Enhancing Healthcare Service Quality: The Role of Organizational Support in Stabilizing Health Policy Implementation

Enhancing Healthcare Service Quality: The Role of Organizational Support in Stabilizing Health Policy Implementation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhancing Healthcare Service Quality: The Role of Organizational Support in Stabilizing Health Policy Implementation Xintao Yu, Yuangeng Guo, Xiaochen Liu, Yongchuang Gao This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5421440/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Healthcare service quality is a core focus of China's health policy, aiming to achieve universal health coverage for its 1.4 billion population. The COVID-19 pandemic exposed threats to sustainable policy implementation, highlighting the need for organizational support to rebuild healthcare workers' confidence and ensure effective policy execution through enhanced commitment. Methods Using Hierarchical Linear Modeling (HLM), data were collected from 600 healthcare workers across 40 public hospitals in China. The study focused on evaluating how organizational support—including leadership, communication, and employee engagement programs—affects organizational commitment and how this commitment further impacts healthcare service quality. Data collection took place during the COVID-19 pandemic, providing a highly relevant context for analyzing these relationships. Findings The results demonstrate that organizational support positively influences healthcare service quality (H1), and this effect is mediated by organizational commitment (H3). During the pandemic, higher levels of perceived organizational support effectively reduced stress and trauma, enhancing healthcare workers' psychological resilience and job performance. Organizational support also increased emotional commitment among employees (H2), strengthening their sense of belonging and responsibility toward organizational goals. Employees who perceive high organizational support are more engaged and better equipped to maintain high standards of care under pressure. Additionally, the study found that organizational commitment significantly contributes to healthcare service quality, particularly in high-pressure environments. Employees with stronger organizational commitment exhibit behaviors that improve patient care, demonstrating greater resilience and adaptability in stressful situations. Conclusion This study provides critical insights into stabilizing the implementation of health policies by adopting a people-centered approach, emphasizing the role of hospital administrators in promoting organizational support to improve healthcare service quality and ultimately achieving the overarching goal of stable, universal health coverage. Sustaining these measures post-pandemic is essential for improving healthcare service quality, stabilizing health policy implementation, and achieving broader public health objectives, ultimately strengthening the healthcare system’s resilience and sustainability. organizational support organizational commitment healthcare service quality healthcare worker multilevel analysis Figures Figure 1 1. Introduction Healthcare service quality is commonly defined as the ability of healthcare services to reduce the gap between patients' expectations and actual outcomes (Relman, 2001). As a core indicator of the United Nations' 2030 Sustainable Development Goals and the Global Health Coverage Initiative (Kirby, 2020 ; Yang et al., 2019 ), healthcare service quality has also been a focal point of China’s health policy. For a developing country with a population of 1.4 billion, improving healthcare service quality and achieving universal health coverage have always been the primary goals of national health policy. While the World Health Organization defines health policy as the decisions, plans, and actions undertaken by society to achieve specific healthcare objectives(Eystad, 2024 ), the successful implementation of these policies ultimately relies on every frontline healthcare worker. The COVID-19 pandemic has prompted many healthcare workers to reassess the safety of their workplaces and their own well-being. The high-risk nature of their profession, coupled with limited career alternatives, has left some feeling frustrated and burned out. This has directly led to a decline in healthcare service quality (Cui et al., 2021 ; Gao et al., 2022 ), posing a fundamental threat to the sustainable implementation of China's health policy. In this context, organizational support plays a critical role in rebuilding healthcare workers' confidence and organizational commitment. By creating a supportive work environment, healthcare organizations can help employees overcome the psychological trauma caused by the pandemic and reengage with their professional responsibilities. This approach not only significantly aids the recovery and improvement of healthcare service quality but also provides a foundational pillar for the stability and sustainability of China’s health policy. Most studies on organizational support primarily focus on the general relationship between organizational support and employee performance (Dawson et al., 2022 ; Ogbonnaya et al., 2018 ; Pahlevan Sharif et al., 2018 ). In recent years, this research direction has gradually been extended to the healthcare system (Akdere and Egan, 2020 ; Kamil et al., 2020; Mitchell et al., 2024 ; Sun et al., 2023 ). However, few studies have explored the mediating role of individual organizational commitment (hereafter referred to as "organizational commitment") in analyzing the impact of organizational support on healthcare service quality. Organizational commitment serves as a critical bridge between organizational support and healthcare service quality. Organizational support enhances employees' psychological safety (Atuahene et al., 2024 ) and sense of belonging (Ampofo and Karatepe, 2022 ), which fosters higher levels of organizational commitment. This commitment, in turn, motivates employees to embrace greater professional responsibility, maintain a positive attitude in high-pressure environments, and improve service quality (Hu et al., 2019 ). Additionally, healthcare service quality relies heavily on the proactivity and sustained engagement of healthcare workers. Organizational commitment, as a stable psychological state, is a key driver of employees' willingness to exert extra effort. Therefore, strengthening organizational commitment is essential to fully realize the positive impact of organizational support on healthcare service quality. Therefore, enhancing organizational commitment not only helps optimize service quality within healthcare institutions but also forms the foundation for the effective implementation of health policies. Frontline healthcare workers are the ultimate executors of health policies, and their level of commitment directly determines the success of policy goals. Especially in the context of major public health crises like COVID-19, employees lacking organizational commitment are more likely to experience burnout and exhibit disengaged behaviors, thereby hindering policy implementation. By improving healthcare workers' organizational commitment, health policies can be implemented more steadily and efficiently, ultimately achieving the ambitious goal of improving public health on a national scale. Therefore, this study aims to fill this theoretical gap by examining how organizational support influences healthcare service quality and commitment levels among healthcare workers in high-pressure contexts through the mediating role of organizational commitment. 2. Theoretical Framework and hypothesis 2.1. Organizational support and service quality Organizational support theory was initially developed from the perspective of employees' perceptions, suggesting that employees assess whether the company cares about their efforts and well-being based on the rewards and care they receive (Eisenberger et al., 1986 ). Later, some scholars further emphasized from the organizational perspective that organizational support should be seen as a guarantee by the organization to assist employees in effectively completing their work and coping with stress when necessary (George et al., 1991 ). Service quality theory serves as a fundamental framework in the study of customer satisfaction and organizational performance in the service industry (Brady and Cronin, 2001 ; Grönroos, 1984 ). It is widely used to evaluate how effectively service providers meet or exceed customer expectations. This concept emphasizes the importance of customer perceptions and experiences during service encounters, thus making it a critical indicator of service efficiency and effectiveness. In the healthcare sector, the concept of service quality has been further refined to address its complexities of healthcare service quality. While there are conceptual similarities between the two, healthcare service quality encompasses more intricate elements, including not only patient satisfaction but also clinical outcomes, quality of communication between healthcare providers and patients, timeliness of service delivery, and comfort of the healthcare environment (Donabedian, 1988 ). Healthcare service quality is inherently tied to patient health and safety, demanding higher standards and more rigorous expectations. In high-pressure healthcare environments, organizational support is crucial for enhancing the quality of medical services (Hossain and Aktar, 2012 ; Ogbonnaya et al., 2018 ). Research shows that when healthcare professionals perceive strong support from their organization, they exhibit higher work engagement and motivation, which directly improves patient care. For instance, perceived organizational support is strongly linked to better employee performance, thus improving overall health care quality (Ogbonnaya and Babalola, 2021 ). During the COVID-19 pandemic, studies have found that higher perceived organizational support was associated with lower stress and trauma levels, enhancing healthcare workers' psychological resilience and job performance (Noetzel et al., 2020 ). Additionally, organizational support has been shown to reduce turnover intention and increase job satisfaction among nurses, leading to better service quality (Msheik-El Khoury et al., 2023 ). Lastly, a strong organizational culture supported by organizational support improves ethical conduct and enhances service quality (Nair et al., 2020 ). Therefore, we hypothesize as follows: H1: Organizational support has a positive cross-level effect on health care service quality. 2.2. Organizational support and organizational commitment Organizational commitment is defined as the relative strength of an employee’s identification and involvement with a particular organization (Mowday et al., 1979 ) and has three characteristics: a firm belief in and acceptance of the goals and values of the organization, a willingness to exert considerable efforts for the organization’s benefit, and a strong desire to maintain membership in the organization (Mowday et al., 1979 ). Organizational support is a crucial factor for enhancing employee commitment. It directly strengthens affective commitment and indirectly fosters loyalty by improving work-life balance and job satisfaction. In healthcare settings, organizational support enhances subjective well-being, especially under high-stress conditions, reinforcing professional commitment (Arage et al., 2023 ). Supervisors show improved performance when supported by high-commitment management practices (Rubel et al., 2022 ). Additionally, perceived organizational support enhances organizational profitability by reducing turnover and boosting performance, especially in resource-constrained environments (Kim et al., 2022 ). Thus, we hypothesize as follows: H2: Organizational support has a positive cross-level effect on organizational commitment. During the COVID-19 pandemic, the healthcare industry faced unprecedented pressure (Ezzamel et al., 2021 ) and strong organizational support played a crucial role in alleviating healthcare workers' anxiety, enhancing their psychological resilience, and ultimately improving their quality of life and job performance (Rockstuhl et al., 2020 ; Zapata-Phelan et al., 2020 ). As a result, healthcare workers' organizational commitment deepened, serving as a driving force behind their continued provision of high-quality care (Arage et al., 2022b ). In Ethiopia, job satisfaction and leadership behavior were found to significantly influence healthcare workers' organizational commitment. When healthcare workers perceive strong leadership support and recognition, they are more willing to fully commit to their work and deliver superior care to patients (Arage et al., 2022a ). Additionally, organizational commitment has been shown to significantly enhance the quality of family centered care by promoting positive employee behavior (Mahooti et al., 2021 ). Furthermore, organizational support was found to improve healthcare workers' mental health, thereby strengthening their professional commitment and enhancing the overall quality of healthcare services (Arage et al., 2023 ). Collectively, these studies demonstrate that in complex and high-pressure healthcare environments, organizational support not only alleviates the stress experienced by healthcare workers but also enhances their organizational commitment, continuously improving the quality of healthcare services. Consequently, we hypothesize as follows: H3: Organizational commitment has a positive on healthcare service quality. The research model sees Fig. 1 . 