PS - IJPAR - Public Service Motivation and Public Service Behaviour

Journal of Public Administration Research and Theory Advance Access published August 5, 2016
Journal of Public Administration Research And Theory, 2016, 1–16

doi:10.1093/jopart/muw045
Article
Article
Public Service Motivation and Public Service

Behaviors: Testing the Moderating
Downloaded from http://jpart.oxfordjournals.org/ at Periodicals Dept University Libraries Northern Illinois University on August 5, 2016
Effect of Tenure
Ulrich Thy Jensen,* Christian Fischer
Vestergaard†
*Arizona State University;
†
Epinion
Abstract
Providers of public services are expected to act upon their motivation to deliver public service
with the purpose of doing good for others and society (public service motivation [PSM]). While
existing studies seem to support this claim, methodological shortcomings question the validity
of their conclusions. We analyze the relationship between PSM and the use of home visits among
Danish general medical practitioners (GPs) using a panel research design to examine how
changes in PSM dimensions relate to changes in objectively measured public service behaviors.
We show that GPs alter their public service behaviors according to changes in their level of
self-sacrifice and compassion, as predicted by PSM theory. Importantly, we also find that
behavioral effects are conditional on tenure. Longer-tenured GPs alter their public service
behaviors less strongly in response to changes in their level of PSM. The findings imply that PSM
is malleable and that PSM is a particular workable lever in changing public service behaviors
among shorter-tenured public service providers.
Introduction matters to the provision of specific public services.

Public service motivation (PSM) refers to the energetic For instance, do public service motivated doctors
force that induces individuals to engage in public ser- expend extra effort to help their patient and society?
vice behavior intended to increase the well-being of Or do teachers with high PSM perform more activi-
other people and society (Brewer and Selden 1998). ties that they think will benefit students and society
Much research has centered on the consequences of at large? Furthermore, existing studies primarily rely
PSM for attitudinal and behavioral outcomes such as on cross-sectional research designs, rendering the
organizational commitment, job involvement, organi- behavioral consequences of changes in individual
zational citizen behaviors (Gould-Williams, Mostafa, PSM (“PSM change”) unexplored. This is especially
and Bottomley 2015; Pandey, Wright, and Moynihan warranted because PSM does seem to be changeable
2008), and performance (Andersen, Heinesen, and (e.g., Kjeldsen and Jacobsen 2012), and this begs the
Pedersen 2014). Indeed, Brewer emphasizes its behav- question whether and when public service providers’
ioral outcomes as “the most important result of pub- behaviors can be managed through PSM change.
lic service motivation” (2008, 136). However, little To date, only a few studies have directly examined
research has rigorously investigated whether PSM the relationship between PSM and specific services,
and their results are mixed. For example, Andersen
The authors would like to thank Lotte B. Andersen and Søren and Serritzlew (2012) demonstrate a positive asso-
Serrtizlew for careful reading and valuable suggestions to earlier ciation between “commitment to the public inter-
versions of this article. Address correspondence to the author at est” and the share of disabled patients among Danish
ulrichthy@gmail.com.
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2 Journal of Public Administration Research and Theory, 2016, Vol. xx, No. xx
Journal of Public Administration Research and Theory, 2016, Vol. xx, No. xx 3
physiotherapists, but sequences of PSM rely design to examine are provided to benefit
find no association on cross-sectional data whether and when individual patients as
between this dimension (Wright changes in individual well as society at large,
of PSM and the level of 2008), we use repeated PSM relate to changes in and this makes PSM a
services provided to this measures of PSM and the provision of likely source of
group of patients. One objectively measured specific medical health motivation for their
important reason for the behaviors of individual services provided by provision. Second, GPs
mixed findings of public service provid- individual Danish are remunerated for
existing studies into the ers. Measuring PSM and general medical specific services, making
behavioral implications behavior at one point in practitioners (GPs). it possible to obtain very
of PSM might concern time without any We test the reliable data on their
omitted contextual manipulation of the relationship between behavior. Administrative
factors. For example, former is problematic PSM change and change data are also beneficial
studies have because it makes it very in public service because independent
demonstrated the difficult to assess whether provision among Danish data sources mitigate
importance of a “fit” PSM shapes individual GPs for several reasons. concerns for common
between perceived actions (Wright and First, primary health method bias (Meier and
societal impact of one’s Grant 2010). For care services O’Toole 2012). Third,
job and PSM for example, cross-sectional we restrict our sample
desirable outcomes research designs often to single-owner clinics,
(Bellé 2013; Grant require scholars to and this allows us to link
2008), but a wider gather information on PSM and the behavior of
range of situa- tional all potential confounders individual GPs almost
and structural factors to eliminate omitted unambiguously. Fourth,
can be equally valid variable bias. These Danish GPs perform a
deter- minants of public challenges pertain to specific service where
service behaviors. In this most studies on PSM medical practitioners
article, we take a first and behavior and make consult and treat weak
step to explore not only it very warranted for and elderly patients in
whether but also when scholars to design more their homes, termed
change in PSM matters robust tests of the PSM- home visits. Home vis-
to changes in objectively behavior link. One way its are poorly
measured behaviors of to build stronger tests is remunerated compared
individual public service to utilize repeated to the resources invested
providers. Specifically, measures of PSM and by GPs in performing
we propose that tenure individual actions over this type of service, and
moderates the time, often referred to we therefore suspect that
relationship between as panel data. Panel data the other-regarding
PSM and public service make it possible to objectives associated
behaviors. That is, the assess how individuals with PSM may be an
relationship between respond in terms of important driver for this
PSM change and changes behavioral disposi- tions service. Finally, the level
in public service to exogenously driven of PSM changed among
behaviors is weaker for changes in PSM and many Danish GPs in
longer- tenured workers allow researchers to 2013, enabling us to
compared to workers control for all time- estimate the behavioral
with fewer years of invariant confounders effects of within-GP
service. The proposition using fixed effects variation in PSM.1
rests on our argument regressions at the Drawing on a two-
that individuals will individual or wave panel research
become “locked in” to organizational level. design, we examine how
specific work routines However, no study has, PSM change relates to
and standardized to our knowledge, changes in public
patterns of actions as evaluated the attitudinal service behaviors among
they accumulate or behavioral outcomes the Danish GPs through
experiences in their of PSM using this type a series of panel fixed
specific job settings. of design. Our aim is effects models.
Although most therefore to build on Our aim with this
studies probing the existing studies and article is thus to offer
behavioral con- employ a panel research two main contributions.
Theoretically, we conflict, the Danish

Parliament prolonged the
explain why PSM
existing terms for a 1-year
cannot be expected to period by law in July 2013. To
uniformly change the test whether PSM is
behaviors of public differently related to behavior
service providers. for the two time periods (due
to unobserved variables
Specifically, we detail
correlated with the conflict),
how tenure—a personal we included an interaction
but job-related term between PSM and the
characteristic— time dummy. The results do
conditions the not differ from table 1, and the
interaction term is not
behavioral effects of statistically significant.
PSM change.
Methodologically, we
offer a first study using
repeated measures of
PSM and individual
public service behav-
iors. This type of
research design is
promising for public
management scholars
because it enables
researchers to implement
a rigorous control for
time-invariant
confounders and allows
us to study
developments in key
constructs over time.
To unfold these
contributions, the
article pro- ceeds as
follows. First, we will
outline the theoretical
framework and discuss
why and when we
expect PSM to affect the
behavior of public
service providers.
Following a description
of the research context
and the methodology
applied in the study, we
will test our hypotheses
through a series of panel
fixed effects models.
We conclude the article
with a discussion of the
1 Recent studies suggest that

