Investigating the organizational commitment and its associated factors among the staff of the health sector: a cross-sectional research

Abstract

Introduction

Organizational commitment (OC) significantly impacts the quality of care provided by healthcare staff. It reflects employees’ connection to and engagement with their organization, affecting job satisfaction, employee turnover, and the overall success of the healthcare organization. This research seeks to assess OC levels and identify its influencing factors among health sector staff in Shiraz, southwestern Iran.

Methods

In this cross-sectional study, the staff of the health sector including physicians/family physician (FP), midwives, healthcare workers, psychologists, dentists, and nutritionists were selected through a multi-stage sampling; they filled out an online 36-item questionnaire (12 demographic items and 24-item Allen and Mayer OC questionnaire). The data were analyzed using SPSS software (version 25). Descriptive statistics of OC scores were provided. Also, independent samples t-test and analysis of variance were used as statistical tests, and P-value < 0.05 was considered the significant level.

Results

Overall, 289 staff with a mean age of 32 ± 7.6 years participated in this study. The OC total mean score was higher in the public sector compared with the private sector and higher in the non-FP team compared with the FP team. The mean score of all types of OC among all job positions was low. Moreover, education level, workplace, job experience in current job, engagement in other jobs for making money, and FP staff showed a significant association with the total mean score of OC.

Conclusion

According to the results, OC among health sector staff is low. Therefore, policymakers in the health sector are strongly recommended to implement immediate measures to enhance this critical factor among their workforce.

Background

Organizational Commitment (OC) in the health sector refers to the degree of attachment, loyalty, and identification that health professionals have with their organization [1, 2]. It is a crucial factor affecting the performance and efficiency of healthcare institutions, as it influences the employees’ motivation, job satisfaction, and overall commitment to the organization [3].

There are three types of OC including affective, continuance, and normative commitment [4, 5]. Affective commitment pertains to the emotional attachment, identification, and active involvement of an employee within the organization [6]. Normative commitment involves a sense of responsibility that employees feel towards the organization [7]. On the other hand, continuance commitment is linked to the perception of the costs associated with leaving the organization [8]. Based on evidence, various factors such as the working environment, recognition, supportive supervisors, workload, leadership styles, and individual and job-related characteristics were identified as the most influential factors contributing to employees’ commitment to their organizations [9, 10].

A high level of employee OC has numerous benefits for healthcare organizations, including achieving goals, improved performance, motivation, attachment, effectiveness, efficiency, job satisfaction, reduced turnover, burnout, and absenteeism [11–13]. Conversely, low OC increases medical errors and jeopardizes patient safety [14]. Committed employees have been found to provide quality care, exhibit better performance, and ensure patient safety [13]. It is obvious that the health sector has a great impact on community health promotion and its employees play a crucial role in this regard [15].

It is clear that the significance of health sector is at least equal to that of care, if not greater, as it promotes a proactive lifestyle that can prevent diseases and enhance overall well-being, but surprisingly, most OC studies in Iran’s healthcare sector primarily focus on hospital employees, particularly clinical nurses [16–18].

Also, from the limited studies conducted in health sector, they examined the healthcare workers in general, but these often did not differentiate between various roles within the healthcare field and instead analyzed all health professionals collectively. We believe that comparing job positions in this regard can help researchers identify role-specific factors influencing OC, which can foster more effective management strategies and enhance employee satisfaction throughout the sector [19, 20].

Additionally, research comparing public and private sectors of Iran’s health system on OC is lacking. Such research can provide valuable insights into how sector factor impact employee engagement and commitment, guiding approaches to improving organizational efficiency in both sectors.

The final point addresses the urban family physician program (UFPP) in Iran, which has been implemented only in the two large provinces of Fars and Mazandaran since 2012. Notably, no research has been conducted to compare OC between FP and non-FP staff. This comparison is highly advantageous, as the UFPP in Fars and Mazandaran serves as an important pilot project designed to improve healthcare services nationwide. Any adjustments to the workforce plans are essential for the success of the upcoming national program.

Therefore, this study aimed to assess the level of OC and its associated factors among the health sector staff in Shiraz, Iran. The research questions are outlined below:

• What is the total mean score of OC and its components among different job positions of health sector in Shiraz?

• Do public sector staff have a higher level of OC than private sector staff?

