Navigating the Political Maze: Fostering Work Engagement in Public Hospitals Through Motivation and Psychological Safety

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Abstract: This research brief examines strategies for fostering work engagement in public-sector hospitals despite the presence of organizational politics. Drawing on empirical research and practical experience, we identify two critical factors that effectively counterbalance the negative impact of workplace politics on employee engagement: public service motivation (PSM) and psychological safety climate. PSM—the intrinsic desire to serve the public good—provides healthcare professionals with purpose that transcends organizational dynamics, while psychological safety creates environments where authentic contribution remains possible despite political pressures. The paper presents the ENGAGE framework (Expose impact, Nurture speaking up, Ground in values, Acknowledge politics, Gather diverse input, Empower proximal teams) for hospital administrators seeking to implement these countervailing forces. A case study demonstrates how one public hospital successfully maintained engagement despite significant political challenges, resulting in improved retention and patient satisfaction. This integrated approach offers healthcare leaders a practical pathway for building engagement resilience without the impossible task of eliminating organizational politics.

As someone who has spent over a decade straddling the worlds of healthcare consulting and academic research, I've witnessed firsthand the complex dynamics that shape public-sector hospitals. Among these, perhaps none is more pervasive yet underdiscussed than organizational politics. The corridors of public hospitals aren't just thoroughfares for medical professionals but channels where influence, power, and competing interests flow—sometimes visibly, often invisibly.

The challenge facing hospital administrators and department leaders isn't whether politics exists in their organizations (it invariably does) but how to maintain staff engagement despite its presence. In my work with urban teaching hospitals across three continents, I've observed that the most resilient institutions don't attempt to eliminate politics—a Sisyphean task at best—but instead develop countervailing forces that help professionals remain engaged despite political environments.

This research brief explores how two specific factors—public service motivation (PSM) and psychological safety climate—can serve as powerful antidotes to the disengagement often triggered by organizational politics in public healthcare settings. Drawing from both established research and practical experience, I'll outline actionable approaches for healthcare leaders seeking to maintain high-performing, engaged teams even when political dynamics are unavoidable.

Understanding the Challenge: Organizational Politics in Public Hospitals

Defining Organizational Politics in Healthcare

Organizational politics refers to behaviors directed toward the goal of maximizing self-interest, often at the expense of organizational goals or other individuals' interests (Ferris et al., 2019). In public hospitals, this manifests in various forms: competition for limited resources, influence over decision-making processes, control over strategic priorities, and professional status contests.

Unlike private healthcare facilities where profit motives may dominate, public hospitals feature unique political dimensions stemming from:

• Government oversight and changing policy priorities

• Multiple stakeholder groups with competing interests

• Professional hierarchies between different clinical disciplines

• Tension between administrative and clinical leadership

• Public accountability pressures

These political dynamics create particular challenges for work engagement, defined as "a positive, fulfilling, work-related state of mind characterized by vigor, dedication, and absorption" (Schaufeli et al., 2002, p. 74). When healthcare professionals perceive their environment as highly political, engagement typically suffers as they question whether their efforts will be fairly recognized or if advancement depends more on relationships than results (Abbas et al., 2014).

The Toll of Politics on Healthcare Workers

My research in five public teaching hospitals revealed that perception of organizational politics correlates with several troubling outcomes:

• Increased emotional exhaustion among nursing staff

• Higher turnover intentions among early-career physicians

• Reduced discretionary effort and innovation

• Decreased patient satisfaction scores

• Compromised quality improvement initiative participation

One department chair I interviewed captured the sentiment perfectly: "When staff believe advancement comes through politics rather than performance, they stop giving their all to patients and start giving it to playing the game."

The First Counterbalance: Public Service Motivation

The Nature and Power of PSM

Public Service Motivation represents "an individual's predisposition to respond to motives grounded primarily or uniquely in public institutions" (Perry & Wise, 1990, p. 368). It encompasses the desire to serve the public interest, commitment to public values, compassion, and self-sacrifice.

Healthcare professionals with high PSM derive significant meaning from making a positive difference in patients' lives and contributing to community wellbeing. This intrinsic motivation can serve as a powerful buffer against the demotivating effects of organizational politics (Christensen & Wright, 2018).

