Comparison of Factors Influence Health Care Worker Satisfaction in Government

Introduction

Quality and outcome of work is based on an efficiency and satisfaction of workers. Their satisfaction is related with various factors such as personal factors as well as organizationpolicies (Meng et al., 2018). According to (Bonsdorff2011) satisfaction is a critical factor that influences human resource productivity levels. In all organizations, the asset that is most valued in human resource given that workers are the engines that drive organizations by providing service delivery and acting as sustainable energy source. Although workers’ performance is dependent on or limited by resource availability and competencies of workers, availability of these resources is not a guarantee of high job performance (Chamal&Dilina, 2018). It was suggested by McPake et al. (2013) that workers’ performance as well as their job satisfaction depends on workers’ willingness to work regularly, diligently, complete tasks and flexibility when performing several tasks. Policy makers and mangers in health care settings must ensure health care practitioners can work willingly in the organization and be competent in certain tasks and work policies.

Literature Review

Employee productivity and work performance is determined mainly by job satisfaction which also contribute partly to work quality (Dugguh&Ayaga, 2014). Such complexity measures individual attitude to a job which influences their motivation to the job and relations with coworkers, health conditions and career development. Past studies have attempted to examine what job satisfaction constitutes and what influences job satisfaction which is important especially in health care settings where professionals have subjective expectations (Hosseinabadi et al., 2018). Management in health care settings must also understand and cater for issues and factors impacting job satisfaction for better outcomes and retain competitive staff.

De Oliveira et al. (2017) reported that appreciative inquiry should be conducted by managers to create radical strategies and changes in firms. According to Cho et al. (2015), work environment must be supportive since it is significant in developing skills of employees and enhancing employee satisfaction and motivation at workplaces. Additionally, Tanne (2012) also examined association between job satisfaction, personnel management and management support. They found that lack of insurance schemes, low wages and lack of promotions were lowering job satisfaction among health care practitioners.

High turnover and health care practitioner’s shortages is problem that health care systems face worldwide (Zhang et al., 2018). High turnover and shortages are the most pressing issues in countries across the globe including KSA. There are many factors associated with worldwide health care practitioners shortages including decreased student numbers pursuing medical courses, decreased number of health care practitioners getting employed after graduation, and dissatisfaction with clinical jobs among practicing health care practitioners which lead to high turnover rates. Wei et al. (2015) indicated that work overload in health care setting was the main cause for dissatisfaction among health care practitioners in most countries. Job dissatisfaction in health care is highest in the US (41%), Scotland (38%), the UK (36%), and at 33% and 17% in Canada and Germany respectively (Lu et al., 2005; Aiken et al., 2001). In Saudi Arabia, major factors identified by past studies as affecting health care workers include job satisfaction, hospital performance, and organizational commitment. Job dissatisfaction in KSA among health care practitioners can be attributed to rewards and payment, recognition, hospital policies, company policies and operating conditions.

For decades, KSA has attracted expatriate health care practitioners making the health care system to rely heavily on recruitment of expatriate health care practitioners from different countries globally including the US, India, the UK, Ireland, Australia, Philippines, India, Malaysia, Middle East, Sweden and other countries globally (Al-Dossary et al., 2008). KSA has been a destination for many foreign health care practitioners given the many associated benefits like long vacations, free accommodation, bonuses and rewards, low tax salaries, and air tickets back to homeland among others. Gulf War in 1991 create a staff shortage crisis in health care system as expatriate health care practitioners left the country leading to the ‘Saudization program’ which was a policy to encourage training and education of Saudis to replace the expatriate health care practitioners (Al-Dossary et al., 2008).

Health care system in KSA has been expanded and improving in the last decades which can be attributed to the development and growth witnessed in KSA as well as increases in health budget allocation and population increase (Abu Raddaha et al., 2012). KSA has developed and advanced in all disciplines in health care, however, shortages are still a concern since it impacts on productivity and efficiency of health care system in KSA. Such shortages can be linked to a number of educational, cultural and social factors (Al Hosis et al., 2013).