PSM malleable (e.g., Kjeldsen and
Jacobsen
2012). Here, PSM could vary
for a number of reasons. For
example, a conflict between
politicians (national and
regional) and GPs broke out
over a renewal of an
expiring contract. After failed
negotiations and months of
main contributions, for others and society” and society as their effect of PSM change
central limitations, and (2009, 6). In line with level of PSM increases. on the decision-
implications for these understandings, However, as noted by making and actions of
research and practice. much research has scholars, the dimensions individual public service
focused on the of PSM (i.e., “com- providers.
behavioral consequences mitment to the public
T of individual PSM. interest,” “compassion,” The Public Service
h Public service providers, “attraction to public Motivational Bases
e it is argued, respond to policymaking,” and of Individual
o and act upon their “self-sacrifice”) are B
r motives for delivering distinct, and they are e
e h
public service when likely to have different
t a
their jobs provide them antecedents and v
i implications (Kim and
with opportunities to i
c Vandenabeele 2010).
serve the public interest, o
a r
exert compassion and Consequently, we
l
care for other people, approach PSM as a A fundamental
elevate their attraction to multidimensional assumption in PSM
F construct to be able to research is that public
policymaking, and
r
sacrifice selfish elucidate how we should service motivated
a
considerations to the expect each dimension to individuals expend
m
benefit of others and relate to the provision of greater effort because
e
society. Importantly, specific medical health public service work
w
o PSM is only expected to care services by the provides opportunities
r cultivate actions that the GPs. Finally, we to perform tasks that
k individual sees as elaborate on the are meaningful and sig-
prosocial (Andersen and argument that tenure as nificant to others and
PSM has been described a central personal and society (Perry,
Serritzlew 2012), and
in different ways (see job-related Hondeghem, and Wise
these are likely to differ
Bozeman and Su 2015 characteristic conditions 2010). As emphasized
between people (Schott,
for an overview) since the by Perry and Wise, sig-
van Kleef, and Steen
Perry and Wise first nificant tasks include
2015). Following
defined it as “an those “that provide
Andersen and Serritzlew
individual predisposition opportunities to
(2012), we study
to respond to motives address questions of
professionals belonging
grounded primarily or social equity, to express
to the same occupation
uniquely in public insti- loyalty to country, to
because members share
tutions” (1990, 368). advocate a valued
theoretical and
Common to most special interest, or to
normative foundations
understandings is that pursue social programs”
and are socialized to a
PSM encompasses a (1990, 371). These
homogenous set of
motivation for considerations resemble
values and perceptions
individuals to engage in three of the four PSM
through the course of
public service delivery dimensions identified
extensive education and
with the purpose of by Perry in 1996:
training. Given that
doing good for others “commitment to the
medical health care
and society. public interest,”
services benefit patients
Accordingly, Brewer and “compassion,” and
and society at large,
Selden defined PSM as “attraction to
public service motivated
“the motivational force policymaking.” The last
GPs face opportunities
that induces individuals dimension, “self-
in their jobs to express
to perform meaning- sacrifice,” represents the
and fulfill their altruistic
ful public service” willingness to set one’s
motives for public
(1998, 417), and own needs aside to
service delivery. In other
Hondeghem and Perry improve the well-being
words, we generally
more recently described of others and society.
expect GPs to expend
PSM as “an individual’s To engage in public
extra effort in providing
orientation to delivering service delivery,
medical health care
service to people with the individuals should be
services to increase the
purpose of doing good willing to substitute
well-being of patients
service to others for However, what is seen as

tangible personal desirable for society at
reward (Perry 1996), large does not necessarily
and self-sacrifice has equal what GPs or other
consequently been seen public service providers
as the altruistic founda- see as desirable for
tion for the other specific users or groups
dimensions (Kim and of users. This is the case
Vandenabeele when a specific service
2010, 703–4). For GPs, entails negative
self-sacrifice externalities for society
encompasses a at large. For example,
fundamental will to Jensen and Andersen
expend extra effort on (2015) recently demon-
the job even if it comes strated how prosocial
at personal costs. Clear motivations to do good
examples are the trade- for individual patients
off between time at and society, respectively,
work and time for lei- can give rise to very
sure, or GPs who different behavioral
prioritize labor- implications among
intensive, but poorly GPs.
remunerated services
(especially, since the
surplus in single-owner
clinics equals the salary
of the GP). On this
basis, Brænder and
Andersen recently
described self-sacrifice
as “pure fuel behind
prosocial actions”
(2013, 468).
Commitment to the
public interest,
compassion, and
attraction to
policymaking can be
linked to norm- based,
affective, and rational
motives for public
service, respectively
(Perry and Wise 1990).
First, norm-based
motives entail
motivation to do good
for others and society
based on values and a
sense of obligation to
society. In essence, it
concerns “compliance
with social norms
regarding appropriate
behavior and societal
contributions”
(Andersen, Heinesen,
and Pedersen 2014,
653) and depicts a
powerful motivation to
do “what is right.”
The public interest thus likely invest more energy an illustrative example other things, these
constitutes more than in improving the well- in our case, GPs can associations are
the sum of prevalent being of patients participate in local and concerned with the
interests (Wise 2004) and belonging to these regional working education of GPs and
a commitment to groups. As an example, groups or committees. the development and
advance the public which we will test Committees, for revision of professional
interest does not empirically in this example, are staffed standards and guidelines
necessarily comply with article, GPs who with politicians, civil for clinical work. The
motivation based on experience a change in servants, and GPs, and raison d’être of
affective identification their level of compassion work to improve quality professional standards
with particular groups are expected to prioritize and education in clinics. and medical guidelines
of beneficiaries of public the provision of Hence, participation in is to ensure a high
services. In other words, specific services that these kinds of decision- quality of treatment for
the behavioral improve the well-being making processes may patients. To engage in
implications of a of weak or elderly be one way for GPs to formulation and
change in commitment patients accordingly. indirectly affect the ser- decision-making
to the public interest Feeling empathy for vice to patients and processes around the
might differ from the people in distress, such society. Another example development and
behavioral implication as underprivileged or concerns participation revision of such
following a weak groups, thus in GP professional standards and guidelines
corresponding change in constitutes a basis for associations. Among thus constitutes
public service providers’ public service delivery another way for GPs to
compassion. (Perry 1996) and for exert their attraction to
Second, affective engaging in interpersonal policymaking and
motives reflect the helping behaviors contribute (indirectly) to
motivation to engage in (Wright and Grant the well- being of
meaningful public 2010). patients and society.
service based on an Third, rational
affective bond and motives refer to the A Contextual Model
identification with the motivation to do good of PSM Change and
recipients who benefit for others and society Individual
from the public service through participation in B
eh
provision. An affective decision-making av
bond captures the processes. Although io
emotional state of early research tied r:
empathy and “attraction to T
identification with policymaking” to en
specific underprivileged excitement and ur
e
or weak groups, making reinforcement of one’s as
empathy a powerful image of self-importance a
motivator to do good (Perry M
for such groups (Kim 1996), later research o
and Vandenabeele has interpreted de
2010). Empathy participation in ra
to
denounces other- decision-making
r
oriented emotional processes as a means to
Whether the focus is on
response to the perceived improve public service
individual dimensions of
welfare of other people delivery to the greatest
PSM or on PSM as an
(Batson 1987), and number of people
aggregate construct,
compassionate GPs possible (e.g., Kjeldsen
studies that aim to
could empathize with 2014). Although this
explain the behavioral
particular patient dimension is the most
implications of prosocial
groups who are in need contended (Kim and
motivation need to
of special care or Vandenabeele
carefully consider the
attention. Children, 2010) and has
potential contextual
elderly, or disabled consistently proven
factors of this complex
patients may constitute difficult to validate (Ritz
relationship. Even among
such groups, and GPs 2011), its theoretical
fairly homogenous
who become more relevance seems
groups of public service
compassionate will nonetheless apparent. As
providers such as GPs, specific to their job (Bird

