Journal of Distribution Science (유통과학연구)

Korea Distribution Science Association (한국유통과학회)
권호 표지
DOI QR코드

DOI QR Code

Distribution Performance of Practice Midwives Through Entrepreneurial Leadership, Motivation, Organizational Learning and Commitment

  • Received : 2022.12.27
  • Accepted : 2023.02.05
  • Published : 2023.02.28
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: to explore more deeply the variables of knowledge construction in influencing performance, through entrepreneurial leadership, motivation, organizational learning, and commitment to the performance of midwives in providing maximum service to patients and the community. Research design, data and methodology: using quantitative methods with hypothesis testing, data was obtained through direct visits and surveys to midwife practice locations through coordination with the Indonesian Midwives Association (IBI) regarding surveys to be carried out and needed. Results: there are 3 direct paths that have significant value. The path between the motivation variable to commitment was found to be significant, then the effect of organizational learning on commitment was found to be significant and finally the effect of the path variable from commitment to distribution performance was found to be significant. The indirect effect was found to be insignificant for the influence of entrepreneurial leadership through commitment to distribution performance, but different results found a significant indirect effect for the relationship between motivation through commitment to performance and organizational learning through commitment to distribution performance. Conclusion: there is a high commitment to the work of midwives, commitment as a good mediation in influencing distribution performance between organizational learning and work motivation.

Keywords

1. Introduction

Performance measures are carried out on various activities in the value chain in a corporate organization (Li et al., 2006) and the results are used as feedback and achievement information (Shin & Konrad, 2017) for adjustment. organizational planning and strategic activities (Oyemomi & Biswas, 2020). It is also often referred to as a powerful way to find out the achievement of targets, vision-mission, and organizational goals (Gagné, 2018; Pang & Lu, 2018). Currently, exploration and performance measures in health organizations are mostly carried out in care facilities (Woznyj et al., 2019), health services, medical and health personnel (Zeng et al., 2021), and hospitals. And now, performance measures in healthcare organizations and services are increasing due to the COVID-19 Pandemic (Wu et al., 2020).

The performance of midwives who open independent practice is the distribution of performance on entrepreneurial leadership, motivation, organizational learning and commitment.

Although several research findings have explained the importance of the performance of medical personnel and midwives, for example, measured the quality of midwife care through prenatal questionnaires and found the three best counseling components (client-midwife relationship, health education, and decision-making support). Antenatal care by midwives is influenced by personal background (age and status of employees), motivation, and facilities. Lewis et al. (2019) revealed a gap in the clinical performance of recently graduated doctors and suggested competency knowledge to improve the quality of care.

However, this discussion has not touched on organizational performance measures for midwives who open independent/entrepreneurial practices (Haugh, 2020) and are defined as business owners and leaders (Scheer, 2011). In addition, several previous findings state the importance of organizational distribution performance with minimal and small-sized employees coming from employee work motivation, entrepreneurial leadership, learning organizations and commitment. Thus, the emergence of maximum distribution performance from midwives who open independent practice may come from entrepreneurial leadership, motivation, organizational learning, and commitment.

The urgency in research on the distribution of the performance of midwives who practice independently is to examine how big the role of the variables of motivation, organizational learning, entrepreneurial leadership and commitment of midwives is to achieve success. This is because midwives who practice independently, play a role as leaders who must have an entrepreneurial spirit, where their leadership as an entrepreneur leader has a high contribution to society so that they can create jobs, can improve economic life, reduce unemployment and poverty, and empower people and society.

This study aims to conduct a more in-depth exploration of the variables of knowledge construction that have developed so far in influencing performance, through entrepreneurial leadership, motivation, organizational learning, and commitment to the distribution performance of midwives in providing maximum service to patients and the community. Because the midwifery profession is a noble profession and is the spearhead of the safety of the birth process of mothers and babies. In addition, this study also determines the commitment variable as a mediating variable from the relationship construction research. By examining several items in this study, it is hoped that they can contribute to knowledge about improving the distribution performance of midwives and promoting the development of distribution performance and health services in practice midwives.

2. Literature Review

A midwife who practices independently, is an entrepreneur. Where Entrepreneurs (entrepreneurs) are people who have the courage to take risks to open a business on various occasions. Having the courage to take risks means having an independent mentality and daring to start a business, without being overwhelmed by fear or anxiety even in uncertain conditions. Entrepreneurial spirit (entrepreneurship) is one of the requirements that must be possessed by every organizational leader. Entrepreneurship in the leadership of an organization gives its own color to the organization that wants to progress and develop, is not apathetic and is always confident in a change which is something that absolutely happens and must be faced with a sense of full responsibility and confidence. Leadership combined with an entrepreneurial spirit will produce a quality organization that is dynamic and accountable.

Theories that support this research are about entrepreneurial leadership, motivation, organizational learning and the theory of commitment, can be shown in the following table.