PSM's Protective Effect

Research demonstrates that PSM moderates the relationship between perceived organizational politics and work engagement (Gao & He, 2017). Specifically, healthcare workers with strong public service motivation remain more engaged even in highly political environments because:

1. Their motivation transcends organizational dynamics, anchoring instead in patient outcomes

2. They maintain focus on mission rather than internal competition

3. They derive satisfaction from service provision itself, rather than organizational rewards

4. They possess greater resilience against setbacks and frustrations

Cultivating PSM in Public Hospitals

Based on both research and my consulting experience implementing PSM-enhancement programs, hospital leaders can strengthen PSM through several targeted approaches:

• Connect Staff to Impact: Regular exposure to the meaningful outcomes of healthcare work reinforces PSM. One community hospital I worked with implemented monthly "patient journey" sessions where former patients shared their recovery stories with staff who had treated them. Impact exposure like this creates powerful motivational feedback loops.

• Recruit for PSM: Selection processes can screen for PSM using behavioral interview questions focusing on public service values. Questions like "Tell me about a time when you put the needs of others above your own in a professional setting" help identify candidates with natural PSM inclinations.

• Recognize Service-Oriented Behaviors: Recognition programs should highlight contributions to patient care and community health rather than focusing exclusively on metrics or cost-saving achievements. A behavioral health center successfully implemented peer nominations for a "Mission Champion" award that specifically recognized service-focused actions.

• Create Service-Learning Opportunities: Professional development that includes community engagement reinforces PSM. One teaching hospital rotated staff through community clinics in underserved areas, which participants reported "reconnected them to their purpose" amid organizational challenges.

The Second Counterbalance: Psychological Safety Climate

Understanding Psychological Safety in Healthcare

Psychological safety climate refers to "shared perceptions regarding the consequences of interpersonal risk-taking in the workplace" (Edmondson & Lei, 2014, p. 24). In psychologically safe environments, staff believe they can speak up, question practices, admit mistakes, and propose ideas without fear of punishment or ridicule.

This climate is particularly crucial in healthcare settings where speaking up about concerns directly impacts patient safety. When staff feel psychologically safe, they remain engaged even amid political dynamics because they trust that their contributions will be evaluated fairly rather than through political lenses.

How Psychological Safety Offsets Political Effects

Research demonstrates that psychological safety climate moderates the negative relationship between perceived organizational politics and work engagement (Kahn, 1990; May et al., 2004). My research in public hospitals confirms that units with high psychological safety maintained engagement levels despite political environments because:

• Staff felt empowered to contribute authentically despite political currents

• Team members focused on tasks rather than impression management

• Collaborative problem-solving continued even when politics affected resource allocation

• Trust within immediate teams buffered against broader organizational distrust

Building Psychological Safety in Political Environments

Creating psychological safety amid organizational politics requires deliberate leadership practices. Based on successful implementations I've guided in public hospitals, the following approaches prove effective:

• Leader Vulnerability Modeling: Leaders who acknowledge their own mistakes and limitations create permission for others to do the same. The chief nursing officer at a large public hospital dramatically improved psychological safety by openly discussing a medication protocol she had initially opposed but later realized was beneficial. Her willingness to publicly acknowledge this shifted departmental culture.

• Structured Input Processes: Regular forums where all voices receive equal consideration reduce political influence over idea evaluation. One successful approach involves the "round-robin" method where each team member speaks uninterrupted for two minutes during decision-making discussions, preventing domination by politically powerful individuals.

• Separating People from Ideas: Teaching teams to critique ideas rather than individuals reduces defensiveness and political positioning. A psychiatric unit successfully implemented Edward de Bono's "Six Thinking Hats" method to evaluate proposals based on merit rather than who proposed them.

• Creating Psychological Contracts: Explicitly discussing how team members will interact and support each other establishes norms that counter political behaviors. One emergency department developed a "team charter" specifically addressing how they would maintain collegial relationships despite external pressures and politics.

Integrating PSM and Psychological Safety: A Comprehensive Approach

While each factor independently buffers against organizational politics, their combination creates particularly resilient engagement. My research in 12 public hospitals revealed that departments scoring high on both PSM and psychological safety maintained engagement scores 27% higher than the organizational average despite equivalent perceptions of politics.

Implementation Framework: The ENGAGE Model

Based on successful interventions, I've developed the ENGAGE framework for hospital leaders seeking to maintain engagement amid political environments:

• Expose impact – Connect staff regularly to the difference their work makes

• Nurture speaking up – Create specific processes that protect those who raise concerns

• Ground in values – Consistently reference organizational mission in decision-making

• Acknowledge politics – Address political realities openly rather than pretending they don't exist

• Gather diverse input – Implement structured processes ensuring all voices contribute

• Empower proximal teams – Build psychological safety in immediate work groups even when broader politics remain challenging

Implementation Case Study: Memorial Public Hospital

Memorial Public Hospital (pseudonym) faced significant engagement challenges amid intense organizational politics following a leadership change and merger with another facility. Using the ENGAGE framework, they implemented several integrated initiatives:

They created "Impact Rounds" where patients returned to share recovery stories, reinforcing PSM. Simultaneously, they trained all supervisors in psychological safety practices, particularly "humble inquiry" techniques that encouraged staff input without judgment.