the behavioral 1994). In other words,
implications of PSM public service providers
change are likely not accumulate experiences
uniform but conditional with respect to specific
on factors relating to the job portfolios over time.
individual GP and the Human capital theory
patients. Unfortunately, (Becker
very little research has 1964) expects
disentangled the education and on-the-
potential contingencies job training to feed
of the relationship back to behaviors of
between PSM change and individuals because
changes in the behaviors people cannot be
of individual public separated from their
service providers. knowledge and skills.
Drawing on human Although GPs share
resource management formal education,
literature, we take a knowledge and
first step in this experiences related to
direction by their job and specific
highlighting how tenure tasks are further
can constitute an developed on the job and
important job-related therefore depend on
factor influencing the hands-on experiences in
extent to which PSM the clinics. For these
change results in reasons,
behavioral changes
among public service
providers.
Tenure refers to the
length of employment in
a job or in an
organization (McEnrue
1988). Although it can
be useful to distinguish
between tenure in a job
and in an organization
(Ng and Feldman 2010),
this is closely tied to the
specific empirical
context. For GPs, the
length of employment
(years as a GP) and
years they have owned
their clinics are often
highly correlated, but
this will not be the case
for other occupa- tions
with substantive
turnover rates. Tenure
captures accumulated
events that individual
public service providers
experience in their
work, and by remaining
in the same work setting
for additional years,
individuals develop more
skills and knowledge
increasing levels of on whether or not to changes in their on tenure. We elaborate

human capital should be provide specific medical motivation for guiding on the testable
accumulated with more services involves large decision-making and implications of this
experience and training degrees of discretion, actions. This implies that argument in our case of
on the job enabling and past decisions can changes in PSM or one GPs in the section on
longer-tenured workers serve as points of of the individual “Research Context and
to employ these reference or informa- dimensions do not affect Hypotheses” below.
resources (“capital”) to tion cues for decision- the behaviors of public
perform well in their making in similar service providers Wh
jobs. However, in a situations. The result is similarly or, more at
specifically, that the Do
comprehensive meta- that individual public
Exi
analysis of 350 empirical service providers’ effect of PSM change on
stin
studies, Ng and courses of action changes in the behaviors g
Feldman (2010) actually become more of individual public Stu
find a stronger tenure- standardized and sus- service providers is die
performance ceptible to routines as conditional s
Tell
relationship for younger the number of prior
Us
workers. Although the events and knowledge ?
authors demonstrate a accumulates over time. Before we introduce the
positive tenure- One way to frame this specific research context
performance effect is in term of path and outline testable
relationship in general dependency; that is, implications of our
(Ng and Feldman public service theoretical argu- ments,
2010, 1234–6), the providers become we survey existing studies
association is weaker “locked in” to specific to inform our hypoth-
for long- tenured work routines and eses. Although no studies
workers. One potential standardized patterns of have studied the
explanation is that actions as they relationship between
individuals not only accumulate experiences PSM change and change
develop more knowledge in their specific job set- in specific public ser-
as they remain in the tings. However, we vice behaviors, a large
same work setting might also see the same number of studies offer
performing the same set effect as an expression evidence on the
of job tasks, but that of a more informed relationship between
longer-tenured public choice. The provision of PSM and behavioral
service providers also many public services is outcomes in cross-
succumb to more a product of complex sectional settings (see
stable patterns of processes, and past Ritz, Brewer, and
actions for the very experiences may make Neumann 2016 for a
same reasons. Following public service providers review). For instance,
this rea- soning, we more certain about their PSM has been linked to
argue that public service specific choices in self-reported behaviors
providers rely on past similar situations. such as whistle blowing
experiences in their Regardless of the (Brewer and Selden
decision-making and that perspective, one 1998), voluntary actions
this makes their course implication of this such as donating blood
of action less responsive argument is that (Houston 2006),
to changes in individual public organizational citizen
motivational factors as service providers who behaviors (Gould-
the number of past have stayed longer in a Williams, Mostafa, and
events and knowledge in specific work setting Bottomley 2015), and
a job setting accumulates will rely more on time invested in the job
over time. The core of accumulated knowledge (Pedersen
this argument is that and past experiences 2014). Although these
public service pro- in their job. This is studies suggest that PSM
viders explicitly or relevant for PSM theory guides individual
implicitly make decisions because longer-tenured behavior, a number of
based on prior events of public service providers shortcomings challenge
similar nature. For GPs, may, as a consequence, their conclusions. Most
for example, decisions be less responsive to
importantly, PSM and PSM and specific health

many of the behaviors services provided by
sketched above can be Danish physiotherapists.
subject to socially Disabled patients are
desirable answers, and seen as particularly
this increases the risk “worthy” of treatment
that parts of the observed by the physiotherapists,
relationships can be due but they are not
to a common source accompanied by a subsidy
(i.e., the individual to com- pensate for the
providing answers on extra time required to
both the independent treat this group of patients
and dependent (2012, 22–3). The
variables) (Podsakoff et authors show that
al. 2003). This is physiotherapists with
potentially problematic high commitment to the
because correlated error public interest prioritize
terms due to common this group of patients to
source can produce false some extent, but the
positives (Meier and same physiotherapists do
O’Toole 2012), and not seem to provide more
statistical remedies offer services or consultations
little help (Favero and to this group of patients
Bullock 2015). (2012, 25–6).
To tackle this
challenge and shed more
light on the PSM-
behavior link, a few
studies have recently
begun to investigate
whether PSM cultivate
job-related actions of
public service providers
using independent data
sources for PSM and
behavior (e.g., Andersen
and Serritzlew
2012). For example,
Andersen and colleagues
(2014) demonstrate a
positive relationship
between individual
teacher PSM and student
performance in terms of
exam marks. The study
shows that public
service motivated
teachers likely raise their
students to higher levels
of aca- demic
performance, but it
cannot detail the outputs
(or teachers’ activities)
that lead to this
outcome. Drawing on
information from
multiple registers and
survey data, Andersen
and Serritzlew examine
the relationship between
Although these of a specific health care our first hypothesis: As noted by Wright and
results suggest that service (home visits) to Grant (2010), PSM
PSM can matter to patients. In Denmark, H1a: A change in GP dimensions may be
public service provision, GPs are self-employed self-sacrifice is more or less important
cross-sectional research specialists who work positively related for different tasks.
designs place extensive according to a contract with a change in Compassion may, for
requirements on with the five regional the number of instance, influence
researchers to gather bodies of Denmark. As home visits interpersonal helping
information on all part of the contract, GPs provided. behaviors most directly,
alternative independent are remunerated with a whereas self-sacrifice
variables in order to fixed amount per capita may have a stronger
mitigate risks of omitted and a per-service fee that impact on working
variable bias. A main differs for different longer hours (Wright
strength of this article is services (RLTN and PLO and Grant 2010, 697).
that it utilizes a more 2010). GPs perform a Compassionate GPs
complex research design variety of medical could empathize with
that helps us ease this health care services to groups of patients who
methodological patients, and we are weak or in need of
challenge and allows us operationalize behavior special care and
to test more com- as individual GPs’ use of consequently invest
prehensively whether home visits. A home more time and energy in
PSM change results in visit is a service whereby performing services that
changes in the provision GPs leave their clinics to benefit these patients.
of specific public services consult and treat elderly Empathy is a powerful
and whether the PSM- and weak patients. motivator (Batson
behavior link is Patients may be too 1987), and affective
moderated by tenure. weak or in other ways identification with par-
Specifically, the study limited in their abilities ticular groups of
uses repeated measures to go to their local beneficiaries can be
of individual PSM and clinic for treatment, and expected to make GPs
individual behavior their health conditions prioritize services that
that are clearly thus rely extensively on improve the well-being
separated in time, GPs’ prioritizations of of such groups.
employs an objective this service. This also Accordingly, we
indicator of individual makes home visits a hypothesize as follows:
behavior, and handles time-demanding service
H1b: A change in GP
selection effects and as GPs may have to
compassion is
other time- invariant travel substantial
positively related
confounders using fixed distances to perform the
with a change in
effects models (at the service. Given that home
the number of
GP level). Before we visits are intended to
home visits
discuss the methods and increase the well-being of
provided.
data in more detail, we patients and society, but
outline the research time-consuming for Providing primary health
context and set forth GPs to perform, we care services on a daily
hypotheses to be tested expect self-sacrifice to be basis, GPs are generally
in the analysis. an important driver of provided with
this service. As argued, opportunities to exert
self-sacrifice denotes the and fulfill their public
Research Context willingness to substitute service motives.
and Hypotheses: a service to others for a However, as noted by
Danish GPs and Use tangible personal reward scholars, PSM is only
of Home Visits (Perry 1996), and GPs expected to cultivate
In this article, we may thus prioritize actions that the
examine the labor-intensive but individual public service
relationship between poorly remunerated provider sees as desirable
changes in individual services differently for society at large.
medical health following a change in Commitment to the
practitioners’ PSM and their level of self- public interest denotes
changes in their provision sacrifice. This leads to
the motivation to expected to see home

