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Journal of Management Development
Inspiring organizational commitment: Responsible leadership and organizational
inclusion in the Egyptian health care sector
Mohamed Mousa, Vesa Puhakka,
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Mohamed Mousa, Vesa Puhakka, (2019) "Inspiring organizational commitment: Responsible
leadership and organizational inclusion in the Egyptian health care sector", Journal of Management
Development, https://doi.org/10.1108/JMD-11-2018-0338
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Inspiring organizational
commitment
Responsible leadership and organizational
inclusion in the Egyptian health care sector
Mohamed Mousa
Oulu Business School, Oulun Yliopisto, Oulu, Finland and
Cardiff School of Management, Cardiff Metropolitan University, Cardiff, UK, and
Vesa Puhakka
Oulu Business School, Oulun Yliopisto, Oulu, Finland
Abstract
Purpose –The purpose of this paper is to focus on physicians in the four public hospitals located in the
October province (Egypt) in an attempt to explore the effect of responsible leadership on physicians’affective,
continuance and normative commitment with and without mediating the role of organizational inclusion.
Design/methodology/approach –A total of 360 physicians were contacted and all of them received a set of
questionnaires. After two follow-ups, a total of 240 responses were collected with a response rate of 66.67 percent.
The authors used the χ
2
test to determine the association between responsible leadership and organizational
inclusion. Multiple regressions were employed to show how much variation in affective, continuance and
normative commitment can be explained by responsible leadership and organizational inclusion.
Findings –The findings highlight a positive association between responsible leadership and organizational
inclusion. Moreover, another positive association is also explored between organizational inclusion and
affective, continuance and normative commitment. Furthermore, the statistical analysis proved that having
an atmosphere of respect, equality and sameness in the workplace fosters the effect of responsible leaders on
physicians’affective, normative and continuance commitment.
Originality/value –This paper contributes by filling a gap in HR management, cultural diversity and
organization literature, in which empirical studies on the relationship between responsible leadership,
organizational inclusion and organizational commitment have been limited until now.
Keywords Egypt, Organizational inclusion, Affective commitment, Normative commitment,
Continuance commitment, Responsible leadership
Paper type Research paper
1. Introduction
Since the global economic crisis in 2008 and the subsequent collapse of global corporations
such as Enron, WorldCom, Arthur Anderson and Tyco, companies have prioritized ethics
and considered it a substantial driver for today’s business practices (McWilliams and Siegel,
2011). Moreover, different stakeholders have questioned the societal obligations companies
have to fulfill (Waldman and Siegel, 2008). This has fostered the emergence of responsible
leadership as a new strategic reality that organizations can employ to ensure continuity
(Pless et al., 2012). Consequently, company managers and decision makers have started to
extensively engage in much more social activities besides their traditional thinking of
maximizing profits for shareholders (Fry and Slocum, 2008). Furthermore, as a kind of
fulfillment of their social contract, companies have extended their ethical domain to include
all stakeholders in their surrounding economic spheres (Carroll and Shabana, 2010).
However, the trade-off between maximizing corporate economic returns and pursuing social
obligations has represented a major challenge facing organizations (Henriques and
Richardson, 2012).
Hymavathi et al. (2015) elaborate that responsible leadership reflects a social and moral
scheme in which different organizational leaders drive, export and disseminate the virtues of
Journal of Management
Development
© Emerald Publishing Limited
0262-1711
DOI 10.1108/JMD-11-2018-0338
Received 27 November 2018
Revised 1 February 2019
Accepted 19 February 2019
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/0262-1711.htm
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wisdom, courage and respect to both in-and-out stakeholders. This entails a people-centered
activity whose main aims include aggregating the welfare of societies, enhancing the
well-being of the environment and securing the values of social peace in the communities in
which the organization operates. Accordingly, the mission of every organization should
guarantee an answer to the question: who is the organization responsible to and for what?
This is in line with what is highlighted by Maak (2007), who considers that today’s
organization has to maintain a social agenda about its surrounding problems
(e.g. unemployment, violations of human rights and environmental awareness) and
regularly play a role in confronting and managing them. The same has been asserted by Pless
(2007) and Voegtlin (2011), who articulate that firms –particularly global ones –have a
massive power base and huge networks of relationships and they should contribute more to
the betterment of their surrounding communities.
