Jordanian Health Employees’ Job Satisfaction. A Vroom Theory Investigation

Abstract

The National health strategy in Jordan for 2015-2019 has the objective of building a viable health care system, utilizing both public and private service providers and improving the quality of health services by implementing a national health services accreditation program. Human resources are the main drivers for achieving the needs of citizens optimally and a special attention need to be granted to managing these resources in order to raise the productivity of the health sector. In this context, the paper aims to prove the validity of Vroom’s expectancy theory on six Jordanian both public and private hospitals having as main purpose the main determinants of employee motivation. According to Vroom’s theory, the motivation is regarded as function of three distinct perceptions: expectancy, instrumentality, and valence. The study aims to test the hypotheses that each component-expectancy, extrinsic instrumentality, intrinsic instrumentality, extrinsic valence and intrinsic valence have a positive effect on employee motivation using data from 325 health workers (doctors and nurses). The results show that from all five components, three of them best explains the process of motivating hospital employees-expectancy, extrinsic instrumentality and intrinsic valence. The results of the study emphasised the influential role of intrinsic factors comparative with the extrinsic factors, highlighting the importance of intrinsic factors on increasing the level of motivation of Jordanian employees.

Keywords: Expectancy theoryhospital employee motivationexpectancyinstrumentalityvalenceJordan

Introduction

The health system in Jordan is composed from three sectors: public, private and donors. The public sector includes the Ministry of Health (MOH) and Royal Medical Services (RMS), university hospitals-Jordan University Hospital (JUH) in Amman and King Abdullah Hospital (KAH) in Irbid- and the centre for diabetes and Endocrinology and Genetics. The private sector includes private hospitals. The international sector provides services through UNRWA clinics for Palestinian refugees and the UNHCR and King Hussein Cancer Center and charity association clinics.

The higher Health Council through the law no.9 of 1999 elaborates the general policy for the health sector in Jordan. According to Health System profile Jordan report published by World Health Organization (2006, p.7), “the main challenges related with health care system in Jordan are problems related to accessibility, equity, duplication of services, poor coordination among major providers, unregulated private sector, low utilization rates in the private sector, limited quality improvement programs, inefficient use of available resources, poor management”.

The Ministry of health hospitals suffers of several limitations in providing a better health care among which the lack of incentives for the hospital staff occupied an important place. Ajlouni (2013) presented the scheme of the Jordan health care system highlighting the main actors involved in the process of health decision making.

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The National health strategy in Jordan for 2015-2019 has the objective of building a viable health care system, utilizing both public and private service providers and improving the quality of health services by implementing a national health services accreditation program.

According to Health System profile Jordan report published by World Health Organization (2006, p. 8), “Jordan has 2.3 physicians, 3.0 nurses, 1.2 pharmacists and 0 .7 dentists per thousand population. During the last four years, the number of all health professions and their percentages to population has been increasing. Human resources are the main drivers for achieving the needs of citizens optimally and a special attention need to be granted to managing these resources in order to raise the productivity of the health sector.

Although the number of health personnel was increased the last decade, there is a certain shortage on specific specialties, like cardiovascular surgery, psychological or family medicine. The women were the most affected by this shortage and they represent almost 44% of total health workers.

The non-governmental sector (private and civil organization sector) is the main employer of health cadres in Jordan, while the private sector attracts experienced professionals from the public sector due to the high financial returns in the private sector, noting that it is prohibited for public sector doctors and other health personnel to work in the private sector. According to the Jordanian Health Sector (2012), there were 57000 employees in the health sector, most of them physicians and nurses and is worth to mention that about 56% of these employees work for private sector despite its smaller size.

Problem Statement

The Vroom’s theory has proved his utility in analysing the motivational factors at the workplace (Regis, Falk, & Dias, 2008; Kanfer, 1990; Ghoddousi, Bahrami, Chileshe & Hosseini, 2014). Chiang & Jang (2008) proposed an adapted version of the expectancy theory for the investigation of work motivation.

The most commonly applied motivational theories in empirical studies who investigate the main factors of employees’ motivation were Maslow theory, Herzberg theory and Vroom theory. Unlike the first two theories, the last one, a process theory highlights how the motivation occurs (Chiang and Jang, 2008). The theory is based on three elements: expectancy (E), instrumentality (I) and valence (V). According to Chiang and Jang (2008, p. 314), the motivation force can be regarded as the result of following interaction:

$$Motivation\mathrm{}force=Expectancy\mathrm{*}Instrumentality\mathrm{*}valence$$

Expectancy (E) is seen as the conviction that performance could be obtained is the effort is applied. Instrumentality (I) refers to the perspective of rewards when the conditions of performance are achieved. Valence (V) is more related to the associated with the rewards (Regis, Falk & Dias 2008).

Empirical evidence on the health employee motivation in Jordanian hospitals have been offered by the studies of AbuAlRub & AL‐ZARU (2008); AbuAlRub (2007); AbuAlRub, Omari & Al‐Zaru (2009); Abualrub, Omari, Abu Alrub & Fawzi (2009); Alhusban & Abualrub (2009); Abualrub (2010); Hayajneh, AbuAlRub, Athamneh, Almakhzoomy (2009); AbuAlRub, El-Jardali, Jamal & Al-Rub (2016).

AbuAlRub and AL‐ZARU (2008) analysed if the recognition of nurses’ performance could be considered as an important factor for retention diminishing the effects of stress, indicating that the recognition of nurses’ performance could be considered as an important factor for the intention to stay.

AbuAlRub (2007) pointed out that one of the main causes of the fall of the number of nurses in Jordanian hospitals is the slow increase of the nurse wage mentioning that a potential solution for retention could be improving working conditions and the satisfaction associated with their profession.