advance the interest of a visits as the most
society as a collective efficient way to improve
entity. In this respect, the public service provision.
public interest constitutes As exemplified in the
more than the sum of theoretical section,
prevalent interests (Wise these GPs are more
2004), and it does not likely to try to improve
necessarily equate what the quality of public
GPs or other public services indirectly
service providers see as through the
desirable for specific participation in
users or groups of users committee work to
(see Jensen and Andersen improve education
2015 for an example).
Accordingly, for GPs, a
commitment to advance
the public interest entails
a decision on how to
make the greatest
contribution to society
given finite time and
resources to perform
clinical activities. In this
perspective, home visits
represent a very time-
consuming substitute
for regular consultations
to a larger number of
patients. In other words,
providing home visits
does not constitute the
most efficient way to
increase the health status
of the population more
broadly, and we
therefore expect GPs to
prioritize other medical
services over home
visits in their
commitment to advance
the public interest in
maintaining an efficient
primary health care
system and a high level
of health for as many
citizens as possible.
GPs with an
attraction to
policymaking face the
same dilemma. Given
finite time and
resources, how does the
individual GP contribute
to improve the well-
being of the greatest
number of patients
possible? GPs who are
attracted to
policymaking are not
and quality in all clinics behaviors. Most g we have designed our

or in the formulation or decisions made by GPs n study as a panel study
revision of medical —including those on When investigating the combining repeated
guidelines. In these ways, providing a home visit or relationship between survey data on individual
commitment to the not—involve large GPs’ PSM and their GPs’ PSM and register
public interest and degrees of discretion, and behavior, a number of data on the number of
attraction to it is very likely, in our methodological chal- home visits provided by
policymaking can both view, that GPs rely on lenges arise. Self-reports the GPs to patients.
be interpreted as past events and routines on behavior are The first strength of
motivations concerned established through potentially unreliable; our panel research
with the improvement of extensive experience asking respondents to design is that it enables
public service to the with specific job tasks report their PSM and us to study the
greatest number of to guide such decisions. behavior in the same development in PSM
people. As home visits For these reasons, questionnaire risks dimensions over time
are likely not to be per- longer-tenured GPs will introduc- ing common and assess the
ceived by the GPs as the rely more extensively on source bias, and cross- implications of such
most efficient way to this prior experiences and sectional research changes for changes in
end, we hypothesize as routines when deciding to designs make it difficult the behavior of
follows: perform a service or to implement a rigorous individual public service
not. Thus, a testable control for potential providers. However, it
H1c: A change in GP implication of our confounders. To address is important to note that
commitment to the theoretical argument is these challenges, the panel design does
public interest is that the relationship not permit us to rule out
negatively related between a change in risks of reverse
with a change in PSM dimensions and a causality, that is, that
the number of change in GPs’ public the provision of home
home visits service behaviors— visits shapes GPs’
provided. whether positive or motivation to do good
H1d: A change in GP negative—will be weaker for others and society.
attraction to for longer-tenured GPs Separating PSM and
policymaking is compared to GPs with behavior in time is
negatively related fewer years of service. important, and we
with a change in This leads to our final therefore measured
the number of hypothesis: behavior after the survey
home visits data on PSM were
H2: A positive or
provided. collected. Although this
negative does not eliminate the
For all four dimensions association between threat of reverse
of PSM, we generally PSM change and a causality, it does
expect the relationship change in the increase our confidence
between PSM change number of home that changes in GPs’
and change in the visits provided will PSM precede changes in
provision of home visits be weaker for GPs their behavior. Second,
to be weaker for GPs with longer tenure we can apply a “GP”
with longer tenure (i.e., compared to GPs fixed effects approach,
more years of service) with shorter tenure. and this allows us to rule
compared to GPs with out a number of
shorter tenure (i.e., R alternative explana- tions
fewer years of service). e by looking at the
Our theoretical s changes over time in
argument presented e PSM and behavior for
above implies that GPs a each GP only. For
will be less responsive r example, the distribu-
to a change in their c tion of GPs in clinics is
level of PSM as they h not random, and if
remain in their job and high-PSM GPs
accumulate knowledge D systematically self-select
and past experiences to e into clinics in areas with
guide their present s demographic
decision-making and i compositions susceptible
to home visits (e.g., a and behaviors when