Despite its significance, and to the best of the author’s knowledge, there is a
dearth of empirical studies on the relationship between responsible leadership and
organization-related aspects, which are academically referred to as organizational
phenomena. Newman et al. (2011) and Mousa (2018a) assert that besides other
organizational phenomena, organizational commitment has been devoted a considerable
research interest over the past 50 years. Organizational commitment is a multi-dimensional
concept that has attracted the interest of scholars from various disciplines
(e.g. management, organizational behavior, public policy and sociology) over the past
50 years (Ahmad et al., 2010; Malik and Naeem, 2011). Introduced in the 1960s, the concept
“organizational commitment”has been defined by Kanter (1968, p. 507) as “the attachment
and individuals fund of affectivity and emotion to the group.”Salancik (1977) refers to
“organizational commitment”as “a state of being in which and individual becomes bound
by his actions”(p. 62), while Mowday et al. (1982, p. 27) define to it as “the relative strength
of an individual’s identification with and involvement in a particular organization.”Pool and
Pool (2007) highlight that organizational commitment reflects “the extent and individual
identifies with and organization and committed to its organizational goals”(p. 353).
Allen and Meyer (2000) and Mousa consider organizational commitment as the
sociological harmony between employee and his employer which reduces employee’s
likelihood of leaving his organization. Haim (2007) assures that organizational commitment
represents a rational choice an employee undertakes to protect his occupation and its
subsequent salary, recognition, etc. The same has been confirmed by Sreejesh and Tavleen
(2011) who consider organizational commitment as a personal choice subject to rational and
relational judgment.
Notably, authors such as Bogler (2005), Maertz et al. (2007), Grant et al. (2008) and
Bolander and Jones (2009) indicate that the significance of organization commitment derives
from its negative association with absenteeism, misuse of power, turnover intentions and
carelessness when doing job activities on the one hand, and its positive relationship with
employees’job performance, job satisfaction and citizenship behavior on the other. This
may justify why the concept organizational commitment has maintained a momentum in
HR and organization-related literature over the past half of the century. Bashir and Long
(2015) and Mousa confirm that despite the paramount importance of organizational
commitment and its related consequences, the majority of its studies have been conducted in
western countries. Mousa (2018a, b) highlighted the dearth of studies on organizational
commitment in Middle-Eastern various contexts.
Accordingly and given the aforementioned, the authors of the present study seek to fill
the gap in both HR and organization-related literature through exploring the relationship
between responsible leadership and the organizational commitment in the context of
Egyptian public hospitals, which has not been addressed and analyzed before. The impetus
of this research emerges from its focus on physicians in Egyptian public hospitals, which
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provide medical assistance to the majority of low- and middle-income families in Egypt.
The remainder of this paper is structured as follows: the authors start first with a literature
review, followed by presenting the methodology, then the results and they end with a
discussion and the implications.
2. Literature review
2.1 Organizational inclusion
Over the past two decades, diversity and inclusion have gained more momentum as
research topics than ever before. Kamenou and Fearful (2006), Caiazza and Volpe (2015a)
and Caiazza (2016) noted that European governments intentionally tend to facilitate
immigration policies, launch socio-political and educational programs that directly relate to
topics of immigration and equality and more recently create and develop skill-fit-protocols,
which assist those who are different in finding jobs that match their qualifications. Many
private commercial and public organizations have employed inclusion management
paradigms and considered them a main part of the organization’s strategies, work
processes, values and social responsibility activities (Bilimoria et al., 2008). According to
Traavik and Adavikolanu (2016), the definition, context and practices of both diversity and
inclusion vary across societies and regions. Scholars (e.g. Ely and Thomas, 2001;
Podsiadlowski et al., 2009; Caiazza and Ferrara, 2016; Mousa, 2017a, b) asserted that the
1964 US Civil Rights Act, which called for equal opportunities for all, and the subsequent
legislation have been perceived to be the first organized framework used to force profit and
not-for-profit organizations to adopt affirmative action and ensure justice in their internal
work settings. In addition, Daya and April (2014) consider inclusion as a social, cultural,
interpersonal and institutional concept that is often perceived as an outcome of the
organizational practices individuals experience in their workplace. Mor Barak (2000), Daya
(2014), Caiazza and Volpe (2015b) and Mor Barak (2015) highlighted that running an
inclusive workplace is a make-up process/procedure by which a specific organizational
setting appreciates individual differences, respects intergroup dissimilarities, undertakes
workplace fairness and supports in-out organizational communities.
