THE IMPACT OF EMPLOYEE EMPOWERMENT ON CONTINUOUS IMPROVEMENT OF HEALTH CARE: AN EMPIRICAL AND COMPARATIVE STUDY BETWEEN HOSPITALS

. The study has been aimed to know the impact of Employee Empowerment on CI of health care between hospitals (government and private). The required data for the purpose of this study were collected by a questionnaire designed on the basis of related practices. It consisted of 73 items divided into two domains, the first one to measure employee empowerment practices (37 items), and the second one to measure CI practices (36 items). The study sample was applied to the (326) respondents; The total number of respondents from hospitals was 326; That is, 76% of the total number of the target group, which is (431) respondents, with a response rate of 96%, which is high percent because the researcher distributed the questionnaires personally. Using IBM SPSS and a comparative descriptive-analytical approach. Three themes emerged from the respondents’ trends. First, the existence of employee empowerment application in government hospitals was moderately level, and in private hospitals was in a high level, and also the existence of CI application in government hospitals was in a low level, and in private hospitals was in a high level. Second, there is a strong correlation between employee empowerment and CI of health care in hospitals (government, private). Third, there is statistically significant impact at the level (α ≤ 0.05) of the Employee empowerment on CI of health care whether the dimensions of CI are combined or fragmented in hospitals. The limitation of this study was in fixed bureaucracy structure in governmental hospitals and competitiveness issues in private hospitals. The study dealt with a dependent variable that was rarely studied by previous Arab studies and also rarely comparative study between profit and nonprofit hospitals.


Introduction
Organizations face many challenges in improving their performance and productivity and becoming more agile in the current changing and competitive business world (Ukil, 2016). Health care and patient safety are a unique services, especially with widely diverse patient needs and expectations, and society demands to improve the quality of hospital services and reduce their costs (Metcalf et al., 2018). The hospitals sector in Jordan has become more interested and interacts with these challenges, especially related to human resources of different types and levels (managers, specialist doctors, nurses, professionals, etc.), therefore, it strives to empower its employees to respond to these challenges through the implementation professional practice environments are of particular importance to employee satisfaction with their work, quality of services provided, and patient safety in hospitals (Laschinger, 2008), so the studying and investing in the human element as the competitive advantage of any organization that seeks to achieve CI to survive in its business market (Daft, 2010). However, Poor hospital arrangements; like lack of authority for decision making, limited access of information, lack of control on the job, vague responsibility, Unfair incentive system often make the jobs difficult for the employees, Which are the enablers of empowerment and they reduce the implementation of CI (Hirzel et al., 2017). To enhance the CI, the hospitals need to give employees enough authority and support (Hirzel et al., 2017). Empowerment is a philosophy that believes in enriching people's jobs and giving the power to exercise control over and take responsibility for outcomes of efforts (Sahoo & Das, 2011). The health care organizations are more concerned about knowledge workers because they are the real drivers of services (Ross et al., 2008).
Importantly, numerous studies have been conducted on CI in different areas such as Continuous Improvement as an Ideal in Health Care (Berwick, 2019), Quality Improvement in Indigenous Primary Health Care (Bailie et al., 2013), Critical thinking and CI (Pérez Rave et al., 2020), Leadership for CI in healthcare (Graham & Woodhead, 2020), Barriers and Enablers that exist when implementing CI within Pharmaceutical Industry (McDermott et al., 2022), A framework how organization can assess sustaining CI in healthcare (Barberato Henrique et al., 2020), A method for transforming the nursing practice by integrating a continuous improvement simulation expansion strategy (Aul et al., 2021), Increase level of employees empowerment in implementing the CI process (Hirzel et al., 2017) and the impact establishing Culture of CI on Ambulance Service (Rodgers & Jiju, 2021).
Despite these works, few studies have been conducted on the impact of employee empowerment and CI of health care. Hirzel et al. (2017) suggested that CI can be developed by employee empowerment. Gatchalian (1997) pointed out that the employee empowerment is the key of TQM and CI success. Following this trend, the present study aims at exploring the impact of employee empowerment on the process of continuous improvement of health care.

