|Year : 2014 | Volume
| Issue : 4 | Page : 249-255
Development of job satisfaction scale for health care providers
Pawan Kumar1, Abdul Majeed Khan2
1 Department of Community Health Administration, National Institute of Health and Family Welfare, Baba Gang Nath Marg, Munirka, New Delhi, India
2 Department of Social Sciences, National Institute of Health and Family Welfare, Baba Gang Nath Marg, Munirka, New Delhi, India
|Date of Web Publication||5-Dec-2014|
B-10, 1-A, Transit Officers Flat, Battery Lane, Rajpur Road, New Delhi - 110 054
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Job satisfaction is a hypothetical construct that is measured on both cognitive and affective parameters. Job satisfaction has been defined as an affective reaction to one's job and an attitude toward it. Objective: To develop the job satisfaction scale for health care providers. Materials and Methods: After exploring existing job satisfaction scales, extensive review of the literature and detailed discussion with different health providers, the statements were prepared for developing the job satisfaction scale. The data were collected on a sample of 333 and analysis was done using SPSS to calculate the Cronbach's alpha value for reliability and validity of the scale. Principal Component analysis and factor analysis of job satisfaction scale were also done. Results: Reliable and valid scale with Cronbach's alpha value of 0.909 was developed. Scale was tested on a mixed group of health care providers in government health facilities in 2013. In the factor analysis, seven components were identified out of 49 items related to job satisfaction. The seven factors emerged from the analysis. These are: Factor (1) privileges attached with job, (2) interpersonal relation and cooperation, (3) working environment, (4) patient relationship, (5) organization facilities, (6) career development, (7) human resource issues. Conclusion: The job satisfaction scale having high reliability and validity is a good tool; it could be used in the health sector for understanding the satisfaction level of health care providers. Study provides a good starting point for standardization of scale in both urban and rural health care setting.
Keywords: Factor analysis, health care organization, reliability, validity
|How to cite this article:|
Kumar P, Khan AM. Development of job satisfaction scale for health care providers. Indian J Public Health 2014;58:249-55
| Introduction|| |
Job satisfaction is most essential driving forces for determining the quality of services of health care organizations. It is defined as a pleasurable emotional state resulting from the appraisal of one's job and an affective reaction to one's job and an attitude toward one's job.  Weiss has reported that job satisfaction is an attitude but pointed out that researchers should clearly distinguish the objects of cognitive evaluation which are affect (emotion), beliefs and behaviors. This definition suggests that we form attitudes toward our jobs by taking into account our feelings, our beliefs, and our behavior.  A lot of research has been done on client satisfaction in the health sector, but it is in a limited context for provider's satisfaction in health care system. In the last few years, increased importance has been given to the human resource in the health sector and steps have been taken to manage them in health care organizations.  The patients of physicians, who rated themselves to be extremely satisfied with their work had higher scores for overall satisfaction with their health care (regression coefficient 2.10; 95% confidence interval 0.73-3.48), and for satisfaction with their most recent physician visit (regression coefficient 1.23; 95% confidence interval 0.26-2.21) thus related with quality of health care perceived by patients.  High physician satisfaction is also likely to result in a good outcome for patient' healthcare. Over the years, it has been seen that our health care workers are not satisfied with their professional lives. An unhappy mind is definitely linked with dissatisfaction on his patients, and higher job satisfaction is associated with increased productivity, lower absenteeism and lower employee turnover. ,
Job satisfaction conceptual construct
Satisfaction is a hypothetical construct that is measured on both cognitive and affective parameters. How does an employee evaluate physical parameters (environment) of the organization? How happy or unhappy they are with juniors and seniors working in the organizations (emotional part)? How do they perceive organization policy, programs and privileges? Do they really derive satisfaction of what they do (performance)? Do they really perceive that they are rewarded for their work or they feel neglected? There are several situations in the organization that continuously affect both cognitive and affective dimensions of employees in the health sector.
The concern for job satisfaction in the health sector is increasingly realized by policy makers at international organizations. In every organization, it is essential to have continuous understanding about how the employees associate with it and how much satisfaction they derive from it. More research is needed to establish linkages between the perceptions of health care providers and organizational environment in which they work. The present study was undertaken to develop a "Job Satisfaction Scale" for health care providers rendering services under primary health care system in Delhi.
| Materials and Methods|| |
Development of statements for job satisfaction scale
Review of available standards job satisfaction tools (i) Minnesota Satisfaction Questionnaire (MSQ)  (ii) Hackman and Oldham job diagnostic survey (JDS)  (iii) Warr et al. job satisfaction scale  was done and items of scale were examined in context of Indian health care settings. Since, all these job satisfaction, psychometric tools are developed in western countries, and their reliability and validity is tested in their respective culture only. Although such tools have high reliability and validity in their respective culture; nevertheless these tools are not culture free in Indian context particularly in health care organizations. Culture free and fair tools reduce the cultural bias. Culture free tools will contain the items that are assumed to be known to individuals from all socioeconomic and ethnic backgrounds. Therefore, extensive review of the literature on job satisfaction in the health sector was done by the authors. Visit to primary health care system was made, detailed discussions about the factors contributing job satisfaction with health personnel's was held. After this statements were prepared for assessing the job satisfaction.
