International Journal of Business Management and Economic Review

Vol. 5, No. 01; 2022

ISSN: 2581-4664

THE EFFECT OF ORGANIZATIONAL COMMITMENT, SERVANT LEADERSHIP,

AND EMPOWERMENT ON EMPLOYEE PERFORMANCE WITH
ORGANIZATIONAL CITIZENSHIP BEHAVIOR AS A MEDIATION AT REGIONAL
GENERAL HOSPITAL dr. ZAINOEL ABIDIN BANDA ACEH

* Iswahyudi, Muslim A Djalil and Sofyan Idris

Management Department, Universitas Syiah Kuala, Indonesia

http://doi.org/10.35409/IJBMER.2022.3357

ABSTRACT
This study aims to examine the model of the influence of organizational commitment, servant
leadership, and empowerment on employee performance, by utilizing organizational citizenship
behavior (OC behavior) as a mediator. The study was conducted at the dr. zainoel Abidin
(RSUDZA) in the city of Banda Aceh. The population is all medical and non-medical personnel,
totaling 1029 people. Sampling using accidental sampling technique, to obtain as many as 288
people. The variable measurement scale used is the Likert scale. The research model was analyzed
using Structural Equation Modeling (SEM) using Amos software. The results of direct hypothesis
testing prove that commitment does not affect OC behavior, Servant leadership and empowerment
affect OC behavior, commitment and empowerment have no effect on performance, servant
leadership and OC behavior affect performance. The indirect hypothesis testing proves that OC
behavior does not mediate the role of commitment on performance, and OC behavior partially
mediates the role of servant leadership and empowerment on performance. This explains that the
RSUDZA performance improvement model is a function of strengthening servant leadership,
increasing empowerment, and strengthening OC behavior. This test result model can be an
academic basis for future researchers in developing further research. For RSUDZA, this model can
be used for making advanced management regulations to improve its performance.

Keyword: Organizational Commitment, Servant Leadership, Empowerment, Organizational

Citizenship Behavior, Employee Performance.

1. INTRODUCTION
Regional General Hospital (RSUD) is a health service institution owned by the Regional
Government, RSUD is the main referral health facility for people who want to obtain health
services both for treatment and for health recovery, therefore, hospitals are required to be able to
provide comprehensive health services. for each patient. The density of existing human resources
in hospitals consisting of various professions is an important thing in supporting the development
of hospitals and becomes a benchmark in assessing the development of hospital service quality.
Regional General Hospital dr. Zainoel Abidin (RSUDZA) Banda Aceh is one of the public
institutions that is currently undergoing a revitalization of hospital service performance by the
Aceh Government. This revitalization was carried out because of complaints from patients and
their families which so far still often occur, especially related to hospital services. The Regional

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Secretary asked the head of the polyclinic to maximize their authority to manage the room so that
patients and their families feel well served. The goal is to provide maximum hospital services to
patients. The poor quality of this service cannot be separated from the poor performance of the
Banda Aceh Regional Hospital's employees (https://bpba.acehprov.go.id/,17/05/2021). Law
Number 23 of 2014 concerning Regional Government mandates the efforts of local governments
to meet the needs of the community as a form of public service so that the community can provide
feedback on public services provided by local governments.
There are still reports from the public who complain about the services of nurses and doctors
which are considered less than the maximum received by the Indonesian Ombudsman for Aceh
Representatives (https:// Ombudsman.go.id, Selasa, 13/03/2018). In addition, one of the Advocacy
Foundations urged the Acting Governor of Aceh to remove the Director of RSUDZA regarding
the neglect of patients by doctors in the emergency room of the hospital. The patient who had a
high fever had fallen to the floor from the wheelchair in front of the doctor's desk, because his
condition was getting weaker, but had not yet received service from the nurses or doctors (rri.co.id,
Senin 10/12/2018). The Aceh Party faction in the DPRA also highlighted RSUZA's services
related to the community who complained because many medics did not show an attitude as
community servants, and there was often no information obtained regarding family medical
records (Serambinews.com, 2018). The contribution of employees is needed as a form of
achievement of the performance of the institution. This behavior to contribute within the scope of
the organization is often referred to as Organizational Citizenship Behavior (OC behavior) (Purba
& Seniati, 2004).
Looking at the performance phenomenon, it shows that the OC behavior owned by
employees at RSUDZA is still inadequate. This is indicated by the number of complaints received
by the community regarding the services received by them. Many things in the future must be
addressed by the management of RSUDZA to improve the performance of its employees and the
OC Behavior of the employees themselves. Some of the things indicated are related to
commitment, servant leadership, and employee empowerment. This was done because the results
of the initial survey showed that commitment, servant leadership, and empowerment of RSUDZA
employees were still not good whereas the survey results revealed an average commitment score
of 3.37. While servant leadership is worth 3.30 and employee empowerment is worth 3.05 where
on the Likert scale this value shows in the poor category.
Moving on from the phenomena mentioned above, this study aims to examine the model of
the Effect of Commitment, Servant Leadership, and Empowerment on Performance with OC
Behavior as Mediator at RSUDZA. This study focuses on OC Behavior and the performance of
employees who are not optimal in organizational performance to achieve organizational goals.