3. Methodology and Hypotheses

3.1. Procedure and Subject

Information in this study was obtained through visits and surveys directly to the location of the practice of midwives. However, previously coordination had been carried out with the administrators of the Indonesian Midwives Association (IBI) regarding the survey to be conducted to find the information needed in this study. In each visit and survey, the midwives will be interviewed and given a questionnaire about entrepreneurial leadership, motivation, organizational learning, commitment, and distribution performance of midwives. It took 4 months to collect all the data and the research team took 1 - to 2 hours on each visit. The population in this study was assigned to midwives who had opened the independent practice and the sample collection method was simple random sampling with the provision that the minimum number of samples was 100 respondents (Hair et al., 2014).

3.2. Hypothesis

Leading employees and companies have challenges for company founders because companies are constantly moving and experiencing growth. An importance of a contextual approach to entrepreneurial leadership to adjust leadership behaviour according to internal and external factors in the company. Thus, when midwives as practice business owners and business leaders are able to apply good entrepreneurial leadership behaviours, it may lead to a high commitment from staff and nurses who help their work.

H1a: Midwife's entrepreneurial leadership style will increase commitment

In healthcare organizations, the entrepreneurial leadership style presents an important challenge in the development of entrepreneurial behaviour (Richter et al., 2019), promoting collective entrepreneurship (Haase & Franco, 2020). Thus, the leadership style applied by midwives in their practical activities may be able to improve their performance and that of their staff.

H1b: The midwife's entrepreneurial leadership style is able to improve her distribution performance.

Research on employee motivation specifically highlights two types of driving factors, namely: intrinsic and extrinsic (Turner, 2017; Bassous, 2015). Job involvement through internal motivation supports the emergence of job commitment, and Organizations that promote commitment will be able to transmit the hopes and desires of health workers (Marchal & Kegels, 2008). Therefore, the higher the organizational ability of midwives to mobilize and sustain their efforts towards organizational goals, the more likely it will affect their work commitment.

H2a: The midwife's work motivation can increase her work commitment.

The achievement of organizational goals reflects the high motivation of individuals in completing tasks and their expectations. An assessment of employee work motivation will result in improved organizational performance (Lee & Raschke, 2016) and when the midwife can understand the motivational drive in carrying out her work, she will likely be able to complete each task and provide the best service to her patients.

H2b: Motivation will improve the distribution performance of midwives

Notion of organizational learning as a way for companies to build, complete, and organize knowledge in their routine activities and including their culture, to be able to adapt and develop organizational efficiency with the aim of increasing the use of the broad skills of their workforce. In the context of health organizations, support for health services and health workers, including nurses, doctors, midwives, and pharmacists, organizational learning measures are widely used to find out about improving health services, professionalism (Darban et al., 2020), and organizational performance (Hartstein & Yackel, 2021). The organization's willingness to learn and adapt for the sake of developing efficiency and work skills implies an acceptance of the supporting factors. Thus, the better the organization of midwives in organizing knowledge and carrying out their work routines, the more likely they will be able to positively increase their work commitment.

H3a: Learning Organization will increase the work commitment of midwives

The application of learning organizations provides opportunities for individuals to continue to grow and develop in their work environment and contributes directly to organizational effectiveness (Shin & Konrad, 2017; Popper & Lipshitz, 2000) and these findings are also conveyed in health care settings. Health organizations that take steps to develop learning opportunities and autonomy in medical action form a culture and work climate that leads to organizational development and performance (Ravichandran & Mishra, 2018). Thus, when midwives are able to emphasize change and learning in finding new ways to support their work routines, they may experience an increase in organizational performance.

H3b: Learning Organizations can improve the distribution performance of midwives

Organizational commitment as a measure of the level of employees in attaching importance to a particular organization and maintaining its goals in order to remain a member of the organization. Commitment is a binding force on every individual behaviour related to achieving organizational targets. Within the scope of midwifery services and practice, commitment issues relate to the delivery of responsive and high-quality services (Brooks & Swailes, 2002). Several previous findings state that commitment has a positive relationship with organizational performance (Berberoglu, 2018; Khunsoonthornkit & Panjakajornsak, 2018; Elorza et al., 2011). Thus, when the midwife is able to demonstrate a high work commitment, the possibility of providing health services to patients and the community will be higher.

H4a: Midwives who promote high commitment will affect their distribution performance.

Some previous literature shows that there are other variables that can support increased performance, for example, Ribeiro et al. (2018) revealed that leader authenticity promotes employees' affective commitment, which in turn improves their performance. Khin and Ho (2018) in their study show digital innovation to be a strong mediating variable in improving company performance. Quality improvement practices are good mediators between people and organizational performance (Habtoor, 2016). Robbins (1996) revealed that the relationship between organizational learning and performance was not very significant and support from other variables allowed to strengthen the relationship. And previous literature suggested the commitment variable as a strong mediating variable in improving performance (Story & Cantanheira, 2019; Hendri; 2019; Raineri, 2017), Thus, when midwives open their practice to providing high-quality services to patients through their leadership style, motivation and learning organizations may be promoted by their high work commitment.

