Effect of organizational commitment on compassionate care behaviour of health care professionals

The healthcare sector in developing countries, is striving to provide quality healthcare services where healthcare professionals should treat the patients with compassion, dignity, attention, and respect. To achieve such objectives, the recent research highlights the key role of compassionate care behaviour in healthcare sector. However, little attention has paid to investigate factors that augment compassionate care behaviour among healthcare professionals. Therefore, the current study marks the first attempt to examine the effect of organizational commitment on compassionate care behaviour. The study design was cross-sectional and questionnaire distributed to 340 healthcare personnel through convenient random sampling. Moreover, confirmatory factor analysis was used to check data reliability and validity while regression analysis was used to test proposed hypothesis. Out of 340 subjects, 330 (97.0%) were female and 10(03.0%) male health care professionals working in indoor units. Majority of the participants belonged to age bracket 24-32 years (40%) and 33-41 years (43%) while remaining 17% from age group 42-60 years. A statistically significant association was found among organizational commitment and compassionate care behaviour (p<0.05). Conclusion: The current study findings revealed significant positive relationship between organizational commitment and compassionate care behaviour of health care professionals. The Current study marks the first attempt to delineate the role of organizational commitment to enhance compassionate care behaviour among healthcare personnel which offers several implications for nursing administration, human resource managers and hospital management.


Introduction
Compassion is a profound feeling, elicited by viewing the pain and distress of others, and trying to alleviate the suffering of others in pain [1]. Compassion is a core value in health care sector. Compassion is valuing and respecting the patient as individuals and answering in the ways to relive suffering of those in distress of health care need [2].Compassion connotes a deep connection with someone's suffering accompanied by the intention to act to alleviate that suffering [3,4]. Moreover, compassion in care is central concepts for the healthcare professionals and described as "healthcare most valuable asset" [5].
Indeed, compassion towards humanity is viewed as basics for provision of excellent quality patient care [6]. Compassion play an important role to unit sufferers in difficult times and healthcare providers acts to promote the physical and mental health of those in difficult times [7]. Compassion is a Latin word means suffer with. The concept of suffering is obvious in the many definitions of compassion, where the healthcare provider views are that the suffering of others are their suffering and they try to mitigate this suffering [8,9]. Health care professionals identify and deliberately acts to alleviate the suffering of those in pain [10]. Compassionate care is one of the most emerging research area in healthcare sector and management. It has two components: first you have awareness of another's suffering and then you must response or act appropriately to relieve [5]. Moreover, Compassionate Care has been defined as a construct which connotes a profound acknowledgment of other's distress of suffering accompanied by intent to alleviate their sufferings [11]. Compassion has two fundamental qualities; kindness and action. Healthcare professional showed kindness in the form of sympathetic awareness of others' suffering, with an action to minimize it. Moreover, Compassionate Care is the immersion into another's suffering, pain, brokenness even though that person is a stranger [12]. Compassion is a fundamental philosophy to the every healthcare profession in the provision of best quality patient care [4]. However, in this contemporary era, compassionate interactions in the health care sector is desirable. Despite its profile, little research has investigated how compassionate care is enacted and influenced by organizational factors. The literature, however, suggests to incorporate organizational commitment (OC) as organizational construct that has strong influence on compassionate care the dependent variables of interest. Organizational commitment (OC) is psychological bond employees' feel towards the goals of the organization [13]. Through organizational commitment employees feel themselves as a part of an organization. Furthermore, extant literature characterizes organizational commitment in three ways; readiness to accept organizational goals and aims, readiness to exercise substantial efforts to achieve goals and a definite desire to be member of an organization [14,15]. The three component model of Meyer & Allen stipulates affective, continuous, and normative as basic types of organizational commitment [1,16]. Moreover, the Latin word affective means emotions, feelings and attitude. Affective commitment is an emotional connection with organization which enables the workforce to feel honour to tell others that they are the part of the organization. In addition, workforce having affective commitment want to stay and retain in the same organization for long run [17][18][19]. Likewise, employees with normative commitment show professional loyalty or obligation to stay in the organization in response to employer's investment in form of training [8]. Affective and normative commitment consistent to each other. Consequently, the effects of normative commitment on organizational outcome not significantly different from affective commitment [2]. In contrast, continuous commitment means employees have to stay because of disbursement associated with leaving the organization [5].The reasons of employee's perceived cost or disbursement include loss of fringe benefits, not getting the better job, family relocation cost and loss of opportunities for promotion [7]. As a large body of research demonstrates that organizational commitment influence behavioural outcomes namely loyalty, motivation, engagement, compassion, turn over intentions, and citizenship behaviours [19,20]. Therefore, the current study aimed to examine the impact of organizational commitment (OC) on compassionate care (CC) practice of health care professionals.
In doing so, current study advances the body of knowledge on an emerging stream of research and contributes to scholarly discourse which endeavours for in-depth understanding of organizational commitment and compassionate care practice.

