Exploring perceived motivation-enhancing HR practices and employee–supervisor relationship quality on affective commitment in public hospitals: a multi-level perspective

Over the last few decades, the linkage among Human Resource Management (HRM), employee outcomes and organizational performance has been the key area of research in the strategic HRM literature (Jiang et al., 2017). The influential strategic HRM process model argues that HR practices implemented by managers (or supervisors) indirectly affect employee outcomes, i.e. their attitudes and behaviours, through exerting their influence on employee perceptions of HR practices (Wright and Nishii, 2013). A crucial employee outcome that significantly influences organizational success is affective organizational commitment (Bos-Nehles and Meijerink, 2018). This type of commitment reflects employees’ emotional attachment, identification with and involvement in the organization (Allen and Meyer, 1996). Employees with high levels of affective commitment experience a strong sense of belonging, pride and loyalty, which fosters greater engagement in workplace activities and a genuine desire to remain with the organization (Kehoe and Wright, 2013). A strong sense of commitment among medical professionals in hospitals is essential for enhancing their performance (Saleem et al., 2018) and ultimately improving the quality of patient care delivered. By cultivating a work environment including HR policies and practices which can strengthen affective commitment, public hospitals can therefore enhance employee motivation and overall service quality (e.g. Chuang et al., 2012; Harmon et al., 2003).

In the extant strategic HRM literature, the predictors of employee perceptions of HR practices are not well understood (Jiang et al., 2017; Van Beurden et al., 2020). The few studies that have attempted to understand the predictors of employee perceptions of HR practices found that HR practices as perceived by supervisors, co-workers and transformational leadership influence how employees perceive HR practices in the workplace (Jiang et al., 2017; Vermeeren et al., 2014). However, empirical evidence on these antecedents is still not clear and often reveals contradictory results (e.g. Liao et al., 2009; Wang et al., 2022). Specifically, the extent to which supervisor perceptions of HR practices influence employee perceptions of HR practices is mixed, with some studies finding a positive relationship and others finding no significant relationship between them (e.g. Den Hartog et al., 2013; Liao et al., 2009). At the same time, it is open to question whether transformational leadership is the only leadership style that can foster positive perceptions of HR practices or whether other positive relationship dynamics are also (and as equally) relevant (Vermeeren et al., 2014). In a similar vein, it is open to question as to whether supervisor perceptions of HR practices or employee–supervisor relationship quality (or leadership styles) are more important in shaping employee perceptions of HR practices and whether they can enhance, undermine or substitute for each other in eliciting pertinent employee and performance outcomes (Leroy et al., 2018). There have been calls in the literature for more empirical studies to understand how and by whom, employee HR perceptions are actually influenced, so that they can be shaped to foster improved employee outcomes (such as commitment) and organizational performance, as intended (Sanders et al., 2022; Wang et al., 2022).

In accordance with social information processing (SIP) theory (Salancik and Pfeffer, 1978), organizations use supervisors as their social agents to communicate and achieve shared perceptions, attitudes and behaviours among employees (Jiang et al., 2017). Since supervisors (i.e. line managers) play an essential role in communicating with and managing workers as well as in implementing HR practices, they represent a crucial element of the social context shaping how employees perceive HRM in organizations (Chênevert et al., 2021; Elorza et al., 2022). However, with some notable exceptions (e.g. Den Hartog et al., 201; Liao et al., 2009; Jiang et al., 2017), the vast majority of studies to date have captured perceptions of HR practices from only one side, either that of the manager (e.g. Fu et al., 2020; Do et al., 2019) or the employee (e.g. Kehoe and Wright, 2013). The particular HR strategy, however, may be well-designed on paper yet could be implemented and perceived very differently by supervisors, resulting in differences in how managers and employees perceive HR practices (Nishii et al., 2008). As a result, a disconnection may occur between what managers implement and how employees actually perceive the HR practices, which is indeed reflected by some of the existing empirical evidence showing a moderate or low correlation between manager and employee perceptions of HR practices (e.g. Den Hartog et al., 2013; Elorza et al., 2022; Jiang et al., 2017; Liao et al., 2009).

Next to HRM implementation by supervisors, the quality of the relationship between the supervisor and their employees (i.e. employee–supervisor relationship quality) has been highlighted to play an important role in determining how employees perceive HR practices (e.g. Den Hartog et al., 2004; Martinson and Deleon, 2016). Indeed, as supervisors are responsible for implementing HRM, their behaviours towards employees and thus the quality of relationship that exists in this regard have been argued to be key (Sanders et al., 2022). However, studies examining the relationship between supervisors and employees’ perceptions of HRM practices rarely take a multi-entity perspective and tend not to integrate other potent sources of influence to decipher their relative effects. Therefore, while it is informative to understand the relationship (and potential differences) between managers and employees’ perceptions of HRM, the unique role of the employee-supervisor relationship in influencing employees’ perceptions of HRM is of significant interest given the centrality of supervisors (and their behaviours) in the process of HRM implementation (Leroy et al., 2018; Sanders et al., 2022; Wang et al., 2022).