2. LITERATURE STUDY
Employee Performance
Every employee is required to make a positive contribution (Gibson, Ivancevic, &
Konopaske, 2012). (Yukl, 2010) use the term proficiency which has a broader meaning.
Employee performance, which is in this research is often mentioned as performance, is not just
information for promotion or salary determination for the organization, but how the
organization can motivate employees and develop a plan to improve performance slumps can
be avoided. According to (Idowu, 2017), his research stated that the performance appraisal

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system was quite effective in offering a comprehensive analysis of employee performance. In

addition, another factor that affects employee performance is OC Behavior. Apart from OC
Behavior, (Wirawan, 2012) and (Edison, Riyanti, & Yustiana, 2016) mentions that
organizational commitment, servant leadership, and empowerment are also factors that can
influence employee performance.

Organizational Citizenship Behavior

(Organ, 2015) and (Huang, Wang, & Xie, 2014) states, OC Behavior is a term used as
behavior that benefits the organization or intends to benefit the organization that directly leads to
the role of expectations. OC Behavior is an extra-role behavior that can benefit the organization.
This behavior is a behavior that is voluntary in nature. OC Behavior can provide the benefits of
increasing the productivity of co-workers, increasing manager productivity, saving management
resources and the organization as a whole, helping to save energy resources that are necessary for
maintaining group functions, effectively coordinating group activities, increasing the
organization's ability to attract and retain the best employees, improve organizational performance
stability, improve the organization's ability to adapt to environmental changes. According to
(Cahyono, 2015) and (Titisari, 2014) mentions that OC Behavior is influenced by two dimensions,
namely internal factors consisting of job satisfaction, organizational commitment, personality,
employee morale, motivation, organizational climate, while the dimensions of external factors are
leadership style, trust in leaders, and organizational culture.

Organizational Commitment
According to (Greenberg & Baron, 2007), in (Chairy, 2011), Employees who have high
organizational commitment are more stable and more productive. (Mowday, Porter, & Steers,
1982), in (Chairy, 2011) suggests the characteristics of organizational commitment, namely: (1) a
strong belief in and acceptance of the goals and values of the organization; (2) readiness to work
hard; and (3) a strong desire to stay in the organization. (Daft & Marcic, 2008) define
organizational commitment is as loyalty and significant involvement in the organization. In
addition, it is also stated that Organizational commitment affects performance in an organization.
Employee satisfaction on material compensation and social compensation has a significant
influence on employee loyalty to the organization. Organizational commitment is associated with
increased results. For individuals or employees with high organizational commitment, achieving
organizational goals is important. Organizational commitment is often mentioned as commitment
in this research.

