The current issue and full text archive of this journal is available at www.emeraldinsight.com/1757-5818.htm

Linking task and goal interdependence to quality service The role of the service climate Anat Drach-Zahavy Faculty of Health and Welfare Sciences, University of Haifa, Haifa, Israel, and

Anit Somech

Linking task and goal interdependence 151 Received 24 October 2011 Revised 28 March 2012 14 August 2012 28 November 2012 Accepted 4 December 2012

Faculty of Education, University of Haifa, Haifa, Israel Abstract Purpose – With a twofold aim, the purpose of this paper is to focus on the service climate, including its antecedents, consequences, and a moderator. First, it examines whether task- and goalinterdependent configuration facilitates the level of service climate; second, it tests the strength of the moderating role of service climate between service climate levels and service behavior. Design/methodology/approach – Among 54 nursing units at six hospitals, the data were collected using multiple methods (surveys, observations, administrative data). Findings – Mixed-linear model analyses indicated that the joint effects of task and goal interdependence related significantly to service climate level. Service climate strength moderated the relationship of service climate level to quality service behavior. Research limitations/implications – The research approach may diminish the generalizability of the research results. Further work should test the propositions in other research contexts. Practical implications – Quality service behaviors and the service climate could be promoted through well-designed task- and goal-interdependence structures within units. Assimilating a service climate in units is not enough. To promote high quality service behaviors, managers must direct their efforts toward finding agreement among team members with regard with the importance of service in their unit. Originality/value – The paper’s findings offer empirical support to the persistent social interaction explanation of climate formation and point to the important role of interdependence for creating and maintaining service climate levels and promoting service behaviors in units. Keywords Hospitals, Service climate, Israel, Service behaviors, Task interdependence, Goal interdependence, Health organizations Paper type Research paper

The overall growth of the service economy and increased competition among service providers has forced organizations to focus on the quality of services they provide (Liao, 2007). Thus, a widespread consensus that “satisfied customers are power” has spread widely, including into the healthcare industry (Drach-Zahavy, 2009). In response, managers must create work environments that support service quality, by developing a positive “service climate” (Schneider et al., 2009), in which employees share the perception that providing high quality service is what really counts (Schneider et al., 2002). Empirical research consistently finds positive relations between service climates and quality service behaviors (Dimitriades, 2007; Salanova et al., 2005).

Journal of Service Management Vol. 24 No. 2, 2013 pp. 151-169 q Emerald Group Publishing Limited 1757-5818 DOI 10.1108/09564231311323944

JOSM 24,2

152

Considering the importance of a service climate as a means to provide both the motivation and the capability to exhibit quality service behaviors (Liao, 2007), this field study focuses on the concept of a service climate, including its antecedents, its moderators, and its consequences. Prior literature in this realm suffers from two key gaps. First, scholars have only recently begun to investigate the antecedents of service climate (Salanova et al., 2005), focusing mainly on the role of leadership (Schneider et al., 2005) and organizational structure (de Jong et al., 2004, 2005). The unit’s structure provides the bridge between a leader’s strategic decisions and the arrangements required to implement the strategy. We therefore focus on important structural factors as antecedents of the service climate, namely, the joint effects of unit-level task and goal interdependence. The former refers to shared perceptions of how much unit members believe that they depend on other unit members’ resources, information, support, or assistance to carry out their job (Brass, 1985). The latter pertains to unit members’ shared perceptions of how much they believe that they are assigned group goals or provided with group feedback (van der Vegt and Janssen, 2003). We provide theoretical arguments and empirical support for our claims that goal interdependence relates positively to service climate and that task interdependence moderates their link (Figure 1). Second, Schneider et al. (2002) highlight the importance of studying not only the service climate level of a certain setting (aggregation of individual climate perceptions) but also the strength of that climate (degree of within-group consensus in employee climate perceptions). Research on climate strength is relatively new though, without sufficient exploration of its role in facilitating quality service behaviors (Dawson et al., 2008; Kuenzi and Schminke, 2009; Lindell and Brandt, 2000). We propose that the extent to which the unit’s service climate level promotes individual employee quality service depends on the strength of the service climate (Schneider et al., 2002). By testing these proposals, this study aims to narrow extant gaps in service literature. Background and hypotheses Service climate The service climate refers to employees’ shared perceptions of the practices, procedures, and behaviors of effective services that are organizationally expected, supported, and rewarded (Schneider et al., 1994). This definition highlights several important themes. First, climate focuses on how a particular “situation” relates to workers’ perceptions (Schneider and Reichers, 1983; Yagil and Luria, 2010). Second, service climate derives from a consensual understanding in a company, department, or group about how to behave in different settings and with different customer populations (Hui et al., 2007). Third, because multiple climates often exist simultaneously in Task Interdependence

Climate for Service Strength H2b

H1b

Figure 1. The research model

Goal Interdependence

H1a

Climate for Service

H2a

Quality Service Behaviors

a single organization, climate should be regarded as a specific construct with a referent or strategic focus that is indicative of organizational goals (Schneider and Reichers, 1983), such as safety (Yagil and Luria, 2010), innovation (Charbonnier-Voirin et al., 2010), or – as in this study – service (Schneider et al., 1994). A service climate exists when employees’ shared perceptions indicate the importance of service in the unit. As is true of any climate, a service climate can be characterized by two distinct indicators, level and strength. The climate level refers to the sense of an imperative, which highlights the goal’s or facet’s importance, as perceived by the members of the entity (Lindell and Brandt, 2000; Schneider and Rentsch, 1988). Operationally, it can be assessed by aggregating individual perceptions, then taking the mean value to represent the climate level for the overall entity; higher scores indicate higher perceived service priority (Schneider et al., 2002). Climate strength instead is the degree of agreement among individual perceptions: the greater the consensus, the stronger the climate (Schneider et al., 2002). Its operational implementation relies on various homogeneity measures, such as within-group correlation (rwg: James et al., 1993) or the average deviation measure (ADM( j): Burke et al., 1999). Antecedents of service climate Relatively robust findings show that service climate relates to high quality service, yet scarce literature pertains to its antecedents, making the question of how climates form increasingly relevant (Schneider et al., 2000, 2009). Climate formation involves social interactions among group members, who attempt to make sense of their environments and understand what is important in their organizations (Ashforth, 1985; Salanova et al., 2005; Schneider and Reichers, 1983). This sense-seeking or sense-making interaction depicts people’s tendency to check, suspend, regroup, and transform their own perceptions of events in light of their interactions with others in the setting, which define or enact their environments (Schneider and Reichers, 1983; Weick, 1979). Shared understanding of a workplace climate thus is socially constructed (Ashforth, 1985) and negotiated interpersonally (Weick, 1979). In light of these theoretical insights, some authors explore specific antecedent variables that facilitate service climate formation. One stream of research focuses on leadership, to show that the value that leaders attach to providing high quality service, as well as leaders’ service orientation, relate to the focal organization’s or unit’s service climate level (Borucki and Burke, 1999; Salvaggio et al., 2007; Schneider et al., 2005). The value that leaders attach to service also tends to be reflected in the centrality of customer service in the organization’s policies, procedures, and practices (e.g. human resource management; Zohar, 2002). Research thus identifies a close relationship between organizational practices (e.g. training, technology, and autonomy) and the service climate level (Salanova et al., 2005; Schneider et al., 1998). Another line of research focuses on structural frameworks (Hackman, 1990). The unit’s structure serves as a bridge between strategy decisions and the arrangements made to operate this strategy; it is embedded in the team’s culture and norms (Schein, 1990). Although some structural fluctuations may exist in individual roles, the structuring modes offer a team-level entity. Accordingly, de Jong et al. (2004, 2005) find links between structural characteristics of the work environment, such as flexibility, and the service climate in self-managing teams. These two lines of research provide important insights into how individual team members become “socialized to act

