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Why are they still here: a look at employee retention amidst the COVID-19 pandemic

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Why are they still here: a look at employee retention amidst the COVID-19 pandemic

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Why Are They Still Here: A Look at Employee Retention Amidst the COVID-19 Pandemic
by
Heather Rene Manley

Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education

August 2022

© Copyright by Heather Rene Manley 2022
All Rights Reserved

The Committee for Heather Rene Manley certifies the approval of this Dissertation

Eric A. Canny
Cathy S. Krop
Jennifer L. Phillips, Committee Chair

Rossier School of Education
University of Southern California
2022

iv
Abstract
The purpose of this mixed methods study was to examine the impact of unplanned change,
driven by the COVID-19 pandemic, on organizational culture and employee retention among
essential workers in a growing healthcare organization. The research addresses the importance of
employee retention, including factors related to retention, consequences of retentions, and the
financial impact of employee attrition. Additionally, the research addresses employer strategies
to increase retention, such as organizational culture, job satisfaction, employer brand, and
generational differences in the workplace. The conceptual framework used for this research is an
adaptation of the Burke-Litwin model of organizational performance and change (BLMOPC).
The study sought to examine the change to the organization caused by the external environment
factor of the COVID-19 pandemic by exploring the transactional factors of work unit climate and
individual needs and values. Data collection consisted of a survey instrument and interviews with
survey participants. The findings and results support the conceptual framework suggesting that
the transformational factor of organizational culture is influenced by the transactional factors
which can be leveraged to inform leaders and turn the COVID-19 crisis into an opportunity to
create a stronger organizational culture. Recommendations to address the impact of the COVID-
19 on organizational culture and employee retention are discussed and include a quantified and
transparent approach to compensation and developing an organizational culture that promotes
work-life balance and leadership presence.

v
Dedication
To my husband, words are not enough. Your support and encouragement have always been
unwavering. I could not have done this without you. I am me because of you. I love you.

To my children, thank you for believing in me and supporting this dream. As you have done for
me, I will always do for you. Follow your hearts, your passion, and your purpose. I will always
believe in you. I love you.

To my mom, your strength and perseverance have always been my inspiration to believe in the
impossible and never give up. Thank you for that gift. I love you.

vi
Acknowledgements
This journey has been one of the scariest, most challenging, and most rewarding times of
my life. As a first-generation student, the leap into a doctoral program was a giant step into
uncharted waters under normal circumstances. The unprecedented times we lived through over
the course of the program only magnified the fears, challenges, and insecurities. I am forever
grateful to my fellow Cohort 14 members for their support throughout these past three years. I
have made friends for life, and I am so grateful.
It took a village to pull this all together. That village included friends and family, near
and far, who would check in periodically and provide the right amount of encouragement at just
the right time. It also took the support of the leadership team and the employees of the study
organization. I appreciate their participation, amidst a chaotic and demanding time. For all of
you, I am eternally grateful for your support on this journey.
Finally, there is something special about the USC Rossier OCL faculty. Each brought
their unique skillset and approach to teaching and guiding. They challenged my thinking and
forced me out of my comfort zone, making me a better global citizen and stronger scholar. I
would like to specifically thank Dr. Eric Canny and Dr. Cathy Sloane Krop for participating in
my committee and engaging me in their courses. I would also like to thank Dr. Doug Lynch and
Dr. Nicole Maccalla for providing flexibility and support during a particularly challenging time
for me and my family. Finally, getting to the finish line would not have been possible without the
guidance and encouragement from Dr. Jennifer Phillips, Dissertation Chair. There were times
when I could not see the light at the end of the tunnel and wanted to give up. Each time I was
met with encouragement and productive feedback that provided just the nudge I needed to keep
going. Thank you so very much.

vii
Table of Contents
Abstract ................................................................................................................................................iv
Dedication ............................................................................................................................................. v
Acknowledgements .............................................................................................................................vi
List of Tables .......................................................................................................................................ix
List of Figures ....................................................................................................................................... x
Chapter One: Overview of the Study .................................................................................................. 1
Context and Background of the Problem................................................................................ 2
Organization Context and Mission.......................................................................................... 3
Purpose of the Study and Research Questions ....................................................................... 7
Importance of the Study ........................................................................................................... 8
Overview of Theoretical Framework and Methodology ....................................................... 9
Definition of Terms ................................................................................................................ 11
Organization of the Dissertation ........................................................................................... 12
Chapter Two: Review of The Literature ........................................................................................... 13
The Impact of the COVID-19 Pandemic .............................................................................. 13
Importance of Employee Retention ...................................................................................... 17
Employer Strategies to Increase Employee Retention ......................................................... 22
Burke-Litwin Model of Organizational Performance and Change (BLMOPC) ................ 27
Conceptual Framework .......................................................................................................... 32
Conclusion .............................................................................................................................. 35
Chapter Three: Methodology ............................................................................................................. 36
Overview of Methodology ..................................................................................................... 36
The Researcher ....................................................................................................................... 38
Data Sources ........................................................................................................................... 39

viii
Ethics ....................................................................................................................................... 45
Chapter Four: Results and Findings .................................................................................................. 47
Participants ............................................................................................................................. 48
Data Analysis and Presentation of Results and Findings .................................................... 52
Research Question 1: What Key Factors in the Area of Work Unit Climate Do
Employees See As Most Influential in Their Decision to Either Remain With or
Leave OMI Under Shifting Market Conditions?.................................................................. 54
Research Question 2: What Key Factors in the Area of Individual Needs and
Values Do Employees See as Most Influential in Their Decision to Either Remain
With or Leave OMI Under Shifting Market Conditions? .................................................... 67
Research Question 3: What Do Employees Need in the Organizational Culture of
OMI to Keep Them With the Organization .......................................................................... 80
Summary ................................................................................................................................. 92
Chapter Five: Discussion and Recommendations ............................................................................ 94
Discussion of Findings and Results ...................................................................................... 94
Recommendations for Practice ............................................................................................103
Limitations and Delimitations .............................................................................................118
Recommendations for Future Research ..............................................................................119
Conclusion ............................................................................................................................121
References .........................................................................................................................................124
Appendix A: Survey Protocol ..........................................................................................................141
Appendix B: Interview Protocol ......................................................................................................147
Appendix C: Participant Information Sheet ....................................................................................150
Appendix D: Cost of Attrition Worksheet ......................................................................................152

ix
List of Tables
Table 1: Overlap of Factors Related to Employee Retention, Job
Satisfaction, Organizational Culture, and Employer Brand
18
Table 2: Tangible and Intangible Costs of Employee Attrition 21
Table 3: Data Sources 38
Table 4: Survey Participant Demographics 49
Table 5: Interview Participant Profiles 52
Table 6: Mean and Standard Deviation for Work Unit Climate Factors (N =
49)
56
Table 7: Open-Ended Responses: Cooperation and Support Among Team
Members
63
Table 8: Open-Ended Responses: Influence of Trust and Respect on Intent
to Retain
65
Table 9: Mean and Standard Deviation for Individual Needs and Values
Factors (N = 49)
69
Table 10: Open-Ended Responses: Feeling Valued as an Employee 77
Table 11: Mean and Standard Deviation for Organizational Culture Factors
(N = 49)
82
Table 12: Crosswalk: Positive Descriptors of the Transformational Factor
Organizational Culture to the Transactional Factors of Work Unit
Climate and Individual Needs and Values
91
Table 13: Crosswalk: Work Unit Climate Factors to Employee Retention
Factors
96
Table 14: Crosswalk: Individual Needs and Values Factors to Employee
Retention Factors
99
Table 15: Crosswalk: Organizational Culture Factors to Employee Retention
Factors
102
Table 16: Annual Market Rate Salary by Position for Occupational
Healthcare in the Organization’s Market
113
Appendix A Survey Protocol 141

x
List of Figures
Figure 1: 2021 Employee Population by Generation 6
Figure 2: The Workforce Generations Defined 26
Figure 3: Burke-Litwin Model of Organizational Performance and Change
(BLMOPC)
28
Figure 4: Transformational Factors of the BLMOPC 30
Figure 5: Transactional Factors of the BLMOPC 31
Figure 6: Conceptual Framework Approach of This Study 34
Figure 7: Percent Distribution of Work Unit Climate Factors Rated as To a Very
Large Extent
58
Figure 8: Open-Ended Responses: Work Unit Climate Weighted by Response
Frequency
59
Figure 9: Work Unit Climate Factor Mention by Interview Participant 61
Figure 10: Percent Distribution of Individual Needs and Values Factors Rated as
To a Very Large Extent
71
Figure 11: Open-Ended Responses: Individual Needs and Values Weighted by
Response Frequency
73
Figure 12: Individual Needs and Values Factor Mention by Interview Participant 74
Figure 13: Percent Distribution of Organizational Culture Factors Rated as To a
Very Large Extent
83
Figure 14: Open-Ended Responses: Organizational Culture 85
Figure 15: Organizational Culture Factor Mention by Interview Participant 86
Figure 16: Positive Descriptors of Organizational Culture 88
Figure 17: Hierarchy of Themes 105
Figure 18: Bridge’s Transition Model 116
1

Chapter One: Overview of the Study
In February 2020, the unemployment rate in the United States was among the lowest on
record in the post-WWII era at 3.8% (Kochhar, 2020). However, many would not expect a
change on March 19, 2020. On this day, California Governor Gavin Newsom issued Stay-At-
Home orders for all individuals living in California due to a pandemic sweeping the globe caused
by a respiratory virus called COVID-19. The only individuals exempted from the Stay-At-Home
orders were those deemed essential to the continuity of operations of critical infrastructure
sectors (Exec. Order No. N-33-20, 2020). Seemingly overnight, the unemployment rate
skyrocketed. By April 2020, California’s unemployment rate was 15.5%, and the national
unemployment rate was 14.7% (Employment Development Department, 2020; BLS, 2020).
The Stay-At-Home order enacted by Governor Newsom on March 19, 2020, referenced
16 critical infrastructure sectors identified by the federal government and ordered that
Californians working in these sectors continue to work because of the importance of the role they
played in the health and well-being of Californians (Exec. Order No. N-33-20, 2020). These
individuals became known as Essential Workers (EW). They were expected to continue to work
even as the fallout of the COVID-19 pandemic was reshaping and redefining how businesses
could safely operate. One of the 16 critical infrastructure sectors the federal government
identified was healthcare.
This research study examined the impact of unplanned change, driven by the COVID-19
pandemic, on organizational culture and employee retention among essential workers in a
growing healthcare organization. The research addresses the importance of employee retention,
including factors related to retention, consequences of retentions, and the financial impact of
employee attrition. Additionally, the research addresses employer strategies to increase retention,
2

such as organizational culture, job satisfaction, employer brand, and generational differences in
the workplace.
Context and Background of the Problem
Healthcare is consistent in its ranking of survival rates for new businesses every year,
with an average survival rate of 45.06% from 2011 through 2015 for new healthcare businesses
(U.S. Bureau of Labor Statistics, 2016). The evidence highlights a greater than 50% chance of
failure for a new health care business. Solutions leading to increased employee retention could
have significant, positive implications for a healthcare organization’s sustainability, even when
not facing a revolutionary unplanned change event such as that caused by the COVID-19
pandemic.
Survival rates for new businesses decrease by approximately 20% in the first year and
continue to decrease on average by 5–10% annually (U.S. Bureau of Labor Statistics, 2016).
Multiple factors result in the success of a new business, many of which surround cost
containment. Personnel payroll costs can run as high as 60% of gross revenue, depending on the
organization’s industry (Browne, 2019). Personnel, specifically attrition driven by low employee
retention, can be the most considerable expense of an organization.
Employee attrition is costly to an organization. There are two types of employee attrition:
voluntary and involuntary. The employee decides on voluntary attrition due to job
dissatisfaction, job insecurity, compensation, lack of autonomy, poor relationship with team
members, poor working conditions, lack career development opportunities, or other reasons
(James & Mathew, 2012). Involuntary attrition results from an employee leaving an organization
for a reason other than a personal decision (McGew, n.d.).
3

Sustainable organizational growth relies on an organization’s ability to retain employees
and limit the costs associated with attrition. The Society for Human Resources Management
(SHRM) published data in 2016 estimating that the costs to recruit and replace an employee
averaged $4219.00 per hire, and the recruitment averaged 42 days (SHRM, 2016). When
adjusted for inflation, this total was approximately $4763.29 per hire in 2021 (US Inflation
Calculator, 2022). According to a benchmark study by Price Waterhouse Cooper in 2016, the
cost of employee attrition was 1 to 1.2 times the employee’s annual salary and cost U.S.
employers up to $27 billion per year (PwC, 2016). Adjusting for inflation, the total cost to U.S.
employers in 2021 was up to $30.5 billion (US Inflation Calculator, 2022).
The organization at the center of this study was a growing healthcare organization
founded in 2012. Survival data published by the U.S. Bureau of Labor Statistics indicates that, as
of March 2021, the survival rate for healthcare businesses that opened in 2012 had dropped to
41.8% (U.S. Bureau of Labor Statistics, 2022). The research aimed to identify strategies to
increase employee retention and leverage organizational culture as a recruitment and retention
strategy to increase the likelihood of survival. For this study, employee retention is defined as the
strategy organizations adopt to sustain a workforce that matches their requirements and is
effective from an operational point of view (Das & Baraugh, 2013). Organizational Culture was
defined as the accumulated shared learning of a group, comprised of a pattern or system of
beliefs, behavioral norms, and values that have worked well enough to be considered valid and
are applied to solve problems of external and internal integration (Schein & Schein, 2016).
Organization Context and Mission
Occ Med, Inc. (OMI), a pseudonym, is a medical corporation operating Occupational
Medicine (OM) clinics in California. The American College of Occupational and Environmental
4

Medicine (ACOEM) defines Occupational Medicine as “A board-certified specialty under
Preventive Medicine that focuses on the diagnosis and treatment of work-related injuries and
illnesses” (ACOEM.org, 2021). The organizational mission of OMI is focused on the experience
of all stakeholders, including its employees. OMI desires to be recognized as the industry-best in
all aspects of the business, whether customer service, patient care, employee relations,
community engagement, or providing industry-leading educational opportunities. As a for-profit
business, OMI must yield significant profit to satisfy its investors and provide opportunities for
future growth and expansion. It is the core belief of the leadership team at OMI that the path to
success is through its people.
Prior to the COVID-19 pandemic, OMI experienced rapid growth, having opened two
new locations, and increased the number of employees by 57% in 2019. The Stay-At-Home
order issued by Governor Newsom on March 19, 2020, had an immediate negative impact on
business levels for the organization. Visits per week decreased by 51% from Week 11, March 9–
15 to Week 13, March 23–29, and continued to decline dramatically until mid-October 2020.
The immediate decline in business volume led to location closures, mandatory pay cuts
for all staff, reduced hours for all hourly staff, increased hours for exempt staff, employee
furloughs, and layoffs. Employee furloughs refers to the act of requiring employees to take
unpaid leave from their place of work (Shepherd, 2017). Furloughs differ from layoffs in that
furloughed staff members remain on the employer’s payroll and are expected to be ready to
return to work as the employer’s need arises while employees who are laid off are no longer
employed by the organization (Oliver, 2020).
On April 28, 2020, Governor Newsom introduced the Resilience Roadmap, which was a
4-stage approach to reopening California (Newsom, 2020). Although the state was opening back
5

up, business levels for the study organization remained consistently low until Week 43, October
19–25, when there was a dramatic increase in business levels, due to the organization’s rollout of
COVID testing. The sudden increase in business levels at a time of decreased staffing resulted in
current employees being asked to work additional hours while critical new positions were being
created and filled, and furloughed employees were being called back to work.
While good for the financial viability of the organization, the increased business volume
created organizational challenges resulting from a shift in the business model required to meet
client needs. The increased business levels were sustained through 2021, peaking in Week 34,
August 23–29, and then steadily declining for the remainder of the year. The data for this study
were gathered in January 2022, while COVID-19 pandemic was active, but California was
completely open. The demand for COVID testing had decreased dramatically thus reducing
business levels to pre-COVID numbers.
As of December 31, 2021, the organization consisted of 73 employees from diverse
gender, racial-ethnic, age, and socioeconomic backgrounds. The gender mix of employees was
71% women and 29% men. The racial-ethnic breakdown was (a) 48% Hispanic, (b) 37%
Caucasian, (c) 7% Asian, (d) 1% Pacific Islander, (e) 3% two or more races, and (f) 13% other or
decline to state. The employee population spanned generations from baby boomers through
Generation Z. Figure 1 shows the employee population by generation.

6

Figure 1
2021 Employee Population by Generation

Note. N = 73. “Defining generations: Where Millennials end and Generation Z begins.” From
Dimock, M., 2019, Pew Research Center (https://pewrsr.ch/2szqtJz). Copyright 2021 by Pew
Research Center.

