Empowering Leadership,Commitment to Managers and Company and Employee Proactivity: A Study of National Accreditation Board for Hospitals and Healthcare Accredited Hospitals

Abstract

The purpose of this article was to explore the relationship between empowering leadership and employee proactivity with commitment to manager and company as mediator in Indian National Accreditation Board for Hospitals and Healthcare (NABH) accredited hospitals. The authors used SPSS Process macro (medication model) in order to examine the proposed hypothesis with collected data through structured questionnaire from 252 frontline employees of Indian NABH accredited hospitals. The results of data analysis support mediating role of commitment to managers and company between empowering leadership and employee proactivity. The finding of this study significantly contributes to theory and offers important implications for hospital managers and administrators.

Keywords

Empowering leadership commitment to managers and company employee proactivity NABH accredited hospitals

Introduction

In ever-changing business environment, business practitioners and researchers have considered various forms of proactive behaviour as an important behaviour for the current workplace (Parker, Williams, & Turner, 2006) and puts continuous pressure on leaders to promote and nurture proactivity among employees (Binyamin & Brender-Ilan, 2018). Ample research studies are available, which revealed the positive outcomes of proactive behaviour such as improved work performance (Fuller & Marler, 2009), job performance and socialization (Parker, Bindl, & Strauss, 2010). Bolino, Valcea, and Harvey (2010) have revealed some negative impact of employee proactivity such as increased stress, tension and reduced organization learning. Employee proactivity refers to an employee’s goal-orientated work behaviour that aims to bring change in them and organizational situations by taking active personal initiatives (Bindl & Parker, 2012). Employees’ proactive behaviour is a combination of actively taking charge of current situation (Morrison & Phelps, 1999) as well as engaging in active learning for creating improved work situations (Frese, Kring, Soose, & Zempel, 1996). Employee proactivity includes four activities which are envisioning, planning, enacting and reflecting (Bindl & Parker, 2012). Envisioning refers to the selection of proactive goals, while planning decides how to implement proactive goals. Enacting is an implementation process of proactive goals, and reflecting refers to learning from proactive goals (Bindl & Parker, 2012). Employee’s proactive behaviour can be measured through increased employee satisfaction, enhanced engagement and commitment, more satisfied customer and good financial results (Presbitero & Teng-Calleja, 2017).

Empowering leadership provides autonomy at workplace, fosters participation in decision-making and enhances participation in decision-making (Ahearne, Mathieu, & Rapp, 2005). Empowering leadership is very crucial for any organization because they are associated with many positive individuals, team and organization-level outcomes. For example, employees who feel empowered at workplace are likely to be more satisfied with the job (Wong & Kuvaas, 2018), life (Kim & Beehr, 2019), career satisfaction (Biemann, Kearney, & Marggraf, 2015; Kim & Beehr, 2017) and more engaged in their job and work (Gyu Park, Sik Kim, Yoon, & Joo, 2017’ Huertas-Valdivia, Javier, & Ruiz-Moreno, 2018; Lee et al., 2017), and they are likely to perform in a more creative way (Amundsen & Martinsen, 2015; Byun, Dai, Lee, & Kang, 2016; Chow, 2018; Harris, Li, Boswell, Zhang, & Xie, 2014; Hon, 2011, 2012; Li & Zhang, 2016; Zhang & Zhou, 2014; Zhang, Ke, Frank Wang, & Liu, 2018). Empowering leadership has positive relationship with some teams and organization-level outcomes such as team effectiveness (Zhu & Chen, 2016), effectiveness in leadership (Amundsen & Martinsen, 2014a; Hassan, Mahsud, Yukl, & Prussia, 2013), team performance (Fausing, Joensson, Lewandowski, & Bligh, 2015; Lee, Lee, & Park, 2014; Liu & Shieh, 2015; Srivastava, Bartol, & Locke, 2006) and increased organization flexibility (Wong & Kuvaas, 2018), organizational ambidexterity (Siachou & Gkorezis, 2018), counterproductive work behaviours towards the organization (Li et al., 2017), lower-level team strategic vision (Margolis & Ziegert, 2016), organization performance (Ling, Wei, Klimoski, & Wu, 2015) and service performance (Wu & Chen, 2015). Past research has revealed that empowering leadership not only has a positive individual-, team- and organization-level outcomes, but it also has some negative outcomes such as increased task uncertainty (Cordery, Morrison, Wright, & Wall, 2010; Martin, Liao, & Campbell, 2013), increased expenditure due to initial performance delay (Lorinkova, Pearsall, & Sims, 2013), employee job-induced tension (Cheong, Spain, Yammarino, & Yun, 2016), employee cynicism (Lorinkova & Perry, 2017) and time theft (Lorinkova & Perry, 2017).

