Administration & Society

The effects of work alienation and policy alienation on behavior of public employees Administration & Society Lars Tummers*, Victor Bekkers*, Sandra van Thiel** & Bram Steijn* Citation: Tummers, L.G., Bekkers, V.J.J.M., Van Thiel, S. & Steijn, A.J. (2015). The effects of work alienation and policy alienation on behavior of public employees. Administration & Society, 47(5):596-617. * Erasmus University Rotterdam, Dept. of Public Administration, 3000 DR Rotterdam, The Netherlands. Tummers@fsw.eur.nl, Bekkers@fsw.eur.nl, Steijn@fsw.eur.nl ** Radboud University Nijmegen, Dept. of Public Administration, 6500 HK Nijmegen, The Netherlands, S.Vanthiel@fm.ru.nl 1 Abstract Public employees are confronted with various pressures, such as increased work demands and the need to implement controversial policies. This study uses work alienation and policy alienation models to analyze work and policy pressures. Based on a survey of 790 respondents, it was firstly found that work alienation results in less work effort and more intention to leave. Secondly, policy alienation negatively impacts behavioral support for a policy and the intention to implement it. These results suggest that work alienation and policy alienation have different –but both important– effects on (intended) behavior on the job. Keywords Public sector work, work alienation, policy alienation, behavior, behavioral public administration 2 Introduction Scholars have become increasingly interested in the pressures faced by public employees (see for instance Brandsen & Honingh, 2013; Brodkin, 2011; DeHart-Davis & Pandey, 2005; Noordegraaf, 2011; Tonkens et al., 2013). There are different causes for the increased pressure. For example, some scholars point towards the rise of ‘new managerialism’ (Brodkin, 2011; Diefenbach, 2009). The introduction of new management techniques and competencies can affect the work of the public employees. This can be done using performance indicators, such as standardized test scores for teachers or the number of publications for professors. Other studies point to the implementation of new policies as a potential cause of pressures (Bottery, 2012; Evans, 2011). In the present day and age, such policies often concentrate on economic outcomes, such as cost reduction, rather than being targeted at values such as increasing legitimacy or trust (Pollitt & Bouckaert, 2013). For instance, in an article entitled “No we won't! Teachers' resistance to educational reform”, Berkovich (2011) shows how Israeli teachers resist a new governmental policy, resulting in among else a strike of 64 days. In a recent article in Administration & Society, Noordegraaf (2014) mentions yet other causes for pressures of public employees working at the frontline, such as raising client demands, the increased use of technology and high media exposure when public employees make a mistake. When public employees feel increased pressure from various sources, this can lead them to leave their organization, reduce work effort, and show greater resistance to new policies (Thanacoody et al., 2013; Tummers, 2013). Hence, it seems that public employees are indeed feeling pressured at times, and that this can have severe effects. However, the literature on this topic can be strengthened. Many researchers focus on isolated problems, such as the pressures related to one specific policy (Terhart, 2013; Kumar et al., 2007) or on the relationship between public employees and managers (Klopper-Kes et al., 2010; Raelin, 1986). Noordegraaf (2011:1355) however, notes that “isolated analyses of professional services are losing their value”. He argues that multiple pressures occur simultaneously, reinforcing each other and strengthening each other’s effects (see also De Bruijn, 2010; Thomas & Davies, 2005). For this reason, he recommends an analysis of how the various pressures public employees face are interrelated. In this article, we therefore analyze two important pressures that public employees face: those coming from work in general and those coming from new policies. Work pressures can be described as demands put on public employees in the general job context (such as lower work autonomy), while 3 policy pressures occur when demands are put on employees regarding specific governmental policies (such as implementing controversial laws) (Noordegraaf & Steijn, 2014). To achieve this end, we draw on work alienation and policy alienation models. These models are useful in the sense of being well-suited for the problems to be analyzed: work pressures and policy pressures. Furthermore, their quantitative measurement has been validated (Mottaz, 1981; Tummers, 2012). Next to being one of the first to study various pressures professionals can experience simultaneously, this study is therefore novel as it is – to our knowledge – the first that uses the work alienation and policy alienation models in one study. Previous studies analyzed either work alienation (Kanungo, 1982; DeHart-Davis & Pandey, 2005; Nair & Vohra, 2010) or policy alienation (Tummers et al., 2009, Tummers, 2013; Loyens, 2014). As will be discussed more elaborately below, work and policy alienation are related concepts: they have a similar background and conceptualization. At the same time, they are theoretically distinct: work alienation looks at the work level, policy alienation examines alienation in relation to a specific policy. As a consequence, it is possible for workers to feel alienated from a certain policy they are supposed to implement (high policy alienation), but not from their job in general (low work alienation). A good example is a psychologist who feels alienated from a new policy which threatens the privacy of her patients, but is generally very happy with and involved in her work (Palm et al., 2008). Although such differences could be expected, they have not been tested empirically. The main goal of this study is to analyze whether work alienation and policy alienation are distinct, and what their effects are on important outcomes for public employees and their organizations. We look especially at work effort (Gould-Williams, 2004), intention to leave (Bozeman & Perrewe, 2000), willingness to implement policies (Metselaar, 1997) and behavioral support for policies (Herscovitz & Meier, 2002). By doing this, we take an interdisciplinary approach, combining insights from public administration, work and organization sociology and psychology, and change management. The next section describes the concepts of work alienation and policy alienation and their expected effects. We will deduce four hypotheses. In the methods section that follows, we present our research design, describing the survey we have conducted among 1,278 Dutch public employees (respondents: 790, response rate 61%). After discussing the results, we will conclude by evaluating our contribution towards understanding the pressures faced during public service delivery. We will also discuss how our results can benefit public administration scholars and practitioners in their quest for improving public service delivery. 