Servant Leadership
Servant leadership is a leadership style characterized by an emphasis on opportunities to help
followers grow and develop (Robbins & Judge, 2017). Servant leadership is leadership that starts
from sincere feelings that arise from within the heart that wants to serve (Neuschel, 2008).
(Northouse, 2013) also added that servant leadership is a leader who serves their people or their
subordinates and not vice versa. Leaders at the top level give orders to middle-level management,
middle-level leaders give orders to their employees, and ultimately employees at lower levels serve
their customers. (Northouse, 2013) added that servant leadership is a leader who serves their
people or their subordinates and not vice versa. Leaders at the top level give orders to middle-level

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management, middle-level leaders give orders to their employees, and ultimately employees at
lower levels serve their customers. He also identified 10 characteristics of servant leadership
namely listening, empathy, healing, caring, persuasion, conceptualization, forecasting, duty to
care, commitment to people growth, and community building.

Empowerment
Organizations must be able to adapt to changes and developments that occur outside the
organization to survive, even more so in today's times, where changes and developments in
technology, knowledge, economy, and the environment occur rapidly, so organizations need
employees who are more creative, full of energy, initiative, and able to take on greater
responsibilities. Empowerment is increasingly considered important by organizations because
employees are no longer prepared only to accept a command and control system (Sinurat, 2004).
By empowering the organization, it is possible to maximize the utilization of the capabilities and
knowledge of its employees, to increase employee productivity, involvement, and sense of
responsibility (Hasibuan, 2016);(Rahayu & Rozak, 2021). According to (Daraei, Maymand, &
Ekhtari, 2014), Empowerment is often defined as an act of providing opportunities to make job
decisions by expanding their authority in decision making.

Research Framework

Organizational
Commitment (X1)

OCB Employee
(Y) Performance(Z)

Empowerment
(X3)

Figure 1. Research Framework

Hypothesis
H1: Commitment Affects OC Behavior
H2: Servant Leadership affects OC Behavior
H3: Empowerment affects OC Behavior
H4: Commitment Affects Performance.
H5: Servant Leadership affects Performance.
H6: Empowerment affects performance.
H7: OC Behavior affects performance
H8: OC Behavior mediates the effect of Commitment on Performance.

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H9: OC Behavior mediates the effect of Servant Leadership on Performance.

H10: OC Behavior mediates the effect of Empowerment on Performance.

3. RESEARCH METHOD
The study explains the effect of organizational commitment, servant leadership, and trust on
employee performance with OC Behavior as a Mediator at RSUDZA. Data were collected through
distributing questionnaires to medical and non-medical employees. Secondary data collection in
this study is in the form of document recording, among others, by collecting data in the form of
documentation sourced from research subjects.
The population of this study was all medical and non-medical employees at RSUDZA. The
details of the data for civil servants and honorary workers who work can be seen below.
Table 1. Population
No Work unit Amount
Medical personnel
- Medical specialist 177
1
- Dentist 6
- General practitioners 32
2 Non-Nurse Paramedic Personnel 246
3 Nursing Paramedics 568
Total Employees 1029
Source: RSUDZA (2020)

This study used an accidental sampling technique which is a sampling method by chance.
The number of samples was determined using the Slovin formula and resulted in as many as 288
respondents. In this study, the researcher builds a construct for each of the variables studied based
on previous theories, and the provisions that bind performance measurement, namely:
1. Employee performance used indicators disclosed by (Prawirosentono, 2010) namely quantity,
quality, time, cost, service orientation, integrity, commitment, discipline, cooperation,
leadership.
2. OC Behavior used indicators disclosed by (Organ, 2015), namely obeying the rules,
awareness, helping face difficulties, helping people around, attention, playing an active role
in improvement, not complaining, maintaining relationships, reminding colleagues in
preventing problems.
3. Organizational commitment used indicators disclosed by (Coryanata, 2014) namely a sense
of belonging to the organization, a sense of attachment to the organization, the meaning of the
organization personally, will not leave the organization, proud of the organization, loyalty.
4. Servant leadership used indicators disclosed by (Poli, 2019) i.e. listening, empathy, healing,
caring, persuasion, conceptualization, forecasting, duty to care for, commitment to growth,
community building
5. Empowerment used indicators disclosed by (Daraei et al., 2014) i.e. the work done is
important, work activities have meaning, cares about what is done, determines for themselves
how the work is done, has the autonomy to make decisions in the work process, has the

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opportunity to choose how to do work, has a great impact on events in the organization, has
control on events in the organization, the work done the results achieved by the organization.