Employee commitment is an imperative for continuous growth of an organization because commitment is associated with employees’ withdrawal behaviour such as reaching late to work, absenteeism and turnover intention (Berry, Lelchook, & Clark, 2012). Employee commitment is found to be the most important source to interpret the employees’ work-related behaviour (Mowday, Porter, & Steers, 2013). Thus, this article examines the direct impact of commitment to managers and company on employee proactivity. Past research studies have revealed that there are multiple foci of commitment such as job, company, team, customer, manager, etc. But, among all types of commitment, commitment to supervisors is the most important because they directly engage in various activities, such as monitoring the performance of employees, decisions regarding pay and promotions, etc. (Panaccio & Vandenberghe, 2011). Employee’s commitment towards managers has significant impact on work outcomes such as job satisfaction, task performance, organization citizenship behaviour and intention to quit (Chughtai, 2013).

A model of proactive motivation has revealed that employee proactivity is influenced by individual factors (emotional regulation, core self-belief, and desire for control etc) and contextual factors (leadership, interpersonal climate and social processes) (Parker et al., 2010). Thus, this article includes both individual and contextual variables which have an influence on employee proactivity. Previous research studies have found many antecedents and consequences of employee proactivity and establish the relationship with creativity and proactivity (Lee, Willis, & Tian, 2018), but mechanisms to promote proactivity are very limited in the existing literature. Therefore, the purpose of the present research study is to explore the relationship between empowering leadership and employee proactivity with commitment to manager and company as mediator in Indian National Accreditation Board for Hospitals and Healthcare (NABH) accredited hospitals’ context. This study contributes to existing literature in two important ways. First, it reveals the direct effect of both contextual and individual factors on employee proactivity in an Indian hospital setting. Second, this study also identifies important linking variable between empowering leadership and employee proactivity by testing the proposed mediation model.

This article has three important sections. The first section presents introduction, relevant literature related to studied variable followed with development of proposed hypothesis. The second section discusses the methodology to test proposed hypothesis like sample and research techniques and presents results of used research technique. Finally, the third section presents important findings—theoretical and practical implications—limitations and future research directions.

Hypothesis Development

Empowering Leadership and Employee Proactivity

There are two theoretical foundations that support a positive association between empowering leadership and employee proactivity. First, self-determination theory proposes that fulfilment of basic psychological needs (autonomy, competence and relatedness) is essential for the development of intrinsic motivation (Gagne & Deci, 2005). Sense of fulfilment of basic psychological needs give intrinsic motivation and that motivation encourages an individual to participate actively in complex and self-directed activities (Gagne & Deci, 2005). Employees find unique ways to satisfy other needs, when they have a feeling of autonomy at workplace (Deci, Olafsen, & Ryan, 2017). Self-determination theory (SDT) also proposes that managerial style at workplace is also a source of intrinsic motivation for their subordinates. Empowering leadership style promotes employees’ participation in decision-making, power sharing with subordinates shows confidence in subordinate’s ability, provides opportunity to learn at workplace and removes bureaucratic constraints, and provides continuous support through coaching, mentoring and teachings (Ahearne et al., 2005; Amundsen & Martinsen, 2014b; Arnold, Arad, Rhoades, & Drasgow, 2000). Therefore, we argue that such kind of leadership style may help employees to believe in their competencies and have a sense of autonomy and relatedness. So, empowering leaders may give sense of fulfilment of basic psychological needs to their subordinates. With this sense, employees reach a psychological state that will lead to intrinsic motivation, and this motivation may enhance proactive behaviour. Second, role breadth self-efficacy proposes that when employees believe in their abilities to perform proactive, interpersonal and integrative tasks which are not mention in their job profile, this confidence is a key component of proactive work behaviour (Parker, 1998). As empowering leaders believe in the capability of their subordinates to perform such types of task, it develops subordinates’ confidence in their capabilities. Thus, we expect that empowering leaders’ power-sharing aspect and motivational and developmental support promote role breadth self-efficacy and prepare suitable environment to exhibit proactivity. Therefore, based on these two theoretical foundations, we hypothesize that empowering leadership is positively associated with employee proactivity.