Linking task and goal interdependence 153

JOSM 24,2

154

in similar ways, are exposed to similar features within contexts, and come to share their interpretations with others in the setting” (Lindell and Brandt, 2000, p. 332) and thus develop a service climate. We chose to focus on task and goal interdependence as prerequisites of a service climate. This choice arose from previous lines of research: task and goal interdependence represent structural means to facilitate interactions, which leaders can shape in their attempts to improve service. Our choice also was governed by the importance of interdependence in healthcare as a strategic structural tool that improved service quality (Nembhard and Edmondson, 2006). We posit that goal interdependence relates directly to the service climate level, whereas task interdependence serves as a moderator of the relationship. Goal interdependence refers to the extent to which team members believe that they receive group goal assignments or group feedback (van der Vegt and Janssen, 2003). This important structural facet directs the efforts of team members toward their common goal, and it enhances interpersonal interactions (Gundlach et al., 2006; Johnson and Johnson, 1989; Somech et al., 2009; van der Vegt and Janssen, 2003). Considering the primacy of service quality in daily activities, such as in the nursing field, goal interdependence can consolidate team members’ perceptions that service is what really counts: H1a. Goal interdependence relates positively to the service climate level. Despite the importance of goal interdependence, previous research also indicates varying effects, depending on its combination with task interdependence (Comeau and Griffith, 2005; Drach-Zahavy and Somech, 2010; Somech, 2008; Stanne et al., 1999; van Vijfeijken et al., 2006; Victor and Blackburn, 1987; van der Vegt and Janssen, 2003). That is, when task interdependence is high, greater goal interdependence implies more congruence between task and goal interdependence in team members’ environment. More congruent conditions signal to employees that they may interact and exchange information, resources, and materials to perform their task (i.e. high task interdependence) and that they will be rewarded according to their common goals (i.e. high goal interdependence). Together, these conditions convey strong and clear messages of support and encouragement for team members’ interaction (van der Vegt and Janssen, 2003). In this vein, service literature confirms that supportive interactions frequently are required to create service-oriented climates and address customer service requests successfully (de Jong et al., 2004, 2005; Gracia et al., 2010; Schneider et al., 2009). Service literature also posits that mutual support among employees is necessary to improve service quality (Borucki and Burke, 1999; Carmeli, 2008; Gracia et al., 2010; Parasuraman et al., 1985; Schneider et al., 1994). In contrast, under the same condition of high task interdependence, the lower the goal interdependence the higher the incongruence of goal and task interdependence (van der Vegt et al., 2003).Team members must interact and exchange information, resources, and material to perform tasks, as prescribed by the high task interdependence, but each member receives independent rewards. This situation is inherently uncertain, because it shifts individual attention to individual benefits, away from coordinated work, to meet customers’ expectations, with potentially detrimental effects on the formation of a service climate and thus on service behaviors.

A different picture might emerge when task interdependence is low. Here, the lower the goal interdependence the higher the congruence between goal and task interdependence. Nevertheless, these congruent conditions of low task and goal interdependence indicate to team members that little interaction is required and each can pursue his or her own task with little potential for conflict with others. This of course stands in sharp contrast to the perception of integrated efforts to fulfill customers’ needs, which is fundamental to the perception of a service climate (Nembhard and Edmondson, 2006). In contrast, under the same condition of low task interdependence, the higher the goal interdependence the higher the incongruence between goal and task interdependence (van der Vegt et al., 2003). High goal interdependence signals that team performance is the sum of each individual’s performance, but the lower the task interdependence the lower the opportunity for employees to interact, and exchange information and other resources. Such incongruence conveys a typical social dilemma (Kramer, 1991): working cooperatively with others to attain joint goals (prescribed by the high goal interdependence) might expose them to exploitation attempts by their counterparts (prescribed by the low task interdependence: Somech, 2008). This interdependence situation creates uncertainty about other members’ intention and goals, hampering the development of shared perceptions of service climate, and diminishing the importance of coordinated work to satisfy customers (van der Vegt et al., 2003; Drach-Zahavy and Somech, 2010): H1b. Task interdependence moderates the relationship between goal interdependence and the service climate level, such that the relationship between goal interdependence and service climate level is more positive when task interdependence is high rather than low. Link between service climate and quality A common outcome of the service climate level, and the focus of extensive research across organizational contexts, is service quality (Schneider et al., 2000, 2009). In healthcare for example, service quality demands excellent communication skills and empathy, as well as shared power and responsibility with patients and the development of common therapeutic goals concordant with each patient’s values and preferences (Epstein et al., 2005; Mead and Bower, 2002). The interaction between customers and health providers thus offers a potential means for a healthcare organization to improve service quality, health outcomes, and patient satisfaction, as well as reduce healthcare delivery costs (Epstein et al., 2005; Mead and Bower, 2002). Recent research attests to the link between service climate levels and service behavior in various service organizations (Salanova et al., 2005; Schneider et al., 2005; Wall and Berry, 2007), as well as specifically in the healthcare sector (Lanjananda and Patterson, 2009; Shipton et al., 2008): H2a. A unit’s service climate level relates positively to the quality of service behaviors of employees in that unit. Climate strength is a relatively new research topic though, so little consensus exists regarding its role in the relation between service climate level and service quality (Dawson et al., 2008). Some research shows a direct link between climate strength and quality service performance (Dawson et al., 2008; Lindell and Brandt, 2000);

