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
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.
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.
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:
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.
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
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.
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.
From our sample of respondents, the majority of them are from public hospitals (66.5%), with the largest age group as being the group of 25-35 years old (51.4%). Of the total number of respondents, the majority was male employees (52.9%) and 43.3% have a bachelor degree in science. Almost 33.5% of the respondents declared to an experience of the same position of more than 10 years and about 51% of them work in the therapeutic area.
Regarding the proportions of nurses vs. doctors, only 36% of the respondents declared to be nurses and only 19% are doctors. Heavy workload and health care financing issues were mentioned by the respondents as the main changes that affect the hospitals. The number of patients treated per day was declared to be more than 20 for almost 62.5% of the employees. Regarding the intention to stay, 61.2% of the respondents confirmed the intention of staying.
Revealing the determinants of work motivation among Jordanian employees
The mean scores for four measures of expectancy ranged from 2.90 to 3.67, and the mean scores of components are extrinsic instrumentality, from 2.87 to 3.00; intrinsic instrumentality, from 3.46 to 3.54; extrinsic valence, from 2.83 to 2.99; intrinsic valence, from 3.43 to 3.59; work motivation, from 3.62 to 3.72. From the all five components of the expectancy theory, intrinsic valence pointed out the highest level of satisfaction among employees. Another important result is related to the correlation between performance and highly motivation.
To validate the new measures and also to verify the validity, a measurement model was estimated with a confirmatory factor analysis. The factor loading for all items was positive, ranging from 0.77 to 0.964. The mean standardized factor loadings for each dimension are: expectancy 0.77, extrinsic instrumentality 0.955, intrinsic instrumentality 0.93, and extrinsic valence 0.95, and intrinsic valence 0.96, work motivation 0.964, suggesting that all items have enough interval consistency to construct a single measure.
In the multiple regression models that are aim to reveal the relevant motivational factors from the perspective of Vroom’s theory among Jordanian employees, the dependent variable was worker motivation determined as mean score of the four items of motivation. The independent variables are the mean score of expectancy, extrinsic instrumentality, intrinsic instrumentality, extrinsic valence and intrinsic valence and personal and employment characteristics.
The empirical results pointed out the statistical significance of the following components of Vroom theory-
The expectancy manifests a positive impact on work motivation, individuals desiring to be regarded as effective employees, with higher productivity and increasing performance.
Extrinsic instrumentality displayed a negative impact on work motivation at the significance level of 10%, highlighting the fact that financial incentives will not maintain for a long time the level of motivation of employees.
The intrinsic valence manifests an important impact on work motivation, pointing out the need of personal development as a main desire of employees.
While expectancy and intrinsic valence manifest a direct influence on the overall level of motivation, extrinsic instrumentality exhibited a negative influence on the level of work motivation, infirming the results from literature review and this results have been explained by Chiang and Jang (2008) using what is called to be the suppressor effect which was defined as a variable that increases the predictive validity of another variable (or set of variables) by its inclusion in a regression equation. According to the results, an increased level of extrinsic instrumentality will conduct to a less motivated employee.
It is worth to mention that the expectancy and intrinsic valence exhibited a greater impact on the level of overall motivation comparative with the component of extrinsic instrumentality. Another important conclusion is related to the fact that in the employees ‘view, the level of responsibility, challenging work tasks, usage of skills and abilities, feelings of accomplishment and the perception of personal growth and development are more important than financial incentives. Expectancy will create among employees the belief that the effort will lead finally to performance. Instrumentality creates the conviction that there is a relationship between performance and rewards.
The perception of employees was that if they will perform well in the job, they will have accomplishment and they do not necessarily link better pay, monetary bonus, pay increases or promotion to performance expectations. For the Jordanian employees, the intrinsic valence elements are indeed very important valorising the responsibility over the job, using their abilities, and feeling of accomplishment. The empirical results of ANOVA analysis pointed out that the model is statistically valid due to the fact that Sig.(F-test) is smaller than 1%.
The goodness of fit of the model revealed that the degree of determination in the model is 0.51, pointing out that the influence of all significant variables explains 51.3% of the total variance in work motivation.
Revealing the main differences on the factors influencing the work motivation
Analysing the differences between the main drivers of work motivation according to the expectancy theory and demographic variables, we can mention the following:
There are statistical significant differences regarding the level of work motivation and intrinsic valence in public hospitals in comparison with private hospitals, stating that the employees in public hospitals have a higher level of work motivation and intrinsic valence, individuals valorising more the responsibility of their job, the challenging work tasks, the usage of their skills and abilities and the feeling of accomplishment and also the personal growth.
Also, the age seems to create some differences related with extrinsic instrumentality and intrinsic valence. While the young people valorise more the extrinsic instrumentality elements (getting good pay, getting monetary bonuses getting pay increases, having more opportunities for promotion) the elderly appreciate more the elements of intrinsic valence.
One of the results of these comparisons is related to the fact that there is not any difference in perception regarding the work motivation by age group.
The illiterate group of employees has the highest level of work motivation, and they appreciate more the elements of intrinsic valence. At the opposite side, health employees with doctoral studies exhibit the lowest level of work motivation.
Regarding the experience in the hospitals, individuals with more than 10 years’ experience in the same position are the most demotivated by extrinsic instrumentality elements (getting good pay, getting monetary bonus getting pay increases, having more opportunities for promotion).
Regarding marital status, separated or divorced individuals are those the most demotivated in terms of expectancy and overall work motivation.
We have also differences between doctors, nurses, administrative staff, support staff or helpers in terms of intrinsic valence and work motivation, revealing that the most motivated are the support staff, while the nurses are the most demotivated personnel.
Another interesting result of our study was the fact that the most motivated people are those from the managerial and diagnostic area of work in terms of work motivation, intrinsic valence or extrinsic instrumentality.
Also, people from the horizontal organizational structure registered a higher level of overall work motivation and extrinsic instrumentality.
It is worth mentioning that there are not statistical significant differences between gender, work experience, and management position and the overall level of work motivation or the main factors identified from expectancy theory-expectancy, intrinsic valence, and extrinsic instrumentality.
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.
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30 July 2017
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Davidescu, A. A., & Eid, M. T. I. (2017). Jordanian Health Employees’ Job Satisfaction. A Vroom Theory Investigation. In A. Sandu, T. Ciulei, & A. Frunza (Eds.), Multidimensional Education and Professional Development: Ethical Values, vol 27. European Proceedings of Social and Behavioural Sciences (pp. 122-133). Future Academy. https://doi.org/10.15405/epsbs.2017.07.03.18