Healthcare workers’ 5-year average separation rate is 35.78% (U.S. Bureau of Labor
Statistics, 2021). Before the onset of the COVID-19 pandemic, the annual attrition rate for the
organization was far below the average separation rate. In 2019, the annual attrition rate had
reached a low of 20.3%, of which 13% was voluntary. The COVID-19 pandemic caused an
7

increase in voluntary attrition in 2020, with the organization reaching an annual attrition rate of
32%, of which 26% was voluntary.
As the pandemic progressed, the organization began to recover, and business levels
increased, resulting in the need to increase staffing. At the same time, the labor market was
tightening, making it more challenging to fill positions. Simultaneously, the organization
continued to see an increase in voluntary attrition at levels far exceeding organizational history
and inching closer to the five-year average separation rate for healthcare workers. The annual
attrition rate for 2021 was 30%, all voluntary. While the rates still fell below the national average
for health care workers, they indicated a critical need for the organization to focus on retention
and recruitment efforts to sustain economic viability.
Purpose of the Study and Research Questions
This study aimed to examine the impact of unplanned organizational change resulting
from the COVID-19 pandemic on organizational culture and employee retention among essential
workers in a growing healthcare organization. Current employees of OMI were interviewed for
this mixed-methods study. The following research questions guided the study:
1. What key factors in the area of work unit climate do employees see as most
influential in their decision to either remain with or leave OMI under shifting market
constraints?
2. What key factors in the area of individual needs and values do employees see as most
influential in their decision to either remain with or leave OMI under shifting market
constraints?
3. What do employees need in the organizational culture of OMI to keep them with the
organization?
8

Importance of the Study
Understanding the factors that influence employee retention is essential because
personnel costs can run as high as 60% of gross revenue, depending on the industry (Browne,
2019). On average, 4.7% of workers leave the labor force voluntarily each year, and 6.2% switch
occupations (U.S. Bureau of Labor Statistics, 2019). Methods to reduce attrition, increase
retention, and promote a business recognized as the best place to work can significantly impact
the bottom line.
In a tight labor market, new jobs being filled by internal candidates limits the number of
qualified candidates available for open positions (Cascio, 2014). The labor market began to
tighten as the workforce began to return during the COVID-19 pandemic. On February 4, 2022,
the U.S. Bureau of Labor Statistics reported that the unemployment rate was 4.0% nationwide,
nearly 11% lower than April 2020, which was previously the highest rate observed since data
collection began in 1948 (U.S. Bureau of Labor Statistics, 2022). In California, the
unemployment rate as of September 2021 was 7.5%, with the state regaining 63.5% of jobs lost
in March and April of 2020 due to the COVID-19 pandemic (Employment Development
Department, 2021). In addition to recovering unemployment rates, the U.S. Bureau of Labor
Statistics (2021) further reported that the rising demand for the labor associated with recovery
from the pandemic had put upward pressure on wages resulting in significant hourly rate
increases over 5 months from May 2021 through September 2021.
A tight labor market favors the employee, and attrition is costly (Browne, 2019). The
study is critical because understanding the factors that influence employee commitment during
this type of unplanned change event created by the COVID-19 pandemic could increase the
likelihood of retaining and attracting top talent as the labor market tightens again. Organizations
9

that can retain talent while improving operations may have a sustainable competitive advantage
over those with high attrition rates as the economy and job market recover.
Overview of Theoretical Framework and Methodology
The theoretical framework utilized for this research was the Burke-Litwin model of
organizational performance and change (BLMOPC). The framework is a causal change model
and conforms to an open-system way of thinking that seeks to show where change arises and
how it flows between different parts of an organization (Burke, 2018). In the model, the external
environment serves as the input dimension, and the organization and internal performance serve
as the output dimension. All dimensions contained within the model serve as throughput. The
BLMOPC categorizes dimensions into transformational and transactional factors. The
transformational factors in the model are caused by direct interaction with the external
environment and require significantly new behavior from the organization’s leaders. Any change
in the transformational factors means the entire organization is affected (Burke, 2018).
According to the BLMOPC, strategy carries more weight in large-scale change than
structure because changing strategy affects the entire system (Burke, 2018). The sudden,
unplanned change from the external environment exerted on the organization by COVID-19
disrupted the entire organizational system. This change forced leaders to implement
transformational and transactional change virtually overnight, limiting the ability to approach the
change through transformational factors and forcing many change actions that would typically be
considered transactional, according to the BLMOPC.
The theory of change guiding the research study was that during a time of immediate and
unplanned change, the external environment, which was the COVID-19 pandemic, in this case,
served as the input dimension causing the most significant impact on organizational change.
10

Overnight, organizations across the United States had to implement new structures, practices,
and systems to meet the requirements of changes mandated by the Centers for Disease Control
and Prevention (CDC). Such changes included social distancing, isolated lunch breaks,
elimination of physical contact, barriers between workstations, and the cancelation of celebrated
social traditions (Centers for Disease Control and Prevention, 2020). In implementing the
mandated changes, employers simultaneously needed to preserve and nurture their employees
during a time of chaos and uncertainty.
The BLMOPC asserts that the external environment drives the most significant change;
although there is a return to all factors, the input from those at the bottom (transactional) is
always less than those towards the top (transformational) back into the external environment.
The impact of the COVID-19 pandemic did not provide the opportunity for transformational
factors to mediate the transactional factors due to the immediacy of the mandated changes. The
changes driven by the pandemic were top-down, but the changes affected all factors of the model
immediately and simultaneously. As business operations normalized during the pandemic,
opening the throughput dimensions within the model became critical to rebuilding organizational
culture and retaining employees. The research sought to identify the most critical factors
contributing to long-term retention beyond the pandemic from the employees’ perspectives, thus
preserving the organization’s financial resources and resulting in future growth.
The research design of this study was a convergent mixed methods design. The
convergent mixed methods design is a strategy in which the researcher collects qualitative and
quantitative data but analyzes them separately and then compares the results and findings to see
if they disconfirm or confirm one another (Creswell & Creswell, 2018). The data was gathered
sequentially. The quantitative data was gathered by conducting a census survey of all employees
11

in the organization, resulting in a response rate of 67%. The qualitative data was gathered by
conducting interviews with a sample of employees who completed the survey and indicated a
willingness to participate in the interview process during their response in the quantitative data
collection process, approximately 18%.
Definition of Terms
Following is a list of terms pertinent to the study:
• Employee retention (EER) is strategy organizations adopt to sustain a workforce that
matches their requirements and is effective from an operational point of view (Das &
Baraugh, 2013).
• Employer brand (ERB) is an integrated approach to aligning internal employee
convictions with the external brand of the organization to attract and retain talent (Rai
& Nandy, 2021).
• Essential workers (EW) conduct various operations and services that are typically
essential to continue critical infrastructure operations. Critical infrastructure is an
umbrella term encompassing sectors from energy to defense to agriculture (National
Conference of State Legislatures, 2021).
• Involuntary attrition results from an employee leaving an organization for a reason
other than a personal decision (McGew, n.d.)
• Job satisfaction is defined into eight components of measurement: (a) compensation
and welfare benefits; (b) work environment; (c) career and promotion opportunities;
(d) leadership style; (e) communication and job clarity; (f) work-life balance; (g)
training and development; and (h) teamwork and job security (Nanjundeswaraswamy,
2019).
12

• Occupational medicine is a board-certified specialty under Preventive Medicine that
focuses on diagnosing and treating work-related injuries and illnesses (ACOEM,
2021).
• Organizational culture is the accumulated shared learning of a group, comprised of a
pattern or system of beliefs, behavioral norms, and values that have worked well
enough to be considered valid and are applied to solve problems of external and
internal integration (Schein & Schein, 2016).
• Unplanned change is an unanticipated external change that affects the core of the
business and requires a response from the organization (Porras & Robertson, 1992).
• Voluntary attrition occurs when an employee decides to leave the organization due to
job dissatisfaction, job insecurity, compensation, lack of autonomy, poor relationship
with team members, poor working conditions, lack of career development
opportunities, or other reasons (James & Mathew, 2012).
Organization of the Dissertation
Chapter 1 introduced the problem of practice and background information regarding the
organization of the study. Chapter 2 includes a comprehensive review of empirical and
theoretical literature related to the problem of practice and an overview of the Burke-Litwin
model of organizational performance and change (BLMOPC); the theoretical framework used
for this research. Chapter 3 provides an overview of the methodology and justification for the
study design and addresses any ethical concerns. Chapter 4 presents the data collection findings
and an analysis of the data utilizing the methodology outlined in Chapter 3. Chapter 5 discusses
and interprets the findings from the data and offers recommendations based on those findings.

13

Chapter Two: Review of The Literature
This study aimed to examine the impact of unplanned organizational change resulting
from the COVID-19 pandemic on organizational culture and employee retention among essential
workers in a growing healthcare organization. This chapter reviews relevant literature
surrounding unplanned change, crisis, organizational culture, and employee retention.
Theoretical literature supporting the Burke-Litwin model of organizational performance and
change (BLMOPC) was applied to the conceptual framework design used to guide data
collection.
The Impact of the COVID-19 Pandemic
The Novel Coronavirus (COVID-19) was first reported in a situation report by the World
Health Organization (WHO) on January 1, 2020 (WHO, 2020). On January 30, 2020, the WHO
declared the coronavirus a public health emergency of international concern, and on March 11,
2020, it declared COVID-19 a pandemic (WHO, 2020). Subsequently, on March 19, 2020,
Governor Gavin Newsom issued Stay-At-Home orders for all individuals in the State of
California (CA.gov, 2020). The orders quickly and radically disrupted how businesses operated
across every economic sector and sent unemployment rates skyrocketing (Employment
Development Department, 2020; U.S. Bureau of Labor Statistics, 2020). The following sub-
sections explore the influence of COVID-19 as unplanned change and the impact of the
pandemic on organizational culture.
COVID-19 As Unplanned Change
Change is difficult to avoid, and organizations must be ready to adapt, whether the
change is unplanned or planned (Ahmed et al., 2021). Planned change occurs when events can be
anticipated (Knowles & Saxberg, 1988). Planned change can be broken into six categories: (a)
14

reengineering, (b) transformational, (c) ad hoc, (d) organizational culture change, (e) problem
solving, and (f) restructuring (Van Wart & Kapucu, 2011). According to Van Wart and Kaucu
(2011), a leader’s strength at managing planned change may not indicate a leader’s ability to
manage unplanned change and vice versa.
Unplanned change occurs when an unanticipated external change affects the core of the
business, requiring a response from the organization (Porras & Robertson, 1988). It is a response
to the need for action precipitated by the external change and involves developments outside of
the experience of the organizational system (Knowles & Saxberg, 1988). Unplanned change
challenges the resilience and hardiness of organizations and is an entirely different experience
than planned change (Edmonson, 2015).
Organizational crises frequently bring on unplanned change. Such crises threaten the
most fundamental goals of an organization (Applebaum et al., 2012). Cooms (2007) defined a
crisis as a potential threat that creates undesired, harmful, or sudden consequences for a business.
Brockner (n.d.) further narrowed the definition of a crisis by breaking it down into five main
elements: (a) the situation is highly ambiguous; (b) there is a low probability of the situation
occurring; (c) there is very little time afforded for a response; (d) it often comes as a surprise to
the organization and its members; and (e) it requires judgment or decision intended to improve
the organization. The COVID-19 pandemic is a significant crisis event that prompted profound
unplanned change for organizations (Harter, 2020).
COVID-19 Impact on Organizational Culture
According to Schein and Schein (2016), organizational culture is the accumulated shared
learning of a group, comprised of a pattern or system of beliefs, behavioral norms, and values
that has worked well enough to be considered valid and are applied to solve problems of external
15

and internal integration. Organizational culture depends on identifying, developing, and
implementing success factors. A policy-focused literature review of 68 articles identified six
guiding principles for sustaining organizational culture: (a) align vision and action; (b) make
incremental changes; (c) foster distributed leadership; (d) promote staff engagement; (e) create
collaborative relationships; (f) and continuously assess and learn (Willis et al., 2016). According
to Applebaum et al. (2012), change to organizational culture can be triggered by three events: (a)
a change from the organization knowing whom they are to not knowing, (b) a difference between
the current organizational identity and a desired future identity, and (c) how members perceive
the organization versus how they believe outsiders perceive the organization. Crises force
organizations to rapidly change everything from daily operating procedures to their
organizational culture, thus initiating one or more of the change triggers to organizational culture
(Applebaum et al., 2012).
The COVID-19 pandemic is a crisis that has left organizations grappling with responding
to new organizational contexts. According to Amis and Greenwood (2021), making incremental
changes is a principle for sustaining organizational change. The pandemic introduced
oscillations, reversals, and fluctuations in the pacing of changes forcing leaders to contend with
exacerbated levels of uncertainty while implementing radical changes in response to new
operating contexts (Amis & Greenwood, 2021). The large-scale economic and social shock
brought on by the pandemic profoundly transformed organizational cultures (Spicer, 2020). The
pandemic caused organizations to reevaluate the nature of their work and provided an impetus to
revise how things are done (Amis & Jaz, 2020). Individuals and organizations were forced to
find new work methods (Kane et al., 2021). At a time when the pandemic magnified employees’
16

needs due to increases in the stresses of job security, finances, and health, the alignment of
organizational culture to create a cohesive work environment became critical (Hammer, 2021).
Changing an organization’s culture resulting from a crisis does not always have to be
negative. Often, followers look to leaders to know what should be next. However, the pandemic
lacked precedent and straightforward solutions for leaders, requiring everyone in the
organization to come together to navigate the change process (Tourish, 2020). Kraus et al. (2020)
suggest that organizations can turn a crisis into an opportunity by creating a new organizational
culture, defined by a strong sense of solidarity among members who successfully navigated the
crisis. A new organizational culture put together by employees and aligned with the new working
environment can foster retention and job satisfaction (Spicer, 2020).
Organizational culture is a critical component in employee job satisfaction and retention.
A congruent fit between an individual’s values and an organization’s culture can serve as a
determining factor in whether the employee chooses to remain part of the organization
(Linnenluecke & Griffiths, 2010). Research indicates that organizational culture and teamwork
predict 35% of job satisfaction (Körner et al., 2015). A positive organizational culture reduces
involuntary turnover by establishing shared values between the organization and the employee,
resulting in increased job satisfaction (Marsden, 2016). In one study, a survey of 1,798
participants revealed that organizational culture and commitment were each positively associated
with job satisfaction and the employee’s intent to remain with the employer (Cravens et al.,
2015). These studies suggest that organizational culture can be leveraged to increase employee
job satisfaction and employee retention.
17

Importance of Employee Retention
Employee retention is defined as strategy organizations adopt to sustain a workforce that
matches their requirements and is effective from an operational point of view (Das & Baraugh,
2013). It is the strategies and tactics related to human resources that begin with selecting the
right employees and continue with the design and execution of diverse programs to ensure that
those employees remain motivated and engaged so the organization can retain them for the
longest time while meeting the objectives of the business (Das & Baraugh, 2013). The primary
purpose of retention strategies is to prevent or limit the loss of employees from the organization
(James & Mathew, 2012).
Factors Related to Retention
Retention is a complex concept, as there is no single solution for a company to keep their
employees, and retention is not influenced by only one factor (Bindu, n.d., Das & Baraugh,
2013). Kyndt et al. (2009) identified three factors influencing employee retention: (a) high
organizational commitment, (b) job satisfaction, and (c) generational issues. Das and Baraugh
(2013) identified nine factors contributing to employee retention: (a) compensation, (b) reward
and recognition, (c) promotion and opportunity for growth, (d) participation in decision making,
(e) work-life balance, (f) work environment, (g) training and development, (h) leadership, and (i)
job security. These identified factors impacting employee retention are nearly identical to the
eight components of job satisfaction outlined by Nanjundeswaraswamy (2019). An additional
factor related to employee retention is employer brand. It is an integrated approach that seeks to
align internal employee convictions with the external brand of the organization to attract and
retain talent (Rai & Nandy, 2021). Table 1 illustrates the overlap of employee retention, job
satisfaction, organizational culture, and employer brand factors.
18

Table 1
Overlap of Factors Related to Employee Retention, Job Satisfaction, Organizational Culture,
and Employer Brand
Factor
Employee
retention
Job
satisfaction
Organizational
culture
Employer
brand
Behavioral norms X X
Communication and job clarity X X
Compensation and welfare benefits X X X
Corporate social responsibility X
Diversity of employee population X X
Generational issues X X X
High organizational commitment X X
Job security and teamwork X X
Leadership style X X X
Participation in decision making X X X
Promotion and opportunity for
growth
X X
Reward and recognition X X
Shared learning X X
Systems and beliefs X X
Training and development X X X
Values X X
Work environment X X
Work-life balance X X X

Note. Factors are derived from a synthesis of research presented in this chapter by multiple
authors (e.g., Das and Baraugh (2013), Kyndt (2009), Nanjundeswaraswamy (2019), Rai and
Nandy (2021), and Schein and Schein (2016)).
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Consequences of Retention
Retention may not always be a positive for an organization. Self and Self (2014) defined
negligent retention as retention that occurs when an employer becomes aware of an employee’s
unfitness, including being unsuitable, not qualified, incompetent, and incapable, but fails to act
such as discharging or reassigning the employee. Counterproductive employees can negatively
impact their organization by lowering performance standards and can also incubate an
atmosphere that threatens employee morale, productivity, and retention of high-performing
employees due to the toxic impact on the organization’s culture (Self & Self, 2014). The positive
consequences of turnover of such poor performers can open new opportunities and increase job
satisfaction, likely leading to increased retention of productive employees (Hom et al., 2020).
An organization’s competitive advantage is driven and determined by its human
resources (Singh, 2019). When an employee leaves an organization, tacit knowledge, valuable,
rare, inimitable, and non-substitutable, is lost (Presbitero et al., 2016). According to Bindu (n.d.),
workforce trends point to a shortage of highly skilled employees. Organizations failing to create
solutions to retain employees with the requisite knowledge and ability to perform at high levels
risk becoming understaffed, with a less qualified workforce, ultimately hindering the
organization’s ability to remain competitive. Securing and retaining employees is critical because
employees’ skills and knowledge and the financial impact of losing highly qualified employees
are central to an organization’s ability to remain economically competitive (Kyndt et al., 2009).
As previously described, attrition is costly, and an organization’s growth depends on its ability to
retain its employees and limit the costs of attrition, whether voluntary or involuntary.
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Financial Impact of Employee Attrition
When an employee leaves an organization, tangible and intangible costs are associated
with the departure, whether voluntarily or involuntarily. Allen et al. (2010) posited that those
combined turnover costs range anywhere from 90% to 200% of an employee’s annual pay.
Tangible costs are more apparent and easier to calculate (Hom et al., 2020). They are those costs
directly associated with the vacated position, such as salary differential for replacement hire,
advertising and recruitment costs, background and screening checks, payout of accrued time to
exiting employees, and hiring and training replacement employees (Garman, 2005).
The Society for Human Resources refers to intangible costs as soft costs and relates all
such costs to lost productivity, broken out into three categories:
• Separation costs: loss of productivity of departing employee and co-workers;
• Vacancy costs: lost productivity of vacant position and supervisor who spends time
filling in;
• Preplacement costs: lost productivity due to the learning curve for the new employee,
co-workers who have to mentor and support new hire, and supervisor time spent
coaching and overseeing new hire (SHRM, 2021).
Intangible costs can also include a drain on management time, additional pressures created in
workforce planning, negative impact on employee morale and organization culture, erosion of
organizational memory, and an adverse effect on social capital (James & Mathew, 2012). Inferior
quality of service, loss of loyal customers, and lost business opportunities are also intangible
costs to consider with employee turnover (Hom et al., 2020). Table 2 provides a breakdown of
tangible and intangible costs.

21

Table 2
Tangible and Intangible Costs of Employee Attrition
Tangible costs Intangible costs
Advertising Adverse effect on social capital
Background and screening checks Competitive loss
Interviewer time per hour Erosion of organizational memory
Payout of accrued time and severance Impaired quality of service
Professional recruiter Loss of loyal customers
Referral bonus Lost business opportunities
Salary differential of new hire Lost productivity
Training of co-workers
of departing employee
of employees training the new hire
of supervisor filling in for a vacancy
of vacant position
due to learning curve of new employee
Negative impact on morale and culture
Supervisor time spent coaching and onboarding
Team erosion

Note. Table 2 is a compilation of tangible and intangible costs as identified by Garman (2005),
Hom et al. (2020), James and Mathew (2012), and Society for Human Resources Management
(2021).

