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Work engagement as a key driver of quality of care: a study with midwives

Yseult Freeney (Dublin City University Business School, Dublin, Ireland)
Martin R. Fellenz (School of Business, Trinity College, Dublin, Ireland)

Journal of Health Organization and Management

ISSN: 1477-7266

Article publication date: 14 June 2013




Against a backdrop of increased work intensification within maternity hospitals, the purpose of this paper is to examine the role of work engagement in the quality of care delivered to patients and in general health of the midwives delivering care, as reported by midwives and nurses.


Quantitative questionnaires consisting of standardised measures were distributed to midwives in two large maternity hospitals. These questionnaires assessed levels of work engagement, supervisor and colleague support, general health and quality of care.


Structural equation modelling analysis revealed a best‐fit model that demonstrated work engagement to be a significant partial mediator between organisational and supervisor support and quality of care, and as a significant predictor of self‐reported general health. Together, supervisor support, social support and organisational resources, mediated by work engagement, explained 38 per cent of the variance in quality of care at the unit level and 23 per cent of variance in general health among midwives (χ2(67)=113; p<0.01, CFI=0.961, RMSEA=0.06).

Research limitations/implications

The study is limited in that it uses self‐report measures of quality of care and lacks objective indicators of patient outcomes. The cross‐sectional design also does not allow for causal inferences to be drawn from the data.

Practical implications

This study provides evidence for the links between individual levels of work engagement and both health and self‐reports of unit level quality of care. The results support the importance of health services organisations and managers deploying organisational resources to foster employee work engagement. The results also highlight the significant role of the immediate nurse manager and suggest training and development for such roles is a valuable investment.


These results are the first to link work engagement and performance in health care contexts and point to the value of work engagement for both unit performance and for individual employee well‐being in health organisations.



Freeney, Y. and Fellenz, M.R. (2013), "Work engagement as a key driver of quality of care: a study with midwives", Journal of Health Organization and Management, Vol. 27 No. 3, pp. 330-349.



Emerald Group Publishing Limited

Copyright © 2013, Emerald Group Publishing Limited

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