2.2 Responsible leadership and organizational inclusion
Pless et al. (2012) indicate that any decision to address social obligations is largely based on
the scope of stakeholder inclusion and the level of accountability decision makers feel
toward their societies. This may justify why Rusjan and Castka (2010) and Persic and Persic
(2016) highlight that every organization has the right to establish its own model and/or
standards of social responsibility through which it can fully serve/meet the expectations of
its stakeholders. Additionally, Hommel et al. (2012) assert the absence of any generally
accepted model of responsible leadership. Moreover, they have noted a disconnect between
academia and practices on ethics and sustainability besides a financial difficulty to pay
much more attention to ethics-related challenges in organizational practices either by
professionals and/or the industry.
For Aguilera et al. (2007), responsible leadership is still an underdeveloped concept. Maak
and Pless (2006) consider responsible leadership as a method for creating and maintaining
trusting relationships with in-and-out of organization stakeholders in an attempt to fulfill a
predetermined set of societal obligations. Gond et al. (2011) and Mousa (2018b) define
responsible leadership as social relational and ethical interactions developed and
maintained between those who affect and those who are affected by a particular
organization’s practices. Waldman and Galvin (2008) and De Hoogh and Den Hartog (2008)
demonstrate that responsible leadership is a combination of ethics, leadership, social
awareness and stakeholder engagement in organizational practices. Waldman (2011) points
out that responsible leadership stems from one of two approaches to the stakeholder.
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The first is normative and urges corporate decision makers to balance between maximizing
shareholders’profits and realizing the expected needs of other stakeholders. This involves
engaging different stakeholders in deciding upon a set of social responsibilities the
organization has to secure. The second approach is economic and prioritizes maximizing
shareholders’financial returns in addition to constantly seeking economic returns from
socially responsible investments. The two aforementioned approaches may be seen as a
rebranding of the following two theories of management –agency theory and stakeholder
theory. Agency theory is where decision makers (agents) act on behalf of the shareholders
(principals) in safeguarding and maximizing the organization’s financial profits
(Friedman, 2007). Stakeholder theory is where decision makers have to consider their
surrounding network of stakeholders through addressing some of their immediate needs
such as managing environmental awareness, safeguarding human rights and alleviating
unemployment rates (Komives and Dugan, 2010).
Due to global uncertainties and demographic shifts, even countries in the
Middle-East have started to become familiar with cultural diversity and inclusion
practices (Devine et al., 2007). However, their history in managing inclusion and diversity
isabitshortwhencomparedwithwesterncountries in the same domain. This may
explain the current broad criticisms of these countries in terms of the fair treatment and
cultural tolerance of minorities (Ashikali and Groeneveld, 2015). According to Ylostola
(2016), societies cannot be labeled friendly and culturally diverse if some of their social
groups face a kind of workplace marginalization. Accordingly, the first hypothesis can be
formulated as follows:
H1. There is a positive association between responsible leadership and an organizational
inclusion.
2.3 Organizational inclusion and organizational commitment
In an Egyptian study, Mousa (2017a) addressed how nurses in an Egyptian public hospital
perceive their cultural diversity and upon conducting 25 semi-structured interviews, the
author could not identify any inclusive organizational strategy or climate through which the
nurses could retain their uniqueness while contributing to their hospital’s organizational
performance. Furthermore, the same author discovered that Christian nurses preferred to
deal with their Christian colleagues and the same for Muslims, which clearly maximizes the
in-out group comparisons between them. Accordingly, work life in Egypt is limited by many
forms of cultural bias, such as organizational ostracism, in-out group comparisons and
workplace discrimination in terms of religion and sometimes origin. The authors, given their
best knowledge, could not find many more papers addressing inclusion and/or cultural
diversity in different Egyptian organizational settings.
For Porter et al. (1980) organizational commitment is characterized by “a strong belief
and acceptance of organizational goals and values; willingness to exert considerable effort
on behalf of the organization and a desire to maintain organizational membership”(p. 604).
Allen and Meyer (1990, 1993) categorize organizational commitment into three approaches:
the first is affective which describes employees’emotional bond and identification with their
employer; the second is continuous which describes employee’s intention to stay in their
organization because of the perceived cost of leaving it; and the third is normative which
describes employees sense of moral obligation to stay in their organizations. The same was
highlighted earlier by Mowday et al. (1982) who define the three approaches of
organizational commitment: affective commitment, which is the emotions employees have
toward their organization when feeling valued and respected; continuous commitment,
which is “the process by which individuals become locked into certain organizations and
how they deal with this problem”(p. 26); and normative commitment, which is the moral
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responsibility of employees to remain with a particular organization. Accordingly, the
following hypotheses can be formulated:
H2a. Organizational inclusion is positively associated with the physicians’affective
commitment.
