Luận án Tiến sĩ: Vai trò của Xã hội hóa Tổ chức đối với Sự hài lòng và Cam kết của Nhà lâm sàng Sức khỏe Tâm thần

Name: Vera Kurdian Program: Doctoral Program in Organizational Leadership Dissertation Title: The Role of Organizational Socialization on Job Satisfaction and Commitment for Fee-for-Service Mental Health Clinicians. Committee Chair: Kathleen Bands, Ph. Program Director: Kathleen Bands, Ph. Statement of Academic Integrity I certify that I am the author of the work contained in this dissertation and that it represents my original research and conclusions.

I pledge that apart from my committee, faculty, and other authorized support personnel and resources, I have received no assistance in developing the research, analysis, conclusions, or text contained in this document, nor has anyone written or provided any element of this work to me. Signed: Vera Kurdian Date HOOD COLLEGE The Role of Organizational Socialization on Job Satisfaction and Commitment for Fee-for-Service Mental Health Clinicians A DISSERTATION Submitted to the Faculty of the Graduate School of Hood College In partial fulfilment of the requirements for the degree Doctor of Organizational Leadership by Vera Kurdian Frederick, Maryland 2021 © Copyright (2021) by Vera Kurdian All Rights Reserved DOCTORAL COMMITTEE The members of the committee appointed to examine the dissertation of Vera Kurdian find that this dissertation fulfills the requirements and meets the standards of the Hood College Doctoral Program in Organizational Leadership and recommend that it be approved., Chair Date Lisa Littlefield, Ph., Member Date Megan D., Member Date TABLE OF CONTENTS List of Tables. vi List of Figures. 1 Statement of the Problem.

16 Purpose of the Study. 24 Research Questions and Hypotheses. 24 Overview of Methodology. 25 Significance of the Study.

28 Definitions of Key Terms. 30 Organization of This Dissertation. 33 Sources and Methods. 36 Herzberg’s Two-Factor Theory.

38 Meyer and Allen Three-Component Model of Commitment. 55 Organizational Socialization, Job Satisfaction, and Commitment. 62 Significance of the Study. 63 Research Questions and Hypotheses.

63 Participants and Sampling. 64 Variables and Measures. 70 Institutional Review Board Approval and Informed Consent. 73 Reliability, Validity, and Limitations.

RESULTS AND ANALYSIS. 79 Summary of Methodology. 80 Data Preparation and Case Validation. 81 Characteristics of Participants.

83 Variable Descriptive Statistics. 85 Organizational Socialization Practices. 92 iii Geographic Location of Participants. 93 Optional/Additional Comments.

94 Summary of Descriptive Statistics. 96 T-tests for Income and Prior Experience. 96 Assumptions of Data Eligibility. 100 Hierarchical Linear Regression.

CONCLUSIONS AND IMPLICATIONS. 111 Common Job Satisfaction Factors. 117 Impact of Organizational Socialization on Satisfaction. 118 Impact of Job Satisfaction on Affective Commitment.

125 Impact of Organizational Socialization on Affective Commitment. 125 Summary of the Study. 132 Implication and Future Direction. Institutional Review Board Application and Approval Letter.

Welcome Letter and Consent Form. 188 v LIST OF TABLES Table Page 1. Van Maanen and Schein’s Six Tactics of Socialization. Key Terms and Definitions.

Research Overview and Chapter 1 Summary. Selected Major Works That Influenced This Study. Research Questions, Survey Tools, and Variables. Study Variables, Measures, and Statistical Tests.

Methodology and Chapter 3 Summary. Study Variables, Measures, and Statistical Tests. Hypotheses of the Study. Descriptive Statistics for Categorical Variables.

Organizational Socialization Experiences. Specific Onboarding Experiences. Optional: Geographic Location. Optional/Additional Comments.

