Journal of Health Organization and Management

The role of organisational justice, burnout and commitment in the understanding of absenteeism in
the Canadian healthcare sector
Denis Chnevert Genevieve Jourdain Nina Cole Brigitte Banville

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Denis Chnevert Genevieve Jourdain Nina Cole Brigitte Banville, (2013),"The role of organisational justice, burnout and
commitment in the understanding of absenteeism in the Canadian healthcare sector", Journal of Health Organization and
Management, Vol. 27 Iss 3 pp. 350 - 367
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JHOM
27,3

350

The role of organisational justice,

burnout and commitment in the
understanding of absenteeism in
the Canadian healthcare sector
Denis Chenevert and Genevieve Jourdain
HEC Montreal HRM, Montreal, Canada

Downloaded by New Mexico State University At 21:34 19 January 2015 (PT)

Nina Cole
Ryerson University HRM, Toronto, Canada, and

Brigitte Banville
Aimia inc HRM, Montreal, Canada
Abstract
Purpose The purpose of this paper is to integrate Greenbergs perspective on the connection
between injustice and stress in order to clarify the role of organisational justice, burnout and
organisational commitment in the understanding of absenteeism.
Design/methodology/approach The study was carried out among 457 workers of a large
healthcare establishment in the Canadian public healthcare sector. The model was tested using
structural equation methods.
Findings The results reveal that procedural and interactional justices have an indirect effect on
exhaustion through distributive injustice. Moreover, it was found that distributive injustice is
indirectly linked to short-term absences through exhaustion. By contrast, the relationship between
distributive injustice and long-term absence can be explained by two mediating variables, namely,
exhaustion and psychosomatic complaints.
Research limitations/implications In spite of the non-longitudinal nature of this study, the
results suggest that the stress model and the medical model best explain the relationship between
organisational injustice and absenteeism, while the withdrawal model via organisational commitment
is not associated in this study with absenteeism.
Practical implications Healthcare managers should consider the possibility of better involving
employees in the decision-making process in order to increase their perception of procedural and
interactional justice, and indirectly reduce exhaustion and absenteeism through a greater perception of
distributive justice.
Social implications For the healthcare sector, the need to reduce absenteeism is particularly
urgent because of budget restrictions and the shortage of labour around the world.
Originality/value This is one of the first studies to provide a complete model that analyses the
stress process in terms of how organisational justice affects short- and long-term absences, in a bid to
understand the specific process and factors that lead to shorter and longer episodes of absence.

Journal of Health Organization and

Management
Vol. 27 No. 3, 2013
pp. 350-367
q Emerald Group Publishing Limited
1477-7266
DOI 10.1108/JHOM-06-2012-0116

Keywords Organizational justice, Burnout, Commitment, Absenteeism, Canada, Health care,

Employees behaviour, Stress, Human resource management
Paper type Research paper

Introduction
In recent years, several reforms to the health and social services system in Canada and
around the world have considerably altered the organisation of services and the work

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environment. To reduce their payroll, healthcare establishments have streamlined their

workforce considerably, which consequently eliminated a large proportion of their
qualified personnel (Shamian et al., 2002; Adams et al., 2000). This situation, coupled
with the growing complexity of treatments and massive re-engineering of work
processes, has imposed a work overload on all personnel, in particular caregivers
(Adams et al., 2000). This intensification of work, in a context of heightened control,
has generated a rise in absenteeism and dissatisfaction, and consequently, intention to
quit (Ito et al., 2001). In Canada, the report of Shamian et al. (2003) shows that
healthcare workers are experiencing higher rates of absenteeism and injury than all
other types of workers. In fact, every week, over 13,000 nurses (7.4 per cent of all
nurses) are absent from work due to injury, illness, professional burnout or disability;
over 16 million hours in nursing care are lost per year because of injury or illness. Were
the absenteeism rate of nurses to be reduced to that of other workers, we would have
the equivalent of 3,500 additional full-time nurses available to offer patient care.
To date, health and social services managers have opted for short-term solutions
and a reactive approach, which entails solving problems when they arise, without
trying to understand their causes (Dubois and Dussault, 2002). Research on
absenteeism has identified a set of factors that can explain absences from work,
including professional burnout, the nature and requirements of the job, weak
commitment to work, the unionisation rate, and the feeling of inequity (De Boer et al.,
2002; Chenevert et al., 2007; Statistics Canada, 2004).
More particularly, research has shown that people who believe they have been
treated unfairly at work experience considerable distress that can result in
withdrawal behaviours, such as absenteeism (e.g. De Boer et al., 2002; Elovainio et al.,
2002; Taris et al., 2002). Drawing on the equity theory (Adams, 1965) and the
cognitive appraisal model of stress (Lazarus and Folkman, 1984), Greenberg (2004)
suggests that injustice can lead to stress, but that not all injustice automatically
function as stressors. In the most commonly accepted sense, stressors refer to
external forces that place physical or psychological demands on the individual (Selye,
1976; McGrath, 1982). According to Greenbergs theoretical perspective on the
connection between injustice and stress, distributive injustice is a form of
organisational justice that functions as a stressor. In other words, distributive
injustice is considered as a demand that impinges on the person, and elicits coping
efforts. Some studies have provided evidence that imbalance between investments
and outcomes can engender considerable distress and lead to burnout (e.g. Moliner
et al., 2005, 2008; Taris et al., 2001; Schaufeli et al., 1996). Consequently, there is
support for the contention that distributive injustice can act as a stressor or demand.
Furthermore, Greenberg describes an activation process whereby the three forms of
organisational justice (Colquitt, 2001) are activated in a specific order, that is,
distributive injustice, procedural justice, and then interactional justice. This
activation process, by which an event (i.e. distributive injustice) is cognitively
appraised as a stressor, is called the justice salience hierarchy.
The aim of the present study is to shed light on the role of the various forms of
organisational justice in the stress process, which leads to absenteeism among
healthcare workers. Our intention is to look beyond previous studies (Moliner et al.,
2005, 2008; De Boer et al., 2002; Elovainio et al., 2002; Taris et al., 2002) in a number of
ways. First, we propose a conceptual framework that integrates Greenbergs

