A case study on Sands Macao Limited

The main purpose of this study is to identify what health values are perceived to exist and be important in Sands Macao Limited.  To do this the study aims to determine the amount of respondent perception on the achievement of seven important organizational outcomes — effectiveness, efficiency, quality, productivity, innovation, profitability and quality of work life.

This research established that the EHPA being used in Sands Macau Limited is a means of containing or reducing health costs and explored a wide range of employee health issues and practices.  The research may also provide more intensive investigations concerning EHPAs.

Moreover, the research provides empirical data for other researchers as well as information that may help non-academics and practitioners deal with EHPA issues on a daily basis. Examining the health values that lie beneath the functioning of organizations may help the managements to assess the efficacy of health values within their operational context.

Finally, the research also makes an important contribution to a developing employee health management data base.  Developing a quality EHPA data base is vital to enhancing awareness of potential outcomes and effects and ultimately, will assist practitioners make the business case for implementing EHPAs.  Such a data base will also assist practitioners identify the barriers that are perceived to impede the implementation of EHPAs and provide insight as to how other organizations have overcome them.

INTRODUCTION

Today, most companies provide food for their employees.  Most employees especially those from disadvantaged backgrounds, rely on the meals provided by their staff canteens for their daily food intake.  Employers feel that by providing food for their employees, they are doing something positive for their workers.  Thus, some companies include free meals as part of their employees’ package.  Now, providing food for employees is regarded as a right instead of a privilege.

Improving organizational performance such as productivity and quality has been identified by leading management scholars as a top organizational priority, and, there is agreement among researchers and theorists that health of employees influence organizational behavior including decision-making and other acts of executives, managers and staff (England, 1967; Hodgkinson, 1978; Katz & Kahn, 1978).  According to Nagel and Cutt (1995), understanding a company’s health values provides a more in-depth understanding of how values are perceived and operationalized can be developed.

Within industrialized nations, political leaders and public policy makers are beginning to recognize the workplace as a critical context not only for increasing economic productivity, but also for enhancing the overall quality of life of their citizens.  Recognizing the synergy between productivity and health, Roy Romanow, Canadian Health Care Commissioner, remarked that “economic growth cannot advance at the expense of social cohesion.”  He further claimed that over the life-course poor jobs are linked with poor health.  Employees, managers, and researchers readily agree that employee health and job performance are both critical to the immediate and long-term viability of organizational life.  It is also known that among employees, job quality plays an important role in attaining these objectives.

Studying health values in companies may help in developing successful employee health programs and activities (EHPAs).  These programs can positively influence such salient organizational concerns as health care costs (Breslow, Fielding, Herrman, & Wilbur, 1990), absenteeism and employee job performance (Bernacki & Baun, 1984) suggest that increased understanding of health values can contribute to increased understanding of organizational performance.

Employee health programs and activities (EHPAs) are long term organizational activities designed to promote the adoption of personal behaviors conducive to maintaining or improving employee health (R. Wolfe et al., 1994).  Since the mid-1970s, the number of EHPAs in the North American workplace has grown exponentially. Organizational sponsorship of these programs in America has been motivated by a number of factors including an interest in improving the health of employees, a desire to provide additional employee benefits and a commitment to controlling health care, accident and absenteeism costs (R. Wolfe et al., 1994).

An increasing number of researchers believe that the potential of EHPAs to improve performance is even greater than their potential for cost-savings.  The decision to implements EHPAs is consistent with arguments that improved competitiveness requires increased investment in human capital.  Recent research indicates that EHPAs can positively influence morale, absenteeism, turnover, recruitment and productivity (Wolfe et al., 1987).  If employers are concerned about performance, they must also be concerned about employee health.

In his dissertation, Lubbers (2003) studied the psychological processes involved in the relationship between job quality and the outcomes of job performance and health among young workers.  He argued the importance of understanding the job quality factors that contribute to perceived job self-efficacy and job-related affect in order to explain how they influence employee health and performance outcomes.  Information derived from job quality conditions, that is intrinsic job characteristics and interpersonal conflict in the workplace, is processed and leads to the formation of both job self-efficacy beliefs and job-related affect, and thereby mediates the effects of job quality on job performance and health outcomes.

Over a decade ago Gist and Mitchell (1992) stated that there is a lack of knowledge about how individuals form judgments of self-efficacy.  Despite considerable research exploring the formation and role of self-efficacy in various contexts (e.g., Bandura, 1997), the role of job quality in the formation of job self-efficacy beliefs among young workers remains largely unexamined.  In addition, Weiss and Cropanzano (1996) argue that affective reactions to events at work are a central factor in understanding the link between the job environment and employee outcomes.

There is increasing recognition that researchers have failed to fully consider the role of affect as a mediator in the workplace (e.g., Brief & Weiss, 2002).  In the context of social and career developmental factors and the trajectory of a career over the life span, the job quality conditions of young workers may be a critical determinant of employee performance and health outcomes.

Recent models of health work have expanded to include personal non-work outcomes along with organizational outcomes; and have incorporated positive indicators of functioning along with the negative stressor and strain indicators of traditional models.  Although traditional models of organizational design focused primarily on organizational outcomes, there has been a consistent call to examine alternative outcomes of job design, beyond job satisfaction and productivity that may influence employee life outside of the workplace (Oldham, 1996).  In addition to the study of job performance, this study examines the influence of work on employee health, an influence of work that is relevant to both work and non-work domains.

Furthermore, this study of young workers examines both positive and negative indicators of occupational functioning.  Interpersonal conflict at work, psychological health symptoms, and physical health symptoms may be described as negative indicators.  However, the remaining constructs of interest assess active or positive components of occupational and individual functioning, including intrinsic job characteristics, job self-efficacy, job performance, and job-related affect (incorporating both pleasant and unpleasant arousal).  This is consistent with attempts to provide a more holistic perspective, moving beyond the medical concept of health as the absence of disease from the body (Nelson & Simmons, 2003) and is consonant with Warr’s (1994) suggestion that positive indicators be incorporated into models of occupational functioning.

However, Lubbers (2003) studied young workers only.  Thus, in this paper, workers in general (with no specific age bracket) comprise the participants of the study.  In Lubber’s (2003) dissertation, he studied the effect of job quality on employee health and performance whereas in this paper, the researcher examines the effect of employee health on job performance.

Statement of the Problem

While recent empirical research suggests that well-designed EHPAs can enhance employee health and a number of important outcomes associated with organizational performance, decisions to implement EHPAs are often influenced by a number of contextual factors including but not limited to an organization’s values or culture (Wolfe, 1989).  Despite broad interest, current knowledge and understanding of the influence of employee health on an organization’s ability to achieve positive performance-related outcomes through EHPAs is limited.

This research explored the relationship that is perceived to exist between employee health and performance.  In this paper, we look particularly at the EHPA provided by Sands Macao Limited to their employees.  We look closely at the situation in the company’s staff canteen in order to examine if the company’s EHPA is implemented there.  If the EHPA is successfully implemented, then the researcher will study if this EHPA affects the employees’ performance.  If not, then the researcher will attempt to develop an appropriate EHPA implemented at the staff canteen of Sands Macao Limited.

Purpose of the Study

The central purpose of this study was to clearly identify the health values that are perceived to exist (and be important in) participant organizations, and, to determine the extent to which respondents perceived the achievement of seven important organizational outcomes (namely, effectiveness, efficiency, quality, productivity, innovation, profitability and quality of work life) to be influenced by organizational values.  Because recent research suggests that well-designed EHPA’s can affect the achievement of important organizational outcomes (R. Wolfe et al., 1994) and that EHPAs are organizational expressions of Health values, the secondary purpose of this study was to examine employer utilization of EHPAs in Sands Macao Limited.

Research Questions

The research aims to study the EHPA at the staff canteen of Sands Macao Limited.  To realize this objective, the researcher attempts to answer the following research questions:

• What are the health values of Sands Macao Limited?
• Is the EHPA at the staff canteen of Sands Macao limited implemented successfully?
• To answer research question (RQ) 1, it is important to delve at the following questions.
• What are the food habits of employees who regularly have lunch at staff canteen in Sands Macao Limited (inside and outside the staff canteen)?
• What are the perceived advantages and disadvantages of having lunch at the staff canteen?
• Are the food served at the staff canteen healthy (as perceived by the employees)?
• Is there any association between the food the employees ate at lunch and their behavior after eating lunch?

Does the EHPA at the staff canteen of Sands Macao Limited contribute to the company’s overall effectiveness?  What kind of EHPA does the staff canteen at Sands Macao Limited need to develop that will contribute to the company’s overall effectiveness?

If results show that the EHPA at the staff canteen of Sands Macao Limited is not successfully implemented, the researcher will address the following research questions:

What are the appropriate actions for the staff canteen of Sands Macao Limited to successfully implement the company’s EHPA?

Significance of the Study

Results of the study will help the management at the staff canteen of Sands Macao Limited to develop a nutrition program that will help in the improvement of the employees’ health.

The systematic study of health value effects on organizational decision-making, particularly as it relates to the implementation of EHPAs, could contribute significantly to an improved understanding of both individual and organizational functioning.  Organization and management scholars may develop more elaborate and precise explanations of key organization system outcomes by understanding the value systems that are operational as well as the influence values have on organizational performance.  The areas in which increased understanding can be expected are outlined below.

Organizational Effectiveness

According to Cameron and Whetten (1983), organizational effectiveness has a long and varied history.  In its simplest form, research related to the study of organizational values, particularly as it relates to EHPAs, attempts to explain why organizations function as they do and how they might function more effectively.  Research, as proposed in this study, will not clarify why organizations do what they do, but, it may help explain how organizations can enhance goal attainment and improve performance.

