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Health Services Management Research

Table 7 The mean score of employees’ job satisfaction in teaching and non-teaching hospitals (on a 6-scale)

Job satisfying factors Educational hospitals Non-educational hospitals

P E P–E P E P–E

Salary and fringe benefits 2.39 4.85 2 2.46 2.68 5.11 2 2.43
Recognition and promotion 2.77 4.95 2 2.18 2.94 4.81 2 1.87
Management and supervision 3.67 5.01 2 1.34 3.99 4.93 2 0.94
Co-workers 4.47 5.21 2 0.74 4.60 5.11 2 0.51
Task requirement 4.01 4.69 2 0.68 4.32 4.81 2 0.49
Working conditions 2.66 4.68 2 2.02 2.55 4.98 2 2.43
Nature of work 4.42 4.94 2 0.52 4.35 4.94 2 0.59
Organization policies 3.20 4.85 2 1.65 3.25 4.76 2 1.51
Job security 3.10 4.76 2 1.66 3.12 4.97 2 1.85
Overall job satisfaction 3.43 4.88 2 1.45 3.57 4.93 2 1.36

shows, this relationship was statistically significant in all the

different among the six hospitals ( P ¼ 0.54). Some
cases ( P , 0.001).
demographic variables were related to one or more of the
The mean score of employees’ satisfaction of job factors,
three commitment measures. Significant differences were
organizational factors and social factors were 4.37, 3.20
obtained between employees’ organizational commitment
and 4.54 credit from 6, respectively. The results of the
and their marital status, age and years of work experiences,
simultaneous multiple regression model indicate that
type of employment and salaries received ( P , 0.03).
organizational, social, job and individual factors overall
Married (as opposed to single) employees have shown
explained 98.8% of the variance in employees’ job
more affective, continuance and normative commitment.
satisfaction. Organizational factors explained the largest
Age and tenure were related to affective and normative
amount of the variance (94.3%), followed by job, social and
commitment. A negative association was seen between
individual factors. With regards to organizational factors,
employees’ organizational commitment and their
management and supervision explained the largest amount
educational levels ( r ¼ 2 0.156, P , 0.001), such that those
of the variance, followed by promotion, task requirement,
with fewer years of education revealed more continuance
security, and salaries and benefits.
commitment. This could be explained by external factors, if
there are fewer opportunities for finding suitable or better
jobs outside the organization.

Organizational commitment
In correlation analysis between organizational
Employees were moderately committed to their
commitment and its three dimensions, affective,
organizations, with a mean global score of 3.98 + 0.68 on a
continuance and normative commitment, respectively, had
six-scale. The overall scores ranged from 2.05 to 5.67
positive and the highest effect on employees’ organizational
(possible range 1–6). Organizational commitment was low,
commitment in that order.
medium, high and very high in 9.1, 41.7, 43.7 and 5.5% of
hospital employees. The mean score of affective,
The results of the simultaneous multiple regression
continuance and normative commitment were 3.86 + 1.12,
model indicate that organizational, social, job and individual
3.97 + 0.73 and 4.13 + 0.64, respectively.
factors overall explained 44.7% of the variance in
employees’ organizational commitment. Organizational

The employees’ organizational commitment in

factors explained the largest amount of the variance
therapeutic and diagnostic departments was less than
(33.3%), followed by job, individual and social factors. With
administrative and ancillary departments. The differences
regards to organizational factors, management and
between values were statistically significant ( P , 0.001).
supervision explained the largest amount of the variance,
Total organizational commitment scores were not
followed by organization policies and job

220
 Table 8 Inter-correlations between job satisfaction, organizational commitment and intention to leave the organization

