The Role Of Work-Life Balance And Job Satisfaction As Predictors Of Healthcare Organisational Commitment

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The Role Of Work-Life Balance And Job Satisfaction As Predictors Of Healthcare Organisational Commitment


Abstract


In order to achieve improved and standard health care delivery, health workforce is of paramount importance. With the inadequate staffing of health workers in Nigeria which has well been reported, satisfied personnel is vital for effective and quality health service delivery. The broad objective of this research was to work-life balance and job satisfaction as predictors of healthcare organisational commitment. This was a cross-sectional study, institutional-based. The target population was all health workers in KCMC, Abuja. Sampling procedure was stratified probability sampling and a total of 257 respondents were included in the study. Collection of data was done through structured questionnaires and analysis was done using SPSS version 23. The hospital management needs to improve on making major decisions more participatory so as to make the employees own those decisions and take active role in the implementation process. Enhancing supervisory support to employees would create enabling working environment, hence improve job satisfaction. Salary increases or promotion should be regularly considered to reward good performance. There is a need to improve on the career advancement opportunities for the employees so that employees can acquire more skills for quality health care delivery. These were some of the recommendations of the study


Chapter One


Introduction

1.1 An Overview

This chapter highlights the background to the study, the statement of the problem, research objectives and research questions. It also addresses justification of the study, limitations, and delimitations of the study. The significance of the study, assumptions and operational definitions of terms are presented in this chapter.


1.2 Background of the Study

A well-functioning health system is composed of six building blocks. Health workers is one among the six blocks. It is regarded as a significant component for delivery of effective and better health services. Health service delivery is considerably affected when there is shortage of human resource for health. The leading needs-driven unavailability of health workforce as in 2013 was approximated to be about 17.4 million, with a distribution of about 2.6 million medical doctors, over 9 million nurses and midwives, and the rest are the allied health workers. The biggest deficiencies of health workforce are in South-East Asia at 6.9 million and Africa at 4.2 million (World Health Organization [WHO], 2016). Worldwide, the figures suggest that the scarcity of health workforce is critical.

Several researches have been conducted globally to study the job satisfaction among human resource for health. In Iran, it the research found out that job dissatisfaction is a major cause of absenteeism and turnover among healthcare employees, and as such, it affects employees’ organizational commitment and the quality of healthcare services (Rad & Moraes, 2009). A study in Slovakia nurses´ job satisfaction is an important part of nurses´ lives affecting their productivity and performance, patients´ satisfaction and the quality of nursing care rendered (Kozuchova et al., 2015). Another study in Saudi Arabia revealed that employee satisfaction is directly linked to employee engagement and that it is good for management to understand what motivates their employees and what they need as individuals. It also concluded that poor employee engagement can cause organizations to have lower profit margins, poor customer service, high employee turnover and decreased competitive edge (Shmailan, 2015).

An effectively working health system is not possible without a satisfied workforce. Each year many dissatisfied professionals either quit their profession or leave jobs in search of better opportunities. A study in Ethiopia showed that job satisfaction of the health workers is highly important in building up employee motivation and efficiency as it determine better employee performance and higher level of patients’ satisfaction (Mengistu & Bali, 2015). A research in Nigeria revealed that job satisfaction has been associated with lots of benefits. The provision of health services depends on several factors but the availability and retention of human resources is particularly important (Kolo, 2019). Africa South of Sahara faces 25% of the worldwide burden of illnesses with only 3% of the health workers. The colossal scarcity of health personnel in sub-Saharan Africa (SSA) is a main reason to the excessively high rates of illnesses and deaths in the region.

A study in Nigeria showed that job satisfaction and working atmosphere are important for optimal health care delivery (Goetz et al., 2011). This applies most importantly to people who need timely intervention services due to the nature of their medical conditions (Terry et al., 2012). The Strategic plan of the ministry of health and social welfare in Nigeria (2014-2019) recognizes the situation with certainty. It states that the deficiency of HRH is now dealt with as a national crisis that calls for unceasing and concerted attention. The preceding human resource for health strategic plan (2008-2013) pointed out the same problem stating clearly that there was crisis of HRH in the country. Thus, both HRH strategic plans acknowledge the crisis of HRH. Health workers are significant for health care services to be delivered well. For the purpose of establishing a well-functioning health system, it is profoundly vital to have adequate number of capable, inspired, and highly reinforced health workforce. Job satisfaction of health personnel is essential for inspiration and proficiency especially based on the fact that improved job satisfaction increases both staff productivity and patient gratification. Although there has been numerous researches on the topic of job satisfaction featuring health workforce in many parts of the world, there are comparatively few researches on health workers’ job satisfaction in Nigeria. Due to this evident lack of researches on the similar subject in Nigeria, the findings obtained from this study will inform the policy makers in the efforts to strengthen health services in Nigeria.