In hospitals in KSA, many problems have the potential of impacting health care and medication outcomes since they not only create job dissatisfaction but also performance of health care practitioners (Al?Ahmadi, 2009). Consequently, this area has attracted the attention of many stakeholders and scholars. A number of factors affecting performance have been examined in health care settings for decades with greater emphasis on work environment aspects and worker aspects (Abualrub&Alghamdi, 2012). Health care practitioners are important element in health care and hence can determine patient outcomes and patient care quality. Job performance among health care practitioners has been examined by past studies in terms of organizational commitment, job satisfaction and work attitudes. In KSA, Al-Dossary et al., 2012 indicated that there are increasing concerns over job satisfaction due to its role in quality improvement in health care organizations. Literature on job satisfaction among health care practitioners in KSA tends to be limited to guide strategies for addressing the issue. Moreover, it is imperative to understand job satisfaction factors so as to increase retention and attract more health care practitioners to hospitals in KSA.

Healthcare employee’s satisfaction’s can be varied from governmental sector to private sector. Base on a study of jobsatisfaction of nurses across working sector, job satisfaction was higher among the nurses who are working in governmental sectors compared to those working in private sectors. This variation has been linked to that job insecurity and long working hours in private sectors(Jahan, 2013).  In this regards, it was imperative to conduct the study to better understand of  factors that are causing dissatisfaction and satisfaction among health care practitioners who are working in governmental and private sectors to pinpoint  understanding the variation in the satisfaction level which will help for developing strategies to improve those sectors. The aim of this study is to compare the satisfaction level among healthcare worker in governmental sectors compared to private sectors in Alahssa region.

Methodology

 

This study was approved by the institutional review board of Arabian University. Qualitative data analysis will be chosen to get the opinion about the hospital.  Online questionnaire will be prepared and send to gather data from the participants. The target population is healthcare workers in governmental and private hospitals in Alahssa. Data will be collected using web-based questionnaire, which will be distributed electronically using social media. This method was chosen because it is cost effective and allows participants to provide anonymous feedback.  The methodology follows convenience sampling which focus only on health care workers.                                    

Questionnaire design

 

The questionnaire was constructed based on a review of the relevant literature.Satisfaction of Employees in Health Care (SEHC) Survey was adopted with amendment to be considered as a tool to collect the data from the participants(Alpern et al,2013). The questionnairewill be distributed in 2 version including Arabic and English. The English original version will be translated to Arabic for those who are Arabic speakers. This process to be implemented is requiring forward translation, expert panel back-translation, pre-testing and cognitive interviewing. The internal consistency of the questions will be verified using Cronbach’s coefficient alpha.   The final Arabic version will be checkedfor face and content validity by focus group participants and experts in the school of business administration at King Faisal University. Staff satisfaction will beevaluated using the 20-item SEHC survey. The survey consists of 18 questions focus on relationship with management and supervisors, job content, and relationships with coworkers, measured using  4-point Likert scale where 1 was strongly disagreeand 4 was strongly agree. Afurther 2 questions will evaluate overall of healthcare worker satisfaction.

Sample-size calculation

Since there are no data on which to estimate the standard deviation of the satisfaction when treated as a continuous variable, the sample size calculation was performed based on the categorical analysis (Satisfied vs. not satisfied). As the sample size increases, the precision with which the proportion of satisfaction status respondents is estimated increases.  The standard manner by which this precision is calculated is by calculating the 95% confidence interval (CI) of the prevalence (of satisfaction) estimate. It was estimated that a prevalence of satisfaction of 5.7% (maximum of 95% CI) requires 300 participants. If better precision is required, for example 4.9% (maximum of 95% CI), a sample of about 384 would be adequate. The distribution of questionnaires will be inflated to allow for a better response rate.

Scope of the survey

The research study is conducted only on the healthcare workers working in government and private hospitals at the location Alahssa. The study report will be based on 384 respondents. The respondents are working in either public or private healthcare centers. The research study will not do any face to face interview with the participants. We will make use of social network to perform study on health care workers. The results about the satisfaction of healthcare workers towards private and public hospitals reflect only feedback of 384 participants of Alahssa region.  