4 Theoretical framework Work alienation and policy alienation The phenomenon of work alienation, i.e. employees feeling alienated from work, has been one of longstanding interest to both scholars and practitioners. Karl Marx (1961 [1844]) used the idea of alienation as developed by Hegel and Hess and transposed it to an economic context, thus introducing the concept of work alienation. Marx concentrated on objective work alienation: workers are alienated when they do not own the means of production or the resulting product. Sociologists, public administration scholars and other social scientists have since used the alienation concept in various studies, thereby building upon Marx (Blauner, 1964; Kanungo, 1982). For instance, Pandey and Kingsley (2000) shown that work alienation is positively related to the degree of red tape that public employees experience. Furthermore, Sarros (2002) show that transactional leadership is positively related to work alienation of employees, while transformational leadership shows a negative correlation. However, these scholars differ in one important aspect from Marx. While Marx looked at objective work alienation, contemporary scholars examine subjective work alienation: alienation as perceived by the worker. For instance, Seeman (1959:784) notes that “I propose […] to treat alienation from the personal standpoint of the actor – that is, alienation is here taken from the social-psychological point of view.” We follow this proposal and analyze alienation as perceived by the public employee. Social scientists have used the concept of alienation in a range of studies, employing it with various shades of meanings. Seeman (1959) separated these different meanings into five dimensions, namely: powerlessness, meaninglessness, normlessness, social isolation and self-estrangement. Researchers have been used (some of) these dimensions for analyzing different types of alienation. For example, Mau (1992) uses four of the five dimensions distinguished in his study of student alienation; Rayce et al. (2008), examining adolescent alienation, uses three. Researchers have frequently, too, used Seeman’s classification for studying the concept of work alienation. An important contribution in this field was made by Blauner (1964), who distinguished between powerlessness, meaninglessness and social isolation in the work context. In addition to the concept of work alienation, we will also employ the concept of policy alienation, as developed in the field of public administration (Tummers et al., 2009). The study of policy alienation 5 examines problems arising from the implementation of a certain policy, rather than problems originating from the job itself. Just as work alienation, policy alienation is a multidimensional concept. Two dimensions can be distinguished here, policy powerlessness and policy meaninglessness. As has been shown above, these dimensions are also considered in the literature on work alienation. DeHart-Davis and Pandey (2005:133) even see powerlessness and meaninglessness as “the key psychological ingredients of alienation”. For this reason, we will take powerlessness and meaninglessness into account at both the work level (work alienation) and the policy level (policy alienation). Powerlessness is a person's lack of control over events that take place in their life. With regard to work alienation, Shepard (1971:13-14) defines powerlessness as “the perceived lack of freedom and control on the job”. Hence, public employees feel that they do not have any influence in their job. This is highly related to notions of autonomy and empowerment, as used in work and organizational psychology (Deci & Ryan, 2002). Regarding policy formulation and implementation, policy powerlessness relates to the feeling that employees do not have any influence on the formulation or implementation of a new policy (Lynch et al., 1997:62). They feel unable to influence policy formulation and implementation. The second dimension of work and policy alienation we will consider is meaninglessness. Seeman (1959:786) argues that meaninglessness occurs when a person cannot understand the events in which he or she is involved. In the work setting, a feeling of meaninglessness arises “when workers are not able to understand the complex system of goals in the organization and its relationship to their own work” (Kanungo, 1982:26). Regarding policymaking and policy implementation, meaninglessness reflects the experience of the public employee that a policy it not beneficial for his/her clients or for society at large (Tummers, 2011). For instance, a policeman can feel that implementing a new ‘zerotolerance’ police policy is meaningless because it does not lead to objectively ‘safer streets’ or a higher feeling of safety in a neighborhood (Van Thiel & Leeuw, 2002). From the above, it follows that work alienation and policy alienation are closely related concepts: they are similar in psychological origin and share the same conceptual basis. At the same time, though, they are dissimilar concepts in the sense that work alienation refers to the work level, whereas policy alienation refers to alienation of a certain policy. Based on this line of reasoning, we expect that we will find a clear empirical distinction between work alienation and policy alienation. In more technical terms, we expect work alienation and policy alienation to show evidence of divergent validity. Divergent validity is evident when measures of presumably unrelated constructs are weakly, or ideally not, correlated 6 (DeVellis, 2011). A correlation of .35 or lower is expected between work alienation and policy alienation measures, as this can be considered as a weak correlation (Taylor, 1990). We also expect that work alienation and policy alienation have different effects. To illustrate this, we can use knowledge developed by the theory of planned behavior (Ajzen & Fishbein, 1980). The theory of planned behavior is a theory about the connection between certain attitudes and subsequent (actual or intended) behavior. For instance, one can research the relationship between a positive attitude towards working for the public sector and subsequently really applying for a public sector job. According to the theory of planned behavior, attitudes and behavior are most highly related if the attitude is specifically related to the behavior. To illustrate this, Weigel et al. (1974) have studied the willingness to actively participate in an environmental organization (the Sierra Club). Is this willingness to participate in the Sierra Club more dependent on a) the attitude towards environmental issues (hence, a quite general attitude) or b) the