This article has Open Peer Review reports available.
The Relationship between Social Capital in Hospitals and Physician Job Satisfaction
© Ommen et al; licensee BioMed Central Ltd. 2009
Received: 30 October 2008
Accepted: 16 May 2009
Published: 16 May 2009
Job satisfaction in the hospital is an important predictor for many significant management ratios. Acceptance in professional life or high workload are known as important predictors for job satisfaction. The influence of social capital in hospitals on job satisfaction within the health care system, however, remains to be determined. Thus, this article aimed at analysing the relationship between overall job satisfaction of physicians and social capital in hospitals.
The results of this study are based upon questionnaires sent by mail to 454 physicians working in the field of patient care in 4 different German hospitals in 2002. 277 clinicians responded to the poll, for a response rate of 61%. Analysis was performed using three linear regression models with physician overall job satisfaction as the dependent variable and age, gender, professional experience, workload, and social capital as independent variables.
The first regression model explained nearly 9% of the variance of job satisfaction. Whereas job satisfaction increased slightly with age, gender and professional experience were not identified as significant factors to explain the variance. Setting up a second model with the addition of subjectively-perceived workload to the analysis, the explained variance increased to 18% and job satisfaction decreased significantly with increasing workload. The third model including social capital in hospital explained 36% of the variance with social capital, professional experience and workload as significant factors.
This analysis demonstrated that the social capital of an organisation, in addition to professional experience and workload, represents a significant predictor of overall job satisfaction of physicians working in the field of patient care. Trust, mutual understanding, shared aims, and ethical values are qualities of social capital that unify members of social networks and communities and enable them to act cooperatively.
National and international studies in recent years have revealed that a significant number of physicians working in the field of patient care are not satisfied with their job and the associated working conditions [1–3]. A survey conducted in the US, for example, demonstrated this dissatisfaction in revealing that up to 40% of the physicians practicing in hospitals would not take up this profession again. Even a higher portion of the questioned physicians stated that they prevented their children from becoming a physician . The workload of physicians proves to be one of the causes for the situation described. This fact is shown by different North American and European studies [5–10]. Also, the working conditions of clinicians in Germany have changed significantly in recent years. The number of patients in German hospitals has increased from approximately 14 million in 1990 to approximately 17 million in 2004. During the same period, however, the average length of stay has fallen from 14.7 days to 8.7 days . In addition to this development, increasing bureaucracy and mechanisation in daily clinical life, particularly the growing demands relating to documentation and quality control, play a significant role in a physician's practice and result in distancing from the patient . This is not only the case in Germany, but can be seen as an international trend [4, 8, 13, 14]. However, in addition to workload, other factors exist. It is reported that growing patients' needs and economic, organisational, and regulatory factors affect job satisfaction decisively . In particular, many physicians feel their autonomy or their self-conception as physicians are restricted by these factors [16, 17]. There exist studies indicating that increasing deprofessionalisation and restriction of professional autonomy evoke job dissatisfaction in physicians [1, 16, 18–20]. In addition, advanced vocational training facilities (offered on the job) have to be considered . Finally, a linkage exists between a physician's salary and satisfaction with the job . The heavy objective and subjective burdens and the dissatisfaction in practising within the medical profession causes a growing number of physicians, especially young physicians, to change their vocational field . Many studies have demonstrated a link between job satisfaction of physicians and the probability of quitting their job or the frequency of job changes [22–26]. A growing number of physicians try to avert the possible consequences of the workload felt to be too heavy and the dissatisfaction involved by taking up jobs in non-medical professions at an early stage. In particular, stress and burnout are common consequences of regular overwork, which is not merely due to the pure quantity of work, but also due to the quality to be delivered. Being responsible for appropriate and successful therapy and catering to the demands of different social circles (colleagues, relatives, and health insurance) frequently leads to chronic stress, burnout, and physical and other mental diseases [7, 27]. Furthermore, a clear relationship between stress, burnout, and job satisfaction could be shown [17, 28, 29]. This relationship certainly has to be considered as reciprocal: stress and burnout diminish job satisfaction, low job satisfaction in turn intensifies the symptoms of stress and burnout. Obviously, it appears that high job satisfaction, however, can also act as a protective factor and prevent chronic job stress [7, 17]. The particular relevance of job satisfaction is demonstrated further by several studies showing links between job satisfaction of physicians and the quality of medical care [23, 30–34]. Thus, for example, in addition to the impact of physician job satisfaction on patient satisfaction [23, 30] and adherence [23, 33], links between the occurrence of errors in treatment and job satisfaction have been described . Although physician job satisfaction has been assessed to a large extent in recent years, very little is known about the effects of organizational characteristics, such as a culture of value and trust, which are expressions of social capital, on overall job satisfaction.
