Through the eyes of the involved: the extent to which different types of influence shape public employed frontline professionals’ perception of involvement in organizational decision-making

ABSTRACT

This article offers a theoretical model on how frontline professionals form their perception of being involved in organizational decision-making by balancing perceived benefits and transaction costs of increased influence. The model suggests that frontline professionals find consultation most beneficial for decisions that are distal from their daily work tasks and prefer joint decision-making for decisions that are proximal to their daily work tasks. Results from a survey experiment with more than 600 public employed junior physicians reveal that, regardless of the proximity of the organizational decision, they perceive consultation as the most beneficial form of influence in organizational decision-making.

KEYWORDS:

• Employee involvement
• employee influence
• organizational decision-making
• survey experiment

Recently, we have seen the emergence of new governance paradigms in the public sector, such as Internal Learning Regimes (e.g., Jakobsen et al. 2018; van Loon and Jakobsen 2018) and New Public Governance (e.g., Osborne 2006; Torfing et al. 2020). In both types of paradigms, the direct involvement of public employed frontline professionals in organizational decision-making is seen as a key component to ultimately improve the delivery of public services (Ansell, Sørensen, and Torfing 2017; Crosby, Hart, and Torfing 2017; Jakobsen et al. 2018, Moynihan et al. 2020; Livingstone 2022; Torfing et al. 2020; van Loon and Jakobsen 2022). Frontline professionals are frontline employees such as teachers, nurses, caseworkers, police officers and physicians who, through their education and work, have acquired some level of specialized theoretical knowledge (e.g., Andersen and Holm Pedersen 2012; Cecchini and Sommer Harrits 2022).

However, it is not given that direct involvement of these frontline professionals in organizational decision-making in the public sector yields positive results. On the one hand, involving professionalized employees directly in organizational decision-making allows managers and employees to share information and knowledge, which should result in better organizational decisions and improved employee outcomes (e.g., Andrews et al. 2007; Jakobsen et al. 2018; Kim 2002, 2005; Kim and Wright 2007; Staniok 2017; Wang and Yang 2015; Wright and Kim 2004). On the other hand, directly involving frontline professionals in organizational decision-making might lead to conflict and sub-optimal decisions (e.g., Destler 2017; Jung and Ritz 2014; Pasha 2018; van Loon and Jakobsen 2022; Wang and Yang 2015). This is also apparent in the generic management literature where employee involvement has been investigated for many decades (Heller 2003; Heller et al. 1998; Wagner 1994). It seems that whether positive or negative results materialize depends on different situational and contextual factors and, naturally, there is an interest in unveiling under which conditions the positive and negative effects from directly involving frontline professionals in organizational decision-making in the public sector materialize (e.g., Grissom 2012; Somech 2010; Wagner and Gooding 1987; Wang and Yang 2015).

To improve our knowledge in this regard, this article builds on two important notions. The first notion is that public frontline employees’ perception of the interventions and decisions by managers is crucial to their general motivation and for organizational performance (e.g., Frey and Jegen 2001; Jacobsen and Bøgh Andersen 2014; Jacobsen, Hvidtved, and Bøgh Andersen 2014; Mikkelsen, Bøtcher Jacobsen, and Bøgh Andersen 2017; Pedersen et al. 2018). In continuation hereof, it is very plausible that the public frontline professionals’ perception of the involvement process might be central in determining whether positive or negative consequences materialize. Thus, an essential step in the endeavour to unveil under which conditions the positive and negative effects of involving frontline professionals in organizational decision-making in the public sector materialize, is to understand what shapes their perception of the involvement process. This leads to the second notion, which is that more direct influence on organizational decision-making is not necessarily something that frontline professionals perceive as beneficial (e.g., Grissom 2012; Petter et al. 2002; Somech 2010). Combined, these notions point towards the importance of understanding how the level of influence offered to frontline professionals in involvement processes, shapes their perception of the involvement process.

Within the framework of bounded rationality (e.g., Simon 1997) this article develops a theoretical model to explain how public frontline employees’ perception of the involvement process is shaped by their perception of whether the benefits of influence outweigh the costs in relation to different organizational decisions. Thus, the article takes the potential costs that come from higher levels of influence, such as time and conflict, seriously when considering how the level of influence shapes frontline professionals’ perception of the involvement process.

More specifically, this article argues that when the organizational decision is proximal to the daily work tasks of the frontline professionals, they will perceive a level of influence that corresponds to joint decision-making as most beneficial. However, when the organizational decision is distal to the daily work tasks, the frontline professionals will perceive influence that corresponds to consultation as most beneficial. The expectations are tested in a survey experiment among more than 600 public employed junior physicians. The results reveal that the junior physicians perceive consultation to be more beneficial than joint decision-making, regardless of whether it is a proximal or distal organizational decision. This indicates that the junior physicians perceive the costs of joint decision-making to outweigh the benefits regardless of the type of decision.

By looking at employee involvement through the eyes of the involved – the frontline professionals – this article's primary contribution is to develop a theoretical model that explains how frontline professionals in the public sector balance expected costs and benefits of influence on organizational decisions, to shape their perception of the involvement process. By taking the costs seriously, the key insight from this model is that frontline professionals do not automatically perceive more influence as more beneficial. The article furthermore offers a first empirical test of the model, which finds that consultation is what junior physicians perceive as the most beneficial level of influence when it comes to direct involvement in organizational decision-making, regardless of the type of decision. Taken together, this has implications for future studies investigating the impact of involving frontline professionals in organizational decision-making in the public sector, in the sense that they should distinguish between whether the frontline professionals are consulted or whether they are to engage in joint decision-making with management.