M1: Entrepreneurial leadership promoted by work commitment will in turn improve midwives' performance

M2: The higher the motivation shown through work commitment will in turn improve the distribution performance of the midwife

M3: Organizational learning capabilities through work commitment will in turn improve the distribution performance of midwives

3.3. Research Construction

There are several general constructs used in this study to measure the relationship of latent constructs between variables, namely: entrepreneurial leadership (a total of 15 questions), motivation (a total of 9 questions), learning organization (a total of 13 questions), commitment (a total of 8 questions) and distribution performance. (a total of 18 questions). Each item is measured using a scale and starts with the number 5 which is associated with "Strongly Agree" and the number 1 is interpreted as "Strongly Disagree”. The process of validity on each instrument and panel used refers to previous references and the experience of current researchers

4. Result

The research results are presented in descriptive form for each variable item (see Appendix A) in describing the population and numerical measures are used to determine the features of the data set (Fisher & Marshall, 2009). There are several items that need to be explained about the overall data, namely: frequency distribution and mean (Shavelson, 1988) variable. The mean value of each variable and indicator item is obtained by dividing the class interval criteria into 5 and referring to the Likert scale points. Interval class values > 4.2 – 5.0 are interpreted as “Very High” and interval class values 1 – 1.8 are interpreted as “Very Low”. In the entrepreneurial leadership variable item (X1), the Mean value was found to be 3.82 and the highest choice was found at point 14 about inspiring attitudes towards subordinates at 4.09. Furthermore, the mean value for the motivation variable (X2) is 3.77 and the highest item is at point 5 about maintaining good relations with colleagues. In the organizational learning variable item (X3), the mean value is 3.78 and the highest item is found at point 6 regarding the similarity of work vision to develop the organization. Furthermore, for the commitment variable (Y1), the highest choice was found to be loyal to the midwife in doing work with a mean value of 3.89, and for the last variable, namely commitment (Y2), the highest choice was in providing information to the public about pregnancy, health, nutrition, family planning (KB). and immunizations.

Furthermore, data analysis was determined to confirm the relationship between the construction variables. The PLS-SEM method was chosen because the data distribution was not normal and had few assumptions on the limited amount of data (Hair et al., 2019). In addition, another provision to support a strong estimation value from this analysis is to set a minimum number of samples that must be equal to the number when multiplied by the number of structural paths in the variable latent construct (Hair et al., 2014). The number of samples specified in this study is one hundred and can be said to meet the requirements.

4.1. Measurement Model

The validation of dimensions and items on the factor load value can be seen by looking at the final CFA value with a threshold value of 0.7 (Hair et al., 2019). In order to obtain a close relationship between the items to be measured, it is necessary to remove the item value below the specified value in order to obtain the appropriate construction (Hair et al., 2014). Because this study includes descriptive statistics and confirmatory research, the significance value in the evaluation is not critical and is not affected by the eligibility criteria (Amrhein et al., 2019). Table 1 shows the modification of the measurement model and the value of the latent variable that does not match will be deleted and not continued to the next analysis. Loading factor value > 0.5 and AVE value > 0.5 (reference). In addition, the Composite Reliability value shows a value > 0.700 (Reliable) and thus the value of the outer model is validated.

Table 1: Previous Research

OTGHB7_2023_v21n2_91_t0001.png 이미지

Source: All Literature

To obtain the appropriate discriminant validity, it can be seen by looking at the square root value of the mean-variance (AVE) which must be higher than the correlation value of the other latent variables (Kock & Lynn, 2012). In addition, the cross-loading value also has a value > 0.70 in one construction variable. The results in table 2 show that the item value of the construction has a higher value than the latent construction of each other item and this condition meets discriminant validity.

Table 2: Model Measurement Results

OTGHB7_2023_v21n2_91_t0003.png 이미지

The results of the reflective test of the construction variables can be seen by looking at the square root value of the mean-variance (AVE) which must be higher than the other construction variables and as shown in table 3 the AVE value of each square has a higher value. compared to other constructions so that it can be concluded constructively and reflectively for the discriminant conditions to be met.

Table 3: Cross Loading Construction Variables

OTGHB7_2023_v21n2_91_t0002.png 이미지

Table 4: Reflective Construction of The AVE Value of The Construction Variable

OTGHB7_2023_v21n2_91_t0004.png 이미지

4.2. Testing Model Relationships and Hypotheses

The results shown in table 5 and Figure 1 regarding the analysis of the direct relationship of each construction variable show varying results, such as entrepreneurial leadership on commitment which was not found to be significant (β = 0.220, t = 1.828, ρ< 0.068), but different things were found for The direct relationship between motivation (β = 0.206, t = 2.167, ρ< 0.031) and organizational learning (β = 0.354, t = 3.709, ρ< 0.000) on commitment was found to be significant. For other direct relationships of leadership variables on distribution performance (β = 0.012, t = 0.212, ρ< 0.832), it was found not significant and the same results were also obtained for other variables, namely motivation (β = 0.011, t = 0.206, ρ < 0.837) and organizational learning (β = 0.036, t = 0.059, ρ < 0.602) which is not significant to distribution performance. Finally, the direct relationship of commitment was found to be significant (β = 0.902, t = 24.208, ρ< 0.000) on distribution performance.