Organizations achieve goals and improve performance through people.  When employees put forth their optimal effort and are more committed, organizational performance improves.  EHPAs have been shown to affect the quality of effort employees are able to put forth (Pate & Blair, 1983) and to enhance job performance (Bernacki & Baun, 1984).

At the same time, EHPAs have been reported to improve employee satisfaction (Breslow et al., 1990) while value congruence between employees and their organization has been shown to improve motivation and involvement (Schein, 1981) and commitment (Posner, Kouzes, & Schmidt, 1985).  Accordingly, the study of health values may help researchers identify how to increase organizational effectiveness.

Employee Productivity

As with organizational effectiveness, employee productivity continues to garner a seemingly disproportionate share of attention from organizational and managerial researchers (Drucker, 1991).  A variety of programs have been initiated to improve productivity in recent years including total quality management, effectiveness frameworks, benchmarking, mentorship, quality circles, management by objectives, world class emulation, and, high performance management to name just a few (Nagel & Cutt, 1995).

While these programs focus on creating processes and mechanisms designed to modify employee behavior, the research issue is whether such practices actually result in employees working more effectively (R. Wolfe, Ulrich, & Parker, 1987).  Investigation of organizational values may produce another set of factors that influence employee productivity.  Consequently, scholars interested studying productivity might consider models that include values as a possible contributor.

Controlling Health Costs

This issue represents a major organizational challenge in the United States.  In Canada alone, most employers are spending more than 10% of payroll on health expenditures while health related costs continue to grow by as much as 15-20% per year (The Conference Board of Canada, 1996).  Analysts predict that employer’s health costs will continue to rise significantly in the future as government cost-containment policies become entrenched, job and stress related illnesses become more widespread and baby-boomers near retirement (Alexander & Nagel, 1996).  Health care in America is among the most expensive employee benefits (Bureau of National Affairs Inc., 1986).

One way of containing or controlling health costs is by ensuring the workforce is mentally and physically fit as these employees typically require less medical attention than unfit employees.  Not surprisingly, recently published health management research supports this assertion and suggests that well-designed EHPAs can enhance employee health (R. Wolfe et al., 1994) and reduce health costs (Baun, Bernacki, & Tsai, 1986; Breslow et al., 1990).  Thus scholars interested in approaches that decrease organizational costs (or conversely, increase effectiveness) might consider studying health values as a means of identifying barriers to EHPA implementation.

Indirect Human Resource Costs

Organizations experience health-related indirect human resource costs in the form of absenteeism, turnover and re-staffing.  Maxey et al. (1982) estimate that it costs US$700 million to replace (via recruitment and staffing) the 200,000 American employees who are killed or disabled each year by cardiovascular disease alone.  They also report that the cost of replacing a senior executive can be as high as US$600,000.

Should studies of organizational values, particularly those related to employee health, be able to contribute to the development of a healthier workforce, they should also be able to contribute to a reduction in health-related indirect human resource costs (such as those incurred with respect to recruitment and staffing).  Accordingly, researchers interested in managing absenteeism may find the study of health values both informative and practically useful.

Public Health System Costs

While the discussion of health values as they relate to EHPAs has thus far been limited to the workplace, many researchers believe that the study of health values has the potential to influence population health through EHPAs ability to generate spill-over or indirect positive benefits for participant family members, friends and associates through the home-to-work interface, and, through general corporate and societal culture exchange.

As described in the Strategies for Population Health: Investing in the Health of Canadians, a report prepared by the Federal, Provincial and Territorial Advisory Committee on Population Health, values of peers and social networks, such as those that exist within organizations, are perceived to play an important role in the formation and maintenance of improved population health practices and behavior.

Service that educate children and adults about health risks and health choices, and encourage and assist them to adopt health living practices, make a contribution… The values and normative behaviors of peers and social networks are powerful influences on health practices.  Social conditioning plays a crucial role in determining and sustaining health behaviors. (pp. 22-25)

Quality of Life

Hodgkinson (1983) believes that a values-based approach to organizational administration which, in this research includes the management of employee health is needed if improvements in the quality of administration and life for citizens are to be realized.  As Hodgkinson puts it:

The need for a valuational approach to administration is intensified in an era of pluralism and value confusion… Increasingly the quality of life is organizationally determined. (p.56)

Because so much of modern life is conducted in or governed by organizations… In the post-industrial society we are all dependent upon the quality of administration for the quality of our lives. (p. 13)

Although the study of health values, particularly as it relates to the implementation of EHPAs, will not completely explain organizational outcomes, organizational and management scholars interested in improving employee productivity and performance, controlling indirect human resource costs, enhancing organizational effectiveness, reducing public health system costs, and, influencing factors affecting the quality of societal life may derive more complete models by considering the influence of health values on both individual and organizational functioning.

Overview of the Paper

In the remainder of this paper I elaborate on the topic introduced above.  More specifically, chapter two provides a literature review of what is currently known about the study of EHPAs, organizational effectiveness, and service marketing (for the staff canteen).  In addition this chapter outlines my research hypotheses as well as elaborating on the methodological challenges related to research in this area.  Chapter three describes how the study was conducted, including a description of the research design, procedure, the participants, and the method of data analysis.  Chapter four outlines the results of the data analysis including the results obtained from the case study at the staff canteen of Sands Macao Limited.  The paper concluded at chapter five with a general discussion of the results as well as of the limitations and directions for future research.

CHAPTER 2 LITERATURE REVIEW

This chapter reviews the relevant research with respect to employee health management, organizational effectiveness and staff canteen management.  Given the vastness of these literatures, no attempt is made in this chapter to develop a comprehensive recitation of the various research methodologies and findings contained in each of them.  Rather, a conceptual review of the literature is presented as prior research is summarized and organized into the individual but contextually related research streams.

Collectively, these literatures are relevant to this dissertation as it relates to two vital aspects of the organizational decision-making process.  First, the influence of healthy employees on decision-making as it relates to the identification of desired organizational objectives or outcomes (that is, those outcomes related to effectiveness, efficiency, quality, productivity, innovation, quality of work life, profitability, etc.) as described in the organizational effectiveness literature.  Second, the influence of health values on decision-making as it relates to the selection of organizational interventions (that is, implementing EHPAs as a means of reducing costs) required to achieve the desired outcomes.

Employee Health Management

The vast majority of research studies addressing employee health programs and activities (EHPAs) have been focused at the level of the individual.  These studies have largely been concerned with modifying risk factors for health in order to improve the individual’s health status as well as outcomes of particular relevance to employers such as absenteeism, sick days, turnover and health care costs.  Few studies have addressed the broader socio-economic and environmental risk conditions for health such as those associated with poverty, housing, employment and health policy that are increasingly being discussed at the community level.

Thus, the research evidence concerning the effectiveness of EHPAs reflects only a limited range of program objectives and not necessarily their full potential in the workplace.  While a number of methodologically rigorous studies have recently demonstrated that positive outcomes can be achieved, past studies concerning EHPAs have been inconclusive in terms of effectiveness.

Conducting research in the area of employee health has been problematic as the terminology used to label such initiatives has varied.  The terms employee fitness programs (Falkenberg, 1987), work-site health promotion programs (Terborg, 1986; K. Wolfe, Slack, & Rose-Hearn, 1993; R. Wolfe et al., 1994) and employee health management programs (Wolfe, Ulrich & Parker, 1987) have all been used.  Furthermore, no widely accepted definition or delimitation of these programs (EHPAs) has emerged.

Contributing to potential confusion concerning what EHPAs are is the overlap in program content, potential benefit and reporting structures that exist among EHPAs and other more established, health-related organizational functions such as employee assistance programs and occupational medicine programs.  In the interests of clarity and to ensure this research contributes to the development of a cumulative EHPA knowledge base, the definition utilized by Wolfe et al. (1994) will be employed in this research.  According to Wolfe et al., EHPAs are: “long-term organizational activities designed to promote the adoption of personal behaviors conducive to maintaining or improving employee health” (p. 23).

There are many reasons why the workplace is an attractive setting for EHPAs.  These include the size of the target population, reduction of time and travel barriers to employees’ participation, availability of peer pressure and peer support, the captive audience, and the stability of the target population.  Decisions concerning the development of programs that are based on the strength of the current research evidence must weigh the value and potential that is inherent in these factors against the likelihood of stronger research evidence becoming available in the future.

Similarly, there are many reasons why employers are interested in instituting EHPAs.  The decision to adopt these programs resides with management and often reflects financial investment decisions.  Thus, the economic return on investment is considered to be an important criterion by which these programs can be evaluated.  Not surprisingly then, much effort has been put forth to evaluate these programs from an economic perspective (Fielding, 1982; Shephard, 1992b; Warner, 1987).

While recent empirical research results are promising, there is no consensus with regard to the economic contribution made by EHPAs due in large part to the circumstance that generating costs savings has not been the primary objective of employers who have adopted them.  Wolfe et al. (1993) found that health professionals considered cost savings to be more important than did senior management.  Other important criteria included altruistic concerns for employee health, the perception that such programs are appreciated by employees as a benefit, and desire to keep up-to-date with trends in employee benefits in order to improve recruitment and reduce turnover.

Fielding (1982) noted that a program with a positive affect on recruitment, productivity, turnover or morale may be considered by a CEO as a better investment than one which had none of these effects but which provided a 25% annual return on investment in health benefit cost and disability claim reduction.  Thus, even if the research literature does not show conclusively that benefits outweigh the costs in economic terms, there may still be valid reasons to implement EHPAs in the workplace.

