A COMPARATIVE STUDY OF JOB SATISFACTION

OF GOVERNMENT AND PRIVATE HOSPITAL

EMPLOYEES

IN LUDHIANA CITY, PUNJAB

MAJOR RESEARCH PROJECT

Submitted by:

Kamlesh Arora

Roll no: 200763382

PGDBA

CERTIFICATE

This is to declare that I have carried out this project myself in part fulfillment of

the PGDBA Program of SCDL.

This is original, has not been copied from anywhere else and has not been

submitted to any other university/institution for an award of any degree/diploma.

Date: Signatures of Student

Place:

(KAMLESH ARORA)

CERTIFICATE

Certified that the work incorporated in this Project Report A COMPARATIVE

STUDY OF JOB SATISFACTION OF GOVERNMENT AND PRIVATE

HOSPITAL EMPLOYEES IN LUDHIANA CITY, PUNJAB submitted by Kamlesh

Arora is her/her original work and completed under my supervision. Material obtained

from other sources has been duly acknowledged in the project report.

Date: Signatures of Guide

Place:

(ANJU PURI)

Contents

Page

Chapter 1 Abstract 1-1

Chapter 2

2.1

2.2

2.3

2.4

2.5

2.6

2.7

2.8

2.9

2.10

Hospitals in India

Pre-Independence period (Before 1947)

Emergence of health care delivery systems and Hospitals in

Independent India (After 1947)

Changing Role of Hospitals (In 21st century)

The Changing Scene in the Hospital Field.

Development of New Management Practices (in 21st Century)

Motto of Specialty Hospitals

Patient Satisfaction is the Main Goal of TQM ins Specialty Hospitals

Role of Hospital Administration in Specialty Hospital

Doctor-Patient Relationship in Specialty Hospital

Role of Public Relation Department in Specialty Hospital

2-2

2-3

4-10

10-13

13-16

16-18

18-18

19-21

21-22

22-22

Chapter 3

3.1

3.2

Background of Problem/Task Undertaken

Rationale of the Study

Scope of Study.

23-23

24-24

Chapter 4

4.1

4.2

4.3

Objectives and Hypothesis of Study

Primary Objectives

Secondary Objectives

Hypothesis of Study.

25-25

Chapter 5

5.1

5.2

5.3

5.4

5.5

Concept of Job Satisfaction

Factors in Job Satisfaction

Job Satisfaction and Work Behaviour

Morale and Job Satisfaction

Approaches to Measure Job Satisfaction

Theories of Job Satisfaction.

26-28

28-29

29-30

30-32

32-40

Chapter 6

6.1

6.2

Review of Literature

Review of the Job Satisfaction Research in Industrial and

Organisational Psychology

Review of the Job Satisfaction Research in Health Care Industry.

41-45

45-47

Chapter 7

7.1

7.2

Research Methodology and Limitations

Research Methodology

Limitations of the Study.

48-48

49-49

Chapter 8

8.1

8.2

8.3

Observations Analysis and Discussion

Survey Data

Comparative Study of Employees Satisfaction Analysis and Discussion

t-Test. Method

50-58

59-66

67-68

Chapter 9 Implications of Study 69-69

Chapter 10 Suggestions/Recommendation in the Following Areas 70-70

Chapter 11 Conclusion of Study 71-71

Questionnaire

Bibliography

TABLES, FIGURES AND GRAPHS

LIST OF Tables

Table 2.1 Hospitals a System Page 6

Table 2.2 Intramural and Extramural Function of a Hospital Page 7

Table 2.3 Time Distribution on Administration Functions Page 19

Table 8.1 Survey Data Page 50-58

Table 8.2 Comparison of Job Satisfaction in Government and Private Hospital Employees

Page 67

Table 8.3 Comparison of Benefits Page 68

LIST OF FIGURES

Figure 2.1 Organizational Chart in Specialty Hospital Page 14

Figure 5.1 Herzberg’s Two-Factor Theory Page 34

Figure 5.2 Lawler’s Facet Satisfaction Model Page 37

LIST OF GRAPHS

Graph 8.1 Level of Satisfaction Page 59

Graph 8.2 Planning Page 60

Graph 8.3 General Aptitude Page 61

Graph 8.4 Performance Issues Page 62

Graph 8.5 Management Issues Page 63

Graph 8.6 Supervisory Issues Page 64

Graph 8.7 Training and Salary Issues Page 65

Graph 8.8 Benefits Page 66

ABBREVIATIONS

PHC — Primary Health Centre

GP — General Practitioner

TQM — Total Quality Management

GH — Government Hospital

PH — Private Hospital

WHO — World Health Organisation

UNICEF — United Nations International Children Emergency Fund

USSR — Union of Soviet Socialist Republics

UK — United Kingdom

USA — United States of America

STD — Subscriber Trunk Dialing

ISD — International Subscriber Dialing

CHP — Community Health Care Programme

CHAPTER – 1

ABSTRACT

Rapid scientific, technological and medical advances in recent years have completely

transformed the health care sector from conventional pattern. Hospitals now have become a dynamic

industry. Their core mission is delivery of quality patient care and medial excellence, which in turn

depends upon the job satisfaction of employees. Employee satisfaction is the amount of pleasure or

contentment associated with a job. The sources of job satisfaction can be extrinsic like superior-

subordinate relationship, working conditions and intrinsic (internal to the person). Intrinsic

satisfaction comes from within. It may be fuelled by achievement, advancement, recognition,

responsibility, authority, interest, challenge, flexibility and freedom of work.

The purpose of this study is to measure and compare job satisfaction of government and

private hospital employees. The sample of this study includes 90 employees, 40 from government

and 50 from private hospital. The data were collected by a survey (questionnaire method) that

consisted of the items from Minnesota Satisfaction Questionnaire, about satisfaction and

dissatisfaction with different facets using a Likert – type scale. The results show that the job

satisfaction level of employees in private hospital is 76% which is more than the government

hospital 55%. The prominent areas of satisfaction in government hospital are job security and

benefits including retirement plan. In case of private hospital working conditions, leadership,

superior subordinate relationship, interpersonal relations, and participation in decision-making are

areas of satisfaction among employees. None of the hypotheses of the study were confirmed but the

results implied that the private hospital has overall high level of employees satisfaction than in

government hospital except some benefits which are more in government hospital.

CHAPTER – 2

HOSPITALS IN INDIA

2.1 PRE-INDEPENDENCE PERIOD (Before 1947)

Early Indian rural considered the provision of institutional care to the sick as their spiritual

and temporal responsibility. The forerunners of the present hospitals can be traced to the times of

Buddha, followed by Ashoka. The Indian system of Medicine Ayurveda was prevalent that is

Sushruta (6th century B.C.) the famous surgeon who wrote Shushruta Samhita and Charaka (200

A.D.) the famous physician who wrote Charak Samhita. Their works are considered as standards for

many centuries with instructions for creation, of hospital, for provisions in lying and children rooms,

maintenance and sterilisation of bed linen with steam and fumigation. Medicine based on Indian

system was taught in the University of Taxila.

The most notable of the early hospitals were those built by king Ashok (273-232 BC). There

were rituals laid down for the attendants and physicians who were enjoined to wear white clothes

and promise to keep the confidence of the patients. In 10th century the age of Indian medicine started

to decline from the Mohammedan invasion. They brought Yunani (Greek) system of Medicine.

The modern system of Medicine in India was introduced in 17 th century with the arrival of

European Christian missionaries in South India. In 1664 the East India company established its first

hospital for soldiers at Chennai and in (1668) for civilian population. European doctors were getting

popular in 18th and 19th century. Organized medical training was started with the first medical college

in Calcutta in 1835 followed by Chennai in 1850. In the British period local government and local

self government bodies were encouraged to start dispensaries at tehsil and district level. In 1885

there were 1250 hospitals and dispensaries in British India. But the medical care scarcely reached 10

per cent of population in India.

2.2 EMERGENCE OF HEALTH CARE DELIVERY SYSTEM & HOSPITALS IN

INDEPENDENT INDIA (AFTER 1947)

The health scenario in 1947 was unsatisfactory. The bed to population ratio was 1:4000,

doctor to population ratio 1:6300 and nurse to population ratio 1:40,000.

After independence various committee were setup like Bohr committee (1943), Mudalidar

committee (1959), Hospital review committee (`1963). This committee made extensive

recommendations in the following areas.

Although the population was disturbed in urban & rural in the proportion of 20:80, a great depravity

existed in the facilities available in urban and rural areas.

1. Provision of adequate preventive, promotive and curative services to all in the

form of comprehensive health care (integration of services).

2. Delivery of this comprehensive health care through an infrastructure of hospital

dispensaries and by opening primary health care (PHC) centers at block level, and taluka

level hospitals.

3. Development of adequate communication in rural areas.

4. Demarcation of health services into two groups, viz. personal and impersonal.

5. Fitting the above concepts into a short-term plan and a long-term plan.

The short term plan envisaged a province wise organization for the combined

preventive and curative health work through establishment of a number of primary,

secondary and district health units. The impersonal health services were to include town and

village planning, housing, water supply, drainage and general sanitation. The bed to

population ratio was planned about 1.03 per 1000 population at the end of 10 years.

The long term plan envisaged a primary Health Care Centre for every 40,000

population with a 30 bedded rural hospital to serve for primary Health Care Centers. The

bed: population ratio is 1 bed per 1000 population.

6. The administrative structure should be tripartite :

(a) Clinical (b) nursing c) business administration

7. The following bed capacity should be attained :

Teaching hospitals – at least 500

District hospitals – At least 200

Tehsil hospital – At least 50

8. In case where distances are long and communication is difficult such as hill

districts, certain tehsil hospital should be developed as fully fledged centers.

2.3 CHANGING ROLE OF HOSPITALS (IN 21ST CENTURY)

From its gradual evolution through the 18th and 19th centuries, the hospital both in the eastern

and the western world-has come of age only recently during the past 50 years or so, the concept of

todays hospital contrasting fundamentally from the old idea of a hospital as no more than a place for

the treatment of the sick. With the wide coverage of every aspect of human welfare was part of

health care-viz. physical, mental and social well-being, a reach-out to the community, training of

health workers, biosocial research, etc.-the health care service have undergone a steady

metamorphosis, and the role of hospital has changed, with the emphasis shifting from :

1. Acute to chronic illness.

2. Curative to preventive medicine.

3. Restorative to comprehensive medicine.

4. Inpatient care to outpatient and home care.

5. Individual orientation to community orientation.

6. Isolated function to area-wise or regional function.

7. Tertiary and secondary to primary health care.

8. Episodic care to total care.

The important factors which have led to the changing role and functions of the hospital are as

follows:

Expansion of the clientele from the dying, the destitute, the poor and needy to all

classes of people.

Improved economic and social status of the community.

Control of communicable disease and increase in chronic degenerative diseases.

Progress in the means of communication and transportation.

Political obligation of the government to provide comprehensive health care.

Increasing health awareness.

Rising standard of living (especially in urban areas) and sociopolitical awareness

(especially in semi urban and rural areas) with the result that people expect better services

and facilities in health care institutions.

Control and promotion of quality of care by statutory and professional

associations.

Increase in specialisation where need for team approach to health and disease is

now required.

Rapid advances in medical science and technology.

Increase in population requiring more number of hospital beds.

Sophisticated instrumentation, equipment and better diagnostic and therapeutic

tools.

Advances in administrative procedures and management techniques.

Reorientation of the health care delivery system with emphasis on delivery of

primary health care.

Awareness of the community.

HOSPITAL AS A SOCIAL SYSTEM:-

Sociologists have considered hospital as a social system based on bureaucracy, hierarchy and

super-ordination-subordination. A hospital manifests characteristics of a bureaucratic organisation

with dual lines of authority, viz. Administrative and professional. In teaching hospital and in some

others, many professionals at the lower and middle level (interns, junior resident, senior residents,

and register) are transitory, while as in others, all medical professionals are permanent with tenured

positions and nontransferable jobs. There are different types of perspectives, which are followed

under social system.

1. Client-oriented perspective, which is that of access to service, use of service, quality

of care, maintenance of client autonomy and dignity, responsiveness to client needs, wishes

and freedom of choice.

2. Provider-oriented perspective that of the physician, nurses and other professionals

working for the hospital, and include freedom of professional judgment and activities,

maintenance of proficiency and quality of care, adequate compensation, control over

traditions and terms of practice and maintenance of professional norms.

3. Organization-oriented perspective which covers cost control, control of quality,

efficiency, ability to attract clients, ability to attract employee and staff, and mobilisation of

community support.

4. Collective oriented perspective which includes proper allocation of resources among

competing needs, political representation, representation of interests affected by the

organization, and coordination with other agencies.

Table 2.1: Hospital as a System

People Communication

A. Staff * Between

* Physician * Physicians and patients

* Nurses * Physicians and nurses

* Paramedical * Physicians/nurses and paramedical staff

* Supportive * Physicians and administrator

B. Patients their attendants and relatives

* Administrative and community

Material * Administrator and nursing/paramedical staff

* Drugs and chemicals * Nursing/paramedical staff and patients

* Equipment

* Diet Decision Making in

Money

* To maintain staff, facilities and procure materials

* Cure: Diagnosis, treatment

* Care: Creature comforts of patients, diet

* Procurement of materials in right place at the right time.

Action

* Putting decisions into practice

* Balanced mix o communication decision making and action

Source: B.M Sakharkar, “Principles of Hospital Administration and Planning” (2003), P-12.

INTRAMURAL AND EXTRAMURAL FUNCTIONS OF HOSPITAL

The activities of the present day hospital can be divided into two distinct types intramural

and extramural. Intramural activities are confined within the walls of the hospital, whereas

extramural activities are the services which radiate outside the hospital and to the home environment

and community. These functions are set out in table below:

Table 2.2: Intramural and extramural functions of a hospital

Intramural Functions of a Hospital

1. Restorative

a. Diagnostic These comprise the inpatient service involving medical, surgical and other specialties, and special diagnostic procedures.

b. Curative Treatment of all ailments

c. Rehabilitative Physical, mental and social rehabilitation.

d. Care of emergencies Accidents as well as diseases

2. Preventive

a. Supervision of normal pregnancies and childbirth

b. Supervision of normal growth and development of children

c. Control of communicable diseases

d. Prevention of prolonged illness

e. Health education

f. Occupational health

3. Education

a. Medical undergraduates b. Specialists and postgraduates

c. Nurses and midwives d. Medical social workers

e. Paramedical staff f. Community (health education)

4. Research

a. Physical, psychological and social aspects of health and disease

b. Clinical medicine

c. Hospital practices and administration

Extramural Functions of Hospital

1. Outpatient service 2. Homecare service

3. Outreach service 4. Mobile clinics

5. Day care center 6. Night hospital

7. Medical care camps

Source: B.M Sakharkar, “Principles of Hospital Administration and Planning” (2003), P-14.

The division of hospitals into three categories:-

1. The first group is the “providers” of medical care, viz. the doctors, nurses,

technicians and paramedical personnel.

2. The second group is management, administrative and support group comprising

of personnel dealing with non clinical functions of the hospitals, such as diet, supplies,

maintenance, accounts, housekeeping, water and ward, etc.

3. The third group and the most important one for whose benefit the first two groups

exist in the first place, is that of the patients who seek hospital service and their attendants,

relatives and associates who, along with patient come in close contact of the hospital. This

group is broadly termed as the “community”.