General definitions of Job Satisfaction and Social capital in the workplace
Job satisfaction is defined as a global attitude that individuals have towards their jobs . It is an extent to which one feels positively or negatively about different facets of the job e.g. job conditions, co-workers and working time [36–39] and is a complex set of interrelationships of tasks, roles, responsibilities, interactions, incentives and rewards .
Social capital in the workplace
Social capital can be regarded as a resource which helps people and organizations cope with stress and helps foster salutogenic potential. There are two forms of social capital: 1) individual social capital and collective social capital. An individualistic version of social capital has been defined by Bourdieu . In brief, social capital, according to Bourdieu, is the "aggregate of the actual or potential resources which are linked to possession of a durable network of more or less institutionalized relationships of mutual acquaintance and recognition – or in other words, to membership in a group – which provides each of its members with the backing of the collectively owned capital, a credential which entitles them to credit, in the various senses of the word" . Social epidemiologic research during the last 20 years shows that social relationships, which are experienced as being helpful and positive, promote general well-being and protect against physical harm [43, 44]. Coleman  described the collective version of the term "social capital" as follows: "Unlike other forms of capital, social capital inheres in the structure of relations between persons and among persons. It is lodged neither in individuals nor in physical implements of production." Given this definition, it can be assumed that not only individuals, but also complex organizations, such as hospitals, possess social capital. Its components are, in particular, the existence of collective values and convictions and mutual trust between the members of an organization . Collective social capital can be defined as a feature of social systems that is able to improve the health and the capacity to perform of its members . Research into support and networks has also shown that a person's social network has a significant impact on his or her performance capacity, health, and emotional balance. The stability, scope, and functionality of social networks have a modulating effect on cognition, motivation, and emotions [48–53]. A successfully established atmosphere of trust and a feeling of common values and convictions may help people work together and make it easier for them to assess the conditions of their daily work by reducing insecurity, uncertainty, and disorientation, and to improve their performance. Social capital is generated from internalized, informal standards within an organization and produces cooperation [54–57]. Putnam and Coleman regard social capital as a way of solving collective problems through a sense of community and trust. The inherent potential for people to exploit others in the production of collective goods is reduced by activity structures that are governed by reciprocity standards .
Aim of the study
Little empirical work has been published using the concept of social capital in the health care industry . However, the studies which have been published on this topic yet refer to the particular importance of social capital in the health care sector, eg. in the inpatient or ambulatory sector. Thus, Waisel demonstrates in his study how social capital improves the operating room working environment and therefore increases efficiency and quality of patient care . DiCicco et al  developed a model of social capital to enhance relationships within primary care practices that promote organizational success and improve patient care outcomes. Hoelscher, Hoffman & Dawley  reviewed the literature and showed that existing social capital leads to competitive advantage and enhanced medical group performance. Hofmeyer & Marck  outlined the role of social capital for organizational integrity, healthy workplace cultures, sustainable resource management, improved nurse retention, effective knowledge translation, and safer patient care. Research into the relationship between social capital in hospitals and job satisfaction of clinicians is however still at an early stage. To our knowledge, there is no existing literature to date that has explicitly examined the relationship between social capital in hospitals and physician job satisfaction. Therefore, the aim of the current study was to examine the effects of collective social capital at the workplace on overall job satisfaction of clinicians. We hypothesized that a significant relationship exists between social capital in the hospital and physician satisfaction, assuming that this relationship can be proved not only in bivariate form, but persists after controlling for socio-demographic factors, such as age, gender, professional experience, and subjective workload.
The following analysis is based on data from a project entitled "Corporate Governance Using Biopsychosocial Indicators" (CoBI) study, funded by the German Federal Ministry of Education and Research. The "Biopsychosocial Indicators for Employees Questionnaire" (BIQ) used herein was especially developed for this study. It contains both internationally-established instruments, such as the "Maslach Burnout Inventory," and scales especially developed for this and further studies, among them the social capital scale described below. It consists of valid indicators of how employees regard their work situation and their organization .
This study was approved by the Research Ethics Board at the University of Cologne. All participants provided informed consent for the survey.
