Organizational justice in primary-care health centers and glycemic control in patients with type 2 diabetes

Abstract

Background: Organizational justice has been put forward as a measure of leadership quality that is associated with better health among employees.

Objectives: We extended that idea to test whether perceived organizational justice among health care providers might be positively associated with glycemic control among their diabetic patients.

Setting: Eighteen primary-care health centers (HCs) in Finland.

Participants: Type 2 diabetes patients (n=8954) and HC staff (n=422).

Measurements: : Mean of 1 year's measurements of glycated hemoglobin [≥ 7.0 (the least optimal); 6.5-6.9; 6.0-6.4; and 4.5-5.9 (the most optimal)], health-center psychosocial work characteristics (staff-reported procedural justice and relational justice, effort-reward imbalance, and work-unit team climate), and individual-level and work-unit-level covariates.

Results: Perceptions of higher levels of procedural justice among staff were associated with more optimal glycated hemoglobin levels among patients (cumulative odds ratio per 1-U increase in justice=1.54, 95% confidence interval, 1.08-2.18) after adjustment for patient-level and unit-level covariates. Relational justice, effort-reward imbalance, and work-unit team climate were not associated with glycemic control.

Conclusion: The quality of leadership at HCs, as indicated by staff perceptions of procedural justice, may play a role in achieving good glycemic control among type 2 diabetes patients.