attitude towards the Sierra Club (hence, a very specific attitude towards that organization)? They showed that the willingness to participate in the Sierra Club depended to a far greater degree on people’s attitude towards that specific organization than their stance on environmental issues in general. Hence, they concluded that, “The findings of this investigation support the hypothesis that attitudes exhibit increased power to predict behavior when the content of the attitude measure is highly specific to the behavioral criterion” (1974:728). This line of reasoning can also be applied to the potential effects of work alienation and policy alienation. We expect that work alienation has effects on the work level (for instance, on work effort) and policy alienation has effects at the policy level (showing, for instance, resistance to implement a certain policy). We can now specify the diverging effects we expect of work alienation (at the work level) and of policy alienation (at the policy level). Effects at the work level At the work level, we measure two effects of alienation, namely, on work effort and on the intention to leave the present job. These two effects have been chosen because they are considered important for organizational performance (Green, 2008; McEvoy & Cascio, 1987). Studying work effort, McAllister (1995:33) notes that employees have to exert themselves more – over and above formal requirements - if higher levels of performance are to be achieved. It is valuable for organizations when their employees ‘go that extra mile’. We especially expect work alienation to have 7 a negative effect on work effort, because work powerlessness and work meaninglessness are negatively related to both work effort and performance (Hackman & Oldham, 1980; May et al., 2004). When employees feel that their work has no autonomy and no meaning, they will be less willing to invest huge efforts into it. This makes intuitive sense. Why should you invest in a job when you have no autonomy and feel the job is not meaningful? The second effect measure, the intention to leave, refers to the wish of an employee to leave his or her job. We must note that not all everyone who would like to leave will actually do so. Having said this, many studies have shown that the intention to leave one’s present position can act as a reasonable proxy for the decision to really leave (Hom et al., 2012). When employees leave their job, it can incur substantial costs for the organizations, such as the finances needed for recruiting and hiring new employees and a loss of tacit knowledge. We expect work alienation in particular to influence an employee’s intention to leave. The mechanism which relates powerlessness to intention to leave can be traced back to the human relations movement. It can be illustrated by a quote of McGregor (1957: 26) who stated that an “essential task of management is to arrange organizational conditions and methods of operation so that people can achieve their own goals best by directing their own efforts toward organizational objectives”. If management does otherwise, employees will feel powerlessness (Mirchandani & Lederer, 2008), which will increase their intention to leave (Lee & Whitford, 2008). In this respect, it must be noted that many studies stress the importance of empowerment – which can be seen as the opposite of powerlessness – as an important determinant of the intention to leave (Moynihan & Landuyt, 2008; Cowden et al., 2011). Similarly, when examining the influence of meaninglessness, we expect that experiencing one’s work as meaningless will increase the tendency to leave. This expectation is substantiated by Hackman and Oldham (1980) who, using their Job Diagnostic Model, argue that experiencing one’s work as meaningful is one of the three critical determinants of personal and work outcomes, such as, amongst others, the intention to stay (see also May et al., 2004). To summarize the argument outlined, if employees experience powerlessness and meaninglessness at work, they are expected to: (a) put less effort into their work; and (b) be more inclined to leave their job. We expect this to be true in particular for powerlessness and meaninglessness as related to work; the effects of policy powerlessness and meaninglessness will be 8 weaker. This is because work effort and the intention to leave are measured at the work level. We will test the following two hypotheses: H1: The work alienation dimensions have a greater effect on work effort than the policy alienation dimensions. H2: The work alienation dimensions have a greater effect on the intention to leave than the policy alienation dimensions. Effects at the policy level At the policy level, we will measure two effects: the willingness to implement a certain policy and the behavioral support given for a policy. We expect that policy alienation will have a greater effect on these outcomes than work alienation. Both of the effect measures have been derived from the change management literature, a field which has a long history of studying the willingness or resistance to change in response to, for instance, a new policy. We use the concept of change willingness to examine the willingness of employees to implement a certain policy. Metselaar (1997:42) defines change willingness as “a positive behavioral intention towards the implementation of modifications in an organization's structure, or work and administrative processes, resulting in efforts from the organization member's side to support or enhance the change process”. Change management scholars argue that a crucial condition for success is that employees are willing to implement the proposed change (Judson, 1991). Behavioral support for a suggested change (in this case, a policy program) is reflected in the actions which employees undertake to support or resist that change (Herscovitch & Meyer, 2002). On the one hand, public employees may be supportive of a certain policy, and be willing to put in extra effort to ensure its success. At the other end of the continuum, public employees can display strong opposition to a policy, engaging in overt behaviors aimed to make the policy fail. A vivid example of the latter is the introduction of “The New Horizon” in Israel (Berkovich, 2011). This policy was meant to introduce longer school days, mainly by adding teaching hours for small-group tutoring. Many teachers, however, went on strike to protest against the proposed change. The strike lasted 64 days, the longest ever in the history of the Israeli education system. Behavioral support for a policy is related to, but logically independent of, the willingness to implement that policy. Behavioral support measures the actual behavior of public employees towards a 9 certain policy, such as putting extreme effort into implementation (championing the policy), mere compliance, and passively or actively