It has been argued that the best approach to economic evaluation of EHPAs is through a cost-effectiveness analysis and not cost-benefit analysis (Warner, 1987).  The latter compares costs and benefits in terms of dollars.  The former compares the cost of alternative means of achieving different health-related outcomes, and therefore, starts with the assumption that improved health and not profit is the real purpose of the program.  This review includes a wide range of evaluation studies and does not necessarily attach greater weight to the economic evaluations in drawing its conclusions.

The issues stated above notwithstanding, if the bottom-line in the decision to develop and EHPA is the economic return on investment, then decision-makers must be apprised of the assumptions underlying such economic evaluations.  Shepherd (1992b) provides an excellent review of these issues.  He notes the need for full economic evaluations to consider a range of factors including the potential transfer of benefits across various sectors of society, opportunity costs to participants, marginal costs and benefits, inflation and discounting.  Results can change markedly with small changes in the analytical procedure, the choice of variable to include and the time frame over which the analysis is conducted.

Time frame is an especially crucial factor since studies which have shown a significant return on investment tend to be based on a relatively short window of time (2-5 years).  In these studies, the short-term gains in health behavior or health status are thought to translate into reduced absenteeism and sick-leave pay-out, and therefore, short-term economic gains to the company.  However, these improvements in health behavior and status may also lead to increased longevity (this is certainly implied in the use of risk reduction equations to predict future cardiovascular mortality).  Increased longevity may increase costs related to pension pay-out and medical benefits for chronic illness in a very elderly population of retirees although Fries (1994) would argue it doesn’t.

According to the literature, no single evaluation of an EHPA incorporates all the important features of economic evaluation, and the available studies require a very critical interpretation.  The strongest evidence concerning the affect of EHPAs will come from randomized controlled trials, which by design, help rule out competing explanations for changes that are observed in participants or the workplace.  Randomization of experimental or control conditions, either across or within work sites, however, is often not possible.  In the few projects that have randomly assigned work sites to intervention or control groups, the number of companies per group is quite small.  In these studies, the number of companies as opposed to the number of employees is the major determinant of statistical power.

The majority of quality evaluation studies have used a quasi-experimental, comparison group design.  Non-randomized comparison groups may come from within the same company or from other companies matched to the intervention site on important variables.  Lagged controls within the same company may also be used (they receive the intervention at a later date) or the program participants may serve as their own controls in time series analysis.

Regardless of the precise design, these quasi-experimental studies often leave unresolved questions about the comparability of the study groups and other competing explanation that can’t be ruled out.  Conrad et al. (1991) discussed the threats to the validity of conclusions drawn from EHPA evaluations.  Often selection is a major problem because employees typically volunteer to participate in health promotion programs and there is considerable evidence that participants may be healthier or more motivated to improve their health than non-participants.

Shepherd (1992b) discussed the significance of the selection problem for economic analyses since the findings from cost-benefit analyses are based on current participants and cannot necessarily be extrapolated to all employees.  A much larger investment may be needed to attract those employees who are currently inactive.

Another factor complicating the evaluation of EHPAs and summarizing findings across studies is the variability in the nature and scope of interventions.  Some EHPAs are quite simple and inexpensive such as those involving distribution of health information pamphlets.  Some others are intensive and comparatively expensive such as risk factor screening and follow-up counseling.  Others concentrate on a single risk factor while others target many health behaviors.  Some focus on individual behavior change while others include an environmental component or concomitant modifications to health insurance and benefit plans.  In order to be useful, evaluation results need to be accompanied by a thorough program description.

Decision-makers assessing their options for EHPAs, who wish to consider the research evidence concerning the effectiveness of these programs, must be clear about the reasons underlying their interest, the covert and overt program objectives, and the role of the workers themselves in program planning, design, operation and evaluation.  Furthermore, given all the difficulties encountered in conducting and comparing evaluation studies of EHPAs, decision-makers need to look for the general weight of the evidence across the best studies available rather than focusing on EHPAs’ definitive study.

Organizational Effectiveness

Organizational effectiveness is a topic with a voluminous literature spanning several disciplines including but not limited to psychology, sociology, business, economics, political science, education and health.  The theoretical literature on organizational effectiveness has historically been characterized as being confused, and despite its volume, still appears to in a developmental stage.

Theorists have had difficulty agreeing on what the term organizational effectiveness means.  Yet almost all of these experts acknowledge the term is the central theme in organization theory.  As Goodman and Pennings (1977) put it: “it is difficult to conceive of a theory of organizations that does not include the concept of effectiveness” (p. 2).

Background

According to Quinn and Rohrbaugh (1983), effectiveness is not a concept but a construct.  A concept is an abstraction obtained from observing which are directly observable or easily measured while constructs are inferences at a higher level of abstraction from concrete events and cannot be easily defined by pointing to specific occurrences.  They need to be constructed from concepts at lower levels of abstraction.  Examples of constructs include leadership, motivation and intelligence.

The root of the problem is that no one seems to be sure which concepts should be built into the construct of organizational effectiveness (Cameron, 1986a).  As a result there has been a proliferation of numerous models of organizational effectiveness many of which are distinctive to the values of the researcher.

Despite the apparent current state of confusion, there are a number of encouraging themes and recent developments in the theoretical literature that offer a more optimistic view of the process for advancing the organizational effectiveness construct (Cameron, 1986a, 1986b; Kanter & Brinkerhoff, 1981). As pointed out by Kanter and Brinkerhoff (1981), there is an air of technicality surrounding the area of organizational effectiveness as though the central problem were merely that of refining measures.

However, the most important questions in this area are not technical but conceptual in nature; not how to measure effectiveness but rather what to measure; how definitions and techniques are chosen; and how they are linked to other aspects of internal and external organizational dynamics.  Numerous problems of defining and assessing organizational effectiveness have been noted in the literature, the most significant of which are related to criteria problems.

As indicated by Cameron (1986a), criteria problems tend to be of two kinds: the type of criteria selected to indicate effectiveness, and the sources or originators of the criteria.  Criteria problems include issues related to: which organizational models underlay the selection of criteria; whether universal or unique criteria must be applied; whether normative (prescribed) or descriptive (derived) criteria should be used; and appropriate use of dynamic versus static criteria.  Sources of criteria problems include which constituencies should determine effectiveness criteria and provide the data for their measurement and what levels of analysis should be used.  There is still considerable debate in the literature over which criteria are best (Cummings, 1983; Schneider, 1983).

A number of scholars and researchers have made contributions with respect to clarifying the organizational effectiveness construct and advancing the literature.  Steers (1975) suggested that the first step was to identify the relevant variables in the domain of effectiveness, and determine their relationship, if there is any.  Campbell (1977) undertook an exhaustive review of literature to identify all of the variables in the domain of effectiveness and generated a list of 30 criteria.  In following this work, a number of researchers categorized various models and advocated multiple model views of organizational effectiveness (Scott, 1977; Seashore, 1979, 1983).  Clearly, none of the existing or potential models of organizational effectiveness is likely to be universally applicable or superior to another.  Different situations will require different applications and in all likelihood, an integrating framework will be required.

Models of Organizational Effectiveness

Approaches to organizational effectiveness can be reduced to one of four major models, namely, goal model, systems resource model, internal processes model and multiple constituencies model.  A brief overview of each of these models is provided below.

The goal model defines effectiveness in terms of how well an organization accomplishes its stated or implied goals.  Despite extensive efforts to define effectiveness in terms of outputs and goal accomplishments (Bluedorn, 1980) the use of goals as a basis for evaluating effectiveness has been criticized as being problematic, due to the difficulty in specifying organizational goals.  A second criticism of the goal approach is its inability to develop generalizable measures of effectiveness which can be used to study a wide range of organizations.  For examples, measures of profitability while applicable across business organizations are not applicable when applied to assessing the effectiveness of most public sector organizations.  The absence of generalizable measures is a serious problem because it hinders comparative research and the development of theory.

The system resource model defines effectiveness in terms of how an organization is able to acquire scarce and valued resources (Seashore, 1967).  Simply put, the more of the needed resources an organization can obtain from its external environment, the more effective it is.  The emphasis on outputs in the goal model is replaced by an emphasis on inputs aimed at enhancing capability and performance.  The system resource approach to effectiveness views the organization as an open system interacting with and adapting to its external environment.  As noted by Seashore & Yuchtman (1967), the emphasis upon the resource acquisition capability of organizations is not intended to overlook two other key aspects of organizational performance, throughput and output.  All three aspects of organizational behavior (resource acquisition, utilization and exportation) in some output form that aids further input are important to organizational effectiveness.

As with the goal approach, considerable effort has been made to define effectiveness in terms of systems resource concepts (Bowers, 1964; Nadler & Tushman, 1980; Yuchtman & Seashore, 1967).  The systems resource approach is the most prominent of general systems models.  Although there are many variations and adaptations of this model, Strasser et al. (1981) point out that the most important common theme is that organizational effectiveness is conceived of as a multi-dimensional construct.  This leads to the broadening of the range of criteria for measuring the effectiveness construct.

These researchers also note that underlying most system models is the view that organizations are not rational machines operating in isolation, but rather, organic systems which through their independent and interactive sub-systems cope with internal problems and demands of their external environments, just as individuals must.  Consequently, systems models implicitly emphasize criteria designed to reflect the concept of an organization as a social system such organizational flexibility, adaptability, acquisition and utilization of resources.

Although the systems resource approach is generally considered to be superior to the goal model, Strasser et al. (1981) point out that defining organizational effectiveness in system terms is also problematic.  Common criticisms of the system model are that: it lacks conceptual consistency; it is difficult to operationalize; and it is unable to account for causal relationships that may exist among the component parts of the system defined.