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theoretical perspective on the connection between justice, stress and absenteeism. In

this regard, we examine the intermediary role played by burnout and organisational
commitment in the stress process originating from the various forms of organisational
justice, and leading to absenteeism. Secondly, while many studies have examined the
determinants of absenteeism without distinguishing short-term from long-term
absences, we seek to understand the specific process and factors that lead to shorter
and longer episodes of absence. For practitioners in the healthcare sector, the
possibility of identifying variables related to commitment and professional burnout,
which act on short- and long-term absenteeism, would be useful. In fact, the results of
this study will suggest potential solutions to the challenges facing healthcare and
social service institutions around the world. In addition, the study has a number of
methodological strengths worth noting. The use of objective outcomes
(e.g. records-based absenteeism data) recommended by Moliner et al. (2008)
strengthens the inferences that can be drawn from the model by eliminating
concerns about mono-method bias. Further, we control for previous absenteeism,
usually considered to be the best predictor of future absenteeism (Martocchio and
Harrison, 1993), which adds credence to the model and the results.
Theoretical framework and hypotheses
Links between forms of organisational justice
According to Greenbergs theoretical perspective on the connection between injustice
and stress, the three forms of organisational justice play a distinct role in the stress
process. Drawing on the equity theory (Adams, 1965) and the cognitive appraisal
model of stress (Lazarus and Folkman, 1984), Greenberg (2004) asserts that distributive
injustice acts as an event that triggers a cognitive appraisal process through which
people mentally assess the impact of the event on them. This process occurs in two
stages. First, a primary appraisal occurs in which the individual considers the extent to
which he or she is harmed by the event. In this regard, assessing procedural justice will
help the individual interpret the meaning of distributive injustice. If it is believed to
result from unfair procedures, then perceived distributive injustice is exacerbated and
elicits stronger stress reactions. Therefore, procedural justice can increase distress if
lacking, while it can reduce distress when present.
To the extent that the individual believes he has been harmed, a secondary
appraisal occurs in which he judges his opportunities to rectify the situation. Searching
for information that explains the organisations questionable procedures, he will most
likely turn to those who can best shed light on the procedures, such as his immediate
supervisor. The adequacy of explanations given (informational justice) and the quality
of inter-personal treatment received during the enactment of a decision-making
procedure (inter-personal justice) reduce the distributive injustice perception, and
indirectly, stress reactions. Therefore, interactional justice (Colquitt, 2001), which
comprises two dimensions namely informational and interpersonal justice can
increase distress if lacking, while it can reduce distress when present.
As Figure 1 illustrates, this study integrates Greenbergs (2004) theoretical
perspective on the connection between injustice and stress in order to shed light on the
role of the various forms of organisational justice in the stress process that leads to
absenteeism. The following hypotheses are formulated according to the Justice

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353
Figure 1.
The role of organisational
justice, burnout and
commitment in the
understanding of
absenteeism

Salience Hierarchy (Greenberg, 2004), the activation process by which an event

(i.e. distributive injustice) is cognitively appraised as a stressor:
H1. Procedural justice is negatively associated with distributive injustice.
H2. Interactional justice is negatively associated with distributive injustice
Links between forms of organisational justice, burnout, and health problems
Burnout is seen as a persistent dysfunctional state that results from prolonged
exposure to chronic stress, that is, a situation where a person is incessantly confronted
with a high level of demands and insufficient resources linked to the work itself and to
the context in which the work takes place (Buunk et al., 1998; Cooper et al., 2001; Leiter
and Maslach, 2004). Organisational justice or absence of justice seems to be linked to
exhaustion, recognised as a central dimension of burnout syndrome (Maslach et al.,
2001; Schaufeli and Enzmann, 1998). Moliner et al. (2005) showed that in the service
sector, distributive and interactional justices are negatively linked to exhaustion. In an
effort to try to interpret distributive injustice, employees will proceed to search for
additional information in their working environment that provides reasons justifying
these results (procedural and interactional justices). If the procedures or the
interactions with the supervisor are perceived as unfair, the stress reactions generated
by the perception of distributive injustice will consequently be accentuated (Tepper,
2001). When individuals are exposed to chronic stress, a process of depletion and
wearing down of their energetic resources develops over time, and incurs health costs
(De Jonge et al., 1996; Landsbergis, 1988). In other words, chronic stress is presumed to
lead to exhaustion and health problems (Cooper et al., 2001; Maslach et al., 2001;
Schaufeli and Enzmann, 1998). Based on these arguments, we therefore formulate the
following hypotheses:
H3. Distributive injustice is positively associated with exhaustion (H3a), and acts
as an intervening variable in the negative relationship between procedural
justice and exhaustion (H3b) and between interactional justice and exhaustion
(H3c).

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H4. Exhaustion is positively associated with psychosomatic complaints (H4a),

and acts as an intervening variable in the positive relationship between
distributive injustice and psychosomatic complaints (H4b).
Link between forms of organisational justice and commitment
Lind and Tyler (1988) identified two models for explaining the effects of procedural
justice:
(1) the self-interest (or instrumental) model; and
(2) the group value (or relational) model.
The self-interest model suggests that procedural justice is important because it
ultimately allows individuals to maximize personal gain, while the group value model
suggests that procedural justice is important because it provides individuals with
information about their group membership. Accordingly, procedural justice may play
a motivational role both by facilitating the attainment of personal objectives and by
satisfying the specific need for interpersonal attachment.
Interactional justice, considered by some researchers as a subset of procedural
justice (Moorman, 1991; Tyler and Bies, 1990), could also facilitate the attainment of
personal objectives, through the informational justice component, and satisfy the need
for interpersonal attachment, through the interpersonal justice component.
We thus contend that by addressing employees psychological needs and interests,
procedural and interactional justice should foster affective commitment toward the
organisation. According to Allen and Meyer (1990), it appears that work experiences
that fulfil employees psychological need to feel comfortable within the organisation
best explain the development of affective organisational commitment. The results
obtained by Moliner et al. (2008) suggest a positive link between procedural justice,
interactional justice and work engagement. Given the previous theoretical arguments,
we posit the following hypotheses:
H5. Procedural justice is positively associated with affective organisational
commitment.
H6. Interactional justice is positively associated with affective organisational
commitment.
Cropanzano et al. (2003) assert that jobs that produce exhaustion are likely to violate
two important conditions for the development of social exchange relationships
between employees and their organisation. Research seems to suggest that individuals
form high quality relationships characterised by attachment, identification and
involvement when they receive worthwhile benefits, and when they feel that these
benefits are assigned in a fair manner (i.e. distributive justice). They argue that because
jobs that produce exhaustion are personally costly and that the conditions in these jobs
are often seen as unfair, exhaustion should impede the development of social exchange
relationships, which would be manifested through lower affective organisational
commitment. The researchers expectations are supported by results of two field
studies (see Cropanzano et al., 2003). We therefore formulate the following hypothesis:
H7. Exhaustion is negatively associated with affective organisational
commitment.