3. Method 3.1. Participants and procedures We selected 40 primary, secondary, and tertiary hospitals in 28 Chinese cities in western, central, and eastern China, and identified a questionnaire coordinator in each hospital. This research was approved (No. 20240308) by Scientific Research Ethics Committee of the School of Economics and Management, Liaoning University of Technology. Before conducting the questionnaire survey, the project team trained the questionnaire coordinators and introduced the objectives, processes, and any matters requiring their attention. Considering that data collection in this study primarily relied on questionnaires, this method may introduce social desirability bias, where participants might provide responses; they believe the researchers expect rather than their true thoughts. To mitigate this bias, the study implemented the following three measures. (1) An anonymous questionnaire was used during data collection to enhance the authenticity of participants' responses. (2) The questionnaire was carefully designed to avoid leading questions, and participants received thorough training prior to questionnaire completion to ensure that they understood the confidentiality and autonomy of their responses. (3) Random sampling was employed to minimize bias and enhance sample representativeness. At the end of the training, each questionnaire coordinator randomly selected 15 healthcare workers from their respective public hospitals to complete the questionnaire within the designated timeframe, after which the responses were collected. During the survey period, 600 valid questionnaires were collected from the 40 public hospitals. 3.2. Measures The principal author, a skilled multilingual Chinese researcher, first translated the material using translation and back-translation technique (Jones et al., 2001 ). To ensure accuracy, several language research assistants retranslated the Chinese version. Before launching the full survey, we conducted a pre-test to confirm the reliability and validity of the data. Organizational Support (OS). We selected six high loading items from the Survey of Perceived Organizational Support (Eisenberger et al., 1986 ). The reliability and validity of this scale have been demonstrated in prior studies (Eisenberger et al., 1990 ). A 5-point Likert scale ranging from strongly disagree to strongly agree was used to evaluate perceived organizational support, with higher values indicating higher perceived organizational support. The scale showed acceptable reliability (Cronbach’s α = .760). Organizational Commitment (OC). Organizational commitment was measured using a 3-item version of the scale used by Singh (Singh et al., 1996 ). The Cronbach’s α for this measure was 0.88. Healthcare Service Quality (HSQ). Healthcare service quality was measured using the Chinese version of the 13-item HSQ (Yang et al., 2018 ), which has three dimensions: psychosocial care, diagnosis/therapy, and quality assurance. The scale showed a high reliability (Cronbach’s α = .946). 3.3. Analysis Technics In this study, hierarchical linear modeling (HLM) was employed to analyze data with a nested structure, in which employee data were nested within hospitals. HLM is particularly suitable for handling such multilevel data as it effectively controls for potential biases arising from dependencies between levels, which traditional regression analysis cannot address because of its assumption of independent observations. This study examined the impact of organizational support (a hospital-level variable) on employee commitment and healthcare service quality (individual-level variables). HLM allows for the simultaneous analysis of both organizational- and individual-level variables, ensuring that individual differences are controlled for while accurately assessing the cross-level effects of organizational support on healthcare service quality. Additionally, HLM accommodates random effects across levels, which is crucial for explaining the variations between hospitals and their employees. By utilizing the HLM, the study can rigorously test cross-level hypotheses, such as the influence of organizational support on healthcare service quality, and verify the mediating role of organizational commitment. This approach ensures the precision of the analysis and avoids statistical biases that may arise from the nested data structure. 4. Result 4.1. Preliminary analysis The sample included 247 (41.2%) men and 330 (55.0%) women. Thirty-eight (6.3%) of the participants were aged < 25 years, 147 (24.5%) were aged 25–30 years, 135 (22.5%) were aged 31–35 years, 84 (14.0%) were aged 36–40 years, 64 (10.7%) were aged 41–45 years, 80 (13.3%) were aged 46–50 years, 35 (5.8%) were aged 51–55 years, and 14 (2.3%) were older than 55 years. The participants were primarily employed as clinicians (49.8%), nurses (25.0%), healthcare technicians (9.2%), and managers (6.8%). With respect to education level, 47.8% held an undergraduate degree, 17.8% held a master’s degree, 24.5% had graduated from junior college, and 2.3% held a doctorate. Most of the respondents (42.0%) had junior job titles, 12.5% had intermediate job titles, and 5.8% had senior job titles. In terms of actual work experience, 16.7% of the participants had worked for less than three years, 19.3% had worked for three to five years, and 20.5% had worked for six to ten years. The most common departmental affiliations were physicians (23.5%) and surgery (21.0%); only 2.2% of participants were in oncology, as shown in Table 1 . Table 1 Demographic variable Category Subcategory Count Percentage Gender Men 247 41.2% Women 330 55.0% Age Younger than 25 38 6.3% 25 to 30 147 24.5% 31 to 35 135 22.5% 36 to 40 84 14.0% 41 to 45 64 10.7% 46 to 50 80 13.3% 51 to 55 35 5.8% Older than 55 14 2.3% Occupation Clinicians 287 49.8% Nurses 144 25.0% Healthcare Technicians 53 9.2% Managers 39 6.8% Education Level Undergraduate Degree 276 47.8% Master’s Degree 103 17.8% Junior College 141 24.5% Doctorate 13 2.3% Career Stage Junior Title 242 42.0% Intermediate Title 72 12.5% Senior Title 33 5.8% Work Experience Less than 3 years 96 16.7% 3 to 5 years 111 19.3% 6 to 10 years 118 20.5% Department Physician 136 23.5% Surgery 121 21.0% Oncology 13 2.2% Table 2 presents the mean (SD) values for perceived organizational support (organizational support), organizational commitment (OC), and healthcare service quality (HSQ). The means for the five healthcare service quality items were very high; however, the range was considerable. The means ranged from 3.36 (“Perform surgeries”; SD = 0.96) to 3.87 (“Show empathy for patients and their relatives”; SD = 0.81). The organizational commitment item (“This organization really inspires me to put forth my best effort”) had the lowest score (M = 3.49, SD = 0.91), and the item (“I really care about the fate of this organization”) had the highest score (M = 3.91, SD = 0.84). The means for perceived organizational support ranged from 2.60 (“The organization shows little concern for me,” SD = 0.99) to 3.42 (“The organization is willing to help me if I need a special favour,” SD = 0.90). Table 2 Mean (SD) scores for perceived organizational support (OS), organizational commitment (OC) and healthcare service quality (HSQ) Variable Mean SD Item OS 3.37 0.86 OS1. The organization takes pride in my accomplishments. 3.15 0.93 OS2. The organization really cares about my well-being. 3.31 0.92 OS3. The organization values my contributions to its well-being. 3.23 0.91 OS4. The organization strongly considers my goals and values. 2.60 0.99 OS5. The organization shows concern for me. 3.42 0.90 OS6. The organization is willing to help me if I need a special favor. OC 3.91 0.84 OC1. I really care about the fate of this organization. 3.61 0.88 OC2. I am willing to put in a great deal of effort beyond what normally is expected in order to help this organization be successful. 3.49 0.91 OC3. This organization really inspires me to put forth my best effort. HSQ 3.36 0.96 HSQ1. Perform surgeries. 3.67 0.77 HSQ2. Assess diagnostic information. 3.75 0.72 HSQ3. Make correct diagnoses. 3.76 0.79 HSQ4. Select appropriate treatments. 3.80 0.77 HSQ5. Maintain healthcare records. 3.81 0.76 HSQ6. Inform patients about rationale for treatment. 3.66 0.77 HSQ7. Consider psychosocial aspects of illness. 3.75 0.77 HSQ8. Manage healthcare resources efficiently. 3.61 0.82 HSQ9. Evaluate healthcare literature to optimize clinical decision making. 3.60 0.84 HSQ10. Participate in implementation of quality improvement programs. 3.87 0.81 HSQ11. Show empathy for patients and their relatives. 3.64 0.84 HSQ12. Involve patients in decision-making. 3.84 078 HSQ13. Consider advance healthcare directives. 4.2. Statistical analysis SPSS 25.0 was used for the descriptive analysis and correlation analysis, and Mplus was used for the Confirmatory Factor Analysis (CFA) and Multilevel Mediation Analysis (MMA). First, we tested the direct cross-level effect of Organization-level organizational support on health care service quality. Second, we tested the direct cross-level effect of organization-level organizational support on organizational commitment. Third, we tested whether organizational commitment mediates the effects of organization-level organizational support on healthcare service quality. We used both grand-mean and group-mean centering to address different hypotheses in this study (Enders and Tofighi, 2007 ). As the primary focus of H1and H2 was on the cross-level effect of an Organization-level predictor on an individual-level outcome while controlling for its stability, we followed the recommendation by (Enders and Tofighi, 2007 ) in grand mean centering both team- and individual-level variables for this analysis. To test hypothesis H3, we specified a 2-1-1 model, which reflects the Organization-level nature of the independent variable (i.e., organizational support), the individual-level nature of the mediator (i.e., organizational commitment), and the dependent variable (i.e., healthcare service quality). We used CWC(M) mediation analysis, in which the individual component of the mediator variable was (Zhang et al., 2008 ). Specifically, we accounted for the multilevel nature of our data and model using a group mean–centering approach (as opposed to a grand mean–centering approach), in which group-level means are included in the estimation of the between-group components of the relationships between variables, and the group-level means are removed from the centered variables that reflect individual-level deviations from group means. A primary benefit of this analysis over grand mean centering is that the CWC(M) method provides unique estimates for the within-group and between-group coefficients of the mediator (i.e., the effects), whereas grand mean centering holds these two coefficients equal, thus reflecting an unnecessary constraint and yielding confounded estimates of the mediator’s effect on the dependent variable (Zhang et al., 2008 ). In the present study, Level 2 represents the team level, and Level 1 represents the individual level. Because variance in the independent variable exists solely at Level 2 in a 2–1–1 model, the independent variable can account only for between-group variation in the mediator; thus, we can meaningfully focus on only the between-group mediation effect (i.e., the extent to which team–level perceptions of organizational support create variation across teams in the healthcare service quality of healthcare workers through their effect on organizational commitment). However, it is important to estimate the within-group effect of the mediator on the dependent variables to ensure the precision of the overall model estimation (Zhang et al., 2008 ). Empirical support for this model indicates that the Level 2 component of organizational commitment mediates the relationship between the Level 2 independent variable (i.e., organizational support) and the Level 1 dependent variable, even after the effect of the Level 1 component of organizational commitment is considered. By setting group-centered organizational commitment as the dependent variable while calculating the Level 2 mean of the organizational commitment of each hospital, we maximized the variation in the dependent variable likely to be explained by group-centered organizational commitment while minimizing the proportion of variance likely to be explained by the job group mean of organizational commitment, thus providing a conservative test of the predicted mediation effect. 4.3. Multilevel CFA results Before testing the hypotheses, multilevel confirmatory factor analyses (MCFA) were conducted using Mplus (Muthén and Muthén, 2017 ) to examine the discriminant validity of the investigated variables at both the individual and team levels. The measurement model consisted of three latent, correlated variables: organizational support (represented by its six items), organizational commitment (represented by its three items), and healthcare service quality (represented by its 13 items). We compared three alternative models and determined that the hypothesized three-factor structure (χ2 = 1218.52, df = 206, p < .01; RMSEA = .09; SRMR = .06; CFI = .87; TLI = .85) demonstrated a significantly more optimal fit with the data compared with all the alternative models (Table 3 ), such as the two-factor model combining organizational support and organizational commitment into one factor (χ2 = 1617.23, df = 208, p < .01; RMSEA = .11; SRMR = .09; CFI = .82; TLI = .90), with a chi-square change of 398.71 (Δdf = 2, p < .01), and the one-factor model combining all three factors into one construct (χ2 = 2675.09, df = 209, p < .01; RMSEA = .14; SRMR = .10; CFI = .68; TLI = .65), with a chi-square change of 1456.57 (Δdf = 3, p < .01). Furthermore, in the three-factor model, all factor loadings were statistically significant (p < .01), suggesting the distinctiveness of the study variables. Table 3 Results of the confirmatory factor analyses Measurement models χ 2 df △χ 2 RMSEA SRMR CFI TLI Three-factor model (Baseline model: organizational support, OC and HSQ) 1218.52 ** 206 - 0.09 0.06 0.87 0.85 Two-factor model (Combine organizational support and OC into one construct) 1617.23 ** 208 398.71 0.11 0.09 0.82 0.80 One-factor model (Combine all factors into one construct) 2675.09 ** 209 1456.57 0.14 0.10 0.68 0.65 Notes: Organizational support, organizational support; OC, organizational commitment; HSQ, healthcare service quality The χ 2 difference was compared with the value of the three-factor model (baseline model). ** p < .01 (two-tailed tests). 