3.1. Activity in the Literature on Organisational Commitment and Healthcare
The 448 documents that form the WoS sample for our research were published between 1992 and 2020 (
Figure 2). The annual publication rate describes two distinct trends. From 1992 to 2006, scientific production in this field is not very numerous; it is from 2006 onwards, and possibly driven by the 2006 World Health Organisation report [
19], that scientific production describes an upward trend that continues to the present day.
The 448 documents in our sample included in the WoS database were written by 1546 authors. Despite the large size of the selected sample, there are no authors with a much higher number of articles than the rest, which gives an idea of the breadth and diversity of areas of knowledge that have addressed organisational commitment in health centres.
Table 2 shows the authors who have published the most research, the dates of their first and last work on this topic, and the number of times they have been cited from other publications included in WoS.
From the sample obtained in this research, we can highlight the documents published by Laschinger, HK or Cummings, G, which include literature review articles [
67,
68,
69,
70] and works related to management and commitment [
49,
55], job satisfaction [
71], working conditions [
7,
72,
73], and consequences in the field of healthcare institutions. We can also highlight Shamian, J. who, despite having participated in only three articles in this sample, obtained a significant number of citations, where the document “
Nurse turnover: A literature review” [
74], in which Laschinger, HK also participates, stands out. Within the set of selected articles, the following research could be highlighted for the citations received and for being precursors of this topic: in 1992, Richardsen et al. published “
Occupational demands, psychological burnout and anxiety among hospital personnel in Norway” [
75] with 52 citations received; in 1995, Gerhon et al. published “
Compliance with universal precautions among health-care workers at 3 regional hospitals” [
76] with 174 citations received; and also in 1995, Mcneese-Smith published “
Job-satisfaction, productivity, and organisational commitment—the result of leadership” [
23], which was cited 69 times.
The journals with the highest presence of research on organisational commitment and healthcare in the sample are shown in
Table 3. The 448 documents analysed were published in 274 different journals. It should be noted that most of the journals that have dealt with the subject matter of this research are related to health sciences; i.e., they are specialised publications in health, nursing, and other healthcare fields, although there are also others related to management
The publications in the sample analysed come from a variety of countries around the world. In fact, most of the articles deal with case studies on health centres and their workers, so that the sample allows us to investigate the different aspects related to human resources in health centres. In order to present in a simple way the countries where scientific production in this field has been most numerous, the residence of the first author has been taken as a reference. This avoids counting errors in cases where articles are presented with several authors of the same nationality, which would lead to an incorrect classification. Of the 53 countries represented, the North American nations stand out above the rest: the USA with 128 manuscripts and Canada with 47. At some distance, Turkey appears with 28, Australia with 20, the UK and China with 18, Iran and the Netherlands with 17, Taiwan with 15, and Finland with 14 articles published in WoS.
Research on Organisational Engagement and Healthcare is characterised by many different authors from all parts of the globe, although with a greater presence in North American countries. The manuscripts are mainly case study oriented and have been published mainly in healthcare-oriented journals. The following is a more detailed analysis of the topics most present in the publications of the sample obtained.
3.3. Longitudinal Analysis
Once it has been established that there is a wide margin of development in the literature relating organisational commitment (OC) and healthcare (HC), the next objective is to analyse, by means of longitudinal maps, the evolution of research work related to these two concepts (
Figure 4). The first finding, due to its significant consistency, is the persistence of the
Job-satisfaction cluster as the leader of the research trend throughout the three periods analysed. This cluster, with respect to the others, agglutinates a greater number of documents, maintaining a constant growth period after period (72 docs, 1992–2010; 96 docs, 2011–2015; and 134 docs, 2016–2020) (
Table 4). However, the behaviour of the impact of publications on the topics to which this cluster is related has been decreasing. Thus, in the first period, the impact was 6194 citations, in the second period, it was 2322 citations, and in the third period, it was only 870 citations. The explanation for these last two periods may lie in the short time span, and the significant impact of the first may be due to the contribution of various literature reviews and meta-analyses such as the work of Humphrey et al. in 2007 [
78], “
Integrating Motivational, Social, And Contextual Work Design Features: A Meta-analytic Of The Summary And Theoretical Extension Work Design Literature”, with 863 citations; Thoresen et al. in 2003 [
79], “
The Affective Underpinnings Of Job Perceptions And Attitudes: A Meta-analytic Review And Integration”, 458 citations; Hayes et al. in 2006 [
74], “
Nurse Turnover: A Literature Review”, 457 citations; Cheng and Chan in 2008 [
47], “
Who Suffers More From Job Insecurity? A Meta-analytic Review”, with 455 citations; Lu et al. in 2005 [
9], “
Job Satisfaction Among Nurses: A Literature Review”, with 353 citations, among others.