1.3 The Statement of the Problem

Personnel in any institution is considered to be the engine that provides sustainable source of energy and service delivery. A study in Malaysia indicated that satisfaction at work can be considered as a proxy indicator of emotional well-being or physiological health. It is also inversely associated with absenteeism, turnover in an organization, level of stress, and eventual exhaustion that ultimately improves productivity (Aazami et al., 2015). Job satisfaction is a multidimensional response to work and workplace environment. It depends on many factors, and affects the behavior of employees that, in turn, affects organizational functioning (Singh et al., 2019).

The job satisfaction of employees in any organization as Conley et al., (1989) have indicated, is regarded as a main component of the work environment and one of the main factors determining organizational climate. Suresh et al., (2015) maintains that if job satisfaction is there in employees, work done by these employees is usually of better quality in comparison where the employees are not satisfied with their job. Bhatnagar & Srivastava (2012) observe that if you want to attain higher job productivity, you should learn the domains of work which are decisive for job satisfaction amongst healthcare providers. In order to get employees contented with their job; the underlying factors which influence job satisfaction in that particular facility must be examined to guide proper intervention.

Several studies in Africa have shown that job dissatisfaction results from one or more attributes of the work environment such as poor living and working conditions, problems with leadership, inadequate equipment and supplies, lack of recognition for good work, stress due to heavy workloads, and limited opportunities for career development and advancement (Huddart et al., 2003., Vujicic et al., 2004). Martins et al., (2016) observes that the quality of performance in the health sector in Nigeria to a large extent depends on whether health care providers are job satisfied or dissatisfied. They noted that prevalence of dissatisfaction among doctors and nurses has not been given considerable attention though it affects patient satisfaction and is associated with reduced quality of care. Ramasodi (2010) observed that relationships have been reported between job satisfaction, productivity, absenteeism and turnover among healthcare employees and as such it affects employees’ organizational commitment and the quality of healthcare services.

Hagopian et al., (2009) observed that Ugandan health workers are dissatisfied with their jobs, especially their compensation and working conditions. About one in four would like to leave the country to improve their outlook, including more than half of all physicians. Goetz et al., (2011) who conducted their study in Nigeria assert that despite the important attention human resource issues have received in recent years, health workers in many low-income settings report their superiors taking little interest in their job satisfaction and work environment, although relatively simple and cost-effective steps can be taken to improve them.

Although there has been an urgent call to address the shortage of health personnel which has been declared as a crisis, it is worth mentioning that in Nigeria, this crisis involves more than a personnel shortage. Unequal distribution of the health workforce, poor motivation and performance, and low productivity are also contributing to the HRH crisis. It is reasonable therefore to study job satisfaction as one of the decisive factors which determine work efficacy, output, income and organizational performance (Ali & Wajidi, 2013). In the context of the acute shortage of HRH both at KCMC, ABUJA and at national level, satisfied workforce is decisive for health facilities to perform to the expectations. Resulting from the crisis in public Hospitals and the declining quality of health care, private Hospitals in Nigeria have emerged as an alternative source of higher health care. These Hospitals have gained a niche in the market for offering market-oriented courses which ensure the employability of their graduates. Health workers from public Hospitals have also sought part-time employment in private Hospitals to supplement their income, thus boosting the quality of teaching in these Hospitals.

However, due to their dependence on tuition as their main source of funding, these Hospitals are not affordable to low-income Nigerians and thus raising concerns about equity. In the light of the above scenario, the prevailing problem which this study intended to investigate is the work-life balance and job satisfaction as predictors of healthcare organisational commitment in the Hospitals in Nigeria.


1.4 Study Objectives

1.4.1 Broad Objective

This study was led by a broad objective of determining factors which work-life balance and job satisfaction as predictors of healthcare organisational commitment in Nigeria, with a case of Kilimanjaro Christian Medical Centre, Abuja Referral hospital.