Summary of Descriptive Statistics for Continuous Variables. T-Test Results Comparing Job Satisfaction, Task Socialization, Organization Socializa- tion, and Affective Commitment Between Those with and Without Prior FFS Experience 97 vi 19. T-Test Results Comparing Job Satisfaction, Task Socialization, Organization Socializa- tion, and Affective Commitment Between One and Two Household Incomes. Ranking of Job Satisfaction Factors.

RQ1 H1 Model Summary. Summary of Hypotheses Finding. 2020 Household Data Annual Averages. 114 vii LIST OF FIGURES Figure Page 1.

Herzberg Two-Factor Theory of Motivation and Satisfaction. Meyer and Allen’s Three-Component Model of Organizational Commitment. Conceptual Framework with Variables and Measurement Model. Mapping of the Hypotheses.

Assumption for Job Satisfaction. Assumption for Task Socialization. Conceptual Framework with Variables and Measures .Error! Bookmark not defined. viii DEDICATION This dissertation is dedicated to my staff, colleagues, and all social workers and counselors who worked tirelessly during the two pandemics.

You put your needs aside and showed up every day to be there for your client and helped them get through these unprecedent times. You inspire me every day! ix ACKNOWLEDGMENT To my husband, Armen, whose love and support have no bounds and who has pushed me to succeed in more ways than one. To my children, Harout and Taleen, you are my inspiration. I am so proud to be your mother.

My love for you is infinite! To my sister, Maral, who helped me find my voice, I hope to make you proud. To my cohort members, with whom I have developed lifelong friendships. To my committee members and, specifically, my Chair, Dr. Kathleen Bands, who believed in my abilities and supported me from day one.

x The Role Organizational Socialization on Job Satisfaction and Commitment of Fee-for-Service Mental Health Clinicians Vera Kurdian, DOL Committee Chair: Dr. Kathleen Bands, Ph. ABSTRACT Increases in Americans' mental health needs, coupled with growing shortages of trained mental health clinicians, concern public and private mental health organizations. Increasing job satisfaction and staff commitment is crucial to reducing turnover as agencies compete to hire and retain staff.

Currently, there is limited research about organizational socialization practices, job satisfaction, and affective commitment for fee-for-service clinicians working within outpatient mental health clinics. Fee-for-service organizations that want to attract new staff and sustain their existing workforce must examine their organizational socialization practices. With fee-for- service practice, clinicians are compensated based on their billable hours. In the absence of salaries, staff are hired and immediately given caseloads to generate revenue.

Often overlooked is the failure to provide resources and skills to mitigate no shows, cancellations, and time management challenges. This research explored the role of organizational socialization on job satisfaction and affective commitment of fee-for-services clinicians. It also identified job satisfaction factors that lead to commitment. Eighty-one fee-for service clinicians completed an online survey of standardized questions to capture data on organizational socialization, job satisfaction, and affective commitment.

Data were analyzed using path analysis to examine relationships. The findings revealed a statistically significant correlation between organizational socialization, job satisfaction, and affective commitment. Moreover, job satisfaction had a statistically significant influence on affective commitment. xi CHAPTER 1 INTRODUCTION The mental health workforce is on the verge of a crisis.

By 2025, there will be a shortage of mental health providers, including social workers, psychiatrists, and marriage and family therapists (Health Resources Services Administration, 2016). According to the National Alliance on Mental Health (NAMI) (2019), 1 out of 5 individuals live with a mental health condition, and 1 out of 25 are diagnosed with a serious mental illness.6 million adults had experienced mental illness and approximately 11.1 million youth between 6 and 17 years of age were diagnosed with mental health disorders. Increased mental health awareness, reduced stigma, health care reform, federal legislative support to promote mental health intervention (Beck et al., 2018), COVID-19, and increased violence and racial injustice have increased the need for mental health care. Both historically significant and current events have highlighted the upcoming predicted shortage.