resisting the policy. “Willingness to implement” measures the intention to put effort into implementing a policy and making it successful. To illustrate the difference, two workers may have similar intentions with respect to putting effort into implementing a policy (i.e. they have the same level of willingness to implement); in practice, however, one may be merely compliant (a medium level of behavioral support) whilst the other is wholly supportive of the policy, perhaps even persuading other colleagues to embrace the change (so, showing a high level of behavioral support). Next to the difference between intended behavior or ‘real’ behavior, another difference is how the concepts are operationalized. Behavior support for the policy is a one item 0-100 scale, while willingness to implement is a latent construct of five items on a 1-5 Likert scale. By taking both concepts into account, we can develop more robust evidence on the effects of work alienation and policy alienation. We expect that an increase in the degree of policy alienation will lead to a decrease in both behavioral support and the willingness to implement a policy. Several studies have shown that an increase in the influence of employees on change decisions leads to higher commitment, and reduces the resistance to change (Judson, 1991; Wanberg & Banas, 2000). Sagie and Koslowsky (1994), for example, report that, in the five Israeli public organizations they studied, the ability to influence the decision-making process was positively related to the acceptance of decisions by individual employees. Research has also shown that employees will be more willing to implement a policy if they perceive it as meaningful (Tummers, 2011). The relation between powerlessness and meaninglessness on the one hand, and behavioral support and the willingness to implement a policy on the other appears to be more closely related to the policy alienation dimensions, and less so to the work alienation dimensions. This leads to the following hypotheses: H3: The policy alienation dimensions have a greater effect on the willingness to implement a policy than the work alienation dimensions. H4: The policy alienation dimensions have a greater effect on behavioral support for a policy than the work alienation dimensions. 10 Method Background To test our hypotheses, we have used data from a survey of Dutch midwives. Midwifery involves caring for women during pregnancy and childbirth, as well as during the postpartum period. A midwifery practitioner is known as a midwife, a term which is used for both genders, even though the vast majority of midwives is female. Midwives can be considered public service workers (or public employees) as they work in a sector that is heavily regulated by the state and subsidized in the public interest (Flynn, 2007). In the Netherlands, many women give birth at home. In a recent study, Christiaens et al. (2013) even conclude that the in-home birth rate in the Netherlands is by far the highest in Europe. Therefore, midwives play a dominant role in the guidance and monitoring process of pregnancy and child delivery. Although choosing for midwives as the focus group to study pressures of public employees seems rather odd, we felt that this is a particularly interesting group for two reasons. First, midwives are increasingly facing work pressures. The profession of midwifery is frequently under discussion: in the Netherlands the risks of child delivery at home in particular is a bone of much contention (Croonen, 2010). Gynecologists, in particular, point towards the faster possible referral to medical experts when delivery takes place in a hospital setting. Although midwives often argue that child delivery at home is at least as safe as delivery in hospital, and far more cost effective, some midwives could experience their job as meaningless because they feel their professional value is constantly being questioned and negatively compared to that of gynecologists (Van der Kooy et al., 2011). Second, some midwives can face policy pressures due to the implementation of the policy called ‘structural ultrasound assessment’ (Structureel Echosopisch Onderzoek, SEO), or the twenty-week ultrasound. In the Netherlands, pregnant women are advised to visit a midwife between the 20th and 22nd week of pregnancy for an ultrasound. The midwife examines whether the unborn child is healthy and development is normal. This twenty-week ultrasound can be of crucial importance to both parents and child. Certain defects may be detected, which can be treated before the child is born, or alternatively, measures can be prepared for the period immediately after birth. In both cases, pregnant women are referred to a gynecologist and often continue to deliver their baby in hospital without much assistance from the midwife. This puts further pressure on the total added value of midwifery, which is already questioned (Van der Kooy et al., 2011, Christiaens et al., 2013; Wax et al., 2010). Consequently, the 11 structural ultrasound assessment is an example of a policy that can affect the professional practice of midwives. Sampling and response A sample of 1,278 midwives was taken, for which we used the databases of the nationwide associations for midwives (KNOV) and midwife ultrasound specialists (BEN). We asked the sampled midwives to respond to an online survey by sending an introductory email (directly whenever possible, or otherwise via their organizations), followed by two reminders. Furthermore, all employing organizations were contacted by phone and asked to encourage their employees to participate in the survey. We received 790 responses, thus arriving at a response rate of 61%. The gender distribution (97% female) and average age (40) of the sample matched the characteristics of the total population (Hingstman & Kenens, 2011). Some midwives who did not complete the survey were contacted to ask why they had failed to do so (non-response check). No indication of potential biases were found. The main reasons given for non-completion of the survey were: (a) current workload (i.e. too busy); (b) having completed many more surveys in the past; and (c) not being involved in the ultrasound process. The large number of respondents, their distribution in terms of gender and age and the results of the non-response check all indicate that our respondents were representative of the total population of midwives. Measures All questionnaire items used five point Likert-scales, with answer categories ranging from “strongly disagree” to “strongly agree”, unless stated otherwise. Cronbach alphas ranged from .76-.89 (see results). Work alienation (powerlessness) was measured with the scale developed by Mottaz (1981). A sample item used is: “My daily tasks are largely determined by others”. Work alienation (meaninglessness) was also measured with the Mottaz scale. A typical sample