Management College of Southern Africa

An Investigation of Job Satisfaction of Professional Physiotherapists in the Public Health

Setting in Durban, Kwa Zulu - Natal

Joel Padayachee

MBA

2013
An Investigation of Job Satisfaction of Professional Physiotherapists in the Public Health
Setting in Durban, Kwa Zulu - Natal

by

Joel Padayachee

Dissertation submitted in partial fulfillment of the requirements for the degree of

Masters of Business Administration in the Department of Business Studies

Management College of Southern Africa (MANCOSA)

Supervisor: Mrs S. Latif

2013

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 DECLARATION

I, Joel Padayachee do hereby declare that this dissertation is the result of my

investigation and research and that this has not been submitted in part or full for any
degree or for any other degree to any other University

________________________ ________________

K. Padayachee Date

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 ACKNOWLEDGEMENTS

I would like to express my sincere gratitude to my supervisor, Mrs S. Latif for the
guidance and support in completing the dissertation

A special thanks to the staff of MANCOSA for their professional support and guidance
whereby I am pleased to have selected this institute to obtain the qualification.

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 ABSTRACT

Job satisfaction is one of the most relevant indicators of how health care professionals
perceive their work environment. When job satisfaction is assessed through relevant
dimensions, it facilitates knowledge about the strengths and weaknesses of each
dimension specific to each health care association. The study aimed to measure job
satisfaction of 130 physiotherapists working in the public health sector in Durban, KZN
and to compare their assessment with the real priorities that they regard as most
important in their daily work using seven dimensions related to all aspects of job
productivity. The first objective of the study is designed to assess the level of job
satisfaction among physiotherapists. The next objective is to study the seven work
dimensions and the impact on job satisfaction. The third objective is to study if there is
any relationship between job satisfaction and work productivity.

Through a self administered questionnaire it was found that 80% of the participants
were dissatisfied with physiotherapy as a career. The majority of the respondents
(95.38%) cited overall dissatisfaction with their jobs while 94.61% of the respondents
were particularly dissatisfied with their current employment in the public health sector.
The findings have revealed that the opportunity to develop, teamwork, good working
relationships, time pressure, compensation, participation in decision making and the
physical work environment were strongly correlated to job satisfaction and work
productivity. All the respondents strongly agreed that the following policies were
instrumental in achieving greater job satisfaction: Staffing management systems,
Performance management systems, Compensation management systems, Employee
participation systems and the Organisational work environment. This study suggests
serious implications for the future of human resource management in the public health
sector. Therefore planning is needed to avert potential problems in the human resource
component. The Department of Health should improve on the public health
infrastructure in order to improve job satisfaction among physiotherapists.

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 TABLE OF CONTENTS

Content Page No.

Title page i

Declaration ii

Acknowledgments iii

Abstract iv

Table of Contents v

List of Tables xi

List of Figures xii

List of Acronyms xiii

CHAPTER ONE: INTRODUCTION

1.1 Introduction 1

1.2 Background to the Study 1

1.3 Problem Statement 2

1.4 Aim of the Study 2

1.5 Objectives of the Study 2

1.6 Research Questions 3

1.7 Significance of the Study 3

1.8 Format of the Study 4

1.9 Conclusion 5

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CHAPTER TWO: LITERATURE REVIEW

2.1. Introduction 6

2.2. Definition, History and Organisational Structure of the Public

Health Sector of South Africa 6

2.3 World Reform and Challenges in the Public Health Sector 7

2.4 Physiotherapy and the South African Public Health Sector 9

2.4.1 Physiotherapy 9

2.5 Global Shortage of Physiotherapists 10

2.6 South Africa’s Shortage of Healthcare Workers 10
2.7 Job Satisfaction 12
2.7.1 Job Satisfaction and Motivation 12
2.7.2 Job Satisfaction and the Employee 13
2.7.3 Job Satisfaction and the Organization 13
2.8 Theories of Job Satisfaction 14
2.8.1 Content Approaches to Job Satisfaction 14
2.8.1.1. Maslow’s Hierarchy of Needs 14

2.8.1.2. Alderfer’s ERG Theory 16

2.8.1.3. Herzberg’s Two Factor Theory 17

2.8.2. Process Theories of Job Satisfaction 19

2.8.2.1. Expectancy Theory 19

2.8.2.2. Equity Theory 20

2.8.2.3. Job Characteristics Model 20

2.9. Factors Influencing Job Satisfaction 21

2.9.1. Time Pressure 21

2.9.2. Employee Participation 22

2.9.3. Physical Work environment 22

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 2.9.4. Opportunity To Develop 23

2.9.5. Teamwork 23

2.9.6. Benefits and Compensation 24

2.10 Job Satisfaction and Work Productivity 24

2.11 Strategies To Improve Job Satisfaction 25

2.11.1. Job Design and the Work Environment 25

2.11.2. Personnel Administration and Employee Relations 26

2.11.3. Performance Management Systems 26

2.11.4. Organisational Culture and Climate 28

2.11.5. Financial and Non financial Incentives 29

2.12 Conclusion 29

CHAPTER THREE: RESEARCH METHODOLOGY

3.1 Introduction 31

3.2 Rationale for the Study 31

3.3 The Research Design 31

3.3.1 The Research Philosophy 32

3.3.2 The Research Strategy 32

3.3.2.1 Exploratory Research 33

3.3.2.2 Explanatory Research 33

3.3.2.3 Descriptive Research 33

3.3.2.4 The Positivist Research Strategy 34

3.4 Target Population 34

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3.5 Sampling 35

3.6 Research Instrument 36

3.6.1 Questionnaire Construction 37

3.7 Pilot Study 38

3.8 Administration and Collection of Questionnaires 38

3.9 Data Analysis 39

3.10 Validity and Reliability 40

3.11 Limitations of the Study 41

3.12 Elimination of Bias 41

3.13 Ethical Considerations 41

3.14 Conclusion 42

CHAPTER FOUR: RESULTS AND INTERPRETATION OF FINDINGS

4.1 Introduction 43

4.2 Statistical Methodology for Sample Analysis 43

4.3 The Demographics of Respondents 44

4.3.1 The Gender of Respondents 46

4.3.2 The Age of Respondents 46

4.3.3 The Marital Status of Respondents 47

4.3.4 The Job Title of the Respondents 48

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 4.3.5 The Educational Level of the Respondents 49

4.3.6 The Years of Work Experience in the Public 50

Health Sector

4.4 Analysis of Job Satisfaction 51

4.5 Inferential Statistics 59

4.5.1 Association Between Demographics and Work

Satisfaction 60

4.5.2 General Level of Job Satisfaction 61

4.5.3 Job Satisfaction and Work productivity 62

4.6 Conclusion 63

CHAPTER FIVE: CONCLUSIONS AND RECOMMENDATIONS

5.1 Introduction 64

5.2 Findings 64

5.2.1 Findings from the Literature Review 65

5.2.2 Findings from the Primary Research 67

5.2.3 Conclusions to the Study 72

5.3 Recommendations 73

5.4 Area for Further Study 76

5.5 Conclusion 76

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Bibliography 77

Appendices

Appendix 1: Letter of Permission 86

Appendix 2: Questionnaire 87

Appendix 3: Follow up 91

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 LIST OF TABLES

Page
Number
Table 2.1: Comparison of the theories of Herzberg and Maslow 18
Table 4.1: Cronbach Alpha 44
Table 4.2: Frequency distribution according to demographic characteristics 45
Table 4.3: Frequency distribution of items related to work satisfaction 51
Table 4.4: Frequency distribution of items related to factors influencing 54
satisfaction
Table 4.5: Frequency distribution of items related to job satisfaction and 57
productivity
Table 4.6: Frequency distribution of items related to the changes that 58
improve job satisfaction
Table 4.7 : Socio-demographics and work satisfaction 60
Table 4.8: Level of job satisfaction 61
Table 4.9: Association between factors influencing satisfaction and 62
productivity

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LIST OF FIGURES
 Page
Number
Figure 2.1: Basic Motivational Model 13
Figure 2.2: Maslow’s Hierarchy of needs 15
Figure 2.3: Hygiene and Motivation factors 18
Figure 2.4: Expectancy approach to Motivation 20
Figure 4.1: Proportion of respondents based on gender 46

Figure 4.2: Frequency distribution of respondents based on age 47

Figure 4.3: Frequency distribution of respondents based on marital status 48

Figure 4.4: Job Title of respondents in the public health sector 48

Figure 4. 5: The educational level of the respondents 49

Figure 4. 6: Work experience in public health institutions 50

Figure 4.7: Bar chart depicting the respondent’s level of job satisfaction 61

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LIST OF ACRONYMS

1. KZN Kwa-Zulu Natal

2. DOH Department of Health
3. PS Public Sector
4. PHS Public Health Sector
5. PHC Primary Health Care
6. HPCSA Health Professional Council of South Africa
7. WHO World Health Organisation
8. SPSS

xiii
 CHAPTER 1:

INTRODUCTION

1.1 Introduction

An employee’s level of job satisfaction is one of the most important piece of data a
manager can have to predict the rate of absenteeism, work productivity, personnel turn-
over or level of psychological withdrawal at work. Health professionals are more
susceptible to reduced job satisfaction due to the unpredictability of their professions
(Dowell, Westcott, McLeod and Hamilton, 2000:269; Daft and Noel, 2001:35). Reduced
job satisfaction among health professionals has been documented as a contributing
factor towards increased staff turnover and absenteeism (Bodur, 2002:353). It is
evident that the delivery of quality health services depends on the availability of a
competent and satisfied workforce, available in adequate numbers with the appropriate
skills (Ramasodi, 2010:15).

This study outlines the background and motivation for the research and presents an
overview of job satisfaction levels and the impact on work productivity and service
delivery in the Public Health Sector (PHS) in Durban, Kwa-Zulu Natal (KZN). The study
seeks to identify the level of job satisfaction among physiotherapists in the workplace,
the factors that influence job satisfaction levels and the relationship between job
satisfaction and work productivity.

1.2 Background to the Study

According to Adams and Bond (2000:536) the subject of job satisfaction is particularly
relevant and of interest to public health practitioners due to the fact that organisational
effectiveness and the employees’ health and well-being rest a great deal on job
satisfaction. Therefore, a number of studies have addressed job satisfaction among
health professionals (HPCSA, 2010:5). However, the studies that were conducted in
South Africa (SA) focused on nurses and doctors due to the ‘brain drain’ that was
highlighted in these groups (World Health Organization, 2006:67). In light of this
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research gap, the study seeks to investigate job satisfaction in the physiotherapy
profession. The study aims to determine the general level of satisfaction among public
sector physiotherapists in Durban KZN, key factors influencing job satisfaction among
physiotherapists in the public sector, to explore the impact of job satisfaction on work
productivity and strategies to improve job satisfaction.

1.3 Problem Statement

S.A is faced with human resource problems in terms of work productivity and service
delivery. Many of the health professionals have been collectively voicing their
dissatisfaction with unsatisfactory remuneration packages, long working hours,
overburdened workloads, limited scope for professional growth, inadequate mentoring
from management and the disproportionate work ratios of physiotherapist to patients in
the public setting. Health professionals have been experiencing low levels of job
satisfaction which has in turn influenced the quality and effectiveness of service delivery
(Dieleman and Hammejer, 2010:6). It is for this reason that the area of job satisfaction
be explored in order to gain better insight thereof.

1.4 Aim of the study

To investigate the job satisfaction of professional physiotherapists, in the public health

setting in Durban, KZN.

1.5 Objectives of the study

In order to achieve the aim of this study, the objectives are highlighted as follows:

 To determine the level of job satisfaction among physiotherapists in the public

health setting;
 To examine the factors influencing job satisfaction among physiotherapists in the
PHS;
 To determine the relationship between job satisfaction and work productivity;
 To determine appropriate human resource strategies to improve job satisfaction;
and

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  To make recommendations to management in the PHS.
1.6 Research Questions

 What is the level of job satisfaction among physiotherapists in the PHS?

 What are the factors that influence job satisfaction among physiotherapists in the
PHS?
 What is the relationship between job satisfaction and work productivity?
 What are appropriate human resource strategies to improve job satisfaction?
 What are the recommendations that can be made to management in the PHS?

1.7 Significance of the study

This study is significant for the achievement of SA’s health service delivery objectives
and goals, having considered the shortage of physiotherapists and the impact on the
delivery of quality services. In addition the study focused on the job satisfaction of
public sector physiotherapists in particular where other studies have concentrated their
efforts largely on nurses and doctors. The focus of this research specifically identifies
those factors that are positive and those that are negative about working as a
physiotherapist in the public sector in Durban, KZN. Ntulini, (2006:10) notes that job
satisfaction in health workers is of interest for three reasons:

 It positively affects the health institute because satisfied employees are less likely
to be absent, engage in behaviour adversely affecting the institute, and change
jobs;

 Job satisfaction positively affects the patient because job satisfaction is

associated with better performance; and

 Job satisfaction positively affects health workers because it enhances the health
professional’s well-being, physical and mental health.

This study could contribute towards a pool of knowledge with respect to job
satisfaction of physiotherapists and will be academically important as it can be

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 applied to other third world and developing countries. This study will propose a
model that will be beneficial to the stakeholders such as physiotherapists,
department of health and hospital managers. The model will also be suitable in the
establishment of new physiotherapy facilities with regards to the human resource
component. A comparative analysis of the physiotherapy work environment in
developed countries versus developing countries can be used to develop strategies
to mitigate migration of physiotherapists from South Africa

1.8 Format of the Study

This dissertation consists of five chapters.

Chapter 1 Introduction to the Research

Chapter one has outlined an introduction to the study, background and the problem
statement. The research objectives, questions and the significance of the study have
been discussed and have given justification for the study.

Chapter 2 Literature Review

Chapter two provides a detailed description of the theoretical background and relevant
literature for this study. The review encompasses the challenges facing the public
health sector in SA. An evaluation of literature as well as a comparison of the
viewpoints of different authors was conducted. Following from this, a clear
understanding of the purpose of the literature review and how it is related to the study
will develop. The literature review provides the theoretical framework and background
against which the primary data can be compared and evaluated.

Chapter 3 Research Methodology

This chapter describes, in detail, how the study was undertaken and justified the
research methodology used for the study. The information was presented under the
following headings such as the design of the study, sample, data collection, ethical
considerations and data analysis techniques.

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Chapter 4 Results and Interpretation of Findings

The results are discussed in chapter four. It includes a statistical analysis of the results
which is then followed by an interpretation and discussion of the findings.

Chapter 5 Conclusions and Recommendations

The chapter provides an understanding of the conclusions that have been made based
on the study as a whole and provides possible recommendations that may be made to
management. This section also highlights the need for further research in order to
improve work productivity and managerial reformation in the public health sector.

