Abby Kahaleh 2007

Research in Social and Administrative Pharmacy
3 (2007) 199e222
Original Research
The effects of work setting on pharmacists’
empowerment and organizational behaviors
Abby Kahaleh, B.Pharm., Ph.D., M.S., M.P.H.a,*,
Caroline Gaither, Ph.D.b
a
LECOM School of Pharmacy, Erie, PA 16509
b
Department of Social and Administrative Sciences, College of Pharmacy,
University of Michigan, Ann Arbor, MI 48109-1065
Abstract
Background: In traditional organizations, power determinantsdaccess to information,

resources, opportunity, and supportdtend to be accessible only to top management. In
today’s health market, however, organizations must compete in a dynamic environment
that affects the relationship between the individuals and their organization.
Objectives: The purpose of the study was to examine the effects of work setting on
antecedents of empowerment, empowerment, and its consequences: loyalty, commit-
ment, identification, and job-turnover intention.
Methods: The study used a cross-sectional design. A model developed by Kanter is
used and extrapolated for the study. A random national sample of 1,200 pharmacists
was selected to participate in this research. Self-administered questionnaires were
mailed to the subjects’ home addresses. For data analyses, structural equation mod-
eling analyses were conducted to test the study model.
Results: A total of 421 usable responses (40.0%) was obtained. Most of the respondents
were white, males, and the average age was 47 years. Goodness-of-fit for the overall
model was acceptable (SRMR ¼ 0.06, RMSEA ¼ 0.07, CFI ¼ 0.91, and NNFI ¼ 0.88.)
Conclusions: Consistent with theoretical considerations, the hypothesized model was
significant. Work setting affected empowerment and its consequences. Pharmacists
* Corresponding author. Ohio Northern University, Pharmacy Practice, 525 South Main
Street, Ada, OH 45810, USA. Tel.: þ1 419 772 1866; fax: þ1 419 772 2720.
E-mail address: a-kahaleh@onu.edu (A. Kahaleh).
1551-7411/$ - see front matter Ó 2007 Elsevier Inc. All rights reserved.
doi:10.1016/j.sapharm.2006.08.001
200 A. Kahaleh, C. Gaither / Research in
Social and Administrative Pharmacy 3 (2007) 199e222
who work in independent community pharmacies were more structurally empowered
than their counterparts in hospitals or chain pharmacies. In each setting, organiza-
tional commitment and loyalty were significant predictors of job turnover intention.
Increasing access to knowledge, opportunity, and support may reduce the likelihood
of job turnover among chain and hospital pharmacists.
Ó 2007 Elsevier Inc. All rights reserved.
Keywords: Empowerment; Work setting; Independent pharmacists; Chain pharmacists;

Hospital pharmacists; Loyalty; Commitment; Identification; Job-turnover intention
1. Background
In traditional organizations, power determinantsdaccess to information,

resources, opportunity, and supportdtend to be accessible only to top man-
agement.1 Employees in such organizations are adapted to being passive and
are successful in a rigid work environment. In today’s health market, how-
ever, organizations must compete in a dynamic environment that affects the
relationship between the individuals and their organization.2-6 Many orga-
nizations, including heath care organizations, are restructuring their work
environments to become more competitive by reducing their costs, decreas-
ing duplicate services, securing resources, and differentiating their services.
Organizational researchers have assumed that organizational behaviors
are entirely related to individual characteristics. More recently, organiza-
tional theorists have examined the relationship between employees and their
work environment.7-17
Strategic management theorists have focused on examining organiza-
tional behavior and its link to the success of organizational redesigning
strategies. They have noted that the success or failure of such transactions
appears to depend on the cooperation and coordination of individuals
within work units. Individuals who are empowered have greater autonomy
regarding the content of their work and are more likely to be committed to
organizational goals.4-10
Based on Kanter’s structural theory, organizational behaviors are consid-
ered rational responses to the work environment.1 Access to power engenders
higher commitment to organizational goals among employees. The theory
postulates that individuals respond rationally to their work environment,
their position, and to the situations that unfold in their organization.1 If an
organization is flat, employees are more likely to be empowered and this
will benefit the organization in terms of the behaviors of employees and the
effectiveness of the organization. Based on Kanter’s theory, power is a struc-
tural determinant that shapes organizational behaviors among employees.1
Empowerment is acquired through access to information, ability to mobilize
resources, support, and opportunities to grow in one’s job.1,10,11
A. Kahaleh, C. Gaither / Research in 201
There have been many studies supporting Kanter’s structural theory in
the business and health care arenas; 4,5,10,12-15 however, the impact of struc-
tural supports on pharmacists’ behaviors has not been examined. Work set-
tings may affect antecedents of empowerment such as job flexibility and
visibility, structural and psychological empowerment, and consequences of
empowerment.
Specifically, the study model proposed examines the effects of antecedents
of empowerment, power factors, and need for achievement on empower-
ment and its consequences, commitment, loyalty, and identification among
pharmacists in different work settings.1-3,7,10,13,14,19,20
1.1. Definitions
1.1.1. Antecedents
Power factors are defined as structural elements that enhance empower-
ment, such as job visibility, relevance of the job to the organization’s mis-
sion, and flexibility, the amount of discretion perceived by the
employees.1,10 Need for achievement is described as a desire to achieve chal-
lenging career goals.7
1.1.2. Empowerment
Structural empowerment is defined as access to information, resources,
opportunity, and support.1,10 Psychological empowerment has 4 dimen-
sions: meaning, competence, self-determination, and impact.13,14
1.1.3. Consequences
Organizational commitment is accepting the organization’s goals and
values, putting forth effort, and wanting to remain a member.19,20 Organiza-
tional loyalty is defined as acting as a loyal booster for the organization.2
Organizational identification is described as a person’s self-concept, which
contains the same attributions as those of the organization.3,18 Job-turnover
intention is defined as intention to leave an organization voluntarily.20
2. Conceptual model
A model developed by Kanter is used and extrapolated to examine the

