Factors affecting employees' job satisfaction in public ... affecting... · understand job satisfaction of healthcare providers. Justification for the need to investigate employees

Factors affecting employees'job satisfaction in publichospitalsImplications for recruitment and retention

AN Mohammed Mosadegh Rad

Lecturer, Health Policy and Management, School of Health, Tehran University of Medical

Science, Iran and Doctoral Researcher, Public Services Management, Royal Holloway,

University of London, UK

Ailson De Moraes

Teaching Fellov/ and Associate Researcher, Public Services Management, Royal Holloway,

University of London, UK

Job dissatisfaction is a major cause of absenteeism and turnover among healthcare employ-ees, and as such, it affects employees' organisational commitment and the quality ofhealthcare services. However, little is known about which factors influence job satisfactionand dissatisfaction in hospital staff. The purpose of this study was to investigate specificfactors associated with job satisfaction and dissatisfaction in employees at the IsfahanUniversity Hospitals (lUHs) in Isfahan, Iran. This study also focuses on revealing homo-geneous demographic characteristics that these employees exhibited, which affect theirsatisfaction level. Questionnaires were distributed among the 950 employees through aclassified randomised sampling. Overall, employees were moderately satisfied with their jobs,and more satisfied with the following aspects of their current work situation: supervision, jobidentity and co-workers. The lowest satisfaction scores were found for benefits, contingentrewards, communication, salaries, work conditions and promotion. Motivating factorsincluded loyalty to employees, job security, good pay, good working conditions, tactfuldiscipline, involvement, recognition and promotion.

Introduction

The healthcare industry increasingly requires a skilled workforce due to rapidadvancements in medical technology, moral attitudes and demands for moresophisticated patient-care delivery methods. Job satisfaction is critical toattracting and retaining well-qualified personnel. Concerns about employeejob satisfaction are just as — if not more — essential in knowledge-based sectorssuch as the healthcare industry as they are in other business sectors, particu-larly in professional and service-based organisations sucb as bospitals, wberelong-term specialist training and retention issues are highly important.

Journal of General Management Vol. 34 No. 4 Summer 2009 5l-:66

Ali Mohammed Mosadegh Rad and Ailson De Moraes

Satisfied employees tend to be more productive, committed to their organ-isation and settled in their job (Irvine and Evans, 1995; Currivan, 1999;Griffeth et a/., 2000; Shader et al, 2001; Strachota et al, 2003; Al-Hussami,2008). Job dissatisfaction has been found to be a strong and consistentpredictor of intention to leave as well as actual turnover (Hellman, 1997;Lum etal, 1998; Ito etal, 2001; Sourdif, 2004). Employees' job satisfaction isalso found to be positively related to quality of service and patient satisfactionin the healthcare setting (Kivimaki etal, 1994; McNeese-Smith, 1995; Leiter etal, 1998; Kaldenberg et al, 1999; Tzeng, 2002). Employees can directlyinfluence customer satisfaction in a service-based industry like hospitals.Their involvement and interaction with customers plays a significant role inquality perceptions and customer satisfaction. Job satisfaction has been themost frequently investigated variable in organisational behaviour (Spector,1997) and healthcare has not been ignored in job satisfaction research. Myriadstudies have examined job satisfaction in the healthcare context (Al-Ahmadi,2002; Bodur, 2002; Aronson et al, 2003; Chu et al, 2003; Lyons, 2003; Seo,2004). This proliferation of research has focused attention on the need tounderstand job satisfaction of healthcare providers. Justification for the needto investigate employees' job satisfaction is exemplified in the relationshipobserved between the lower levels of job satisfaction and negative symptomsof absenteeism, grievance expression, tardiness, low morale and high turn-over. Job satisfaction is important to managers because ofthe desire to retain astable and skilled workforce. Researchers are interested in understanding thefactors that influence an individual's decision to stay or leave an organisation.

