Factors Influencing the Job Satisfaction of Health System Employees in Tabriz, Iran

Abstract

Background: Employees can be counseled on how they feel about their job. If any particular dimension of their job is causing them dissatisfaction, they can be assisted to appropriately change it. In this study, we investigated the factors affecting job satisfaction from the perspective of employees working in the health system and thereby a quantitative measure of job satisfaction.

Methods: Using eight focus group discussions (n=70), factors affecting job satisfaction of the employees were discussed. The factors identified from literature review were categorized in four groups: structural and managerial, social, work in it-self, environmental and welfare factors.

Results: The findings confirmed the significance of structural and managerial, social, work in it-self, environmental and welfare factors in the level of job satisfaction. In addition, a new factor related to individual characteristics such as employee personal characteristics and development was identified.

Conclusion: In order to improve the quality and productivity of work, besides, structural and managerial, social, work in it-self, environmental and welfare factors, policy makers should be taken into account individual characteristics of the employee as a factor affecting job satisfaction.

Introduction

Job satisfaction is defined as harmonizing the people's understanding of needs and what they receive from their jobs and is recognized as one of the most important research variables belonging to organizational behaviors and also as a crucial variable in the organization's researches and theories [1].

Improving the quality of health services is a continuing challenge to managers in the health system [2]. As a matter of fact, the job satisfaction of health care employees is a very important factor that has a profound impact on productivity as well as on the quality of patient care [3]. Job satisfaction has a direct link with absenteeism and turnover of the staff in organizations [4]. Nearly 70% of the physicians working in the teaching hospital of Karachi were not satisfied with their job, which, in turn, affected the quality of their work [5]. The issue of job satisfaction has always been considered as a problem in organizations and still is. In a way that up to the year 1980, more than 4000 articles have been published concerning this [6].

The factors that impact job satisfaction are often categorized into extrinsic and intrinsic ones [7]. Intrinsic factors are related to the work itself (such as the ability to develop one’s skills, sense of autonomy, success, achievement and control); whereas extrinsic factors are not directly related to work itself (such as, salary, relationships with colleagues) [7-8].

As well as autonomy and cohesion with colleagues, many factors such as task variety, feedback, promotional opportunities, task identity (professional status), working conditions, collaboration with the staff and strength of the organizational culture have been associated with job satisfaction [9]. Demographic variables, job characteristics and organizational environment factors contribute to job satisfaction [8]. Most Singapore's doctors are rather satisfied with their freedom of action to treat patients (92%) and the kind of their relationships with patients (94%); furthermore their most dissatisfaction is related to their leisure time (48%) and their work improvement and promotion (38%) [10].

The lack of valid evidence in the diverse areas of defining and measuring job satisfaction and its relation with other concepts such as functionality and job efficiency, absence and the like, indicates that most of researches and studies used to determine job satisfaction have failed to determine its dimensions, aspects and factors accurately and completely [11].

In this study, we investigated health system employees’ perspectives on work factors most affecting job satisfaction.

Methods

Focus Group Discussion (FGD) were used as an appropriate qualitative method to elicit knowledge, beliefs, feelings, and experiences of health system employees about the factors affecting job satisfaction, and to gauge the congruence of their attitudes with these aspects found in the literature in order to identify potential aspects of job satisfaction.

Seventy health system employees were selected from four departments: East Azerbaijan provincial health center, treatment center, teaching hospital center and health care center. The selected employees participated in 8 FGDs from March, 2011 to June, 2011.

The study participants were selected using a purposive sampling method and the inclusion criteria were having at least 5 years of work experience, as general practitioner, midwife, nurse, occupational health worker, or environmental health worker. We reached the saturation when after 8 sessions of FGDs, all themes and issues were repetitive and there were no new issues to discuss about. Approximately 90% of those invited to participate in the study attended the FGDs. Refusals were for personal reasons such as work time interference with FGD session hours and fear of losing their job.

A semi-structured questionnaire was designed using material obtained from the literature review, and structural and managerial, social; work it-self, environmental and welfare issues were discussed with FGD members. Each session lasted to 60-90 min and started with a broad opening question. The opening question focused on identifying the most important issues related to group members’ job satisfaction. All FGDs were recorded using a voice recorder and verbatim transcriptions were prepared. To assess respondent validity, before analysis, all recorders were checked with the notes and all notes were checked for correctness with participants. To ensure expert validation, the interview contents were checked and evaluated by two specialists and their assessments were combined.

Thematic analyses, as used by Manongi et al. (2006) [12] were used on the transcripts through 3 stages.