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Links between exhaustion, commitment, health problems, and absenteeism

According to our research model depicted in Figure 1, absenteeism could be a response
to either exhaustion or low affective organisational commitment in the case of
short-term episodes of absence, or it could be a consequence of psychosomatic
complaints in the case of long-term episodes of absence. As we will argue, absenteeism
can have different meanings.
The stress model, which depicts absence as a coping mechanism to deal with job
strain ( Johns, 2001), supports the relationship between exhaustion and short-term
episodes of absence. A person whose energetic resources are depleted would certainly
be prompted, at some point, to take some time off to recuperate, in the form of a
short-term leave of absence.
In contrast, the withdrawal model, which depicts absence as a means of adapting to
unfavourable job attitudes ( Johns, 2001), supports the relationship between affective
organisational commitment and short-term episodes of absence. A person whose
psychological needs and interests are left unfulfilled would most likely be tempted to
take short-term leaves of absence, a readily available solution to relieve some of the
frustration engendered by a non-supportive work environment (De Boer et al., 2002;
Meyer and Smith, 2000; Meyer and Allen, 1991). Based on the previous arguments, we
therefore formulate the following hypotheses:
H8. Exhaustion is positively associated with short-term absence (H8a), and acts
as an intervening variable in the positive relationship between distributive
injustice and short-term absence (H8b).
H9. Affective organisational commitment is negatively associated with short-term
absence (H9a), and acts as an intervening variable in the negative
relationships between procedural and interactional justice and short-term
absence (H9b).
Absence as a response to psychosomatic complaints engendered by a high level of
exhaustion would best be explained by the medical model (Johns, 1997). Highly
exhausted employees whose capacity to attend work is greatly compromised by health
problems will most likely be forced at some point to take a longer medically certified
leave of absence in order to restore their health. In this case, it is less a drastic decrease
in organisational commitment that would predict a change in the type of absenteeism,
from short-term to long-term, than an impairment in bodily structures and functions.
Consequently, we expect that psychosomatic complaints will be the most important
determinants of long-term episodes of absence (Bakker and Demerouti, 2003; Marmot
et al., 1995). Given the last argument and evidence, we therefore formulate the
following hypothesis:
H10. Psychosomatic complaints are positively associated with long-term absence
(H10a), and act as an intervening variable in the positive relationship between
exhaustion and long-term absence (H10b).
Methodology
Participants
The study was carried out among workers of a large healthcare establishment in the
Canadian public healthcare sector. Questionnaires were distributed to all employees of

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the establishment by a human resources professional. In total, 580 participants (48.7

per cent) completed the questionnaire, and 457 (38.3 per cent) consented to their
personal absence files being matched to the questionnaire responses. More than 80 per
cent of the respondents were female, and nearly 60 per cent were involved in patient
care (37.4 per cent as nurses, 12.7 per cent as technicians, and 8.5 per cent as
professionals), 13.1 per cent in clerical support, 7.4 per cent in management, 8.6 per cent
in food and cleaning services, and 12.3 per cent in auxiliary services. The average age
was 43, and the average seniority of respondents was 8.8 years. Nearly 62 per cent of
respondents worked full-time, while 30 per cent worked part-time, and 8 per cent were
on call. Regarding education, over 70 per cent of respondents had completed
postsecondary studies (43 per cent college level, 8 per cent university certificate, 17 per
cent Bachelors degree and 3 per cent Masters degree).
Measures
Unless otherwise specified, employees were asked to express their level of agreement
with each statement on a continuum ranging from strongly disagree (1) to Strongly
agree (7).
Distributive injustice (a 0:71) was assessed on a scale referring to Niehoff and
Moormans (1993) study of the fairness of immaterial outcomes (e.g. work schedule).
The four items examined focused on training opportunities, work scheduling, vacation
assignment, and decisions regarding promotions. A sample item was I feel that my
work schedule is fair. The items were reverse coded to measure distributive injustice.
Procedural justice (a 0:85) was assessed through five items taken from Niehoff
and Moormans (1993) formal procedures scale, and adapted slightly to reflect
perceived procedural justice from all general managers (e.g. General managers make
sure that all employee concerns are heard before job decisions are made).
Interactional justice (a 0:95) was measured through four items taken from
Niehoff and Moormans (1993) interactive justice scale, and adapted slightly to reflect
perceived interactional justice from the employees supervisor. Two of the items refer
to interpersonal justice (e.g. My supervisor treats me with respect and dignity), and
the two others assess informational justice (e.g. My supervisor offers adequate
justification for decisions made about my job).
Exhaustion (a 0:89) was assessed through four items taken from the Maslach
Burnout Inventory Human Services Survey (MBI-HSS) (Maslach and Jackson, 1996).
(e.g. I feel physically exhausted at the end of my workday). Employees were asked to
indicate the frequency of symptoms experienced on a continuum ranging from never
(1) to a few times a month (4) to every day (7).
Psychosomatic complaints (a 0:73). On the basis of the psychosomatic
complaints included in the Depression Inventory of Beck (1978), three items were
formulated and measured on a frequency scale rather than by the severity of the
symptom. The items referred to sleep disorders, appetite disturbances and health
problems (e.g. backache, headache, breathing problems, problems with digestion).
Employees were asked to indicate the frequency of symptoms experienced on a
continuum ranging from never (1) to a few times a month (4) to every day (7).
Affective organisational commitment (a 0:86) was measured using four items
taken from Meyer et al.s (1993) instrument (e.g. I really feel as if this organisations
problems are my own).