effects of work setting on psychological and structural empowerment and
consequences of empowerment, loyalty, commitment, identification, and
job turn intention.1 The study model examines both structural and psycho-
logical empowerment among pharmacists. The comprehensive model links
structural determinants of empowerment to organizational behaviors. The
underlying rationale behind the model is that pharmacists who have access
to power factors in their work environment develop a sense of structural and
psychological empowerment, which shapes their organizational behaviors.1
The model has 3 important components. First, a cognitive component,
which represents the 4 dimensions of psychological empowerment. Second,
a structural component, which represent the interactions between pharma-
cists and their environments, and includes access to structural determinants
of empowerment. Finally, there is a behavioral component, which represents
organizational outcomes such as commitment, identification, loyalty, and
job-turnover intention. These 3 components are important requisites of em-
powerment based on the empowerment theory. This theory posits that re-
searchers need to include all 3 components to adequately measure
empowerment.1
3. Objective
The main purpose of the study is to examine the effects of work setting on
antecedents of empowerment, empowerment, and consequences of empow-
erment. The research questions for the study are:
1. Does work setting affect the levels of power factors, need for achieve-
ment, empowerment, loyalty, commitment, identification, and job-turn-
over intention?
2. Does work setting affect the relationships between antecedents of em-
powerment, empowerment, and consequences of empowerment?
4. Methods
4.1. Research design and subjects
The study used a cross-sectional survey design. A random sample of

5,000 pharmacists and their home addresses was purchased from KM Lists,
which maintains a list of approximately 200,000 pharmacists in the U.S.
4.2. Data collection
A pretest was conducted to assess the reliability and validity of the survey
instrument on a sample from the study population. A random sample of 120
pharmacists was selected and subtracted from the purchased sample of 5,000
pharmacists. This pretest sample represents 10% of the final sample. We
used summated scales to measure power factors, need for achievement, psy-
chological empowerment, structural empowerment, commitment, loyalty,
identification, and job-turnover intention. Preliminary reliability analyses
provided estimated Cronbach’s coefficient alphas for all of the scales at
0.70 or higher.
A cover letter, questionnaire, and preaddressed, postage-paid return en-
velope were mailed to home addresses of a random sample of pharmacists
nationwide. The cover letter and questionnaire were approved by the Insti-
tutional Review Board of the University of Michigan. Four weeks prior to
this mailing, early notice postcards were mailed to the subjects’ home ad-
dresses.21-25 Two weeks after the mailing of the survey, reminder postcards
were mailed to nonrespondents. Finally, a second mailing of the question-
naire was sent to nonrespondents.
4.3. Study variables
4.3.1. Power factors and structural empowerment

The subjects were asked about their access to power factors in their work-
place. Power factors are structural elements that facilitate empowerment. A
job with more flexibility and visibility allows easier access to knowledge, op-
portunity, support, and resources.1 Five-point Likert scales were used to
measure flexibility and visibility. Results of the reliability analyses showed
that for flexibility Cronbach’s a ¼ 0.78.
Structural empowerment is defined as having access to structural determi-
nants. Specifically, subjects were asked to evaluate how much knowledge
they have about their organizations, opportunity to advance in their careers,
support they receive from their supervisors, and resources that are available
to them to get the job done.1
Five-point Likert scales were used to measure knowledge, opportunity,
support, and resources.1,10 Results of the reliability tests showed that Cron-
bach’s alphas for the scales were as follows: knowledge (a ¼ 0.86), opportu-
nity (a ¼ 0.89), support (a ¼ 0.92), and resources (a ¼ 0.72).
4.3.2. Need for achievement

Pharmacists were given a list of items that measured their level of
achievement. For instance, they were asked to rank items that measured
their need to improve their performance and to perform better than their co-
workers.7 A 7-point Likert scale was used to measure need for achievement
(a ¼ 0.60).
4.3.3. Psychological empowerment

