FOSTERING ORGANIZATIONAL CITIZENSHIP BEHAVIOR BY DEVELOPING ORGANIZATIONAL CULTURE THROUGH WORK ENGAGEMENT

. In the hospital industry, patient-and family-centered care is a key factor that measures hospital management performance. Hospital management requires the support of quality resources, especially human resources, who directly provide services to their customers. Therefore, Organizational Citizenship Behavior (OCB), known as extra role behavior from employees, is highly effective to apply because it can lead employees to deliver performance that goes beyond just performing their formal duties. The purpose of this study was to analyze the effect of organizational culture and leadership style on the OCB of employees in A Class A-Noncommunicable disease hospital in Jakarta through Work Engagement. The research method used a quantitative method with a sample of 260 employees. The hypotheses were tested through the SEM (Structural Equation Model) method with the SmartPLS3.0 application and SPSS version 27. The results showed that organizational culture, leadership style and work engagement affected OCB simultaneously. Organizational culture and leadership style were positively related to work engagement and OCB among employees. Meanwhile, leadership style affected OCB through work engagement. Having employees who demonstrate OCB is crucial to the hospitals to provide quality service delivery. Hence, maintain the stability of a positive organizational culture are required to improve work engagement amongst employee such as employee career development strategies and holding togetherness events that may increase work engagement thereby motivating employees to carry out OCB.


INTRODUCTION
Quality health services can provide services efficiently and effectively in accordance to professional standards, service standards, and run thoroughly according to patient needs, as well as using appropriate technology so that an optimal health degree is achieved.Like Patient Center Care, the patient is the center of the services provided and the needs and values embraced by the patient and his family are important and must be responded positively by all parties involved in providing services to the patient.SL Hospital is a Class A-noncommunicable disease hospital in Jakarta.Patients in SL hospital need longterm care, so they will become loyal consumers when they get quality services.Realizing the importance of this, SL Hospital establishes and is committed to continuing to provide quality services and set measurement standards to be able to measure this through the Patient Satisfaction Index (PSI) and Net Promoter Score (NPS).The PSI value at SL Hospital shows an increasing trend from month to month and above the target, but the NPS value is still below the target.The low NPS value indicates that consumers desire to refer the hospital to others or themselves is still lacking.
Based on patient feedback and observation, it was concluded that the employees in the operational line are busy performing their routine tasks, reluctant to help their colleagues, which causes missed communication and lack of coordination.There is an impression of throwing patients from one part to another.Meanwhile, human resources should be one of the supporters to strengthen organizational capacity.Human resources or employees with good performance will improve organizational performance and assist the organization in achieving the goals that have been set.A successful organization needs employees who can do work beyond the expectations of the organization itself.
According to Guven, today an organization expects its employees to show behaviors that are not forced, but behaviors that have a positive contribution to the organization in addition to their formal duties to achieve the goals of the company.(1) According to Pickford and Joy, employee behavior outside of their routine work, willingness to do more than the minimum necessary, which can make an additional contribution to their work environment socially and psychologically is called civic behavior or referred to as Organizational Citizenship Behavior (OCB).(2) According to Organ et al., OCB can increase efficiency by increasing employee productivity, such as employees who help each other and coordinate well will speed up the work process.The supervision process can also be effective so that managers can allocate their time for more productive work such as strategic planning, improving business processes, and others.An organization that has employees with good OCB will then be a great organization.(3) Several studies in the field of organizations mention that one of the most key factors of OCB is leadership in organizations.The role of the leader has a great impact on employee behavior, without leadership the relationship between organizational goals and employee goals becomes tenuous.A person's leadership style will affect the success of the organization in achieving its goals.The leader can affect the behavior of his subordinates through the style or approach used to manage employees.(4) As per research conducted by Lingyun Mi et al. transformational leadership style can Effectively promote employees' OCB.Leader's vision motivation directly inspires employees' OCB and both leaders' individualized consideration and moral modeling promote OCB indirectly through phycological ownership.(5) According to Rudnick, Jr. servant leadership is suitable for the healthcare industry.The alignment between the values fostered in healthcare and the principles of servant leadership lends itself to achieving this leadership style compatibility.(6) According to research conducted by Khan et al. (2020), in addition to leadership, OCB is also affected by organizational culture.Organizational culture contains values that are believed and lived in the organization, being a code of conduct, to direct the people in the organization to behave like these values to be accepted by their environment.This organizational culture will be seen in the way employees think which translates into the way employees work, reflected in the form of employee behavior and impacting employee performance and their productivity and improving OCB.(7) According to research conducted by Xiong and Wen in 2 major banks in China, work engagement was significantly correlated with OCB and counterproductive behavior.(8) According to research conducted by Putri et al., organizational culture also positively affects employee (work) engagement and OCB.The more conducive the culture of an organization or company, the greater the level of employee engagement.employee (work) Engagement has a positive effect and significantly affects OCB.The higher the engagement rate indicated by the employee, the higher the OCB level of the employee in question in the organization.(9) Some studies have also shown that work engagement is a mediating factor between OCB and leadership style.Wardani and Helmy's research conclude that high OCB is affected by transformational leadership styles and work engagement, where work engagement can be partially used as a mediating factor.(10) From the background above, the researcher intends to conduct a study about the effect of Organizational Culture and Leadership Style on Organizational Citizenship Behavior at A Class A-Noncommunicable disease hospital in Jakarta with Work Engagement as a mediation variable.

