Job Satisfaction among Healthcare Employees in Public and Private Sector Hospitals in Punjab

Doctoral Thesis / Dissertation, 2014

264 Pages





List of Tables

List of Figures


1.1 Job Satisfaction
1.2 Dimensions of Job Satisfaction
1.3 Significance of Job Satisfaction
1.4 Factors Affecting Job Satisfaction
1.5 Demographic Variables and Job Satisfaction
1.6 Job Stress and Job Satisfaction
1.7 Health Workforce: A Global Profile
1.8 Indian Healthcare Sector: An Overview
1.9 Effect of Globalization on Health Sector in India
1.10 Health Workforce in India
1.11 Healthcare Workers and Health Care Infrastructure: A Major Shortfall
1.12 Job Satisfaction and Healthcare Workers
1.13 Conclusion

2.1 International Studies
2.2 National Studies

3.1 Need of the Study
3.2 Scope of the Study
3.3 Objectives of the Study
3.4 Research Methodology
3.4.1 Secondary Source
3.4.2 Primary Source
3.4.3 Personal Observation
3.4.4 Development of Questionnaire Job Satisfaction Survey (JSS) JSS Scoring Internal Consistency Reliability & Test-Retest Reliability Validity Work Tension Scale Reliability Validity
3.4.5 Pilot Study
3.4.6 Sampling Size and Sample Design Selection of Population and Sampling Unit Size of the Sample Sampling Technique
3.4.7 Analysis And Interpretation
3.4.8 Limitation of the Study

4.1 Punjab: A Socio-Economic Profile
4.2 Economic Reforms and Economy of Punjab
4.3 Health Indicators in Punjab
4.4 Disease Burden in Punjab
4.5 Health Delivery System in Punjab
4.6 Punjab Government Health Expenditure
4.7 Healthcare for Poor in Punjab
4.8 Public-Private Partnership (PPP) in Punjab
4.9 Deterioration and Stagnation of Health Services in Punjab
4.10 Conclusion and Policy Implication

5.1 Demographic Information of the Healthcare Employees
5.2 Relationship between Job Satisfaction of Healthcare Employees and Factors Affecting Job Satisfaction
5.2.1 Satisfaction with Pay
5.2.2 Satisfaction with Promotion
5.2.3 Satisfaction with Supervision
5.2.4 Satisfaction with Fringe Benefits
5.2.5 Satisfaction with Contingent Reward
5.2.6 Satisfaction with Operating Procedures
5.2.7 Satisfaction with Co-workers
5.2.8 Satisfaction with Nature of Work
5.2.9 Satisfaction with Communication
5.3 Relationship between Overall Job Satisfaction of Healthcare Employees and Type of Hospital
5.4 Relationship between Demographic Variable and Job Satisfaction
5.4.1 Age
5.4.2 Gender
5.4.3 Education Level
5.4.4 Income Level
5.4.5 Job Experience
5.5 Job Stress and Job Satisfaction
5.5.1 Job Stress
5.5.2 Job Satisfaction
5.5.3 Relationship between Job Stress and Job Satisfaction Inter-Relationship
5.6 Conclusion

6.1 Summary
6.2 Findings
6.3 Recommendations
6.4 Areas for Further Research




This is to certify that the Ph.D. Thesis entitled, "Job Satisfaction among Healthcare Employees in Public and Private Sector Hospitals in Punjab" has been completed by Mr. Akshay Rana for the award of Ph.D. degree in Commerce represents the original work of the candidate. It is further certified that the work of this thesis has been carried out under my supervision and no part of this thesis has been submitted elsewhere for any degree or diploma. The data and references used in the present study have been duly acknowledged.

I recommend the thesis for evaluation.

Place: Shimla (Dr. Kuldeep Kumar Attri)



Today the competitive ability of a healthcare sector gets defined by its ability to manage its healthcare workers. Health workers management and its usage has become a crucial function of healthcare organizations. In such a scenario, people who are engaged in health sector have become more sought after and are likely to stay in demand in near future too. Healthcare is undergoing major changes as a result of a multitude of factors, including rapidly changing technology, unprecedented access to information, cost pressures, globalization and global changes, changing demographics and new levels and forms of competition among healthcare organizations. Our society has seen repeated examples of the impact of natural and man-made threats, and we recognize that we will face severe staffing shortages with the confluence of the aging of the population and of the healthcare workforce.

The present study started as an exploration based upon secondary data, collected from research papers and various articles from academicians working on similar subject. The inferences have been drawn from purposive conversation held with the people engaged in delivering healthcare services ranging from medical professionals to paramedical staff working in different public and private hospitals of select district of Punjab.

The study goes on to find out the organizational factors that influence job satisfaction of hospital employees. The desire to understand and explain job satisfaction was motivated by utilitarian reasons as well as humanitarian interest. There are many reasons for healthcare organizations to improve job satisfaction; it creates happier employees, it lowers costs for hiring and training new personnel, it lowers costs for sickness absence and also creates more motivated and productive employees. At the same time it cannot be denied that the employees deserve to be treated with love and respect.