Drawing from SIP theory together with the social exchange and leader–member exchange (LMX) theory, the present study aims to shed light on the relationship between both supervisor perceptions of HR practices and the employee-supervisor relationship (E-SR) quality, on employees’ perceptions of HR practices, and in turn, their effects on affective commitment. In doing so, the mediating role of employee perceptions of HR practices with respect to both antecedents and the pertinent outcome of affective commitment is explored. Finally, in addition to testing the independent role of ES-R quality in influencing employee perceptions of HR practices, the study seeks to further disentangle the relationship between supervisor and employee perceptions of HR practices by exploring the potential moderating role of ES-R quality. We focus on motivation-enhancing HR practices (i.e. performance appraisal, internal promotion and compensation). The reason is that the primary aim of such practices is to motivate and foster employees’ commitment (see, Jiang et al., 2012; Lai et al., 2024). These practices serve as signals of organizational support and investment, shaping employees’ perceptions of fairness and value within the organization. Moreover, since supervisors play a pivotal role in implementing these HR practices, the alignment between employees’ and supervisors’ perceptions of these practices is crucial. This alignment is particularly significant in the context of the employee-supervisor relationship quality, as it can significantly impact variations in employee commitment.

By testing the proposed model, this study advances research in strategic HRM in the following ways. Firstly, the present study directly responds to the burgeoning calls from scholars to study both supervisor and employee perceptions of HR practices in the same model (Jiang et al., 2017; Wang et al., 2022; Yanadori and Van Jaarsveld, 2014) given that they represent separate but highly related concepts that might help to explain the implementation gap between HR policy and practice (Den Hartog et al., 2013; Liao et al., 2009). In this regard, our study adds to the existing empirical evidence seeking to substantiate the relationship between supervisor perceptions of motivation-enhancing HR practices (SPMPHM) and employee perceptions of motivation-enhancing HR practices (EPMHRM), for which there has been mixed empirical evidence reported in the literature to date (e.g. Elorza et al., 2022; Wang et al., 2022). Secondly, and in the same vein, the present study addresses the calls from HR scholars to elucidate broader contextual elements that either directly impact employee perceptions of HRM or which might strengthen the relationship between supervisor and employee perceptions of HRM (Jiang et al., 2017). The need to take a multi-entity perspective has been stressed by previous researchers and in this regard, have especially called for studies that examine the salience of social factors, such as E-SR quality (Den Hartog et al., 2004; Lee and Chui, 2019; Sanders et al., 2022; Wang et al., 2022). Examining ES-R quality as a direct and interactive predictor of EPMHRM can unravel how a “strong HRM system” can be created (Bowen and Ostroff, 2004), thereby reducing the disconnection that might exist between manager and employee perceptions of HRM and ensuring positive outcomes for employees and organizations alike (Jiang et al., 2017). Testing the independent and interactive role of ES-R quality in the HR-outcomes relationship also responds to the call from Leroy et al. (2018) to empirically explore the precise interrelationship between HRM and leadership in fostering pertinent organizational outcomes.

Finally, our study contributes to the HRM literature by exploring the aforementioned relationships in the underexplored context of public hospitals in Pakistan. Hospitals in this context encounter challenges related to limited resources, centralized HR systems and bureaucratic procedures, all of which exert a significant impact on the implementation and subsequent perception of HR practices (Faisal et al., 2022; Suhail and Steen, 2021). The complex nature of hospitals with these features, where the HR messages can easily become “lost in translation”, represents an intriguing context to explore the relationship between supervisors and employees’ perceptions of HRM practices (Bartram et al., 2007; Kilroy, 2024). Moreover, studies examining HR perceptions that incorporate both supervisor and employee perspectives within a single study remain limited (c.f. Van Beurden et al., 2020; Vermeeren et al., 2014). This gap is particularly evident in non-western contexts, where research on HRM practices has predominantly focused on either managerial or employee viewpoints in isolation (c.f. Wang et al., 2022). As a result, our understanding of how HR practices are implemented and perceived across hierarchical levels remains fragmented, highlighting the need for more integrative research across diverse contexts.

In the current study, we advance that motivation-enhancing HR practices and ES-R quality are particularly important in public hospitals in Pakistan. Motivation-enhancing HR practices, such as internal promotion and compensation, are regarded to be more centralized and subject to a wider range of institutional constraints (Suhail and Steen, 2021). In addition, it is believed that motivation-enhancing HR practices are especially potent for medical professionals in Pakistan since they are believed to experience heavy workloads and experience low levels of motivation (Saleem et al., 2018). A good quality relationship with supervisors and experiencing HRM practices can be particularly useful in dealing with these issues (e.g. McAlearney and Robbins, 2014).

