Trust in Leaders and Job Satisfaction of Health Care Workers: Linking Organizational Justice to Citizenship Behavior

Grounded on the social exchange model, the authors theorized the intermediating part of job satisfaction and trust in supervisors by linking it with justice and OCB in service sector, especially Hospital industry of Pakistan. Structual equation modeling is performed to analysze the data collected from 346 health care workers in Pakistan. Results revealed that procedural, distributive, and interactional justice are positively related to citizenship behavior. Furthermore, trust in supervisor and job satisfaction mediates the relationship between justice and citizenship behavior. The future research and theoratical implications of these findings are discussed.


Introduction
Currently, hospital management requires a workforce with positive behavior because all the staff including physicians, nurses, and lab technicians have to interact with the patients (Ghodse et al., 1986). Also, they have hectic long-time jobs and they have to work in different shifts (Buyukhatipoglu et al., 2010). Organizational citizenship behavior might be one of the essential and value-adding qualities of hospital staff but Public and private hospitals are facing challenges to incorporate citizenship behavior among workforce. Organizational behaviors like organizational justice, support, organizational commitment, and job satisfaction contribute towards OCB (Perreira and Berta, 2015). Hospital management needs to identify which factors could help them to create an employee's organizational citizenship behavior. Precisely, numerous studies held in the Pakistani context have illustrated the legitimacy of justice in foreseeing subordinates' attitudes and performance (Khan et al., 2015;Sarfraz et al., 2018;Shan et al., 2015). To testify these propositions, we aimed to contribute theoretically and practically by doing experiments with these organizational behaviors in the hospital industry of Pakistan.
Previous studies suggest measuring the direct and indirect effect of justice on OCB by incorporating different attitudinal behaviors as mediators. Such as, Liao and Rupp (2005) explored that organizational justice has an insignificant influence on citizenship behavior, which indicates that there must be some other factors, which can possibly mediate this relationship. In another study, Malik and Naeem (2011) recommended that it is essential to explore the influence of dimensions of justice in relevance to workplace behaviors like employee satisfaction linked to their work, commitment, and OCB. The literature also supported to inspect the influence of justice on OCB (Jehanzeb and Mohanty, 2019;Singh and Singh, 2019). Therefore, the recent study has attempted to explore the direct effect of justice on citizenship behavior in the presence of two mediators namely job satisfaction and trust in the supervisor. There are no such studies to highlight attitudinal behaviors for the service sector organizations, especially in Pakistani hospital industry.
Trust in supervisor and job satisfaction are the essential concepts in human resource, present research approves the theoretical context of social exchange to explicate the association among justice and OCB in the presence of trust in supervisor and job satisfaction. Studies have used the context of social exchange theory to explain the association amongst justice and citizenship behavior (Fassina et al., 2008;Karriker and Williams, 2009) and it is most appropriate in the context of Pakistan where associations are considered precious and exchange morals are powerfully sanctioned. In this study, the literature related to justice have been reviewed and explained. It clarifies how this justice enhances citizenship behavior in Pakistani health care workers. Then findings of this empirical study have been reported and its generalizability in other highly power distanced societies have been discussed.
The current research provides numerous contributions to justice, trust, job satisfaction, and OCB literature. Firstly, by exploring the mediating role of job satisfaction and supervisor's trust between justice and OCB, the current study creates theoretical foundations in linking these constructs. While supervisory trust has been given attention in western culture's but in societies with high power distance (where leaders mostly behave authoritatively) it has not been linked to organizational justice. Secondly, the current study considers the Pakistani context when elucidating the significant role of trust and job satisfaction with organizational justice. This cultural perspective is still scarce but crucial in considering how justice and trust in supervisor progress for people with a certain value system. Ortiz (1999), explores that the concept of justice and OCB is valid in theory. Justice is defined as an impartial or moral way of treating the workforce in the organization (Greenberg, 1990). Justice has a solid impact on the employees citizenship behavior (Farid et al., 2019;Lim and Loosemore, 2017). Citizenship behavior is the flexible behavior of employees, which collectively enhances organizational functioning. This behavior is beyond the formal rewards and volunteers welfare actions of employees (Jahangir et al., 2004). Podsakoff et al. (2000), censoriously reviewed the previous work on citizenship behavior and its constructs. Organ (1988) 5-factor model explicitly civic virtue, altruism, courtesy, consciousness, and sportsmanship, is used in this study. Altruism is about voluntarily helping others at workplace to avoid the problems before their occurance (Podsakoff et al., 2000). Courtesy is the human gesture that is established to avoid the problems before they occur (Organ, 1997). Sportsmanship is the conduct of an individual in which he is willing to show tolerance against the inconvenience that occurs to him without complaints, protests, and appeals (Organ, 1990). Civic Virtue is defined as human resource macro-level belongingness or affection with the firm (Graham, 1991). Conscientiousness is conduct that involves the workforce in a task that goes beyond the minimal job requirements like avoiding extra breaks, obeying all the organizational rules and regulations beyond the limit, and work for the extra period (Organ, 1997).