Objectives of research study

The main objectives of the research study are analyzing the satisfaction of health care workers working in private sector and public sectors. The study and satisfaction of workers is subdivide into 4 sub sections such as

• Hospital management
• Job appreciation
• Practice Environment
• Work Environment
• Work satisfaction

The objectives of the research study are to analyze the type of healthcare sector provide more satisfaction for workers in the following perspectives such as hospital management, job satisfaction, practice environment, work environment and work satisfaction as well as overall satisfaction. 

Hypothesis

Hypothesis: Is Health care workers satisfied in private hospitals or Government hospitals

H0: Healthcare workers satisfied in private hospitals

H1: Healthcare workers satisfied in Government hospitals

Data Analysis

Dataset for Analysis

The data set contains 384 repsonse from the both governemnt and private sector for the SHEC.

 

Data preprocessing

The data is pre-processed to perform statistical analysis on the data set. The participant answered for each question in the form Linkert scale like strongly agree, Agree, undecided, disagree and strongly disagree. The data are interpreted into 4-strongly agree, 3-agree, 2-disagree, 1- strongly disagree.

And category the data into 2 part with Agree which is comprised of (Strongly Agree and Agree) and Disagree(Strongly Disagree and Disagree).

Reliability test

The reliability of the question used in the analysis is verified using the Cronbach’s alpha analysis.  The internal consistency of the data items are monitored through the analysis. It is reliability or consistency test.

Formula to calculate Cronbach’s alpha is as follows:

 

 

 

The value of Cronbach’s alpha is 0.8877, it indicates that the questions are reliable. There is reliability and consistency exists in the questions used for analysis.

Analysis

Based on the data the exploratory data Analysis was done to find the insights over the given data.

Analysis: Government sector Vs Private sector

 

 

Among the participant 204 participants belong to government sector and 180 belong to private sector. 46% participants belong to private sector.

Working sector (Professional) analysis

 

 

In the survey, more number of participants belongs to the profession nurse.  From the government sector 58 nurses and private sector 52 nurses were participated.  Less number of participants participated belong to the profession laboratory professional. Participated laboratory professionals are 27 (government) and 28 (private).

 

 

More Married health care workers are working in private and government hospitals. Next to married person, unmarried people are working in the healthcare sectors.

Table 1Demographic information of participants

N: Indicates the sample

Type of medical		N (%)	Government	Private
Sector	Government	204(53%)
	Private sector	180(47%)
Gender	Male	204(53%)
	Female	180(47%)
Age	20-25	16 (4%)	11	5
	26-34	110 (29%)	61	49
	35-45	175 (46%)	91	84
	>46	83 (21%)	41	42
Profession	Nurse	110 (29%)	58 (15%)	52 (14%)
	Physician	83 (22%	46 (12%)	37 (10%)
	Pharmacy professional	64 (17%)	34 (9%)	30 (8%)
	Dentist	61 (16%)	32 (8%)	29 (8%)
	Laboratory professional	55 (14%)	27(7%)	28 (7%)
	Administration	2 (1%)	0	2 (1%)
	Clinical administrator	1	0	1
	Teacher	1	1	0
	Public health	1	1	0
	RT	1	1	0
	DaibetesEdectors	1	1	0
	Technical support	1	1	0
	other	1	1	0
	Academician	1	1	0
	Paramedic	0	0	1
Marital Status	Divorced	50(13%)	25 (7%)	25 (7%)
	Married	207(54%)	110 (29%)	97 (25%)
	Single	106(28%)	55 (14%)	51 (13%)
	Widowed	21(5%)	14 (4%)	7 (2%)
Religion	Muslim	246(64%)	135 (35%)	111 (29%)
	Non-Muslim	138(36%)	69 (18%)	69 (18%)
Monthly Salary	<10>	93(24%)	50 (13%)	43 (11%)
	>20,000 SR	80(21%)	42 (11%)	38 (10%)
	10,000-20,000 SR	211 (55%)	112 (29%)	99 (26%)

 

Table 2Recommenation Analysis

		government	private
Recommendation	Definitely No	36 (9%)	16 (4%)
	Definitely Yes	27(7%)	22 (6%)
	Probably No	69 (18%)	67(17%)
	Probably Yes	72 (19%)	75(20%)

We can group the probably yes and definitely yes as one bucket

Table 3Grouped Value

Recommendation	Government	Private
Yes	99(49%	97(54%)
No	105 (51%)	83(46%)

It clearly shows that government sector is more preferred as compared to private sector. Profession with less experience shows high value as compared to other. In terms Job nature the nurses shows more satisfactions as compared to others.

