Objective: This study aims to investigate the effects of self-leadership and organizational culture on job performance of medical insurance review nurses, so as to contribute to broadening the scope of work and advancing the expertise of medical insurance review nurses, promoting efficient human resources management, and improving hospital management performance, ultimately to present foundational data for establishing and promoting the role of medical insurance review nurses. To this end, the concepts of self-leadership, organizational culture, and job performance were established and their relationships were examined to investigate their effects on job performance in medical insurance review nurses.
Method: Data were collected from 134 medical insurance review nurses from eight general hospitals with 300 beds or more in a large city from August 1 to August 30, 2020 using a self-report questionnaire.
The data were analyzed with descriptive statistics, independent t-test, and ANOVA, Scheffe post-hoc test, correlation analysis, and hierarchical regression using the SPSS 27.0 software for Windows.
Results: The results can be summarized as follows:
1) The mean age was 37.38±7.66 years, and 124 (92.5%) had a bachelor's degree. Sixty-seven (50.0%) were a manager or chief, and mean career in insurance review was 7.65±6.01 years. Sixty-six (49.2%) worked in a hospital with 501 - 700 beds, and 89 (66.4%) worked in a general hospital in terms of type of healthcare facility. The mean number of personnel in the unit was 19.42±8.20 years. The mean number of monthly inpatient claims was 3.38±0.81 and the mean number of monthly outpatient claims was 1.22(±0.41). Ninety-five (70.9%) considered their workload to be "moderate."
2) The mean self-leadership score (18 items rated on a 5-point scale) was 3.69±0.79. By 4 subscales, the mean organizational culture scores were 3.90±0.89 for hierarchy culture, 3.83±0.85 for market culture, 3.77±0.82 for adhocracy culture, and 3.57±0.72 for clan culture. The mean job performance score for medical insurance review was 2.70±0.98 out of 5. The mean job performance score for essential domains was 3.65±0.79, and by sub-domain, the score was 3.94±0.61 for review and claims, 3.74±0.96 for statistical analysis, and 3.27±0.80 for bill reduction analysis and appeals and grievances. The mean job performance score for supportive work was 2.19±1.03, and by sub-domain, the mean score was 2.71±0.83 for providing information, 2.48±1.16 for managing outstanding bills and complaints, 2.16±1.01 for medical fee management, 2.10±1.10 for quality improvement activities and appropriateness assessment, and 1.66±1.08 for policy involvement.
3) Participants' overall job performance significantly differed according to age (F=25.02, p〈.001), job position (F=12.93, p〈.001), length of career in medical insurance review (F=27.12, p〈.001), number of beds (F=3.73, p=.026), number of monthly outpatient claims (t=1.23, p=.016), and workload (F=8.18, p〈.001). Job performance in the essential domains significantly differed according to age (F=4.72, p=.004), job position (F=5.83, p=.002), length of career in medical insurance review (F=6.37, p=.002), number of beds (F=11.86, p〈.001), types of healthcare facility (t=16.26, p〈.001), and number of personnel in the unit (F=7.75, p=.001). Job performance in the supportive work significantly differed according to age (F=38.56, p〈.001), education level (t=28.72, p〈.001), job position (F=20.50, p〈.001), length of career in medical insurance review (F=31.45, p〈.001), and workload (F=9.85, p〈.001).
4) Job performance in the essential domains was significantly positively correlated with self-leadership (r=0.419, p〈.001), clan culture (r=0.406, p〈.001), adhocracy culture (r=0.475, p〈.001), market culture (r=0.274, p〈.001), and hierarchical culture (r=0.276, p〈.001). Job performance in the supportive work domain was significantly positively correlated self-leadership (r=0.479, p〈.001), clan culture (r=0.244, p=.004), and adhocracy culture (r=0.230, p=.007).
5) The statistically significant predictors of overall job performance of medical insurance review nurses were self-leadership (β =0.30, p=.002), adhocracy culture (β =0.29, p=.003), and market culture (β =-0.19, p=.022), and these three variables explained for .66 (F=12.93, p〈.001) of the variance and 6.9% of the variance of overall job performance (F=4.63, p=.001). The significant predictors of job performance in the essential domains were self-leadership (β =0.36, p〈.001), clan culture (β =0.19, p=.040), and adhocracy culture (β =0.19, p=.049), and these three variables explained for .64 (F=10.89, p〈.001) of the variance. Nurses with high self-leadership and are in organizations with a clan culture and adhocracy culture showed higher job performance in the essential domains, and market culture and hierarchy culture did not moderate job performance in the essential domains. The significant predictors of job performance in the supportive work domain were self-leadership (β =0.25, p=.012), adhocracy culture (β =0.25, p=.013), and market culture (β =-0.19, p=.025) and these three variables explained for .64 (F=1.57, p=.026) of the variance. Nurses who have higher self-leadership and work in organizations with a higher level of adhocracy culture showed higher job performance in the supportive work domain, and nurses in an organization with a higher level of market culture had lower job performance in the supportive work domain. Clan culture and hierarchy culture did not moderate job performance in the supportive work domain.
Conclusion: This study investigated the relationships between self-leadership, organizational culture, and job performance in medical insurance review nurses of general hospitals. This study is significant in that it attempted to identify the predictors of job performance among medical insurance review nurses in healthcare settings other than the ones identified in previous studies, namely knowledge, function, and competence, by separately examining job performance in the essential work domain and supportive work domain using a questionnaire. Further, this study documented individual and organizational support strategies needed in addition to material support in order to promote job performance in medical insurance reviews. The findings of this study would contribute to improving hospital management performance by expanding the scope of work and improving the expertise of medical insurance review nurses and serve as foundational data for establishing and promoting the role of medical insurance review nurses.