Participants and procedure
Structures of the selected hospitals
Number of cases in 2001
Overall Job Satisfaction
Following Scarpello and Campell , Wanous et al.  and Nagy  we decided to measure overall job satisfaction taking a single item approach. The most frequently argued advantages of single item measures in contrast to multi-item, multi-dimensional instruments measuring overall job satisfaction are the following: single item measures are much shorter and take up less space, are more cost-effective, may contain more face validity, appear to be correlated fairly with multi-item measures of overall satisfaction and may be better to measure changes in job satisfaction. Furthermore, the problem to operationalize job satisfaction – similar to patient satisfaction – is to integrate all factors influencing job satisfaction in one comprehensive instrument according to their individual weighting. In particular due to the lack of knowledge of the completeness of all potential influence factors and the lack of empirical and theoretical information about their individual weighting, a single item approach seems to be the more appropriate method. Highhouse and Becker  e.g. found that facets such as company loyalty, enjoyment of work, and job significance were not captured by a composite facet measure, but were considered in making a global judgment about job satisfaction. Therefore the used variable, "job satisfaction" , is based on a homonymous item worded as follows: "If you consider everything that matters in your job (e.g., kind of work, working conditions, colleagues, and working time), how satisfied are you with your job?" Subjective complaints were assessed with a seven-point Likert-type scale with smiley/sad faces above each point.
Sociodemographic characteristics and workload
Information about age, gender, and years of professional experience was provided by the respondents. The variable, "workload," based on the scale, "intensity of labour" according to Richter et al. , was designed to measure the workload of physicians (Cronbach's α: .78). The six items of the scale were worded as follows: 1) "The required pace of work is very fast," 2) "The tasks are often very difficult to cope with," 3) "I often have very much work to be done," 4) "Usually time is too short and I often work under time pressure," 5) "I'm often exposed to physical strain," and 6) "Too much work has to be done at the same time." Answers ranged from "disagree" to "agree," with each response category measured by a score from 1–4 points; all item values were summed and divided by the number of items.
Social capital in hospitals
The variable, "social capital in hospitals," was designed to measure two key features of social capital: 1) common values and 2) perceived trust at the hospital . We used six items to measure this variable , e.g., "Agreement and consent dominate in our hospital" and "At our hospital we trust each other." The items were developed using basic sociological principles and central statements relating to social capital described by Coleman [45, 54], Putnam , and Fukuyama . Respondents could choose from four given responses and each response was assigned points ranging from 1–4; the total scores ranged from 6–24 points. The central determinants of this variable were divided into three types: common values, perceived trust, and reciprocity. Agreement and consent (item 1) and the presence of a "sense of unity" (item 3) represent a common value base . One of the prerequisites for cooperative action is "trust" (item 2). The probability of trust in a partner increases with the expectation of benefits from trust-based action. Putnam  speaks of the standard of generalized reciprocity; these standards ensure that hospital employees work together by causing them to behave cooperatively . Item 4 looks at perceptions of the quality of the atmosphere at work. Reciprocal behaviour (item 5) is a form of exchange, commonly referred to as a quid pro quo and forms the basis of what is called "a contingent relationship." In other words, workplace relationships lead to staff feeling obliged to the organization to act reciprocally. According to Coleman , the decisive prerequisite for solving problems using cooperation is the amount of social capital . The common values within the hospital are emphasized in item 6.
We performed stepwise multivariate linear regression using SPSS 15.0. If the proportion of missing values for a variable was < 25%, a mean value was imputed; variables with > 25% of missing values were excluded from analysis . Variables with an intercorrelation > 0.8, which is an indicator for problems of collinearity, would also have been excluded from analysis, but no variable fulfilled this (both) criteria either . The following analysis was conducted in a three step manner, as follows: first, we give an overview of descriptive values of all analysis variables, in the second step, we show Pearson product moment correlation coefficients (PMCC) for correlations between all variables to demonstrate bivariate relationships and to control for multicollinearity; and in the final analysis, we computed a multiple linear stepwise regression model on "job satisfaction."
163 respondents were male (58.8%) and 114 (41.2%) female. The average age was 40.0 years (standard deviation 9.9 years). 89 of the respondents (32.1%) had up to five years of professional experience, 111 (40.1%) had 6–16 years, and 77 (27.8%) had 17 years or more. 82 physicians (29.6%) specialize in internal medicine (e.g., cardiology and oncology), 57 physicians (20,6%) in visceral and vascular surgery, 40 physicians (14.4%) in neurology, psychiatry, and psychosomatics, 29 physicians (10.4%) specialize in other fields (e. g. gynaecology and paediatrics). 69 physicians (25.0%) hadn't specified their speciality.