H2b. Organizational inclusion is positively associated with the physicians’continuance
commitment.
H2c. Organizational inclusion is positively associated with the physicians’normative
commitment.
2.4 Responsible leadership, organizational inclusion and organizational commitment
Social exchange theory has come to be perceivedasoneofthemostimportanttheoriesin
explaining workplace behavior. Therefore, it can be touched upon when exploring various
organizational and managerial topics such as organizational commitment, psychological
contract, organizational justice, board independence and responsible leadership
(Cropanzano and Mitchell, 2005). Social exchange theory reflects “those voluntary
actions of actors that are motivated by the returns they are expected to elicit from the
other”(Blau, 1964, p. 91). Fao and Fao (1974) identify that love, status, money, information,
goods and services are considered the six determinants in an employer–employee
relationship. According to this theory, when an employer cares about his/her employees
and these employees perceive fair treatment from their employer, they subsequently do
their best to fulfill organizational objectives and they also have a steady positive attitude
toward their employer.
Since, to the best of the author’s knowledge, no studies have been conducted to elaborate
the effect of responsible leadership on approaches among physicians to organizational
commitment (affective, continuance and normative) through the mediation of organizational
inclusion, the following hypotheses are formulated in question form:
H3a. Can responsible leadership positively impact affective commitment through the
mediation of organizational inclusion?
H3b. Can responsible leadership positively impact continuance commitment through the
mediation of organizational inclusion?
H3c. Can responsible leadership positively impact normative commitment through the
mediation of an organizational inclusion?
3. Methodology
The conceptual framework of the present quantitative study was drawn from previous
literature conducted separately on responsible leadership, organizational inclusion and the
organizational commitment. To the best of the authors’knowledge, the relationship between
responsible leadership, organizational inclusion and the organizational commitment has not
been addressed before, particularly within the context of health care sector. The study was
conducted in four public hospitals located in the October province (Egypt) and the main
reason for choosing these hospitals was author’s relationships with a number of physicians
who work there.
As elaborated, the authors targeted all physicians in the chosen hospitals and decided to
employ a hierarchical multiple regression. They distributed 360 questionnaire forms and
successfully collected 240 completed questionnaires. Before distributing the questionnaire,
the authors decided to rely on comprehensive count sampling in which a questionnaire was
handed to every physician of the chosen hospitals. It is important to note here that the
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authors addressed four public hospitals. The choice of comprehensive count sampling
ensures that every physician is contacted and represented in the collected sample, and this
reduces any possibility of a bias.
Concerning the measures, the authors of this paper found that not all three
variables –responsible leadership, organizational inclusion and the organizational
commitment –have previously been researched. Accordingly, the authors themselves had to
develop a model for organizational inclusion, for which there is no generally accepted model.
The following describes the content of the three models for the questionnaires.
3.1 Responsible leadership
The authors of this paper used Mousa’s (2018b) model of responsible leadership to prepare
the responsible leadership part of a questionnaire. Mousa’s (2018b) model has been
developed based on a qualitative study prepared by Antunes and Franco (2016) that
included the following four dimensions (the aggregate of virtues, stakeholder involvement,
model of leader’s roles and the principles of ethical values). Needless to say that the author
did not have to change any of the items included within the model because it was originally
prepared to fit the Egyptian context.
3.2 Organizational inclusion
(1) My hospital appreciates all physicians regardless of their differences.
(2) My hospital respects the uniqueness of physicians.
(3) My hospital treats all physicians as insiders.
(4) I did not feel any discrimination while working at my hospital.
(5) My hospital recruits and develops all physicians based on their qualifications.
(6) Equality, tolerance and sameness are the main feature of my hospital.
3.3 Organizational commitment
When conducting this study, the authors took into account that many studies have been
conducted on organizational commitment (Haim, 2007; Mousa and Alas, 2016a). Moreover, the
tri-dimensionalmodelsuggestedbyAllenandMeyer (1990) is the most widely accepted model
for investigating organizational commitment, as it comprehensively covers the three approaches
to commitment: affective, continuance and normative commitment. The model includes three
subscales. The first covers affective commitment, the second focuses on continuance
commitment, while the third includes questions dealing with normative commitment.