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

1. Overall job –
satisfaction
2. Salaries and 0.648 –
fringe benefits
3. Recognition and 0.785 0.642 –
promotion Re
lati
4. Management 0.794 0.423 0.626 –
on
and supervision shi
p
Do 5. Co-workers 0.578 0.238 0.282 0.506 –
wnl bet
oa 6. Task 0.743 0.362 0.474 0.615 0.567 – we
de
d
requirement en
fro
m
job
hs 7. Working 0.549 0.304 0.370 0.333 0.198 0.258 – sat
m.
sa conditions isf
ge
pu
act
b.c 8. Nature of job 0.675 0.295 0.425 0.457 0.447 0.577 0.296 – ion
om
by 9. Organization 0.610 0.330 0.487 0.411 0.222 0.372 0.390 0.315 – ,
gu org
est
on
policies ani
Ju
ne 10. Job security 0.773 0.415 0.563 0.606 0.358 0.494 0.507 0.429 0.551 – zat
7, ion
20 11. Organizational 0.637 0.332 0.433 0.510 0.441 0.508 0.244 0.561 0.372 0.436 – al
13
commitment co
m
12. Affective 0.690 0.341 0.474 0.546 0.564 0.543 0.292 0.565 0.437 0.501 0.923 – mit
commitment me
nt
13. Continuance 0.326 0.185 0.210 0.310 0.229 0.271 0.069 0.299 0.145 0.273 0.690 0.453 – an
commitment d
tur
14. Normative 0.328 0.140 0.187 0.203 0.308 0.290 0.149 0.397 0.153 0.231 0.669 0.525 0.303 –
no
commitment ver
int
15. Intention to 0.452 0.233 0.284 0.303 0.212 0.290 0.209 0.233 0.382 0.348 0.436 0.462 0.245 0.198 –
ent
leave ion
16. Recommending 0.617 0.406 0.488 0.467 0.287 0.424 0.299 0.349 0.368 0.396 0.435 0.497 0.245 0.149 0.431 –
the organization
for work to
others

Correlation is significant at the 0.05 level Correlation is

significant at the 0.01 level

22
1
Health Services Management Research

security. Employees’ characteristics explain a lower degree

of variation in commitment. This is primarily the result of the
effect of the employee’s age and education.

Relationships between job satisfaction,

organizational commitment and
intention to leave Figure 2 Relationship between job satisfaction, organizational
Table 8 shows the correlations between these three commitment and turnover intention

variables. As can be seen, there is a positive correlation

between job satisfaction and organizational commitment ( rs
¼ 0.637,
P , 0.001) indicating that those employees who are more
satisfied with their job are also more committed to the
health-care service. This study observed an asymmetric
relationship where satisfaction had a stronger effect on
commitment than the reverse. The relationship running
from satisfaction to commitment is much stronger than the
relationship running in the other direction.
The positive correlation between intention
to
( rs ¼ leave and organizational commitment
( rs ¼ 00..443562,, P,,
0.001)aindicjoabtessatthisaftatchtioosne who less
are satisfied with their job are less com-
mitted to their organization. The influence of external
factors needs to be investigated further, particularly with
respect to normative and continuance commitment.
Furthermore, correlation analysis revealed that job
satisfaction dimensions such as nature of the job,
management and supervision, task requirement,
co-workers, job security, and recognition and promotion
had more effect on employees’ organizational commitment.
Nature of the work, co-workers, and management and
supervision had the most effect on affective commitment.
Management and supervision, nature of work and job
security had the most effect on continuance commitment.
Finally, nature of the job and co-workers had the most
effect on normative commitment. On the other hand,
affective commitment had more effect on employees’ job
satisfaction. Employees’ job satisfaction and commitment
are significant predictors of turnover intention. The results
of the simultaneous multiple regression model indicate that
together, these two variables explain 22.5% of the variance
in employees’ turnover intention. Job satisfaction explained
the largest amount of the variance (19.2%) followed by
commitment.
Organizational factors explained 14% of the variance in
employees’ turnover intention (Figure 2).
Factors that have a significant impact on intention to
leave are affective commitment, job satisfaction,
organizational policies, job security, management and
supervision, recognition, amount of salaries received and
the department in which the employees work. Factors that
have a significant impact on recommending the hospital to
others by employees as a good place for work are job
satisfaction, affective commitment, recognition and
promotion, management and supervision, amount of
salaries and task requirement.
Discussion
This study set out to assess the degree of job satisfaction
and organizational commitment among Iranian hospital
employees and examine the relationships between those
variables and employees’ turnover intention. From the
results of this study, the job satisfaction level of hospital
employees’ can be seen to be in a medium scale, mainly
because of salaries and benefits, working conditions,
recognition and job security. It is recommended that
particular attention be given to improve employees’ job
satisfaction by addressing these issues at the managerial
level.
This study confirmed a positive relationship existing
between job satisfaction and organizational commitment.
Findings revealed that employees who were more satisfied
with their job had higher levels of organizational
commitment. The result supported Hypothesis 1 that job
satisfaction is positively related to organizational
commitment. This finding is consistent with the findings of
other previous studies in health-care settings. 20–22 Furthermore,
job satisfaction and commitment were significantly