OTGHB7_2023_v21n2_91_f0001.png 이미지

Figure 1: Model Test Results

Table 5: Direct Relationship between Variables and Hypothesis Testing

OTGHB7_2023_v21n2_91_t0005.png 이미지

Furthermore, the test results for the indirect relationship of construction variables as shown in table 6 which obtained different results, the relationship of entrepreneurial leadership through commitment to distribution performance (β = 0.203, t = 1.893, ρ< 0.067) obtained insignificant results and the motivation relationship through commitment to distribution performance (β = 0.190, t = 2.142, ρ< 0.000) obtained significant results and the same thing was also found in the relationship of organizational learning through commitment to distribution performance (β = 0.354, t = 3.614, ρ< 0.000) showed the effect of significant.

Table 6: The Results of Testing the Indirect Relationship between Variables

OTGHB7_2023_v21n2_91_t0006.png 이미지

The results of the tests carried out through the bootstrap procedure were carried out to determine the direct relationship of the construction variables by looking at the path coefficient value and the t value. In general, there are 3 paths that have a significant value. The path between the motivation variable to commitment (H2a) was found to be significant (β = 0.206, t = 2.167, < 0.031), then the relationship between organizational learning and commitment (H3a) was found to be significant (β = 0.354, t = 3.709, < 0.000) and finally the path relationship of the commitment variable to distribution performance (H4a) was found to be significant (β = 0.902, t = 24.208, < 0.000).

The results of R2 presented in Figure 1 of the relationship between entrepreneurial leadership, motivation and organizational learning get a value of 26.5% and the relationship between commitment to performance contributes a value of 83.5%. Furthermore, the indirect effect was found to be insignificant for the relationship of entrepreneurial leadership through commitment to performance, but different results were found in the indirect relationship of motivation through commitment to performance and organizational learning through commitment to performance which was found to be significant. Finally, Table 7 presents the test results of all research hypotheses.

Table 7: Hypothesis Testing Results

OTGHB7_2023_v21n2_91_t0007.png 이미지

5. Discussion

5.1. Finding Research

Consistent with several previous findings, where commitment is the best predictor of distribution performance (H4a), organizational learning on commitment (H3a), and finally motivation on commitment (H2a). Previous findings explain the magnitude of the loyalty shown by health workers through a commitment not only to the welfare of the people they care about but also to the welfare of society through actions to improve the distribution performance of the health system (Wilson et al., 2020; Berberoglu, 2018). Where the findings in this study explain that high commitment can affect the distribution performance of midwives and this is shown by midwives in carrying out their work with feelings of pleasure, choice of heart so that there are no regrets with these choices, and competency development is the best choice in supporting their profession. The improvement in the distribution performance of midwives may be due to the routine work carried out with pleasure, choice, and the desire to continuously improve skills in providing the best service to their patients. Furthermore, other findings from organizational learning on the commitment of midwives were found in the decision-making made by midwives carried out with consideration, supporting the aspirations of nurses and midwifery staff, and providing more opportunities for nurses and midwifery staff to continue to improve their abilities. Koon et al. (2020) explain that assistance to nurses and midwifery staff by midwives in service to the community can offer a workforce development approach and support their work. Finally, the relationship shown in motivation to commitment is explained in the choice of midwives who work according to their field of expertise, job security guarantees, and organizational support, as well as good relations with professional colleagues. The possible explanation of this finding is the emergence of strong work motivation from midwives because personal competence is in accordance with the demands of their work. In addition, midwives also have legal protection when carrying out their work and the relationship between midwives can increase the desire to continue to work well. Where these findings support the findings of Bloxsome et al. (2020) that feelings of mutual support in work and making a difference 'with women', and passing on skills, knowledge, and wisdom to the next generation are the reasons that emerge for the choice to become a midwife. For items, the distribution performance of midwives is shown through being active in providing counselling to the community, monitoring the development of the baby's birth, checking patient blood pressure, maintaining cleanliness during examinations, and wearing protective equipment while working.

Entrepreneurial leadership was not found to have an effect on commitment (H1a) and distribution performance (H1b), where the findings of Drennan et al. (2007) can explain well the effect and support this finding where the number of nurses, midwives, and health visitors who act as entrepreneurs is very small and reflect evidence of entrepreneurial activity inductively constructed by very low status and employment levels. Another direct relationship between motivation has no effect on distribution performance (H2b). Although in a previous study Fernandez et al. (2017) explained that personal motivation was identified as the main driver of performance, in the context of this study, external motivation was found to be more dominant. Lastly is the insignificant relationship of organizational learning to distribution performance (H3b). Although Reineck (2002) suggested the importance of general characteristics of learning organizations in retaining talented staff, the element of characteristics such as critical thinking was an important finding in this study.