Theoretical framework

Organizational decision-making directly affects what the organization does and how it does it (March and Simon 1993; Simon 1997). Organizational decisions include—but are not limited to—the formulation of organizational strategy or the vision of the organization, setting and prioritizing organizational goals, and deciding on the structure of work processes in the organization. These decisions are all central in public organizations and affect how public employees are able to make individual-level decisions and carry out their daily work, which ultimately affects the organization’s ability to deliver services to the public (see for instance, Jung 2018; March and Simon 1993; Simon 1997). The general idea of employees being directly involved in, or directly participating in, organizational decision-making has been labelled many different things with involvement and participation being only a few of these (e.g., Heller 2003; Yukl 2006). However, as argued by Heller (2003), these terms can be quite ambiguous, and the focus should be on the influence that employees have when directly involved in organizational decision-making.

One way of understanding employee influence in organizational decision-making is as a continuum ranging from ‘no influence’ to ‘joint decision-making’ (e.g., Petersen 2021, 430, based on; Yukl 2006). ‘no influence’ denotes a situation where the manager makes a decision without the employees having any influence. This is what is sometimes referred to as autocratic decision-making (Petersen 2021, 430; Yukl 2006). ‘Joint decision-making’ denotes a situation where the decision ‘requires consent from both sides’, meaning that the employees have the same amount of influence on the decision as the manager (Petersen 2021, 430; Yukl 2006). Thus, joint decision-making requires deliberation between managers and the employees involved in decision-making to be able to arrive at a decision where there is consent from both sides. In between these two ends is ‘consultation’, which ‘[…] means that management listens to employees’ suggestions and may even seek their ideas; nevertheless, management retains the right to make the final decision’ (Heller et al. 1998, 18). As such, consultation is an involvement practice often initiated by managers to draw on information and knowledge from employees to inform the decision of the manager.¹

Frontline professionals’ benefits from being directly involved in organizational decision-making

The question in this article is what level of influence frontline employees in the public sector perceive as most beneficial. The notion that frontline employees in the public sector might see benefits from directly influencing organizational decisions can be linked to the fact that many public employees are professionals (e.g.,Andersen and Holm Pedersen 2012; Andersen and Jakobsen 2016; Cecchini and Sommer Harrits 2022; Freidson 2001; van Loon et al. 2018).

There are many different theoretical approaches when it comes to understanding the role of professions. Three prominent approaches are the neo-Weberian approach, the functionalist approach and the system of professions approach. All three approaches emphasize that professionals have discretion in their work due to their specialized theoretical knowledge and their practical knowledge, which they have acquired through their work and their education (e.g., Abbott 1988; Andersen and Holm Pedersen 2012; Cecchini and Sommer Harrits 2022).

However, the three approaches differ in terms of what they argue primarily motivate professionals. The neo-Weberian approach to professionalism argues that professionals are collectively self-interested and try to further and protect the strength and influence of the profession, aiming to maximize the power, status and wealth of the profession and control the market for their services (e.g. Andersen and Holm Pedersen 2012; Collins 1990). The functionalist approach, on the other hand, argues that professionals are altruistic and that their norms drive them to do good for their clients and society (e.g., Andersen and Holm Pedersen 2012; Freidson 2001). Finally, the systems of professions approach argue that professionals are motivated by a desire to uphold and expand jurisdiction over their domain of expertise and to do so they compete with other professions for this jurisdiction (Abbott 1988).

Modern views on professions argue that different approaches to professions and the motives of professionals should be viewed as complementary (e.g. Andersen and Holm Pedersen 2012). That is, frontline professionals are interested in being able to strengthen and protect the power and influence of their own profession, while also being interested in shaping the organizational environment in a way that makes it easier for them to adhere to the norms of their profession. This can either be for altruistic reasons and with the aim to do good for their clients and society, or for the benefit of the profession in a market-oriented sense, or in contrast to other professions.

By gaining influence on organizational decisions, frontline professionals can shape what the organization does and how it does it. No matter whether their motives are collective self-interest, altruistic or focused on expanding their jurisdiction over areas of expertise, more influence on organizational decisions enables the frontline professionals to affect the organizational decisions so that what the organization does and how it does it, is more aligned with the views and norms of the profession. Thus, we might expect that frontline professionals see higher levels of direct influence on organizational decisions as beneficial.

Frontline professionals’ transaction costs from being directly involved in organizational decision-making

However, being directly involved in organizational decision-making is not free; there are transaction costs linked to the level of influence for the frontline professionals who are to be involved. Transaction costs is a broad concept and include, among other things, ‘costs tied to deciding, planning, arranging and negotiating the actions to be taken […] [and] any losses resulting from inefficient group decisions, plans, arrangements or agreements’ (Milgrom and Roberts 1990, 60–61; see also Coase 1937; Williamson 1975; Williamson 1985). The transaction costs tied to influence on organizational decision-making can be linked to time, conflict, and blame. At lower levels of influence, these transaction costs for the frontline professionals are relatively small. Being asked to provide input to a decision does not require much effort or extra work other than attending a meeting where information can be conveyed to the manager, while the potential for conflict and blame is low when the influence is only to provide input. Thus, if the level of influence is within the domain of consultation, the transaction costs are relatively low. However, when the level of influence rises and comes closer to the domain of joint decision-making, the transaction costs increase sharply.

When the level of influence approaches the domain of joint decision-making, which ‘requires consent from both sides’ (Petersen 2021, 430; Yukl 2006), it first requires some level of deliberation and discussion between manager and frontline professionals, which naturally necessitates time and attention. Thus, the frontline professionals must shift their attention and time from something else and use it on the decision-making process. Considering that they still must perform day-to-day tasks, they will have to shift their attention away from these tasks and use their time on something else than their own work. Engaging in joint decision-making thus increases the total workload of the frontline professionals, which is the employees’ total work obligations and expectations (Lipsky 1980; Roe and Zijlstra 2000; van Loon and Jakobsen 2018, 438).

