Ci a ion: San Román-Nia es, M.;
Coo, C.; Llo ens, S.; Salano a, M. The
Media ing Role o Compassion
be ween Social Job Resou ces, and
Heal hy Heal hca e P o essionals: A
C oss-Sec ional S udy wi h Gende
Pe spec i e. In . J. En i on. Res.
Public Heal h 2022,19, 7500. h ps://
doi.o g/10.3390/ije ph19127500
Academic Edi o s: Paul B.
Tchounwou and Richa d G ay
Recei ed: 30 May 2022
Accep ed: 17 June 2022
Published: 19 June 2022
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In e na ional Jou nal o
En i onmen al Resea ch
and Public Heal h
A icle
The Media ing Role o Compassion be ween Social Job
Resou ces, and Heal hy Heal hca e P o essionals:
A C oss-Sec ional S udy wi h Gende Pe spec i e
Mabel San Román-Nia es * , C is ián Coo, Susana Llo ens and Ma isa Salano a
WANT Resea ch Team, Uni e si a Jaume I, 12071 Cas ellóde la Plana, Spain; [email p o ec ed] (C.C.);
[email p o ec ed] (S.L.); [email p o ec ed] (M.S.)
*Co espondence: msan [email p o ec ed]; Tel.: +34-947-29572
Abs ac :
The aim o his s udy is o examine he ole o Compassion owa ds o he s as a media o
be ween Social Job Resou ces (social suppo clima e, coo dina ion, and posi i e leade ship), Heal hy
Employees (psychological well-being such as esilience, engagemen , and op imism) and Heal hy
O ganisa ional Ou comes (in- ole pe o mance, ex a- ole pe o mance and commi men ) om a
gende pe spec i e in heal hca e p o essionals. Th ough he mul iple analyses o a iance, s uc u al
equa ion models, and mul iple-g oup analyses in a sample o 1420 heal hca e p o essionals om
di e en public and p i a e hospi als in Spain, his s udy p o ed he exis ence o gende di e ences,
wi h women pe cei ing highe le els o Compassion. Mo eo e , his s udy shows ha Compassion
pa ially media es he ela ionship be ween Social Job Resou ces and Heal hy Employees. In addi ion,
Compassion pa ially media es he ela ionship be ween Social Job Resou ces and Heal hy O ganisa-
ional Ou comes. Finally, Heal hy Employees media e he posi i e ela ionship be ween Social Job
Resou ces and Heal hy O ganisa ional Ou comes. This is an inno a i e con ibu ion o he limi ed
esea ch examining Compassion owa ds o he s as a pe sonal esou ce ha can ha e a posi i e impac
in he wo kplace. The esul s also p opose a way o de elop and conduc in e en ions in o de o
inc ease Compassion owa ds o he s in he heal hca e con ex .
Keywo ds:
compassion; heal hca e con ex ; social esou ces; well-being; heal hy employees; heal hy
ou comes
1. In oduc ion
The aim o his s udy is o examine he ole o Compassion as a media o be ween So-
cial Job Resou ces (social suppo clima e, coo dina ion, and posi i e leade ship), Heal hy
Employees (psychological well-being such as esilience, engagemen , and op imism) and
Heal hy O ganisa ional Ou comes (in- ole pe o mance, ex a- ole pe o mance and com-
mi men ) om a gende pe spec i e in heal hca e p o essionals.
The need o Compassion owa ds o he s has eached an unp eceden ed le el du ing
ou ime and bea s no con ex ual compa ison, pa icula ly among heal h ca e p o essionals
(HCPs), who a e cu en ly acing consis en ly s ess ul si ua ions. These si ua ions expose
hem o mul iple psychosocial isks a wo k, such as quan i a i e o e load, ole s ess,
exhaus ion, mo al anguish (HCPs know wha o do, bu canno ac ), lack o companionship
and lack o ime [
1
]. Mo eo e , inadequa e s a ing le els and longe shi s (i.e., mo e han
12 h [
2
]) hinde clinicians’ abili y o es ablish he apeu ic ela ionships wi h pa ien s. This,
in u n, inc eases he wo kload, causing s ess and exhaus ion [
3
]. Addi ionally, HCPs
a e unde inc easing p essu e o mee pe o mance a ge s and achie e “mo e wi h less”
se ice e iciencies [
4
]. All hese nega i e ou comes ha e a se ious impac on he heal h o
pa ien s and pe cep ion o he quali y o ca e hey ecei e [5].
Resea ch sugges s ha si ua ions o de e io a ion o men al heal h, mo i a ion and
well-being can be alle ia ed by inc easing job and pe sonal esou ces [
6
]. Fo example,
In . J. En i on. Res. Public Heal h 2022,19, 7500. h ps://doi.o g/10.3390/ije ph19127500 h ps://www.mdpi.com/jou nal/ije ph
In . J. En i on. Res. Public Heal h 2022,19, 7500 2 o 18
in he Job Demands and Resou ces (JD-R) Model, Bakke and Deme ou i [
7
] indica ed
he impo ance o he pe sonal esou ces, which diminish he nega i e impac o job
demands and enhance he posi i e impac o job demands on mo i a ion, pa icula ly on
he challenges ha may a ise du ing he wo king day.