The next result is the indirect relationship of the commitment variable and there is two strong mediation of the relationship between motivation and organizational learning on distribution performance. The commitment was found to have a significant effect on the relationship between motivation to distribution performance and organizational learning to distribution performance. These results indicate that in order to improve their services to patients and the community, midwives need to pay attention to work motivation, support from learning organizations, and commitment. The last is the insignificant mediation of entrepreneurial leadership on distribution performance through commitment, it needs serious attention from midwives about the best entrepreneurial leadership model so that work and organizational management can run well.

5.2. Implications

There are several interesting implications of research for academics and promotion to midwives who open practice, namely: First, a high commitment to work is the best predictor in influencing the distribution performance of midwives and this is shown through the implementation of work carried out by midwives with feelings of pleasure, a choice of heart and competency development to support their profession. Second, organizational learning has a significant effect on work commitment through thoughtful decision making, supporting aspirations, and improving the abilities of nurses and health staff. Midwives need to consider the best learning model to support their work through the evidence in this study. Third, motivation has a significant effect on commitment, through job demands according to the field of expertise, job security guarantees and organizational support, as well as good relations with professional colleagues. There are 2 intrinsic motivations and 1 extrinsic motivation from these findings and midwives need to take careful steps in maintaining their activities so far. Fourth, commitment is a good mediation of the relationship of motivation to distribution performance and organizational learning to distribution performance.

Theoretical Implications, means: performance distribution in terms of entrepreneur leadership, motivation, organizational learning, and commitment, is expected to: have an impact on the development of knowledge, especially the enrichment of theory implementation, more specifically about human resource development, motivation theory, leadership theory, organizational behaviour theory, learning organizations, which are integrated with the theory of commitment and distribution of performance, provide solutions to overcome problems that occur related to work motivation, leadership style, learning organization, commitment and performance distribution, as a contribution of thought to organizations and practitioners in Indonesia in the context of making leadership decisions in order to be able to provide motivation to members/subordinates, and provide opportunities for organizations to be able to learn continuously in a better direction through high commitment so as to improve performance distribution.

As practical Implications, the results of this study certainly make a positive contribution to institutional organizations in Indonesia so that they always pay attention to and increase motivation so that employee commitment will be maintained and performance distribution can be increased. Provision of learning opportunities through learning organizations must be improved both individual employee abilities, team learning so that later it will have an impact on increasing commitment and distribution of employee performance as a whole. The results of this study can provide an understanding of the importance of applying the concepts of motivation, existing leadership styles, learning organizations and increased commitment and distribution of performance in the development of existing human resources.

Thus, this research has an important role for Indonesia. As an important and valuable asset that can be used to solve existing problems for relevant stakeholders. The more data information obtained and owned, the more valuable it will be. For readers, the results of this research value can be used as a decision-making policy for the public. The distribution of performance in terms of entrepreneur leadership, motivation, organizational learning, and commitment greatly influences the ability of midwives to practice independently in order to support public health efforts down to the lowest level. Furthermore, to support healthy communities in Indonesia.

5.3. Limits and Future Framework

There are two general limitations that exist in this study, First, this research includes descriptive statistics and confirmatory research using pre-existing research instruments on a sample of midwives who open independent practice, so the findings of this study may not apply to other market segments and locations different. Thus, it is possible to replicate this study in specific locations and places. Second, the profession of midwife is found in practice, health facilities, and hospitals, by examining the sample of midwives who open independent practice, it is hoped that they will be able to answer the general needs of this research.

This research has several frameworks for thinking about the future, namely: First, increasing the number of research samples in the entire midwifery profession. Second, further examining some of the relationships between the construction variables in this study can be done by developing the causal factors. Third, the factors that can support the distribution performance of midwives can be confirmed more deeply through the evidence in this project. Fourth, further, examine learning knowledge through critical thinking on the work of midwives.

Variables in this study can be done by developing the causal factors. Third, the factors that can support the distribution performance of midwives can be confirmed more deeply through the evidence in this project. Fourth, further, examine learning knowledge through critical thinking on the work of midwives.

6. Conclusion

Commitment to be the best support for the distribution performance of midwives is found in the work done because of feelings of pleasure, choice of heart, and competency development, while other influences from organizational learning and motivation it is found that it can increase the work commitment of midwives. In addition, the provision of commitment as a mediating variable is found in the relationship between work motivation and organizational learning promoted by work commitment which in turn can improve the distribution performance of practicing midwives. And for the midwife's distribution performance items described in outreach activities to the community, monitoring the development of the birth of a baby, checking patient blood pressure, maintaining cleanliness during examinations, and wearing protective equipment while working the number of research samples in the entire midwifery profession. Second, further examining some of the relationships between the construction variables in this study can be done by developing the causal factors. Third, the factors that can support the distribution performance of midwives can be confirmed more deeply through the evidence in this project. Fourth, further, examine learning knowledge through critical thinking on the work of midwives.

CRediT authorship contribution statement

Endang Suswati: Conceptualization, Methodology, Data Analysis, Writing the original draft.