For all variables, a five-point likert scale was formulated, where 5 means strongly agree,
4 is agree, 3 is neutral, 2 is disagree and 1 means strongly disagree. The following presents
the reliability analysis for responsible leadership, organizational inclusion and the
organizational commitment using Cronbach’sα. Cronbach’sαis used to assess the internal
consistency of each of the variables used in the study. As depicted in Table I, all variables
Scale name Number of items Coefficient αvalues
Responsible leadership 6 0.801
Organizational Commitment 24 0.902
Affective commitment 8 0.846
Continuance commitment 8 0.803
Normative commitment 8 0.710
Organizational inclusion 6 0.711
Table I.
Reliability analysis
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have adequate levels of internal consistency and meet the acceptable standard of 0.60.
The table shows the reliability analysis for organizational inclusion, psychological contract
types and responsible leadership using Cronbach’sα.
Table II shows the demographic variables of the respondents.
4. Findings
4.1 Statistical association relationships
The first purpose of this research is to determinewhetherthereisanassociation between
responsible leadership and organizational inclusion or not, and also to determine if there is
an association between organizational inclusion and the three approaches of
organizational commitment or not. The χ
2
test was employed to determine this
association. Moreover, and given the fact that using a χ
2
test requires having nominal or
ordinal variables, the following were recorded:
•Create the value of the variable responsible leadership (the total mean of all
8 elements included under the variable responsible leadership divided by 8).
•Create the value of the variable organizational inclusion (the total mean of all
6 elements included under the variable responsible leadership divided by 6).
•Create the variable affective commitment (the total mean of all 8 elements included
under the variable responsible leadership divided by 8).
•Create the variable continuance commitment (the total mean of all 8 elements
included under the variable continuance commitment divided by 8).
•Create the variable nominative commitment (the total mean of all 8 elements included
under the variable normative commitment divided by 8).
Demographic variables Items Count
Gender Male 280
Female 80
Age (years) Below 25 20
26–30 100
31–35 80
36–40 100
41–45 42
46–50 10
More than 50 8
Marital states Single 100
Married 215
Other 45
Level of education Bachelor 0
Bachelor +Diploma 300
Master 60
Level of income EGP 1,200 0
EGP 1,300–2,500 260
EGP 2,500–4,000 110
EGP 4,000–5,500 0
Above 5,500 0
Religion Muslim 320
Christian 40
Work bases Full time 360
Part time 0
Table II.
Profile of the
respondents
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Table III reflects a statistically significant association between responsible leadership and
organizational inclusion; χ
2
(1) ¼70.106, p¼0.000. φ¼0.508, p¼0.000 means a strong
association between the two variables. It also reflects a statistically significant association
between organizational inclusion and affective commitment; χ
2
(1) ¼50.111, p¼0.000. φ¼0.418,
p¼0.000 means a moderate to strong association between the two variables. Moreover, it
asserts a statistically significant association between organizational inclusion and continuance
commitment; χ
2
(1) ¼38.911, p¼0.000. φ¼0.321, p¼0.000 means a moderate association
between the two variables and finally it points out a statistically significant association between
organizational inclusion and nominative commitment; χ
2
(1) ¼31.666, p¼0.000. φ¼0.339,
p¼0.000 means a moderate association between the two variables.
4.2 The variation (regressions) in relationships
The second purpose of this research is to understand how much variation in affective,
continuance and normative commitment can be explained by responsible leadership and
organizational inclusion. For the second purpose, multiple regressions were used.
It is worth evaluating the regression models in the hierarchical multiple regressions.
Here the author used two models. In the first model the independent variable is responsible
leadership and the three elements of organizational commitment will be used as dependent
variables one by one. In the second model, the independent variables are responsible
leadership and organizational inclusion. As can be seen, the second model is not a
completely separate model but is a variation on Model 1 with one variable added. Each
model is a standard multiple regression procedure with the variables in that model entered
simultaneously. Therefore, each model has measures that show how well that particular
model fits the data, and these are presented in Table IV.
The measure of most importance when interpreting a hierarchical multiple regressions is
R
2
, which represents the variation in the dependent variable explained by the independent
variables. We can see from these results that each model explains a greater amount of the
variation in the dependent variable as more variables are added. Essentially, the models
here get better at predicting the dependent variable.