Pe sonal esou ces a e de ined as psychological cha ac e is ics ela ed o esilience
and o he abili y o con ol and o posi i ely impac one’s own en i onmen , which help
wo ke s o achie e hei goals and encou age pe sonal and p o essional g ow h [
6
]. Re-
sea ch has p o ed he impo ance o pe sonal esou ces as media o s in he ela ionship
be ween job esou ces and well-being, including sel -e icacy, op imism, and o ganisa ional
sel -es eem [
8
] o psychological capi al (PsyCap) (hope, esilience sel -e icacy and op i-
mism) [
9
]. Employees wi h high le els o PsyCap pe cei e ewe job demands and b ing
highe job esou ces [
8
]; hey he e o e eel less exhaus ed and a e mo e igo ous, which is
di ec ly ela ed o engagemen [10].
Compassion is one o he pe sonal esou ces ha esea ch has p o ed o be ele an o
HCPs [
11
]. Gilbe and Choden [
12
] de ined Compassion “as a mo i a ion ha o ien a es
o a sensi i i y o su e ing in sel and o he s wi h a commi men o y o alle ia e and
p e en i ”. Resea ch has es ablished ha Compassion owa ds o he s can help HCPs
inc ease hei sel -es eem and app ecia ion o hei wo k and o p o ide a high-quali y ca e
se ice [
13
]. Mo eo e , Compassion owa ds o he s can help o educe pe cei ed s ess,
anxie y, dep ession, bu nou and imp o e emo ion egula ion [14].
So a , Compassion looks like an e ec i e d i e o imp o e wellbeing and could be
a pe sonal esou ce ele an o HCPs o cope wi h job s ess and con ibu e o heal hy
and posi i e heal hca e o ganisa ions. In ha sense, Salano a e al. [
15
,
16
] p oposed
ha Heal hy and Resilien O ganisa ions (HEROs) a e “ hose o ganisa ions ha p omo e
heal hy esou ces and p ac ices” and “ha e heal hy employees and wo kg oups ha enjoy
high psychosocial well-being, which in u n is ela ed o heal hy o ganisa ional esul s”.
The HERO model [
15
] conside s a mo i a ional p ocess in which Social Job Resou ces
a e i al o ace job demands, leading o Heal hy O ganisa ional Ou comes. The HERO
model explains ha , in si ua ions o excessi e demands, pe sonal and social esou ces
mus be p esen in o de o p e en a de e io a ion in heal h, mo i a ion, and pe o mance.
Compassion owa ds o he s can be conside ed as a pe sonal esou ce ha posi i ely a ec s
he h ee a iables o he HERO model, i.e., o ganisa ional esou ces and p ac ices, heal hy
employees, and heal hy o ganisa ional ou comes.
To his end, he e is e idence abou he posi i e e ec s (i.e., educing job s ess and
imp o ing wellbeing) o cul i a ing Compassion owa ds o he s, pa icula ly conside ing
he gende pe spec i e. As men ioned ea lie , Compassion is a p ocess o alle ia ing su e -
ing and ca ing o o he s, and his de ini ion is o en seen as gende ed since p esc ip i e
gende oles see i mo e as a eminine ai [
17
]. The e is limi ed esea ch ega ding he
e ec s o gende on Compassion, so his esea ch p o ides a g ea oppo uni y o show he
ole o Compassion om a gende pe spec i e.
The e is no much esea ch on he p emises and consequences o de eloping Com-
passion in he heal hca e con ex . Fo his eason, i is impo an o explo e he ole o
Compassion as a pe sonal esou ce ha could be de eloped by speci ic job esou ces ha ,
in u n, can p omo e men al heal h, well-being (Heal hy Employees) and posi i e esul s.
In addi ion, he impo ance o s udying Social Job Resou ces mus also be highligh ed, as
hey play a undamen al ole in shaping employees’ expe iences and beha iou s [18].
To add ess his issue, his a icle aims o examine he ex en o which Compassion,
conside ing gende , media es be ween Social Job Resou ces (social suppo clima e, coo -
dina ion, and posi i e leade ship) and Heal hy Employees (engagemen , esilience, and
op imism) ha , in u n ha e a posi i e e ec on Heal hy O ganisa ional Ou comes (com-
mi men , in- ole, and ou -o - ole pe o mance).
In . J. En i on. Res. Public Heal h 2022,19, 7500 3 o 18
2. Theo e ical F amewo k
2.1. Compassion owa ds O he s as a Pe sonal Resou ce
In ecen yea s, in e es in s udying Compassion as a pe sonal esou ce has inc eased [
19
].
Despi e his in e es , he e is a lack o esea ch emphasising i s ole as a pe sonal esou ce and
how i can make job esou ces a ailable in he heal hca e con ex o HCPs. Compassion in
medical ca e has ecei ed inc easing a en ion om he heal h p omo ion li e a u e, heal h
ca e policy and p o essional o ganisa ions in ecen yea s [
20
], and in e es in Compassion
owa ds o he s has also inc eased due o i s posi i e impac on he heal h o pa ien s [21].
Al hough he link be ween high quali y ca e and Compassion is o en assumed o
be pa o he job cha ac e is ics o he HCPs [
22
,
23
], and mos HCPs a e dedica ed o
pe o ming hei p ac ice wi h Compassion, inciden s o poo ca e ha e aised in e na ional
conce n abou he s a e o Compassion in heal hca e sys ems [20].