Second, when the level of influence approaches joint decision-making, it increases the potential for conflict in the organization because more individuals with potential diverging opinions about the decision must agree on the decision (Destler 2017; March and Simon 1993). More influence might not only expose conflict between manager and frontline professionals but potentially also between different fractions of the frontline professionals, complicating the decision-making process further, which again can affect the relationship between the frontline professionals in the organization (Destler 2017).

Third, even though the formal responsibility of organizational decision-making is always that of the manager, influence approaching joint decision-making can also potentially put some informal responsibility on the frontline professionals. In that way, offering more influence to the frontline professionals can be seen as a co-optation strategy from management where the frontline professionals gain responsibility in exchange for backing up the decision (March and Simon 1993, 73; see also Selznick 1949). Thus, the potential for being blamed for being part of a decision-making process that could ultimately yield some negative outcome, seen from the perspective of a principal further up in the organizational hierarchy, is also a potential transaction cost for the frontline professionals. That is, it could ultimately harm the frontline professionals’ status in the organization.

Balancing perceived costs and benefits under bounded rationality

There are two mechanisms at play here: the frontline professionals’ interest in the potential benefits that come with having more influence over organizational decisions and the potential transaction costs of having more influence. The question is then how the frontline professionals balance these benefits and costs when forming their perception about the involvement process, given their motives that is argued here to consist of both altruistic and self-serving elements (Abbott 1988; Andersen and Holm Pedersen 2012; Freidson 2001). To formulate expectations about how they form their perceptions, the article draw on the theoretical lens of bounded rationality. That is, even though the frontline professionals are intentionally rational, they lack full information about how they can find the optimal level of influence compared to the costs associated with more influence (e.g., Simon 1997) which have a number of implications for the expectation about how the frontline professionals form their perception.

First, the frontline professionals will not try to reach an optimal level of influence but a level that they find satisfying and sufficient (e.g., Simon 1997). In relation to this, rather than being concerned with the degrees of influence, the frontline professionals might be more concerned with whether they are not involved, whether they are consulted, or whether they are to engage in joint decision-making. That is, they will think in types of influence instead of levels or degrees of influence. Second, they might use the type of decision that they are to be involved in as a heuristic to decide how large potential transaction costs they are prepared to accept in relation to the level of influence they can get. Following Simon (1997, 205), employees might be most interested in being involved in organizational decisions that affect them directly and less so in those that are not as clearly linked to their day-to-day activities. Organizational decisions can generally be divided into distal and proximal decisions. Proximal decisions are decisions related to employees’ immediate conditions for performing the job (e.g., Jønsson 2008, 597), which could be work performance and organization (Jeppesen, Jønsson, and Shevlin 2011, 71). Distal decisions are decisions related to employees’ distal organizational environment (e.g. Jønsson 2008, 597), which could be economic and development strategies (Jeppesen, Jønsson, and Shevlin 2011, 71). Thus, the frontline professionals can use whether the decision is proximal or distal as a heuristic, in terms of at what level of influence they perceive the marginal benefits of influence to outweigh the transaction costs.

Distal decisions are thus strategic organizational decisions concerned with what the organization is supposed to do, while the proximal decisions are operational organizational decisions about how the organization is supposed to do it. Considering that frontline professionals are ultimately interested in affecting the working conditions for their profession – for the good of society and their clients and/or the profession – they might perceive that influence on proximal decisions creates more benefit for them than is the case with distal decisions because distal decisions are more indirectly linked to their day-to-day work tasks. Thus, we might expect that they will see many benefits from gaining an initial level of influence on both types of decisions, albeit the marginal benefits will be decreasing. However, it is expected that the initial slope is much steeper for the perceived benefits of a proximal decision than that of a distal decision. Figure 1 summarizes the theoretical expectations graphically.

Figure 1. Theoretical model.

Note: From left to right, the vertical dotted lines denote where the level of influence moves from no involvement into the domain of consultation and from consultation into the domain of joint decision-making.

As can be seen from the figure, the perceived marginal transaction costs from more influence are expected to increase rapidly when the level of influence approaches a point that might be characterized as joint decision-making. Furthermore, the perceived marginal benefit of more influence, depicted in the figure as the willingness to accept higher transaction costs, is expected to rise rapidly in the beginning for both proximal and distal decisions but then wears off, as the level of influence increases. However, the perceived marginal benefit of being involved in proximal decisions is expected to rise more rapidly in the beginning than the perceived marginal benefit of being involved in distal decisions cf. the above argumentation.

In Figure 1, the point a denotes the frontline professionals’ theoretical optimal level of influence on distal organizational decisions, considering the costs. However, when considering the bounded rationality of individuals and their tendency to satisfice instead of optimize (e.g., Simon 1997), it is expected that they will prefer some level of influence within the area denoted with A. In this area, they can influence the distal organizational decision trough consultation without the transaction costs outweighing the perceived benefits. Here, they use the heuristic that it is a distal decision where they might not gain as much benefit from more influence considering the costs. Further, they use the heuristic that consultation, all things equal, is less costly than joint decision-making to form the perception that consultation is the most beneficial level of influence when it comes to distal organizational decisions. That is, the model does not expect the frontline professionals to be able to calculate the optimal level of influence nor to be able to have a clear understanding of the actual costs and benefits. However, it serves as a visual aid to understand the theoretical points; even though we might theoretically think in degrees of influence, costs and benefits, the frontline professionals do not in reality due to their bounded rationality.