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Absenteeism data were retrieved from the organisations computerised registration

system. We gathered absence data for the 12-month period before and following the
administration of the questionnaire. A period of one year was chosen to ensure stability
in the absences measures (Hammer and Landau, 1981). Previous absences were used as
a control variable in this research because they are usually considered to be the best
predictor of future absenteeism (Martocchio and Harrison, 1993). We examined two
categories of absences as classified by the organisation:
(1) illness-related (short-term); and
(2) wage insurance (long-term).
Absences of less than five consecutive days in duration fall under the short-term
category, and are not medically certified. Absences lasting five or more consecutive
days fall under the long-term category, and are medically certified and covered by
wage insurance. For each absence category, we collected the total number of hours of
absence (i.e. absence duration).
Control variables. In addition to previous absenteeism, information related to
gender, age, work schedule and organisational tenure was collected in order to measure
their impact on the endogenous variables included in our model. Moreover, following
De Boer et al. (2002), we measured perceived workload (a 0:86), autonomy
(a 0:70), and supervisor support (a 0:93), and included these variables in our
research model (not shown in Figure 1) in order to examine the predictive value of
different forms of organisational injustice beyond these three traditional work-related
stressors, which are the core elements of the demand-control-support model developed
by Karasek (1979).
Analyses
The model was tested using structural equation methods. Consistent with the approach
suggested by Anderson and Gerbing (1988), we verified the quality of fit of the
measurement model using confirmatory factor analysis, and then validated the
structural model to test our hypotheses. The quality of the fit of the models was
evaluated based on a number of indices. In these computations, a root mean square
error of approximation (RMSEA) below 0.05 is a sign of a good degree of fit, and values
of up to 0.08 indicate a reasonable error of approximation in the population (Byrne,
1998). A normed fit index (NFI) and a comparative fit index (CFI) situated between 0.90
and 1 also indicate the presence of a well-fitted model (Bentler, 1992). Lastly, we
estimated the significance of the indirect effect using a bootstrap approach (Preacher
and Hayes, 2008), which overcomes the shortcomings of the Sobel (1982) test (i.e. high
Type I error rates due to violation of the normal distribution assumptions; see Shrout
and Bolger, 2002).
Results
Measurement model
Table I presents the descriptive statistics, correlations between variables included in
this study and Cronbachs a values. The quality of fit of the measurement model was
evaluated using a first-order confirmatory factor analysis (CFA). In this nine-factor
model, each item was associated with the factor defined a priori, and factor loadings
ranged from 0.50 to 0.95 (p , 0:001), thus meeting the minimum threshold of 0.50

Absenteeism in
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357

SD

Table I.
Descriptive statistics,
correlations and
reliability coefficients
0.11
0.01

2 0.07 2 0.04
2 0.01

0.73

0.05

0.20

0.14
0.45

10

11

12

13

14

15

16

17

2 0.03
0.05
0.31

0.18
0.05
0.05 2 0.03

2 0.06 2 0.03 2 0.02 2 0.06

0.06

0.08
0.07
0.00
0.03
0.15
0.04

0.24
0.16 2 0.03 2 0.01
0.49
0.02
0.17

2 0.03
0.01
0.04
0.02
0.03 2 0.07 2 0.02 2 0.01
0.70
2 0.07 2 0.02
0.03
0.06 2 0.01 2 0.03 2 0.04 2 0.13
0.25
0.93
0.04
0.08
0.02
0.02
0.01
0.09
0.05
0.02 2 0.16 2 0.14 0.86

0.10 20.03 2 0.05 2 0.03

0.17 20.02

0.16 20.07

0.86

0.07
0.02
0.06
0.15
0.08
0.04
0.08 2 0.05
0.04
0.09
2 0.01
0.04 2 0.10
0.05 20.16
2 0.03
0.08
0.01
0.03 20.01
2 0.08
0.14
0.13
0.08 20.05
0.26 20.10 2 0.13 2 0.12
0.29
0.80 20.05 2 0.25 2 0.09
0.30
2 0.14
0.11
0.52
0.25 20.06

0.04

0.19

0.05
2 0.07
2 0.08
2 0.06
2 0.20
0.28
0.30
2 0.16

0.55

0.89

0.27 20.09 2 0.23 2 0.15

2 0.12 2 0.08

0.40

0.13

2 0.20 2 0.13

0.71
0.19

0.85
0.34
0.95
2 0.19
0.08
2 0.30 2 0.26

358

1. Procedural justice
3.44
1.26
2. Interactional justice
5.09
1.65
3. Distributive injustice
4.08
1.69
4. Exhaustion
4.06
1.50
5. Psychosomatic
complaints
2.73
1.42
6. Organizational
commitment
4.50
1.41
7. Previous short-term
absences
14.24 24.67
8. Prospective short-term
absences
16.09 23.66
9. Previous long-term
absences
47.60 177.2
10. Prospective long-term
absences
33.65 164.1
11. Age
42.86 44.00
12. Gender
1.81
0.40
13. Work schedule (day)
0.68
0.47
14. Organizational tenure 140.6 131
15. Autonomy
5.47
1.26
16. Supervisor support
4.93
1.69
17. Workload
5.03
1.45

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recommended by Roussel et al. (2002). The level of reliability of internal consistency of

the latent variables (f) ranged from 0.70 to 0.94, which satisfies the minimum
threshold of 0.70 recommended by Roussel et al. (2002). Regarding the quality of fit, the
indices suggested a satisfactory level of fit (x 2 593 1; 082:97, p , 0:001;
RMSEA 0:043; NFI 0:90; CFI 0:95).