4.4. Correlation analysis Table 2 presents the correlations among the study variables. At the organizational level, perceived organizational support showed a significant positive relationship with organizational commitment ( r = 0.524, p < .01) and healthcare service quality ( r = 0.589, p < .01), and organizational commitment had a positive relationship with healthcare service quality ( r = 0.637, p < .01). At the individual level, organizational commitment was positively related to healthcare service quality ( r = 0.536, p < .01). Table 2 Mean scores, standard deviations, and correlations among study variables. Variable (Mean, SD) 1 2 3 Individual Level (Healthcare workers, N = 600) 1 OC (3.67, 0.73) 1 - - 2 HSQ (3.70, 0.59) 0.536** 1 - Organization Level (Hospitals , N = 40) 1 OS (3.31, 0.31) 1 - - 2 OC (3.67, 0.41) 0.524** 1 - 3 HSQ (3.72, 0.31) 0.589** 0.637** 1 Note: * p < .05, ** p < .01 4.5. Aggregation analyses The reported ratings of organizational commitment and healthcare service quality were aggregated to the between-group level after computing the within-group interrater agreement (James et al., 2008 )(rwg) and interclass correlation coefficient (ICC) values to justify this aggregation. Healthcare service quality had an average rwg value of 0.88 (p < 0.001) with ICC [1, 2] values of 0.17 and 0.75, respectively, indicating that 17% of the total variance of healthcare service quality existed between organizations. Organizational commitment had an average rwg value of 0.84 (p < 0.001) with ICC [1, 2] values of 0.26 and 0.84, respectively, indicating that 26% of the total variance of organizational commitment existed between organizations. These estimates indicate significant organizational differences in organizational commitment and healthcare service quality, suggesting that it is meaningful to use organization-level organizational support to explain inter-organizational differences in individual-level outcomes (ICC1>0.25 and ICC2 > 0.70; rwg = 0.70 (Lin et al., 2008 )). 4.6. Multilevel mediation analyses Table 3 reports the results of the multilevel analyses. Certain control variables affect the outcome variables. Specifically, at the individual level, healthcare workers’ position were negatively related to healthcare service quality (β = -0.05, p < 0.01), indicating that healthcare workers of clinicians and nursing staff performed more healthcare service quality than those of management staff and medical technicians. After controlling for demographic variables, organization-level organizational support had a marginally significant positive effect on the team mean of organizational commitment (γ = .68, SE = .21, p < .01), while organization-level organizational support was positively related to the team mean of healthcare service quality (γ = .36, SE = .11, p < .01). Next, the 2-1-1 model was tested. The total direct relationship between organizational support and healthcare service quality (γ = 0.59, p < 0.001) was found lending supports H1. A positive relationship with healthcare service quality was found for both the team mean of organizational commitment (γ = .34, SE = .08, p < .001) and group-centered organizational commitment (β = .39, SE = .04, p < .001). Hence, H2 is supported. An indirect effect was found between organization-level organizational support and healthcare service quality through the team mean of organizational commitment (Î ³ = .23, p < .05). A parametric bootstrap procedure using the Monte Carlo method (bootstrap = 20,000) was also used (Preacher and Selig, 2012) to estimate the hypothesized cross-level indirect relationship. The results indicated a positive indirect relationship between organizational support and average healthcare service quality via average organizational commitment (indirect effect = .23, 95% Monte Carlo CI [0.04, 0.42]), thus supporting H3. Table 3 research result Variables Organizational Commitment Healthcare service quality Estimate SE Estimate SE Organization level intercepts 1.43 ⁎ 0.68 1.30 ⁎⁎⁎ 0.26 Organizational support 0.68 ⁎⁎ 0.21 0.36 ⁎⁎ 0.11 Team mean of organizational commitment 0.34 ⁎⁎⁎ 0.08 Individual level Group- centered organizational commitment 0.39 ⁎⁎⁎ 0.04 Control Variables Age -0.02 0.02 Gender -0.07 0.04 Education level 0.04 0.04 Position -0.05 ⁎⁎ 0.02 Duration of Employment 0.04 0.02 Total effect Organizational Support → healthcare service quality 0.59 ⁎⁎⁎ 95% CI [LL, UL] [0.38, 0.80] Indirect effect Organizational Support → team mean of organizational commitment →healthcare service quality 0.23 ⁎ 95% CI [LL, UL] [0.04, 0.42] Note: CI = confidence interval; LL = lower limit; UL = upper limit. * p < 0.05, ** p < 0.01, *** p < 0.001 5. Discussion This study examined the model within the high-pressure healthcare environment during the COVID-19 pandemic, revealing that organizational support has a significant impact on healthcare service quality, mediated by organizational commitment. The results confirm that organizational support has a significantly positive cross-level effect on healthcare service quality (H1). While this study focuses on China's healthcare system, the effects of organizational support on health service quality are likely to have comparable implications in other countries (Chatzittofis et al., 2021 ; Ogbonnaya et al., 2018 ). For example, organizational support directly contributes to better employee performance, which in turn enhances overall healthcare quality (Ogbonnaya et al., 2018 ). Moreover, during the COVID-19 pandemic, higher perceived organizational support was crucial in mitigating stress and trauma among healthcare workers, thereby enhancing their psychological resilience and job performance (Chatzittofis et al., 2021 ). This study collected data during the pandemic, a period that significantly intensified stress on healthcare workers, underscoring the critical role of organizational support. In the post-pandemic era, it is essential for hospital administrators to continue prioritizing employees' mental health and work environments, particularly by sustaining effective support measures introduced during the pandemic, such as psychological support and flexible work arrangements. Moreover, as healthcare service quality standards are likely to rise in the post-pandemic context, the role of organizational support and commitment in enhancing service quality will become increasingly pivotal. By institutionalizing these measures, hospitals can better adapt to post-pandemic demands and ensure the delivery of high-quality healthcare services. This study confirms the cross-level positive effect of organizational support on employees’ organizational commitment (H2) and highlights the critical role of this relationship in enhancing employees' sense of organizational belonging. Strong organizational support significantly increases employees' emotional commitment to the organization, motivating them to invest more effort in organizational goals (Arage et al., 2023 ). When employees perceive organizational support in high-pressure healthcare environments, they demonstrate higher levels of engagement and responsibility, further strengthening their emotional connections with the organization. Research indicates that healthcare workers who receive recognition and support from their organizations show greater resilience and loyalty in the face of work challenges, thereby maintaining higher levels of organizational commitment (Rubel et al., 2022 ). Therefore, hospital managers should continually enhance employees' emotional commitment through measures such as providing mental health support and optimizing the work environment to ensure their long-term engagement and loyalty in the workplace. These findings further support the hypothesis that organizational commitment positively affects healthcare service quality (H3). Although this study focused on China's healthcare system, the effects of organizational commitment on health service quality are likely to have similar implications in other countries (Arage et al., 2023 ; Mahooti et al., 2021 ). Healthcare workers with high organizational commitment are more likely to exhibit behaviors that contribute to superior service quality. This is particularly evident in high-pressure environments where committed employees are better equipped to handle stress and maintain high standards of care. Studies corroborate this, showing that organizational commitment is critical in fostering behaviors that improve the quality of patient care (Arage et al., 2023 ; Mahooti et al., 2021 ). 6. Conclusion In this study, 600 healthcare workers from 40 public hospitals were recruited as survey participants to explore the influence of organizational support on healthcare service quality and whether this influence is mediated by organizational commitment. Based on this study’s findings, it is evident that organizational support plays a crucial role in enhancing healthcare service quality by fostering higher organizational commitment among healthcare workers. The positive relationship between organizational support and healthcare service quality mediated by organizational commitment underscores the importance of providing robust support systems within healthcare organizations. To improve healthcare service quality, hospital administrators must focus on creating a supportive work environment that addresses both the material and emotional needs of healthcare workers. This includes fair working conditions, appropriate rewards, and strong leadership support, which collectively contribute to higher job satisfaction and organizational commitment. By prioritizing the well-being and professional growth of healthcare workers, organizations can significantly improve their service quality, ultimately benefiting the overall healthcare system. 7. Managerial and Academic Implication 7.1. Managerial Implication This study provides critical insights into stabilizing the implementation of health policies by adopting a people-centered approach, emphasizing the role of hospital administrators in promoting organizational support to improve healthcare service quality and ultimately achieving the overarching goal of stable, universal health coverage. First, administrators can enhance employees' perception of organizational support by strengthening communication, offering psychological assistance, and implementing reward mechanisms. These measures not only increase employee engagement but also reduce turnover intentions, aligning with health policy goals of workforce stability and improved care quality. Second, differentiated strategies should be developed to address the unique needs and work environments of employees at various levels, such as clinicians and nurses. Regular training and activities to promote organizational support and commitment can strengthen employees’ organizational identity and enthusiasm, contributing to better service delivery and supporting broader national health policy objectives. Third, different types and sizes of hospitals face unique challenges in implementing organizational support strategies, which carry significant policy implications. For example, tertiary hospitals with more abundant resources can focus on systematic support systems, such as mental health services and specialized reward programs, to align with high-level policy initiatives. In contrast, resource-constrained primary hospitals can prioritize strengthening frontline management and optimizing communication processes to achieve policy goals within their operational capacity. Flexibly tailoring these strategies to hospital-specific conditions ensures that health policies promoting organizational support are both practical and sustainable across diverse healthcare settings. By addressing these challenges, hospitals can play a pivotal role in advancing health policy objectives, ultimately improving healthcare service quality and equity nationwide. 7.2. Academic contribution First, this study systematically explored the impact of organizational support on healthcare workers' service quality and commitment in high-pressure environments, such as during the COVID-19 pandemic. Through empirical analysis, this study revealed the critical role of organizational support in alleviating work-related stress and enhancing employee performance. This finding provides a new perspective for researching human resource management in high-pressure contexts, emphasizing the importance of organizational support for employees during crises. Second, this study proposes a new theoretical framework for understanding the dynamic relationships between organizational support, employee commitment, and service quality. The framework not only integrates existing theoretical models from the literature, but also considers the specificities of high-pressure environments, providing systematic theoretical support for future research in similar contexts. This contribution aids in advancing theory in the field, particularly in crisis management and organizational behavior research. Third, through empirical research across multiple hospitals, this study provides evidence-based recommendations for implementing effective organizational support strategies in high-pressure environments. The implementation of these strategies can significantly improve healthcare workers' service quality and professional commitment, thereby enhancing patient satisfaction and overall health care service levels. This empirical contribution offers practical guidance for healthcare managers, especially in developing effective management strategies in response to urgent situations, such as pandemics. 