Conference Agenda

To combat current societal challenges such as budget cuts and ageing populations, digital technologies are being widely adopted into public service organisations. Digital transformation is believed to increase accessibility, efficiency, cost reduction, and fairness (Busch, 2019; MacLean & Titah). For instance, in healthcare, telemonitoring services have been adopted to support teleconsultation and care at a distance, decreasing hospitalisations, healthcare utilisation and costs (Bekker et al., 2023; Dyb & Kvam, 2022; Fairbrother et al., 2012).

Many scholars present how digital transformation affects the work that professionals perform. However, a greater body of literature focuses on theoretical models and work task-related effects, such as the room for discretion in decision-making (Bovens & Zouridis, 2002; Busch & Henriksen, 2018). Therefore, the dynamics of how professionals adapt to these changes, how they cope with transformations, learn and grow into new roles is understudied. To understand this, the concept of adaptive work behaviour is useful. Adaptive work behaviour concept refers to the degree to which professionals cope with, respond to, and support changes resulting in more effective contributions in their roles as individuals, team members or members of an organisation (Griffin et al., 2010). Adaptive work behaviour is essential for fostering resilience and successful organisational change across several disciplines (Ali et al., 2020; Atkinson et al., 2009; Wiig et al., 2020). Nevertheless, the literature so far is not clear about how such adaptive behaviour unfolds.

To unpack how healthcare professionals adapt to the digital transformation of their work, we ask the following questions: What adaptive mechanisms and strategies do healthcare professionals adopt following digital transformation and how do these vary across different implementation stages of digital transformation?

We draw on the theory of work practices which can be defined as “what professionals do” daily (Reay et al., 2016) as it shows how technologies influence work practices in different ways (Kessing et al., 2022). Based on this we use ethnographic approaches consisting of observation, field notes and semi-structured individual interviews with healthcare professionals in three Dutch hospitals with diverging stages of digital transformation. By exploring the behaviour of frontline healthcare professionals we provide an in-depth analysis for a better understanding of how digital transformation is being adopted across three distinct hospitals. We also unveil the factors that influence healthcare professionals' ability to adapt to policy change.

People management —line managers’ implementation of HR practices and supportive leadership behavior — plays a crucial role in stimulating public service performance and employee well-being (Knies et al., 2020). Although people management is conceptually defined as well-intended support, its effectiveness is not self-evident. This depends on how well line managers fulfill their people management role ánd how their actions are perceived by employees (Wright & Nishii, 2013). To be beneficial, line managers must align the type and frequency of their people management behaviors to employees’ preferences. Failure to do so – providing ‘too much’ (overinvestment) or ‘too little’ (underinvestment) people management - may result in unfavorable employee attitudes and behaviors. These consequences are particularly harmful in the healthcare sector—this study’s empirical context—where resource constraints are prevalent and unsatisfactory supervisor support seems the primary reason for employee turnover (Kellner et al., 2016).

Therefore, we examine whether the ‘Goldilocks principle’ applies by investigating whether people management follows a nonlinear pattern: to what extent is there a nonlinear relationship between people management and employees’ affective well-being (emotional state at work) and extra-role performance (discretionary behaviors that benefit the organization)?

Our aim is twofold. First, we investigate the occurrence of nonlinear effects of people management, in line with the ‘too-much-of-a-good-thing’ (TMGT) principle. This principle suggests that high levels of a beneficial antecedent can reach an inflection point after which the positive effect diminishes or becomes negative (Pierce & Aguinis, 2013). We propose that people management is TMGT when employees perceive it to be, and therefore subsequently may express negative attitudes and behaviors (Wright & Nishii, 2013).

Second, we study to what extent the alignment between offered and preferred people management moderates the nonlinear relationships between people management and outcomes. By building on the Person-Environment fit literature (Kristof-Brown et al., 2005) and the need fulfillment theory (Schuler et al., 2012), we argue that the most beneficial effects are reached when there is alignment between offered and preferred people management. This alignment is assessed by examining discrepancies between employees’ perceptions of the frequency of offered people management and their preferred frequency of people management, providing insight into the conditions through which people management affects well-being and performance.

This study is essential for ensuring effective investments in people management and maintaining the delivery of high-quality healthcare. We conduct a survey study among 10,000 employees in various healthcare organizations. Preliminary results are presented at the conference.

Public personnel shortages are putting increasing pressure on public service delivery (Jakobsen, Lokke & Keppeler, 2023). This is particularly true in healthcare, where the WHO anticipates a global shortfall of 18 million healthcare professionals by 2030 (WHO, 2021). Studies addressing healthcare personnel shortages often focus on hiring new staff by improving recruitment, encouraging return-to-practice, and drawing on other countries to increase the workforce (Daniels et al., 2020). However, such strategies neglect the importance of focusing attention on retaining existing staff (Boselie, van Harten & Veld, 2021).