The study proposes that hospital employees perceive pay, promotion, supervision, fringe benefits, co-workers and nature of work as significant factors affecting their job satisfaction level while contingent rewards, operating procedures and communication were non significant factors. Also demographic variables like age, gender, education level, income level and job experience has a significant relationship with job satisfaction. Furthermore, job stress correlated negatively with job satisfaction. If due care is accorded to these propositions, the hospital management would in all probability be able to draw forth that elusive satisfied worker.

The present study “Job Satisfaction among Healthcare Employees in Public and Private Sector Hospitals in Punjab” comprise of six chapters.

The first chapter includes the basic concept of job satisfaction. This chapter lays a theoretical foundation for the study. The factors involved in job satisfaction are investigated. The purpose of this chapter is to highlight the dominant factors that affect the job satisfaction of certain individuals in a given set of circumstances in order to provide a more comprehensive picture of the job satisfaction process. The first chapter also deals with the general introduction, global profile of health work force followed by a brief overview of health work force in India. The chapter also discusses the effect of globalization on Indian health sector along with existing shortage of healthcare employees and healthcare infrastructure in India. The objective of this chapter is to build a focus on healthcare employees in relation to job satisfaction in healthcare sector.

A perusal of literature is provided in the second chapter under two separate sections a) International studies and b) National studies where the previous works are reviewed to primarily draw attention to the studies affecting job satisfaction at national and international level.

Third chapter explains the research methodology and methods employed in this research. A part of the chapter focuses on research methodological issues, such as research philosophy, objectives, methods of data collection, and tools for the analysis of data etc. It provides details of how the researcher conducted his research to achieve the research objectives.

In the fourth chapter an attempt has been made to analyze the performance of health sector in Punjab. It provides a brief overview of the Punjab State along with the existing health scenario in both public and the private sector.

Fifth chapter highlights the quantitative findings derived from the questionnaire. This chapter answers the research hypotheses and predicts job satisfaction level and stress level among employees working in public and private hospitals in Punjab.

The final chapter provides a discussion of the results of the analysis. This chapter provides with an overall summary of the research findings and their contribution to existing knowledge and outlines avenues of future inquiry within the research area.

Dated: (Akshay Rana)


It is the glory of the god who gives wisdom and whose blessing makes things possible. Writing this acknowledgement, I am humbled to realize that so many people have spent time and effort in making this endeavor a success. I am deeply indebted to all those who, in their own different ways have helped me in completing the task.

It is my pleasure to acknowledge indebtedness and heartfelt thanks to my supervisor, Dr. Kuldeep Kumar Attri, Professor, Department of Commerce and Management, International Centre for Distance Education and Open Learning, Himachal Pradesh University, Shimla, for his enlightening, thought provoking and painstaking guidance and supervision at every stage of my study. His sympathetic attitude and continued encouragement made it possible for me to complete my work and is an additional source of inspiration for me.

I like to acknowledge the support and express my heartfelt gratitude to Dr. Yoginder Verma, Pro Vice-Chancellor, Central university of Himachal Pradesh for giving me precious time and resources needed in such a study. My special acknowledgement to Dr. Shashi Verma, Professor, Department of Management, Himachal Pradesh University who had been so forthcoming in her help. She has been extremely supportive and encouraging all through my work.

I convey my sincere thanks to Dr. Vijay Kaushal, Professor, Department of Commerce, Himachal Pradesh University for his insightful comments in the initial phase of the study.

I am extremely thankful to Dr. O. P Verma, Chairman, Department of Commerce, Himachal Pradesh University, Prof. R.C. Kondle, Prof. Kulwant Singh Rana for rendering valuable assistance in various ways to complete this study.

I would also like to thank to Dr. Sanjeev Thakur, Lecturer, Dept. of Higher Education, Himachal Pradesh, whose suggestions have been of great help in bringing the thesis into shape.

I am also very grateful to Er. S.K. Punj, Chairman and Mrs. Tripta Punj, Managing Director, Sri Sai Group of Institutes, who have not stopped mouthing words of encouragement, blessings and support ever since I began working on my research project. Philanthropists like them, who encourage academic pursuit, are a few, my respect and heart felt thanks to them.

I especially wish to thank all the medical and paramedical staff of both the public sector and private sector hospitals who willingly became part of this study and spared their time for interviews with the researchers and filling up the questionnaire at the time of data collection.

I also thank my elder brothers Dr. Ashwani Rana, Wg. Cdr. Ajay Rana and my sister-in-law Dr. (Mrs.) Rashima Rana who helped and guided me in every sphere of my life with love and affection. I would also like to make a special mention to my very loving nephew Aaryan for helping me in many sweet ways. May God bless them all with all his might. It was their moral support, patience and optimism which helped me in reaching this stage of academic pursuit. I once again thank them from bottom of my heart for being there when I needed them the most.

Finally, I have no words to pay my deep-hearted gratitude to my worshipped Lord, beloved parents, my loving wife Samriti and most beautiful and adorable daughter Ridhima for coping with my irritatable behaviour at times during the study.

I am grateful to all whose names I have been able to mention and also to many others whose I couldn’t because of obvious constraints.

The above notwithstanding, I must place on record that, none of above mentioned names is responsible for any shortcoming or error found in the study.