Measurements of the variables "social capital," "workload," and "job satisfaction"
Intercorrelation coefficients for all ordinal and metric analyses variables
2. Profess. experience
4. Social capital
5. Job satisfaction
2. Profess. experience
4. Social capital
The intercorrelations ranged between .055 (workload with professional experience) and .736 (age with professional experience). Seven of 10 relationships were significant at the 0.01 level (2-tailed). The link between social capital and job satisfaction as a main topic of this analysis proved to be highly significant on a bivariate level (.524). All in all, no variable in the present study reached a critical correlation with another variable of > .8, which is discussed with regard to multicollinearity .
Results from hierarchical multiple linear regression
The last analysis is computed with a 3-step hierarchical multiple linear regression model with overall job satisfaction as dependent and age, gender, professional experience, workload, and social capital as independent variables (see table 4). In the first step, only socio-demographic variables (age, gender, and professional experience) are introduced in the model. In the second step, workload is additionally introduced, and in the third step, social capital is added.
In the first step of the regression model, the explained variance of the dependent variable, job satisfaction, accounted for nearly 9%, and only age reached a significance level of p < .05. In the second step, the explained variance increased up to 18%. Besides workload, age remained significant. In the third step, the explained variance increased up to 37%. Significant information for explaining the dependent variable, job satisfaction, was given by the independent variables, professional experience, workload, and social capital. These variables explained > 1/3 of the variance of the dependent variable job satisfaction.
To our knowledge, there is no existing literature to date that has explicitly examined the relationship between social capital in hospitals and physician job satisfaction. Therefore, this article extends prior research of social capital in the health care industry by examining the relationship between social capital at the workplace and job satisfaction of clinicians. Our analysis demonstrates that not only subjective workload and professional experience show a statistical significant correlation with job satisfaction, but also social capital in the hospital. Trust, mutual understanding, and shared aims are qualities of social capital, which unify members of social networks and communities and enable them to act cooperatively. Investment in the social capital of an organisation, e.g., a hospital, is a valuable investment in the social system, since the social capital, as shown in this analysis, has a significant impact on job satisfaction. On the basis of the recent literature, it is to be assumed that job satisfaction, in turn, affects well-being and health of an organisation's members and therefore the efficiency of the organisation itself. Furthermore, it becomes evident that job satisfaction is significantly associated with professional experience. The reason for this may be partly due to a "survival" function, which means that physicians who have found more strategies to maintain their satisfaction are more likely to survive a full career as a physician. It is argued that the higher satisfaction of physicians in later career stages results from "weeding out" the less satisfied physicians . It has been further shown that subjective workload is associated with job satisfaction, such that the lower the workload, the higher the job satisfaction. Like many other studies, this analysis confirms again that clinicians consider their workload generally to be high (19.3 points on average of a maximum of 24). In contrast, sociodemographic variables, such as age and gender, did not have a significant impact.
Limitations of the study
The current study had methodological limitations that may have affected interpretation of the results. Our cross-sectional design allowed identification of several factors associated with job satisfaction, although causal inferences can hardly be made. Since job satisfaction, as the dependent variable, and all predictor variables were assessed by self-reports, the results might be contaminated by common method variance or self-report bias . Whether the results are applicable to other hospitals is difficult to assess. The selection of the four hospitals intentionally included hospitals in East and West Germany, and hospitals providing maximum and basic healthcare services in an attempt to achieve a form of guided random sampling of German hospitals and hospital-based physicians. On a positive note, a high response rate of 61% was achieved.
Increasing social capital in hospitals requires in-house strategies for reinforcing a culture of trust and willingness to work together. Problems in the hospital or with individuals should be identified using regular, standardized employee polls. We propose regular "team sessions" and professional supervision as suitable measures for enhancing the social climate in hospitals and for improving communication structures.