1.9 Conclusion

The introductory chapter outlined the background and the motivation for the study and
presented the significance of the study, aims of the study, objectives of the study,
problem statement and the research questions. The level of job satisfaction and the
factors that affected job satisfaction were discussed. The impact of job satisfaction on
work productivity was evaluated and strategies that could influence positive job
satisfaction were discussed. Key concepts to this research were presented and briefly
discussed. The literature review which follows is discussed in Chapter Two and
provides the theoretical framework for the study.

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 CHAPTER 2:

LITERATURE REVIEW

2.1 Introduction

Job satisfaction has remained a remarkable area of discussion in the field of business
management, industrial psychology, organisational behaviour and human resource
management. Understanding what motivates workers and the impact thereof on work
effectiveness, productivity and service delivery has been an area of interest for
organisations and managers alike (Murrells, Robinson and Griffiths, 2008:1).

In Chapter two, the literature review introduced a brief description of the PHS and the
advantages of, or the challenges in the PHS which might influence the job satisfaction
of physiotherapists working in this environment. The challenge and shortage of
healthcare workers were highlighted both in a global context and in SA. The link
between physiotherapy and health, more specifically the PHS, was examined.

The complex phenomenon known as job satisfaction was discussed and the theories
and determinants of job satisfaction were explained. Measurement and consequences
of job satisfaction were conferred. Lastly, this chapter provided insight into the findings
of other studies on the subject of the job satisfaction of physiotherapists in other parts of
the world.

2.2. Definition, History and Organisational Structure of the Public Health Sector of

South Africa

The Public Sector (PS) can be defined as:

“that portion of the economy whose activities (production, delivery and allocation of
goods and services) are under the control and direction of the state” (RSA, 2007:1).

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The state owns all the resources in this sector and uses them to achieve whatever goals
it may have to promote the economic welfare of the ruling elite or to maximize the well-
being of society as a whole (Ramasodi, 2010:6). Taken from this, the PHS is described
as that portion of government concerned with governing and providing health services
to the public of SA (RSA, 2007:9). Today, the PHS is more commonly known as the
Department of Health (DOH). Earlier health services in SA were distinctly known by its
bureaucratic structure and characterised by a strong hierarchy governed by centralised
authority, strict channels of command and impersonal contact between managers and
subordinates (WHO, 2006:50).

In 1994, the new democratic government of SA inherited an inequitable health system

with health departments for four different racial groups as well as each of the 10
homelands having its own department of health. That same year, the African National
Congress (ANC) adopted a primary health care philosophy. However, it would seem
that the changes needed for the restructuring of the health system presented many
challenges.

2.3 World Reform and Challenges in the Public Health Sector

Challenges in the PHS described by Jooste (2003:7) seem to be directly related to

issues of reform as adopted by the new democratic government. Industrial and
behavioural psychologists have long been concerned with the global reform of
organisational behaviour and hold up the following as examples of such transformation:
the creation of a global village, from homogeny to workforce diversity, improving quality
and productivity, improving people skills, from management control to empowerment
and from stability to flexibility (Jooste, 2003:25; Robbins, 2003:18). Reforms in
management strategies, greater quality and productivity and workforce diversity have all
become concerns in public health management and administration (Prabst-Hunt,
2002:63).

Jooste (2003:8) described challenges such as the pressure to achieve greater

proficiency in service delivery, work productivity, moral imperatives, public pressure and
opinion, equity and accessibility and changing demographic patterns as prominent

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influences in the reform-process in public health. The improved management and
availability of resources, decentralisation of responsibility, power and authority to lower
levels and reduction of bureaucratic practices are all concerns that have come under
scrutiny since democracy in SA (Jooste, 2003:8).

In addition, Ramasodi (2010:14) adds the following as challenges in the PHS:

 resistance to change;
 breakdown in communication;
 poorly designed training programs;
 personal and domestic problems of employees;
 unsatisfied employees;
 disproportionate working hours;
 overtime and shift-work;
 poor remuneration;
 poor organisation and leadership;
 inadequacy of resources and equipment;
 poor physical working conditions; and
 incorrect placement of persons and lack of opportunities for promotion.

Robbins (2003:545) consistently observes the inherent nature of man to resist change.
Change and reformation is often viewed as a threat by personnel in an organisation and
is therefore met with reservation and opposition (Robbins, 2003:632). Sulsky and Smith
(2005:152) reflect that any event eliciting feelings of insecurity, prejudice and unfairness
in employees is perceived as a threat and will have a negative impact on the
employee’s job satisfaction and work performance. Taking into account all these
challenges and viewed within the organisational structure of the PHS, the variables of
ineffective organisational behaviour such as absenteeism, decreased work
performance, indifferent attitudes, low motivation and excessive rates of personnel turn-
over can almost be anticipated and predicted (Robbins, 2003:27).

Physiotherapy forms an integral part of health services and is an important component

of the changing PHS. The question is: how are physiotherapists dealing with all of the
8
above-mentioned challenges? Perhaps even more pertinent would be the question of
how these challenges affect experiences on the job and how physiotherapists respond
to these experiences in attitude and emotion?

2.4 Physiotherapy and the South African Public Health Sector

The following section of this literature review provides an overview of the profession
physiotherapy and its relationship with the PHS.

2.4.1 Physiotherapy

Physiotherapy is based on the use of treatment modalities such as exercise, massage,

rehabilitation and electrical therapeutic treatment rather than drugs for the treatment of
disease, bodily defects or bodily weaknesses (SASP, 2012:1). It is concerned with the
whole person and aims to promote good physical and psychological health through
treatment intervention.

A physiotherapist is seen as a clinical practitioner, who has obtained a four-year degree

in physiotherapy, and holds a current registration as a physiotherapist with the Health
Professions Council of South Africa (HPCSA). For the purpose of this study, the term
will include only physiotherapists working in the PHS.

It would seem reasonable that a need to help is a common factor that links most
physiotherapists to their jobs. This suggestion is supported by studies relating to the job
motivation of therapists around the world and speaks a fundamental truth about the
need for paramedical professionals to bring about hope, ability and wellness where it
might otherwise be lost (Moore, Cruickshank and Haas, 2005:312). This central theme
in the motivation of therapists may well become very important to the study of their job
satisfaction. The opportunities to serve and make a difference may be adversely
influenced by challenges or even by generic issues (such as perceived status of the
profession) experienced by the global physiotherapy community (Moore et al.
2005:312).

Although physiotherapists can be found in various settings of society, the organisational

structure most relevant to this study is that of the PHS. Within the PHS, physiotherapy

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forms an integral part of the health service package provided by the government of SA
and as such, physiotherapists are appointed in all areas of health service delivery
including management, administration and the clinical field of practice (SASP, 2012:1).
As mentioned previously, challenges within the PHS (Ntulini, 2006:68) may well be
deciding factors in the experience of job satisfaction/dissatisfaction by physiotherapists.
These challenges are better understood when seen against the background of the
changing nature of the global health care system and SA’s present health system.

2.5 Global Shortage of Physiotherapists

Physiotherapists are well recognised in the rehabilitation component and hence play a
key role in healthcare service delivery (Chartered Society of Physiotherapists, 2011:31).
In 2011, the World Health Organisation (WHO) published a report on the Global
Physiotherapy Workforce in which the global shortage of physiotherapists was
highlighted. The shortage of physiotherapists globally can be attributed to the increasing
number of the population over the age of 65 years, the changing role of physiotherapists
and the growing number of women in the profession who are less likely to work full time
(DOH, 2000:4). Shortages of physiotherapists affect all the different sectors of
paramedical services and the public sector tends to suffer more (DOH, 2011:23). There
are no internationally accepted recommendations for the ratio of physiotherapist to
population but some countries have developed their own individual ratios influenced by
their specific settings (WHO, 2011:22). Interviews that were conducted at leading public
health institutes in Durban, KZN expressed the need for a suitable model that could be
used to develop therapist patient ratios in order to address understaffing issues in the
public health institutes.

2.6 South Africa’s Shortage of Healthcare Workers

The national DOH is mandated by the Constitution and the National Health Act (Act 61
of 2003) to provide an equitable health service to all citizens in S.A (DOH, 2011:24). For
the health department to deliver on this mandate, it must ensure that adequate human
resources are available. In S.A, the government has identified the challenges faced by
the country in relation to skills shortage, especially healthcare professionals. The

10
shortage is mostly felt in the PHS, an indication that the distribution of healthcare
professionals between the private and public sector of the country is un-equitable
(Padarath et al., 2003:300). The private health sector consumes 59% of the total health
expenditure and employs a higher proportion of personnel due to the lucrative
remuneration offered compared to the PHS (Padarath et al., 2003:300; Wadee and
Khan, 2007:36). It should be noted that the private health sector caters for about 1% of
the total population of SA (Bletcher and Harrison, 2006:31).

High levels of staff migration are experienced within SA’s PHS thus contributing to the
“brain drain” currently experienced by most of the developing African countries
(Padarath et al., 2003:313). In most cases the reason for moving, besides the financial
benefit is said to be related to working conditions. (Bletcher and Harrison 2006:81). The
majority of skilled South Africans who emmigrate to developed countries such as the
United Kingdom, United States of America and Canada do so, because working
conditions are perceived to be better (WHO, 2011:44). The DOH attempted to address
the ongoing problem with the introduction of compulsory community service for
physiotherapists in 2003 (SASP, 2004:12) to ensure an improved provision of health
services to all citizens, especially in the previously under-serviced areas. Although
community service has contributed to slightly higher numbers of physiotherapists in the
PHS, the long term impact has been limited (SASP, 2012:5).

In 2004, the National DOH introduced additional incentives for healthcare professionals
in the form of scarce skills and rural allowances (DOH, 2011:30). The sole purpose of
the allowance was to address the inequity in the distribution of healthcare professionals
between the public and private sector (Padarath et. al., 2003:304). There is currently no
data available to determine if these incentives have managed to achieve their intended
goal. This is a potential area of research that needs to be investigated. The section
that follows explored job satisfaction and the related theories utilised in the study.

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2.7 Job Satisfaction

One aspect that may have been overlooked in the issue of physiotherapist shortages is
job satisfaction. Job satisfaction is a complex phenomenon that has been studied quite
extensively. Leading authorities in the field of business management stated that job
satisfaction is a state of emotional gladness, and results from the achievement of the
goals that one can get through the individual contribution within the organisation (Locke,
2009: 45). Dawis and Lofquist (2004:24) narrated job satisfaction as being the outcome
of the worker’s appraisal of the extent to which the work environment fulfills the
individual’s needs. According to Ramayah, Jantan and Tadisina (2001:14) “job
satisfaction explained how employees were buoyant to come to work and how they got
enforced to perform their jobs”. The above descriptions have relevance to the study in
the examination of job satisfaction in the PHS. In the PHS, job satisfaction has an
impact on the delivery of quality healthcare. This is because there is often a
relationship between job satisfaction and employee turnover, absenteeism, worker
productivity and the overall organizational effectiveness (Dawis and Lofquist, 2004:25)

2.7.1 Job Satisfaction and Motivation

According to Hollyforde (2002:56) literature has indicated that there is a strong link
between job satisfaction and worker motivation, whereby motivation encourages an
employee, depending on their level of job satisfaction to act in a certain manner. Rao
(2005:20) argues that positive individual job satisfaction acted as a motivating factor
towards promoting quality service delivery. Therefore, the findings of Rao (2005:25)
and Hollyforde (2002:56) are in keeping with the literature trends offered by Ramaya et
al. (2001:14) and have highlighted the role of motivation in relation to work productivity
and effectiveness. Figure 2.1 explains the cycle of the basic model and how motivation
is linked to satisfaction.

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Figure 2.1: Basic Motivational Model

Need or deficiency

Direct behaviour to
Satisfaction/Unsatisfied
satisfy need/ goals

Rewards/Punishment Action/Achievement
performance

Source: Cronje, du Toit , Marais and Motlatla, 2005:223

2.7.2 Job Satisfaction and the Employee

From the employee’s point of view, job satisfaction may reflect benefits that people seek
when commencing the job (Ramasodi, 2010:3). In addition, Aswathappa (2003:23)
suggested that the employee’s desire to use their skills and abilities to make a
meaningful contribution and to be valued in the organisation would also affect job
satisfaction. Aswathappa (2003:23) also added that job satisfaction could be achieved
when an employee performed to the best of their ability, and showed a certain level of
commitment.

2.7.3 Job satisfaction and the Organisation

From the organisational perspective, the aim is to recruit people to perform tasks in an
efficient and effective manner in order to achieve the overall objectives of the business.
Therefore organisations have invested heavily in the recruitment procedure in order to
recruit the best candidate on offer (Mayer and Botha,2004:34). This is especially

13
relevant in today’s labour market. However, the PHS has not invested adequately in
determining factors that have affected the satisfaction levels of employees in order to
create relationships that could be sustained in the long run (WHO, 2011:43). As Mayer
and Botha (2004:34) indicated, South African organisations were experiencing low
levels of job satisfaction, which had resulted in a lack of commitment to service delivery.
In healthcare institutes, satisfaction has been found to be positively related to service
quality and patient satisfaction (Tzeng, 2002:51). The issue of job satisfaction must be
considered when addressing physiotherapy shortages in SA. One would expect that
improved job satisfaction will not only address retention and recruitment issues but also
improve patient well-being in the public healthcare system.

2.8 Theories of Job Satisfaction

There are a number of theories that have been used to describe job satisfaction. Each
of the theories is discussed according to the content and process approaches to job
satisfaction. Content theories focus on the needs and factors that motivate behavior to
the “what” of motivation whilst process theories focus on the origin of behavior and the
factors which influence the strength and direction of the behavior, the “how” of the
motivation (Cronje et al., 2005:224).

2.8.1 Content Approaches to Job Satisfaction

The content theories of satisfaction emphasise the factors within individuals that guide
behaviour. These theories include Maslow’s Hierarchy of Needs, Alderfer’s Existence
Relatedness and Growth Needs (ERG) theory, Herzbergs Two Factor Theory and
McClelland’s Theory (Cronje et al., 2005:224).

2.8.1.1 Maslow’s Hierarchy of Needs

Maslow’s theory is the most widely recognized motivation theory and perhaps the most
referenced of the content theories (Cronje et al., 2005:224). The main premise of this
theory rests on the basis that needs are hierarchically arranged where the lowest level
needs are physiological and the highest level needs are self-actualisation.