PRIMARY HEALTH CARE (PHC) AND HOSPITALS

Realisation of the importance of the role of hospitals in primary health care (PHC) was

generated as a result of the International conference on Primary Health Care held at Alma Ata in the

erstwhile USSR in 1978 jointly sponsored by WHO and UNICEF. PHC is a concept providing

comprehensive health care, i.e., promotive, preventive, curative, and rehabilitative services covering

the main health problem in the community. Hospitals have an important role in fostering and

encouraging the growth of primary health care.

The exercise of providing primary medical care (supported by other components of medical

and health services) has evolved into certain concepts based on basic technical knowledge. “Health

for all by 2000 AD” declared as a goal of all nations at Alma Ata and accepted by India needs to be

supported by all components of medical and health care services.

ELEMENTS OF PRIMARY HEALTH CARE

Eight essential elements of PHC as described by the WHO are as follows.

1. Adequate nutrition

2. Safe and adequate water supply

3. Safe waste disposal

4. Maternal and child health and family planning services.

5. Prevention and control of locally epidemic diseases

6. Diagnosis and treatment of common diseases and injuries

7. Provision of adequate drugs and supplies

8. Health education.

BENEFITS TO THE HEALTH CARE SYSTEM

Tremendous costs are incurred every time a patient is treated in a hospital who could well be

treated in an efficient PHC facility which his inexpensive, avoiding the overuse of the hospital by

unnecessary patient self-referral.

However, there has been a traditional hospital disinterest in PHC activities. The interest of

acute care hospitals has been centering on development of quality secondary and tertiary care

facilities and programmes. Hospitals have viewed their role as delivery of curative services and not

in early intervention, reduced mortality, prevention of disease or health education which is the basis

of most PHL programmes. However, there is now growing realisation of the role hospitals can play

in PHC.

PHC AS ENTRY POINT INTO HOSPITALS

In large cities there is marked tendency to bypass primary care facilities in preference for the

teaching hospital resulting in primary and routine care workload on specialised services, defeating

the special role of such hospitals. Opening PHC units within the premises as the first entry point to

the hospital for such routine direct cases will reduce avoidable routine workload for specialised

outpatient department (OPD). Teaching hospitals, as a back-up support to PHC, can start screening

units within their premises for patient’s coming directly for routine medical care as part of PHC.

These PHC units can also be utilised as laboratories for experimentation with different models of

primary health care after epidemiological research, besides setting examples for hospitals at district

level and others.

THE ROLE OF GENERAL PRACTITIONERS (GPS)

The position of GPs in providing primary health care and the potential for integrating their

activities with other health personnel is being increasingly recognised. A community primary health

care programme (CHP) started by a small urban hospital can establish a strong relationship between

the CHP and the hospital, with GPs helping to run the primary health care centre. Coordination

between these CHPs and the hospital at the appropriate level with open channels of communication

can keep the programme going well.

DEVELOPMENT OF A PHC POLICY BY EACH HOSPITAL

To decide the scope and extent of the PHC to be provided by it, every hospital will have first

to prepare a PHC policy and strategy. The policy statement should outline the essential points to be

included and then list the actions needed ensure putting the policy into effect.

The hospital may either assume as lead role in organising PHC for its population or play a

purely supportive role. With its concentration of health professionals, a hospital is in a position to

effectively supervise and monitor PHC work, in addition to providing primary care though the

hospital-staffed mobile and outreach clinics. The secondary car role of the hospital would support

PHC by providing referral from primary health services, technical and logistic support and acting as

a centre for education and training of PHC-oriented manpower.

REFERRAL FUNCTION

1. Organising a two way referral system from mobile and outreach clinics to the hospital and

referral back with reports for follow-up.

2. Backing up the referral system with medical records.

3. Organising visits of hospital specialists to outreach clinics.

4. Carry out training and reinforcing skills at PHC workers by visiting specialists.

5. Giving preferences to patients referred from PHC centres for specialist clinics and for

admissions.

SUPPORT FUNCTION

1. Providing logistics support in respect of equipment, materials, drugs and other supplies.

2. Reinforcing diagnostic capabilities of PHC workers and outreach clinics.

3. Providing transport for referrals and outreach services.

4. Making hospitals facilities available for training and retraining of PHC workers.

2.4 THE CHANGING SCENE IN THE HOSPITAL FIELD

The technical abilities have outstripped our social, economic and political policies. The

technological advances in the field of medical sciences have provided clinicians with more esoteric

aids to diagnose and treat illnesses. Clinics and communities will continue to pressure hospital

management to provide such advances even though they will be very costly. Not only pressures will

increase for providing newer technological capabilities, but there will be growing demands for such

care. There are growing indications that this has started happening in our Indian situation.

Since treatment is provided free of charge in government hospitals, it has in many cases

resulted in abuse, particularly in the outpatient department. This has led to the patient being made to

pay a small charge, varying between 10 to 20 per cent of the cost of medical attention, which, though

modest is a useful contribution to hospital running costs.

The model of the nationalised health system that took shape in Great Britain and some other

countries has not found true acceptance in India, because health and medical care is not a central but

state subject. Allocation of funds for the health sector both in the central and state budgets has also

declined gradually. Perhaps this is the reason, among others, that private institutions, commercial

firms and corporate bodies are jumping into the medical care field to form investor-owned, for profit

hospitals.

One third of the last decade’s increase in medical costs is attributed to increase use of high

technology medicine particularly surgical and diagnostic procedures. Even then, successful

launching of state of the art investor owned hospitals has proved that hospitals can benefit from

corporate management principles and can function profitably and efficiently without sacrificing

quality and affordability.

At the turn of the century most people died at home cheaply. Today, more than 20 per cent

die in expensively equipped hospitals, and it is estimated that up to half of an average person’s

lifetime medical expenses will occur during his last six months.

The changing trends are indicating the following:

In determining the extent and coverage, there will be more and more dominance

by consumers rather than providers or producers.

Hospitals and health care institutions will become akin to industries.

Not all services under one roof. Hospitals will be catering more and more to the

needs of patients in fragments, which:

1. Will lead to more and more specialised hospitals in place of general hospitals

which provided medical, surgical, obstetric and gynecological, ENT, pediatrics, etc. under

one roof.

2. people will shop for medical care

3. Hospital will require more and more management skills as administrators at each

level.

4. Will lead to growth of corporate hospitals and modern management concepts.

5. will be capital intensive

6. will be technology intensive

7. Ascendancy of technical expectations over human values.

URBAN HOSPITAL CONCENTRATION

More and more doctors are concentrating in larger cities; as a result the quality of service

which the outlying communities get has remained mediocre. The government and health care

services are increasingly dependent upon young doctors to provide medical care services through

measures promoting two or three year’s rural service in peripheral hospitals and primary health care

centres. This is not a pleasing arrangement for rural people who have constant changes of their

doctor, and the latter regards his or her stay as a temporary one with no future to it in the rural health

centre/hospital.

The teaching of medicine and medical research play a decisive role and has therefore a great

influence on hospital planning. Today, specialised training comprises a very large part of medical

curriculum, and a student spends more and more time in the specialist departments. The people’s

perception of teaching hospitals as centres for highly specialised treatments and excellence has

tended patients to concentrate in urban centers with medical colleges.

SICKNESS INSURANCE

The charitable nature of hospital of the past has given way to the principle of the universality

where every social class is admitted. The introduction of sickness-insurance and social security

schemes, although not on universal scale has contributed to this. The economic structure in India has

not yet permitted large scale application of this principle, but the hospital system has to take stock of

this emerging development.

PREVENTIVE MEDICINE, HEALTH PROMOTION AND HOSPITALS

The scope of medical examination and treatment is being extended gradually to take care of

the post-sickness conditions and the importance of rehabilitation of sick and disabled people is being

emphasised. The scope of medicine is also expanding to include “pre-sick” conditions of human

beings. In this context, the example of the so-called “ningen dock” in Japan, which performs

complete physical check-up of apparently healthy people is illustrative. The term “ningen dock” is a

olloquial Japanese term meaning examination in dock, comparing to a ship’s dock wherein a ship is

thoroughly inspected on completion of long voyage. Ordinary people can undergo a complete

physical check-up at such facilities during a period of three to seven days once every year or two, be

hospitalised and receive early treatment if any disease condition is discovered, and can receive

proper guidance and instruction on their physical condition. Most general hospitals in Japan have

beds specially reserved for this “ningen dock” programme.

Priorities in the developing countries should be of preventive nature, whereas modern

medical technology strives to lessen the effects of disease, to defer incapacity or death. The

organisation of preventive medicine and the hospital system have developed independently along

dual lines. The fusion of preventive medicine activities and the hospital has not yet emerged. But as

medicine has both a preventive and curative purpose, ideally hospital facilities should meet both

these ends. In making available the resources of specialised establishments for prevention on one

hand and inpatient care and treatment on the other, the multipurpose centre, combined and

coordinated with other health activities, represent the best service available. The future hospitals will

have to develop on these lines.

2.5 DEVELOPMENT OF NEW MANAGEMENT PRACTICES (IN 21ST CENTURY)

Exchange of knowledge pertaining to hospital practices by consultation and coordination

among hospitals, and on the same lines consultation and guidance in administrative matters

including costs, purchasing, personnel and other phases of hospital administration would promote

efficient utilisation of personnel and finances. Hospitals in a defined area can accomplish better

standards of patient care and promotion of efficiency through cooperation among participating

hospitals.

SPECIALTY HOSPITALS

These hospitals are like Escorts, Apollo. Medical science has expanded laterally include the

conditions surrounding sick people. Specialised hospitals are coming upon many plans in recent

years under one roof like Cancer and cardiovascular, geriatric hospitals, pediatric hospitals, prenatal

hospitals both in India as well as abroad.

Health maintenance organisation are institutions that are concentrating on preventive aspects

of medicine, emphasizing on diet, exercise, anti-smoking and anti alcohol programmes, meditations

and the like, with provision of only primary medical care. The scope of conventional preventive

medicine is being expanded by the health check-up centres

ORGANISATIONAL CHART IN SPECIALITY HOSPITAL

NursingSuperintendent

MaintenanceEngineer

ManagerSupport Services

StoresManager

AccountO fficer

GOVER NINGBODY

CHAIRMAN

COM MITTEES

Structure :Credentia lsInfectionMed. OutditMed. RecordPharm acy andtherapeuticsUtilisation

WardsOperationtheatresuiteLaboursuiteEmergencyCentralsupply

Buildings,grounds,gardensElectricalandMechanicalMedicalEquipment

CSSDDietaryMed. RecordsLaundry andlinenAdmissionofficeHouse-keepingSecurity

PurchasingCentralsupply

BudgetAccountsSalaryandWages

CHIEF OFSERV ICE

Medicine

Pathology

Surgery Obs-G yn. Paediatrics

Radiology

Emergency

CHIEFHOSPITAL

ADM INISTRATOR

MEDICALDIRECTOR

COM MITTEEMED. STAFF

————— Direct Reporting

– – – – – – Advisory Relationship

Source: B.M Sakharkar, “Principles of Hospital Administration and Planning” (2003), P-143.

Fig.2.1

MARKETING OF SPECALITY HOSPITALS

Health care industry in India seems to have arrived at a turning point. As in some other

service industries, viz. banking and the hospitality (hotels, restaurants, travel, and tourism) industry,

health care industry is going through a marketing revolution.

During the 1980s in USA hospital trustee boards and hospital administrators realised that

because institutional strategic planning is an essential management task –

1. Marketing can be a useful function that should not be rejected summarily because of the

sanctimony attached to health care activities.

2. Promotion, including advertising is not inherently bad but is an important communication

activity. (Reference of doctors from clinics).

3. The word “customer” is not a dirty word.

STRATEGIC PLANNING IN SPECIALTY HOSPITALS

Diligent promotion of the marketing concept is changing professional attitudes as it

challenges the institution to provide services that consumers want and will pay for.

Strategic planning is that set of decisions and actions which lead to the development of an

effective strategy to achieve the basic objectives of the hospitals, viz. quality patient care at a

reasonable cost and excess revenue over costs. Strategic planning is gaining importance in advanced

countries, because the health care need and technology is changing so fast that it is the only way to

anticipated future threats and opportunities.

Strategic planning is the need of the “marketplace”-which the health care industry resembles in

some respect.

MARKETING OF MEDICAL SERVICES IN SPECIALTY HOSPITALS

India lacks the infrastructure to attract overseas patients in substantial numbers; we do not

have a lobby to sell medical services to west. Yet, among the services that India can sell to the west,

health care could be one of the easiest. And the pickings promise to be plentiful in foreign currency.

When the UK’s National Health Service found hospital beds going empty at home, it began

to sell healthcare service to the US. India needs to market its medical service abroad aggressively if

it is to win a share of the global healthcare market.

India can now offer world-class facilities and services, with its growing number of well-

equipped corporate hospitals at costs far below the international rates. The cost of a major surgical

procedure, e.g. open heart surgery is still about one-third of that which would cost in UK or US.

Hospitals will have to be more receptive to marketing management philosophy which involves many

conceptually new approaches within the framework of strategic planning. With increasing health

insurance coverage, price competition becomes an appealing marketing tool.

THE 5 P’S IN MARKETING MIX:-

The time-honoured model used for describing the marketing process in hospitals is popularly

referred to as the five P’s in the hospital set – up, the product is the service which is primarily the

health care. The price that patients pay has two distinct aspects – one is the value in terms of money

they pay for the services. The other is intangible price – often much bigger than the money price –

which the patients pay in terms of pain, unending waiting at every stage of hospital visit. Place is the

availability of service at a time and place convenient to the patient, usually hospital, Promotion is

usually communication (i.e. sign boards, enquiry, hospital information system). The fifth ‘P’ is

public relations and advertising (image and product wise) which are both essential to successful

marketing.

2.6 MOTTO OF SPECIALTY HOSPITALS

Patient satisfaction – The physical factors like location of hospital away from densely

populated area, easily accessible by various modes of transportation such as roads, rail etc. The

layout should be provided with sufficient ventilation good lighting, seating arrangements, drinking

facility, availability of rooms like ordinary, semi-deluxe and deluxe, depending upon facilities

available, along with public telephone booth with STD/ISD facilities, recreation facility, and

newspaper. Physical facilities in hospital should be such that the attendants and their relatives feel

secure and comfortable within and around the hospital.

Service factors include professional services as well as nursing services. The performance of

the hospital is measured only by its quality of service provided to public. The sympathetic and

courteous behaviour of the hospital staff has a lasting effect on the patient and relatives. A

responsible organization is the one that makes the every effort to sense and satisfy the needs and

wants of its clients and the public, within the constraints of its budget and good clinical practices.

The medical, nursing, paramedical and other staff in the hospital should be skilled and competent.

Their attitude should be customer friendly. A ‘service strategy’ is important for hospital. It is a

distinctive formula of delivering service. Such a strategy is keyed to a well-chosen benefit premises

that is valuable to the customer and that establish an effective competitive position.

One way defining service strategy is to describe it as an organization principle that allows

people in a service enterprise to channel their efforts to better oriented service that makes significant

difference in the eyes of the customer. This principle can guide everyone from the top management

on the down to in and staff employees. The principle must take assessment that say’s “this is what

we are, this is what we do and this is what our believe”. Adherence to this principle helps the

hospitals make service decision within its realm of concern.

TECHNOLOGICAL FACTOR

Technology is needed to a greater extent, but amount of modernized techniques or

sophisticated equipment’s may not contribute to the satisfaction of the patient. Even while using

technology the human aspect of care should be considered. Technology only assists in giving correct

diagnosis and treatment. The socio economic aspect the patient should be considered when we go in

for high tech treatment.