As such, exploring supervisors’ implemented motivation-enhancing HR practices and the ES-R quality among medical professionals in Pakistan in order to determine if they influence employees’ perceptions of such practices and, in turn, their level of affective commitment to the organization is critical. Pakistan’s public hospitals are confronted with significant challenges, including high rates of brain drain and the difficulty of finding replacements for skilled staff (Zafar, 2023). This makes it essential for public hospitals in this context to understand and enhance staff member’s affective commitment. By fostering such affective commitment to the organization, hospitals can better retain their skilled workforce, ensuring continuity of care and maintaining high standards in the face of staffing challenges. Research conducted in public hospitals in Pakistan reveals a lack of commitment among medical professionals in the public sector, which adversely affects their performance (Saleem et al., 2018) and ultimately the quality of patient care delivered. Our overall research model is depicted in Figure 1, of which the focal relationships are now discussed below.

The present study draws on the idea that HR practices can impact performance by enhancing employees’ motivation to contribute to the organization’s strategic goals (Wright and Snell, 1998). We examine a motivation-enhancing HR bundle, operationalized as HR practices that direct, sustain and energize work behaviour. Such practices include salary and perks, performance feedback, opportunities for promotion, career development and job security, which play an essential role in enhancing the motivation of workers (Jiang et al., 2012). Supervisor perceptions of HR practices have been touted to predict employee perceptions of HR practices, although the empirical evidence on this relationship has been mixed (Liao et al., 2009; Wang et al., 2022) and has not yet been subject to empirical testing in the hospital context in Pakistan.

SIP theory purports that individuals adapt their attitudes, behaviours and belief systems in response to their social context (Salancik and Pfeffer, 1978). The underlying premise of the theory is that people depend on various cues in their social environment to define reality and are influenced foremost by those with whom they have immediate interactions with, i.e. supervisors, coworkers and subordinates. Since the immediate supervisor implements HR practices (Elorza et al., 2022), supervisors are considered the social agents who implement the HR practices in the organization, which in turn influence employee perceptions, attitudes and behaviours (Bauer et al., 2007; Jiang et al., 2017). Specifically, during the implementation of HR practices, i.e. motivation-enhancing practices, supervisors are generally the ones charged with the responsibility of providing performance feedback and career development/promotion opportunities to employees, which also makes these employees prone to pay attention to supervisors’ view or perception of HR practices (Wang et al., 2022). As such, supervisors can influence employees’ perceptions of HR practices and are likely to influence whether the employees perceive the HR practices.

Despite this logic inherent to SIP theory, some studies found a weak or no effect of supervisor perceptions of HR practices on employees’ perception of HR practices (see Den Hartog et al., 2013; Liao et al., 2009, respectively). In addition, empirical research has shown that the relationship between supervisor and employee HR perceptions is only significant when certain factors are introduced to reduce the difference between the two (Zhang et al., 2018). Therefore, both parties do not always see “eye to eye” on the same practices because managers may have different perceptions of or disregard the practices as intended by the organization (and HR department) and thus fail to effectively communicate and implement them for their employees (Liao et al., 2009). Employees can also use other channels than their supervisor to be informed about HR practices, such as their colleagues or HR professionals (Jiang et al., 2017; Van Beurden et al., 2025).

However, more recent studies building on the foundation of SIP theory found a positive relationship between supervisor HR perceptions and employee HR perception (Jiang et al., 2017; Wang et al., 2022), further highlighting that those shared perceptions among the supervisor and employee can enhance employee outcomes and performance. To understand this relationship further and especially to add to the growing empirical evidence in this area, this study will focus on testing the relationship between supervisor and employee perceptions of motivation-enhancing HR practices in the hospital context of Pakistan. In the hospital context in Pakistan, a lack of motivation is regarded as an ongoing challenge (Suhail and Steen, 2021; Suhail and Azhar, 2016) and like health care institutions more broadly, the gap between manager and employees’ perceptions of HRM can be quite high given that HR messages often become “lost in translation” (e.g. Bartram et al., 2007). Therefore, we propose the following hypothesis:

In testing the relationship between SPMHRM and EPMHRM, we propose that the latter will mediate the relationship between the former and employees’ affective commitment. Primarily drawing on the premise of social exchange theory (Blau, 1964), studies have revealed that employees’ perceptions of HR practices (including motivation-enhancing HRM) are positively associated with increased levels of employees’ affective commitment (Alfes et al., 2013; Bos-Nehles and Meijerink, 2018). Such practices are akin to the organization providing support for employees and indicative of the organization’s commitment to them, which in turn engenders a reciprocation process whereby employees increase their commitment to the organization (Whitener, 2001).