8. Limitations and Future Research Although this study provides valuable insights, it is essential to acknowledge its limitations. (1) The cross-sectional design employed in this study, which is effective for data collection, has certain limitations regarding causal inference. Since data were collected at a single point in time, it was not possible to determine the causal relationships between organizational support and healthcare workers' service quality and commitment. Therefore, future research should adopt a longitudinal design to better capture the dynamic relationships between these variables. This approach not only allows for tracking changes over time, but also reveals the direction of causal relationships, thereby providing empirical support for the development of more effective intervention measures. (2) Although the methodology used in this study effectively reveals the relationships between organizational support and healthcare workers' service quality and commitment, it still has some limitations. First, the diversity of study participants may have affected the generalizability of the results. To gain a deeper understanding of these relationships, future research should focus on specific groups of healthcare professionals such as doctors, nurses, and technicians. By concentrating on these groups, researchers can better capture the influence of different professional backgrounds on the relationship between organizational support and service quality, thereby providing more nuanced and targeted conclusions. (3) It is important to note that while the data collection method used in this study aligns with the research objectives, the sample predominantly reflects the perspectives of physicians. However, given the functional and role differences between physicians and nurses, this sampling choice may limit the generalizability of our findings. Therefore, future research should explicitly differentiate between the perspectives of physicians and nurses during data collection to explore the distinct impacts of different professional roles on the relationship between organizational support and service quality. This approach will help to provide a more comprehensive understanding of healthcare workers' performance and the underlying mechanisms in high-pressure environments. Declarations Clinical trial number Not applicable. Ethics approval This research was approved (No. 20240308) by Scientific Research Ethics Committee of the School of Economics and Management, Liaoning University of Technology. Human Ethics and Consent to Participate declarations All methods were performed in accordance with the relevant guidelines and regulations. All participants gave informed consent prior to the study. All participants gave informed consent prior to the study. Consent for publication All authors agree to publication. Availability of data and materials Mail requests can be sent to the corresponding author. Competing interests. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest. Funding This research was supported by Basic Scientific Research Project of Colleges and Universities of Liaoning Province Education Department in 2022 (Approval number: LJKQR20222503); 2022 PhD Research Start-up Fund of Liaoning University of Technology (Approval number: XB2022018); 2024 PhD Research Start-up Fund of Liaoning University of Technology (Approval number: XB2024012); Basic Scientific Research Project of Colleges and Universities of Liaoning Province Education Department in 2024 (Approval number: LJ112410154046). Authors' contributions Xintao Yu (X.Y.) conceptualized the research, designed the study methodology, and was responsible for data analysis and interpretation. Yuangeng Guo (Y.G.) contributed to the literature review, provided theoretical insights, and helped refine the research framework. Xiaochen Liu (X.L.) assisted with data collection, conducted statistical analyses, and supported the interpretation of the results. Yongchuang Gao (Y.G.) was responsible for drafting the manuscript, editing the final paper, and providing overall guidance throughout the research process. All authors read and approved the final manuscript. Acknowledgements Not applicable. References Akdere M, Egan T. Transformational leadership and human resource development: Linking employee learning, job satisfaction, and organizational performance. Hum Resource Dev Q. 2020;31:393–421. https://doi.org/10.1002/hrdq.21404 . Ampofo ET, Karatepe OM. The effects of on-the-job embeddedness and its sub-dimensions on small-sized hotel employees’ organizational commitment, work engagement and turnover intentions. IJCHM. 2022;34:509–33. https://doi.org/10.1108/IJCHM-07-2021-0858 . Arage SM, Daba DB, Dessalegn AY. Organizational commitment of health professionals and associated factors in primary healthcare facilities of Addis Ababa, Ethiopia: A multi-center cross-sectional study. 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Mitchell R, Gu J, Boyle B. The impact of leader member exchange quality and differentiation on counterproductive and citizenship behavior in health care teams. Health Care Manage Rev. 2024;49:86–93. https://doi.org/10.1097/HMR.0000000000000394 . Mowday RT, Steers RM, Porter LW, Porter LW. The Measurement of Organizational Commitment. J Vocat Behav. 1979. https://doi.org/10.1016/0001-8791(79)90072-1 . Msheik-El Khoury F, Naser DD, Htway Z, Zein El Dine S. 2023. The Effect of Work Engagement and Perceived Organizational Support on Turnover Intention among Nurses: A Meta-Analysis Based on the Price–Mueller Model. PLoS ONE 2023, 1–14. https://doi.org/10.1155/2023/3356620 Muthén B, Muthén L. Mplus. Handbook of Item Response Theory. Chapman and Hall/CRC; 2017. pp. 507–18. Nair S, Gaim M, Dimov D, Cayla J, Auriacombe B. Impact of organizational culture and capabilities on employee commitment to ethical behavior in the healthcare sector. 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Mediating role of psychological well-being in the relationship between organizational support and nurses’ outcomes: A cross‐sectional study. J Adv Nurs. 2018;74:887–99. https://doi.org/10.1111/jan.13501 . Relman AS, Washington DC. National Academy Press, 2001. $ 44.95. 0-309-07280-8. The New England Journal of Medicine. https://doi.org/10.1056/nejm200108303450917 Rockstuhl T, Eisenberger R, Shore LM, Kurtessis JN, Ford MT, Buffardi LC, Mesdaghinia S. Perceived organizational support (POS) across 54 nations: A cross-cultural meta-analysis of POS effects. J Int Bus Stud. 2020;51:933–62. https://doi.org/10.1057/s41267-020-00311-3 . Rubel MRB, Kee DMH, Daghriri YQ, Rimi NN. Does perceived organizational support matter? The effect of high-commitment performance management on supervisors’ performance. Front Psychol. 2022;13. https://doi.org/10.3389/fpsyg.2022.837481 . Singh J, Verbeke W, Rhoads GK, Rhoads GK. Do organizational practices matter in role stress processes? A study of direct and moderating effects for marketing-oriented boundary spanners. J Mark. 1996. https://doi.org/10.2307/1251842 . Sun M, Alam F, Ma C. How Nurses’ Person-Organization Fit Influences Organizational Loyalty. RMHP Volume. 2023;16:2019–36. https://doi.org/10.2147/RMHP.S425025 . Yang T, Ma T, Guo Y, Chen Q, Liu J, Deng J. Development and reliability and validity assessment of Chirurgisches Qualitätssiegel- Chinese version. Epidemiol Stud. 2018;34:1083–5. Yang T, Ma T, Liu P, Liu Y, Chen Q, Guo Y, Zhang S, Deng J. Perceived social support and presenteeism among healthcare workers in China: the mediating role of organizational commitment. Environ Health Prev Med. 2019. https://doi.org/10.1186/s12199-019-0814-8 . Zapata-Phelan CP, Colquitt JA, Scott BA, Livingston B, Van Quaquebeke N, Felps W, Mikalef P, Pateli A, Labrague LJ, Santos JAA. COVID-19 anxiety among front‐line nurses: Predictive role of organisational support, personal resilience and social support. J Nurs Manag. 2020;28:1653–61. https://doi.org/10.1111/jonm.13121 . Zhang Z, Zyphur M, Preacher K. 2008. TESTING MULTILEVEL MEDIATION USING HIERARCHICAL LINEAR MODELS: PROBLEMS AND SOLUTIONS. null. https://doi.org/10.5465/ambpp.2008.33716518 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5421440","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379956260,"identity":"07014ebf-3ca6-43f7-ade9-041ce4d9ffcc","order_by":0,"name":"Xintao Yu","email":"","orcid":"","institution":"Liaoning University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Xintao","middleName":"","lastName":"Yu","suffix":""},{"id":379956261,"identity":"15b46240-51ca-4446-8481-afe144c40a5d","order_by":1,"name":"Yuangeng Guo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxklEQVRIiWNgGAWjYBACxvmHDxh8qLCRY2NvIFIL8wy2hMIZZ9KM+XkOEKmFfQaPwWfelkOJM2ckEKmFd3aP4WbehgPGBjcfb7zBUGMTTVCL5JxjxYZzd9yRM7idVmzBcCwtt4GQFsOG5G0Gb888Mza4nWMmwdhwmLAW+wMJ5j942w4nbrh5hkgtjDNSDAxBWmbO4CFWS8+xBENIIAP9kkCMXxjbm2FReXjjjQ81NoS1IAMDiQRSlEO0kKpjFIyCUTAKRgYAANhKSJAZRVFwAAAAAElFTkSuQmCC","orcid":"","institution":"Tsinghua University","correspondingAuthor":true,"prefix":"","firstName":"Yuangeng","middleName":"","lastName":"Guo","suffix":""},{"id":379956262,"identity":"1aa2ce3e-0b58-4b5d-9006-c1abcdb55497","order_by":2,"name":"Xiaochen Liu","email":"","orcid":"","institution":"Liaoning University of Technology","correspondingAuthor":false,"prefix":"","firstName":"Xiaochen","middleName":"","lastName":"Liu","suffix":""},{"id":379956263,"identity":"f4972f18-6082-4229-b827-3d64a75d10fb","order_by":3,"name":"Yongchuang Gao","email":"","orcid":"","institution":"Renmin University of China","correspondingAuthor":false,"prefix":"","firstName":"Yongchuang","middleName":"","lastName":"Gao","suffix":""}],"badges":[],"createdAt":"2024-11-09 10:53:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5421440/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5421440/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":71690353,"identity":"6dc03875-b959-4861-ac2f-521114421ef9","added_by":"auto","created_at":"2024-12-17 18:02:11","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":149849,"visible":true,"origin":"","legend":"\u003cp\u003eResearch model\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5421440/v1/1adebf2018a145c3679f4a28.jpg"},{"id":90105753,"identity":"e390c479-2831-4597-8a0a-228fe7a14e0c","added_by":"auto","created_at":"2025-08-28 14:09:04","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1188982,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5421440/v1/1aedc7bb-b347-4913-8ab0-a119d71423f6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Enhancing Healthcare Service Quality: The Role of Organizational Support in Stabilizing Health Policy Implementation","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eHealthcare service quality is commonly defined as the ability of healthcare services to reduce the gap between patients' expectations and actual outcomes (Relman, 2001). As a core indicator of the United Nations' 2030 Sustainable Development Goals and the Global Health Coverage Initiative (Kirby, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Yang et al., \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e2019\u003c/span\u003e), healthcare service quality has also been a focal point of China\u0026rsquo;s health policy. For a developing country with a population of 1.4\u0026nbsp;billion, improving healthcare service quality and achieving universal health coverage have always been the primary goals of national health policy. While the World Health Organization defines health policy as the decisions, plans, and actions undertaken by society to achieve specific healthcare objectives(Eystad, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2024\u003c/span\u003e), the successful implementation of these policies ultimately relies on every frontline healthcare worker. The COVID-19 pandemic has prompted many healthcare workers to reassess the safety of their workplaces and their own well-being. The high-risk nature of their profession, coupled with limited career alternatives, has left some feeling frustrated and burned out. This has directly led to a decline in healthcare service quality (Cui et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Gao et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), posing a fundamental threat to the sustainable implementation of China's health policy.\u003c/p\u003e \u003cp\u003eIn this context, organizational support plays a critical role in rebuilding healthcare workers' confidence and organizational commitment. By creating a supportive work environment, healthcare organizations can help employees overcome the psychological trauma caused by the pandemic and reengage with their professional responsibilities. This approach not only significantly aids the recovery and improvement of healthcare service quality but also provides a foundational pillar for the stability and sustainability of China\u0026rsquo;s health policy. Most studies on organizational support primarily focus on the general relationship between organizational support and employee performance (Dawson et al., \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Ogbonnaya et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Pahlevan Sharif et al., \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). In recent years, this research direction has gradually been extended to the healthcare system (Akdere and Egan, \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Kamil et al., 2020; Mitchell et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Sun et al., \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). However, few studies have explored the mediating role of individual organizational commitment (hereafter referred to as \"organizational commitment\") in analyzing the impact of organizational support on healthcare service quality.\u003c/p\u003e \u003cp\u003eOrganizational commitment serves as a critical bridge between organizational support and healthcare service quality. Organizational support enhances employees' psychological safety (Atuahene et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) and sense of belonging (Ampofo and Karatepe, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2022\u003c/span\u003e), which fosters higher levels of organizational commitment. This commitment, in turn, motivates employees to embrace greater professional responsibility, maintain a positive attitude in high-pressure environments, and improve service quality (Hu et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2019\u003c/span\u003e). Additionally, healthcare service quality relies heavily on the proactivity and sustained engagement of healthcare workers. Organizational commitment, as a stable psychological state, is a key driver of employees' willingness to exert extra effort. Therefore, strengthening organizational commitment is essential to fully realize the positive impact of organizational support on healthcare service quality.