(Akshay Rana)

List of Tables

1.1 Countries with Critical Shortage of Healthcare Providers (Doctors, 22 Nurses and Midwives)
1.2 Shortfall in Health Infrastructure: All India
1.3 Shortfall in Health Personnel: All India (as on March 2011)

3.1 List of Nine Subscales
3.2 Question Number Assigned to Each Subscale
3.3 Internal Consistency and Test-Retest Reliability for the Job Satisfaction Survey
3.4 Total Norms for the Job Satisfaction Survey
3.5 Multitrait-Multimethod Matrix for Job Descriptive Index and Job Satisfaction Survey Subscales
3.6 District-wise Sample Size for Survey

4.1 Health Indicators of Punjab
4.2 Broad Category-wise Outdoor-Patients, Indoor-Patients Treated 123 and Number of Deaths among Indoor Patients in 2009 (Punjab)
4.3 Medical Institutions in Punjab
4.4 Population Served per Institution, Bed, Area Covered per 127 Institution, Beds per ‘000’ Population, Doctor, Midwife and Nurse in Punjab
4.5 Expenditure on Medical and Public Health and Family Welfare: Ratio to Aggregate Expenditure
4.6 State Budget of Punjab : Expenditure on Revenue Account
4.7 Eleventh Five Year Plans and Annual Plans of Punjab
4.8 Shortfall in Health Infrastructure: Punjab
4.9 Shortfall in Health Personnel: Punjab

5.1 Age Distribution of Public and Private Healthcare Employees
5.2 Gender Distribution for Public and Private Hospitals
5.3 Level of Education Distribution for Public and Private Hospitals
5.4 Job Experience Distribution for Public and Private Hospitals
5.5 Job Position Distribution for Public and Private Hospitals
5.6 Monthly Income Distribution for Public and Private Hospitals
5.7 Relationships between Healthcare Employees’ Job Satisfaction with Pay and Type of Hospital
5.8 Pay and Level of Job Satisfaction (Chi-Square Test)
5.9 Relationship between Healthcare Employees’ Job Satisfaction with Promotion and Type of Hospital
5.10 Promotion and Level of Job Satisfaction (Chi-Square Test)
5.11 Relationship between Healthcare Employees’ Job Satisfaction with Supervision and Type of Hospital
5.12 Supervision and Level of Job Satisfaction (Chi-Square Test)
5.13 Relationship between Healthcare Employees’ Job Satisfaction with Fringe Benefits and Type of Hospital
5.14 Fringe Benefits and Level of Job Satisfaction (Chi-Square Test)
5.15 Relationship between Healthcare Employees’ Job Satisfaction with Contingent Reward and Type of Hospital
5.16 Contingent Reward and Level of Job Satisfaction (Chi-Square Test
5.17 Relationship between Healthcare Employees’ Job Satisfaction with Operating Procedures and Type of Hospital
5.18 Operating Procedures and Level of Job Satisfaction (Chi-Square Test)
5.19 Relationship between Healthcare Employees’ Job Satisfaction with Co-workers and Type of Hospital
5.20 Co-workers and Level of Job Satisfaction (Chi-Square Test)
5.21 Relationship between Healthcare Employees’ Job Satisfaction with Nature of Work and Type of Hospital
5.22 Nature of Work and Level of Job Satisfaction (Chi Square Test)
5.23 Relationship between Healthcare Employees’ Job Satisfaction with Communication and Type of Hospital
5.24 Communication and Level of Job Satisfaction (Chi-Square Test)
5.25 Relationship between Overall Job Satisfaction and Type of Hospital
5.26 Overall Level of Job Satisfaction (Chi-Square Test)
5.27 Age and Healthcare Employees’ Job Satisfaction of Public and Private Hospitals
5.28 Age and Level of Job Satisfaction (Chi-Square Test)
5.29 Gender and Healthcare Employees’ Job Satisfaction of Public and Private Hospitals
5.30 Gender and Level of Job Satisfaction (Chi-Square Test)
5.31 Education Level and Healthcare Employees’ Job Satisfaction of Public and Private Hospitals
5.32 Education Level and Level of Job Satisfaction (Chi-Square Test)
5.33 Income Level and Healthcare Employees’ Job Satisfaction of Public and Private Hospitals
5.34 Income Level and Level of Job Satisfaction (Chi-Square Test)
5.35 Job Experience and Healthcare Employees’ Job Satisfaction of Public and Private Hospitals
5.36 Job Experience and Level of Job Satisfaction (Chi-Square Test)
5.37 Work Tension (Job Stress)
5.38 Job Satisfaction