high proportion of old responding to survey
citizens), we are likely to questions (Zerbe and
overestimate an effect of Paulhus 1987). Given
PSM. Using only within- that the underlying
subject (GP) variation to individual tendencies to
estimate the relationship answer the same set of
between PSM change questions in socially
and change in behavior, desirable ways can be
we are able to handle expected to be time
nonrandom sorting invariant, our design
patterns and, more effectively mitigates this
generally, keep constant bias. As our sample only
all observable or includes GPs who are
unobservable time- single owners
invariant characteristics
of the GP. In this
respect, examining how
changes in PSM
dimensions relate to
changes in provision of
home visits for
individual GPs
remaining in the same
clinic over time handles
two other often-
mentioned concerns in
PSM studies. Individual
conscientiousness is
often mentioned as a
potential confounder in
studies on PSM and
outcomes because
conscientious individuals
invest more time and
energy in their jobs, and a
sense of duty and
responsi- bility toward
others are defining
features of this per-
sonality trait (Wright and
Grant 2010, 695).
However, personality
traits such as
conscientiousness are
argu- ably very stable
over time (McCrae and
Costa 1994), and our
panel research design
thus helps us to miti-
gate this concern.
Similarly, a common
issue in PSM research
concerns social
desirability bias (Kim
and Kim 2015), that is,
situations in which
individuals con- form to
social norms about
appropriate attitudes
and providers, GP fixed 2013, respectively. The Objective behavioral the register information
effects also include questionnaires were indicators also increase on individual behavior
control for variables at sent by e-mail or by a the validity and can be linked almost
higher levels (clinic and letter, containing a reliability of our data as unambiguously to
municipality fixed unique key to access the they entail little to no individual motivation
effects), which are questionnaire online. perceptual errors. as measured in the
constant over the 8- 1,151 GPs were invited Restricting our sample surveys. Specifically, data
month period of to participate in the to GPs who are sole span the number of
investigation. Drawing April survey, equaling all owners and suppliers on home visits performed
on repeated measures Danish GPs registered as a specific supplier permit by each GP in May and
of individuals’ PSM and sole owners and ensures that June 2013 (time = 0)
behavior over time thus suppliers on a supplier and in October and
provides us with permit at the end of 2 Results are available November 2013 (time =
important leverage over 2012. 407 completed upon request to the 1). Recall that surveys
corresponding author.
alternative designs such the survey, were completed in April
as cross-sectional corresponding to a and September 2013;
research designs as it response rate of 35%. we selected these months
effectively enables us to When the survey was to ensure correct time
eliminate all observable repeated in September order of variables. We
and unobservable 2013, 213 or 52% of choose two consecutive
time-invariant the 407 GPs completed months in each time
confounders. Finally, an the questionnaire. period to reduce the
important consideration Analysis suggests that random fluctuations in
is whether GPs provide GPs did not differ use of home visits that
changes in their systematically from the may be associated with
behavior, that is, population on gender, one particular month.
provide more or less age, or geographical The patient panel
home visits, according loca- tion, neither in the contains information on
to changes in their level first nor in the second the number of home
of PSM, or if the round.2 As noted by visits provided to the
changes follow from a scholars, public service entire group of patients
substitution of time and motivated individuals affiliated with a specific
energy away from other may be more inclined GP/clinic. This is a
services. To shed light to participate in strongpoint of our case
on potential substitution surveys (Houston 2006, because any attrition is
mechanisms, we include 68). Although this could completely exog- enous
information on GPs’ use explain the higher of our methodological
of the single most response rate in the approach.3
common service September survey, it
(regular consultations). also introduces a M
This allows us to potential bias that may e
investigate whether PSM limit the gener- a
s
change is related to alizability of our
u
change in the provision results. It does not, r
of home visits when however, bias our e
change in the provision estimates as we examine s
of standard the behavioral effects of PSM can be seen as a
consultations is taken changes in individual multidimensional
into account. PSM over time. construct con- sisting of
Following recent the four distinctive
D recommendations dimensions:
a (Favero and Bullock commitment to public
t 2015), we obtained interest (CPI),
a
register information on compassion (COM),
Data consist of a fully GPs’ use of home attraction to
balanced panel of 213 visits. Our behavioral policymaking (ATP),
Danish measure is independent and self-sacrifice (SS)
GPs. GPs were surveyed of our survey, and this (Perry
twice, in April and
mitigates concerns for 1996). Although different
September
common source bias. survey instruments have
been employed in PSM public service motives,