In addition we assume, as often "the rot starts at the top," that the leaders in the middle and upper management levels in hospitals can contribute considerably to strengthen social capital. Management seminars should impart skills of optimising communication structures and processes in the hospital, detecting problems arising in the interaction between staff members and teamwork early, and reacting adequately. Thus, leaders can contribute effectively to improve the working atmosphere significantly in a top-down approach and thus act as role models for the next generation of leaders. This is an important, but too often disregarded task of physicians in leadership positions, especially in hospitals. Furthermore we suggest interventions implemented or designed not only on the individual level (i.e. physicians/leaders) but also on the organizational level. For example, hospital settings should be designed so that there is ample interaction and cooperation among health professionals, emphasizing trust, reciprocity, alliances, bonding, and shared understanding, while promoting organizational justice and conflict resolution. Additionally, we recommend assessing physical and mental symptoms (e.g., burnout, stress) and job satisfaction with standardized instruments within the scope of regular examinations by the hospital medical officer. In this way, first signs of weak social capital or a bad working atmosphere and the potential physical or mental effects on the staff members can be detected early.
The study was funded by the German Federal Ministry of Education and Research. We would like to thank the physicians who participated in the survey and the hospitals supporting this study.
- Bergin E, Johansson H, Bergin R: Are doctors unhappy? A study of residents with an open interview form. Quality management in health care. 2004, 13 (1): 81-7.View ArticlePubMedGoogle Scholar
- Kassirer J: Doctor discontent. The New England journal of medicine. 1998, 339: 1543-5. 10.1056/NEJM199811193392109.View ArticlePubMedGoogle Scholar
- Smith R: Why are doctors so unhappy?. British medical journal. 2001, 322: 1073-1074. 10.1136/bmj.322.7294.1073.View ArticlePubMedPubMed CentralGoogle Scholar
- Zuger A: Dissatisfaction with medical practice. The New England journal of medicine. 2004, 350: 69-75. 10.1056/NEJMsr031703.View ArticlePubMedGoogle Scholar
- Van Ham I, Verhoeven AA, Groenier KH, Groothoff JW, De Haan J: Job satisfaction among general practitioners: a systematic literature review. The European journal of general practice. 2006, 12: 174-80. 10.1080/13814780600994376.View ArticlePubMedGoogle Scholar
- Spickard A, Gabbe SG, Christensen JF: Mid-career burnout in generalist and specialist physicians. The journal of the American Medical Association. 2002, 288: 1447-50. 10.1001/jama.288.12.1447.View ArticlePubMedGoogle Scholar
- Ramirez AJ, Graham J, Richards MA, Cull A, Gregory WM: Mental health of hospital consultants: the effects of stress and satisfaction at work. Lancet. 1996, 347: 724-8. 10.1016/S0140-6736(96)90077-X.View ArticlePubMedGoogle Scholar
- Bovier PA, Perneger TV: Predictors of work satisfaction among physicians. European journal of public health. 2003, 13: 299-305. 10.1093/eurpub/13.4.299.View ArticlePubMedGoogle Scholar
- McMurray JE, Williams E, Schwartz MD, Douglas J, Van Kirk J, Konrad TR, Gerrity M, Bigby JA, Linzer M: Physician job satisfaction: developing a model using qualitative data. SGIM Career Satisfaction Study Group. Journal of general internal medicine. 1997, 12 (11): 711-4. 10.1046/j.1525-1497.1997.07145.x.View ArticlePubMed CentralGoogle Scholar
- Bergner T: Lebensaufgabe statt Lebens-Aufgabe. Deutsches. Ärzteblatt. 2004, 101 (33): 2232-4.Google Scholar
- Deutsche Krankenhausgesellschaft: Zahlen, Daten, Fakten 2005/2006. 2006, Düsseldorf: Deutsche Krankenhaus VerlagsgesellschaftGoogle Scholar
- Blum K, Müller U: Dokumentationsaufwand im Ärztlichen Dienst der Krankenhäuser. 2003, Düsseldorf: Deutsche Krankenhaus VerlagsgesellschaftGoogle Scholar