AbuAlRub, Omari & Al‐Zaru (2009) highlighted the higher level of work motivation and also the higher intention to stay of nurses in private hospitals comparative with public hospitals.

Abualrub, Omari, Abu Alrub & Fawzi (2009) have proved that social support from co-workers and supervisors increase the level of satisfaction for Jordanian nurses, while Abualrub (2010) have shown that female nurses who are mothers, have a full-time job and receive support from co-workers and supervisors tend to have a higher level of retention than others.

Hayajneh, AbuAlRub, Athamneh, & Almakhzoomy (2009) determined the rate of nurses’ turnover in Jordanian hospitals to be 36.6% and also identified significant differences by geographical region, health sector and place of residence pointing out that further research is need to reveal the cause of these differences.

AbuAlRub, El-Jardali, Jamal & Al-Rub (2016) investigated if there is a potential connection between work environment, job satisfaction and the level of retention using a sample of 330 Jordanian hospitals’ nurses, revealing that receiving housing, the level of job satisfaction and also work environment significantly influenced the level of retention of nurses.

Usually, the studies that treat job satisfaction, the intention of stay at work and other factors related to work motivation for health employees in Jordan take into account mostly the perceptions of nurses. The present study aims to investigate the level of work motivation and especially the factors who contribute to motivation for all employees (doctors, nurses, administrative staff, support staff, helpers) and also to reveal potential differences of opinions regarding these factors.

Research Questions

The study aims to respond to the following questions: What makes health employees satisfied with their jobs in Jordanian hospitals?” There are significance differences between the opinions of doctors versus nurses regarding the degree of satisfaction and the main factors? What kind of statistical differences in opinions can be revealed among the main determinants of work motivation? What is the level of work motivation among health employees in Jordanian hospitals?

Purpose of the Study

T he main goal of this paper is to investigate the level of motivation of employees in Jordanian hospitals and to reveal the main factors who lead to an increase of a job motivation applying one of the most known theories in the field-the expectancy theory of Vroom (1964). The paper aims to respond to the following questions” What makes health employees motivated and satisfied with their jobs?” and which kind of determinants of motivation according to Vroom’s theory are more influential for the Jordanian employees?, investigating also if among employees there are differences of opinion regarding the main determinates of motivation.

Research Methods

The starting point in the investigation of the main drivers of work motivation in hospitals was the study of Chiang and Jang (2008), according to which the expectancy theory was adapted by dividing instrumentality and valence into extrinsic instrumentality, intrinsic instrumentality, extrinsic valence, and intrinsic valence in order to capture the impact of intrinsic/extrinsic components.

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The study aims to test the hypotheses that each component-expectancy, extrinsic instrumentality, intrinsic instrumentality, extrinsic valence and intrinsic valence have a positive effect on employee motivation. From the five component of expectancy theory, expectancy, extrinsic instrumentality, intrinsic instrumentality were measured using four items, while extrinsic and intrinsic valence were measured using five items. For work motivation there were used four items. The items were rated using a 5 point Likert scale where 1=very dissatisfied and 5=very satisfied. In order to analyse the responses of items were used descriptive statistics (mean and standard deviation).Comparisons of work motivation elements following the expectancy theory and the demographic and employment variables were performed using t-test and one-way between-groups analysis of variance (ANOVA). To validate the constructs, we applied CFA (confirmatory factor analysis). Following Cohen and Cohen (1983), we have applied multiple regression models to reveal the factors with a relevant role on increasing the level of satisfaction of Jordanian employees. The Statistical Package for Social Sciences version 22.0 (SPSS) was used to analyse the data from the questionnaire.

The data was collected using a sample of 325 health workers from six Jordanian hospitals: King Abdullah Hospital public hospital in north of Jordan IRBID city, Amman Specialist Hospital private hospital in Amman, Irbid Specialist Hospital private hospital, Ibn Al-Nafees private hospital in Irbid city, Al-Shona public hospital in the middle area of Jordan, and Princess Basma hospital. The respondents were doctors, nurses, helpers, support staff, administrative staff and other health related staff.

Findings

Conclusion

Using a sample of 325 heath employees from six Jordanian hospitals, the paper certificated the legality of the modified version of Vroom’s theory proposed by Chiang and Jang (2008), revealing the statistical significance of three from the five components -expectancy, extrinsic instrumentality and intrinsic valence. In establishing the overall level of motivation of employees it is important to take into account the type of hospital, graduation degree, and experience in the same position and also the area of work, which manifested a significant impact.

For Jordanian hospital employees, the intrinsic valence is the most appreciated followed by expectancy. Expectancy increases employee motivation by creating a sense of accomplishment, while intrinsic valence offers an incentive to employees for assuming a higher level of responsibility, making full use of their abilities and accomplishments. Thus, the main conclusion of our paper concerns the fact that at least for Jordanian employees, the most important factors that could crucially influence the level of motivation are expectancy and intrinsic valence. Extrinsic instrumentality showed no positive effect on work motivation, revealing that the lack of these elements good pay, monetary bonuses, pay increases or promotions are more likely to produce a decrease in the level of employee motivation.

The empirical results highlighted that managers need to be more focused on using the elements that could produce an increase in the level of motivation an satisfaction-intrinsic valence and expectancy and not to be very focused only of financial incentives, who could produce a stimulation of motivation only on short-run.

Since having a fully use their skills and knowledge in the workplace and a sense of accomplishment and a personal growth and development, taking responsibility, and having challenging work are good motivators for employees, managers should recognize employees who do well.

References

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