• Do staff of the FP team have a higher level of OC than non-FP team staff?

• What are the factors associated with OC among health sector staff in Shiraz?

Methods

Setting and participants

This cross-sectional study was carried out using cluster sampling from January to June 2024 in Shiraz, Western Iran. The health sector staff including physicians/FP, midwives, healthcare workers, psychologists, dentists, and nutritionists were eligible to participate in this study. The target population was selected from both public and private sectors including comprehensive health centers, health posts and public clinics, and private clinics and offices. There were no exclusion criteria, except for unwillingness to participate in this study. According to a report by Shiraz University of Medical Sciences (SUMS), the total number of staff of health sector was 1158 (Table 1).

Table 1.

The number of staff of the health sector in Shiraz, Iran

Type of health sector	Job environment	Physician			Midwives and healthcare workers		Psychologists	Dentists		Nutritionists
Public sector	Comprehensive health centers, health posts and public clinics	FP and Non-FP	216	355		47		36	37
Private sector	Private clinics and offices	Only FP	278	189		-		-	-

Using the Cochran formula (n= $\frac{{\text{Nz}}^2\text{pq}}{N{d}^2+z^{2}pq}$), we calculated the sample size as 289 with a confidence level of 95% and an error of 4.96%; the sample size for each job displayed in the above table is shown in Table 2.

Table 2.

The sample size for staff of the health sector in Shiraz, Iran

Type of health sector	Job environment	Physician			Midwives and healthcare workers		Psychologists	Dentists		Nutritionists
Public sector	Comprehensive health centers, health posts and public clinics	FP and Non-FP	54	89		12		9	9
Private sector	Private clinics and offices	Only FP	69	47		-		-	-

A multi-stage stratified and cluster sampling was employed to conduct this study. At first, Shiraz was divided into five geographical regions (North, South, Center, East, and West) and allocated an equal sample size for each region. Then, we defined five public and private centers/clinics in each region to invite their employees to participate in this study.

Initially, the researchers were provided with a contact list by SUMS to call the health sector staff and explain the objectives of the study to them. Those who agreed to participate were included in the study, while those who were unwilling were excluded. Next, the researchers provided an anonymous questionnaire to each participant after obtaining their written consent and asked them to fill it out carefully.

Data collection

The data collection tool in this study was a 36-item questionnaire including demographic characteristics (12 questions) and the Allen and Meyer OC questionnaire (24 items) [21]. In this study, the translated valid and reliable version of the Allen and Meyer OC questionnaire was used (Cronbach’s alpha was reported from 0.77 to 0.91) [22–24]. Additionally, the reliability of the translated questionnaire was assessed in the present study, with a reported Cronbach’s alpha of 81.3%.

Allen and Meyer OC questionnaire has 24 items in three dimensions: Affective Commitment (AC) (8 items), Continuance Commitment (CC) (8 items), and Normative Commitment (NC) (8 items). The OC questionnaire was scored using a five-point Likert scale (1: Strongly disagree; 2: Disagree; 3: Neither agree nor disagree; 4: Agree; 5: Strongly agree). The minimum and maximum scores in each dimension of commitment are 8 and 40, respectively. Moreover, the interpretation of the overall score for each dimension is as follows: a score of 8 to 18 indicates low OC, a score of 19 to 29 moderate OC, and a score of 30 to 40 indicates high OC.

Data analysis

In this study, the data were analyzed using IBM SPSS Statistics software (version 25). Descriptive statistics regarding OC and its three types were provided. The normality analysis of the data performed (Sig. value of the Shapiro-Wilk Test was greater than 0.05) and then univariable analysis was done using independent samples t-test and analysis of variance [25]. The tests were two-sided, and P-value less than 0.05 was considered statistically significant.

Ethics statement

The proposal of this study was approved by the Ethics Committee of Shiraz University of Medical Sciences (SUMS), Shiraz, Iran, with the code of IR.SUMS.NUMIMG.REC.1402.080. Also, the Declaration of Helsinki [26], the ethical principles for medical research involving human subjects, was considered in this study. Additionally, the anonymous nature of the questionnaire, possibility of access to the researchers of the study, and privacy and confidentiality of the data were highly taken into account. Moreover, voluntary participation was highly considered by asking participants to willingly participate in this study and written informed consent was obtained from each. Also, they were assured that they could withdraw from the study at any stage without providing any justification.