Definition of CI
CI as a philosophy is based on constant tendency for the better, continuously and permanently, shifting the entire curve of production upward even slightly (Berwick, 2019), CI is a work through which it aims to consolidate a culture aimed at eliminating waste in all systems and processes of the organization and involves everyone who wishes to improve without making a huge capital investment (Bhuiyan & Baghel, 2005), also seen as a culture of innovation that focuses on critical processes, engaging employees with integrated improvement activities in the organization (Kaye & Anderson, 1999). In other simplest form CI can be defined as "a company-wide process of focused and continuous incremental innovation" (Bessant et al., 1994). CI is improving processes and reducing errors to improve overall performance for the customer (Fryer et al., 2007;Dana, 2004). CI according to the Japanese approach called kaizen; which consists of two parts (Kai) and (Zen), as (Newitt, 1996;Imai, 1986) explained Kai means Change while Zen means Good (change to better), Kai zen actually means "continuous improvement and innovation -in everything -forever!" Thus, Deming (1982) defined CI as improve constantly and forever in production system and service Similarly. Imai (1997), defined CI as incremental improvement involving all employees in the organization. Juran et al. (1999) who was one of the pioneers in this field defined CI as meaningful change and achieve unprecedented levels of performance.
From all these definitions CI is where all members of the organization work together continuously and using the initiative, creativity, and innovation methodology to improve processes and reduce errors in light of customer satisfaction.

Dimensions of CI in the literature
Researchers took different dimensions to measure CI. Examples of these dimensions include those mentioned by Dale et al. (2007) cited three dimensions of CI: focus on client identification, mental and strategic efforts in decision-making. Aqili (2009) addressed CI through large steps (accelerated), where the focus is on the creation of new things and Innovation to replace the old. The study of Fabiane et al. (2021) was applied on companies that carry out process innovations and have continuous improvement initiatives, and demonstrate the result that CI has positive and statistically significant relationships with innovation performance. The MacLean (2021) conducted a study aimed at developing CI conceptual framework where it is formed from the following components: Awareness: user-centered, Understanding the system, Evaluate the system and measurement, Anchor practice through learning, Accelerate change through collaboration. The critical success factors for CI implementation are include: supportive delegation, effective communication, commitment to the CI initiative and employee empowerment (Thivya et al., 2019). The enabling factors of CI according Van Assen (2021) are leadership commitment, creation of CI culture and employee empowerment. Mokhtar et al. (2012) reviewed numerous scales used to success CI implementation and concluded key dimensions that utilized to measure this success: customer focus, Understanding of process, Use of data in decision-making, change management.

Dimensions of CI in the current study
The current study is concerned to find a comprehensive strategy for CI in the health care, the researcher was able to develop dimensions have been used to assess CI in terms of five dimensions: Client-centered, Process understands, Improvement Initiative, Creativity and Innovation. The researcher proposes the theoretical relationship between these variables, which will be in the form shown in Figure 1, where the spark of continuous improvement is launched from the improvement initiative, which creative ideas are generated from it, and then those ideas are converted to a practical reality through which we can understand the processes and activities within the organization in a way that ensures the production of good services that achieve client satisfaction.

Definition of employee empowerment
Employee empowerment tended to revolve around issues of power, control, and considered a management technique used to motivate employees by delegating or sharing of power with them (Sahoo & Das, 2011), employee empowerment defines as a strategy that aims to free up the potential of individuals abilities and involve them in the processes of building the organization, which depends on Harmonize the needs of individuals with the vision of the organization (Brown, 1996). Evans and Lindsay (2020) define employee empowerment as giving individuals the power to make decisions based on what they feel is right, and they have control over work, and learn from their mistakes and encourage change. Also the empowering employees means the organization's recognition that employees have the capabilities, wisdom and hopes that generate the desire to enhance employee value by supporting them to serve their role in work and non-work in an environment of trust and tolerance in order to achieve the goals of the organization (Badjie et al., 2019). According to Gary and Becker (2006) employee empowerment is the process of enabling employees to take decisions, relating to their work, and controlled by management, but with assume full responsibility and risk for their actions.