Psychological empowerment is defined as the cognitive status that enables
managerial interventions to be effective among pharmacists. Subjects were
asked to rate their levels of competence and self-determination. Also, they
were asked to evaluate how meaningful their jobs are to them and how
much they affect their organizations.13,14 Seven-point Likert scales were
used to measure various components of psychological empowerment. Re-
sults of the reliability analyses showed that Cronbach’s alphas for the scales
were as follows: competence (a ¼ 0.92), meaning (a ¼ 0.92), self-determina-
tion (a ¼ 0.90), and impact (a ¼ 0.88).
4.3.4. Consequences of empowerment
Subjects were asked to rate their commitment to their employers and how
much they identified with their organizations.3,20 In addition, subjects were
asked to evaluate their loyalty toward their organizations and the likelihood
of them leaving their employers.2,20 A 7-point Likert scale was used to mea-
sure consequences of empowerment. Results of the reliability analyses
showed that Cronbach’s alphas for the scales were as follows: loyalty
(a ¼ 0.91), commitment (a ¼ 0.87), identification (a ¼ 0.88), and job-turn-
over intention (a ¼ 0.91).
4.4. Analysis plan
Data were managed and analyzed with SPSS 9.0.26,27 Analyses of vari-
ances were conducted to examine the effects of the pharmacists’ work setting
on psychological and structural empowerment. These statistical analyses
enable researchers to examine the effects of work setting on the levels of
empowerment. The analysis focuses on differences in the levels of empower-
ment between independent, chain, and hospital pharmacists. Posthoc (Tukey)
tests were performed to compare means among groups and to determine any
significant differences between the means.
Structural equation modeling using LISREL 8.026 was conducted to test
the overall theoretical model. The structural equation technique allows
researchers to obtain precise estimates of the parameters by including the
error measurements of the instruments. Structural equations model can be
divided into 2 specific models. 26 The first is the measurement model or con-
firmatory factor analysis model, which can be used to test for convergent
validity and to examine the linear relationships between the observed vari-
ables or indicators and the latent variables or the unobserved constructs.
The second is the structural model, which evaluates the relationships
between dependent and independent latent variables.26
Moment matrices included in the structural equation modeling analyses
were covariance matrices. Indicators were computed by averaging every
other item within each scale. The method of parameter estimation was the
maximum likelihood. Calculated lambdas (li) represent factor loadings of
the observed variables on the latent variables in the hypothesized model.
The error variances in the observed variables are represented by theta-
deltas (qdi). High factor loadings and low error variances are sensibly fa-
vored. There were no negative error variances and no correlations were
greater than 1. The composite reliability is calculated by dividing the factor
loadings squared by the sum of the loadings squared plus the error vari-
ances. Composite reliabilities were calculated using the following formula:
2 2
r ¼ ðSli Þ var: xj =ðSli Þ var: xj þ Sðqdi Þ
Satisfactory model fits are indicated by nonsignificant chi-square tests, stan-
dardized root mean square residual (SRMR) and root square error of ap-
proximation (RMSEA) values less than 0.08, comparative fit index (CFI),
normed fit indices (NFI), and nonnormed fit index (NNFI) values that
exceed 0.90.26 The data were split by practice setting for the final path anal-
yses. Due to sample size limitations, the models for each practice setting
were estimated with lambdas set to 1 and error variances set to zero.
5. Results
Surveys were mailed to 1,200 pharmacists nationwide. After 5 mailings

consisting of 2 surveys, 2 reminder postcards, and a survey of nonrespon-
dents, 447 pharmacists responded for an overall response rate of 42.4%.
Of the 447 responses, 421 were usable questionnaires. Three responses out
of the 421 were completed on the phone or sent electronically. Out of the
1,200 pharmacists that were mailed the surveys, 83 of them were nonreach-
able, 31 were noneligible, and 32 indicated that the survey was nonapplica-
ble to their work status. Therefore, the usable response rate is 40.0%.
5.1. Description of respondents
Table 1 provides the demographic and job-related variables for the respon-
dents. Most of the respondents were white, males, and the average age of the
study population was 47 years. The majority of them had 1 or more children
and the mean graduation date was the late 1970s. Most of the respondents did
not complete a residency, had full-time jobs, worked in pharmacy-related
jobs for 20 years on average, and worked in large entities.
The majority of the respondents were staff in community pharmacies. On
average, pharmacists worked for current employers for at least a decade and
had 5 different employers throughout their careers. Most of the respondents
indicated having an average or above average salaries and benefits based on
their qualifications and job experiences.
5.2. Antecedents of empowerment
Job flexibility, job visibility, and need for achievement were measured
among pharmacists. Results of the study showed that the levels of job flex-
ibility and visibility were moderate. The majority of the respondents indi-
cated that in their current jobs they have flexibility in contacting the
people they need to be in touch with and that they have autonomy in deter-
mining how they do their own work. Approximately 30% of the respon-
dents said that they set their own work hours and get around
bureaucratic regulations. Most of the respondents stated that they consider
their work-related activities to be visible within the organization.
Table 1
Description of respondents
Variable Mean (SD) Number Percent
Age 47(12)
<40 years 132 32
40-60 years 221 53
>60 years 65 15
Gender
Male 232 56
Race/ethnicity
White Caucasian 345 86
Other 56 14
Number of children
1 or more 242 61
None 155 39
Years since graduation 23(15)
Degrees earned
B.S. 354 84
Pharm.D. 71 16
Completed a residency 73 18
Number of employers
for the first 5 years
2 employers 226 56
Between the 6th and 10th years
2 employers 132 38
Between the 11th and present
2 employers 129 41
Work setting
Chain 113 36
Hospital 81 26
Independent 55 17
Othera 69 21
Primary position
Staff 175 56
Manager 80 25
Owner 19 6
Assistant manager/director 12 4
Otherb 29 9
a
Home care, infusion, mail order, industry, government, academia, and nuclear pharmacy.
b
Medical affairs, consultant.
Need for achievement among pharmacists was moderately high. Almost

all of the respondents agreed that they try ‘‘very hard’’ to improve prior
work performance. The majority of the respondents agreed that they do
their best work when their job assignments are difficult, try to perform better
than their coworkers, and do not try to avoid additional job responsibilities.
Finally, slightly less than half of the respondents agreed that they take mod-
erate risks to get ahead at the work (Table 2).
5.3. Empowerment
Structural empowerment and psychological empowerment were mea-

