The role of fairness perceptions in patient and employee health: a multi-level, multi-source investigation

This research extends the group engagement model (GEM) to examine how fairness judgments implicate both organizational-level and individual-level outcomes, including patient health and satisfaction (i.e., patient health outcomes) and employee health. Based on the social identity arguments of the GEM, we argue that fair career advancement procedures at the organizational level and experiences of discrimination at the individual level are indicators of identity-based evaluations of fairness. Utilizing annual staff survey data from the National Health Service (NHS) in the U.K. (n = 147 hospitals with n = 60,602 employees), we observe that organizational fairness of career advancement procedures significantly relates to patient health through the hospital-level mediator, employee voice. Individual fairness of an employee’s personal experience with discrimination significantly relates to employee health through the individual-level mediator, psychological safety. Results support the three-stage indirect effect from organizational-level fairness to employee health via individual-level fairness and individual-level psychological safety. In supplemental studies, measurement limitations are addressed through multitrait multimethod matrix and content validation approaches. These results indicate that the archival NHS measures sufficiently operationalize the constructs of interest providing further support for the hypothesized model. The theoretical and practical implications of this work for multilevel conceptualizations of fairness and healthcare organizations are presented.