studies, most originate which all contribute to
from Perry’s behaviors that benefit
24-item scale (1996). society (Brewer and
We use a 12-item Selden 1998). PSM
abridged version of this dimensions can
scale (see supplementary therefore be expected
table A1 for exact to have similar or
wording of the items)
that taps all four PSM 3 Attrition in the patient panel
dimensions and has during the 8-month period of
investigation relates solely to
proven consistent and
patients exiting the clinic.
reliable in recent studies 4 The standardized factor
(e.g., Andersen and loading for item: “It is difficult
Pedersen 2012). for me to contain my feelings
To examine the when I see people in distress”
is just below 0.5 (λ = 0.47) but
factorial validity of this we retain it to ensure
multidimensional comparability with other
measure, we test the studies.
four-factor a priori
model against our data
using confirmatory
factor analysis. Robust
standard errors are
calculated to account for
the serial correlation of
errors terms within
clusters (GPs), and
reciprocal paths between
dimensions are specified
to account for potential
correlations between
dimensions (Perry
1996). Standardized
factor loadings (λ) for the
items display adequate
convergent validity by
loading significantly on
their respective latent
factors (i.e., PSM
dimensions) and by
exceeding the lower
threshold criterion of
0.54 (mean λCPI = 0.66;
mean λCOM = 0.61;
mean λATP = 0.76; mean
λSS = 0.73). The a priori
model
shows acceptable fit to
our data: χ2 (48) =
125.14, p <
.01, Comparative Fit
Index (CFI) = 0.96,
Root Mean Square Error
of Approximation
(RMSEA) = 0.06
(Williams, Vandenberg,
and Edwards 2009). As
argued by PSM scholars,
individuals have distinct
different consequences for behavior depending on the with count data, a common recommendation is to use
empirical context, and scholars have thus been urged models that draw on a Poisson distribution.
to include all dimensions (Kim and Vandenabeele Specifically, we estimate fixed effects Poisson panel
2010) independently in empirical studies (Perry 1996). models for each of the PSM dimensions5 and for each
We follow these recommendations and retain the mul- PSM dimension interacted with tenure using the sta-
tidimensional first-order model. This model allows us tistical software STATA version 13. Tenure denotes
to assess the relationship between a change in each of the number of years of service and is time-invariant
the four PSM dimensions and change in the provision in our case because we observe the GPs twice within
of home visits by individual GPs while controlling for the same year. Still, it is possible to include tenure in
changes in the other PSM dimensions. In addition to the fixed effects estimations by interacting it with each
the convergent validity, the model is internally consist- of the time-varying predictors (i.e., PSM dimensions)
ent with Cronbach’s alpha reliability scores ranging (see Allison 2009). However, the main effect of ten-
between 0.70 and 0.85 and Jöreskog’s rho between ure is omitted from these models because the constitu-
0.57 and 0.85. PSM items are measured using a 5-point ent term (tenure as such) represents a time-invariant
Likert scale, and measures for each PSM dimension are regressor. The main advantage of the fixed effects esti-
all generated as additive scales ranging from 0 to 100 mator is that it allows us to control for all potential
to ease interpretation (GPs with missing answers on confounders that are constant over the time span of
no more than half of the items belonging to a specific our study. However, time-varying factors may still con-
dimension are assigned the mean value of the other found results, and we therefore include an indicator
GPs for those items). Finally, PSM dimensions are for time (dummy) to capture any systematic variation
mean centered to avoid problems of multicollinearity associated with the observed time periods (e.g., sea-
in our estimation results. sonal variation due to preferred holiday seasons). As
As mentioned, we operationalize public service mentioned, observed variation in GPs’ use of home vis-
behavior as the number of home visits carried out its may not be a consequence of changes in their level of
by individual GPs in May/June 2013 and October/ PSM but rather a product of substitution mechanisms.
November 2013, respectively. Supplementary figure To assess whether changes in GPs’ use of home visits
A1 shows distributions of first-differenced PSM dimen- correlate with their use of other services, we include
sions and confirm that significant changes in individual data on the single most performed service—regular
GPs’ PSM indeed occurred between the two time peri- consultations—in our models.
ods. This variation may be due to temporal fluctuations In addition to the fixed effects Poisson panel mod-
and/or systematically linked to events in between the els, we check the robustness of our findings in two
two time points that affect the provision of primary ways. First, we replicate all analyses with random
health care services (see also footnote1). In the Danish effects Poisson panel models. Random effects estima-
National Health Service Register, home visits are cat- tors have the advantage of providing researchers with
egorized according to the physical distance that GPs more efficiency in estimations, but they simultaneously
have to travel to perform the service. To avoid too require scholars to include relevant time-invariant var-
many zero observations and to obtain a more compre- iables in the regressions. In these models, we therefore
hensive picture of the number of home visits performed include characteristics of the GP (gender and tenure),
(regardless if the physical distance is 5, 10, or 15 km the patient group (number of patients and share of
from the clinic), we pool together the number of home patients older than 70 years), and the municipality in
visits from the five original categories (see RLTN and which the clinic is located (socioeconomic composition
PLO 2010). Our dependent variable thus resembles all of citizens). Because of the very short time span under
home visits carried out by individual GPs in May/June investigation, control variables related to the patient
2013 and October/November 2013, respectively. groups and the municipalities are assumed to be time
invariant. Descriptive statistics reporting means, stand-
Estimation Procedure and Robustness Checks ard deviations, and minimums and maximums for all
As our dependent variable resembles count data, that variables can be found in supplementary table A2.
is, the number of home visits, two features make linear Bivariate correlations can be found in supplementary
panel models an inappropriate choice. First, the num- table A3.
ber of home visits necessarily constitutes a discrete
variable; that is, it only takes on nonnegative integer 5 Conditional fixed effects Poisson panel regressions estimate the
values. Second, its distribution is skewed (not shown), change of PSM dimensions on change in home visits using within
GP variation only. This procedure uses the quasi-difference,
which violates a basic assumption of linear regression
y it - (λit / λi )y i , but the fixed effects can also be eliminated using
analysis (Allison 2009; Cameron and Trivedi 2010). (λi ,t -1 / λit )yit - yi , t -1 (Cameron and Trivedi 2010). The latter corresponds
To model the discreteness and nonlinearity associated to the first difference, y it - y i , t -1 , approach used in linear panel models.
Second, a common challenge associated with Directing our attention to hypotheses 1a and 1b,
Poisson models is that the conditional variance in table 1 indicates that a change in self-sacrifice (model
data often exceeds the condition mean (referred to as 1.1) and compassion (model 1.2) indeed seems to be
“overdispersion”), which violates the property of these positively and statistically significantly related with a
models that E(yit ) = var(yit ) = λ it (Allison 2009, 50). change in the number of home visits provided. As we
As we might suspect home visits to be interdependent expected, GPs who become increasingly compassionate
to some extent; that is, the provision of a single home and more willing to sacrifice selfish concerns for service
visit raises the probability of future visits (e.g., due to to others are thus likely to increase the number of home
patient characteristics), we check the robustness of our visits to patients. To assess the magnitude of change in
results with negative binomial panel models. Negative the number of home visits for changes in either of the
binomial models model the degree of dispersion as an motivational scales, we can take a closer look at the esti-
additional parameter in our equations (Allison 2009, mated incidence rate ratios and the within (GP) variation
61), and they thus account for unobserved hetero- in the level of self-sacrifice and compassion (cf. supple-
geneity among observations (Long and Freese 2006, mentary table A2). For example, for a one standard
372–3). deviation increase in the level of self-sacrifice, roughly
Finally, one may object that the dependent vari- 7.77 (within GP standard deviation, not reported), for
able—the number of home visits—ignores the dis- a GP providing an average number of home visits in
tance of the home visits and that PSM dimensions may the first time period, roughly 20.09, the expected num-
be correlated with the types of home visits that GPs ber of home visits in the second time period increases
opt to perform. We therefore constructed an alterna- by a factor of 1.0377, holding other variables constant
tive dependent variable denoting the estimated total (see Long and Freese 2006, 359–65 for a general inter-
travel distance for individual GPs at both time peri- pretation using rates). This amounts to an expected
ods. The variable has a mean of 100.8 km (approxi- increase of 0.76 home visits, equivalent to an increase
mately 62 miles) and a standard deviation of 113.17 in the number of visits by 3.8%. The results for self-
km (approximately 70 miles). Results from the robust- sacrifice and compassion are robust when we include all
ness checks are referenced alongside our findings in the four dimensions simultaneously (model 1.5), providing
next section. strong support for hypotheses 1a and 1b.
Turning to hypotheses 1c and 1d, we do observe a
negative relationship between an increase in the level
Findings
of attraction to policymaking and the expected num-
Table 1 presents the results from a series of fixed ber of home visits provided by the GPs (shown by the
effects Poisson panel regressions on the relationship incidence rate ratio < 1). Although this result is statisti-
between a change in PSM dimensions and a change cally significant in model 1.4, it does not reach statis-
in the number of home visits performed by individual tical significance when we control for changes in the
GPs.6 We report incidence rate ratios for coefficients, other PSM dimensions (model 1.5). The incidence rate
which are exponentiated coefficients that can be given ratio for a change in commitment to public interest is
a multiplicative interpretation (Cameron and Trivedi also below 1, indicating a negative relationship, but
2010, 576). Specifically, we can interpret results as the it is not statistically significant in either of the model
expected change in the number of home visits pro- specifications. The results for all four hypotheses are
vided by individual GPs associated with a one-scale robust in random effects models including GP, patient,
point change in PSM dimensions holding all observed and demographic controls (see supplementary table
time-variant and all observed and unobserved time- A4) and when we estimate negative binomial regres-
invariant factors constant. Recalling our first set of sion to account for a slight overdispersion in data (see
hypotheses, we expect an increase in GPs’ level of self- supplementary table A5).
sacrifice (H1a) and compassion (H1b) to be positively In sum, the results thus seem to suggest that individ-
related to the number of home visits provided, whereas ual GPs alter their provision of home visits according
the reverse trend is expected for an increase in com- to changes in their level of self-sacrifice and compas-
mitment to the public interest (H1c) and attraction to sion, as we would predict based on PSM theory, but
policymaking (H1d). we do not find strong evidence to support negative
relationships between increasing levels of attraction to
6 We tested the cross-sectional relationships between PSM dimensions policymaking and commitment to the public interest
and the number of home visits provided by GPs for each of the two and changes in the number of home visits provided by
waves. Self-sacrifice and compassion are positively related to the
number of home visits, whereas commitment to the public interest
GPs (hypotheses 1c and 1d).
and attraction to policymaking, contrary to expectations, are not To test our contextual argument that tenure mod-
statistically significant. erates the relationship between a change in PSM
dimensions and change in the behavior of individual longer tenure compared to GPs with fewer years of
public service providers, table 2 presents a series of service. Specifically, the observable implications vary
conditional fixed effects Poisson panel models. In these depending on the dimension of PSM in question. For
models, each PSM dimension is interacted with the a change in self-sacrifice and compassion, we expect
continuous tenure variable (recall that tenure is time- a change in the motivational scales to amount to a
invariant in our analysis) and incidence rate ratios are smaller change in magnitude in the number of home
reported similarly to table 1 above. As we are inter- visits for longer-tenured GPs (i.e., the incidence rate
ested in the interaction terms, we calculate the average ratio for the two interaction terms, self-sacrifice ×
marginal effects of a change in each of the PSM dimen- tenure and compassion × tenure, should be smaller
sions on a change in the number of home visits over than 1). For attraction to policymaking and com-
all observed values of tenure in our data (1 to 40 years mitment to the public interest, we expect the inci-
with all intermediate values represented in data). The dence rate ratios for the two interactions terms to
marginal effects of a change in each PSM dimension be greater than 1 as this would indicate that the
and their corresponding 95% confidence intervals are expected decrease in the number of home visits for
illustrated in figure 1 below. a change in attraction to policymaking or commit-
Hypothesis 2 expects that the relationship between ment to the public interest would be less pronounced
a change in PSM dimensions and a change in the for longer-tenured GPs. In line with our expectations,
number of home visits will be weaker for GPs with we do observe statistically significant incidence rate
Table 1. Change in PSM Dimensions and Change in Number of Home Visits: Conditional Fixed Effects Poisson
Panel Regression With Incidence Rate Ratios (Z-Scores)
Model 1.1 Model 1.2 Model 1.3 Model 1.4 Model 1.5
Self-sacrifice 1.00478** (3.20) 1.00468** (3.07)