sured among pharmacists. In general, access to components of structural
empowerment was low to moderate. Pharmacists ranked the level of knowl-
edge as the highest followed by opportunity, support, and resources.
Psychological empowerment among pharmacists was high. Respondents
ranked competence as the highest component of psychological empower-
ment, followed by meaning, self-determination, and impact (Table 2).
Table 2
Antecedents of empowerment, empowerment, and consequences of empowerment (N ¼ 421)
Study variables Means (SD)
1,10
Antecedents of empowerment
Job visibilitya 3.75 (0.9)
Job flexibilityb 3.25 (0.9)
Need for achievementc 5.19 (1.3)
Structural empowerment
Knowledged 3.32 (0.7)
Opportunitye 3.13 (0.9)
Supportf 2.80 (0.9)
Resourcesf 2.30 (1.0)
Psychological empowerment
Competencec 6.22 (0.8)
Meaningc 6.00 (1.0)
Self-determinationc 5.42 (1.3)
Impactc 4.85 (1.5)
Consequences of empowerment
Loyaltyc 4.95 (1.3)
Commitmentc 4.71 (1.3)
Identificationc 4.66 (1.4)
Job-turnover intention 3.10 (2.0)
Thinking about leaving their organizationg 3.46 (2.0)
Searching for other employmentg 3.00 (2.0)
Leaving current employmentg 2.80 (2.0)
a
1 ¼ Strongly disagree, 5 ¼ Strongly agree.
b
1 ¼ Out of my hands, 5 ¼ Act on my own.
c
1 ¼ Strongly disagree, 7 ¼ Strongly agree.
d
1 ¼ No knowledge, 5 ¼ Know almost everything.
e
1 ¼ Not at all, 5 ¼ A lot.
f
1 ¼ None, 5 ¼ A lot.
g
1 ¼ Very unlikely, 7 ¼ Very likely.
5.4. Consequences of empowerment
Loyalty, commitment, identification, and job-turnover intention were mea-

sured among pharmacists. Results showed that the levels of consequences of
empowerment were moderate. Respondents ranked loyalty as the highest fol-
lowed by commitment, identification, and job-turnover intention (Table 2).
5.5. Analyses of variance
Results of the analyses of variance on the effects of work setting on psy-

chological empowerment and structural empowerment, and their respective
components are shown in Tables 3 and 4. Examining the effects of work set-
ting on psychological empowerment revealed that pharmacists who worked
in independent settings had a significantly higher level of psychological
empowerment than those who worked in hospitals or chain pharmacies.
Table 3
The effects of pharmacists’ work setting on psychological empowerment (N ¼ 418)
Psychological empowerment
Groupsa Mean difference Standard error Significanceb Model
1-2 0.67 0.12 0.00b F ¼ 10.89, Sig. ¼ 0.00b
1-3 0.55 0.12 0.00b
2-3 0.11 0.11 0.74
I. Meaning
1-2 0.24 0.15 0.40 F ¼ 2.31, Sig. ¼ 0.07
1-3 0.38 0.14 0.04b
2-3 0.14 0.13 0.70
II. Competence
1-2 0.28 0.12 0.09 F ¼ 2.34, Sig. ¼ 0.07
1-3 0.07 0.11 0.92
2-3 0.21 0.10 0.18
III. Self-determination
1-2 0.77 0.18 0.00b F ¼ 11.2, Sig. ¼ 0.00b
1-3 0.87 0.17 0.00b
2-3 0.10 0.16 0.92
IV. Impact
1-2 1.38 0.22 0.00b F ¼ 13.6, Sig. ¼ 0.00b
1-3 0.89 0.21 0.00b
2-3 0.48 0.19 0.06
a
Group 1 ¼ Independent pharmacists, Group 2 ¼ Hospital pharmacists, Group 3 ¼ Chain
pharmacists. Groups 1-2, 1-3, 2-3 ¼ comparisons between groups 1 and 2, 1 and 3, 2 and 3.
b
Significant level P < .05.
Table 4
The effects of pharmacists’ work setting on structural empowerment (N ¼ 418)
Structural empowerment
1-2 0.53 0.10 0.00b F ¼ 21.74, Sig. ¼ 0.00b
1-3 0.73 0.09 0.00b
2-3 0.20 0.08 0.09
I. Opportunity
1-2 0.26 0.13 0.19 F ¼ 16.55, Sig. ¼ 0.00b
1-3 0.73 0.12 0.00b
2-3 0.46 0.11 0.00b
II. Knowledge
1-2 0.80 0.11 0.00b F ¼ 25.46, Sig. ¼ 0.00b
1-3 0.82 0.10 0.00b
2-3 0.01 0.09 0.99
III. Support
1-2 0.50 0.14 0.00b F ¼ 9.12, Sig. ¼ 0.00b
1-3 0.62 0.13 0.00b
2-3 0.12 0.12 0.72
IV. Resources
1-2 0.28 0.16 0.27 F ¼ 1.74, Sig. ¼ 0.15
1-3 0.32 0.15 0.13
2-3 0.03 0.13 0.99
a
Group 1 ¼ Independent pharmacists, Group 2 ¼ Hospital pharmacists, Group 3 ¼ Chain
pharmacists. Groups 1-2, 1-3, 2-3 ¼ comparisons between groups 1 and 2, 1 and 3, 2 and 3.
b
Significant level P < .05.
A further examination of the effects of work setting on meaning, compe-

