This paper finds out if a committed physician will go the extra mile for his/her employer when faced with psychological

contract breach (PCB), a psychosocial stressor. Data from 214 physicians across 26 health-care units in the Upper East (UE)

and Upper West (UW) regions of Ghana were analysed. A semi-structured, pre-tested and validated questionnaire was

utilised. Research philosophy was positivism, research approach was quantitative, research design was explanatory, and

stressful, more meaningful and purposeful atmosphere for the benefit other health-care professionals, patients and the

worker of a health-care unit and the several executives and

others in that unit (Huy & Takahashi, 2018).

Health-care

units, on one hand, may expect health-care professionals to

do their best on behalf of the health-care unit: to make

themselves available for the heath-care facility; to be fully

committed to its values, to be compliant and loyal; and to

improve the image of the facility with its patients and

suppliers (Rousseau & Greller, 1994). Health-care

professionals, on the other hand, may expect to be treated

development, to know what is expected of them, to be given

peaceable and inclusive community for sustainable

development respectively (Catholic Agency for Overseas

Development, 2015).

advocates that health-care professionals must be in a setting

where there is mutual trust, recognition and respect for one

another’s efforts and results. Ghana Healthcare Quality

Report (2017) matches up with the core mission of the

Ghana Health Service (2017), which pursues to establish a

more equitable, efficient, accessible and responsive health-

care system.

care facility meets its obligations to an health-care

professional, from the professional’s vantage, and it serves

to build upon the social exchange element (Karagonlar et al.,

2016), which are founded on trust, reciprocation and reward

(Blau, 1964). In contrast, a PC is said to have been breached

if the health-care facility fails to deliver on an expected

obligation to the professional and this expected obligation

can either be documented or undocumented (Robinson &

organisation, the desire to strive at what organisation

desires and certain beliefs and acceptance of value and

purpose of the organisation (Akbar et al., 2018).

The negative relationship between PCB and JCM is

described by the social exchange theory (SET), which one of

the most applied conceptual paradigms for understanding

workplace behaviour (Cropanzano et al., 2017; Opoku

organisation helps the employee out, the employee is likely

to do something in return for the organisation. But, if the

workers, customers, and the organisation at large. As an

commitment and affective commitment positively and

significantly affected citizenship behaviour among

university support workers in Thailand. Anggraeni et al.

(2017) also report that JCM positively and significantly

influenced citizenship behaviour among Indonesian young

transformations in organisations are a result of committed

organisational outcomes, in the form of discretionary

behaviour for the benefit of co-workers, customers and the

organisation itself. Thus, the SET and RBT aids in

understanding the relationship between PCB and JCM, and

JCM and ETB respectively.

The SET, as power as it is, offers additional

understanding on the negative relationship between PCB

and ETB, such that when an employee feels breached

psychological, he/she is unlikely to demonstrate

discretionary behaviour for the benefit of the

patients, patients’ friends, and their relatives. As proof, Shen

(2019) report a negative linkage between PCB and ETB

among employees and supervisors in China. Koomson and

Opoku Mensah (2020) also share that PCB caused medical

doctors to show low citizenship behaviour in Ghana.

activation theory (ACT) to describe the proposed

moderating role of PCB in the direct relationship between

JCM and ETB, such that the direct positive relationship

between JCM and ETB may be weakened by a high-PCB, but

strengthened by a fulfilled PC or low-PCB. The ACT (Gardner,

1986; Gardner & Cummings, 1988) holds that too much

stress from the employer can damaged an employee’s

ability to perform, particularly for complex and difficult task

(Gardner, 1990), thereby negating the tendency of that

linkage between perceived organisational support and job

satisfaction. Paillé and Rainer (2015) disclose that PCB

moderated the linkage between perceived organisational

support and eco-initiatives. Haque et al. (2016) educate that

PCB moderated the direct positive relationship between

psychological capital and work engagement, and the direct

burnout.

connection between perceived organisational support and

and turnover. Against this background, this study seeks to

physicians in Ghana, and further test the moderating role of

PCB, a psychosocial stressor, on this direct relationship.

suggest that severe PCB among physicians working in the

Upper East (UE) and Upper West (UW) Regions of Ghana,

to 2017. Concomitantly, the number of hospital beds

available to serve Ghanaians living in these two regions has

been relatively low from 2016 to 2017. Besides, the total

and hospitals in these two regions has been comparably

minimal from 2016 to 2017. To make matters worse, the

doctor-population ratio for the two regions have been

the table by recording one doctor to 26, 489 population for

the year 2017.

stress on the physicians working in these two regions. This

stress can be likened to high-PCB on the part of their health-

care employer, which may eventually lead the physicians to

show low levels of JCM (Hazrati, 2017), as well as low ETB

(Koomson & Opoku Mensah, 2020), as explained by the SET.

physician and supress his/her effort to offer ETB, with its

associated benefits. Stated differently, this high-PCB may

suppress the direct positive linkage between JCM and ETB,

as explicated by the ACT. As a consequence, this study

working in the UE and UW Regions of Ghana.

perceived organisational support and work engagement

(Gupta et al., 2016), perceived organisational support and

ETB (Gupta et al., 2016), benevolent leadership and

psychological well-being (Erkutlu & Chafra, 2016),

perceived corporate environmental policies and employees

commitment and intentions to quit (Addae et al., 2006). In

addition, these studies were conducted in western

countries, ignoring Sub-Saharan Africa, particularly Ghana.

between JCM and ETB among physicians working in the UE

and UW Regions of Ghana.