Iran's healthcare system is passing through a period of transformation.Since the early 2000s, the Ministry of Health has been working on acomprehensive healthcare reform programme, especially in hospitals. Oneofthe aims of this reform programme is to strengthen healthcare managementto improve the performance of healthcare organisations. However, humanresource management is still not what it should be, and the human aspectsrelating to employee satisfaction and quality of work life, which affectproductivity, are neglected. The results of the study presented in this paperwill enable a better understanding of factors associated with job satisfactionand dissatisfaction of employees. Factors promoting job satisfaction can alsobe significant for attracting new employees to the organisation. Therefore, it isanticipated that a better understanding of these issues can aid further research,pinpoint better strategies for recruitment, promotion and training of futurehospital managers and employees, and for reducing the level of turnover andabsenteeism, particularly in Iran but perhaps in other societies as well.

Loterature revoewEmployee job satisfaction is an attitude that people have about their jobs andthe organisations in which they perform these jobs. Job satisfaction is definedas "the extent to which people like or dislike their jobs" (Spector, 1997, p. 2). Itis an employee's affective reaction to a job, based on a comparison betweendesired and actual outcomes. Job satisfaction is generally recognised as amultifaceted construct that includes employee feelings about a variety of both

52 Journal of General Management Vol. 34 No. 4 Summer 2009

Factors affecting employees' job satisfaction in public hospitals

intrinsic (e.g. job itself and opportunities for personal growth and accom-plishment) and extrinsic (e.g. pay and benefits, company policies, super-vision and support, co-workers, job security, chances for promotion) jobelements (Misener et al, 1996). Two different categories of theories such ascontent and process theories help to conceptualise job satisfaction. Whilecontent theories focus on what motivates people, process theories focus onhow people's needs influence their behaviour. The latter provide an oppor-tunity to understand processes of motivation and reflect on the dynamiccontextual and individual factors which constitute the employees' expecta-tions, which in turn influence their behaviour. Combining these two theoriesgives a better insight in the understanding of motivation and job satisfactionof employees. Herzberg's (1966) two-factor theory and Maslow's (1970)Hierarchy of Needs exemplify content theories by identifying needs or valuesto be realised in order for an individual to be satisfied at work. For instance,Herzberg (1966) identified hygiene and motivating factors related to peoples'attitudes to work. Hygiene factors or "dissatisfiers" are those factors thataffect job dissatisfaction. Examples of hygiene factors include salary, benefits,organisational policies, supervision, working conditions and relationships.Although their absence causes job dissatisfaction, they do not impact jobsatisfaction. On the other hand, motivators such as achievement, recogni-tion, promotion, responsibility and work itself promote motivation andconsequently satisfaction. Once hygiene factors are met, the motivationfactors will promote job satisfaction. According to Maslow (1970), humanneeds form a five-level hierarchy ranging firom physiological needs, safety,love and esteem to self-actualisation. Once individuals have satisfied oneneed in the hierarchy, it ceases to motivate their behaviour and they aremotivated by the need at the next level up the hierarchy. Based upon thistheory, employees will seek to fulfil self-actualisation needs whenever theirother' low-level needs have been met.

Sources of low satisfaction are associated with low salaries and benefits,working with unskilled or inappropriately trained staff, laborious tasks such asdocumentation, repetition of duties, tensions within role expectations, roleambiguity, role conflict, job/patient care, feeling overloaded, the increasingneed to be available for overtime, relations with co-workers and personalfactors (McNeese-Smith, 1999; Furnham, 2002; Heywood etal, 2002; Chu etal, 2003; Gigantesco etal, 2003; Hies etal, 2003; Thyer, 2003; Navaie-Waliseret al, 2004). According to Glisson et al (1998) factors influencing jobsatisfaction can be divided into three main categories: job characteristics,organisational characteristics and characteristics of employees who performthe job. The theoretical framework used is shown in Figure 1 below. The studysought to examine the validity of this hypothesised model with a sample ofIranian hospital employees.

journal of General Management Vol. 34 No. 4 Summer 2009 5 3


Job satisfiers

Job factors:

• Job identity• Variety in job• Routinisation• Workload

Organisational factors:

• Organisation structure• Policies and procedures• Management support• Co-worker support' Communication• Management systems• Working conditions• Payment• Promotion and recognition• Fairness• Training

Individual factors:

AgeGenderEducational levelPersonalityExperience yearsMarital statusFinancial status

Cultural factors:

• Cultural values• Religious beliefs• Attitudes

Employees'outcome

Job satisfaction

IOrganisationalcommitment

Figure 1: Hypothesised relationship between job satisfaction and turnover

The study, whose purpose was to investigate specific factors associated withjob satisfaction and dissatisfaction of employees in IUHs, utilised descriptivecorrelation design and cross sectional survey methodology. The healthcaresettings for this study included 12 university hospitals in Isfahan, Iran. At thetime ofthe study (2004), these hospitals employed 6,405 full time employees.Spector's (1997) Job Satisfaction Survey (JSS) was used to measure jobsatisfaction. Respondents rated each item on a six-point Likert scale from 1(disagree very much) to 6 (agree very much). Spector reported coefficientalphas ranging from 0.60 for the co-worker facet to 0.91 for the overallmeasure. The JSS consists of 36 items within nine categories. Table 1 belowshows a description of job satisfaction facets.

Since hospital employees deal with very specific tasks on a daily basis, theremay be a link between individuals' demographic characteristics and their jobsatisfaction. This part contained a standard set of socio-demographic and job-related questions addressing age, sex, education, position, years of experienceand department, on which data was also gathered. Also, the questionnaireprovided ten important job motivators. Employees were asked to prioritisethese motivators according to their personal interests. Managers were asked toprioritise these motivators once according to their personal interests andanother time according to their employees' interests to find out more aboutmanagers' knowledge of employees' perceptions of their most importantmotivators. Those motivators were listed as good pay, job security, goodworking conditions, involvement, recognition, promotion, interesting work,loyalty to employees, tactful discipline and help with personal problems.

A detailed explanation ofthe validity, reliability and acceptability ofthe study can be found in

Appendix A.



Table 1: Description of job satisfaction facets

Job satisfier factors

Pay

Promotion

Supervision

Fringe benefits

Contingent rewards

Working conditions

Co-workers

Nature of work

Communication

Description of facet

Satisfaction with pay and pay rises

Satisfaction with promotion opportunities

Satisfaction with the person's supervisor and manager

Satisfaction with fringe benefits

Satisfaction with given for good performance

Satisfaction with working rules and procedures

Satisfaction with co-workers

Satisfaction with type of work done

Satisfaction with communication within organisation

ResultsA total of 814 employees participated in this study. These included 665employees, 127 first line managers (departments' heads), 11 middle managers(hospital managers) and 11 senior managers (hospital presidents). Respect-ively 51.5%, 87,4 %, 90,9% and 90.9% of employees, first line, middle andsenior managers had permanent employment. There was no relationshipbetween educational background and current organisational positions ofhospital managers in 90,9 % cases. The mean age for employees, first line,middle and senior managers were 34.2, 41,8, 46,4 and 45.2 years respectively.The ages ranged from 18 to 58 year, Male employees were significantly olderthan female employees. Employees, first line, middle and senior managers onthe average, had 10,6, 18.7, 20.2 and 17,7 years of working experiencesrespectively, Male employees, on the average, had 12.28 years of workingexperience while females averaged 9.30 years. Males had significantly moreyears of working experience than females. First line, middle and seniormanagers on the average had 8,7,11.8 and 8.7 years of managerial experiencesrespectively. The majority of employees of IUHs had attained a bachelor'sdegree (see Table 2 below).

Total job satisfaction ofthe respondents was measured on a six-point scale,where 6 stood for highly satisfied and 1 for highly dissatisfied. The overall jobsatisfaction ofthe respondents was 3,26±0,56 point (moderate satisfaction).The mean score of job satisfaction of employees, first line, middle and seniormanagers was 3,21, 3,40, 3,97 and 3,73 from 6 credits respectively. Participantscores were lowest in the benefits, contingent rewards, communication,salaries, working conditions and promotion areas but scores were highest inthe supervision, nature of the job and co-workers domains (Table 3 below). Thedifferences between values of employees' job satisfaction in different hospitalswere statistically significant (p = 0,038), The mean score of employees' jobsatisfaction in general and specialised hospitals was 3.19 and 3.37 respectively.The mean score of employees' job satisfaction in hospitals with the specialty inburn (3.08), psychiatry (3.29) and cancer (3.31) were low and in hospitals withthe specialty in ophthalmology (3,42) and cardiology (3.52) was high.