In the internal processes model, organizational effectiveness is defined in terms of an organization’s internal processes, structural characteristics and operations.  Examples included in this model are processes for minimizing internal strain, integrating members into the system and ensuring smooth information flows.  Under this model, effectiveness is defined in terms of characteristics of the organization including both structural arrangements and process activities (Kanter & Brinkerhoff, 1981).  Kanter & Brinkerhoff (1981) explains that performance is a function of structure and process mediated by organization climate.  Goal attainment, outputs and inputs draw back in importance and the organization itself and various internal transformational processes become principal.  There is little literature describing this model.

Kanter & Brinkerhoff (1981) further stress that sets of internal organizational characteristics, whether involving structure or process can only be correlated roughly with an organization’s overall effectiveness (including productivity or output).  They can however, be useful state-of-the-systems indicators for managerial decisions.  Process approaches are indicative since the latter consider only outputs and not internal processes or structures.  In other words, the reasons underlying organizational effectiveness can be determined through process models, not goal models.  Moreover, process approaches may be more useful as predictive models of future performance.

In the multiple constituency model, organizational effectiveness is defined as the extent to which an organization’s key constituencies are at least minimally satisfied.  Constituencies can include employees, resource providers, customers, groups whose support is needed to ensure organizational survival and others who are significantly affected by the organization.  Advocates of this model emphasize powerful external constituencies that have an impact on its functioning.  In this model, organizational effectiveness is based on how well the enterprise responds to the demands and expectations of its various constituencies.

Multiple constituency model tends to be the subject of more current literature that with systems or goal models (Connolly et al., 1980; Zammuto, 1984).  According to Zammuto (1984), in this model, the effectiveness criteria are derived from the preferences of multiple constituencies.  The multiple constituency model disputes the one crucial assumption shared by both goal and systems models — that it is both possible and desirable to establish a single set of evaluative criteria, and thus, a single statement of organizational effectiveness (Connolly et al., 1980).

Advocates of this model argue that organizational effectiveness can reflect several different effectiveness statements from the evaluative criteria of various constituencies involved with the focal organization.  Proponents of multiple constituency approaches view goal and systems models as providing valuable, but only partial, insights into the relationships between an organization’s activities and its constituencies.

Literature on the multiple constituency model still lacks.  However, in examining this model, a number of important theoretical and empirical challenges need to be addressed.  These challenges include the distribution and weighting of multiple constituency satisfactions, the opportunities for constituencies to effect the organization, and the organization’s location or positioning in regard to current and possible future constituencies.  The multiple constituency model is an intriguing approach which may help in the progress surrounding goal and systems approaches to organizational effectiveness.  At the same time, however, further theoretical consideration and empirical research should be undertaken in order to fully establish its conceptual and practical merits.

The Staff Canteen as Service Market

The staff canteen is a kind of service marketed to the employees of a company.  Thus, in order for employees to have their lunch at the staff canteen, it is important that the canteen, although it does not need promotion strategies entirely, may promote itself to the employees of the company.  In this regard, the following sections will establish literature on service marketing.

Service Marketing

Service marketing is defined as “an activity or benefit that one party can offer to another that is essentially intangible and does not result in the ownership of anything. Its production may or may not be tied to a physical product” (Pradhan).  In other words, the promotion of activities and procedures and not of the products or objects is called the service marketing. The concept originated from Ward McDowell and Donald Parker’s scholastic studies in 1950s. Hence, service marketing became an acknowledged marketing discipline (Seidman, 2000).

In 1969, Eugene M. Johnson raised the question if services and goods are two different things. From then on, it had always been a debate whether marketing services and marketing goods are different or the same and took much of the time of scholars to find peculiarity between the two concepts (Seidman, 2000).

Today, there are four major distinctions recognized between service marketing and goods marketing. These are namely intangibility, perishability, inseparability, and heterogeneity (Brown, 2006).

In terms of intangibility, firms would need much promotion of the service. This is because before availing the service, a great deal of service promotion should depend on attributions of performance. These attributes are normally measured only after experiencing the service, while goods, which are tangible, have search characteristics. Aside from this, specialized services impose credibility and confidence. Promotions or marketing, therefore, would aid the firm to make customers see their services as if highly touchable. However, intangibility still causes problems in terms of pricing and the visibility of a service.

For example, an auto repair shop would not be so certain of the cost of the service they provide. Even the shop has fixed or repaired the problem with the car, customers would still think of the reason why their service costs such.  Thus, the shop has to explain the customers the time it took them to repair the problem and the other operations they perform so that the service would be more tangible or real. Customers tend to see the price as the basis of service quality when the other indicators of quality are not present.  If the service is quite expensive, then the quality must worth it (Brown, 2006).

Meanwhile, since services are intangible, then, they cannot be stored. This is why services are different from goods. Services are perishable. When there is a surfeit of unfulfilled demands and facility, resources could be utilized inefficiently. Nevertheless, there are ways to resolve this weak point of service marketing. Below are the given examples of ways on how to reduce this error:

• market services to segments with different demand patterns
• market new services having counter cyclical demand patterns from existing services
• market new services to compliment existing services
• market service extras at non-peak times
• market new services not affected by existing capacity constraints
• train personnel to do multiple tasks
• offer incentives (Brown, 2006)

Inseparability, in the meantime, can head to a more direct or straight means of delivering the service. Good interpersonal skills of employees are advantages. There are some cases that value of relationships of customer and service provider predicts the possibility of constant transactions between them. Sometimes, customers become trustier to the employee rather than the company. This is very rampant in industry of advertising. So, most of the employees should be also capable of carrying out the same function. Services always come along with the providers of service (Brown, 2006).

Precision has often been a problem for service providers. Services provided are heterogeneous. However, this dilemma can be resolved by being consistent and competent at all times. This can be helped by the modern technology and with employees that are literate and skilled in using it (Brown, 2006).

Aside from these four distinctions, there are still four major concepts that are relevant to be tackled in this section of the paper. These are the 4 P’s of Marketing Mix. Decision-making in marketing is crucial to most managers. And this decision often fall under these 4 P’s that managers can take control: product, place, price, and promotion.

The Marketing Mix

Marketing mix originated from Neil H. Borden’s 1964 article. He coined the term from James Culliton’s description of marketing manager as “mixer of ingredients”. In Borden’s idea of marketing mix, it involves “product planning”, pricing, labeling the product, means of distribution, treatment, data gathering, and analysis. Later on, a certain E. Jerome McCarthy compressed these marketing functions into four categories. It is presently recognized as The 4 P’s of Marketing (Seidman, 2000). Below is the illustration of how the Marketing Mix works:

Under internal and external constraints, these four P’s, the product, price, place, and promotion, are the limitations that managers can still handle.  With this model, the marketing managers make decisions that focus on the four P’s with customers as the target market at the center. This would make customers produce perceived values and respond positively (Cameron & Whetten, 1983).

Product decisions involved the goods and services that are being sold by the firm, physical or non-physical. Things to be considered in making decisions regarding the product are the brand name, styles, security, packaging, warranty, support, maintenance, other accessories and services. Pricing is also a crucial stage. This involves pricing strategy, discounts, retail prices, early payment discounts, recurrent pricing, and price flexibility.

Distribution, at the meantime, deals with the means of making the products, goods or services, reach the target market. It concerns decision-making over distribution channels, market coverage, channel members, managing inventory, centers of circulation, warehousing, processing of orders. Promotion, last but not the least, primarily contends with communication of the products and its qualities in order to gain positive responses from the customers. This would involve advertising, promotional tactics, publicity, sales promotions, and allotted budget for marketing communications (Cameron & Whetten, 1983).

“Relationship Marketing”

As time passed by, the concept of service marketing developed into a new perspective. The “relationship marketing” was born. “Relationship marketing” acknowledges the worth of customers. Along with this, this concept also realizes that customers should be given incessant services so that they would stay loyal to the firm. Nowadays, the significance of the “relationship marketing” argued and criticized the conventional 4 P’s approach. It is said that the Marketing Mix approach is inaccurate and tends to be controlling. It does not take into considerations the needs of the customers and ignores services marketing. Furthermore, it is argued that these four P’s are not practically applicable as a “general marketing theory” (Seidman, 2000).

Relationship marketing can root from service encounters. During service encounters, customers and sellers or service providers have simple exchanges or interactions. When this encounters become constant, this buyer-seller relationship could be nurtured and developed into a better friendly relationship. The significance of this concept surpasses other marketing principles (Seidman, 2000).

Service Encounters

Service encounter or the interaction is recognized as the “heart of every service between the customer and the server” (R.Chase&S.Dasu). In this instance, emotions of people touched economics. This is the time when most of the customers judge or assess the service quality. Aside from being the heart of every transaction, this encounter also is considered to be one of the customers’ satisfaction or dissatisfactions’ fundamental elements. This is also the so-called “moment of truth” (Seidman, 2000).

Shostack defines service encounter as the point wherein the consumer or customer has an immediate interaction with the service. It is the period when the buyer or customer straightly links with an employee, service provider, physical amenities, and other concrete service components (Seidman, 2000).