Declaration of Competing Interest

The author declares that there is no potential conflict of interest related to this manuscript's research, authorship, and publication.

References

  1. Abid, T., Altaf, M., Yousaf, U., & Bagram, M. (2012). Entrepreneur as an authentic leader: A study of small and medium sized enterprises in Pakistan. Management Science Letters, 2(7), 2355-2360. doi: https://doi.org/10.5267/j.msl.2012.08.007 
  2. Amrhein, V., Trafimow, D., & Greenland, S. (2019). Inferential statistics as descriptive statistics: There is no replication crisis if we don't expect replication. The American Statistician, 73(1), 262-270. doi: https://doi.org/10.1080/00031305.2018.1543137 
  3. Barney, C. E. & Elias, S. M. (2010). Flex-time as a Moderator of The Job Stress-work Motivation Relationship: A Three Nation Investigation. Personal Review. 39(4), 487-502. doi: https://doi.org/10.1108/00483481011045434 
  4. Bassous, M. (2015). What are the factors that affect worker motivation in faith-based nonprofit organizations?. VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations, 26(1), 355-381. doi: https://doi.org/10.1007/s11266-013-9420-3 
  5. Berberoglu, A. (2018). Impact of organizational climate on organizational commitment and perceived organizational performance: empirical evidence from public hospitals. BMC health services research, 18(399), 1-9. doi: https://doi.org/10.1186/s12913-018-3149-z 
  6. Bloxsome, D., Bayes, S., & Ireson, D. (2020). I love being a midwife; it's who I am: A Glaserian grounded theory study of why midwives stay in midwifery. Journal of clinical nursing, 29(1-2), 208-220. doi: https://doi.org/10.1111/jocn.15078 
  7. Borghi, J., Lohmann, J., Dale, E., Meheus, F., Goudge, J., Oboirien, K., & Kuwawenaruwa, A. (2018). How to do (or not to do)... Measuring health worker motivation in surveys in low-and middle-income countries. Health policy and planning, 33(2), 192-203. doi: https://doi.org/10.1093/heapol/czx153 
  8. Brooks, I., & Swailes, S. (2002). Analysis of the relationship between nurse influences over flexible working and commitment to nursing. Journal of Advanced Nursing, 38(2), 117-126. doi: https://doi.org/10.1046/j.1365-2648.2002.02155.x 
  9. Cheng H., Niu M.-S., & Niu K.-H. (2014). Industrial cluster involvement, organizational learning, and organizational adaptation: An exploratory study in high technology industrial districts. Journal of Knowledge Management, 18(5), 971-990. doi: https://doi.org/10.1108/JKM-06-2014-0244 
  10. Chiva R., Ghauri P., & Alegre J. (2014). Organizational learning, innovation and internationalization: A complex system model. British Journal of Management, 25(4), 687-705. doi: https://doi.org/10.1111/1467-8551.12026 
  11. Darban, F., Rabori, R. M., Farokhzadian, J., Nouhi, E., Sabzevari, S., & Safarzai, E. (2020). Organizational learning: The missing link to promote nurses' professional self-efficacy. Creative Nursing, 26(1), 40-47. doi: https://doi.org/10.1891/1078-4535.26.1.e40 
  12. Drennan, V., Davis, K., Goodman, C., Humphrey, C., Locke, R., Mark, A., Murray, S. F., & Traynor, M. (2007). Entrepreneurial nurses and midwives in the United Kingdom: an integrative review. Journal of Advanced Nursing, 60(5), 459-469. doi: https://doi.org/10.1111/j.1365-2648.2007.04458.x 
  13. Elorza, U., Aritzeta, A., & Ayestaran, S. (2011). Exploring the black box in Spanish firms: the effect of the actual and perceived system on employees' commitment and organizational performance. The International Journal of Human Resource Management, 22(7), 1401-1422. doi: https://doi.org/10.1080/09585192.2011.561956 
  14. Fernandez, R. S., Sheppard-Law, S., & Manning, V. (2017). Determining the key drivers and mitigating factors that influence the role of the Nurse and/or Midwife Consultant: a cross-sectional survey. Contemporary Nurse, 53(3), 302-312. doi: https://doi.org/10.1080/10376178.2017.1338525 
  15. Fisher, M. J., & Marshall, A. P. (2009). Understanding descriptive statistics. Australian critical care, 22(2), 93-97. doi: https://doi.org/10.1016/j.aucc.2008.11.003 
  16. Gagne, M. (2018). From strategy to action: transforming organizational goals into organizational behavior. International Journal of Management Reviews, 20(S1), S83-S104. doi: https://doi.org/10.1111/ijmr.12159 
  17. Haase, H., & Franco, M. (2020). Leadership and collective entrepreneurship: evidence from the health care sector. Innovation: The European Journal of Social Science Research, 33(3), 368-385. doi: https://doi.org/10.1080/13511610.2020.1756231 