1.4.2 Specific Objectives

The study focused at achieving the specific objectives as outlined below:

  1. To ascertain the level of jab satisfaction among health workers
  2. To ascertain the work life balance among health workers
  3. The relationship between work life balance and organizational performance
  4. The relationship between job satisfaction and organizational performance

1.5 Research Questions

  1. What is the level of jab satisfaction among health workers?
  2. What is the work life balance among health workers?
  3. What is the relationship between work life balance and organizational performance?
  4. What is the relationship between job satisfaction and organizational performance?

1.6 Organization of the Study

This study is organized into five chapters. Chapter one included the background of the study, research problem, research objectives and questions as well as limitation of the study. Chapter two contains the literature review. Chapter three includes the methodology and study area. Chapter Four contains the results and discussion of key findings of the study. Chapter Five finally looks at the summary, conclusions, and recommendations based on the findings.


1.7 Limitations of the Study

Given that the instrument used for survey was through self-administered questionnaires, the data provided by respondents could have been largely subjective. Although an assurance of confidentiality was made, lack of confidence among participants could have led to exaggerated reports of their levels of satisfaction. This was likely to happen especially due to the current Nigerian political climate in which government employees are threatened to lose their jobs should they express any sense of dissatisfaction with their job. As an attempt to overcome this limitation, the study objectives were made thoroughly clear to the study participants. Provided that this was a cross sectional study, the research results may not be representative of the entire set health care personnel in Nigeria since it will be taken only from one health facility. Given that this study was cross-sectional, one cannot deduce a causal sequence correlation between job contentment and the factors found to have influence on job satisfaction. Provided that the study participants were limited to health personnel at the Kilimanjaro Christian Medical Centre, Abuja, the generalization of our findings would be difficult. Also, given that this study was conducted over a specific period of time, it could only provide a reflection reliant on circumstances happening during that particular time.


1.8 Significance of the Study

Given the lack of evidence on the topic addressing job satisfaction among health personnel at the area of study (KCMC, ABUJA), and the substantial shortage of workforce, this study was expected to provide evidence – based findings to the management of KCMC, ABUJA referral hospital on the status of job satisfaction among her staff. The findings informed the health managers on the key areas to address so as to improve job satisfaction to health workers at the study area and other similar institutions. By so doing, the study provided a significant contribution towards optimum utilization of HRH, which in turn would lead to delivery of quality healthcare at Kilimanjaro Christian Medical Centre, Abuja.


1.9 Assumptions of the Study

This study postulated that all participants would have a sincere interest of participating in this research. This was anchored on the postulation that every staff would wish to be satisfied with the job he/she is doing. The assumption of each staff wishing to be satisfied at the workplace made the study motivating and probably rewarding to the participants. The study assumed that respondents would respond honestly and truthfully. This was possible because each study participant was assured of anonymity and confidentiality.


1.10 Operational Definition of Terms

Operationalization of variables means defining concept to render it measurable and quantifiable.

Job Satisfaction:

It will be measured by perception of employees towards the job and the way they are treated by the institution. The mood about the job is usually influenced by the job factors such as pay, the type of work accomplished, supervision, working conditions, and opportunity for advancement. Satisfaction, gratification, fulfillment and contentment shall be used interchangeably to mean the same.

Remuneration:

This will address opinion of employees as to whether what they are paid tally with the tasks they perform or they have a feeling that they are underpaid.

Quality of Work Life:

Refers to perceptions held by employees on the suitability and quality of the working conditions.

Promotion:

The view of employees regarding the advancement they are making if it matches with one’s educational level and the working years.

Supervision:

Perception of employees regarding the support received from supervisors.

Team Work:

Perception of employees concerning cooperation given by different
individuals as they use their skills at the work place.

Human Resource for Health:

“All individuals engaged in actions whose main goal is to improve health. These people include clinical staff namely as doctors, nurses, pharmacologists and dentists, as well as health managers and support workers – the ones who do not offer services directly but are important to the effectiveness of health systems, such as health administrators, ambulance drivers and the people responsible with finance management.” (WHO, 2009).


Chapter Five


Summary, Conclusion and Recommendations

5.1 Conclusions

Based on the objectives of the study, the following conclusions were made;

There are more male than female Health workers in Hospitals in Abuja, most of the Health workers here have master’s degree and above. Most of the Health workers are also in the middle adult hood age.