14
Figure 2.2: Maslow’s Hierarchy of needs

SELF
ACTUALISATION

ESTEEM
ACHIEVEMENT,APPROVAL

AFFILIATION
ACCEPTANCE,AFFECTION,BELONGING

SECURITY
SECURITY ,FREEDOM FROM FEAR

PHYSIOLOGICAL
FOOD,DRINK,SHELTER

Source: Cronje et al., 2005:225

Physiological needs can include the basic ingredients for survival and for biological
functioning. It may be suggested that in a physiotherapy environment, employees are
satisfied by providing aspects such as salary, rest rooms, cafeterias, heating and
adequate lighting (APTA, 2009:2). The next level in the hierarchy is safety and security
needs, which include protection from physical and emotional harm (Al-Hussami,
2008:15). It may be suggested that this can be translated into job security, pension
plans, structures to deal with grievances and employee assistance programs. Affiliation
needs suggests the need to be accepted by peers, friendships, love and affection
reference (Cronje et al., 2005:225). This level of social interaction may be satisfied by
the attendance of office social events and team building gatherings.

Esteem needs include the need for a positive self-image and self-respect, and the need
for recognition from others (Cronje et al., 2005:225). In organisations this need can be
satisfied by means of job titles, challenging work tasks, access to information and the

15
receiving of compliments. The highest level in the hierarchy incorporates the self-
actualisation needs, which involve realising one’s potential through growth and
development (Aswathappa, 2003:110).

In the physiotherapy context the employee will focus on the opportunity for making
decisions, obtaining challenging work tasks and development opportunities. In relation
to Maslow’s theory, when these needs are unsatisfied in the organisational context, it
can cause stress, frustration, internal and external conflict. Therefore it can be
suggested that employers should seek to implement organisational human resource
policies and procedures that support need satisfaction in order to reduce stress,
frustration and conflict. Maslow’s theory provides a useful framework for understanding
needs and expectations and can therefore be linked to the various intrinsic and extrinsic
factors that can influence job satisfaction levels. Figure 2.2 represents the different
levels and the needs that belong to each level.

2.8.1.2 Alderfer’s Existence Relatedness And Growth Theory

In this theory, there are three core needs namely “existence”, “relatedness” and
“growth”. According to Alderfer’s ERG theory, these needs are summarised as follows
(Aswathappa, 2003:111):
 Existence needs: These needs relate to a person’s basic material and existence
needs;
 Relatedness Needs: These needs relate to a person’s desire for interpersonal
relationships and interaction; and
 Growth Needs: These needs relate to the desire of an individual to make a
creative or productive contribution.

In contrast to Maslow’s theory, Alderfer’s ERG theory supports the belief that two or
even all three need categories can influence behaviour simultaneously, rather than the
hierarchial influence offered by Maslow. In the organizational context, it would be
impractical to assume that employees only achieve job satisfaction as stipulated by

16
Maslow’s theory. Whilst Maslow’s theory has provided the framework for investigating
extrinsic and extrinsic factors of job satisfaction, the current study is based on the ERG
theory which is more indicative of job satisfaction as experienced in the PHS.

2.8.1.3 Herzberg’s Two Factor Theory

According to Grobler, Warnich, Carrell, Elbert and Hatfield (2006:220), the Herzberg’s
two factor theory has been cited as one of the most interesting and controversial
theories. Hygiene factors included the following aspects that people considered
essential to perform any job:
 Salary;
 working conditions;
 security; and
 organisational policy and administration (Cronje et al., 2005:242).
Whilst these factors do not act as motivational factors, it has been noted that when
these factors are absent in an organisation, it can adversely influence employee morale,
the level of job satisfaction and the level of employee service delivery (Grobler et al.,
2006:221).

Motivational factors which are also called growth factors focus on the job content and
are more likely to motivate employees to achieve higher work productivity, commitment
and effectiveness, and to find creative ways of accomplishing both personal and
organizational goals (Aswathappa, 2003: 115). According to Aswathappa (2003:115)
these comprised achievements, recognition for what had been achieved, the job itself,
progress and growth, responsibility and feedback. This theory is utilised in conjunction
with Maslow’s theory to identify the leading factors influencing job satisfaction. Figure
2.3 demonstrates the Two Factor Theory based on the hygiene and motivation factors.
Table 2.1 draws the comparison between Maslow’s theory and the Two Factor theory.

17
Figure 2.3: Hygiene and Motivation factors
security
Money, status,
Personal Life

HYGIENE FACTORS
Relationships
Interpersonal

(ENVIRONMENTAL)
Working Conditions
Supervision
Administration
Policies and

personal growth
Opportunities for

MOTIVATOR advancement
Opportunities for

FACTORS responsibility
Increased

(JOB ITSELF)
Challenging work
Recognition
Achievement

Source: Rue and Byars, 2008:290

Table 2.1: Comparison of the theories of Herzberg and Maslow

Herzberg Maslow
Social Network Social
Supervision Belongingness
Policy/Administrative Safety/Security
Maintenance Factors Job security Physiological
Salary
Working conditions
Recognition Esteem needs
Status
Motivational Factors Advancement
Work itself Self-Actualisation
Responsibility

Source: Cronje et al., 2005:252

2.8.2 Process Theories of Job Satisfaction

18
Behaviour is a fundamental indication of an individual’s perception and expectations
about a situation and possible outcomes of behaviour. Process theories define how and
by which goals individuals are motivated. They are based on the assumption that
people make conscious decisions regarding their behaviour. The most documented
theories include the equity theory, expectancy theory and the job characteristics model
(Ramasodi, 2010:5).

2.8.2.1 Expectancy Theory

According to Ramasodi (2010:5) this theory was developed by Vroom who asserted that
job satisfaction was based on an individual’s beliefs about the probability that their effort
will lead to performance (expectancy) multiplied by the probability that performance
leads to reward (instrumentality) and the value of perceived rewards (valence). Vroom’s
theory was based on the belief that the amount of effort exerted on a job depends on
the expected return and may result in increased or decreased pleasure (Ramasodi,
2010:5). Therefore an individual may perform their job and be satisfied if they believe
that their efforts will be rewarded. The fundamental principle of Vroom’s theory is the
understanding of individuals’ goals and the linkages between effort and performance,
performance and rewards and rewards and individual goal satisfaction (Ramasodi,
2010:5).

In addition, Vroom’s theory recognizes that there is no universal principle that explains
peoples’ motivation and is regarded as a contingency model (Adams and Bond,
2000:540). Understanding what needs a person seeks to satisfy does not ensure that
the individual perceives high performance as necessarily leading to the satisfaction of
these needs. Vroom’s theory can be used in the organisational context whereby
rewards are linked to performance standards as well as the linking of personal goals to
organisational goals (Ramasodi, 2010:10). This theory has also been applied to the
study. Figure 2.4 demonstrates the Expectancy theory.

Figure 2.4: Expectancy approach to Motivation

19
 External Factors External Factors

Level of Motivation Effort Performances Outcomes

Expectancies Instrumentalities Valencies

Source: Adams and Bond, 2000:540

2.8.2.2 Equity Theory

According to Adams and Bond (2000:543) employees will compare their efforts and
rewards against other employees in the organisation in similar situations. This theory is
based on the assumption that employees are motivated by the desire to be treated
equitably in the workplace. A state of equity exists when one employee’s position is
equal when compared with another employee’s position with reference to the input-
outcome ratio. However, if the ratios are considered unequal, a state of inequity exists.
Therefore employees would perceive the situation to be unfair and therefore not be
motivated positively. This theory has provided great insight into the motivation of
employees and should be noted in the study of worker satisfaction and retention (Daft
and Noel, 2001:143). It must be noted that this theory rests heavily on what the
employee perceives to be equal.

2.8.2.3 Job Characteristics Model

Bergh and Theron (2000:34) described this model as an interactive model that helped to
develop employees and the work environment in order to achieve the “best fit” in the
work setting. The model places emphasis on the need for the job to be designed to
20
possess characteristics that enable conditions for high motivation, satisfaction and
performance. There are five core characteristics of the job that have been identified to
influence the employee’s behavior and attitude. These include skill variety, task identity,
task significance, autonomy and feedback.

2.9 Factors Influencing Job Satisfaction

Barnes (2004:1) identified three factors that determined the job satisfaction of
rehabilitation professionals as extrinsic and intrinsic context as well as intrinsic content
factors. The extrinsic factors were identified as competitive pay and benefits such as
family leave, flexible schedules and support for child care. The identified intrinsic
factors were factors less tangible but inherent to the job. Intrinsic context factors
included factors that were controlled by outside forces and those that affected the
internal satisfaction of professionals (Barnes, 2004:2). Adequate staffing, a realistic
workload, stable work environment, and support by the administration are regarded as
intrinsic context factors. Barnes (2004:2) identified intrinsic content factors as those that
are controlled primarily by the professionals and are believed to affect his or her sense
of effectiveness and competence. They include the rewards of helping people to
overcome their disability, meaningful work, proper training and the provision of quality
care. Time pressure, employee participation, physical work environment, the
opportunity to develop, teamwork, patient care and service delivery are determinants of
job satisfaction in the healthcare environment (Hughes, Ginnet and Curphy, 2005:321).

2.9.1 Time Pressure

Time Pressure is defined as the quantity of time that is allocated for the completion of
treatment per patient (Hughes et al., 2005:3321). According to Nasaab (2008: 54), time
is a subjective experience despite the fact that it can be measured. While the quality of
time is of great importance so is quantity. Literature shows that perceived time pressure
is associated with low job satisfaction among healthcare professionals (Ramasodi,
2010:14). Dissatisfaction about time pressure expressed by healthcare professionals
may indicate concerns about autonomy. Nasaab (2008:55), showed that time pressure
was strongly and positively associated with job dissatisfaction. The reduction in the

21
number of working hours and shift work was found to support higher levels of job
satisfaction but health professionals who felt that they lacked sufficient time to provide
optimal care for patients showed low levels of job satisfaction.

2.9.2 Employee Participation

Employee participation may enhance motivation through power sharing, and increased
responsibility (Ayers, 2005:2). Employee participation can afford individuals an
opportunity to make key managerial decisions that have an impact on other employees,
thus increasing job satisfaction, work effectiveness and performance. In 2006, the
American Physical Therapy Association investigated the recruitment and retention
patterns of physical therapists using the Health professional work satisfaction survey
and the study revealed that the respondents were more satisfied when given an
opportunity to participate actively in the work environment (APTA, 2009:22-34).

2.9.3 Physical Work Environment

The physical work environment: temperature, humidity, ventilation, noise, light, colour
and safety can affect employee performance and productivity (World Confederation for
Physical Therapy, 2008:4). Studies clearly show that adverse physical conditions have
a negative impact on performance (Rue and Byars, 2008:155). Ayers (2005:5)
conducted a study on job satisfaction among healthcare workers who worked with
disabled patients. The study found very low levels of job satisfaction due to the fact that
the work environment was not stimulating and their jobs did not motivate them.
Unhealthy work environments affect health professionals’ physical and psychological
health through the stress of heavy workloads, long hours, low status, difficult relations in
the workplace, problems carrying out professional roles and a variety of workplace
hazards (Rue and Byars, 2008:155). The costs related to unhealthy work environments
for health professionals has been well documented. Evidence suggests that long
periods of job strain caused by an unhealthy work environment can increase sick time,
conflict, job dissatisfaction, turnover and inefficiency (World Confederation for Physical
Therapy, 2008:4).

22
 2.9.4 Opportunity to Develop

Education and training may be defined as the “planned effort by an organisation to

facilitate the employees learning of job related competencies (Rue and Byars, 2008:34).
Human resources can provide the intellectual capital that is needed to support the
organisation’s competitive advantage in the market place (Noe, Hollenbeck, Gerhart
and Wright, 2006:352). Therefore, training is necessary to support the sustenance of
intellectual capital within the organisation. The relevance of education, training and
development is also noted when one considers the relationship between these factors
and the level of job satisfaction.

A study conducted by Shah, Al-enezi, Chowdury and Shah (2007:156) on healthcare

professionals revealed a significant relationship between the level of education and
training and job satisfaction. Respondents who were given the opportunity to participate
in education and training programs were more satisfied than those who did not. A study
conducted by Ali-Mohammed (2004:51), on the factors affecting employees’ job
satisfaction in public hospitals found that the opportunity to develop professionally was a
significant predictor of job satisfaction among the participants. Effective in service
training was also one of the significant determinants of job satisfaction in healthcare
providers. Therefore, the greater the chance for internal development, the greater was
the incidence of higher job satisfaction (Ali-Mohammed, 2004:51).

2.9.5 Teamwork

Various studies conducted among healthcare workers have shown the importance of
interpersonal relationships in job satisfaction (Eker, Tuzan, Duskapan and Surenkok,
2004:500). These studies that have highlighted the importance of interpersonal
relationships in job satisfaction showed that teamwork led to increased patient safety,
improved quality of care and greater patient satisfaction. Therefore developing a good
relationship with colleagues or co-workers can positively influence the level of job
satisfaction and the level of work productivity. Teams are more responsive to patient

23
needs, more cost effective and provide more job satisfaction to providers than staff
members working individually (Royal Pharmaceutical Society and the British Medical
Association, 2000). However, teams do not work effectively simply through putting
people together, teams must have clear goals, to which all members are committed,
they need communication and a clear overall management structure. Individual
members must view teamwork as rewarding and their own role as essential (Sims,
2003:68). In order to remain effective, teams need coaching. This is where effective
managers play an important role in the coaching of teams.

2.9.6 Benefits and Compensation

Employee benefits and services may be classified as voluntary or mandatory

(Ramasodi, 2010:24). According to Cronje et al. (2005:576) mandatory employee
benefits and services include leave, unemployment insurance and compensation for
injuries and diseases and the voluntary employee benefits and services within South
Africa include pension, insurance and employee services such as childcare
programmes and food services. Compensation may be defined as “the human resource
management function that deals with every type of reward individuals receive in
exchange for performing organisation tasks” (Ramasodi, 2010:25). In a study
conducted in Turkey (Bodur, 2002:353), it had been demonstrated that benefits,
compensation, working conditions and income were among the most important factors
for dissatisfaction of healthcare providers working at public health centres, which is
consistent with the findings of previous studies.

2.10 Job Satisfaction and Work Productivity

Job satisfaction among healthcare professionals is an important predictor of individual

wellbeing, general life satisfaction and work productivity. According to Cronje et al
(2005:578), productivity is the determination to perform better than yesterday with a
desire to improve the existing situation, irrespective of how good the current situation is.
Poor performance and productivity of service providers leads to inaccessibility of care
and inappropriate care. In turn, this contributes to reduced health outcomes as people

24
are not using services or are mistreated due to harmful practices. A number of articles
and documents have reported problems relating to service provision due to poor
performance and productivity of health workers (WHO, 2006; Garcia-Prada and Chawla,
2006:91).