  18. Habtoor, N. (2016). Influence of human factors on organisational performance: quality improvement practices as a mediator variable. International Journal of Productivity and Performance Management, 65(4), 460-484. doi: https://doi.org/10.1108/IJPPM-02-2014-0016. 
  19. Hair, J. F., Sarstedt, M., Hopkins, L., & Kuppelwieser, V. G. (2014). Partial least squares structural equation modeling (PLS-SEM): An emerging tool in business research. European business review, 26(2), 106-121. doi: https://doi.org/10.1108/EBR-10-2013-0128. 
  20. Hair, J. F., Sarstedt, M., & Ringle, C. M. (2019). Rethinking some of the rethinking of partial least squares. European Journal of Marketing, 53(4),566-584. doi: https://doi.org/10.1108/EJM10-2018-0665. 
  21. Hartstein, B., & Yackel, E. (2021). The United States Army Medical Command, becoming a learning organization. The Learning Organization, 28(3),283-297. doi: https://doi.org/10.1108/TLO-03-2020-0038 
  22. Haugh, H. (2020). Call the midwife! Business incubators as entrepreneurial enablers in developing economies. Entrepreneurship & Regional Development, 32(1-2), 156-175. doi: https://doi.org/10.1080/08985626.2019.1640480 
  23. Hendri, M. I. (2019). The mediation effect of job satisfaction and organizational commitment on the organizational learning effect of the employee performance.International Journal of Productivity and Performance Management, 68(7), 1208-1234. doi: https://doi.org/10.1108/IJPPM-05-2018-0174 
  24. Imran, R., & Aldaas, R. E. (2020). Entrepreneurial leadership: A missing link between perceived organizational support and organizational performance. World Journal of Entrepreneurship, Management and Sustainable Development, 16(4), 377-388. doi: https://doi.org/10.1108/WJEMSD-10-2019-0077 
  25. Khin, S., & Ho, T. C. (2018). Digital technology, digital capability and organizational performance: A mediating role of digital innovation. International Journal of Innovation Science, 11(2), 177-195. doi: https://doi.org/10.1108/IJIS-08-2018-0083. 
  26. Khunsoonthornkit, A., & Panjakajornsak, V. (2018). Structural equation model to assess the impact of learning organization and commitment on the performance of research organizations. Kasetsart Journal of Social Sciences, 39(3), 457-462. doi: https://doi.org/10.1016/j.kjss.2018.07.003. 
  27. Kock, N., & Lynn, G. (2012). Lateral collinearity and misleading results in variance-based SEM: An illustration and recommendations. Journal of the Association for information Systems, 13(7), 546-580.  https://doi.org/10.17705/1jais.00302
  28. Koon, A. D., Hoover, J., Sonthalia, S., Rosser, E., Gore, A., & Rao, K. D. (2020). In-service nurse mentoring in 2020, the year of the nurse and the midwife: learning from Bihar, India. Global health action, 13(1823101), 1-5. doi: https://doi.org/10.1080/16549716.2020.1823101 
  29. Kuo, Y. K. (2013) Organizational in an intense competition environment. Industrial Management & Data Systems, 113(1), 39-56. doi: https://doi.org/10.1108/02635571311289656 
  30. Lee, M. T., & Raschke, R. L. (2016). Understanding employee motivation and organizational performance: Arguments for a set-theoretic approach. Journal of Innovation & Knowledge, 1(3), 162-169. doi: https://doi.org/10.1016/j.jik.2016.01.004 
  31. Lewis, T. P., Roder-DeWan, S., Malata, A., Ndiaye, Y., & Kruk, M. E. (2019). Clinical performance among recent graduates in nine low-and middle-income countries. Tropical Medicine & International Health, 24(5), 620-635. doi: https://doi.org/10.1111/tmi.13224 
  32. Li, S., Ragu-Nathan, B., Ragu-Nathan, T. S., & Rao, S. S. (2006). The impact of supply chain management practices on competitive advantage and organizational performance. Omega, 34(2), 107-124. doi: https://doi.org/10.1016/j.omega.2004.08.002 
  33. Marchal, B., & Kegels, G. (2008). Focusing on the software of managing health workers: What can we learn from high commitment management practices?. The International journal of health planning and management, 23(4), 299-311. doi: https://doi.org/10.1002/hpm.882 
  34. Miao, Q., Eva, N., Newman, A., & Cooper, B. (2019). CEO entrepreneurial leadership and performance outcomes of top management teams in entrepreneurial ventures: The mediating effects of psychological safety. Journal of Small Business Management, 57(3), 1119-1135. doi: https://doi.org/10.1111/jsbm.12465 
  35. Mo, S. (2011). An exploratory study of intrinsic & extrinsic motivators and student performance in an auditing course. American Journal of Business Education (AJBE), 4(2), 19-26. doi: https://doi.org/10.19030/ajbe.v4i2.3558 