Employee turnover is costly to organizations. It is generally identified as the employer’s
responsibility to take the necessary measures to encourage employees to remain with their
organization for the maximum period (James & Mathew, 2012). Researchers recognize that
22

employees and organizations engage in recurring exchange relationships where both parties
derive value (Kryscynski, 2021). Retention of employees is critical to the success of
organizations, as attrition is costly and can harm the organization’s ability to sustain and grow.
When employers take care of employees, positive reciprocation leading to beneficial
consequences can emerge, including employee retention (Narayanan et al., 2019)
Employer Strategies to Increase Employee Retention
An organization’s ability to remain competitive in its industry relies on its ability to
prevent high-performing employees from leaving (Wright, 2021). Identifying strategies to
increase retention is critical to the success of a growing organization. While there are numerous
strategies related to increasing employee retention, for this research study, four strategies were
explored: (a) organizational culture, (b) job satisfaction, (c) employer brand, and (d) appealing to
generational differences.
Organizational Culture
Organizational culture is a critical component in employee job satisfaction and retention.
A congruent fit between an individual’s values and an organization’s culture can serve as a
determining factor in whether the employee chooses to remain part of the organization
(Linnenluecke & Griffiths, 2010). Organizational culture depends on identifying, developing,
and implementing success factors. As previously mentioned, there are six guiding principles for
sustaining organizational culture: (a) align vision and action; (b) make incremental changes; (c)
foster distributed leadership; (d) promote staff engagement; (e) create collaborative relationships;
(f) and continuously assess and learn (Willis et al., 2016). Research indicates that organizational
culture and teamwork predict 35% of job satisfaction (Körner et al., 2015).
23

The assumptions, beliefs, and values shared by all members of an organization define the
organization’s culture and establish standards of behavior or expected values for members (Rider
et al., 2021). An organization’s culture should be constructed by following the values expected
of individuals and considering the shared values of people in the organization (Rahman &
Theopilus, 2021). According to Rider et al. (2021), steps to establish shared values in an
organization are (a) identifying shared values in interprofessional interactions and (b) identifying
organizational values (Rider et al., 2021).
A positive organizational culture reduces voluntary turnover by establishing shared
values between the organization and the employee, resulting in increased job satisfaction
(Marsden, 2016). In one study, a survey of 1,798 participants revealed that organizational culture
and commitment were each positively associated with job satisfaction and the employee’s intent
to remain with the employer (Cravens et al., 2015). These studies suggest that organizational
culture can be leveraged to increase employee job satisfaction and employee retention.
Job Satisfaction
Job satisfaction is not directly observable but crucial to employee retention (Peters et al.,
2010). Daly and Dee (2006) describe job satisfaction as to how an employee feels toward their
job and the difference between actual and expected outcomes. Nanjundeswaraswamy (2019)
defined eight components of measurement of job satisfaction: (a) compensation and welfare
benefits; (b) work environment; (c) career and promotion opportunities; (d) leadership style; (e)
communication and job clarity; (f) work-life balance; (g) training and development; (h) and
teamwork and job security.
Monetary and non-monetary strategies may be required to increase job satisfaction in
organizations. Monetary strategies increase the financial rewards for employees, such as
24

compensation increases, enhanced benefit offerings, and opportunities for financial growth via
promotion (Jackson, 2020). Non-monetary strategies are of no financial value and focus on
motivational methods to add value to the employee’s well-being and work, including
recognition, flexibility, and variety of work (Lovick-McDaniel, 2019).
There are multiple benefits to increased job satisfaction levels, including decreased
employee stress, decreased absenteeism, and increased productivity (Swarnalatha &
Sureshkrishna, 2013). Decreased turnover positively correlates with increased job satisfaction
(Wright, 2021). In addition, satisfied employees are engaged in their organizations and become
ambassadors for their employers, both internally and externally, resulting in a positive employer
brand (Dabirian et al., 2017).
Employer Brand
The focus of this research study originally surrounded employer brand as the company at
the center of the study had historically low turnover compared to industry benchmarks. Employer
branding is “the package of functional, economic and psychological benefits provided by
employment, and identified with the employing company” (Ambler & Barrow, 1996, p. 187). It
is an integrated approach that seeks to align internal employee convictions with the external
brand of the organization to attract and retain talent (Rai & Nandy, 2021). The employer brand
reflects the value of being an employee of a company. It is promoted to existing and potential
employees in the context of the whole organization, rather than a single factor such as
organizational reputation (Alshathry et al., 2017).
According to Tanwar and Prasad (2016), the antecedent variables of employer branding
are (a) work environment, (b) corporate social responsibility, (c) work-life balance, and (d)
training and development. The outcomes generated from the employer branding process through
25

these antecedent variables that result in employee retention are (a) job satisfaction, (b)
formulation of the psychological contract between employee and employer, (c) increased
productivity, (d) strong organizational commitment, and (e) brand advocacy.
Effective branding can generate a competitive advantage, help employees internalize the
organization’s values, and assist in retaining employees (Conference Board, 2001). Much like an
established consumer product brand can retain loyal customers, organizations can leverage their
employee’s experiences to enhance their reputation as a top place to work, creating an employer
brand that will help reduce employee turnover. Among other factors, a successful employer
brand that encompasses the experiences of their diverse workforce and factors in generational
differences may create added value to the employee.
Appealing to Generational Considerations
Today’s workforce is represented by the greatest range of generational diversity than at
any other time in history, directly impacting employee retention efforts (Glass, n.d.). Smith and
Garriety (2020) identify five generations in the current workplace: (a) silent generation, (b) baby
boomers, (c) Generation X, (d) millennials, and (e) Generation Z. Figure 2 provides the
chronological definition of each generation, as defined by the Pew Research Center (Dimock,
2019).

26

Figure 2
The Workforce Generations Defined

Note. From Defining generations: Where millennials end and Generation Z begins, by Dimock,
M., 2019, Pew Research Center (https://pewrsr.ch/2szqtJz). Copyright 2021 by Pew Research
Center.

Embracing generational differences provides both challenge and opportunity. Research
conducted by Haynes (2011) indicated that different generations all want an environment that
creates a productive workplace, but what that looks like to each generation is different. A study
by Magni and Manzoni (2020) indicated that millennials have higher expectations of high pay,
training, power, and responsibility. In contrast, non-millennials place more expectancy on job
security, work-life balance, social atmosphere, and pay-for-performance. Reduced centrality of
work is less meaningful to millennials than to other generations (Magni & Manzoni, 2020).
27

While an understanding of the broad characteristics of each generation is helpful to an
organization, more important is to engage with the individuals across generations and gain a
better understanding of their perspectives, values, challenges, and opportunities to facilitate a
bridge across all generations (Smith & Garriety, 2020). For organizations to retain as much talent
as possible, the different needs and preferences of the individual employees will need to be
considered.
Burke-Litwin Model of Organizational Performance and Change (BLMOPC)
The conceptual framework used for this research is an adaptation of the Burke-Litwin
model of organizational performance and change (BLMOPC). The BLMOPC is a causal change
model and conforms to an open-system way of thinking that seeks to show where change arises
and how it flows between different parts of an organization (Burke, 2018). In the model, the
external environment serves as the input dimension, and the organization and internal
performance factors serve as the output dimension. The BLMOPC categorizes dimensions into
transformational and transactional factors that drive individual and organizational performance.
Figure 3 illustrates the complete Burke-Litwin model of organizational performance and change.
28

Figure 3
Burke-Litwin Model of Organizational Performance and Change (BLMOPC)

Note. From Organization Change: Theory and Practice (p. 227), by Burke, W., 2018, Sage
Publications, Inc. Copyright 2018 Sage Publications, Inc.

29

Transformational Factors
There are four transformational factors in the model: (a) external environment, (b)
mission and strategy, (c) leadership, and (d) organizational culture (Burke, 2018). According to
the BLMOPC, the external environment is made up of variables and forces outside of the
organization that directly influences the organization’s performance and impacts organizational
change more than any other factor in the model. Changes in the transformational factors are
discontinuous and revolutionary, impacting the deep structure of the organization and requiring
visionary leadership to facilitate the change. Transformational factor changes require
significantly new behavior from the organization’s leaders. They are not carried about by
employees in the BLMOPC, yet any change in the transformational factors means the entire
organization is affected (Burke, 2018). Figure 4 illustrates the transformational factors of the
BLMOPC.

30

Figure 4
Transformation Factors of BLMOPC

Note. From Organization Change: Theory and Practice (p. 230), by Burke, W., 2018, Sage
Publications, Inc. Copyright 2018 Sage Publications, Inc.

Transactional Factors
The transactional factors in the BLMOPC concern the day-to-day operations of an
organization. Changes to these factors tend to be evolutionary, selective, and in line with
continuous improvement efforts. Whereas leaders carry out transformational factors,
transactional factors are more closely aligned with managers who focus on improvement and
quality in their functions rather than overhauling an entire system. The transactional factors in
31

the BLMOPC are (a) structure, (b) systems, (c) management practices, (d) work unit climate, (e)
individual needs and values, (f) task requirements and individual skills and abilities, and (g)
motivation (Burke, 2018). Figure 5 illustrates the transactional factors of the BLMOPC.

Figure 5
Transactional Factors of BLMOPC

Note. From Organization Change: Theory and Practice (p. 231), by Burke, W., 2018, Sage
Publications, Inc. Copyright 2018 Sage Publications, Inc.
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Conceptual Framework
This study aimed to examine the impact of unplanned organizational change resulting
from the COVID-19 pandemic on organizational culture and employee retention among essential
workers in a growing healthcare organization. A fundamental premise of the BLMOPC is that it
is based on planned change. In this context, the external environment has the most significant
impact on the organization, as stated in the model. Following in sequential order, according to
the model, leadership is the factor immediately affected by the external environment. Those
leaders then turn to determine the mission and strategy and follow with the shaping of the
organization’s culture. Transactional factors follow transformational factors and rank in
importance as portrayed within the model.
When considering the COVID-19 pandemic and its impact on organizational culture and
employee retention, three things became clear:
1. The pandemic was the unplanned external environment impacting the organization.
2. The rapid and unplanned nature of the pandemic’s changes lacked precedent and
straightforward solutions for leaders.
3. The onset of the COVID-19 pandemic created job uncertainty. However, as the
pandemic resolved, the labor market tightened, posing an additional and unexpected
threat to the organization’s sustainability.
This study sought to examine the change to the organization caused by the external environment
factor of the COVID-19 pandemic but not by studying the effects of the environment on the
transformational factors. Instead, this study explored how two transactional factors could be
leveraged to inform leaders to address long-term transformational considerations. The
transactional factors explored were work unit climate and individual needs and values.
33

The approach to this study prioritized the employees’ perspectives rather than the leaders
in the organization. The viewpoint of the employees provides leaders with the information they
may need to turn the crisis into an opportunity by creating a new organizational culture defined
by a strong sense of solidarity among members who navigated the crisis together. This new
culture and sense of togetherness may lead to increased retention, thus providing the organization
with opportunities for growth and sustainability. Figure 6 illustrates the conceptual framework
guiding this study.

34

Figure 6
Conceptual Framework Approach of This Study

Note. The figure shows the conceptual framework for the research based on the BLMOPC. In the
figure, the COVID-Pandemic caused a top-down, unplanned organizational change. This change
required leaders to respond and implement change to transactional factors without seeking
employee input. Through this study, the input from employees regarding changes and subsequent
35

leadership response could lead to increased employee retention and a renewed organizational
culture.
Conclusion
Change is difficult to avoid, and organizations must be ready to adapt, whether the
change is unplanned or planned (Ahmed et al., 2021). The COVID-19 pandemic is a significant
crisis event that prompted profound unplanned change for organizations (Harter, 2020). This
study aimed to examine the impact of unplanned organizational change resulting from the
COVID-19 pandemic on organizational culture and employee retention among essential workers
in a growing healthcare organization.
Retention is a complex concept as there is no single solution for a company to keep their
employees, and retention is not influenced by only one factor (Bindu, n.d.; Das & Baraugh,
2013). The primary purpose of retention strategies is to prevent or limit the loss of employees
from the organization (James & Mathew, 2012). Securing and retaining employees is critical
because employees’ skills and knowledge and the financial impact of losing highly qualified
employees are central to an organization’s ability to remain economically competitive (Kyndt et
al., 2009). The tightening labor market, combined with increasing wages, favors employees, thus
increasing the urgency for employers to increase employee retention.
Employee retention is critical. Personnel payroll costs can run as high as 60% of gross
revenue, depending on the organization’s industry (Browne, 2019). Personnel costs are
frequently the most considerable expense of an organization. Reducing turnover and increasing
retention can substantially impact an organization’s bottom line.

36

Chapter Three: Methodology
This mixed-methods study aimed to examine the impact of unplanned organizational
change resulting from the COVID-19 pandemic on organizational culture and employee
retention among essential workers in a growing healthcare organization. Chapter 3 outlines the
research questions; provides an overview of the methodology of the study; discusses the data
collection methods; describes the researcher’s positionality; addresses the validity and reliability
of quantitative data and the credibility and trustworthiness of qualitative data; explains the
survey and interview designs; outlines the data analysis process; and addresses ethical
considerations. The following research questions guided the study:
1. What key factors in the area of work unit climate do employees see as most
influential in their decision to either remain with or leave OMI under shifting market
constraints?
2. What key factors in the area of individual needs and values do employees see as most
influential in their decision to either remain with or leave OMI under shifting market
constraints?
3. What do employees need in the organizational culture of OMI to keep them with the
organization?
Overview of Methodology
The research design was a convergent mixed methods design. Mixed methods research is
defined as an approach to an inquiry involving collecting both qualitative and quantitative data
(Creswell & Creswell, 2018). The core assumption of a mixed methods approach is that the data
yields additional insights beyond what could be provided by exclusively quantitative or
qualitative data. The convergent mixed methods design is a strategy in which the researcher
37

conducts qualitative and quantitative data, analyzes them separately, and then compares the
results of the findings to see if they disconfirm or confirm one another (Creswell & Creswell,
2018). The strategy aligned with the study’s framing by providing all employees an opportunity
to participate and give additional voice to the participants via interviews.
According to Merriam and Tisdell (2016), triangulation increases the credibility of a
mixed-methods study, particularly as it relates to the qualitative data. Therefore, this study’s
strategy was applied by applying qualitative and quantitative research methodology to the
sample. Quantitative responses and qualitative themes were compared and contrasted.
The sample population for the quantitative survey was a census sample of all current
employees. The sample population for the qualitative interviews was a purposeful sample based
on the employee’s desire to participate, as indicated in their response to a question in the
quantitative data collection instrument. Table 3 provides a breakdown of data sources for each
research question.

38

Table 3
Data Sources
Research questions Survey Interview
What key factors in the area of work unit climate do
employees see as most influential in their decision to
either remain with or leave OMI under shifting
market constraints?
X X
What key factors in the area of individual needs and
values do employees see as most influential in their
decision to either remain with or leave OMI under
shifting market constraints?
X X
What do employees need in the organizational culture
of OMI to keep them with the organization?
X X

The Researcher
I am a former employee of the study organization and was not in a position of authority
or a supervisor to any potential study participants. I was aware that I may have experienced
response bias from the study participants. A response bias occurs when survey participants give a
different pattern of answers to survey questions than what would have been provided by those
who do not participate (Robinson & Leonard, 2019). To mitigate this influence, I took every
precaution to ensure the anonymity and confidentiality of the participants in the process such that
all respondents felt comfortable participating.
Respondents may provide inaccurate responses based on their perception of what is
socially desirable (Robinson & Leonard, 2019). The survey instrument was disseminated via
39

email from the researcher’s USC email account and not from an internal email at the
organization to mitigate social desirability in responses resulting from perceived power or
privacy dynamics. Personally identifiable demographic data was not linked to individual survey
responses, and IP addresses were not tracked.
Survey context is the environment and all systems in which the survey is administered
(Robinson & Leonard, 2019). Designing an empathetic survey requires the researcher to
understand the context in which they are designing, respondents are answering questions, and
these two contexts may or may not overlap. The political, environmental, organizational, and
cultural context had to be considered during the survey design process, given the immense
change the organization has endured over the past two years. I addressed these considerations in
the quantitative survey by adapting the 2002 Langley Research Center (LaRC) Organizational
Performance Survey rather than creating my own tool. The considerations were handled in the
qualitative research by adhering to the pre-designed questions and reviewing my protocol
questions in advance with the doctoral dissertation committee.
Data Sources
Data were collected in this mixed methods, convergent design study through an online
survey and participant interviews. An online survey created in Qualtrics was sent via email to all
current employees. Participants for the qualitative data collection were identified through their
indicated interest in response to a survey question. Interviews began within five days of survey
responses being received.
Method 1: Surveys
Data were collected using a cross-sectional quantitative survey instrument. This method
allowed efficient data collection while protecting the participants’ privacy. The survey
40

instrument consisted of 22 close-ended questions using a 5-point Likert scale (1 = to a very small
extent to 5 = to a very large extent), three open-ended questions to seek additional input, five
demographic questions, and one question regarding the respondent’s desire to participate in an
in-person interview.
Participating Stakeholders
The population of a study is defined as all members of a defined group studied by
researchers, and a census sample is everyone in the population (Robinson & Leonard, 2019).
Census sampling was the method used to recruit participants for the survey, and the census
population included all 73 current employees of the organization. The census method opened the
survey to the greatest possible number of participants within a limited timeframe.
Instrumentation
The survey tool utilized for research primarily consisted of an adapted version of the
2002 Langley Research Center (LaRC) Organizational Performance Survey, explicitly designed
utilizing the Burke-Litwin model of organizational performance and change framework (Burke,
2018). The originally designed survey aimed to assess how employees viewed the organization
and measure progress since 2000, when the same tool was initially administered to the
organization (IBM Consulting Services, 2002). The LaRC survey consists of 134 questions,
excluding demographic data. As the survey was adapted for this research, the number of
questions was reduced to only those that directly supported the research questions and eliminated
common redundancies. Additional open-ended questions were added that were not adapted from
the LaRC survey and supported the research questions. Appendix A presents the survey
instrument.
Data Collection Procedures
41

Before collecting data, the survey and interview protocols and plans were submitted to
USC’s Institutional Review Board (IRB). The IRB is a committee that reviews research to
determine to what extent the researcher could place participants at risk during the study
(Creswell & Creswell, 2018). Once IRB approved the study, the survey was sent electronically
via email to all organization members, guaranteeing anonymity in their responses. When
reaching out to survey participants, Robinson et al. (2019) recommend five or more total points
of contact that range from invitations to reminders and a follow-up thank you or
acknowledgment. Participants were sent a series of reminder emails to encourage participation.
Participants were offered a $10 gift card incentive in exchange for participation which was paid
within 72 hours of participation.
Pazzaglia et al. (2016) recommended a 5-step process for selecting a sample and
administering a survey. The data collection process for this research study closely followed Step
5: Administering the Survey. Upon approval from IRB, a survey tool designed in Qualtrics was
distributed via email to all study participants. The survey was preceded by an email explaining
the purpose of the study and outlining the importance of participation. The timing of the survey
distribution was carefully planned to avoid periods of distraction. Respondents were given 10
days to complete the survey, and three reminders were sent throughout that period. A link to a
separate form was provided at the end of the survey. This link took the respondent to a form to
fill out to send them a $10.00 gift card. All gift cards were sent within 72 hours of submitting the
form, and individuals who indicated they had trouble with the form were sent a gift card upon
notifying the researcher of the issue.
Data Analysis
42