List of Figures

1.1 The Problem of Stress

1.2 Signs of Stress

1.3 A Model of Stress at Work

1.4 Techniques of Managing Stress

1.5 Framework for Defining the Health Workforce

1.6 Health Worker Density: All India (per 10000 Population)

1.7 Rural-Urban Distribution of Health Workers in India

1.8 Distribution of Health Workforce by Sector

5.1 Age Distribution and Type of Hospital

5.2 Gender Distribution and Type of Hospital

5.3 Level of Education Distribution and Type of Hospital

5.4 Job Experience Distribution and Type of Hospital

5.5 Job Position Distribution and Type of Hospital

5.6 Income Distribution and Type of Hospital

5.7 Job Satisfaction with Pay and Type of Hospital

5.8 Job Satisfaction with Promotion and Type of Hospital

5.9 Job Satisfaction with Supervision and Type of Hospital

5.10 Job Satisfaction with Fringe Benefits and Type of Hospital

5.11 Job Satisfaction with Contingent Reward and Type of Hospital

5.12 Job Satisfaction with Operating Procedures and Type of Hospital

5.13 Job Satisfaction with Co-workers and Type of Hospital

5.14 Job Satisfaction with Nature of Work and Type of Hospital

5.15 Job Satisfaction with Communication and Type of Hospital

5.16 Overall Job Satisfaction and Type of Hospital

5.17 Relationship between Age and Job Satisfaction

5.18 Relationship between Gender and Job Satisfaction

5.19 Relationship between Education Level and Job Satisfaction

5.20 Relationship between Income and Job Satisfaction

5.21 Relationship between Job Experience and Job Satisfaction

5.22 Pie Chart showing a Comparison of Mean Values of Job Satisfaction

5.23 Pie Chart showing a Comparison of Mean Values of Work Related Tension (Job Stress)


illustration not visible in this excerpt


Employee job satisfaction has been under academic and scholarly investigation by the researchers for more than a century now. The existence of such studies takes us back to 1911, when Taylor began to study employees and their job duties to develop better ways to train workers. Seven years later, the interest in job satisfaction had clearly arrived when Edward Thorndike examined the link between work and satisfaction in the Journal of Applied Psychology in 1918.1 The actual curiosity in exploring job satisfaction began with ‘Hawthorne studies’ by Elton Mayo (1933) and works by Hoppock (1935). Although, these two studies were carried out at the same time yet the Hawthorne studies (1927-33) had the most long lasting influence on job satisfaction research.

As a layman understands, the term ‘job satisfaction’ may sound simple and easy to define—‘as one who is satisfied with his/her job’ yet from a researcher’s point of view conceptual problem associated with job satisfaction or what actually job satisfaction means is a matter of debate since there is no clear cut definition or unanimous decision on what is job satisfaction. The more one defines it, the more complex phenomenon it becomes. It is interesting here to quote a comment made by Mumford that—“job satisfaction is a nebulous concept” expresses the nature of difficulties facing the researchers in this field. Continuing in similar vein, she further argues, “The literature on job satisfaction is of equally small help in providing us with an understanding of the concept. There appears to be no all-embracing theories of job satisfaction and work on the subject has been focuses on certain factors thought to be related to feelings of job satisfaction or dissatisfaction at work. Few studies take a wide and simultaneously survey of a large number of related variables. Job dissatisfaction has been found easier to identify and measure than job satisfaction…Two points emerge clearly from the work that has been done up to date. One is the elusiveness of the concept of job satisfaction- what does it mean? The second is the complexity of the whole subject”.2 Since, job satisfaction is an uneasy concept therefore, one cannot arrive at its singular perfect definition. It remains a vague concept for two main reasons. First, one cannot comprehend the concept. Second has the reference to its methodological problems, the question of construct validity. Construct validity is deployed to understand how well a test or experiment measures the true theoretical meaning of the concept. In order to further confirm the complexity involved in defining the term, it a worthwhile exercise to list a few definitions or interpretation of the term.


Oxford Advance Learner ’ s Dictionary defines the term job satisfaction as, “The good feeling that you get when you have a job that you enjoy”. In other words a feeling of goodness is associated with an enjoyable job. Various researchers have defined the term. Hoppock’s early definition is “any combination of psychological, physiological and environmental circumstances that causes a person to truthfully say, ‘I am satisfied with my job’ ”.3 He has emphasized psychological, physiological, and environmental circumstances which lead a person to express satisfaction with their job. Schaffer’s interpretation of job satisfaction is one of individual’s needs fulfillment: “overall job satisfaction will vary directly with the extent to which those needs of an individual which can be satisfied: stronger the needs, the more closely will job satisfaction depends on its fulfillment”.4 Sergiovanni also supports the personal need fulfillment interpretation and draws attention to the evident link between Maslow’s (1954) theory of human motivation based upon a hierarchy of human needs and Herzberg’s (1968) motivation-hygiene theory.5 Lawler focuses on the expectations rather than needs: “overall job satisfaction is determined by the difference between all those things which a person feels he should receive from his job and all those things he actually dose receive”.6 However, Locke dismisses both need and expectation and favours values explaining that understanding job satisfaction is possible only through introspection, for him, “job satisfaction may be defined as a pleasurable or positive emotional state resulting from the appraisal of one’s job or job experiences”.7 He suggests that job satisfaction is a positive or pleasurable reaction resulting from the appraisal of one’s job, job achievement, or job experiences. Vroom defines job satisfaction as “affective orientation on the part of individual towards work roles they presently occupy”.8 Vroom focuses on the role of the employee in the workplace. Smith, Kendal, and Hulin define job satisfaction as “feelings or affective responses to facets of situations”.9 Churchill, Ford and Walker have defined the domain of job satisfaction as “all characteristics of the job itself and work environment which people find rewarding, fulfilling, and satisfying, or frustrating and unsatisfying”.10 Kalleberg identifies both job rewards and job values as determinants of job satisfaction, which he defines as “an overall orientation on the part of individuals towards work roles which they are presently occupying”.11 Similarly, Siegal and Lance states that job satisfaction is an emotional response defining the degree to which people like their job.12 Lofquist and Dawis define job satisfaction as “an individual’s positive affective reaction of the target a result of the individual’s appraisal of the extent to which his or her needs is fulfilled by the environment”.13 Spector feels that it has to do with the way people feel about their job. It is extent to which people like (satisfaction) or dislike (dissatisfaction) their job.14 Statt defines job satisfaction as the extent to which a worker is content with the rewards he or she gets out of his or her job, particularly in terms of intrinsic motivation.15 Armstrong refers to the attitude and feelings people have about their work. Positive and favorable attitudes towards the job indicate job satisfaction. Negative and unfavorable attitudes towards the job indicate job dissatisfaction.16 According to George and Jones job satisfaction is the collection of feeling and beliefs that people have about their current job. People’s levels of degrees of job satisfaction can range from extreme satisfaction to extreme dissatisfaction. People also can have attitudes about various aspects of their jobs such as the kind of work they do, their co-workers, supervisors or subordinates and their pay.17 Some of the other versions of definition use the terms ‘work satisfaction’, ‘job attitudes’, ‘job morale’ etc., interchangeably which proves lack of a standardized job satisfaction definition.