item is: “Sometimes I am not sure I completely understand the purpose of what I’m doing”. Policy alienation (powerlessness) had been measured in a previous study, in which strategic, tactical and operational powerlessness were individually distinguished (Tummers, 2011). In the midwife study, however, we combined these three aspects, following suggestions on how to create one measure for powerlessness (Tummers, 2012). A typical sample item used is: “In my opinion, midwives have too little power to influence policy”. In measuring policy meaninglessness, we used the policy 12 meaninglessness scale developed by Tummers (2012) (combining societal and client meaninglessness). A typical sample item is: “The ultrasound policy is contributing to the welfare of my clients” (R). The intention to leave the present job was measured by means of the scale developed by Bozeman and Perrewé (2001). A sample item is: “I will probably look for a new job in the near future”. To study work effort, we built on Gould-Williams (2004) who developed a measure to capture employee discretionary effort. A sample item is: “I volunteer for tasks that do not form part of the job”. The willingness to implement the ultrasound policy was measured using the validated scale of Metselaar (1997). A sample item is: “I make time to implement the ultrasound policy”. Behavioral support for the ultrasound policy was measured using the work of Herscovitch and Meyer (2002), who developed a continuum ranging from resistance to supportive behavior. Behavioral support for the twenty-week ultrasound policy was measured using a continuum. Following Herscovitch and Meyer (2002), positions on the continuum were labeled from left to right as “active resistance” (0-20 points), “passive resistance” (21-40), “compliance” (31-60), “cooperation” (61-80), and “championing” (81-100). The respondents had to give a number (between 0 and 100) to indicate their reaction to the policy. Besides the variables described, some commonly used control variables were included in the analysis, namely: gender, age, management position (yes/no) and educational level. Results Descriptive statistics and the relation between work alienation and policy alienation Descriptive statistics and the correlations between the different measured variables are presented in Table 1. 13 Table 1. Descriptive statistics and correlations for the variables in the study. Variable Mean SD C.A. 1 1. .97 N/A N/A 1 Female 2 3 4 5 6 7 8 9 10 11 12 (male=ref.cat) 2. Age 40.1 1.9 N/A -.14** 1 3. Education 4.1 .4 N/A .02 .07* 1 4. Managing position .2 N/A N/A -.01 .08* .07 1 3.5 1.2 .77 -.02 .13** .08* -.16** 1 2.7 0.9 .85 .00 .15** -.02 -.12** .42** 1 5.6 1.2 .82 -.07 -.16** .00 -.15** .06 -.03 1 4.6 1.0 .87 .01 -.03 .02 -.05 .01 .09* .23** 1 8.1 1.0 .89 .01 .00 .05 .23** -.26** -.34** -.10** -.12** 1 10. Intention to leave 2.8 1.9 .76 -.03 .02 .07 -.02 .21** .24** .01 .04 -.15** 1 11. Willingness to 6.2 1.6 .85 -.02 .16** .03 .01 .03 -.01 -.23** -.30** .18** -.06 1 73.1 15.8 N/A -.05 .13** .01 .05 -.01 -.03 -.21** -.40** .21** -.13** .36** (non-managing = ref. cat) 5. Work Powerlessness 6. Work Meaninglessness 7. Policy Powerlessness 8. Policy Meaninglessness 9. Work effort implement policy 12. Behavioral support for the policy Note. * p < .05, ** p < .01, N/A=Not applicable. The means for variables 5 to 11 are adjusted to an 1-10-point scale to ease interpretation 14 1.0 Looking at Table 1 (underlined values) it can be seen that the dimensions of work alienation and policy alienation are only weakly related. Only one correlation is statistically significant, that between work meaninglessness and policy meaninglessness, but the relation is weak (r=.09). Hence, work alienation and policy alienation are empirically only weakly related. In the next section, we will analyze whether they have different effects. The effects of work alienation and of policy alienation Multiple regression analyses were conducted to test the four hypotheses. The results are presented in Table 2. Hypothesis 1 states that the work alienation dimensions have a bigger effect on work effort than policy alienation dimensions do. This does indeed seem to be the case. Work alienation has a significant and negative influence on the effort employees put into their work (β=.12, p<.01 for work powerlessness and β=-.27 p<.01 for work meaninglessness). The policy alienation dimensions have a far smaller effect (β=-.05, p=NS and β=-.07 p<.05 respectively). Hypothesis 2 states that the work alienation dimensions have a bigger effect on the intention to leave (a work-level measure) than policy alienation dimensions do. Our empirical data confirm this. Midwives who feel alienated from their work are more inclined to look for another job (β=-.14, p<.01 for work powerlessness; β=-.19 p<.01 for work meaninglessness). The policy alienation dimensions are not statistically significant. The third and fourth hypotheses examine the effects of work and policy alienation at the policy level. In Hypothesis 3, we stated that the policy alienation dimensions will have a bigger effect on the willingness to implement a policy than work alienation dimensions do. This hypothesis was confirmed by the data. The more policy alienation midwives experience, the less willing they are to implement the ultrasound policy (policy powerlessness: β=-.16, p<.01; policy meaninglessness: β=-.26 p<.01 respectively). The work alienation dimensions were not statistically significant. Our final hypothesis was formulated as follows: ‘The policy alienation dimensions have a greater effect on behavioral support for a policy than the work alienation dimensions.’ The policy alienation dimensions, in particular policy meaninglessness, do indeed have an effect on the behavioral support for the twenty-week ultrasound assessment (β=-.11, p<.01; β=-.37 p<.01 respectively). The work alienation dimensions were not statistically significant. This means that hypothesis 4 is also corroborated by our analysis. Table 2. Work alienation influences work level effects and policy alienation influences policy level effects. Work level Work level Work Intention to leave Willingness to effort Policy level implement policy Policy level Behavioral support for the policy Control variables Female .01 -.03 -.01 -.04 Age .03 -.04 .12** .10 Education .04 .06 .03 .01 Managing position .16** .02 -.04 .00 Powerlessness -.12** .14** .03 -.02 Meaninglessness -.27** .19** -.03 .00 Powerlessness -.05 .00 -.16** -.11** Meaninglessness -.07* .02 -.26** -.37** R2 .18** .08** .13** .19** Work alienation dimensions Policy alienation dimensions Note: * p < .05 ** p < .01. Standardized coefficients (β) are shown. Regression criteria were met (Independent residuals, no multicollinearity, no exclusion of influential outliers, Cook’s distance < 1. Homoscedasticity and normality criteria met). Discussion and conclusions The main