tence, self-determination, and impact was conducted. Pharmacists who
worked in independent settings had significantly higher levels of self-
determination and impact than those who worked in hospitals or chain
pharmacies.
Examining the effects of work setting on structural empowerment re-
vealed that pharmacists who worked in independent settings had a signifi-
cantly higher level of structural empowerment than those who worked in
hospitals or chain pharmacies. A further examination of the effects of
work setting on opportunity, knowledge, support, and resources was
conducted. Results showed that pharmacists who worked in independent
settings had a significantly higher level of knowledge and support than those
who worked in hospitals or chain pharmacies. In addition, pharmacists who
worked in independent settings had significantly higher levels of opportunity
than did those who worked in chain pharmacies. Also, pharmacists who
worked in a hospital setting had significantly higher levels of opportunity
than did their counterparts in chain pharmacies.
5.6. Structural equation modeling
Results of testing the overall measurement model of the structural equa-

tion analyses are shown in Table 5. Similar to Cronbach’s alpha coefficients,
the values of composite reliabilities range from 0 to 1 and high values are
favored.26 Examining the factor loadings of the observed variables showed
that most of the lambdas (li) were high, which is indicative of convergent
validity. Most theta-deltas (qdi) were low to moderate indicating low mea-
surement errors.
Since the chi-square test is sensitive to sample size (c2 ¼ 626.46, df ¼ 172,
P < .05), 4 descriptive goodness-of-fit indexes were examined to provide ad-
ditional information about the fit of the model: SRMR ¼ 0.06,
RMSEA ¼ 0.07, CFI ¼ 0.91, and NNFI ¼ 0.88. The values of the good-
ness-of-fit indices for SRMR, RMSEA, and CFI of the hypothesized model
are indicative of an acceptable model fit.
Table 5
Confirmatory analysis of antecedents and consequences of pharmacists’ empowerment
(N ¼ 412)
Parameter Estimatea (error variances) Composite reliability
l1 0.86 (0.25) L1L2 ¼ 0.89
l2 0.94 (0.12)
l3 0.89 (0.21) L3L4 ¼ 0.78
l4 0.71 (0.50)
l5 0.85 (0.28) L5L7 ¼ 0.71
l6 0.17 (0.97)
l7 0.89 (0.21)
l8 0.94 (0.11) L8L9 ¼ 0.90
l9 0.88 (0.22)
l10 0.74 (0.46) L10L13 ¼ 0.68
l11 0.70 (0.51)
l12 0.67 (0.55)
l13 0.19 (0.97)
l14 0.41 (0.83) L14L17 ¼ 0.72
l15 0.84 (0.29)
l16 0.72 (0.48)
l17 0.49 (0.76)
l18 0.74 (0.45) L18L19 ¼ 0.60
l19 0.54 (0.71)
l20 0.79 (0.38) L20L21 ¼ 0.68
l21 0.64 (0.59)
a
Standardized estimates: c2 ¼ 580.26; df ¼ 161; P ¼ 0.0; Root mean square error of approx-
imation (RMSEA) ¼ 0.07; Standardized root mean square residual (SRMR) ¼ 0.06; Non-
normed fit index (NNFI) ¼ 0.88; Comparative fit index (CFI) ¼ 0.91.
The overall structural model was tested and Table 6 reveals the results of
the parameters estimates. Like the measurement model most lambdas (li)
were high and most theta-deltas (qdi) and theta-epsilons (qei) were low to mod-
erate. These results are indicative of convergent validity and generalizability
of the study measures. Results of the structural model show the effects of
power factors on psychological empowerment and structural empowerment
and the effects of empowerment on loyalty, organizational commitment,
and identification and, in turn, on job-turnover intention. (Figs. 1-4).
5.6.1. Independent pharmacists’ empowerment

The path model represents the effects of antecedents on empowerment
and, in turn, the effects of empowerment on organizational behaviors and
job-turnover intention. Specifically, the effects of power factors and need
for achievement on psychological empowerment (g11 ¼ 0.31, g21 ¼ 0.50)
and structural empowerment (g12 ¼ 0.41, g22 ¼ 0.26) and the effects of psy-
chological empowerment and structural empowerment on loyalty
(b31 ¼ 0.45, b32 ¼ 0.38), commitment (b41 ¼ 0.40, b42 ¼ 0.47), and identifica-
tion (b51 ¼ 0.38, b52 ¼ 0.47) are shown. Finally, the effects of loyalty
Table 6
Standardized estimates of the structural model of antecedents and consequences of pharmacists’
empowerment (N ¼ 412)
Parameter Estimate Error variances
ly1 0.88a qe1 ¼ 0.23
ly2 0.93b qe2 ¼ 0.14
ly3 0.89b qe3 ¼ 0.21
ly4 0.71a qe4 ¼ 0.50
ly5 0.85a qe5 ¼ 0.28
ly6 0.17b qe6 ¼ 0.97
ly7 0.89b qe7 ¼ 0.21
ly8 0.94b qe8 ¼ 0.11
ly9 0.88a qe9 ¼ 0.22
ly10 0.74b qe10 ¼ 0.46
ly11 0.71b qe11 ¼ 0.50
ly12 0.67b qe12 ¼ 0.55
ly13 0.19a qe13 ¼ 0.97
ly14 0.42a qe14 ¼ 0.83
ly15 0.83b qe15 ¼ 0.31
ly16 0.72a qe16 ¼ 0.49
ly17 0.50b qe17 ¼ 0.75
lx1 0.76b qd1 ¼ 0.43
lx2 0.54b qd2 ¼ 0.70
lx3 0.75b qd3 ¼ 0.44
lx4 0.67b qd4 ¼ 0.55
a
Parameter is fixed to 1.00.
b
Significant level P < .05. Lambdas (li) ¼ factor loading of the observed variables. Theta-
epsilons (qei) ¼ error variances of the dependent variables. Theta-deltas (qdi) ¼ error variances
of the independent variables.
Fig. 1. Model of independent pharmacist’s empowerment.
(b63 ¼ 0.46), commitment (b64 ¼ 0.35), and identification (b65 ¼ 0.17) on