In a study done by Chase and Dasu, they developed a model of how they perceive the concept of service encounter. According to this model, during the transaction between the customer and the server, psychological experiences of the customer surrounds or encloses the core task, which is the service encounter (R.Chase&S.Dasu). Aside from this model, Chase and Dasu also came up with five categories that are extensive and useful concepts in the comprehension of service encounter. These are:

Understanding emotions
Sequence effects
Duration effects
Shaping attributions; and
Perceived control (R.Chase&S.Dasu)

During service encounters, there is give-and-take of emotions. For good experiences and relationship to materialize, managers and service providers should be aware of the factors that affect high and low emotions. This awareness would then aid the managers in developing emotional strategies and stands that would produce positive emotions among customers during encounter and be able to handle them. This would probably yield more loyalty among the customers (R.Chase&S.Dasu).

Sequence effects tell how people lay their focus in the occurrence of such encounters. It is very unprofessional to believe that people should concentrate on having a strong start and let things unfold and fall into right places. A number of studies and researches suggest that people ponder on the highlight of the incident or the encounter, its finale, and also on the inclination of the sequence. The result of this process is said to be very intense (R.Chase&S.Dasu).

It is also essential to take into considerations the duration effects. This means that we should know how to make the time of positive happenings longer and the negative ones shorter (R.Chase&S.Dasu).

Duration effect is all about the time spent by the customer availing a certain service or a product. The concept of the duration effect says that the length of time can seem longer or shorter depending on the activities done by the consumer (R.Chase&S.Dasu).

There are studies that several short segments of events seem to be a longer process to the customer than few long segments of events. That is why in an amusement park, few longer rides seem more pleasurable to the consumer even though the time spent in the park when riding several shorter rides is just the same. Also, in the case of the call center, the greater the steps and options, the longer it is perceived by the customer even if the time is shorter than what the consumer perceives. This is where the concept of wait comes in which results to dissatisfaction. Wait is actually dependent on emotions, pace of goal improvement, degree of perceived control, and the attention paid by the consumer to the passage of time (R.Chase&S.Dasu).

These four variables are used in psychology to improve a person’s waiting encounters.  Waiting can seem shorter if you can learn to manipulate these four variables (R.Chase&S.Dasu).

An outcome of a service can either be blamed or claimed. One lesson that the Attribution theory tells us is that people are susceptible in claiming a responsibility for success and reject it for failure. The theory says that this is primarily because people tend to protect their self-esteem. In using the service encounter design, the technique is to identify the consumer’s responsibility so as not to damage his self-esteem. That’s basically what shaping attributions is all about (R.Chase&S.Dasu).

People always like to have some control over the service or product that they are availing. Although some of them do not actually have, they still perceive some control over services and products.

There are studies that showed the relationship of a person’s perceived control and satisfaction. In the medical industry, for example, patients are more satisfied if they seem to have more control over their treatment and medications than the doctors. Letting a patient decide from which arm the doctor will draw blood will cause less pain than when the doctor decides to draw blood from a particular arm. Another example is that patients under intensive care units get well faster when they seem to have control over visiting hours, time of their eat and their exercise (R.Chase&S.Dasu).

Service Quality

Service quality, in brief, refers to the difference between ‘customer expectations as to what they want to obtain’ and ‘the real received service or products’ (Skinner, 2005; Woodside & Daly, 1989). This perception on service quality has been further propelled by a 1985 multi-sector study conducted by Parasuraman, Zeithaml, and Berry (PZB) which gave attention to twelve customer focus group interviews in analyzing the service quality through the responses of the customers, thus leading to PZB’s definition of service quality as the degree and direction o discrepancy between customer’s service perceptions and expectations (Skinner, 2005; Woodside & Daly, 1989).

From a deeper angle, for service quality to be classified as such there ought to be first the conditions which will bring about the demarcations in service quality. Customer expectations have to be identified first prior to anything else. A premium consideration of the expectations of the customers helps in identifying the necessary steps or course of actions that the company will have to follow in order to address these expectations. Having a definitive knowledge on what it is that the customers desire to obtain in products and services greatly aids the company in creating a blueprint of business transactions they would want to pursue in connection to these expectations. As Zeithaml points out:

…customers use more than just the service outcome or “core” in assessing service quality. Customer assessments are also influenced by the service process and the “peripherals” associated with the service…both outcome and process dimensions influence customer’s evaluation of service quality. In addition, focus group response patterns revealed 10 general evaluative criteria that customers might use, regardless of service sector. These criteria were consistent with previously outlined service constructs, yet constituted a more comprehensive set of dimensions. (Skinner, 2005; Woodside & Daly, 1989)

What can be generally observed from these claims is that the close association between the expectations of the customers and the actual products they are able to receive in the end construes the quality of service that the company is able to create in the process.

Langeard and Eiglier’s Servuction System Model (1999)

The Servuction Model illustrates the participation of customers is always an integral part of service process no matter in a passive or active way. It used to demonstrate factors that influence service experience, including those that invisible or visible to customers. Invisible part refers to organization and system. Visible part contains three items: inanimate environment, contact personnel, and other customers.

Inanimate environment: All nonliving features display during service encounter.

Contact personnel: Employees other than primary providers who interact with consumers. Service provider: primary provider of core service.

Other customers: in the below chart, it refers to Customer B who is not directly benefited through the service but considered as a part of customer A’ experience.

(Bateson & Hoffman, 1999)

Bitner’s Physical Evidence and the Servicescape (1992)

Bitner (1992) proposed that the physical surroundings within which the service takes place can also influence customer perceptions, so that it can lead to a source of competitive strengths or a possible opportunity to come out top in the trades for those service providers who can obviously differentiate their servicescape from other competitors with an effective management. According to her definition, servicescape is a ‘visual metaphor’ for intangible service, critical in shaping initial impressions through the outward appearance of the service organization.

(Bitner, 1987)

The Measurement of Service Quality

It is assumed that service quality plays a crucial role in determining the results of a business. Therefore, measuring or evaluating the quality of a service becomes one of the top priorities of the management (“ALIGNING IT MANAGEMENT WITH BUSINESS OBJECTIVES: Indicative Business Service Management Solution,” 2004). The measurement of service quality comes in different processes and approaches, depending on the kind of business.

The SERVQUAL Model or the Gap Analysis Model (1998)

This model, first noting customer expectations of the service encounter are likely to be drawn from mixing their past experience, word of mouth and personal needs, identifies five gaps between what customer wants and what they think they really get.

• Gap1 is created where service managers’ perceptions of consumer expectations do not match the service consumers actually expect to receive.
• Gap2 happens when management perceptions of consumer expectations are not translated into adequate service quality specifications.
• Gap3 is the difference between designed service specifications and actual delivered service.
• Gap4 occurs where the delivered service varies from the service communicated to consumers.
• Gap5 is a variance between what customers expect and what they actually get. (Parasuraman, Zeithaml, & Berry, 1988)

Brady and Cronin’s three-dimensional Service Quality Model (2001)

Service Environment quality: means the tangible or physical element of the organization.
Interaction quality: includes the employees’ attitudes, behaviour, and expertise.
Outcome quality: refers to the fulfilment of a customer’s expectations after having used the service. (Brady & Cronin, 2001)

Customer Satisfaction

Maintaining high customer satisfaction levels is not easy. A lot of effort must be exerted and the effort exerted must also be continuous. In the changing environment today, satisfying the customer is not an easy task. Customer wants continues to change together with the changing environment.  As markets drop, firms are focusing on customer satisfaction not by looking for new customers but by keeping their current customers. Perhaps they would not want to risk additional resources just to attract new customers. In fact, there is a claim that it is five to eight times more expensive to attract new customers than to keep the old ones. (Cacioppo, 2000)

Many companies might not be familiar in the measurement of customer satisfaction especially those who are familiar with just income statements and balance sheets in running the business. In the world today, competition is inevitable. Competition is good because it promotes efficiency but not if there is little product differentiation. That is why satisfying the customers is really an important part of the business. (Cacioppo, 2000)

A lot of global competitors perceive customer satisfaction as the key to maintaining high profits. Many believe that they can start attracting new customers only if they can retain old customers. In this case, customer satisfaction can be a good weapon in strategizing in the business. (Cacioppo, 2000)

It is easy to say, actually but it will not be effective unless done correctly. Customer satisfaction is subjective but companies must learn to quantify and measure customer satisfaction. If they do not know the exact amount of the customer needs, companies will not succeed in pursuing customer satisfaction. (Cacioppo, 2000)

Many establishments and institutions depend on obsolete and inaccurate customer satisfaction measures. They listen to sales reps, watch sales volumes, and other wrong practices which cannot really help in improving customer satisfaction. (Cacioppo, 2000)

Of course, no company will be able to apply the concept of satisfaction if they do not know what it really means. Before you can apply anything, you must first know what is really meant by customer satisfaction. (Cacioppo, 2000)

Customer satisfaction is the condition of the customer’s mind over the services of the company. It is actually a state of mind on whether their expectations are met by what the company has to offer. Of course, if customer satisfaction is attained, customers will be loyal to the company. Definitely, customer satisfaction is subjective. It does not come in numerical values and is not exact. However, in order for it to be accurate, companies must undergo sampling and statistical analysis. (Cacioppo, 2000)

Customer Satisfaction is one of the most critical and most important aspects to consider when it comes to the concept of costumer service. The level of service should be permanently maintained and should be kept high so that you can be assured that the costumers are pleased with what you give them. You should also meet their demands, not only by your standards, but by their needs. You should be able to give excellent service and assurance that they can rely on you whenever the need be.

Considering the meaning of satisfaction, we could put it in line with the concept of gratification. Gratification is defined as the positive emotional response because of the fulfilment of a certain desire. Basing on its definition, customer satisfaction can also be achieved through gratification.

Theories on Customer Satisfaction

People tend to compare product services from an individual’s expectations. In this way, they reach satisfaction decisions. This is called the disconfirmation of expectations paradigm. This disconfirmation may have a significant effect on satisfaction. Some theories on customer satisfaction can be used to explain disconfirmation of expectations (Seidman, 2000).