Results

A total of 289 staff members participated in this study. Their mean age was 32 (SD = 7.6) years, and 185 subjects (64%) were married. Over half of them were contractual employees and worked in the public sector. Almost all of them complained that their income did not match their expenses which caused over half of them to get a second job to meet their needs (Table 3).

Table 3.

Demographic characteristics of the participants (n = 289)

Variable N (%)		Variable N (%)
Age (year)		Compatibility of the current job with the field of study
< 25	72 (25)	Yes	273 (94.5)
25–40	168 (58.2)	No	16 (5.5)
> 40	49 (16.8)	Employment status
Mean age	32 ± 7.6	Permanent employment	114 (39.5)
Gender		Contractual employment	163 (56.4)
Female	236 (81.7)	Manpower planning	12 (4.1)
Male	53 (18.3)	Workplace
Marital status		Employed in public sector	173 (59.9)
Single	104 (36)	Employed in private sector	116 (40.1)
Married	185 (64)	Mean years of work experience	11 ± 5.5
Mean number of children	1.1 ± 1.08	Job experience in current job (n)
Ethnicity		n < 2	39 (13.5)
Fars	133 (46)	2 ≤ n < 5	45 (15.6)
Turk	97 (33.6)	5 ≤ n < 10	73 (25.2)
Lor	54 (18.7)	10 ≤ n < 15	65 (22.5)
Kurd	0 (0)	15 ≤ n < 20	38 (13.2)
Other	5 (1.7)	20 ≤	29 (10)
Education Level		Expenses equals monthly incomes from this job
Associate degree	13 (4.5)	Yes	27 (9.4)
BSc	118 (40.8)	No	262 (90.6)
MSc	26 (9)	Having other jobs for making money
PhD/Professional doctorate	132 (45.7)	Yes	103 (35.6)
Current living area		No	186 (64.4)
In Shiraz city	228 (78.9)	Being FP staff (among physicians, midwives and healthcare workers (259))
Around Shiraz city	61 (21.1)	Yes	164 (63.3)
		No	95 (36.7)

According to Table 2, the OC total mean score in the public sector was about 1.1 times higher than in the private sector. Considering the position of participants in the public sector, midwives/healthcare workers had the highest OC total mean score, followed by physicians, nutritionists, psychologists, and dentists; however, physicians in the private sector showed a higher OC score compared with midwives/healthcare workers. Also, among the three types of OC, the mean score of CC was higher than the other types. Notably, the mean score of all types of OC among all positions studied in this research was lower than 40, indicating poor OC (Table 4).

Table 4.

The OC scores among health staff (public/private)

Position	Sector	AC	CC	NC	Total OC
Physician	Public	19.1 ± 1.4	25.2 ± 4.2	20.4 ± 3.6	64.7 ± 7.2
	Private	14.9 ± 2.3	22.8 ± 5.1	16.6 ± 2.5	54.3 ± 9.7
Midwife / Healthcare worker	Public	21.3 ± 1.2	27.1 ± 1.6	23.6 ± 3.8	72 ± 5.8
	Private	12.6 ± 2.7	22.4 ± 3.1	13.7 ± 2.1	48.7 ± 7.2
Dentist	Public	17.1 ± 1.8	16.2 ± 3.8	17.4 ± 3.6	50.7 ± 8.1
Psychologist	Public	14.3 ± 3.5	26.4 ± 1.2	13.5 ± 2.8	54.2 ± 6.9
Nutritionist	Public	15.4 ± 1.6	23.9 ± 3.2	15.7 ± 2.1	55 ± 5.7
All staff	Public	17.7 ± 3.5	23.8 ± 5.5	18.9 ± 3.1	60.4 ± 6.3
	Private	13.8 ± 2.8	22.6 ± 2.4	15.5 ± 2.7	51.9 ± 4.1

As Table 5 shows, the mean total OC score in the FP team was 2.9 times lower than in the non-FP team. Moreover, in both FP and non-FP teams, physicians had a higher OC score in comparison with midwives/healthcare workers.

Table 5.