goal of this study was to analyze the impact of work alienation and policy alienation on important outcomes for public employees and their organizations. We looked especially at work effort, intention to leave, willingness to implement policies and behavioral support for policies. Based on the literature on public administration, work and organization sociology and psychology and change management, four hypotheses were formulated. These hypotheses were tested using data from a survey of 790 health care workers (midwives). The size of our sample, its high internal consistency values and the fact that it meets regression criteria all attest to the reliability and validity 16 of our study. The analyses showed that work alienation and policy alienation are empirically distinct, and that they have different effects on (intended) behavior. From this, two important conclusions can be drawn. . The first conclusion relates to the integrated analysis of the different pressures faced by public employees. Noordegraaf (2011) and others (De Bruijn, 2010; Thomas & Davies, 2005) argued that different forms of pressure co-exist. We also found that public employees do indeed face both work alienation and policy alienation, although their degree of policy alienation was far higher than work alienation. However, our findings do not corroborate the second argument advanced by these researchers, of pressures being interrelated and spillover effects taking place. Work alienation and policy alienation are only lowly correlated. Furthermore, they have different effects on (intended) behavior. When employees experience work alienation, this has a strong impact on work-level (intended) behavior, such as reduced work effort and a stronger intention to leave. Conversely, the policy alienation dimensions mainly influence (intended) behavior at the policy level. A higher level of policy alienation resulted in a reduction in the willingness to implement a policy and less behavioral support for the proposed policy. We found one spillover effect (policy meaninglessness is related to work effort), but this relationship was quite weak. From the above it follows that, in order to analyze the experiences of public employees, it is important to analyze attitudes specifically related to the (intended) behavior. For instance, when making predictions about the resistance to a certain policy, it will be more useful to analyzing policy attitudes rather than focusing on work attitudes: the prime source of resistance to a certain policy does not lie in negative work attitudes. This argument corresponds with the theory of planned behavior as outlined by Ajzen and Fishbein (1980), as outlined in the theoretical framework. The findings of our study suggest that policymakers and public managers should distinguish between problems related to the work level and problems related to the policy level. Such an approach would increase their understanding of the various aspects of public employees, and enable them to implement changes aimed at improving the quality of work and the effectiveness of policy implementation. For instance, policymakers and public managers could exert a positive influence on the willingness of public employees to implement a new policy by means of interventions geared at increasing the perceived influence of public employees at the 17 policy level - pointing out, for instance, that they can help to improve the suggested policy. Furthermore, it is important not to easily accept statements that the resistance to new policies can be simply explained by generally deteriorating work conditions (see for instance Peters & Pouw, 2005). In a similar vein, it seems unwarranted to claim that if public employees are willing to implement a certain policy, this also means they are committed to the organization’s overall management or goals. The second major conclusion to be drawn pertains to the concept of alienation. Given the results, we argue that both work alienation and policy alienation are useful concepts for the study of the problems faced by public employees. Indeed, in our view the concept of alienation should regain its former central position in public administration and organizational science. As a topic, work alienation was extensively studied until the 1990s. Afterwards, it went “out of fashion” (notable exceptions are DeHart-Davis & Pandey, 2005; Pandey & Welch, 2005; Davis, 2013). McKinlay and Marceau, however, stress the importance of the alienation framework. In a recent study (2011), entitled ‘New wine in an old bottle: does alienation provide an explanation of the origins of physician discontent?’, they analyze the discontent displayed by physicians and conclude that: “The classic concept of alienation may build upon valuable earlier work and provide a new, coherent explanation of the workplace origins of physician discontent. Alienation theory combines both structural and psychological components associated with workplace discontent and has the potential to explain the changing position of knowledge workers (such as physicians) in the new economy.” We fully concur with this observation, with the addition that it is also vitally important to study the different types of alienation (policy alienation, work alienation, and other types). We showed that different types of alienation have different types of effects. Moreover, we wish to emphasize the importance of the meaninglessness dimension. In the results section, it was shown that, for all effects measured, the effects of the meaninglessness dimensions were greater than those of the powerlessness dimensions. For instance, if the respondents felt that their work was meaningless, this has a far more significant impact on their (intended) behavior than feelings of powerlessness. 18 Many studies in HRM and change management, however, concentrate on powerlessness, studying the extent to which employees feel they can influence general decision-making processes or relevant organizational changes (for example Deci & Ryan, 2002; Judson, 1991). Far less research is being done on the meaninglessness/meaningfulness of work or new policies/change (notable exceptions are Hackman & Oldham, 1980; May et al., 2004; Tummers & Knies, 2013). Given the results of our study, we would urge practitioners and scholars to pay more attention to the perceived meaninglessness of work or policies, rather than focusing solely on aspects of powerlessness. We end this article with limitations and future research suggestions. As with all research, our study does have its limitations. First, although we enhanced generalizability by taking a large sample of public employees who are active across the country, we cannot simply generalize the findings to other public-sector policies or domains. The profession of a midwife is very specific, and perhaps even more so in the Dutch context given its traditions