Linking task and goal interdependence 155

JOSM 24,2

156

other studies treat service climate strength as a moderator (Schneider et al., 2002). We adopt the latter prediction, which focuses specifically on the service dimension of climate, because we anticipate differential effects for different climate dimensions (Dawson et al., 2008). This hypothesis is grounded in Mischel’s (1973) concept of strong/weak situations, which posits that strong situations convey strong cues of desired behaviors, whereas individual differences determine behavior most clearly in ambiguous situations. In a typical healthcare setting, each employee is responsible for caring for specific patients during a specific shift. If the service climate is both positive and strong, such that it prioritizes quality service (Mischel, 1973), consistently high quality behaviors likely characterize the service provided. If the service climate is negative and strong, consistent negative service behaviors are likely. In contrast, the less consistent a unit is in terms of its service climate level and strength, the more diverse the care provided to patients, because service behaviors are determined primarily by individual differences: H2b. The relation of a unit’s service climate to employees’ quality service behavior is stronger in a high than in a low climate strength work unit. Method Sample Fifty-five nursing units at six public hospitals in Israel were randomly selected to participate in this study. One unit had a policy in place that prevented it from participating in research, so 54 units (9 per hospital), representing medical, surgical, internal, and critical care functions, participated. In each unit, we surveyed all registered staff nurses (n ¼ 350), working on different shifts. Of them, 266 nurses returned surveys, for an average response rate of 76 percent (ranging from 63 to 85 percent/unit). The relatively high response rates likely reflect our use of well-documented response facilitation strategies, such as establishing the importance of the survey in our application to the nursing authorities, fostering nurses’ commitment to the survey, and providing survey feedback (Baruch and Holtom, 2008), as we detail in the procedure section. Nurses in our sample interacted with colleagues working on the same shift to provide care for patients. Yet their job required constant cooperation with nurses on other shifts (e.g. formal handovers and informal information exchange) to ensure continuity of care. This cross-responsibility across shift teams enables a unit climate to develop, and it also suggests that a lack of agreement about climate offers a good signal of a less integrated unit (Dawson et al., 2008). Hospital size ranged from 409 to 898 beds, with an average of 541 (SD ¼ 192). The units ranged form 6 to 18 nursing staff, with an average of 14 nurses (SD ¼ 7.3), who were 67 percent women, of 38.4 years in age on average (SD ¼ 9.0). All the nurses in our sample were permanent employees, and their average unit tenure was 10.4 years (SD ¼ 7.6), with an average job tenure of 14.3 years (SD ¼ 9.5). In terms of education, 49.7 percent, had Bachelor’s degrees, 44.4 percent had some college degree, and 5.9 percent had earned a Master’s degree. Procedure Two research assistants performed the data collection. After receiving ethical approval for the study, they met the head nurse and described the general purpose of the study,

as well as providing assurances that the study was not focused on any specific unit or head nurse and that all data would remain confidential. Questionnaires were distributed to all nurses in each unit on site; only those who completed questionnaires were observed independently, which occurred over the course of three separate patient guidance encounters (different shifts and times of the day, different patients), each averaging 20 minutes. We chose guidance encounters, such as providing patients with vital information during medication administration, before medical treatment, or on discharge, because though undertaking these encounters is part of health providers’ role, they also are the first tasks abandoned if workloads grow too heavy. They are unstructured too, so there is potential for substantial variance across nurses, depending on their personal tendencies and the climate. Two undergraduate nursing students (nearing completion of their academic degrees), blind to the study’s hypotheses, participated as observers. Their presence was generally interpreted by the participant nurses as natural in the unit environment, which helped prevent biased responses, according to post-observation discussions with several nurses. Each nurse was observed by the two research assistants. To ensure inter-rater reliability and observations’ validity, the observers received ten hours of training, focused on: . observation techniques in research; . a thorough study of service behavior and climate; and . participation in periodic meetings during the observation period to discuss and resolve any categorization discrepancies through group consensus techniques (k ¼ 0.85-0.93). Measures To measure service behavior, we used a structured observation sheet (Schirmer et al., 2005), as used in previous studies (Drach-Zahavy, 2010). Observations represent an effective method in healthcare settings, because studies relying on nurses’ or patients’ retrospective self-reports about service behavior are susceptible to estimation biases (Epstein et al., 2005). The tool’s nine evaluation criteria assess functional and relational aspects of service quality, measured on five-point Likert scales (1 – “not attempted,” 5 – “done very well,” plus a “not applicable” option; Appendix). We averaged service behavior across the nine criteria and three observed encounters. The Cronbach’s a values ranged from 0.85 to 0.88. Service climate used an eight-item global service climate scale developed by Schneider et al. (1998). A sample item (five-point Likert scale, 1 – “poor,” 5 – “excellent”) was, “How would you rate the job knowledge and skills of department employees to deliver superior quality service?” (Cronbach’s a ¼ 0.90). Climate strength was operationalized using Burke et al.’s (1999) average deviation (ADM( j)) measure, which calculates the average deviation from the mean of all individuals in a unit. Because this index is a direct measure of within-team variability, we multiplied the values provided by the index by 21, so higher scores represented higher within-team agreement and climate strength (Gonzalez-Roma et al., 2009). We measured perceived task interdependence with a five-item scale developed by van der Vegt et al. (2003), including for example (five-point Likert scale, 1 – “completely disagree,” 5 – “completely agree”), “I need information and advice from