The increased demand for and shortage of mental health providers have resulted in delayed treatment and poor patient care (Levine, 2018; Thomas et al. Several agencies have reported on the scarcity of mental health clinicians. For example, the National Association of Social Workers (NASW) (2011) reported the lack of social workers in managed care (i., investing in social work workforce). More recently, the National Council for Mental Wellbeing (2017) reported a shortage of psychiatrists within the field of psychiatry.

Additionally, in 2019, Senate Bill 944 passed in Maryland, and became codified (Md. The new law changed the staffing criteria for outpatient mental health centers and allowed psychiatric nurse practitioners to act as medical directors. Although this change promoted the establishment of new clinics to meet the demands of the mentally ill, it did not address the already existing shortage of clinicians. Instead, it highlighted the lack of trained clinicians within 1 the field and contributed to the delay in services.

After all, the underlying issue is not the absence of clinics but rather the lack of professionals who can offer much-needed services. The year 2020 was a difficult year. Americans endured two major life-altering events. The first was the health pandemic of COVID-19 that wreaked havoc on the healthcare system and disrupted personal and family lives.

As a result, government leaders were forced to take action to prevent the spread of the virus. An unprecedented “State of Emergency” closed most businesses leading to significant financial repercussions. Many families lost jobs and wages, and some families were unable to pay their bills. All indoor and outdoor activities were prohibited.

Schools were closed, and only essential businesses were allowed to remain open with strict guidelines in efforts to stop the spread of the virus. The “stay home” orders increased isolation and anxiety, and intensified depression and other mental health issues expanding the need for treatment. Essential personnel were also overwhelmed due to many issues including lack of daycare for their children, lack of medical supplies, and longer work hours, increased workload (Sovold et al., 2021) that increased fatigue and the potential for burnout (Sultana et al. While the world was dealing with the unpredictability of the virus, increased death toll, long-lasting health issues, and lost income, Americans dealt with a heightened sense of injustice towards the Black community that was identified as the second pandemic of 2020 (Addo, 2020).

The events of the increased violence also led to senseless deaths and negatively impacted people’s mental health and overall wellbeing. The lack of tolerance and hatred further escalated depression, anxiety, and trauma (Lewsley, 2020), increasing the need for mental health treatment and adding extra strain on mental health providers regardless of their place of employment (Evanoff et al. 2 Historically, the mental health field is low paying (Schweitzer et al., 2013), plagued with burnout (Lizano, 2015; Morse et al., 2012), high stress (Lloyd et al., 2009), compassion fatigue (Craig & Sprang, 2009; Geoffrion et al., 2016), and lack of autonomy (Morse et al. As early as 1979, the issues of poor salaries and high caseloads were few of the reasons leading to low job satisfaction and retention (Loewenberg, 1979).

To address both the shortage and turnover, leaders within the field can benefit from collaborating with their human resources departments to address three equally important priorities. First, acquiring the right talent can be a crucial step for retention. Coker (2019), for example, reported that talent management is not just a term but “the commitment an organization has in hiring, managing, developing, and retaining extremely talented individuals” (para. Second, examining their organizational socialization activities and implementing effective practices to help new staff succeed can increase job satisfaction and commitment.

Organizational socialization practices are activities that allow a newcomer an opportunity to learn about their organization, their specific role, and the needed skills to successfully integrate within the larger organization. Finally, recognizing the need to continuously engage and motivate staff to keep their level of job satisfaction high can also subsequently improve commitment. Due to the projected shortages and the increased need for mental health clinicians, administrators cannot afford to ignore the relationship between what they offer new staff by way of their socialization practices and their level of commitment that influences a decision to stay. There is a large body of literature supporting the relationship between organizational socialization, job satisfaction, and commitment (Bauer et al., 2007; Saks et al., 2007; Bauer & Erdogan, 2011; Van Maanen & Schein, 1977; Abramson, 1993 & Abu-Doleh et al.

Poor satisfaction breeds lack of commitment and ultimately can result in staff leaving to seek better 3 opportunities.