COST FACTOR

One of the important aspect with the patient satisfaction is the economic satisfaction of the

patient, there should be balance between quality and cost. With the advancement of technology the

cost of treatment is becoming high as a result of which high-class treatment is becoming

unaffordable to the vulnerable section of the society.

A hospital must accurately determent the cost of providing all its service though a proper

system of accounting. “An important administrative function is to determine then schedule of

changes for the service to be rendered. The change must be reasonable at sufficient income must be

generated. The first requirement is to find out the actual cost for providing each of the service.

In addition to the price of fees which we collect patients incur three other costs:

The time cost and trouble of looking into information locating the hospital and traveling,

which could be termed as effort cost.

The fear about the disease and treatment, trouble and pain side effects, recovery time and

extent of recovery could be termed as efforts cost.

Waiting time of the patient has to be considered as waiting cost.

This effort psychic and waiting cost also influence patient satisfaction to greater extent.

Adam Smith rightly said, “The real price of everything what everything real costs to the man

who wants to acquire it, it is the tool and the trouble of acquiring it”.

COMMUNICATION FACTOR

“Communication is the touching of mind, of person with person whether it is one man to a

thousand. It can include conversation, interview, dialogue, visual technique carefully used.” This is

of great significance as any wrong communication or misunderstanding can be responsible for

damages to patient as well as to the hospital. There is a need to issue, orders, instruction, and

proscription to be carried out clearly and understandably.

Better techniques of communication can contribute to the improvement of health

management by securing the flow of information needed for the effective functioning of the

organization at minimum cost. Communication such as signboards, information enquiry etc. is

important. The lack of ability of doctors, nurses and other staff to explain the things properly is a

major source of dissatisfaction by many patients.

2.7 PATIENT/SATISFACTION IS THE MAIN GOAL OF TQM IN SPECIALITY

HOSPITALS (Result of employee satisfaction)

A FAMILY PHYSICIAN APPROACH TO TOTAL QUALITY MANAGEMENT (TQM)

TQM in the family practice is an organized approach to achieve maximum patient

satisfaction, by involving and respecting the patients, doctors, suppliers and the staff member in the

clinic. Total quality management enables continuous improvements in the process used to prepare

and deliver clinic’s products and services to its patients. The emphasis is on preventing problems and

not waiting for them to occur. In a nutshell patient satisfaction is the primary objective of TQM.

FAMILY PHYSICIANS IN INDIA BE INTERESTED IN PRACTICING TQM

All family physicians in the subcontinent would like to have a list of satisfied patients by

improving the ‘quality’ of practice. They would like to deliver more professional satisfaction,

improve the employee productivity and morale, augment the clinic revenue and recognized as ‘a

quality conscious doctor’. Therefore, one can see every reason that family physicians would be keen

to practice TQM which is going to give more personal satisfaction, improve the employee

productivity and morale. Among the clinic revenue and be recognized and quality conscious doctor.

Therefore, one can see every reason that family physician would be keen to practice TQM which is

going to be the mantra of the next millennium.

TQM IS GOING TO PLAY SUCH AN IMPORTANT ROLE IN THE 21ST CENTURY

In the process of having professional skills little did one know that in addition to academic

qualification and clearing to the responsibilities of being a physician, one would also have to fit into

the roles of chief executive officer, chief financial controller personal times. Time that could be

better utilized by learning the rules of efficient TQM in our practice instead of waiting in crisis

management.

2.8 ROLE OF HOSPITAL ADMINISTRATOR IN SPECIALITY HOSPITAL

The job of the administrator is to plan, to organize, to direct and to control—functions which

are inherent to the job of every administrator. As a general manager, he represents the organization

to higher authorities and to the outside world. He is responsible for policies and procedures, the

overall administrative structure, financial management, personnel management, reporting to the

board, relations with the medical staff, overseeing medical care, maintaining the physical facilities,

legal matters and maintaining good public relation.

Hospital chief executives have to spend almost 100 per cent of their time on non-medical

function and activities, far removed from direct patient care (Table 6.1). This precludes appointing

senior practicing doctors as chief executives. Medical doctors trained in health and hospital

administration, who are alive to the medical care needs of the patient also understand the needs of

the hospital and professionals working in them, and are thus more suitable to head hospitals.

Table 2.3: Time Distribution on Administration Functions

Activity Percentage of time

Planning 25

Directing and coordinating 48

Personal meeting people 11

Controlling 12

Organizing 4

Source: B.M Sakharkar, “Principles of Hospital Administration and Planning” (2003), P-12.

ROLES AND FUNCTIONS OF HOSPITAL ADMINISTRATOR

Working with People

The administrator has no direct clinical responsibility for any patients that rests firmly on the

members of the medical staff who have the clinical freedom to decide who shall be treated for what,

by what means and for how long. He should balance the goals of the hospitals by working with

patient care teams where physician is the kingpin who in turn works with others in rendering patient

care. Understand workers, their motivations and aspirations, and knit them together as a team.

The Enabling Role

One of the prime roles of the administrator is to enable the doctors, nurses and patient-care

team to do their job.

He ensures the provision of necessary physical facilities and ensures that the supportive

services are available in the right amount, of the right quality, and at the right time and place.

Hospital Administrational Staff

Running any hospital calls for a great deal of tact and ingenuity. This is because there are

many types of staff who are specialist in their own sphere and departments, which function more or

less as autonomous units.

He should understand the staff and understand variations in styles of administration.

Staff Motivation

Expensive facilities and equipment do not necessarily make for good hospital; it is the people

who operate them that make the hospital go. This function is one of the most challenging functions

of a hospital administrator. The staff needs to be motivated to give their best at all times even in

trying situations. Many discouraging factors and stress situations. Many discouraging factors and

stress situations, in which hospitals abound, tend easily to lead to erosion in motivation. He develops

measures to keep up motivation of all categories of staff, and be constantly on the look-out for cases

of dissatisfaction and conflict.

Facilitating Decision Making

The administrator provides appropriate inputs to decision making at the clinical departmental

level, and coordinate decision making at the inter-departmental level.

Management of Resources

All decision making is limited by the human and material resources the hospitals has. The

variety and quantum of the pressures and constraints on hospital administration is best seen when it

comes to deciding between competing claims for manpower and financial resources. The hospital

administrator as an expert in the art of getting things done, does not arbitrate on this or that but

assimilates, reconciles and synthesizes all the views of those who put up competing demands.

Nevertheless, in making decisions, at times, he may have to succumb to what is expedient.

Negotiating

The administrator spends considerable time negotiating both with agencies outside the

hospital and with staff members within, especially regarding their working arrangements and

conflict resolution. Administrators must negotiate with third party payers (insurance companies,

employers) regulatory agencies, planning groups, equipment vendors and so on. There are also

elements of negotiation in the hiring of personnel and salary determination. Ideally, the administrator

should strive for a positive problem-solving situation. This implies moving away from a win-lose (I

win you lose, or vice versa) situation to a win-win (I win-you win) end result.

Containing Costs

With phenomenal rise in hospital costs, the administrator has to devote considerable time and

energy to monitor and contain costs. The medical staff knows very little or nothing about the

economics of hospital care. Therefore, it is necessary to make them cost conscious, to reduce

expenditure without jeopardizing patient care. The hospital administrator achieves this through

presenting them with different types of costing data and seeking their cooperation in containing

costs.

Dealing with New Technology

Hospital administrator strike a judicious balance between new technology and the hospital’s

needs, cater for training and retraining to catch up with new technologies, innovations and

improvements. Organize such training at formal, informal, institutional and individual levels.

Evaluation

The ability to evaluate people, programmes and the overall effectiveness of the hospital is

one of the competencies the administrator has to develop. Evaluation includes evaluation of

employee-clientele relationship and interpersonal behaviour. The judging ability of the administrator

at times incorporates “intuition”.

2.9 DOCTOR-PATIENT RELATIONSHIP IN SPECIALITY HOSPITALS

The doctor patient relationship has changed in the 21st century. The doctors earlier were only

concerned to treat the patient’s illness, but now they understand the emotional needs of the patients.

With the advancement of communication technology the patients can talk to the doctor and ask his

medical advice at phone. The patients can freely discuss their problems with the counselors and

doctors having friendly and cordial relations. Doctors now spent much time in communication with

the patient at various visits along with treating the patient’s illness. For example in the event of a

postoperative case, the patient who has been discharged a ‘Get Well’ card from the hospital signed

by the doctor and the administration can mean much to the patient.

2.10 ROLE OF PUBLIC RELATION DEPARTMENT IN SPECIALTY HOSPITALS

Larger hospitals should have a public relations or social service department strategically

located at outpatient department to monitor the attitude of people towards the hospital and provide

timely information, guidance and assistance of the people towards the hospital that will instill a

sense of confidence. The department should act as an official spokesman of the organization in all

matters pertaining to places, practices and programmes. In case of negative publicity breaking out

the department can play a role of fire extinguisher. In certain cases they can act as an advisor to the

top management in abandoning certain policies.

In the traditional period that is before independence the objective of the hospital was to treat

the patient and cure him. But after independence with the evolution of government hospitals both at

central and state level the objective was to prevent, cure and rehabilitate people and serve

community. The public health care system is crippled down due to lack of funds, as a result private

hospitals and corporate bodies are jumping into the medical care field to form investor owned, profit

hospitals to serve the quality health care with patient satisfaction at top priority. After globalisation,

medical tourism and cost effective health care is becoming a centre of attraction in developing

nations like India. As a result more super specialty hospitals are opening in urban areas and rural

health care is left to graduate doctors who are appointed on contract basis and specialized doctors

and services are provided at district levels by State Governments but with inadequate and untrained

staff and lack of infrastructure. Due to this there is more proliferation of hospitals, which cater to

different needs of patient. These hospitals are capital as well as labour intensive and customer

friendly in nature and are run by hospital administrators/management personal, which act as a pillar

in supporting various functions of hospital. Their role is planning, organizing, directing, staffing, co-

coordinating and controlling the various administration as well as medical functions.

CHAPTER – 3

BACKGROUND OF PROBLEM/TASK UNDERTAKEN

During the past decade, the health care sector has undergone rapid and striking changes due

to rapid globalisation and liberalization, increased competition due to entrance of private (corporate)

sector hospitals, introduction as well as transfer of technologies and outsourcing of services. The

advent of technological revolution in health care sector has drastically changed the conventional

pattern of patient care that is treatment of his ailment. The corporate health care sector is more

focused on patient satisfaction and quality health care to cater the medical, psychological as well as

personal needs of patient. This project has been undertaken to evaluate the employee satisfaction

level between the government and private hospital as there is innate relationship with employee

satisfaction and quality of patient care.

3.1 RATIONALE OF THE STUDY

There is a definite link between employee attitudes and patient satisfaction. If employees are

unhappy or dissatisfied, despite their best efforts, it is difficult for them to conceal this factor when

interacting with patients and other staff members. One of the primary reasons for evaluating

employee satisfaction as to identify problems and try to resolve them before they impact on patient

care and treatment.

Improving the quality of patient care in Indian hospitals is a vital and necessary activity.

Patients report they receive less individual attention than ever before. They complain that doctors

and nurses are too busy attending to the technical aspects of care to provide the much needed

attention to patient’s personal needs.

Not only it is important in terms of quality patient care assessing employee satisfaction is a

critical component in retaining qualified health professionals. Many health care providers feel

frustrated and delusional in jobs they expected to find fulfilling. They have less time to do a quality

job of caring for patients; they are continually expected to cut corners, but see waste and feel unable

to change the situation; they feel unappreciated and their skills are underused. This leads to low

morale, staff turnover and overall disenchantment with job opportunities in healthcare. In this

juncture, the present study is undertaken to address specific aspects of job satisfaction related to

hospital employees. It attempts to investigate and to compare the level of job satisfaction

experienced by the employees of a government and private hospital in Ludhiana City of Punjab.

3.2 SCOPE OF STUDY

Job satisfaction is viewed as a positive emotional response to a job situation resulting from

what the employee wants and values from the job. Employee’s satisfaction from their jobs is highly

significant for the effective functioning of any organization. It plays a key role in influencing the

attendance of workers, their productivity, work motivation, morale and bringing profits to the

organization. Thus the understanding of the job satisfaction level of employees and comparing with

both private and government hospital, is essential in order to motivate them from for better

performance as there is an intricate relationship between employee attitudes and patient satisfaction.

The present study is conducted in two renowned hospitals at Ludhiana City in Punjab viz

Government Civil Hospital and Dayanand Medical College Hospital.

CHAPTER – 4

OBJECTIVES AND HYPOTHESIS OF STUDY

The objectives of study are as follows:

4.1 PRIMARY OBJECTIVES

To measure and compare job satisfaction of government and private hospital employees.

4.2 SECONDARY OBJECTIVES

To identify variables which have a significant impact on the satisfaction level of both private

and government hospital staff.

To identify prominent areas of dissatisfaction among the employees of government and

private hospital.

To suggest measures for inducing greater satisfaction in above mentioned areas.

4.3 HYPOTHESIS OF STUDY

There is no difference between government and private hospital employees regarding job

satisfaction.

There is no difference between government and private hospital employees regarding the

benefits provided.

CHAPTER – 5

CONCEPT OF JOB SATISFACTION

Job satisfaction may be defined as a ‘pleasurable or positive emotional state resulting from

the appraisal of one’s job or experiences’ (Locke, 1976). Thus, job satisfaction is often regarded as a

work- related attitude with potential antecedent conditions leading to it (such as autonomy and pay),

and potential consequences resulting from it (such as absenteeism and job performance good/bad). It

can also be viewed as representing a complex assemblage of cognitions (beliefs or knowledge) and

emotions (Hamner and Organ, 1982); (Landy, 1989).

Job satisfaction has often been considered synonymous with related concepts of morale and

job involvement. Morale has been defined as ‘an attitude of job satisfaction with a desire to continue

and willingness to pursue the goals of an organization’ (Viteles, 1953). Therefore, we can expect

individuals who are satisfied with their job to possess a high morale and vice-versa. On the other

hand, we would expect individuals who are greatly involved in their job to experience greater

emotions (positive or negative) and as consequence higher levels of satisfaction or dissatisfaction.

5.1 FACTORS IN JOB SATISFACTION

Several research studies, both in the West and in India have been conducted and the results

of their findings have lighted factors influencing employees' attitudes and responsible for their job

satisfaction or job dissatisfaction. According to studies conducted by Hoppock in (1935), the

important factors that matter in job satisfaction are :

FINANCIAL AND NON FINANCIAL FACTORS

It goes without saying that financial considerations - fair wages, do matter in job

satisfaction, but apart from that there are good many other things that influence job satisfaction.

There are:

1. Relative status, which an individual holds within the social and economic groups with which

he identifies himself.

2. Relationships with supervisors and associates on the job.

3. Work situations, including nature of the work.

4. Working condition - earnings, hours of work, facilities, etc.

5. Greater opportunities for advancement.

6. Variety in work, that does away with the dullness and monitory of work.

7. Freedom from close supervision.

8. Opportunities to see results of one's own work.

9. Knowledge of job progress and satisfaction of doing good work.

10. Opportunities for service to others.

11. Environments - healthy, cleaner, safer, etc.

12. Living of one's own choice.

13. Initiative and personal responsibility.

14. Vacations.

15. Thrill and excitement of the job.

16. Less fatigue work.

17. Health criticism.

18. Job security - steady employment, etc.

19. Ability to adjust oneself to unpleasant circumstances.

In their research report findings, entitled, "The Motivation of Work" published in 1959, in

Pittsburgh, psychologists, Frederick Herzberg and his associates have stated that five factors, or

ideas as people mentioned to them, during the investigation, when they talked about feeling 'good'

about their job (expressing job satisfaction) were :

1. Achievement, 2. Recognition,

3. The work itself, 4. Responsibility, and

5. Advancement.

Elucidating these factors further:

1. Achievement

It brings to the worker feelings that he has done something of which he could naturally be

proud of. He feels satisfied and pleased with his achievements.