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 Relationship between job satisfaction, organizational commitment and turnover intention

associated with employees’ intention to leave. The results

within the organization, the higher it is likely to be the level
do not support Hypothesis 2 that there is a negative
of organizational commitment and job satisfaction
relationship between turnover intention and employees’ job
expressed by the employee. This finding is consistent with
satisfaction and commitment. This may be due to external
other studies that have shown that the opportunity for
factors, such as job market conditions and workforce
personal and professional growth and achievement is one
mobility, which may influence perceived opportunities for
of the best predictors of job satisfaction and organizational
career advancement elsewhere.
commitment. 40,43,45 Unfair promotion policies perceived by
employees may negatively impact their organizational
commitment. It is therefore, recommended that managers
Several researchers have concluded that employees’ job
provide equal promotion opportunities for employees.
satisfaction generally and in health-care organizations is
Management should put in place localization programmes
shown to be correlated with age, gender, marital status,
and initiatives that would promote employees’ to key
number of children, educational level and work experience
positions and increase their involvement in
(years). 37–44 In this current study, variables such as
decision-making. Such steps will help to increase the level
employees’ age, gender, marital status, work experience
of job satisfaction and commitment.
years, organizational position, education level, type of
employment and salaries received, and benefits were seen
as having significant effects on their job satisfaction.

Tenure was significantly related to affective and

normative commitment. When the experience increases,
A higher level of job satisfaction in illiterate employees
commitment will rise as well; but there is an exception in
may be due to the fact that most of these individuals are old
employees with one to five years of work experience.
and have been working in the hospitals for many years.
Employees in the first year of their job career are highly
Therefore, they are receiving higher pay because of their
committed to their organization, especially because of
length of service and the privileges that this brings. Also,
continuance and affective commitments. The employees
they do not do difficult jobs in hospitals. However, their
enter their organizations with great expectations, but when
younger colleagues who do not have higher education,
they realize that they may have overestimated what they
have to do the hard and nonprofessional jobs in hospitals,
might be able to achieve, their commitment may decrease.
such as working in the laundry, cleaning patients’ rooms
and so on.

Marital status was related to commitment, especially

affective commitment, as married employees demonstrated
The U-formed relationship between age and seniority
more emotional attachment than single employees. This
and job satisfaction requires two kinds of explanation.
could again reflect a tendency for married employees’ to be
Among younger employees, a higher level of satisfaction
more family-oriented and see the organization as a kind of
may be due to the fact that inexperienced employees have
‘family provider’, as opposed to single employees who,
fewer duties and responsibilities, less pressure and fewer
being more self-oriented, may view the employing
demands from colleagues. They may also be less exposed
organization only as a source of income and therefore feel
to work-to-family conflicts. Among older employees, higher
less emotionally attached to it. Education also showed a
satisfaction could be explained by a better knowledge of
significant negative correlation, such that those with fewer
hospital working, by benefits linked to seniority and by
years of education revealed more normative commitment.
fewer external demands. It is also possible that older
These findings are also consistent with several studies in
employees refocus their priorities to factors outside the
which education was found to have an inverse relationship
work setting, such as family and/or planning for retirement.
with organizational commitment. 34,46 Amount of

The current study showed that promotion opportunities

salaries was correlated with continuance commitment.
were another significant predictor of job satisfaction and
organizational commitment among study participants. The
Employees with permanent contracts notified higher
greater the chances are for advancement
levels of job satisfaction and organizational commitment
than temporary