The survey responses were collected through Qualtrics over 10 days. Once the survey
period closed, the data collected were reviewed and screened for errors and unusable data. A
total of 49 useable responses were received, for a response rate of 67%. A descriptive statistical
analysis was conducted to organize and describe the characteristics of the data. Salkind (2014),
states that mean, median, and mode are all commonly used descriptive statistics used to analyze
quantitative data. In addition to mean, median, and mode, percentage and frequency were also
calculated. This approach was preferred given that the survey was primarily comprised of closed-
ended, ordinal items. Data are reported in narrative and displayed formats such as tables and
figures. The open-ended questions were tallied using Qualtrics and coded using the qualitative
data analysis codes.
Validity and Reliability
Validity is the property of an assessment tool that indicates the tool does what it says
(Salkind, 2014). The 2002 LaRC Organizational Performance Survey was developed based on a
conceptual model supported by empirical evidence (Burke, 1992). The findings from the 2002
LARC survey and the survey tool itself are considered valid based on the following three factors:
(a) the survey was pilot tested to ensure clarity of the questions, (b) the response rate of 55% is
reasonable, and (c) the demographics of the survey respondents were proportionate to the overall
population of the organization. Since the survey was an adaptation of the LaRC survey, there is
no guarantee of validity in survey findings. Given the researcher’s former role in the
organization, response bias may have played a factor.
According to Salkind (2014), reliability is whether a test or any other measurement tool
consistently measures something. The 2002 LaRC survey results were consistent with the same
survey administered in 2000. Therefore, it stands to reason that the instrument is reliable. As this
43

was original research for the organization, repeating the same survey throughout different time
intervals could provide proof of the adapted tool’s reliability. Salkind (2014) referred to this
method as Test-retest reliability.
In order to maximize survey responses, the survey was designed to appeal to a variety of
participants and was easy to navigate on multiple platforms. In addition, the design included
language that met the standards of reading reliability (Salkind, 2014). Given the sample
population, there was no need to offer the survey in a language other than English.
Method 2: Interviews
Data were collected by conducting in-person, one-to-one, semi-structured interviews of
current employees of the organization. Consideration of familiarity with the participants was
taken as the interview took place. Each interviewee was allowed to review their interview
transcription before analysis to ensure the participant’s intent had been appropriately captured.
Participating Stakeholders
The qualitative portion of the study was interviews with a purposeful sample of 18% of
the quantitative survey participants, nine employees. According to Merriam and Tisdell (2016),
purposeful sampling assumes that the researcher wants to discover, gain insight, and understand;
therefore, a researcher must select a sample from which the most insight can be gained. The
participants were selected from those who indicated an interest in participating, and interviews
were set up as they volunteered. There was great interest from volunteers for the interviews,
eliminating the need to take additional steps to recruit participants.
Instrumentation
The interview protocol was focused on a semi-structured approach in which all questions
were flexibly worded and guided by issues to be explored (Merriam & Tisdell, 2016). This
44

approach was chosen to respond and change course as the interview and conversation unfolded.
This approach also ensured that collected data were sufficient to answer the study research
questions. At times, the respondent needed to be brought back to the question to collect valuable
data.
The crafted interview questions drew from the Burke-Litwin model of organizational
performance and change (BLMOPC). They were designed to address one or more concepts
within the model for each question (Burke, 2018). Probes were developed to elicit additional data
from respondents and encouraged them to add, expand, or revise their initial answers when
needed (Robinson & Leonard, 2019). Appendix B provides the interview protocol.
Data Collection Procedures
The interviews were conducted over two weeks. Interview participants were identified
through their response to a link in which they filled out their contact information if they were
interested in participating in this part of the study. The link was provided based on a survey
question regarding the desire to participate in follow-on interviews. Interview participants were
contacted via email. Once contacted, the date and time were set for the interview.
The interview protocol consisted of eight open-ended questions and a planned time limit
of one hour per interview. The allotted time of one hour per interview proved to be plenty of
time, even when the conversation began to move too far away from the study purpose and
research questions. Interviews were held in person or over Google Meet video at a time
convenient to both the researcher and the respondent. All interviews were conducted outside of
the participant’s scheduled work hours.
Data Analysis
45

Qualitative content analysis was applied to the process of data analysis using a deductive
approach. Qualitative analysis is a research method for subjective interpretation of data through
the systematic classification process of identifying and coding patterns or themes (Hsieh &
Shannon, 2005). A priori coding based on the work unit climate, individual needs and values
factors from the BLMOPC, and indicators of employee retention, as identified in the literature
review, was utilized for the data’s initial coding. Axial coding was applied to refine, develop,
and relate the interconnectedness of broader categories developed from the initial coding (Gibbs,
2018).
Credibility and Trustworthiness
Ensuring credibility and trustworthiness for the qualitative research being conducted
requires that all research is conducted ethically (Merriam & Tisdell, 2016). Careful attention to
the study’s design, how interviews were conducted, and how data were analyzed and interpreted
was critical. The following three strategies were utilized to maximize credibility and
trustworthiness in this study:
1. Triangulation was applied using multiple sources of data collected from different
people with different perspectives (Merriam & Tisdell, 2016).
2. Interview transcripts were presented to the interview participants to determine if
captured responses aligned with the respondent’s intent (Merriam & Tisdell, 2016).
3. Discrepant case analysis was utilized to identify data that challenged expectations
(Merriam & Tisdell, 2016).
Ethics
The research conducted for this study fell within the exempt level for the IRB. No data
were gathered until IRB approval was granted. Once approved, interviews were conducted with
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the participants in a manner that protected confidentiality, including arranging for the interviews
to take place outside of the workplace and all participant identities remaining anonymous. Each
participant was provided with an information sheet detailing the study’s purpose and reiterating
that their participation was voluntary. Appendix C provides the participant information sheet.
Informed consent was not required. A $10 gift card for each survey response and an additional
$25 gift card for each interview was offered as an incentive for participation. All gift cards were
sent to participants within 72 hours of participation.
The study organization was given a pseudonym. All participant data were collected and
transcribed such that personally identifiable information could not be discerned. Audio
recordings were deleted from the recording device and stored in a password-protected file.
Interview notes, codebook, and quantitative survey data were stored in a password-protected file.
At no time were representatives from the organization granted access to raw data from the
research. All data will be destroyed at the end of the retention period required by IRB.
The research study served the interests of the study organization, as well as the personal
academic pursuits of the researcher, resulting in mutual benefit to both parties. No harm to
participants was anticipated due to participation or outcome. Upon publication, all stakeholders
will have access to the complete study.

47

Chapter Four: Results and Findings
This study aimed to examine the impact of unplanned organizational change resulting
from the COVID-19 pandemic on organizational culture and employee retention among essential
workers in a growing healthcare organization. The study utilized the Burke-Litwin model of
organizational performance and change (BLMOPC; Burke, 2018) to identify factors contributing
to employee retention. The analysis focused specifically on the factors of work unit climate and
individual needs and values. The following research questions guided the study:
1. What key factors in the area of work unit climate do employees see as most
influential in their decision to either remain with or leave OMI under shifting market
constraints?
2. What key factors in the area of individual needs and values do employees see as most
influential in their decision to either remain with or leave OMI under shifting market
constraints?
3. What do employees need in the organizational culture of OMI to keep them with the
organization?
Chapter 4 presents the findings of the study. The first section of the chapter describes the
participant stakeholder demographics. The second section describes how the data were analyzed
and how they will be presented throughout the chapter. The subsequent sections are broken out
by research question and include a presentation of results and findings for each, including themes
and tables illustrating participant responses. Each theme is discussed as a sub-section to the
research question. Chapter 4 concludes with a summary of results and findings.
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Participants
The data for the study were collected utilizing a convergent mixed methodology
approach. Participating stakeholders were current employees of the organization of the study.
Demographic data were collected for each participant group and are reported such that specific
individuals could not be identified.
Survey Participants
A quantitative survey was sent via email to obtain a census sample of all current
company employees, 73 individuals. The survey data were collected in Qualtrics and resulted in
49 participants completing the survey. No unusable or outlier data was found, yielding a 67%
response rate. Although a scientifically proven minimally acceptable response rate has not been
established, a response rate of 60% has face validity. It has been used as a measure of survey
quality and has been used as a threshold of acceptability (Johnson & Wislar, 2012). A high
response rate does not automatically mean the study results have high validity; they indicate a
potentially higher likelihood of high validity (Morton et al., 2012).
The demographic data collected provide a comprehensive overview of the participants,
allowing for a great understanding of the characteristics of respondents. Table 4 provides a
summary of survey participant demographics.
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Table 4
Survey Participant Demographics
Characteristic n %
Gender
Woman 34 69.39
Man 11 22.45
Prefer not to answer 4 8.16
Generation
Generation Z (born 1997–2012) 8 16.32
Millennials (born 1981–1996) 23 46.94
Generation X (born 1965–1980) 11 22.45
Baby boomers (born 1946–1964) 7 14.29
Race
White 30 54.55
Black or African American 3 5.45
Asian 4 7.27
Native Hawaiian or Pacific Islander 1 1.82
Other: No description 3 5.45
Self-described: Hispanic/Mexican/Latino 7 12.73
Prefer not to answer 7 12.73
Department
Administration 5 10.20
Billing 3 6.12
Customer service specialist 5 10.21
Medical assistant 8 16.33
Clinician 12 24.49
Orthopedic rehabilitation 8 16.33
Other: No description 2 4.08
Prefer not to answer 6 12.24
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Characteristic n %
Employment Status
Full-time, permanent 42 85.72
Part-time, permanent 3 6.12
Part-time, temporary 1 2.04
Independent contractor 1 2.04
Prefer not to answer 2 4.08

Note. N = 49. For the characteristics of Gender and Race, participants could select more than one
answer. Gender answers totaled 49. Race answers totaled 55. Characteristics with zero
participants were excluded from this table. The survey participant population was nearly
identical to the organization’s population for gender: 71% Women and 29% Men. When looking
at race, however, the survey participant population lacked representation from individuals
identifying as Hispanic on the organization’s employee intake information, with 12.73% of
survey respondents self-describing as Hispanic. In comparison, the organization reported 48% of
employees as Hispanic. Survey participation by generation was nearly identical to the employee
population, with representation from baby boomers, Generation X, and millennials
representation within 1% of the employee population and Generation Z representation within 3%
of the employee population.

Interview Participants
The qualitative data were collected from interviews with a purposeful sample of survey
participants using criteria as detailed in Chapter 3. Ten survey respondents volunteered to be
interviewed for the study. Due to a scheduling conflict, nine survey respondents were
interviewed, yielding an 18% participation rate of survey respondents. During the interviews,
51

participants were asked to provide limited demographic data. Participants were all White women,
except for one man who self-described his race as Hispanic.
The interview participant sample represented three generations. Millennials made up
55.56%, followed by baby boomers at 33.33%, and one participant from Generation X, 11.11%.
The generational mix of interview participants only reflected the employee population in that
millennials were the majority. Generation Z, 19% of the employee population, did not participate
in the interviews. For confidentiality purposes, the answers for departments were consolidated
into clinical and non-clinical, resulting in 77.78% of participants classified as clinical and
22.22% classified as non-clinical. Participants’ employment status was 77.78% full-time and
22.22% part-time.
The interview sample population was similar to the organization’s employee population
for employment status, which comprises approximately 85% full-time and 15% part-time
employees. However, the interview sample population was inversely represented by clinical
employees compared to the organization’s employee population, which classified approximately
66% as non-clinical and 34% as clinical. Given that the clinical employees are the highest
compensated group, have the option to work flexible schedules, and conduct their work with
professional autonomy, the findings from interview participants may not reflect the experience of
non-clinical employees. Additionally, the absence of participation from Generation Z may result
in the omission of critical findings, given that this group is all lower-wage, frontline workers.
Participants will be referred to by the letter P and their number for reference throughout
the discussion of the findings. For example, participant one will be referred to as P1. Table 5
summarizes the demographic data of interview participant profiles for reference.

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Table 5
Interview Participant Profiles
Participant Gender Generation Department Race Employment status
P1 Man Millennial Non-clinical Hispanic Full time
P2 Woman Millennial Clinical White Full time
P3 Woman Generation X Non-clinical More than one Full time
P4 Woman Millennial Clinical White Full time
P5 Woman Boomer Clinical White Full time
P6 Woman Boomer Clinical White Full time
P7 Woman Boomer Clinical White Full time
P8 Woman Millennial Clinical White Part time
P9 Woman Millennial Clinical White Part time

Note. n = 9. Clinical is defined as any position requiring a state license to conduct business and
includes staff from Clinician and Orthopedic Rehabilitation survey categories. Non-clinical
includes all other departments within the company.

Data Analysis and Presentation of Results and Findings
The survey tool utilized for research consisted of 22 closed-ended and three open-ended
questions. Of the closed-ended questions, nine related to work unit climate, nine related to
individual needs and values, and three related to organizational culture. The closed-ended
questions were scored using a 5-point Likert-scale (1 = to a very small extent to 5 = to a very
large extent). A 60% or greater threshold for a response of to a very likely extent was defined to
establish significant findings for all closed-ended survey questions. The 60% threshold was
chosen to identify the most critical factors reported by employees so that leaders of the
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organization could focus on a prioritized list of factors contributing to employee intention to
remain or leave the organization rather than trying to address all factors at once.
The survey tool included three open-ended questions regarding factors that would lead to
an employee’s intent to stay with the company, their intent to leave the company, and their
overall description of its culture. The analysis of the open-ended responses yielded a total of 221
responses. Open-ended responses were coded and grouped into the factors similar to the
quantitative survey design. Frequencies were calculated for each factor within the research
question.
The data collection protocol included interviews with nine survey participants. Interview
data were coded to open-ended survey data. Frequencies were identified by the number of
participants who mentioned a specific factor within their responses to the interview questions
rather than the number of times the participant may have mentioned a factor. This approach was
taken to identify the importance of the factor to each participant.
Triangulating data can result in new lines of inquiry and novel interpretations of the data
(Gibbs, 2018). Triangulation is achieved by using multiple sources of data collection methods to
confirm emerging findings and is a principal strategy to ensure validity and reliability (Merriam
& Tisdell, 2016). To achieve triangulation in this study, quantitative results and qualitative
findings were analyzed to identify patterns of consistency as well as discrepancies in responses.
In some instances, the qualitative findings supported quantitative results that did not meet the
60% threshold thus necessitating further analysis and discussion.
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Research Question 1: What Key Factors in the Area of Work Unit Climate Do Employees
See As Most Influential in Their Decision to Either Remain With or Leave OMI Under
Shifting Market Conditions?
According to the Burke-Litwin model of organizational performance and change
(BLMOPC), work unit climate considers employees’ perception of the management of their
immediate working environment and how effectively colleagues work together (Burke, 2018).
Research question 1 sought to identify the key factors related to work unit climate that may
contribute to employee retention. The work unit climate factors for consideration were:
• WUC 1: Trust and respect
• WUC 2: Clear expectations
• WUC 3: Involved in decision making
• WUC 4: Diverse opinions and views
• WUC 5: Cooperation and support
• WUC 6: Diversity
• WUC 7: Recognition by team
• WUC 8: Work and ethical standards
• WUC 9: Adapt to change
Survey data is presented first for each research question, followed by interview data. Themes
from the results and findings of the data are discussed following the presentation of the survey
and interview data for each research question. Two factors of importance for work unit climate
were identified upon review of the data. They are (a) cooperation and support among team
members in accomplishing work and (b) trust and mutual respect among coworkers within the
employees’ department.
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Survey Results
The survey tool utilized for this study contained nine questions related to work unit
climate. The questions were scored using a 5-point Likert-scale (1 = to a very small extent to 5 =
to a very large extent). Table 6 provides a descriptive statistical analysis of the nine questions,
including the mean score and standard deviation for each question.

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Table 6
Mean and Standard Deviation for Work Unit Climate Factors (N = 49)
Factor M SD
WUC 1: Trust and mutual respect among coworkers
within your department
4.73 0.49
WUC 2: Clear expectations of your roles,
responsibilities, and goals
4.49 0.58
WUC 3: Ability to be involved in making decisions that
directly affect your work
4.29 0.89
WUC 4: Support and encouragement of diverse opinions
and views
4.35 0.83
WUC 5: Cooperation and support among team members
in accomplishing work
4.53 0.84
WUC 6: Value placed on diverse backgrounds of team
members (i.e., gender, race, ethnicity, age, etc.)
3.96 0.93
WUC 7: Recognition of good work by other team
members
4.12 0.78
WUC 8: Team members hold each other to highest
possible work and ethical standards
4.45 0.68
WUC 9: Team members successfully adapt to changes
affecting responsibilities
4.37 0.81

Note. The data shows that all responses are less than one standard deviation from the mean,
indicating little variability in the importance placed on each factor. The questions were scored
using a 5-point Likert-scale (1 = to a very small extent to 5 = to a very large extent).

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A frequency distribution was created based on the number of responses for each level on
the Likert scale in the quantitative survey to understand better the most critical factors of work
unit climate related to intent to retain. The percentage was determined for each frequency within
a response. Figure 7 illustrates the percent distribution of the highest point on the scale by factor.

Figure 7
Percent Distribution of Work Unit Climate Factors Rated as To a Very Large Extent

58
59

Note. N = 49. A 60% threshold, indicated by the green line, was set to establish this study’s
significance factors for the closed-ended questions on the survey.

The survey tool included three open-ended questions regarding factors that would lead to
an employee’s intent to stay with the company, their intent to leave the company, and their
overall description of its culture. The analysis of the open-ended responses yielded a total of 221
responses. A total of 70 responses were identified as relating to work unit climate. These data are
displayed by percent in Figure 8.

Figure 8
Open-Ended Responses: Work Unit Climate Weighted by Response Frequency

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Note. Seventy open-ended responses were collected and coded relating to work unit climate
factors.

Interview Findings
Interview data were coded to open-ended survey data. Frequencies were identified by the
number of participants who mentioned work unit climate factors within their responses to the
interview questions rather than the number of times the participant may have mentioned a factor.
This approach was taken to identify the importance of the factor to each participant. Figure 9
illustrates the factor mentioned frequency by a participant.