The OC scores among FP team and non-FP team

Position	FP staff or non-FP staff	AC	CC	NC	Total OC
Physician	FP	13.1 ± 3.4	24.5 ± 6.1	16.6 ± 4.7	54.2 ± 13.1
	non-FP	21.1 ± 4.7	29.2 ± 5.2	27.4 ± 3.9	77.7 ± 13.6
Midwife / Healthcare worker	FP staff	12.9 ± 3.1	25.4 ± 6.5	11.9 ± 4.1	50.2 ± 13.2
	non-FP staff	21.3 ± 1.2	27.1 ± 1.6	23.6 ± 3.2	72 ± 5.6
All	FP team	13 ± 3.2	24.9 ± 6.1	14.2 ± 4.3	52.1 ± 12.1
	non-FP team	21.2 ± 2.5	28.1 ± 3.3	25.5 ± 3.4	74.8 ± 7.7

According to Table 6, age, gender, current living area, compatibility of the current job with the field of study, employment status, workplace, expenses equal monthly incomes from this job, involvement in other jobs for making money, and employment as the FP staff showed a significant association with the score of AC (p value < 0.05).

Table 6.

Univariable analysis of demographic determinants of OC scores

Demographic variables	AC		CC		NC		Total OC
	Mean ± SD	P-Value	Mean ± SD	P-Value	Mean ± SD	P-Value	Mean ± SD	P-Value
Age (year)		< 0.001		0.089		< 0.001		0.052
< 25	21.2 ± 3.1		23.4 ± 3.6		16.8 ± 3.3		61.4 ± 10
25–40	15.9 ± 4.7		25.7 ± 6.4		19.1 ± 4.2		60.7 ± 15.3
> 40	20.6 ± 7.2		28.2 ± 5.1		22.2 ± 1.9		71 ± 14.2
Gender		< 0.001		0.077		0.068		0.059
Female	22.8 ± 4.9		24.7 ± 6.2		22.7 ± 5.2		70.2 ± 16.3
Male	13.9 ± 3.1		26.2 ± 3.5		20.1 ± 4.5		60.2 ± 11.1
Marital status		0.093		< 0.001		0.070		0.063
Single	19.9 ± 2.5		21.2 ± 5.6		19.6 ± 2.5		60.7 ± 10.6
Married	16.3 ± 4.3		29.6 ± 3.3		17.4 ± 1.9		63.3 ± 9.5
Ethnicity		0.071		0.054		0.060		0.057
Fars	21.1 ± 2.8		24.1 ± 4.3		20.3 ± 4.5		65.5 ± 11.6
Turk	19.5 ± 2.1		22.4 ± 3.2		22.3 ± 3.5		64.2 ± 8.8
Lor	20.9 ± 3.9		22.9 ± 3.7		21.7 ± 2.4		65.5 ± 10
Other	18.7 ± 5.2		24.0 ± 2.1		23.3 ± 1.1		66 ± 8.4
Education Level		0.064		< 0.001		0.077		< 0.001
Associate degree	18.2 ± 3.7		25.8 ± 3.1		19.7 ± 3.6		63.7 ± 10.4
BSc	15.1 ± 5.8		24.2 ± 2.5		17.1 ± 3.1		56.4 ± 11.4
MSc	15.8 ± 3.3		25.2 ± 3.2		15.6 ± 2		56.6 ± 8.5
PhD/Professional doctorate	14 ± 4.1		16.8 ± 4.2		17.9 ± 3.2		48.7 ± 11.5
Current living area		< 0.001		0.096		0.089		0.072
In Shiraz city	19.8 ± 4.9		25.1 ± 6.5		17.5 ± 2.1		62.4 ± 13.5
Around Shiraz city	13.3 ± 5.1		27.2 ± 3.3		15.8 ± 4.5		56.3 ± 12.9
Compatibility of the current job with the field of study		< 0.001		0.067		0.081		0.055
Yes	16.5 ± 3.2		24.6 ± 4.5		18.1 ± 1.3		59.2 ± 9
No	21.1 ± 3.5		27.2 ± 3.3		16.9 ± 1.5		65.2 ± 8.3
Employment status		< 0.001		0.081		0.065		0.070
Permanent employment	16.2 ± 4.1		22.8 ± 3.4		19.9 ± 5.2		58.9 ± 12.7
Contractual employment	13.5 ± 2.9		23.5 ± 4.1		15.8 ± 1.7		52.8 ± 8.5
Manpower planning	20.2 ± 1.5		25.0 ± 2.6		15.2 ± 2.3		60.4 ± 6.4
Workplace		< 0.001		0.074		< 0.001		< 0.001
Employed in public sector	17.7 ± 3.5		23.8 ± 5.5		18.9 ± 3.1		52.1 ± 12.1
Employed in private sector	13.8 ± 2.8		22.6 ± 2.4		15.5 ± 2.7		74.8 ± 7.7
Job experience in current job		0.085		0.062		< 0.001		< 0.001
n < 2	17.8 ± 3.3		22.3 ± 4.6		15.2 ± 2.1		55.3 ± 9.8
2 ≤ n < 5	13.8 ± 4.1		22.9 ± 4.3		17.6 ± 2.5		54.3 ± 10.5
5 ≤ n < 10	15.2 ± 3.5		23.5 ± 2.8		19.1 ± 3.2		57.8 ± 9.5
10 ≤ n < 15	19.5 ± 4.1		25.8 ± 3.2		21.9 ± 4.2		67.2 ± 11.3
15 ≤ n < 20	19.7 ± 3.8		24.8 ± 6.1		22.4 ± 3.6		66.9 ± 13.3
20 ≤	17.5 ± 4.3		23.2 ± 4.5		22.9 ± 3.2		63.6 ± 12
Expenses equals monthly incomes from this job		< 0.001		0.055		< 0.001		< 0.001
Yes	21.9 ± 3.5		21.8 ± 2.6		20.1 ± 2.9		63.8 ± 8.5
No	12.6 ± 2.8		23.3 ± 3.9		15.3 ± 3.2		51.2 ± 9.7
Having other jobs for making money		< 0.001		< 0.001		< 0.001		< 0.001
Yes	16.1 ± 4.5		24.8 ± 2.3		14.1 ± 3.6		55 ± 9.8
No	22.6 ± 1.8		21.7 ± 4.7		19.8 ± 4.2		64.1 ± 10.5
Being FP staff		< 0.001		< 0.001		< 0.001		< 0.001
Yes	13 ± 3.2		24.9 ± 6.1		14.2 ± 4.3		52.1 ± 12.1
No	21.2 ± 2.5		28.1 ± 3.3		25.5 ± 3.4		74.8 ± 7.7