- Landon BE: Career Satisfaction among physicians. The journal of the American Medical Association. 2004, 291: 634-10.1001/jama.291.5.634.View ArticlePubMedGoogle Scholar
- Grant P: Physician job satisfaction in New Zealand versus the United Kingdom. N Z Med J. 2004, 117: 1204.Google Scholar
- Bogue RJ, Guarneri JG, Reed M, Bradley K, Hughes J: Secrets of physician satisfaction. Study identifies pressure points and reveals life practices of highly satisfied doctors. Physician executive. 2006, 32 (6): 30-9.PubMedGoogle Scholar
- Mechanic D: Physician discontent. The journal of the American Medical Association. 2003, 290: 941-6. 10.1001/jama.290.7.941.View ArticlePubMedGoogle Scholar
- Visser MR, Smets EM, Oort FJ, De Haes HC: Stress, satisfaction and burnout among Dutch medical specialists. Canadian Medical Association journal. 2003, 168: 271-75.PubMedPubMed CentralGoogle Scholar
- Pousette A, Hanse JJ: Job characteristics as predictors of ill health and sickness absenteeism in different occupational types – a multigroup structural equation modelling approach. Work & Stress. 2002, 16: 229-50. 10.1080/02678370210162737.View ArticleGoogle Scholar
- Stoddard JJ, Hargraves JL, Reed M, Vratil A: Managed care, professional autonomy, and income: effects on physician career satisfaction. Journal of general internal medicine. 2001, 16: 675-84. 10.1111/j.1525-1497.2001.01206.x.View ArticlePubMedPubMed CentralGoogle Scholar
- Epstein RM: Time, autonomy, and satisfaction. Journal of general internal medicine. 2000, 15 (7): 517-8. 10.1046/j.1525-1497.2000.05014.x.View ArticlePubMedPubMed CentralGoogle Scholar
- Laubach W, Fischbeck S: Job satisfaction and work situation of physicians: a survey at a German hospital. International Journal of Public Health. 2007, 52: 54-59. 10.1007/s00038-006-5021-x.View ArticlePubMedGoogle Scholar
- Walker KA, Pirotta M: What keeps Melbourne GPs satisfied in their jobs?. Australian Family Physician. 2007, 36 (10): 877-80.PubMedGoogle Scholar
- Pathman D, Konrad T, Williams E, Linzer M, Douglas J: Physician job satisfaction, dissatisfaction, and turnover. Journal of Family Practice. 2002, 51 (7): 593.PubMedGoogle Scholar
- Coyle YM, Aday LA, Battles JB, Hynan LS: Measuring and predicting academic generalists' work satisfaction: implications for retaining faculty. Academic Medicine. 1999, 74: 1021-7. 10.1097/00001888-199909000-00017.View ArticlePubMedGoogle Scholar
- Price JL, Mueller CW: Absenteeism and Turnover among Hospital Employees. Edited by: Greenwich CT. 1986, JAI PressGoogle Scholar
- Kay LE, D'Amico F: Factors influencing satisfaction for family practice residency faculty. Family Medicine. 1999, 31: 409-14.PubMedGoogle Scholar
- Grassi L, Magnani K: Psychiatric morbidity and burnout in the medical profession: an Italian study of general practitioners and hospital physicians. Psychotherapy and Psychosomatics. 2000, 69 (6): 329-34. 10.1159/000012416.View ArticlePubMedGoogle Scholar
- Williams ES, Manwell LB, Konrad TR, Linzer M: The relationship of organizational culture, stress, satisfaction and burnout with physician-reported error and suboptimal patient care: results from the MEMO Study. Health Care Management Review. 2007, 32 (3): 203-212.View ArticlePubMedGoogle Scholar
- McManus IC, Keeling A, Paice E: Stress, burnout and doctors' attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Med. 2004, 2: 29-10.1186/1741-7015-2-29.View ArticlePubMedPubMed CentralGoogle Scholar
- Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA: Is the professional satisfaction of general internists associated with patient satisfaction?. Journal of general internal medicine. 2000, 15: 122-158. 10.1046/j.1525-1497.2000.02219.x.View ArticlePubMedPubMed CentralGoogle Scholar
- Linn LS, Brook RH, Clark VA, Davies AR, Fink A, Kosecoff J: Physician and patient satisfaction as factors related to the organization of internal medicine group practices. Medical Care. 1985, 23: 1171-8. 10.1097/00005650-198510000-00006.View ArticlePubMedGoogle Scholar
- Grol R, Mokkink H, Smits A, van Eijk J, Beek M, Mesker P, Mesker-Niesten J: Work satisfaction of general practitioners and the quality of patient care. Family Practice. 1985, 2: 128-35. 10.1093/fampra/2.3.128.View ArticlePubMedGoogle Scholar