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Figure 9
Work Unit Climate Factor Mention by Interview Participant

Note. n = 9. Frequencies are represented by the percent of interview participants who mentioned
a factor during the interview.

Work unit climate factors influence an employee’s decision to remain with or leave the
organization. The 60% threshold utilized to identify significant factors within quantitative data
revealed two factors that influenced an employee’s intent to retain to a very likely extent were
identified. The two factors are (a) cooperation and support among team members in
accomplishing work and (b) trust and mutual respect among coworkers within the employees’
62

department. Qualitative findings from the open-ended responses in the survey supported the
quantitative results in identifying the two factors. Mentions of factors by the interview
participants supported each factor; however, they were not in identical rank order as in the
survey responses. Findings and results did not provide significant support for generational
differences. Discussion regarding results and findings are presented for these two themes in the
following sub-sections.
Theme 1: Cooperation and Support Among Team Members Is the Work Unit Climate
Factor Most Consistently Identified as Influencing Intent to Retain
The mean score for the factor was 4.53, with 67.30% of survey respondents indicating
that cooperation and support among team members were likely to influence an employee’s intent
to remain with the organization moving forward to a very likely extent. Survey participant
responses to open-ended questions support the quantitative results, finding the factor ranked
highest in percentage distribution of mentions at 34.29% and shed light on what cooperation and
support mean to the employees. Table 7 is the verbatim text from open-ended survey responses
related to cooperation and support among team members and the influence on remaining with or
leaving the organization.

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Table 7
Open-Ended Survey Responses: Cooperation and Support Among Team Members
Verbatim response Leave Stay
Bad relationship with coworker X
If the working environment evolved into an unsupportive
one
X
Conflicts not resolved adequately X
Feeling supported and appreciated feeling a sense of
belonging and connecting with the team of employees
X
I feel appreciated and supported by my supervisors and I
feel welcomed by my peers
X
We help each other out as much as possible. X
I can count on each one of my TEAM members
including upper management.
X

Note. Answers were copied as they were written to preserve the respondent’s intent.

Cooperation and support among team members was the only factor in the study
mentioned by 100% of interview participants. The interview participants mentioned cooperation
and support in positive and negative contexts, similar to the open-ended responses. P9 described
the organization as “very supportive and loving.” She stated, “I never feel isolated or alone, and
people are always checking in.” P5 said, “It is not competitive, and everyone just helps each
other. It is a really collaborative environment.” P6 addressed the factor as a positive but
recognized that it could become negative, stating,
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Right now, I can pick up the phone and call any of the clinics. Even if I have never met
the person on the other end of the line, I feel a connection and know that I can get the
help and support I am looking for. As we grow, I worry that this sense of connection and
support may disappear.
Two participants see a negative change occurring and worry that staying on the same path
will ultimately cause people to leave the organization. P1 and P3 identified a lack of support
resulting from recent changes in leadership and the absence of a point person. P1 stated,
“Leadership is lacking, and they need to communicate, listen, and follow up on things that
require attention. No one is accountable for anything anymore, so it is hard to feel like someone
has your back.” P3 stated similarly, “The lack of presence of leadership in certain clinics leaves
us feeling like we are on our own.”
Although the factor did not receive the highest score across the quantitative results for
work unit climate factors, the combination of quantitative results exceeding the established
threshold, the highest percent distribution of mentions for open-ended question responses, and
100% mention by interview participants highlights its importance. The data analysis revealed an
overall positive sentiment toward cooperation and support among team members. However,
given the recent leadership changes, concern is rising among participants over the sustainability
of this most important factor, which could impact employee job satisfaction and retention
moving forward if not addressed.
Theme 2: Trust and Mutual Respect Will Influence Intent to Retain for Most
The mean score of trust and mutual respect among coworkers in the department was 4.73,
with 75.50% of survey respondents indicating that the factor had a high likelihood of influencing
an employee’s intent to remain with the organization moving forward to a very likely extent.
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Responses to open-ended survey questions support the quantitative results, ranking second
highest in percentage distribution of mentions at 28.57% and highlighting what trust and mutual
respect mean to the employees. Table 8 is the verbatim text from open-ended survey responses
related to trust and mutual respect among coworkers and its influence on remaining with or
leaving the organization.

Table 8
Open-Ended Responses: Influence of Trust and Respect on Intent to Retain
Response Leave Stay
If respectfulness stopped X
Tension and disrespect between employees X
Feeling untrusted and disrespected X
Lack of trust X
Compassion and respect for each other as coworkers X
There is a huge amount of mutual respect between all
employees at all levels.
X
Trust and integrity X
Respect and admiration for my coworkers X
Sense of family makes for a trusting environment X

Note. Answers were copied as they were written to preserve each respondent’s intent.

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As a factor, trust and respect among coworkers were mentioned by 33% of interview
participants, two of whom were the only non-clinical participants in the interview process. The
lack of mention by clinical staff may result from their work environment and role. Clinical staff
relies on each other for day-to-day input on medical decision-making and treatment plans, so
they build trust within their peer group out of necessity. Another possibility may be that those
interview participants as a group tended to be those who already trust the organization or that
those who did not participate made that decision based on response bias. My interpretation of the
research of Robinson and Leonard (2019) suggests this may be due to the perceived relationship
between myself and the organization’s executive leadership team.
The interview participants who mentioned trust and respect among coworkers did so from
very different points of view. P1, a non-clinical participant, felt that trust and respect were
lacking,
My direct leadership is really good. It is the overall leadership that is problematic. I am
getting fed up with poor treatment from leaders. Everything is nice on the surface when
they talk to you, but underneath you know it is completely fake. They push to make
things go faster or cover up for things they were supposed to get done but never did, so
they throw you under the bus and make it your fault when they get called out on it. I feel
like they are trying to drive me out. I do not trust them at all, and respect is a big deal to
me.
A more positive point of view regarding trust and respect among coworkers was expressed by
P8, who stated, “I feel like the leaders are looking out for us.” P2 echoed this sentiment,
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I feel like if I have an issue or concern about anything, I can take it to the leaders, and
they will at least consider my input. They respect me and my role, which is important.
Trust and respect make you feel good about what you are doing.
The quantitative results for trust and respect among coworkers indicate that this factor is
the most critical factor of the work unit climate that would influence a decision to remain with or
leave the organization. Additional support to emphasize the importance of this factor is provided
by the response to open-ended survey questions ranking second highest in mention. Although the
interview participants provided little reference to trust and respect among coworkers as an
influencing factor, the comments indicate two very different points of view and warrant further
review by leadership.
Research Question 2: What Key Factors in the Area of Individual Needs and Values Do
Employees See as Most Influential in Their Decision to Either Remain With or Leave OMI
Under Shifting Market Conditions?
Individual needs and values comprise psychological factors that concern the extent to
which one’s needs are met on the job (Burke, 2018). Research question 2 sought to identify
factors related to individual needs and values contributing to employee retention. The individual
needs and values factors for consideration were:
• INV 1: Work-life balance
• INV 2: Valued as an employee
• INV 3: Feel secure about employment
• INV 4: Conduct work my way
• INV 5: Adequate recognition
• INV 6: Adequate compensation
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• INV 7: Aligned with personal values
• INV 8: Training and development opportunities
• INV 9: Professional growth opportunities
Survey data is presented first for each research question, followed by interview data. Themes
from the results and findings of the data are discussed following the presentation of the survey
and interview data for each research question. Two factors of importance for individual needs
and values were identified upon review of the data. They are (a) feeling valued as an employee
of the organization and (b) feeling secure about one’s employment.
Survey Results
The survey tool utilized for this study contained nine questions related to individual
needs and values. The questions were scored using a 5-point Likert-scale (1 = to a very small
extent to 5 = to a very large extent). Table 9 provides a descriptive statistical analysis of the nine
questions, including the mean score and standard deviation for each question.

69

Table 9
Mean and Standard Deviation for Individual Needs and Values (N = 49)
Factor M SD
INV 1: The ability to maintain a healthy balance between
work and personal life
4.35 0.93
INV 2: Feeling valued as an employee of the
organization
4.65 0.63
INV 3: Feeling secure about your employment 4.53 0.65
INV 4: Ability to conduct your work in the way you
think it should be done
4.20 0.93
INV 5: Adequate recognition for your work 4.16 0.80
INV 6: Adequate compensation for your work 4.33 0.85
INV 7: Requirements of your work are consistent with
your personal values
4.39 0.91
INV 8: Opportunity for professional training and
development
4.31 0.85
INV 9: Opportunity for professional growth and
promotion
4.35 0.88

Note. The data shows that all responses are less than one standard deviation from the mean,
indicating little variability in the importance placed on each factor. The questions were scored
using a 5-point Likert-scale (1 = to a very small extent to 5 = to a very large extent).

A frequency distribution was created based on the number of responses for each level on
the Likert scale in the quantitative survey to understand better the most important factors of
individual needs and values related to intent to retain. The percentage was determined for each
70

frequency within a response Figure 10 illustrates the percent distribution of the highest point on
the scale by factor.

Figure 10
Percent Distribution of Individual Needs and Values Factors Rated as To a Very Large Extent

71
72

Note. N = 49. A 60% threshold, indicated by the green line, was set to establish this study’s
significance factors for the closed-ended questions on the survey.

The survey tool included three open-ended questions regarding factors that would lead to
an employee’s intent to stay with the company, their intent to leave the company, and their
overall description of its culture. To triangulate the data, the 91 responses to the open-ended
questions regarding individual needs and values were coded, grouped into the quantitative survey
questions’ factors, and calculated frequencies. These data are displayed by percent in Figure 11.

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Figure 11
Open-Ended Responses: Individual Needs and Values Weighted by Response Frequency

Note. Ninety-one responses were collected and coded relating to individual needs and values
factors.

Interview Findings
Interview data were coded to open-ended survey data. Frequencies were identified by the
number of interview participants who mentioned an individual needs and values factor within
their responses to the interview questions, rather than the number of times the participant may
have mentioned a factor. This approach was taken to identify the importance of the factor to each
interview participant. Figure 12 illustrates the factor mentioned frequency by an interview
participant.
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Figure 12
Individual Needs and Values Factor Mention by Interview Participant

Note. n = 9. Frequencies are represented by the percent of interview participants who mentioned
a factor during the interview.

Individual needs and values factors are critical to employee retention and appear to build
upon each other rather than stand alone as unique factors. Utilizing a 60% threshold from the
quantitative survey results, two factors that influenced an employee’s intent to retain to a very
likely extent were identified. The two factors are (a) feeling valued as an employee of the
organization and (b) feeling secure about one’s employment. Interview participants supported
each factor, with equal mention of both factors ranking highest. However, qualitative findings
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from the open-ended responses in the survey suggest that feeling valued as an employee and
feeling secure about employment may result from a combination of additional individual needs
and values factors being met. Discussion regarding results and findings of the two themes are
presented in the following sub-sections.
Theme 3: Job Security Is a Concern for Many As the Pandemic Resolves
The mean score for the factor was 4.53, with 61.20% of respondents indicating that
feeling secure about one’s employment could influence an employee’s intent to remain with the
organization moving forward to a very likely extent. However, responses to open-ended
questions provided little additional support for this factor, ranking lowest in the percent
distribution of responses at only 1.10%. The single response identified “stability” as influencing
intent to remain with the organization.
Job security was mentioned by 77.78% of the interview participants and tied as the
highest-ranking mention within individual needs and values, along with feeling valued as an
employee. The degree of concern and its influence on their intent to retain varied among
participants. Concern regarding business levels and future growth of the organization and its
impact on job security was expressed by multiple participants. P7 expressed her concern, “I just
worry about sustained growth and whether or not they (leadership) will sell out to a larger
organization which would put some of us out of work.” P8 posed the question, “What are the
current business levels? Are the higher-ups worried? I worry about having a big enough caseload
to justify my job.”
Concern about growth was also expressed by P2, who stated, “I just wonder if they are
aggressive enough in getting new accounts, so the company grows,” and P4 worried about
layoffs once the COVID-19 pandemic was resolved. However, not all mention of job security
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came from a place of worry. P1 stated, “I don’t have any worries about job security. I know a lot,
and they need me.” Regardless of the degree of concern, none of the interview participants
indicated an intent to decide to leave or stay based on perceived job security.
Theme 4: Feeling Valued as an Employee May Be the Result of a Variety of Factors
The mean score for the factor feeling valued as an employee was 4.65%, with 71.40% of
survey respondents identifying feeling valued as an employee as influencing their intent to
remain to a very large extent. Open-ended responses provided moderate support for feeling
valued as an employee, with 12.09% of survey responses identifying the factor as important.
Table 10 is the verbatim text from open-ended responses related to feeling valued as an
employee and its influence on remaining with or leaving the organization.

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Table 10
Open-Ended Responses: Feeling Valued as an Employee

Note. Answers were copied as they were written to preserve the respondent’s intent.

Feeling valued as an employee was mentioned by 77.78% of interview participants and
tied as the highest-ranking mention within individual needs and values, along with job security.
Participant comments were overwhelmingly positive regarding this factor. P8 shared, “I feel like
a part of a family, part of a team.” P6 feels valued because, “We are still growing, so being part
of that is great. It is nice to have a voice in the growth.”
While the response from interview participants was positive, many of the reasons cited
for feeling valued were a sub-set of additional individual needs and values factors. These
included conducting work in a way the employee thinks it should be done, work-life balance, and
compensation.
Response Leave Stay
Losing a sense of purpose and worth to the company X
Not feeling appreciated X
Feeling not valued X
If leadership does not see the value I bring to the
organization
X
Feeling appreciated and valued among the team X
Feeling valued as an employee X
Feeling trusted, valued, and appreciated X
The organization cares for its employees. X
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As most participants were clinical, the ability to practice medicine autonomously was not
surprising. However, it was not just clinical staff indicating a desire to conduct work the way
they think it should be done. P3, a non-clinical interview participant, felt appreciated and
supported but she had more to offer,
I want to bring more of what I have to the company in regard to my experience. I am not
feeling underutilized necessarily, but I have more potential to help the company and
would like to be able to implement some of what I know to improve what we do.
The mention of work-life balance is presented as a factor that would influence a decision
to leave the organization, meaning at the point there is no balance, the participant would consider
leaving because the organization is not valuing their time. P4 indicated that burnout was a factor
that had caused her to consider leaving the organization at one point and that lack of leadership
response to work-life balance challenges would cause her to leave moving forward. P6
contemplated work-life balance stating,
I often wonder what I am giving up because I am choosing to work full time. What life
opportunities am I missing? I feel like it would be such a hole in my life if I left, though,
so I work and give up on those things for now. Maybe if things changed and leadership
didn’t seem to care, I would opt for more personal time.
The lack of work-life balance was also a factor for P5, who stated,
During the peak staffing shortage, I was just always working or thinking about working. I
began to question whether I was giving the organization what it needed and whether I
should leave. I finally realized it was me letting work fill up space in my life I didn’t
want to address. It was very personal. I recognize that I play a role in my own work-life
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balance and that I cannot blame a lack of it entirely on the organization, but there is a role
the organization plays in making sure that expectations and workload are balanced.
P7 views work-life balance from a different angle stating,
I have work-life balance. In medicine, and a lot of jobs, burnout is a factor. However, I
do believe the company should look at building flexible schedules for all staff. Right now
it is just the providers, but I think all staff would like the opportunity, and it could reduce
burnout.
Although adequate compensation as a stand-alone factor did not meet the threshold for a
factor of significance based on the quantitative data, scoring 53.10%, it was the most frequent
open-ended response for a reason to stay with or leave the company, at 34.07%. Identical
comments were used to reflect a reason for staying or leaving and included the following:
• adequate compensation
• compensation
• competitive pay
• improved benefits and compensation
• opportunity for greater compensation
• pay raises
• salary
Compensation was also mentioned by 44.44% of interview participants. P1 indicated that
compensation could play a factor in his decision to leave, stating, “If I had and understanding of
how valuable my skillset is outside of the organization and I learned I was not being
compensated appropriately, that could make me want to leave.” P8 identified financial growth
opportunities as important, “I am young, and I want to continue to grow professionally, which
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means I want to be able to keep increasing my pay. If I could not achieve that here, I would have
to start looking elsewhere.” indicating that it could be a contributing factor to feeling valued as
an employee. P2 sees things differently when it comes to compensation, “The work is the same
wherever you go. The pay here is good, and where you work makes a difference.”
The findings from the open-ended responses to the survey warrant further review. They
could indicate that feeling valued as an employee may not be a stand-alone factor but a
combination of multiple factors within individual needs and values. Factors contributing to
feeling valued as an employee included being able to conduct work in a way the employee thinks
it should be done, work-life balance, and compensation. The organization’s ability to respond to
these needs may impact an employee’s intent to retain.
Research Question 3: What Do Employees Need in the Organizational Culture of OMI to
Keep Them With the Organization
According to the BLMOPC, organizational culture embodies rules that employees follow,
implicit and explicit (Burke, 2018). Explicit rules are the organizational norms that define the
way things are done, while implicit rules are the values in which the organization believes and
guides behavior (Burke, 2018). Although organizational culture is a transformational factor in
the BLMOPC, the transactional factors of work unit climate and individual needs and values in
the model are directly connected to culture, representing a potential for congruence between the
organization and its employees.
Research question 3 sought to identify factors related to organizational culture that may
need to be addressed or could be leveraged to bring about congruence and contribute to
employee retention. The organizational culture factors for consideration were:
• CUL 1: Teamwork
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• CUL 2: Initiative and action for change
• CUL 3: Communication with managers
• CUL 4: Positive culture
Survey data is presented first for each research question, followed by interview data. Themes
from the results and findings of the data are discussed following the presentation of the survey
and interview data for each research question. Utilizing the same threshold of 60% from the
quantitative survey results, none of the four organizational culture factors rated as influencing an
employee’s intent to retain to a very likely extent. However, when taken into context with open-
ended responses and interview participant mentions, a positive organizational culture was
identified as the most significant organizational culture factor of influence on an employee’s
intent to retain.
Survey Results
The survey tool utilized for this study contained four questions related to organizational
culture. The questions were scored using a 5-point Likert-scale (1 = to a very small extent to 5 =
to a very large extent). Table 11 provides a descriptive statistical analysis of the nine questions,
including the mean score and standard deviation for each question.

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Table 11
Mean and Standard Deviation for Organizational Culture Factors (N = 49)
Factor M SD
CUL 1: Employees put the good of the organization
ahead of battles over turf.
4.00 1.01
CUL 2: Employees take the initiative and actions
necessary to make successful change happen.
3.98 0.93
CUL 3: Employees feel comfortable bringing up work-
related issues and concerns with their managers.
3.96 1.07
CUL 4: The organizational culture can be described as
positive.
4.33 0.88

Note. Indicated by a standard deviation greater than one, the data gathered for this factor had
more significant variability in responses than those for work unit climate and individual needs
and values.