journal of General Management Vol, 34 No, 4 Sumnner 2009 55


Table 2: Frequency and percentage of participants and the mean Í

Demographic parameters

Sex:MaleFemale

Marital status:SingleMarried

Graduation degree:IlliterateUnder diplomaDiplomaPost diplomaBachelor of scienceMaster of science or doctor of medicineDoctor of philosophy

Area of work:Managerial and clericalAncillary or logisticTherapeuticDiagnostic

Age group:Under 20 yearsBetween 20-30 yearsBetween 31-40 yearsBetween 41-50 yearsBetween 51-60 years

Work experience years group:Under 1 year (6 months-1 year)Between 1-5 yearsBetween 6-10 yearsBetween 11-15 yearsBetween 16-20 yearsBetween 21-25 yearsBetween 26-30 years

Received wages:< 1,500,000 RLS> 1,500,000 RLS

core of their job

Frequency and percent

Frequency

394420

147667

239762

202325

58

47

156

108

448

102

3234

340

21720

26202

16914711210454

667147

Percent

48.451.6

1882

2.8

11.97.6

24.839.9

7.2

5.8

19.113.355.112.5

0.428.741.826.6

2.5

3.224.820.718.113.812.86.6

81.918.1

satisfaction

Job satisfaction

Mean

3.283.23

3.213.27

3.583.233.283.213.243.153.37

3.323.443.203.24

4.043.253.213.303.50

3.343.293.203.153.323.333.34

3.223.44

SD

0.500.56

0.590.52

0.540.650.590.580.620.500.43

0.590.430.560.47

0.330.530.540.480.69

0.430.480.530.530.510.460.65

0.530.54

The mean score of employees' job satisfaction in the Central StorageDepartment (4.21), Secretarial Unit (4.05), Public Relations Office (3.91),Social Worker Office (3.90) and Material Supply Department (3.66) were highand in the Psychiatry Ward (2.55), Paediatrics Ward (2.63), Dialysis Ward(2.75), Urology Ward (2.85) and Medical Records Department, (2.88) werelow. The employee's job satisfaction in therapeutic and diagnostic depart-ments was lower than in administrative and ancillary departments. Astatistically significant association was seen between employees' job satisfac-tion and their area of work or specialty (p < 0.01).



Table 3: The mean score of employees' and managers' job satisfaction according to job satisfier factors

Job satisfier factors Seniormanagers

Middlemanagers

First linemanagers

Employees Allemployees

Pay 3.04 3.63 2.75 2.64 2.67

Promotion 3.95 3.59 3.09 2.85 2.91

Supervision 4.29 3.36 4.77 4.71 4.69

Fringe benefits 2.75 2.34 1.91 1.92 1.93

Contingent rewards 2.72 3.29 2.76 2.37 2.44

Working conditions 2.65 3.06 2.64 2.78 2.76

Co-workers 4.77 4.98 4.54 4.32 4.36

Nature of work 5.06 4.8 4.60 4.34 4.39

Communication 3.54 3.72 3.14 2.38 2.53

Overall job satisfaction 3.73 3.97 3.40 3.21 3.26

Table 4: The level of employees' and managers' job satisfaction

Job satisfier factors

Senior managers

Middle managers

First line managers

Employees

Low

9.1

27.2

23.9

28

Medium

63.6

45.5

63.2

64.7

High

27.3

27.3

12.9

7.3

As Table 5 (below) shows, motivators such as loyalty to employees, jobsecurity, good pay, good working conditions, tactful discipline and involve-ment were more important respectively for employees. From the viewpoint offirst line managers, motivators such as tactful discipline, involvement, goodworking conditions, recognition, loyalty to employees and good pay weremore important respectively. From the point of view of middle managers,motivators such as involvement, loyalty to employees, recognition, and tactfuldiscipline were more important respectively. From the point of view of seniormanagers, motivators such as good working conditions, good pay, loyalty toemployees, involvement and tactful discipline were important respectively.When managers were asked to prioritise their employees' job motivators fromthe viewpoint of their employees, first line and senior managers chosesufficient salaries and recognition and middle managers listed job security,promotion and involvement as important. Job satisfaction amongst maleemployees was found to be significantly higher amongst female employees (p< 0.001). Married employees reported higher job satisfaction rather thansingle employees. The differences between values were statistically significant(p < 0.05). There was strong correlation between the job satisfaction ofemployees and their age, years of work experience, organisational positionand received salaries (p < 0.01). There was no statistically significantcorrelation between job satisfaction of employees and their graduation levelsand type of employment: permanent or contract employment (p > 0.05). In

