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ORIGINAL ARTICLE
Year : 2011  |  Volume : 20  |  Issue : 2  |  Page : 124-130  Table of Contents     

A study on factors of dissatisfaction and stress of the blacksmiths resulting from the organizational culture in the surgical instrument industry of India


1 Department of Physiology, Manipal College of Medical Sciences, Pokhara, Nepal
2 South Calcutta Girls' College, University of Calcutta, Kolkata, India
3 Occupational Ergonomics Laboratory, University College Science and Technology, University of Calcutta, Kolkata, West Bengal, India

Date of Web Publication16-Oct-2012

Correspondence Address:
Tirthankar Ghosh
Department of Physiology, Manipal College of Medical Sciences, P. B. 155, Deep Heights-16, Pokhara
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-6748.102513

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   Abstract 

Background: It is important to understand what motivates workers and the extent to which the organization and other contextual variables satisfy them. The aim of the study was to determine factors of dissatisfaction resulting from the organizational culture among the blacksmiths involved in the surgical instrument industry. Materials and Methods: Fifty male surgical blacksmiths each of the skilled and unskilled groups of the forging section were selected. Organizational Role Stress Scale was used to measure the individuals' role stress and several forms of conflict within an organization. Also, the organizational culture and personal involvement in an organization was measured among the surgical blacksmiths. Results: The mean score for total role stress for Skilled was 71.7 and for unskilled was 77.2. The most frequent type of organizational culture was reported to be hierarchy, both by skilled and unskilled surgical blacksmiths, followed by market and clan culture. Conclusion: This study shows that the skilled surgical blacksmiths have lower level of stress and conflicts in comparison with unskilled surgical blacksmiths. Both skilled and unskilled surgical blacksmiths estimated their level of personal involvement as low and indicated insufficient involvement in work teams. The satisfaction of the employees with their status and role in the organizational culture was also poor for both skilled and unskilled surgical blacksmiths.

Keywords: Blacksmiths, job pressure, low control, organizational culture


How to cite this article:
Ghosh T, Das B, Gangopadhyay S. A study on factors of dissatisfaction and stress of the blacksmiths resulting from the organizational culture in the surgical instrument industry of India. Ind Psychiatry J 2011;20:124-30

How to cite this URL:
Ghosh T, Das B, Gangopadhyay S. A study on factors of dissatisfaction and stress of the blacksmiths resulting from the organizational culture in the surgical instrument industry of India. Ind Psychiatry J [serial online] 2011 [cited 2020 Nov 27];20:124-30. Available from: https://www.industrialpsychiatry.org/text.asp?2011/20/2/124/102513

Schein [1] has given a definition of organizational culture that is as well applicable to professional culture: "The pattern of basic assumptions that a given group has invented, discovered, or developed in learning to cope with its problems of external adaptation and internal integration, and that have worked well enough to be considered valid, and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to these problems." Outside and inside pressures form a professional culture in a similar way to an organizational culture. There are, however, different forces at work coining either a professional or an organizational culture.

If culture is the "software of the mind", then the environment is the programmer. This can be organized into two lines: input criteria and process criteria. The inputs are labor, materials, and plant. The remainders are other costs.

It is important to understand what motivates workers (labor) and the extent to which the organization and other contextual variables satisfy them. Job dissatisfaction has frequently been cited as the primary reason for a high turnover of workers [2],[3],[4],[5] as well as increased rates of absenteeism [6] both of which impede efficiency and effectiveness, which in turn pose a threat to a healthcare organization's capacity to provide good care as well as meet the needs of patients. [7] Workplace attendance and absenteeism are of fundamental importance to industrialized society. Primarily, this appears most directly to affect those in the industry as a cost of production, yet lost productivity also affects the whole economy and society directly and indirectly. It adds to the cost, or may reduce the quality, of public and private goods and services. At the workplace, it may place additional burdens on employers and workers, especially at critically important times, or in key processes.

Work satisfaction is also an essential part of ensuring high-quality output. Dissatisfied providers not only give poor quality, less efficient output, [8] there is also evidence of a positive correlation between professional satisfaction and job outcomes. [4],[9],[10]

There is also compelling evidence of a positive relationship between job satisfaction and employee health. Blegen et al.,[11] demonstrated a strong negative association between work satisfaction and stress, while Grieshaber et al.,[12] showed that dissatisfaction led to increased stress and frustration, which resulted in physical, emotional and behavioral problems.