H1: Empowering leadership is positively associated with employee proactivity.

Empowering Leadership and Commitment to Managers and Company

Empowering leadership style promotes self-management through employees’ participation in decision-making, job autonomy and development support. Thus, empowering leadership develops positive psychological state in which employee’s exhibit favourable attitude. Employee’s commitment to managers and company is a psychological attachment, involvement in and identification with manager and company as a result of good experiences with manager and company (Meyer & Allen, 1991). Commitment to managers and company reflects the employees’ bond with their manager and company due to tangible (financial benefits) and intangible benefits (job security). Empowering leaders’ behaviour enhances motivation, increases personal efficacy and fosters job engagement. Thus, employees may have positive emotions and mood towards their manager and company. Commitment (a kind of positive feeling) develops when employees have positive work experiences such as communication with managers and other co-workers (Meyer & Allen, 1997). Empowering leaders develop this positive feeling among subordinates through three important ways. First, an empowering leader puts his/her efforts to increase employees’ understanding about organizational goals and strategies and shows the path and helps an employee to understand his or her contribution in order to accomplish organizational goals. Second, an empowering leader’s belief in subordinate’s competence builds trusting relationship, promotes self-development belief and the subordinate gains confidence. Third, an empowering leader allows a subordinate to participate in important decisions and motivates him to take personal initiative by granting autonomy to choose their own path for achieving goals and supports them by taking the responsibility of unfavourable outcomes. Lastly, an empowering leader also provides continuous development support through coaching, mentoring, counselling and modeling. Past research studies also mention that employees become more committed, when they receive opportunities and support for personal growth (Mathieu & Zajac, 1990). These developmental activities help employees to improve and upgrade their job-related skills, knowledge and attitude, which, in turn, may develop positive mood and feelings of obligation towards managers and company. Psychological contract theory (Rousseau, 1998) and reciprocity theory (Cropanzano & Mitchell, 2005) provide the support for empowering leadership and commitment to managers and company relationship. According to psychological contract theory, employees expect certain unwritten terms to be fulfilled by their managers and company such as job security, safe and secure work environment and transparency. Reciprocity theory says that if these unwritten terms are fulfilled, then employees are likely to have more positive feeling towards their manager and company. Past research studies also support the positive relationship of empowering leadership with affective organization commitment (Kim & Beehr, 2018) and employee commitment to service quality (Clark, Hartline, & Jones, 2009). Therefore, it is reasonable to propose that empowering leadership has positive association with commitment to managers and company.

H2: Empowering leadership is positively associated with commitment to managers and company.

Commitment to Managers and Company and Employee Proactivity

Commitment to managers and company refers to an intangible force that binds an individual with his/her manager and company (Meyer & Herscovitch, 2001). According to the general model of commitment, affective commitment develops when an employee wants to get involved in a course of action, realize the value of that course of action and gets associated with that course of action (Meyer & Herscovitch, 2001) and some personal factors like the great need for achievement and strong work ethics, and the drive for affiliation and high confidence in his or her abilities also make an individual more committed. There are two types of studies found on commitment and proactivity relationship. First, there is no relationship between affective organization commitment and task-focused proactivity (Parker et al., 2006). Second, there is positive relationship between commitment to team and personal initiative (a specific form of proactivity) (Den Hartog & Belschak, 2007).

There are two important reasons proposed for the positive relationship between affective commitment and proactivity. First, in a recent study, Luu (2018) found that effective commitment mediates the relationship between discretionary human resources (HR) practices and proactive work behaviour, and Strauss, Griffin and Rafferty (2009) found positive relationship between team commitment and employee proactivity. Thus, we would like to clarify the nature of relationship between commitment and proactivity. Second, social exchange norms (Blau, 1968) establish the link between empowering leadership and employee proactivity. Norms of reciprocity (Gouldner, 1960) says that when employees feel that his/her supervisor and the organization care and value them, they feel a sense of obligation and, in return, employees want to contribute significantly in the growth of that organization. Empowering leader’s activity—such as coaching, mentoring, teaching and power sharing—develops a sense of perceived organization support in the employees. This sense of perceived support may motivate employees to offer their commitment towards manager and company. A general model of commitment at workplace (Meyer & Herscovitch, 2001) reveals that employees want to exhibit his/her commitment by getting involved in a particular course of action, realizing the value of that action and desire to get associated with that action. This form of commitment may force employees to get involved in deciding their own goals, preparation to implement them, implementing and learning from them. Therefore, we hypothesize that commitment to managers and company mediates the relationship empowering leadership and employee proactivity.