A frequency distribution was created based on the number of responses for each level on
the Likert scale in the quantitative survey to understand better the current organizational culture
based on identified factors. The percentage was determined for each frequency within a
response. Figure 13 illustrates the percent distribution of the highest point on the scale by factor.

Figure 13
Percent Distribution of Organizational Culture Factors Rated As To a Very Large Extent

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Note. N = 49. A 60% threshold, indicated by the green line, was set to establish this study’s
significance factors for the closed-ended questions on the survey.

The survey tool included three open-ended questions regarding factors that would lead to
an employee’s intent to stay with the company, their intent to leave the company, and their
overall description of its culture. The 61 responses to the open-ended questions regarding
organizational culture were coded, grouped into the quantitative survey questions’ factors, and
calculated frequencies to triangulate the data. These data are displayed by percent in Figure 14.

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Figure 14
Open-Ended Responses: Organizational Culture

Note. Sixty-one responses were collected and coded relating to organizational culture factors.
One factor, initiative for action and change, had no responses.

Interview Findings
Interview data were coded to open-ended survey data. Frequencies were identified by the
number of participants who mentioned an organizational culture factor within their responses to
the interview questions rather than the number of times the participant may have mentioned a
factor. This approach was taken to identify the importance of the factor to each participant.
Figure 15 illustrates the factor mentioned frequency by a participant.

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Figure 15
Organizational Culture Factor Mention by Interview Participant

Note. n = 9. Frequencies are represented by the percent of interview participants who mentioned
a factor during the interview.

Organizational culture is a transformational factor directly influenced by, and connected
to, work unit climate and individual needs and values in the BLMOPC (Burke, 2018). Utilizing
the same threshold of 60% from the quantitative survey results, none of the four organizational
culture factors rated as influencing an employee’s intent to retain to a very likely extent.
However, when taken into context with open-ended responses and interview participant
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mentions, a positive organizational culture was identified as the most significant organizational
culture factor of influence on an employee’s intent to retain. Discussion regarding the results and
findings are presented as a theme in the following sub-section.
Theme 5: An Organizational Culture Described as Positive Influences, and Is Influenced
by, Work Unit Climate and Individual Needs and Values
The quantitative results for the organizational culture being described as positive ranked
highest among the four factors with a mean score of 4.33, and 52.10% of interview respondents
identified the factor as influencing their intent to retain to a very large extent. Open-ended
responses for positive organizational culture supported this factor significantly, with 67.21% of
the open-ended responses identifying this factor as important. Survey and interview respondents
used various terms to describe the organization as positive. A positive organizational culture was
characterized by participants by directly stating they felt the organizational culture was positive
and by providing descriptors of the positive culture. Figure 16 illustrates positive descriptors
used to describe the organizational culture, pulled from the 61 open-ended responses.
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Figure 16
Open-Ended Survey Responses Describing Positive Descriptors of Organizational Culture

Note. The descriptors are pulled from the 61 open-ended responses regarding how employees
would describe the organizational culture.

Reference to the organizational culture as positive was mentioned by eight of nine,
88.89%, interview participants, making it the highest-ranking factor related to organizational
culture. Participants referenced the organizational culture with a sense of reverence and
gratitude. P2 stated,
The culture is conducive to learning and growing and listening. We have definitely had
our ups and downs, but it is generally nurturing. You just cannot find that in a lot of
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organizations and in even fewer healthcare organizations. People underestimate the value
of a positive organizational culture when it comes to their experience at work.
Additional comments among the nine participants that discussed culture mimicked the responses
to open-ended questions and supported the finding of the organizational culture being described
as positive. “I feel like I am part of a family and a team,” stated P8. The organizational culture
seems to persist, according to P7, who commented, “New staff fit in really well and keep the
culture positive.”
However, three participants voiced concern that the organizational culture was changing
negatively. According to P6,
I worry that, as we grow, we will lose the personal connection. With the recent leadership
change, there is no glue keeping us all connected between people and departments. I am
worried that we are all going to start feeling like cogs in a wheel as the organization
grows, and there is no point person in charge of maintaining the culture.
P4 also worries, “With all of the new faces, you worry about the culture changing and the feel of
the day-to-day changing.” P9 expressed a similar sentiment,
The culture is very supportive, friendly, and sends back a lot of positive energy.
However, it is getting harder to maintain that small company feel and the sense of family.
I don’t want this to start feeling more like a job.
Although the quantitative results for positive organizational culture did not meet the 60%
threshold established as a significant result, the qualitative data elevated the factor to be worthy
of consideration as a theme. The connectedness, as evidenced by the research that led to the
creation of the BLMOPC (Burke-Litwin, 2018), of organizational culture as a transformational
factor to the transactional factors of work unit climate and individual needs and values is vital to
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consider. Table 12 provides a crosswalk of positive organizational culture descriptors to work
unit climate and individual needs and values.

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Table 12
Crosswalk: Positive Descriptors of the Transformational Factor Organizational Culture to the
Transactional Factors of Work Unit Climate and Individual Needs and Values
Descriptor of organizational culture Work unit climate Individual needs and values
Caring X X
Cohesive X
Collaborative X
Compassionate X X
Employees are happy X X
Encouraging X
Enjoyable X X
Excellent X
Family X
Friendly X
Fun X
Good X
Great X
Inviting X
Love the culture X X
Positive X X
Positive environment X X
Positive people X
Supportive X
Team X
Uplifting X
Warm X
Welcoming X X

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Note. Work unit climate considers employees’ perception of the management of their immediate
working environment and how effectively colleagues work together. Individual needs and values
comprise psychological factors that concern the extent to which one’s needs are met on the job
(Burke, 2018). Descriptors were collected from open-ended responses and participant interviews.

Summary
Three research questions were used to guide this study. The first research question was:
What key factors in the area of work unit climate do employees see as most influential in their
decision to either remain with or leave OMI under shifting market constraints? The two themes
that emerged during data analysis were: (a) cooperation and support among team members is the
work unit climate factor most consistently identified as influencing intent to retain, and (b) trust
and mutual respect are essential to all. Findings and results to answer the first research question
indicate that employees place high importance on the environment in which they work. Although
the current work unit climate seems adequate for employee retention, an absence of leadership
results in reduced trust in the organization and is combined with concerns regarding the growth
and sustainability of the organization. These factors may lead to attrition if not addressed
immediately.
The second research question used to guide the study was: What key factors in the area of
individual needs and values do employees see as most influential in their decision to either
remain with or leave OMI under shifting market constraints? The two themes that emerged
during the data analysis were: (a) job security is a concern as the pandemic resolves, and (b)
feeling valued as an employee may result from various factors. Findings and results to answer
the second research question reveal that communication and visibility of leadership may play an
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essential role in satisfying individual needs and values. Additionally, employees identified
compensation, work-life balance, and professional growth opportunities as factors that make
them feel valued. However, these individual factors did not meet the 60% survey response
threshold established to elevate these factors to a theme.
The third research question used to guide the research study was: What do employees
need in the organizational culture of OMI to keep them with the organization? One theme
emerged from the data. It was: An organizational culture described as positive influences, and is
influenced by, work unit climate and individual needs and values. The weighted data, supported
by the framing of the model, suggest that organizational culture, work unit climate, and
individual needs and values are interdependent. Employees describing the culture as positive
reflected components of the two transactional factors. As the organization grows and the
pandemic resolves, leadership must balance the transformational and transactional factors to
sustain a positive organizational culture and retain employees.
In conclusion, the data support the conceptual framework of the research study. The
study explored how two transactional factors could be leveraged to inform leaders to address
long-term transformational considerations. The transactional factors explored were work unit
climate and individual needs and values. The data suggest that the viewpoint of the employees
can provide leaders with the information they need to turn the COVID-19 crisis into an
opportunity by creating a new organizational culture defined by a strong sense of solidarity
among members who navigated the crisis together. This new culture and sense of togetherness
may lead to increased retention, thus providing the organization with opportunities for growth
and sustainability. Chapter 5 will discuss and interpret the findings from the data and offer
recommendations based on these findings.
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Chapter Five: Discussion and Recommendations
This study aimed to examine the impact of unplanned organizational change resulting
from the COVID-19 pandemic on organizational culture and employee retention among essential
workers in a growing healthcare organization. The study organization’s annual attrition rate for
2021 fell below the national average for health care workers at 30%. However, all attrition was
voluntary, meaning that employees chose to leave the study organization on their own via
resignation. It was the third consecutive year in which the voluntary attrition rate had increased,
indicating a critical need for the study organization to focus on retention efforts to sustain
economic viability. Chapter 5 discusses the results and findings of this study and provides
recommendations to mitigate voluntary attrition moving forward.
Discussion of Findings and Results
Three factors from the Burke-Litwin model of organizational performance and change
(BLMOPC) were examined related to employee intent to retain through the research questions in
this study: (a) work unit climate, (b) individual needs and values, and (c) organizational culture.
The study’s conceptual framework prioritized the employees’ perspectives of the impact of the
COVID-19 pandemic through the transactional factors of work unit climate and individual needs
and values. This study intended to provide organizational leaders with critical information
regarding influences on retention factors and the pandemic’s impact on the organization’s
culture. Findings and results for each research question are discussed in the following sub-
sections.
Work Unit Climate
Research question 1 addressed work unit climate factors influencing an employee’s intent
to remain with the organization under shifting market constraints. Work unit climate considers
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employees’ perception of the management of their immediate working environment and how
effectively colleagues work together (Burke, 2018). The study considered nine factors of work
unit climate that may contribute to an employee’s intent to remain with the organization. The
nine key factors of work unit climate are related to one or more factors of employee retention.
Table 13 provides a crosswalk of the work unit climate factors related to employee retention
factors.

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Table 13
Crosswalk: Work Unit Climate Factors to Retention Factors
Work unit climate factor Employee retention factors
Job
satisfaction
Organizational
culture
Employer
brand
WUC 1: Trust and mutual respect among
coworkers within your department
X X
WUC 2: Clear expectations of your roles,
responsibilities, and goals
X
WUC 3: Ability to be involved in making
decisions that directly affect your work
X
WUC 4: Support and encouragement of
diverse opinions and views
X
WUC 5: Cooperation and support among
team members in accomplishing work
X X
WUC 6: Value placed on diverse
backgrounds of team members (i.e.,
gender, race, ethnicity, age, etc.)
X X
WUC 7: Recognition of good work by
other team members
X
WUC 8: Team members hold each other
to highest possible work and ethical
standards
X
WUC 9: Team members successfully
adapt to changes affecting
responsibilities
X

Note. Employee retention factors are derived from a synthesis of research presented by multiple
authors (e.g., Das and Baraugh (2013), Kyndt (2009), Nanjundeswaraswamy (2019), Rai and
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Nandy (2021), and Schein and Schein (2016)). Work unit climate factors are derived from an
adapted version of the 2002 Langley Research Center (LaRC) Organizational Performance
Survey, explicitly designed utilizing the Burke-Litwin model of organizational performance and
change framework (LaRC, 2002; Burke, 2018).

The survey results related to work unit climate revealed little variability in the importance
placed on any of the nine factors, with a standard deviation of less than one from the mean for
each factor. When analyzed against a 60% threshold to establish findings of significance, two
work unit climate factors emerged as significant: (a) cooperation and support among team
members and (b) trust and respect among coworkers. The survey results were supported by the
findings from the open-ended question responses and participant interviews. The two work unit
climate factors are the only two of the nine related to employee retention factors of both job
satisfaction and organizational culture.
A recent change in leadership and a lack of presence by current leadership were raised as
a concern by several survey and interview participants. A guiding principle of organizational
culture is fostering distributed leadership (Willis et al., 2016). Organizational culture and
teamwork predict 35% of job satisfaction (Körner et al., 2015). If not addressed, the lack of
leadership presence could negatively impact the organization’s culture by diminishing
cooperation and support among team members and eroding trust and respect among coworkers
across the organization. The negative impact on the organization’s culture could reduce job
satisfaction, thus increasing the likelihood of increased voluntary attrition.

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Individual Needs and Values
Research question 2 addressed individual needs and values factors influencing an
employee’s intent to remain with the organization under shifting market constraints. Individual
needs and values comprise psychological factors that concern the extent to which one’s needs are
met on the job (Burke, 2018). The study considered nine individual needs and values factors that
contributing to an employee’s intent to remain with the organization. The nine key factors of
individual needs and values are related to one or more factors related to employee retention.
Table 14 provides a crosswalk of the individual needs and values factors related to employee
retention factors.

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Table 14
Crosswalk: Individual Needs and Values Factors to Employee Retention Factors
Work unit climate factor Employee retention factors
Job
satisfaction
Organizational
culture
Employer
brand
INV 1: The ability to maintain a healthy
balance between work and personal life
X X
INV 2: Feeling valued as an employee of
the organization
X X
INV 3: Feeling secure about your
employment
X
INV 4: Ability to conduct your work in the
way you think it should be done
X
INV 5: Adequate recognition for your work X
INV 6: Adequate compensation for your
work
X X
INV 7: Requirements of your work are
consistent with your personal values
X
INV 8: Opportunity for professional
training and development
X X
INV 9: Opportunity for professional growth
and promotion
X

Note. Employee retention factors are derived from a synthesis of research presented by multiple
authors (e.g., Das and Baraugh (2013), Kyndt (2009), Nanjundeswaraswamy (2019), Rai and
Nandy (2021), and Schein and Schein (2016)). Individual needs and values factors are derived
from an adapted version of the 2002 Langley Research Center (LaRC) Organizational
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Performance Survey, explicitly designed utilizing the Burke-Litwin model of organizational
performance and change framework (LaRC, 2002; Burke, 2018).

The nine factors of individual needs and values revealed similar results to work unit
climate with a standard deviation of less than one from the mean for each factor. Two factors met
the 60% threshold of significance established for this study based on the survey responses: (a)
job security and (b) feeling valued as an employee. Findings from participant interviews also
supported these two factors as being significant. However, the open-ended questions provided
additional insight into employee perspectives on the other individual needs and values factors
and whether each factor was a stand-alone factor or if an employee’s intent to remain with the
organization is contingent upon a mix of factors being met.
Job security is defined as an employee’s perception that there are no objective or
subjective factors that can make them susceptible to job loss and that they can have their jobs as
long as they want (Abolade, 2018). An employee’s perception of potential involuntary job loss is
called job insecurity (Salas-Vallina & Alegre, 2017). As the pandemic resolves, this study
suggests that employees may be experiencing job insecurity related to the decreased business
volume, which could lead to a reduction in force. Future growth strategies are unknown to the
employees, and some interview participants expressed fears of the company being sold.
Feeling secure about employment is a factor of job satisfaction, and the most reported
turnover predictor is job satisfaction (Liu et al., 2019). Falatah et al. (2021) found that job
satisfaction mediated the association between job security and turnover intent. Efforts to alleviate
job insecurity concerns expressed by participants may lead to increased job satisfaction, thus
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resulting in increased retention, and may also contribute to an employee’s perception of being
valued by the organization.
Survey results and participant interview findings from this study revealed that feeling
valued as an employee is a factor of influence related to employee retention. However, responses
to open-ended questions and participant interviews indicate that the factor of feeling valued as an
employee may not be a sole factor but rather a confluence of individual needs and values factors
that lead to the employee feeling valued. Work-life balance, compensation, and the ability to
conduct work in a way in which the employee feels it should be done comprised much of the
feedback related to the factor of feeling valued as an employee. Each of the three additional
factors relates to job satisfaction and the intent to retain (Das & Baraugh, 2013; Liu et al., 2019).
Further, work-life balance and compensation are factors associated with employer brand that can
be leveraged to attract top talent in a competitive labor market.
Organizational Culture
Research question 3 addressed employee needs related to organizational culture.
Organizational culture is a transformational factor in the BLMOPC and embodies rules that
employees follow, implicit and explicit (Burke, 2018). The model’s transactional factors of work
unit climate and individual needs and values are directly connected to organizational culture. The
study considered four factors of organizational culture that may contribute to an employee’s
intent to remain with the organization. The four key factors of organizational culture are related
to one or more factors related to employee retention. Table 15 provides a crosswalk of the
organizational factors related to employee retention factors.

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Table 15
Crosswalk: Organizational Culture Factors to Employee Retention Factors
Organizational culture factor Employee retention factors
Job
satisfaction
Organizational
culture
Employer
brand
CUL 1: Employees put the good of the
organization ahead of battles over turf.
X X X
CUL 2: Employees take the initiative and
actions necessary to make successful
change happen.
X X
CUL 3: Employees feel comfortable
bringing up work-related issues and
concerns with their managers.
X X
CUL 4: The organizational culture can be
described as positive.
X X X

Note. Employee retention factors are derived from a synthesis of research presented by multiple
authors (e.g., Das and Baraugh (2013), Kyndt (2009), Nanjundeswaraswamy (2019), Rai and
Nandy (2021), and Schein and Schein (2016)). Organizational culture factors are derived from an
adapted version of the 2002 Langley Research Center (LaRC) Organizational Performance
Survey, explicitly designed utilizing the Burke-Litwin model of organizational performance and
change framework (LaRC, 2002; Burke, 2018).

The results and findings from the study revealed that, of the four factors related to
organizational culture, a positive organizational culture was the most significant factor
influencing an employee’s intent to remain with the organization. Organizational cultural values
are influenced by management systems and reinforced by human resource practices and
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behaviors (Coetzee et al., 2014). Practices surrounding organizational culture cultivation and
preservation influence employees’ perceptions of leadership and the work environment,
ultimately affecting retention (Lok & Crawford, 2004). Positive organizational culture is a factor
in job satisfaction, organizational culture, and employer brand, which leads to increased
employee retention.
A crosswalk of employees’ descriptors of positive organizational culture indicated that
work unit climate and individual needs and values are critical to an employee’s perception of
organizational culture. A strong organizational culture begins with leadership and the
development of strong, unified behavior led by shared values and beliefs (Tsai, 2011). As
evidenced by the research that led to the creation of the BLMOPC (Burke-Litwin, 2018), the
connectedness of organizational culture as a transformational factor to the transactional factors of
work unit climate and individual needs and values is vital to consider.
Recommendations for Practice
The results and findings of this research study indicate that work unit climate and
individual needs and values play a critical role in an employee’s intent to remain with the
organization. Factors of significance may influence job satisfaction, organizational culture, and
employer brand, thus impacting employee retention. Based on the results and findings of the
study, five themes were identified:
1. Cooperation and support among team members is the work unit climate factor most
consistently identified as influencing intent to retain.
2. Trust and mutual respect will influence intent to retain for most.
3. Job security is a concern for many as the pandemic resolves.
4. Feeling valued as an employee may be the result of a variety of factors.
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5. An organizational culture described as positive influences, and is influenced by, work
unit climate and individual needs and values.
Maslow’s hierarchy of needs is a five-tier model of human needs, represented as levels in
a pyramid that build on each other from the bottom up (Maslow, 1943). The motivational theory
suggests that needs lower in the hierarchy must be satisfied before higher needs can be attended
to. The five themes identified from the results and findings of the research provide a range of
opportunity for organizational improvement and range from immediate to long-term. Adapted
from Maslow’s theory, Figure 17 illustrates the order in which the themes could be addressed
such that they build on each other and support employee retention and a renewed organizational
culture. Two recommendations are provided to support the results and findings of this study and
begin with the lowest level of the adapted model.

