 8798.
McNeese-Smith DK (2001) A nursing
shortage: building organizational commitment among nurses. Journal of
Healthcare Management 46, 173187.
Moen , Madsen TK & Aspelund A (2008)
The importance of the internet business-to-business markets. International
Marketing Review 25, 487503.
Mowday RT, Steers RW & Porter LW
(1979) The measurement of organizational commitment. Journal of Vocational Behavior 14, 224247.
Nahapiet J & Ghoshal S (1998) Social capital, intellectual capital and the organizational advantage. The Academy of
Management Review 23, 242266.
Orton JD & Weick KE (1990) Loosely
coupled systems: a reconceptualization.
Academy of Management Review 15,
203223.
Pearce N & Smith GD (2003) Is social
capital the key to inequalities in health?
American Journal of Public Health 93,
122129.
Porter LW, Steers RM, Mowday RT &
Boulian PV (1974) Organizational
commitment, job satisfaction and
turnover among psychiatric technicians.
Journal of Applied Psychology 59, 603
609.
Putnam RD (1993) The prosperous community: social capital and public life.
American Prospect 13, 3542.
Ravlin E & Meglino B (1987) Issues of work
values measurement. Research in Corporate Social Performance and Policy
9, 153183.

1391

C-P Hsu et al.


Reed KK, Srinivasan N & Doty DH (2009)
Adapting human and social capital to
impact performance: some empirical
findings from the U.S. personal banking
sector. Journal of Managerial Issues 21,
3659.
Rodwell J, Noblet A, Demir D & Steane P
(2009) The impact of the work conditions of allied health professionals on
satisfaction, commitment and psychological distress. Health Care Management Review 34, 273283.
Rousseau D, Sitkin S, Burt R & Camerer C
(1998) Not so different afterall: a cross

discipline view of trust. Academy of


Management Review 23, 393404.
Seibert SE, Maria LK & Robert CL (2001)
A social capital theory of career success.
The Academy of Management Journal
44, 219237.
Smith KG, Smith KA, Olian JD, Sims JHP,
OBannon DP & Scully JA (1994) Top
management team demography and
process: the role of social integration
and communication. Administrative
Science Quarterly 39, 412438.

Starbuck WH (1983) Organizations as action generators. American Sociological


Review 48, 91102.
Tsai W & Ghoshal S (1998) Social capital
and value creation: the role of intrafirm networks. Academy of Management Journal 41, 464476.
Watson GW & Papamarcos SD (2002)
Social capital and organizational
commitment. Journal of Business
Psychology 16, 537551.
Whitney J (1994) The Trust Factor.
McGraw-Hill, New York.

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