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Health Services Management Research
employees. These findings suggest that types of
employment may have an independent effect on
employees’ job satisfaction. Further research is necessary
to overcome various shortcomings of this study, and to
assess the role either job security or level of income and
social protection.
This study also demonstrates that those employees who
work with patients had less job satisfaction and as a result
less commitment. Employees working in cardiology,
psychiatry, pathology, obstetric, urology and paediatric
wards had less satisfaction. Job rotation could possibly be
a good strategy for improving job satisfaction of these
employees. Lower levels of job satisfaction in employees
working in the medical record department is likely due to
the specific nature of the jobs they perform. Automation is
not used in these hospitals and these employees have to
perform their tasks manually. Documentation, repetition of
duties and low salaries are the most important sources of
dissatisfaction of employees in this department. It is
recommended that management use job enrichment as a
motivational strategy to satisfy these employees.
Another major finding as the cause of employee job
dissatisfaction is the lack of respect and recognition they
receive from hospital management. Recognition and
respect are highly important, especially for employees who
are in direct contact with patients, families, peers and other
health-care team members. Respect and recognition from
managers for good performance is vital in increasing job
satisfaction and is central to boosting commitment.
It is interesting to mention that employees’ expectations
about their jobs in private hospitals are greater than in
public and semi-public hospitals. Type of organization
shapes the employees’ expectation. Employees in public
hospitals know about the limitations and difficulties in their
organization, so will modify their expectations and
demands.
The strongest direct predictors of intention to leave,
based on this study, are low organizational commitment
(particularly affective commitment), lack of job satisfaction
and its dimensions (especially organizational policies), lack
of job security, and management and supervision. Thus,
managers should try to improve employees’ commitment by
increasing their job satisfaction and thus reduce their
intention of leaving the organization.
224
Conclusions
In a cross-sectional study, the relationship between
employees’ job satisfaction and organizational commitment,
and their turnover intention in Isfahan Hospitals, Isfahan,
Iran were explored. This study revealed a positive
relationship between employees’ job satisfaction and
organizational commitment, and a relationship between job
satisfaction, commitment and intention to leave the
organization. This research has found that job satisfaction
and organizational commitment appear to be predictors of
turnover intention but moderating factors, such as individual
and cultural characteristics, play a significant role in both
turnover intention and actual turnover.
The findings show that hospital employees are
moderately satisfied with their jobs. Factors that may
influence the level of employees’ job satisfaction are
demographic variables of gender, age, marital status,
education, years of work experience, organizational
position, monthly salary, type of employment, type of
hospital, employees’ organizational commitment (and its
three dimensions) and the nine subscales of job satisfying
factors, as indicted in Table 5. Management and
supervision, recognition and promotion, job security and
task requirement are the best predictors of job satisfaction
among hospital employees. Specific job satisfaction
dimensions indicate that highest dissatisfaction level occurs
in the area of working conditions, salaries and benefits,
recognition and job security. Thus, areas of dissatisfaction
can be interpreted as signals that change is needed.
The findings also revealed that hospital employees are
moderately committed to their organization. Factors that
may influence the level of employees’ organizational
commitment are demographic variables of gender, age,
marital status, education, years of work experience,
monthly salary, type of employment, employees’ job
satisfaction (and its nine dimensions) and the three
subscales of organizational commitment dimensions.
Affective, continuance and normative commitment are the
best predictors of organizational commitment among
hospitals employees.
Implications for management
There are several practical implications that can be derived
from our findings. As job
 Relationship between job satisfaction, organizational commitment and turnover intention