Relevant to the current context, Mustafa and colleagues (2017) found that a motivation-enhancing bundle of HR practices was a positive predictor of employee affective commitment in the textile industry in Pakistan. The influential strategic HRM process model purports that employees’ perceived HR practices mediate the relationship between implemented HR practices by supervisors and pertinent employee and organizational outcomes (Wright and Nishii, 2013). In accordance with SIP theory, supervisor perceptions of motivation-enhancing HR practices thus might shape employees’ evaluative perceptions of motivation-enhancing HR practices, thereby influencing their attitudes and behaviours (Beijer et al., 2019; Elorza et al., 2022). Hence, when employees perceive motivation-enhancing HR practices as a motivating factor or an investment in them, they are more likely to feel a strong association with the organization, as manifested in affective commitment. Therefore, we propose the following hypothesis:

While SPMHRM may be crucial for EPMHRM, it is plausible to suggest that other social contextual determinants can also play a role in this regard, thereby influencing employee outcomes, i.e. affective commitment. For instance, LMX theory indicates that employees who spend more time with their supervisor will learn more about implemented HR practices in the organization (Kuvaas and Dysvik, 2010). This implies that it is not just about managers’ perceptions and social cues regarding the specific HR practices in the organization, but the quality of the relationship that employees have with their supervisor (E-SR quality) in itself may be a relevant antecedent in this regard. In this study, E-SR quality refers to the general sense of support an employee feels from their line manager (Farndale et al., 2011). This includes the supervisor’s competence, the support they provide in resolving work-related issues, their fairness, the quality of feedback they offer and the interpersonal relations between the employee and supervisor.

Supervisors are usually the ones involved in implementing motivation-enhancing HR practices, i.e. performance appraisal and promotion, as indicated above. Audenaert et al. (2016) argue that employees cannot perceive performance management, i.e. motivation-enhancing HR practice, without taking their relationship with their supervisor into account. For instance, when employees perceive the relationship with their supervisor as stronger, they may receive more attention, feedback and opportunities during appraisal meetings. In this way, it is likely that employees pay more attention to communication and behaviour as well as the overall relationship with their supervisor, which could ultimately impact whether they perceive various HR practices more positively. Therefore, E-SR quality (via the signals and exchanges inherent to the relationship) could also directly influence EPMHRM irrespective of the specific perceptions that supervisors have of the practices.

Empirical evidence has revealed that employees with a more positive perception of their relationship with supervisors also perceive the presence of HR practices more positively (Bos-Nehles and Meijerink, 2018; Martinson and Deleon, 2016). Similar to the social exchange theory logic articulated for the impact of EPMHRM on affective commitment (as part of H2), we also envisage that EPMHRM will mediate the relationship between E-SR quality and employees’ affective commitment. Indeed, social exchange theory (Blau, 1964) predicts that an exchange relationship can develop between two parties (i.e. supervisor and employee) when one party provides a benefit to the other (e.g. providing support and benefits to employees), thereby causing an obligation to respond by providing something beneficial in return (e.g. employee affective commitment).

To our knowledge, this mediated relationship unpacking the “process of HRM implementation” via employees’ perceptions of the quality of their relationship with supervisors has not yet been subject to empirical testing. This is despite longstanding calls from scholars to pay more attention to social relations between leaders and employees as a key independent variable predicting HRM perceptions given that such relations can enable particular HR practices to be implemented (Frenkel et al., 2012). Knowledge of this issue can also unravel to what extent other relationship dynamics (i.e. ES-R quality) can foster EPMHRM in addition to SPMHRM and indeed garner a more nuanced understanding of the relative importance of each antecedent. Based on the above theoretical argumentation and empirical evidence, we propose the following hypotheses:

Given the tenuous relationship between supervisors and employees’ perceptions of HR practices and the importance of ensuring such perceptions are aligned for a “strong” HRM system to materialize, it is imperative to uncover the contextual factors that may impact this relationship (Wang et al., 2022). While predicting that E-SR quality can directly shape EPMHRM, it is theoretically conceivable that ES-R also functions in an interactive role with respect to the relationship between SPMHRM and EPMHRM.

Den Hartog et al. (2013) found that communication quality strengthens the relationship between supervisor and employee perceptions of HR practices. Communication is an integral part of the supervisor-employee relationship in LMX research, which argues that a high-quality relationship is characterized by open communication, mutual trust and informal influence on the employees (Graen and Uhl-Bien, 1996; Liden and Graen, 1980). When employees have a stronger relationship with their supervisors, it is likely that they will communicate more with each other and exchange information. These typical exchanges are more likely to lead to trust between the parties, thereby garnering an overall positive relationship and, thus positive outcomes on both sides (Erdogan, 2002; Liden and Graen, 1980). Pertaining to the alignment of HR practice perceptions, it is conceivable that employees who have a stronger relationship with their supervisor, i.e. ES-R quality, are more likely to perceive them in positive terms and perhaps more confident that they will communicate and discuss with them their HR ambiguities. In return, acquiring accurate and valuable information helps them reduce HR uncertainties and develop trust in their supervisor’s perception. When there is a strong relationship between employees and their supervisors, it is also conceivable that both parties share a similar perception of reality and thus HR practices and employees may enjoy greater access to (or more favourable decisions) related to HR practices (Harris and Kacmar, 2005). This implies that communication alone does not work but that overall relationship quality may also be essential.