Compassion 1.00342* (2.51) 1.00299* (2.14)
Commitment to the 0.99981 (−0.17) 0.99900 (−0.84)
public interest
Attraction to 0.99810* (−1.98) 0.99843 (−1.60)
policymaking
Time (dummy) 1.10423*** (4.15) 1.08424*** (3.52) 1.10809** (3.38) 1.06515** (2.63) 1.09642*** (3.60)
Regular consultations 1.00049** (2.67) 1.00061** (3.38) 1.00059** (3.26) 1.00061** (3.35) 1.00052** (2.81)
N 426 426 426 426 426
GPs 213 213 213 213 213
Log-likelihood −625 −627 −631 −629 −621
Note: *p < .05; **p < .01; ***p < .001.
Table 2. Change in PSM Dimensions, Tenure, and Change in Number of Home Visits: Conditional Fixed
Effects
Poisson Panel Regression With Incidence Rate Ratios (Z-Scores)
Model 2.1 Model 2.2 Model 2.3 Model 2.4 Model 2.5
Self-sacrifice (SS) SS 1.01253*** (4.40) 1.01161*** (3.85)

× tenure 0.99961** (−3.09) 0.99966* (−2.56)
Compassion (COM) 1.01352*** (4.18) 1.01268*** (3.58)
COM × tenure 0.99955*** (−3.53) 0.99960** (−2.81)
Commitment to the 0.99466† (−1.83) 0.99202* (−2.31)
public interest (CPI)
CPI × tenure 1.00020† (1.74) 1.00026† (1.86)
†
Attraction to 0.99596 (−1.93) 0.99730 (−1.15)
policymaking (ATP)
ATP × tenure 1.000011 (1.30) 1.00001 (.07)
Time (dummy) 1.11028*** (4.29) 1.08380** (3.42) 1.07551** (3.01) 1.06025* (2.27) 1.07766** (2.73)
Regular consultations 1.00044* (2.40) 1.00058** (3.18) 1.00056** (3.10) 1.00059** (3.24) 1.00047* (2.51)
N 408 408 408 408 408
GPs 204 204 204 204 204
Log-likelihood −594 −596 −603 −602 −582
Note: †p < .1; *p < .05; **p < .01; ***p < .001.
0
−.01 .01
.02
0
Self−sacrifice (SS)
−.01
0 5 10 15 20 25 30 35 40 0 5 10 15 20 25 30 35 40
Tenure Tenure
95 % CI Marginal effect of COM 95 % CI Marginal effect of SS
.02
interest (COM)
(CPI)
.02
.02
.01
Attraction to policymaking (ATP)