Dimensions of employee empowerment in the literatures
Researchers took different dimensions to measure employee empowerment. Examples of these dimensions include those mentioned by Ukil (2016)

Dimensions of employee empowerment in this study
The current study, seven dimensions were used to measure employee empowerment as follows: first -Information Sharing: Choosing the direct way of communicating information to managers is an essential element of empowerment (Mahmoud & Mahmoud, 2007). Second -Knowledge: is an important resource and a key component of empowerment and expression of facts and information (Kim et al., 2017). Third -Delegation Freedom & Autonomy: are meant to give employees broad powers to take broader tasks and procedures (Mahmoud & Mahmoud, 2007). Fourth -Organization Culture: it helps to instill and sustain the values and behavior required by the organization, and helps individuals perform their duties properly (Areiqat & Zamil, 2011). Fifth -Enabled Leadership: creates empowerment opportunities and support employees; by delegating authority, engaging employees, assuming responsibilities, enhanced performance, motivating employees to innovate at work (Appelbaum et al., 2015). Sixth -Empowerment processes: such as access to information, access procedures, coordination between departments and management of the Organization, for building skill and capability of employees for changing roles and behaviors (Dimitmades, 2001). Seventh -Work Team work: It is the empowerment synergistic action it means that the sum of individual's performance efforts are greater than individual's inputs if they are separate (Robbins & Judge, 2009).

Relationship between employee empowerment strategy and CI
The recent studies, they were about the contextual factors that influence the relationship between empowerment practices and Organizational performance, the results indicated that employee empowerment had a positive impact on organizational performance, and they work efficiently and effectively to achieve organizational goals (Marjani & Alizadeh, 2014;Ahmad & Manzoor, 2017;Yin et al., 2019;Akingbola, 2013). But study of Banerjee (2019) has concluded that empowering employees if it is not planned in a comprehensive manner will not be effective in the organization and this was apparent by not significantly improving performance. Another Several studies have indicated the results show that there is a significant impact between empowerment and continuous improvement, so the Effective empowerment increase the level of employee satisfaction and allowed to employees encourages strategic thinking, creative problem-solving, decision making and make sound judgments concerning their job (Hirzel et al., 2017;Roslin et al., 2019;Ukil, 2016;Stewart, & Brown, 2009). As for the impact of empowerment on the quality of health care Metcalf et al. (2018) find that the use of employee empowerment was associated with higher quality health care, higher compliance with standards. Another study indicates that the empowerment of medical personnel in hospitals contributes to facilitating the environment for professional practice and staff commitment, satisfied employees and provide better service to the customers (Yang et al., 2013). The study of Fernandez and Moldogaziev (2013) point out that the various empowerment practices are working to convert creative initiatives into innovative behavior among front-line employees in the US federal. Sundbo (1999) also emphasized in his studies that the application of the empowerment process for employees in small and medium-sized service institutions can improve innovative and educational competencies when revealing the impact of empowerment on processes within the organization. Chandhok and Saranya (2019) concluded that empowering employees enhance motivation towards high productivity due to a positive correlation between motivation and empowerment which leads to momentum in effective organizational performance. Laschinger (2008) sees that the practice of empowerment in the professional environment of the hospital leads to positive and satisfactory results for the nursing and the patient and provides encouraging support for the ongoing efforts to create and maintain satisfactory healthy working conditions. And also Holt et al. (2000) (see that empowerment is only a first step in a fundamental rethinking of the way we do things and requires the implementation of empowerment outside the boundaries of the organization in order to embrace all stakeholders). While Alomari (2020) point out there is a positive impact of empowerment on customer satisfaction, through improving overall performance. On the basis of these studies, the following hypotheses were suggested: Hypothesis (Ho1): There are no statistically significant differences for applying the practices of employee empowering between hospitals due to the variable of hospital type (government and private).
Hypothesis (Ho2): There are no statistically significant differences for applying the CI practices between hospitals due to the variable of hospital type (government or private).
Hypothesis (Ho3): There is no statistically significant impact of the employee empowerment on continuous improvement of health care whether the dimensions of CI (Client-centered, Process understand, improvement initiative, creativity, innovation) are combined or fragmented in hospitals. From this Hypothesis the following sub-hypotheses emerge: -Ho3-1 -There is no statistically significant effect of the employee empowerment on client-centered of CI. -Ho3-2 -There is no statistically significant effect of the employee empowerment on understanding the process of CI. -Ho3-3 -There is no statistically significant effect of the employee empowerment on improvement initiatives of CI. -Ho3-4 -There is no statistically significant effect of the employee empowerment on creativity of CI. -Ho3-5 -There is no statistically significant effect of the employee empowerment on innovation of CI.

