Background: Organizational justice has been put forward as a measure of leadership quality that is associated with better health among employees.
Objectives: We extended that idea to test whether perceived organizational justice among health care providers might be positively associated with glycemic control among their diabetic patients.
Setting: Eighteen primary-care health centers (HCs) in Finland.
Participants: Type 2 diabetes patients (n=8954) and HC staff (n=422).
Measurements: Mean of 1 year’s measurements of glycated hemoglobin [≥7.0 (the least optimal); 6.5–6.9; 6.0–6.4; and 4.5–5.9 (the most optimal)], health-center psychosocial work characteristics (staff-reported procedural justice and relational justice, effort-reward imbalance, and work-unit team climate), and individual-level and work-unit-level covariates.
Results: Perceptions of higher levels of procedural justice among staff were associated with more optimal glycated hemoglobin levels among patients (cumulative odds ratio per 1-U increase in justice=1.54, 95% confidence interval, 1.08–2.18) after adjustment for patient-level and unit-level covariates. Relational justice, effort-reward imbalance, and work-unit team climate were not associated with glycemic control.
Conclusion: The quality of leadership at HCs, as indicated by staff perceptions of procedural justice, may play a role in achieving good glycemic control among type 2 diabetes patients.
*Unit of Expertise in Work and Organizations, Finnish Institute of Occupational Health, Helsinki, Finland
†Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA
‡Department of Health and Social Services, National Institute for Health and Welfare, Helsinki
§Department of Public Health, University of Turku, Turku
∥Folkhälsan Research Center
¶Department of Public Health, Hjelt Institute, University of Helsinki
#Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
**Department of Epidemiology and Public Health, University College London, London, UK
††Turku University Hospital, Turku, Finland
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Supported by grants from the Medical Research Council (G0902037), the British Heart Foundation (RG/07/008/23674), the Stroke Association, the National Heart Lung and Blood Institute (5RO1 HL036310), the National Institute on Aging (5RO1AG13196) and the Agency for Health Care Policy Research (5RO1AG034454), the Finnish Innovation Fund (SITRA), the Academy of Finland (projects 124271, 124322, 126602, 129262 and 132944), and the European Union New OSH ERA Research Programme. The funders had no role in the study design, data collection and analysis, the decision to publish, or the preparation of the article.
The authors declare no conflict of interest.
M.V., the guarantor: formulated the initial hypotheses, designed the study, analyzed and interpreted data, and wrote the manuscript. J.V. and S.S.: formulated the initial hypotheses, designed the study, contributed to interpretation of the data, and reviewed/edited the manuscript. T.O., I.K., SV.S., M.E., A.L., A.K, and M.K.: designed the study, contributed to interpretation of the data, and reviewed/edited the manuscript. J.P.: designed the study, analyzed data, contributed to interpretation of the data, and reviewed/edited the manuscript.
Reprints: Marianna Virtanen, PhD, Finnish Institute of Occupational Health, Unit of Expertise in Work and Organizations, Finnish Institute of Occupational Health, Topeliuksenkatu 41 a A, Helsinki FIN-00250, Finland. E-mail: firstname.lastname@example.org.