Poor productivity results from low levels of job satisfaction which has been attributed to
a failing health system, low salaries, difficult working and living conditions and
inappropriate training (Hughes et al., 2005:321). Health worker productivity is a complex
issue to address, as a variety of determinants influence staff behaviour at different
levels (WHO, 2006). Efforts to improve job satisfaction are closely related to efforts to
improve productivity, competency and effectiveness (Garcia-Prada and Chawla,
2006:91).

2.11 Employee Motivational Strategies to Improve Job Satisfaction

2.11.1 Job design and the Work Environment

Job design can be seen as an important factor that influences how an employee feels
and reacts to their work or job task which therefore implies that job design can affect an
employee’s performance and job satisfaction (Potter and Brough, 2004:336). Cronje et
al. (2005:232) stated that employees will place a high value on a job that provides
satisfaction, is challenging, provides growth, and allows for adequate achievement
opportunities. Therefore, physiotherapy jobs can be redesigned to make them more
satisfying by using the principles of job rotation, enlargement or enrichment.

Solutions to improve the level of job satisfaction should also seek to enhance the work
environment, which is often a significant factor that causes job dissatisfaction.
Literature has suggested that health workers are more likely to remain with
organisations that offer a combination of benefits to boost job satisfaction (Cronje et al.,
2005:234) Given that there are many resource limitations, health care organisations will
need to address areas of the work environment that can yield quick and sustainable
results. Good performance, productivity and effectiveness are enabled via a supportive
working environment. This encompasses more than simply having sufficient equipment

25
and supplies. It also includes infrastructure issues, such as decision making and
information exchange processes, and capacity issues such as workload, support
services and infrastructure (Potter and Brough, 2004:336).

2.11.2 Personnel Administration and Employee Relations

The World Health Report of 2006, showed that in many countries the salaries of health
workers were below the minimum living wage and that the pay levels of public sector
workers were often unfair compared to others in similar jobs (WHO, 2006:21). Since
equal pay will be hard to achieve in many countries, health workers will search for ways
to supplement their low income (WHO, 2006:22). There are several options available to
address this problem (Jan, Bian, Jumpa, Meng, Nyezama, Rakongsai and Mills,
2005:771).

 Establishing a regulatory framework;

 Self regulation through professional associations; and
 Changes in the payment system, such as using output related payments.

If the approaches indicated above are to be successful, human resource management

adaptations must be made and a management commitment, sufficient staff and a
functioning human resource management information system are important (Jan et al.,
2005:771).

2.11.3 Performance Management Systems

According to Martinez and Martineau (2005: 154), performance management consists

of the following activities:

 job descriptions;
 performance appraisals; and
 compensation and career development.

Marquez and Kean (2002:22) recommends that managers must be able to:

26
  Assess the quality of service delivery and work productivity of their staff;
 Must be able to supervise and motivate their staff;
 Ensure that staff have the appropriate tools and resources for their specific
jobs; and
 Identify and address performance gaps.

Hence Marquez and Kean (2002:22) believe that implementing performance

management contributes to improved employee performance. However, comprehensive
performance management systems are almost non-existent in developing countries.
Performance management activities that do form part of a system, have tools that are
either outdated, poorly understood or managers lack the skills needed to implement
them properly (Martinez and Martineau, 2005:155).

Career management may be defined as “the process of designing and implementing

goals, plans, strategies that enable HR professionals and managers to satisfy workforce
needs and allow individuals to achieve their career objectives” (Carrel, Elbert, Hatfield,
Grobler, Marx, and Van der Schyf, 2005:347). The implementation of an effective
career management programme brings about a number of benefits for both the
employer and employee that include the following (Nel et al., 2001: 501):

 The ability of the organisation to gain competitive advantage within the

physiotherapy department and the hospital as a result of the maintenance of the
organisation’s intellectual capital;
 The organisation would avoid the negative effects of obsolescence;
 Increased employee job satisfaction and motivation; and
 Reduction in staff turnover due to satisfied employees.

Organisational career planning may be achieved through the development of individual

development plans for employees (Carrel et al., 2005:356). The individual development
plan provides details of an employee’s potential progression from one job to another
according to the goals of the organisation. When individuals find a career path that
utilizes their full potential, they are likely to be more motivated and productive thus

27
increasing job satisfaction. Career planning ensures that the individual employee’s
career goals are realistic and the organisation is able to achieve its goals. Career
development determines the nature and quality of individuals’ lives as well as the social
and economic contribution they make. Career development is crucial for an effective
labour market (Carrel et al., 2005:356).

2.11.4 Organisational Climate and Culture

The literature suggests that the ability of an organisation to support and deliver quality
patient care is important to healthcare professionals’ job satisfaction (Caulkin, 2001:32).
Different managerial style and practices at the department level can have a direct
bearing on the physiotherapist’s level of job satisfaction. Improved work effectiveness
and productivity does not result from the implementation of suitable human resource
practices alone, but, also from effective implementation which requires management
skills (Caulkin, 2001:32). Buchan (2002:2) demonstrated the importance of leadership
and management skills for supporting work productivity and effectiveness. Research
has also shown that management recognition contributes towards job satisfaction
(Adams and Bond, 2005:536). Hence, it is important for managers to possess the
required skills to ensure that the staff perform according to recognized standards and
are therefore motivated to work. However, management positions in the health sector
are often occupied by untrained managers who lack the required skills needed to
support high levels of employee satisfaction (Caulkin, 2001:32).

The work of Adams and Bond (2005:536) highlighted the importance of management
relationships in healthcare workers. Organisational factors such as teamwork,
autonomy, management support, workload and staffing levels have a great influence on
job satisfaction because they impact on the delivery of patient care. A number of
studies have also shown a positive association between management effectiveness and
levels of job satisfaction (Roedel and Nystrom, 2008:34; Spector, 2006:1005).

2.11.5 Financial and Non Financial Incentives

28
The South African DOH introduced a “rural and scarce skill” allowance in 2003 to curtail
the alarming number of workers that were leaving the public health sector (Lehmann
and Sanders, 2004:57). Preliminary proposals have suggested that as a result of this
allowance, health professionals will be more likely to alter their plans in favour of staying
in the present government posts. Another convincing case that showed a link between
financial compensation, motivation and job satisfaction is drawn from a study where
health workers with relatively higher remuneration retained higher levels of job
satisfaction in comparison with the health workers with a lower pay structure
(Bhattacharayya, Winch, LeBan, Tien, 2001:43).

Given the difficulty of providing financial incentives, governments in resource

constrained countries have explored other avenues to offer to healthcare workers.
Malawi provided housing facilities (Huddart and Picazzo, 2003:14) and a work
improvement initiative in Tanzania attempted to link good management practices,
worker satisfaction and retention (Dovlo, 2004:12). Special attention needs to be paid
to training, as many managers still see this as the best solution to addressing staff
productivity and effectiveness problems. Professional development is important for
staff, but various learning approaches can be applied to learning. Examples include
cost effective methods for on the job training and at the workplace through supportive
supervision, clinical meetings or peer support and through distance learning schemes.
Off site training schemes appear less effective, as implementation of new skills in the
workplace is not guaranteed, nor are follow ups after training or an enabling
environment (Shahabudin, 2003:350). These schemes are also expensive, as they
create staff shortages in the workplace that must be dealt with, which is often difficult in
places where there are high staff shortage levels.

2.12 Conclusion

Job satisfaction is an important component of the healthcare worker and can impact on
patient safety, staff morale, productivity and performance, quality of care, retention and
turnover, commitment to the organisation and the profession (Waldman, Kelly, Arora

29
and Smith, 2004:7). In SA, as the population ages and grows, the importance of
improving rehabilitation services remains a critical issue and physiotherapists play a
vital role in rehabilitative health care. Through job satisfaction studies, job satisfaction
determinants influencing physiotherapists were identified, and necessary measures that
could be taken to increase the levels of job satisfaction. This would consequently
improve the quality of rehabilitative services on offer to the public. Establishing positive
practice environments that support job satisfaction is of paramount importance in the
PHS to ensure the provision of quality service delivery by physiotherapists. The next
chapter details the research methodology utilised for the study.

CHAPTER 3:

30
 RESEARCH METHODOLOGY

3.1 Introduction

This chapter discusses the methodology that was used in the study. In order to employ
suitable remedies for a problem, researchers are expected to employ suitable
methodologies (Cooper and Schindler: 2003:5). The rationale for the study was
examined followed by a discussion on the research design components. Sampling
techniques and methods utilised in this study are presented with a clear identification of
the target population and sample. Data collection and analysis were discussed.

3.2 Rationale for the study

Abrahams (2011:1) defined research as an organised, structured, and purposeful

investigation, aimed at discovering, interpreting, and revising human knowledge on
different aspects of the world by someone first hand. According to Shajahan (2005:2)
research was especially useful in solving the operational and planning problems of
industry and business. The significance of the study was contained in understanding
the degree of job satisfaction and its effect on work productivity by physiotherapists,
which could impact greatly on the ability to provide affordable, accessible and
accountable rehabilitative healthcare to the PHS. The study was closely linked to the
research methodology and the specific research design as outlined below.

3.3 Research Design

Neuman (2003:114) defined research design as the “science (and art) of planning
procedures for conducting studies so as to get the most valid findings”. The research
design for this study was aligned to the aims and objectives of the study in order to yield
the most valid findings. In terms of the research purpose, this study was classified as
an explanatory study. This study “seeks to explain the relationship among variables
and allow for the identification of connectedness among the components of a
phenomenon” (Tshuma, 2010:39). Therefore the aim of the study was to “closely study
a problem, collect data, and through an analytic and deductive process with statistical
analyses, explain the relationship among variables” (Neuman, 2003:120). The aims of

31
the explanatory study, to investigate job satisfaction among physiotherapists in the
public health sector, and more specifically determine the factors which influence job
satisfaction, the impact of job satisfaction on work productivity and the changes that
could influence positive job satisfaction.

3.3.1 Research Philosophy

The research paradigm that was adopted in this study has a direct relationship with the
research methodology that was utilised in the study. There are broadly two recognized
research paradigms according to Saunders, Lewis and Thornhill (2009:83) which could
be explained as the positivist and the phenomenological approach. Saunders et al.
(2009:83) stated that positivism required an emphasis on a highly structured
methodology in order to facilitate replication and on quantifiable observations which
easily lend themselves to statistical analysis. For this study, the positivist (quantitative)
research paradigm was appropriate as it permitted the analysis of numerical data and
provided predictions regarding human behavior.

A quantitative methodology requires a more analytical approach to data analysis than a

qualitative approach, allowing the researcher to objectively measure objects and facts
independent of context (Neuman, 2003: 545). A quantitative research also provides a
level of validity and repeatability of results that may be replicated (Creswell: 2002: 59).
The use of the quantitative study can be used for further research across SA and can
also be applied to other medical professions. Given the above this study made use of a
quantitative research design and data was collected through the use of a questionnaire.

3.3.2 Research Strategy

According to Saunders et al. (2009:210) research strategies could be defined as a

general plan of how the researcher would go about answering the research question(s).
Research objectives could be achieved by using one of the three types of research
designs, namely exploratory research, descriptive and explanatory research.

3.3.2.1 Exploratory Research

32
Cooper and Schindler (2009:151) explained that exploratory research was a discovery
of new areas in which very little research has been done. The exploratory research
uses various methods of obtaining both primary and secondary data. There are three
principle ways of conducting exploratory research, namely, a search of the literature;
interviewing experts in the subject, and conducting focus group interviews (Saunders et
al., 2009:140). This method was not conducive for gathering primary data because of
the large population of the study and the limited time to produce this study. However,
the research process adopted exploratory research to gather secondary data via
interviews for this study

3.3.2.2 Explanatory Research

According to Shajahan (2005:28), the main idea in an explanatory research method

studied a particular issue with the aim of obtaining and measuring the existence of
relationships between the variables. Shajahan (2005:28) further explained that studies
that established casual relationships between variables were related to explanatory
studies. Saunders et al. (2003:134) stated that the data collected should be subjected
to statistical tests for example correlation tests in order to establish relationship between
variables.

3.3.2.3 Descriptive Research

Descriptive statistics was concerned with the technique for aggregating, summarising
and presenting data. In addition descriptive statistics was concerned with techniques
that allowed for the description of the main features of data gathered (Wishiewski and
Stead, 2007:10).

The study implemented a descriptive research design as the characteristics of a

descriptive study are as follows (Bhattacharyya, 2006:41):

 The study described the phenomena under study;

33
 Data collected related to the demographic or the behavioural variables of the
respondents under study;

 The study had very specific objective/s;

 It had clear-cut data requirements;

 Used a large sample which was drawn through a probability sampling design; and

 Recommendations and findings were definite.

3.3.2.4 The Positivist Research Strategy

The research strategy for this study was the survey strategy. Saunders et al. (2009:92)
identified the survey strategy as a common and popular strategy as the collection of
data which was primarily by the means of a questionnaire ensured the standardisation
of data. The survey strategy was adopted for this study as the findings from surveying a
sample of physiotherapists could be utilised to infer the general level of job satisfaction
among physiotherapists, identify factors that influence job satisfaction and evaluate the
impact of job satisfaction on work productivity in the public health sector.

3.4 Target Population

Katzenellenbogen, Joubert and Karim (2001:74) described the study population as the
source population from which cases and controls are selected. Bryman (2008:698)
defined a sample as the segment of the population that was selected for research – a
subset of the population. The target population for this study consisted of 150
professional physiotherapists that were employed in the PHS during the study. The
study concentrated its focus on a sample of physiotherapists based in public health care
institutes in Durban, KZN. An 86.7% percent response rate was achieved by the
researcher.

34
3.5 Sampling

Katzellenbogen et al. (2001:82) advised that it was important that the sample
represented the population from which it was drawn in order for the research to yield
accurate findings. In conducting research, it is not always practical or feasible to include
the entire study population in the study. Therefore a representative sample must be
chosen from the study population. Saunders et al. (2009:151) indicated that sampling
would provide a valid alternative to a census survey in the following situations where:

 it was impractical to survey the entire population;

 the budget constraints prevented a census survey;
 time constraints prevented surveying the full population; and
 data was collected but results were required quickly.

The sample size was often dictated by the “confidence‟ that one required in the data;
the margin of error that could be tolerated; the types of analysis that would be
undertaken and the size of the total population (Saunders et al., 2009:155).
Katzenellenbogen et al. (2001:80) mentioned that a small sample size may yield results
that were not useful or conclusive, whilst, on the other hand, a large sample size usually
yielded more stable and reliable results. A sample size of 150 professional
physiotherapists from the healthcare population of 350 physiotherapists (SASP, 2012:6)
situated in KZN was deemed suitable to yield more reliable results for the study.