job-turnover intention are depicted in the model. Results showed that the
effects of psychological empowerment on loyalty, commitment, and identi-
fication among independent pharmacists were stronger than those among
hospital or chain pharmacists (Fig. 1)
Most of the goodness-of-fit statistics indicate that the model has an over-
all acceptable fit.26 Specifically, the fit statistics were: chi-square ¼ 31.22
(P ¼ .00), RMSEA ¼ 0.16, SRMR ¼ 0.09, GFI ¼ 0.91, NFI ¼ 0.91, and
the CFI ¼ 0.94.
5.6.2. Hospital pharmacists’ empowerment

The effects of power factors and need for achievement on psychological
empowerment (g11 ¼ 0.62, g21 ¼ 0.63) and structural empowerment
(g12 ¼ 0.23, g22 ¼ 0.15) and the effects of psychological empowerment and
structural empowerment on loyalty (b31 ¼ 0.25, b32 ¼ 0.45), commitment
(b41 ¼ 0.04, b42 ¼ 0.41), and identification (b51 ¼ 0.34, b52 ¼ 0.43) are shown.
Finally, the effects of loyalty (b63 ¼ 0.19), commitment (b64 ¼ 0.44), and
identification (b65 ¼ 0.06) on job-turnover intention are depicted in the
model (Fig. 2).
The goodness-of-fit statistics indicate, with the exception of the RMSEA
value, that the model has an overall acceptable fit.26 Specifically, the fit sta-
tistics were as follows: chi-square ¼ 28.31 (P ¼ .00), RMSEA ¼ 0.12,
SRMR ¼ 0.06, GFI ¼ 0.94, NFI ¼ 0.93, and the CFI ¼ 0.95.
Fig. 2. Model of hospital pharmacist’s empowerment.
5.6.3. Chain pharmacists’ empowerment

The effects of power factors and need for achievement on psychological
empowerment (g11 ¼ 0.30, g21 ¼ 0.46) and structural empowerment
(g12 ¼ 0.37, g22 ¼ 0.26) and the effects of psychological empowerment and
structural empowerment on loyalty (b31 ¼ 0.18, b32 ¼ 0.46), commitment
(b41 ¼ 0.03, b42 ¼ 0.56), and identification (b51 ¼ 0.16, b52 ¼ 0.50) are
shown. Finally, the effects of loyalty (b63 ¼ 0.17), commitment
(b64 ¼ 0.34), and identification (b65 ¼ 0.07) on job-turnover intention
are depicted in the model (Fig. 3).
The goodness-of-fit statistics indicate, with the exception of the RMSEA
value, that the model has an overall acceptable fit.26 Specifically, the fit sta-
tistics were as follows: chi-square ¼ 33.77 (P ¼ .00), RMSEA ¼ 0.12,
SRMR ¼ 0.07, GFI ¼ 0.94, NFI ¼ 0.92, and the CFI ¼ 0.95.
6. Discussion
Consistent with previous research in nursing, structural empowerment

had the following 4 distinct factors: support, opportunity, knowledge, and
resources.10 Similarly, psychological empowerment had the following 4 dis-
tinct factors: meaning, competence, self-determination, and impact.
Examining the effects of work setting on psychological empowerment re-
vealed that pharmacists who worked in independent settings had a significantly
Fig. 3. Model of chain pharmacist’s empowerment.
higher level of psychological empowerment than those who worked in hospi-

tals or chain pharmacies. A further examination of the effects of work setting
on meaning, competence, self-determination, and impact was conducted.
Pharmacists who worked in independent settings had significantly higher
levels of self-determination and impact than those who worked in hospitals
or chain pharmacies.
Examining the effects of work setting on structural empowerment re-
vealed that pharmacists who worked in independent settings had a signifi-
cantly higher level of structural empowerment than those who worked in
hospitals or chain pharmacies. A further examination of the effects of
work setting on opportunity, knowledge, support, and resources was con-
ducted. Pharmacists who worked in independent settings had a significantly
higher level of knowledge and support than those who worked in hospitals
or chain pharmacies. In addition, pharmacists who worked in independent
settings had significantly higher levels of opportunity than did those who
worked in chain pharmacies. Also, pharmacists who worked in a hospital
setting had significantly higher levels of opportunity than did their counter-
parts in chain pharmacies.
Work settings in independently owned, hospital, and chain pharmacies
had significant effects on both psychological and structural empowerment.
Findings suggest that pharmacists who worked in independent settings
had a significantly higher level of psychological empowerment, based on
Fig. 4. Confirmatory factor analysis.