One potentially crucial factor in retaining healthcare professionals is employee resilience: the skills and behaviors that facilitate individuals to perform under pressure (Gillespie et al., 2007). Resilience is associated with lower burnout (Rushton, 2015; Lebares et al., 2018) and higher job satisfaction (Yu et al., 2019), therewith likely to be crucial for staff retention.

In this interdisciplinary study, we focus on the resilience of surgical staff. Surgical staff provide an interesting case for studying employee resilience, as adapting to unexpected events, coping with stress, and dealing with adverse events is inherent to the surgical profession (Ng et al., 2019). In particular, we focus on the role of self-regulation and leadership as antecedents of resilience. Self-regulation as the cornerstone of resilience is in line with psychological principles around learning and performance (Bakker & de Vries, 2021). However, to effectively self-regulate actions, thoughts, and emotions, professionals need leadership facilitating the use of self-regulation strategies.

To study how leadership and self-regulation impact the resilience of surgical professionals, we used a quantitative experience sampling methodology. Forty-one surgical professionals participated in a diary study, reporting on their last surgery five times across separate days. The questionnaire for the diary study was based on insights from 100 hours of observation and 32 interviews. Participants of the diary study reported pressures related to the surgery, team dynamics, and work conditions; strategies for self-regulation like proactive coping and emotion-regulation; task- and relation-oriented leadership by surgeons and other team members; and outcomes such as engagement, resilience, and satisfaction with the surgery. This data was paired with information on surgery type, complexity, duration, and the backgrounds of the professionals involved.

The study's findings contribute to a better understanding of how self-regulation and leadership impact resilience among surgical professionals, enabling them to perform under pressure. This understanding could, in turn, contribute to more insight into staff retention.

References

Bakker, A. B., & De Vries, J. D. (2021). Job Demands–Resources theory and self-regulation: New explanations and remedies for job burnout. Anxiety, stress, & coping, 34(1), 1-21.

Boselie, P., Van Harten, J., & Veld, M. (2021). A human resource management review on public management and public administration research: stop right there… before we go any further…. Public Management Review, 23(4), 483-500.

Daniels, K. M., Riesel, J. N., Verguet, S., Meara, J. G., & Shrime, M. G. (2020). The scale-up of the global surgical workforce: can estimates be achieved by 2030?. World journal of surgery, 44, 1053-1061.

Gillespie, B. M., Chaboyer, W., Wallis, M., & Grimbeek, P. (2007). Resilience in the operating room: Developing and testing of a resilience model. Journal of advanced nursing, 59(4), 427-438.

Jakobsen, M., Løkke, A. K., & Keppeler, F. (2023). Facing the human capital crisis: A systematic review and research agenda on recruitment and selection in the public sector. Public Administration Review, 83(6), 1635-1648.

Lebares, C. C., Guvva, E. V., Ascher, N. L., O'Sullivan, P. S., Harris, H. W., & Epel, E. S. (2018). Burnout and stress among US surgery residents: psychological distress and resilience. Journal of the American College of Surgeons, 226(1), 80-90.

Ng, R., Chahine, S., Lanting, B., & Howard, J. (2019). Unpacking the literature on stress and resiliency: a narrative review focused on learners in the operating room. Journal of surgical education, 76(2), 343-353.

Rushton, C. H., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American journal of critical care, 24(5), 412-420.

World Health Organization (WHO) (2021). WHO Guideline on Health Workforce Development, Attraction, Recruitment and Retention in Rural and Remote Areas. Geneva: World Health Organization.

Yu, F., Raphael, D., Mackay, L., Smith, M., & King, A. (2019). Personal and work-related factors associated with nurse resilience: A systematic review. International journal of nursing studies, 93, 129-140.

Public sector employees frequently operate in volatile and dynamic environments, where internal reforms, policy shifts, and external pressures contribute to perceptions of organizational change. While autonomy is often conceptualized as a stabilizing factor that enhances employee resilience, this study challenges that assumption by examining whether higher levels of job and team autonomy actually shape employees’ perceptions of change. Using quantile regression on survey data from a Belgian public sector organization, we find that job autonomy reduces perceived change, but only for employees experiencing high levels of change. In contrast, team autonomy amplifies perceived change, suggesting a paradoxical effect. These findings challenge the conventional assumption that autonomy is inherently beneficial in public organizations. Instead, we show that while individual autonomy provides a buffer against instability, team autonomy may exacerbate perceptions of change by introducing greater complexity, uncertainty, and coordination challenges. This study contributes to the public administration literature on job design, organizational change, and employee well-being, offering important insights for managers navigating the tension between autonomy and stability in an era of ongoing transformation.

