Topic: Organization-Employee Relationships

Author(s), Title and Publication

Seltzer, T., Gardner, E., Bichard, S., & Callison, C. (2012). PR in the ER: Managing internal organization–public relationships in a hospital emergency department. Public Relations Review, 38(1), 128-136.


Focusing on a university-affiliated emergency department (ED), this study investigated the antecedents and outcomes of organization-employee relationships, and the cultivation strategies (symmetrical vs. asymmetrical) used to manage the relationships. The relationship was assessed based on four dimensions: trust, control mutuality, commitment, and satisfaction. Trust is about whether an organization does what it says it will do, and whether it follows through on promises. Control mutuality refers to the degree to which parties in the relationship agree on who has the power to influence the relationship. Commitment is an employee’s emotional attachment, loyalty to the organization, and willingness to contribute to the organization. Satisfaction refers to the extent to which parties believe the benefits of staying in the relationship outweigh the costs of leaving the relationship.

In this case study, the ED studied had a history of struggling with communication issues among its staff and between staff and patients. The researchers interviewed six members of the ED’s dominant coalition, conducted focus groups with 53 employees, and carried out field observations (e.g., shadowing ED staff).

Results indicated that the significant barriers to effective communication within the ED included: high volume of patients, fast pace, bullying behavior among the staff, and organizational policies (e.g., a lack of centralized internal communication and public relations expertise, unfamiliarity among the staff, and computerized patient management system). The ED relied on asymmetrical cultivation strategies (e.g., little access to decision-making process, top-down communication style, and employees’ perceptions of being out of the team). These strategies resulted in poor organization-employee relationships, such as the lack of trust between nurses and physicians or administrators; low commitment levels; the exclusion of employees from decision-making processes; and low job satisfaction among nurses. The unfavorable internal relationships in turn fostered cynical and skeptical attitudes, non-compliant behavior, and a toxic culture. Despite the overall negative environment, the ED began applying some symmetrical cultivation strategies by implementing a new communication-training program (e.g., use of opinion leaders), which fostered positive relationship perceptions among some employees.

Implications for Practice

Managers interested in improving internal relationships might want to 1) apply two-way symmetrical communication and provide employees with feedback opportunities, 2) establish centralized and coordinated internal communication, and 3) swiftly deal with disgruntled employees by seeking mutual understanding or removing the problem.

Location of Article

The article is available online at: (abstract free, purchase full article)


Heidy Modarelli handles Growth & Marketing for IPR. She has previously written for Entrepreneur, TechCrunch, The Next Web, and VentureBeat.
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