As such, employees who have a stronger E-SR quality interact with their supervisor informally, receive more information and benefits associated with HRM and develop trust in their supervisor’s HR perception. In this regard, HRM and leadership (such as perceiving the leader in positive and supportive terms) can work hand-in-hand to foster positive perceptions of HRM, thereby improving outcomes for workers and organizations alike (Sanders et al., 2022). Applying this to motivation-enhancing HR practices, we propose that when E-SR quality is perceived as high rather than low, employees are more likely to have access to the specific HR practices, can informally discuss HR ambiguities such as promotion or career-development opportunities and are likely to receive more accurate information from their supervisor. The opposite is expected to be the case when the E-SR quality is perceived as low. In this way, implemented HR practices and ES-R quality should be complementary in nature in fostering perceived HR practices (Leroy et al., 2018). Consequently, the relationship between EPMHRM and SPMHRM is likely to be stronger when E-SR quality is perceived as high rather than low, as highlighted in the following hypothesis.

The data for this study were collected from two large public territory care hospitals in Pakistan: both in the city of Lahore (capital of Punjab province), which are similar regarding their status, size and level of specialization (all being autonomous, large general public medical teaching hospitals). Ethical approval was obtained before the data collection phase. Access was requested from the top management of the selected hospitals and all departments (units) in the selected hospitals were asked to participate in the research, which was fielded between December 2019 and February 2020. Prior to the data collection, ethical approval was obtained. The first author contacted the doctors of all departments to gain their consent to participate. A questionnaire was shared that first explained the purpose of the research and highlighted the anonymity and confidentiality of responses. The survey was developed in English as it is the official language in the medical profession in Pakistan and was self-administered using paper and pencil via a standardized, structured questionnaire. Data were collected among different categories of senior and junior doctors (e.g. medical professors, medical associate and assistant professors, medical officers, senior registrars and consultants) across two hierarchical levels within the hospitals. In total, 542 senior and junior doctors (e.g. medical professors, medical associate and assistant professors, medical officers, senior registrars and consultants) are nested within 38 departments, each led by one supervisor who is the head of department (HOD) – medical professor/associate professor ^[1], completed the survey. Supervisors were the HOD (doctors) – medical professor/associate professor who performed HR functions for employees (doctors) within their department. Overall, the response rates of supervisors range between 72% and 80% and for employees (doctors), between 60 and 65% in both hospitals. The questionnaires of supervisors and employees within the same departments were coded so that it was possible to relate answers to each other within the same hospital department, supporting a multi-level approach.

The team size range for the respondents varies from 2 to 20, with an average of 14 respondents. In the employee survey, 60% of respondents are female. The average year of experience in the department is three years (SD = 0.640). Among supervisors, 90% of respondents are male. The average year of experience in the hospital is nine years (SD = 7.6), and the average year of experience of the HOD is three years (SD = 1.49).

A 7-point Likert scale ranging from 1 (very strongly disagree) to 7 (very strongly agree) was used for all the items in the survey.

Supervisor Perceptions of Motivation-enhancing HR Practices (SPMHRM) is measured by asking HODs to fill out a questionnaire reflecting on the implemented HR practices, i.e. performance appraisal, promotion and compensation since the HODs appraise employees in their department in the two hospitals studied. The items were taken from Vermeeren et al. (2014) and adapted to align with local terminology. These include items on the performance appraisal (5 items, e.g. “I make performance objectives with doctors in my department every year.”), internal promotion (3 items, e.g. “There is a clear career structure for doctors in my department.”) and compensation (3 items, e.g. “The hospital offers my doctors attractive fringe benefits (these could include working hours, holidays, pension scheme and childcare”). Cronbach’s alpha = 0.845.

Employee Perceptions of Motivation-enhancing HR Practices (EPMHRM) is measured with items taken from Vermeeren et al. (2014) and adapted to align with local terminology. These include items on the perception of performance appraisal (5 items, e.g. “My performance objectives are made with my supervisor every year”), internal promotion (3 items, e.g. “There is a clear career structure in the hospital”) and compensation (3 items, e.g. “My rewards are not in line with my work performance (reverse coded)”)). Cronbach’s alpha = 0.781.

Employee-Supervisor Relationship (ES-R) quality is measured based on 5-items derived from Farndale et al. (2011), originally taken from Cook and Wall (1980), by asking employees about their perception of their relationship with their supervisor. Examples of items are: “I get support from my supervisor when I have a problem at work” and “I do not get along with my supervisor (reverse coded)”. Cronbach’s alpha = 0.786.

Affective Commitment is measured using five items, adapted from Kehoe and Wright (2013) and originally taken from Allen and Myers (1996). Examples of items included are “I feel a strong sense of belonging to this hospital”, “I am willing to work harder to help this hospital to meet its goals” and “I would recommend a friend to come to work at this hospital”. Cronbach’s alpha = 0.733.