Research model
The model that developed for the purpose of the present study as exhibited in Figure 2 contains one independent variable (employee empowerment) with seven dimensions and one dependent variable (CI) with five dimensions. Thus, the model shows three main hypotheses and five sub-hypotheses that clarify the applying of employee empowering, CI and the impact of employee empowerment on CI. Independent variable (employee empowerment) was evaluated as a Whole Construct (as exhibited in Figure 2). In contrast, CI was assessed as a multidimensional construct comprised five dimensions: Client-centered, Process understands, Improvement Initiative, Creativity, and Innovation.  Table 1 shows that the government hospital sector constitutes 37.36% of the total number of beds in the public and private sectors, and that the total number of the target group is 156 respondents, representing the entire study population.  Table 2 shows that the private hospitals that were selected as a sample from the study population constitute 34.5% of the total number of beds in the public and private sectors, and that the target group in them amounted to 275 respondents, and a simple random sample of 62% was taken of this category, it reached 170 respondents.

Sample and data collection
According to Table 1 and Table 2, the total number of the sample taken from the public and private sectors becomes 326 respondents. That is, 76% of the total number of the target group, which is (431) respondents. As for the process of collecting primary data, it was through the design of a questionnaire for the study, to collect the necessary information in the subject of the research, and then unpacking and analyzing it using the SPSS (Statistical Package for Social Sciences) program and using the appropriate statistical tests to reach valuable indications that support the subject of the study, where the researcher distributed (156) questionnaires directly to the upper and middle management in government hospitals, from them (150) questionnaires were retrieved. Then 170 questionnaires were distributed to the senior and middle management in private hospitals, 162 questionnaires were retrieved from them, and therefore the total of the retrieved questionnaires was (312) out of (326) questionnaires distributed, i.e., a retrieval rate of (96%).

Measures and instruments
Aiming to maintain consistency with the previous literature, the questionnaire has been designed based on the measures of the previous literature. The instruments of this study have been divided into two segments: measuring the respondents' perceptions of independent and dependent variables under investigation. A total of 44 items has been used in this study. In terms of measuring all these 44 items, a 5-point Likert scale has been used with an interval scale ranging from 1 (strongly disagree) to 5 (strongly agree), It was assigned to agree (5) very strongly, strongly agree (4), medium agree (3), disagree (2), and strongly disagree (1). Employee empowerment has been measured by investigating seven dimensions that have been emerged in the literatures: Information Sharing, Delegation Freedom (Mahmoud & Mahmoud, 2007), and Knowledge (Kim et al., 2017), and Organization Culture (Areiqat & Zamil, 2011), and Enabled Leadership (Appelbaum et al., 2015), and enabled empowerment processes (Dimitmades, 2001), and Finally Work Team (Robbins & Judge, 2009). CI has been analyzed with the five dimensions: first -clients Focus; A clear understanding of the needs and requirements of clients draws a road map for the process of continuous improvement (Luxford, 2010), second -Understanding Process: is one of the main pillars for process improvement and better quality (Goetsch & Davis, 2016, p. 487), third -Improvement Initiative: The upper Management Initiative and commitment is necessary to build and maintain a continuous quality improvement program (Lebrasseur et al., 2002, p. 160), fourth -Creativity: is not born out of nothing (Assaf, 2011), But it can be accessed through the idea of others to generate new ideas (Hughes, 2003), fifth -Innovation: the transform creative idea to creative work (Najm & Alhmeidiyeen, 2019).