Journal of General Management Vol. 34 No. 4 Summer 2009 57


Table 5: Motivators ranking from managers' points of view

Motivators

Good working conditions

Involvement

Tactful discipline

Recognition

Loyalty to employees

Good pay

Promotion

Help with personal problems

Job security

Interesting work

Senior managers

1

4

5

6

3

2

9

8

7

10

Middle managers

8

1

4

3

2

10

9

6

7

5

First linemanagers

3

2

1

4

5

6

8

10

7

9

Table 6: Employees' motivators ranking from themselves and managers' points of view

Motivators

Good working conditions

Involvement

Tactful discipline

Recognition

Managers' loyalty to employees

Good pay

Promotion

Help with personal problems

Job security

Interesting work

Employees

4

7

6

8

1

3

9

10

2

5

Seniormanagers

8

6

9

2

7

1

3

5

4

10

Middlemanagers

10

3

7

6

4

8

2

5

1

9

First linemanagers

6

4

8

2

3

1

9

5

7

10

order to determine the main factors that cause satisfaction and/or dis-satisfaction with work, the relationship between total job satisfaction and jobsatisfier factors was analysed. Calculations of Spearmen's ratios revealed thestrongest correlation between total job satisfaction and such characteristicsas salaries, 0.687; fringe benefits, 0.685; promotion, 0.673 and communica-tions, 0.637. On the other hand. Work conditions, 0.468; nature of the job,0.502; supervision, 0.536 and co-workers, 0.554 had less effect on employees'job satisfaction respectively. This relationship was statistically significant inall of cases (p < 0.001). The results ofthe simultaneous multiple regressionmodel indicate that together, the employee demographics explain 11% ofthevariance in employees satisfaction (F = 2.767, p = 0.002). Age explained thelargest amount of the variance, followed by work experience. Job andorganisational factors explain 25% and 95% of the variance in employees'

58 journal of General Management Vol. 34 No. 4 Summer 2009


job satisfaction respectively. Therefore, a supportive environment is mostimportant to the job satisfaction of employees.

DiscussionThe study evaluated both global job satisfaction and different dimensions ofsatisfaction. The results show that employees are moderately satisfied withtheir jobs. They demonstrated less satisfaction with benefits, contingentrewards, communication, salaries, work conditions and promotion. It isrecommended that particular attention be given to improving employees'job satisfaction. Motivators such as managers' loyalty to employees, jobsecurity, good pay, good working conditions, discipline, involvement, recog-nition, promotion and help with personal problems were important respect-ively for employees. Hospital mangers, particularly in the public sector, do notoften have ultimate decision-making power on job security and additionalfinancial incentives, which could motivate employees to perform better.However, they could make effective efforts in other areas of motivation toimprove employee morale and satisfaction. A good working environment isimportant to most employees. Creating a pleasant working environment withadequate resources and facilities reduces employees' job-related stress andincreases their satisfaction. Employees need to know that their contributionsand good performance are recognised and valued. This inspires them to workeven harder. Training for additional knowledge and skills is also a greatmotivator for many employees; in addition, it also improves employees'performance and productivity. Employees' needs and consequently motiva-tors are different. Therefore it is important to understand what satisfies themin their workplace and motivates them to improve performance. In thiscurrent study, variables such as employees' age, gender, marital status, workexperience years, organisational position, and received salaries and benefitswere seen as having significant effects on their job satisfaction. Education levelwas the only demographic variable that did not show a statistically significantassociation with employees' job satisfaction. It seems that job satisfier factorssuch as salaries, benefits and working conditions were more important inneutralising the effect of graduation level on job satisfaction. Also, thedifferences between employees benefit because of the differences in theireducation level is not too much.