Linking task and goal interdependence 157

JOSM 24,2

158

my colleagues to perform my job well” (Cronbach’s a ¼ 0.79). Perceived goal interdependence was assessed with three items adapted from previous research (Tjosvold, 1984; van der Vegt et al., 1999), such as (five-point Likert scale, 1 – “completely disagree,” 5 – “completely agree”), “Goal attainment for one team member facilitates goal attainment for the other team members” (Cronbach’s a ¼ 0.85). As control variables, we measured the mean tenure in the unit and the unit’s load, calculated by the mean nurse/patient ratio across the observational session days (Buchan, 2005), controlled at the unit level. Other controls, accounting for potential differences among hospitals and units were controlled for in the statistical analyses. Analyses Because our hypotheses focus on effects at the individual level (nurses), when those individuals are nested in naturally occurring hierarchies (units, hospitals), we applied mixed linear model analysis (Singer, 1998). That is, we aggregated the service climate and task- and goal-interdependence scores to the unit level of analysis, to capture shared perceptions. To limit common method bias, we analyzed a split-sample approach, creating interdependence ratings from one subsample and climate ratings from the other. The average rwg( j) (based on a uniform expected variance distribution) for service climate, task interdependence, and goal interdependence were, respectively, 0.79, 0.82, and 0.80; the median rwg( j) were 0.86, 0.81, and 0.80; and the ICC(1) scores were 0.20, 0.18, and 0.18 ( p , 0.001). These findings justified our data aggregation to department-level service climate scores (Bliese, 2000; James et al., 1993). Results Confirmatory factor analysis Using confirmatory factor analysis (CFA), we assessed the validity of four constructs: service climate, task interdependence, goal interdependence, and service behavior. The parameter estimates stemmed from the LISREL 8 computer package, using the maximum likelihood method. The four-factor model yielded an adequate overall fit (comparative fit index (CFI) ¼ 0.96, root mean square error of approximation (RMSE) ¼ 0.02). The factor loadings for each item on its corresponding construct were greater than 0.52 and significant at the 0.05 level or better (i.e. most model loadings were in the 0.70s and 0.80s). To validate the four-factor structure, we conducted a second CFA, in which all items could load on one factor. This CFA yielded an unacceptable fit level, with CFI ¼ 0.51 and RMSE ¼ 0.18. Because we wanted to test a model in which task and goal interdependence appeared as distinct factors, we assessed a further CFA: a three-factor structure that included task and goal interdependence as a single factor. This CFA yielded a worse fit than the four-factor structure (CFI ¼ 0.68; RMSE ¼ 0.17). Thus, our four-factor model provided the best fit of the models we tested, in support of construct validity. With these fit results, we turned to examining the convergent and discriminant validity of the four factors, using a stringent procedure outlined by Fornell and Larcker (1981). For the test of convergent validity, we computed the rvc(h) index, which denotes the proportion of variance in items explained by the underlying factor. All values exceeded the 50 percent criterion (Fornell and Larcker, 1981). For the test of discriminant validity, we followed Fornell and Larcker’s (1981) suggestion that the average variance

extracted for each construct should be greater than the squared correlation between that construct and any other construct. This test held for all four constructs. Hypothesis tests In Table I we provide the means, standard deviations, and intercorrelation matrix for the study variables. The mixed linear model analysis tested the effects of goal and task interdependence, as well as their interaction, on the level of service climate, after controlling for the unit’s load and mean seniority (Table II). To facilitate interpretation and minimize multicollinearity concerns, we used standardized variables to conduct all the analyses (Aiken and West, 1991). Of the control variables, only the unit’s load related negatively to the service climate level (estimate ¼ 20.26; p , 0.001). When we entered the two main effects of goal and task interdependence, only goal interdependence was associated with it (estimate ¼ 0.17; p , 0.001), in support of H1a. The two-way interaction effect of goal and task interdependence also was significantly linked to the service climate level (estimate ¼ 0.12; p , 0.05). Figure 2 shows a graphic representation of this interaction, plotted using procedures suggested by Aiken and West (1991). The simple slope of the regression line, indicating the association between goal interdependence and the service climate level, was positive and significant in high task interdependence (0.34, t ¼ 2.45; p , 0.05) but not

Variables (1) (2) (3) (4) (5) (6) (7)

M

SD

(1)

(2)

(3)

Seniority 14.30 9.55 Load 6.8 2.08 0.08 Task interdependence 4.10 0.56 20.21 * * 0.20 * Goal interdependence 3.92 0.59 20.06 0.24 * * Service-climate level 3.61 1.01 20.01 0.31 * * Service-climate strength 0.65 0.17 20.05 0.01 Service behavior 2.10 0.67 20.06 20.17 *

(4)

(5)

Seniority Load Task interdependence Goal interdependence Task £ goal interdependence SD of organization level intercept SD of unit level intercept SD of residuals D-2 Res LL

159

(6)

0.66 * * 0.27 * 0.36 * * 0.02 0.12 0.18 * 0.25 * * 0.22 * * 0.27 * * 0.22 * *

Notes: Significant at: *p , 0.05 and * * p , 0.01; level 1 – nurses: n ¼ 266

Controls Estimate SE

Linking task and goal interdependence

Table I. Means, standard deviations and inter-correlation matrix among study variables

Climate-for-service level Main effects Interaction Estimate SE Estimate SE

20.06 20.26 * *

0.09 0.05

2 0.08 2 0.22 * * 2 0.04 0.17 * *

0.09 0.07 0.07 0.04

0.01 0.20 * 0.19 * *

0.01 0.15 0.02

0.01 0.18 * 0.17 * * 6.7 *

0.01 0.14 0.02

Notes: Significant at: *p , 0.05 and * *p , 0.01; level 2 – nursing units: n ¼ 54

2 0.03 2 0.14 * 2 0.03 0.23 * * 0.12 * * 0.01 0.17 * 0.16 * *

0.09 0.07 0.07 0.04 0.03 0.01 0.14 0.02 6.2 *

Table II. Results of mixed model analyses for predicting the level of climate for service from interdependence configuration

JOSM 24,2

Service Climate by Task and Goal Interdependence Service Climate 4.5

160

4

3.5

3

2.5 –1SD

+1SD Goal Interdependence

Figure 2. Service climate’s level by task and goal interdependence

Low Task Interdependence High Task Interdependence

significant in low task interdependence (0.12, t ¼ 1.15; p . 0.05) conditions. The service climate level thus was highest at high goal and task interdependence, in line with H1b. In Table III we present the mixed linear model analyses results for H2. Of the control variables, only unit load related, significantly and negatively, to service behavior (estimate ¼ 2 0.24; p , 0.001). The service climate level also was positively and significantly associated with service behavior (estimate ¼ 0.23; p , 0.01), in support of H2a. Furthermore, service climate strength did not exert a significant main effect on service behavior, though as posited in H2b, climate strength moderated the climate level-quality service behavior relationship (estimate ¼ 0.19; p , 0.05), as we depict in Figure 3. The simple slope of the regression line, indicating the association between the

Variables

Table III. Results of mixed model analysis for predicting service behavior from climate-for-service level and strength, and their interaction

Seniority Load Service-climate level Service-climate strength Service-climate level £ strength SD of organization level intercept SD of unit level intercept SD of residuals D-2 Res LL