Data analysis techniques
Raw data were analyzed using SPSS (Statistical Package of Social Science). A set of statistical techniques including descriptive analysis, Pearson correlations, regression analysis, Independent T. Test has been applied to analyze the gathered data. Pearson correlations and multiple regression they measure the levels of relationship and the extent of influence between variables (eight dimensions of employee empowerment to five dimensions of continuous improvement), and Stepwise Regression It helps to measure the impact strength of the variables that were mentioned previously. As for the (Independent T. Test) to show the statistically significant differences in the averages of the respondents' opinions between two independent samples (government hospitals and private hospitals). The reliability measures have been instituted by calculating the values of Cronbach's alpha Where appropriate values (Alpha ≥ 0.60) are practically reasonable in research related to management and humanities (Sekaran & Bougie, 2016). The values of alpha coefficient have been exhibited in Table 3. The number of cases, No. of items have also been presented in Table 3.  Table 3 indicates that the stability coefficient of the study tool (Cronbach's alpha coefficient) ranged between (0.967) in front of Creativity phrases, and (0.921) in front of the Improvement Initiative variable phrases, which are two high coefficients, and much higher than (Alpha ≥ 0.60), which is the minimum acceptable value of Cronbach's alpha coefficient, which indicates that the study instrument, in general, has a high stability coefficient and its ability to achieve the objectives of the study. Table 4 indicates that the mean of the employee empowerment in government hospitals reached (2.66) and with a standard deviation of (0.94), which indicates that the practice of empowerment in government hospitals to a medium degree, while in private hospitals, the mean was (3.57), with a standard deviation of (0.91), This indicates the practice of empowerment in private hospitals to a high degree. As for the mean of Client-centered in government hospitals, it reached (3.01) and with a standard deviation of (1.03), which indicates that the level of Client-centered in government hospitals was moderate, while in private hospitals The mean was (3.95), which indicates that the level of application of Client-centered in private hospitals was highly. Regarding process understand, the mean in government hospitals was (2.92) and with a standard deviation of (1.02), which indicates that the level of application of that dimension was at a medium degree, while in private hospitals, the mean of the dimensions of a process understand was (3.74), which indicates that the level of application of that dimension in private hospitals was in a high degree. Table 4 also indicates that the mean of implementing Improvement Initiative in government hospitals has reached (2.57) with a standard deviation of (1.05), which indicates that the level of that dimension in government hospitals was at a low degree, While the mean for the application of that dimension in private hospitals was (3.49) and with a standard deviation of (0.93), which indicates that the level of application in private hospitals was highly. Finally, the mean of creativity and innovation in government hospitals was: 2.27, 2.12, and the standard deviation: 0.93, 0.96, which indicates a low level of application, compared with the means of creativity and innovation in private hospitals, which respectively amounted to: 3.24, 3.15 and the standard deviation: 1.13, 1.15, which indicates a high level of application.