Bold values are statically significant

Moreover, marital status, education level, involvement in other jobs for making money, and employment as the FP staff had a significant association with the score of CC (p value < 0.05). Furthermore, age, workplace, job experience in the current job, involvement in other jobs for making money, and employment as the FP staff were significantly associated with the score of NC (p value < 0.05). Finally, education level, workplace, job experience in the current job, involvement in other jobs for making money, and employment as the FP staff showed a significant association with the total mean score of OC (p value < 0.05).

Discussion

According to the findings of this study, the OC total mean score was higher in the public sector than in the private sector and higher in the non-FP team than in the FP team. The mean score of all types of OC among all job positions was low. Moreover, education level, workplace, job experience in current job, involvement in other jobs for making money, and employment as the FP staff showed a significant association with the total mean score of OC.

As previously stated, there are three types of OC: affective, continuance, and normative commitment [4, 5]. A high level of employee OC had numerous benefits for healthcare organizations, including achieving goals, improved performance, motivation, attachment, effectiveness, efficiency, job satisfaction, reduced turnover, burnout, and absenteeism [11–13]. Conversely, low OC increased medical errors and jeopardizes patient safety [14].

As mentioned earlier, the OC score was found to be poor in the employees of the health sector. Similarly, two studies in Ethiopia revealed low OC among healthcare professionals [1, 27]. The below evidence indicated that the level of OC among healthcare professionals was in the moderate range in the past few years and this decline may be attributed to the unstable economic conditions in Iran in recent years, which have been exacerbated by sanctions.

Contrary to our results, three Iranian studies showed that most of healthcare workers in Gorgan, Marand, and Sarpol-e Zahab city had a medium level of OC [20, 28, 29].

Another study in the west of Iran showed that employees in administrative units of health care centers had a moderate OC [30]. Also a systematic review on Iranian nurses demonstrated that their OC was moderate in the half of studies. It seems that healthcare workers have worse OC compared to employees in administrative roles at healthcare centers and clinical nurses in hospitals. This difference could be further investigated in future comparative studies.