Direct hypothesis testing using Structural Equation Modeling (SEM) analysis tools through
the use of Amos software (Hair, Hult, Ringle, & Sarstedt, 2016). Furthermore, indirect hypothesis
testing (mediation) was carried out using the model (Baron & Kenny, 1986).

4. RESULTS
Direct Effect
The structural model is figured as follows.

Figure 2. SEM Test Results

The results of hypothesis testing through a full model after fulfilling the SEM assumptions
are clearly presented below.

Table 2. Test Results

R-
Estimate S.E. C.R. P
Square
OC Behavior <--- Commitment 0.034 0.072 0.692 0.489
0.295
OC Behavior <--- Servant Leadership 0.533 0.076 7.826 0.000
OC Behavior <--- Empowerment 0.100 0.043 2.230 0.026
Performance <--- Commitment 0.038 0.055 0.600 0.549
Performance <--- Servant Leadership 0.478 0.058 5.439 0.000
0.386
Performance <--- Empowerment 0.062 0.048 1.069 0.285
Performance <--- OC Behavior 0.209 0.035 3.526 0.000
Source: Primary Data, 2021 (processed)

The SEM analysis also resulted in the formulation of the statistical equation as follows:
OC Behavior = 0.034 Organizational Commitment + 0.533 Servant Leadership + 0.100
Empowerment

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Employee Performance = 0.038 Organizational Commitment + 0.478 Servant Leadership + 0.062

Empowerment + 0.209 OC Behavior

The results of the direct influence test in the table above are explained that:
1. In Table 2, the R square value for the role of Commitment and Servant Leadership on OC
Behavior is 0.295. This figure shows that together the variables of Commitment and Servant
Leadership can explain the OC Behavior variable of 29.5%, while the remaining 71.5% is
explained by other variables that are not in this study.
2. The value of R square for the effect of Commitment, Servant Leadership, and OC Behavior
on Performance is 0.386. This figure shows that together the variables of Commitment,
Servant Leadership, Empowerment, and OC Behavior can explain the Performance variable
of 38.6%, while the remaining 61.4% is explained by other variables that are not in this study.
3. Testing Commitment on OC Behavior produces a CR of 0.692 and p of 0.489. The figure
concludes that Commitment does not affect increasing OC Behavior.
4. Testing Servant Leadership on OC Behavior produces a CR of 7.826 and p of 0.000. The
figure concludes that Servant Leadership affects increasing OC Behavior. The coefficient of
the role of Servant Leadership in OC Behavior is 0.533 or 53.3%. This reveals that the higher
the level of Servant Leadership, the higher the OC Behavior of employees.
5. Empowerment testing on OC Behavior produces a CR of 2.230 and p of 0.026. The figure
concludes that Empowerment affects increasing OC Behavior. The coefficient of the role of
Empowerment in OC Behavior is 0.100 or 10.0%. This explains that the higher the level of
empowerment, the higher the OC Behavior of employees.
6. Testing Commitment on Performance produces a CR of 0.600 and p of 0.549. The figure
concludes that Commitment does not affect Performance. The coefficient of the role of
Commitment on Performance is 0.223 or 22.3%.
7. Testing Servant Leadership on Performance resulted in a CR of 5,439 and p of 0.000. This
figure concludes that Servant Leadership influences increasing performance. The coefficient
of the role of Servant Leadership on Performance is 0.478 or 47.8%. This illustrates that the
higher the level of Servant Leadership will further improve performance.
8. Empowerment Testing on Performance resulted in a CR of 1.069 and p of 0.285. The figure
concludes that Empowerment does not affect improving Performance.
9. OC Behavior testing on performance resulted in a CR of 3,526 and p of 0.000. The figure
concludes that OC Behavior affects Performance. The coefficient of the role of OC Behavior
on Performance is 0.209 or 20.9%. This reveals that the higher the OC Behavior will have a
direct effect on improving performance.