In heal hca e, Compassion owa ds o he s consis s mainly o wo elemen s: a deep
awa eness and willingness o gain knowledge o people’s su e ing and he desi e o alle i-
a e su e ing [
24
]. One o he mos impo an cha ac e is ics ha di e en ia es Compassion
owa ds o he s om o he p osocial beha io s, like empa hy and pi y, is he powe ul
desi e o alle ia e su e ing [
20
]. In addi ion o ul illing a p o essional du y, esea ch
inc easingly sugges s ha HCPs’ capaci y o be compassiona e is associa ed wi h be e
ou comes, including pa ien sa is ac ion, be e quali y doc o -pa ien in e ac ions, and
be e long- e m pa ien ou comes, bo h psychically and psychologically [25].
HCPs selec ea men s based on hei e icacy, some imes o he disad an age o he
quali y o human ela ionships. Howe e , his does no appea o be wha pa ien s wan ,
qui e he opposi e. They wan o be ea ed as people, o alk abou hei si ua ion [
26
]
and o speak as openly as possible [
27
]. When a pe son is ill, hey become pa icula ly
ulne able and may equi e he assis ance o o he s, e en o he mos insigni ican hings.
In hese si ua ions, hey wan o be ea ed wi h ca e and Compassion [
28
]. Sinclai e al. [
5
]
de eloped a “Compassion Empi ical Model” whe e hey explained he poin o iew o
pa ien s and amily membe s ega ding hei needs o hei HCPs’ compassiona e skills.
The esul s showed ha communica ion, i uous esponse and a ending o needs a e
undamen al in HCPs o p o ide a quali y se ice o hei pa ien s.
I is impo an o highligh he posi i e aspec s o Compassion in HCPs men al heal h.
Sansóe al. [
29
] implemen ed he Mind ul-Based S ess Reduc ion T aining (MBSRT) and
Compassion Cul i a ion T aining (CCT) in HCPs and he esul s o his aining showed
an imp o emen o hei quali y o li e (Compassion, sa is ac ion, esilience, empa hy and
dec eased bu nou and Compassion a igue). O he s udies e ealed ha mind-body skills
(MBS) and CCT diminished s ess and imp o ed mind ulness, empa hy, and esilience [
30
,
31
].
Conside ing he abo e, i is impo an o s udy Compassion as a posi i e pe sonal esou ce
ha can help o de elop skills such as: knowing he pa ien , pe cei ing he pa ien ’s su e ing,
iden i ying wi h and being kind o he pa ien and showing espec , among o he s [11].
P e ious esea ch has shown ha he e a e signi ican gende di e ences in Compas-
sion, wi h mos s udies showing ha women ha e highe le els o Compassion [
32
–
36
].
This is an expec ed esul as i may be ela ed o women’s emo ional s uc u e and ma e nal
ins inc [
37
]. Cu en ly, mo e han 75% o he wo king popula ion in he heal h sec o a e
women [
38
], which means ha i is a eminised p o ession, as s a is ically he pe cen age o
women compa ed o men is abou 55%. Taking no e o p e ious esea ch, we a e in e es ed
in how he gende a iable can be linked o Compassion owa ds o he s.
2.2. The Media ing Role o Compassion owa ds O he s be ween Social Job Resou ces and Heal hy
Employees
Compassion owa ds o he s is commonly seen as a undamen al social o ce ha c e-
a es and enhances in e pe sonal ela ionships [
39
]. Likewise, i has been shown o imp o e
well-being in ulne able people, p omo ing an in ima e bond be ween colleagues, and
acili a ing coope a ion be ween s ange s [
40
], hus engaging suppo i e beha iou s [
18
].
People also eel Compassion o ano he pe son when hey a e in discom o , dis ess and
In . J. En i on. Res. Public Heal h 2022,19, 7500 4 o 18
e iden need and espond o his si ua ion by helping hem [
41
]. This p osocial beha iou
helps o elie e he wounded indi iduals’ pain [42].
Social Job Resou ces a e hose aspec s o wo k including he emo ional and ins u-
men al suppo o supe iso s and wo k colleagues [
43
]. I could be expec ed ha ha ing
a wo kplace clima e wi h ich social ela ionships, social suppo , posi i e coo dina ion
among co-wo ke s as well as a posi i e leade ship will esul in c ea ing Compassion
among HCPs. Fo example, i has been shown ha social suppo gi es he oppo uni y o
he HCPs o ecei e eedback, o e lec , o sha e challenges, di icul ies, and successes wi h
colleagues, and o p o ide and ecei e suppo om leade s [
44
]. I leade s and manage s
c ea e a posi i e and suppo i e en i onmen o HCPs, he HCPs in ques ion c ea e a
ca ing, suppo i e clima e and gi e a highe quali y ca e se ice [
45
]. Addi ionally, he
coo dina ion wi h HCPs’ colleagues c ea es impo an bonds and encou ages sha ing o
esponsibili ies, hus c ea ing basis o educe su e ing [
46
]. Social Job Resou ces can help
o inc ease Compassion owa ds o he s in a mo e e icien and eliable manne [47].