Manufacturing of surgical instruments is one of the successful small-scale industrial sectors in the 24 Parganas District of West Bengal, India. It has an enormous export potential. Manufacturers are now supplying their products to big dealers and exporters of Delhi, Mumbai, Jalandhar and often directly to overseas clients. Manual forging in the local blacksmithy units is the first step in the production chain. Blacksmiths forge the stainless steel components from rolled rounds, which are supplied by the instrument manufacturers. About 7,500 persons are directly or indirectly involved in forging of surgical products in Baruipur subdivision [Figure 1] and [Figure 2]. [13] Lately, however, some changes in this industry threaten their existence.
Figure 1: Skilled and unskilled blacksmiths at forging section

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Figure 2: Steps of making surgical instrument (Artery forceps)

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In view of increasing demands of cheaper products in Europe, United States and some developing countries renowned manufacturers have introduced a cheaper brand product as instruments made of 'Pakistani/Indian Steel'. These global operators are purchasing moderately cheap surgical instruments from the Indo-Pak subcontinent and marking them with their own brand names and attractive packing. The blacksmiths are unable to cope with this increased demand. The easiest solution would be to drop forging units to meet the increased demand. Sialkot Surgical Cluster of Pakistan is considered to be the leader of this industry in the subcontinent. A study on the Sialkot Surgical Cluster by Nadvi [14] shows that about 50% of large firms offload jobs for forging. So it is estimated that at least 50% of the large firms have installed power-forging units. It can also be assumed that some firms are offloading forging to power-forging units run by professional hands. This is the trend in the subcontinent. In that case the total blacksmith community comprising 10-12 villages in the 24 Parganas District will lose their jobs. It should also be noted that users outside the subcontinent prefer hand-forged instruments to power-forged ones.

The main aim of the study was to determine factors of dissatisfaction resulting from the organizational culture among the blacksmiths involved in the surgical instrument industry.


   Materials and Methods Top


Selection of subjects

In the present investigation, 50 male blacksmiths each of the skilled and unskilled groups of the forging section were selected. To avoid selection bias, all the workers were selected randomly from the Baruipur subdivision of West Bengal. In our random selection, we did not find any worker who had less than one-year experience.

Organizational role stress scale

Organizational role stress scale (ORSS) was used to measure individuals' role stress and several forms of conflict within an organization. The items on ORS were based on the organizational role stress scale constructed by Udai Pareek in 2004, who divided role stress into ten dimensions, namely: 1) Inter-role distance (IRD); 2) role stagnation (RS); 3) role expectation conflict (REC); 4) role erosion (RE); 5) role overload (RO); 6) role isolation (RI); 7) personal inadequacy (PI); 8) self-role distance (SRD); 9) role ambiguity; and 10) resource inadequacy (RIn).

Part one of the questionnaire consisted of demographic items: subjects were asked to identify themselves according to the department in which they work, their rank, length of service, employment position, gender, and age.

Part two consisted of ORSS which has 50 statements with a five-point Likert scale regarding role stress and anchored by: 'If you never or rarely feel that way', 'If you occasionally feel that way', 'If you sometimes feel that way', 'If you frequently feel that way', and 'If you always feel that way', respectively. The scores for each role stress dimension ranged from a minimum of 0 to a maximum of 20 and total scores ranged from 0 to 200, as the scale has ten dimensions and each dimension has five items.

Organizational culture

We used the validated questionnaire by Cameron and Quinn. [14] The type of organizational culture depends on whether an organization has a predominantly internal or external focus and whether it strives for flexibility and individuality or stability and control.

There are several types of organizational culture as follows: 1) clan - an organization that concentrates on internal maintenance with flexibility, concern for people, and sensitivity for customers; 2) hierarchy - an organization that concentrates on internal maintenance with a need for stability and control; 3) adhocracy - an organization that concentrates on external positioning with a high degree of flexibility and individuality; and 4) market - an organization that concentrates on external maintenance with a need for stability and control.

Participants were asked to respond to 24 statements on organizational culture. These were divided into six dimensions with four descriptive statements each. The dimensions included dominant characteristics, organizational leadership, management of employees, organizational glue, strategic emphases, and criteria of success. The respondents distributed 100 points across each dimension, to show the degree of their agreement with each of the statements.