METHOD
This research has 2 (two) independent variables, which are Organizational Culture (X1) and Leadership Style (X2), 1 (one) dependent variable, which is Organizational Citizenship Behavior (OCB) (Y), and 1 (one) mediation variable, which is Work Engagement(Z).The conceptual framework of the research is shown in figure 1.

Participants and Data Collection
The population of this study was all employees at the noncommunicable disease hospital in Jakarta which amounted to 800 people, with a random sample of 260 people.This study used a survey method for the data collection by distributing online questionnaires using Google Form.Likert scale was employed for the measurements, with a scale of 1 -4 (1 = strongly disagree and 4 = strongly agree).

Instruments
Measurement of Organizational culture using 54 statements taken from Robbins.(11)

Data Analysis Technique
Hypothesis test using the Structural Equation Modeling (SEM) with Smart PLS 3.0 programs.The decision of the hypothesis in the study is based on a significance value of 0.05 and compares the t statistic and t table .Test the quality of the data using validity and reliability tests.The reliability test uses Cronbach's Alpha measurement with values were > 0.6.The closer Cronbach's Alpha value to 1, the better.The Validity value refers to the factor loading is 0.7.Index analysis in this study uses the Three Box Method, where this analysis divides respondents' answers into 3 categories of low, medium and high.

RESULTS
From the table of respondents (Table 1), based on gender, women dominate, namely 62%.Meanwhile, based on the position of position, it is dominated by mployees at the staff level, which is 83%.Based on the length of work, the most respondents were those who worked over 8 years, which was 34%.Based on the last education 56% with the last education strata 1, while based on his age, the most respondents were aged in the range of 20-30 years, namely 52%.The reliability value of the construct and variance extract is above the upper limit of the required value where all Composite Reliability (CR) values are above 0.7 and all Average Variance Extracted (AVE) values are above 0.5.In general, it can be concluded that the indicators used as observed relative variables are able to explain the latent variables they form.