Absenteeism in
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Structural model
The quality of fit of the structural model to the data appears to be satisfactory overall
(x 2 758 1; 289:41, p , :001; RMSEA 0:039; NFI 0:89; CFI 0:95), and the
variance explained for each of the endogenous variables is respectively 57 per cent for
distributive injustice, 41 per cent for exhaustion, 27 per cent for affective organisational
commitment, 44 per cent for psychosomatic complaints, 21 per cent for short-term
absences, and 11 per cent for long-term absences.
Figure 2 shows a significant negative relationship between procedural justice and
distributive injustice (g 20:57; p , 0:001), and between interactional justice and
distributive injustice (g 20:33; p , 0:001), which confirms our first and second
hypotheses.
The results in Figure 2 also confirm H3a: the more employees perceive distributive
injustice, the more they feel exhausted (g 0:30; p , 0:01). H3b states that
distributive injustice acts as an intervening variable in the negative effect of procedural
justice on exhaustion. Following Preacher and Hayess (2008) recommendations, we
estimated the significance of the indirect effect of procedural justice on exhaustion via
distributive injustice using a bootstrap approach. We bootstrapped 5,000 samples to
obtain the 95 per cent bias-corrected confidence interval (CI) (MacKinnon et al., 2004)
for the indirect effect. If the CI does not include zero, the indirect effect is deemed to
be significantly different from zero. We found this negative indirect effect
(estimate 20:09, 95 per cent CI 20:01; 2 0:19) to be significant. These results
confirm H3b. We obtained similar results with the indirect effect of interactional justice
on exhaustion via distributive injustice (estimate 20:08, 95 per cent
CI 20:04; 2 0:14), which confirms H3c.
H4a and H4b pertain to the relationship between exhaustion and psychosomatic
complaints on the one hand, and to the indirect effect between distributive injustice and
psychosomatic complaints via exhaustion, on the other. Overall, H4 is confirmed.
Figure 2 shows a positive relationship between exhaustion and psychosomatic
complaints (g 0:66; p , 0:01) and, as mentioned, between distributive injustice and
exhaustion (g 0:30; p , 0:01). In fact, a positive indirect effect on psychosomatic
complaints was observed via exhaustion (estimate 0:18, 95 per cent CI 0:12; 0:26).
This result suggests that the direct positive relationship that we observed between
distributive injustice and psychosomatic complaints is mediated by exhaustion (see
Mathieu and Taylor, 2006).
The results we obtained confirm H5, but not H6. We found a significant link
between procedural justice and organisational commitment (g 0:33; p , 0:01), but
no significant link between interactional justice and organisational commitment
(g 20:11; NS). H7 posits that exhaustion is negatively linked to organisational
commitment, but our results do not support this hypothesis (b 20:08; NS).
H8a and H8b pertain to the relationship between exhaustion and short-term
absence duration on the one hand, and the indirect effect of distributive injustice on

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360

Figure 2.
Structural models

short-term absence duration, on the other. Overall, H8 is confirmed. Figure 2 shows a

positive relationship between exhaustion and short-term absence duration (b 0:17;
p , 0:001). For the indirect effect of distributive injustice on short-term absence
duration via exhaustion, our results showed a positive indirect effect (estimate 0:15,
95 per cent CI 0:02; 0:09), confirming H8b.
For H9a and H9b, none of them are supported because organisational commitment
is not significantly linked to short-term absence duration (b 0:03; NS).
Lastly, H10a and H10b pertain to the relationship between psychosomatic
complaints and long-term absence duration on the one hand, and the indirect effect of
exhaustion on long-term absence duration, on the other. Overall, H10 is confirmed.
Figure 2 shows that psychosomatic complaints are positively associated with
long-term absence duration (b 0:17; p , 0:001). We estimated the significance of the

indirect effect of exhaustion on long-term absence duration via psychosomatic

complaints using a bootstrap approach. The positive indirect effect we observed
confirms H10b (estimate 0:14, 95 per cent CI 0:04; 0:25).

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Discussion
Consistent with Greenbergs (2004) theoretical perspective, we found that procedural
and interactional justice are indirectly related to exhaustion through distributive
injustice. When the perception of procedural justice is not positive, employees will most
likely turn to those who can best shed a light on the procedures, such as their
immediate supervisor. The supervisors response will be important because it will
influence the employees perception of injustice concerning a specific outcome.
Theoretical implications
Our results also demonstrate that perceived organisational injustice is not directly
linked to absenteeism, but rather is linked indirectly through exhaustion and
psychosomatic complaints. We proposed that the stress model best explains the
relationship between exhaustion and absenteeism, while the medical model best
explains the relationship between psychosomatic complaints engendered by a high
level of exhaustion and absenteeism. Our results confirm both of these models. These
findings may be explained by the work adaptation strategy (coping strategy).
According to Lazarus and Launiers (1978) theoretical perspective, individuals analyse
a situation in terms of its impact on their well-being. When individuals consider that
they are not able to adapt to the situation or to change it, the event will be appraised as
stressful, and will engender psychological tension manifested in the form of anxiety,
and eventually, exhaustion (Tepper, 2001). Employees who experience such malaise
may be tempted to use an active and direct adaptation strategy which involves
occasionally taking days off to relieve the stress (Lazarus and Launier, 1978). Hackett
and Bycio (1996) assert that despite this adaptation strategy, some employees may not
necessarily improve the state of their mental health, although they may avert
aggravating it. High exhaustion for a long period of time will generate psychosomatic
complaints and eventually lead to long-term leaves of absence.
Contrary to the withdrawal model, the links between the employees perception of
organisational justice or injustice, engagement or disengagement and absenteeism are
not significant in our study. More particularly, interactional justice is not linked to
affective organisational commitment when the perception of organisational support
(POS) is controlled. The study by Rhoades et al. (2001) suggests that organisational
justices (procedural and interactional) are indirectly linked to affective commitment via
POS. Therefore, it is possible that interactional justice in our study has an indirect effect
on organisational commitment via POS or procedural justice. The supervision structure
in the Canadian healthcare sector can also explain the limited role of interactional justice
in the withdrawal process. For example, the caregivers supervisor frequently manages
more than 100 professionals, which considerably reduces the possibility of social
interactions. We also believe that the population examined may explain this result. The
interdependence between the tasks of caregivers (60 per cent of our sample) and their
commitment to abide by a code of ethics are factors that contribute to increasing the level
of commitment of workers in the healthcare sector, who may hesitate to take short-term
leaves of absence in order to avoid increasing the workload of their co-workers and