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Figure 17
Hierarchy of Themes

Note: Adapted from Maslow’s hierarchy of needs, the figure presents the themes from the
research as levels that should be satisfied to support the conceptual framework of the study. The
two recommendations provided in this study derive from the individual needs and values factor
of the BLMOPC which are the psychological factors that concern the extent to which one’s
needs are met on the job (Burke, 2018; Maslow, 1943).

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Recommendation 1: Implement a Work-Life Balance Initiative for All Employees
Work-life balance ranked fourth as a factor influencing a decision to leave the
organization in the quantitative survey results with a frequency of 57.10%. Additionally, work-
life balance rated second highest in open-ended survey responses and fourth in participant
interview findings. The study’s results and findings suggest that when there is no balance,
employees would consider leaving because the organization is not valuing their time. Work-life
balance is the term used to describe the relationship between non-work and work aspects of an
individual’s life. Achieving this balance is generally understood as restricting work to allow
more time for non-work aspects (Kelliher, 2018).
Work-life balance has traditionally been thought to concern only issues related to work-
family balance. However, non-work domains outside of family, such as health, friendship,
leisure activities, training activities, household management, and community involvement, are
becoming critical features of perceived work-life balance for employees (Gragnano et al., 2020).
The importance of a non-work domain will vary from person to person (Gragnano et al., 2020).
Employers’ concern for their employees’ work-life balance can positively impact employee
retention and job satisfaction (Farivar et al., 2016).
Considering the impact of work-life balance on employee retention and its alignment
with the results and findings of individual needs and values factors of importance in this study,
implementing a comprehensive work-life balance initiative comprised of three components
available to all employees is recommended. The components of the initiative include: (a) flexible
and consistent work schedules, (b) work-health balance, and (c) training and development
budgets. As a former employee of the organization, responsible for setting policies related to
operations of the organization, I am aware that the proposed components of a work-life balance
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initiative are not currently offered to employees. Each component is discussed briefly in the
following sub-sections.
Flexible and Consistent Work Schedules
The first proposed component of the work-life balance initiative is the creation of flexible
and consistent work schedules for all staff. Interview participant, P7, is clinical but recognizes
burnout as a factor for non-clinical staff. She stated, “Building flexible schedules for all staff is
something the organization should consider to reduce burnout. My team has asked for it.” The
organization currently allows only clinical staff the opportunity to work alternative workweek
schedules with set days week over week. non-clinical staff must work traditional workweek
schedules of five, eight-hour days per week, which vary weekly.
According to the Society for Human Resources Management (2018), California Labor
Code 511 allows for the creation of alternative workweek schedules for nonexempt employees,
permitting employees to work either a 4/10 schedule in which the employee works 4 days with
10-hours each day or a 9/80 schedule with 80 hours in 9 days over 2 workweeks. Implementing
such schedule offerings requires the organization to hold a secret ballot election, with at least
two-thirds of the affected employees in the work unit voting in favor of the change (Society for
Human Resources Management, 2018). Once adopted, the organization may allow employees to
work various schedules. This change would allow employees who prefer a traditional schedule to
continue working as they had been and open the opportunity for those who would prefer a
different schedule to have that flexibility. Research conducted by Wadsworth and Facer (2016)
suggests that schedule choice can positively impact job satisfaction and perception of work-life
balance. However, a forced alternative workweek schedule may not produce similar sentiment.
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A fair and consistent schedule can be established for each work unit based on the
employees’ choice of scheduled hours, providing additional opportunities to plan activities
outside work. The organization could reap additional benefits from offering flexible work
schedules, as overtime would not be paid out until an employee reached 10 hours of work in a
day (Society for Human Resources Management, 2018). The current structure requires overtime
payment for non-clinical staff after eight hours of work.
The organization currently comprises 66% non-clinical staff, for a total of 48 employees.
Of those employees, approximately 42 are classified as non-exempt and must be paid overtime
pay at a rate of time and a half for any hours worked over 8 in a workday. Based on an estimate
of each non-clinical employee averaging a pay rate of $20 per hour and working 1 hour of
overtime per day, 5 days per week, the organization could save $6,300 in wages per week or
$327,600 per year. Such cost savings could be reallocated to supplement an employee health
program and training and development budgets. In addition to the cost savings, flexible work
schedules have been shown to positively affect employee productivity, job satisfaction,
satisfaction with work schedule, and employee absenteeism (Baltes et al., 1999).
Work-Health Balance
The second component of the proposed work-life balance initiative is work-health
balance. Adapting a work-health balance component by implementing an employee wellness
program as part of the work-life balance initiative generates job satisfaction because work is not
detrimental to managing health (Gragnano et al., 2020). According to Gragnano et al. (2020),
work-health balance covers the care needs of workers with chronic conditions or illnesses and
the needs a worker considers necessary to care for his or her health consistently. When
referencing factors that would influence an employee’s decision to remain with the study
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organization moving forward, open-ended responses to the survey mentioned access to the gyms
at each site, free yoga and fitness training classes offered on the weekends, healthy eating
classes, and financial support for gym memberships as desirable.
The organization does not currently provide a structured employee wellness program but
could benefit from the implementation of such a program in numerous ways. Favorable
outcomes, such as health risk reduction, improved employee engagement, and enhanced business
performance, can result from employee wellness programs (McCleary et al., 2017). Evidenced-
based programs positively influence health behaviors such as smoking, diet, and physical
activity; biometric measures such as blood pressure and cholesterol levels; medical utilization by
employees; productivity; and the overall health profile of workers (Soler et al., 2010). The
average return-on-investment (ROI) from employee wellness programs was $2.73 for every
dollar when considering absenteeism and $3.27 for every dollar when considering medical
expenditures (Baicker et al., 2010). The implementation could significantly impact employee job
satisfaction, reducing attrition and yield financial savings by increasing productivity and
decreasing absenteeism and healthcare costs.
Training and Development Budgets
The third component of the work-life balance initiative is the implementation of training
and development budgets for all employees. The organization currently provides training and
development stipends to individuals who require licenses to perform the duties of their position
and are required to complete ongoing education to qualify to renew such licensure. The
organization does not provide funding for non-licensed staff. Training and development are
factors of employee retention, job satisfaction, and employer brand (Das and Baraugh, 2013;
Nanjundeswaraswamy, 2019; Rai & Nandy, 2021). Survey results revealed that 55.10% of the
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participants identified professional training and development as influencing their intent to remain
with the organization.
According to Statista’s (2022) research on the average spend on workplace training per
employee worldwide from 2008 to 2019, employers who invested in training and development
saw increased productivity, profitability, and customer satisfaction. The average per-employee
spending on training and development worldwide in 2019 was $1,308.00 and $1,286.00 per
employee in the United States (Statista, 2022). By comparison, data provided by the study
organization revealed that the allocation of training and development funds for 2019 was
approximately $822 per person but only applied to 23 out of 60 employees. Spread across the
entire employee population, the spend per employee in 2019 would have averaged $315 per
person, approximately 31% of the average per-employee spend in the United States.
Training and development are factors of individual needs and values identified through
this study as influencing an employee’s intent to retain. Research by Tribal Habit (2022)
suggested that organizations average between 2% and 6% of total salaries on training budgets.
Implementing a company-wide training and development budget could significantly impact the
organization’s ability to retain and grow current employees and attract new employees amidst the
tightening labor market.
Recommendation 2: Develop a Structured Compensation Strategy Based On Market Rates
and Factoring in the Cost of Attrition
Compensation is a factor that contributes to employee retention and job satisfaction (Das
& Baraugh, 2013; Nanjundeswaraswamy, 2019). It is a component of the transactional factor of
individual needs and values that influences an employee’s intent to retain (BLMOPC, 2018).
This study found that adequate compensation scored 53.10% in the quantitative survey and was
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the most frequent open-ended response for a reason to stay with or leave the company, at
34.07%. Compensation was also mentioned by 44.44% of interview participants as a reason to
consider leaving the organization.
Transparency in pay is becoming an expectation for employees and applicants with the
prevalence of online salary sharing tools and recently enacted state laws (Stofberg et al., 2022).
California was the first state to require mandatory transparency related to compensation with the
enactment of Assembly Bill No. 2282, passed on July 18, 2018 (Patrick & Rad, 2022). The bill
applies to all employers and requires employers to provide the pay scale for a position to an
applying applicant upon reasonable request. The law prohibits an employer from relying on an
applicant’s salary history to determine what salary to offer the applicant upon hire (Patrick &
Rad, 2022).
According to information available at the time research was conducted, the study
organization did not have a formalized and transparent compensation structure with established
ranges and was therefore non-compliant with state law. An unexpected benefit of pay
transparency goes to the organization. Studies show that transparency has a negative impact on
wages over time, resulting in increased profits for the organization (Cullen & Pakzad-Hudson,
2021). Developing a comprehensive compensation strategy informed by labor market rates and
the cost of attrition could position the organization to retain existing talent, attract new talent in a
competitive market, and bring the organization into compliance with state law. Tools to establish
such a strategy are provided in the following sub-sections.
Establish Salary Ranges by Position Based on Market Data
Salary data for private-sector employers are not readily available. Consulting firms are
often brought in to establish best practices but can be costly to small organizations. Hays U.S. is
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a worldwide recruiting organization whose services were engaged by an organization within the
same healthcare field in 2021. Permission was granted by the engaging organization to share the
established ranges for the organization’s market for this study. Table 16 provides the annual
market rate salary ranges by position provided to the engaging organization (Hays U.S., 2021).
While not all positions are identical, the study organization can use the information to establish
ranges that meet the operational needs and are competitive in the market.

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Table 16
Annual Market Rate Salary by Position for Occupational Healthcare in the Study Organization’s
Market
Position Minimum ($) Mid ($) Maximum ($)
Administrative assistant 29,700 37,100 44,600
Billing specialist 53,700 71,500 89,400
Clinic operations manager 52,100 65,100 78,200
Customer service specialist 34,200 42,700 51,300
Director: non-clinical 91,200 121,600 152,000
Executive: CEO, CFO, COO 211,200 301,600 392,100
Medical assistant 34,200 42,700 51,300
Medical director 188,500 269,200 350,000
Nurse practitioner 102,200 136,200 170,300
Physician assistant 102,200 136,200 170,300
Physical/occupational therapist 81,400 108,500 135,700
Physical therapy aide 29,700 37,100 44,600
X-ray technician 47,400 59,200 71,100

Note. Salaries ranges are presented in U.S. dollars. Data were provided to the engaging
organization in 2021 and are used with permission for this study (Hays U.S., 2021). Position
titles have been modified to reflect the study organization.

Determine the Cost of Attrition
On average, 4.7% of workers leave the workforce voluntarily each year (U.S. Bureau of
Labor Statistics, 2019). Over the past 3 years, the study organization has seen its voluntary
attrition rate steadily increase from 13% in 2019 to 30% in 2021. While still falling under the
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industry’s 5-year average separation rate of 35.78%, the trend warrants attention and action (U.S.
Bureau of Labor Statistics, 2021). This study revealed multiple reasons an employee would
consider leaving the organization: professional growth opportunities, need for work-life balance,
a decline in organizational culture, and a lack of adequate compensation. Although compensation
may not be the only reason behind an employee’s decision to leave an organization, analyzing
the cost of attrition could provide a valuable resource for compensation negotiation to the
organization when an employee does seek to exit for better-paying jobs. Once the cost of the
attrition is determined, a revised compensation rate could be determined and compared with the
established range of the position to inform better the organization of its ability to provide a
counteroffer to the employee, thus reducing the likelihood of the employee’s departure.
Determining the cost of attrition will be unique to each position. However, the cost of
attrition will only vary slightly by individuals within each position, as the variable factors would
be related to the exiting employee’s hourly rate and employment status. All other variables in
determining the cost are relatively fixed by position. Appendix D provides a Cost of Attrition
Worksheet. The worksheet is derived from the Turnover Cost Calculation Worksheet, The
Hidden Costs of Employee Turnover, and additional components unique to the study
organization (SHRM, 2021; Garman et al., 2005). The recommendation is for the organization to
prepare a Cost of Attrition Worksheet for each position, utilizing the mean salary for each
position to get an idea of what it costs to lose an employee. When an employee chooses to leave
the organization voluntarily, and upon review of performance and desire to retain the employee,
the supervisor will complete the worksheet to determine the cost of the attrition and make a
counteroffer within the established salary range of the position based on the analysis.
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Integrated Recommendations
The COVID-19 pandemic brought about significant unplanned change to the
organization. As the pandemic resolves and business operations normalize, OMI is faced with
finding closure for the chaos brought on by the pandemic, rediscovering who it is as an
organization, and establishing its future identity while retaining the staff who fought so hard to
get them through the crisis. Applying the Bridges transition model (BTM; William Bridges
Associates, n.d.) to the change and the transition individuals face could facilitate a successful
recovery from the pandemic and result in positive organizational change.
The Bridges transition model acknowledges a difference between change and transition.
Change is an external event or situation that can happen quickly and happens to people
regardless of their willingness or level of resistance to engaging in the change (William Bridges
Associates, n.d.). Transition is the inner psychological process individuals undergo as they come
to terms with the new situation that change brings about (William Bridges Associates, n.d.).
According to the model, the transition occurs in three stages: (a) endings, (b) neutral zone, and
(c) new beginnings. The three stages are upsetting to the individuals experiencing the transition;
therefore, the process can take longer than the change itself (Bridges & Mitchell, 2000). Figure
18 illustrates the Bridges transition model.

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Figure 18
Bridges Transition Model

Note. From Bridges Transition Model. (https://wmbridges.com/about/what-is-transition/).
Copyright 1998 by William Bridges Associates.