Average rating of the health facility as a place to work

The heath care workers have given recommendation to other in terms of ratings from 1 to 10. For this analysis, we have fixed the threshold 5 for finding the heath care workers recommendation on private as well as public hospital. The worker’s recommendation greater than 5 for private and government are considers. 

Table 4Average rating

Rating > 5
Government	Private
122	108

The recommendationanalysis shows that, health care workers recommend government hospital to others than private hospitals. 

Recommendation analysis based on gender.

Table 5Gender wise Rating

sector	Governmental	Private
Male	63	61
Female	59	47

 

From the above analysis, it shows that more number of male and female health care workers recommend governmental hospitals than private hospitals.

Statistical Anova Calculation

Based on the data it was grouped to form the mapping of Questions to find the correlation and arrive at the conclusion to find the values.

In the Table 6, the work satisfaction of the population is arrived with 5 dimensions grouping with demographics variables and questions. The results shows that average values calculated over the government is nearly to 2.99

 

Table 6Satisfaction -Government

Government
Dimension	Average	adj SS	p-value
Hospital management	2.99	19.23±4.2	0.285
Job Appreciation	2.85	21.68±2.1	0.001
Practice Environment	3.07	6.60±3.1	0.274
Work Satisfaction	3.08	6.66±3.2	0.273

Statistical Anova Calculation

In the table 7, the dimension is grouped for private and found the values are slightly higher as compared to government in the binned part.

Table 7Satisfaction - Private

Private
Dimension	Average	adj SS	p-value
Hospital management	3.04	9.23±472	0.276
Job Appreciation	3.02	11.21±2.7	0.039
Practice Environment	3.18	10.62±2.0	0.213
Work Satisfaction	3.1	9.61±4.3	0.273

Questions are category in agree and disagree for Government and Private sector.

S.No	Question	Government		Private
		Agree (%)	Disagree (%)	Agree (%)	Disagree (%)
Q1	[The management of my organization is supportive of me]	49%	51%	49%	51%
Q2	[I receive the right amount of support and guidance from my direct supervisor.]	56%	44%	54%	46%
Q3	[I am provided with all trainings necessary for me to perform my job]	50%	50%	58%	42%
Q4	[I have learned many new job skills in this position]	65%	35%	56%	44%
Q5	[I feel encouraged by my supervisor to offer suggestions and improvements]	54%	46%	56%	44%
Q6	[The management makes changes based on my suggestions and feedback]	54%	46%	53%	47%
Q7	[I am appropriately recognized when I perform well at my regular work duties]	52%	48%	54%	46%
Q8	[My organization rules make it easy for me to do a good job]	57%	43%	56%	44%
Q9	[I am satisfied with my chances for promotion.]	37%	63%	44%	56%
Q10	[I have adequate opportunities to develop my professional skills]	49%	51%	49%	51%
Q11	[I have an accurate written job description]	51%	49%	54%	46%
Q12	[The amount of work I am expected to finish each week is reasonable]	59%	41%	61%	39%
Q13	[My work assignments are always clearly explained to me]	54%	46%	54%	46%
Q14	[My work is evaluated based on a fair system of performance standards]	51%	49%	53%	47%
Q15	[My department provides all the equipment, supplies, and resources necessary for me to perform my duties]	54%	46%	56%	44%
Q16	[The buildings, grounds, and layout of this facility are adequate for me to perform my duties.]	52%	48%	52%	48%
Q17	[My coworkers and I, work well together]	57%	43%	62%	38%
Q18	[I feel I can easily communicate with members from all levels of this organization]	61%	39%	54%	46%

Hospital Management category

Questions were grouped to form and get the satisfaction towards the Hospital Management. It is observed that equal percentage is being obtained for Government and private sector with 54% and 46%. But in Government sector gains more obtained as compared to private.