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reducing the quality of care offered to patients. Although their level of commitment
toward the organisation may be low, their level of commitment toward the team and the
patients will most likely motivate them to attend work. However, these factors are not
likely to have a great impact when employees are experiencing feelings of exhaustion
and lack the capacity to attend work. Even though commitment toward the team and the
patients may be high and employees may want to attend work despite their state of
exhaustion, they are no more and no less capable of doing so. This would explain why we
found, in our study, that exhaustion leads directly and indirectly to absenteeism, while
low affective organisational commitment does not.
Finally, we argued that by addressing employees psychological needs and
interests, procedural and interactional justice should foster affective commitment
toward the organisation. Nevertheless, only the relationship with procedural justice
was found to be significant. One possible explanation for this finding might be the fact
that procedural justice is a job resource more strongly related to the organisational
facet of the work environment, while interactional justice is a job resource more
strongly associated with its social interactions facet more precisely, in this study,
with the immediate supervisor.
Managerial implications
For managers in the healthcare sector, the need to reduce absenteeism is particularly
urgent because of budget restrictions and the shortage of labour in healthcare
establishments around the world. The low level of perception of procedural and
distributive justice in this sample (average 3.4 and 3.5 out of 7) confirms the importance
of carrying out immediate actions to enhance these aspects of fair treatment. For
example, more specific performance appraisal and salary increase criteria could reduce
the pressure on managers to explain and justify their decisions. A consultation process
and a multidisciplinary decision team should also be implemented in order to increase
the perception of procedural justice and indirectly reduce exhaustion and absenteeism
through a better perception of distributive justice. In the Canadian healthcare sector,
employees are normally excluded from the decision making process. In fact, most
reorganisation decisions come from the Canadian government, and are imposed on
hospitals. The boards of directors of many hospitals perpetuate the same directive
decision process by implementing changes without employee feedback. This absence
of consideration for employees generates suspicion, perceptions of unfairness, stress
and eventually, sickness and absenteeism. Employers must also be attuned to the
relational abilities of their managers. If managers are able to show employees
consideration and clearly and honestly explain why they took a given decision, they
will reduce the negative perception of distributive injustice. A major training effort can
be made to increase the quality of interpersonal relations between supervisors and
their employees. Moreover, as this study has demonstrated, perceptions of
organisational injustice are not directly linked to absenteeism, but rather, are linked
indirectly through exhaustion and psychosomatic complaints. Because commitment to
the organisation does not fluctuate easily in response to exhaustion, as shown in this
study, it is not likely to be a factor that could prompt exhausted healthcare workers to
take occasional short-term sick leaves in order to restore or at least maintain their state
of health (Hackett and Bycio, 1996). As a consequence, workers may aggravate their
health by prolonging exposure to chronic stress, up to a point where they will need to

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stay at home and rest. However, Hackett and Bycios (1996) study reveals that
sickness-related short-term absence is more likely to slow down the rate of aggravation
of burnout symptoms, thereby serving more of a health maintenance function than a
restorative one. Then, after realizing that taking short-term sick leaves occasionally is
not an effective health restoring strategy and experiencing physical symptoms of ill
health, workers may feel a stronger need to seek medical advice and be given a
doctors order to take a long-term sick leave. Managers must therefore listen to their
employees to identify signs of professional burnout and work jointly with the RH staff
to formulate an action plan. All in all, absenteeism is an important individual,
organisational and societal issue, and managers in the healthcare sector should take
actions to implement a presenteeism prevention policy in their organisation.
Limitations and future research
This study has some limitations that should be noted. First, it was carried out in a
single organisation, which limits the possibility of using organisational differences as
determinants. The culture of absence and social pressures within the group are often
better determinants than individual attitudes (Gellatly, 1995). The measurement of
absenteeism based uniquely on the duration not the frequency of absences can
also constitute a limitation. Although we considered short- and long-term absences, we
could not differentiate between several one-day absences and absences of a few days
within the short-term absences category. Nevertheless, the meta-analysis of Darr and
Johns (2008) suggests no significant difference across frequency and time lost
absenteeism measures. Moreover, the measures of exhaustion and psychosomatic
complaints were collected at the same time, and we know that exhaustion precedes
psychosomatic complaints. Consequently, it is preferable, in a future research
endeavour, to measure these concepts at two different times, in order to take the
development process into account. The same remark could be considered with
organisational justice dimensions (distributive, procedural and interactional). To
perfectly test the justice salience hierarchy model of Greenberg (2004), a longitudinal
research design with three time measurements is necessary. On the basis of the results
of the present study, one important research avenue would be to test the same research
model with different categories of workers, departments and organisations in the
healthcare sector, who present different contexts, depending on their mission and
clientele, to see if there is support for the withdrawal model, which maintains that low
affective organisational commitment will encourage absenteeism.
In conclusion, absenteeism is an important individual, organisational and social
issue. The associated human and organisational costs of absenteeism are disturbing,
particularly in a sector facing budget restrictions and a shortage of qualified labour. Our
results, consistent with those of Bourbonnais and Mondor (2001), suggest that the causes
of absenteeism are complex, and differ depending on the nature of the absenteeism. As
this study has demonstrated, perceptions of organisational injustice are not directly
linked to absenteeism, but rather are linked indirectly through exhaustion and
psychosomatic complaints. As predicted by the stress and medical models (Johns, 1997),
our results support the instrumental role played by stress and exhaustion in explaining
short-term and long-term absenteeism phenomena. However, contrary to the
withdrawal model ( Johns, 2001), affective organisational commitment did not play a
significant role in the understanding of short-term absence duration in this study.

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References
Adams, A., Lugsden, E., Chase, J., Arber, S. and Bond, S. (2000), Skill-mix changes and work
intensification in nursing, Work Employment and Society, Vol. 14, pp. 541-555.
Adams, J.S. (1965), Inequity in social exchange, in Berkowitz, L. (Ed.), Advances in
Experimental Social Psychology, Vol. 2, Academic Press, New York, NY, pp. 267-299.

364

Allen, N.J. and Meyer, J.P. (1990), The measurement and antecedents of affective, continuance
and normative commitment to the organization, Journal of Occupational Psychology,
Vol. 63, pp. 1-17.