The figure below is a diagram of the disconfirmation of expectations paradigm (Nevo, 2005).

Consistency Theories

Consistency theories explain that an individual’s perception on a product might change whenever disconfirmation happens. For example, a person may expect that hamburger in burger king tastes better than Mc Donald’s. That is his expectations. But at the moment he tasted Mc Donald’s and liked it, his perception about their hamburger may change from what he had expected. These theories also suggest that expectations have great effects on satisfaction (Seidman, 2000).

Consistency theories are composed of two other theories, the dissonance theory and the assimilation theory. The dissonance theory or the cognitive dissonance theory states that when a customer shows hesitations about purchasing a product, it can result to the occurrence of dissonance or conflict. As a result of that, customers will tend to alter their stance about their expectations to avoid conflicting thoughts. The illustration below can help in understanding the cognitive dissonance theory (Alon, 2006).

The comic strip below is an example of a situation where cognitive dissonance theory is manifested (Alon, 2006).

On the other hand, assimilation theory explains that customers are willing to change their attitude towards their expectations in order to avoid conflicts in their purchase behavior.  The assumption of this theory is that individuals are unwilling to accept inconsistencies from formerly held positions thus, incorporating decision toward their attitude for a thing or situation.

Contrast Theories

If the relationship of satisfaction and expectations are explained by the Consistency theories, Contrast theories try to explain the relationship between satisfaction and performance. Contrast theories state that poor performance of product or service (relative to expectations) results to negative disconfirmation which will lead to dissatisfaction.

However, if the performance of the product is better than what the individual has expected, positive disconfirmation will occur. In that way, satisfaction of expectations is likely to happen. Another case is when the expectations of the individual is just met by the performance, expectations are simply confirmed. Basing from these, it can be said that satisfaction is primarily based on how the performance of the product or service meets the individual’s expectations (Seidman, 2000).

Comparison Level Theory

Comparison level theory says that expectations are created through past experiences and that a product or service is compared to that particular past experience. These expectations could an encounter with salespersons and other staff in a manufacturing or a service type firm. This theory also states that customers have different expectations on different product characteristics (Seidman, 2000).

Assimilation-Contrast Theory

The assumptions of this theory say that the degree of difference between expectations and performance dictates the satisfaction level of an individual. Apparently, Assimilation and Contrast theories are combined in this theory. It only shows that these two theories are possible to occur at any given time at certain situations and events.

If the difference between expectations and performance is less, there is a tendency that customers will change their behavior to equal their expectations. This assumption seems to have a resemblance with the assimilation theory. However, if the difference is big, customers will not make any show any change in their behavior thus, making the actual performance as the only basis of the individual’s satisfaction. This assumption, on the other hand, is similar to the contrast theory. This is where you can clearly understand that the two theories can be combined at any given time at particular situations (Bitner, 1987).

Attribution Theory

Not at all times, customers become satisfied with the product or service they avail. When this happens, they would think about it and find reasons why they did not get satisfaction. They would experience a thinking process to find logic of what happened. This process of attribution connects the behavior of the customers and their attitude (Seidman, 2000).

Attributions are seen by customers as the grounds of people’s behavior, their own behavior, and the other observable events. Attribution theory is extensively dealt in consumer behavior, psychology, and in marketing literature (Seidman, 2000).

Fritz Heider’s 1958 book presents the early discussions of concepts of attribution theory. His theory tells that man tends to seek for the sources of such event, when it happens, and how it occurs. It is not merely because of the intellectual inquisitiveness, but also he believes that attributions could help him understand the world he lives, foresee what could happen in the future and have control on it and on the other incidents that would involve him and others (Seidman, 2000).

From then on, researchers made further studies regarding the attribution theory. They did it through fundamental research and experimental testing. At many times, the theory of attribution has been associated with product and service satisfaction (Seidman, 2000).

This section of the paper would discuss the influence of attribution theory on customer satisfaction and service encounters and the four major theories under it. Aside from the theories, applications of the attribution on responses of consumers or customers and on behaviors of the employees will be also presented (Seidman, 2000).

Overview

Attribution has no colossal meaning or view. There are two ample examinations have specified the four major theories of attribution. These are the theories of Heider (1958), Jones and Davis (1965), Bem (1972), and Kelley (1973). Among these four theories, Heider’s and Kelley’s are more related to each other than the other two when it comes to the elucidation of attribution used in most of empirical studies (Seidman, 2000).

The attribution theory of Heider makes an analysis of how people formulate causal presumptions of given circumstances. He explained how this inferential process helps people get explanations. For example, a person is walking in the street when a stick hit him. His initial reaction would be to find out where that stick came from. If he identified that the stick was thrown away by another person, of course, he would get very angry. But when he found out that the stick just fell off from a tree, his anger might be relatively lessen (Seidman, 2000).

Based on the initial studies of Heider, Kelley made further researches that gave him a theory that people undergo a process of cause and effect that would identify certain outcomes. In 1973, he wrote an article that discussed the covariation theory. This theory tells how people link the effects or the results from the causes.  For example, people infer that it gets cold in a room when someone turns on the air-conditioning unit. Hence, because the turning on and off of the unit is directly followed by the getting cold in a room, people assume that one causes the other. Covariation theory explains this cause and effect pattern. Consequently, this resulted to empirical researches on attribution theory (Seidman, 2000).

In 1965, Jones and Davis came up with a connection of the attribution’s influence theory. Jones and Davis made advance definitions of attribution by using the “action-attribute paradigm”. Instead of focusing on the actions, they put their focus on the effects of the actions. People look for to comprehend the underlying personal temperament and purposes to understand the causality of such events. For example, a person is about to buy an expensive jewelry. But then, when she is in the store, the salesperson recommends a cheaper one. This would make the buyer to wonder and look for reasons of the behavior of the salesperson (e.g., when the buyer knows that the salesperson would get a less commission) (Seidman, 2000).

With Heider’s work as the basis, which aimed to have an understanding on the environment’s impact, Bem came up with her own theory in 1972. Bem hypothesized that people use their actions as basis on making assessment on them or on an incidence. In this theory, Bem believes that people already have sets of self-perception reasoning that cause them to react or respond before thinking about it. This is obviously a contrary of the Heider’s theory since Heider assumes that people think first before reacting (Seidman, 2000).

Bernard Weiner identified three general assets as he developed and constructed the model of Heiner’s theory. These three common properties are ‘locus, stability, and controllability”. These three apparently bring about failure or success (Seidman, 2000; Weiner, 1980).

‘Locus’ is the account that represents the person, place, or thing that a costumer or a consumer impugns. The question that arise is if the dissatisfaction of the customer is instigated by the company, restaurant, etc. or by the consumer/customer himself. If the customer is disappointed with the food served in the restaurant, it could probably because of the wrong preparation of the cook. Or, maybe, it was because of the customer’s wrong choice of order (Weiner, 1980).

Meanwhile, the term that is appropriate to determine if the cause is temporary or permanent is ‘stability’. A customer or consumer could think that the poor service or poor preparation of the food is just at the moment, or he/she could think that it is always like that (Weiner, 1980).

Thirdly, ‘controllability’ determines if the performance of the staff, whether it is a success or a failure, is under the management’s control. A bad meal or a poor service could be brought about by a sudden, unexpected incidence that the management did not anticipate. The occurrence could cause the general food quality served at certain moment (Weiner, 1980).

Scholarly studies on customer satisfaction and behavior of employees are now concentrated on these findings since Weiner’s three properties materialized. Researchers always have used one, two, or the three properties in conducting studies on behavior and satisfaction (Seidman, 2000).

Consumer/Customer Response

There are categories or divisions under the application on dissatisfaction of attribution theory. This could be by general impact of the dissatisfaction on the responses of the consumer and on the behavior of the employees. There are many studies conducted on how attributions take effect on the behavior of both consumer and the employee (Seidman, 2000).

The examination on the effect of attributions on responses and behaviors paved way for Folkes to formulate another hypothesis. She theorized that argumentative behaviors of the customers/consumers are associated with the seeming causes of the failure of a service or a product. Subjects were raised about the earlier not good enough experiences in restaurant to study the professed locus, stability, and control concerning the attribution (Seidman, 2000).

The result of Folkes’ study tells that when the customer/consumer determined that the dissatisfaction is caused by the firm/company/restaurant, they believe that they should get a discount, exchange, refund, or even a simple apology. But those consumers who found out that the problem occurred is constant and should have been solved earlier by the management, they easily get angry and choose refund than exchange (Seidman, 2000).

Furthermore, Folkes affirmed that the degree of anger of the customer or consumer is directly affected by the insinuations on the cause of the failure of a product or service. Folkes interviewed people in airport about the failures of service in airline industry. With this method, she concluded that re-acquisition intent and the irritability of the customers are greatly influenced by attributions. The point is in terms of causality, if the airline is responsible for the failure or the problem, the customers get mad. But if the problem is out of the airline’s control, then, the intensity of antagonism of the customers is lesser (Seidman, 2000).

Stability and controllability had undergone another scrutiny against service fiasco in a later study.  Again, a survey from clients or travelers of an unsystematic agency was done. Attributions of stability and control were evaluated or quantified opposed to satisfaction. Once more, the attributions of these properties were found out to have significant connection with satisfaction or dissatisfaction. Customers/consumers become dissatisfied with the firm when they realized that the firm is in charged of the failure of the product or service, which is shown by the controllability property (Seidman, 2000).