Also, in contrast to the findings of our research, an Iranian study, showed that the components of OC among healthcare workers in Marand city were: AC > NC > CC [28].

The combination of job satisfaction, work environment, leadership quality, work-life balance, emotional well-being, and demographic factors all play a significant role in shaping the OC of healthcare professionals in the health sector [27, 31–33]. By implementing focused interventions in these areas, organizations can boost commitment levels, ultimately leading to improved effectiveness in healthcare services.

According to our findings, the OC was higher in the public sectors than in the private sectors. Similarly, a study explored OC as a feeling of dedication towards the employing organization, highlighting significant differences in commitment levels between public and private sector employees [34]. Also, another research suggests that employees in the public sector experience better working conditions that may lead to higher levels of commitment, mainly due to factors such as job satisfaction and internal communication [35]. We believe that higher OC of public sector employees may be due to the fact that most people who work in the public sector have a permanent contract and consequently higher job security, which affects their level of commitment to the organization.

Our findings showed that the OC was higher in the non-FP team than in the FP team. Likewise, a study found that FPs demonstrated lower OC than other physicians [36]. Also, qualitative study in Fars province, Iran indicated that the Family FP team exhibited low responsiveness, which may be rooted in their low level of OC [37]. This could be attributed to their low income despite having numerous responsibilities. In contrast, another study noted that FPs exhibited higher OC than other physician groups [38].

According to our result, employees aged under 25 and over 40 years were found to have a higher OC. The reason can be that people under 25 have recently graduated and have a strong desire for a job. Also, people over 40 years of age are well-oriented to do their tasks and have a low tendency to leave. Similarly, several studies have shown that older employees tend to exhibit higher levels of affective commitment as they get older; their emotional attachment to the organization increases and they are more likely to feel a sense of belonging and loyalty to their workplace [39]. Conversely, a study conducted in Marand, Iran indicated that there was no significant association between the age range of healthcare workers and their OC [28].

A systematic review also revealed that personal factors, such as age, play a significant role in Iranian nurses’ OC levels, with younger nurses frequently reporting lower OC than their older counterparts [18].

Due to our findings, female employees have a higher OC. Similarly, a study revealed that male physicians were more likely to leave their jobs than female physicians because the latter may feel the need to remain in the organization due to concerns about future job opportunities and the potential loss of social status [33]. Conversely, a study in Poland demonstrated that, when controlling for other factors, women and men exhibit similar levels of organizational commitment. Although women showed a statistically significant higher commitment than men, the effect size was described as trivial in practical terms [40]. Also, a study in Marand, Iran showed that male healthcare workers have the higher level of OC compared with female colleagues, which contrasts with the findings of the current study [28].

Our findings show that married employees exhibited greater OC than their unmarried counterparts. Similarly, a study in Shiraz, Iran found that married nurses had a higher average score for normative commitment compared to those who were single [41]. This is attributed to the increased family responsibilities and the need for job stability often accompanying. Similarly, a study found that married employees report higher commitment levels due to their financial burdens and family obligations [42]. Conversely, a study in Marand, Iran reported that there was no significant association between health workers’ marital status and their OC [28].

According to our study, education level was an important factor in the OC, and highly educated employees may have lower OC. Similarly, Bakan et al. asserted that the level of education is statistically related to all types of OC [43]. Also, a study by Asl IM et al. showed that the relationship between the OC and education level was significant [28]. Moreover, several studies in Iran reported that the level of education of healthcare workers and nurses is significantly associated with their OC [28, 41]. It can be attributed to their perceptions of inadequate rewards, unmet expectations, poor job fit, and the availability of alternative employment options. These factors create a landscape where commitment is diminished as these employees may feel less tethered to their current organizations than their less-educated counterparts.

Our study showed that employees who lived in the city had higher OC than those living around the city of their workplace. Likewise, a study conducted in Birjand, Iran, found that residing in the same city as one’s workplace had a positive effect on life satisfaction, which subsequently improved OC [44].

A systematic review also highlighted that nurses residing nearer to their workplaces generally exhibited greater OC, probably because of lower commuting stress and an improved work-life balance [18]. Moreover, evidence revealed that poor living conditions could contribute to role stress and ambiguity, negatively impacting job satisfaction and organizational commitment [45].