2. Recognition

In the worker's supervisors, recognising his good work, appreciate and say a word or two of

praise, or a customer, hails the worker, and gives a pat at his beck for the good quality of

product, he has turned out, the worker feels, his achievement has been recognised and so he

gets job satisfaction.

3. The work itself

The job that involves work, which is interesting, challenging and has variety all through,

from the beginning to the end, itself stands complimented and affords job satisfaction to the

worker.

4. Responsibility

Jobs done by the workers of their own initiative, with full responsibility, and without being

supervised, merits consideration with the workers, as having been well accomplished and

thus workers feel very much satisfied with their jobs.

5. Advancement

Sudden promotion of the employee, in recognition of this good work, causes the employee

much satisfaction about his job.

Thus It may be observed, as the conclusions for the report findings go, that the five factors

of importance that lead people to feel satisfied and happy with their jobs, centre around the idea that

people want to grow and develop progressively in their work - develop themselves to their optimum

capacity, as creative and unique individuals - so talked of concept of self-realisation.

Here comes fulfillment of their hopes and ambitions in the work they do they like their work

and derive both pleasure and satisfaction from it.

All this, is so conducive to the development of good Human Relations in an organisation.

5.2 JOB SATISFACTION AND WORK BEHAVIOUR

Generally the level of job satisfaction seems to have some relation with various aspects of

work behaviour like absenteeism, adjustment, accidents and productivity.

JOB SATISFACTION & ABSENTEEISM

In everyday life certain contingencies require a little extra effort of the part of workers to

come to work. A minor problem with bicycle, a drizzle, a small tiff with spouse and several such

incidents have a tremendous impact on the work attendance. For a dissatisfied worker these may be

major reasons for missing the work but for a satisfied worker these may be relevant.

JOB SATISFACTION AND ADJUSTMENT

If the employee is facing problems in general adjustment, it is likely to affect his work life.

Although it is difficult to define adjustment most psychologists and organisational behaviorist have

been able to narrow it down to what they call neuroticism and anxiety.

Adjustment problems usually show themselves in level of job satisfaction. For long, both

theorists and practitioners have been concerned with employee’s adjustment and have provided

vocational guidance and training to them to minimise it is compact on work behaviour. Most

literature in this area, generally suggests a positive relationship between adjustment and job

satisfaction. People with lower level of anxiety and low neuroticism have been found to be more

satisfied with their jobs.

JOB SATISFACTION AND ACCIDENTS

Research on relationship between job satisfaction and accident, generally shows that the

higher the satisfaction with the job, the lower is the rate of accidents with the job, the lower is the

rate of accidents. Though it is difficult to explain such a relationship but generally a satisfied

employee would not be careless or negligent and would encounter lesser possibilities of running

into an accident situation. The more favourable towards job would make him more positively

inclined to his job and there would be a lesser probability of getting and unexpected incorrect or

incorrect or in controlled event in which either his action or the reaction of an object or person may

result in personal injury.

JOB SATISFACTION AND PRODUCTIVITY

It is generally assumed that satisfied employee is more productive. But research reveals no

relationship between job satisfaction and productivity.

Many Indian studies however show significant relationship between job satisfaction and

productivity. For instance, a study analyzed the relationship between two variables among workers.

The results showed high productive workers were more satisfied with their job.

In India giving the limited opportunities for job openings and large number of people

aspiring for them, to get a job itself may be very satisfying. In order to retain the job, the employee

may be tempted to please the management by producing more. Hence there may be a positive

correlation between job satisfaction productivity.

5.3 MORALE AND JOB SATISFACTION

More than two and a half decades ago, Seashore (1981) came to the conclusion that there is

no definition of morale. It is a condition which exists in a context where people are:

a. motivated towards high productivity

b. want to remain with organisation

c. act effectively in crisis

d. accept necessary changes without resentment or resistance

e. actually promote the interest of the organisation and

f. are satisfied with their job.

According to this description of morale, job satisfaction is an important dimension of morale

and not morale itself.

Morale is a general attitude of the worker and relates to group while job satisfaction is an

individual feeling which could be caused by a variety of factors including group. This point has

been summarised by Sinha (1974) when he suggests that industrial morale is a collective

phenomenon and job satisfaction is a distributive one. In other words job satisfaction refers to

general attitude towards work by an individual worker. On the other hand, morale is group

phenomenon which emerges as a result of adherence to group goals and confidence in the

desirability of these goals.

5.4 APPROACHES TO MEASURE JOB SATISFACTION

There have been two major approaches to measure job satisfaction. Firstly, the facet

approach focuses on factors related to the job that contribute to overall satisfaction. Some of these

include salary, promotion, and recognition within the workplace. This approach holds that workers

might feel differently towards each aspect of the job, but the aggregate of each facet would

constitute overall satisfaction. Despite, the extensive use of this approach by researches it has been

criticised on the premise that individuals might not attribute equal importance to each of the facets

(Thierry, 1998).

The second approach has been termed the global approach as it focuses on an individual’s

overall job satisfaction. The global approach suggests that job satisfaction is more than the sum of its

parts, and individuals can express dissatisfaction with facets of the job and still be generally satisfied

(Smither, 1994; Thierry, 1998). There is no consensus in the literature as to which is a better

approach. Researchers who have used the facet approach argue that the global approach is too broad

and thus responses cannot be effectively interpreted (Rice et al, 1989; Morrison, 1996). However

studies, which have utilised the global approach, argue that the global approach is more inclusive

(Weaver, 1980; Scarpello and Campbell, 1983; Highhouse and Becker, 1993).

The usefulness of the global or facet approach appears to greatly depend on the nature of the

study. For example, Wanous et al (1997), argue that the use of global measures should not be

considered as a fatal flaw and its appropriateness for a particular study needs to be evaluated.

McCormick and llgen (1985), suggest the use of the facet approach when the aim of the study is to

identify problem areas in the job setting, and the global approach if the focus is to identify problem

areas in the job setting, and the global approach if the focus is to study a relationship. In addition,

other studies have shown that the global measures tend to possess a higher correlation with variables

like satisfaction with occupational choice, satisfaction with life off the job and satisfaction with

career progress (Scarpello and Campbell, 1983).

Researchers have used different methodologies in the study of job satisfaction. These include

data collection methods such as behavioural observations, survey questionnaires, interviews and

critical incident analysis. Using the critical incident technique, the researchers require the subjects to

recall or talk about a specific incident which they regard as being critical (White, 2000).

The choice of methodology depends on a number of considerations as outlined below

(Thierry 1998):

1. The ability of the researcher to access instruments whose

validity and reliability have been established.

2. The time and funds available.

3. The nature of the problem and the degree of insight sought by

the researcher.

Generally, the literature suggests the use of self-report questionnaires as the dominant

approach in measuring job satisfaction (Morrison, 1996). Measurement techniques that have been

most commonly utilised range from Likert-type scales, Kunin ‘faces’ scale and list of adjectives

(Morrison, 1996). A brief description of the main measuring instruments is provided below:

The Job Descriptive Index (JDI) measures satisfaction via five categories (work, supervision,

pay, promotion and co-workers). Each category has a series of adjectives that the respondents

mark with a ‘Yes’, ‘No’ or ‘?’ depending on how they relate to each question. Scores within

each category can be summed to indicate facet satisfaction, or all five facet scores can be

summed to measure overall satisfaction (Smith et al, 1969).

The Minnesota Satisfaction Questionnaire (MSQ) asks questions about satisfaction and

dissatisfaction with different facets using a Likert-type scale. The scales can be scored in

total to determine overall satisfaction or in subsets to measure the level of extrinsic/intrinsic

satisfaction (Weiss et al, 1969).

The Kunin ‘faces’ scale is a one-item global measure of job satisfaction. Respondents are

presented with faces ranging from perfectly blissful to deeply distressed. The respondents

choose the ‘face’ which best represents their attitude or feeling. More recently, a version of

the Kunin scale using female faces has been developed as an addition to the previous ‘male’

version (Kunin, 1955; Dunham and Herman, 1975).

Instead of using the ‘faces’ scale some researchers have used a single-item measure of

overall job satisfaction, based for example on the statement, “All things considered, I am satisfied

with my job”. Using Likert-type scales the respondents are required to identify the number on the

scale to represent the level of agreement or disagreement with the statement (Staw and Ross, 1985;

Gerhart, 1987; Morrison, 1996).

It is observed researchers have used different methodologies to collect data on job

satisfaction; however, the literature suggests the use of self-report/survey questionnaire as the

dominant data collection method. Two distinct approaches to measure job satisfaction, namely, the

facet and global approach, have been highlighted. In recent years, the literature indicates that the

facet approach using the MSQ or the JDI has been more commonly used. Researchers using this

approach argue that the global approach is too broad and thus cannot be effectively interpreted.

However, there is considerable evidence in the literature which suggests that the global approach

using single-item measures (such as Kunin ‘faces’ scale or single-item questions) is more inclusive

than the facet approach and should not be considered as being flawed – rather its appropriateness to

the research needs to be evaluated.

5.5 THEORIES OF JOB SATISFACTION

This section examines the literature regarding theories and models used to explain the

determinants of job satisfaction. There are two broad categories to classify job satisfaction theories,

that is, process and content theories. Content theories are predominantly concerned with the

identification of specific needs or motives most conducive to job satisfaction (Locke, 1976). Process

theories go further than identifying basic needs that motivate people. They focus on the individual’s

dynamic thought processes and how they produce certain types of behaviour/attitudes.

Amongst the theories discussed below, the Maslow’s Need Hierarchy and Herzberg’s Two-

Factor theory are examples of content theories. Examples of process theories include; Equity theory,

Need-Fulfillment Theory, Social Comparison Theory, Facet-Satisfaction Model, Job Characteristics

Model, Locke’s Value Theory and Genetic Theory.

MASLOW’S NEED HIERARCHY

Maslow (1954) suggested that there exists a hierarchy of human needs, commencing with

physiological needs and progressing through to needs of safety, belongingness and love, self-esteem

and self actualisation. Maslow suggests that these needs must be satisfied in the order listed in order

to be operative. Therefore, outcomes satisfying a particular need will only be attractive provided the

lower-order needs are first satisfied. In other words, the physiological needs must be satisfied before

the safety neds. Maslow’s theory is essentially two-fold. It aims to identify the needs which provide

motivation, and secondly, to explain the inter-relationship between the needs.

Despite the simplistic approach and wide recognition for this framework, there is little

empirical support for Maslow’s proposition (Miner and Dachler, 1973). The theory has been

criticised by researchers on at least two grounds. There is little evidence of any such hierarchical

effect, beyond that of the primacy of safety needs (Hall and Nougaim; 1967; Lawler and Suttle;

1972). Secondly, there is no agreement that the five basic needs are inherent in all individuals (Miner

and Dachler, 1973).

HERZBERG’S TWO-FACTOR THEORY

A theory of work motivation, which has aroused a good deal of interest, is Herzberg’s (1959)

two-factor theory also referred to as the ‘Motivation-Hygiene’ theory (Hamner and Organ, 1982).

This was based on Herzberg’s research with a sample of 200 accountants and engineers in the

Pittsburgh area in the US. The study used a ‘critical incident’ methodology, where each person was

asked to recall an exceptionally good and bad aspect of their job. This was followed by subsequent

interviews. The information collected was content analysed to determine any systematic relationship

between positive and negative events and various aspects of the job (Herzberg, 1966). The various

aspects of the job were classified as:

‘Motivators,’ representing sources of satisfaction derived from various facets of the job (eg

promotion, recognition).

‘Hygienes’ represented sources of dissatisfaction and were primarily concerned with the

work environment (eg salary, supervision) (Davis, 1974).

Hezberg’s theory inherently assumed that dissatisfaction and satisfaction do not represent a

single continuum (traditional view). Instead, two separate continua are required to reflect peoples

dual orientation to work, representing both the hygiene and motivator factors (Fig. 5.1) (McCormick

et al, 1985).

Traditional View

Dissatisfaction Satisfaction

Herzberg’s Two-Factor Theory

Dissatisfaction No Dissatisfaction

Hygienes

No satisfaction Satisfaction

Motivators

Source : Champoux J E (1996), “Organisational Behaviour : Integrating Individuals Groups and

Processes”, p 182

Fig. 5.1: Herzberg’s Two-Factor Theory

Empirical research designed to test Herzberg’s theory has produced mixed results. Studies

using the ‘critical incident’ methodology have found support for the theory (Myers, 1964). However,

other researchers using different methodologies have found little support for the theory (Hinrichs

and Mischkind, 1967; Hulin and Smith, 1967; Schwab and Heneman, 1970; Miner and Dachler,

1973).

EQUITY THEORY

Adam’s Equity theory assumes that individuals value and seek social justice in how they are

rewarded for their productivity and work quality (Adam, 1963). In this context, fairness is said to be

achieved when an individual perceives that their outcome in terms of pay or promotion

proportionately reflects their inputs (such as task behaviour, effort). Individuals compare the ratio of

their input/output to that of others to determine the presence of inequity. If the individual believes

that there exists an inequity (positive or negative) they may alter their inputs, alter their perceptions

of others’ input/outcomes, or in extreme cases even leave the work situation (Campbell and

Pritchard, 1976; Kanfer, 1990).

Equity literature has primarily dealt with financial compensation as an outcome. The

majority of studies have dealt with the effects of underpayment and overpayment on job

performance and to lesser extent job satisfaction (Locke, 1976; Hamner and Organ, 1982). Empirical

evidence has found support for the underpayment effect with Adam’s model (Carrell and Dittrich,

1978). That is individuals who perceive that they are underpaid relative to others reduce the quality

and increase the quantity of their work. (These results were found when the employees were working

under conditions where the pay was dependent upon the output level).

On the other hand, studies of overpayment have been equivocal (Kanfer, 1990). Weiner

(1980), found that equity norms do operate and overpayment inequity can exist. Researchers have

also argued that overpayment can be difficult to interpret due to different induction procedures (for

example, during the process of recruiting new staff, if the potential candidates are made to believe by

the management that the pay is better than what their qualifications should attract) used, and with

variations over time of ratios suggesting inequity, particularly with changes in pay (Lawler, 1968;

Pritchard, 1969).

NEED-FULFILLMENT THEORY

According to the need-fulfillment theory, satisfaction is determined by the extent to which

the work or the work environment produces outcomes which an individual desires, or wants (Vroom,

1964; Lawler, 1973). The theory assumes that all individuals have differing needs (eg self-respect,

self-development), and these needs determine how motivated an individual will be to perform a job.

As a consequence, fulfillment of these needs would lead to greater levels of satisfaction. In addition,

the greater the importance an individual attaches to a particular need, the more the resulting

satisfaction when the need is fulfilled and the greater the dissatisfaction if it is not (Korman, 1971;

Smither, 1994).