Materials and methods
A cross sectional design was used. Demographic Characteristics of Respondents are given in (Table 1). Target population was health care personnel having continuous contact with the patient of Services Hospital Lahore, Pakistan. Sample size was estimated as 340 healthcare personnel. The investigator would not factor analyse a sample until the sample size preferably should be 100 or large for quantitative studies. As a rule of thumb, minimum is to have five times observation as the number of constructs/ variables. The researcher tries to take highest cases-per-variable ratio to reduce the chances of overfitting the collected data [21]. Therefore, Registered Nurses of Services Hospital having continuous contact with the patients were accessed conveniently.
We distributed 500 questionnaires to Registered Nurses and received 365 filled questionnaire from which 25 were not considered for data analysis because of incomplete responses. Finally, we used 340 complete responses for final data analyses. Inclusion criteria of the study was Registered Nurses of Services hospital having continuous contact with the patient. Ethical permission was taken from the institutional review board (IRB) committee of the University of Lahore. Moreover, Informed consent was signed by the participants before giving data. Confidentiality of the participants was maintained and assured. The measures of all constructs were adopted from prior literature. A structured questionnaire of Organizational Commitment (OC) and Compassionate Care (CC) were used to collect data from registered Nurses. The questionnaire was distributed to the participants by the researcher. Organizational Commitment was measured with 08 item scale of Allen and Meyer (1996). We adopted 12 items measure of Compassionate Care from previous study [22]. The response of all 20 items was taken on seven point mostly ranging from 1= strongly disagree/ not successful to 7= strongly agree/ very successful on likert scale. Statistical analysis was done with SPSS software (version 24). The holistic view of the study findings, reliability and validity testing were performed by regression analysis shown in (Table 2) and Confirmatory factor analysis (CFA) given in (Table 3). Regression and correlation analysis was used to examine the impact of organizational commitment (0C) on compassionate care (CC) practice of healthcare personnel.

Results
Demographic characteristics of respondents are given in (Table 1). As reported in (Table 2) demographic analysis showed that data comprises of one percent (N=10) males and 99 percent (N=330) females health care personnel. Mostly respondents hold diploma (65%) and graduate degree healthcare personnel (34%). Majority of the participants belong to age bracket 33-41 years (43%) and 24-32 years (40%) while remaining 17% from age group 42-60 years. All of the respondents are from public sector. Besides above demographic information, we inquired about respondents' years of experience with organization. Experience of respondents range from 1-5 years (35.6%), 6-10 years (35%), 11-15 years (25%) and only small number of respondents have experience from 16-20 years (4%). The Cronbach-alpha value for reliability of every construct is greater than 0.70 which indicates high consistency among different items. Confirmatory factor analysis (CFA) given in (Table 3). The statistics of CFA indicates the suitability of collected data for further analysis as it meets criteria for reliability and validity. The data fulfils the requirements of reliability and validity. Moreover, factor loading values pertaining to individual items are higher than 0.50 that provide support for convergent validity. In addition, the values of average variance extracted for almost all the measures are higher than 0.5. Additionally, Cronbachalpha value for every construct reliability is greater than 0.70 which indicates high consistency among different items. Correlation among different study variables is provided in (Table 4). Table 4 showed correlation among different study variables. Results confirmed that organizational commitment (OC) has significant positive correlation with nurses' compassionate care (CC) at level of significance (p=0.000) and (r=0.584).
The Regression analysis reported in (Table  5) specifies that Organizational Commitment significantly contributes in the provision of Compassionate care with 0.711 of beta, R2 = 0.506, and P (sign.) = 0.00. F-statistic value of 207.32 with level of significance 0.00, supporting the hypothesis that organizational commitment (0 C) has significant positive effect on compassionate care. Unstandardized and Standardized Coefficients are represented in (Table 6). Where the significant value is 0.000. Thus, it is concluded that organizational commitment imposes great effect on compassionate care health care personnel.     Current study advances the body of knowledge by exploring the organizational related factors like an organizational commitment that enhances compassionate care behaviour of health care personnel in public sector hospitals of a developing country. In this regard, the study findings indicated that the organizational commitment is the leading organizational practice to augment compassionate care behaviour that ultimately reduces the patient distress and healthcare sector prestige will be enhanced. Moreover, practically our study provides useful insights to the hospital administration and human resource managers. The hospital administration and human resource managers should use different highcommitment human resource practices as strategic imperative to attract best employees and enhance their motivation/commitment through developmental performance appraisal system. In addition, competitive and equitable compensation could further augment employees' level of commitment with the organization and instigate compassion for the clientele. The human resource department of healthcare sector should be equipped with insights to use selective staffing, equitable reward systems and performance appraisal as the dominating forces to recruit and motivate the health care personnel to provide effective care to the patient in committed manner. More importantly, ward mangers/ head nurses should utilized the committed employees to provide high quality nursing care to the patients. The committed workforce of nurses express sensitivity to patient in critical situations. This study also comes with some limitations. Firstly, we collected data only from nurses of one public sector hospital that might limit the generalizability of findings in private sector. Thus, future studies may consider to utilize observational/ experimental approach to collect data both from human resource managers and nurses of public and private sector to further enrich the topic. All the participants were nurses with professional qualification that may not reflect entirely the view of all other healthcare staff. Therefore further research should be done on other health care professionals to strengthen the compassionate care in different health care sectors. Though, there is a study that has examined two human resource practices with Nurse's turnover intention but they did not consider role of organizational commitment on compassionate care behaviour. Therefore, there's a dire need to study the relationship of organizational commitment with compassionate care in healthcare sector. In fact, the actual problem is the scarcity of research studies in the realm of organizational commitment in healthcare sector which motivates the authors to design this study to figure out how organizational commitment lead toward compassionate care behavior. Ward mangers/ head nurses should utilized the committed employees to provide high quality nursing care to the patients. The committed workforce of nurses express sensitivity to patient in critical situations.