H3: Commitment to managers and company is positively associated with employee proactivity.

Mediating Role of Commitment to Managers and Company

Previous studies found that affective commitment explains the relationship between empowering leadership and employees’ withdrawal behaviour (Kim & Beehr, 2018), and organization commitment also mediates the relationship between leadership behaviour and work outcomes (job satisfaction and job performance) (Yousef, 2000). Supportive work environment developed by leaders has a positive impact on employee’s commitment and job outcomes (Chiok Foong Loke, 2001). If empowering leadership style can increase the employees’ commitment for their managers and company through power sharing, motivational support and developmental support, then committed employees may be keen to show proactive behaviour at workplace. As shown in a research model, commitment to managers and company may explain the relationship between empowering leadership and employee proactivity. Therefore, we propose that commitment to managers and company mediates the relationship between empowering leadership and employee proactivity.

H4: Commitment to managers and company mediates the relationship between empowering leadership and employee proactivity.

Figure 1.

Source: The authors.

Methodology

Sample and Procedure

The proposed hypotheses were examined through data collected from frontline employees in Indian NABH accredited hospitals. These frontline employees of hospitals were working in departments like reception, nursing, junior doctors, billing, physiotherapy, diagnosis, pharmacy and doctors’ supporting staff in outpatient department (OPD) and inpatient department (IPD). However, all these frontline employees are directly responsible for patient care in hospitals. In any hospital, employees who perform diagnosis, treatment and nursing are strategically very important employees (van Harten, Knies, & Leisink, 2017). Authors have taken response from only permanent employees of the hospital. After taking permission from hospital management for data collection, we had visited five hospitals in some of the major Indian cities like Dehradun, Ahmedabad and New Delhi. Previous research studies also have collected data for testing hypothesis through survey method. Thus, we also adopted the same method for our study and distributed printed questionnaire with the help of HR department of hospitals among 300 frontline employees in five NABH accredited hospitals (Metro Hospital, Synergy Hospital, Max Hospital, Narayana Hospital and Global Hospital) in India. We got 282 filled questionnaires and after data screening, finally, considered 252 samples. We do not have data about exact number of frontline employees working in NABH accredited hospitals but as of 3 November 2018, India has 550 NABH accredited hospitals and approximately each hospital has 100 frontline employees. Therefore, total number of frontline employees working in NABH accredited hospitals in India is 5,500. According to this calculation, we have taken 0.54 per cent of the population for our study.

Measures

All measures used in this study were measured by frontline employees’ responses to questions on seven options ranging from ‘strongly agree to strongly disagree’. Cronbach alpha of all specific measures are presented below. If any measure is having multiple dimensions, the dimensions (average item score) were considered as indicators for their construct in data analysis. Otherwise, measures do not have dimensions and all items’ scores were averaged for data analysis.

Empowering Leadership

Leaders’ empowering behaviour was measured through most accepted 12 items’ measure done by Ahearne et al. (2005). This measure has four sub-scales consisting of four dimensions, namely enhancing the meaningfulness of work, fostering participation in decision-making, expressing confidence in high performance and providing bureaucratic constraints. We used this measure due to its focus on subordinate empowerment through leaders’ behaviour. First- and second-order confirmatory factor analysis (CFA) were performed to check fit indices. Results of CFA indicate that all four dimensions are distinct and collectively reflect the construct of empowering leadership behaviour.

Commitment to Manager and Company

This research used the 5-item measure of commitment to managers and company developed by Ineson, Benke, and Laszlo (2013). A sample item of this scale is ‘I enjoy good communications with my managers’. All items were rated on 7-point Likert scale from ‘1’—strongly agree to ‘7’—strongly disagree. Composite scores for each construct were used for further analysis. This scale has shown an internal consistency (alpha) reliability of 0.839 in this study.