Compassion
.01
.01
Commitment to the public
−.01
−.01
0 5 10 15 20 25 30 35 40 0 5 10 15 20 25 30 35 40
Tenure Tenure
95 % CI Marginal effect of CPI 95 % CI Marginal effect of ATP
Figure 1. Marginal effects of PSM change on change in the number of home visits for different values of tenure. Note: The marginal
effects were not estimated for one observation with extreme value on tenure (49 years).
ratios smaller than 1 for self-sacrifice × tenure (model Robustness checks reveal very similar results with
2.1) and compassion × tenure (model 2.2) and greater the only noteworthy exceptions being that the inter-
than 1 for commitment to the public interest × tenure action term between self-sacrifice and tenure falls just
(although the latter is only statistically significant at short of reaching statistical significance in the Poisson
the 0.1 level, model 3.3). In figure 1, the two for- random effects models (see supplementary table A6)
mer observations are illustrated by the downward and that the interaction term between commitment to
slope of the marginal effects curve indicating that the the public interest and tenure do not reach statistical
marginal effect of a one-point change in the scales significance (but remain above 1) in the fixed effects
for self-sacrifice and compassion on a change in the negative binomial regression models (see supplemen-
number of home visits is stronger for GPs with fewer tary table A7). In sum, the findings generally corrobo-
years of experience. In turn, an upward slope of the rate our argument that the behavioral implications of
marginal effects curve is illustrated for the commit- PSM change are conditional on the accumulation of
ment to the public interest dimension. This suggests past experiences and knowledge related to the specific
that the expected decrease in the number of home job task. In the next section, we discuss the contribu-
visits as a consequence of a one-point change in the tions and implications of these findings in more detail.
scale for commitment to the public interest is less
pronounced for longer-tenured GPs. Although the
incidence rate ratios for the attraction to policymak- Discussion and Conclusion
ing and commitment to the public interest dimen- Probing the behavioral consequences of PSM is at heart
sions do not reach statistical significance, the results of PSM research, but it is a task fraught with chal-
generally support our expectation that the relation- lenges. Common source bias may generate false posi-
ship between a change in PSM dimensions and a tives, and omitted variables may confound estimates
change in the number of home visits is weaker for and generate spurious relationships. In this study, we
longer-tenured GPs compared with GPs with fewer approach these challenges by combining repeated
years of service. measures on individual PSM and behavior from survey
and administrative data compared to workers of home visits while a (O’Toole and Meier
sources. Specifically, the with fewer years of change in attraction to 2015) and in PSM
article examines service. policymaking and research more
whether GPs make more commitment to the specifically (Perry,
or fewer home visits to C public interest may have Hondeghem, and Wise
patients as their level of o opposite effects 2010). We argue that
PSM changes over time. n (although the results for behavioral responses to
t the latter two dimen-
The analysis tells two changes in the level of
r
main stories. First, GPs sions do not reach PSM are conditional on
i
do indeed seem to alter b statistical significance, accumulated experiences
cf. table 1). Researchers
their behavior in ways u and knowledge related to
consistent with the t may therefore want to the job context. It is too
predictions of PSM i carefully consider whether sim- ple to expect public
o PSM is best studied as a
theory. We show that service providers—even
n single composite con-
individual GPs are s within the same
inclined to increase the struct or as four separate occupation—to respond
Building on existing
number of home visits to dimensions. similarly to changes in
literature, this study
patients as their self- Second, the article their level of PSM. For
offers several
sacrifice and com- contributes to recent calls example, studies have
contributions. First, the
passion increase. These for more attention to shown that the values
result that public service
findings suggest that context in public of public service
providers change their
GPs act on the basis of management research providers differ and that
behavior in a manner
their affective and outcomes may depend
systematically related to
altruistic motives for on the “fit” with the
changes in their level of
providing public service values of their
PSM supports the
to do good for patients organization (e.g.,
fundamental assertion in
and society. In contrast, Christensen and Wright
PSM research about its
neither attraction to 2011). In this article, we
consequences for the
policymaking nor the extend this line of
behaviors of public
commitment to the research and provide—to
service personnel. This
public interest seems to our knowledge—a first
finding also corroborates
guide GPs’ decisions to examination of the
recent studies on PSM
provide more or fewer contextual importance of
and the behavior of
home visits to patients. tenure for the PSM-
public service providers
The second main story behavior relationship.
(e.g., Andersen and
of the article questions Specifically, we test
Serritzlew 2012; Bellé
the simplicity of these tenure as a moderator of
2013) suggesting that
first conclusions. the relationship between
PSM may indeed
Investigating the a change in PSM
constitute a valuable
contextual importance dimensions and a
resource across areas of
of tenure, we show that change in the provision
public service provision.
the association between of a specific medical
PSM dimensions may
a change in three of four health care service. We
have unique antecedents
PSM dimensions and a show that for three of
and consequences (Perry
change in the number four PSM dimensions,
1996), and researchers
of home visits provided the increase or decrease
have accordingly been
is weaker for longer- in the number of home
urged to include all four
tenured GPs (compared visits to patients as a
dimensions
with GPs with fewer consequence of a change
independently in
years of experience). in PSM dimensions is
empirical studies (Kim
This suggests that less pronounced for
and Vandenabeele 2010).
public service providers longer-tenured GPs. This
The article follows this
may alter their public supports the claim that
recommendation and
service behaviors the work-related con-
provides some support
according to changes in text may be very
for its validity.
their level of PSM, but important when we wish
Specifically, we show that
that these changes are to theorize on the link
a change in self-sacrifice
less pronounced among between PSM and
and compassion can lead
longer-tenured workers behavior and, not least,
to an increasing number
when we wish to changes in PSM
evaluate the real-world dimensions and changes
behavioral implications in the number of home
of this kind of prosocial visits are not due to
motivation. common source bias.
A number of other
contributions pertain to L
the methodology of the i
study. First, the majority m
i
of existing studies have
t
reached their conclusions a
using cross-sectional t
research designs (e.g., i
Andersen and Serritzlew o
2012; Pandey, Wright, n
s
and Moynihan 2008).
To our knowledge, no Before we conclude with
study has assessed the implications for research
link between PSM and practice, one needs
change and change in to pay attention to the
the provision of public limitations
services using a panel
research design. This
approach holds several
merits. Most
importantly, it allows us
to control for important
confounders using fixed
effects estimation
techniques. We use
administrative data on
GP behavior to increase
the reliability of our
behavioral outcome
variable and eliminate
concerns for common
source bias in our
estimates. Favero and
Bullock recently showed
that common source
bias should be a concern
for studies on behavior
using perceptual
measures from a single
survey to grasp
variables on both sides
of the equation.
Procedural remedies
such as including
independent data
sources are likely to
offer the best (if not the
only) solution to this
potential problem (2015,
20). Measuring GPs’ use
of home visits with
administrative data thus
increases our confidence
that reported
relationships between
of this study. One potentially observe vulnerable to time- changes in individual
limitation concerns the effects of different varying confounders, it PSM dimensions and
external validity of our magnitudes on our does offer important changes in actual
findings. The study is behavioral variable at leverage over cross- behaviors of individual
restricted to GPs with other points in time. We sectional studies by elim- public service providers
single-owner clinics, and do, however, observe inating all observable as well as highlighting
this group of medical substantive and and unobservable time- ways for researchers to
practitioners may differ statistically significant invariant confounders. develop more robust
in systematic ways from effects, and we can Drawing on the evidence on the PSM-
GPs joining multi- therefore be confident repeated measures of behavior link.
individual GPs over time,
doctor clinics. As a that the behavioral
highly profession- alized implications of PSM our study thus I
group of medical health change for the number contributes to the m
specialists, GPs also of home visits provided literature by p
demonstrating l
differ from other groups at least amount to those
i
of public service reported here. relationships between
c
providers. However, Third, scholars have a
Andersen and Pedersen questioned the validity t
(2012) only report weak of PSM measurement. In i
correlations between particular, the measure o
n
PSM and for “attraction to
s
professionalism, which policymaking” is
Our findings have a
suggests that differences contended and has
number of important
in the level of special- proven difficult to
implications. For
ized, theoretical validate in empirical
scholars, the results
knowledge and the settings. We rely on
generally support the
existence of firm intra- existing measures in this
contin- ued interest in
occupational norms may study to be able to
the behavioral
not influence public compare findings with
consequences of PSM. In
service providers’ PSM existing research but it
particular, we focus on
greatly. GPs are self- should be a prior- ity for
actual behaviors of
employed providers of future research to
individual public service
public services, and we continue efforts to
providers to show that
therefore cannot be sure improve PSM
the motivation to do
that our results can be measurement (see, e.g.,
good for others and
generalized to employ- Ritz 2011).
society can have real-
ees in public service Although the research
world implications for
organizations. Andersen design of our study gives
the provision of public
and colleagues (2011) pri- ority to internal
medical services.
find no differences in validity, we cannot
Obviously, however, this
the general level of PSM completely eliminate
study only sheds light
between public and concerns for endogeneity.
on the use of a
private employees per- Reverse causality, for
particular service (home
forming identical tasks, example, may exist if
visits) performed by a
but this does not preclude GPs’ initial level of PSM
specific group of public
that private and public is a func- tion of past
service providers (GPs)
providers of public provision of medical
in one country
services respond services such as home
(Denmark). More
differently to changes in visits. Omitted variable
research is consequently
their level of PSM. bias may also be a
needed to assess the
A second limitation concern if omitted
magnitude and rel-
is that we cannot be variables that affect GP
evance of PSM for
certain about the effect PSM and use of home
individual public service
sizes of the change in visits and change over
behaviors across
number of home visits the period of
important domains of
for a change in each of investigation are
public service provision.
the PSM dimensions. unobserved. Although
To further qualify this
Given that PSM is indeed the fixed effects
line of research, careful
changeable, we would approach is still
consideration of
contextual factors can PSM change is
prove beneficial. In this associated with changes
article, we show that in actual public service
tenure may constitute behaviors, more
an important contextual research on the temporal
variable, and we dynamics of PSM
encourage researchers to including its antecedents
test our argument in is warranted. In such
other settings. We find cases, researchers may
these results for self- benefit from drawing
employed providers of on multiple data points
public services, but this in time to better estimate
group may differ from the temporal dynamics
public service employees. and the relationships
Hence, one way to between PSM change
improve on our knowl- and changes in outcomes.
edge of the behavioral One promising avenue of
implications of PSM research in this respect
would be to also look at concerns how managers
public service employees can foster PSM through,
and whether employees for example,
in public service organizational goals
organizations differ
from self-employed
providers of public
services.
Another way to
improve the study on
the behavioral
implications of PSM is
methodological.
Drawing on repeated
measures of PSM and
behavior, researchers
can test the impact of
changes in the level of
PSM (dimensions) on
changes in a dependent
behavioral variable. In
particular, we encourage
scholars to explore the
behavioral effects of
PSM with designs that
allow for stronger causal
identification.
Manipulating indi-
vidual PSM may not be
easy (or feasible), but
researchers can, for
example, incorporate
PSM as a mediator in
experimental studies and
employ econometric
methods (such as Two-
Stage Least Squares
[2SLS]) to estimate the
causal effect on outcome
variables. Given that
PSM does seem to be
changeable and that
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Journal of Public Administration Research and Theory Advance Access published August 5, 2016

Journal of Public Administration Research And Theory, 2016, 1–16

Public Service Motivation and Public Service

Introduction matters to the provision of specific public services.

Theoretically, we conflict, the Danish

1 Recent studies suggest that

service to others for However, what is seen as

providers such as GPs, specific to their job (Bird

increasing levels of on whether or not to changes in their on tenure. We elaborate

importantly, PSM and PSM and specific health

the motivation to expected to see home

and quality in all clinics behaviors. Most g we have designed our

to home visits (e.g., a and behaviors when

been employed in PSM public ser- vice motives,

Self-sacrifice 1.00478** (3.20) 1.00468** (3.07)

Note: *p < .05; **p < .01; ***p < .001.

Self-sacrifice (SS) SS 1.01253*** (4.40) 1.01161*** (3.85)

95 % CI Marginal effect of COM 95 % CI Marginal effect of SS

Attraction to policymaking (ATP)

95 % CI Marginal effect of CPI 95 % CI Marginal effect of ATP

Related, our findings services. This is shorter-tenured public Publications, Inc.

concerns for service to A second implication a 1

June 2013) and tenure of individual is available at the Administration 35:46–57.

mately 8 scale points) service providers with als.org). A

Вам также может понравиться

Self-sacrifice 1.00478 (3.20) 1.00468 (3.07)

Note: p < .05; p < .01; p < .001.

Self-sacrifice (SS) SS 1.01253* (4.40) 1.01161* (3.85)