Following on om his, esea ch has shown ha Compassion posi i ely ela es o
indica o s o psychological well-being, such as engagemen , esilience, and op imism.
Engagemen can be de ined as a posi i e, pleasing, job- ela ed s a e o mind ha is dis in-
guished by igou , dedica ion, and abso p ion [
48
]. In he heal hca e con ex , i has been
shown ha Compassion is highly ela ed o wo k engagemen , pa icula ly when he job
asks a e e y challenging [
49
], and HCPs who a e Compassiona e eel mo e engaged [
50
].
Wi h ega ds o esilience, de ined by Su cli e and Vogus [
51
] as “ he main enance o posi-
i e adjus men unde challenging si ua ions, so ha he o ganisa ions eme ge om hose
condi ions s eng hened and mo e esou ce ul”, i HCPs ha e high le els o Compassion,
hey a e mo e likely o be mo e esilien , eme ging s onge om ad e se si ua ions o
c isis and auma [
52
,
53
]. Finally, op imism is an indi idual’s endency o belie e ha
good hings will happen o hem [
54
]. Vogus e al. [
47
] showed ha Compassion owa ds
o he s is ela ed o op imism as a posi i e esponse ha deli e s and e-es ablishes posi i e
meaning and psychological well-being. These s udies sugges ha Compassion can lead
HCPs o eel be e (well-being), enjoy highe le els o men al heal h and, he e o e, be
mo e p oduc i e, which ansla es in o he happy-and-p oduc i e wo ke hesis [
55
]. This
hesis p oposes ha people who a e happie a wo k a e mo e p oduc i e han hose who
a e less happy, which implies ha he highe he job and pe sonal sa is ac ion, he be e
he pe o mance. The e o e, people who a e happie in and ou o he wo k con ex will
pe o m e en be e [56].
In summa y, he li e a u e p o es he impo ance o Social Job Resou ces as enhance s
o Compassion owa ds o he s and hei posi i e impac , which, in u n, has a posi i e e ec
on di e en elemen s o employee wellbeing. In o he wo ds, Social Job Resou ces inc ease
Compassion owa ds o he s [
57
,
58
], making wo k engagemen , esilience, and op imism
eadily a ailable and use ul o inc easing he likelihood o enhancing HCPs psychological
well-being. The p esen s udy will ocus on in es iga ing Compassion as a posi i e psychol-
ogy mechanism ha could lead o psychological well-being (i.e., engagemen , op imism,
and esilience) and excellen o ganisa ional ou comes.
2.3. The Media ing Role o Compassion owa ds O he s be ween Social Job Resou ces, Heal hy
O ganisa ional Ou comes and P oduc i e Wo ke s
Compassion owa ds o he s allows Social Job Resou ces o be mo e easily accessed
and deployed. As o c ea ing esou ces, ein o cing ce ain sha ed belie s and alues, and
he cul i a ion o ela ional skills [
39
], his os e ing o ac s o Compassion can p oduce
employees ha a e no only mo e engaged, bu also mo e p oduc i e [59].
P e ious esea ch sugges s ha Compassion owa ds o he s helps people o eco e
om su e ing and pain ul si ua ions, o e coming hese ci cums ances, e-engaging and
imp o ing hei job pe o mance [
60
]. Fu he mo e, de eloping compassiona e skills allows
people o a ain a be e wo k-li e balance, which is ela ed o Heal hy O ganisa ional
Ou comes [60] and has a posi i e impac on employees’ job pe o mance [61].
In . J. En i on. Res. Public Heal h 2022,19, 7500 5 o 18
Conside ing commi men as ano he Heal hy O ganisa ional Ou come, p omo ing
commi men in he heal hca e con ex is an e ec i e s a egy o gi e a sense o belonging
in he o ganisa ion [
62
], inc ease e en ion, b ing a be e -quali y ca e se ice and mo e
impo an ly, conse e pa ien heal h along wi h a g ea commi men o pa ien s [
63
]. HCPs
who a e highly commi ed o hei place o wo k main ain iendly ela ionships wi h
colleagues and achie e asks based on he o ganisa ion [
64
]. Besides, Compassion also
d i es commi men among employees [65].
This s udy is also based on he heo e ical amewo k o he HERO Model [
15
,
16
],
his model has been es ed in di e en o ganisa ional sec o s, whe e he main esul s
showed ha HEROs (heal hy and esilien o ganisa ions) can enhance pe sonal esou ces
a wo k such as us [
66
], whe eas ho izon al and e ical us is posi i ely ela ed o eam
commi men ( igou , dedica ion, and abso p ion). Salano a e al. [
15
] indica ed ha he
de elopmen o esilience can ha e signi ican e ec s on job pe o mance as well. I can be
assumed ha he e icien use o social esou ces and o ganisa ional p ac ices leads o a
posi i e ou come ha imp o es he employees’ psychological well-being [16].
This can be seen in he s udy conduc ed by Fa is [
67
], showing e ec i eness in he
heal hca e con ex . The esul s o he s udy men ion ha i HCPs a e sa is ied and happy
wi h hei wo k and he wo k en i onmen , hey will be be e able o de elop hei skills
o pe o m hei asks and, as a esul , an inc ease in p oduc i i y will ollow.