Model 1 – controls Estimate SE

Model 2 – main effects Estimate SE

20.07 20.24 * *

0.06 0.09

20.01 0.01 0.23 * * 0.11

0.06 0.09 0.05 0.08

0.02 0.31 * 0.17 * *

0.01 0.27 0.02

0.01 0.09 * 0.16 * * 12.20 *

0.01 0.08 0.02

Notes: Significant at: *p , 0.05 and * *p , 0.01; level 2 – nursing units: n ¼ 54

Model 3 – interaction Estimate SE 2 0.01 0.01 0.11 0.04 0.19 * 0.01 0.10 * 0.16 * * 2.12 *

0.06 0.09 0.07 0.11 0.08 0.01 0.01 0.02

Service Behavior by Service Climate Level and Strength Quality Service Behavior 3

Linking task and goal interdependence 161

2

1 –1SD

+1SD Climate Level Low Climate Strength High Climate Strength

service climate level and quality service behaviors, was significant and positive when service climate strength was high (0.38, t ¼ 3.16; p , 0.01) but not significant when the service climate level was low (0.06; t ¼ 2 1.23; p . 0.05). As we predicted in H2b, service climate was highest with high service climate levels and strength. Discussion This study provides insights into the relations of perceived interdependence, service climate level and strength, and quality service behaviors. These issues are important, considering the modern organizational focus on providing excellent service, as a strategy for achieving a competitive advantage over rival organizations, cutting costs, and gaining customer loyalty (Liao, 2007; Salanova et al., 2005). Seeking a better understanding of how a service climate can be developed and maintained thus is a timely task. Our findings contribute to service literature in several respects. First, we demonstrate the relationship of service climate to healthcare employees’ quality service behaviors. By accounting for different dimensions of service climate (i.e. level and strength), we shed light on the debate about the role of service climate strength for service quality delivery (Dawson et al., 2008; Potocˇnik et al., 2011). Among our sample of hospital nurses, service climate strength moderated the link between service climate level and quality service behaviors: they were highest when the level and strength of the service climate were both high, lowest when the level of service climate was low and its strength was high; and medium when the level and strength were low. These findings are significant for healthcare organizations; as important as healthcare managers are for service delivery in this industry, paradoxically, the nature of care provision grants them little control over service quality, compared with their counterparts in manufacturing or

Figure 3. Service behavior by climate for service level and strength

JOSM 24,2

162

other service organizations (Schneider et al., 2009). In this setting, “it pays to be positive if you are going to be strong!” (Schneider et al., 2002, p. 227). Second, our findings broaden understanding of how to create a service climate. Previous research has focused largely on the consequences of service climates in terms of improved service behavior, customer satisfaction, and loyalty, such that investigations of climate antecedents have lagged (Schneider et al., 2000). Our findings emphasize the importance of structural arrangements in the unit – including the joint effects of high task and goal interdependence – as key elements that determine the service climate. Apparently, assigning tasks to the whole unit, rather than to individuals, such that unit members must rely on one another for information, materials, and support (high task interdependence), while also setting goals for the unit and not for the individual (high goal interdependence), promotes a unit-wide, shared perception of the importance of service. Without sufficient interdependence, this perception instead suggests the low priority of service quality in the unit, resulting in diverse role behaviors. Because the interaction between task and goal interdependence represents a progression, from a wholly independent task to a wholly interdependent, or seemingly interdependent, task (Comeau and Griffith, 2005; Wageman, 2001), our findings suggest that any task that requires the use of a collective or interdependent work effort probably increases the amount of service behaviors in the unit too; any collection of workers engaged independently on a task likely will engage in decreased service behaviors (Comeau and Griffith, 2005). This trend concurs with recent findings advocating teamwork as a key factor for improving the quality of care (Drach-Zahavy, 2004; Poulton and West, 1999; Shortell et al., 2004). Policy reports and research findings both emphasize the importance of teamwork, if the health and social care provided to patients are to be of the highest quality and efficiency. These teams play essential roles in identifying health needs, planning, and coordinating and delivering care, which enables a more integrated and effective approach to managing and improving service quality (Poulton and West, 1999). Our findings augment calls in prior literature, by emphasizing the importance of task and goal interdependence configurations for the development and validation of the shared perception that service is what counts in the unit, to promote service behaviors. These findings are especially important for hospital units, as they shift toward more teamwork to improve the quality of care (Nembhard and Edmondson, 2006). The success of this process will remain limited though, as long as the fit between goal and task interdependence is lacking. As is evident from our findings, mean perceived task interdependence was significantly higher than mean goal interdependence (t ¼ 6.10; p , 0.001). If nurses’ main task was to work interdependently with others to provide quality service for clients (high task interdependence), and they have individual accountability for the impacts of their caring (low goal interdependence), incongruence probably fosters differentiation and conflicts within units, which might adversely affect the creation of a service climate and quality behaviors. Implications for practice Our findings suggest some important lessons for managers who hope to improve employees’ service behaviors, despite having limited direct control over them (Schneider et al., 2009). First, the finding that service climate strength moderates the

association between service climate level and service quality behaviors should attract managers’ attention. Managerial efforts must be directed simultaneously at creating a high-level and a strong service climate. A high-level service climate implies that management offers logistic support for staff members’ efforts to provide excellent service (e.g. training, sufficient staffing, and computer aids), discusses service failures and successes at team meetings, rewards high quality-service behaviors, and removes obstacles to excellent service provision (Schneider et al., 2005). Our findings show that this is not enough. Managers also need to invest in creating a strong service climate, including agreement among team members that service is important to their unit (Schneider et al., 2002). This agreement might be achieved by creating opportunities for team members to validate their individual perceptions of the importance of service in the unit in team meetings, as well as during their daily work. Zohar and Tenne-Gazit (2008) find that activities that promote social ties and friendships promote shared group cognitions and thus should be considered highly instrumental, apart from their effects on group social needs (Zohar and Tenne-Gazit, 2008). Second, if a service climate and behavior are strongly affected by interdependence perceptions, and interdependence perceptions can be manipulated effectively through workflow design (Comeau and Griffith, 2005; Wageman, 2001), then organizations in general and hospitals in particular can elicit service behaviors through well-designed task- and goal-interdependence structures within units. To enhance the level of task interdependence, unit leaders should redesign nurses’ tasks to create more opportunities for them to interact, such as by empowering nurses to serve as champions of a certain clinical/administrative area (e.g. treating complex wounds and safety), reviewing clinical issues through team meetings, or creating team projects. Yet to gain the benefits of high task interdependence, staff members must perceive their own goal interdependence. Managers could induce perceptions of goal interdependence by formulating group goals, rewarding the group as a whole for collective performance, and providing group feedback (Tjosvold, 1984). Common goals and tasks designed for the nursing staff as a whole can help members realize that their goal is to help one another attain high quality service, not to compete with or outdo their coworkers (Somech, 2008). Limitations and further research suggestions This study has juxtaposed survey and observational methods to identify cross-level relations between the interdependence configuration, service climate level and strength, and the service behavior of nurses working in hospital units. Despite these promising approaches, the findings must be considered in light of the study’s limitations. The first limitation pertains to the cross-sectional design, which raises causality concerns. It is difficult to determine the nature of the relations among task and goal interdependence, service climate, and service behaviors. Is service climate a determinant or a consequence of task and goal interdependence? Our data cannot provide direct evidence of causal links among these relevant variables; perhaps units generating a positive service climate perceive their tasks and goals as more dependent. Longitudinal studies thus are required to explore the nature of these relations. Because our starting point is grounded in theory though, our explanation seems more probable. A challenge related to examining the antecedents of service climate stems from the wide range of influences on the inquiry, such that any discussion of climate creation must