\u003c/p\u003e \u003cp\u003eTherefore, enhancing organizational commitment not only helps optimize service quality within healthcare institutions but also forms the foundation for the effective implementation of health policies. Frontline healthcare workers are the ultimate executors of health policies, and their level of commitment directly determines the success of policy goals. Especially in the context of major public health crises like COVID-19, employees lacking organizational commitment are more likely to experience burnout and exhibit disengaged behaviors, thereby hindering policy implementation. By improving healthcare workers' organizational commitment, health policies can be implemented more steadily and efficiently, ultimately achieving the ambitious goal of improving public health on a national scale. Therefore, this study aims to fill this theoretical gap by examining how organizational support influences healthcare service quality and commitment levels among healthcare workers in high-pressure contexts through the mediating role of organizational commitment.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"2. Theoretical Framework and hypothesis","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Organizational support and service quality\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eOrganizational support theory was initially developed from the perspective of employees' perceptions, suggesting that employees assess whether the company cares about their efforts and well-being based on the rewards and care they receive (Eisenberger et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1986\u003c/span\u003e). Later, some scholars further emphasized from the organizational perspective that organizational support should be seen as a guarantee by the organization to assist employees in effectively completing their work and coping with stress when necessary (George et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e1991\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eService quality theory serves as a fundamental framework in the study of customer satisfaction and organizational performance in the service industry (Brady and Cronin, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2001\u003c/span\u003e; Gr\u0026ouml;nroos, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e1984\u003c/span\u003e). It is widely used to evaluate how effectively service providers meet or exceed customer expectations. This concept emphasizes the importance of customer perceptions and experiences during service encounters, thus making it a critical indicator of service efficiency and effectiveness. In the healthcare sector, the concept of service quality has been further refined to address its complexities of healthcare service quality. While there are conceptual similarities between the two, healthcare service quality encompasses more intricate elements, including not only patient satisfaction but also clinical outcomes, quality of communication between healthcare providers and patients, timeliness of service delivery, and comfort of the healthcare environment (Donabedian, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e1988\u003c/span\u003e). Healthcare service quality is inherently tied to patient health and safety, demanding higher standards and more rigorous expectations.\u003c/p\u003e\u003cp\u003eIn high-pressure healthcare environments, organizational support is crucial for enhancing the quality of medical services (Hossain and Aktar, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2012\u003c/span\u003e; Ogbonnaya et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Research shows that when healthcare professionals perceive strong support from their organization, they exhibit higher work engagement and motivation, which directly improves patient care. For instance, perceived organizational support is strongly linked to better employee performance, thus improving overall health care quality (Ogbonnaya and Babalola, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). During the COVID-19 pandemic, studies have found that higher perceived organizational support was associated with lower stress and trauma levels, enhancing healthcare workers' psychological resilience and job performance (Noetzel et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Additionally, organizational support has been shown to reduce turnover intention and increase job satisfaction among nurses, leading to better service quality (Msheik-El Khoury et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Lastly, a strong organizational culture supported by organizational support improves ethical conduct and enhances service quality (Nair et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). Therefore, we hypothesize as follows:\u003c/p\u003e\u003cp\u003e\u003cem\u003e H1: Organizational support has a positive cross-level effect on health care service quality.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Organizational support and organizational commitment\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eOrganizational commitment is defined as the relative strength of an employee\u0026rsquo;s identification and involvement with a particular organization (Mowday et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1979\u003c/span\u003e) and has three characteristics: a firm belief in and acceptance of the goals and values of the organization, a willingness to exert considerable efforts for the organization\u0026rsquo;s benefit, and a strong desire to maintain membership in the organization (Mowday et al., \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e1979\u003c/span\u003e). Organizational support is a crucial factor for enhancing employee commitment. It directly strengthens affective commitment and indirectly fosters loyalty by improving work-life balance and job satisfaction. In healthcare settings, organizational support enhances subjective well-being, especially under high-stress conditions, reinforcing professional commitment (Arage et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Supervisors show improved performance when supported by high-commitment management practices (Rubel et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Additionally, perceived organizational support enhances organizational profitability by reducing turnover and boosting performance, especially in resource-constrained environments (Kim et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Thus, we hypothesize as follows:\u003c/p\u003e \u003cp\u003e \u003cem\u003eH2: Organizational support has a positive cross-level effect on organizational commitment.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eDuring the COVID-19 pandemic, the healthcare industry faced unprecedented pressure (Ezzamel et al., \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2021\u003c/span\u003e) and strong organizational support played a crucial role in alleviating healthcare workers' anxiety, enhancing their psychological resilience, and ultimately improving their quality of life and job performance (Rockstuhl et al., \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e2020\u003c/span\u003e; Zapata-Phelan et al., \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e2020\u003c/span\u003e). As a result, healthcare workers' organizational commitment deepened, serving as a driving force behind their continued provision of high-quality care (Arage et al., \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022b\u003c/span\u003e). In Ethiopia, job satisfaction and leadership behavior were found to significantly influence healthcare workers' organizational commitment. When healthcare workers perceive strong leadership support and recognition, they are more willing to fully commit to their work and deliver superior care to patients (Arage et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2022a\u003c/span\u003e). Additionally, organizational commitment has been shown to significantly enhance the quality of family centered care by promoting positive employee behavior (Mahooti et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Furthermore, organizational support was found to improve healthcare workers' mental health, thereby strengthening their professional commitment and enhancing the overall quality of healthcare services (Arage et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Collectively, these studies demonstrate that in complex and high-pressure healthcare environments, organizational support not only alleviates the stress experienced by healthcare workers but also enhances their organizational commitment, continuously improving the quality of healthcare services. Consequently, we hypothesize as follows:\u003c/p\u003e \u003cp\u003e \u003cem\u003eH3: Organizational commitment has a positive on healthcare service quality.\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe research model sees Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. Method","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Participants and procedures\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe selected 40 primary, secondary, and tertiary hospitals in 28 Chinese cities in western, central, and eastern China, and identified a questionnaire coordinator in each hospital. This research was approved (No. 20240308) by Scientific Research Ethics Committee of the School of Economics and Management, Liaoning University of Technology. Before conducting the questionnaire survey, the project team trained the questionnaire coordinators and introduced the objectives, processes, and any matters requiring their attention.\u003c/p\u003e\u003cp\u003eConsidering that data collection in this study primarily relied on questionnaires, this method may introduce social desirability bias, where participants might provide responses; they believe the researchers expect rather than their true thoughts. To mitigate this bias, the study implemented the following three measures. (1) An anonymous questionnaire was used during data collection to enhance the authenticity of participants' responses. (2) The questionnaire was carefully designed to avoid leading questions, and participants received thorough training prior to questionnaire completion to ensure that they understood the confidentiality and autonomy of their responses. (3) Random sampling was employed to minimize bias and enhance sample representativeness.\u003c/p\u003e\u003cp\u003eAt the end of the training, each questionnaire coordinator randomly selected 15 healthcare workers from their respective public hospitals to complete the questionnaire within the designated timeframe, after which the responses were collected. During the survey period, 600 valid questionnaires were collected from the 40 public hospitals.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Measures\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe principal author, a skilled multilingual Chinese researcher, first translated the material using translation and back-translation technique (Jones et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2001\u003c/span\u003e). To ensure accuracy, several language research assistants retranslated the Chinese version. Before launching the full survey, we conducted a pre-test to confirm the reliability and validity of the data.\u003c/p\u003e \u003cp\u003eOrganizational Support (OS). We selected six high loading items from the Survey of Perceived Organizational Support (Eisenberger et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e1986\u003c/span\u003e). The reliability and validity of this scale have been demonstrated in prior studies (Eisenberger et al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1990\u003c/span\u003e). A 5-point Likert scale ranging from strongly disagree to strongly agree was used to evaluate perceived organizational support, with higher values indicating higher perceived organizational support. The scale showed acceptable reliability (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;.760).\u003c/p\u003e \u003cp\u003eOrganizational Commitment (OC). Organizational commitment was measured using a 3-item version of the scale used by Singh (Singh et al., \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e1996\u003c/span\u003e). The Cronbach\u0026rsquo;s α for this measure was 0.88.\u003c/p\u003e \u003cp\u003eHealthcare Service Quality (HSQ). Healthcare service quality was measured using the Chinese version of the 13-item HSQ (Yang et al., \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e2018\u003c/span\u003e), which has three dimensions: psychosocial care, diagnosis/therapy, and quality assurance. The scale showed a high reliability (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;.946).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Analysis Technics\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eIn this study, hierarchical linear modeling (HLM) was employed to analyze data with a nested structure, in which employee data were nested within hospitals. HLM is particularly suitable for handling such multilevel data as it effectively controls for potential biases arising from dependencies between levels, which traditional regression analysis cannot address because of its assumption of independent observations. This study examined the impact of organizational support (a hospital-level variable) on employee commitment and healthcare service quality (individual-level variables). HLM allows for the simultaneous analysis of both organizational- and individual-level variables, ensuring that individual differences are controlled for while accurately assessing the cross-level effects of organizational support on healthcare service quality. Additionally, HLM accommodates random effects across levels, which is crucial for explaining the variations between hospitals and their employees. By utilizing the HLM, the study can rigorously test cross-level hypotheses, such as the influence of organizational support on healthcare service quality, and verify the mediating role of organizational commitment. This approach ensures the precision of the analysis and avoids statistical biases that may arise from the nested data structure.