regarding at home births. A suitable line for further research would be to test our hypotheses for other types of workers working in different domains, and in other countries. However, the concepts of work alienation and policy alienation haven proven to apply to employees in other sectors as well, for example social security, care and education (Tummers, 2013; Loyens, 2014). Therefore, we feel confident that most of the lessons drawn here can also be applied to other domains. A second limitation concerns the possible influence of context-dependent factors, such as specific management styles in parts of an organization or the way information is shared (how, when, with whom). A survey cannot take all these aspects into account. A fruitful line for future research would be to carry out qualitative case studies in which such context-specific variables can be included. Furthermore, experiments can be used to test for causality, in line with research in behavioral psychology (here: behavioral public administration). This can be helpful in analyzing important relationships, such as between policy alienation and resistance, and between work alienation and work effort. To conclude, in the present day and age public employees are faced with various pressures. This article has contributed to the debate on the topic by analyzing work pressures and policy pressures. Its main conclusion is that work alienation and policy alienation are conceptually and empirically distinct. Second, we have shown that work alienation and policy alienation have 19 strong effects at both the work and the policy level. Based on this, we assert that the concept of alienation should regain its formal central position in management and policy studies. Policymakers and public managers can use our findings to adapt their change strategies to the type of reform (at either the work or policy level), so as to ensure a more successful policy implementation and positive behavior in public organizations. References Ajzen, I., & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall. Berkovich, I. (2011). No we won't! teachers' resistance to educational reform. Journal of Educational Administration, 49(5), 563-578. Blauner, R. (1964). Alienation and freedom. Chicago: University of Chicago Press. Bottery, M. (2012). Leadership, the logic of sufficiency, and the sustainability of education. Educational Management Administration & Leadership, 36(2), 183-189. Bozeman, D. P., & Perrewé, P. L. (2001). The effect of item content overlap on organizational commitment questionnaire-turnover cognitions relationships. Journal of Applied Psychology, 86(1), 161-173. Brandsen, T., & Honingh, M. (2013). Professionals and shifts in governance. International Journal of Public Administration, 36(12), 876-883. Brodkin, E. Z. (2011). Policy work: Street-level organizations under new managerialism. Journal of Public Administration Research and Theory, 21(suppl 2), i253-i277. Christensen, T., & Laegreid, P. (2008). NPM and beyond-structure, culture and demography. International Review of Administrative Sciences, 74(1), 7-23. Christiaens, W., Nieuwenhuijze, M. J., & de Vries, R. (2013). Trends in the medicalization of childbirth in Flanders and the Netherlands. Midwifery, 29(1), e1-e8. Cowden, T., Cummings, G., & Profetto-McGrath, J. (2011). Leadership practices and staff nurses’ intent to stay: a systematic review. Journal of Nursing Management, 19(4), 461-477. Croonen, H. F. (2010). We moeten trots zijn op de thuisbevalling. Medisch Contact, 39(September 30), 1980-1983. 20 Davis, R. S. (2013). Unionization and work attitudes: how union commitment influences public sector job satisfaction. Public Administration Review, 73(1), 74-84. De Bruijn, J. A. (2010). Managing professionals. London: Routledge. Deci, E. L., & Ryan, R. M. (2002). Handbook of self-determination research. Rochester, NY: University of Rochester Press. DeHart-Davis, L., & Pandey, S. K. (2005). Red tape and public employees: Does perceived rule dysfunction alienate managers? Journal of Public Administration Research and Theory, 15(1), 133-148. DeVellis, R.F. (2011). Scale development: Theory and applications. Thousand Oaks: SAGE Publications. Duyvendak, W. G. J., Knijn, T., & Kremer, M. (Eds.). (2006). Policy, people, and the new professional. de-professionalisation and re-professionalisation in care and welfare. Amsterdam: Amsterdam University Press. Evans, T. (2011). Professionals, managers and discretion: Critiquing street-level bureaucracy. British Journal of Social Work, 41(2), 368-386. Flynn, N. (2007). Public sector management (5th ed.). Brighton, UK: Harvester. Gould-Williams, J. (2004). The effects of ‘high commitment’ HRM practices on employee attitude: The views of public sector workers. Public Administration, 82(1), 63-81. Green, F. (2008). Work effort and worker well-being in the age of affluence. In R. Burke, & C. L. Cooper (Eds.), Effects of working hours and work addiction: Strategies for dealing with them (pp. 115-136). Elsevier: London. Hackman, J. R., & Oldham, G. R. (1980). Work redesign. Reading, MA: Addison Wesley. Herscovitch, L., & Meyer, J. P. (2002). Commitment to organizational change: Extension of a threecomponent model. Journal of Applied Psychology, 87(3), 474-487. Hingstman, L., & Kenens, R. J. (2011). Cijfers uit de registratie van verloskundigen: Peiling 2011. Utrecht: Nivel. Hinkin, T. R. (1998). A brief tutorial on the development of measures for use in survey questionnaires. Organizational Research Methods, 1(1), 104-121. 21 Hom, P. W., Mitchell, T. R., Lee, T. W., & Griffeth, R. W. (2012). Reviewing employee turnover: Focusing on proximal withdrawal states and an expanded criterion. Psychological Bulletin, 138(5), 831. Judson, A. S. (1991). Changing behavior in organization: Minimizing resistance to change. Cambridge, MA: Basil Blackwell. Kanungo, R. N. (1982). Work alienation: An integrative approach. New York: Praeger Publishers. Klopper-Kes, H. A. H. J., Siesling, S., Meerdink, N., Wilderom, C. P. M., & Van Harten, W. H. (2010). Quantifying culture gaps between physicians and managers in dutch hospitals: A survey. BMC Health Services Research, 10(1), 86. Lee, G., Benoit-Bryan, J., & Johnson. T.P. (2012). Survey Research in Public Administration: Assessing Mainstream Journals with a Total Survey Error Framework. Public Administration Review 72(1): 87-97. Lee, S. Y., & Whitford, A. B. (2008). Exit, voice, loyalty, and pay: Evidence from the public workforce. Journal of Public Administration Research and Theory, 18(4), 647-671. Loyens, K. (2014). Coping with policy alienation in law enforcement. In Hupe, P., Hill, M., Buffat, A. (Eds.), Understanding street-level bureaucracy (in press). London: Routledge Lynch, J., Modgil, C., & Modgil, S. (1997). Education and development: Tradition and innovation. London: Cassell. Marx, K. (1961 [1844]). Alienated labor. In K. Marx (Ed.), Economic and philosophic manuscripts of 1844 (pp. 67-83). Moscow: Foreign Languages Publishing House. Mau, R. Y. (1992). The validity and devolution of a concept: Student alienation. Adolescence, 27(107), 731-741. May, D. R., Gilson, R. L., & Harter, L. M. (2004). The psychological conditions of meaningfulness, safety and availability and the engagement of the human spirit at work. Journal of Occupational and Organizational Psychology, 77(1), 11-37. McAllister, D. J. (1995). Affect-and cognition-based trust as foundations for interpersonal cooperation in organizations. The Academy of Management Journal, 38(1), 24-59. McEvoy, G. M., & Cascio, W. F. (1987). Do good or poor performers leave? A meta-analysis of the relationship between performance and turnover. Academy of Management Journal, 30(4), 744762. 