Justice and OCB
From the social exchange perspective, when organizational justice is ensured within the organization, in exchange employees willingly show citizenship behavior. Farid et al. (2019), used social exchange theory to investigate that employees who perceive justice within the organization always show citizenship behavior. Al-Hyasat and Rumman (2013), discussed that to create justice in organizations it is needed to assign duties fairly among the employees, matching the duties with the abilities of employees, distributing outcomes on merit basis among the employees, enhancing the participation of the employees in decision making, providing knowledge and information to the employees and discussing the organizational decisions with the employees. Liao and Rupp (2005), provides evidence on the insignificant association between justice and OCB. Therefore, hinge on the above arguments following the hypotheses are developed.

Justice Satisfaction at Job and Citizenship Behavior
Workers' satisfaction at job is equal to liking one's job and operative feelings regarding the work after identifying the extent to which job fulfills the needs (Griffin et al., 2010). Numerous studies evident the job satisfaction antecedents and consequences (Alegre et al., 2016;Ilies et al., 2018;Judge et al., 2017). Safdar and Liu (2019), discussed that organizations which ensure justice could gain benefit from employee's job satisfaction. Hurst et al. (2017), found that workers who are satisfied with their works are more frequent in showing citizenship behavior at the workplace. Where, Najafi et al. (2011) evident that organizational justice has an optimistic but indirect relationship with citizenship behavior. Nadiri and Tanova (2010), examined that to enhance citizenship behavior of the employees, organizations should practice justice which will satisfy the employees, and in return they will show citizenship behavior at the workplace. Therefore, it could be said that organizational justice cannot impact the citizenship behavior of the employees alone, but in the existence of satisfaction at the job. This indicated that when there is a lack of justice in the firms then the job satisfaction can not impact OCB (Schappe, 1998). Therefore, it could be theorized that organizational justice could enhance employee citizenship behavior when they are satisfied from their job. H 2 : Job satisfaction plays a mediating role between the relationship of justice and citizenship behavior H 2a : Job satisfaction plays a mediating role between the relationship of distributive justice and citizenship behavior H 2b : Job satisfaction plays a mediating role between the relationship of procedural justice and citizenship behavior H 2c : Job satisfaction plays a mediating role between the relationship of interactional justice and citizenship behavior

Organizational Justice Trust in Supervisor and Citizenship Behavior
To elucidate how organizational justice influences employee's citizenship behavior, the current study proposes a mediating mechanism of trust in the supervisor. Trust is the one's subjective condition of positive expectation in a risky condition related to another one's goodwill (Das and Teng, 2001). Colquitt and Rodell (2011), examined the influence of justice on trust in managers consuming the theoretical amalgamation of social exchange theory. According to social exchange theory, when justice is ensured in the organizations in return employees trust enhances towards manager. Agarwal (2014), also explored the positive and significant link between justice and trust. While, Tourigny et al. (2019), studied the influence of trust on OCB in the presence of personal social responsibility. They concluded that at individual level organizational trust enhances citizenship behavior when employees have personal social responsibility. Aryee et al. (2002), studied the mediating role of trust between justice and dimensions of OCB. He concluded that trust in the supervisor is related to interactional justice. He also found out that trust in the supervisor mediated the association between interactional justice and OCB. Therefore, the following hypothesis is developed based on the above arguments. H 3 : Trust in supervisor plays a mediating role between the relationship of justice and citizenship behavior H 3a : Trust in supervisor plays a mediating role between the relationship of distributive justice and citizenship behavior H 3b : Trust in supervisor plays a mediating role between the relationship of procedural justice and citizenship behavior H 3c : Trust in supervisor plays a mediating role between the relationship of interactional justice and citizenship behavior 3. Methodology 3.1. Participants 346 questionnaires were filled by doctors, nurses, and paramedical staff of Pakistani hospitals. The questionnaire of this study had two parts including demographic characteristics and the items of the variables. The demographic portion is included depicting age, gender, and job title. The demographic data contains information on the respondents' gender, age, designation, and experience. Data were collected from 36.5% male and 63.5% female.

