• Terje Slåtten, Gudbrand Lien, and Peer Jacob Svenkerud.
• Inland Norway University of Applied Sciences Campus Lillehammer, 2604, Lillehammer, Norway. Terje.Slatten@inn.no.
• Bmc Health Serv Res. 2019 May 14; 19 (1): 307.

BackgroundHospitals need to understand how to reduce their frontline employees' turnover rate as well as how to positively engage them and improve their service. Central to these issues, we find, is the employees' perception of their organization's attractiveness. This objective of this paper is to clarify how the role of organizational attractiveness relates to frontline employees' perception of their internal market-oriented culture as well as their turnover rate, engagement, and service quality. To our knowledge, no previous research has explored the role of organizational attractiveness from a frontline employee perspective in health-service organizations.MethodsThe conceptual framework we developed was tested in a quantitative study. We sent a questionnaire to nurses in several public hospitals in Norway. We then analyzed the data with confirmatory factor analysis and structural equation modeling in Stata. Further, we performed multi-group comparisons to test heterogeneity in personal characteristics. The indirect effects were tested by mediator analyses.ResultsWe made three main findings. First, organizational attractiveness has a significant positive effect on frontline employees' engagement (β = 0.833) as well as on the service quality they provide to hospital patients (β = 0.472). Additionally, it significantly lowers their turnover rate (β = - 0.729). Second, the 'internal market-oriented culture' (IMOC) has a significantly positive effect on organizational attractiveness (β = 0.587) and explains a total of 35% of the variance in organizational attractiveness. Third, organizational attractiveness fully mediates the relationship between "internal market-oriented culture" (IMOC) and frontline employees' engagement and the service quality they provide to patients, and it partially mediates the relationship with the turnover rate.ConclusionsThis study proves that organizational attractiveness is vital for hospital managers to focus on, as it affects employees' perception of whether the organizations is a great place to work. It reveals the need for those same managers to develop an internal market-oriented culture (IMOC) directed toward hospital frontline employees, as it has both a direct effect on organizational attractiveness and an indirect effect on employees' engagement, turnover intention, and service quality.

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