Field testing of statements for the scale
Before the application of scale on a larger sample, testing of the tool was done on a small sample size different from study sample in primary urban health centers (PUHCs). PUHCs are dispensaries and urban health centers designated as "PUHCs" by state government which provide preventive, promotive and curative health services to citizens of Delhi. Knowledge gained, while testing of scale for relevance of items, understanding of content of items/statements by respondents has helped in doing the suitable changes. After getting understanding of each item of the scale and its relevance in the field, the scale was applied to the study population. Multistage simple random sampling technique was used for sampling in 2013. List of all the PUHCs and the total staff for each category under study were procured from the chief district medical officers (CDMOs)/management information system (MIS) cell for all the nine districts in Delhi. Total sample size of 333 primary health care providers was calculated from the total staff list available from the CDMO offices by assuring 10% of the cadre strength for each category of staff, which includes Medical Officer (101), auxiliary nurse and midwives (ANMs) (114), Pharmacists (85), Lab Assistants/Lab Technicians (33) both under regular and contractual provisions. Thereafter, out of nine districts in Delhi, three districts were chosen by simple random technique (Stage 1). There were total 63 PUHCs in three selected districts and all were considered for sampling purpose (Stage 2) and interviews were conducted for different category of staff in all the centers after ensuring the inclusion criteria of >2 years job for regular personnel and 6 months of job for contractual personnel. With this criteria requisite sample of 333 was selected from PUHCs of three districts, which includes regular medical officers 30, contractual medical officers 71, regular ANMs 30, contractual ANMs 84, regular pharmacists 55, contractual pharmacists 30, regular lab technicians/assistants 3 (only 3 available in three districts and all were considered for study) and contractual lab technicians/assistants 30 (stage 3). Reason to include 2 years job criteria for regular employee is that by that time personnel have completed the probation period and for contractual employee 6 months is the initial period for the job and after that it is likely to be extended subject to satisfactory performance of personnel in the organization.
Application of job satisfaction scale
After collection of data from the sample of 333 subjects, screening of data for any incompleteness or error was done. Data were entered in the Microsoft excel sheet and percentages of variables were calculated. Further analysis of data was done by using Statistical Package for Social Sciences (SPSS) version 18 (IBM Corporation) to calculate the Cronbach's alpha for reliability and validity of the scale. Principal Component analysis and factor analysis of job satisfaction scale were done.
| Results|| |
Reliability of job satisfaction scale
Cronbach's alpha for internal consistency of job satisfaction scale was found 0.909. As per George and Mallery alpha value of >0.8 is acceptable and good for scale.  Therefore, the present scale is reliable as Cronbach's alpha value is 0.909. Further, each scale item was analyzed for item-total correlation and inter-item correlation, which showed significant internal consistency for each item and same items were retained in the scale as shown in [Table 1].
Validity of scale
Contents of scale were validated by three experts in the field area. Construct and concurrent validity of the scale were established by confirmation of a strong relationship between present job satisfactions with another 34 item tool to measure job satisfaction. Pearson correlation coefficient of 0.706 at significance level of 0.01 establishes significant correlation between job satisfactions calculated by another tool concurrently used in the present study for comparison.
Principal component analysis of scale
Factor analysis of job satisfaction items was done by SPSS version 18. In Kaiser-Meyer-Olkin (KMO measure of sampling adequacy) and Bartlett's test, the KMO adequacy is 0.855. This value is far >0.6, which means sample was adequate for factor analysis. Bartlett test of sphericity is significant that is associated with a probability of 0.000 (< 0.05) and it indicates the acceptance of components in the questionnaire. In running factor analysis, minimum factor loading was set at 0.4. The 49 job satisfaction statements were subjected to principal component analysis using direct varimax rotations with Kaiser Normalization (as there were grounds for supposing that the factors might correlate). All factors were considered if they had an eigenvalue over: (1) In the factor analysis, seven components (factor) were identified out of 49 job satisfaction items. These seven components are found to be determinants of job satisfaction which are; factor (1) privileges attached with job, (2) interpersonal relation and cooperation, (3) working environment, (4) patient relationship, (5) organization facilities, (6) career development, (7) human resource issues. Details of the factors loading and factor analysis of job satisfaction items are shown in [Table 2].
|Table 2: Variables involved in principal factor analysis and factor loadings for scale|
Click here to view
| Discussion|| |
Assessment of job satisfaction by present scale
Job satisfaction is measured in the study using five point Likert Scale. Score 1 is given to "I am very much dissatisfied," score 2 is given to "I am dissatisfied," score 3 is given to "can't say," score 4 is given to "I am satisfied" and score 5 is given to "I am very much satisfied." The midpoint of the scale is 2.5 in the scale of 1-5 point. Score of job satisfaction >2.5 gives direction toward job satisfaction and score <2.5 gives direction toward job dissatisfaction.