The point b denotes the frontline professionals’ optimal level of influence on proximal organizational decisions, considering the costs. Again, considering the bounded rationality of individuals and their tendency to satisfice instead of optimize (e.g., Simon 1997), it is expected that they will prefer some level of influence within the area denoted with B. In this area, they can influence the proximal organizational decision through joint decision-making without the transaction costs outweighing the perceived benefits. Here, they use the heuristic that it is a proximal decision where they might perceive to gain more from having more influence considering the costs compared to a distal decision. Further, they use the heuristic that even though it is more costly, joint decision-making also gives them more influence, and they will be prepared to accept these costs, which form the perception that joint decision-making is the most beneficial level of influence when it comes to proximal organizational decisions.

Thus, even though theoretically we might think of influence as a continuum, the bounded rationality of individuals means that the frontline professionals will think in types of influence and use this as a heuristic when they form their perception of how beneficial the type of influence will be, given the type of decision. With the above in mind, the following hypotheses can be formulated:

H1:

Frontline professionals perceive some level of direct influence (consultation or joint decision-making) to be more beneficial than no influence, no matter the type of organizational decision.

H2:

Frontline professionals perceive consultation as more beneficial than joint decision-making when the organizational decision is distal to their daily work tasks.

H3:

Frontline professionals perceive joint decision-making as more beneficial than consultation when the organizational decision is proximal to their daily work tasks.

Research design and data

Considering the causal expectations formulated in this article, the hypotheses were tested using a between-subject vignette survey experiment, making it possible to randomly assign different treatments to the respondents and thus investigate the causal effect of the level of influence in relation to proximal and distal decisions on frontline professionals’ perception of the involvement process. The survey experiment was embedded in a large survey distributed to the population of 14,975 junior physicians, who are part of the union for junior physicians in Denmark, which is called “Danish Junior Doctors Association”, and 3684 of the junior physicians responded to the survey (see Hansen, Siboni Lund, and Bøtcher Jacobsen 2022 for data rapport). Of the 3684 responding to the survey, 916 (approximately 25%) were randomly invited to the experiment, and 603 completed it, meaning that the response rate for those invited into the experiment was 65.83%.

Junior physicians encompass physicians who have obtained their postgraduate degree in medicine and are either in the process of furthering their knowledge within a medical speciality or have already completed their education within a specific medical speciality. As such, some junior physicians move around to different hospitals and clinics as part of the process of furthering their knowledge within a medical speciality. Furthermore, junior physicians are usually managed by someone who is also a physician – at a hospital, this would be a clinical director or a managing chief physician.

The reason for choosing junior physicians is that they are frontline professionals who work in organizations that solve complex tasks where managers must make different types of organizational decisions that ultimately affect the way the physicians can deliver services to patients. Due to the nature of delivering healthcare services, organizational decision-making within healthcare is furthermore permeated with uncertainty and complexity, which means that the managers on a regular basis might involve frontline professionals in decision-making to gain information and knowledge from them (Jakobsen et al. 2018; Moynihan, Bækgaard, and Mads 2020). Junior physicians generally have very strong professional norms and specialized and theoretical knowledge, which only resides within this particular profession (Andersen and Holm Pedersen 2012). This implies that they can be expected to have an interest in having influence on organizational decisions which could be driven by different motives. That is, they could be interested in more influence in organizational decisions so that they can shape these for the benefits of their patients, and/or they could be interested in more influence in organizational decisions to increase the professions power and jurisdiction in the organizational context.

The single focus of the article on junior physicians naturally limits the certainty of which the results can be inferred to other types of frontline professionals, and as further discussed in the discussion section, future studies should aim to replicate this study in other contexts.

In the sample that completed the experiment, 67% are female, the respondents are on average 36.85 years old, 62% have leader ambitions and 81% work at a hospital. The sample characteristics of those who completed the experiment are not statistically different from those in the sample who was not invited to the experiment. The comparison can be seen in Table A1 in the Appendix. In terms of gender and age, the sample characteristics of those who completed the experiment also closely correspond to the full population of junior physicians in Denmark when it comes to gender and age, where the proportion of women is 64.5% and the mean age is 37 (Hansen et al. 2023).

The survey experiment

A 3 × 2 vignette experiment was designed where the respondents were presented with a fictional upcoming decision in their organization. It varied along the two theoretical dimensions: 1) type of influence in the decision-making process, and 2) the type of decision. Following the theoretical dimensions, the influence dimension varied depending on whether the frontline professionals are not to be involved by the manager in the upcoming decision (no influence), whether they are to be consulted by the manager (consultation), or whether the manager is to make a decision together with the frontline professionals (joint decision-making). In terms of the type of decision, it varied depending on whether the decision is focused on deciding on the overall vision of the organization (distal decision), or whether it is focused on deciding on the structure of day-to-day work processes in the organization (proximal decision). Table 1 shows the treatment conditions.

Table 1. The six treatment conditions.

	No involvement	Consultation	Joint decision-making
Change vision	Imagine the following scenario: To support the continued development of your unit, the management of your unit wants to change the overall vision of the unit. The management makes it clear that they themselves—without involving the employees in the unit—decide what the overall vision of the unit should be.	Imagine the following scenario: To support the continued development of your unit, the management of your unit wants to change the overall vision of the unit. The management makes it clear that the employees in the unit will be involved so that they can provide input before the management decides what the overall vision of the unit should be.	Imagine the following scenario: To support the continued development of your unit, the management of your unit wants to change the overall vision of the unit. The management makes it clear that the employees in the unit will be involved by deciding on an equal footing with the management what the overall vision of the unit should be.
Change work processes	Imagine the following scenario: To support the continued development of your unit, the management of your unit wants to change the daily work processes in the unit. The management makes it clear that they themselves—without involving the employees in the unit—decide how the daily work processes in the unit are to be organized.	Imagine the following scenario: To support the continued development of your unit, the management of your unit wants to change the daily work processes in the unit. The management makes it clear that the employees in the unit will be involved so that they can provide input before the management decides how the daily work processes in the unit are to be organized.	Imagine the following scenario: To support the continued development of your unit, the management of your unit wants to change the daily work processes in the unit. The management makes it clear that the employees in the unit will be involved by deciding on an equal footing with the management how the daily work processes in the unit are to be organized.