According to the findings of this study, the workplace had a significant association with the OC. Likewise, a study by Asl IM et al. indicated that the relationship between the OC and place of employment was significant [28]. In our study, OC was higher in the public sector than in the private sector. Similar to our study, Markovits et al. asserted that public sector employees generally form stronger affective and normative commitment toward their organizations than their private sector counterparts [46]. This could be attributed to the nature of their employment contracts and the greater job security typically found in the public sector. Conversely, a systematic review showed that nurses in Iran’s private sector express greater job satisfaction attributed to improved pay and working conditions. Nonetheless, this sense of fulfillment may be diminished by concerns over job security [44, 47]. This finding may be rooted in the different nature of working condition and career promotion and security in these two sectors.

In our study, having job experience in the current job showed a significant association with the total mean score of OC. Similarly, studies by Meyer et al. and Tahere et al. revealed a strong link between higher work experience and better OC [48, 49]. Also, a study by Asl IM et al. demonstrated that the relationship between the OC and job experience was significant [28].

A systematic review similarly found that work experience has a considerable impact on nurses’ OC as those nurses with longer job tenures generally demonstrate greater levels of commitment to their organizations [18].

Conversely, a study in Marand, Iran showed that there was no significant association between health workers’ OC and their job experience [28]. Also, a study by Yağar et al. revealed that as the professional experience of employees increased, their levels of affective commitment decreased [38]. The reason for this different result may be explained by the fact that although employees get used to their job over time, as their work experience and professional skills increase, they see themselves as deserving of a better and higher-level job, and this causes their affective commitment to the recent organization to become decreased [49]. Moreover, another study revealed an opposite result, indicating that individuals who have been working for many years may reduce their level of OC due to burnout and being occupied with various responsibilities [27].

In this study, not being satisfied with the salary of the current job and having to get other jobs to make money were found to be important factors impacting the OC of employees. Likewise, a meta-analysis conducted by Esfahani and Heydari indicated that job satisfaction significantly contributes to enhancing employees’ OC in Iranian hospitals [50]. Furthermore, a study by Gabrani et al. revealed that being satisfied with salary plays a major role in determining their level of commitment to their organization [51]. Therefore, the managers of organizations are recommended to pay more attention to their employees’ financial issues which have an important effect on their quality of life and commitment to the organization [28].

Limitations and recommendations

Due to the restricted budget and time, we have to conduct a cross-sectional study which cannot reflect accurate changes over time and make it difficult to establish causal relationships between variables. So, longitudinal studies could help address some of these issues by allowing for a clearer understanding of causality and change over time. Also, in order to reduce the response bias and limited contextual understanding, research with qualitative design is highly recommended.

Conclusion

This study showed that the overall level of OC among staff members of the health sector was low. In addition, the main drivers of overall OC were financial factors, indicating an immediate need for health policymakers to review and revise financial policies related to the staff of the health sector. Improvement of these financial aspects, along with other associated factors, is critical for enhancing the quality of healthcare services and patient outcomes.

Abbreviations

OC

Organizational commitment

AC

Affective commitment

CC

Continuance commitment

NC

Normative commitments

Authors’ contributions

Conceptualization: MP, MAM, and FSh, Methodology: MP, AHJ, FF, ZGh, FSh, NJ, SRB, MAM, and HDE, Data curation: MP, AHJ, FF, ZGh, FSh, NJ, SRB, MAM, and HDE, writing—original draft preparation all authors, Writing—review and editing: MP, AHJ, FF, ZGh, FSh, NJ, SRB, MAM, and HDE. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by the research vice-chancellor of Shiraz University of Medical Sciences, Shiraz, Iran [registration number 26296].

Data availability

The datasets used and analyzed during the current study available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The proposal of this study was approved by the Ethics Committee of Shiraz University of Medical Sciences (SUMS), Shiraz, Iran, with the code of IR.SUMS.NUMIMG.REC.1402.080. Also, the Declaration of Helsinki, the ethical principles for medical research involving human subjects, was considered in this study. Additionally, the anonymous nature of the questionnaire, possibility of access to the researchers of the study, and privacy and confidentiality of the data were highly taken into account. Moreover, voluntary participation was highly considered by asking participants to willingly participate in this study and written informed consent was obtained from each. Also, they were assured that they could withdraw from the study at any stage without providing any justification.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.