Employee Proactivity

Employee proactivity was assessed with Dhar and Dhar (2010) with 10-item measure. It has four dimensions—envisioning (employees’ efforts in setting a proactive goal), planning (preparation to implement their proactive goal), enacting (implementing their proactive goal) and reflecting (engaging in learning from their proactive goal process). Reliability of complete scale was 0.890 (alpha).

Data Analysis Strategy

Majority of the previous research studies have used popular Baron and Kenny (1986) causal steps approach for mediation analysis. Later on, few authors identified certain weaknesses of causal steps approach like quantification of indirect effects and dependence on multiple hypothesis. In a nutshell, causal steps approach was found to be inappropriate due to its inability to find mediation effects. Hayes and Preacher (2013) have developed advanced technique, which gives simultaneously direct, indirect and total effects of mediation analysis. Thus, we have deployed this technique in order to test proposed hypothesis. Figure 1 presents the testing model—whether commitment to managers and company mediates the relationship between empowering leadership and employee proactivity. Authors have used PROCESS macro (Model 4) developed by Hayes and Preacher (2013) in order to examine both direct and indirect effects of empowering leadership on commitment to managers and company through goal orientation and task significance. In mediation model, we have entered empowering leadership as independent variable, commitment to managers and company as a mediating variable and employee proactivity as dependent variable. The PROCESS macro gives percentile-based bias-corrected bootstrap confidence intervals for each indirect effect, where significance of indirect paths depends on whether confidence interval is zero or not. If confidence interval is zero, then indirect path is insignificant, and if not, then it is significant. It found that bootstrapping procedure is more appropriate for examining the mediating effects (MacKinnon, Lockwood, & Williams, 2004; Williams & MacKinnon 2008). Previous studies of Preacher and Hayes (2008) and Hayes (2009) revealed that bias bootstrap confidence intervals gives more accurate estimates than normal theory-based Sobel test because it does not require only normal distribution.

Results

Common Method

We used Harman’s one-factor test in order to examine the influence of common method variance as suggested by Podsakoff, MacKenzie, and Podsakoff (2012). In order to execute this test, we have run exploratory factor analysis for all current study variables and limited number of factors extracted to one. We found that one factor accounts for only 41.4 per cent explained variance that is less than 50 per cent. Harman’s one-factor test guidelines stated that one-factor explained variance should be less than 50 per cent (Podsakoff et al., 2012). Thus, common method variance does not influence the results to a great extent.

We have assessed the convergent, discriminant validity and goodness of fit of measurement model through CFA before testing the hypothesis of the study. CFA was used to examine the convergent and discriminant validity. Convergent and discriminant validity both are sub-types of construct validity. The items that are indicators of a specific construct should converge or share a high proportion variance in common, known as convergent validity (Hair, Black, Babin, Anderson, & Tatham, 2006). The composite reliability (CR) statistics is used to assess the convergent validity; CR values (displayed in Table 1) of all constructs were found to be more than recommended threshold value of 0.70 (Bagozzi & Yi, 1988). Cronbach’s alpha values (displayed in Table 1) for all measures were also higher than recommended threshold of 0.60. Thus, all measures have shown internal consistency.

Table 1.

Reliability and Validity Analysis

Latent Variables	Alpha	CR	AVE
Employee proactivity	0.890	0.843	0.574
Empowering leadership	0.927	0.912	0.536
Commitment to managers and company	0.839	0.825	0.543

Source: The authors.

Table 2:

Discriminant Validity

Latent Variables	Mean	S.D.	1	2	3	4
Employee proactivity	2.54	0.96	0.758
Empowering leadership	2.51	1.11	0.590	0.732
Commitment to managers and company	2.10	1.04	0.701	0.717	0.658	0.737

Source: The authors.

Table 3.

Regression Coefficient, Standard Errors, and Mediation Model Summary Consequent

Antecedent	M (CMC)			Y (EP)
Antecedent	Coeff.	SE	p-Value	Coeff.	SE	p-Value
X (EL)	a = 0.659	0.042	0.05> p	c = 0.238	0.053	0.05 > p
M (CMC)	-	-	-	b = 0.459	0.057	0.05 > p
Constant	iM = 2.28	0.235	0.05> p	iY = 1.43	0.250	0.05 > p
	R-square = 0.495			R-square = 0.516
	F(1,250) = 245.52, p < 0.01			F(2,249) = 132.59, p < 0.01

Source: The authors.