There is fair level of work life balance among Health workers in Hospitals in Abuja

There is fair level of job satisfaction among the Health workers in Abuja Hospitals.

The study found out that there is a strong significant relationship between organizational commitment and Health workers’ job satisfaction and work life balance.


5.2 Recommendations

Although the Nigerian data may not fully support the multi-dimensionality of the commitment concept, the research does indeed confirm that the concept itself is valid in the Nigerian context. The findings from this study have shown that positive work practices as predictors of work life balance, organizational commitment and job satisfaction transcend cultural boundaries and apply in the West as well as in the East. The study has shown that the factors influencing job satisfaction and organisational commitment in Nigeria are largely consistent with what has been found in studies from Western countries. Such consistency suggests that organisations in developed and developing countries are quite similar in relation to the factors that motivate their employees, and therefore points at the generalisability of the theories of job satisfaction and organizational commitment which were developed and tested in Western contexts to the Nigerian context (Mulinge, 1998). This is supported by Cohen (2003) who, from a reviewed organisational commitment studies from non-Western countries, did not find any major differences between American employees’ organisational commitment and that of employees from other nationalities. Similarly, Sommer, Bae and Luthans (1996) in their study of 1192 employees from Korean firms, found that their results were consistent with those found in American studies, since all antecedents (age, health care, position, organisation and job tenure, size, organisational structure and organizational climate) with the exception of management style, had significant correlations with Koreans’ organisational commitment. Sommers et a/s concluded that popular work practices originating from America should not be automatically dismissed as culture bound.

Despite the cultural differences between the West and non-Western contexts, the applicability of these Western theories to the Nigerian context That be attributed to several conflicting forces which have played a role in shaping its management systems. The population of this study, that is, employees in Nigerian Hospitals, have been exposed to western values in a number of ways thus, enhancing the applicability of these Western theories in a Nigerian context. Firstly, the British colonisation of Nigeria and subsequent introduction of bureaucratic hierarchies and Western values, through formal western health care, considerably transformed the African cultural beliefs and attitudes towards paid labour (Mulinge, 1998; Walumbwa eta/., 2005).

During early colonial days, the notion of work for wages, and subsequently loyalty to employers, was alien to Africans and this was made worse by extremely low wages, forceful tactics used by the colonisers to compel the African to work, manipulation of African access to land which forced them to work for someone else and cultural barriers such as, reluctance to severe family ties and fear of illness or death in urban areas (Mulinge, 1998; Jackson, 2004). However, the advent of western health care and the spread of monetary rewards transformed these barriers to paid labour, and enhanced employees’ loyalty to their organisations. Secondly, the modelling of Nigeria’s health care system to replicate the British health care system (i.e. from pre independence until two decades ago) and later the American health care system, inculcated western values and perceptions in educated Nigerians. Further, the models of Western management styles have been transferred to the Nigerian context through managers and healths who have studied in Hospitals in the West. Consequently, employees working in these Hospitals, just like their counterparts in the West, have been socialised through the health care system in terms of what their job expectations and values are, uork attitudes and behaviours. The results of this study have also helped to dispute the long held belief by some scholars (Kiggundu, 1989;

Waweru, 1984; Blunt and Jones, 1992; Taylor, 1992) that African organisations are managerially impoverished in terms of narrowly defined jobs, decision making which is limited to senior executives, reactive management styles indicating lack of planning and lack of intrinsic motivation among African workers. Some of these scholars have claimed that the typical African worker is motivated by material things, derives no satisfaction from their job (Blunt and Jones, 1992), and is passive and reactive to their tasks. Contrary to these studies, the present study has shown that Nigerian employees just like their Western counterparts, desire to work in institutions that have well established HR systems and positive work practices


5.3 Recommendation for Further Research

The researcher recommends future researchers to emphasize on the following areas.

  1. The findings examined the effects of organizational commitment on job satisfaction of Health workers in Abuja Hospitals, Other researchers then could fruitfully look in to “the impact of Health workers’ qualification on the health performance of students”
  2. Future researchers could also look at “the effect classroom discipline on the performance of Health workers”.
  3. Researchers can also study’ Socio-economic status of parents and Hospitals’ performance.

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