Inner Model Evaluation
From the results of the multicollinearity test shows that all variables have a VIF number < 5.The value concludes that there is no multicollinearity.From the results of the R2 test, it can be seen that the organizational culture model and leadership style towards OCB gives a value of 0.691, which can be interpreted that the variability of the OCB construct that can be explained by the variability of the Organizational Culture construct and leadership style is 69.1% (strong substantive), while the rest is explained by variables outside this study.Likewise, the Organizational Culture and Leadership Style model for Work Engagement provides a value of 0.633, which can be interpreted that the variability of the work engagement construct that can be explained by the variability of the organizational culture and leadership style constructs is 63.3% (strong substantial), while the rest is explained by other variables outside this study.
Based on the results of the fit model shows the SRMR value < 0.1 (good fit) states the avoid ability of errors in the model specification and shows the average difference between the observed correlation and the expected correlation as the absolute fit criterion of a model.The NFI in the table shows a value of 0.728 where the closer to the value of 1, the closer to the match of a model, so it meets the fit model requirements.RMS theta shows a result of 0.117 which is below 0.12 so the rms theta requirement already meets the fit model.In the dimension of Helping subordinates grow and succeed, there are also 3 statements that fall into the moderate category, namely "My leader pays attention to and prioritizes my career development", "My leader is interested in ensuring I achieve my desired career goals", and "My leader has a desire or knows my career goals".This means that some employees feel that their career development is still not a priority.In the Putting subordinates first dimension, the 4 statements all fall into the moderate category of "My leader cares more about my success than his own success", "My leader puts my interests ahead of his own", "My leader will sacrifice his personal interests to meet my interests/needs", and "My leader will do anything to make my job easier".This means that some employees feel that leaders have not prioritized employee success over themselves.The lowest judgment occurs on the question item "My leader will sacrifice his personal interests to meet my interests / needs." The average respondent's assessment of the Work Engagement variable is in the High Category, and for all statements are in the High category.The highest rating occurs on the question item "I feel proud to be part of the company".The average respondent's assessment of the OCB variable is in the High Category.The highest rating occurs in the question item "There is a sense of satisfaction in my heart when my work is completed on time".

DISCUSSION
The effect of organizational culture, Leadership Style, Work Engagement on Organizational Citizenship Behavior (OCB) simultaneously.Based on the results of this study, it is known that organizational culture, leadership style and Work Engagement affect OCB simultaneously.
OCB which is a positive behavior and activity of employees that is voluntary in nature will occur effected by internal and external factors (3).Some of the external factors that affect employee OCB include organizational culture and leadership style.When organizational culture is believed and adopted by employees, it will make employees attached to their organization, and the impact will be seen from their behavior to colleagues or to their organization.Meanwhile, work engagement as a mediation factor has many factors that affect it, one of which is the leadership style of its superiors which will affect the attachment of employees to their work or organization.Superiors who pay attention to their subordinates (leadership style) will make employees more enthusiastic about work and dedicated (work engagement) to do their work, even voluntarily helping their co-workers (OCB).As according to Leiter & Bakker's theory that Work Engagement supports Extra-role Performance, where it is expected that they do more than their boss or organization expects, going beyond the formal structure of their position to take the initiative, so this Work Engagement will strongly support the OCB of employees.(14) The results of this study support research that has been done before, namely research conducted on Chinese employees who work in high tech industries.(15) In this study, inclusive leadership effected the OCB behavior of its employees which was partly mediated by work engagement, where to increase OCB employees need to increase Work Engagement because the higher the employee's attachment to the organization or work, the employee behavior that is expected to be extra miles outside of their routine duties will be carried out voluntarily.
Based on the analysis of the three-box method on the four variables studied, the lowest is the average index on the leadership style variable, which is included in the medium category, while the other three variables are in the High category.The lowest leadership style is in the dimension of "Putting subordinates first" which is felt by the lack of concern for the leader to prioritize his subordinates in terms of pursuing their success, interests or needs.While the highest index is in the OCB variable and of the 19 indicators, 18 of them are in the High category.This shows the employee feels they already have OCB behavior.The Work Engagement variable is included in the High category on average and the overall indicator is also in the High category, which shows the good work attachment of employees in this organization.