Notes: EL: Empowering leadership, CMC: commitment to managers and company, EP: employee proactivity, M: mediator (M = 2.28 + 0.659X; Y = 1.43 + 0.238X + 0.459M).

Table 4.

Results of Indirect Effects

Indirect paths	Indirect effects	SE	LLCI	ULCI	Result
EL – CMC - EP	β = 0.3032,	0.0547	0.1983	0.4115	Supported

Source: The authors.

Note: Beta values are displayed in hypothesis testing.

The average variance extracted (AVE) is used to examine the discriminant validity of the constructs. Discriminant validity assesses the extent to which one construct is different to another construct used in the model (Bagozzi, Yi, & Phillips, 1991). We found acceptable value of AVE more than 0.50 (Fornell & Larcker, 1981) for all constructs which indicate that each measure explains more than half of the variance for their respective construct (Hair et al., 2006; Terglav, Ruzzier, & Kaše, 2016). In order to assess the discriminant validity of constructs, we have compared the square root of the AVE with the correlation values (displayed in –Table 2) between constructs (Gerbing & Anderson, 1988). Thus, all measures were having sufficient value for ensuring the convergent and discriminant validity.

Structural Model Testing

The proposed three-factor measurement model comprises of empowering leadership, commitment to managers and company and employee proactivity. According to the results of CFA measurement model, fit indices (CMIN/Df = 2.37; RMR = 0.059; RMSEA = 0.074; GFI = 0.875; TLI = 0.907; CFI = 0.920) were found satisfactory (Gaskin & Lim, 2016; Hair et al., 2006).

Hypothesis Testing

Authors used Hayes (2013) method to test the proposed hypothesis of mediation model. According to this method, two important conditions are there. First, independent, dependent and mediating variables must be significantly related with each other. Second, indirect effect of mediating variable also must be significant. The SPSS macro PROCESS was used to analyse the data. The first hypothesis (H1) has examined the total effect of empowering leadership on employee proactivity. The regression analysis results revealed that empowering leadership has positive and significant effect on employee proactivity (β = 0.625, SE = 0.04, p < 0.005). The second hypothesis (H2) tested the association between empowering leadership and commitment to managers and company, and statistical analysis found positive and significant relationship (β = 0.659, SE = 0.04, p < 0.005). The third hypothesis of this study examines the relationship between commitment to managers and company and employee proactivity. The mediation analysis results support hypothesized relationship of commitment to managers and company and employee proactivity (β = 0.459, SE = 0.04, p < 0.005). To test the fourth hypothesis, significant prediction of indirect effect of empowering leadership commitment to managers and company and employee proactivity is required. The test results revealed that indirect effect is significant (β = 0.3032, SE = 0.0547, LLCI = 0.1983 ULCI = 0.4115). Thus, this study accepts all hypothesized relationships. Therefore, empowering leadership is associated with a higher level of commitment to managers and company, which, in turn, promotes employee proactivity.

Discussion

Theoretical Implications

The findings of the present study support and extend the findings of previous studies. Past research studies also found the positive relationship between empowering leadership and employee proactivity (Hong, Liao, Raub, & Han, 2016; Martin et al., 2013; Schilpzand, Houston, & Cho, 2018). However, our study supports the arguments by adding the commitment to manager and company as mediator in the relationship between empowering leadership and employee proactivity. The findings of this revealed that commitment to managers and company mediates the relationship between empowering leadership. Whenever employee perceives that their leaders provide job autonomy, shares power and supports for enhancing knowledge, skill and attitude, then employees are more likely to be psychologically, and emotionally, associated with their managers and company, and thereby they are more likely to exhibit proactive behaviour. Furthermore, this study also reveals that employees exhibit more commitment towards managers and company when their leaders share power, provide job autonomy and developmental support. This finding is consistent with previous study results (Clark, et al., 2009; Kim & Beehr, 2018; Raub & Robert, 2013). In addition to this, authors found positive and significant relationship between commitment to managers and company and employee proactivity. This finding supports the findings of Thomas, Whitman, and Viswesvaran (2010). Moreover, commitment to managers and company mediates the relationship between empowering leadership and employee proactivity. These findings of the study extend the existing literature by adding the mediating role of commitment to managers and company and empowering leadership and commitment to managers and company as antecedents of employee proactivity. The author found that the present study is unique because this mediation model has been tested with hospital employee’s sample, which is a very complex service industry.