Linking task and goal interdependence 163

JOSM 24,2

164

acknowledge a wider range of antecedents, as well as moderating factors that facilitate climate emergence, and also must study their impact over time. Further studies should examine if task- and goal-interdependent configurations contribute to service climate levels, above and beyond previously identified antecedents (e.g. leadership). In addition, studies might identify moderating factors, such as the unit’s level of heterogeneity, power relations within it, and its cultural values (individualism-collectivism). These factors seem highly likely to influence the level of differentiation and conflicts among sub-teams in a unit, which could impair the creation of a shared service climate (Drach-Zahavy and Somech, 2010; Hogg and Terry, 2000). We did not examine how service climate affects employees’ improved quality service. Additional research might explore other possible mediators, such as employees’ commitment or engagement (Abeldalhi and Drach-Zahavy, 2012), to specify the link between service climate and quality service behavior. Nor can we confirm that our observational measure of service behavior is free of bias. Roter (1989) has concluded that the “good impression bias” that stems from the presence of an observer in patient-provider encounters is minimal, because nurses become quickly accustomed to the presence of observers and exhibit their natural behaviors. Yet our choice to rely on observations of nurses’ behaviors meant that our study could not represent tangible aspects of service quality. Finally, we acknowledge the uniqueness of our sample of nurses, nested in hospitals. The underlying theory cuts across organizational types, but a question arises as to whether health services organizations are sufficiently similar to one other or to other types of organizations, or if they are so distinct as to require different views and measures of organizational phenomena. The participating hospitals were typically public, and the choice of nurses, as emotional workers, meant that we had to specify unique tasks, often involving intensive interactions with patients and families. We chose this sample because the quality of service is especially important for such organizations, but some mechanisms that lead to these results may not apply similarly in other service organizations or across national cultures. Further research should seek to replicate our results with other samples to establish generalizability across settings. A concluding note The present study has focused on service climate, together with its antecedents, moderators, and consequences, in hospital wards. The findings highlight the important role of structural characteristics (as they are perceived by employees) for forming a service climate and influencing employees’ quality service behaviors. Specifically, the combination of high goal and task interdependence can boost employees’ perceptions of a service climate, motivating them to display high quality service behaviors. Our findings also support a moderating role of service climate strength in the connection between service climate level and quality service behaviors. References Abeldalhi, N. and Drach-Zahavy, A. (2012), “Promoting the patient’s care: task engagement as a mediator in the relationship between ward service climate and patient-centered care”, Journal of Advanced Nursing, Vol. 68 No. 6, pp. 1276-1287. Aiken, L.S. and West, S.G. (1991), Multiple Regression: Testing and Interpreting Interactions, Sage, Newbury Park, CA.

Ashforth, B.E. (1985), “Climate formation: issues and extensions”, Academy of Management Review, Vol. 10, pp. 837-847. Baruch, Y. and Holtom, B. (2008), “Survey response rate levels and trends in organizational research”, Human Relations, Vol. 61, pp. 1139-1160. Bliese, P.D. (2000), “Within-group agreement, non-independence, and reliability”, in Kline, K.J. and Kozlowski, S.W. (Eds), Multilevel Theory, Research, and Methods in Organizations, Jossey-Bass, San Francisco, CA, pp. 349-381. Borucki, C.C. and Burke, M.J. (1999), “An examination of service-related antecedents to retail store performance”, Journal of Organizational Behavior, Vol. 20, pp. 943-962. Brass, D.J. (1985), “Technology and the structuring of jobs: employee satisfaction, performance, and influence”, Organizational Behavior and Human Decision Processes, Vol. 35, pp. 216-240. Buchan, J. (2005), “A certain ratio? The policy implications of minimum staffing ratios in nursing”, Journal of Health Services Research & Policy, Vol. 10, pp. 239-247. Burke, M.J., Finkelstein, L.M. and Dusig, M.S. (1999), “On average deviation indices for estimating interrater agreement”, Organizational Research Methods, Vol. 2, pp. 49-68. Carmeli, A. (2008), “Top management team behavioral integration and the performance of service organizations”, Group & Organization Management, Vol. 33, pp. 712-735. Charbonnier-Voirin, A., El Ahnemi, A. and Vandenberghe, C. (2010), “A multilevel model of transformational leadership and adaptive performance and the moderating role of climate for innovation”, Group & Organization Management, Vol. 35, pp. 699-726. Comeau, D.J. and Griffith, R.L. (2005), “Structural interdependence, personality, and organizational citizenship behavior: an examination of person-environment interaction”, Personnel Review, Vol. 34, pp. 310-330. Dawson, J.F., Gonza´lez-Roma´, V., Davis, A. and West, M.A. (2008), “Organizational climate and climate strength in UK hospitals”, European Journal of Work and Organizational Psychology, Vol. 17, pp. 89-111. de Jong, A., de Ruyter, K. and Lemmink, J. (2004), “Antecedents and consequences of a service climate in boundary spanning self-managing service teams”, Journal of Marketing, Vol. 68, pp. 18-35. de Jong, A., de Ruyter, K. and Lemmink, J. (2005), “A service climate in self-managing teams: mapping the linkage of team member perceptions and service performance outcomes in a business-to-business setting”, Journal of Management Studies, Vol. 8, pp. 1593-1620. Dimitriades, Z.S. (2007), “The influence of a service climate and job involvement on customer-oriented organizational citizenship behavior in Greek service organizations: a survey”, Employee Relations, Vol. 29, pp. 469-491. Drach-Zahavy, A. (2004), “Primary nurses’ performance: role of supportive management”, Journal of Advanced Nursing, Vol. 45, pp. 7-16. Drach-Zahavy, A. (2009), “Patient-centered care and nurses’ health: the role of nurses’ caring orientation”, Journal of Advanced Nursing, Vol. 65, pp. 1463-1474. Drach-Zahavy, A. (2010), “How does service workers’ behavior affect their health? Service climate as a moderator in the service behavior-health relationships”, Journal of Occupational Health Psychology, Vol. 15 No. 2, pp. 105-119. Drach-Zahavy, A. and Somech, A. (2010), “From an intra-team to an inter-team perspective of effectiveness: the role of inter-team interdependence and teams’ boundary activities”, Small Group Research, Vol. 41, pp. 143-174. Epstein, R.M., Franks, P., Fiscella, K., Shields, C.G., Meldrum, S.C., Kravitz, R.L. and Duberstein, P.R. (2005), “Measuring patient-centered communication in patient-physician