self-determination and impact, than those who worked in hospital or chain
settings. Independent pharmacists also had a significantly higher level of
meaning, which is defined as the congruence between an individual’s values,
beliefs, organizational behaviors, and work requirements, than those who
worked in chains.
Since independent pharmacies are separate entities and their owners are
pharmacists, one might argue that pharmacists are more likely to treat other
pharmacists who work with them as professionals and allow them to have
more autonomy and freedom in their jobs. In turn, those pharmacists work-
ing under such a manager would perceive that they have more impact in
their organizations.
Pharmacists who worked in independent settings had significantly higher
levels of structural empowerment than their counterparts in hospitals or
chain pharmacies. Specifically, independent pharmacists had significantly
higher levels of opportunity, knowledge, and support.
As mentioned earlier, perhaps pharmacists who own the independent
pharmacies, as opposed to those in chain pharmacies or in hospital settings,
collaborate with their colleagues and treat them as peers rather than as em-
ployees. That being said, however, results of this study indicate that the
work setting did not affect the pharmacists’ level of access to resources.
This finding indicates that lacking needed supplies, handling excessive
paperwork, and working short of adequate personnel are common work
conditions among pharmacies in all work settings.
The subgroup analyses based on the work settings independent, hospital,
and chain showed similar patterns with regard to the theoretical path model.
Almost all the paths were significant. There were, however, some differences
among the 3 groups with regard to the effects of identification on job-turn-
over intention and the effects of psychological empowerment on commit-
ment. Unlike hospital and chain settings, the independent work setting
resulted in a significant effect of psychological empowerment on organiza-
tional commitment. It is likely that independent pharmacists have higher
levels of psychological empowerment, which in turn significantly affected or-
ganizational commitment. Unlike hospital and chain pharmacists, identifi-
cation was positively related to job-turnover intention. However,
identification did not significantly affect job-turnover intention among inde-
pendent pharmacists.
6.1. Implications of the study
6.1.1. Implications for pharmacy research

These findings suggest that future research in pharmacy needs to include
external as well as internal factors when examining pharmacists’ organiza-
tional behavior. Results of the study provide additional evidence supporting
Kanter’s theory that structures of the organization and work setting have an
impact on pharmacists’ organizational behaviors. A unique contribution of
the present study to pharmacy administration literature is examining the ef-
fects of work setting on a comprehensive model that includes antecedents
and consequences of empowerment.
Many researchers focused on examining the relationship between em-
powerment and organizational behaviors among nurses.4,5,10 Findings of
these studies supported Kanter’s structural theory.1 Specifically, the results
showed that nurses had low scores on empowerment and conditions of work
effectiveness. Researchers concluded that unless these conditions are
changed, nurses will more likely be less motivated, lack initiative, and be
less committed to their organizations.4,5,10 Health care administrators and
policy makers need to focus on the effectiveness of pharmacists’ work envi-
ronment. Recruiting qualified pharmacists as well as retaining them is essen-
tial for succeeding in today’s health care market. Specifically, through
increasing access to opportunity, knowledge, support, and resources, man-
agers can provide the key structural elements to empower pharmacists
and ultimately enhance the quality of patient care.
Based on the findings of this study, there is enough empirical evidence to
support that empowerment differs based on work setting. Further research
is needed to identify critical environmental factors that impinge on empow-
erment and organizational behaviors among pharmacists. Perhaps these en-
vironmental factors could be identified by interviewing pharmacists in
different settings.
6.1.2. Implications for pharmacy education

Presently, it is common for pharmacy schools to offer their entry-level
students courses on health care administration, management, and market-
ing. Offering pharmacy students additional courses on organizational be-
haviors would be beneficial for pharmacists and their supervisors.
In addition to individual models, pharmacy students need to understand
the effects of environmental factors that influence their behaviors as well as
the behaviors of their supervisors. They would also benefit from being able
to recognize different types of work settings. Hierarchical organizations, for
instance, tend to foster authoritative styles of management whereas flat or-
ganizations tend to be more persuasive and allow their subordinates more
discretion. Having access to this information would be helpful to pharma-
cists in selecting their jobs, having positive relationships with their future
employers.
Finally, a deeper understanding of the effects of work setting on struc-
tural determinants of organizational behaviors would enable educators, pol-
icy makers, and future leaders of the pharmacy profession to enhance the
quality of work life among pharmacists. The structuralist view, which
focuses on the effects of work environment on organizational behaviors,
provides guidance to decision makers in implementing policies that would
positively influence pharmacists’ organizational behaviors.
6.1.3. Implications for pharmacy practice
Knowledge about values and goals of top management needs to be
clearly communicated to pharmacists, specifically in chain and hospital set-
tings. Organizational goals and objectives need to be based on shared values
between management and pharmacists. Feedback on achieving these objec-
tives and administrative support for pharmacists must be actively distrib-
uted to assure collaboration between pharmacists and management.
Pharmacists need to have access to adequate resources to be able to ac-
complish their goals. Pharmacists in this study often worked without an ad-
equate number of pharmacy technicians, thereby decreasing the quality of
services. This shortage of personnel may lead to a decrease in patient coun-
seling services and an increase in potential medication errors. To enhance
the quality of patient care, pharmacists need to be involved in decisions
regarding resources and personnel that are important to their practice.
Decentralization of the decision-making processes, which pertain to phar-
macists’ job activities, needs to be implemented to create more productive
work environments in chain and hospital settings. Increasing pharmacists’
professional responsibilities without involving them in decision-making pro-
cesses decreases their productivity and increases the likelihood of job
turnover.
6.2. Limitations
Despite the fact that the sample size was sufficient to conduct the statis-
tical analyses, the response rate, nonetheless, was modest. Second, the re-
search has a cross-sectional design; it is not possible to make definite
cause and effect conclusions without the use of longitudinal research. Third,
given the small number of pharmacy owners who responded to the survey,
researchers were unable to conduct separate analyses for pharmacy owners.
Finally, given the fact that a mail survey was used as a method to collect
data, it is not possible to be certain that all the surveys were completed
by the study sample. However, given the level of information and details
that the respondents had to know about their jobs and work environment,
the likelihood of this occurrence is very small.
6.3. Future research
Researchers may build on the study findings and conduct a longitudinal