There are two different types of models which use the need-fulfillment framework, the

‘subtractive’ and the ‘multiplicative’ model. Both models assume that job satisfaction is an outcome

of the degree to which the work environment satisfies an individual’s needs (Vroom, 1964). The

subtractive model proposes that satisfaction is a function of the discrepancy between a person’s

needs and the extent to which the work environment provides satisfaction of those needs. The greater

the discrepancy lower the satisfaction level and vice-versa. The multiplicative model sums the

product of the individual’s needs and the degree to which the job provides satisfaction of those

needs. The sum of all the needs reflects the individual’s level of satisfaction (Korman, 1971, pp139-

140).Research suggests some usefulness for the models based on the need-fulfillment theoretical

framework (Schaffer, 1953; Kuhlen, 1963). For example, Kuhlen’s study (1963) found support for

the subtractive model as a predictor of job satisfaction for men, although not for women. Korman

(1967) suggested that the subtractive model is limited in its applicability to individuals with high

self-esteem. It appears that the need-fulfillment framework provides an incomplete framework in

understanding the concept of job satisfaction (Korman, 1971).

SOCIAL COMPARISON THEORY

In the need-fulfillment theory, it is assumed that individuals evaluate their outcomes in

relation to what they are striving for. Therefore, the analysis is based on the desires and opinions of

the individual. The social comparison theory suggests that an individual infers a level of his/her

satisfaction based on the desire and interests of the group to which he/she looks for guidance (the

‘reference’ group) (Weiss and Shaw, 1979).

This theory suggests that facets of a job are not nearly as important as perceptions about how

one is doing in relation to his/her reference group (Salanick and Pfeffer, 1978). Researchers who

have supported this theory argue that job characteristics are not inherently pleasing or displeasing.

Rather, pleasing or displeasing to individuals is attributes that are socially constructed (Katzell et al,

1961; Hulin, 1966). However, Korman (1971) argues that a limitation of this theory is its

applicability across different individuals. For example, there are individuals who are independent in

nature and have their own opinions compared to those whose views are largely derived from group

influences. Another limitation of this theory is its lack of applicability across individuals with similar

characteristics but different reference groups.

FACET SATISFACTION MEODEL

The Facet-Satisfaction model developed by Lawler (1973) draws upon the equity theory and

the discrepancy theory (Thierry, 1998). According to this model, job satisfaction will only result if

actual rewards equal perceived equitable rewards. Therefore, if actual rewards are more/less than

perceived equitable rewards, guilt discomfort, will result. Accordingly, this model moves the

phenomenon of job satisfaction closer to the ‘equity’ theory. It implies that psychological discomfort

results from the knowledge that we are receiving more or less than we deserve, and this

psychological discomfort is synonymous to the inequity tension as suggested by Adam’s equity

theory (Landy, 1989).

The critical issue implied by this model is that of perception (Landy, 1989). The perceived

amount of rewards that an individual should receive (such as pay, promotion, recognition) is based

on perceived job inputs (such as skill, effort, beauty), perceived inputs/outcomes of reference groups

and perceived job characteristics (such as responsibility, job level, difficulty). On the other hand, the

perceived amount of rewards received is based on the outcomes of reference groups and actual

outcomes received as illustrated below in Fig. 5.2. Therefore, this model reinforces the importance

of the perception of reality as opposed to reality itself.

Skill levelExperienceTrainingEffort

AgeYears of serviceTraining

Loyalty to organisationPast performanceCurrent performance

Observed personaljob-inputs

Observed job features

Observed inputs andoutcomes of referentothers

Observed amount ofrewards which shouldbe received A

A=B: SatisfactionA>B: dissatisfactionA<B: feelings of guilt, inequity

Level of difficultyAmount of responsibility

Observed outcomes ofrelative others

Outcomes actually received

Observed amountof rewards received B

Source: Adapted from Thierry H, (1998) : Motivation and Satisfaction, p. 279.

Fig 5.2: Lawler’s Facet Satisfaction Model

JOB CHARACTERISTICS MODEL

The Job Characteristic Model (JCM) stands as one of the most widely researched models in

organisational behaviour research (Roberts and Glick, 1981; Spector, 1985; Spector and Jex, 1991).

The JCM was developed by Hackman and Oldham (1975) and is an extension of the Job

Characteristics theory proposed by Turner and Lawrence (1965) suggests that employees’ attitudes

towards their work (such as satisfaction, absenteeism) is function of their task

characteristics/attributes (such as work variety, autonomy, amount of responsibility entrusted, skill

required and opportunity for interaction with others). The higher a job’s standing on these attributes

the more satisfied the jobholders would be. (Hackman and Oldham (1975; 1980) suggested that

motivating jobs are characterised by 5 core characteristics (skill variety, task variety, task

significance, autonomy, and job feedback). These core characteristics are proposed to influence

‘three’ psychological states (feeling of meaningfulness, feeling of responsibility and knowledge of

results), which then influence/result in positive work outcomes such as job satisfaction. According to

the model, individuals who perceive their jobs to rank highly on the 5 core characteristics would

enjoy higher levels of job satisfaction and vice-versa.

The JCM also accounts for individual’s differences by taking into account the characteristic

of ‘growth needs strength’ (GNS). Since individuals have differing needs for personal

accomplishment, learning and growth, they will react to their jobs differently. Individuals having a

high GNS are likely to respond more positively to jobs that are high on the 5 core characteristics

(Hackman and Oldham, 1980).

Recent studies have indicated that job characteristics reliably correlate with outcomes such as

job satisfaction and absenteeism (Spector, 1985; Fried and Ferris, 1987). That is, individuals who

perceive their jobs to be high on the 5 core characteristics have reported high levels of job

satisfaction and vice-versa. Despite, the general agreement towards the JCM, it has been criticised

for ignoring other individual characteristics and demographic variables that may act as moderators

(Pierce and Dunham, 1976; Morrison, 1996). These include need for achievement (nAch), social

status, and age.

LOCKE’S VALUE THEORY

Locke’s value theory explains job satisfaction as a ‘pleasurable emotional state resulting

from the perception of one’s job as fulfilling or allowing for the fulfillment of one’s important job

values, providing these values are compatible with one’s needs’ (Locke, 1976, p 1342). The essential

element in this theory is to provide a clear distinction between values and needs.

In essence, Locke’s theory requires an identification of; (a) what is valued, and (b) the

relative ‘importance’ of each value being considered. This means that a more accurate picture of an

individual’s job satisfaction should be obtained by weighting the level of satisfaction with each

specific job element by its importance to the individual. The importance of a particular job aspect

affects the range of emotional response a given job element can produce (Landy, 1989; p 458).

Therefore, job factors to which an individual places greater importance would generate great

variations in satisfaction levels, should there be variations from desired levels.

Few studies have been undertaken using this approach; however, studies that have partially

adopted this theoretical framework have indicated preliminary support for its explanation of job

satisfaction (Mobley and Locke, 1970).

GENETIC THEORY

Recent research suggests that the genetic theory is a vital concept for understanding job

satisfaction (Staw and Ross, 1985; Newton and Keenan, 1991; George, 1992). The Oxford

Dictionary defines ‘disposition’ as a personality construct, referring to a person’s temper or intellect.

There exists no clear definition of the term ‘disposition’ in the organisational behaviour literature. In

its application to research, dispositional studies have made personality factors as the focus of

investigation, in determining their influence on work-related attitudes such as job satisfaction).

Therefore, individuals can be satisfied or dissatisfied irrespective of situational influences (Smither,

1994). It is argued that personality factors are genetically based (such as Agreeableness, Emotional

Stability, Extraversion), and therefore job satisfaction is related to genetic influences (Arvey et al,

1989).

Studies that have found support for this theory not only suggest the influence of dispositions

on job satisfaction but also the presence of stability over time and across varying situations (Staw

and Ross, 1985, Staw et al, 1986). Arvey et al (1989), in their study reported that genetics account

for about 30% of the variation in job satisfaction in identical twins raised separately. Despite the

recent interest shown by researchers in examining the influences of dispositions on job satisfaction,

the role played by situational influences in explaining variations in ob satisfaction should not be

discarded (Gerhart, 1987; Davis-Blake and Pfeffer, 1989).

From the above theories it is observed that there seems to be no consensus in the literature as

to a single most useful conceptual framework or theory to explain the causes of job satisfaction. This

is no doubt due to the complex nature of job satisfaction. The majority of theories/models have

focused on the influence of work characteristics on job satisfaction. The Herzberg’s Two-Factor

theory, Need-Fulfillment theory, Facet- Satisfaction model, Locke’s Value theory, and the Job

Characteristics model are examples of such theories/models. However, most of these fail to

recognise the role played by dispositional/personality factors.

The Maslow’s Need Hierarchy encompasses personality traits in explaining human

motivation, however, recent research studies have found the model to be methodologically flawed.

The Genetic theory which considers dispositional factors as major antecedents of job satisfaction has

found increasing support in the literature. These studies not only suggest the influence of

dispositions on job satisfaction but also the presence of stability over time and across varying

situations. However, studying the influence of genetics on job satisfaction requires a longitudinal

research design. In light of this limitation, the majority of dispositional research has used personality

characteristics which are argued to be genetically based as the main focus of investigation in

determining influences on job satisfaction.

The Social Comparison theory has an intuitive appeal in explaining the determinants of job

satisfaction, however, it provides an incomplete evaluation, as some individuals are independent in

nature and do not go along with group opinions. Similarly, the majority of the research studies using

the Equity theory as the conceptual framework are limited because they only studied the effects of

underpayment and overpayment on job performance and to a lesser extent job satisfaction. In

addition, the model does not specify how time influences responses to perceived inequity.

In light of our discussion, there appears to still be a need for a theory or frame work which draws

upon both work or situational characteristics and personality variables to expand an understanding of

the determinants of job satisfaction.

CHAPTER – 6

REVIEW OF LITERATURE

6.1 REVIEW OF THE JOB SATISFACTION RESEARCH IN INDUSTRIAL AND

ORGANISATIONAL PSYCHOLOGY

The study of job satisfaction has established its importance as one of the most extensively

researched topics in industrial and organisational psychology. This research interest is well

demonstrated by the large number of published articles (estimated at 3,350 by Locke, 1976).

Oshagbemi (1996) suggests that this figure today would have more than doubled.

The late 1920s saw one of the first studies of job satisfaction undertaken by Mayo and his

colleagues. This study, also referred to as the ‘Hawthorne’ study, predominantly focused on

employee attitude and its impact on production levels. The study highlighted that employees/workers

develop their own perceptions of the work situation and the social environment, which affects their

attitudes towards their work.

The findings of the Hawthorne study provided consistent results with the observations of

Taylor in 1911, that individual workers value economic incentives/monetary rewards and are willing

to work harder for it (Locke, 1976; Landy, 1989). Following the Hawthorne study, Hoppock (1935)

published the first study of job satisfaction in its entirety. Using the global approach to measure job

satisfaction, Hoppock studied the job satisfaction of workers in the community of New Hope,

Pennsylvania. The study found that 88% of the surveyed were classified as being satisfied, and there

was a direct linear relationship between occupational level and job satisfaction. Despite being

methodologically flawed, the studies are well regarded as the onset of the study of the social aspects

of organizational behaviour (Roethlisberger and Dickson, 1939; Locke, 1976).

Schaffer’s (1953) study was the next major cornerstone in job satisfaction research. Schaffer

proposed a need- satisfaction framework, suggesting a hierarchy of 12 basic needs. The study found

that individual differences existed in the importance of the needs, and individuals satisfied with their

2 most important needs reported overall satisfaction.

The mid 1950s saw two important reviews of the job satisfaction literature – the first by

Brayfield and Crockett (1955) and subsequently by Herzberg et al (1957). Brayfield and Crockett

(1955), found no reportable correlations between job satisfaction and work-related outcomes. In

contrast, Herzberg et al (1957) suggested a systematic relationship between job satisfaction and

work-related outcomes. Herzberg et al, regarded satisfaction and dissatisfaction as different

phenomena, reflecting individual’s dual orientation towards work.

In developing taxonomy of job satisfaction research, the literature suggests 5 different

approaches to the study of job satisfaction.

DEMOGRAPHIC APPROACH

Researchers using this approach have dealt with the relationships of overall satisfaction and

other specific job attitudes to individual worker characteristics. The most commonly researched

demographic factors include age, education, gender and tenure (Saleh and Otis, 1964; Hulin and

Smith, 1965; Witt and Nye, 1992).

AGE AND JOB SATISFACTION

Literature suggests some association arising from the age- satisfaction relationship. However,

despite the general agreement amongst researchers that there exists a relationship, its nature is

currently being debated.

Some researchers argue that a positive relationship exists between the two variables

(controlling for occupational level). That is, older workers tend to experience greater satisfaction

than their younger counterparts (Rhodes, 1983; Kong et al, 1993). The most comprehensive study

supporting this view was by Rhodes (1983) who concluded that overall satisfaction is positively

associated with age, based on a review of 8 different studies. Mottaz (1987) proposed a few

explanations for the observed positive relationship. Firstly, older workers due to their greater

experience can easily move from one job to another. Secondly, having worked in an organisation for

extended period implies a process of adjustment. Finally, the process of ‘grinding down’ occurs,

whereby workers form more realistic expectations and demand less of their jobs.

The second view of the age- satisfaction relation argues for a U-shaped relationship between

the two factors (Handyside, 1961; Kacmar and Ferris; 1989; Clarke et al, 1996). That is employee

morale start high, declines after a few years due to non-fulfillment of some expectations/work-

related values and finally rises in the last few years due to the formation of more realistic

expectations.

GENDER AND JOB SATISFACTION

The relationship between gender and job satisfaction has also received a great deal of

research interest (Hulin and Smith, 1964; Lambert, 1991; Agho et al, 1993), but the findings are

somewhat equivocal. For example, some studies have found no significant relationship (Witt and

Nye; 1992; Agho et al, 1993). Other studies that have found that a relationship exists are in

contradiction as to which gender is more satisfied (Mannheim, 1983; Brush et al, 1987).

Research efforts investigating the relationship between age, gender and job satisfaction have

provided inconclusive results. Kacmar and Ferris (1989), argue that this can largely be attributed to

the use of improper statistical and methodological controls.

SITUATIONAL/ENVIRONMENTAL APPROACH

The most dominant approach in the study of job satisfaction is the situational/environmental

approach. This studies the influence of a set of environmental variables/job characteristics on

employee affect and behaviour (Spector and Jex, 1991). The approach assumes that job satisfaction

is a direct result of the nature of the job and the work environment, and is based on the assumption

that individuals have ‘universal’ needs that can be satisfied by similar job attributes (Morrison,

1996). Researchers have generally argued against the existence of ‘universal’ human needs (Turner

and Lawrence, 1965). (This weakness of earlier models (eg Herzberg’s Work Characteristic Model)

was adequately dealt with by the outgrowth of the Hackman and Oldham’s (1975) Job

Characteristics Model (JCM).

Recent studies using the Job Characteristics Model (JCM) have indicated that job

characteristics reliably correlate with outcomes such as job satisfaction and absenteeism (Spector,

1985; Fried and Ferris, 1987). Individuals who perceive their jobs to be high on the 5 core

characteristics have reported high levels of job satisfaction and vice-versa. In addition, Hacker

(1990) found similar correlations between job characteristics and job satisfaction irrespective of the

nature of the job.

SOCIAL INFORMATION APPROACH

An outgrowth of the situational/environmental approach is the Social Information Approach

proposed by Salanick and Pfeffer (1977). They argue that job satisfaction is a result of personal

perceptions as to whether certain standards are being achieved, where the perceptions and standards

are socially governed (Weiss and Cropanzano, 1996; Judge et al, 1997). Job satisfaction is a function

of degree to which the characteristics of the job meets the standards of the individual’s ‘reference’

group (Korman, 1971). This approach has not been subject to a great deal of research, but has

nonetheless found some preliminary support (Weiss and Shaw, 1979; White and Mitchell; 1979).