There are two broad types of sampling being probability and non-probability according
to Saunders et al. (2009:153). Based on Saunders et al. (2009: 153) view that the use
of probability sampling was more commonly associated with surveys, the probability
sampling technique was appropriate for the study. Simple random, stratified, cluster and
systematic sampling are the different techniques that could be utilized in probability
sampling. The recipients were selected using a simple random sampling technique from
a register of physiotherapists, which was deemed to be the most suitable sampling
strategy for this study. In simple random sampling, each element in the population had
an equal and independent chance of being selected as part of the sample (Saunders et
al., 2009:170).

35
The sample population consisted of qualified physiotherapists in the PHS randomly
selected from a public sector medical database directory. The population of interest
included physiotherapists from public health care institutes in Durban, KZN. In this
research, physiotherapists included qualified physiotherapists with an active HPCSA
registration in the public health care sector. The inclusion criteria were all professional
physiotherapists who were available at the time of study and willing to participate. The
exclusion criteria were those who were not available at the time of the study which
comprised those who were on leave and those who had exercised their right not to
participate.

Participants were contacted and invited to complete the questionnaire. The

questionnaires were administered via e-mail or posted to the recipient. A permission
letter that explained the purpose of the study and assured anonymity of the
respondents, as well as the provision of instructions on how to complete the
questionnaire was sent to the participants (Refer to Appendix 1).

3.6 Research Instrument

The study made use of a quantitative research methodology which involved the use of a
questionnaire to explore job satisfaction amongst physiotherapists in the healthcare
sector. Quantitative research was defined by David and Harvey (2002:46) as data which
can be sorted, classified and measured in a strictly ‘objective’ way. Leedy and Omrod
(2001:94) define a questionnaire as a pre-formulated written set of questions to which
respondents record their answers, usually within rather closely defined alternative.

The primary data was collected using the questionnaire which was comprised of section
A and B. Section A comprised information regarding the socio-demographic
characteristics whilst Section B was adapted from a Masters in Science Psychology
thesis (Basson, 2004:95), Staff at work survey (USCD, 2004:67) and a Masters in
Business Administration thesis (Ramasodi, 2010:56).

36
 3.6.1 Questionnaire Construction

The research instrument addressed the needs of the study and the questionnaire was
specifically designed to accomplish the objectives of the study. Section A collected
information such as gender, age, marital status, qualification and professional status
(Basson, 2004:95). A well-constructed questionnaire must include socio-demographic
items in order to develop a profile of the respondents. Section B comprised the
questionnaire items that were divided into four parts. The questionnaire consisted of
closed questions only as this type of questions are better suited to questionnaires as
they readily lend themselves to coding and quantitative analysis. The total number of
questions was limited to twenty five. Every question was relevant and had a clear
purpose which resulted in a good participant response rate.

The majority of the questions in the research instrument were designed according to the
Likert Scale rating system. McBurbey and White (2007:241) defined the Likert scale as
a method of rating of the extent of agreement or disagreement with a statement. In
addition Saunders et al. (2009:594) agreed that the Likert scale allowed the respondent
to indicate how strongly he or she agreed or disagreed with a statement. The Likert
scale allowed for a small set of dimension ratings from a large number of opinion
statements which was individually rated on Likert scales. The questionnaire is
structured as follows:

Part A: This section measured the level of job satisfaction which included six
questionnaire items (Ramasodi, 2010:56).

Part B: This section examined the factors influencing job satisfaction and comprised of
seven questionnaire items (USCD, 2004:67).

Part C: This section highlighted the role of job satisfaction and the impact on work
productivity. There are seven questionnaire items included in part three (Ramasodi,
2010:56).

37
Part D: This section examines the potential changes that can be made to improve the
level of job satisfaction (Bassoon, 2004:95). There are five questionnaire items
included in part four.

The separation into the four parts was deliberate and carefully designed to provide
adequate feedback for each of the four objectives and research questions of the study.
Section B utilized a 5 item Likert scale ranging from Strongly Agree, Agree, Uncertain,
Disagree and Strongly Disagree. The close alignment of the questionnaire to the
objectives and research questions of the study would ultimately achieve the overall aim
of the study.

3.7 Pilot Study

According to Teijilingen and Hundley (2011:1) a pilot study is used to detect

weaknesses in the design of an instrument. A pilot study was conducted on 30
physiotherapists to test the validity, reliability and sustainability of the questionnaire.
The questionnaire was considered to be valid and reliable based on the results of the
pilot study. Participants were able to answer the questionnaire with no difficulty. The
questionnaires were administered to the sample population of the study.

3.8 Administration and Collection of Questionnaires

Saunders et al. (2009:387) stated that once a questionnaire is designed, pilot tested
and amended and the sample selected, the questionnaire can be used to collect data.
This final stage is called administering the questionnaire. The questionnaires and
accompanying cover letter were administered to the physiotherapists via fax, email or
hand delivery. These methods were used to ensure a high response rate. The time
frame provided for the completion of the questionnaire was 3 weeks with a follow up
reminder being sent at the end of the second and third week. The majority of
participants responded within the three week period whilst some participants eventually
responded at the end of the six weeks. Once all the responses were received, the
responses were securely stored. Response Rate: One hundred and thirty (86.7%) out of
one hundred and fifty (total population) respondents took part in the survey

38
3.9 Data Analysis

The process of data collection and data analysis were closely tied and quantitative in
nature.

“Quantitative data refers to all data that can be reduced to numerical values,
ranging from the numerical frequency of occurrences to complete presentation of
data in terms of graphs and charts” (Saunders et al., 2009:296).

In keeping with the aims and objectives of the study, the responses of the participants
were analysed. Statistical Package for Social Sciences (SPSS) was implemented to
yield significant findings and results for the study. The Likert style questions in the
research instrument were analysed. Saunders et al. (2009:296) stated that rating or
scale questions were often utilised to collect opinion data, and this was applicable to the
current study where job satisfaction was investigated.

According to Brink (2002:179) statistics was the most powerful tool available in
analysing quantitative data. Agresti and Franklin (2009:10) distinguished between
descriptive and inferential statistics as follows:

 Descriptive statistics referred to methods for summarising the data. The summaries
usually consisted of graphs and numbers such as averages and percentages.
 Inferential statistics referred to methods for making decisions or predictions about a
population, based on data obtained from a sample of that population.

For the purpose of this study both descriptive and inferential statistics was used. The
findings from the data analysis are presented in the chapter that follows. The use of
various data presentation tools were useful in presenting the findings of the analysis.
Data analysis should always be directed on increasing the validity of the findings of the
study and provide support towards the research objectives and questions contained in
the study.

39
3.10 Validity and Reliability

Saunders et al. (2009:188) explained that validity addressed the issue of whether the
researcher had actually measured what had been originally intended. There are four
specific types of validity that the researcher should establish for the research instrument
prior to the administration of the research instrument. These included the following
(Saunders et al., 2009:188):

 Face validity required that the instrument was relevant to participants in the study
and this could be achieved by gathering feedback from the target population.
Face validity was established by gathering relevant feedback from
physiotherapists regarding the level of job satisfaction and the impact on work
productivity in the public health care sector. As per the feedback obtained, it was
established that the research instrument was appropriately constructed to
support the achievement of the objectives.
 The criterion validity or predictive validity referred to the capacity of the
responses from the participants to predict a pattern of behavior.
 Concurrent validity indicated whether the level of responses to items on the
research instrument were parallel to other facets of the respondents overall
behaviour. The pilot study was used to confirm the criterion and concurrent
validity of the research instrument. The researcher used the pilot study to
determine if any patterns of behavior could be predicted for this study.

Joppe (2002:234) defined reliability as the extent to which results were consistent over
time. Therefore reliability was the degree to which the instrument can be depended
upon to yield consistent results if used repeatedly over time on the same person or if
used by two different investigators. At the stage of the pilot study, the reliability of the
research instrument was tested for internal consistency or repeatability. Every effort has
been made to ensure that the questionnaire used in this research was valid and reliable
and was constructed to meet these criteria. The goal of developing a reliable measure
was to minimize the influence or chance of variables that were unrelated. An unreliable
measuring instrument may reveal information that was ambiguous, inconsistent and

40
useless. The pilot study was used to ensure that the questions were unambiguous and
clear and would therefore yield results that were unambiguous, consistent and useful.
The research instrument was deemed to be suitable for the achievement of the
objectives of the study based mainly on the various components of the reliability and
validity constructs. Therefore the pilot study facilitated a continuation into the main
study without any further amendments being made to the research instrument.

3.11 Limitations of the Study

The time period for conducting the study was limited and therefore the study had to be
confined to certain constraints. The lack of resources rendered it impossible to conduct
the survey on a large scale. The area for the study was limited to Durban and the
sample was limited to physiotherapists in the public health sector.

3.12 Elimination of Bias

The anonymity of the respondents prevented bias when analysing the research findings.
The questionnaire was designed ensuring that prejudices and stereotypes were
eliminated in order to eliminate bias.

3.13 Ethical Considerations

Cooper and Schindler (2003:87) described ethics as norms or standards of behavior

that guide moral choices about our behavior and relationship with others. The ethics of
the research design had important implications for the negotiation of access to people
and organisations and the collection of data (Saunders et al., 2009:104).The general
principles usually invoked in codes of research ethics are, firstly, that no harm should
befall the research subjects, and secondly, that subjects should participate freely based
on informed consent (Welman, Kruger and Mitchell, 2005:182).

The following principles were enforced in this study to ensure that the rights of the
respondents were safeguarded and that the research was conducted in an ethical
manner. Firstly, data collection began by explaining to the respondents the benefits of
the study in relation to the health sector, physiotherapists and hospital managers.
Secondly, maintaining confidentiality of the responses would adequately protect the
41
rights and well-being of the participants. The participant’s identities were protected at
all times and participants were not asked to reveal their identities on the questionnaire
as a further point of identity protection.

Participation in the study was completely voluntary. All the completed questionnaires
were safely stored in order to restrict access to the questionnaires. The data analysis
and discussion of the findings also did not compromise the participant’s identity as data
was presented in aggregates. These ethical considerations were utilised in the study to
ensure a high level of ethical behaviour, the participants and the study in general.

3.14 Conclusion

This chapter presented the rationale for the study, the research design, and the
research instrument. The quantitative method was selected because of its ability to
gather data from a large population in a limited amount of time and also for its objectivity
in the results gathered. The results from the sample selected was generalised to the
entire population. The research instrument has also been specified as well as the
sampling method used. The data collection process, data analysis, eliminations of bias
and ethical considerations were also discussed.

The construction of the questionnaire and the questionnaire items were also discussed.
The pilot study was then presented as well as the administration and the collection of
questionnaires. The data analysis technique, validity, reliability and ethical
considerations were also discussed. Finally, this chapter rounded up with a discussion
of the limitations of the study and methods employed to eliminate bias. The next
chapter presents the findings from the primary data. In Chapter Four the data is
discussed and interpreted in the context of the research problem.

42
 CHAPTER 4:

RESULTS AND INTERPRETATION OF FINDINGS

4.1 Introduction

According to Creswell (2002:184) research analysis may be defined as the breaking

down and ordering of data into meaningful groups, plus the searching for patterns of
relationship among these data groups. This chapter focuses on the statement of results
as well as analyses and interpretation of the findings, based on the responses from all
130 respondents who completed the quantitative research questionnaires. The chapter
begins with an outline of the statistical methodology used for this research study. This
is followed by the presentation of results and discussion of: demographical data,
reliability of the measuring instrument, general work satisfaction, factors influencing
work satisfaction, job satisfaction and productivity and changes to improve job
satisfaction. The chapter concludes with a discussion and interpretation of the findings
in the context of the current study in order to attempt to answer the research questions
so that the objectives of the study could be achieved.

4.2 Statistical Methodology for Sample Analysis

Descriptive statistics in the form of frequencies and percentages were computed for the
variables. Keller and Warrack (2001:54) explained that descriptive statistics were useful
in summarising some aspect of the values making up the variable. Calculating
averages, frequency distributions and percentage distributions are the most common
ways of summarising data according to David and Harvey (2002:2). These methods
were utilized to summarise the data. Each response has been graphically represented
where applicable according to the questionnaire. This allows for easy identification of
problem areas that require attention.

The calculation of frequencies were useful in the comparison of the variables outlined in
the research instrument. The frequency distribution for the biographical and
demographic variables was presented using pie and bar charts. Each item of the
research instrument was analysed with the intention of achieving the objectives of the

43
study. This enabled the researcher to examine the impact of job satisfaction factors on
the level of service delivery. Therefore the researcher was able to achieve the main aim
of the study. The results are presented as follows:

The measure of internal consistency that was used in this research was Chronbach’s
coefficient Alpha. This coefficient measures how well a set of variables or items
measure a single construct (Smith, 2005:102). Values of alpha close to 0 indicate no or
little correlation between the items that makes up a subscale, whilst values close to 1
indicate high inter-item correlations. Values for Alpha of 0.7 or larger are acceptable
whilst smaller values are an indication that one or more of the items do not consistently
measure the construct.

Table 4.1: Cronbach Alpha

Variable Number of items Cronbach Alpha Inter-item

correlation
General Satisfaction 6 0.81 0.42
Factors influencing 7 0.82 0.43
satisfaction
Job satisfaction and 7 0.92 0.64
productivity
Changes to improve job 5 0.84 0.45
satisfaction

As seen in Table 4.1, the alpha values for this data were all above 0.8 indicating a
strong correlation between the items of each subscale. This means that all the items
within the subscale measured that subscale consistently. The alpha value for job
satisfaction and productivity was the highest at 0.92 and this confirms a strong
correlation between the items in this scale.

4.3 The Demographics of Respondents

Descriptive statistics were computed on the gender, age, marital status, job title,
educational level and the number of year experience in the public health sector.

44
Table 4.2: Frequency distribution according to demographic characteristics

N %
Gender
Male 30 23,1
Female 100 76,9
Age
20-30 64 49.2
31 and older 66 50,8
Marital Status
Single 56 43,1
Married 74 56,9
Job Title
Junior 61 46,9
Senior 37 28,5
Chief 29 22,3
Physiotherapy Manager 3 2,3
Educational level
B.Physio (HONS) 125 96,2
Masters in Physiotherapy 5 3,8
Doctorate in Physiotherapy 0 0
Years of experience
1-4 years 61 46,9
5-9 years 37 28,5
10-15 years 29 22,3
16 years and over 3 2,3

4.3.1 The Gender of Respondents

45
Table 4.2 reflected that 76.9% of respondents were females and 23.1% were males.
This is clearly indicated in Figure 4.1 shown below. From the records of the database
for professional physiotherapists there is a disproportionate ratio of female to male
physiotherapists with females dominating the profession (HPCSA, 2009:12). The
management of physiotherapy departments in tertiary institutes also had difficulty in
meeting its gender targets due to the extreme difficulty of attracting skilled learners from
the designated groups, especially male learners (Lehmann and Sanders, 2004:34).
Therefore such a high proportion of female respondents in the KZN region was evident.