Job satisfaction is understood as a uni-dimensional construct i.e. one was either satisfied or dissatisfied with one’s job.18 Some view job satisfaction and dissatisfaction on two different dimensions. According to them, one may be satisfied or not satisfied with one’s job on the other hand is dissatisfied or not dissatisfied with the job. They attributed job satisfaction and dissatisfaction to different sets of factors known as motivation or hygiene factors respectively.19 However, there are three important dimensions to job satisfaction:

- Job satisfaction is an emotional response to a job situation. As such it cannot be seen, it can only be inferred.
- Job satisfaction is often determined by how well outcome meets or exceeds expectations. For instance, if employees feel that they are working much harder than others in the department but are receiving fewer rewards they will probably have a negative attitudes towards the work, the boss and or co- workers. On the other hand, if they feel they are being treated very well and are being paid equitably, they are likely to have positive attitude towards the job.
- Job satisfaction represents several related attitudes which are most important characteristics of a job about which people have effective response. These are: the work itself, pay, promotion opportunities, supervision and co-workers.20

Some argue that job is multidimensional i.e. one may be satisfied with one’s job, one’s pay, one’s workplace etc. As of today job satisfaction is generally recognized as a multifaceted construct that includes variety of both intrinsic and extrinsic job elements.21 It emerges from above discussion that earlier job satisfaction was understood as a uni-dimensional construct whereas according to recent studies on job satisfaction it is understood as multi-dimensional construct dependent on different set of factors.


The employer should be concerned with the level of job satisfaction in an organization for various reasons viz. job satisfaction is normally linked with a low level of job complaints and work grievances. It is known that satisfied employees are less likely to resort to damage and reactive behaviour. One of the most disregarded aspects of job satisfaction is its relationship with employee’s well-being. A number of studies have revealed those workforces who are satisfied with their jobs are less prone to health hazards. High job satisfaction may lead to improved productivity, less absenteeism, lower turnover ratio, reduce accident, less job stress and less unionization. Job dissatisfaction produces low morale among workers which is highly undesirable. Significance of job satisfaction may be understood in respect of the following factors:

1.3.1 Productivity

It is understood that there has been a debate over number of years over the relation between satisfaction and productivity. Although, majority of people believe that there is a positive relationship between the two, however, it is not so. According to the research findings the correlation between satisfaction and performance is only 0.14.22 There is more evidence to suggest that job performance leads to job satisfaction and not the other way round.23 If people receive rewards that have both intrinsic and extrinsic value, they will be satisfied and it would result in greater job performance.

1.3.2 Absenteeism

It seems quite natural that employees’ absence from work would be one reaction to a high level of job dissatisfaction. Empirical research has provided only a weak support for the relation between job satisfaction and absenteeism. A meta- analysis of 31 studies found the correlation between job satisfaction and absenteeism to be only 0.09. Researchers offer a number of explanation for this weak relation. One such reason is the measurement of absenteeism, since it is a complex task to measure absenteeism. Second reason is that job satisfaction represents a general attitude, whereas absenteeism is a specific form of behavior. According to them, job satisfaction may play some role in employee absence, but that role is marginal.24

1.3.3 Employee Turnover

Individuals who are satisfied with their jobs are less likely to leave the organization than those who are dissatisfied.25 Another issue which might expect to be related with job satisfaction is whether people will remain with the current employer. Analysis suggests fairly low average correlation between overall job satisfaction and employee turnover which was 0.23 and 0.16 respectively. This weak correlation may be due to various factors which may influence turnover decisions includes the availability of suitable alternative employment, job satisfaction better predicts actual turnover when local employment is lower.26 However, job satisfaction obtained a moderate negative relationship with employee turnover in other similar studies.27