Downloaded by New Mexico State University At 21:34 19 January 2015 (PT)

Anderson, J.C. and Gerbing, D.W. (1988), Structural equation modeling in practice: a review and
recommended two-step approach, Psychological Bulletin, Vol. 103, pp. 411-423.
Bakker, A.B. and Demerouti, E. (2003), Job demands and job resources as predictors of absence
duration and frequency, Journal of Vocational Behavior, Vol. 62, pp. 341-356.
Beck, A. (1978), Depression Inventory, Center for Cognitive Therapy, Philadelphia, PA.
Bentler, P.M. (1992), On the fit of models to covariances and methodology to the Bulletin,
Psychological Bulletin, Vol. 112, pp. 400-404.
Bourbonnais, R. and Mondor, M. (2001), Job strain and sickness absence among nurses in the
province of Quebec, American Journal of Industrial Medicine, Vol. 39 No. 2, pp. 194-202.
Buunk, B.P., de Jonge, J., Ybema, J.F. and de Wolff, C.J. (1998), Psychosocial aspects of
occupational stress, in Drenth, P.J.D., Thierry, H. and de Wolff, C.J. (Eds), Handbook of
Work and Organizational Psychology, 2nd ed., Vol. 2, Psychology Press, Hove, pp. 145-182.
Byrne, B.M. (1998), Structural Equation Modeling with LISREL, PRELIS, and SIMPLIS: Basic
Concepts, Applications, and Programming, Lawrence Erlbaum Associates, Hillsdale, NJ.

Chenevert, D., Charest, A. and Simard, G. (2007), Etude de levolution des determinants de
lengagement affectif: le role de lhabilitation, du plafonnement de carrie`re et de la justice
organisationnelle, Relations Industrielles/Industrial Relations, Vol. 62 No. 2, pp. 258-281.
Cooper, C.L., Dewe, P.J. and ODriscoll, M.P. (2001), A special form of strain. Job related
burnout, in Cooper, C.L., Dewe, P.J. and ODriscoll, M.P. (Eds), Organizational Stress: A
Review and Critique of Theory, Research, and Applications, Sage Publications, Thousand
Oaks, CA.
Colquitt, J. (2001), On the dimensionality of organizational justice: a construct validation
measure, Journal of Applied Psychology, Vol. 86 No. 3, pp. 386-400.
Cropanzano, R., Rupp, D.E. and Byrne, Z.S. (2003), The relationship of emotional exhaustion to
work attitudes, job performance, and organizational citizenship behaviors, Journal of
Applied Psychology, Vol. 88, pp. 160-169.
Darr, W. and Johns, G. (2008), Work strain, health, and absenteeism: a meta-analysis, Journal of
Occupational Health Psychology, Vol. 13 No. 4, pp. 293-318.
De Boer, E.M., Bakker, A.B., Syroit, J.E. and Schaufeli, W.B. (2002), Unfairness at work as a
predictor of absenteeism, Journal of Organizational Behavior, Vol. 23, pp. 181-197.
De Jonge, J., Janssen, P.P.M. and Van Breukelen, G.J.P. (1996), Testing the
demand-control-support model among health-care professionals: a structural equation
model, Work & Stress, Vol. 10, pp. 209-224.
Dubois, C.-A. and Dussault, G. (2002), La politique de ressources humaines et la transformation
des syste`mes de soins, Gestion, Vol. 27, pp. 55-63.

Elovainio, M., Kivimaki, M. and Vahtera, J. (2002), Organizational justice: evidence of a new
psychosocial predictor of health, American Journal of Public Health, Vol. 92 No. 1,
pp. 105-108.
Gellatly, I.R. (1995), Individual and group determinants of employee absenteeism: test of a
causal model, Journal of Organizational Behavior, Vol. 16 No. 5, pp. 469-485.
Greenberg, J. (2004), Stress fairness to fare no stress: managing workplace stress by promoting
organizational justice, Organizational Dynamics, Vol. 33, pp. 352-365.

Downloaded by New Mexico State University At 21:34 19 January 2015 (PT)

Hackett, R.D. and Bycio, P. (1996), An evaluation of employee absenteeism as a coping

mechanism among hospital nurses, Journal of Occupational and Organizational
Psychology, Vol. 69, pp. 327-338.
Hammer, T.H. and Landau, J. (1981), Methodological issues in the use of absence data, Journal
of Applied Psychology, Vol. 66, pp. 574-581.
Ito, H., Eisen, S.V., Sederer, L.I., Yamada, O. and Tachimori, H. (2001), Factors affecting
psychiatric nurses intention to leave their current job, Psychiatric Services, Vol. 52 No. 2,
pp. 232-234.
Johns, G. (1997), Contemporary research on absence from work: correlates, causes and
consequences, in Cooper, C.L. and Robertson, I.T. (Eds), International Review of Industrial
and Organizational Psychology, Vol. 12, Wiley, Chichester, pp. 115-173.
Johns, G. (2001), The psychology of lateness, absenteeism and turnover, in Anderson, N., Ones,
D.S., Sinangil, H.K. and Viswesvaran, C. (Eds), Industrial, Work and Organizational
Psychology, Vol. 2, Sage Publications, London, pp. 232-252.
Karasek, R.A. (1979), Job demands, job decision latitude, and mental strain: implications for job
redesign, Administrative Science Quarterly, Vol. 24 No. 2, pp. 285-308.
Landsbergis, P.A. (1988), Occupational stress among health care workers: a test of the job
demands-control model, Journal of Organizational Behavior, Vol. 9, pp. 217-239.
Lazarus, R.S. and Folkman, S. (1984), Stress, Appraisal and Coping, Springer, New York, NY.
Lazarus, R.S. and Launier, R. (1978), Stress-related transactions between persons and
environment, in Pervin, L.A. and Lewis, M. (Eds), Perspectives in Interactional Psychology,
Wiley, New York, NY, pp. 287-327.
Leiter, M.P. and Maslach, C. (2004), Areas of worklife: a structured approach to organizational
predictors of job burnout, in Perrewe, P.L. and Ganster, D.C. (Eds), Research in
Occupational Stress and Well Being, Vol. 3, Elsevier, Amsterdam, pp. 91-134.
Lind, A.E. and Tyler, T.R. (1988), The Social Psychology of Procedural Justice, Plenum Press, New
York, NY.
McGrath, J.E. (1982), Methodological problems in research on stress, in Krohne, H.W. and
Laux, L. (Eds), Achievement, Stress, and Anxiety, Hemisphere, Washington, DC, pp. 19-48.
MacKinnon, D.P., Lockwood, C.M. and Williams, J. (2004), Confidence limits for the indirect
effect: distribution of the product and resampling methods, Multivariate Behavioral
Research, Vol. 39, pp. 99-128.
Marmot, M., Feeney, A., Shipley, M., North, F. and Syme, S.L. (1995), Sickness absence as a
measure of health status and functioning: from the UK Whitehall II study, Journal of
Epidemiology and Community Health, Vol. 49, pp. 124-130.
Martocchio, J.J. and Harrison, D.A. (1993), To be there or not to be there? Questions, theories, and
methods in absenteeism research, in Ferris, G.R. (Ed.), Research in Personnel and Human
Resources Management, JAI Press, Greenwich, CT, pp. 259-328.