Figure 4.1: Proportion of respondents based on gender

GENDER

GENDER

MALE MALE; 23.1

FEMALE FEMALE; 76.9

0 10 20 30 40 50 60 70 80 90

4.3.2 The Age of Respondents

Most of the respondents range in the age group of 31 – 35 years based on the
frequencies shown in Table 4.2. This result is further confirmed in Figure 4.2 below.

Figure 4.2: Frequency distribution of respondents based on age

46
 31-35 Female ; 37.3 Male; 13.1

Male
Column1

26-30 Female ; 19.2 Male; 2.3

20-25 Female ; 20 Male; 7.7

The distributions of respondents according to age were:

 37,7% females and 13,1% males were in the age category of 31-35 years
 19,2% females and 2,3% males were in the age category of 26-30 years
 20% females and 7,7% males were in the age category of 20-25 years

These findings show that the majority of female and male respondents were in the 31-
35 age grouping.

4.3.3 The Marital Status of Respondents

Table 4.2 reflected that 56.9% of the respondents were married, 43.1% of the
respondents were single and none of the respondents were divorced. This result is
confirmed in Figure 4.3.

Figure 4.3: Frequency distribution of respondents based on marital status

47
 Divorced

Married 50.7 6.2

Single 27.7 15.4

0 10 20 30 40 50 60

Male Column1

These finding showed that the majority of respondents were married females capturing
in total 50.7% of the sample.

4.3.4 The Job Title of the Respondents

Figure 4.4: Job Title of respondents in the public health sector

Physio Manager 2.3

Chief Physio 20.7 1.5

Male
Senior Physio 24.6 3.8 Column1

Junior Physio 29.2 17.7

0 5 10 15 20 25 30 35 40 45 50

Table 4.2 and Figure 4.4 indicated that respondents were made up of 46,9% Junior
Physiotherapists, 28.5% Senior Physiotherapists, 22.3% Chief Physiotherapists and
2.3% Physiotherapy Managers. Thus Junior and Senior Physiotherapists make up the
majority of the sample.

4.3.5 The Educational Level of the Respondents

48
Table 4.2 reflected that 96.2% of the respondents had obtained a B.Physio (HONS)
degree and 3.8% of the respondents had obtained a Masters in Physiotherapy. There
were no respondents that had completed a Doctorate in Physiotherapy. Figure 4.5
demonstrates the results.

Figure 4.5: The educational level of the respondents

80
73
70

60

50

40

30
23.1
20

10
3.9
0
B.Physio (HONS) MASTERS DOCTORATE

Figure 4.5 shows that there is a downward trend with the majority of the respondents
only having obtained a B.Physio (HONS). A mere 3.9% of the respondents had
furthered their studies by obtaining a Masters degree. When compared with the
statistics of previous researchers, it is evident that more respondents are reluctant to
further their studies (Lehmann and Sanders, 2004:54) especially when they do not
derive job satisfaction from their professional development.

4.3.6 The Years of Work Experience in the Public Health Sector

49
Figure 4.6: Work experience in public health institutions

>15 years 2.3

10-15 years 20.9 1.5

Male
Column1
5-9 years 24.6 3.8

1-4 years 29.2 17.7

0 5 10 15 20 25 30 35 40 45 50

Table 4.2 and Figure 4.6 demonstrated that the majority of the respondents have been
working in the public health institutions between 1-4 and 5-9 year category. This is in
keeping with the majority of respondents occupying the junior and senior level in
physiotherapy.

Based on the demographical data, respondents in the public health institutions have the
following characteristics:

 Predominantly female;
 Age range between 31 and 35 years;
 Most of the respondents are married or single;
 Mainly respondents have a B.Physio (HONS);
 Predominantly junior physiotherapists; and
 The large proportion of respondents worked between 1-4 years.

4.4 Analysis of Job Satisfaction

50
Single items were used to design the questionnaire. All items were measured using a
five point Likert rating scale with an uncertain centre. Descriptive statistics were
computed for responses to each item.

Table 4.3: Frequency distribution of items related to general work satisfaction

Strongly Disagree Uncertain Agree Strongly Agree

Disagree
n % N % n % n % n %
A1 I am satisfied 104 80% 6 4.62% 17 13.07% 0 0% 3 2.31%
with
physiotherapy as
a career choice
A2 I am satisfied 123 94.61% 0 0% 7 5.39% 0 0% 0 0%
with employment
in a public health
institute
A3 I would 115 88.46% 0 0% 9 6.92% 0 0% 6 4,62%
recommend
employment in a
public health
institute to other
physiotherapists.
A4 I am satisfied 127 97.69% 0 0% 2 1.54% 0 0% 1 0.77%
with the level of
management
efficiency in my
department
A5 Overall I am 124 95.38% 0 0% 3 2.31% 0 0% 3 2.31%
satisfied with the
nature of my job
A6 I am 90 69.23% 0 0% 37 28.46% 0 0% 3 2.31%
committed to
ensuring quality
service delivery

The reader should refer to the questionnaire (Appendix 2) and the exact phrasing of the
statements, in order to interpret the results shown in the following tables. The results in

51
Table 4.3 displays the results of general work satisfaction and a large proportion of
respondents selected strongly disagree to most of the items related to general work
satisfaction. 80% of participants strongly disagreed that if they had to choose a career
again, they would choose physiotherapy as their career choice.

Almost the entire sample (94.61%) strongly disagreed that they were satisfied with their
employment in the public health institutions. In order to further ascertain how the
participants really felt about working as physiotherapists for the South African public
sector, a question about whether or not they would recommend working as
physiotherapists in the South African public sector to their colleagues outside was
asked. Over three quarters of the respondents (88.46%) did not think that they would
recommend employment in the public health sector to other job seeking
physiotherapists. This could be as a result of the low salaries, followed by the lack of
promotion opportunities, the stressful work environment in South African public sector
health institutions. It may also be speculated that physiotherapists have to go through
four rigorous years of university studies, followed by community service, only to get paid
poor salaries and have no job satisfaction. Therefore 94.61% of the respondents
expressed dissatisfaction with working for the South African public sector and 88.46 %
of respondents stated that they would not recommend it to other physiotherapists, as
they did not want them to feel this kind of frustration.

On the other hand, 4.62% of the respondents felt that they would definitely recommend
work as a physiotherapist in the public health sector to their colleagues whilst 6.92% of
the respondents remained neutral on the matter. The reasons that could be speculated
for the former response includes the fact that they felt that the public sector was a better
place to gain experience in physiotherapy, particularly for newly qualified
physiotherapists. The public sector offers a wider variety of conditions to treat, in
addition to opportunities for continuous learning from members of multidisciplinary
teams, as well as supervisor support. This may be lacking in the private sector, which
can also be more aggressive and has a general focus of making as much money as
quickly as possible. Contrary to the notion that the public sector offers good supervisory

52
support, almost all the respondents (97.69%) expressed dissatisfaction with the level of
management efficiency in the physiotherapy department. Different managerial style and
practices at the department level can have a direct bearing on the physiotherapist’s
level of satisfaction. Improved work effectiveness and productivity does not result from
the implementation of suitable human resource practices alone, but, also from effective
implementation which requires management skills (Caulkin, 2001:32).

Hence, it is important for managers to possess the required skills to ensure that the staff
perform according to recognized standards and are therefore motivated to work. It may
be speculated that, management positions in the health sector are often occupied by
untrained managers who lack the required skills needed to support high levels of
employee satisfaction. The respondents (95.38%) indicated in general, that they were
dissatisfied with the nature of their jobs. Almost two thirds of the respondents (69.23%)
indicated that they were not committed to ensuring quality service delivery.

Table 4.4: Frequency distribution of items related to factors influencing

satisfaction

53
 Strongly Disagree Uncertain Agree Strongly Agree
Disagree
N % N % n % N % N %
B1. I am satisfied when 17 13.08% 0 0% 7 5.39% 0 0% 106 81.53%
I have sufficient time to
manage my workload
effectively
B2 .I am satisfied when 32 24.62% 0 0% 0 0% 0 0% 98 75.38%
I participate in
management decision
making
B3 I am satisfied when 0 0% 0 0% 0 0% 0 0% 130 100%
the work environment is
safe
B4 I am satisfied when 3 2.31% 0 0% 0 0% 0 0% 127 97.69%
there are opportunities
for training and
development
B5 I am satisfied when 22 16.92% 0 0% 47 36.16% 0 0% 61 46.92%
there is a high level of
work commitment by
my co-workers
B6 I am satisfied when 0 0% 0 0% 6 4.61% 0 0% 124 95.39%
the Teamwork
approach is used for
patient management

B7 I am satisfied when 0 0% 0 0% 0 0% 0 0% 130 100%

my total compensation,
including salary and
benefits is market
related

The results in Table 4.4 show that a large proportion of the respondents selected
strongly agree to most of the items relating to the factors influencing work satisfaction.
Respondents (81.53%) indicated that they were satisfied when they were given
sufficient time to manage their workloads effectively. Nasaab (2008:55), showed that
time pressure was strongly and positively associated with job dissatisfaction.

54
Approximately three quarters of the participants indicated that there was greater job
satisfaction when they were allowed to participate in the management of the work
environment whilst only one quarter of the respondents were disagreeable to the role of
participation in management responsibilities and job satisfaction.

In 2006, the American Physical Therapy Association investigated the recruitment and
retention patterns of physical therapists using the Health professional work satisfaction
survey and the study revealed that the respondents were more satisfied when given an
opportunity to participate actively in the work environment (American Physical Therapy
Association, 2006:2234). A culture of participation is crucial for reducing resistance and
also offers management an opportunity to communicate and brainstorm ideas and
challenging issues at hand (Kotter and Schlesinger, 2008:1). The entire sample strongly
agreed that a safe and healthy physical work environment supported job satisfaction.

In a study conducted by Shah et al., (2007:156) on healthcare professionals, the

findings revealed a significant relationship between the level of education and training
and job satisfaction. Ninety seven point six nine percent of the respondents indicated
that they were satisfied when they were given the opportunity for training and
development. A study conducted in Iran by Ali-Mohammed (2004:51), on the factors
affecting employees’ job satisfaction in public hospitals found that the opportunity to
develop professionally was a significant predictor of job satisfaction among the
participants. The results of the study are similar to the research conducted in other
studies.

Approximately half of the respondents indicated that they were satisfied when there was
high level of work commitment from their co-workers. Teams are more responsive to
patient needs, more cost effective and provide more job satisfaction to providers than
staff members working individually (Royal Pharmaceutical Society and the British
Medical Association, 2000). Views about the teamwork approach were largely positive
with 95.39% of the respondents indicating that they were more satisfied when this
approach was utilised. Some respondents preferred working independently, possibly

55
due to the potential of personnel conflicts in rehabilitation teams. Respondents with the
above mindset resist team cohesiveness and ultimately hinder team effectiveness. In a
study conducted in Turkey (Bodur, 2002:353), it had been demonstrated that benefits,
compensation, working conditions and income were among the most important factors
for dissatisfaction of healthcare providers working at public health centers, which is
consistent with the findings of previous studies (Bodur, 2002:353).

A staggering 100% of the respondents were satisfied with the possibility that the
compensation allocated to their jobs would be market related. Another convincing case
that showed a link between financial compensation, motivation and job satisfaction is
drawn from a study where health workers with relatively higher remuneration retained
higher levels of job satisfaction in comparison with the health workers with a lower pay
structure (Bhattacharayya et al., 2001:43).

Table 4.5: Frequency distribution of items related to job satisfaction and

productivity

Strongly Disagree Uncertain Agree Strongly Agree

Disagree
N % N % N % N % N %
C1 Work productivity is 14 10.77% 0 0% 6 4.62% 0 0% 110 84.61%

56
 high when there are no
time pressures
C2 Work commitment is 32 24.62% 0 0% 36 27.69% 0 0% 62 47.69%
high when I participate
in management
decision making
C3 Work productivity is 26 20% 0 0% 3 2.31% 0 0% 101 77.69%
high when my work
environment is safe
C4 Work productivity is 23 17.70% 0 0% 15 11.53% 0 0% 92 70.77%
high when the
opportunity for training
and development is
high
C5 Commitment to 3 2.31% 0 0% 1 0.77% 0 0% 126 96.92%
service delivery is high
when I am satisfied with
the level of work
commitment from co-
workers
C6 Work productivity is 6 4.62% 0 0% 0 0% 0 0% 124 95.38%
high when the team
approach is used
C7 Work productivity is 32 24.62% 0 0% 0 0% 0 0% 98 75.38%
high when I am
satisfied with my total
compensation

The results from Table 4.5 show that a large proportion of the respondents selected
strongly agree to most of the items relating job satisfaction to productivity. 84.61% of
participants strongly agreed that the absence of time pressures ensured that work
productivity was high. Opinions on decision making to enhance service delivery and
work productivity were relatively spread across the spectrum with a greater proportion of
respondents (47.69%) indicating that their commitment to their work was high, when
given enough opportunity to participate in decision making. Almost three quarters
(70.77%) of the participants strongly agreed that the opportunity to acquire new skills
through training and development would ensure high work productivity. However a

57
large proportion of the participants (96.92%) had indicated that their commitment to
service delivery was largely influenced by the commitment from the co-workers. Nearly
all of the respondents showed strong agreement to the use of the team approach for
effective patient management and to ensure high work productivity. Whilst three
quarters of the participants indicated that the work productivity would be high if they
were satisfied with the total compensation

Table 4.6: Frequency distribution of items related to the changes that improve

job satisfaction

Strongly Disagree Uncertain Agree Strongly

Disagree Agree
N % N % N % N % N %
D1 Reduce time constraints 0 0 0 0 0 0 0 0 130 100
for service delivery by
increasing staff numbers
D2 Increase employee 0 0 0 0 0 0 0 0 130 100
participation in decision
making
D3 Create safe work 0 0 0 0 0 0 0 0 130 100
environments
D4 Develop suitable 0 0 0 0 0 0 0 0 130 100
performance management
systems
D5 Develop policies to 0 0 0 0 0 0 0 0 130 100
provide financial and non
financial incentives

The results from Table 4.6 showed that all the respondents (100%) selected strongly
agree to most of the items relating to the changes to improve job satisfaction. This is
indicative that the respondents are agreeable to changes that encourage increased
staffing, reduction of time constraints, increased employee participation, better working
conditions, appropriate performance management systems and the use of financial and
non financial incentives. Solutions to improve the level of job satisfaction should also
seek to enhance the work environment, which is often a significant factor that causes

58
job dissatisfaction. Literature has suggested that health workers are more likely to
remain with organisations that offer a combination of benefits to boost job satisfaction
(Cronje et al., 2005:234). Marquez and Kean (2002:22) believe that implementing
performance management contributes to improved employee performance.