Welfare services are delivered by professionals equipped with specialized theoretical knowledge and intraoccupational norms that regulate their behavior (Andersen & Pedersen, 2012). Professionals often collaborate with colleagues from different professions in delivering these welfare services. Such interprofessional collaboration has become increasingly important, as the challenges facing public service organizations today are highly complex and interdependent, requiring a connective professionalism (Noordegraaf, 2020). Several authors have attempted to identify the key factors driving effective interprofessional collaboration (Schot et al., 2020; Wei et al., 2022), but the role of managers has only received limited attention (Brewer et al., 2016). This paper focuses on: How can leadership support interprofessional collaboration, as perceived by managers and employees?

Interprofessional collaboration can be hindered if intraoccupational norms and knowledge are not shared among different professions (Lund & Andersen, 2023). Professional development leadership (PDL) offers a framework for understanding how managers can influence professionals via their norms and knowledge (Lund, 2022, 2024; Lund & Andersen, 2023). PDL can thus be crucial in bridging the diverse professional norms and knowledge that can hinder interprofessional collaboration. However, we still need to understand the role of the power imbalances that exist in an interprofessional context, where the occupational hierarchy places some roles and functions over others (Abbott, 1988; Freidson, 1970; Ospina, 1996). Unequal power relationships can hinder interprofessional collaboration by leading to conflict, causing communication breakdowns, discouraging lower-ranking professions to speak up and making higher-ranking individuals less receptive to input (Fox & Reeves, 2015; Nembhard & Edmondson, 2006; Senot et al., 2016; Reeves et al., 2010).

I adopt an abductive approach, building on existing insights from PDL, theory on unequal power relationships and in-depth qualitative analysis (Schwartz-Shea & Yanow, 2011). This approach is relevant because PDL is more advanced in addressing diverse professional norms and knowledge, but less developed in addressing unequal power relationships. By continuously refining the theoretical framework through an iterative interaction between theory and empirics, I try to understand how managers can exercise PDL in an interprofessional context, where both diverse norms and knowledge and unequal power relationships exist. The in-depth qualitative analysis relies on 44 interviews with healthcare managers and employees from various professions, along with departmental observations, enabling both reflections and direct observations of PDL in an interprofessional context (Lamont & Swidler, 2014). My preliminary analysis indicates that PDL behaviors addressing diverse professional norms, knowledge, and unequal power dynamics can support interprofessional collaboration.

Leadership exercised by managers in the public sector will only make a difference if followers respond to it. One key factor that increasingly attracts scholarly attention in this regard is leader credibility (Gabris et al., 2001; van Luttervelt, 2024; Williams et al., 2022), defined as “the plausibility followers assign to the leader acting in accordance with communicated intentions” (Jakobsen et al., 2022, p. 4). Studies have documented the importance of leader credibility and generally find that employees respond more powerfully to the leadership of their superiors once they deem them credible (Cooper et al., 2020; Gabris et al., 2001; Hermalin, 2007). Yet, recent studies indicate that context may be key to account for when studying the importance of leader credibility in public organizations (Penning de Vries & Vermeeren, 2024; van Luttervelt, 2024, p. 83).

In the slipstream of these studies and in response to a more general lack of research on context in public management and leadership (Pollitt, 2013; O’Toole & Meier, 2014; Bryman et al., 1996; Porter & McLauglin, 2006; Meier et al., 2015), we study how context affects the extent to which public sector employees perceive managers as credible. Building on existing work, we argue that leader credibility is affected by 1) institutional circumstances (Miller, 1992, 2005), 2) the formal authority of the leadership position, 3) the attributes of the person holding the leadership position (Jakobsen et al., 2022; Penning de Vries & Vermeeren, 2024; van Luttervelt, 2024) and 4) congruence between employee and manager (Fjendbo et al., 2022; Song & Meier, 2022).

To test our argument, we conduct a preregistered combined vignette-conjoint experiment among healthcare professionals in the Netherlands (Expected N = 4.000). We randomly assign respondents to a vignette depicting a situation of institutional (un)certainty and then present them with pairs of fictitious manager profiles varying on attributes related to background, personal attributes, and managerial authority. Respondents are asked to choose which of the managers they find the most credible and rate the extent to which they evaluate each of the manager profiles as credible.

The data will be collected in May 2025 allowing us to provide a first draft of the manuscript for the EGPA conference.