Although the measures have been validated in previous research, it is important to check the measurement quality since we study public health institutions in a non-Western context. To do this, we conducted Confirmatory Factor Analysis (CFA) using structural equation modelling (SEM). For employee perceptions, a CFA was conducted to assess the scales’ psychometric properties (convergent and discriminant validity). Three latent variables were included in the measurement model of EPMHRM, E-SR quality and AC. A good fit is achieved when the CFI is 0.90 or more, the RMSEA is 0.08 or less, and the SRMR is 0.10 or less (Williams et al., 2009). The fit of the overall measurement model was acceptable (χ² (df = 182) = 681.153, p < 0.01, CFI = 0.840, RMSEA = 0.071 and SRMR = 0.062). For supervisor perceptions, a multilevel CFA and a robust MLR comprising one latent variable were conducted. After deleting four items due to the insignificant factor loadings, the fit of the measurement model was acceptable ((χ² (df = 11) = 16.332, p < 0.01, CFI = 0.958, RMSEA = 0.030 and SRMR = 0.053)). For this study, composite scores were used, and all individual variables were grand mean-centred (Hofmann et al., 2000).

As the survey data were collected in a multi-stage design (doctors nested within teams/departments), multilevel modelling (MLM) was the appropriate analysis technique to use. MLM accounts for the hierarchical structure of the data, capturing the dependency among observations within the same department. Additionally, MLM considers the clustering of the observations and adjusts the standard errors, thereby reducing type 1 errors. This methodological choice ensures that the analysis appropriately reflects the nested nature of the data and enhances the robustness of our findings (Muthén et al., 2017). To evaluate the hypotheses, we proceeded in five steps: In Step 1, we estimated an intercept-only model to calculate the between-level (between department) variance in EPMHRM. In Step 2, we added fixed effects for level 1 (characteristics of the employees including gender and experience) along with the ES-R quality and for the level 2 variable (supervisor characteristics: SPMHRM) to the model to evaluate hypotheses 1 and 3. In Step 3, we performed MLM mediation analyses to investigate hypothesis 2, i.e. whether EPMHRM will mediate the relationship between SPMHRM and affective commitment. In Step 4, we performed a mediation MLM to investigate hypothesis 4, i.e. whether EPMHRM will mediate the relationship between the E-SR quality and affective commitment. In the final step, we included a cross-level interaction effect of perceived E-SR quality between SPMHRM and EPMHRM.

The descriptive statistics and correlations between the continuous variables across the two hospitals are presented in Table 1. Almost all variables are positively correlated except EPMHRM and gender, but the size remains only weak to moderate. The strongest relationship was between EPMHRM and the ES-R (r = 0.415) and between the E-SR quality and affective commitment (r = 0.414). At the department level, as expected, SPMHRM and EPMHRM were positively correlated (r = 0.501).

Next, we proceed with the MLM to evaluate the two hypotheses. The results are displayed in Table 2, which shows the unstandardized parameter estimates.

The intraclass correlation (ICC) shows that 43.2% of the variance in EPMHRM resides between departments, indicating that a very substantial part of the variation in employee perception can be explained by differences between departments and probably also between supervisors managing these departments.

In hypothesis 1, it was expected that SPMHRM will be positively related to EPMHRM. As depicted in Model 1 (M₁ – With predictors) of Table 2, the results are significant (B = 0.298, p < 0.05), thereby confirming that hypothesis 1 is accepted.

Next, for hypothesis 2, it was assumed that EPMHRM mediates the relationship between the SPMHRM and affective commitment. As revealed in Model 3 (M₃-mediation 1) of Table 2, the indirect effect of SPMHRM on affective commitment is positive and significant (B _indirect = 0.093, p < 0.05), showing support for hypothesis 2. When SPMHRM positively affects EPMHRM, employees respond to these positive perceptions of HR by exhibiting higher levels of commitment to the organization. Here, we also checked for the fixed effect of SPMHRM on affective commitment, which was not found to be significant (B = 0.050, p > 0.05). Thus, our results reveal full mediation.

To test for hypothesis 3, it was expected that E-SR quality would be positively related to EPMHRM. As shown in Model 1 (M₁ – With predictors) of Table 2, the results reveal that the relationship is significant and positive (B = 0.337, p < 0.05), thereby lending support to hypothesis 3.

In hypothesis 4, it was assumed that EPMHRM would mediate the relationship between the ES-R quality and affective commitment. The MLM mediation analysis in Model 4 (M₄-mediation 2) supports this: the indirect effect from the ES-R quality to affective commitment is positive and significant (B _indirect = 0.086, p < 0.01). The stronger the relationship between the supervisor and employee, the more positive the employees perceived the motivation-enhancing HR practices, which, in turn, is positively associated with employees’ affective commitment. Here, we found partial mediation (B = 0.249, p < 0.01).

Finally, hypothesis 5 predicted that the positive relationship between SPMHRM and EPMHRM would be stronger when E-SR quality is perceived as high rather than low. Including the cross-level interaction in Model 2 (M₂ – With cross-level interaction) was not found to be significant (B = 0.057, p > 0.05). Specifically, the effect of SPMHRM on EPMHRM was equal for every level of ES-R quality (be it at a higher or lower level). As such, hypothesis 5 was not supported.

In the present study, we explored whether EPMHRM acts as a mediator between both (1) SPMHRM and affective commitment and (2) E-SR quality and affective commitment. Additionally, we explored whether E-SR quality may strengthen the relationship between SPMHRM and EPMHRM. The multi-level analysis revealed three main findings. First, EPMHRM mediates the relationship between SPMHRM and affective commitment. Second, EPMHRM mediates the relationship between E-SR quality and affective commitment. Finally, contrary to our expectations, no support was found for the moderating role of E-SR quality in the relationship between SPMHRM and EPMHRM. We discuss the implications of these findings for theory and practice below.

