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Study of quality of work life of nurses and its impact on their job satisfaction in selected private & government hospitals of Gujarat.
Abstract:
In this paper, the factors affecting the quality of work life of nurses in private and government hospitals of Gujarat and the impact of quality of work life (working conditions) on individual job satisfaction level of the nurses has been studied. A comparative study on the quality of work life of nurses prevailing in a private and a government hospital of Gujarat is also undertaken. Here multinomial logistic regression and non-parametric Mann-Whitney U test have been used to analyze the data related to the above objectives.

The findings throw light on some new quality of work life factors that play a significant role in determining work-life balance of nurses in these hospitals and have a positive effect on the individual job satisfaction of nurses. Moreover comparison of private and public hospitals show that the difference in job satisfaction levels among hospitals is not only factor related but also related to extent to which work-life enhancing facilities are provided by a hospital.

Keywords: Quality of Work Life (QWL), job satisfaction, private and government hospitals, multinomial regression

Article Type:
Report
Subject:
Nursing (Research)
Medical care (Quality management)
Nurses
Hospitals, Public
Job satisfaction
Authors:
Pandit, Nirali
Pant, Rashmi
Pub Date:
07/01/2010
Publication:
Name: International Journal of Business Research Publisher: International Academy of Business and Economics Audience: Academic Format: Magazine/Journal Subject: Business, international Copyright: COPYRIGHT 2010 International Academy of Business and Economics ISSN: 1555-1296
Issue:
Date: July, 2010 Source Volume: 10 Source Issue: 3
Topic:
Event Code: 353 Product quality
Product:
Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners SIC Code: 8062 General medical & surgical hospitals; 8063 Psychiatric hospitals; 8069 Specialty hospitals exc. psychiatric
Accession Number:
243957224
Full Text:
1. INTRODUCTION TO HEALTH CARE INDUSTRY

The Indian healthcare sector comprises of many segments, which include hospitals, medical infrastructure, medical devices, clinical trials, outsourcing, telemedicine, and health insurance. Its delivery market is estimated at US$ 18.7 billion and employs over four million people, making it one of the largest service sectors in the economy today. In the year 2004, total national healthcare spending had reached 5.2% of GDP, or US $34.9 billion and was expected to rise to 5.5% of GDP, or US $60.9 billion by 2009. Today, the industry has grown at about 13 per cent and is expected to grow at 15 per cent per year over the next four to five years. The growth of managed care has had major financial implications for health care delivery. One of the major implications is the quality of care which is directly affected by the quality of work life of patient care personnel (nurses) and the level of satisfaction they see in their jobs. Staffing levels of patient care personnel in hospitals comprise of registered nurses, licensed practical nurses, and unlicensed assistive personnel. However, the proportion of these nurses varies, and is usually adjusted to reduce the overall cost of patient care. But the fact is that, on an average, minimum nurse-to-patient ratios for the day shift of typical medical-surgical nursing units rage between 1:4 and 1:10. Apart from the number of nurses employed, cost reduction techniques also include the kind of facilities and work life provided to nurses on duty in hospitals. Ideally, this ratio should increase, but in order to have efficacious and cost-effective nursing staff, it becomes important to provide a congenial working environment, fair and equitable compensation, safety and healthy work place, personal and professional development, job security, ethical organizational actions, employee privacy issues, constitutionalism and supportive work culture. Provision of all these facilities will improve their quality of work life which in turn will boost their level of job satisfaction.

The quality of service provided by the hospitals is of utmost importance for improving its in-patient rate and the nurses in the hospitals play a vital role maintaining this level of service. So in order to improve the quality of its service and organizational effectiveness hospitals must ensure high commitment from its patient-care personnel which is derived if they experience a sense of job satisfaction that is directly affected by their Quality of Work Life (QWL). Thus, in the present paper, the key providers of improving organizational performance of hospitals, that is, nurses, have been studied in the context of their QWL (Quality of Work Life) and resultant job satisfaction, at few sample private and government hospitals of Ahmedabad.

