1. Introduction

Cultural values influence the reactions and attitudes of people to different events. (see also: ^{Gelfand et al., 2007}). Managerial behavior is also influenced by cross-cultural variations. As managers are socially and culturally shaped, they tend to run their companies based on the values they have internalized. In Turkish culture, loyalty, helping one another, and maintaining close relationships with large associations and professional organizations are highly valued rituals. These cultural values have a significant impact on the way managers lead their teams and run their organizations.

Turkey is known for having a culture with a high power distance, where social stratification based on income, prestige, and interpersonal position is prevalent. In many organizations, certain areas such as car parks, canteens, toilets and dining rooms are designated on the basis of the status of the individual, and visitors are often referred to by their titles.

In organizations with a high power distance, there is often a noticeable difference in how employees and superiors are treated (^{Örücü et al., 2019}). Workers in such organizations may feel disconnected from their jobs and the company due to the significant distance between them and their superiors. This can impact their ability to use their expertise, skills, and knowledge to contribute to the organization processes, as they may only focus on completing assigned tasks and following instructions without question. When workers are not included in the management procedures of a company, they may become unaware of the circumstances within the organization. This can lead to a sense of disconnection from both the company and their position, and can have an impact on all stakeholders involved. Additionally, it could hinder the establishment of healthy communication and interaction. Social relationships play a crucial role in maintaining stability within organizational structures, and prioritizing organizational justice is important in building a strong foundation for these relationships. This can significantly impact how employees perceive their work environment, and how they behave and interact with one another (^{Lambert, 2003}).

The aim of the present study is to determine the mediator role of justice in the relationship between power distance and organizational alienation of healthcare workers. In this study, survey was used, SPSS package program was used in the analysis of research, Model 4 was used for mediation and SPSS Process macro was used to determine the effect of mediation.

The proposed model is shown in Figure 1. In the proposed model, power distance was treated as an independent variable, organizational alienation as a dependent variable and organizational justice as a mediator variable.

Source: Authors’ own elaboration.

Figure 1 Research Model  

Based on the above literature, the following research hypotheses were proposed:

H ₁ : There is a significant relationship between power distance and organizational alienation.

H ₂ : There is a significant relationship between power distance and organizational justice.

H ₃ : There is a significant relationship between organizational alienation and orga­ni­zational justice.

H₄: Organizational justice has a significant mediation role on the effect of power distance on organizational alienation.

2. Power Distance

Power distance is one of the six cultural dimensions that were first defined by Geert ^{Hofstede (1984)} (^{Krishnakumar et al., 2021}). It refers to the perception of members in an organization or society regarding the unequal distribution of power (^{Hofstede et al., 2010}; ^{Hofstede and Mooij, 2010}). It has been observed that cultures with high power distance tend to accept and justify inequalities, while those with low power distance are less comfortable with them and do not support them. This has been suggested by research conducted by ^{Jha et al., (2019)} and ^{Krishnakumar et al., (2021)}. In societies with high power distance, social stratification based on factors such as power, wealth, status, prestige, and authority is emphasized. This inequality is often reinforced by the hierarchical structure prevalent in organizations, which can result in longer distances in the superior-subordinate relationship. Consequently, communication within the organization may suffer as employees find it more difficult to take initiative and actively participate in decision-making (^{Örücü et al., 2021}; ^{Ghosh, 2011}). In organizations with low power distance, there are typically few supervisory staff and limited pay differentiation. The organizational structure tends to be flat, with similar rights and duties available to all employees. This results in non-rigid centralization, with low levels of inequality in opportunities and rewards. In such organizations, it is not common for superiors to benefit from privileges (^{Kartari, 2001}; ^{Bakan et al., 2004}). This has been suggested by ^{Kartari (2001)} and ^{Bakan et al. (2004)}. In contrast, in organizations with high power distance, employees tend to follow the orders given by their managers without questioning them. This has been suggested by ^{Yaman and Irmak (2010)}. Such organizations tend to have a hierarchical structure with significant pay differentiation and a greater number of supervisory staff. This inevitably leads to greater social stratification, where superiors enjoy privileges that are not available to their subordinates (^{Yaman and Irmak, 2010}).