DISPOSITIONAL APPROACH

Over the last few decades there has been increasing literature focusing on the work or

dispositional factors in explaining job-related attitudes (Staw and Ross, 1985; Levin and Stokes,

1989; Judge, 1993; Morrison, 1996; Steel and Rentsch, 1997;). This approach draws its theoretical

underpinnings from the Genetic theory. Mitchell (1979) regarded dispositional variables as playing a

‘secondary’ role, but subsequent empirical evidence has tended to refute this. Staw and Ross (1985)

conducted the first major study using the dispositional argument. A longitudinal study was

conducted to investigate dispositions and job factors as determinants of job satisfaction. The study

found temporal stability in job satisfaction scores and this could be largely attributed to the role

played by dispositions in shaping work-related outcomes. Arvey et al (1989) also found support for

the genetic theory by studying job satisfaction of monozygotic (identical) twins reared apart. The

findings of this study were later re-inforced by a replicate study by Arvey, McCall, Bouchard and

Taubman (1994).

The majority of dispositional research has used personality characteristics as the main focus

of investigation in determining influences on job satisfaction. The literature suggests that personality

characteristics have generally been classified into 2 main categories : Positive affectivity and

Negative affectivity (Weiss and Cropanzano, 1996). (ie. The disposition to experience positive or

negative emotional states (Watson and Tellegen, 1985) Research findings indicate that individuals

high on positive affectively tend to experience greater levels of satisfaction and individuals high on

negative affectivity experience lower satisfaction (Porwal and Sharma, 1985; Levin and Strokes,

1989; Kraiger et al, 1989).

More recently, there has been increasing support for the Five-Factor Model of Personality

(referred to as the ‘Big-Five’), which aims to encompass most personality dimensions (Burke et al,

1993; Morrison, 1996; Salgado, 1997; Chiu and Kosinski, 1997; Mount and Barrick, 1998). In

addition, studies have indicated significant correlations between positive and negative affectivity and

the Big-Five personality dimensions (Watson and Clark, 1992). Specifically, it appears that the

personality characteristics of positive and negative affectivity correspond to the Extraversion and

Neuroticism dimensions, in the Five-Factor model of personality (Costa and McCrae, 1980, 1984;

Morrison, 1996). Studies conducted using the ‘Big-Five’ personality taxonomy have found support

for personality dimensions as predictors of work-related attitudes (job satisfaction) and outcomes

(job performance) (Barrick and Mount; 1991; Morrison, 1996; Tett et al, 1991).

Kohan and Connor (2002) examined job satisfaction, job stress and thoughts of quitting in

relation to positive and negative effect, life satisfaction, self-esteem and alcohol consumption among

police officers. The study concluded that job satisfaction was primarily associated with positive

effect, life satisfaction and self esteem; job stress was primarily associated with negative effect and

alcohol consumption; troughs of quitting had moderate loading on both the factors.

Lounsbury, et. al (2006) used a conceptual model proposing paths from personality traits to

career satisfaction and life satisfaction and then from career satisfaction to life satisfaction. The

sample consisted of information science professionals. An exploratory ‘maximum lifeblood common

factor’ analysis revealed two oblique personality factors. While the first factor comprised of

extraversion, optimism, assertiveness, openness and emotional stability, the second consisted of

conscientiousness and tough-mindedness. Results indicated a good fit for a two factor personality

model, showing significant links between personality factor and career satisfaction, between

personality factor and life satisfaction and then between career and life satisfaction.

From the above research it is concluded that the situational (or work) and the dispositional

(or personality) approaches have dominated the study of job satisfaction. However in recent years

researchers have argued using only one of these approaches presents an incomplete understanding.

This points to the appeal of an interactive approach in developing an improved conceptual

framework for studying job satisfaction by using both the characteristics of the job and the

individual’s personality characteristics.

6.2 REVIEW OF THE JOB SATISFACTION RESEARCH IN HEALTHCARE

INDUSTRY

After 1991 due to liberalization policy of India and globalization the health sector groomed

very fast pace in the hands of private hospitals due to technology exchange and expertise, various

researches were conducted on employee satisfaction which is related to patient satisfaction which is

the central motto of the private hospitals.

In (1996) David S. Osion conducted a study on hospital pharmacists to find relationship

between pharmacist’s job satisfaction and involvement in clinical activities, the study conducted that

number of hours or the percentage of time hospital pharmacists were engaged in clinical activities

was significantly associated with job satisfaction.

Deary, Blenkin and Agius (1996), in their study, they looked at the causes and outcomes of

job stress and personal achievement, have defined environmental demand, perceptions of demand

and ability to cope, and also stress responses, consequences of coping responses and feedback

among various stages of the stress process ass the aspects of satisfaction and dissatisfaction of the

doctors.

In Aronson (1997) conducted a study of job satisfaction of nurses working in private

psychiatry hospitals, about 3000 employers which revealed that working conditions pay dividends

and recognition of work were drivers of satisfaction among nurses.

In Anthony knight (2000) conducted a study on nuclear medicine technologists job

satisfaction having a sample size of 5000 employers in mainly four hospitals, the study revealed that

autonomy in making work schedules by the supervisor and superior subordinate relationship were

the main factors of satisfaction among technologists.

Kluger, Townend and Laid law (2003), in their study, in which the aim was to analyze the

job satisfaction, dissatisfaction and stress of anesthetists in Australia, have mentioned that private

practitioners find time issue more important compared to public ones, whereas public hospital

doctors find communication issue more important than private ones.

Zingeser (2004) conducted a study on career and job satisfaction in speech-language

pathology health care, the study examined that career growth and job satisfaction, are more subtle

aspects in the work lives of audiologists to gets and speech language pathologists.

Eker et al. (2004), in their study, where they examined the level of job satisfaction among

physiotherapists in Turkey, have stated that leadership, interpersonal; relationships advancement and

salary were the most important predictors of job satisfaction.

In (2005) study conducted by Dr. Bidhan Das on employee satisfaction means an efficient

health care facility, the study was conducted in a questionnaire format with 30 front office team

members and it revealed that compensation of benefits are important to employee job satisfaction.

Bennett, Plint, Clifford (2006), conducted survey at Canadian hospital based child protection

professionals on burnout, psychological morbidly, job satisfaction and stress. The study concluded

that burnout, and high levels of job stress were most responsible for the staff to leave and that

increasing the number of programme staff and consequently reducing the number hrs of work were

important areas of job satisfaction.

William, Bvelens and Jony (2007) conducted a study on impact of organizational structure or

nurse’s job satisfaction. The sampling unit consisted of 764 non-managing nurses in three Belgian

general care hospitals. The research concluded the importance of the dimension pay in nurse’s job

satisfaction which is not a function of the organization structure, is limiting hospitals in improving

nurse’s job factor. However the organizational structure does impact the other dimensions of

satisfaction i.e., specialization and formalization of authority.

Bayliss (2007) a comparative study of role stress on government and private hospital

employers of New Zealand. The sample size was 2000 conducted in four hospitals. The factors of

job stress are bureaucracy and interference of politicians in government hospitals and in private

hospitals the workload was a significant factor which indirectly affects satisfaction levels.

It is observed from different studies that nursing ranks are thinning just as the need for nurses

is poised to soar due to baby boomers heading into retirement. Radiation technologists and

technically inclined students are increasingly choosing software related jobs. Pharmacists are also in

short supply. Pharmacists are also in short supply at about half of all Indian hospitals. The causes are

lower pay combined with a frustrating work environment. With increased job pressures, an increase

in the acuity of patients, declining nurse to patient ratios, less autonomy and more administrative

duties, its no wonder health care professionals are re-evaluating their decisions. Non-hospital jobs

offer more flexible hours, more advancement opportunities, equal or better pay and a best less stress.

The stress level is same is in both government and private hospitals but factors contributing it to are

different, bureaucracy and interference of politicians in government hospital and workload in private

hospitals. The drivers of job satisfaction in case of pharmacists and radiation technologists are

reduced working hours, superior-subordinate relationship and autonomy in work in case of nurse are

working conditions, pay dividends and recognition of work. Stress due to work overload, inadequate

flow of communication is areas dissatisfaction among doctors.

CHAPTER – 7

RESEARCH METHODOLOGY & LIMITATIONS

7.1 RESEARCH METHODOLOGY

Research Methodology of the project is as follows:

Universe: - The population for this particular study consists of physician, nurses, paramedical

staff of Government Civil hospital and Dayanand Medical College Hospital at Ludhiana City in

Punjab.

Sampling unit: - The sampling unit of this research consists of 120 employees (50 from

government hospital and 70 from private hospital) but the response result is 40 from government

hospital and 50 from private hospital.

Sampling design: - Exploratory design

Sampling method: - Random sampling

Method of data collection: - The method of data collection was a field research and the

material used in study was a survey (questionnaire). In order to assess the job satisfaction Minneosta

Satisfaction Questionnaire (MSQ) was used. The questions of the survey were adapted to the

hospital environment in order for them to be compatible with the research. The survey consisted of a

Likert-type scale ranging from 1 “Strongly agree” to 5 “Strongly disagree”. The scale was

standardized by calculating its reliability and validity. Reliability came to be 0.793 and validity was

0.890.

Procedure:-The self –administer questionnaires were anonymous in order to prevent any

hesitation while answering the questions and to control internal validity. They were given to the

senior medical superintendent to be distributed to doctors, nurses and paramedical staff. They were

requested to return back in two weeks. It was predicted that filling out the survey would take 20

minutes. After two weeks, they were collected and taken into data analysis.

7.2 LIMITATIONS OF THE STUDY

1. Biasness on the part of respondents: Some respondents were not ready to reveal the true

information.

2. Time Consuming-Many respondents do not return the Questionnaire in time despite of

several reminders.

3. Inaccurate access-Risk of colleting incomplete and wrong information as people are

unable to understand questions properly.

4. Non response-many people do not respond and returned the questionnaire without

answering all questions.

5. Questionnaire method cannot to used for illiterate persons.

CHAPTER – 8

OBSERVATIONS, ANALYSIS & DISCUSSION

8.1 SURVEY DATA

The following is the actual responses to all questions asked. The data is displayed as

government Hospital (GH)/Private Hospitals (PH)

1. How would you describe the level of your overall job satisfaction with your work at

……………. Hospital?

Table 8.1

Very

Satisfied

1

Somewhat satisfied

2

Neither satisfied nor dissatisfied

3

Somewhat dissatisfied

4

Very dissatisfied

5

Number of responses GH/PH

6

16

16

22

8

5

6

5

4

2

% of total responses

15%

32%

40%

44%

20%

10%

15%

10%

10%

4%

Describe your level of agreement/disagreement with each statement:

Question Agree strongly

1

Somewhat agree

2

Neither agree nor disagree

3

Somewhat disagree

4

Disagree strongly

5

2. I understand the long-term plan of ….. Hospital

(40/50)

Number responses

8 / 18 24 / 20 6 / 5 2 / 6 0 / 1

% responses 20%/36% 60%/40% 15%/10% 5%/12% 0%/2%

3. I have confidence in the hospital

Number

Responses

10 / 20 20 / 25 6 / 5 1 / 0 3 / 0

leadership to implement the plan

(40/50)

% responses 25%/40% 50%/50% 15%/10% 2.5%/0% 7.5%/0%

4. There is adequate planning of hospital objectives

(40/50)

Number

Responses10 / 19 10 / 26 16 / 5 4 / 0 0 / 0

% responses 25%/38% 25%/52% 40%/10% 10%/0% 0%/0%

5. I contribute to the planning process at Hospital

(40/50)

Number responses

8 / 15 10/20 12 / 10 6 / 0 4 / 5

% responses 20%/30% 25%/40% 30%/20% 15%/0% 10%/10%

6. I am proud to work for Hospital

(40/50)

Number responses

4 / 18 8 / 23 14 / 09 10 / 0 4 / 0

% responses 10%/36% 20%/46% 35%/18% 25%/0% 10%/0%

7. I fee I contribute to the facility’s plan and mission

(40/50)

Number responses

2 / 20 16 / 30 8 / 0 12 / 0 2 / 0

% responses 5%/40% 40%/60% 20%/0% 30%/0% 5%/0%

8. I am given enough authority to make decisions I need to make.

(40/50)

Number responses

2 / 10 8 / 22 2 / 10 10 / 5 18 / 3

% responses 5% / 20% 20%/44.% 5%/20% 25%/10% 45%/ 6%

9. My physical working conditions are good

(40/50)

Number responses

16 / 41 14 / 6 2 / 3 0 / 0 8 / 0

% responses 40%/82% 35%/12% 5%/6% 0%/01% 20%/0%

10. If I do good work I can

Number responses

8 / 20 16/ 25 8 / 4 6 / 1 2 / 0

count on making more money

(40/50)

% responses 20%/40% 40%/50% 20%/8% 15%/2% 5%/0%

11. If do good work I can count on being promoted

(40/50)

Number responses

2 / 26 14 / 14 20 / 6 2 / 2 2 / 2

% responses 5%/52% 35%/28% 50%/12% 5%/4% 5%/ 4%

12. I believe my job is secure

(40/50)

Number responses

24/ 10 8 / 15 6 / 15 2 / 6 0 / 4

% responses 60%/20% 20%/30% 15%/30% 5%/12% 0%/8%

13. I feel part of a team working towards shared goals

(40/50)

Number responses

12 / 24 2 / 23 14 / 2 8 / 0 4 / 1

% responses 30%/48% 5%/46% 35%/4% 20%/0% 10%/2%

14. I like the type of work that I do

(40/50)

Number responses

4 / 18 6 / 30 2 0/ 2 4 / 0 6 / 0

% responses 10%/36% 15%/60% 50%/4% 10%/0% 15%/0%

15. I feel valued at ……… Hospital

(40/50)

Number responses

2 / 7 10 / 30 16 / 6 10 / 5 2 / 2

% responses 5%/14% 25%/60% 40%/12% 25%/10% 5%/4%

16. I like the people I work with at Hospital

(40/50)

Number responses

2 / 25 12 / 15 8 / 5 14 / 4 4 / 1

% responses 5%/50% 30%/30% 20%/10% 35%/8% 10%/2%

17. I experience a spirit of cooperation at Hospital

(40/50 )

Number responses

10 / 15 14 / 30 10 / 2 4 / 3 2 / 0

% responses 25%/30% 35%/60% 25%/4% 10%/6% 5%/0%

18. At ………. Hospital I am treated like a person, not a number

(40/50)

Number responses

2 / 16 28 / 20 4 / 7 6 / 6 0 / 1

% responses 5%/32% 70%/40% 10%/14% 15%/12% 0%/02%

19 I am given enough recognition by manage-ment for work that’s well done

(40/50)

Number responses

4 / 15 14 / 25 10 / 5 8 / 5 4 / 0

% responses 10%/30% 35%/50% 25%/10% 20%/10% 10%/0%

20. Communica-tion from manage-ment are frequent enough

(40/50)

Number responses

0 / 8 14 / 35 16 / 0 8 / 6 2 / 1

% responses 0% / 16% 35%/70% 40%/0% 20%/12% 5%/2%

21. Communication from manage-ment keep me up to date on the hospital

(40/50)

Number responses

2 / 8 30 / 39 6 / 1 2 / 2 0 / 0

% responses 5%/16% 75%/78% 15%/2% 5%/4% 0%/0%

22. I feel I can trust what I am told by the manage-ment staff

(40/50 )