The effect of organizational culture on Work Engagement
Based on the results of this study, organizational culture affects Work Engagement.According to Kreitner et al that organizational culture facilitates the collective commitment of its employees, where employees are proud to be part of the organization.By being proud to be part of the organization, the dimensions in work engagement such as vigor or great energy when employees work (vigor), the willingness to be involved (dedication) and employees will be serious in conducting their work (absorption) will be higher.(16) The results of this study support previous research on employees working in Latvia where organizational culture has a positive effect on Work engagement, especially on the dimensions of innovation, performance orientation, and social responsibility.(17)Based on the analysis of the threebox method on the Organizational Culture variable, the average Index is included in the High category.Of the 54 indicators, 6 (11%) are in the medium category and none are in the low category.The lowest indicator is "The company conducts regular family gathering events" where indeed the program has not been activated regularly in the company, while this is a good opportunity for togetherness to share vision can be done to maintain stability which is one of the dimensions in organizational culture.

The effect of leadership style on Work Engagement
Based on the results of this study, leadership style affects Work Engagement.A leader who is attentive, serves, focuses on his subordinates will make the employee feel valued and will increase his attachment to his leader, his work or even with his organization.They will do their job more optimally because they feel cared for and valued.
Leaders who apply the servant leadership style will have a positive impact on the commitment, work attitude and performance of subordinates in the organization because of the development given to their subordinates.(12) The results of this study support previous research conducted on employees of the regional secretariat of NTB province that leadership style (in this leadership transformational leadership) has a significant effect on work (employee) engagement, where the better the implementation of leadership, the higher the work engagement in employees.(18) Based on the analysis of the three-box method on the Leadership Style variable, the average Index is included in the medium category.Of the 27 indicators, 11 (41%) are in the medium category and none are in the low category.There are 7 dimensions in this leadership style (servant leadership) and 4 of them are in the medium category, namely Emotional Healing, Creating Value, helping subordinates grow and succeed and Putting subordinates first, and these are the lowest.Employees feel a lack of concern for leaders to put their subordinates first when it comes to pursuing their success, interests or needs.

The effect of Work Engagement on OCB
Based on the results of this study, Work Engagement affects OCB.Work engagement supports extra-role performance, where it is expected that they do more than their boss or organization expects beyond the formal structure of their position.(14) Because of the strong attachment, it will form positive behavior according to the organization.With attachment, employees will have positive energy and be willing to do work outside of their routine duties.This is in line with previous research conducted on a manufacturing company, PT XYZ which revealed that employee (work) engagement has a positive and significant effect on OCB.The higher the level of engagement shown by the employee, the higher the OCB level of the employee concerned in the organization or company.(9) Based on the analysis of the three-box method on the work engagement variable, there are 3 dimensions (Vigor, dedication & absorption) which consist of 11 indicators, each indicator is in the high category so that on average it is also in the high category, which shows that employees feel work attachment to their work or organization.