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Result","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Preliminary analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThe sample included 247 (41.2%) men and 330 (55.0%) women. Thirty-eight (6.3%) of the participants were aged\u0026thinsp;\u0026lt;\u0026thinsp;25 years, 147 (24.5%) were aged 25\u0026ndash;30 years, 135 (22.5%) were aged 31\u0026ndash;35 years, 84 (14.0%) were aged 36\u0026ndash;40 years, 64 (10.7%) were aged 41\u0026ndash;45 years, 80 (13.3%) were aged 46\u0026ndash;50 years, 35 (5.8%) were aged 51\u0026ndash;55 years, and 14 (2.3%) were older than 55 years. The participants were primarily employed as clinicians (49.8%), nurses (25.0%), healthcare technicians (9.2%), and managers (6.8%). With respect to education level, 47.8% held an undergraduate degree, 17.8% held a master\u0026rsquo;s degree, 24.5% had graduated from junior college, and 2.3% held a doctorate. Most of the respondents (42.0%) had junior job titles, 12.5% had intermediate job titles, and 5.8% had senior job titles. In terms of actual work experience, 16.7% of the participants had worked for less than three years, 19.3% had worked for three to five years, and 20.5% had worked for six to ten years. The most common departmental affiliations were physicians (23.5%) and surgery (21.0%); only 2.2% of participants were in oncology, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic variable\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubcategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYounger than 25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 to 30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 to 35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36 to 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 to 45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 to 50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 to 55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOlder than 55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealthcare Technicians\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eManagers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUndergraduate Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e276\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u0026rsquo;s Degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior College\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctorate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eCareer Stage\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJunior Title\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermediate Title\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSenior Title\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eWork Experience\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 to 5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 to 10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eDepartment\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhysician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the mean (SD) values for perceived organizational support (organizational support), organizational commitment (OC), and healthcare service quality (HSQ). The means for the five healthcare service quality items were very high; however, the range was considerable. The means ranged from 3.36 (\u0026ldquo;Perform surgeries\u0026rdquo;; SD\u0026thinsp;=\u0026thinsp;0.96) to 3.87 (\u0026ldquo;Show empathy for patients and their relatives\u0026rdquo;; SD\u0026thinsp;=\u0026thinsp;0.81). The organizational commitment item (\u0026ldquo;This organization really inspires me to put forth my best effort\u0026rdquo;) had the lowest score (M\u0026thinsp;=\u0026thinsp;3.49, SD\u0026thinsp;=\u0026thinsp;0.91), and the item (\u0026ldquo;I really care about the fate of this organization\u0026rdquo;) had the highest score (M\u0026thinsp;=\u0026thinsp;3.91, SD\u0026thinsp;=\u0026thinsp;0.84). The means for perceived organizational support ranged from 2.60 (\u0026ldquo;The organization shows little concern for me,\u0026rdquo; SD\u0026thinsp;=\u0026thinsp;0.99) to 3.42 (\u0026ldquo;The organization is willing to help me if I need a special favour,\u0026rdquo; SD\u0026thinsp;=\u0026thinsp;0.90).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean (SD) scores for perceived organizational support (OS), organizational commitment (OC) and healthcare service quality (HSQ)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eOS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOS1. The organization takes pride in my accomplishments.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOS2. The organization really cares about my well-being.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOS3. The organization values my contributions to its well-being.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOS4. The organization strongly considers my goals and values.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOS5. The organization shows concern for me.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOS6. The organization is willing to help me if I need a special favor.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOC1. I really care about the fate of this organization.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOC2. I am willing to put in a great deal of effort beyond what normally is expected in order to help this organization be successful.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOC3. This organization really inspires me to put forth my best effort.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003eHSQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ1. Perform surgeries.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ2. Assess diagnostic information.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ3. Make correct diagnoses.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ4. Select appropriate treatments.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ5. Maintain healthcare records.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ6. Inform patients about rationale for treatment.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ7. Consider psychosocial aspects of illness.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ8. Manage healthcare resources efficiently.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ9. Evaluate healthcare literature to optimize clinical decision making.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ10. Participate in implementation of quality improvement programs.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ11. Show empathy for patients and their relatives.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ12. Involve patients in decision-making.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e078\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHSQ13. Consider advance healthcare directives.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Statistical analysis\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSPSS 25.0 was used for the descriptive analysis and correlation analysis, and Mplus was used for the Confirmatory Factor Analysis (CFA) and Multilevel Mediation Analysis (MMA). First, we tested the direct cross-level effect of Organization-level organizational support on health care service quality. Second, we tested the direct cross-level effect of organization-level organizational support on organizational commitment. Third, we tested whether organizational commitment mediates the effects of organization-level organizational support on healthcare service quality.\u003c/p\u003e\u003cp\u003eWe used both grand-mean and group-mean centering to address different hypotheses in this study (Enders and Tofighi, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2007\u003c/span\u003e). As the primary focus of H1and H2 was on the cross-level effect of an Organization-level predictor on an individual-level outcome while controlling for its stability, we followed the recommendation by (Enders and Tofighi, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2007\u003c/span\u003e) in grand mean centering both team- and individual-level variables for this analysis.\u003c/p\u003e\u003cp\u003eTo test hypothesis H3, we specified a 2-1-1 model, which reflects the Organization-level nature of the independent variable (i.e., organizational support), the individual-level nature of the mediator (i.e., organizational commitment), and the dependent variable (i.e., healthcare service quality). We used CWC(M) mediation analysis, in which the individual component of the mediator variable was (Zhang et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Specifically, we accounted for the multilevel nature of our data and model using a group mean\u0026ndash;centering approach (as opposed to a grand mean\u0026ndash;centering approach), in which group-level means are included in the estimation of the between-group components of the relationships between variables, and the group-level means are removed from the centered variables that reflect individual-level deviations from group means. A primary benefit of this analysis over grand mean centering is that the CWC(M) method provides unique estimates for the within-group and between-group coefficients of the mediator (i.e., the effects), whereas grand mean centering holds these two coefficients equal, thus reflecting an unnecessary constraint and yielding confounded estimates of the mediator\u0026rsquo;s effect on the dependent variable (Zhang et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn the present study, Level 2 represents the team level, and Level 1 represents the individual level. Because variance in the independent variable exists solely at Level 2 in a 2\u0026ndash;1\u0026ndash;1 model, the independent variable can account only for between-group variation in the mediator; thus, we can meaningfully focus on only the between-group mediation effect (i.e., the extent to which team\u0026ndash;level perceptions of organizational support create variation across teams in the healthcare service quality of healthcare workers through their effect on organizational commitment). However, it is important to estimate the within-group effect of the mediator on the dependent variables to ensure the precision of the overall model estimation (Zhang et al., \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e2008\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEmpirical support for this model indicates that the Level 2 component of organizational commitment mediates the relationship between the Level 2 independent variable (i.e., organizational support) and the Level 1 dependent variable, even after the effect of the Level 1 component of organizational commitment is considered.\u003c/p\u003e\u003cp\u003eBy setting group-centered organizational commitment as the dependent variable while calculating the Level 2 mean of the organizational commitment of each hospital, we maximized the variation in the dependent variable likely to be explained by group-centered organizational commitment while minimizing the proportion of variance likely to be explained by the job group mean of organizational commitment, thus providing a conservative test of the predicted mediation effect.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Multilevel CFA results\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eBefore testing the hypotheses, multilevel confirmatory factor analyses (MCFA) were conducted using Mplus (Muth\u0026eacute;n and Muth\u0026eacute;n, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) to examine the discriminant validity of the investigated variables at both the individual and team levels. The measurement model consisted of three latent, correlated variables: organizational support (represented by its six items), organizational commitment (represented by its three items), and healthcare service quality (represented by its 13 items). We compared three alternative models and determined that the hypothesized three-factor structure (χ2\u0026thinsp;=\u0026thinsp;1218.52, df\u0026thinsp;=\u0026thinsp;206, p\u0026thinsp;\u0026lt;\u0026thinsp;.01; RMSEA\u0026thinsp;=\u0026thinsp;.09; SRMR\u0026thinsp;=\u0026thinsp;.06; CFI\u0026thinsp;=\u0026thinsp;.87; TLI\u0026thinsp;=\u0026thinsp;.85) demonstrated a significantly more optimal fit with the data compared with all the alternative models (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e), such as the two-factor model combining organizational support and organizational commitment into one factor (χ2\u0026thinsp;=\u0026thinsp;1617.23, df\u0026thinsp;=\u0026thinsp;208, p\u0026thinsp;\u0026lt;\u0026thinsp;.01; RMSEA\u0026thinsp;=\u0026thinsp;.11; SRMR\u0026thinsp;=\u0026thinsp;.09; CFI\u0026thinsp;=\u0026thinsp;.82; TLI\u0026thinsp;=\u0026thinsp;.90), with a chi-square change of 398.71 (Δdf\u0026thinsp;=\u0026thinsp;2, p\u0026thinsp;\u0026lt;\u0026thinsp;.01), and the one-factor model combining all three factors into one construct (χ2\u0026thinsp;=\u0026thinsp;2675.09, df\u0026thinsp;=\u0026thinsp;209, p\u0026thinsp;\u0026lt;\u0026thinsp;.01; RMSEA\u0026thinsp;=\u0026thinsp;.14; SRMR\u0026thinsp;=\u0026thinsp;.10; CFI\u0026thinsp;=\u0026thinsp;.68; TLI\u0026thinsp;=\u0026thinsp;.65), with a chi-square change of 1456.57 (Δdf\u0026thinsp;=\u0026thinsp;3, p\u0026thinsp;\u0026lt;\u0026thinsp;.01). Furthermore, in the three-factor model, all factor loadings were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;.01), suggesting the distinctiveness of the study variables.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResults of the confirmatory factor analyses\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeasurement models\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003edf\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e△χ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRMSEA\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSRMR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTLI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eThree-factor model\u003c/em\u003e\u003c/p\u003e \u003cp\u003e(Baseline model: organizational support, OC and HSQ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1218.52\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eTwo-factor model\u003c/em\u003e\u003c/p\u003e \u003cp\u003e(Combine organizational support and OC into one construct)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1617.23\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e398.