Results of hypotheses testing
Referring to the results of the data Descriptive analysis in Table 4 which is related to the means and standard deviation, and T-test of the levels of application of the study dimensions in government and private hospitals, where the study showed that there are differences in the application levels of the independent variable (employee empowerment) between hospitals, and this rejects the null hypothesis (Ho1), which says: There are no statistically significant differences at the level of significance (α ≤ 0.05) in study members' attitudes towards the level of applying the strategy of employee empowering due to the variable of hospital type (government and private). Also the study showed that there are differences in the application levels of the dependent variables (Client-centered, Process understands, Improvement Initiative, Creativity, Innovation) between hospitals and this rejects the null hypothesis (Ho2), which says: There are no statistically significant differences at the level of significance (α ≤ 0.05) in study members' attitudes towards the level of application of health care CI due to the variable of hospital type (government and private). Regarding testing Hypothesis (Ho3) the study have been used multiple regressions analysis as shown in Table 5 and Table 6 to find out the impact relationship between the independent and dependent variables for the study.
It is clear from the results of the statistical analysis in Table 5 that indicates a strong correlation (0.849) between employee empowerment and CI, and the calculated value of (t) was (6.104), at the significance level of 0.000, which is indicated by (R2) the coefficient of determination, it reached (0.755), meaning that the employee empowerment explains its value (75.5%) of the variance in the level of CI in government hospitals, and the value of (Beta) reached (0.488), which means that the increase by one degree in the level of application of the employee empowerment leads to an increase in promoting CI in government hospitals by a value of (48.8%). This confirms the rejection of the null hypothesis (HO3).
The results in Table 5 regarding the impact of employee empowerment in the process of Client-centered in government hospitals, indicates that the calculated value of (t) was (4.894), at the significance level of 0.000, and the coefficient of determination R2 was (0.657), meaning that the employee empowerment explain the value of (65%) of the variation in the level of Client-centered and the value of the influence degree β was (0.534) which means that the increase by one degree in the level of application of the employee empowerment leads to an increase in promoting Client-centered in government hospitals by a value of (53.4%), and this confirms the rejection of the first sub-null hypothesis (HO3-1). Also the results related to the impact of the strategy of employee empowerment in Process understands indicate that the calculated value of (t) was (6.676), at the significance level of 0.000, and the coefficient of determination R2 was (0.714), meaning that the employee empowerment explain the value of (71.4%) of the variation in the level of Process understands and the value of the influence degree β was (0.557) which means that the increase by one degree in the level of application of the employee empowerment leads to an increase in promoting Process understands in government hospitals by a value of (55.7%), and this confirms the rejection of the second sub-null hypothesis (HO3-2). While the results related to the impact of employee empowerment on initiative, creativity and innovation in government hospitals came as follows: calculated value of (t) respectively was (5.658, 2.104, 0.321) at the significance level respectively (0.000, 0.037, 0.036) and the coefficient of determination R2 was (0.602, 0.583, 0.515), and the value of the influence degree β respectively was (0.591, 0.225, 0.037), and this confirms the rejection of the third, fourth, fifth sub-null hypothesis (HO3-3, HO3-4, HO3-5). Table 6 shows that the results of the statistical analysis in private hospitals, indicated that a strong correlation (0.860) between employee empowerment and CI, and the calculated value of (t) was (21.288), at the significance level of 0.000, it means the effect of employee empowerment in promoting the continuous improvement of health care in private hospitals, It also confirms by the coefficient of determination R2 was (0.739), meaning that employee empowerment explain the value of (73%) of the variance in the level of continuous development in private hospitals, and the value of (Beta) reached (0.860), which means that the increase by one degree in the level of application of the employee empowerment leads to an increase in promoting continuous improvement in private hospitals by a value of (86%). This confirms the rejection of the null hypothesis (HO3).
The results in Table 5 regarding the impact of employee empowerment in the process of Client-centered in Private hospitals, indicates that the calculated value of (t) was (4.894), at the significance level of 0.000, and the coefficient of determination R2 was (0.587), meaning that the employee empowerment explain the value of (58.7%) of the variation in the level of Client-centered and the value of the influence degree β was (0.534) which means that the increase by one degree in the level of application of the employee empowerment leads to an increase in promoting Client-centered in private hospitals by a value of (53.4%), and this confirms the rejection of the first sub-null hypothesis (HO3-1). Also the results related to the impact of the strategy of employee empowerment in Process understands indicate that the calculated value of (t) was (5.342), at the significance level of 0.000, and the coefficient of determination R2 was (0.697), meaning that the employee empowerment explain the value of (69.7%) of the variation in the level of Process understands and the value of the influence degree β was (0.457) which means that the increase by one degree in the level of application of the employee empowerment leads to an increase in promoting Process understands in private hospitals by a value of (45.7%), and this confirms the rejection of the second subnull hypothesis (HO3-2). While the results related to the impact of employee empowerment on initiative, creativity and innovation in private hospitals came as follows: calculated value of (t) respectively was (4.273, 3.088, 2.111) at the significance level of (0.000, 0.002, 0.036) and the coefficient of determination R2 respectively was (0.720, 0.705, 0.673), and the value of the influence degree β was (0.591, 0.225, 0.037), and this confirms the rejection of the third, fourth, fifth sub-null hypothesis (HO3-3, HO3-4, HO3-5).