22 McGregor, D. (1957). The Human Side of Enterprise. The Management Review, 46(1) 22-28. McKinlay, J. B., & Marceau, L. (2011). New wine in an old bottle: Does alienation provide an explanation of the origins of physician discontent? International Journal of Health Services, 41(2), 301-335. Metselaar, E. E. (1997). Assessing the willingness to change: Construction and validation of the DINAMO. (Doctoral dissertation, Free University of Amsterdam). Mirchandani, D. A., & Lederer, A. L. (2008). The impact of autonomy on information systems planning effectiveness. Omega, 36(5), 789-807. Mottaz, C. J. (1981). Some determinants of work alienation. Sociological Quarterly, 22(4), 515-529. Moynihan, D. P., & Landuyt, N. (2008). Explaining turnover intention in state government: Examining the roles of gender, life cycle, and loyalty. Review of Public Personnel Administration, 28(2), 120-143 Nair, N., & Vohra, N. (2010). An exploration of factors predicting work alienation of knowledge workers. Management Decision, 48(4), 600-615. Nesbit, R., Moulton, S.; Robinson, S.; Smith, C.; DeHart-Davis, L.; Feeney, M.K.; Gazley, B. & Hou, Y (2011). Wrestling with intellectual diversity in public administration: Avoiding disconnectedness and fragmentation while seeking rigor, depth, and relevance. Journal of Public Administration Research and Theory, 21(1), i13-i28. Noordegraaf, M. (2011). Risky business: How professionals and professional fields (must) deal with organizational issues. Organization Studies, 32(10), 1349-1371. Noordegraaf, M. (2014). Reconfiguring professional work: Changing forms of professionalism in public services. Administration & Society, doi: 10.1177/0095399713509242 Noordegraaf, M., & Steijn, A. J. (Eds.). (2014). Professionals under pressure: Perspectives on professionals and professionalism. Amsterdam: Amsterdam University Press. Palm, I., Leffers, F., Emons, T., Van Egmond, V., & Zeegers, S. (2008). De GGz ontwricht: Een praktijkonderzoek naar de gevolgen van het nieuwe zorgstelsel in de geestelijke gezondheidszorg. Den Haag: SP. Pandey, S. K., & Kingsley, G. A. (2000). Examining red tape in public and private organizations: Alternative explanations from a social psychological model. Journal of Public Administration Research and Theory, 10(4), 779-800. 23 Pandey, S. K., & Welch, E. W. (2005). Beyond stereotypes: A multistage model of managerial perceptions of red tape. Administration & Society, 37(5), 542-575. Peters, J., & Pouw, J. (2005). Intensieve menshouderij. hoe kwaliteit oplost in rationaliteit. Schiedam: Scriptum. Pollitt, C., & Bouckaert, G. (2004). Public management reform. A comparative analysis. Oxford: Oxford University Press. Raelin, J. A. (1986). The clash of cultures: Managers and professionals. Boston: Harvard Business Press. Rayce, S. L. B., Holstein, B. E., & Kreiner, S. (2008). Aspects of alienation and symptom load among adolescents. The European Journal of Public Health, 19(1), 79-84. Sagie, A., & Koslowsky, M. (1994). Organizational attitudes and behaviors as a function of participation in strategic and tactical change decisions: An application of path-goal theory. Journal of Organizational Behavior, 15(1), 37-47. Sarros, J. C., Tanewski, G. A., Winter, R. P., Santora, J. C., & Densten, I. L. (2002). Work alienation and organizational leadership. British Journal of Management, 13(4), 285-304. Seeman, M. (1959). On the meaning of alienation. American Sociological Review, 24(6), 783-791. Shepard, J. M. (1971). Automation and alienation: A study of office and factory workers. Cambridge, Mass.: The MIT Press. Taylor, R. (1990). Interpretation of the correlation coefficient: a basic review. Journal of Diagnostic Medical Sonography, 6(1), 35-39. Terhart, E. (2013). Teacher resistance against school reform: reflecting an inconvenient truth. School Leadership & Management, 33(5), 486-500. Thanacoody, P., Newman, A., & Fuchs, S. (2013). Affective commitment and turnover intentions among healthcare professionals: The role of emotional exhaustion and disengagement. The International Journal of Human Resource Management, (ahead-of-print), 1-17. Thomas, R., & Davies, A. (2005). Theorizing the micro-politics of resistance: New public management and managerial identities in the UK public services. Organization Studies, 26(5), 683-706. Tonkens, E., Bröer, C., Van Sambeek, N., & Van Hassel, D. (2013). Pretenders and performers: Professional responses to the commodification of health care. Social Theory & Health, 1-20. 24 Tummers, L. G. (2011). Explaining the willingness of public professionals to implement new policies: A policy alienation framework. International Review of Administrative Sciences, 77(3), 555-581. Tummers, L. G. (2012). Policy alienation of public professionals: The construct and its measurement. Public Administration Review, 72(4), 516-525. Tummers, L. G. (2013). Policy alienation and the power of professionals: Confronting new policies. Cheltenham: Edward Elgar. Tummers, L. G., & Knies, E. (2013). Leadership and meaningful work in the public sector. Public Administration Review, 73(6), 859-868. Tummers, L. G., Bekkers, V. J. J. M., & Steijn, A. J. (2009). Policy alienation of public professionals: Application in a New Public Management context. Public Management Review, 11(5), 685706. Van der Kooy, J., Poeran, J., de Graaf, J. P., Birnie, E., Denktas, S., Steegers, E. A., & Bonsel, G. J. (2011). Planned home compared with planned hospital births in the Netherlands: intrapartum and early neonatal death in low-risk pregnancies. Obstetrics & Gynecology, 118(5), 1037-1046. Van Thiel, S., & Leeuw, F. L. (2002). The performance paradox in the public sector. Public Performance and Management Review, 25(3), 267-281. Wanberg, C. R., & Banas, J. T. (2000). Predictors and outcomes of openness to changes in a reorganizing workplace. Journal of Applied Psychology, 85(1), 132-142. Weigel, R. H., Vernon, D. T. A., & Tognacci, L. N. (1974). Specificity of the attitude as a determinant of attitude-behavior congruence. Journal of Personality and Social Psychology, 30(6), 724728. 25