Linking task and goal interdependence 165

JOSM 24,2

166

consultations: theoretical and practical issues”, Social Science & Medicine, Vol. 61, pp. 1516-1528. Fornell, C. and Larcker, D.F. (1981), “Evaluating structural equation models with unobservable variables and measurement error”, Journal of Marketing Research, Vol. 48, pp. 39-50. Gonzalez-Roma, V., Fortes-Ferreira, L. and Peiro, J.M. (2009), “Team climate, climate strength and team performance”, Journal of Occupational & Organizational Psychology, Vol. 82, pp. 511-536. Gracia, E., Cifre, E. and Grau, R. (2010), “Service quality: the key role of service climate and service behavior of boundary employee units”, Group & Organization Management, Vol. 35, pp. 276-298. Gundlach, M., Zivnuska, S. and Stoner, J. (2006), “Understanding the relationship between individualism, collectivism and team performance through an integration of social identity theory and the social relations model”, Human Relations, Vol. 59, pp. 1603-1632. Hackman, J.R. (Ed.) (1990), Groups That Work (and Those That Don’t), Jossey-Bass, San Francisco, CA. Hogg, M.A. and Terry, D.J. (2000), “Social identity and self-categorization processes in organizational contexts”, Academy of Management Review, Vol. 25, pp. 121-140. Hui, C.H., Chiu, W.C.K., Yu, P.L.H., Cheng, K. and Tse, H.H.M. (2007), “The effects of service climate and the effective leadership behavior of supervisors on frontline employee service quality: a multi-level analysis”, Journal of Occupational & Organizational Psychology, Vol. 80, pp. 151-172. James, L.R., Demaree, R.G. and Wolf, G. (1993), “rwg: an assessment of within-group interrater agreement”, Journal of Applied Psychology, Vol. 78, pp. 306-309. Johnson, D.W. and Johnson, R.T. (1989), Cooperation and Competition: Theory and Research, Interaction Book Company, Edina, MN. Kramer, R. (1991), “Intergroup relations and organizational dilemmas”, in Cummings, L.L. and Staw, B.M. (Eds), Research in Organizational Behavior, Vol. 13, JAI Press, Greenwich, CT, pp. 191-228. Kuenzi, M. and Schminke, M. (2009), “Assembling fragments into a lens: a review, critique, and proposed agenda for the organizational work climate literature”, Journal of Management, Vol. 35, pp. 634-717. Lanjananda, P. and Patterson, P.G. (2009), “Determinants of customer-oriented behavior in a health care context”, Journal of Service Management, Vol. 20, pp. 5-32. Liao, H. (2007), “Do it right this time: the role of employee service recovery performance in customer-perceived justice and customer loyalty after service failures”, Journal of Applied Psychology, Vol. 92, pp. 475-489. Lindell, M.K. and Brandt, C.J. (2000), “Climate quality and climate consensus as mediators of the relationship between organizational antecedents and outcomes”, Journal of Applied Psychology, Vol. 85, pp. 331-348. Mead, N. and Bower, P. (2002), “Patient-centered consultations and outcomes in primary care: a review of the literature”, Patient Education and Counseling, Vol. 48, pp. 51-61. Mischel, W. (1973), “Toward a cognitive social learning reconceptualization of personality”, Psychological Review, Vol. 80, pp. 252-283. Nembhard, I.M. and Edmondson, A.C. (2006), “Making it safe: the effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams”, Journal of Organizational Behavior, Vol. 27, pp. 941-966.

Parasuraman, A., Zeithaml, V.A. and Berry, L.L. (1985), “A conceptual model of service quality and its implications for future research”, Journal of Marketing, Vol. 49, pp. 41-50. Potocˇnik, K., Tordera, N., Martı´nez-Tur, V., Peiro´, J.M. and Ramos, J. (2011), “Is service climate strength beneficial or detrimental for service quality delivery?”, European Journal of Work and Organizational Psychology, Vol. 20, pp. 681-699. Poulton, B.C. and West, M.A. (1999), “The determinants of effectiveness in primary health care teams”, Journal of Interprofessional Care, Vol. 13, pp. 7-18. Roter, D.L. (1989), “Which facets of communication have strong effects on outcome: a meta-analysis”, in Stewart, M. and Roter, D. (Eds), Communicating with Medical Patient, Sage, Newbury Park, CA, pp. 183-196. Salanova, M., Agut, S. and Peiro, J.M. (2005), “Linking organizational resources and work engagement to employee performance and customer loyalty: the mediation of a service climate”, Journal of Applied Psychology, Vol. 90, pp. 1217-1227. Salvaggio, A.N., Schneider, B., Nishii, L.H., Mayer, D.M., Ramesh, A. and Lyon, J.S. (2007), “Manager personality, manager service quality orientation, and a service climate: test of a model”, Journal of Applied Psychology, Vol. 92, pp. 1741-1750. Schein, E.H. (1990), “Organizational culture”, American Psychologist, Vol. 45 No. 2, pp. 109-119. Schirmer, J.M., Mauksch, L., Lang, F., Marvel, M.K., Zoppi, K., Epstein, R.M., Brock, D. and Pryzbylski, M. (2005), “Assessing communication competence: a review of current tools”, Family Medicine Journal, Vol. 37, pp. 184-192. Schneider, B. and Reichers, A.E. (1983), “On the etiology of climates”, Personnel Psychology, Vol. 36, pp. 19-39. Schneider, B. and Rentsch, J. (1988), “Managing climates and cultures: a futures perspective”, in Hage, J. (Ed.), Features of Organizations, Lexington Books, Lexington, MA. Schneider, B., Gunnarson, S.K. and Niles-Jolly, K. (1994), “Creating the climate and culture of success”, Organizational-Dynamics, Vol. 23, pp. 17-29. Schneider, B., Salvaggio, A.N. and Subirats, M. (2002), “Climate strength: a new level for climate research”, Journal of Applied Psychology, Vol. 87, pp. 220-229. Schneider, B., White, S.S. and Paul, M.C. (1998), “Linking a service climate and customer perceptions of service quality: test of a causal model”, Journal of Applied Psychology, Vol. 83, pp. 150-163. Schneider, B., Bowen, D.E., Ehrhart, M.G. and Holcombe, K.M. (2000), “The service climate: evolution of a construct”, in Ashkanasy, N.M., Wilderom, C.P. and Peterson, M.F. (Eds), Handbook of Organizational Culture and Climate, Sage, Thousand Oaks, CA, pp. 21-36. Schneider, B., Macey, W.H., Lee, W.C. and Young, S.A. (2009), “Organizational service climate drivers of the American Customer Satisfaction Index (ACSI) and financial and market performance”, Journal of Service Research, Vol. 12, pp. 3-14. Schneider, B., Ehrhart, M.G., Mayer, D.M., Saltz, J.L. and Niles-Jolly, K. (2005), “Understanding organization-customer links in service settings”, Academy of Management Journal, Vol. 48, pp. 1017-1032. Shipton, H., Armstrong, C., West, M. and Dawson, J. (2008), “The impact of leadership and quality climate on hospital performance”, International Journal for Quality in Health Care, Vol. 20, pp. 439-445. Shortell, S.M., Marsteller, J.A., Lin, M., Pearson, M.L., Wu, S., Mendel, P. and Rosen, M. (2004), “The role of perceived team effectiveness in improving chronic illness”, Medical Care, Vol. 42, pp. 1040-1048.