In the case of the dependent variable affective commitment in Model 1, in which
responsible leadership alone is the independent variable, R
2
is 0.401, with statistical
significance of po0.005, and F¼96.590. Due to the inclusion of organizational inclusion as
an additional independent variable, R
2
increased by 0.104 (the variance explained increased
by 10.4 percent), and this increase was statistically significant ( po0.0005) and Fincreased
to 98.633. In other words, organizational inclusion adds statistical significance to the
prediction of affective commitment. In summary, the addition of organizational inclusion to
the prediction of affective commitment (Model 2) led to a statistically significant increase in
R
2
of 0.104 and F(1, 137) ¼98.633, po0.0005.
In the case of the dependent variable continuance commitment for Model 1, in which
responsible leadership alone is the independent variable, R
2
is 0.315, with statistical significance
of po0.005, and F¼63.483. Due to the addition of organizational inclusion as an independent
variable, R
2
increased by 0.166 (the variance explained increased by 16.6 percent), and this
increase was statistically significant ( po0.0005) and Fincreased to 64.489. In other words,
organizational inclusion adds statistical significance to the prediction of continuance commitment.
The addition of organizational inclusion to the prediction of continuance commitment (Model 2)
led to a statistically significant increase in R
2
of 0.166, F(1, 137) ¼64.489, po0.0005.
In the case of the dependent variable normative commitment for Model 1, in which
responsible leadership alone is the independent variable, R
2
is 0.276, with statistical significance
of po0.005, and F ¼52.611. Due to the addition of organizational inclusion as an independent
variable, R
2
increased by 0.12 (the variance explained increased by 12 percent), and this increase
was statistically sign ificant ( po0.0005) and F increased to 53.755. In other words, organizational
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Responsible leadership Affective commitment Continuance commitment Normative commitment
DNADNAD NA DNA
Organizational inclusion
Disagree
Count 8 5 20 12 9 12 11 11 11 11 8 14
Expected count 7.6 13.2 8 5.9 21.9 5.8 6.8 20.5 5.7 9.1 17.7 5.9
Neutral
Count 21 62 5 2 62 3 3 58 4 18 45 4
Expected count 20.5 40.4 26.1 11.1 43.2 10.7 13 40.4 11.6 18.6 35.3 11.1
Agree
Count 5 3 18 9 26 8 14 18 10 13 24 9
Expected count 5.4 10.7 6.9 7.2 27.9 6.9 8.4 26.1 7.5 12 22.8 7.2
Pearson χ
2
Value 70.106 50.111 38.911 31.666
Asymp. Sig. (2-sided) 0 0 0 0
Cramer’sV
Value 0.508 0.418 0.321 0.339
Approx. Sig. 0 0 0 0
Notes: D, disagree; N, neutral; A, agree
Table III.
χ
2
test for association
between responsible
leadership and
an organizational
inclusion,
organizational
inclusion and affective
commitment,
organizational
inclusion and
continuance
commitment and
organizational
inclusion and
normative
commitment
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inclusion adds statistical significance to the prediction of normative commitment. The addition of
organizational inclusion to the prediction of normative commitment (Model 2) led to a statistically
significant increase in R
2
of 0.14 and F(1, 137) ¼53.755, po0.0005 (Table V):
•Hierarchical multiple regressions were run to determine if the addition of
organizational inclusion improved the prediction of affective commitment over and
above responsible leadership. The full model of responsible leadership and
organizational inclusion for predicting affective commitment (Model 2) was
statistically significant –R
2
¼0.520, F(1, 137) ¼98.633, po0.0005 and adjusted
R
2
¼0.104. When responsible leadership is used alone (Model 1) to predict affective
commitment R
2
¼0.146, F(1, 138) ¼96.590, po0.0005; therefore, H3a is confirmed.
Affective commitment Continuance commitment Normative commitment
Model 1 2 1 2 1 2
R0.615 0.769 0.601 0.693 0.505 0.634
R
2
0.401 0.517 0.315 0.484 0.276 0.416
Adjusted R
2
0.412 0.51 0.31 0.477 0.271 0.408
SE of the estimate 0.347 0.317 0.402 0.35 0.399 0.359
R
2
change 0.401 0.104 0.315 0.166 0.276 0.12
F96.590 97.433 63.483 64.299 52.611 52.622
Fchange 96.590 98.633 63.483 64.489 52.611 53.755
df1 1 1 1 1 1 1
df2 138 137 138 137 138 137
Sig. Fchange 0.000 0.000 0.000 0.000 0.000 0.000
Table IV.