- DiMatteo MR, Sherbourne CD, Hays RD, Ordway L, Kravitz RL, McGlynn EA, Kaplan S, Rogers WH: Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study. Health psychology. 1993, 12: 93-102. 10.1037/0278-6126.96.36.199.View ArticlePubMedGoogle Scholar
- Weisman CS, Nathanson CA: Professional satisfaction and client outcomes: a comparative organizational analysis. Medical Care. 1985, 23: 1179-92. 10.1097/00005650-198510000-00007.View ArticlePubMedGoogle Scholar
- Best ME, Thurston NE: Measuring nurse job satisfaction. Journal of Nursing Administration. 2004, 34: 283-290. 10.1097/00005110-200406000-00007.View ArticlePubMedGoogle Scholar
- Spector PE: Job satisfaction: Application, assessment, causes, and consequences. 1997, Thousand Oaks, CA: SageGoogle Scholar
- Bhuian SN, Menguc B: An extension and evaluation of job characteristics, organizational commitment and job satisfaction in an expatriate, guest worker, sales setting. Journal of Personal Selling & Sales Management. 2002, 22 (1): 1-11.Google Scholar
- Hunt SD, Chonko LB, Wood VR: Organizational commitment and marketing. Journal of Marketing. 1985, 49 (1): 112-26. 10.2307/1251181.View ArticleGoogle Scholar
- Williams J: Job satisfaction and organizational commitment, a Sloan Work and Family Encyclopedia entry. Retrieved March 31, 2009, from the Sloan Work and Family Research Network website. 2004, [http://wfnetwork.bc.edu/encyclopedia_entry.php?id=244&area=academics]Google Scholar
- Cameron S: Job satisfaction: the concept and its measurement. 1973, Michigan: Work Research UnitGoogle Scholar
- Bourdieu P: Ökonomisches Kapital, kulturelles Kapital, soziales Kapital. Soziale Ungleichheiten. Sonderband 2 der Sozialen Welt. Edited by: Kreckel R. 1983, Göttingen: Schwartz, 182-98.Google Scholar
- Bourdieu P: The Forms of Capital. Handbook of Theory and Research for the Sociology of Education. Edited by: Richardson J. 1986, New York: Greenwood Press, 241-58.Google Scholar
- Badura B, Kaufhold G, Lehmann H, Pfaff H, Schott T, Waltz M: Leben mit dem Herzinfarkt. Eine sozialepidemiologische Studie. 1987, Berlin: SpringerView ArticleGoogle Scholar
- Berkman LF, Kawachi I: Social Epidemiology. 2000, New York: Oxford University PressGoogle Scholar
- Coleman JS: Foundations of Social Theory. 1990, Cambridge: Harvard University PressGoogle Scholar
- Badura B, Hehlmann T: Betriebliche Gesundheitspolitik. 2003, Berlin: SpringerView ArticleGoogle Scholar
- Janssen C, Pfaff H: Psycho-social environments. ABC of Behavior Change: A Guide to Successful Disease Prevention and Health Promotion. Edited by: Kerr J, Weitkunat R, Moretti M. 2005, London: Elsevier, 153-165.Google Scholar
- Henderson SA: A development in social psychiatry: the systematic study of social bonds. Journal of Nervous and Mental Disease. 1980, 168: 63-9. 10.1097/00005053-198002000-00001.View ArticlePubMedGoogle Scholar
- Hammer M: Social support, social networks and schizophrenia. Schizophrenia Bulletin. 1981, 7 (1): 45-57.View ArticlePubMedGoogle Scholar
- Badura B, Waltz EM: Social support and quality of life following myocardial infarction. Social Indicators Research. 1984, 14: 295-311. 10.1007/BF00692986.View ArticleGoogle Scholar
- Cohen S: Psychosocial models of the role of social support in the etiology of physical disease. Health Psychology. 1988, 7 (3): 269-97. 10.1037/0278-6188.8.131.529.View ArticlePubMedGoogle Scholar
- Schwarzer R, Leppin A: Sozialer Rückhalt und Gesundheit: Eine Meta-analyse. 1989, Göttingen: HogrefeGoogle Scholar
- Röhrle B: Soziale Netzwerke und soziale Unterstützung. 1994, Weinheim: Beltz VerlagGoogle Scholar
- Coleman JS: Grundlagen der Sozialtheorie, Band 1: Handlungen und Handlungssysteme. 1991, München: Oldenbourg VerlagGoogle Scholar
- Putnam RD, Leonardi R, Nanetti RY: Making Democracy Work. 1993, Princeton, NJ: Princeton University PressGoogle Scholar
- Fukuyama F: Social capital, civil society and development. Third World Quarterly. 2001, 22 (1): 7-30. 10.1080/713701144.View ArticleGoogle Scholar