Our study contains important insights for the ongoing debate in the strategic HRM field on the factors influencing employee perceptions of HR practices. One commonly highlighted factor in the literature is supervisor perceptions of HR practices (Den Hartog et al., 2013; Jiang et al., 2017). However, no conclusive evidence is available on the role of supervisors’ perceptions, especially in the hospital context and in non-western contexts (Do et al., 2019; Faisal et al., 2022; Sanders et al., 2022). Studies in emerging economies, such as Pakistan, India and Bangladesh, suggest that centralized decision-making and resource shortages often limit supervisors’ autonomy, constraining their ability to effectively implement HRM practices (Faisal et al., 2022; Suhail and Steen, 2021). In contrast, healthcare systems in developed countries like the UK and Australia tend to have more decentralized, providing greater managerial flexibility and facilitating better communication between supervisors and employees (Bartram et al., 2007; Stanton et al., 2010). Our findings contribute to this debate by providing empirical evidence, derived from public hospitals in Pakistan, that there is indeed a significant relationship between supervisors’ perceptions and employees’ perceptions of motivation-enhancing HR practices. The hierarchical structure of hospitals, where decision-making authority is concentrated among senior medical and administrative personnel (Suhail and Azhar, 2016), presents a unique setting to examine the (mis)alignment of HR perceptions between supervisors and employees (Van Beurden et al., 2025). Moreover, given the lack of studies that address both types of HR perceptions, especially in non-western contexts, we advance our understanding by examining both perspectives together in the same model while also integrating E-SR quality as an important yet unexplored antecedent in relation to employee HR perceptions and affective commitment.

These findings showcase the utility of taking an SIP theory lens to understand HRM practice perceptions (Chênevert et al., 2021; Elorza et al., 2022; Jiang et al., 2017) and confirm conclusions from other studies carried out in other contexts like construction/manufacturing and the hotel sector (c.f. Elorza et al., 2022; Den-Hartog et al., 2013; Jiang et al., 2017). While health care professionals can be prone to responding differently to HR practices than employees in other sectors because of their specific and institutionalized background (Ang et al., 2013), and because the gap between what management perceives and do is often quite distal to the reality and perceptions of health care professionals on the ground (Bartram et al., 2007), our findings show that employees can indeed be still influenced by their supervisor’s perceptions of HRM. When supervisor’s perceptions of HRM shape employee perceptions of HRM consistent with SIP, a social exchange (Blau, 1964) process is then activated that ultimately culminates into employees demonstrating higher levels of affective commitment. Indeed, our findings reveal that EPMHRM fully mediates the relationship between SPMHRM and affective commitment. These findings showcase the utility of SIP theory and social exchange theory simultaneously explaining the process of HRM implementation as conceptualized in the process model of SHRM (Wright and Nishii, 2013).

In addition, our study advances knowledge in the HRM field by showing that E-SR quality represents an important antecedent of EPMHRM, which in turn, is positively associated with employee affective commitment. This highlights that when employees have a stronger E-SR quality, they are likely to perceive motivation-enhancing HR practices more positively and thereby enhancing their levels of commitment to the organization. As such, while SIP theory is crucial in explaining how supervisors convey HR messages, the social exchange relationship (Blau, 1964) that exists between employees and their supervisors acts in a parallel fashion to also foster positive perceptions of motivation-enhancing HR practices. These findings extend the process model of strategic HRM (Nishii et al., 2008) and thereby advance the research examining variability in employee perceptions of HR practices. In this regard, our study introduces a distinct but related social contextual relationship construct, i.e. employee-supervisor relationship quality, that can also independently ensure that employees’ perceptions of various HR practices are realized (Frenkel et al., 2012; Wang et al., 2022). It is worth pointing out that the impact of ES-R quality as an independent predictor of EPMHRM (B = 0.337) is even stronger than the predictor of SPMHRM on EPMHRM (B = 0.298).

Finally, the present study responds to the call for testing contextual factors (boundary conditions), such as ES-R quality, as a moderator between supervisor perceptions of HR practices and employee perceptions of HR practices (Den Hartog et al., 2004; Wang et al., 2022). Our results revealed that both SPMHRM and ES-R operate independent from each other in terms of predicting EPMHRM and in turn affective commitment. Placing this finding in the existing literature, our results are supportive of Leroy et al.’s (2018) “independence” categorization (option 1) whereby HRM and leadership (ES-R quality) are considered to be independent predictors of follower outcomes. It might be, for example, that supervisors see their role in motivating employees through a positive exchange relationship as something which is distinct from their actions in conveying HR practice messages to employees and seeking to foster the same outcome but via different means (Kehoe and Han, 2020). It may also be the case that they have significant leeway in some elements of HRM such as the performance appraisal conversations but perhaps have less influence on internal promotion and compensation, making distinct motivational techniques, like a strong ES-R, necessary. While ES-R quality may not be a prerequisite to ensure the gap between supervisors’ HR perceptions and employees HR perceptions is reduced, other relationship dynamics could be relevant that involve specific behaviours of leaders (e.g. other leadership styles) and/or the capacity of the specific supervisor involved in implementing HRM (e.g. Den Hartog et al., 2013; Kilroy et al., 2022).