A higher level of job satisfaction in illiterate employees may be due to thefact that most of these individuals are old and have been working in thehospitals for many years. Therefore, they are receiving higher pay because oftheir length of service. Also, they do not do the more complex jobs in hospitals.The higher level of job satisfaction for employees with diplomas is because ofthe nature ofthe jobs they perform. In studied hospitals, such individuals dothe paper work. However, those employees who fail to finished high schooland do not have a diploma, have to do the hard and non-professional jobs inhospitals such as working in the laundry or cleaning patients' rooms and soon. As regards differences according to age and seniority, a curvilinearrelationship has been observed. Scores were higher for the lowest andhighest ages and seniority ranges and lower after five to 15 years of

Journal of General Management Vol. 34 No. 4 Summer 2009 5 9


experience of working in the hospital. The U-formed relationship betweenage, seniority and job satisfaction requires two interpretations. Amongyounger employees, a higher level of satisfaction may be due to the factthat inexperienced employees have fewer duties and responsibilities, lesspressure, and fewer demands from colleagues. They may also be less exposedto work-to-family conflicts. Among older employees, higher satisfactioncould be explained by a better knowledge of hospital working, by benefitslinked to seniority and by fewer external demands. It is also possible thatolder employees refocus their priorities to factors outside of the worksetting, such as family, or planning for retirement.

The current study showed that promotion opportunities were anothersignificant predictor of job satisfaction among study participants. The greaterthe chances are for advancement within the organisation, the higher is likely tobe level of job satisfaction expressed by the employee. This finding is consist-ent with other studies, which have shown that opportunities for personal andprofessional growth and achievement is one of the best predictors of jobsatisfaction (Al-Ahmadi, 2002; Lyons et ai, 2003; Wittig, 2003). As expected,satisfaction was higher among employees with higher occupational positions.This can be attributed to having more control over the job and more decision-making latitude, along with a more central position between healthcareprofessionals, a valued position within the hospital hierarchy, higher salariesand benefits linked to seniority and more social recognition. Hospitalpresidents (senior managers) expressed less job satisfaction than hospitalmanagers (middle managers). Senior managers are medical practitioners whoprefer to spend more of their time on professional medical practices instead ofstressful managerial works. In addition, their benefit from managerial works isless than what they receive from professional medical practice.

This study also demonstrates that those employees who work with patientshad less job satisfaction. Employees working in psychiatry, paediatrics,haemodialysis and urology had less satisfaction. Job rotation could possiblybe a good strategy for improving job satisfaction of these employees. The lowerlevel of job satisfaction for employees working in the medical record depart-ment is likely also because ofthe specific nature ofthe jobs they perform andhaving more contacts with clients. Automation is not used in these hospitals,and these employees have to perform their duties manually. Documentation,repetition of duties and low salaries are the most important sources ofdissatisfaction of employees in this department. It is recommended thatmanagement use job enrichment as a motivational strategy to satisfy theseemployees. It is also one way to ensure that employees enjoy responsibility anda sense of accomplishment. The motivational effect of job enrichment stemsfrom the opportunities for personal achievement, challenge and recognition.Research findings also identified that the nature of the job is not an importantmotivator for either employees or managers. This has important implicationsfor the universities which educate people in healthcare professions, A higherimportance should be placed on the interest people need to have in workingwith patients before they choose such people-oriented careers in the first place.

Another major finding as to the cause of employee job dissatisfaction is thelack of respect and recognition they receive from hospital management.

6 0 journal of General Management Vol, 34 No, 4 Summer 2009


Recognition and respect are highly important, especially for employees whoare in direct contact with patients, patients' relatives, peers and otherhealthcare team members. Recognition from managers for good performanceis vital in increasing job satisfaction and is central to boosting morale. Asupportive management style, demonstrated through open communication,respect and recognition can greatly improve the satisfaction of employees onthe job. Possessing knowledge and information about employee motivationand their needs and wants helps managers understand how employees can beinvolved to achieve better performance in the workplace. While managementthinks that good pay is the number one desire of the employees, the results ofthis survey show that this factor is usually in the middle of the ranking. It isinteresting to note that the perceptions of managers of the importance ofmotivators for employees vary considerably from how employees view whatmotivates them.