- Pfaff H, Badura B, Pühlhofer F, Siewerts D: Das Sozialkapital der Krankenhäuser – wie es gemessen und gestärkt werden kann. Fehlzeiten-Report 2004. Gesundheitsmanagement in Krankenhäusern und Pflegeeinrichtungen. Edited by: Badura B, Schellschmidt H, Vetter C. 2005, Berlin: Springer, 81-109.View ArticleGoogle Scholar
- Salvatore D: Physician Social Capital: Its Sources, Configuration, and Usefulness. Health Care Management Review. 2006, 31 (3): 213-222.View ArticlePubMedGoogle Scholar
- Waisel DB: Developing social capital in the operating room: the use of population-based techniques. Anesthesiology. 2005, 103 (6): 1305-10. 10.1097/00000542-200512000-00026.View ArticlePubMedGoogle Scholar
- DiCicco-Bloom B, Frederickson K, O'Malley D, Shaw E, Crosson JC, Looney A: Developing a model social capital: Relationships in primary care. Advances in Nursing Science. 2007, 30 (3): 13-24.View ArticleGoogle Scholar
- Hoelscher ML, Hoffman JJ, Dawley D: Toward a social capital theory of competitive advantage in medical groups. Health Care Manage Rev. 2005, 30 (2): 103-109.View ArticlePubMedGoogle Scholar
- Hofmeyer A, Marck PB: Building social capital in healthcare organizations: thinking ecologically for safer care. Nurs Outlook. 2008, 56 (4): 145-151. 10.1016/j.outlook.2008.01.001.View ArticlePubMedGoogle Scholar
- Pühlhofer F, Stoll A: Mitarbeiterkennzahlen als strategisches Führungsinstrument im Krankenhaus. „Weiche" Kennzahlen für das strategische Krankenhausmanagement. Stakeholderinteressen zielgerichtet erkennen und einbeziehen. Edited by: Pfaff H, Lüttike J, Badura B, Piekarski C, Richter P. 2004, Bern: Verlag Hans Huber, 31-50.Google Scholar
- Scarpello V, Campbell JP: Job satisfaction: Are all the parts there?. Personnel Psychology. 1983, 36: 577-600. 10.1111/j.1744-6570.1983.tb02236.x.View ArticleGoogle Scholar
- Wanous JP, Reichers AE, Hudy MJ: Overall job satisfaction: How good are single-item measures?. Journal of Applied Psychology. 1997, 82: 247-252. 10.1037/0021-9010.82.2.247.View ArticlePubMedGoogle Scholar
- Nagy MS: Using a single-item approach to measure facet job satisfaction. Journal of Occupational and Organizational Psychology. 2002, 75: 77-86. 10.1348/096317902167658.View ArticleGoogle Scholar
- Highhouse S, Becker AS: Facet measures and global job satisfaction. Journal of Business and Psychology. 1993, 8 (1): 117-127. 10.1007/BF02230397.View ArticleGoogle Scholar
- Pfaff H, Lütticke J, Badura B, Piekarski C, Richter P: „Weiche" Kennzahlen für das strategische Krankenhausmanagement. Stakeholderinteressen zielgerichtet erkennen und einbeziehen. 2004, Bern: Verlag Hans HuberGoogle Scholar
- Richter P, Hemmann E, Merboth H, Fritz S, Hänsgen C, Rudolf M: Das Erleben von Arbeitsintensität und Tätigkeitsspielraum- Entwicklung und Validierung eines Fragebogens zur orientierenden Analyse (FIT). Zeitschrift für Klinische Psychologie und Psychotherapie. 2000, 44 (3): 129-39.Google Scholar
- Coleman JS: Social capital in the creation of human capital. American Journal of Sociology. 1988, 94: 95-120. 10.1086/228943.View ArticleGoogle Scholar
- Diekmann A: Sozialkapital und das Kooperationsproblem in sozialen Dilemmata. Analyse und Kritik. 1993, 15 (1): 22-35.View ArticleGoogle Scholar
- Wirtz M: Über das Problem fehlender Werte: Wie der Einfluss fehlender Informationen auf Analyseergebnisse entdeckt und reduziert werden kann. Die Rehabilitation. 2004, 43 (2): 109-115. 10.1055/s-2003-814839.View ArticlePubMedGoogle Scholar
- Katz MH: Multivariable Analysis: A Practical Guide for Clinicians. 2006, Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo: Cambridge University PressView ArticleGoogle Scholar
- Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP: Common method biases in behavioral research: a critical review of the literature and recommended remedies. The Journal of applied psychology. 2003, 88 (5): 879-903. 10.1037/0021-9010.88.5.879.View ArticlePubMedGoogle Scholar
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6963/9/81/prepub
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.