Moreover, behaviors of marketing managers of certain firms were analyzed. Through this examination, the influence or effect of attributions on supposed accomplishment or failure was observed. To assess how managers recognize success or disappointment, this analysis made use of the three properties of attribution, locus, stability, and controllability. The result of this inquiry is that managers or decision-makers accredit achievements with steady and internal basis. On the other hand, failures and breakdowns are accounted to the wobbly and external grounds. Nevertheless, in this research, personal controllability is cannot be associated with success and failure (Seidman, 2000).

In 1996, an extended study of the effects of attributions on complaining behavior was done. For another time, the setting of a food establishment was used to investigate the relation between the customer dissatisfaction and the attributions. 87% of the respondents credited the failure and dissatisfaction to the manager and to the employee of the restaurant (Seidman, 2000).

Performance of Employees

Aside from the customer satisfaction, there are also some studies that dealt with the behavior or performance of the employees regarding the effects of attribution. These researches had been able to illustrate pragmatically the link between the contentment and discontentment of the customer and the employee’s performance. This connection is when the customers attribute the malfunction or failure to the service of the employee (Seidman, 2000).

Folkes, in her study, stated that customers’ satisfaction is also attributed to effort. She realized that customers got really angry when they found out that their dissatisfaction was a result of the employees’ lack of effort. When this occurred, they would ask for an explanation and apology (Seidman, 2000).

A 1995 study further delved into the effort attribution on customer satisfaction. Again, an airline industry was examined. In conclusion, the researchers determined that employees’ lack of effort in serving the customers just kept on repeating every once in a while. Therefore, they also kept on disappointing the customers (Seidman, 2000).

In 1983, Folkes, together with Kostos, analyzed the failures in products and their causes as perceived by the sellers and buyers. The two parties do not have the same perceptions and opinions on the sources of failures. This study was conducted in two different settings. Later on, the research yielded that purchasers and vendors have dissimilar justifications on the products defect. Also, the inconsistencies in attributions are connected to the frequency of both parties’ perception of the failure of the product. Of course, the sellers or retailers believe that their products are less likely to be defected (Seidman, 2000).

One study was conducted by Australian researchers during the year 1996. The study made use of the hotel environment. It is an exploratory research on the relationship between the components of service encounters and fulfillment of customers. The Australian researchers showed the respondents some video vignettes that would display different incidence of service failure. Afterwards, they observed that satisfaction or fulfillment could be predicted with the customers’ provenance of the service breakdown. Specifically, the most essential indicator is the attributions on the apparent effort exerted by the provider of service. Results and findings of Folkes and Mohr and Bitner were strengthened by this research (Seidman, 2000).

The main point of these researches sturdily recommends that the management and the staff of a firm should exert more effort in serving the customers/consumers because it is one of the basic indicators of the satisfaction of the customers. The tendency of customers that would attribute service/product breakdown on lacking of effort of the employees would be to increase the level of their disappointment or dissatisfaction (Seidman, 2000).

Attribution Impacts on Satisfaction and Disconfirmation Relationship

Based on the analysis of “disconfirmation of expectations model”, satisfaction and disconfirmation are directly associated without any variable that interfere. The process had been substantiated until 1987 by the written work. From then on, attributions were connected to both satisfaction and disconfirmation. Along with this, current researches and studies have customized the model. Generally, attributions arbitrate the level of satisfaction of customers. This level of satisfaction or dissatisfaction is often driven by expectations. In additional, failures that are accountable to the management of the firm make the customers more dissatisfied (Seidman, 2000).

Truly, existing studies provide ample data on the consequences and precursors of attributions. However, these studies cannot tell or identify disconfirmation as the origin of process of contentment. Kelley and Michela came up with an attribution model through illustrating the peripheral relationship between the two concepts. This model tells that information, impetus, and values are all attributions’ precursors. Nevertheless, a consumer or customer would still embark on the behavioral process that is integrated in the consequences. Attributions of services encounters have significant role to play in the evaluation of service encounters (Seidman, 2000).

CHAPTER 3 METHOD

In the preceding chapters, we have looked at the background of the problem and some literatures that discuss about related theories on the subject.  In this chapter, we will now discuss the methodology used to investigate the project.  Findings will be shown in the next chapter.

Population

Twenty employees (including five canteen personnel) were randomly selected from among the employees who regularly have lunch at the staff canteen in Sands Macao Limited.  These employees have different positions in the company.  Among these 20 employees, four were selected for the case study interview.

Procedure

The study used both qualitative and quantitative data.  For the qualitative study, a descriptive case study on the staff canteen of Sand Macao Limited was carried out.  The qualitative study helped in describing the situation of the company’s staff canteen.  For the quantitative study, survey questionnaires were distributed to the participants.  These questionnaires helped in measuring certain variables.

Case Study Methods

For the qualitative data, a case study on the staff canteen of Sands Macao Limited was carried out.  An interview was first carried out to review the case.  According to Paige (1992), non-experimental research is performed when description and explanation on a specific subject are sought, when it is not possible to manipulate the potential causes of behavior, when variables cannot be easily identified, or when variables are too fixed in the fact that it is hard to be extracted for study.

In descriptive case studies, an inductive process is used (Paige, 1992).  Descriptive case studies focus on many variables in a single company.  This process uses direct observation and systematic interviewing as study techniques.  Descriptive case studies are used to gain understanding of an event instead of measuring predetermined outcomes.  A case study is used because it is not possible to separate the changes in a company from the way the company is organized.

Case studies are useful in exploring situation wherein the intervention being evaluated has no clear, single set of outcomes (Yin, 1984).  The elements needed to be defined in advance in company case studies are the questions needed to be answered, the relevant data, the units of analysis, the logic linking data to propositions and the components of the research design.

The Company Under Study

Sands Macao Limited was chosen as the company under study because of the kind of service it renders to the public.  The researcher attempted to study how the EHPA at the staff canteen of Sands Macao Limited affects the performance of its employees.  Note that if the performance of employees is first-rate, the company will attract more customers.

Sands Macau, established in May 2004, is casino and entertainment complex combined.  It is the first gaming establishment in the Special Administrative Region of Macau operated by Westerners, the Las Vegas Sands Corporation.  Sands Macau, thus, serves as Las Vegas Sands’ counterpart in the East.  An estimate of 360 table games and 680 slot machines and many other gaming devices are contained in the one million square feet building (“Case Study: Sands Macau”, 2006).

As known by everyone, Macau is famous for its gaming facilities. It is actually one of the largest gaming markets in the world. Since it is one of the best facilities in Macau, Sands Macau became very successful by catering several demands starting from the opening day. Because of this, they did not have time improve their marketing plans for the establishment. Of course, this should not go on forever because the competition continues and the gaming facility should thoroughly think of their marketing plan for it to be sustainable (“Case Study: Sands Macau”, 2006).

One of the challenges is that they have to create a superior marketing procedure from scratch. This might be difficult because they are operating 24 hours a day and seven days a week and targeting a market where traditional marketing programs are untested. Also, they have to incorporate an ample information system to keep up the strategy and goals of the establishment (“Case Study: Sands Macau”, 2006).

No doubt, first-class Las Vegas marketing personnel can solve all the problems but it is not that easy because he is dealing with staff coming from an inexperienced local market. This is where the real problem starts. It is easy for a marketing personnel to create the appropriate marketing plan for the gaming facility but the staff should also be trained to apply the marketing strategies in order for it to be successful (“Case Study: Sands Macau”, 2006).

Quantitative Study

For the quantitative study, survey questionnaires were distributed to the employees at Sands Macau Limited’s staff canteen.  The questionnaire consists of fill-in forms for information on the respondent and 12 5-point scale statements regarding their eating habits inside and outside the canteen and perceived healthiness of the food served to them.

Employees at the staff canteen were also asked to answer a different questionnaire regarding the nutrition facts of the food they serve.  These questionnaires also consist of 5-point scale statements.

Data Collection

A critical factor to the success of this research is to gain access to the company in study.  In order to do this, a letter was sent to the company manager of Sand Macao Limited.  Once the access was granted, a preliminary visit to the company was made in January 2007.  Meetings were held with the manager to plan an agenda for the researcher’s two day site visit.

An interview protocol was developed to guide in discussions with company personnel.  Other survey instruments were reviewed in developing the final document.

Data Analysis

Qualitative Study

After completing the field work, the case studies were completed.  This makes up the results and discussion section of this research.  Trust and confidence were also key factors in the success of this research.  The interview questions were developed in such a way as to encourage people to tell their story.  What emerged was an understanding of the issues in the staff canteen at Sands Macao Limited.

Quantitative Study

The data gathered were presented in table and graphical forms.  For each question a table and graphical presentation are shown.  The table consisting of the standard basis (strongly-disagree, disagree, neutral, agree, strongly-agree) on the first column, the frequency (or the number of times a respondent answer that certain standard basis) on the second column.  The relationship of the standard basis and the frequency are further shown in the graph.  The results are plotted in a line graph for the trend and pattern for easy viewing.

The data was analyzed using the Likert scale.  The primary tool used to examine Likert Scale is by the use of graphical analysis.  Since the frequency distribution can visually be seen in the graph, it is easier to explain the results.  The trend represents certain patterns that match with the frequency distribution.

A horizontal line means responses are more or less even across the scale

(Frequency of answers are distributed evenly –from strongly disagree to agree)

The graph of this pattern represents a possible polarization later on or a polarization which is in a period of cooling off.

A slant to the right pattern shows a general disagreement or harmony on the answers of the respondents.  This means that the answers of respondents fall more on “strongly disagree”.

A slant to the left pattern show a general agreement that the answers of the respondents fall more on the “strongly agree” section.