Personal involvement in an organization

We made a derived variable "personal involvement," with the α coefficient of 0.782. Respondents were asked to rate the statements on a 5-point Likert-type scale, where 1 stands for "strongly disagree" and 5 stands for "strongly agree."

Statistical analysis

Anova and Mann Whitney Rank Sum Test were applied to analyze the collected datas on ORS and Organization Culture. Statistical analysis was performed using the statistical package PRIMER OF BIOSTATISTICS (Primer of Biostatistics 5.0.msi, Msi Version 1.20.1827.0, Primer for Windows, McGraw-Hill).


   Results Top


Surgical blacksmiths are divided into two classes, owner (skilled) of the Hearth (locally called Kamarshal) and daily wage laborers (unskilled). Average monthly income of an owner is Rs. 4000 and that of a laborer is Rs.1200. On an average they got married at the age of 20 and had two to three offspring. Some of them had a patch of land for cultivating seasonal vegetables for their own meals. Most of them were addicted to country Liquor, which increases the severity of their poverty. Manufacturers complain that if a blacksmith gets a thousand rupees in advance he would not report for work before squandering the entire amount on intoxicants. At the time of festivals people are involved in rustic drama or local horse-betting, forgetting delivery commitments. As a result their family often starves during festivals.

It has been observed that blacksmiths fail to keep their commitments because of absenteeism of daily-wage laborers. Daily-wage labors are engaged for heavy unskilled work in the forging units. These men frequently absent themselves from duty in order to work as agricultural laborers.

As a result they are averse to any kind of training and development. But when skilled workers were asked about their goals, a handful of them said that they would like to set fitting units to their blacksmithy units. This tendency to raise themselves to the next higher step of the supply chain indicates that a better working environment and uninterrupted production may motivate them to achieve social needs.

The general physical information of the surgical blacksmiths is presented in [Table 1]. The mean values of age and physical parameters (height, weight, of skilled and unskilled blacksmiths are shown in [Table 1]. The mean age of the skilled and unskilled blacksmiths was 40.4±6.38 years and 37.6±5.21 respectively. The body height of the skilled and unskilled blacksmiths was 168.16±11.23 and 166.32±10.13 respectively. The body weight of the skilled and unskilled blacksmiths was 59.9±9.90 and 57.9±8.70 respectively.
Table 1: General physical information of the workers

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The daily work schedule including the mean duration of work per day and rest as well as the number of working days in a week and number of absent days in a week is mainly presented in [Table 2]. It was observed that, both the groups of blacksmiths (skilled and unskilled) work six days in a week and the both groups worked 10.0 hrs per day and got 1.5 hrs rest per day. A significant (P=0.001) difference was found in the absenteeism per week among the skilled and unskilled blacksmiths. The unskilled blacksmiths (3.2±0.81 days/week) were more absent from their work then the skilled blacksmiths (2.1±1.01 days/week).
Table 2: Mean duration of work and rest per day with average number of working days in a week

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The mean score for total role stress for Skilled blacksmiths was 71.7 and for unskilled blacksmiths was 77.2. According to one-way ANOVA, there were significant differences in the means of IRD scores among the skilled and unskilled surgical blacksmiths [Table 3]. Total scores, RS, REC, RO, S/RC and RA in Unskilled Workers were different from the Skilled Workers.
Table 3: Comparison of role stress scores among surgical blacksmiths

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Skilled and unskilled surgical blacksmiths had significantly different scores on current culture type (P<0.001) for Adhocracy culture [Table 4]. The most frequent type of organizational culture was reported to be hierarchy, both by skilled and unskilled surgical blacksmiths, followed by market, clan culture, and adhocracy [Table 4].
Table 4: Organizational culture scores according to the personnel categories for the current and preferred situations

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There were no significant differences between skilled and unskilled surgical blacksmiths' scores on preferred culture type. Both skilled and unskilled surgical blacksmiths preferred clan culture and least preferred hierarchy and market culture [Table 4].