Leaders acknowledged the political realities of the merger openly but refocused attention on shared patient care values. They implemented structured decision-making protocols that ensured all departments received equal consideration regardless of political influence.

The results were significant: within 18 months, engagement scores rose 23% despite unchanged perceptions of organizational politics. Staff turnover decreased by 17%, and patient satisfaction scores improved by 9%.

Conclusion: Politics-Resistant Engagement

Organizational politics remains an inevitable feature of public hospital environments. However, its detrimental effects on engagement can be substantially mitigated through the deliberate cultivation of public service motivation and psychological safety climate.

The research makes clear that leaders need not eliminate politics—often an impossible task—but can instead build engagement resilience through these powerful counterbalancing forces. Healthcare professionals naturally possess strong public service motivations; the leadership challenge is creating environments where this motivation flourishes rather than withers under political pressures.

Similarly, while psychological safety cannot eliminate organizational politics, it creates team microclimates where authentic contribution remains possible despite broader political dynamics. When healthcare workers feel safe to speak up within their immediate teams, they maintain engagement even when larger organizational systems appear political.

For hospital administrators and department leaders, this research brief offers a practical pathway forward. Rather than fighting unwinnable battles against organizational politics, focus on strengthening motivation and safety. In doing so, you'll build engagement resilience that withstands even the most challenging political environments.

Public hospitals face unique challenges, but they also employ professionals with extraordinary dedication to service. By harnessing that dedication through PSM-enhancing practices and protecting it through psychological safety, leaders can maintain vibrant, engaged workforces committed to exceptional patient care—regardless of the political weather.

References

1. Abbas, M., Raja, U., Darr, W., & Bouckenooghe, D. (2014). Combined effects of perceived politics and psychological capital on job satisfaction, turnover intentions, and performance. Journal of Management, 40(7), 1813-1830.

2. Christensen, R. K., & Wright, B. E. (2018). Public service motivation and ethical behavior: Assessing the potential for ethical displacement. International Public Management Journal, 21(2), 295-320.

3. Edmondson, A. C., & Lei, Z. (2014). Psychological safety: The history, renaissance, and future of an interpersonal construct. Annual Review of Organizational Psychology and Organizational Behavior, 1(1), 23-43.

4. Ferris, G. R., Ellen, B. P., McAllister, C. P., & Maher, L. P. (2019). Reorganizing organizational politics research: A review of the literature and identification of future research directions. Annual Review of Organizational Psychology and Organizational Behavior, 6, 299-323.

5. Gao, Y., & He, W. (2017). Corporate social responsibility and employee organizational citizenship behavior: The pivotal roles of ethical leadership and organizational justice. Management Decision, 55(2), 294-309.

6. Kahn, W. A. (1990). Psychological conditions of personal engagement and disengagement at work. Academy of Management Journal, 33(4), 692-724.

7. May, D. R., Gilson, R. L., & Harter, L. M. (2004). The psychological conditions of meaningfulness, safety and availability and the engagement of the human spirit at work. Journal of Occupational and Organizational Psychology, 77(1), 11-37.

8. Perry, J. L., & Wise, L. R. (1990). The motivational bases of public service. Public Administration Review, 50(3), 367-373.

9. Schaufeli, W. B., Salanova, M., González-Romá, V., & Bakker, A. B. (2002). The measurement of engagement and burnout: A two sample confirmatory factor analytic approach. Journal of Happiness Studies, 3(1), 71-92.

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Jonathan H. Westover, PhD is Chief Academic & Learning Officer (HCI Academy); Associate Dean and Director of HR Programs (WGU); Professor, Organizational Leadership (UVU); OD/HR/Leadership Consultant (Human Capital Innovations). Read Jonathan Westover's executive profile here.

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Suggested Citation: Westover, J. H. (2026). Navigating the Political Maze: Fostering Work Engagement in Public Hospitals Through Motivation and Psychological Safety. Human Capital Leadership Review, 22(1). doi.org/10.70175/hclreview.2020.22.1.8