Italic denotes variation in the level of influence, and bold denotes variation in the type of decision. The text was not bolded or italic when presented to the respondents. The following text was included to make it clear to the respondent what was meant with ‘unit’: ‘Glossary: With unit we mean your daily workplace. If you are employed at a hospital, it would be your department’..

The vignettes were created with the aim of making the vignettes realistic while at the same time making sure that they were concise and made sense to junior physicians from across different types of contexts. While the terms related to the level of influence can be thought of as quite universal, the type of decision is more important to think through, as types of decisions can vary between types of organizations such as hospital departments where junior physicians for instance work. For strategic decisions, deciding on the overall vision was chosen, as visions are used in many types of organizations and are relatively distal from the daily work tasks in the organization although related to them, as visions require some translation from managers to be tied to daily work tasks and how it might ultimately affect the users (e.g. Jensen, Moynihan, and Salomonsen 2018). For proximal decisions, changing daily work processes were chosen, as work processes are universal to all organizations and organizational decisions about how these are organized, directly affect how the junior physicians can carry out their daily work and deliver services to their patients.

Results from a balance check can be seen in the Appendix in Table A2, which indicates that the randomization of the junior physicians into the six conditions was successful, even though it seems that there is a difference between the groups in terms of age. However, including age in the analyses does not affect the results.

In order to test whether the junior physicians paid attention to the different treatments, an attention check was conducted after the respondents had responded to the dependent variable. In the attention check, the junior physicians were asked about the treatment to see if they could recall it. Thus, they were asked about the level of influence in the fictitious situation they had been presented with and the type of decision in the situation. The attention check reveals that the junior physicians paid attention to the treatments, which can be seen in Table A3 and Table A4 in the Appendix, although it was not all respondents who correctly recalled the treatment. Leaving out those who failed the attention check in the analyses does not alter the substance of the results.

Dependent variable

To measure the frontline professionals’ perception of the decision-making process, four items were used, that are supposed to capture how the frontline professionals perceive the decision-making process. The four items build on the notion in the theory section that influence can be seen in costs and benefits. In terms of costs, questions concerning the time spent and fairness of the decision-making process is used. Time spent captures the transaction cost of spending time on the decision, time which could otherwise be used on other things such as delivering services. Fairness should capture costs like conflict and the potential for being blamed for the decision. In terms of benefits, questions concerning whether the decision-making process contributes to securing professional quality and whether the decision benefits the patients are used. These two questions are supposed to capture whether the physicians experience that the decision is in accordance with professional norms and whether it benefits the users/clients. No matter whether the motives of the professionals is to do good for society and their clients and/or increase the power and influence of the profession, securing professional quality and benefitting users (patients) is of central interest to them. If their motives are altruistic, their end goal is to benefit the patients. If their motives are to increase the power and influence of the profession, benefitting patients and securing professionals quality can be seen as steps to securing power and influence.

The items are used to create an index capturing how the frontline professionals perceive the decision-making process. The wording of the items, the mean, the standard deviation, and the factor loadings can be seen in Table 2 together with the eigenvalue and Cronbach’s α of the collective measure. The collective measure is scaled 0–1.

Table 2. Dependent variable.

Variable	Mean	Standard deviation	Respondents	Factor loadings
Perception of the decision-making process (Eigenvalue = 2.67, Cronbach’s α = 8.89)	0.58	0.25	603
The described decision-making process is fair	4.57	1.80	603	0.80
The described decision-making process is a waste of time (reversed)	3.57	1.65	603	−0.61
The described decision-making process contributes to secure a high professional quality	4.38	1.75	603	0.91
The described decision-making process will ultimately benefit the patients	4.51	1.65	603	0.91

The perception measure is scaled 0–1. The respondents were asked ‘To what degree do you agree with the following statements’ and could answer on a 1–7 point Likert scale with the answers ‘Completely agree’, ‘Mostly agree’, ‘Slightly agree’, ‘Neither agree nor disagree’, ‘Slightly disagree’, ‘Mostly disagree’ ‘Completely disagree’. Higher values indicate more agreement.

Results

To test hypothesis 1, which is that frontline professionals perceive some level of direct influence (consultation or joint decision-making) to be more beneficial than no influence, no matter the type of organizational decision, Table 4 shows the effects of different types of influence on perception of the decision-making process for distal decisions (Model 1) and proximal decisions (Model 2), with “No involvement” as reference category. The perception measure is scaled 0–1 and higher levels on the perception measure reflect that the frontline professionals perceive the decision-making process as more beneficial. As can be seen in Table 3, the junior physicians perceive some level of influence (consultation or joint decision-making) to be more beneficial than not being involved (reference category), no matter whether the decision is proximal or distal, which supports hypothesis 1.

Table 3. Effects of influence on perception of the decision-making process for distal decisions (model 1) and proximal decisions (model 2), with ‘no involvement’ as reference.

	Model 1	Model 2
Treatment (Ref.: No involvement)
Consultation	0.32*** (0.026)	0.39*** (0.028)
Joint decision-making	0.27*** (0.026)	0.32*** (0.028)
Constant	0.37*** (0.019)	0.35*** (0.020)
N	299	304

Standard errors in parentheses. Dependent variables are rescaled from 1–7 to 0–1. ⁺p < 0.10, *p < 0.05, **p < 0.01, ***p < 0.001.