Measurements / Refinement of Instrument
The questionnaire is designed by considering the literacy level of the targeted audience. The questionnaire was divided into four sections. The questionnaire with a 5 point Likert scale adapted for all the items to examine the hypotheses of the research effort.
Organizational justice: To measure organizational justice researchers used a 3-dimensional scale established by Niehoff and Moorman (1993). Sample items include "My work schedule is fair", "Job decisions are made by managers in an unbiased manner", and "When decisions are made about my job, the manager treats me with respect and dignity". Cronbach's Alpha for distributive is 0.87, for procedural is 0.75, and for interactional is 0.88.
OCB: To measure the citizenship behavior researcher used a five-dimensional scale established by Podsakoff and MacKenzie (1989). Four items of each dimension included altruism, sportsmanship, consciousness, courtesy, and civic virtue. Sample items include "Helps others who have heavy workloads", "Consults with me or other individuals who might be affected by his/her actions or decisions", and "Consumes a lot of time complaining about trivial matters (R)". Cronbach's Alpha is 0.97.
Job satisfaction: It is measure by six questions given by Crow et al. (2012). Sample items include "Overall, I am satisfied with my job", "I like my job more than others do", and "I spend my time working hard". Cronbach's Alpha is 0.93.
Trust in the supervisor: Trust in the supervisor is measured by adopting the 9 items scale of Yoon and Suh (2003). Sample items include "My supervisor follows through on assignments", "My supervisor will back me up in a pinch", and "When my supervisor tells me something, I can rely on what she/he tells me". Cronbach's Alpha is 0.87. Table 1 depict the values of mean, SD, reliability, and correlation between the model variables namely citizenship behavior, organizational justice, work satisfaction, and trust in manager. The correlation values show a positive relationship of distributive, procedural and interactional justice with citizenship behavior (r DJ = .55, p < .01; r PJ = .48, p < .01; r IJ = .43, p < .01, respectively), job satisfaction (r DJ = .50, p < .01; r PJ = .49, p < .01; r IJ = .45, p < .01, respectively), and trust in supervisor (r DJ = .48, p < .01; r PJ = .51, p < .01; r IJ = .46, p < .01, respectively). Moreover, correlation values show the positive relationship of trust in supervisor (r TS = .66, p < .01) and job satisfaction (r JS = .63, p < .01) with citizenship behavior.

CFA Analysis
To inspect the construct distinctiveness of ten main variables of the current study, CFA is used. CFA is conducted on three dimensions of justice, satisfaction, trust in supervisor, and OCB. Multiple indexes values recommended by SEM researches (i.e. (Kline, 2015;Schumacker and Lomax, 2004;Williams et al., 2009), has been stated in the current study. The Table 2 depicts results of CFA that the projected ten factors model comprises of three dimensions of Justice, trust in leader, job satisfaction, and five dimensions of OCB, fit the data well (χ 2 /df = 1.95, CFI = .917, RMSEA = .05, IFI = .918, TLI= .911, RMR = .036, SRMR = .046). Another model 1 compromised of distributive, interactional, and procedural justice which were merged into one factor. The outcomes depict that the baseline model (ten factors) fits the data well comparing to the model 1 (eight factors) (Δχ 2 = 582.76, p < 0.01). Another model 2 compromised of merged factors of OCB dimenesions combined as one. The outcomes depict that the baseline model (ten factors) fit the data well comparing to model 2 (six factors) (Δχ 2 = 1018.9, p < 0.01).

SEM
To conduct the analysis and to test Hypothesis H 1 , using the structural equation model three dimensions of justice and citizenship behavior were tested at the same time. Outcomes of analysts predict that distributive (β= 0.41, p<0.01), interactional (β= 0.12, p<0.05), and procedural justice (β=0.18, p<0.01) significantly increase citizenship behavior in healthcare workers. Consequently, SEM outcomes support hypotheses H 1a , H 1b , and H 1c . To test the mediation of trust in supervisor and job satisfaction between justice and citizenship, Barger and Grandey (2006) propositions are tracked. For testing mediation they suggest that, if "(i) in the full model the independent variable significantly relates to mediator and non-significant relates with the dependent variable, and (ii) model fit significantly decreases when the path from mediator to dependent variable is constrained, and direct link between dependent and independent variable show significant results.

Figure-2. The Mediating Role of Trust and Job Satisfaction
Notes: Standardized coefficients are reported. *p<.10, **p<.05. Parentheses values show the coefficients when the direct paths are simultaneously constrained from the mediator (trust in supervisor, job satisfaction) to the dependent variable Figure 2 displays the outcomes of SEM mediation.
Step 2, following Barger and Grandey (2006) , the path from trust in supervisor and job satisfaction to OCB has been constrained. Results indicate that after constraining paths, the model fit reduced significantly, Δχ 2 (2) = 125.787, p < .05. The significant relationship of distributive, procedural, and interactional justice (β DJ = .41, p<0.05; β PJ =.18, p<0.05; β IJ = .12, p<0.05, respectively) with OCB is evident. Briefly, SEM results depict that trust in supervisor and job satisfaction mediates the relationship between justice and OCB.