2.4. The Cu en S udy
The p esen s udy aims o e alua e he media ing ole o Compassion be ween Social
Job Resou ces (social suppo clima e, coo dina ion, posi i e leade ship), Heal hy Employ-
ees (engagemen , esilience, op imism) and Heal hy O ganisa ional Ou comes (in- ole and
ex a- ole pe o mance, commi men ) om a gende pe spec i e, using he da a collec ed
in di e en hospi als in Spain. Mo e speci ically, we explo e Compassion as a posi i e
psychological mechanism ha can lead o high le els o well-being o heal hca e wo ke s
and lead o success ul o ganisa ional ou comes. On he o he hand, we also examine he
ole o he Social Job Resou ces as Compassion enable s. All hese issues a e e lec ed in
he ollowing hypo heses:
Hypo hesis 1 (H1). Women show highe le els o Compassion owa ds o he s han men.
Hypo hesis 2 (H2).
Compassion pa ially media es he posi i e ela ionship be ween Social Job
Resou ces and Heal hy Employees.
Hypo hesis 3 (H3).
Compassion pa ially media es he posi i e ela ionship be ween Social Job
Resou ces and Heal hy O ganisa ional Ou comes (in- ole, ex a- ole pe o mance and commi men ).
Hypo hesis 4 (H4).
Heal hy Employees media es he posi i e ela ionship be ween Social Job
Resou ces and Heal hy O ganisa ional Ou comes.
3. Ma e ials and Me hods
3.1. Pa icipan s
The sample consis ed o 1420 HCPs om di e en public and p i a e hospi als in
Spain. Mean age was 41.72 (SD = 10.77), a e age enu e ime was 12.3 yea s (SD = 10.1),
78.67% (1117) we e women and 21.33% (303) we e men.
The p ocedu e consis ed o wo pa s: The i s pa , which was he con ac wi h he
hospi als, was ca ied ou h ough a non-p o i o ganisa ion ha o ganises a yea ly na ional
compe i ion o awa d hospi als and se ices wi h high le els o psychosocial well-being.
The call o en ies was launched ia he NGO’s websi e and social media. Hospi als and
se ices in e es ed in pa icipa ing egis e ed and submi ed a nomina ion in acco dance
wi h he compe i ion ules. As a p e- equisi e, egis e ed pa icipan s had o ha e he
app o al o hei hospi al/depa men adminis a ion. Once he egis a ion deadline had

In . J. En i on. Res. Public Heal h 2022,19, 7500 6 o 18
passed, da a collec ion began o a pe iod o wo mon hs. The second pa was he da a
collec ion, i was ca ied ou h ough he Heal hy and Resilien O ganisa ions (HERO)
Ques ionnai e [
15
,
16
] ha included 5 i ems o he B ie Compassion Scale [
68
,
69
], and
o he a iables. The ques ionnai e was dis ibu ed among all he pa icipan s h ough an
on-line link, encou aging hem o pa icipa e olun a ily. In o med consen was ob ained
om each pa icipan and da a p o ec ion p o ocols we e s ic ly ollowed acco ding o
exis ing GDPR egula ions. The E hics Commi ee o Jaume I Uni e si y app o ed he
s udy (CD/57/2020).
3.2. Ins umen s
•
Compassion owa ds o he s was measu ed using a b ie adap a ion o he Compassion
Scale [
68
,
69
]. Fi e i ems we e chosen om he o iginal scale (since, a e conduc ing
he analyses, hey we e he ones wi h he bes ac o sco es), dis ibu ed be ween
sel -kindness, common humani y, mind ulness, and non-judgemen / o gi eness. The
i ems a e sco ed on a se en-poin equency a ing scale anging om 0 (ne e ) o 6
(always). Sample i ems include “I I see ha someone is ha ing di icul ies, I y o
help” (kindness), “I y no o judge o he s when hey make mis akes o a e w ong”
(non-judgemen / o gi eness), “I hink e e yone eels sad some imes, i is pa o being
human” (common humani y), “I usually lis en pa ien ly when people ell me abou
hei p oblems” (mind ulness). C onbach’s Alpha (
α
= 0.65), and McDonald’s Omega
(
ω
= 0.65): he C onbach’s Alpha is mode a e, so i is abo e he accep able limi [
70
],
which is why he decision was made no o emo e he i em ha sco ed less, as i
would emain wi h wo o he h ee cons uc s ha make up Compassion.
•
Social Job Resou ces we e measu ed using he HERO ques ionnai e subscale by he
same name including social suppo clima e, posi i e leade ship, and coo dina ion.