More specifically, we can see in Table 3 that when no involvement is the reference category, going from no involvement to consultation increases the frontline professionals’ perception of the decision-making process with 32% points for distal decisions (Model 1) and 39% points for proximal decisions (Model 2). Furthermore, we can see that going from no involvement to joint decision-making increases the frontline professionals’ perception of the decision-making process with 27% points for distal decisions (Model 1) and 32% points for proximal decisions (Model 2).

Moving on to hypothesis 2, which is that frontline professionals perceive consultation as more beneficial than joint decision-making when the organizational decision is distal to their daily work tasks, Table 4 shows the effects of different types of influence on perception of the decision-making process for distal decisions (Model 1) and proximal decisions (Model 2), with “Consultation” as reference.

Table 4. Effects of influence on perception of the decision-making process for distal decisions (model 1) and proximal decisions (model 2), with ‘consultation’ as reference.

	Model 1	Model 2
Treatment (Ref.: Consultation)
No involvement	−0.32*** (0.026)	−0.39*** (0.028)
Joint decision-making	−0.06* (0.026)	−0.07* (0.028)
Constant	0.692*** (0.018)	0.735*** (0.019)
N	299	304

Standard errors in parentheses. Dependent variables are rescaled from 1–7 to 0–1. ⁺p < 0.10, *p < 0.05, **p < 0.01, ***p < 0.001.

Looking at Model 1 in Table 4, we see that when consultation is the reference category, going from consultation to no involvement decreases the frontline professionals’ perception of the decision-making process with 32% points, when the decision is distal. Furthermore, we can see that going from consultation to joint decision-making decrease the frontline professionals’ perception of the decision-making process with 6% points, when the decision is distal. Taken together, this supports hypothesis 2, as it shows that consultation is seen as a more beneficial decision-making process, compared to both no involvement and to joint decision-making, when the decision is distal.

Finally, focusing on hypothesis 3, which is that frontline professionals perceive joint decision-making as more beneficial than consultation when the organizational decision is proximal to their daily work tasks, we look at Model 2 in Table 4. Here, we see that when consultation is the reference category, going from consultation to no involvement decreases the frontline professionals’ perception of the decision-making process with 39% points, when the decision is proximal. Furthermore, we can see that going from consultation to joint decision-making also decreases the frontline professionals’ perception of the decision-making process with 7% points, when the decision is proximal. This goes against expectations, as it shows that the junior physicians also perceive consultation to be the most beneficial decision-making process compared to no involvement and to joint decision-making when the decision is proximal. Thus, this is not in accordance with hypothesis 3. Taken together, this indicates that the junior physicians do not differentiate between the two types of decisions when forming their perception of the involvement process but seem to treat both types of decisions equally. Thus, the study finds support for hypothesis 1 and 2 but not for hypothesis 3. The results are furthermore corroborated in Table A5 in the Appendix where the direct effect of both treatments on the perception of the decision-making process is included.

Supplementary analyses

The theoretical argument presented in this article elucidates that frontline professionals are expected to balance perceived benefits and perceived transaction costs when forming their perceptions of the involvement process. The argument is that the benefits at some point will no longer outweigh the costs because the costs of influence will start to increase exponentially, while the marginal benefits will flatten out, cf. Figure 1. To see if this theoretical argument could indeed be what drives the perception, the analysis was made with the four items as dependent variables. The four models in Table 5 shows that there is a strong negative effect from not being involved compared to being consulted on all four items. Thus, this indicates that when moving from no involvement to consultation, the junior physicians perceive the benefits to outweigh the costs, which means that they perceive consultation to be more beneficial than no involvement for both proximal and distal decisions.

Table 5. Effects of influence and type of decision on each item.

	Fairness	Waste of time	Quality of decision	Outcome of decision
Treatment 1 (Ref.: Consultation)
No involvement	−0.41*** (0.024)	0.26*** (0.025)	−0.38*** (0.024)	−0.37*** (0.022)
Joint decision-making	−0.07** (0.024)	0.12*** (0.025)	−0.02 (0.023)	−0.04^+ (0.022)
Treatment 2 (Ref.: Change vision)
Change work processes	0.01 (0.020)	0.04^+ (0.021)	−0.02 (0.019)	−0.02 (0.018)
Constant	0.755*** (0.019)	0.325*** (0.020)	0.683*** (0.019)	0.706*** (0.018)
N	603	603	603	603

Standard errors in parentheses. Dependent variables are rescaled from 1–7 to 0–1. ⁺p < 0.10, *p < 0.05, **p < 0.01, ***p < 0.001.

However, looking at the effect from joint decision-making compared to being consulted, the effect is only strong and negative for two of the items, namely fairness and waste of time. This indicates that the junior physicians perceive the decision-making process to be equally beneficial in terms of the quality of the decision and the outcome of the decision when they are consulted and when it is joint decision-making. This supports the notion that the perceived marginal benefit of influence flattens out at some point. More specifically, it indicates that moving from consultation to join decision-making does not make the junior physicians feel that the decision improves. Thus, it seems that there is no perceived marginal benefit from joint decision-making compared to consultation. On the other hand, it can see that the junior physicians perceive the decision-making process as less fair and as more of a waste of time when they are to engage in joint decision-making compared to consultation. This supports the notion that the transaction costs of being involved increase as the level of influence increases. Thus, the results indicate that when moving from consultation to joint decision-making, the perceived costs will outweigh the perceived benefits of influence, which will make the junior physicians perceive joint decision-making as less beneficial than consultation.