Number responses

0 / 20 12 / 25 16 / 0 10 / 4 2 / 1

% responses 0%/40% 30%/50% 40%/0% 25%/8% 5%/2%

23. Quality is a top priority at ……… Hospital

(40/50)

Number responses

2/ 32 4 / 11 10 / 3 20 / 3 4 / 1

% responses 5% / 64% 10%/22% 25 % / 6% 50% / 6% 10% / 2%

24. My supervisor asks me for input to help make decisions

(40/50)

Number responses

10 / 18 16 / 27 8 / 0 4 / 5 2 / 10

% responses 25%/36% 40%/54% 20%/0% 10%/10% 5%/0%

25 I feel that my supervisor gives me adequate support

(40/50)

Number responses

4 / 10 12 / 30 20 / 1 2 / 9 2 / 0

% responses 10%/20% 30%/60% 5%/2% 5%/18% 5%/0%

26. My supervisor treats me with respect

(40/50)

Number responses

2 / 18 12 / 20 8 / 5 14 / 6 4 / 1

% responses 5% / 36% 30%/40% 20 %/10% 35%/12% 10%/2%

27. I feel that my supervisor treats me fairly

(40/50)

Number responses

2 / 16 14 / 24 8 / 3 12 / 5 4 / 2

% responses 5% / 32% 35%/48% 20%/6% 30%/10% 10%/4%

28. My supervisor tells me when my work needs to be improved

(40/50)

Number responses

2 / 17 16 / 23 10 / 4 12 / 5 0 / 1

% responses 5%/34% 40%/46% 25%/8% 30%/10% 0%/2%

29. My supervisor tells me when I do my work well

(40/50)

Number responses

4 / 15 14 / 20 12 / 5 8 / 8 2 / 2

% responses 10%/30% 35%/40% 30%/10% 20%/16% 5%/4%

30. I am provided enough information the Hospital to do my job well

(40/50)

Number responses

2 / 15 10 / 18 14 / 10 12 / 7 2 / 0

% responses 5%/30% 25%/36% 35%/20% 30%/14% 5%/0%

31 My initial training provided by the Hospital was as much as I needed

(40/50)

Number responses

2 / 15 12 / 22 16 / 7 10 / 6 0 / 0

% responses 5%/30% 30%/44%40%/14%

25%/12% 0%/0%

32. As much on-going training as I need is provided by the Hospital

(40/50)

Number responses

2 / 25 10 / 22 10 / 0 16 / 2 2 / 1

% responses 5%/50% 25%/44% 25 %/0% 40%/4% 5%/2%

33. I believe my salary is fair for my respon- sibilities

(40/50)

Number responses

8 / 4 16 / 16 10 / 15 4 / 10 2 / 5

% responses 20%/8% 40%/32%25%/30%

10%/20% 5%/10%

34. I would recommend employment at Hospital to my friend

(40/50)

Number responses

6/ 10 20 / 32 12 / 6 0 / 2 2 / 0

% responses15%/20%

50%/64%30%/12%

0 %/04% 5%/0%

I am satisfied with the

35. Overall benefits package

(40/50)

Number responses

6 / 5 26 / 28 4 / 6 2 / 7 2 / 4

% responses15%/10%

65%/56%10%/12%

5%/14% 5%/8%

36. Amount of vacation

(40/50)

Number responses

8 / 8 22 / 20 4 / 6 6 / 12 0 / 4

% responses20%/16%

55%/40%10%/12%

15%/24% 0%/8%

37. Sick leave policy

(40/50)

Number responses

8 / 7 24 / 18 6 / 10 2 / 10 0 / 5

% responses20%/14%

60%/36%15%/20%

5%/20% 0%/10%

38. Amount of health care paid for by health insurance

(40/50)

Number responses

10 / 7 24 / 16 2 / 10 2 / 12 2 / 5

% responses25%/14%

60%/32% 5%/20% 5 %/24% 5%/10%

39. Retirement plan benefits

(40/50)

Number responses

10 / 4 22 / 16 2 / 10 6 / 15 0 / 5

% responses 25%/8% 55%/32% 5%/20% 15%/30% 0%/10%

40. Life insurance

(40/50)

Number responses

12 / 4 24 / 24 2 / 11 0 / 8 2 / 3

% responses 30%/8% 60%/48% 5 %/22% 0 %/16% 5%/6%

41. Disability benefits

(40/50)

Number responses

12 / 3 22 / 16 2 / 13 4 / 12 0 / 6

% responses 30%/6% 55%/32% 5%/26% 10%/24% 0%/12%

42. Are there any benefits you would like to see added to ………….. Hospital’s benefits package?

YES NO NO ANSWER TOTAL

24 / 31 (60% /62%) 6 / 8 (15% / 16) 10 / 11(25% / 22%) 40 / 50

What would you like added?

Response # Response % of Respondent

1. Health insurance 4 / 10 8% / 17%

2. Dental 6 / 15 12% / 25%

3. Lower deductions & deductibility 2 / 5 4% / 8%

4. Vision 10 / 13 20% / 22%

5. Retirement plan 2 / 9 4% / 15%

6. Reduced fee for clinic visits 8 / 0 16% / 0%

7. The current basics 6 / 1 12% / 2%

8. Paid continuing education and professional fees 4 / 4 8% / 7%

9. Bonuses for longevity and years of service 8 / 3 16% / 5%

43. How long do you plan to continue your employment at …………. Hospital?

Response # Response %n of Respondent

1. 3 to 4 more years 2 / 10 5% / 20%

2. Will leave as soon as possible 4 / 8 10% / 16%

3. Until retirement 14 / 13 35% / 26%

4. Not long 0 / 0 0% / 0%

5. As long as possible 16 / 9 40% / 18%

6. 2 to 3 months 0 / 0 0% / 0%

7. 3 weeks 0 / 0 0% / 0%

8. Unknown 2 / 5 5% / 10%

9. 5+years 2 / 3 5% / 6%

10. Will leave if no health insurance 0 / 2 0 %/ 4%

44.  Please tell us what _________ can do to increase your satisfaction as an employee.

RESPONSES

Put people in positions of management that know what they are doing and that don’t do

the crisis micro management thing. Also provide insurance that is affordable and wages that

are competitive to other facilities and that allow us to pay for the insurance.

There needs to be more communication between all employees, management and staff.

They need to hire more dependable help and then treat them good.

Training for specific job duties to improve skills, cross train other employees to fill in

while on vacation or ill.

These questions are for statistical use only. This section was optional.

45. What is your age?

Under 21 0 / 0

21 to 34 12 / 24

35 to 44 10 / 11

45 to 54 10 / 5

55 or older 8 / 10

46. What is your sex?

Male 21 / 28

Female 19 / 22

47. What is your marital status?

Married 29 / 32

Unmarried 11 / 18

48. How many children under the age of 18 do you have?

None 15 / 21

One 10 / 12

Two 9 / 10

Three 5 / 4

Four 1 / 2

Five or more 0 / 1

49. How long have you worked for …….. Hospital?

Less than one year 0 / 13

One year to less than two years 0 / 7

Two years to less than five years 6 / 14

Five years to less than ten years 21 / 9

Ten years or more 13 / 7

50. What is your total before-tax monthly income from this job, including overtime and bonuses?

Less than Rs 1000 4 / 14

Rs 10,000 to less than Rs 20,000 12 / 16

Rs 20,000 to less than Rs 30,000 10 / 8

Rs 30,000 to less than Rs 40,000 12 / 10

Rs 40,000 to less than Rs 50,000 2 / 2

Rs 50,000 or more 0 / 0

8.2 COMPARATIVE STUDY OF EMPLOYEES SATISFACTION (ANALYSIS &

DISCUSSION)

This report presents the results of the Hospital Employee satisfaction survey of Civil Hospital

and Dayanand Medical College Hospital Ludhiana. Of the 40 and 50 completely filled

questionnaires from both the hospitals:

70% / 52% are 35 years of age or older

48% / 44% are female

72% / 64% are married

47% / 44% have two or less children

15% / 28% have worked at hospital less than 5 years

40% / 60% have a total before tax income less than Rs 20000/- per month

Graph 8.1 : LEVEL OF SATISFACTION (IN % AGE)

15%

32%

40%

44%

20%

10%

15%

10% 10%

4%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Very satisfied Somewhatsatisfied

Neithersatisfied norunsatisfied

Somewhatunsatisfied

Veryunsatisfied

Government

Private

Observation: The overall employee satisfaction level is more in private hospital than in

government hospital.

Analysis & Discussion: The study reveals that the overall level of job satisfaction in private

hospital (32+44=76%) is more than in government hospital (15+40=55%). It is attribute to the better

infrastructure, god working conditions, better facilities and work culture etc. in private hospital than

in government hospital.

Graph 8.2: PLANNING (IN % AGE)

80%76% 75%

90%

50%

90%

45%

70%

45%

100%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

UnderstandPlan

Confidencein

Leadership

AdequatePlanning

Contributesto process

Contributesto Mission

Government

Private

Note: The percentage of ‘Understand Plans’ is the sum of the percentages of strongly agree

and somewhat agree. Similar pattern is followed in all the graphs for all the factors.

Observation : Confidence in leadership, contribution to the planning processer mission of

the hospital are more in private hospital while understanding of plan is more in government

hospitals.

Analysis & Discussion : Confidence in leadership, contribution to the planning process or

mission of the hospital are more in private hospital because of the participatory style of management.

In private hospital the employees are free to consult with the management their problems,

innovations regarding the methods of performing the job. They are confident that the top

management is trying its level best to achieve the organizational goals as well as individual goals of

the employees. In government hospital employees are dissatisfied as they are not asked to contribute

to the framing of health care polices. They have no authority to contribute to the innovative changes

as the hierarchy is rigid and tall and moreover due to lot of political interference in government

hospital.

Graph 8.3: GENERAL APTITUDE (IN % AGE)

30%

82%

25%

64%

75%

94%

25%

96%

30%

74%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Proud to work Givenauthority

Goodconditions

Like work Feel valued

Government

Private

Observation: All general aptitude factors are higher in private hospital than in government

hospital.

Analysis & Discussion : General aptitude e.g., proud to work, given authority, good working

conditions, role clarity, recognition of work are higher in private hospital in comparison to the

government hospital due to the clean working environment, proper layout, centrally air conditioned

building, availability of latest equipment as demanded by doctors and technicians, maintenance of

equipments are well provided in private hospital. These facilities lack in government hospital. If a

doctor demands some latest equipment a lot of paper work has to be done. The undue legal

formalities and allocation of funds for the purchase takes long time. The class four employees do not

work properly. Sometimes they show disobedience to their senior due to security of job in

government hospital. In private hospital the duties are well defined, properly documented and

distributed at all levels of working without duplication of efforts. In government hospital undue

interference of seniors disrupts the activities of the juniors which also lead to stress. The recognition

of work is more in private hospital as the management appraises the employees though rewards and

promotions but in government hospital if any challenging work is accomplished by someone, the

management does not take into account and the awards if any are given politically.

Graph 8.4: PERFORMANCE ISSUES (IN % AGE)

60%

90%

40%

80% 80%

50%

35%

94%

60%

90%

35%

80%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Go

od

wo

rk=

mo

rem

on

ey

Go

od

wo

rk=

Pro

mo

tion

Job

isse

cure

Fe

el p

art

of

tea

m

Co

op

era

tive

spir

it

Lik

es

Co

-w

ork

ers

Government

Private

Observation: Security of job is more in government hospital while all the other factors are

on higher side in private hospital.

Analysis & Discussion: In private hospital team cohesiveness is more among doctors, nurses

and paramedical staff for achieving the set targets and goals. They work together in a team spirit and

obey to the command of the team leader usually a senior doctor and results in utmost satisfaction of

the patients. In government hospital nurses and paramedical staff do not perform their duties well;

there is also lack of group cohesiveness. A doctor has to do their task also. In private hospital work

is acknowledged. The staff is promoted on the performance basis. In government if some critical

work is accomplished the senior do not recognize the work. The promotion is merely on the basis of

seniority and not on the basis of skill and targets accomplishment.

Job security is maximum in government hospital than in private hospital. The staff working in

government hospital cannot be fired even in case of very high negligence of duties. On the contrary

the staff in private hospital can be fired at any time; the organization can show any reason as the

cause of firing process.

Graph 8.5: MANAGEMENT ISSUES (IN % AGE)

45%

80%

35%

86%80%

94%

30%

90%

15%

86%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Giv

en

reco

gn

itio

n

Fre

qu

en

tco

mm

un

ica

tion

Ke

pt c

urr

en

t

Fe

el t

rust

Qu

alit

y p

rio

rity

Government

Private

Observation: The entire management issues factor have high percentage in private hospital

in comparison to government hospital.

Analysis & Discussion: In private hospital, the recognition of work, communication flow,

and quality of services is higher than in government hospital. The management acknowledges the

work of each employee though the achievement of targets and feedback from the patients.

The communication flow is fast and frequent through intercom, e-mails or use of hospital

information system. Junior reports to the seniors and senior to the top management. The information

flow is two-way i.e., from top to bottom and vice-versa. The management keeps suggestion /

complaint boxes at important places in the hospital so that anyone can reveal easily his problems as

well as his views to improve the working and the services provided by the hospital. Junior can freely

discuss the critical as well as important matters with the seniors. In government hospital there is a lot

of bureaucratic set up and the flow of information is inadequate.

Graph 8.6: SUPERVISORY ISSUES (IN % AGE)

65%

90%

40%

80%

35%

76%

40%

80%

45%

80%

45%

70%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Ask

s fo

rin

pu

ts

Giv

en

sup

po

rt

Re

spe

cts

Tre

ats

fair

ly

Tells

ne

ed

to im

pro

ve

Tell

we

lld

on

e

Government

Private

Observation: All the supervisory issues have higher percentage in private hospital than in

government hospital.

Analysis & Discussion : The supervisory issues have a high percentage in private hospital

than in government hospital as the seniors contribute in guiding and watching the juniors regarding

handling of instruments, proper care of patients, diagnosis and treatment of illness, the medicine

with quantity and quality to be administered. In government hospital there is lack of support from

juniors as well as the seniors. They do not discuss the case with each other and thus do not contribute

to the learning process.

Graph 8.7: TRAINING & SALARY ISSUES (IN % AGE)

30%

66%

35%

74%

30%

94%

60%

40%

65%

84%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Adequateinformation

Adequateorientation

Ongoingtraining

Fair salary Wouldrecommend

Government

Private

Observation: Fair salary is more in government hospital while all the others have high

percentage in private hospital.

Analysis & Discussion: Fair salary is more in government hospital as the salary is quantified

according to the post held. In private hospital the salary of doctors is based on per patient or on share

basis and of paramedical staff and nurses is even on hourly basis. In government hospital there is no

adequate provision of on the job training or reorientation programmes. The doctors as well a other

staff are not updated on the latest researches in the medical field. If anyone wants to go for higher

education at the first instance he is not allowed to go or has to complete a lot of formalities and even

sometimes he is compelled to go on leave without salary. It mars the tempo of learning in the

hospital. In private hospital the training on the job is given very much importance. The management

organizes various seminars and conferences for updating the employees at all levels. In some cases

sanctions half pay leave for further training, sponsor fellowship for doctors and diploma courses for

nurses. All these measure contribute to the higher level of job satisfaction in a private hospital.

Graph 8.8: BENEFITS (IN % AGE)

80%

66%

75%

56%

80%

50%

85%

46%

80%

40%

90%

56%

85%

38%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Ove

rall

Va

catio

n

Sic

k le

ave

He

alth

Re

tire

me

nt

Be

ne

fits Life

Dis

ab

ility

Government

Private

Observation: All these benefits are more in government hospital than in private hospital.