Each o hese i ems was ep esen ed by a single i em, whe e each o hese single
i ems is he mean o he HERO subscale [
15
,
16
]. Pa icipan s answe ed using a se en-
poin equency ype scale wi h sco es om 0 (ne e ) o 6 (always). Sample i ems
include “Deg ee o which you supe iso conside s he needs o you se ice/ca e
uni , ecognising he e o and achie emen o goals o he se ice/ca e uni ” (posi i e
leade ship), “Deg ee o which you eel suppo ed by you colleagues and supe i-
so pe sonally and p o essionally” (social suppo clima e) and “Deg ee o which
you a e coo dina ed wi h you wo k eam, in o de o espond o wo k si ua ions”
(coo dina ion). (C onbach’s Alpha (α= 0.80), and McDonald’s Omega (ω= 0.81))
•
Heal hy Employees we e measu ed using he HERO ques ionnai e subscale by he same
name including engagemen , esilience, sel -e icacy, and op imism. Each o hese
i ems was ep esen ed by a single i em, whe e each o hese single i ems is he mean
o he HERO subscale [
15
,
16
]. Pa icipan s answe ed using a se en-poin equency
wi h sco es om 0 (ne e ) o 6 (always). Sample i ems include “Deg ee o which you
eel imme sed, ull o ene gy and dedica ed o you wo k, c ea ing a posi i e clima e
o ul ilmen and hope” (engagemen ), “Deg ee o which you eel capable o eme ging
s onge a e acing ad e si y and ailu es a wo k” ( esilience), and “Deg ee o which
you gene ally expec he bes in di icul imes, you a e op imis ic abou he u u e and
in gene al, you expec mo e good hings o happen han bad” (op imism). (C onbach’s
alpha (α= 0.81), and McDonald’s omega (ω= 0.81))
•
Heal hy O ganisa ional Ou comes we e measu ed using i ems om he HERO ques-
ionnai e subscale by he same name including a single i em each o commi men ,
ex a- ole, and in- ole pe o mance [
15
,
16
]. Each one o hese elemen s was ep e-
sen ed by a single i em, his was due o ac o loadings whe e hey i ed bes as
obse ed a iables. Pa icipan s answe ed using a se en-poin equency ype scale
wi h sco es om 0 (ne e ) o 6 (always). Sample i ems include “Deg ee o which you
wo k asks a e ca ied ou and ul illed” (in- ole pe o mance), “Deg ee o which asks
ha exceed wha is p esc ibed by you wo k a e pe o med” (ex a- ole pe o mance),
In . J. En i on. Res. Public Heal h 2022,19, 7500 7 o 18
“Deg ee o which you eel commi ed o he heal h cen e and i s ou comes, how p oud
you eel o belong he e” (commi men ).
3.3. Da a Analyses
Fi s , o es he Hypo hesis 1, Mul iple Analyses o Va iance (MANOVA) we e pe -
o med wi h IBM SPSS S a is ics 28.0 o es o signi ican di e ences in he s udy a i-
ables acco ding o gende (women and men). Fo hese analyses, he gene al da abase o
1420 HCPs (78.6% women and 21.4% men) was used. Subsequen ly, chi-squa e es s (
χ2
)
and - es s we e pe o med, whe e signi ican di e ences in a ou o women we e ound.
Based on Yoon and Lai [
71
], who men ion ha g oups ha a e e y unbalanced can al e
he esul s, he decision was made o andomise he sample o 606 HCPs (N = 303 men,
N = 303
women). The andom sample o women and men was pe o med using he R 4.1.0
sample unc ion [72].
Conside ing ha he da abase has a highe pe cen age o women, i was decided o
use he women (N = 1117) o es he es o he hypo hesis, so desc ip i e and co ela ion
analyses we e he second s ep. Reliabili y was es ima ed wi h C onbach’s alpha and
McDonald’s hie a chical omega coe icien s [
73
]. A e wa ds, se e al di e en models
we e examined using a s uc u al equa ion modelling app oach (SEM) wi h maximum
likelihood es ima ion in SPSS AMOS 26. To es ablish goodness o i we calcula ed ela i e
and absolu e i -indexes, speci ically, chi-squa ed (
χ2
) and no med chi-squa ed (
χ2
/d ),
oo –mean–squa ed e o o app oxima ion (RMSEA) wi h uppe and lowe con idence
in e als, Tucke Lewis Index (TLI), and Compa a i e Fi Index (CFI) ollowing he cu -o
poin s sugges ed by Sch eibe [
74
]. We also calcula ed he indi ec e ec s o he di e en
media ion pa hs, hei s a is ical signi icance and con idence in e als using R package o
causal media ion analysis [75].
To es ou p oposed hypo heses, we es ablished six di e en SEM models o inc easing
complexi y wi h he emale sample. Fo Hypo hesis 2, we i s es ablished Model 1 (M1)
whe e we es ed he pa ial media ing ole o Compassion owa ds o he s be ween Social
Job Resou ces and Heal hy Employees. Model 2 (M2) es ed he ull media ing ole o
Compassion owa ds o he s be ween Social Job Resou ces and Heal hy Employees as an
al e na i e model o M1.
Nex , o es Hypo hesis 3 we es ablished Model 3 (M3) which was buil upon M1 and
ex ended i including he pa ial media ing ole o Compassion owa ds o he s be ween
Social Job Resou ces and Heal hy O ganisa ional Ou comes. In Model 4 (M4) we es ed he
ull media ion o Compassion owa ds o he s be ween Social Job Resou ces and Heal hy
O ganisa ional Ou comes as an al e na i e model.
Addi ionally, o es Hypo hesis 4 we es ablished Model 5 (M5) which ex ended M3
including he pa ial media ion o Heal hy Employees be ween Social Job Resou ces and
Heal hy O ganisa ional Ou comes. Addi ionally, we es ed in Model 6 he ull media ion o
Heal hy Employees be ween Social Job Resou ces and Heal hy O ganisa ional Ou comes
as an al e na i e model. Compassion owa ds o he s, Social Job Resou ces and Heal hy
Employees we e included as la en a iables Heal hy O ganisa ional Ou comes we e
included as h ee dis inc obse ed a iables, namely: in ole pe o mance, ex a ole
pe o mance, and o ganisa ional commi men (see Figu e 1).