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003eOne-factor model\u003c/em\u003e\u003c/p\u003e \u003cp\u003e(Combine all factors into one construct)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2675.09\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1456.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNotes: Organizational support, organizational support; OC, organizational commitment; HSQ, healthcare service quality The \u003cem\u003eχ\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e difference was compared with the value of the three-factor model (baseline model).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e**\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01 (two-tailed tests).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e4.4. Correlation analysis\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the correlations among the study variables. At the organizational level, perceived organizational support showed a significant positive relationship with organizational commitment (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.524, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01) and healthcare service quality (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.589, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01), and organizational commitment had a positive relationship with healthcare service quality (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.637, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01). At the individual level, organizational commitment was positively related to healthcare service quality (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.536, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean scores, standard deviations, and correlations among study variables.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable (Mean, SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eIndividual Level (Healthcare workers, \u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;600)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 OC (3.67, 0.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 HSQ (3.70, 0.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.536**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrganization Level (Hospitals\u003c/b\u003e, \u003cb\u003eN\u003c/b\u003e\u0026thinsp;\u003cb\u003e=\u0026thinsp;40)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 OS (3.31, 0.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2 OC (3.67, 0.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.524**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3 HSQ (3.72, 0.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.589**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.637**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eNote: * \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05, ** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.5. Aggregation analyses\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe reported ratings of organizational commitment and healthcare service quality were aggregated to the between-group level after computing the within-group interrater agreement (James et al., \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2008\u003c/span\u003e)(rwg) and interclass correlation coefficient (ICC) values to justify this aggregation. Healthcare service quality had an average rwg value of 0.88 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with ICC [1, 2] values of 0.17 and 0.75, respectively, indicating that 17% of the total variance of healthcare service quality existed between organizations. Organizational commitment had an average rwg value of 0.84 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) with ICC [1, 2] values of 0.26 and 0.84, respectively, indicating that 26% of the total variance of organizational commitment existed between organizations. These estimates indicate significant organizational differences in organizational commitment and healthcare service quality, suggesting that it is meaningful to use organization-level organizational support to explain inter-organizational differences in individual-level outcomes (ICC1\u0026gt;0.25 and ICC2\u0026thinsp;\u0026gt;\u0026thinsp;0.70; rwg\u0026thinsp;=\u0026thinsp;0.70 (Lin et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2008\u003c/span\u003e)).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.6. Multilevel mediation analyses\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e3\u003c/span\u003e reports the results of the multilevel analyses. Certain control variables affect the outcome variables. Specifically, at the individual level, healthcare workers\u0026rsquo; position were negatively related to healthcare service quality (β = -0.05, p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), indicating that healthcare workers of clinicians and nursing staff performed more healthcare service quality than those of management staff and medical technicians.\u003c/p\u003e \u003cp\u003eAfter controlling for demographic variables, organization-level organizational support had a marginally significant positive effect on the team mean of organizational commitment (γ\u0026thinsp;=\u0026thinsp;.68, SE\u0026thinsp;=\u0026thinsp;.21, p\u0026thinsp;\u0026lt;\u0026thinsp;.01), while organization-level organizational support was positively related to the team mean of healthcare service quality (γ\u0026thinsp;=\u0026thinsp;.36, SE\u0026thinsp;=\u0026thinsp;.11, p\u0026thinsp;\u0026lt;\u0026thinsp;.01). Next, the 2-1-1 model was tested. The total direct relationship between organizational support and healthcare service quality (γ\u0026thinsp;=\u0026thinsp;0.59, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was found lending supports H1. A positive relationship with healthcare service quality was found for both the team mean of organizational commitment (γ\u0026thinsp;=\u0026thinsp;.34, SE\u0026thinsp;=\u0026thinsp;.08, p\u0026thinsp;\u0026lt;\u0026thinsp;.001) and group-centered organizational commitment (β\u0026thinsp;=\u0026thinsp;.39, SE\u0026thinsp;=\u0026thinsp;.04, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Hence, H2 is supported.\u003c/p\u003e \u003cp\u003eAn indirect effect was found between organization-level organizational support and healthcare service quality through the team mean of organizational commitment (\u0026Icirc; \u0026sup3; = .23, p\u0026thinsp;\u0026lt;\u0026thinsp;.05). A parametric bootstrap procedure using the Monte Carlo method (bootstrap\u0026thinsp;=\u0026thinsp;20,000) was also used (Preacher and Selig, 2012) to estimate the hypothesized cross-level indirect relationship. The results indicated a positive indirect relationship between organizational support and average healthcare service quality via average organizational commitment (indirect effect\u0026thinsp;=\u0026thinsp;.23, 95% Monte Carlo CI [0.04, 0.42]), thus supporting H3.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eresearch result\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOrganizational Commitment\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eHealthcare service quality\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eEstimate\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eEstimate\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOrganization level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eintercepts\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.43\u003csup\u003e⁎\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.30\u003csup\u003e⁎⁎⁎\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.68\u003c/b\u003e\u003csup\u003e\u003cb\u003e⁎⁎\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.36\u003c/b\u003e\u003csup\u003e\u003cb\u003e⁎⁎\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeam mean of organizational commitment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.34\u003c/b\u003e\u003csup\u003e\u003cb\u003e⁎⁎⁎\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndividual level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup- centered organizational commitment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.39\u003c/b\u003e\u003csup\u003e\u003cb\u003e⁎⁎⁎\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eControl Variables\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.05\u003csup\u003e⁎⁎\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal effect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational Support \u0026rarr; healthcare service quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.59\u003c/b\u003e\u003csup\u003e\u003cb\u003e⁎⁎⁎\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e95% CI [LL, UL]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e[0.38, 0.80]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIndirect effect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrganizational Support \u0026rarr; team mean of organizational commitment \u0026rarr;healthcare service quality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.23\u003c/b\u003e\u003csup\u003e\u003cb\u003e⁎\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e95% CI [LL, UL]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e[0.04, 0.42]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eNote: CI\u0026thinsp;=\u0026thinsp;confidence interval; LL\u0026thinsp;=\u0026thinsp;lower limit; UL\u0026thinsp;=\u0026thinsp;upper limit.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, ** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, *** \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"5. Discussion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis study examined the model within the high-pressure healthcare environment during the COVID-19 pandemic, revealing that organizational support has a significant impact on healthcare service quality, mediated by organizational commitment.\u003c/p\u003e \u003cp\u003eThe results confirm that organizational support has a significantly positive cross-level effect on healthcare service quality (H1). While this study focuses on China's healthcare system, the effects of organizational support on health service quality are likely to have comparable implications in other countries (Chatzittofis et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e; Ogbonnaya et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). For example, organizational support directly contributes to better employee performance, which in turn enhances overall healthcare quality (Ogbonnaya et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2018\u003c/span\u003e). Moreover, during the COVID-19 pandemic, higher perceived organizational support was crucial in mitigating stress and trauma among healthcare workers, thereby enhancing their psychological resilience and job performance (Chatzittofis et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). This study collected data during the pandemic, a period that significantly intensified stress on healthcare workers, underscoring the critical role of organizational support. In the post-pandemic era, it is essential for hospital administrators to continue prioritizing employees' mental health and work environments, particularly by sustaining effective support measures introduced during the pandemic, such as psychological support and flexible work arrangements. Moreover, as healthcare service quality standards are likely to rise in the post-pandemic context, the role of organizational support and commitment in enhancing service quality will become increasingly pivotal. By institutionalizing these measures, hospitals can better adapt to post-pandemic demands and ensure the delivery of high-quality healthcare services.\u003c/p\u003e \u003cp\u003eThis study confirms the cross-level positive effect of organizational support on employees\u0026rsquo; organizational commitment (H2) and highlights the critical role of this relationship in enhancing employees' sense of organizational belonging. Strong organizational support significantly increases employees' emotional commitment to the organization, motivating them to invest more effort in organizational goals (Arage et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). When employees perceive organizational support in high-pressure healthcare environments, they demonstrate higher levels of engagement and responsibility, further strengthening their emotional connections with the organization. Research indicates that healthcare workers who receive recognition and support from their organizations show greater resilience and loyalty in the face of work challenges, thereby maintaining higher levels of organizational commitment (Rubel et al., \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Therefore, hospital managers should continually enhance employees' emotional commitment through measures such as providing mental health support and optimizing the work environment to ensure their long-term engagement and loyalty in the workplace.