3. Organizatioanl Alienation

It can be observed that that employees who are dissatisfied with the relationships within the organization tend to experience a sense of meaninglessness in their job. They may also feel weak, lonely, and inadequate, and view themselves as mere cogs in the system, leading to a loss of hope for the future (^{Elma, 2003}). Organizational alienation can arise among employees due to private and arbitrary behaviors, which can lead to feelings of hostility. When complaints are not addressed, the situation can worsen. The perspective of managers towards employees is also a significant factor that can affect organizational alienation. In workplaces where the employees’ organizational commitment is not valued, social needs are not met, and organizational values are not internalized, employees may become alienated from the organization. This alienation can negatively impact their productivity and motivation, ultimately affecting the success of the organization. Therefore, prioritizing employee well-being and creating a positive work environment that fosters a sense of belonging and commitment is crucial (^{Babür, 2009}; ^{Şimşek et al., 2014}). In situations like these, employees may find it difficult to behave in a manner that is congruent with their knowledge and skills, which can lead to feelings of dissatisfaction and disengagement. When employees lack a clear understanding of their roles and responsibilities or the purpose of their job, they may feel disconnected and lost within the organization.

4. Organizational Justice

Organizational justice refers to the employees’ perception of how punishments, promotions, salaries, and rewards are applied within the organization. It encompasses the decision-making process involved in these areas and how such decisions are communicated to the employees (^{İçerli, 2010}).

Over the last thirty years, various researchers have defined organizational justice in different ways. ^{Greenberg (1987)}, ^{Colquitt et al. (2001)}, and ^{Cropanzano et al., (2007)} have all explored different aspects of organizational justice, including distributive justice, operational justice, and interactional justice.

The level of power distance within an organization can significantly impact the behavior of employees. High or low levels of power distance can affect employees in different ways. While employees may not react to the centralization of power and privileges by those in authority, it does not necessarily mean that they view it as fair. In cases where employees experience injustice within the organization, it can have negative impacts on their overall well-being. They may feel alienated from the rules, procedures, applications, social relationships, and even from themselves.

5. Research Methodology

6. Results

The socio-demographic profile of the participants are presented in Table 1.

The correlations between study variables are computed using Pearson correlations. The results are presented in Table 2.

It was concluded that there is a positive significant relationship between organizational alienation and power distance (r=.184, p<01); there is a negative significant relationship between organizational justice and power distance (r=-.189, p<01), and there is a negative significant relationship between organizational justice and organizational alienation (r=-369, p<01). The hypotheses H_1, H_2, H₃ were accepted.

While interpreting if the mediator variables are significant or not, BootLLCI and BootULCI mut be considered because “If there is a “0” value among the values of BootLLCI and BootULCI, it is not possible to mention mediation effect” (^{Adıgüzel and Küçükoğlu, 2020}). If there is no “0” among the values of BootLLCI and BootULCI, then the mediation has a significant impact. The results are presented in Table 3.

It is observed that the variable of organizational justice has the mediation role on the effect of power distance on organizational alienation (BootLLCI=.038, BootULCI=.126). H₄ hypothesis was accepted. When the effect of the perception of organizational justice on partial mediation role, it was determined that the value is 14.1%, and it was found that the effect value on complete mediation role is 7.9%.

7. Discussion

This research was carried in order to determine the mediation role of justice in the relationship of power distance and organizational alienation of healthcare staff. Results showed that there is a positive relationship between power distance and organizational alienation; a negative relationship between power distance and organizational justice; a negative relationship between organizational alienation and organizational justice. In the results of regression analysis, power distance affects organizational alienation in a positive way and organizational justice perception in a negative way. The study found that organizational justice plays a mediation role in the relationship between power distance and organizational alienation. This research is believed to make a valuable contribution to the existing literature. This is the first study in the health sector that examines the mediation effect of organizational justice on the connection between power distance and organizational alienation.

