Duality of command in teaching hospitals: exploring its impact on employee emotions and the mediating effect of role ambiguity

The prime purpose of this study is to investigate the impact of duality of hierarchical structure on various employee related outcomes in teaching hospitals. Teaching hospitals in Pakistan are usually managed by professional - clinical and administrative hierarchies simultaneously. The study is seminal and novel because it explores how duality of command affect employees' well-being within the context of teaching hospitals of under developed countries. A quantitative, explanatory, and cross-sectional study design was employed to conduct this study. Doctors, nurses and administrative staffs were randomly classified into three strata and data was collected from 430 respondents on an adopted questionnaire. Hypotheses were tested through inferential statistics including Structural Equation Modeling using SmartPLS. Our findings reveal that duality of command effect employees' feelings of frustration, depression, overwhelm and burnout. Role ambiguity mediates the relationship between duality of command and employees' emotional responses. The study contributes to the field by providing empirical evidence of the negative implications of duality of command on employees' mental health and suggesting the need for redefining the hierarchy of these teaching hospitals. Additionally, it opens venues for further research in diverse cultural and organizational context, highlighting global importance of understanding organizational structure and its impact on employees' well-being.