  36. Oyemomi, D., & Biswas, W. (2020). Articulating the value of human resource planning (HRP) activities in augmenting organizational performance toward a sustained competitive firm. Journal of Asia Business Studies, 14(1), 62-90. doi: https://doi.org/10.1108/JABS-01-2019-0025 
  37. Pang, K., & Lu, C. S. (2018). Organizational motivation, employee job satisfaction and organizational performance: An empirical study of container shipping companies in Taiwan. Maritime Business Review, 3(1),36-52. doi: https://doi.org/10.1108/MABR-03-2018-0007 
  38. Popper, M., & Lipshitz, R. (2000). Organizational learning: Mechanisms, culture, and feasibility. Management Learning, 31(2), 181-196. doi: https://doi.org/10.1177/1350507600312003 
  39. Raineri, A. (2017). Linking human resources practices with performance: the simultaneous mediation of collective affective commitment and human capital. The International Journal of Human Resource Management, 28(22), 3149-3178. doi: https://doi.org/10.1080/09585192.2016.1155163 
  40. Ravichandran, N., & Mishra, R. (2018). Toward building HR competencies: a shift from the non-learning toward the learning organization. International Journal of Healthcare Management, 11(3), 233-238. doi: https://doi.org/10.1080/20479700.2017.1336835 
  41. Reineck, C. (2002). Create a learning organization. Nursing Management (Springhouse), 33(10), 42-43.  https://doi.org/10.1097/00006247-200210000-00019
  42. Renko, M. (2017). Entrepreneurial leadership. Forthcoming in Nature of Leadership (3rd Ed.), by David V. Day and John Antonakis. SAGE Publications. 
  43. Ribeiro, N., Gomes, D., & Kurian, S. (2018). Authentic leadership and performance: the mediating role of employees' affective commitment. Social Responsibility Journal, 14(1), 213-225. doi: https://doi.org/10.1108/SRJ-06-2017-0111 
  44. Richter, S. A., Santos, E. P. D., Kaiser, D. E., Capellari, C., & Ferreira,G. E. (2019). Being an entrepreneur in nursing: challenges to nurses in a strategic leadership position. Acta paulista de enfermagem, 32(1), 46-52. doi: https://doi.org/10.1590/1982-0194201900007 
  45. Robbins, S. P. (1996). Organizational behavior. Englewood Cliffs. NewJersey: Prentice Hall International Ltd.
  46. Scheer, S. (2011). The entrepreneur as business leader: cognitive leadership in the firm. Strategic Direction, 27(6), 1-7. doi: https://doi.org/10.1108/sd.2011.05627fae.002 
  47. Shavelson, R. J. (1988). Statistical reasoning for the behavioral sciences (2nd Ed.). Needham Heights, MA: Allyn and Bacon. 
  48. Shin, D., & Konrad, A. M. (2017). Causality between high-performance work systems and organizational performance. Journal of management, 43(4), 973-997. doi: https://doi.org/10.1177/0149206314544746 
  49. Story, J. S., & Castanheira, F. (2019). Corporate social responsibility and employee performance: Mediation role of job satisfaction and affective commitment. Corporate Social Responsibility and Environmental Management, 26(6), 1361-1370. doi: https://doi.org/10.1002/csr.1752 
  50. Turner, A. (2017). How does intrinsic and extrinsic motivation drive performance culture in organizations?. Cogent Education, 4(1337543), 1-5. doi: https://doi.org/10.1080/2331186X.2017.1337543 
  51. Wilson, R. L., Carryer, J., Dewing, J., Rosado, S., Gildberg, F., Hutton, A., Johnson, A., Kaunonen, M., & Sheridan, N. (2020). The state of the nursing profession in the International Year of the Nurse and Midwife 2020 during COVID-19: A Nursing Standpoint. Nursing Philosophy, 21(:e12314), 1-3. doi: https://doi.org/10.1111/nup.12314 
  52. Woznyj, H. M., Heggestad, E. D., Kennerly, S., & Yap, T. L. (2019). Climate and organizational performance in long-term care facilities: The role of affective commitment. Journal of Occupational and Organizational Psychology, 92(1), 122-143. doi: https://doi.org/10.1111/joop.12235 
  53. Wu, A. W., Buckle, P., Haut, E. R., Bellandi, T., Koizumi, S., Mair, A., Ovretveit, J., Power, C., Sax, H., Thomas, E. J., Newman-Toker, D., & Vincent, C. (2020). Supporting the emotional well-being of health care workers during the COVID-19 pandemic. Journal of Patient Safety and Risk Management, 25(3), 93-96. doi: https://doi.org/10.1177/2516043520931971 
  54. Zeng, Z., Wang, X., Bi, H., Li, Y., Yue, S., Gu, S., & Xiang, G. (2021). Factors that influence perceived organizational support for emotional labor of Chinese medical personnel in Hubei. Frontiers in Psychology, 12(684830), 1-8. doi: https://doi.org/10.3389/fpsyg.2021.684830 
  55. Zimmerer, T. W., Scarborough, N. M., & Wilson, D. (2008). Essential of entrepreneurship and small business management (5th Ed.). Pearson Education, Inc., Upper Saddle River, New Jersey.