Finally, using he andomised sample o men and women (w = 303, m = 303), s uc u al
equa ion modelling analyses (SEM) we e pe o med using mul i-g oup analysis wi h SPSS
AMOS 26.0 so wa e o es he hypo hesised model ha assumes ha Compassion pa ially
media es be ween Social Job Resou ces, Heal hy Employees, and Heal hy O ganisa ional
Ou comes. To explo e gende in a iance— ollowing Chen [
76
]—we es ed o con igu al
(i.e., same s uc u e ac oss g oups), me ic (i.e., same ac o loadings ac oss g oups), and
scala in a iance (i.e., same in e cep s ac oss g oups) h ough mul iple–g oup CFA.
In . J. En i on. Res. Public Heal h 2022,19, 7500 8 o 18
In . J. En i on. Res. Public Heal h 2022, 19, x FOR PEER REVIEW 8 o 18
we e included as h ee dis inc obse ed a iables, namely: in ole pe o mance, ex a ole
pe o mance, and o ganisa ional commi men (see Figu e 1).
Figu e 1. Resea ch model in ol ing Compassion, Social Job Resou ces, Heal hy Employees and
Heal hy O ganisa ional Ou comes. No e. SSC = Social Suppo Clima e, PL = Posi i e Leade ship,
COO = Coo dina ion, COM1 = Compassion I em 1, COM2 = Compassion I em 2, COM3 = Compas-
sion I em 3, COM4 = Compassion I em 4, COM5 = Compassion I em 5, ENG = Engagemen , RES =
Resilience, OPT = Op imism.
Finally, using he andomised sample o men and women (w = 303, m = 303), s uc-
u al equa ion modelling analyses (SEM) we e pe o med using mul i-g oup analysis
wi h SPSS AMOS 26.0 so wa e o es he hypo hesised model ha assumes ha Com-
passion pa ially media es be ween Social Job Resou ces, Heal hy Employees, and
Heal hy O ganisa ional Ou comes. To explo e gende in a iance— ollowing Chen [76]—
we es ed o con igu al (i.e., same s uc u e ac oss g oups), me ic (i.e., same ac o load-
ings ac oss g oups), and scala in a iance (i.e., same in e cep s ac oss g oups) h ough
mul iple–g oup CFA.
4. Resul s
4.1. Mul iple Analyses o Va iance (MANOVA)
Fi s , he MANOVA was pe o med. Using he andom sample, ega ding gende (as
an independen a iable), and he es o he s udy a iables (Social Job Resou ces, Com-
passion, Heal hy Employees, and Heal hy O ganisa ional Ou comes) as dependen a i-
ables. The esul s showed signi ican di e ences be ween he HCPs o men and women
[F (10,595) = 2.047, p < 0.05]. Women also showed signi ican ly highe le els o Compassion
[F (1,888) = 10.135, p < 0.05]; mean o women = 4.957, mean o men = 4.763; and posi i e
leade ship [F (1,593) = 4.840, p < 0.05]; mean o women = 4.851, mean o men = 4.620.
4.2. Desc ip i e Analyses
Second, Table 1 shows he pa icipan ’s socio-demog aphic in o ma ion. Table 2
shows he means, s anda d de ia ions, and in e co ela ions o all he a iables included
in he s udy (N = 1420), i.e., Compassion ( he mean o he 5 i ems), Social Job Resou ces
(social suppo , coo dina ion, posi i e leade ship), obse ed a iables o Heal hy O gan-
isa ional Ou comes (in- ole pe o mance, ex a- ole pe o mance, commi men ) and
heal hy employees (wo k engagemen , esilience, op imism). The esul s show ha all
Figu e 1.
Resea ch model in ol ing Compassion, Social Job Resou ces, Heal hy Employees and
Heal hy O ganisa ional Ou comes. No e. SSC = Social Suppo Clima e, PL = Posi i e Leade ship,
COO = Coo dina ion, COM1 = Compassion I em 1, COM2 = Compassion I em 2, COM3 = Com-
passion I em 3, COM4 = Compassion I em 4, COM5 = Compassion I em 5, ENG = Engagemen ,
RES = Resilience, OPT = Op imism.
4. Resul s
4.1. Mul iple Analyses o Va iance (MANOVA)
Fi s , he MANOVA was pe o med. Using he andom sample, ega ding gende
(as an independen a iable), and he es o he s udy a iables (Social Job Resou ces,
Compassion, Heal hy Employees, and Heal hy O ganisa ional Ou comes) as dependen
a iables. The esul s showed signi ican di e ences be ween he HCPs o men and women
[F (10,595) = 2.047, p< 0.05]. Women also showed signi ican ly highe le els o Compassion
[F (1,888) = 10.135, p< 0.05]; mean o women = 4.957, mean o men = 4.763; and posi i e
leade ship [F (1,593) = 4.840, p< 0.05]; mean o women = 4.851, mean o men = 4.620.