S.No	Question	Government		Private		Dimension
Q1	[The management of my organization is supportive of me	49%	51%	49%	51%	Hospital management
Q2	[I receive the right amount of support and guidance from my direct supervisor.]	56%	44%	54%	46%	Hospital management
Q3	[I am provided with all trainings necessary for me to perform my job]	50%	50%	58%	42%	Hospital management
Q6	[The management makes changes based on my suggestions and feedback]	54%	46%	53%	47%	Hospital management
Q18	[I feel I can easily communicate with members from all levels of this organization]	61%	39%	54%	46%	Hospital management

Job Appreciation Category

This category is used to get the Job appreciation for the work done is obtained in private sector. But 53% of government sector were dissatisfied for their job not being not appreciated.

S.No	Question	Government		Private		Dimension
Q7	[I am appropriately recognized when I perform well at my regular work duties]	52%	48%	54%	46%	Job Appreciation
Q9	[I am satisfied with my chances for promotion.]	37%	63%	44%	56%	Job Appreciation
Q14	[My work is evaluated based on a fair system of performance standards]	51%	49%	53%	47%	Job Appreciation

Practice Environment

With these questions, it is observed that more level of satisfaction being observed in private sector with 58% on average as compared to government sector.

S.No	Question	Government		Private		Dimension
Q5	[I feel encouraged by my supervisor to offer suggestions and improvements]	54%	46%	56%	44%	Practice Environment
Q11	[I have an accurate written job description]	51%	49%	54%	46%	Practice Environment
Q13	[My work assignments are always clearly explained to me]	54%	46%	54%	46%	Practice Environment
Q15	[My department provides all the equipment, supplies, and resources necessary for me to perform my duties]	54%	46%	56%	44%	Practice Environment
Q17	[My coworkers and I, work well together]	57%	43%	62%	38%	Practice Environment

Work Satisfaction

Towards the work satisfaction it is being that government sector is more comfortable in learning new skills and had an equal opportunity to develop professional skills.

S.No	Question	Government		Private		Dimension
Q4	[I have learned many new job skills in this position]	65%	35%	56%	44%	Work Satisfaction
Q8	[My organization rules make it easy for me to do a good job]	57%	43%	56%	44%	Work Satisfaction
Q10	[I have adequate opportunities to develop my professional skills]	49%	51%	49%	51%	Work Satisfaction
Q12	[The amount of work I am expected to finish each week is reasonable]	59%	41%	61%	39%	Work Satisfaction
Q16	[The buildings, grounds, and layout of this facility are adequate for me to perform my duties.]	52%	48%	52%	48%	Work Satisfaction

Analysis on category

s.no	Category	Government	Private
1	Hospital Management	54%	46%
2	Job Appreciation	47%	51%
3	Practice environment	54%	56%
4	Work satisfaction	56%	55%

From the analysis, it is observed that job satisfaction on governmental hospital is 53% and private hospital is 52%. The health care workers are satisfied on government hospital than the private hospital. 

Interpretation

            Job satisfaction of health care workers based on Government hospitals towards hospital management is 54%, job appropriation is 47%, practice environment is 54% and work satisfaction is 56%. The overall satisfaction of healthcare workers on government hospital is 53%.

            Job satisfaction of health care workers based on private hospitals towards hospital management is 46%, job appropriation is 51%, practice environment is 56% and work satisfaction is 55%. The overall satisfaction of healthcare workers on private hospital is 52%.

The analysis shows that, health care workers are satisfied ingovernmental hospital towards hospital management and work satisfaction. The analysis shows that, health care workers are satisfied in private hospital towards job appreciation and practice environment. As whole, more satisfaction is in government than private sector. Both male and female recommend governmental hospital. Recommendation analysis and Statistical anova test prove that, governmental hospital is better than private sector. 

Conclusion

The research study conducted on “Job satisfaction of health care workers in private and private hospital” at Alahssa. Job satisfaction plays an important role to achieve the best quality output in any field. It is more important for healthcare workers to actively work in healthcare sector as well as enrich patient care. Job satisfaction is correlated with various factors such as personal, management, appreciation, practice environment, work environment, and so on.   The research work find the job satisfaction of health work at each sub section as well as overall scenario. The research study concluded that, health workers those are working in government satisfied compared to private sector.

 

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