Skilled surgical blacksmiths preferred control organization (60.44±17.2) over flexible organization (39.54±10.4; P<0.001). In case of unskilled surgical blacksmiths, the difference in preferences between control organization (54.03±10.1) and flexible organization (45.81±8.6) was less pronounced, but still significant (P<0.001). There were significant differences between skilled and unskilled surgical blacksmiths in flexible organization and control organization, with unskilled surgical blacksmiths favoring flexible organization (F=17.368, P<0.001) and skilled surgical blacksmiths favoring control organization (F=18.614, P<0.001).

From the personal involvement respondents it was found that, the job of surgical blacksmiths partially satisfied them. There were significant differences between the skilled and unskilled surgical blacksmiths in two points. Unskilled surgical blacksmiths are less satisfied with their status and role in this job. They believed that, their suggestions and wishes regarding their development are not taken into account in all cases. They also felt, the changes or implementations in jobs are not done by consulting with them [Table 5].
Table 5: Personal involvement scores among surgical blacksmiths

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   Discussion Top


In can be said that at different levels surgical blacksmiths felt role stress. However, the findings of the present study may suggest that surgical blacksmiths face role stress possibly due to the new levels of complexity and diversity in their roles and responsibilities. This study also shows that the skilled surgical blacksmiths have lower level of stress and conflicts in comparison with unskilled surgical blacksmiths. Therefore, the higher range of role stress among unskilled surgical blacksmiths may be attributed to their expanded role, job pressure, and low control. The current organizational culture among surgical blacksmiths does not advocate the ability of individuals to develop and integrate. Inappropriate leadership could explain hierarchical organizational culture and perceived subordination of unskilled surgical blacksmiths by skilled surgical blacksmiths found in our study. Both skilled and unskilled surgical blacksmiths estimated their level of personal involvement as low and indicated insufficient involvement in work teams. The satisfaction of employees with their status and role in the organizational culture was also poor for both skilled and unskilled surgical blacksmiths.

It was observed from the previous study that work-related incidents affect different body parts of the blacksmiths. This has also led to a high rate of workday loss. A study found that, the unskilled blacksmiths are more affected than the skilled ones and unskilled blacksmiths are exposed to the highest number of injuries in this industry. [15]

The mean scores in this study show that higher role stress was experienced among surgical blacksmiths as compared to the norms reported by Cameron and Quinn. [16] Mean scores of RO, REC, IRD, RIn, RS, and RIs have been found to be relatively higher than the RA, PI, S/RC, and RE dimensions of role stress.

Role overload describes situations in which workers feel that there are too many responsibilities or activities expected of them in respect to their available time and abilities. [17],[18],[19] This was the case in this study, where a high level of role overload was found among surgical blacksmiths.

Role-expectation conflict was the second major role-related problem among surgical blacksmiths. This means they do experience conflicting demands from their colleagues and superiors [20] The high level of inter-role distance found among workers may show that surgical blacksmiths feel stressed due to the many roles they perform, which may lead to strain.

Resource inadequacy was also found to be at a significantly high level among surgical blacksmiths. They seem to be more efficient in their organization if they have the autonomy to select tasks and have adequate facilities available to do their job as well as having opportunities to learn new skills. [20] A high level of role stagnation among surgical blacksmiths was also found. This demonstrates that they feel stress due to covering similar professional roles and dealing with similar type of challenges in daily work. [20],[21],[22]

The gap between desired and existing linkage will indicate the amount of distance between two roles. [20] This was the case in this study for surgical blacksmiths.

Personal inadequacy was also found to be relatively high. This form of role stress takes place when individuals feel they are not adequately skillful, competent and trained to meet the demands of their role. Feeling of personal inadequacy is quite usual among unskilled surgical blacksmiths compared to skilled surgical blacksmiths.

Inter-role distance is a conflict between self-concept and expectations and the role as perceived by the role occupants. In the present study, inter-role distance was found to be high. It could be argued that if surgical blacksmiths had the autonomy to take decisions for different activities and tasks, they would be doing something different than what they currently do.

The ANOVA analyses showed significant differences in the mean ORSS scores among the surgical blacksmiths, which imply differences in work level and educational programs, and that role stress is felt at different levels. However, the findings of the present study may suggest that surgical blacksmiths face role stress possibly due to new levels of complexity and diversity in their roles and responsibilities. In other words, sources of stress are possibly due to working in a broader and more complex field (increasing demands of cheaper products in Europe, United States), more responsibilities with insufficient autonomy, and dealing with the many challenges.