4.5 Inferential Statistics

In this section, the overall results given above are further analyzed to elicit possible
correlations that will contribute to making inferences. Questions from the various
sections of the questionnaire including general work satisfaction, factors influencing job
satisfaction, job satisfaction and productivity and the change factors to improve job
satisfaction were used to build the constructs. Measurements were effected using the
five –point Likert scale with neutral centres.

4.5.1 Association between Demographics and Work Satisfaction

Table 4.7: Socio-demographics and work satisfaction

Variables Level of Satisfaction Chi square value P-value

Satisfied Dissatisfied

Gender Female 1 98 1.642 0.200

Male 2 26

59
 Age 20-30 3 58 0.027 0.870
31 and older 0 66
Marital Status Single 2 51 0.100 0.751
Married 0 74
Job Title Junior and 2 96 0.009 0.232
Senior
Chief and 1 31
manager
Duration of work 1-9 years 2 93 0.00 0.297
service 10and longer 1 34
Level of B.Physio 2 95 0.022 0.235
Education (HONS)
Masters 1 4

The chi-square analysis between the respondents’ socio-demographic characteristics

and the level of satisfaction are shown in Table 4.7. It is significant that 46.9% of junior
physiotherapists and 28.5% of senior physiotherapists indicated that there was a high
level of work dissatisfaction (p> 0.009, V = 0,232). The results of the table above are
as expected with those in the 1-9 years of work experience category classified as either
junior or senior physiotherapists being more inclined to cite job dissatisfaction in the
public health sector in South Africa (p> 0.00, V = 0.297). There is a moderately strong
correlation between the level of education and the level of job dissatisfaction.
Respondents with a B.Physio (HONS) qualification were more likely to cite job
dissatisfaction in the public health sector. Since the male female ratio is not
representative of the population demographics in Durban, KZN, one cannot infer that
female physiotherapists are more likely to cite job dissatisfaction in the public health
sector. The results indicate that the younger, less qualified and lower professional level
physiotherapists are more likely to cite job dissatisfaction in the PHS in SA. This
suggests that the new graduates are dissatisfied with the current work situation. There
is no proportional difference and relationship between the other demographic variables
and the satisfaction levels.

4.5.2 General Level of Job Satisfaction

60
Table 4.8: Level of job satisfaction

Level of satisfaction N Percentage

Highly dissatisfied 124 95,38
Not satisfied 0 0
Fairly satisfied 3 2,31
Moderately satisfied 0 0
Highly satisfied 3 2,31
Total 130 100

The level of job satisfaction among respondents was tested using the satisfaction
questionnaire.

Figure 4.7: Bar chart depicting the respondent’s level of job satisfaction

Highly satisfied 2.31%

Moderately satisfied 0.00%

Fairly satisfied 2.31%

Not satisfied 0.00%

Highly Dissatisfied 95.38%

0.00% 20.00% 40.00% 60.00% 80.00% 100.00% 120.00%

In the study, 95.38% of the respondents indicated that they were highly dissatisfied with
the nature of physiotherapy. This is closely related to the results from Table 4.3 where
80% of the respondents indicated that they dissatisfied with their choice of
physiotherapy as a career choice. Also, 94.61% of the respondents were dissatisfied
with their employment in the public health sector. The overwhelming response from the
participants shows that job dissatisfaction among physiotherapists is a significant
problem in the PHS.

4.5.3 Job Satisfaction and Work Productivity

61
Table 4.9: Association between factors influencing satisfaction and service
delivery

Level of Pearson Chi- Cramer’s V

productivity square
Time Pressure High 10.77% 0.008 0.189
Low 84.61%
Participation High 47.69% 0.032 0.162
Low 24.62%
Physical Work High 77.69% 0.015 0.260
Environment
Low 20%

Opportunity to High 70.77% 0.020 0.322

develop
Low 17.7

In-service training High 96.92% 0.006 0.174

Low 2.31

Teamwork High 95.38% 0.007 0.180

Management
Low 4.62

Compensation High 75.38% 0.023 0.290

Low 24.62

As the results in Table 4.9 show, there is indeed a strong and statistically significant
between time pressure and the level of work productivity. When time pressures are
high the level of work productivity is low. This suggests that physiotherapists are unable
to work productively under time constraints and may deliver inferior physiotherapy
service. These time constraints may have been instigated by the shortage of qualified
physiotherapists in the public health sector. The profession has a “hands on approach”
that necessitates close interaction and time in order to maximise the treatment session.
There is a moderately strong correlation between the level of participation in
management decision making and work productivity. Physiotherapists that participate
in decision making are able to provide information to improve on the delivery of the
physiotherapy service in the public sector.

In Table 4.9 the correlation between a safe work environment and the effect on work
productivity in the public health sector. The results show that there is a strong and
62
significant correlation between these two factors. Studies clearly show that adverse
physical conditions do have a negative impact on performance (Rue and Byars,
2007:155). Evidence suggests that long periods of job strain caused by an unhealthy
work environment can increase sick time, conflict, job dissatisfaction, turnover and
inefficiency (World Confederation for Physical Therapy, 2008:4). Respondents who
were in a safe work environment were more likely to have higher work productivity. The
results show that there is a statistically strong and significant relationship between in-
service training, the use of the teamwork approach, compensation and work
productivity.

4.6 Conclusion

This chapter addressed the different facets of job satisfaction by means of descriptive
and inferential statistics. The data was analysed and presented in tables and figures.
The research methodology described in Chapter three was used in the analysis of the
data obtained from the questionnaire. Chapter five discusses the conclusions to the
findings and possible recommendations to the study.

CHAPTER 5: CONCLUSIONS AND RECOMMENDATIONS

5.1 Introduction

In the previous chapter, the results and findings of this study were presented, discussed
and interpreted. It was found that the overall job satisfaction of the physiotherapists in
the PHS of Durban, KZN was low. Numerous facets influencing this dissatisfaction were
identified. The linkage of the primary findings to the secondary findings will be
discussed in terms of the aim, objectives and research questions of the study.
Recommendations were offered to resolve the challenges that the health sector faces
with regards to physiotherapy service delivery. Areas of future research related to the
study were identified and proposed. The chapter closes with a discussion on the scope

63
for further research. The limitations to the study will also be presented and discussed at
the end of this chapter.

5.2 Findings

The aim of this research was to investigate job satisfaction in public sector
physiotherapists working in the public health sector in Durban, KZN

In order to achieve the aim of this study, the objectives are highlighted as follows:

 To determine the level of job satisfaction among physiotherapists in the public

health sector;
 To examine the factors influencing job satisfaction among physiotherapists in the
public health sector;
 To determine the relationship between job satisfaction and work productivity
(service delivery in the public health sector); and
 To determine appropriate changes to improve job satisfaction

Having considered the objectives above, the research now focuses on the conclusion
and recommendations for the PHS

5.2.1 Findings from the Literature Review

 Job Satisfaction
According to Ramayah et al. (2001:14):

“job satisfaction explained how employees were buoyant to come to work and how they
got enforced to perform their jobs”.

Mayer and Botha (2004:34), indicated, most South African organisations were
experiencing low levels of job satisfaction, which had resulted in a lack of commitment
to service delivery and the resultant failure of the achievement of organisational goals.
64
  Factors Influencing Job Satisfaction
Maslow’s theory provides a useful framework for understanding needs and expectations
and can therefore be linked to the various intrinsic and extrinsic factors that can
influence job satisfaction levels According to Maslow’s theory, when needs are
unsatisfied in the organisational context, it can result in stress, frustration, internal and
external conflict. According to Hertzberg’s two factor theory hygiene factors included
the following aspects that people considered essential to perform any job such as
salary, working conditions, security, organisational policy and administration (Cronje et
al., 2005:242). Motivational factors which are also called growth factors are focused on
the job content and are more likely to motivate employees to achieve higher work
productivity, commitment and effectiveness, and to find creative ways of accomplishing
both personal and organizational goals (Aswathappa, 2003: 115). Vroom’s theory can
be used in the organisational context whereby rewards are linked to performance
standards as well as the linking of personal goals to organisational goals (Ramasodi,
2010:10).

Based on the above theories, the following factors that influenced job satisfaction in the
public health setting were identified:
 time pressure;
 employee participation;
 physical work environment;
 the opportunity to develop;
 teamwork;
 patient care; and
 service delivery are determinants of job satisfaction in the healthcare
environment (Hughes et al., 2005:321) and were utilized in this study.

 Job Satisfaction And Work Productivity

The relationship between job satisfaction and employee turnover, absenteeism, worker
productivity and the overall organizational effectiveness has been highlighted in the

65
literature review. In the healthcare work environment, job satisfaction has an impact on
the work productivity of employees which in turn influences the delivery of healthcare.
Poor productivity results from low levels of job satisfaction which has been attributed to
a failing health system, low salaries, difficult working and living conditions and
inappropriate training (Hughes et al., 2005:321).

Health worker productivity can be a complex issue to address, as a variety of

determinants influence staff behaviour at different levels. This study has focused on job
satisfaction as a determinant of work productivity. Positive individual job satisfaction
acts as a motivating factor towards promoting quality service delivery (Rao, 2005:25).
In healthcare institutes, employee satisfaction has been found to be positively related to
service quality and patient satisfaction (Tzeng, 2002:51).

 Policies to Improve Job Satisfaction

In light of the above, it can be suggested that the employers should seek to implement
human resource policies and procedures that support need satisfaction in order to
reduce stress, frustration and conflict (Cronje et al., 2005: 225). Cronje et al. (2005:232)
stated that employees will place a high value on a job that provides satisfaction, is
challenging, provides growth, and allows for adequate achievement opportunities.
Factors such as teamwork, autonomy, management support, workload and staffing
levels have a great influence on job satisfaction because they impact on the delivery of
patient care. Therefore the implementation of performance management systems,
staffing management systems, employee participation, safe work practices, financial
and non financial incentives were highlighted in the literature review

5.2.2 Findings from the Primary Research

 Demographics

Based on the demographical data, respondents in the public health institutions have the
following characteristics:

 Predominantly female;

66
  Age range between 31 and 35 years;
 Most of the respondents are married or single;
 Mainly respondents have a B.Physio (HONS);
 Predominantly junior physiotherapists; and
 The large proportion of respondents have worked between 1-4 years.

Being a traditionally female dominated profession (SASP, 2012:3), it was not surprising
to find that, at 76.9%, there were more female participants than males. Also consistent
with physiotherapist samples in other international studies, the majority of participants
(50.8%) were above the age of 31years. Similarly, in terms of marital status, 56.9% of
the participants in this study reported being married. The majority of respondents
belonged to the junior and senior levels of the physiotherapy profession whilst 22.3% of
the respondents were chief physiotherapists and 2.3% of the respondents were
managers. As in most other counties in the world, physiotherapy is offered as a four
year degree qualification in SA. However, this change in the degree qualification that
took place as recently as the early 1980’s (SASP, 2012:4). At 96.2%, the percentage of
physiotherapists with Bachelor’s degrees was consistent with that of countries, such as
Australia, where between 80 to 100% of all qualified physiotherapists have
undergraduate degrees or higher (APTA, 2009:12). Although the results reveal that only
3.8% have postgraduate qualifications in physiotherapy, there are many more
physiotherapists who possess certificates for various continuing education short
courses. However, for the purpose of this study, specific details on these were not
required.

The fact that physiotherapists are quite a mobile group of professionals, is confirmed by
the relatively low mean number of years worked by the participants of this study, where
46.9% of respondents worked between 1-4 years. Furthermore, due to their mobility,
which is not necessarily from the public to other sectors, but is often from one public
sector institution to another, 28.5% of all respondents had been employed at their
current workplaces for less than nine years.

67
  General Satisfaction of Physiotherapists

It was documented that 80% of respondents were dissatisfied with their choice of
physiotherapy as a career. The expressed dissatisfaction with physiotherapy as a
career choice is similar to findings from other studies that have examined job
dissatisfaction in health professionals such as doctors and nurses. It may be
recommended that physiotherapists should utilise their full potential, in order to be more
motivated and productive thus increasing job satisfaction. This can be achieved through
the use of career planning which ensures that the individual employee’s career goals
are realistic and the organisation is able to achieve its goals. Career development is
crucial for an effective labour market (Carrel et al., 2005:356).

A high proportion of respondents (95.38%) cited that they were dissatisfied with the
overall nature of their job. The results from the job satisfaction rating and participants’
responses also revealed that the issue of dissatisfaction with the job situation for South
African public sector health professionals, including physiotherapists, continues to
contribute to the country’s high turnover and migration levels. Almost all the
respondents (94, 61%) were dissatisfied with their current employment in the public
health sector and 88.46% of physiotherapists were not willing to recommend
employment in the public health sector to other job seeking physiotherapists.

The majority of the respondents (97, 69%) expressed a general dissatisfaction towards
management efficiency in their departments. This is in keeping with other satisfaction
studies that have highlighted the role of proper management and employee satisfaction.
Therefore, it can be recommended that physiotherapy managers should be adequately
equipped to function optimally within their management roles. Without proper
management skills and training, the level of job dissatisfaction is more likely to increase
in the public health sector. In most South African public sector institutions,
physiotherapy managers do not undergo formal management training, but are simply
promoted from being clinicians to management positions through the ranks of the
profession. A recommendation in this regard is to provide basic management training as
a component in the undergraduate physiotherapy curriculum at South African

68
universities. In addition to this, once physiotherapists are faced with the task of
becoming departmental managers, they need to be sent for specific courses in
management. Good management and authority are some of the factors that lead to
improved job satisfaction of physiotherapists, and by formally training those who are
interested in becoming managers they are given an added level of responsibility and
heightened professional status which may most likely enhance job satisfaction among
physiotherapists in the public health sector (Adams and Bond, 2005:536).

The work of Adams and Bond (2005:536) highlighted the importance of management
relationships in healthcare workers and other medical staff, workload and ward
cohesiveness. Organisational factors such as teamwork, autonomy, management
support, workload and staffing levels have a great influence on job satisfaction because
they impact on the delivery of patient care. A number of studies have also shown a
positive association between management effectiveness and levels of job satisfaction
(Roedel and Nystrom, 2008:34; Spector, 2006:1005). More than half of the respondents
indicated that they were not committed to ensuring quality service delivery. Rao
(2005:20) argues that positive individual job satisfaction acted as a motivating factor
towards promoting quality service delivery.