Analysis & Discussion: One of the major findings is that benefits are case of government

hospitals are more than in private hospital. In government hospital the salary is on the basis of post

held and seniority and not on performance basis whereas in private hospital it is based on the number

of patients per day treated by doctors or cared by staff nurses. The vacations on various occasions

are more in government hospital than in private hospital. The sick leaves, maternity leaves, paternity

leaves and earned leaves are more in government hospital. In private hospital there is no adequate

provision of these types of leave. In fact the staff has to serve 24-hours with a shift system. During

national and state holidays the management persons get leave while the doctors, nurses and

paramedical staff have to be present. In government hospital the employees get more retirement

benefits like pension, gratuity, and leave-encashment even after 20 years of service whereas in

private hospital no such benefits are given. In the form of disability benefits in government hospital

disabled persons are employed by reserving some posts for them and after posting they are given

some more benefits like traveling allowance for coming and going back from their home to the

hospital daily. In private hospital the management does not give employment to the disabled persons.

If a staff member during the service becomes disabled physically and is unable to achieve the set

targets, he is fired out by the management. He is given little compensation and is not allowed to

continue his job. Life and health insurance policies are provided in government hospital with small

percentage of premium contributed by the employees and remaining by the government. In private

sector such facilities are denied.

8.3 T-TEST METHOD

Table 8.2: Comparison of Job Satisfaction in Government and

Private Hospital Employees

Let us take the hypotheses 1:

Ho= There is no difference between GH and PH regarding job satisfaction.

H1= GH have more job satisfaction than PH.

t-test Agree strongly

1

Somewhat Agree

2

Neither Agree Nor Disagree

3

Somewhat Disagree

4

Disagree Strongly

5

No. of observation GH/PH

n40,40 40,40 40,40 40,40 40,40

Mean X 6,15 15.2,22.5 9.75,5.67 6.62,5.0 2.52,1.67

Standard deviation S 6.73 6.66 4.71 4.45 2.57

Calculated values of t -5.98 -4.90 3.87 1.63 1.48

Degrees of freedom =n1+n2-2

78 78 78 78 78

Table value of t t0.05(78) 1.64 1.64 1.64 1.64 1.64

The calculated value of |t| is greater than the table value in case 1, 2, and 3. Hence,

H0 is rejected in cases 1, 2 and 3 showing there is a difference, Government hospital has less

job satisfaction level than the private hospital.

The calculated value of t is less than the table values in cases 4 and 5.

Hence H0 is accepted in cases 4 and 5 showing there is no significant difference to the

disagreement level to the job satisfaction in government hospital and private hospital.

T-Test Method

Table 8.3: Comparison of Benefits

Let us take the hypotheses 2:

H0 =There is no difference between GH and PH regarding the benefits provided.

H1=GH provide less benefits than PH

t-test Agree strongly

1

Somewhat Agree

2

Neither Agree Nor Disagree

3

Somewhat Disagree

4

Disagree Strongly

5

No. of observation GH/PH

n

40,40 40,40 40,40 40,40 40,40

Mean X 9.43,5.4323.14,19.7

13.14,9.43 3.14,1086 0.86,4.6

Standard deviation S 2.07 3.443 2.132 2.511 1.032

Calculated values of t 3.62 1.86 -5.52 -5.75 -6.78

Degrees of freedom

= n1+n2-212 12 12 12 12

Table value of t 0.05(12) 1.78 1.78 1.78 1.78 1.78

The calculated values of |t| are greater than the table value in all cases 1, 2, 3, 4 and 5. Hence

H0 is rejected in all the five cases. It shows there is difference. The benefits like overall benefits

package, vacation, sick leave, health care, retirement, and disability are more in government hospital

than in private hospital.

CHAPTER – 9

IMPLICATIONS OF STUDY

The study reveals that job satisfaction of private hospital employees is more than government

hospital employees as a result, specialist doctors move in private hospitals due to availability of

modern equipments, good working conditions, recognition and challenging work and chances of

advancement. The nurses and paramedical staff are happier in government hospital due to high

salary as compared to private hospital and less work. Due to high job security in government

hospital the nurse and paramedical people do not support the doctors in performing operations and

medical duties. The class four people show disobedience in performing their duties pertaining to

cleaning and maintaining the hospital premises, rather these people enjoy their working more in

government hospital than private hospital i.e. why the private hospitals are always in short of nurses

& paramedical staff. In government sector the promotion is on seniority basis than on performance

and is timely. These people have access to political persons. The quality of health care in

government hospital is almost degraded due to lack of latest instruments and support of staff which

led to the proliferation of private hospitals in Ludhiana city. There is one government hospital and

four big renowned hospitals like Dayanand Medical College and Hospital, Christian Medical

College and Hospital, Mohan Dai Oswal Hospital and Apollo Hospital recently came into operation

in 2005. These all are super specialty hospitals with a capacity of more than 500 beds each.

The Punjab Government in 2006 appointed the doctors and paramedical staff on contract

basis in rural areas with a lucrative salary especially for graduate doctors as they are under paid in

private hospitals. This has resulted in the shortage of junior doctors in private hospitals. Now the

government is revising its healthcare machinery by appointing more doctors and paramedical staff

on contract basis even in urban areas in order to deliver the better health care facilities to poor

section of the society for which responsibility of healthcare lies on government. The contractual

labour policy helps the government to keep a track of highly performing staff so that they will enter

into job on achievement basis.

The doctors get a competitive exposure in the private hospital and their skills are optimally

utilized and they are promoted on performance basis only. The private hospital has an edge over

government hospital in terms of infrastructure, autonomy given by management on clinical activities

and improvement in the clinical processes. The sponsoring of doctors to fellowship programmes and

nurses and paramedical staff to diploma courses is done on the basis of achievement and

performance. They are provided with subsidized houses and canteen facilities. Due to above reasons

the healthcare is going day by day into the private hands from government as there is efficient

management in terms of manpower, materials, equipments, procedures and funds.

CHAPTER – 10

SUGGESTIONS / RECOMMENDATIONS

IN THE FOLLOWING AREAS

Variable which have a significant impact on satisfaction level

(a) Job security

(b) Job benefits

Areas of dissatisfaction in Government Hospital:

1. Superior-subordinate relationship

2. Lack of infrastructure an support from staff

3. Working conditions

4. Participation in decision making and recognition of work

Areas of dissatisfaction in Private Hospital:

(a) Job security

(b) Benefits

In government hospital the satisfaction level can be increased by providing better

infrastructure, latest equipments, decentralizing the power to make decisions, making adequate

planning, giving performance based promotions, by giving rewards in recognition to good work,

giving priority to quality of work and by imparting adequate training to upgrade knowledge and skill

of employees through of seminars, workshops and medical camps. The senior should contribute to

the development of juniors by sharing their experience with juniors, and by avoiding the political

interference.

In private hospital the employees satisfaction level can be increased further by giving fair

salary to the employees, by providing security of job, giving retirement benefits like pension,

gratuity, leave encashment, adequate number no of leaves, health and insurance policies.

CHAPTER – 11

CONCLUSION OF STUDY

The survey has brought certain features regarding the job satisfaction of government and

private hospital employees. The prominent areas of satisfaction among government hospital

employees are job security and benefits where as in private hospital areas of satisfaction are good

working conditions, better superior-subordinate relationship, interpersonal relations, promotion on

performance basis and recognition of good work. The employees of government hospital are

dissatisfied mainly due to lack of adequate and modern infrastructure, interference of seniors,

bureaucracy and politicians in the working of physicians, nurses and paramedical staff, lack of

support, disobedience from lower staff and lagging behind the private hospital in terms of up

gradation of equipments. The prominent area of dissatisfaction in private hospital is in terms of

benefits (like pension, insurance policies) and job security. Thus the government hospital is not at

par with private hospital.

**********

QUESTIONNAIRE OF STUDY

………………… Hospital

We need your help! Your answers to the following questions will be an important part of the

an organizational review being competed for ………… Hospital. Please take a few minutes to

complete this survey, and return it today. The information you provide will be completely

anonymous.

1. How would you describe the level of your overall job satisfaction with your work at

……………..Hospital? Circle one answer.

Very Satisfied Very Dissatisfied

1 2 3 4 5

Describe your level of agreement/disagreement with each statement by circling one number

for each statement.

Agree

Strongly

Disagre

e

Strongly

2. I understand the long-term plan of

……….Hospital

1 2 3 4 5

3. I have confidence in the hospital leadership to

implement the plan

1 2 3 4 5

4. There is adequate planning of hospital

objectives

1 2 3 4 5

5. I contribute to the planning process at

………….. Hospital

1 2 3 4 5

6. I am proud to work for ………. Hospital 1 2 3 4 5

7. I feel I contribute to the facility’s plan and

mission

1 2 3 4 5

8. I am given enough authority to make

decisions I need to make.

1 2 3 4 5

9. My physical working conditions are good 1 2 3 4 5

10 If I do good work I can count on making more 1 2 3 4 5

. money

Agree

Strongly

Disagre

e

Strongly

11

.

If I do good work I can count on being

promoted

1 2 3 4 5

12

.

I believe my job is secure 1 2 3 4 5

13

.

I feel part of a team working toward shared

goals

1 2 3 4 5

14

.

I like the type of work that I do 1 2 3 4 5

15

.

I feel valued at...…………. Hospital 1 2 3 4 5

16

.

I like the people I work with at …………..

Hospital

1 2 3 4 5

17

.

I experience a spirit of cooperation at

………… Hospital

1 2 3 4 5

18

.

At ………… Hospital I am treated like a

person, not a number

1 2 3 4 5

19

.

I am given enough recognition by

management

1 2 3 4 5

20 Communications from management are

frequent enough

1 2 3 4 5

21

.

Communications from management keep me

to date on the hospital

1 2 3 4 5

22

.

I feel I can trust what I am told by the

management staff

1 2 3 4 5

23

.

Quality is a top priority at ………… Hospital 1 2 3 4 5

24

.

My supervisor asks me for input to help make

decisions

1 2 3 4 5

25

.

I feel that my supervisor gives me adequate

support

1 2 3 4 5

26

.

My supervisor treats me with respect 1 2 3 4 5

27

.

I feel that my supervisor treats me fairly 1 2 3 4 5

28

.

My supervisor tells me when my work needs

to be improved

1 2 3 4 5

Agree

Strongly

Disagre

e

Strongly

29

.

My supervisor tells me when I do my work

well

1 2 3 4 5

30

.

I am provided enough information by the

Hospital to do my job well

1 2 3 4 5

31

.

My initial training provided by the hospital

was as much as I needed.

1 2 3 4 5

32

.

As much ongoing training as I need is

provided by the Hospital

1 2 3 4 5

33

.

I believe my salary is fair for my

responsibilities

1 2 3 4 5

34

.

I would recommend employment at

……………. Hospital to my friend

1 2 3 4 5

35

.

Overall benefits package 1 2 3 4 5

36

.

Amount of vacation 1 2 3 4 5

37

.

Sick leave policy 1 2 3 4 5

38

.

Amount of health care paid for by health

insurance

1 2 3 4 5

39

.

Retirement plan benefits 1 2 3 4 5

40

.

Life insurance 1 2 3 4 5

41

.

Disability benefits 1 2 3 4 5

42

.

Are there any benefits you would like to see added to …………… Hospital’s benefits

package? (check one)

Yes 0

What would you like added? …………………………………………………………

No 0

43

.

How long do you plan to continue your employment at …………… Hospital? (check one)

0 Less than 6 months 0 Less than 10 years

0 Less than 1 year 0 Indefinitely

0 Less than 5 years 0 Until retirement

44

.

Please tell us what …………….. Hospital can do to increase your satisfaction as an

employee.

…………………………………………………………………………………………………

…………………………………………………………………………………………………

…………………………………………………………………………………………………

The following questions are for statistical use only. The information will not be used to

attempt to identify individuals. This section is optional, but would help our analysis of the

data.

Check one box for each question.

45

.

What is your age?

Under 21 0

21 to 34 0

35 to 44 0

45 to 54 0

55 or older 0

49.

How many children under the

Age of 18 do you have?

None 0

One 0

Two 0

Three 0

Four 0

Five or more 0

46

.

How long have you worked for

…………….. Hospital?

47

.

What is your sex?

Male 0

Female 0

50.

What is your income before tax per month from

this job, including overtime and bonuses?

Less than Rs.10,000 0

Rs.10,000 to less than Rs.20,000 0

Rs.20,000 to less than Rs.30,000 0

Rs.30,000 to less than Rs.40,000 0

48

.

What is your marital status?

Married 0

Unmarried 0

Rs.40,000 to less than Rs.50,000 0

Rs.50,000 or more 0

Please return your entire questionnaire fulfilled.

Your help and your input are greatly admirable.

BIBLIOGRAPHY

BOOKS

Tripathi, P.C.; Personal Management and Industrial Relations, Sultan Chand and Sons,

New Delhi 2000.

Shankar, B.M.; Principles of Hospital Administration and Planning, Jaypee Brothers,

New Delhi, 2002.

Chabbra, T.N.; Human Resource Management Concepts and Issues, Danpat Rai and

Company Limited, New Delhi, 2005.

Kunders, G.D.; Hospital Facilities Planning and Management, Tata McGraw-Hill

Publishing Company, New Delhi, 2005.

Journal, Magazines

Oison David S; “Relationship between hospital pharmacists” job satisfaction and

involvement in clinical activities,” Healthy-system Pharmacy Journal June 1, 1996, Vol. No.

53, pp 281-284.

Tokar D.M., and Subich L.M., “Relative contributions of congruence and personality

dimensions to job satisfaction,” Journal of Vocational Behaviour, November 10, 1997, vol.

77, pp 703-7483.

Khwaja A., Qureshi R., Andrades M., Fatima Z., and Khwaja W., “Comparison of job

satisfaction and stress among male and female doctors in teaching hospital of Karachi,”

Social Psychiatry and Psychiatric Epidemiology, May 5, 1999, vol. 6, pp 301-308.

Lopoplo B Rosalie, “The Relationship of Role-Related variables to Job satisfaction and

commitment to the organization in a Restructured Hospital Environment”; Physical Therapy

Journal October 10, 2002, vol 82, pp 984-999.

Verhaeghe R., Mak R. and Van Maele G., “Job stress among middle-aged healthcare

workers and its relation to sickness absence,” Stress and Health: Journal of the International

society for investigator of stress, April 15, 2003, vol. 5, pp 265-274.

Randhawa G., “Job satisfaction and work performance: An empirical study”, IBAT

Journal of Management, Oct. 20, 2004, vol. 56, pp 70-80.

Byaliss R., “The national health service versus private and complementary medicine,”

British Medical Journal June 10, 2004, vol. 66, pp 95-100

Zingeser, “Career and Job satisfaction”, The ASHA. Leader June 12, 2004, vol 20, pp

14-20.

Tanka Geetika; “A comparative study of Role Stress in Government and Private

Hospital”; Journal of Health Management December 1, 2006, vol 8, pp 11-22.

Salgado J.F., “The five factor model of personality and job performance in the European

community”, Journal of Applied Psychology Jan 3, 1997, vol 9, pp 408-430.

Kanfer, “every theory as a predictor of productivity and work quality”, Bulletin, July 13,

1990, vol 70, pp 50-60.

WEB PAGES

http://www.nbrii.com/employee_surveys/satisfaction_study.html

http://herbules.oulii.fi/isbn9514268121/htmlc612.html

http://www.springerlink.com/content?k=job+satisfaction