The Effect of Organizational Culture on Organizational Citizenship Behavior (OCB)
Based on the results of this study that Organizational Culture affects OCB.Organizational culture facilitates the collective commitment of its employees and shapes employee behavior within the organization by helping managers feel their existence, which helps employees understand why the organization is doing what it is supposed to do and how the company intends to achieve its long-term goals.(16) A positive organizational culture such as attaching importance to teamwork and providing clear individual targets and tasks will shape employee behavior to be positive, just as employees will voluntarily help their co-workers and respect each other.In addition, employees will be satisfied when they can complete their work according to the target given.
The results of this study support previous research on employees at private vocational schools in the South Tangerang area where school culture provides space for employees to take initiative, be creative and dare to take risks in their work.(19)In addition, Guven (1) also conducted research on quantifiable and qualitative analysis of OCB, where organizational culture is one of the factors that make up OCB.It was said in the study that differences in organizational culture would even affect OCB behavior positively or negatively.Employee behavior represents their organization because their behavior and attitudes provide clues about OCB behavior.
Based on the analysis of the three-box method on the Organizational Culture variable, the average Index is included in the High category.Of the 54 indicators, 6 (11%) are in the medium category and none are in the low category.The lowest indicator is "The company conducts regular family gatherings" where indeed the program has not been activated regularly in the company, where new gatherings are carried out for the Section Head level and above, while this is a good opportunity for togetherness to share vision can be done in order to maintain stability which is one of the dimensions in organizational culture.
The Effect of Leadership Style on OCB Based on the results of this study, leadership style does not directly affect OCB.Another research that has been done is the effect of transformational leadership styles on OCB, namely research conducted by Hadinata (18) in the NTB Provincial Secretariat Study and the effect of Relationship leadership on OCB, namely research conducted by Ariani (20) on service organizations in Yogyakarta.In the study, it was said that Relationship Leadership has a positive and significant effect on OCB both directly and through Employee engagement.
However, there are also studies that support this research where leadership style (transformational) does not have a direct effect on OCB but through organizational culture, namely research conducted by Arifiani et al.(21)However, there have been no other studies found by researchers that confirm the effect of this servant leadership style on OCB, although according to Rudnick, Jr., servant leadership is a leadership style that is suitable to be applied in the healthcare industry.(6) Based on the analysis of the three-box method on the Leadership Style variable, the average Index is included in the medium category, different from the other 3 variables that are included in the High category.Of the 27 indicators, there are quite a few, namely 11 indicators (41%) that are in the medium category.Of the 7 dimensions in this leadership style (servant leadership), 4 dimensions of which are in the medium category, namely Emotional Healing, Creating Value, helping subordinates grow and succeed and Putting subordinates first, and these are the lowest.Employees feel a lack of concern for leaders to put their subordinates first when it comes to pursuing their success, interests or needs.However, it turns out that the medium index on Leadership Style does not directly affect the OCB of employees.Thus, OCB is more affected by internal factors in employees so that if indirectly or through mediation variables Work engagement will show a positive effect, while directly there is no effect between this servant leadership style and OCB.

CONCLUSION
In accordance with the research that has been conducted, the following conclusions can be obtained: Organizational Culture and Leadership Styles that are indirectly mediated by Work Engagement have a positive and significant effect on Organizational Citizenship Behavior.Organizational culture has a positive and significant effect on Work Engagement.The higher the organizational culture that is considered good and becomes valuable for employees, the higher the employee's attachment to their work.Leadership Style has a positive and significant effect on Work Engagement.The higher the characteristics of the leadership style that serves the leader, the higher the employee's attachment to his work or organization.Work Engagement has a positive and significant effect on Organizational Citizenship Behavior.The higher the employee's attachment to their work, the higher the employee's OCB will be as seen from his extra miles.Organizational Culture has a positive and significant effect on Organizational Citizenship Behavior.The higher the organizational culture that is considered good and becomes valuable for employees, the higher the OCB of employees as seen from their extra miles.Servant leadership style has no effect on Organizational Citizenship Behavior.The leadership style reflected by the leader does not directly affect the OCB or the behavior of employees who are extra miles.
By looking at the conclusions above, the implications of this study can be seen from the theory as well as from the managerial implications.The strength of organizational culture is important because it will affect work engagement (employee attachment) to their organization and have a positive impact that makes employees behave OCB (extra miles, exceeding expectations, and routine tasks).This is expressed by Kreitner et al. that organizational culture shapes employee behavior in an organization and facilitates the collective commitment of its employees, where employees are proud to be part of the organization.(16) Good work engagement needs to be fostered so that employees continue to have strong energy and mentality during work (vigor), always feel involved and enthusiastic about their company (dedication) and are full of seriousness in work and responsibility (absorption), as in the theory of Schaufeli et al. (13) Leadership Style also affects Work Engagement, where according to Rudnick, Jr, servant leadership is a leadership style that is suitable to be applied in the healthcare industry, such as hospitals.(6) For Greenleaf as a person who develops a leadership style, serving leaders must address the needs of their followers, help them develop their abilities, and help them become more willing to accept their responsibilities.Serving leadership involves 3 things, namely Nurturing, Defending and Empowering.(22) Managerial Implications: For the expected OCB behavior of employees to continue to increase, it is necessary to pay attention to the factors that effect it.As a hospital management, this is important so that consumers, namely patients and their families, can get a good patient experience when serving in hospitals, especially in special hospitals where many patients seek treatment for a long time (long term).
Organizational culture, which is the values that are believed and lived in the organization needs to be continuously managed to direct the people in the organization in accordance with the vision, mission, and values of the organization.Management needs to make a strategy so that the existing organizational culture can be better from year to year and employees can internalize in accordance with the vision, mission, and values of the organization, for example by holding regular togetherness events which is a good time to share vision.It is necessary to have a supportive reward system to show appreciation to employees for the results that have been achieved.Management can empower employees by facilitating programs or projects that involve cooperation and coordination between teams and arouse employee creativity and initiative to be better prepared and make decisions (facing consumers) and take risks, in accordance with the authority and responsibility given.Thus, it is expected that Work Engagement will continue to increase, and OCB can continue to increase.
Leadership style affects OCB behavior and work engagement so that superiors as leaders need to continue to develop themselves, both conceptually and developing their personality.Leaders need to clearly convey employee success indicators, understand their career goals, and prioritize their career development.The talent mapping system and Individual Development Plan can be developed as a strategy in succession planning for employee career paths.Leaders also need to have emotional concern and closeness with their employees (as a means of maintaining employees' mental health), especially because in specialized hospitals they face patients and families who have special needs for their services.This can be done by consistently doing Gemba which is a down-to-bottom activity or seeing firsthand the operational activities of employees.Thus, employees feel cared for and can be helped by empowerment in areas that they still need help in making decisions, facing consumers, by coaching and counseling.