DmplîcatDomis for maoagememit

Employees are the most important assets in organisations (Dibble, 1999).Nevertheless, managers do not spend enough time learning more abouthuman behaviour, communication and how their attitudes and behaviourimpact employee performance. Management requires a keen understandingof human nature, the basic needs, wants and abilities of people. Managers at alllevels cannot cause an employee to become motivated; they must create theenvironment for individuals to motivate themselves. Since job satisfaction hasa strong correlation with job performance it is very important to reinforce thisby applying the right human resources polices. If employees are highlysatisfied with their work, supervision, co-workers and pay and derive a highlevel of overall job satisfaction with their jobs they are more likely to becommitted to the organisation than if they are not satisfied. The results of thisstudy suggest that management might be able to increase the level of jobsatisfaction in the organisation by increasing satisfaction with policies, workconditions and compensation. One way of addressing this could be byincreasing the interactions with employees in staff meetings and hospitalcommittees. Treating employees with respect, rewarding them appropriate toeffort and value to the organisation and changing in organisational variablescould help increase employees' job satisfaction and decrease employee turn-over.

If managers want to increase job satisfaction of employees, they must bemore supportive and give staff opportunities for advancement. Unfairpromotion pohcies (as perceived by employees) may negatively impact jobsatisfaction. It is therefore recommended that managers provide equalpromotion opportunities for employees that would promote them to keypositions and increase their involvement in decision-making. Such steps willhelp to increase the level of job satisfaction. Developing staff and empoweringthem to make decisions about their work is necessary to achieve a high-quality, cost-effective outcome (Zwingman-Bagley, 1999). To motivate anindividual, a job itself must be challenging, have scope for enrichment and beof interest. With regard to satisfaction with work itself, findings show that

Journal of General Management Vol. 34 No. 4 Summer 2009 6 D


hospital employees were less satisfied with their work. It is recommended thatmanagement redesign employees' jobs to activate the achievement-orientedbehaviour that characterises employees. This can be done by giving them moreresponsibility and by allowing them to make important decisions related totheir works. This would enable them to fulfil their need for achievement andenhance their job satisfaction.

LomiitatôonsIn this study, employees' participation was voluntary and was conducted at 12university hospitals in Isfahan, Iran. These factors limit the possibility ofgeneralising from the study findings. The results of the study can only begeneralised to all employees employed in IUHs. So, the findings should beinterpreted with caution since the participants were hospital employees from aparticular province of Iran and do not represent all hospital employees in thiscountry. This study may serve as a foundation for future studies in differentcountries, on a larger scale. It is certainly worth further exploration, especiallywithin hospitals that are perhaps not as hierarchical as the public hospitalsurveyed in the current study.

Conclusooini

In a cross-sectional study, specific factors associated with job satisfaction anddissatisfaction of employees in Isfahan University Hospitals, Isfahan, Iranwere explored. The study provides information about the status of global anddimension-specific job satisfaction among hospital employees. Seventeenvariables were found to contribute significantly to variance in hospitalemployees' job satisfaction. Factors that may influence the level of employees'job satisfaction are demographic variables of age, years of work experience,marital status, gender, organisational position, monthly salary, ' type ofdepartment, type of hospital and the nine sub-scales of job satisfier factors,as indicated in Table 3 above. The findings show that hospital employees aremoderately satisfied with their jobs. Salaries, benefits, promotion, contingentrewards, interpersonal relationships and working conditions are the bestpredictors of job satisfaction among hospitals employees. Specific job satis-faction dimensions indicate that highest dissatisfaction levels occur in the areaof benefits, contingent rewards, communication, salaries, work conditionsand promotion. Areas of dissatisfaction are signals for change.

Acknowledgement

This study was funded by the Isfahan University of Medical Sciences. Theauthors gratefully acknowledge the IUHs' managers and employees for theirassistance in conducting this research.



acceptabilüty of the study

Independent variables

Demographic variables play an important role in determining an employee'sjob satisfaction. In analyses, gender, marital status, age, tenure, educationallevel, type of employment and amount of salaries were included as controlvariables. Prior studies have demonstrated that these demographic variablesare potential predictors of job satisfaction (Hespanhol etal, 1999; Al-Ahmadi,2002; Bodur, 2002; Aronson et al, 2003; Chu et al, 2003; Lyons, 2003; Seo,2004).