2. LITERATURE REVIEW

The term Quality of Work Life (QWL) was initially introduced in the late 1960's as a way of focusing on the effects of employment on worker health and general well being, and a way to enhance the quality of a person's on-the-job experience. As quoted by Islam and Siengthai, quality of work life is a concept of behavioral scientist, and the term was first introduced by Davis in 1972 (Hian and Einstein, 1990). In simple terms QWL is extent to which employees can enhance their personal lives through their work environment and work place experiences. It is focusing strongly on providing a work environment conducive to satisfy individual needs. It is assumed that if employees have more positive attitudes about the organization and their productivity is high, everything else being equal, the organization should be more effective.

Though quality of work-life (QWL) has been gaining increasing attention in health care settings it is quite difficult to best conceptualize the quality of work life elements. Effect of QWL on job satisfaction has also been studied on employees of many industries other than healthcare. Winter et al viewed QWL for academicians as an attitudinal response to the prevailing work environment and posited five work environment domains that include role stress, job characteristics, and supervisory, structural and sectoral characteristics to directly and indirectly shape academicians' experiences, attitudes and behavior. Irrespective of occupational role, good quality of work life has always shown a positive effect on the job satisfaction of employees. This positive job satisfaction plays a key role in organizational effectiveness. Thus QWL is said to make a huge contribution to organizational effectiveness, making it important for the employer to take care of QWL effecting on job satisfaction of his/her employees.

3. RESEARCH METHODOLOGY

The present research has been conducted with the objective of studying the factors of quality of work life affecting job satisfaction level of nurses in private and government hospitals. Further, to study the impact of the prevailing quality of work life (working conditions) on individual job satisfaction level of the nurses and then compare the quality of work life of nurses of a private and government hospital.

10 variables to quality of work-life namely company's health and safety policy, provision of free working lunch, provision of transport facilities by the hospital, availability of maternal leave with salary, job related training programs provided on regular basis by the management, availability of leave when required, provision of living with family, living accommodation provided by organization, living in a hired house, healthy and hygienic living accommodation and 7 reflecting job satisfaction namely safety and security of job in the organization, confidence of being able to keep the job, satisfaction with Company's provident fund, supportive supervisor, satisfaction with organizational induction/orientation/job related training, right to put across the voice to top management and satisfaction of work related technology have been considered for study. Since the data is primarily categorical in nature (5-point nominal likert scale), nonparametric methods are adopted to test the hypotheses.

A hypothesis had been formulated is test the effect of QWL on job satisfaction of nurses and to check the difference in QWL of nurses in private and government hospitals. It is an analytical type of research where data had been collected through arranged and intercepts interviews from government & private hospitals of Ahmedabad, with the help of a reliable and validated schedule. A sample of 200 Nurses (100 from government hospital & 100 from private hospitals) has been drawn using a non probability convenience sampling technique.

Five point Likert type scale has been used in the schedule to measure QWL and Job Satisfaction of nurses where the scale rates 5 for strongly agree, 4 for agree, 3 for maybe, 2 for disagree and 1 for strongly disagree.

4. ANALYSIS AND INTERPRETATION

Here, the intention is to investigate the effect of quality of work-life (stimulus) on job satisfaction (response); and which of the stimulus variables is significant in determining the response level. For this purpose a composite score of job satisfaction has been used to create three job satisfaction levels: High, Medium and Low. Job satisfaction level (JSLevel) is then ordinal in nature. The chi-square test applied helps to identify which of the 10 variables related to quality of work-life are statistically significant for identifying job satisfaction level.

Results from the analysis on identifying factors of QWL that have an effect on job satisfaction using chisquare test show that company health and safety policy, free working lunch, availability of transport facility, maternal leave with salary, provision of job related training program and provision of healthy and hygienic accommodation are the factors that significantly affect quality of work life. While factors related to living with family and provision of accommodation by the company or the situation of living in a hired house are not significant in determining quality of work life or its effect on job satisfaction level. This means that inorder to boost the job satisfaction level of nurses and thus reduce their attrition; health care organizations in Ahmedabad should concentrate on factors related to career advancement, security and expediency. Moreover, as shown in table 1, the response of nurses towards expediency factors like availability of free working lunch and transport facility highlights the fact that they are not only overall satisfied with their jobs but also believe that the availability of these two stimuli will boost their QWL in hospitals. This is evident from the data seen in table 2. This table shows the extent of nurses that will move from a lower job satisfaction level to a higher one due to improvement or provision of QWL factors.