The study organization is currently in the endings stage of the Bridges transition model
(William Bridges Associates, n.d.). This stage requires that people let go of the way things used
to be. Employees are faced with letting go of how the business was operating prior to and during
the pandemic, knowing that the end of the pandemic does not necessarily mean a return to the
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way things were before the pandemic. During this stage, individuals determine what is left
behind and what will be kept, including relationships, processes, coworkers, and expectations
(William Bridges Associates, n.d.). Leaders of the organization are close to changes when they
occur, so they may fail to remember that it takes time for others to come to terms with change. In
this ending stage, leaders need to understand the transition process and the impacts of the change
on the organization (Bridges & Mitchell, 2000).
As employees of the organization enter the second stage of the BTM, the neutral zone,
they will face discomfort, and they may be driven to get out of it by getting into a new situation
or retreating to the past. The model suggests that the neutral zone is the core of the transition
process and where fundamental transformation occurs. During this stage, new processes are
being created, and new roles are formed. The results and findings from the research study
suggest that the organization is experiencing the confusion and distress of this stage, putting it at
risk for increased voluntary attrition due to discomfort and flux. Helping individuals understand
how they can positively contribute to the change is essential for leaders during this stage
(William Bridges Associates, n.d.).
In time, the organization will reach the new beginnings stage, marked by a fresh identity
for the organization and renewed energy. Ideally, the transition will have allowed people to
establish new roles and understand their purpose in those roles. Individuals should understand
their part in the organization and how to participate and contribute most effectively. The
conceptual framework of this study suggests that this stage may be most influenced by employee
participation in the design and build of the transactional factors rather than a top-down leadership
approach to the transition. The primary measure of success for the recommended change plan
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will be a reduction in voluntary attrition in 2022 and the continuation of the organization’s
culture being described as positive.
Limitations and Delimitations
Study limitations are defined by Price and Murnan (2004) as the systematic bias that
could inappropriately affect the study results for which the researcher could not or did not
control. Delimitations are the systematic biases intentionally introduced by the researcher in the
study design or the instrument (Price & Murnan, 2004). This section outlines the limitations and
delimitations of the study. Limitations of the study are addressed in the first section, and
delimitations related to the generalizability of the findings and results are reviewed in the second
section.
Limitations
Two critical limitations underlined this study. The first limitation was response bias in
responses from the participants in both the survey and interviews. Although participants were
ensured that their responses were confidential and not individually identifiable, they may have
hesitated to be honest in their responses or provided answers based on what they thought the
organization wanted to hear, given my affiliation with the organization. The second limitation
was the timing of the survey. When the survey was administered and data were being analyzed,
the unemployment rate had reached historic lows nationwide at 4.0% and, in the State of
California, was at 7.5% (BLS, 2022; EDD, 2021). Additionally, the COVID-19 pandemic
impacted business operations for the organization positively, and most staff had recently
received compensation increases due to the increased business levels and the competitive labor
market. The confluence of the circumstances resulting from the timing of the data collection
could have influenced responses.
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Delimitations
There are three delimitations in this study. The first delimitation of the study is that it was
limited to a single organization in a particular field of the healthcare industry. Participants’
experience in this organization may not represent healthcare workers in other fields. The second
delimitation is the sample size of the study, as the small size of the sample population limits the
scope of the study and the transferability of findings. The third delimitation is the framework
used to approach the research. The BLMOPC is an acceptable framework for analyzing
organizational change. However, limiting the research to this framework may have resulted in
missed findings that may have been more apparent if reviewed through a different framework.
Potential impacts from the delimitations were mitigated by presenting the results and findings
exclusively as they applied to the study organization and not attempting to extrapolate beyond
the scope of the research project.
Recommendations for Future Research
The study was limited to evaluating two of the transactional factors of the Burke-Litwin
model of organizational performance and change and their relationship with one of the
transformational factors of the model. The BLMOPC is premised on the idea that when it comes
to large-scale organizational change, the transformational factors of strategy, mission, culture,
and leadership carry more weight than transactional factors because changes in transformational
factors affect the total system. In contrast, changes in transactional factors may or may not affect
the total system (Burke, 2018). The COVID-19 pandemic challenged this idea because the
required immediate changes to the transactional factors significantly impacted the
transformational factors within the organization and carried more weight when it came to
influencing organizational change. The pandemic introduced oscillations, reversals, and
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fluctuations in the pacing of changes forcing leaders to contend with exacerbated levels of
uncertainty while implementing radical changes in response to new operating contexts (Amis &
Greenwood, 2021).
Further research should consider the impact of unplanned change through the BLMOPC
framework, including the connectedness of organizational culture as a transformational factor to
the transactional factors of work unit climate and individual needs and values. The results and
findings from the study suggest that the viewpoint of the employees, which is transactional, can
provide leaders with the information they need to turn the COVID-19 crisis into an opportunity
by creating a new organizational culture defined by a strong sense of solidarity among members
who navigated the crisis together. Understanding whether transformational factors are influenced
by, or are the influencer of, the transactional factors during periods of unplanned change warrant
further exploration to effect positive organizational change during challenging times.
The study was limited to a small healthcare organization when the COVID-19 pandemic
was starting to resolve but had not yet impacted business levels and operations. The pandemic
brought unexpected business and revenue to many organizations through testing and vaccine
administration service lines, causing many healthcare organizations to increase staffing during
historically low unemployment rates and record increases in wages (U.S. Bureau of Labor
Statistics, 2021.) Further research should examine the experience of similar employee
populations once the pandemic has resolved and business levels resume to pre-pandemic levels
to evaluate if influencers of intent to retain have changed. Understanding of the long-term impact
of unprecedented unplanned change, including how to resume pre-change business operations,
could position organizations for success through planning should another unplanned change
occur.
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An additional recommendation for future research surrounds work-life balance and
flexibility. Frontline healthcare workers do not have an option to work remotely. However, the
COVID-19 pandemic forced the healthcare industry to reimagine in-person work and adapt
operations to include the delivery of healthcare through such as telemedicine, opening numerous
opportunities within healthcare that provide remote work opportunities for clinical and non-
clinical roles (Kupietzky, 2022). Research into how these new opportunities impact the ability of
frontline organizations to recruit and retain employees may be of great value to the industry.
Research related to employee retention should consider the availability of remote work within
the scope of practice and the skillset of frontline healthcare workers as a factor related to intent
to retain.
Research prior to the pandemic suggested that the antecedent variables of employer
branding were (a) work environment, (b) corporate social responsibility, (c) work-life balance,
and (d) training and development (Tanwar and Prasad, 2016). On May 20, 2022, the U.S. Bureau
of Labor Statistics reported that the national unemployment rate was 3.6% (U.S. Bureau of Labor
Statistics, 2022). As identified through the literature review, a tight labor market favors the
employee, and effective branding can generate a competitive advantage, help employees
internalize the organization’s values, and assist in retaining employees (Browne, 2019;
Conference Board, 2001). A final recommendation for future research is to determine the impact
of the COVID-19 pandemic on employer brand variables and whether the pandemic
fundamentally changed the importance of these variables for employees.
Conclusion
This study examined the impact of unplanned organizational change resulting from the
COVID-19 pandemic on organizational culture and employee retention among essential workers
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in a growing healthcare organization. The study’s conceptual framework prioritized the
employees’ perspectives of the impact of the COVID-19 pandemic through the BLMOPC’s
transactional factors of work unit climate and individual needs and values. This approach
intended to provide leaders with critical information regarding influences on retention factors
and the pandemic’s impact on the organization’s culture. Two factors emerged as significant due
to the research for each transactional factor. Cooperation and support among team members and
trust and respect among coworkers were significant for work unit climate. Job security and
feeling valued as an employee emerged as significant for individual needs and values. A positive
organizational culture was identified as the most significant factor influencing an employee’s
intent to remain with the organization.
Factors of significance may influence job satisfaction, organizational culture, and
employer brand, thus impacting employee retention. Two recommendations were provided to
increase the likelihood of employee retention and contribute to the organization’s long-term
sustainability by reducing voluntary attrition. The first recommendation is to implement a work-
life balance initiative comprising three components available to all employees. The components
of the initiative include: (a) flexible and consistent work schedules, (b) work-health balance, and
(c) training and development budgets. The second recommendation is to develop a structured
compensation strategy based on market rates and factoring in the cost of attrition.
The significant unplanned change to the organization brought on by the COVID-19
pandemic requires transition (William Bridges Associates, n.d.). Employees are currently faced
with letting go of how the business was operating during the pandemic and are heading into the
neutral zone stage, where the core of the transition process and fundamental transformation takes
place (William Bridges Associates, n.d.). Leaders need to understand the transition process and
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the impacts of the change on the organization and help individuals understand how they can
positively contribute to the change (William Bridges Associates, n.d.).
The COVID-19 pandemic brought about unprecedented change to organizations across
the world. This study was limited in scope but contributes to understanding the employee
experience for frontline workers in a growing healthcare organization. In the face of increased
opportunity to work remotely in healthcare and a competitive labor market, the idea of
organizational culture as a means of competitive advantage and employee retention and
recruitment begs to be challenged.
On May 23, 2022, the Surgeon General of the United States issued an advisory sounding
the alarm on healthcare worker burnout and resignation across the country (Murthy, 2022).
According to the advisory, there is a projected shortage of nearly 140,000 physicians by 2033
and a projected shortage of more than 3 million essential low-wage workers in the next 5 years.
The advisory acknowledges that the health care system has faced systemic challenges prior to the
pandemic but that the pandemic further exacerbated burnout for healthcare workers. A topline
recommendation from the advisory is to protect the health, safety, and well-being of all
healthcare works by providing living wages, evaluating workloads, supporting educational
efforts, and developing policies that allow for work-life balance (Murthy, 2022).
Frontline healthcare workers are essential to patient care. Successful healthcare
organizations that require frontline workers will have to find ways to compete with remote
opportunities, competitive compensation, and work-life balance options. Organizations that can
differentiate the employee experience based on this research may leverage the recommended
practices that provide a sustainable competitive advantage as the industry changes.

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Appendix A: Survey Protocol
Question Open or closed
Level of
measurement
Response
options
(if close-ended)
RQ
Concept
being
measured
When considering your employment future, to what extent will the following factors influence your decision to remain with the
organization?
1. Trust and mutual respect among coworkers within
your department
Closed Ordinal 1–5 1 Work unit
climate
2. Clear expectations of your roles, responsibilities,
and goals
Closed Ordinal 1–5 1 Work unit
climate
3. Ability to be involved in making decisions that
directly affect your work
Closed Ordinal 1–5 1 Work unit
climate
4. Support and encouragement of diverse opinions and
views
Closed Ordinal 1–5 1 Work unit
climate
5. Cooperation and support among team members in
accomplishing work
Closed Ordinal 1–5 1 Work unit
climate
6. Value placed on diverse backgrounds of team
members (i.e., gender, race, ethnicity, age, etc.…)
Closed Ordinal 1–5 1 Work unit
climate
7. Recognition of good work by other team members Closed Ordinal 1–5 1 Work unit
climate
8. Team members hold each other to highest possible
work and ethical standards
Closed Ordinal 1–5 1 Work unit
climate
141

Question Open or closed
Level of
measurement
Response
options
(if close-ended)
RQ
Concept
being
measured
9. Team members successfully adapt to changes
affecting responsibilities
Closed Ordinal 1–5 1 Work unit
climate
10. The ability to maintain a healthy balance between
work and personal life
Closed Ordinal 1–5 2 Individual
needs and
values
11. Feeling valued as an employee of the organization Closed Ordinal 1–5 2 Individual
needs and
values
12. Feeling secure about your employment Closed Ordinal 1–5 2 Individual
needs and
values
13. Ability to conduct your work in the way you think it
should be done
Closed Ordinal 1–5 2 Individual
needs and
values
14. Adequate recognition for your work Closed Ordinal 1–5 2 Individual
needs and
values
142

Question Open or closed
Level of
measurement
Response
options
(if close-ended)
RQ
Concept
being
measured
15. Adequate compensation for your work Closed Ordinal 1–5 2 Individual
needs and
values
16. Requirements of your work are consistent with your
personal values
Closed Ordinal 1–5 2 Individual
needs and
values
17. Opportunity for professional training and
development
Closed Ordinal 1–5 2 Individual
needs and
values
18. Opportunity for professional growth and promotion Closed Ordinal 1–5 2 Individual
needs and
values
To what extent do you believe…
19. … employees put the good of the organization ahead
of battles over turf?
Closed Ordinal 1–5 3 Culture
20. … employees take the initiative and actions
necessary to make successful change happen?
Closed Ordinal 1–5 3 Culture
21. … employees feel comfortable bringing up work-
related issues and concerns with their managers?
Closed Ordinal 1–5 3 Culture
143

Question Open or closed
Level of
measurement
Response
options
(if close-ended)
RQ
Concept
being
measured
22. … the culture of the organization can be described
as positive?
Closed Ordinal 1–5 3 Culture
Open-Ended Questions
23. What factor(s) will ultimately play the biggest role
in your decision to stay with the organization
moving forward?
Open Open
24. What factor(s) will play the biggest role in your
decision to leave the organization moving forward?
Open Open
25. How would you describe the overall culture of the
organization?
Open Open

144

Question Open or closed
Level of
measurement
Response options
(if close-ended)
The following demographic data is being collected to determine if there are preferential differences based on gender identification,
generation, and/or position within the company. This information will not be linked back to individual survey responses.
26. Which statement best describes your current
employment status?
Closed Nominal Full-time, permanent employee
Part-time, permanent employee
Full-time, temporary employee
Part-time, temporary employee
Independent contractor
Other: __________
Prefer not to answer
27. Current Department Closed Nominal Administrative
Billing
CSS
MA
Clinician
Ortho rehab
Other: ______
Prefer not to answer

145

Question Open or closed
Level of
measurement
Response options
(if close-ended)
28. To which generation do you belong? Closed Nominal Generation Z (born 1997-2012)
Millennials (born 1981-1996)
Generation X (born 1965-1980)
Boomers (born 1946-1964)
Silent (born 1928-1945)

29. How would you describe your gender? Closed Nominal Man
Woman
Agender
Cisgender
Non-binary
Transgender
Prefer to self-describe: _________
Prefer not to answer

Note. Closed-ended questions were scored using a 5-point Likert-scale (1 = to a very small extent to 5 = to a very large extent).

146
147

Appendix B: Interview Protocol
Thank you for taking time out of your day to participate in this interview. I will respect
your time and keep this to one hour. My name is Heather Manley, and I am a doctoral student at
USC, researching the impact on the COVID-19 pandemic on employee retention and
organizational culture. (Description of the interviewer’s identity was omitted to protect the
privacy of the study organization.)
The purpose of my study is to examine the impact of unplanned organization change,
resulting from the COVID-19 pandemic, on organizational culture and employee retention
among essential workers in a growing healthcare organization, specifically yours. Your
participation in this process is voluntary, and you are free to choose to stop participating at any
time. Here is an information sheet for you to keep. I will give you as much time as you need to
review. Please let me know when you are ready to continue.
Your responses to the interview will be transcribed without any identifiable information,
so your identity will be known only to me. I will use pseudonyms or non-unique identifiers, such
as Participant 1, when referring to statements in my study that may be made by you. Finally, I
will not provide demographic data on any single participant to guard against someone being able
to guess at your identity. Once again, the interview protocol I am presenting to you has been
reviewed by and Institutional Review Board and approved on the condition that participant
identities will not be discernable to anyone in the organization.
So that I can capture all your remarks accurately, I would like to ask your permission to
record this session. Once the recording has been transcribed, I will delete it. At no time will it be
shared with anyone. I am the only person who will have access at all times. Do I have your

permission to record? Declining does not preclude you from participating. If you do decline
recording, I will take hand notes on our conversation.
Thank you. Before we begin, do you have any questions for me? I will begin the
recording.
1. How would you describe the current culture of the organization? (RQ3: Culture)
Probe: In what ways, if at all, do you feel your individual values are aligned with
those of the organization?
Probe: In what ways, if at all, do you feel engaged in the organization?
2. What are you most worried about right now, if anything, as it relates to the
organization? (RQ1: Work Unit Climate)
Probe: Who do you feel is most accountable in the organization for helping alleviate
this worry?
3. What are you most worried about right now, if anything, as it relates to your job?
(RQ2: Individual Needs and Values)
Probe: Who do you feel is most accountable in the organization for helping alleviate
this worry?
Probe: How do you feel you can best influence the alleviation of this worry?
4. Why have you chosen to stay at the organization? (RQ2: Individual Needs and
Values)
Probe: What is the most important reason for staying?
5. Has anything caused you to consider leaving the organization? (RQ1 and RQ2:
Individual Needs and Values, Work Unit Climate)
Probe: What made you decide to stay?

Probe: If you decided to leave, what would be your primary reason?
Probe: What could be done to change your mind?
6. On a scale from 1 to 10, with 10 being most likely, how would you rate your
likelihood of recommending the organization to someone searching for employment?
(RQ3: Culture)
7. What factors do you see as most influential in your decision to either remain with or
leave OMI moving forward? (RQ2: Individual Needs and Values)
8. Is there anything I have not asked that you would like to address or contribute as it
relates to your experience as an employee?

Appendix C: Participant Information Sheet
University of Southern California
Rossier School of Education
3470 Trousdale Pkwy | Los Angeles, CA 90089

INFORMATION SHEET FOR EXEMPT RESEARCH

STUDY TITLE: MAKE THEM WANT TO STAY. A LOOK AT EMPLOYEE RETENTION
AMIDST THE COVID-19 PANDEMIC

PRINCIPAL INVESTIGATOR: Heather Manley

FACULTY ADVISOR: Jennifer Phillips, D.L.S

You are invited to participate in a research study. Your participation is voluntary. This document
explains information about this study. You should ask questions about anything that is unclear to
you.

PURPOSE
The purpose of this study is to examine the impact of unplanned organization change, resulting
from the COVID-19 pandemic, on organizational culture and employee retention among
essential workers in a growing healthcare organization. You are invited as a possible participant
because you are a current employee of the organization.

PARTICIPANT INVOLVEMENT
If you decide to take part, you will be asked to take an online, anonymous survey, consisting of
approximately 28 questions. The survey should take no longer than 15 minutes. At the end of the
online survey, you will be asked if you would like to participate in an in-person interview. The
interview will last one hour and consists of 8 questions. All survey and interview responses are
kept confidential and no personally identifiable information will be shared with your
organization.

PAYMENT/COMPENSATION FOR PARTICIPATION
You will receive $10 gift card for your time completing the online survey. You do not have to
answer all of the questions in order to receive the card. The card will be emailed to you within 72
hours of survey submission.

If you participate in the in-person interview, you will receive an additional $25 gift card for your
participation, even if the interview is not completed in its entirety.

CONFIDENTIALITY
The members of the research team and the University of Southern California Institutional
Review Board (IRB) may access the data. The IRB reviews and monitors research studies to
protect the rights and welfare of research subjects.

Online survey data will be collected through Qualtrics, a survey tool, which is only accessible to
the researcher through a secure login. Interview data will be transcribed from recordings. The
interview participant has a right to review the audio transcript at any time. Recordings will not be
shared with anyone other than the researcher. All data will be held until such time the research
has been published to ProQuest.

INVESTIGATOR CONTACT INFORMATION
If you have any questions about this study, please contact the researcher, Heather Manley, at
hmanley@usc.edu or 760.402.6278 or Dr. Jennifer Phillips, Faculty Advisor, at
jlp62386@usc.edu or 662.312.7367.

IRB CONTACT INFORMATION
If you have any questions about your rights as a research participant, please contact the
University of Southern California Institutional Review Board at (323) 442-0114 or email
irb@usc.edu.

Appendix D: Cost of Attrition Worksheet
Employee Information
Position Title: Full-time (FT) ☐ or Part-time (PT) ☐
Hourly Salary: (If salary, divide by 2080 for FT or 1040 for PT)
Hours Worked Per Shift (HWPS): Supervisor:
Hourly/Daily Costs Amount
EHR: Employee Hourly Rate
EEPD: Employee Cost Per Day of Work
SUP: Supervisor Hourly Rate
HR: Human Resources Staff Hourly Rate
IT: IT Staff Annual Salary as an Hourly Rate
RC: Recruiter Cost Per Hour
JPC: Job Posting Cost Per Day
TD: Number of Training Days Required for New Hire
COV: Cost Per Hour to Cover Vacancy
NHR: New Hire Hourly Rate

Tangible Costs (TC) Formula TC
Total
Payout of accrued hours HER * hours
Exit interview (HR * EHR) * 1 hour
Removal of exiting employee from systems IT * 1 hour
Vacancy coverage COV * # of days
Job posting JPC * days posted
Candidate review HR * hours spent
Interview (HR * SUP) * 1 hour
per interview

Hiring bonus Enter total if applicable
Hiring/onboarding admin time HR * hours required
Pre-employment screening, drug screen, physical, etc… Actual costs
Background check Actual cost
Set up of new hire IT * 1 hour
Training time until fully trained (NHR + SUP + COV) *
# of hours

Annualized increased or decreased salary (EHR – NHR) *
FT or PT hours

Subtotal Tangible Costs

Intangible Costs (IC) Translated to Dollars IC Total
Lost productivity of existing employee (EHR * Remaining
hours) * 50% lost
productivity

Lost productivity of team members (Combined hourly rate
of employees in work
unit * remaining hours)
* 25% lost productivity

Increased workload/overtime (COV * 1.5) *# of hours
Lost productivity of supervisor due to training (SUP * training hours) *
25%

Lost productivity of training team members due to
training
(Combined hourly rate
of employees in work
unit * training hours) *
25% lost productivity

Lost productivity of new hire until fully trained

(NHS * training hours)
* 50%

Subtotal Intangible Costs

Other Intangible Costs (OIC) to be Considered OIC
Total
Competitive loss
Opportunity cost of
damage to
reputation/competitive
advantage

Erosion of organizational memory
Hours spent trying to
replicate knowledge
base

Impaired quality of service
Hours spent repairing
relationships and fixing
errors

Loss of loyal customer
Cost of annual loss *
number of losses

Lost business opportunities
Opportunity cost of not
realizing new business

Negative impact on morale and culture
May be expressed as
productivity loss

Team erosion
May be expressed as
productivity loss

Subtotal Other Intangible Costs
TOTAL COST OF ATTRITION (TCA) TC + IC + OIC
Total Cost of Attrition Expressed as an Hourly Rate
TCA / 2080 (FT)
or 1040 (PT)

Abstract (if available)

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Asset Metadata

Creator Manley, Heather Rene (author)

Core Title Why are they still here: a look at employee retention amidst the COVID-19 pandemic

School Rossier School of Education

Degree Doctor of Education

Degree Program Organizational Change and Leadership (On Line)

Degree Conferral Date 2022-08

Publication Date 06/23/2022

Defense Date 06/06/2022

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag COVID-19,employee retention,employer brand,job satisfaction,OAI-PMH Harvest,organizational culture,pandemic

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Phillips, Jennifer L. (committee chair), Canny, Eric A. (committee member), Krop, Cathy S. (committee member)

Creator Email hmanley@usc.edu,manley.heather@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC111345521

Unique identifier UC111345521

Legacy Identifier etd-ManleyHeat-10782

Document Type Dissertation

Rights Manley, Heather Rene

Type texts

Source 20220623-usctheses-batch949 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA

Repository Email cisadmin@lib.usc.edu