The ANOVA analyses show significant differences in the mean ORSS scores of the grand total and dimensions of IRD, RS, REC, RO, SRC, and RA among skilled and unskilled surgical blacksmiths. It is obvious that according to the variety of skills, the roles of the workers are different. The results show that the skilled surgical blacksmiths have a lower level of stress and conflicts in comparison with unskilled surgical blacksmiths. Therefore, the higher range of role stress among unskilled surgical blacksmiths may be attributed to their expanded role, job pressure, and low control, [23] over the task in an unhygienic working environment. These unskilled workers are highly stressed in their occupation.

Our study examined the relationship between skilled and unskilled surgical blacksmiths in terms of their perception of organizational culture. We found out that skilled and unskilled surgical blacksmiths comprehend the subordination of unskilled surgical blacksmiths differently. Unskilled surgical blacksmiths felt subordinated by skilled surgical blacksmiths and perceived them as a group responsible for creating hierarchical relationships between team members.

This study showed that skilled and unskilled surgical blacksmiths favored the culture of internal focus, stability, and control. This culture does not encourage personal involvement and flexibility, as it is predominately marked by the need for stability, reliability, efficiency, and low costs. Market culture was the second most dominant culture type for both personnel categories. It is characterized by external focus, but still stems from control, efficiency, and productivity, and is marked by a tense atmosphere, central decision-making, competitiveness, and result orientation. Apparently, skilled and unskilled surgical blacksmiths tend not to favor clan and adhocracy cultures, which are essential for future development, teamwork, and innovation. The current organizational culture in surgical blacksmiths does not advocate the ability of individuals to develop and integrate.

We can, therefore, claim that such an organizational culture lacks external focus in terms of integration, comparability, competitiveness, innovation, and communication. Hierarchy and market culture are the two cultures that will not improve the quality of work at the individual, team, organizational, and system levels. Market and hierarchy cultures have been shown to correlate with resistance to change and personal involvement. [24],[25] Inappropriate leadership could explain the hierarchical organizational culture and perceived subordination of unskilled surgical blacksmiths by skilled surgical blacksmiths found in our study.

The results for the derived variable personal involvement and the results for the statements used to establish this variable are not encouraging. Both skilled and unskilled surgical blacksmiths estimated their level of personal involvement as low and indicated insufficient involvement in work teams. This means that surgical blacksmiths are not able to take advantage of their skill, experience and enormous export potential. The satisfaction of employees with their status and role in the organizational culture was also poor for both skilled and unskilled surgical blacksmiths.

The results of organizational culture and personal involvement indicate that work may act as stressors for individuals, since surgical work has shown enormous export potential. Furthermore, there is a lack of support for individual work and teamwork, employee growth, participation in decision-making, and trust in the employees and their respective tasks. Gollan [26] discovered that high-quality communication and consultation between management and employees at the workplace was essential for achieving effective management, improved organizational performance and sustainable outcomes for organizations and employees. Our research showed that a control-oriented organizational culture did not create conditions in which employees can receive social support from leaders regarding their professional work.

 
   References Top

1.Schein E. Organizational Culture and Leadership. San Francisco: Jossey-Bass; 1985.  Back to cited text no. 1
    
2.Lambert EG, Hogan N, Barton SM. The impact of job satisfaction on turnover intent: A test of a structural measurement model using a national sample of workers. Soc Sci J 2001;38:233-50.  Back to cited text no. 2
    
3.Larabee JH, Janney MA, Ostrow CL, Witbrow ML, Hobbs GR Jr, Burant. C. Predicting registered nurses job satisfaction and intent to leave. J Nurs Adm 2003;33:271-83.  Back to cited text no. 3
    
4.Tzeng HM. The influence of nurses' working motivation and job satisfaction on intention to quit an empirical investigation in Taiwan. Int J Nur Stud 2002;39:867-78.  Back to cited text no. 4
[PUBMED]    
5.Yin JC, Yang KP. Nursing turnover in Taiwan: A meta-analysis of related factors. Int J Nurs Stud 2002;39:573-81.  Back to cited text no. 5
[PUBMED]    
6.Siu OL. Predictors of job satisfaction and absenteeism in two samples of Hong Kong nurses. J Adv Nurs 2002;40:218-29.  Back to cited text no. 6
[PUBMED]    
7.Tai T, Barne S, Robinsin C. Research of nursing turnover research. Soc Sci Med 1998;12:1905-24.  Back to cited text no. 7
    