The results of testing the indirect hypothesis are as shown in the following explanation:
1. Testing Commitment on Performance through OC Behavior
The results of the mediating effect of the variable Commitment on Performance are
presented as follows:
Organizational
Citizenship 0.209
0.034 Sig. = 0.000
Sig. = 0.489 Behavior SE = 0.035
SE = 0.072

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Organizational Page 57
Commitment
0.038
Sig. = 0.549
SE = 0.055
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Employee
Performance

Figure. 3 Testing the Mediating Effect of Hypothesis 8

Sobel test resulted in a statistical test value of 0.470 and significant at = 0.637. Thus, OC
Behavior does not act as a mediating variable between Commitment and Performance.
Based on Figure 3, the results of the Sobel scores can be seen in Figure 4 as follows:

Figure 4. Sobel Test Results of Hypothesis 8

2. Testing Servant Leadership on Performance through OC Behavior

The results of the mediating effect of the Servant Leadership variable on OC Behavior are
presented as follows:
Organizational
Citizenship 0.209
Behavior Sig. = 0.000
0.533
SE = 0.035
Sig. = 0.000
SE = 0.076
0.478
Servant Sig. = 0.029 Employee
Leadership SE = 0.058 Performance

Figure 5. Testing the Mediating Effect of Hypothesis 9

Sobel test resulted in a statistical test value of 4.546 and significant at = 0.000. Thus, OC
Behavior acts as a mediator between Servant Leadership and Performance. Thus, because OC
Behavior affects and acts as a mediating variable, Servant Leadership affects performance, the role
of OC Behavior in mediating the relationship between Servant Leadership and performance is
partially mediating. Mediation partially shows that OC Behavior is not able to perfectly mediate
the effect of Servant Leadership on Performance where there are still other variables not examined
that can mediate the effect of Servant Leadership on Performance.
Based on Figure 5, the results of the Sobel value can be seen in Figure 6 as follows:

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Figure 6. Sobel Test Results of Hypothesis 9

3. Empowerment Testing on Performance through OC Behavior

The results of the mediating effect of the Empowerment variable on OC Behavior are
presented as follows:
Organizational
Citizenship 0.209
Behavior Sig. = 0.000
0.100
SE = 0.035
Sig. = 0.06
SE = 0.043

Empowerment 0.062 Employee

Sig. = 0.285
SE = 0.048
Performance

Figure 7. Testing the Mediating Effect of Hypothesis 10

The Sobel test resulted in a statistical test value of 2.167 and was significant at = 0.030.
Thus, OC Behavior acts as a mediator between Empowerment and Performance. So, because OC
Behavior affects and acts as a mediating variable, Empowerment does not affect Performance, then
OC Behavior's role in mediating the relationship between Empowerment and Performance is fully
mediating. Mediation in full shows that OC Behavior can perfectly mediate the influence of
Servant Leadership on Performance.
Based on Figure 7, the results of the Sobel scores can be seen in Figure 8 as follows:

Figure 8. Sobel Test Results of Hypothesis 10

5. CONCLUSION
The results of the study at RSUDZA show that the results of hypothesis testing directly prove
commitment does not affect OC Behavior, Servant leadership and empowerment affect OC

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Behavior, commitment and empowerment do not affect performance, servant leadership and OC
Behavior affect performance. Indirect hypothesis testing proves that OC Behavior does not
mediate the effect of commitment on performance, and OC Behavior partially mediates the
influence of servant leadership and empowerment on performance. This explains that the
RSUDZA performance improvement model is a function of strengthening servant leadership,
increasing empowerment, and strengthening OC Behavior. This test result model can be an
academic basis for future researchers in developing further research. For RSUDZA, this model can
be used for making advanced management regulations to improve its performance. The limitation
of this study is the number of variables and research subject.

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