In the longitudinal analysis, all the periods are important because they give us an idea of how the literature has evolved; however, the first one is particularly important, as it brings together the research that initiated the interest in the subject, and the last one, which provides a perspective on the current research interest or trend. In the case of the first period (1992–2010), we find that in addition to
Job-satisfaction, research originated around the following clusters:
Outcomes,
Performance,
Quality,
Burnout,
Decision-making, and
Staff-retention. From a quantitative point of view (number of papers), the most significant, apart from
Job-satisfaction, were
Outcomes and
Performance. In terms of the impact of the publications, the third and last in the list of clusters with the most documents should be highlighted;
Performance with 1910 citations and, strikingly,
Staff-retention with 305 citations in only three documents, including the work of Spence et al. [
8], “
Workplace Empowerment, Incivility, And Burnout: Impact On Staff Nurse Recruitment And Retention Outcomes” with a total of 275 citations. As for the last period (2016–2020), which concentrates the topics with the highest current trend, we find (ordered by highest number of documents) in addition to
Job-satisfaction,
Organisational-factors,
Employees,
Affective-commitment,
Work-family,
Services,
Motivation,
Teamwork, and
Work-environnment. The most relevant clusters in terms of the impact of their publications are
Job-satisfaction (870 citations),
Employees (242 citations),
Organisational-factors (219 citations), and
Affective-commitment (122 citations).
From the point of view of the evolution of the clusters between periods, it should be noted that the only cluster that is maintained in the three periods and, as a result, retains its consistency is the aforementioned Job-satisfaction which, in addition, has been the recipient in the second period (2011–2015) of themes from the first (1992–2010) such as Outcomes, Staff-retention, Performance, and Quality. Although some of the themes of the latter two clusters have also evolved towards Leadership and Patient, respectively. As for the Burnout cluster, it is the only cluster that has been maintained for two consecutive periods, from the first to the second. Although it is true that some of its themes from the first period also evolved towards the Professional factors cluster.
By way of conclusion, it can be suggested that (a) the motivation for research on OC and HC in a related way started on clusters that brought together topics that had to do with job satisfaction, analysis of results, performance, quality, and burnout syndrome, mainly; (b) only two clusters have remained in more than one period over time, Job-satisfaction, which has remained in all three periods, and Burnout, which has remained between the first (1992–2010) and the second period (2011–2015), while the rest of the clusters have dispersed between the periods; and (c) research is currently focussed, in addition to job satisfaction (which has been the same since the beginning), on issues related to organisational factors, on aspects related to employees such as leadership or attitudes, on affective commitment and, to a lesser extent, on aspects such as work–life balance, motivation or work climate.
3.4. Period-by-Period Strategy Map Analysis
Once we know, through the longitudinal analysis, the evolution of the clusters or themes between periods, we first proceed to analyse the importance of each cluster in the field of research. For this, we use the “Strategy Maps” (
Figure 5-left). These provide an overview of the role played by the clusters in terms of their centrality and density. Secondly, we are interested in finding out about the main theme, i.e., the cluster which, due to its centrality and density, occupies the top right-hand position on the strategy map, which the methodology used calls “Driving Themes”. The next step is to analyse the structure of its network, in order to find out which themes have been researched and what the relationship between them has been. This is the essential core of the literature review in terms of finding out the trend of researchers’ interest. In short, it is about finding the main driving theme and then analysing how researchers have become interested in the themes of this cluster in a related way. For this, we use the “Thematic network” maps (
Figure 5—right).
In the period 1992–2010, we mainly found two driving themes (
Figure 5-left),
Job-satisfaction and
Outcomes, with a centrality and density of 114.71/29.63 and 68.79/19.50, respectively (
Table 4). Therefore, we can confirm that they were the trending topics or clusters in this period, i.e., the ones that had the ability to attract more publications around them, in a related way, with other topics in their internal network. They were at the centre of the research. As core topics, i.e., those that are important for the research field, but need to be developed, we find
Quality and
Performance, whose centrality and density were 35.26/12.09 and 30.11/9.54 respectively. As for the more specialised topics, which the methodology used calls “peripheral”, we find
Decision-making and
Staff-retention. These have a high density but not sufficient centrality. In the case of the two clusters mentioned above, their centrality and density were 6.14/50 and 11.48/16.67, respectively. Finally, in the lower left quadrant, there are those clusters that due to their low centrality and density may be in a situation of decay or emergence; in this period, the
Burnout cluster is in this position with a centrality and density of 6.24/11.30.
In order to go into the internal analysis of the thematic network of the main driving theme of each period, in order to be able to compare the different periods, we have analysed the dyads of those relationships that exceed a minimum weight limit of 0.10 or more.
In the case of the first period (1992–2010), in the internal analysis of the
Job-satisfaction thematic network, the main driving theme and, as a consequence, the cluster leading the research trend, we found with a density equal to or greater than 0.10 the following dyads (
Table 5): (a)
Job-satisfaction with the themes
Turnover-intention,
Nurses,
Stress,
Work,
Empowerment, and
Absenteeism, (b)
Nurses with
Turnover-intention, (c)
Stress with
Social-support, (d)
Turnover-intention with the themes
Absenteeism,
Work, and
Career. The themes that—although important as a trend—did not reach the established limit of 0.10 weight in the density of their relationships within the cluster were
Hospitals,
Care, and
Normative commitment.