This study has important practical implications for organizations and HR professionals. Given the positive relationship between SPMHRM and EPMHRM, the HR department may want to consider providing contextualized training (e.g. on conducting performance appraisal) on HR implementation to all supervisors to foster consistent implementation within and across departments. This may help in developing a “strong HR system” that can be consistently perceived at all levels in the organization, and specifically among employees (Bowen and Ostroff, 2004). Moreover, our findings suggest that to enhance employee affective commitment, the organization could invest in motivation-enhancing HR practices—including appraisal, promotion and compensation practices—and ensure that employees perceive these practices positively. Therefore, consistently implementing motivation-enhancing HR practices across units can enhance employee affective commitment in the organization. These findings are essential for overcoming the declining commitment among public health doctors in Pakistan (Saleem et al., 2018).

Regarding the critical role played by E-SR quality for EPMHRM and affective commitment, management could pay particular attention to strengthening E-SR quality which could be useful in independently influencing employees’ experience of motivation-enhancing HR practices and ultimately in achieving desired employee outcomes. Rather than solely focusing on conveying their own view of motivation-enhancing HR practices, management should recognize the unique contextual factors within public hospitals in Pakistan, such as centralized decision-making, labour shortages and the high-stress nature of healthcare environments, which significantly shape the employee–supervisor relationship (Faisal et al., 2022; Suhail and Steen, 2021). This can be achieved first, by encouraging open communication between HR professionals and supervisors about the HR policies and practices intended by management, and how they are expected to be implemented in the organization. In addition, they could discuss the role that line managers play in implementing these practices and the support they require to navigate the complexities of a hierarchical hospital setting. Second, supervisors should be trained to enhance E-SR quality, through regular dialogues with employees to create a safe, open and constructive relationship where employees feel they can share their concerns, such as excessive patient loads, extended duty hours, resource shortages and the emotional toll of handling critical and emergency cases in a public hospital setting. Third, besides annual appraisal meetings, constructive and regular feedback could be given to employees, but feedback could also be provided to the supervisors, to build a strong and trusting relationship with doctors in their departments. In this way, participatory management could be practiced so employees feel more engaged and empowered. All these strategies can be used to enhance E-SR quality, which could further enhance EPMHRM and their affective commitment.

Despite being a multi-level, multi-actor and multi-organization study, the results should be considered in light of three main limitations. Firstly, data are collected from two sources, i.e. supervisors and employees, but the cross-sectional design limits our ability to claim inferential causality. However, there is a solid theoretical logic underpinning the proposed relationships in our model (Wright and Nishii, 2013). Nevertheless, we encourage future research to adopt a longitudinal research design to establish conclusions related to causality.

Secondly, data is collected from supervisors (HOD) who could have a more favourable view of HR practices than their employees (doctors) because they are involved in implementing them. Thus, there might be a certain level of social desirability or impression management in their answers, as supervisors may be inclined to present themselves as more competent or responsible in their implementation of HR practices than they actually are. We acknowledge that this may have influenced the validity of their answers. However, to partially address this concern, we have included negatively worded items in the questionnaire (see Billiet and McClendon, 2000). However, due to the small sample size of supervisors’ data, it was not possible to check for response style and with larger sample sizes, future research could check the acquiescence response style (see Billiet and McClendon, 2000).

Finally, a small sample size was obtained at both department and individual levels. The small sample size especially for department/units is a limitation of our study and this may have caused non-significant results for our moderation hypothesis. Additionally, public healthcare professionals have specific backgrounds and may thus have responded to HR practices differently than employees in other sectors (Ang et al., 2013). Therefore, we encourage future research to extend the study with different levels in hospitals including paramedics and nurses. Moreover, extending the studies by comparing public and private hospitals to understand the trends and differences in perceived HR practices will help to increase the generalizability of the findings.

This study aimed to contribute to the ongoing debate in the strategic HRM field in understanding the antecedents of employee perceptions of HR practices. In light of our findings, we conclude that there are other factors next to SPMHRM that influence how employees perceive motivation-enhancing HR practices. Specifically, our findings show the importance of E-SR quality in predicting EPMHRM, which in turn encourages employees to demonstrate affective commitment. Overall, the present study enriches our understanding of the antecedents (and their boundary conditions) of employee perceptions of HR practices in the context of public hospitals in Pakistan, an under-researched context in the HRM and performance linkage.

Support for the data analysis was provided by Cecil Meeusen, an assistant professor at ReSPOND, KU Leuven, Belgium.

Funding: This research received funding from the Flanders Research Foundation (FWO) under grant number V443919N for data collection.