study that examines pharmacists’ organizational behaviors at different work
settings. This would enable researchers to make definite conclusions on the
causal relationships between work settings, empowerment, and its conse-
quences. Recent pharmacy graduates might be tracked and their levels of
empowerment throughout their careers could be examined.
Additional research is also warranted on the role that pharmacy owners
play within their organizations. Researchers may stratify study samples
based on position and test a model that captures the influence of owning
a pharmacy on empowerment.
7. Conclusions
Consistent with theoretical considerations, almost all the paths for the
structural equation modeling among the subgroups were significant. Results
of the study revealed that work setting had a significant effect on empower-
ment and its consequences. Pharmacists who worked in independent settings
had significantly higher levels of structural empowerment than their coun-
terparts in hospitals or chain pharmacies. Specifically, independent pharma-
cists had significantly higher levels of opportunity, knowledge, and support.
Also, unlike hospital or chain pharmacists, structural and psychological em-
powerment had significant effects on loyalty, commitment, and identifica-
tion. Finally, loyalty among independent pharmacists significantly reduced
job-turnover intention.
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Appendix 1
Pharmacists’ structural empowerment
I. Opportunitya
Item
Having challenging work
Having the chance to gain new skills on the job
Having access to training programs for learning new things
Having a chance to work closely with their boss
Knowing how the organization works
Doing tasks that use all your skills and knowledge
Having the chance to advance to better jobs
Being rewarded for a job well done
Having the chance to develop individual friendships
Having the chance to utilize tuition reimbursement
II. Knowledgeb
Item
Relationship between the work in your unit to the work of the organization
How other people in positions like yours do their jobs
Values and goals of management
How salary and promotion decisions are made for people in positions like yours
This year’s plans for your unit work
What patients think of the work of your unit
What other departments think of the work of your unit
III. Supportc
Item
Having specific information about things that they did well
Receiving comments on things that they could improve
Getting helpful hints or problem-solving advice
Receiving suggestions about job possibilities open to them
Discussing their further training or education
Getting help in gaining access to people who can help to get the job done
Obtaining materials and supplies needed to get the job done
Getting help when there’s a work crisis
IV. Resourcesd
Item
Lacking needed supplies
Handling excessive paperwork
Working short of adequate personnel resources
Getting money for themselves
Getting promotions for themselves
a
1 ¼ Not at all, 5 ¼ A lot.
b
1 ¼ No knowledge, 5 ¼ Know almost everything.
c
1 ¼ None, 5 ¼ A lot.
d
1 ¼ None; 5 ¼ A lot.
Appendix 2
Pharmacists’ psychological empowerment
I. Meaning
Item
Work is important to them
Job activities are personally meaningful to them
Caring about what they do on the job
Work that they do is meaningful to them
II. Competence
Item
Their confidence in their abilities to do their jobs
Their jobs are within the scope of their abilities
Their assurance about their capabilities to perform their work activities
They have mastered the skills necessary to do their jobs
III. Self-determination
Item
Having significant autonomy in determining how they do their jobs
Being able to decide on their own how to go aboutdoing their jobs
Having considerable opportunity for independence and freedom
Having a chance to use personal initiative in carrying out their work
IV. Impact
Item
Having a large impact on what happens in their departments
Having a great deal of control over what happens in their departments
Having significant influence over what happens in their department
Making their opinions count in departmental decision-making process
1 ¼ Strongly disagree; 7 ¼ Strongly agree.

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Research in Social and Administrative Pharmacy

Background: In traditional organizations, power determinantsdaccess to information,

Keywords: Empowerment; Work setting; Independent pharmacists; Chain pharmacists;

In traditional organizations, power determinantsdaccess to information,

A model developed by Kanter is used and extrapolated to examine the

4.1. Research design and subjects

The study used a cross-sectional survey design. A random sample of

4.2. Data collection

4.3. Study variables

4.3.1. Power factors and structural empowerment

4.3.2. Need for achievement

4.3.3. Psychological empowerment

4.4. Analysis plan

Surveys were mailed to 1,200 pharmacists nationwide. After 5 mailings

5.1. Description of respondents

5.2. Antecedents of empowerment

Need for achievement among pharmacists was moderately high. Almost

Structural empowerment and psychological empowerment were mea-

Loyalty, commitment, identiﬁcation, and job-turnover intention were mea-

5.5. Analyses of variance

Results of the analyses of variance on the eﬀects of work setting on psy-

A further examination of the eﬀects of work setting on meaning, compe-

5.6. Structural equation modeling

Results of testing the overall measurement model of the structural equa-

5.6.1. Independent pharmacists’ empowerment

Fig. 1. Model of independent pharmacist’s empowerment.

(b63 ¼ 0.46), commitment (b64 ¼ 0.35), and identiﬁcation (b65 ¼ 0.17) on

5.6.2. Hospital pharmacists’ empowerment

Fig. 2. Model of hospital pharmacist’s empowerment.

5.6.3. Chain pharmacists’ empowerment

Consistent with previous research in nursing, structural empowerment

Fig. 3. Model of chain pharmacist’s empowerment.

higher level of psychological empowerment than those who worked in hospi-

Fig. 4. Conﬁrmatory factor analysis.

6.1. Implications of the study

6.1.1. Implications for pharmacy research

6.1.2. Implications for pharmacy education

6.3. Future research

Researchers may build on the study ﬁndings and conduct a longitudinal

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