Stage1: Familiarization with the notes, reading of the notes and transcribing them. Primary coding was developed from aspects emerging from the familiarization stage.

Stage 2: The process of applying codes to the data. Textual codes were used to recognize specific pieces of data and differing themes.

Stage 3: Development of themes emerging from the discourse.

All FGD participants were informed that all findings would be kept strictly confidential and that they could quit participating in the study at any time.

Results

Approximately half of participants (51.4%) were 40-49 yr of age. 55.7% were male. For most participants employment status was formal with 81.4% of the participants being of permanent employment status. Those who stayed in their job were 10-19 yr of age (64.3%) (Table 1).

Table 1. Characteristics of health system employees participating in the focus group discussions.

Characteristics	Participants (n= 70) n %
Age (yr)
30-39	30 42.9
40-49	36 51.4
50 and more	4 5.7
Gender
Male	39 55.7
Female	31 44.3
Employment status
Formal	57 81.4
Informal	13 18.6
Tenure (years)
5-9	10 14.3
10-14	27 38.6
15-19	18 25.7
20 and more	15 21.4

Findings of FGDs showed that in addition to structural, managerial, social, work in it-self, environmental and welfare factors, a new theme was identified from FGDs: individual characteristics (Table 2).

Table 2. Health system staffs' perspective on Factors affecting job satisfaction.

Theme	Sub theme
Structural and managerial factors	-Lack of discrimination in the organization
	-Executive power of managers
	- Performance-based management systems in organizations
	- Existence of the participatory management system
	- Transparent selection and appointment of managers
	- Clear promotion path for staffs in organization
	- Intersectional collaboration
	- Appropriate reward and punishment systems in organization
	- Job security
	- Delegation
	- Evaluation system in organization
	- Specific duties
	- Support of employees needs by managers
	- Congruence of manager education level with his organizational position
Social factors	- Organizational relationships,
	-Informed policy makers about the value the health system - Customer satisfaction
Individual factors	-Personal characteristics
	- Personal development
Work it-self factors	-the right person being on the right job
	-Job prestige
	- Workload
	- Interesting job
Environmental and welfare factors	- Salary and organizational benefits
	- Suitability of work equipment,
	-Work environment and physical conditions, ,
	- Relation between workload and payment
	- Providing travel opportunity using organizational resources
	-Transportation services
	- Good loans (housing, marriage, etc.)

Structural and managerial factors

Based on participants' perspectives, lack of discrimination in the organization, executive power of managers, performance-based management systems in organizations, existence of a participatory management system, transparent selection and appointment of managers, clear promotion path for staff in organization, intersectional collaboration, appropriate reward and punishment systems in the organization, job security, delegation, evaluation system in organization, specific duties, support of employees needs by managers, correlation of managers’ education level with their organizational positions were the most important factors affecting job satisfaction.

Some of the issues raised during the discussion were as follows:

“There is something which causes satisfaction and dissatisfaction… that is discrimination… we are doctors … what is the difference between me who works in the primary health system and my friend who works in the treatment system?” (P3, FG4). “When I was an operator, my position was higher than it is now. Now I am an environmental expert … a bank accountant who has 1 or 2 years’ work experience gets promoted over time” (P 9, FG1). “We have no job responsibility description”(P5, FG2).

“Another issue is delegation which is now almost zero degree” (P5, FG2).

Social factors

FGDs participants believe that organizational relationships, informed policy makers about the value the health system and customer satisfaction are social factors which need to be considered by all actors of the health system.

Some of participants’ discussions are:

“A personal relationship with others or even with the direct manager or top managers, relations with colleagues (how friendly they are), relations with other sub-units… “Relation can be classified in another category” (P5, FG2). “When we want to talk to our managers, they say what are you doing in health units?” (P 4, FG4).

Individual characteristics

The study participants expressed that individual factors such as personal characteristics and development were directly related to job satisfaction.

For example participants believed that: “Personal characteristics such as personality and temperament are important in job satisfaction”(P 3, FG1). “Personal development is very important... and this directly impacts job satisfaction” (P6).

Factors intrinsic to the job

Participants believed that factors related to the job in it-self were a determining element in job satisfaction and included the right person being on the right job, job prestige, workload and interest in the job.

Some of our subject's views are: “Lack of compatibility between job and academic degree …. I think this is one of the factors causing dissatisfaction” (P2, FG2). “Work overload is also another issue which contributes to dissatisfaction”(P2, FG7).

Environmental and welfare factors

From participants’ perspective, salary and organizational benefits were environmental factors affecting job satisfaction. Suitability of work equipment, work environment and physical conditions, relation between workload and payment, transportation, provision of travel opportunity using organizational resources, loans (housing, marriage and etc), are important.