As for the period 2011–2015,
Job-satisfaction repeats as the main driving theme with a centrality and density of 144.69 and 43.25 respectively, which is even higher than in the previous period (
Table 4). This is joined by
Burnout, which evolves from the previous period, when it was considered as a declining or emerging theme (
Figure 6-left). Its centrality and density were 53.12 and 16.5, which was much higher than in the previous period. As basic themes, we find
Normative-commitment and
Leadership, whose centrality and density were 47.56/14.79 and 43.68/9.97, respectively. On the other hand, on the border between the emerging themes and the basic themes is the
Professional-factor cluster, with a centrality of 27.07 and a density of 14.65, and, on the border between these and the peripheral themes, the
Public-health cluster with a centrality of 9.3 and a density of 15.48. Finally, in the upper left quadrant, the peripheral themes formed in this period are
Patient and
Ethic with a centrality and density of 9.3/15.48 and 4.65/22.22, respectively.
With regard to the internal analysis of the thematic network of the main driving theme,
Job-satisfaction (
Figure 6-right), it should be noted that in general, the density of the relationships of the members of the thematic network has been higher. Proof of this is that the weight of the ties of the dyads that relate the
Job-satisfaction theme to the rest of the themes was equal to or greater than 0.10 (
Table 6); however, this was not the case in any of the previous periods. As for the rest of the dyads that equalled or exceeded 0.10 weight in their relationships, the following should be noted: (a)
Nurses with the themes
Turnover-intention,
Staff-retention,
Quality, and
Hospitals, (b)
Performance with the themes
Organisational-factors,
HRM, and
Work, (c)
Work with themes such as
Organisational-factors and
Turnover-intention, (d)
Hospitals with
Turnover-intention, and finally, (e)
Turnover-intention with
Staff-retention. The themes that formed part of this cluster, but with a density of less than 0.10 in the relationships other than the main theme (
Job-satisfaction), were
Stress and
Outcomes.
Finally, in the 2016–2020 period,
Job-satisfaction maintains its leadership as a reference cluster for the research trend concerning the literature relating OC and HC and, although its centrality (108.78) and density (28.93) have decreased with respect to the two preceding periods (
Table 4), compared to the rest of the clusters in this period, it has achieved an even more prominent position (top right position) (
Figure 7). The other clusters that form part of the so-called “Driving Themes” are
Employees,
Affective-commitment, and
Work-family with a centrality and density of 53.17/10.87, 52.76/10.21, and 14.89/19.44, respectively. In the lower right quadrant, only
Organisational-factors, which has a centrality of 44.93 and a density of 8.34, is found as a basic theme. There is also only one theme in the so-called “peripheral themes”,
Work-environment, with a centrality of 7.14 and a density of 9.88 and, finally, in the emerging or declining themes, there are
Services,
Motivation, and
Teamwork, with a centrality and density of 14.14/8.30, 10.18/3.76, and 8.17/5.36 respectively.
With regard to the analysis of the
Job-satisfaction thematic network, as the main driving theme, we find a less dense network than in the previous period. The dyads that equal or exceed a weight above the stipulated 0.10 are (
Table 7) (a)
Job-satisfaction with the themes
Nurses,
Turnover-intention,
Stress,
Leadership,
Leave, and
Empowerment, (b)
Burnout with
Stress, (c)
Nurses with themes such as
Turnover-intention,
Empowerment,
Quality, and
Leave and, finally, (d)
Turnover-intention with
Leave. The themes that do not have a density equal to or greater than 0.10 were
Mediating-role,
Psychological factors, and
Performance.
From a cross-sectional perspective, it is evident that the main driving theme has consistently been
Job-satisfaction, which means that the research trend related to organisational commitment and the healthcare system has been oriented towards the themes integrated in the network of this cluster. Analysing their behaviour longitudinally, we can see that the themes that have permanently belonged to this cluster throughout the three periods have been
Job-satisfaction,
Nurses,
Turnover-intention, and
Stress, and therefore, due to their relational solidity, they could be considered to be the main core of the research. It should be noted that themes such as
Performance and
Quality, which in the first period (1992–2010) were considered basic themes, i.e., not very developed, were incorporated in the second period (2011–2015) into the cluster of the main driving theme (
Job-satisfaction) and have been maintained in the third period (2016–2020). Something similar happens to
Burnout, which in the first period formed an independent cluster as an emerging or declining theme and, in the second period, this cluster evolved with greater centrality and density in its network, being classified as a driving theme. Finally, in the third period,
Burnout is incorporated into the
Job-satisfaction cluster. On the other hand,
Empowerment, which already belonged to the
Job-satisfaction cluster in the first period, was reincorporated from the first to the third period. Finally, the most relevant themes that have been incorporated for the first time in the third period, apart from
Burnout, are
Leave,
Psychological factors, and
Leadership (
Figure 5—right); (
Figure 6—right); (
Figure 7—right).