Managerial Implications

The present theoretical model acknowledges certain important implications for healthcare organizations as well. As employee proactivity has become imperative in the current dynamic business environment, the positive association between empowering leadership and employee proactivity indicates that empowering leader’s behaviour can be vital for employee proactivity at the workplace. As present study provides empirical support that empowering leadership leads to a higher level of employees’ commitment towards managers and company, which, in turn, enables employees to exhibit proactive behaviour. Amundsen and Martinsen (2014a) revealed eight types of empowering behaviour (delegation, coordination, information sharing, encourage initiative, encourage goal focus, efficacy support and inspiring, modeling and guidance). Empowering leaders should make use of these behaviours at the workplace in order to empower employees. Indian healthcare industry is characterized by low pay with high responsibility, long working hours, limited opportunities, high employee turnover and poor working conditions. In these conditions, empowering leadership style might be useful for achieving positive employee outcomes. Therefore, first of all, Indian private hospitals must identify empowering leaders in the organizations so that they can be deployed at strategic positions in organizations. We must remember that empowerment is not a solution for all employees’ problems but the right implementation of empowering techniques may bring many positive outcomes at the workplace. Cheong et al. (2016) have highlighted two elements of empowering leadership. First, empowering leadership enables employees to enhance self-efficacy and job performance. Second, it can burden the employees by increasing job-induced tension. Thus, managers should note that empowering leadership is not a solution for all kinds of organizational sickness. Therefore, leaders must analyse the cost and benefits of empowering employees and decide why, when, how and to whom to empower to achieve desired goals. Past research has suggested that leaders do not empower each employee of the team at the same time (Yukl & Fu, 1999). Employee commitment could be one indicator in order to find appropriate employees. Empowering leaders must identify the right candidate to empower based on employees’ response to leaders’ empowering behaviour (enhancing meaningfulness of work, believing in their abilities, promoting their participation in decision-making and removing their bureaucratic constraints), and employees should be empowering only when they have desire to get empowered at workplace or feeling powerless. Thus, empowering leaders must recognize those subordinates who want to be empowered because empowering leadership behaviour may not be fruitful in a situation of crisis and for incompetent and disinterested employees (Portugal & Yukl, 1994).

Limitation and Future Research Directions

Authors have acknowledged certain limitations of the present study. First, authors have used self-reported measures of commitment to managers and company and employee proactivity. Thus, respondents may give socially biased responses. Second, authors measured empowering leadership, commitment to managers and company and employee proactivity from the same survey. Thus, while interpreting the results of this study, common method bias must be considered. However, CFA results indicate that all constructs are distinct from each other. Third, the present study has measured empowering leadership through Ahearne et al. (2005). According to Amundsen and Martinsen (2014b), empowering leadership has three important dimensions (power sharing, motivation, developmental support) to empowering employees but Ahearne el al. (2005) measure includes only two dimensions (power sharing and motivation). Therefore, future studies can include developmental support as well in order to measure empowering leadership. Fourth, data were taken from only one type of service organization (private hospital) from major cities of India. Therefore, future studies may collect data from other service organizations as well—hotel, travel agency, insurance or government hospital. Fifth, some other important intervening variables such as psychological empowerment, meaningfulness of work and trust in leader may be examined in the relationship of empowering leadership and employee proactivity. Sixth, the present study has used cross-sectional data for examining the proposed hypothesis. Therefore, cause and effect relationship should be inferred while considering cross-sectional research design. Past research studies empowering leadership style have been linked with team-level outcomes as well (Srivastava et al., 2006). Thus, this leadership style indicates the possibility of multilevel analysis. Therefore, future research studies may explore the empowering leadership relationship with team-level proactivity. Finally, data were not collected from government hospitals, small single specialty hospital (eye hospital) and private non-NABH accredited hospitals. Therefore, future studies can test the relationship by collecting the data from these hospitals and compare the results.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

The authors received no financial support for the research, authorship and/or publication of this article.

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