Validation of research instruments

Spector's (1997) lob Satisfaction Survey questionnaire was originally devel-oped in English. A Persian translation of this questionnaire was developed byapplying a sequential forward and backward translation approach. The finaltest version was then pilot-tested, using a random sample of 40 hospitalemployees, (not included in the sample) and found to be well accepted andeasy to fill in. The pilot-testing showed that the instrument was simple andstraightforward to complete, not time-consuming (approximately 15 min-utes) and generally accepted by the interviewees.

Reliability of research instruments

Cronbach's alpha coefficient has been used for estimating the reliability ofquestionnaire. An alpha value of 0.70 or higher was considered as acceptablereliability for questions. The reliability coefficient for the questionnaire was0.87, while the coefficients for the nine domains were as follows: wages andsalaries, 0.76; fringe benefits, 0.83; promotion and achievement, 0.79; con-tingent rewards, 0.78; communication, 0.77; working conditions, 0.80; natureof work, 0.78; supervision, 0.89 and co-workers, 0.77.

Acceptability of research instruments

Acceptability was assessed in terms of refusal rates, and rates of missingresponses. A total of 814 (85.68 %) hospital employees filled out the jobsatisfaction questionnaires. Organisation specific response rates varied from91% to 100%. Missing data analysis showed that 92% respondents had nomissing values for the entire set of 36 items. The main reasons for non-participation were either the refusal to take part in the study or absence.

Data collection

The sampling method was stratified random sampling. From 6,405 employeesof hospitals, 950 persons were selected for this research after a pilot study byusing the following formula (N == 6405, d = 0.03, z = 1.96 and s = 0.51).Employees who had less than 6 months working experience were excludedfrom this study. Erom the 950 distributed questionnaires, 832 questionnaireswere returned and from those, 814 questionnaires were completely filled inshowing a return rate of 85.68%.

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Analysis of data

All data were analysed using the statistical package for the Social Sciences(SPSS 11). Appropriate statistical procedures for description and inferencewere used. The missing values were checked prior to further statistical analysis.In order to normalise the Likert scale on 1-6 scales for each domain, the sum ofraw scores of items in each domain was divided by 4 and for overall jobsatisfaction; sum of raw scores of items was divided by 36. The possiblejustified scores were varied between 1 and 6. Scores of 2 or lower on the totalscale indicate very low, scores between 2 and 2.99 indicate low, scores between3 and 3.99 indicate moderate, scores between 4 and 4.99 indicate high andscores of 5 or higher indicate very high job satisfaction or commitment.Higher scores in the domains indicate better job satisfaction. The differencesbetween groups were tested with the chi-square, T-Test, Mann-Whitney, oneway ANOVAs and Kruskal Wallis tests. The correlation coefficients werecalculated to evaluate the relationship between variables. Stepwise multipleregression analysis was used to identify the most important predictor domainsin global satisfaction. Data were presented as the mean ± standard deviation(SD) and percentage (p values less than 0.05 were considered as significant).

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Ali Mohammad Mosadeghrad is a Lecturer in Health Policy and Management at TehranUniversity of Medical Sciences in the School of Health, and Doctoral Researcher, PublicServices Management, School of Management, Royal Hollov/ay, University of London. He holdsa Bachelor and Master's Degree in Healthcare Services Management. Ali has vi^rittenextensively on many aspects of Healthcare organisation and management. He has v/rittenthree books, and more than 30 articles in journals. His research interests include strategicmanagement, quality management and organisational change.

Ailson De Moraes, Teaching Fellow and Associate Researcher completing his PhD thesis inLeadership and Strategic Management, Public Services Management, School of Management,Royal Holloway, University of London. Ailson holds visiting lectureship positions at theEuropean School of Management (ESCP) and the Katholieke Hogeschool Leuven. Beforeentering academia, Ailson worked for a number of international organisations in the UK,Portugal and Brazil, including the Gerdau Group, the 13th largest steelmaker and the largestproducer of long steel in the Americas.

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