 Factors Influencing Satisfaction

Time Pressure: From the findings 81.53% of respondents strongly agreed that they
were satisfied when there was sufficient time to manage their workloads effectively.
84.61 of respondents indicated that their work productivity was high when they had no
time pressures. These results are in keeping with the studies of Hugh et al. (2005:321)
and it may be suggested that time pressure is strongly and positively associated with
job dissatisfaction and poor work productivity.

Employee participation: Approximately three quarters of the participants indicated

that there was greater job satisfaction when they were allowed to participate in the
management of the work environment. Only 47.69% of respondents agreed that they

69
showed greater work commitment when given an opportunity to participate in
management decision making. Many of the respondents also reported poor
management participation as one of the reasons why they experienced job
dissatisfaction in the South African public sector.

Physical working environment: The entire sample strongly agreed that a safe and
healthy physical work environment supported job satisfaction. 77.69 % of the
respondents indicated that the level of work productivity was high given that the physical
work environment was safe. Unhealthy work environments affect health professionals’
physical and psychological health through the stress of heavy workloads, long hours,
low status, difficult relations in the workplace, problems carrying out professional roles
and a variety of workplace hazards (Rue and Byars, 2008:155). This is a large
percentage of the sample, and the implication of this is that there are probably many
physiotherapists that are not performing their work duties optimally at their permanent
workplaces due to the potentially unsafe and unhealthy work environments. This is also
a potential cause of frequent absenteeism, which is often a direct consequence of
elevated stress levels. The result of frequent absenteeism can be the loss of
productivity and disruptions to proper service delivery.

Opportunity to develop: 97.69% of the respondents indicated that they were satisfied
when they were given the opportunity for training and development. 70.77% of the
respondents agreed that their work productivity was when the opportunity for training
and development was high. Another strong deterrent against job satisfaction in the
South African public sector is the perceived lack of opportunities for training and
development. Indeed, many of the participants felt that the only way of advancing
professionally and in status was to leave their work places in search for more senior
positions elsewhere, usually in other public sector institutions or in the private sector.

Teamwork: Views about the teamwork approach were largely positive with 95.39% of
the respondents indicating that they were more satisfied when this approach was
utilised. 95.38% of the respondents indicated that their work productivity was high when

70
the team approach was used. Approximately half of the respondents indicated that they
were satisfied when there was a high level of work commitment from their co-workers.
96.92% of the respondents indicated that their commitment to service delivery was high
when they were satisfied with the level of work commitment from their co-workers.

Compensation: A staggering 100% of the respondents were satisfied with the

possibility that the compensation allocated to their jobs would be market related. The
results from similar studies also revealed that current South African public sector
salaries for physiotherapists are by far the greatest source of demotivation and
dissatisfaction. The respondents reported being unhappy with their non-market related
compensation, and they felt that the Department of Health had a responsibility to
provide better financial and non-financial incentives that were more market-related and,
also in line with their B.Physiotherapy (HONS) degree qualifications. According to
Yumkella (2006) salary outranked all other factors when health workers in different
African countries, such as Ghana, Cameroon and South Africa were asked what would
make them remain in their home country. The financial implications of this to the
government are potentially great, and possibly higher than what it would cost to
increase their salaries and invest more money into their retention efforts. In a study
conducted in Turkey (Bodur, 2002:353), it had been demonstrated that benefits,
compensation, working conditions and income were among the most important factors
for dissatisfaction of healthcare providers working at public health centers, which is
consistent with the findings of previous studies (Bodur, 2002:353). Similarly, the
findings of the available job satisfaction studies quoted earlier reveal that salaries are
also reported to be very significant for ensuring the job satisfaction of professionals
(Cronje et al, 2005:325). Another convincing case that showed a link between financial
compensation, motivation and job satisfaction is drawn from a study where health
workers with relatively higher remuneration retained higher levels of job satisfaction in
comparison with the health workers with a lower pay structure (Bhattacharayya et al.,
2001:43).

Despite the unsatisfactory salaries and certain working conditions that were mentioned
by the respondents, there are physiotherapists who choose to remain in the South

71
African public sector. This is in direct contrast to the views offered Grobler et al.
(2005:334) where unsatisfactory employment benefits and poor working conditions may
encourage physiotherapists to resign from their present employment. It may be
speculated that these unsatisfied professionals may contribute to the brain drain. South
Africa continues to lose health professionals from all disciplines, including
physiotherapists, who are seeking better pay elsewhere.

 Policies to Improve Job Satisfaction

All the respondents strongly agreed that the following policies were instrumental in
achieving greater job satisfaction: Staffing management systems, Performance
management systems, Compensation management systems, Employee participation
systems and the physical work environment.

5.2.3 Conclusions to the Study

The following section of this chapter encompasses the conclusions of this study.
Readers are advised that the conclusions are based on evidence gathered in this study
and include the individual interpretations of the researcher. The findings from the
literature review together with the findings from the primary research resulted in the
following conclusions. The general level of job satisfaction was significantly low. This
may affect the already weakened health system where health worker shortages have
crippled service delivery. Compensation in the form of financial and non financial
incentives, training and development, physical work environment and time pressure
were highlighted as a factor influencing job satisfaction. The influence of job
satisfaction on work productivity, work commitment and service delivery is noted.
Policies to improve job satisfaction must be implemented in order to improve work
productivity, work commitment and service delivery.

5.3 Recommendations

The following section of this chapter deals with the recommendations with regard to
improving the current state of job satisfaction among the professional physiotherapists

72
in the PHS in Durban, KZN. The DOH should consider various methods to promote
overall job satisfaction amongst physiotherapists in the PHS. This is probably not the
first time that a recommendation is being made to the government for regular
engagements in discussions with physiotherapy managers to be made by the relevant
government officials in order to review and improve the job satisfaction levels of public
sector physiotherapists as a direct measure of ensuring their work productivity, work
commitment and service delivery. However, these must be accompanied by the
formulation of definite strategies, follow-up action, dead-lines, monitoring and
evaluation.

The findings of this study can be used to contribute to and support existing evidence
that reveals the fact that physiotherapists in the PHS are not working productively or
providing good service delivery mainly due to their job dissatisfaction. Until something is
done about this by the relevant government stakeholders, there will be no changes in
the status quo and this subject will continue to be a key matter of discussion in most
physiotherapy and allied health management meetings. Based on the findings of the
study a model was developed to improve job satisfaction. The following
recommendations are made based on this model developed from this study:

 Physiotherapy jobs can be redesigned to make them more satisfying by using the
principles of job rotation, enlargement or enrichment. Job rotation can be utilized
by allocating physiotherapists to a particular ward and then subsequent changes
are made according to a ward schedule. This will enable physiotherapists to not
become bored with one particular type of patient or condition. Physiotherapists
can benefit from job enlargement when they are given opportunities to participate
in workplace forums, rehabilitation management committees and health
awareness programs. The use of in-service training and continual professional
development can be used to facilitate job enrichment.

 Physiotherapy managers must be able to:

 Assess the quality of service delivery and work productivity of their staff;

73
  Must be able to supervise and motivate their staff;
 Ensure that staff have the appropriate tools and resources for their
specific jobs;
 Identify and address performance gaps; and
 Measure job satisfaction on a regular basis in order to improve overall
employee satisfaction.

 The promotion policy should be made known to all employees, and it should be
fair so as to enhance employee morale and improve job satisfaction. Recognition
of performance in the form of performance appraisal should be part of the
process of recognition of good performance.

 The employer should consider ways of promoting and improving employee

relations. The physiotherapists in this study were satisfied when their colleagues
worked well in the Team approach and were committed to their task completion.
These relationships should be encouraged and strengthened.

 Salaries for physiotherapists in the public sector are determined centrally and in
the case of provincial authority facilities, this decision is taken at provincial level.
The employer should engage in discussions with the physiotherapist forum and
the South African Society of Physiotherapy to ensure pay equity, and to make
sure that the benefits structure for physiotherapists is acceptable and
competitive. From the literature surveyed it is evident that the public sector is
experiencing an exodus of professional skilled employees to other sectors and
countries. It is recommended that executive management accord significant
attention to future studies of this nature as to identify those variables having a
major impact on job satisfaction in an attempt to retain high quality skills, in
particular scarce skills such as Physiotherapy services.

74
  The human resource practitioners in the public service should be knowledgeable
and supportive to the physiotherapists, vacancies should be filled quickly and the
recruitment process should be speeded up.

 The employer should invest in staff development activities to improve productivity

and influence quality of physiotherapy care provided. In-service training should
be provided to ensure the competencies of the physiotherapists are of high
standard at all times.

 The ratio of physiotherapist to patient has been recommended to be 1:10. This

allows the physiotherapist to provide quality service delivery without becoming
stressed or overburdened with workloads.

 Finally, future research of this nature may assist personnel managers and
operational managers on all levels to be aware of the status of job satisfaction
and allow them to pro-actively put mechanisms in place to enhance job
satisfaction of employees and ultimately, improve service delivery.

5.4 Area for Further Study

 Future research on the link between job satisfaction and the global migration of
physiotherapists is necessary as most surveys have focused on nurses and
medical doctors.
 A comparative analysis between job satisfaction levels in public versus private
physiotherapists.
 A closer evaluation of the effectiveness of the scarce skills benefit that was
implemented for physiotherapists in S.A.

5.5 Conclusion

75
The overall aim was reached. Subsequently, all objectives were achieved. The current
status of the job satisfaction of physiotherapists in the PHS in Durban, KZN at the time
of the study was low. It is the opinion of the researcher that with the shortage of
physiotherapists in most facilities in this study, the respondents were generally
overloaded with work and hence this added on stress in their lives. The employees in
this research were generally dissatisfied at the operational level and the administrative
aspects of the job. The areas of dissatisfaction such as promotion and salaries are a
central government matter which requires policy change and hence the institution
cannot effectively address these entirely. However, work productivity and service
delivery issues as a result of job dissatisfaction must be addressed. This necessitates
changes at the national, provincial and local levels to promote job satisfaction and
ensure high levels of work productivity and service delivery especially if the South
African government plans to succeed in the proposed implementation of a National
Health Insurance system in SA.

By implementing the recommendations of the study, it is predicted that the job

satisfaction of these physiotherapists will show marked improvement leading directly to
lower absenteeism rates, improved productivity, greater occupational flow, improved
service delivery , greater work commitment decreased personnel-turn-over and lower
rates of career attrition. Moreover, these dedicated, motivated and passionate
physiotherapists will secure the profession for future generation
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APPENDICES
Appendix 1 – Letter of Permission

To whom it may concern

I am presently completing a master’s degree in business administration at the

Management College of Southern Africa. The research conducted, includes an
investigation into job satisfaction levels and the impact on work effectiveness among
physiotherapists in Durban, Kwa-Zulu Natal. More specifically, I will be analysing the
level of job satisfaction, the issues and factors that motivate physiotherapists and the
impact of job satisfaction on work effectiveness and service delivery in the health sector.
It would be greatly appreciated if you could assist the research process by completing
the enclosed questionnaire. It takes an average of 15 minutes to complete the
questionnaire. There are three ways to complete and send the questionnaire:

1. Online completion and submission

2. Request the hard copy via e-mail and return the questionnaire via fax to (031
5397390) or

3. Ask me to send you a self addressed stamped envelope.

The data provided will be utilised to identify current and future work effectiveness trends
that are relevant to the healthcare sector. Please note that the responses will be
treated as confidential, the results will be aggregated and presented anonymously.
Information in reports will be discussed at an aggregate level so that information about
any particular firm cannot be ascertained or deduced by readers. Please note that your
participation is completely voluntary. If you choose to complete the questionnaire, then
it is accepted that you have given permission to participate in the study. Thank you for
your time and consideration in completing this questionnaire if you choose to do so.
Please contact me if you have any further enquiries at kp.sportsphysio@gmail.com .

K. Padayachee

86
Appendix 2 - Questionnaire

Part A: Socio demographic characteristics

1. Gender: male/ female

2. Age ………………..
3. Marital Status ………………….
4. Job Title ………………………..
5. How long have you worked at the public health institute………………
6. What is the level of education…………………………..

Part B: Evaluation of job satisfaction

Please tick the appropriate box to reflect your response.

General Satisfaction Strongly Agree Uncertain Disagree Strongly

Agree Disagree

1. I am satisfied with
physiotherapy as a career choice

2. I am satisfied with
employment in a public health
institute

3.I would recommend

employment in a public health
institute to other physiotherapists

4. I am satisfied with the level of

management efficiency in my
department

5. Overall I am satisfied the

nature of my job

6. I am committed to ensuring
quality service delivery

Factors influencing satisfaction Strongly Agree Uncertain Disagree Strongly

87
 Agree Disagree

7. I am satisfied when I have

sufficient time to manage my
workload effectively

8.I am satisfied when I participate

in the management decision
making

9.I am satisfied when the work

environment is safe

10.I am satisfied when there are

opportunities for training and
development

11. I am satisfied when there is a

high level of work commitment by
my co-workers

12.I am satisfied when the

Teamwork approach is used for
patient management

13 .I am satisfied when my total

compensation, including salary
and benefits

Job satisfaction and Productivity Strongly Agree Uncertain Disagree Strongly

Agree Disagree

14.Work productivity is high when

88
there are no time pressures

15.Work commitment is high

when I participate in management
decision making

16.Work productivity is high when

my work environment is safe

17.Work productivity is high when

the opportunity for training and
development is high

18.Commitment to service
delivery is high when I am
satisfied with the level of work
commitment from co-workers

19.Work productivity is high when

the team approach is used

20. Work productivity is high

when I am satisfied with my total
compensation

Changes to improve job Strongly Agree Uncertain Disagree Strongly

satisfaction
Agree Disagree

21.Reduce time constraints for

service delivery by increasing
staff numbers

89
 22.Increase employee
participation in decision making

23. Create safe work

environments

24. Develop suitable performance

management systems

25.Develop policies to provide

financial and non financial
incentives

You have reached the end of the questionnaire. Thank you for completing this questionnaire.

Appendix 3 : Reminder

Dear Sir/Madam

90
First, let me thank all those who have participated in the study by completing either the
online questionnaire or the hard copies. Your responses have been very valuable and
are greatly appreciated.

Secondly, this e-mail is directed to those who have not completed the questionnaire as
yet. It would be greatly appreciated if you could assist in the research study by
completing the administered questionnaire as your response is important to the study.

Once again, thank you for time spent in completing the questionnaire.

91