Discussion
Though the reputation of organizational justice has been well-thought-out for periods (e.g. Greenberg, 1987;Rawls, 1958). The focus of the current study was to understand the effect of organizational justice on OCB through job satisfaction and trust in managers among the employees working in hospitals. In this integrated model, job satisfaction and trust in the manager mediated the influence of justice on OCB. The results of this study show that organizational justice has a direct effect on OCB when employees are satisfied and have a high level of trust in their supervisors. To investigate the relationship of justice with citizenship behavior in the presence of trust and satisfaction structural equation modeling is used. The outcomes supported the hypotheses, which are consistent with previous studies. When equality is ensured in the distribution of resources, procedures, and treatment it results in greater citizenship behavior of healthcare workers (Farid et al., 2019;Jehanzeb and Mohanty, 2019;Lim and Loosemore, 2017;Mohammad et al., 2016;Singh and Singh, 2019).
The mediating effect of job satisfaction among the relationship between justice and citizenship behavior has also been evident. Henceforth, the results show that when an organization provides justice to the employees, they feel satisfied and show citizenship behavior at the workplace. These results are consistent with previous studies that justice enhances employees satisfaction (Kim and Chung, 2019;Lambert et al., 2020) which results in greater citizenship behavior (Li et al., 2010;Nadiri and Tanova, 2010). Results also depict the consistent outcomes with previous studies that when justice is created in the organization employees start trusting their supervisors (Gobena and Van Dijke, 2016;Kaltiainen et al., 2017) and ultimately show citizenship behavior (Nasra and Heilbrunn, 2016;Tremblay, 2017). Therefore, based on results two major conclusions are drawn. Firstly, justice affects the OCB and second, job satisfaction and trust in supervisors mediates the effect of justice on OCB.

Theoretical and Practical Implications
This study highlights implications for the interconnected model of different organizational behaviors namely organizational justice, job satisfaction, trust in the manager, and citizenship behavior. This study provides implications for the organization and employees as well. The organization's management and employees should change their behavior. Management should try to work for the betterment of employees and organizations. The management and the hospital staff should take positive initiatives towards organizational justice, job satisfaction, and trust in managers to increase the performance of hospital employees through improving citizenship behavior. This will help managers to plan and create policies for justice in their organizations. After identifying, the importance of the organizational justice manager will ensure the implementation of the policies developed for the creation of organizational justice.
Managers will focus fairly on the distribution of the outcomes, procedures of outcome distribution, and interaction with the employees of the organization. They will be able to make fair decisions about the employees' working schedules, pay levels, workload, rewards, and job responsibilities to ensure organizational justice. Managers will be able to cultivate citizenship behavior among their employees. Therefore, employees can help other colleagues during increased workload showing absentieesm previously and have problems related to their work. Likewise, they introduce the new employee with staff, consult colleagues who are affected by decisions. Beside this, citizenship behavior will enable employees to be punctual on their job, avoid long and extra breaks, attend the meetings of the company and follow the directions and procedures of the company when no individual is watching.
Managers will be able to satisfy their employees at a job so that their employees start liking their job, spend more time, working hard, feel rewarded at their job, are proactive, and feel that their job is important in their life. Manager will be able to build trust in employees by changing their perception that their supervisors are technically expert of their job and they can make good decisions. Moreover, supervisors don't create any conflict among employees, supervisors support the employees in the time of trouble, supervisors judge the employees based on the tasks they perform, employees rely on what their supervisor tells them, supervisors support the employees and reward them when they perform a good job and employees feel that their supervisors treats them fairly.
In short, managers will be able to enhance justice in the organization, which will help them to cultivate employees' citizenship behavior by satisfying them and building their trust in their supervisors. When managers will create justice in the organization, satisfy their employees, build the trust of employees in their supervisor and cultivate the citizenship behavior in employees they will ultimately increase the performance of employees, and the overall image of the organization will be enhanced as well.

Limitations and Future Research
Although the study contributed to previous research efforts still some limitations are there. The data is collected only from hospitals which means data is only collected from one service industry so the results obtained from this data might be limited and cant be generalised. Time was also a limit in this research effort. If the time is extended the results could be better and it could ultimately increase the significance of the results. In future different job-related outcomes including turnover, job involvement, organizational commitment, and job performance, etc. should be combined in the research model. Researchers in the future should re-analyze the effect of changing or rearranging the relationship of the variables used in this study. Researchers in the future could re-analyze the effect of organizational justice on the citizenship behavior of employees through job satisfaction and trust by collecting data from manufacturing sectors. For more reliable and valid results, researchers in the future can collect data from the other organizations of Pakistan. In future, the researchers should also observe the effect of the HR practices, implementations and the employees' job quality practices.

Conclusion
Justice in hospital management is a stirring zone of investigation in the justice literature. Based on the social exchange theory, it has been shown that justice results in a positive attitude of employees in Asian cultures as well. Current research has accrued supplementary evidence and shows that trust in supervisor and job satisfaction is a crucial underlying process in describing why employees with a perception of justice perform better by showing OCB at work.