Furthermore, FGD members expressed: “The main concern of general practitioners is low income”(P5, FG4). “Work equipment is another influential factor in job satisfaction and dissatisfaction” (P3, FG2). “Another factor could be physical conditions of the workplace, such as light, air conditions and welfare facilities”(P1, FG3). “Lack of transportation services also leads to dissatisfaction”(P5, FG5).

Discussion

Structural, managerial, individual, social, job in it-self, environmental and welfare factors were indicated as affecting job satisfaction. Findings are in agreement with those reported in articles published in Iran. Movahhed and Moghadam [13] classified factors affecting job satisfaction among nurses into the following categories: work security, relations, managerial and social conditions.

Furthermore, regarding structural and managerial factors, the results of our study showed that discrimination was one of the major issues. This is in agreement with the findings of Bester and colleagues [14]. Justice plays a pivotal role in the organization and job satisfaction and the way individuals are treated directly affects their axioms, emotions, attitudes and their manners and thereby, their satisfaction [15]. Therefore, it can be argued that the way employees are judged, the existence of justice in organizations, and employees’ reactions to such equality or inequality influence the degree of job satisfaction felt. A manager's full support of staff is mentioned as one of the structural and managerial factors. This finding is consistent with the finding of El-Salam stated that nurses are supported by managers; tend to be successful at their jobs [16]. The more the managers' support, the less is the occurrence of medical and nursing errors [17]. Participants also mentioned that the existence of a participatory management style is an influential factor in job satisfaction. A participatory management style could result in increasing job satisfaction levels, sense of trust and power [16,18-19]. Therefore, in the work field, if supervisors and staff do consult with each other and colleagues cooperate with each other in decision making, then all these factors will tend to increase job satisfaction levels. Lack of appropriate reward and punishment systems in an organization, which decreases the desire in people to perform better and makes them disappointed or even alienates them from the organization, was found in Stone and colleagues study [20] and this finding is in line with ours.

The findings of Asl et al., [21], as well as findings of our study indicate that transcendental values which provoke satisfaction in employees consist of recognition of their merits, respect for them, freedom in their performance and work security.

Furthermore, as regards factors pertaining to the individual, our findings indicate that personal characteristics and possibility for individual development of the employee affect job satisfaction. The same factors affecting job satisfaction were revealed in another study [22] and included genetic factors and personal characteristics.

Concerning the social dimension, an appropriate organizational the relationship with colleagues and managers is mentioned as an important factor throughout the FGDs. Having a good relationship with the manager tends to decrease stress in staff. On the other hand, a weak relationship and lack of good supervision increased job related stress, sense of loneliness and distrust to the manager [19]. Furthermore, good relations with colleagues are important in feeling respected and supported and increases the level of motivation in employees. A good support of colleagues and a good relationship with them has multidimensional effects on the work environment, motivation of staff and creates a positive attitude in employees. A supportive environment increases the individual’s efforts to reach the organizational goals. Having good relations with managers creates an atmosphere in which the sense of being healthy and cheerful, the sense of having enough welfare and the level of satisfaction will improve [23].

On the dimension of work in it-self, an appropriate workload is mentioned as an important factor throughout the FGDs. A study [19], reveals that work overload is one of the most influential factors upon nurses’ negative attitudes toward their organizational atmosphere. High workload tends to increase the sense of tiredness and, aggravated by inadequate sleep, leads to negative organizational and individual performance [24]. Work overload will lead to work depression, tiredness and lack of power [16].

Regarding welfare and environmental factors, inadequate income and other benefits were mentioned as influential factors in almost all FGDs. Low income has a negative consequence which affects individuals’ attitudes towards the organization and their job satisfaction [17].

Limitations of the study

This study only explored the subjective views of employees in the health system and the responses obtained were analyzed only theoretically. Therefore, the factors uncovered are by no means exhaustive. Another limitation of this study is that only the views and experiences of some health personnel who were able to participate in the study were collected; therefore, the factors discovered to affect job satisfaction are by no means exhaustive. Further research is needed to confirm the findings of this investigation.

Conclusion

In order to improve the quality and productivity of work, apart from structural and managerial, social, work in it-self, environmental and welfare factors, policy makers should take into account the individual characteristics of the employees as a factor affecting job satisfaction. We did not find any qualitative research has been conducted in this field in Iran, the present study is the first to identify factors affecting job satisfaction in the target population, and the obtained findings provide guidelines for constructing a questionnaire of job satisfaction conforming to conditions prevailing in the Iranian health system.