Summary of the
regression analyses
of the models
BβR
2
FΔR
2
ΔF
Affective commitment
Model 1
(Constant) 1.047 0.416 96.590 0.416 96.590
Responsible leadership 0.606 0.745
Model 2
(Constant) 0.736 0.520 97.433 0.104 98.633
Responsible leadership 0.314 0.434
Organizational inclusion 0.439 0.545
Continuance commitment
Model 1
(Constant) 1.186 0.315 63.483 0.315 63.483
Responsible leadership 0.537 0.561
Model 2
(Constant) 0.756 0.481 64.299 0.166 64.489
Responsible leadership 0.179 0.158
Organizational inclusion 0.521 0.576
Normative commitment
Model 1
(Constant) 1.301 0.276 52.611 0.276 52.611
Responsible leadership 0.476 0.525
Model 2
(Constant) 0.924 0.396 52.622 0.120 53.755
Responsible leadership 0.073 0.158
Organizational inclusion 0.545 0.624
Notes: n¼240. po0.05
Table V.
Hierarchical multiple
regression predicting
organizational
commitment from
responsible leadership
and organizational
inclusion
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•Hierarchical multiple regressions were run to determine if the addition of
organizational inclusion improved the prediction of continuance commitment
over and above responsible leadership. The full model of responsible leadership
and organizational inclusion for predicting continuance commitment (Model 2)
was statistically significant –R
2
¼0.481, F(1, 137) ¼64.489, po0.0005 and
adjusted R
2
¼0.166. When responsible leadership is used alone (Model 1) to predict
the continuance commitment, R
2
¼0.315, F(1, 138) ¼63.483, po0.0005; therefore,
H3b is confirmed.
•Hierarchical multiple regressions were run to determine if the addition of
organizational inclusion improved the prediction of normative commitment over
and above responsible leadership. The full model of responsible leadership and
organizational inclusion for predicting normative commitment (Model 2) was
statistically significant –R
2
¼0.396, F(1, 137) ¼53.755, po0.0005 and adjusted
R
2
¼0.120. When responsible leadership is used alone (Model 1) to predict normative
commitment, R
2
¼0.276, F(1, 138) ¼52.611, po0.0005; therefore, H3c is confirmed.
5. Discussion and implications
The findings support the hypothesis that responsible leadership is positively associated
with organizational inclusion. The authors believe this is logical because responsible leaders
and/or decision makers constantly seek to expand their socio-ethical domain to include all
stakeholders in their surrounding economic spheres (Fry and Slocum, 2008; Carroll and
Shabana, 2010; Mousa, 2017b). Physicians are considered one of the main stakeholders.
Consequently, considering them as a main part of any functioning social network the
decision makers build and/or launch represents a work duty they have to fulfill. It is worth
highlighting that including employees (physicians in this case) in any relational networks
entails and is not limited to developing a neutral work-related communication with them,
appreciating individual differences, supporting intergroup cultural correspondence and
promoting continuous in-organization fairness (Daya, 2014; Mor Barak, 2015). Furthermore,
the authors of this paper assume that even if responsible leadership entails developing
in-out organization relational networks, it seems much more beneficial for decision makers
to start constituting these networks from inside their organization (hospitals in this case).
Otherwise, leaders cannot expect the full support of their staff and then engagement when
attempting to build out-organization relationships.
The results also found a statistically positive association between organizational inclusion
and organizational commitment approaches (affective, continuance and normative). This is in
line with Adam’s (1965) theory of equity, which highlights that individuals (physicians in this
case) seek to balance their work behavior and/or attitude (organizational commitment in this
case) with the benefits (e.g. recognition, respect, non-work time, justice) granted from their
employer. In this case, physicians expect a rational level of justice, recognition, respect and
other values of inclusion, and translate these into affective, continuance and normative
commitment. Accordingly, hospitals that adopt relevant workplace inclusion should expect a
high level of performance, engagement and integration from physicians on the one hand, and
a low level of absenteeism, turnover and withdrawal behavior on the other (Allen and Meyer,
2000; Haim, 2007; Mousa and Alas, 2016a, b). This also represents the obvious adoption of
social exchange theory, which indicates that employees constitute a kind of psychological tie
with their organization only when perceiving care from it (Blau, 1964). Furthermore, an
Egyptian study conducted by Mousa and Alas (2016a) has earlier asserted that cultural
diversity challenges (workplace communication and training) positively affect employee
affective, continuance and normative commitment. This supports the results yielded by the
second hypothesis of this paper.