If the reference category in Table 5 is changed from “Consultation” to “No Involvement”, the results show that, across all items, there is a positive significant effect of going from no involvement to both consultation and to joint decision-making, which reflects the results in Table 3.

Discussion and conclusion

The offset of this article was the notion that if involving frontline professionals in organizational decision-making, in new public sector governance paradigms such as Internal Learning Regimes (e.g., Jakobsen et al. 2018) and New Public Governance (e.g., Torfing et al. 2020), is to result in better organizational decisions and more employee satisfaction, it is central that the frontline professionals perceive the decision-making process as beneficial. The article has shown that the type of influence that public employed frontline professionals have over the decision-making process is key in shaping their perception of the decision-making process. More specifically, the article shows that the junior physicians in the sample perceive the decision-making process as most beneficial when they are consulted, regardless of whether the decision is proximal or distal.

The article contributes to recent scholarly discussions about the involvement of frontline professionals in organizational decision-making in the public sector, by offering a theoretical model in which frontline professionals are expected to form their perception of the involvement process based on whether they perceive the expected gains from more influence to outweigh the expected costs. The initial model expected that the frontline professionals are concerned with the type of influence (no involvement, consultation, joint decision-making) instead of degrees of influence. Furthermore, the model expected the frontline professionals to use whether the decision is proximal or distal to their day-to-day work tasks as a heuristic to help them decide how large costs they are willing to accept to gain more influence. The results indicate that this model needs some revision, at least for this particular type of frontline professional, i.e. junior physicians. It seems that the junior physicians do not differentiate between proximal and distal decisions but instead treat them the same in terms of the type of influence they perceive as most beneficial. The revised theoretical model can be seen in the Appendix, Figure A1.

However, it is important to keep in mind that we cannot be sure that the results are inferable to other public sector contexts and that this is only the first empirical test of the theoretical model. We might speculate that the relatively high degree of discretion that highly professionalized frontline professionals in the public sector, such as physicians, have in their day-to-day work (e.g., Abbott 1988; Andersen and Holm Pedersen 2012) means that they are less inclined to prefer joint decision-making when it comes to proximal organizational decisions than frontline professionals with a lower degree of discretion. That is, the degree of discretion the physicians already have in structuring day-to-day work might be so high that they do not perceive the marginal benefits of influence corresponding to joint decision-making to outweigh the costs when it comes to proximal organizational decisions.

Another explanation could be that junior physicians are indeed junior, and we might speculate that this mean that they to some degree might be more inclined to accept the input of more senior colleagues and thus feel that consultation and not joint decision-making is the right amount of influence they should be able to assert in organizational decision-making.

Either way, future research could and should test both the initial and the revised theoretical model proposed in this article among frontline professionals belonging to different professions, both within and outside healthcare, and of different levels of seniority, to see if there is a difference among them. For instance, within healthcare, physicians work closely together with other healthcare professionals such as nurses, and it could be interesting to test the theoretical models among this group of professionals, as they have another level of professionalization than physicians (e.g. Andersen and Holm Pedersen 2012).

Another important contextual factor to keep in mind is that in this case the ones with formal managerial responsibility of the junior physicians are most often physicians themselves in managing positions. That the manager and the frontline professionals belong to the same profession might mean that the frontline professionals believe that their own opinions and knowledge regarding an organizational decision, to a larger extent is represented by their manager, compared to a situation where the manager and the frontline professionals do not share profession. This could potentially be another factor that might help explain why consultation is perceived as more beneficial than joint decision-making, also for proximal organizational decisions. We could speculate that if there was a difference in profession between the manager and the frontline professionals, they react differently to the different types of involvement. These thoughts are corroborated by the views of Abbott (1988), who argue that frontline professionals are focused on securing jurisdiction for their profession over services. Moving this line of thought into the context of this study, we might speculate that when the manager is indeed from the same profession as the frontline professionals, the frontline professionals have a larger ‘trust’ in the manager to represent the frontline professionals in the organizational decision-making processes, when it comes to securing jurisdiction. Were the manager instead from another profession, this might have been different. Teasing out whether this is indeed the case, points to another interesting direction for future research, which could be done in a somewhat similar research design, were there could be introduced variation in the profession of the manager.

Finally, a contextual factor to keep in mind when interpreting the results is that employees in Denmark are required by law to be indirectly and formally involved in some local organizational decisions through their union representative (e.g., Bjørnholt, Boye, and Wesley Hansen 2022; Hansen 2015). Public frontline professionals in Denmark, such as junior physicians, might feel that they have indirect and formal influence on proximal organizational decisions through their local union representative, which means that they do not perceive as large a marginal benefit from direct and informal influence in the form of joint decision-making in relation to proximal decisions. Thus, future studies should test the theoretical model in countries where frontline professionals might have less influence on organizational-level decisions through their local union representative.

The above discussion about the context of the study, generally call for more insights into what form the different types of influence take and what specific types of decisions the frontline professionals want to have influence on. That is, qualitative studies could offer important insight into how consultation more specifically plays out among frontline professionals, in which forums it happens and what types of motives there is from management to consult or engage in joint decision-making with the frontline professionals. Furthermore, such studies could also explore which more specific types of organizational decisions frontline professionals, such as junior physicians, perceive as being for instance a waste of time to be involved in and which are perceived as decisions which could potentially benefit the patients.