According to research, there exists a significant and positive correlation between power distance and organizational alienation. A similar study conducted by ^{Güzel (2022)} found a positive and significant association between power distance and work alienation. ^{Can and Gündüz (2021)} found that teachers’ perceptions of power distance and work alienation were both very low. Research indicates that various factors can affect organizational alienation, depending on the organizational structure (^{Ertekin and Özmen, 2017}; ^{Öz, 2020}; ^{Türe and Akkoç, 2021}; ^{Vanderstukken and Caniels, 2021}). In order to reduce the effect of power distance on work alienation, communication between managers and employees should be increased and hierarchical barriers should be reduced. It is recommended to remove privileges (dining room, toilet, parking place) used only by senior management.

Our study found a substantial negative correlation between power distance and organizational justice. ^{Blader et al. (2001)} suggested that a high power distance in organizations may result in reduced expectations for fair treatment among employees due to differences in status and hierarchical structure between power holders and subordinates. Numerous studies have come to similar conclusions (^{Lee et al., 2000}; ^{Blader et al., 2001}; ^{Fischer and Smith; 2006}; ^{Daniels and Greguras, 2014}; ^{Ertaş and Unur, 2018}; ^{Köksal, 2018}; ^{Acaray, 2019}). Contrary to our findings, ^{Köksal (2018)} studied organizational justice and found a positive correlation between perceived organizational justice and organizational culture. Their study identified a strong relationship between these variables. To reduce power distance among healthcare professionals, it is recommended to provide in-service training, engage in guiding activities, incorporate employee participation in decision-making processes, and establish open communication between managers and employees. Our study also revealed a significant negative correlation between organizational justice and organizational alienation. ^{Sulu and Ceylan (2010)} found similar results in their study on health workers.In the study, we also found that there is a negative significant relationship between organizational justice and organizational alienation. ^{Sulu and Ceylan (2010)} reached similar results in their study on health workers. Similarly, Ceylan and Sulu (2010) suggested that there is a negative relationship between organizational justice and work alienation on health workers. According to the study of ^{Zengin and Kaygın (2016)}, there is a negative correlation between organizational justice and organizational alienation. Several other studies (^{Günsal, 2010}; ^{Sookoo, 2014}; ^{Amazue et al., 2016}; ^{Dilixiati, 2017}; ^{Moç, 2018}; ^{İrdem, 2020}) have also found similar results. It is crucial to distribute resources fairly among employees to promote organizational justice, and the decision-making process should follow the principle of impartiality. Additionally, implementing fair policies within the organization and reducing employees’ workload is also important. Turkey, as a collectivist society, is thought to have a high perception of power distance, as in other collectivist societies (^{Hofstede, 1983}). This high perception of power distance is expected to contribute to organizational alienation, and organizational justice is believed to play a mediation role in this alienation.

8. Conclusion

The research aimed to find out if justice plays a mediation role in the relationship between power distance and organizational alienation among healthcare staff. The findings suggest that power distance is positively related to organizational alienation and negatively related to organizational justice. Additionally, organizational alienation is negatively related to organizational justice. Regression analysis shows that power distance has a positive impact on organizational alienation and negative impact on organizational justice perception. The study also shows that organizational justice mediates the relationship between power distance and organizational alienation. On the basis of this result, H₁, H₂, H₃ and H₄ are accepted.

9. Limitation and Future Research

The research took into account factors such as time and cost. It was limited to healthcare workers in various positions in the Ankara province. It was assumed that participants answered the questions truthfully and with sincerity. The study revealed that power distance has an impact on the organizational alienation of employees, while organizational justice plays a mediation role in this relationship. However, it is important to note that the results cannot be generalised due to the design and limitations of the study. Despite this, the study provides a unique perspective. Future studies could be conducted in different populations and sectors, and transnational comparisons could be made.