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The research also identified a statistically significant effect of responsible leadership
on organizational commitment approaches (affective, continuance and normative)
through mediating organizational inclusion. The fact that responsible leadership
creates and maintains trusting relationships with in-and-out of organization (hospitals in
this case) stakeholders in an attempt to fulfill a predetermined set of societal obligations
besides their traditional goals of maximizing shareholder profits turns employees
(physicians in this case) into effective partners with a share of the organization’s work
results instead of being traditional performers (Waldman, 2011; Gond et al., 2011; Mousa,
2017a). This in turn not only enhances employee willingness to accept an organization’s
goals but also their readiness to invest their maximum in fulfilling its predetermined set of
objectives (Porter et al., 1980; Allen and Meyer, 1993). Accordingly, responsible leadership
has a statistically significant effect on employee organizational commitment.
Furthermore, the fact that decision makers appreciate individual differences and
intergroup dissimilarities on the one hand, and utilize fair procedures to constitute their
in-organization relational networks on the other, strongly supports the climate of
in-organizational transparency, trust and mutual respect, which then enhances employee
levels of organizational commitment.
The practical implications of this paper are that the authors suggest that each hospital
administration rethink the psychological and cultural mechanism to be adopted when
dealing with their physicians. Creating and maintaining long-lasting relationships with in-
and-out stakeholders plays a significant role in enhancing affective, continuance and
normative commitment among physicians toward their workplace (their hospital in this
case). Moreover, there is a need to understand that organizational inclusion is no longer
limited to management intervention. Accordingly, the administration of public hospitals in
Egypt should responsibly employ an ongoing policy for disseminating organizational
inclusion practices (e.g. organizational justice, solidarity, tolerance and equality) in each
hospital and/or department. Any discourse about workplace discrimination, organizational
nepotism and preferential selection in recruiting, hiring, developing and retaining
physicians should be met with a hospital mechanism of affirmative action against
discrimination and in support of a realistic equal employment opportunity approach. Hence,
asking physicians to write a monthly anonymous report about what their likes, dislikes,
hopes and concerns will, to some degree, diminish the view of their hospitals’irresponsible
practices. Moreover, utilizing open communication policies and monthly training in
managing cultural differences should play a role in enhancing the emotional, continuance
and normative commitment of physicians.
6. Conclusion
This study focused on physicians in the four public hospitals located in the October
province (Egypt) and provides empirical evidence of a positive association between
responsible leadership and organizational inclusion. Moreover, it secures additional insights
into the positive effect of responsible leadership and organizational inclusion on physicians’
affective, continuance and normative commitment.
The study statistically highlights that having responsible decision makers who seek to build
socio-ethical and relational networks with in-out group networks on the one hand, and securing
a work climate of cultural harmony in which individual differences, intergroup dissimilarities
and identity-related conflicts are well-managed and solved on the other, considerably inspires a
high level of affective, continuance and normative commitment among physicians. This comes
in agreement with the study by Mousa and Alas (2016a) –the only study conducted to address
the relationship between cultural diversity challenges and organizational commitment in the
Egyptian context to the best of the author’s knowledge. Moreover, the results support the
findings of Mousa (2017a, b) who addresses nurses in Egyptian public hospitals and found that
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in-out group differentiation, exclusion and injustice are the main factors increasing nurses’
desire to discontinue their organizational membership.
This research has clear limitations. First, focusing only on public hospitals in a single
Egyptian province out of 26 provinces may diminish the author’s ability to generalize his
results. Second, depending on physicians as the only source of research data may lead to an
inflation of the statistical results. Finally, relying mostly on references with business
backgrounds, due to the novelty and the rareness of the empirical studies on responsible
leadership, may be considered a third limitation.
The uniqueness of the present research derives from the reality –to the best of the
author’s knowledge –that it is considered the first to address the relationship between
responsible leadership and organizational commitment in the context of Egyptian public
hospitals, which may yield further research opportunities for Egyptian researchers to test
the same hypotheses in other types of hospitals (military, private, etc.) in Egypt.
Furthermore, the research may also be considered an open invitation for more
interdisciplinary studies by HR, public administration, sociology and cultural diversity
scholars in different health care organizational settings.
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Corresponding author
Mohamed Mousa can be contacted at: bbcc2050@gmail.com
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