RECOMMENDATIONS
Looking at the conclusions of this study, there are several recommendations for the management of the hospital under study and for future researchers who may read this study, namely as follows: For Hospital Management: Hospital management needs to maintain the stability of a positive organizational culture that stimulates employees to perform OCB, in various ways such as: Create clear strategies and programs for employee career development, reward employees for their achievements and outcomes that meet expected targets and develop talent mapping systems and Individual Development Plans for employee career development.
Conducting regular togetherness events that can foster a sense of community and unite a personal vision and mission to match the vision and mission to be achieved by the organization (shared vision), for example conducting family gatherings for all employees.
Provide attention and support to employees so that employees can work more optimally, such as conducting Gemba or directly down to see employee operations and interacting with employees, as well as facilitating to complete the work facilities needed by employees.Create programs and engage in activities that contribute to the community such as Corporate Social Responsibility (CSR) programs to make employees actively involved as part of implementing organizational culture and are expected to improve OCB behavior.

Figure 1 .
Figure 1.Conceptual Framework of the Research

Theoretical Implications:
As the theory from Organ et al.(3) that the increase in Organizational Citizenship Behavior (OCB) is affected by two main factors, namely internal factors, and external factors.These external factors come from outside the employee, including leadership style and organizational culture.The results of this study are organizational culture factors affect directly and significantly on OCB, while leadership style (servant leadership) does not affect OCB directly, but through Work Engagement.Work Engagement supports extrarole performance, where employees are expected to do more than their boss or organization expects, going beyond the formal structure of their position to take the initiative, as Leiter & Bakker reveals.(10)

Evaluation of the Outer Model
validity and reliability tests can be conducted by designing the outer or measurement model.An indicator is valid if the factor loading value> 0.6 (original sample value).Thus, there are indicators used with 4 latent variables, namely Organizational Culture with 21 indicators, Leadership Style with 14 indicators, Work Engagement with 9 indicators and OCB with 11 indicators.

Table 2 .
The Testing Result In table 2 can be seen the results of the effect between variables.The direct effect of organizational culture on Work Engagement showed that the value of t statistics 13.457 > 1.96 (t statistics calculate > t statistics table) and p-value of 0.000 (p-value < 0.05), meaning that the effect of organizational culture on positive work engagement is significant.

The Three-Box Method Index Analysis
compared to the profit obtained".Meanwhile, there are 11 statements that fall into the moderate category.In the Emotional Healing dimension, there is a statement "When I feel sad, my leader knows this without having to ask me".This means that the leader