1.3.4 Union Activities

Satisfied employees are generally not interested in unions. Job dissatisfaction has proved major cause of unionization.28 The workers join union for the reason that alone they are not capable to make a change which would remove the cause of job dissatisfaction. Job satisfaction without unionism would be very unrealistic. This means if the organizational climate, personnel policies and policies of management seems dissatisfying most workers tend to look up at union officials to settle their grievances.29

1.3.5 Safety

Job satisfaction is associated with perception of risk. In hazardous work environment, greater perceived risk is associated with low job satisfaction. This would imply that job satisfaction is linked to safe working while job dissatisfaction is linked with lower job performance and increased accident.30 This means when employees are dissatisfied with their jobs, they are more likely to meet with accidents.

A basic reason for this is that dissatisfaction sidetracks an individual’s attention from the job in hand and leads directly to accidents. A satisfied worker will always be careful and attentive towards his job, and chances of accidents will be less.

1.3.6 Other Effects of Job Satisfaction

In addition there are a number of other effects brought about by high job satisfaction. Highly satisfied employees are likely to have more positive outlook, have better physical and mental well-being, learn new task easily, have less stress and instability.


Job satisfaction can be determined through factors that describe the relationship between employees and organization. Organizational characteristics refer to factors that are perceived to assist or hinder employees in performing their duties.31 Various researchers have contributed significantly through their research findings on factors affecting job satisfaction and have given various suggestions to boost up the employee’s job satisfaction. Some of these factors are discussed in brief in the following section:

1.4.1 Pay

Wages and salaries play an important role in influencing job satisfaction. This is because of a few basic reasons. Firstly, money plays an important role in fulfilling one’s needs. Secondly, employees often see money as reflection of management’s concern for them. Thirdly, it is considered as a symbol of achievement and source of recognition. Financial rewards to have a significant impact on job satisfaction. Pay is associated with global satisfaction and even more closely with the facet of pay satisfaction. Money is important to individuals, research has shown that individuals who earn more are not necessarily more satisfied in their jobs.32 On the other hand, a researcher argues that a lack of empirical evidence exists to indicate that pay alone improves worker satisfaction or reduces dissatisfaction.33 The author examines that highly paid employees may still be dissatisfied if they do not like the nature of job or cannot enter a more satisfying job. Thus, it is not sure that pay alone can be a factor causing job satisfaction or dissatisfaction.

1.4.2 Promotion

Promotion involves placement of an employee to a position having higher pay, increased responsibilities, more privileges, increased benefits and greater opportunities. Promotion chances considerably affect the job satisfaction because it indicates an employee’s worth to the organization as well as employees takes promotion as ultimate achievement in their career. Thus, in other words, promotion means advancement of an employee to a higher post with greater responsibilities and high salary, better service conditions and thus higher status. Promotion enhances the yield of an organization when an employee climbs a promotion ladder on the basis of his seniority and resultantly he gets an increased wage rate.34 However, promotion is not considered to be an incentive device, thus the optimal results cannot be generated by promoting the employee in the organization.35 Dissatisfaction with promotion and training opportunities has a stronger impact on job satisfaction than workload or pay.36 They conclude that improving pay would have had limited success without better opportunities. Absence of such prospects makes the employees dissatisfied and frustrated. On the other hand, if employees perceive that there are fair chances of promotion in the organization, same will be reflected in increased quality of output, less wastage, lower absenteeism and turnover of employees.

1.4.3 Supervision

Supervisor is a front-line manager who is responsible for the supervision of employees.37 Supervision is a moderately important source of job satisfaction. Whenever the supervisor is responsive, sympathetic and takes personal interest in employee’s welfare there will be job satisfaction. The supervisors, who allow their subordinates to participate in decisions that affect their own jobs, help in creating an environment which is highly favorable to job satisfaction. However, such situation decreases job satisfaction, where supervisors emphasis more on the job performance and people become less important. Workers are generally more satisfied with their jobs when they are more satisfied with their supervision and liked their supervision better when it matched their preferred style.38 Research appears to be unclear since most research indicates that employees are likely to have high levels of job satisfaction if supervisors provide them with support and co-operation. On the other hand, supervisors who allow their employees to participate in decisions making stimulate higher levels of employee satisfaction.

1.4.4 Fringe Benefits

Fringe benefit include benefits like free life or health insurance, paid holidays, a pension, etc., and is often received by an employee in addition to his/her regular pay. Fringe benefits can be divided into monetary and non-monetary benefits. The impact of fringe benefits on job satisfaction have been examined less frequently, although available research strongly suggests that a positive relationship exists.39 The employer provides several benefits and services to the employees working in the organization to maintain and promote the employees’ favorable attitude towards the work and work environment which is essential in maintaining high motivation and morale. Increasing intrinsic and extrinsic fringe benefits that attract an employee’s attention may subsequently increase their performance and induce higher levels of satisfaction.40