The RBT regard a committed employee as a firm

competitive advantage by being rare and difficult to imitate

(2017) also report that JCM positively and significantly

influenced citizenship behaviour among Indonesian young

studies and assumptions of the SET, the first hypothesis of

this study is formulated as follows:

H

something in return for the organisation (Golden & Veiga,

2018). Fallon and Rice (2015) argue that employees will

behave favourably within firms when they perceive that the

organisation as having their best interests at heart, by

offering them safe working environment, working tools,

When employees’ PC with their employer is honoured,

they become happy (Roy & Konwar, 2019) and they are

likely show positive workplace behaviour. Nonetheless,

when their PC is in breach, they reciprocate by show

undesirable behaviour. For instance, Hazrati (2017)

commitment among banking sector employees in Dubai.

Opoku Mensah and Koomson (2021) utilised the SET and

assumes that too much stress caused by the employer can

damaged an employee’s ability to perform, particularly for

complex and difficult task (Gardner, 1990), thereby

behaviour. According to the ACT, at this moderate level,

the direct relationship between JCM and ETB, such that the

direct positive relationship between JCT and ETB is

weakened by a high-PCB, but strengthened by low-PCB or a

studies who have modelled PCB as a moderator in a few

direct relationships. For instance, Addae et al. (2006)

likely to think about quitting their jobs. Paille et al. (2014)

the direct positive relationship between psychological

capital and work engagement, as well as the direct negative

among doctors working in direct health-care units in

Pakistan.

connection between perceived organisational support and

work engagement, as well as the nexus between perceived

organisational support and ETB among nurses in India.

Erkutlu and Chafra (2016) uncovered that high-PCB

With this in mind, the second hypothesis is formulated as

such that a committed physician who senses high-PCB will

be less likely to demonstrate ETB than one who perceives

low-PCB

Underpinned in the SET, RBT and ACT, a conceptual

as the exogenous latent variable, while ETB is used as the

this study. Sex (CTL1), age (CTL2), employment type (CTL3)

and tenure (CTL4) are used as control variables, with lessons

and the remaining 2 indicators showed a median of 2:

. This finding suggested that majority of the

providing evidence of a high-PCB among the physicians

working in the UE and UW Regions of Ghana. The IQR ranged

suitable even for skewed distributions.

median of 3:

, 4 items showed a median of

4:

, and 2 items showed a median of 5:

. This result suggested that respondents

were less satisfied their work, as majority of the indicators

indicators. The IQR of JCM were 1 to 2, indicating that the

to 0.42 and kurtosis ranged from 0.63 to 1.06, confirming

that the data on JCM were not normally distributed, because

some of the values were far from zero. This result vindicated

ETB was 1, signalling that the responses were not wide-

was not normally distributed, because, some of the values

were far from zero. This finding also warranted the use of

PLS-SEM, which has been deemed suitable even for skewed

distributions.

all three reflective latent constructs. With respect to

convergent validity, all the average variance extracted (AVE)

values passed the acceptable AVE of 0.5, so convergent

validity was confirmed. The indicators reliability, composite

Regarding discriminant validity, all the indicators

loaded higher with their associated constructs than the

average variance extracted was calculated to be 0.51,

consequently, its square root was 0.71. This number was

among the independent or exogenous latent constructs of

PCB and JCM, as the VIF values were lower than 5.00, and the

Tolerance level were higher than 0.20.

value of the endogenous construct(s). As a

guideline, Henseler et al. (2009) advocates that the

values

of 0.70, 0.50, and 0.20 can be considered substantial,

substantial. This outcome implied that the model fit the data

collected and it reflected the overall population. The same

model would likely fit if used on another sample drawn

. Path coefficient of path linking job commitment to citizenship behaviour

. T-statistics of path linking job commitment to citizenship behaviour

of the negative interaction term was that, at the middle of

PCB, the relationship between JCM and ETB obtained a value

of 0.19. At a high-PCB, that is, when PCB is increased by one

standard deviation point, the relationship between JCM and

ETB is decreased by the size of the interaction effect and had

the UE and UW Regions of Ghana. On the contrary, given a

low score on PCB or high psychological contract fulfilment,

JCM increased its importance in explaining ETB among

physicians working in the UE and UW Regions of Ghana. This

statistics of the negative interaction term of JCT and PCB

(JCM*PCB) was greater than 1.96 (3.88). This finding

suggested that PCB worked as a moderator in the

T-statistics of the moderating role of psychological contract breach in job satisfaction–citizenship behaviour

First and foremost, this study therefore found that the

low level of JCM among physicians working in the UE and

UW Regions of Ghana led them to show low discretionary

committed physician to show ETB. On another hand, a low-

PCB or a high psychological contract fulfilment strengthens

a committed physician to display ETB, which presents

patients. This result, therefore, lengthens the ACT, and

improves on the results of existing studies.

This study recommends that managers of health-care

organisations, particularly Ghana Health Service should

improve on their PC with physicians working in stress-

prone health zones, as it has the tendency to enhance JCM

of physicians and increase their tendency to show STB.

appreciate that, one of their key roles is to manage

they believe physicians should achieve, the competencies

they should possess, and the values they should uphold,

particularly at the time of employment, where promises and

the recruitment and induction stage when promises and

commitments are made by employers on such matters as

interesting work, learning and development opportunities,

unreasonable demands on employees, feedback on

performance, fair treatment, work/life balance, a reasonable

degree of security, and a safe working environment. This

paper is original, fresh and unique as it offers empirical

psychosocial stressor, on the relationship between JCM and

ETB by integrating and lengthening three critical theories,

The author declared no potential conflicts of interest

with respect to the research, authorship, and/or publication

of this article.

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