Keeping in mind that this is the first test of the theoretical model, and that the test is conducted among a very specific group of frontline professionals, namely junior physicians at Danish public hospitals, another avenue for discussion is the potential practical implications of the findings. First, the results clearly indicate that if the managers want the junior physicians to perceive the decision-making processes as more beneficial, they should choose to involve them, either by consulting them or by engaging in joint decision-making with them, compared to not involving them. Second, the results indicate that when it comes to organizational decisions, the managers of the junior physicians should be aware that junior physicians might perceive that being consulted is slightly more beneficial than engaging in joint decision-making with them. This could be important to consider for the managers of the junior physicians, as joint decision-making might require that the frontline professionals spend a lot of time on the decision-making process; time they could otherwise have used on delivering public services. However, again, it is important to keep in mind that it is still too early to say that these findings will travel to other contexts, cf. the above discussion. Even so, if these results are replicated across different contexts, they could have quite important practical implications for how frontline managers think about how much influence they should offer frontline professionals, across different types of organizational decisions. This, in turn, can ultimately in the future have implications for policy, as studies such as this one can help elucidate how we should think about the involvement of frontline professionals in new governance model such as Internal Learning Regimes (e.g. Jakobsen et al. 2018) and New Public Governance (e.g. Torfing et al. 2020).

Finally, and related to the implications of involving frontline professionals in organizational decision-making, future studies should explore how the type of influence is linked to the outcomes of the involvement of frontline professionals to see whether it only matters for the frontline professionals’ perception of how beneficial the process is or whether it also affects outcomes such as the quality of the decisions.

Document regarding ethics

The research has not been reviewed by an internal review board and this is not a requirement for this this type of research in Denmark. Furthermore, at the time of data collection, no internal review board existed at Aarhus University. However, there are no ethical concerns related to the research and it meets all ethical guidelines and the legal requirements of the study country.

Acknowledgments

The author would like to thank Christian Bøtcher Jacobsen, Peter Bjerre Mortensen, and the participants at the 2021 NiG Panel 10 for helpful comments and suggestions on earlier drafts of this article.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Sometimes, delegation of authority is seen as the end point of the continuum where managers leave the decision to the employees. However, considering that the focus here is on organizational decisions and not on decisions regarding the individual employee’s work, this type of influence seems less relevant here. Delegation of decision-making authority is more closely related to the literature on employee empowerment, where empowerment, among other things, is providing employees with more decision-making power and discretion to change own work processes and to make individual level decisions (e.g. Fernandez and Moldogaziev 2011, 2013a; 2013b, 2015).

Appendix

Table A1. Descriptive statistics of the respondents and comparison.

	Completed experiment		Not invited for the experiment
Variable	N	Mean	N	Mean
Gender (0= male 1= female)	603	0.67 (0.02)	3080	0.68 (0.01)
Age	603	36.85 (0.31)	3080	36.66 (0.15)
Leader ambition (0 = no, 1 = yes)	603	0.62 (0.02)	2636	0.61 (0.01)
Job satisfaction (0-10)	602	7.51 (0.07)	2519	7.43 (0.03)
Organization (0 = other, 1 = hospital)	576	0.81 (0.02)	2491	0.81 (0.01)

T-tests revealed no statistically significant difference at the p < 0.10 or below, between the group that completed the experiment and the group consisting of the part of the sample not invited for the experiment.

Table A2. Balance test.

Variable	Group 1	Group 2	Group 3	Group 4	Group 5	Group 6
Gender (% female)	64.9	66.7	61	67	68.6	70.6
Age (mean years)*	36.25	36.02	38.19	35.20	37.45	37.89
Leader ambition (% yes)	62.89	57.84	61	56.7	62.86	70.59
Job satisfaction (0–10)	7.5	7.40	7.57	7.53	7.63	7.42
Organization (% hospital)	80.68	84.54	76.29	79.12	79.61	88.00

⁺p < 0.10, *p < 0.05, **p < 0.01, ***p < 0.001. One-way ANOVA.

Table A3. Attention check of treatment 1—level of influence.

	Model 1. No Involvement	Model 2. Consultation	Model 3. Joint decision-making
Treatment 1
No involvement	-	−0.62*** (0.041)	−0.48*** (0.032)
Consultation	−0.60*** (0.034)	-	−0.46*** (0.03)
Joint decision-making	−0.58*** (0.034)	−0.52*** (0.041)	-
Constant	0.660*** (0.025)	0.787*** (0.029)	0.500*** (0.023)
N	603	603	603

The effect of treatment on whether the respondents remembered the treatment. No Involvement is reference category in Model 1, Consultation is reference category in Model 2, and Joint Decision-Making is reference category in Model 3. Standard errors in parentheses. ⁺p < 0.10, *p < 0.05, **p < 0.01, ***p < 0.001.

Table A4. Attention check of treatment 2—type of decision.

	Model 1. Change vision	Model 2. Change work processes
Treatment 2
Change vision	-	−0.58*** (0.033)
Change work processes	−0.57*** (0.032)	-
Constant	0.649*** (0.023)	0.747*** (0.023)
N	603	603

The effect of treatment on whether the respondents remembered the treatment. Change vision is reference category in Model 1, and change work processes is reference category in Model 2. Standard errors in parentheses. ⁺p < 0.10, *p < 0.05, **p < 0.01, ***p < 0.001.

Table A5. Effects of influence and type of decision on perception of the decision-making process.

Treatment 1 (Ref.: Consultation)
No involvement	−0.35*** (0.019)
Joint decision-making	−0.06** (0.019)
Treatment 2 (Ref.: Change vision)
Change work processes	−0.02 (0.016)
Constant	0.705*** (0.016)
N	603

Standard errors in parentheses. Dependent variables are rescaled from 1–7 to 0–1. ⁺p < 0.10, *p < 0.05, **p < 0.01, ***p < 0.001.

Figure A1. Revised theoretical model. Note: From left to right, the vertical dotted lines denote where the level of influence moves from no involvement into the domain of consultation and from consultation into the domain of joint decision-making.