1.4.5 Contingent Rewards

Contingent rewards are appreciation, recognition and rewards for good work. Employee dissatisfaction may result if an employee perceives that their efforts are not recognized or that their rewards are not equitable tied to their performance or tailored to their needs. Contingent rewards support the reinforcement theory of motivation in terms of which performance-relevant behaviours will increase in frequency if rewarded.41 Lack of proper recognition for a job well done by an employee seems to be a major problem for many organizations. For example, employees who experience little recognition are more likely to experience dissatisfaction and frustration.42

1.4.6 Operating Conditions

Good working conditions are sought-after by the employees, as they lead to more material comforts. Employees wish for clean and healthy working environment. Temperature, humidity, ventilation, lighting and noise, cleanliness of work place and adequate tools and equipment affect job satisfaction. However, desirable operating conditions may not contribute heavily towards job satisfaction whereas poor working conditions do become source of job dissatisfaction. If people work in a hygienic, friendly environment they will find it easier to come to work. If the opposite happen, they will find it difficult to accomplish tasks.43

1.4.7 Co-workers

A friendly and cooperative group provides opportunities to the group members to interact with each other. It serves as a source of support and comfort to the individual group members. If on the other hand people are difficult to get along with, the work group will have a negative impact on job satisfaction. An employee would be dissatisfied from his job if he/she is repeatedly exposed to negative statements from the co-worker about their lack of decision making authority. On the other hand, if employee’s co-worker talks positively then opposite happens i.e. greater satisfaction.44 An employee would feel stronger job satisfaction when their co-workers share similar attitude and values. The factor of relationship with co-workers reflects the extent to which members of an individual's workgroup are perceived to be socially supportive and competent in their own tasks.45

1.4.8 Nature of Work

The job condition itself plays a major role in determining the level of job satisfaction. The most important situational influence on job satisfaction is the nature of the work itself—often termed as “intrinsic job characteristics.” Various research studies across many organizations and types of jobs show that when employees are asked to evaluate different facets of their job such as pay, supervision, promotion opportunities, co-workers, and so forth, the nature of the work itself by and large appears as the most important job facet. Of all the major job satisfaction areas, satisfaction with the nature of the work it-self—which includes autonomy, job challenge, variety and scope—best predicts overall job satisfaction, in addition to other important outcomes like employee retention. Also, it is not to state that well- planned compensation programs or effective supervision are unimportant; rather, much can be done to influence job satisfaction by ensuring work is as interesting and challenging as possible.46 Thus, in order to rightly comprehend what causes people to be satisfied with their jobs, the nature of the work itself is on the top for researchers to focus on.

1.4.9 Communication

Communication is defined as exchanging of thought or information between two or more persons to bring about mutual understanding. Modus operandi used for communication includes newspaper, telephones, magazines, meetings conferences and seminars, fax, email and internet etc. There are two types of communication formal and informal channel of communication. Formal channel consist of a vertical track and a horizontal track of communication. The vertical track runs in two directions, upward and downward communication between top of organization structure and bottom. The horizontal track carries communication across the organizational structure between departments and individual on about same level.47 Communication load is also important variable in assessing the degree of adequacy of information exchange. Communication underload takes place when people think they need or could use more information. Whereas, communication overload happens when people have more information than they can possibly process. Further, the most common complaint in organization is that employees do not get enough communication from underload to overload.48 However, studies show a positive relationship between communication and employee job satisfaction.49


When considering job satisfaction, demographic variables should also be considered to thoroughly understand the possible factors that lead to job satisfaction and dissatisfaction.

1.5.1 Age

With growing age, people become more mature and realistic. The relationship between age and job satisfaction is a complex phenomenon. The relationship between job satisfaction and age has been studied extensively over last forty year. Regardless of number of studies a general consensus regarding the relationship between age and job satisfaction has yet to be reached. Numerous studies show consistent linear relationship.50 Others studies argue that age and job satisfaction may not be related in simple linear fashion.51 According to these researchers, job satisfaction may decline as the newness of the work diminishes and employees become bored with their work. Over the past two decades the notion of a U shaped relationship between age and job satisfaction has gained importance and has received empirical support.52

1.5.2 Education

Many studies have concerned themselves with the relationship between education and job satisfaction. Except for few studies which show positive relationship and the other which show negative relationship, most studies show no relationship between job satisfaction and education. Further, the more educated persons would be more frustrated he/she will be in their routine jobs.53

1.5.3 Income

Various studies find a significant positive correlation between emoluments and job satisfaction. Whereas, other studies conclude that none of the commonly studied background variables like income level show any correlation with expressed job satisfaction.54

1.5.4 Experience

During the initial stage of employment, new workers tend to be satisfied with their jobs. This period involves developing skills and capabilities. The work may seem attractive just because it is new. Early satisfaction decreases if employees do not receive feedback on their progress and tangible evidence of their achievements. After spending a few years on job, dissatisfaction begins which is often being brought on by the feeling that advancement in the organization is too slow. Job satisfaction appears to increase after a number of years of experience and improve gradually thereafter. The relationship between job satisfaction and length of work experience parallels the relationship with age.55

1.5.5 Gender

Studies on gender difference in job satisfaction find mixed results. Some studies examine that women in predominantly male workplace are less satisfied with their jobs compared to men. Studies even examined job satisfaction for women and men in gender similar vs. gender diverse organization have found mixed results. Other studies find no gender differences or higher level of job satisfaction in women compared to men.56