An inverted U-shaped graph shows that there is a non-involvement on the part of the most respondents regarding that issue (that certain question).  This means that the answers of the respondents fall more on the “undecided” sides.

A U-shaped graph represents that the respondents are split in half, both favoring the two sides (the strongly disagree and strongly agree stand) and less are on neutral side.

CHAPTER 4 RESULTS: Sands Macao Limited

The Company

Sands Macau is a combination of casino and entertainment complex which was established in May of 2004. Its floor area is one million square feet and is located in Macau China. Sands Macau is the first gaming establishment in the Special Administrative Region of Macau operated by Westerners. It is actually operated by the Las Vegas Sands Corporation. It is estimated that they have more than 360 table games and over 680 slot machines and many other gaming devices (“Case Study: Sands Macau”, 2006).  The company has a total of 9,000 employees.

Staff Canteen

On May 18, 2004, a staff canteen with capacity for 400 people opened on the second level of the casino.  It opened at six in the morning until three in the morning.  Breakfast is served from 6 am to 10 am.  Food served at this hour are Chinese foods such as congee, din sam, flours roll and others and western food such as milk, bread, egg and others.  From 10 am to 3 am, the employees were served with two Chinese foods such as roast duck and Soya chicken and one western food like roast rib eye.  The canteen also has a salad bar present from opening until closing time.  The salad changes every day.

When the canteen opened, the feedback on food service is good.  However, as the number of employees increased and the company cost cut, the canteen is getting crowded and the feedback becomes bad.  Because of this, a second staff canteen with capacity for 100 people opened on December 15, 2006 now located at the first floor.  Now with two staff canteens, the food service is getting better.

Workforce and Budget. The canteen has a total of 22 personnel including the senior chef and six other chefs.  The senior chef controls the budget.  He has to release the menu before 2 weeks.  So, every time when he realize the under budget, he will order some more expensive foods, as the delivery take time, the month end always keep near $800,000 patacas under.  So, the quality for goods may be poor 2 weeks, and 1 week better.

The budget for employee food in Sands Macao Limited is based on the total staff.  The following is a computation of the daily budget allocated for the employees’ food:

Budget for Canteen: 9000 staff x 68% (assume daily people have meal in canteen) x MOP$35 = MOP$214200 per day.

A MOP$35 for a meal in Macau is already considered a high standard meal for employees.  Normal meal in Macau is around MOP$20.

Issues on Job Performance. After spending two days at the company and observing the employees who regularly have lunch at the canteen, the researcher noticed that most of these employees seem to lose focus on their work after lunch.  This observation is more evident to the employees handling the games.  Some becomes sleepy and tired after lunch.

Because of this, the researcher (with the permission of the senior chef) experimented a diet consisting of whole milk powder, ground whole wheat (with 1.3% sodium chloride), freshly cut lean beef and green string beans (bought each day in the open market to ensure freshness).

Three days after this service, employees become more focused on their work after lunch (refer to question 10).  The feel energetic more (if not the same level as) after lunch than when they started work at morning.  Sleepiness and tiredness became less apparent.  Employees even become friendlier to the customers in the early afternoon than in early morning.  As employees become friendlier and more pleasant in serving customers, customer satisfaction tends to increase.  Thus, the overall effectiveness of the company also increased.

Survey Results

Graphs were shown to illustrate the distribution of the respondents’ answers.  A brief interpretation follows each graph.  The frequency is shown on Appendix C.

Employee satisfaction on the staff canteen

First, we need to determine whether the employees are satisfied with the service provided by the staff canteen.  Statements such as “I like to eat at the staff canteen.” and “The food served at the canteen is excellent.” determine if the employees are satisfied with the both food and the service.

Figure 1

The above graph shows the distribution of the respondents’ answers on the statement “I like to eat at the staff canteen.”  It is clear that the employees were undecided if they like to eat at the canteen.

Figure 2

The above graph illustrates shows the distribution of the respondents answer on the statement “The food served at the canteen is affordable.” The graph shows that the employees think that the food at the canteen is affordable.

Figure 3

The distribution of answers to the statement “The food served at the staff canteen is excellent” is shown in the above graph.  Some employees think that the food at the staff canteen is great while others seem to be undecided.

Figure 4

Figure 4 shows the distribution of answers on the statement “I wish there will be more variety of food served at the canteen”.  Most employees seem undecided on whether to add more variety of food at the canteen.

Figure 5

The above figure shows the respondents’ answer distribution on the statement “I’m satisfied with the food served at the canteen.”  It is clear that the employees are satisfied with the food served at the canteen.

Figures 1 to 5 indicates the perception of employees on the service provided by the canteen.  Because food at the canteen is affordable, the employees felt satisfied with it.  However, they seem to be neutral when asked about the quality of food served at the canteen.  This may stem from the fact that the canteen serves not-so-bad but not-so-good food for two weeks because of the budget but gets excellent food for rest of the month.  Thus, they are also undecided if they like to add more variety of food at the canteen and so becomes undecided on whether they like to eat at the canteen.

After Lunch Effects

The next goal of the survey is to determine the after lunch effects of the food to the employees.  This includes how the employees feel before and after lunch.  The following issues and results are also the issues tackled in the case study.

Figure 6

Figure 6 illustrates the employees’ response to the statement “I feel sleepy after having lunch.”  Most employees feel sleepy and tired after having lunch at the canteen.

Figure 7

Figure 7 shows the respondents’ answers to the statement “I seem to have difficulty focusing on my work after having lunch.”  As with the previous graph, most employees seem to lose their focus after having lunch at the canteen.

Figure 8

The above figure shows the distribution of the employees’ answers on the statement “I feel more energetic before than after having lunch.”  Likewise with the previous two graphs, employees feel more energetic in the morning than after having lunch.

Figures 6 to 8 show how the employees feel after having lunch.  All these graphs show that employees feel more tired and sleepy after having lunch than in the morning when they just started work.  Because of this sleepiness, they eventually lose their focus on their work.  This is a serious matter since it can affect not just the employees’ job performance but the overall effectiveness of their company as well.

Employees’ perception on EHPA

Finally, we need to determine the employees’ awareness and perception on their company’s EHPA.

Figure 9

The above graph shows the number of employees who are aware of the EHPA in their company.  Out of the 20 surveyed respondents, only 8 were aware of the EHPA, 5 of which are the canteen personnel.  It is good that all of the personnel knew of the EHPA.  However, most employees (14 out of 20) were not aware of the existence of EHPA in their company.

Figure 10

The above graph shows the distribution of answers on the statement “The EHPA of our company is effective.”  Of those who answered yes, they seemed undecided on the effectiveness of the EHPA in their company.

Figure 11

The above graph shows the distribution of answers on the statement “The staff canteen strictly follows the EHPA of our company.”  Similarly with the previous graph, the employees seemed undecided on this.

Figure 12

Figure 12 illustrates the distribution of answers on the statement “The company must have an EHPA to give better privileges to the employees.”  Most employees seem to think that it is a good idea to develop an EHPA for their company.

Figures 9 to 12 show the awareness and perception of the employees on the EHPA of their company.  Most employees were not aware that their company has an EHPA.  These employees think that developing an EHPA for their company can help not just them as individuals but the whole company as well.

CHAPTER 5 CONCLUSION

Summary of Main Findings

This research found that employee influence an organization’s ability to achieve performance-related outcomes by influencing the identification of desired organizational outcomes.  This finding may provide the foundation for additional studies concerning organizational performance and effectiveness in which health is considered as one of the key determinants.

The research examined the relationship that is perceived to exist between health values and organizational performance. This research also established that the EHPA being used in Sands Macau Limited is a means of containing or reducing health costs and explored a wide range of employee health issues and practices.  As a result, this research not only provides a foundation for initiating more complex empirical health values and organizational performance studies but also, more intensive investigations concerning EHPAs.

In addition to providing empirical data for other researchers with respect to organizational values and EHPAs, this research provides information which may assist non-academics and practitioners alike deal with EHPA issues on a day-to-day basis. Examination of the value bases that underlie the functioning of organizations, for example, will enable middle and senior managers to assess the efficacy of values within their existing operational context. Also, exploration of humanistic-based approaches of improving performance will assist practitioners realize both tangible benefits and intangible benefits that are proven to influence bottom-line results.

This research also makes an important contribution to a developing employee health management data base.  Developing a quality EHPA data base is vital to enhancing awareness of potential outcomes and effects and ultimately, will assist practitioners make the business case for implementing EHPAs.  Such a data base will also assist practitioners identify the barriers that are perceived to impede the implementation of EHPAs and provide insight as to how other organizations have overcome them.

Implications for Future Research

The results of this research may provide a basis for a wide range of EHPA issues.  There are several general directions that can be followed to extend this empirical research.  The generalizability of results to other organizations can be investigated, other performance-related outcomes can be studied and results of this study which cannot be explained with the existing data can be investigated further.

The generalizability of the study’s results could be addressed from several perspectives including the extent to which the results are generalizable to a broader population of American, European and Asian organizations.  In this regard, the items contained in the questionnaire could be tested on a more universal scale by a culturally diverse group of international organizations.  Based on the results of this study, the researcher suspects that cultural orientation would play a significant role with respect to the various ratings assigned to the items contained in the questionnaire.

Since this dissertation focused on the influence of health values on organizational performance, an interesting extension of the research would be to investigate the relationship that exists between each of the other organizational values and outcomes identified in the study.  Subsequently, this research could be extended further by including other values and performance-related outcomes, such as those deemed to be important in international organizations. Another extension could investigate the influence of EHPAs on the organizational outcomes identified.

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