4.2. Desc ip i e Analyses
Second, Table 1shows he pa icipan ’s socio-demog aphic in o ma ion. Table 2shows
he means, s anda d de ia ions, and in e co ela ions o all he a iables included in he
s udy (N = 1420), i.e., Compassion ( he mean o he 5 i ems), Social Job Resou ces (social
suppo , coo dina ion, posi i e leade ship), obse ed a iables o Heal hy O ganisa ional
Ou comes (in- ole pe o mance, ex a- ole pe o mance, commi men ) and heal hy employ-
ees (wo k engagemen , esilience, op imism). The esul s show ha all a iables co ela e,
excep o ex a- ole pe o mance which has no co ela ion wi h esilience, op imism, and
Social Job Resou ces.
In . J. En i on. Res. Public Heal h 2022,19, 7500 9 o 18
Table 1. Sociodemog aphic in o ma ion o he pa icipan s (N = 1420).
Va iables Demog aphic In o ma ion
Age anges
14.71% (209) aged 20–29
28.66% (407) aged 30–39
32.18% (457) aged 40–49
17.60% (250) aged 50–59
6.26% (89) aged 60–75
Job Posi ion
39.64% (563) nu ses
18.45% (262) nu sing assis an s
9.92% (141) physicians
9.71% (138) coo dina o s/supe iso s
5.28% (75) die icians and ki chen
3.87% (55) adminis a i e
3.16% (45) echnicians
9.92% (141) o he s (e.g., o de lies, psychologis s,
midwi es, suppo s a )
Tenu e
33.59% (477) one o i e yea s
18.09% (257) six o 10 yea s
16.97% (241) 11 o 15 yea s
11.33% (161) 16 o 20 yea s
13.52% (192) 21 o 30 yea s
6.05% (86) 31 o 45 yea s
Type o con ac
65.63% (932) pe manen con ac
22.6% (321) empo a y con ac
11.76% (167) ano he ype o con ac
Table 2. Desc ip i e s a is ics and co ela ions among all s udy a iables.
M SD 1 2 3 4 5 6 7 8 9 10 11
1. Compassion 4.91 0.70 -
2. Social Job
Resou ces 4.89 0.83 −0.11 ** -
3. Social Suppo 4.89 1.11 −0.12 ** −0.01 -
4. Coo dina ion 4.99 0.98 −0.62 ** −0.05 0.32 ** -
5. Posi i e
Leade ship 4.82 1.24 −0.07 * −0.02 0.28 ** 0.83 ** -
6. In-Role
Pe o mance 5.45 0.82 −0.09 ** −0.01 0.36 ** 0.45 ** 0.31 ** -
7. Ex a Role
Pe o mance 3.85 1.40 0.02 0.04 0.12 ** 0.01 −0.00 0.05 -
8.O ganisa ional
Commi men 4.96 1.14 −0.13 ** 0.02 0.37 ** 0.51 ** 0.37 ** 0.42 ** 0.42 ** -
9. Heal hy
Employees 4.66 0.94 −0.13 ** −0.01 0.43 ** 0.72 ** 0.58 ** 0.60 ** 0.56 ** 0.43 ** -
10. Wo k
Engagemen 4.81 1.01 −0.14 ** 0.02 0.39 ** 0.62 ** 0.47 ** 0.54 ** 0.45 ** 0.42 ** 0.07 * -
11. Resilience 4.58 1.11 −0.11 ** −0.00 0.35 ** 0.61 ** 0.50 ** 0.51 ** 0.47 ** 0.36 ** 0.03 0.54 ** -
12. Op imism 4.58 1.21 −0.09 ** 0.00 0.36 ** 0.60 ** 0.51 ** 0.48 ** 0.50 ** 0.34 ** 0.05 0.57 ** 0.86 **
No e. M = Mean; SD = S anda d De ia ion. All scales we e measu ed using a using a 7-poin scale. N = 1420.
** p< 0.01, * p< 0.05.
4.3. S uc u al Equa ion Modelling Analyses
In SEM es s o Hypo hesis 2, M1 showed good i indexes,
χ2
= 153.688; d = 41;
p< 0.001;
RMSEA = 0.05; TLI = 0.964 and CFI = 0.973. On he o he hand, M2 showed less
han accep able i indexes,
χ2
= 503.951; d = 42; p< 0.001; RMSEA = 0.099; TLI = 0.858 and
CFI = 0.891. Mo eo e , he media ion e ec was signi ican (β= 0.143, p< 0.001).
Fo Hypo hesis 3 esul s o M3 showed poo e i indexes,
χ2
= 190.792; d = 40;
p< 0.001;
RMSEA = 0.058; TLI = 0.933 and CFI = 0.951. M4 showed accep able i in-
dexes in compa ison,
χ2
= 328.533; d = 43; p< 0.001; RMSEA = 0.077; TLI = 0.882 and
CFI = 0.907
. Again, all h ee media ion e ec s we e signi ican , speci ically in- ole pe o -
mance (
β= 0.187
,p< 0.001), ex a- ole pe o mance (
β
= 0.128, p< 0.001) and o ganisa ional
commi men (β= 0.190, p< 0.001).
In . J. En i on. Res. Public Heal h 2022,19, 7500 16 o 18
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