1.5.6 Occupation Level

Higher the occupational or status level of a job, higher the job satisfaction. Executives express more positive job attitude and feelings than first line supervisors, who in turn are usually satisfied than their subordinates are. The higher the job level the greater the opportunity for satisfying motivators needs. Also, high level job offers greater autonomy, challenge and responsibility. Job satisfaction varies with job category. High job satisfaction is more likely to be reported by entrepreneurs (self- employed persons) and by the people in technical, professional and managerial jobs. The least satisfied employees work in manufacturing and service industries.57


Stress is a multi-dimensional concept. It is derived from the Latin word, ‘stringere’ which means—to draw tight, and was first used in the seventeenth century to describe affliction and hardship.58 Stress can be of two types: ‘eustress’ (good stress) and ‘distress’(bad stress). Eustress motivates individuals to strive for more. Eustress can be associated with the feeling of boosted energy and feeling more awake and alert. Distress occurs when an individual experiences/faces uncomfortable situation in which an individual does not have the proper coping mechanism to manage them.59 Stress affects both ways psychologically as well as physiologically. Stress-related disorders includes psychological disorders or those related with thinking (e.g., depression, anxiety, dissatisfaction, getting angry, tension, memory problem, poor decision making etc.). Stress can undermine the achievement of goals, both for individuals and for organizations (Figure 1.1).

Figure 1.1: The Problem of Stress

illustration not visible in this excerpt

Source: S. Michie, 68.

Stress can also affect individual behaviour especially, one may indulge in taking drugs (alcohol, tabacoo) or may suffer from change in sleeping pattern, social behaviour etc. Other physical symptoms include (e.g. sweating, pains, palpitations, nausea, headaches etc.) (Figure 1.2). It is evident from figure 1.1 and 1.2, that individuals react differently in experiencing stress and becomes helpless to the adverse effects of stress.

Figure 1.2: Signs of Stress

illustration not visible in this excerpt

Source: S. Michie, 68.

Individuals will experience more stress if they lack material resources (e.g. financial security) and psychological resources (e.g. self-esteem, coping skills) and are more likely to be harmed by this stress if they tend to react emotionally to situations.

1.6.1 Factors Causing Job Stress

The place of work plays a significant role in causing stress which originates due to overwhelming job demand and job pressures. There are various sources of stress at work that have been found to be associated with stress and other health hazard risks. These sources can be categorized as those related with social and organizational context and those related with the work content (Figure 1.3). Source of stress which are intrinsic to the job include poor physical work conditions (for example, space, temperature, light), long hours, work overload, time pressure, difficult or complex tasks. Others are related to roles in the organization (viz. unclear

Figure 1.3: A Model of Stress at Work

Sources of stress at work

illustration not visible in this excerpt

work or conflicting roles and boundaries, responsibility for people). The possibility for career development is an important stress buffer which includes (e.g. over promotion, under promotion, lack of training, and job insecurity).

There are two other sources of job stress: organizational structure and climate and relationships at work. Managers who demands, critical, unsupportive or bullying create stress, whereas good team work and a positive social dimension of work reduces it. A culture of providing good amenities and recreation facilities, involving people in decisions and keeping them informed about what is happening in the organization reduces stress.

On the other hand, organizational changes like relocation, mergers, restructuring or downsizing, individual contracts, etc., is a huge source of stress. Even more, the job demands on the individual in the place of work get to the homes and social lives of employees. Long working hours, working away from home, high levels of responsibility, taking work home, job insecurity, and job relocation—all may badly affect leisure activities and family responsibilities. These probably, damage a good and relaxing quality of life outside work, which is important against the stress caused by work.

Several studies have tried to determine the link between stress and job satisfaction. Many researchers think that physiological stress, psychological stress, and job satisfaction are distinct, but highly interrelated constructs. For example, the ability of employees to properly control and manage their physiological and psychological stresses in performing job may lead to higher job satisfaction in organizations. Organization factors such as workload and working condition have been negatively related with job satisfaction. High levels of work stress are associated with low levels of job satisfaction.60

The techniques listed in Figure 1.4 are techniques for managing stress viz. the active coping (fight/flight) and rest phases (habituation). Although, it is true that stress can affect the physical and mental well-being of an individual and also plays an important role in causing job dissatisfaction yet it can be reduced through proper training and management.

Figure 1.4: Techniques for Managing Stress

illustration not visible in this excerpt

Source: S. Michie, 70.


The World Health Organization (WHO) defines the health workforce as “all people engaged in actions whose primary intent is to enhance health”.61 Human resource pertaining to healthcare can be defined as the various kinds of medical and para-medical staff responsible for individual and public health intervention. This includes both public and private sectors and different areas of health systems, such as curative, preventive care, personal and non-personal public health interventions, disease prevention, health promotion services, research, management and support services (Figure 1.5).


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Job Satisfaction among Healthcare Employees in Public and Private Sector Hospitals in Punjab
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Dr. Akshay Rana (Author), 2014, Job Satisfaction among Healthcare Employees in Public and Private Sector Hospitals in Punjab, Munich, GRIN Verlag,


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