An analysis on parameter estimates of ordinal model indicates the effect of levels of the quality of worklife variables on job satisfaction. This is indicated by the odds (computed by taking the inverse of the complementary-log link function of the parameter estimates). Negative values indicate that the odds of respondents being in a particular job satisfaction level as compared to reference level decrease for a given level of the stimulus variable.

From his analysis it can be proved that if proper health and safety policy is provided then there is almost 24% of chance that nurses will move from low satisfaction level to a higher one, free lunches would motivate nurses with approximately 27% of chance to move from low to high job satisfaction level, company sponsored transport facilities will bring 55% of chance for nurses to move from low to high job satisfaction level, while there is hardly 9% chance of higher job satisfaction level affected by lack of maternity leave facility. Significantly, provision of healthy and hygienic living conditions provide a chance of almost 54% for nurses to move from low to higher job satisfaction level a chance of 39% for nurses for increased job satisfaction level is due to management sponsored career programmes, but provision of leaves will give a chance of 13% for nurses to move from low to high job satisfaction. Results indicate that these odds tend to increase as the responses change from disagreement towards agreement. Analysis also shows that a nurse who agrees that company health and safety policy contributes to job satisfaction is 0.58 times more likely to have a high job satisfaction level as compared to a low/medium level. Thus, it is evident that on an average almost 32% of chance is there for the job satisfaction level of survey respondents, who have given low scores on the quality of work-life variables, are less likely to have high job satisfaction levels till all QWL factors are not implemented or provided to them.

In order to study the second objective of finding difference in opinion of quality of work life of nurses in government and private hospitals, a use of Mann-Whitney U test has been done for comparison. In each case the following hypothesis has been tested.

H0: There is no difference in quality of work life variable in government and private hospitals

Against

H1: There is a difference between government and private hospitals with respect to quality of work-life variable considered.

Analysis of comparison of QWL in government and private hospitals highlights the QWL factors that bring the difference between these two units. The factors like company health and safety policy, availability of maternal leave, provision and availability of training programs, availability of free working lunch and a company provided family accomodation play an important role to differentiate these hospitals on QWL criteria.

While analysis of comparison of job satisfaction and QWL of nurses in government and private hospitals tells us that the odds that a nurse from a government hospital has low/medium satisfaction level are 0.178 as compared to that from a private hospital. This means that there is only 17.8% of chance that a government hospital nurse can experience low/medium job satisfaction level as compared to that of a private hospital nurse. Further, since the odd calculated is hardly 18% approximately, it cannot be said that there is a huge difference in QWL related job satisfaction between nurses of government and private hospitals. Had this odd value been greater than at least 40%, there would have been a significant difference between the two. Therefore we can conclude that the factors affecting QWL in private and government hospitals are almost the same and both the types of hospitals almost equally incorporate them, thus, reducing the difference in job-satisfaction level of their nurses.

Thus, out of the 10 variables measuring different aspects of quality of work-life, availability of transport services, availability of leave when required and healthy and hygienic accommodation were found to be statistically insignificant (p-value>0.05). Analysis of parameter estimates of ordinal regression model also shows that above 50% of the nurses lie in low or medium job satisfaction level due to these three factors. The data did not provide enough evidence for the rejection of the null hypotheses. Hence we can conclude that for the above three variables measuring quality of work-life, there is no difference in opinion between government and private hospitals.

Analysis of extent of provision of QWL factors in government and private hospitals shows percentage of provision and non-provision of various factors in government and private hospitals. Analysis of QWL factors having effect on job satisfaction and analysis of parameter estimates of ordinal regression model shows the six important QWL factors that lead to job satisfaction in these hospitals. Out of these six factors, only provision of free working lunch is greatly ignored in both the type of hospitals. But in case of government hospitals, provision of QWL factors like company health and safety policy, job-related training and a hired house are given average attention. In order to boost the job satisfaction level nurses in government hospitals, it is important for the management to concentrate on provision of these four factors of QWL. On the other hand, in case of private hospitals, provision of QWL factors like hired house and free working lunch is ignored to quite a great extent. And provision of QWL factors like job related training programs and family accommodation is given average attention. This means if private hospitals also concentrate on provision of QWL factors like hired family accommodation, free working lunch, and job related training programs then the job satisfaction of nurses is bound to go up.