8.Grol R, Lawrence M. Quality Improvement by Peer Review. London: Oxford University Press; 1995.  Back to cited text no. 8
    
9.Leiter M, Harvie P, Frizzell C. The correspondence of patient satisfaction and nurse burnout. Soc Sci Med 1998;47:1611-7.  Back to cited text no. 9
    
10.Linn LS, Brook RH, Clark VA, Davies AR, Fink A, Kosecoff J. Physician and patient satisfaction as factors related to organization of internal medicine group practices. Med Care 1985;23:1171-8.  Back to cited text no. 10
[PUBMED]    
11.Blegen MA, Mueller CW. Nurses' job satisfaction: A longitudinal analysis. Res Nurs Health 1987;10:227-37.  Back to cited text no. 11
[PUBMED]    
12.Grieshaber LD, Parker P, Deering J. Job satisfaction of nursing assistants in long-term care. Health Care Superv 1995;13:18-28.  Back to cited text no. 12
[PUBMED]    
13.Roy SK. Diagnostic study report on surgical cluster at Baruipur, 24 Parganas (S): Small Industries Service Institute: West Bengal, Kolkata; 2003.  Back to cited text no. 13
    
14.Nadvi K. Collective Efficiency and Collective Failure: The Response of Sialkot Surgical Instrument Cluster to Global Quality Pressure. World Dev 1999;27:1605-26.  Back to cited text no. 14
    
15.Gangopadhyay S, Ghosh T, Das T, Ghoshal G, Das B. Impact of injuries on work performance among the surgical blacksmiths of West Bengal. Int J Inj Contr Saf Promot 2007;14:85-92.  Back to cited text no. 15
[PUBMED]    
16.Cameron KS, Quinn RE. Diagnosing and changing organizational culture based on the competing values framework. Reading (MA): Addison-Wesley; 1999.  Back to cited text no. 16
    
17.Pareek U. The Role. In Training instruments in Human Resource Development and Organisational Development. In: Pareek U, editor. New Delhi: Tata McGraw-Hill; 2005.  Back to cited text no. 17
    
18.Fisher S. Stress in academic life: The mental assembly line. Buckingham: Society for Research into Higher Education and the Open University Press; 1994.  Back to cited text no. 18
    
19.Rizzo RJ, House JR, Lirtzman IS. Role conflict and ambiguity in complex organisation. Adm Sci Q 1970;15:150-63.  Back to cited text no. 19
    
20.Azeem SM, Pestonjee DM. A Study of Organizational Role Stress in relation to Job Burnout among University Teachers. IIMA Working Papers: Ahmedabad, IIMA Research and Publication Department; 2001.  Back to cited text no. 20
    
21.Gmelch HW, Wilke KP, Lovrich PN. Dimensions of stress among university faculty: Factor-analytic results from a national study. Res Higher Educ 1986;24:266-86.  Back to cited text no. 21
    
22.Narayanan L, Menon S, Spector PE. Stress in the workplace: A comparison of gender and occupation. J Organ Behav 1999;20:63-73.  Back to cited text no. 22
    
23.Basu J, Gangopadhyay S, Ghosh T, Ghoshal G, Das T. A Study on Work-Stress and Factors of Dissatisfaction of the Blacksmiths Resulting due to the Difference in Technology Level with the Upper Links of the Production Chain in Surgical Instrument Industry of West Bengal. Humanizing Work and Work Environment (HWWE 2005), International Ergonomics Conference, Indian Institute of Technology, Guwahati, Assam. In: Chakrabarti D, Das A, editors. India: Allied Publishers Private Limited; 2006. p. 518-25.   Back to cited text no. 23
    
24.Jones KR, Redman RW. Organizational culture and work redesign: Experiences in three organizations. J Nurs Adm 2000;30:604-10.  Back to cited text no. 24
[PUBMED]    
25.Ferlie EB, Shortell SM. Improving the quality of health care in the United Kingdom and the United States: A framework for change. Milbank Q 2001;79:281-315.  Back to cited text no. 25
[PUBMED]    
26.Gollan PJ. High involvement management and human resource line sustainability. Handb Bus Strategy 2006;7:279-86.  Back to cited text no. 26
    


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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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