\u003c/p\u003e \u003cp\u003eThese findings further support the hypothesis that organizational commitment positively affects healthcare service quality (H3). Although this study focused on China's healthcare system, the effects of organizational commitment on health service quality are likely to have similar implications in other countries (Arage et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Mahooti et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Healthcare workers with high organizational commitment are more likely to exhibit behaviors that contribute to superior service quality. This is particularly evident in high-pressure environments where committed employees are better equipped to handle stress and maintain high standards of care. Studies corroborate this, showing that organizational commitment is critical in fostering behaviors that improve the quality of patient care (Arage et al., \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Mahooti et al., \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2021\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"6. Conclusion","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eIn this study, 600 healthcare workers from 40 public hospitals were recruited as survey participants to explore the influence of organizational support on healthcare service quality and whether this influence is mediated by organizational commitment. Based on this study\u0026rsquo;s findings, it is evident that organizational support plays a crucial role in enhancing healthcare service quality by fostering higher organizational commitment among healthcare workers. The positive relationship between organizational support and healthcare service quality mediated by organizational commitment underscores the importance of providing robust support systems within healthcare organizations. To improve healthcare service quality, hospital administrators must focus on creating a supportive work environment that addresses both the material and emotional needs of healthcare workers. This includes fair working conditions, appropriate rewards, and strong leadership support, which collectively contribute to higher job satisfaction and organizational commitment. By prioritizing the well-being and professional growth of healthcare workers, organizations can significantly improve their service quality, ultimately benefiting the overall healthcare system.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e"},{"header":"7. Managerial and Academic Implication","content":"\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e7.1. Managerial Implication\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThis study provides critical insights into stabilizing the implementation of health policies by adopting a people-centered approach, emphasizing the role of hospital administrators in promoting organizational support to improve healthcare service quality and ultimately achieving the overarching goal of stable, universal health coverage.\u003c/p\u003e \u003cp\u003eFirst, administrators can enhance employees' perception of organizational support by strengthening communication, offering psychological assistance, and implementing reward mechanisms. These measures not only increase employee engagement but also reduce turnover intentions, aligning with health policy goals of workforce stability and improved care quality.\u003c/p\u003e \u003cp\u003eSecond, differentiated strategies should be developed to address the unique needs and work environments of employees at various levels, such as clinicians and nurses. Regular training and activities to promote organizational support and commitment can strengthen employees\u0026rsquo; organizational identity and enthusiasm, contributing to better service delivery and supporting broader national health policy objectives.\u003c/p\u003e \u003cp\u003eThird, different types and sizes of hospitals face unique challenges in implementing organizational support strategies, which carry significant policy implications. For example, tertiary hospitals with more abundant resources can focus on systematic support systems, such as mental health services and specialized reward programs, to align with high-level policy initiatives. In contrast, resource-constrained primary hospitals can prioritize strengthening frontline management and optimizing communication processes to achieve policy goals within their operational capacity. Flexibly tailoring these strategies to hospital-specific conditions ensures that health policies promoting organizational support are both practical and sustainable across diverse healthcare settings. By addressing these challenges, hospitals can play a pivotal role in advancing health policy objectives, ultimately improving healthcare service quality and equity nationwide.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e7.2. Academic contribution\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eFirst, this study systematically explored the impact of organizational support on healthcare workers' service quality and commitment in high-pressure environments, such as during the COVID-19 pandemic. Through empirical analysis, this study revealed the critical role of organizational support in alleviating work-related stress and enhancing employee performance. This finding provides a new perspective for researching human resource management in high-pressure contexts, emphasizing the importance of organizational support for employees during crises.\u003c/p\u003e \u003cp\u003eSecond, this study proposes a new theoretical framework for understanding the dynamic relationships between organizational support, employee commitment, and service quality. The framework not only integrates existing theoretical models from the literature, but also considers the specificities of high-pressure environments, providing systematic theoretical support for future research in similar contexts. This contribution aids in advancing theory in the field, particularly in crisis management and organizational behavior research.\u003c/p\u003e \u003cp\u003eThird, through empirical research across multiple hospitals, this study provides evidence-based recommendations for implementing effective organizational support strategies in high-pressure environments. The implementation of these strategies can significantly improve healthcare workers' service quality and professional commitment, thereby enhancing patient satisfaction and overall health care service levels. This empirical contribution offers practical guidance for healthcare managers, especially in developing effective management strategies in response to urgent situations, such as pandemics.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"8. Limitations and Future Research","content":"\u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eAlthough this study provides valuable insights, it is essential to acknowledge its limitations. (1) The cross-sectional design employed in this study, which is effective for data collection, has certain limitations regarding causal inference. Since data were collected at a single point in time, it was not possible to determine the causal relationships between organizational support and healthcare workers' service quality and commitment. Therefore, future research should adopt a longitudinal design to better capture the dynamic relationships between these variables. This approach not only allows for tracking changes over time, but also reveals the direction of causal relationships, thereby providing empirical support for the development of more effective intervention measures. (2) Although the methodology used in this study effectively reveals the relationships between organizational support and healthcare workers' service quality and commitment, it still has some limitations. First, the diversity of study participants may have affected the generalizability of the results. To gain a deeper understanding of these relationships, future research should focus on specific groups of healthcare professionals such as doctors, nurses, and technicians. By concentrating on these groups, researchers can better capture the influence of different professional backgrounds on the relationship between organizational support and service quality, thereby providing more nuanced and targeted conclusions. (3) It is important to note that while the data collection method used in this study aligns with the research objectives, the sample predominantly reflects the perspectives of physicians. However, given the functional and role differences between physicians and nurses, this sampling choice may limit the generalizability of our findings. Therefore, future research should explicitly differentiate between the perspectives of physicians and nurses during data collection to explore the distinct impacts of different professional roles on the relationship between organizational support and service quality. This approach will help to provide a more comprehensive understanding of healthcare workers' performance and the underlying mechanisms in high-pressure environments.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003eClinical trial number\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eEthics approval\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis research was approved (No. 20240308) by Scientific Research Ethics Committee of the School of Economics and Management, Liaoning University of Technology.\u003c/p\u003e\n\u003cp\u003eHuman Ethics and Consent to Participate declarations\u003c/p\u003e\n\u003cp\u003eAll methods were performed in accordance with the relevant guidelines and regulations. All participants gave informed consent prior to the study. All participants gave informed consent prior to the study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eAll authors agree to publication.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eMail requests can be sent to the corresponding author.\u003c/p\u003e\n\u003cp\u003eCompeting interests.\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis research was supported by Basic Scientific Research Project of Colleges and Universities of Liaoning Province Education Department in 2022 (Approval number: LJKQR20222503); 2022 PhD Research Start-up Fund of Liaoning University of Technology (Approval number: XB2022018); 2024 PhD Research Start-up Fund of Liaoning University of Technology (Approval number: XB2024012); Basic Scientific Research Project of Colleges and Universities of Liaoning Province Education Department in 2024 (Approval number: LJ112410154046).\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Xintao Yu (X.Y.) conceptualized the research, designed the study methodology, and was responsible for data analysis and interpretation. Yuangeng Guo (Y.G.) contributed to the literature review, provided theoretical insights, and helped refine the research framework. Xiaochen Liu (X.L.) assisted with data collection, conducted statistical analyses, and supported the interpretation of the results. Yongchuang Gao (Y.G.) was responsible for drafting the manuscript, editing the final paper, and providing overall guidance throughout the research process. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAkdere M, Egan T. Transformational leadership and human resource development: Linking employee learning, job satisfaction, and organizational performance. 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TESTING MULTILEVEL MEDIATION USING HIERARCHICAL LINEAR MODELS: PROBLEMS AND SOLUTIONS. null. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.5465/ambpp.2008.33716518\u003c/span\u003e\u003cspan address=\"10.5465/ambpp.2008.33716518\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"organizational support, organizational commitment, healthcare service quality, healthcare worker, multilevel analysis","lastPublishedDoi":"10.21203/rs.3.rs-5421440/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5421440/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHealthcare service quality is a core focus of China's health policy, aiming to achieve universal health coverage for its 1.4\u0026nbsp;billion population. The COVID-19 pandemic exposed threats to sustainable policy implementation, highlighting the need for organizational support to rebuild healthcare workers' confidence and ensure effective policy execution through enhanced commitment.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUsing Hierarchical Linear Modeling (HLM), data were collected from 600 healthcare workers across 40 public hospitals in China. The study focused on evaluating how organizational support\u0026mdash;including leadership, communication, and employee engagement programs\u0026mdash;affects organizational commitment and how this commitment further impacts healthcare service quality. Data collection took place during the COVID-19 pandemic, providing a highly relevant context for analyzing these relationships.\u003c/p\u003e\u003ch2\u003eFindings\u003c/h2\u003e \u003cp\u003eThe results demonstrate that organizational support positively influences healthcare service quality (H1), and this effect is mediated by organizational commitment (H3). During the pandemic, higher levels of perceived organizational support effectively reduced stress and trauma, enhancing healthcare workers' psychological resilience and job performance. Organizational support also increased emotional commitment among employees (H2), strengthening their sense of belonging and responsibility toward organizational goals. Employees who perceive high organizational support are more engaged and better equipped to maintain high standards of care under pressure. Additionally, the study found that organizational commitment significantly contributes to healthcare service quality, particularly in high-pressure environments. Employees with stronger organizational commitment exhibit behaviors that improve patient care, demonstrating greater resilience and adaptability in stressful situations.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study provides critical insights into stabilizing the implementation of health policies by adopting a people-centered approach, emphasizing the role of hospital administrators in promoting organizational support to improve healthcare service quality and ultimately achieving the overarching goal of stable, universal health coverage. Sustaining these measures post-pandemic is essential for improving healthcare service quality, stabilizing health policy implementation, and achieving broader public health objectives, ultimately strengthening the healthcare system\u0026rsquo;s resilience and sustainability.\u003c/p\u003e","manuscriptTitle":"Enhancing Healthcare Service Quality: The Role of Organizational Support in Stabilizing Health Policy Implementation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-17 18:02:06","doi":"10.21203/rs.3.rs-5421440/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"519d5211-f2a7-4bcf-8e75-cb0b43b018a8","owner":[],"postedDate":"December 17th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-28T14:08:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-17 18:02:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5421440","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5421440","identity":"rs-5421440","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}