Absenteeism in
the healthcare
sector
365

JHOM
27,3

Downloaded by New Mexico State University At 21:34 19 January 2015 (PT)

366

Maslach, C. and Jackson, S.E. (1996), Maslach Burnout Inventory-Human Services Survey
(MBI-HSS), in Maslach, C., Jackson, S.E. and Leiter, M.P. (Eds), ), Maslach Burnout
Inventory Manual, 3rd ed., CPP, Inc., Mountain View, CA, pp. 3-17.
Maslach, C., Schaufeli, W.B. and Leiter, M.P. (2001), Job burnout, Annual Review of Psychology,
Vol. 52, pp. 397-422.
Mathieu, J.E. and Taylor, S.R. (2006), Clarifying conditions and decision points for meditational
type inferences in organizational behaviour, Journal of Organizational Behaviour, Vol. 27,
pp. 1031-1056.
Meyer, J.P. and Allen, N.J. (1991), A three-component conceptualization of organizational
commitment, Human Resource Management Review, Vol. 1, pp. 61-89.
Meyer, J.P. and Smith, C. (2000), HRM practices and organizational commitment: test of a
mediation model, Canadian Journal of Administrative Sciences, Vol. 17 No. 4, pp. 319-331.
Meyer, J.P., Allen, N.J. and Smith, C.A. (1993), Commitment to organizations and occupations:
extension and test of a three-component conceptualization, Journal of Applied Psychology,
Vol. 78, pp. 538-551.
Moliner, C., Martinez-Tur, V., Ramos, J. and Cropanzano, R. (2005), Relationships between
organizational justice and burnout at the work-unit level, International Journal of Stress
Management, Vol. 12, pp. 99-116.
Moliner, C., Martinez-Tur, V., Ramos, J. and Cropanzano, R. (2008), Organizational justice and
extrarole customer service: the mediating role of well-being at work, European Journal of
Work and Organizational Psychology, Vol. 17, pp. 327-348.
Moorman, R.H. (1991), Relationship between organizational justice and organizational
citizenship behaviors: do fairness perceptions influence employee citizenship?, Journal
of Applied Psychology, Vol. 76, pp. 845-855.
Niehoff, B.P. and Moorman, R.H. (1993), Justice as a mediator of the relationship between
methods of monitoring and organizational citizenship behavior, Academy of Management
Journal, Vol. 36, pp. 527-556.
Preacher, K.J. and Hayes, A.F. (2008), Asymptotic and resampling strategies for assessing and
comparing indirect effects in multiple mediator models, Behavior Research Methods,
Vol. 40, pp. 879-891.
Rhoades, L., Eisenberger, R. and Armeli, S. (2001), Affective commitment to the organization:
the contribution of perceived organizational support, Journal of Applied Psychology,
Vol. 86 No. 5, pp. 825-836.
Roussel, P., Durrieu, F. and Campoy, E. (2002), Methodes dequations structurelles: recherche et
applications en gestion (Structural Equation Methods: Research and Applications in
Management), Economica, Paris.
Schaufeli, W. and Enzmann, D. (1998), The Burnout Companion to Study and Practice: A Critical
Analysis, Taylor & Francis, London.
Schaufeli, W., Van Dierendonck, D. and Van Gorp, K. (1996), Burnout and reciprocity: towards a
dual-level social exchange model, Work & Stress, Vol. 3, pp. 225-237.
Selye, H. (1976), The Stress of Life, McGraw-Hill, New York, NY.
Sobel, M.E. (1982), Asymptotic confidence intervals for indirect effects in structural equation
models, in Leinhard, S. (Ed.), Sociological Methodology, American Sociological
Association, Washington, DC, pp. 290-312.
Shamian, J., Kerr, M.S., Spence-Laschinger, H.K. and Thomson, D.A. (2002), Hospital-level
analysis of the work environment and workforce health indicators for registered nurses in

Downloaded by New Mexico State University At 21:34 19 January 2015 (PT)

Ontarios acute-care hospitals, Canadian Journal of Nursing Research, Vol. 33 No. 4,

pp. 35-50.
Shamian, J., OBrian-Pallas, L., Thomson, D., Alksnis, C. and Kerr, M.S. (2003), Nurse
absenteeism, stress and workplace injury: what are the contributing factors and what
can/should be done about it?, International Journal of Sociology and Social Policy, Vol. 23
Nos 8/9, pp. 81-103.
Shrout, P.E. and Bolger, N. (2002), Mediation in experimental and nonexperimental studies: new
procedures and recommendations, Psychological Methods, Vol. 7, pp. 422-445.
Statistics Canada (2004), Work Absence Rates, Catalogue #71-211-XIE, Statistics Canada,
Ottawa.
Taris, T.W., Kalimo, R. and Schaufeli, W.B. (2002), Inequity at work: its measurement and
association with worker health, Work & Stress, Vol. 16, pp. 297-301.
Taris, T.W., Peeters, M.C.W., Le Blanc, P.M., Schreurs, P.J.G. and Schaufeli, W.B. (2001), From
inequity to burnout: the role of job stress, Journal of Occupational Health Psychology,
Vol. 6, pp. 303-323.
Tepper, B.J. (2001), Health consequences of organizational injustice: tests of main and
Interactive effects, Organizational Behavior and Human Decision Processes, Vol. 86,
pp. 197-215.
Tyler, T.R. and Bies, R.J. (1990), Beyond formal procedures: the interpersonal context of
procedural justice, in Carroll, J.S. (Ed.), Applied Social Psychology and Organizational
Setting, Laurence Erlbaum Associates, Hillsdale, NJ, pp. 77-98.
Corresponding author
Denis Chenevert can be contacted at: denis.chenevert@hec.ca

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