Job Autonomy and Innovation in Healthcare and Human Services: Pathways Through Appraisal, Engagement, and Burnout

Background/Objectives: Healthcare and human service organizations face mounting pressures to adapt to social and public health challenges while maintaining quality care. Innovative work behavior among healthcare and human service professionals is critical to organizational resilience. Prior research suggests that job autonomy fosters innovative work behavior, but the mechanisms underlying this relationship remain unclear. This study examined how cognitive appraisal, work engagement, and job burnout mediate the relationship between job autonomy and innovative work behavior. Methods: A non-experimental, cross-sectional online survey was conducted with 607 healthcare and human service professionals in the United States. Validated measures assessed job autonomy, cognitive appraisal, work engagement, job burnout, and innovative work behavior. Serial mediation analyses were performed using Hayes' PROCESS macro (Model 6) with bootstrapping (n = 5000). Work innovation was included as a covariate to control for organizational climate effects. Results: Job autonomy was positively related to innovative work behavior, work engagement, and both challenge and hindrance appraisal. The direct relationship between job autonomy and job burnout was mixed, significant in the hindrance appraisal model but not in the challenge appraisal model. Mediation analyses revealed that challenge and hindrance appraisal significantly influenced the pathways from job autonomy to work engagement and job burnout, which in turn mediated the job autonomy-innovative work behavior relationship. Burnout had a significant negative effect on innovative work behavior, whereas engagement strengthened the positive relationship between job autonomy and innovative work behavior. The full model explained 65.12-67.73% of the variance in innovative work behavior. Conclusions: Job autonomy is a critical driver of innovative work behavior among healthcare and human service professionals, operating through appraisal, engagement, and burnout. Building on previous research, this study extends prior evidence by clarifying when autonomy enables professionals to thrive and innovate, and when it risks contributing to burnout. Findings underscore the importance of appraisal-based interventions and autonomy-supportive climates to sustain workforce well-being and organizational innovation.