Spectrum of satisfaction and dissatisfaction in the scale
In satisfaction and dissatisfaction spectrum, there is always a situation of neutrality. It is unique feature in the Indian culture. People love to remain neutral. Most of the people don't make their positions clear whenever there is a question of taking some real positions. Most of the employees remain dissatisfied with their organizations, but they don't make their position clear or agree. Therefore, any scale ignoring the neutrality in it would not be culturally suitable scale.  Further, previous studies revealed that likert scale should have characteristics like
(i) A scale must contain multiple items,
(ii) In the scale multiple items are combined or summed,
(iii) each individual item must measure something that has an underlying, quantitative measurement continuum.
In other words, it measures a property of something that can vary quantitatively rather than qualitatively.  That is why present Likert scale was developed and used.
Comparison of scale with previous job satisfaction scales
The MSQ "long form" consists of 100 questions (five point Likert scale) that make up 20 subscales measuring satisfaction of workers with ability utilization, achievement, activity, advancement, authority, company policies and practices, compensation, coworkers, creativity, independence, moral values, recognition, responsibility, security, social service, social status, supervision-human relations, supervision-technical, variety, and working conditions.  Coefficient alpha values for the 20-item MSQ ranged from 0.85 to 0.91. , Whereas present scale that is 49 items (five point likert scale) is subdivided into seven components derived from factor analysis measuring job satisfaction in Indian Context. Present scale also takes into consideration the Indian culture and working conditions of health care system. The seven factors important for Indian context are; privileges attached with the job, interpersonal relation and cooperation, working environment, patient relationship, organization facilities, career development, and human resource issues. The Cronbach's alpha value of present scale 0.909 is similar to earlier old MSQ scales developed in western countries. Seven factors also identified take care of internal and external satisfaction facets in the job for health care providers. In MSQ theme related to human resource issues and patient relationships is lacking. 
The JDS developed by Hackman and Oldham, measures overall job satisfaction in terms of three-dimensions including general satisfaction (five items), internal work motivation (six items), and growth satisfaction (four items).  The reliability of JDS seven point Likert scale lies between 0.55 and 0.92 in comparison to present scale that is 0.909. , JDS scale lacks job satisfaction in terms of human resource issues, privileges attached with job, patient relationship which is important in Indian context, and present scale development has taken into account these facets of job satisfaction with acceptable reliability.
Warr et al. used 15 items (seven point likert) to describe overall job satisfaction developed in Britain.  This has two subscales assessing satisfaction with regard to extrinsic (eight items) and intrinsic (seven items) aspects of a job. The reliability Cronbach's alpha score of the composite scale calculated in western countries is 0.8-0.9. , Scale developed by Warr et al. is tested and developed according to western working conditions, which is not culture free and fair. Present scale thus developed has high reliability (Cronbach's alpha 0.909) having thrust on different facets of job satisfaction in the health sector in India. Scale developed by Warr et al. lacks human resource issue, patient relationship, privileges attached with the job. All standardized job satisfaction scale from western countries lack the new facets of job satisfaction that were revealed in factor analysis of the present scale and may play an important role in job satisfaction and motivation for workforce in the health sector.
This scale is specifically developed for assessing the job satisfaction of health care providers in government organizations for a wide range of health professional groups. The sample used in this study is from both regular and contractual staff of various categories. The scale will have relevance in health care organization under government setup. Scale items also show that job satisfaction is related to various variables inside and outside the work place. It is likely that the job and life satisfaction influence each other and the nature of that influence may change from time to time.
Application of results in the policy context
The results of the scale would inform the health care managers about the expectations and daily work-related problems of their employees in the organization. This will help the health managers to understand the needs of employees for effective results. The seven factors emerged in the study are determinants of job satisfaction, which include: Privileges attached with job, interpersonal relation and cooperation, working environment, patient relationship, organization facilities, career development, and human resource issues. Any human resource development policy without considering these seven factors would be ineffective for the organization. The results of job satisfaction can be used as a reference level and indicators for the human resources development in the health care system for future improvement.
| Conclusion|| |
The present five point rated scale (likert scale) having high reliability (Cronbach's alpha 0.909) and validity is a good tool; and it could be used in the health sector for understanding the job satisfaction of providers by the public health managers. Content validity of the scale established by three experts and concurrent validity measured by strong correlation coefficient (r = 0.706; P = 0.01) of job satisfaction measured by another scale. The development of the scale is a modest effort to assess the job satisfaction in health care providers under both regular and contractual staff in Indian setup. Study provides a good starting point for further standardization of scale for measuring job satisfaction of health care providers in both urban and rural health care setting. Validation of the scale in the private sector of health care would enhance its scientific relevance and application.
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[Table 1], [Table 2]
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