satisfaction and organizational commitment have strong

Nevertheless, managers spend a minimal amount of time
correlation with job performances, it is very important to
learning more about human behaviour, communication, and
reinforce them by applying the right human resource
how their attitudes and behaviours impact employee’s
policies. If employees are highly satisfied with their work,
performance. Management requires a keen understanding
supervision, co-workers, policies and pay, and derive high
of human nature, the basic needs, wants and abilities of
level of overall job satisfaction with their jobs they are more
people. Managers at any level cannot motivate an
likely to be committed to the organization than if they are
employee; they must create the environment for individuals
not satisfied.
to motivate themselves. It is in the interest of an
organization to retain employees and minimize turnover.
However, many hospital managers have little
The results of this study revealed that management and
understanding of how to satisfy their employees and how
supervision are important predictors of job satisfaction,
these employees’ satisfaction levels influence their intent to
organizational commitment and turnover intention among
leave their positions. In fact, because of this limited
hospital employees. A supportive management style,
understanding, managers’ efforts towards employees’
demonstrated through open communication, respect and
satisfaction can sometimes create more dissonance than
recognition can greatly improve the satisfaction of
cohesion between employees and management, leading to
employees on the job. Management might be able to
excessive employee turnover. Possessing knowledge and
increase the level of commitment in the organization by
information about employee motivation helps managers
increasing satisfaction with policies, work conditions, equal
understand how employees can be involved to achieve
compensation and equal promotion. Changes in
process improvement. More understanding of the needs
organizational variables, such as benefit scales, employee
and wants of their employees, as well as a better
input in policy development and work environment, could
understanding of the impact of their own managerial
then be made in an effort to increase employees’ job
behaviour on others would help them in terms of improving
satisfaction, organizational commitment and decrease
performance in the workplace.
subsequent turnover.

This study revealed that hospital employees’

commitment is more because of normative commitment.
The employees commit to and remain with the organization
because of feelings of obligation. In other words,
employees think that they ought to remain with an Limitations and implications for future
organization because they think it is morally right to do so. research
It could be because of investigation of this concept in an
In this study, employees’ participation was voluntary and
Islamic country where working in a hospital is a holy job.
was conducted at six hospitals in Isfahan city, Iran an
Nursing and providing services for patients is strongly
Islamic country. So, the findings should be interpreted with
recommended in Islam. So, management should implement
caution as the participants were hospital employees from a
policies that will increase employees’ affective commitment.
particular province of Iran and do not represent all hospital
Policies such as treating the employee with respect and
employees in this country. More studies of Iranian
consideration, improving their quality of work, defining the
health-care employees are needed with samples, which are
job and responsibilities of employees, designing,
large enough to detect statistically significant associations
stimulating and challenging jobs, providing high-quality
between the variables under investigation.
information to employees about organization’s plans and
activities, providing appropriate working environment, fair
assessment and promotion, compensation and benefits can
be helpful.
Another potential limitation of this study includes
cross-sectional nature of the design, which does not allow
for an assessment of impact or cause and effect. Perhaps,
most valuable would be prospective cohort of hospital
employees, which are able to detect changes in employees’
job satisfaction and commitment. If these studies also
In summary, employees are the most important resource
incorporated
of an organization.

225
Health Services Management Research
interviews with subjects, this would increase our
understanding of the factors within hospital services as a
job which influences job satisfaction and commitment.
Future research also needs to explore the effects of
variables that were not measured in the current study,
which can also directly or indirectly influence feelings of job
satisfaction and commitment, such as the organization’s
structure and culture. From a methodology perspective, the
reliance on the Delphi method that involves consulting the
domain experts in the instruments design may present
additional limitations. It would be beneficial if future studies
were to enhance the reliability of the method by other
means, for example, relying more heavily on the model
illustrated in Figure 1. As more results become available
from the surveys, their findings can further define the
relationships between job satisfiers, moderating factors and
employees’ outcomes in different real-life contexts. Such
an enhancement may also serve to articulate important
aspects of expert knowledge, thus providing a more explicit
formulation of the cause-effect and correlation types of
relationship.
Furthermore, this study may serve as a foundation for
future studies in different countries, on a larger scale. More
studies, which involve hospital employees from other
countries, would enrich the literature on hospital
employees’ job satisfaction and commitment, which in turn
could generate strategies to improve the global retention of
new hospital managers and employees.
Acknowledgements
This study was the result of a phase of a research funded
by Ministry of Health, Iran. The authors gratefully
acknowledge the hospital managers and employees for
their assistance in performing this research.
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Meyer JP, Allen NJ. A three component conceptualization
of organizational commitment. Hum Resour Manage Rev
1991; 1: 61–89
227