Employee health is an important factor for individual and organizational performance. In particular the healthcare sector is characterized by high physical and mental demands that result in poor employee health and high levels of sick leave. One way to support employee health at the workplace is through leadership. By creating a healthy work environment and climate, leadership can promote employee health and well-being, in particular health-specific leadership. However, there has been scant insights into contextual factors that are relevant for health-specific leadership. This dissertation aims to investigate the relevance of contextual factors for health-specific leadership and its relationship with employee health. Three studies were conducted to identify relevant individual and work-related characteristics for health-specific leadership as well as to investigate the influence of specific individual and organizational factors. The first study is a questionnaire-based survey with 861 healthcare employees. Its findings show a positive relationship between health-specific leadership and employee health in the healthcare sector. Social demands and social resources are analysed as mediating factors. Furthermore, the affective commitment of employees is considered as an additional outcome of health-specific leadership. The second study identifies drivers and barriers for health-specific leadership in an explorative design based on 51 interviews with healthcare managers and collates these factors with the theoretical background. The findings show various influencing factors relating to leadership, employees, and the organization. The third study investigates the influence of individual factors on health-specific leadership and is based on a questionnaire survey among 525 healthcare employees. Managers personal initiative and employee self-care influence the relationship between health-specific leadership and employee burnout in different ways. In summary, this dissertation contributes to the literature by putting health-specific leadership into context and providing insights into influencing factors. The findings broaden the understanding of how health-specific leadership can influence employee health. The implications for theory and practice are discussed and directions for future research are outlined.
Does grass-roots civic engagement improve the quality of public services in countries in which formal oversight institutions are weak? It is obvious that formal oversight institutions are weak in developing countries, which causes low-quality public services. This weakness is particularly critical in the health sector - a service domain of crucial relevance for development. This observation has led practitioners to believe that the direct engagement of the beneficiaries of public services is a means to compensate the weakness of oversight institutions and to improve the quality of these services. Given that beneficiaries have incentives to demand good quality services, it is indeed logical to assume that their participation in the monitoring of public services helps to improve the quality of these very services. This positive view of grass-roots civic engagement resonates with the idea that an active civil society helps a political system to build up and sustain a high institutional performance In the eyes of the donors of development aid, this idea nurtures the expectation that strengthening civic engagement contributes to increased aid effectiveness. Accordingly, donor countries have increased their efforts to strengthen beneficiary participation since the 1990s, which moved the concepts of voice and accountability center-stage in the international development discourse. However, whether citizens' capacity to exercise pressure on service providers and public officials really improves the effectiveness of development aid remains an unresolved question. Building upon recent experimental and comparative case study evidence, the thesis examines the role of citizens' engagement in the effectiveness of development interventions. The focus is on such interventions in the health sector because population health is particularly critical for prosperity and development, and ultimately for democratization. The key question addressed is if and under what conditions ordinary people's engagement in collective action and their inclination to raise their voice improves the effectiveness of development assistance for health (DAH). I analyze this question from an interactionist viewpoint, unraveling the complex interplay of civic engagement and health aid with three key institutional variables: (i) state capacity, (ii) liberal democracy and (iii) decentralized government. Drawing upon social capital theory, principal-agent theory, and selectorate theory, I provide compelling evidence that health aid effectiveness depends on (a) bottom-up processes of demand from service users as well as (b) formal processes of top-down monitoring and horizontal oversight arrangements. In other words, the very interaction of behavioral and institutional factors drives the accountability in public service provision and thus the effectiveness of development assistance for health in recipient countries.