Original purposes of the research and implications
The purpose of this study was to test three main hypotheses regarding the impact of employee empowerment on CI of Health Care in Hospitals (government and private). The first hypothesis (Ho1): There are no statistically significant differences at the level of significance (α ≤ 0.05) in study members' attitudes towards the level of applying the strategy of employee empowering due to the variable of hospital type (government and private) was strongly rejected by the data in Governmental hospitals; which indicates the practice of empowerment and the participation of employees in governmental hospitals to a medium level, and strongly rejected by the data in private hospitals; which indicates the practice of empowerment and the participation of employees in private hospitals to high level; These results are attributed to the belief of the Hospital management that the delegation of authority and the participation of employees increase the organizational agility and the response of employees to improve the patient experience and thus achieve the strategic goals of the hospital. The second hypothesis (Ho2): There are no statistically significant differences at the level of significance (α ≤ 0.05) in study members' attitudes towards the level of application of health care continuous improvement due to the variable of hospital type (government and private) was strongly rejected by the data in Governmental hospitals; which indicates the practice of Continuous improvement (all dimensions) in governmental hospitals to a low level; this decline in the continuous improvement process can be explained by infrastructure and organizational defects, lack of human and material resources, as well as other challenges related to legislation, laws, regulations and government policies. And strongly rejected by the data in private hospitals; which indicates the practice of Continuous improvement (all dimensions) in private hospitals to high level; This result can be explained by the interest of private hospital management in the quality system and improving the patient experience and thus achieving competitiveness And increasing market share and profits. The third hypothesis (Ho3): There is no statistically significant impact at the level (α ≤ 0.05) of the employee empowerment on continuous improvement of health care whether the dimensions of CI (Client-centered, Process design, improvement initiative, creativity, innovation) are combined or fragmented in hospitals (government, private) was strongly rejected by the data in Governmental and private hospitals; which indicates the strong impact of the employee empowerment practices on the process of CI of health care in all its five dimensions.
The comparison between governmental and private hospitals regarding the impact of the independent variable on the dependent variable in all its dimensions. The study showed through statistical analyzes that the impact data of the employee empowerment workers have shown a high explanatory capacity for variations in the CI of health care, and the result in the public and private sectors came close to Somewhat. This can be explained by the fact that Jordanian hospitals are keen to implement royal initiatives in achieving high-quality health care, and obligating the hospital sector in Jordan to join national and international accreditation programs, which in turn established a methodology and established a culture that supports the CI and development of health care.
Studies on the effect of employee empowerment on CI are very few and therefore it is not easy to find previous studies that are consistent with or different from the results of the current study. In any event, it can be said that employee empowerment was associated with higher quality health care (Metcalf et al., 2018). A study by Yang et al. (2013) Concluded that empowering employees provide better service to the customers. The application of the empowerment process for employees can improve innovative and educational competencies (Sundbo, 1999), and the various empowerment practices are convert creative initiatives into innovative behavior (Fernandez & Moldogaziev, 2013). While Alomari (2020) point out there is a positive impact on improving overall performance. Ultimately, the study concluded that employee empowerment leads to an increase in promoting CI in government and private hospitals.

Conclusions
The study concluded that empowerment practices in all its dimensions in hospitals, both governmental and private, enhance the capabilities of individuals to launch improvement initiatives that help unleash the mental energies of individuals and produce creative ideas and innovative applications that help to understand the processes and activities within hospitals, which ultimately lead to CI of health care, which appears more strongly in private hospitals than in government hospitals.

Limitations
The researcher faced some limitations related to the difficulty of the procedures that precede the approval of distributing questionnaires in governmental hospitals, the time taken to distribute the questionnaires to the sample members, and the waiting period of up to a month until they are answered, due to the work load in those hospitals. Also the researcher face some difficulties in private hospitals due to the privacy and competitiveness between them, which increase in the complexity of the approval and distributing questionnaires to the respondents.

Direction for future research
The future studies should consider that this research was implemented in Jordan health sector, which is a developing country; therefore, future studies should go towards conducting such research in developed countries in order to discover the perspective of implementing employee empowerment practices and its role in transforming creative ideas into innovative reality in hospitals. The study gives decisive advice for health care organizations on how they can improve the quality of health care services by encouraging the practices of employee empowerment. As a result, if the findings are put into practice, they may result in CI of patient experience outcomes in hospitals.