6. CONCLUSION

It is indisputable that quality of work life plays an important role in bringing job satisfaction in employees. This study has explored the factors that are important for quality of work life for employees in a hospital set up. These quality of work life (QWL) factors are company health and safety policy, provision of free working lunch, maternal leave with salary, job related training programs and provision of hired family accommodation by the organization.

The QWL factors that have an impact on job satisfaction level of nurses in government hospitals are provision of free working lunch, job related training program, hired family accommodation and a proper health and safety policy. While those that have an impact of job satisfaction of nurses in private hospitals are free working lunch, job related training program and availability of hired family accommodation. Thus, there is no major difference in the QWL factors and their impact on job satisfaction of nurses in private and government hospitals. The only QWL factors showing difference is company health and safety policy which is well provided in private hospitals but not in government hospitals.

REFERENCES:

Journal Articles:

(1.) Rose et al, "An Analysis of Quality of Work Life (QWL) and Career-Related Variables", American Journal of Applied Sciences, 3 (12), 2006, 2151-2159

(2.) Lawless, Cheryle, "Exploring the value of dignity in the work life of nurses", Advances in Contemporary Nurse Recruitment and Retention: Problems and Challenges in Human Capacity Development, 24(2), 2007, 225-236

(3.) Lewis et al, "Extrinsic and Intrinsic Determinants of Quality of Work Life", Leadership in Health Services, 14(2), 2001. 9-15

(4.) Kumar, "NURSING FOR DELIVERY OF ESSENTIAL HEALTH INTERVENTIONS", Financing and Delivery of Health Care Services in India, SECTION III: 175-184

(5.) Smoke, Sale, "Measuring Quality of Work-Life: A Participatory Approach in a Canadian Cancer Center", Journal of Cancer Education, 22, 2007, 62-66

(6.) Kane," Stress causing psychosomatic illness among nurses", Indian Journal of Occupational & Environmental Medicine, 13(1), 2009, 28-32

(7.) Muthusamy," Job Satisfaction: A Study among Hospital Nurses in Coimbatore, India", Social Science Research Network, 2009.

(8.) Lau, T., Y.H., Wong, K.F., Chan, and M., Law, (2001) "Information Technology and the Work Environment-Does it Change the Way People Interact at Work". Human Systems Management, 20(3),2001, 267-280.

(9.) Hian, C.C., and Einstein , W.O., "Quality of work life (QWL): What can unions do? S.A.M. Advanced Management Journal, Vol. 55, No. 2, 1990, 17-22.

Websites:

1. Output and growth of healthcare sector http://www.economywatch.com/world-industries/healthcare/world.html

2. ILO Conference on 'Regulating for Decent Work, to be held at the International Labour Office, Geneva during July 8-10, 2009. Quality of work life and organizational performance: Empirical evidence from Dhaka Export Processing Zone Md. Zohurul Islam* and Sununta Siengthai** http://www.ilo.org/public/english/protection/condtrav/pdf/rdwpaper37a.pdf

Nirali Pandit, Gujarat University, Ahmedabad, Gujarat, India

Rashmi Pant, Jaipuria Institute of Management, Lucknow, U.P, India

AUTHOR PROFILES:

Ms. Nirali Pandit is currently pursuing her Ph.D. in Economics from Gujarat University. She is a doctoral fellow of Indian Council of Social Sciences and Research, New Delhi. She has published 5 research papers and has presented 7 research papers in seminars and conferences. She has around five years of experience in teaching and her research areas are Human Resource, Entrepreneurship and Small Business Units.

Dr. Rashmi Pant earned her Ph.D in Statistics from the University of Lucknow, India and a Six sigma green Belt certificate from the Indian Statistical Institute, New Delhi India. She has 4 years of teaching experience at the undergraduate and postgraduate teaching a gamut of courses on applied statistics. She continues to be a consultant on various subject areas in life sciences and social sciences. Her research interests include, but are not limited to, qualitative and quantitative regression modeling and extreme-value theory.
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