Linking task and goal interdependence 167

JOSM 24,2

168

Singer, J.D. (1998), “Using SAS proc mixed to fit multilevel models and individual growth models”, Journal of Educational and Behavioral Statistics, Vol. 24, pp. 323-355. Somech, A. (2008), “Managing conflict in school teams: the impact of task and goal interdependence on conflict management and team effectiveness”, Educational Administration Quarterly, Vol. 44, pp. 359-390. Somech, A., Desivilya, H.S. and Lidogostor, H. (2009), “Team conflict management and team effectiveness: the effects of task interdependence and team identification”, Journal of Organizational Behavior, Vol. 30, pp. 359-378. Stanne, M.B., Johnson, D.W. and Johnson, R.T. (1999), “Does competition enhance or inhibit motor performance: a meta-analysis”, Psychological Bulletin, Vol. 125, pp. 133-154. Tjosvold, D. (1984), “Cooperation theory and organizations”, Human Relations, Vol. 37, pp. 743-767. van der Vegt, G.S. and Janssen, O. (2003), “Joint impact of interdependence and group diversity on innovation”, Journal of Management, Vol. 29, pp. 729-751. van der Vegt, G.S., Emans, B.J.M. and van de Vliert, E. (1999), “Motivating effects of task and outcome interdependence in work teams”, Journal of Social Psychology, Vol. 139 No. 2, pp. 202-215. van der Vegt, G.S., van der Vliert, E. and Oosterhof, A. (2003), “Informational dissimilarity and organizational citizenship behavior: the role of intrateam interdependence and identification”, Academy of Management Journal, Vol. 46, pp. 715-728. van Vijfeijken, H., Kleingeld, A., van Tuijl, H., Algera, J.A. and Thierry, H. (2006), “Interdependence and fit in team performance management”, Personnel Review, Vol. 35 No. 1, pp. 98-117. Victor, B. and Blackburn, R.S. (1987), “Interdependence: an alternative conceptualization”, Academy of Management Review, Vol. 12, pp. 486-498. Wageman, R. (2001), “The meaning of interdependence”, in Turner, M.E. (Ed.), Groups at Work: Theory and Research, Lawrence Erlbaum Associates, Inc., Mahwah, NJ, pp. 197-218. Wall, E.A. and Berry, L.L. (2007), “The combined effects of physical environment and employee behavior on customer perceptions of restaurant service quality”, Cornell Quarterly, Vol. 48, pp. 59-69. Weick, K.E. (1979), The Social Psychology of Organizations, 2nd ed., Addison-Wesley, Reading, MA. Yagil, D. and Luria, G. (2010), “Friends in need: the protective effect of social relationships under low safety climate”, Group & Organization Management, Vol. 35 No. 6, pp. 727-750. Zohar, D. (2002), “The effects of leadership dimensions, safety climate, and assigned priorities on minor injuries in work groups”, Journal of Organizational Behavior, Vol. 23, pp. 75-92. Zohar, D. and Tenne-Gazit, O. (2008), “Transformational leadership and group interaction as climate antecedents: a social network analysis”, Journal of Applied Psychology, Vol. 93, pp. 744-757. Appendix Evidence of quality service behavior: (1) Elicits concerns, fears and expectations from patient. (2) Expresses empathy for patient’s concern(s) and/or dilemma(s). (3) Clearly presents the evidence in understandable terms (avoiding medical jargon).

(4) (5) (6) (7) (8) (9)

Checks with patient for understanding and invites questions. Elicits patient’s preferences regarding decision making. Assesses patient’s readiness for change (if appropriate). Makes recommendations. Allows patient time to consider options. Summarizes the discussion, decisions, and next steps.

Scoring key: 5 – very well done. 4 – well done. 3 – done incompletely or awkwardly. 2 – attempted but not accomplished. 1 – not attempted (missed opportunity). NA – not applicable in this encounter. About the authors Anat Drach-Zahavy is a Senior Lecturer at the Faculty of Health and Welfare Sciences at the University of Haifa, Israel. She received her PhD degree in the Department of Industrial Engineering and Management, at the Technion, Israel. Her research is focused on healthcare organizations, particularly in the areas of quality service, safety and employee’s health. Anat Drach-Zahavy is the corresponding author and can be contacted at: [email protected] Anit Somech is an Associate Professor at the Faculty of Education at the University of Haifa, Israel. She received her PhD degree in the Department of Industrial Engineering and Management, at the Technion, Israel, with an emphasis on Behavioral Sciences and Management (1994). Her research focuses on teamwork, management, and work motivation.

To purchase reprints of this article please e-mail: [email protected] Or visit our web site for further details: www.emeraldinsight.com/reprints

Linking task and goal interdependence 169