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Original Article

Job satisfaction among hospital staff working

in a Government teaching hospital of India
Poonam Jaiswal, A. K. Gadpayle1, Ashok K. Singhal, Sandeep Sachdeva2, Rajesh Kumar Modi3,
RabindraPadaria4, V. Ravi5
Departments of Hospital Administration, 1Medicine and 2Community Medicine, PGIMER, Dr. RML Hospital, 3Department of Medicine,
Dr. RML Hospital, 4Indian Agricultural Research Institute, 5Lady Shri Ram College, New Delhi

ABSTRACT
Background: In a resource-limited and high burden disease
setting, satisfied human resource is an asset in terms of high
productivity, efficiency and quality care. Aim: To assess
job satisfaction among permanent employees working in a
government hospital. Materials and Methods: A sample
of 200 staff members was interviewed using 34-item,
Likert response based, modified job satisfaction scale. Key
factors for job satisfaction were identified after subjecting
data to principal component analysis, varimax rotation and
multivariate analysis using step-wise regression procedure.
Results: The mean job satisfaction index was computed
to be in a similar range, but was found to be highest for
nurses (0.68), followed by doctors (0.66), support staff
(0.63) and technicians (0.62). Nine uncorrelated and critical
factors related to job satisfaction that explained 68.09% of
the variability was identified, that is, communication, pay/
salary, working conditions, organization supervision system,
co-workers, workload, benefits, career aspects and rewards.
A positive association was reported between job satisfaction
score and factor scores (units) of communication (0.133),
benefits (0.110), working condition (0.027) and coworkers (0.032) and a negative relation with organizational
supervision system (0.118), workload (0.093), rewards
(0.035), pay/salary (0.034) and career prospects (0.017)
respectively for all categories of respondents. However in
case of doctors, co-workers (0.023 units) showed a negative
relation. Conclusion: There is scope for interventions
to enhance job satisfaction and concomitant continuous
monitoring can be useful in determining various service
aspects that necessitate improvement. By enhancing job
satisfaction, hospital administrator can improve not only the
mental, psychological and social well-being of work-force,
but also the financial health of an organization.
Keywords: Benefits, communication, environment, factor
analysis, human relation, organization, public, rewards, salary,
supervision, work

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DOI:
10.4103/0975-2870.153136

Introduction
Healthcare system is a labor intensive sector. Over the
years, it has undergone a dramatic change as a result of razor
edge competition, technological advancement, knowledge
transfer, escalating cost and concomitant demand for
better-patient care services. Job satisfaction is one of the
most important determining factors of enhanced efficiency,
productivity and also quality of work within an organization.
The phenomenon of job satisfaction has been inversely
associated with absenteeism, stress, exhaustion, and increase
turnover.[1,2] Dissatisfaction affects patient rated quality of
care and is strongly related to early retirement and cutback
of working hours.[3,4] Studies on this subject matter remain
scanty in the Indian settings where shortage of health
manpower and high burden of disease are prevalent. With
this back ground, a cross-sectional study was undertaken
to assess job satisfaction amongst permanent employees
working in government teaching hospital of north India.

Materials and Methods

Study setting
The study was conducted in Ram Manohar Lohia (RML)
Hospital, New Delhi. RML was originally named Willingdon
hospital and established by the British government in

Address for correspondence:

Dr. Poonam Jaiswal, Department of Hospital Administration, PGIMER, Dr. RML Hospital, New Delhi.
E-mail: pjrmlh@gmail.com
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Jaiswal, et al.: Job satisfaction amongst hospital staff

the heart of New Delhi during 1932. The hospital was

administratively taken over by Government of India in
1954 and with continuous expansion/growth over the
years; Post-Graduate Institute of Medical Education and
Research started functioning from the year 2008. Currently,
hospital caters to an average daily outpatient department
attendance of 5000 patients with an annual admission of
60,000 supported by 1065 patient beds and managed by
2270 permanent government employees (doctors-192,
nurses-1025, technician-376, and support staff-677) in
addition to residents and contractual employees.

excluding residents/temporary/contract/daily wagers

employed by this hospital. Respondents were contacted
(February-April 2011) after taking informed verbal consent
in a nonjudgmental manner by a single researcher. Ethical
clearance was obtained from Institutional Review Board.
Study instrument
Study instrument consisted of two broad parts:
Part-A (socio-personal profile of respondents) and
Part-B (Job Satisfaction Scale).
For operational purpose, job satisfaction scale developed
by Spector[5] containing 36-item was adapted to measure
job satisfaction in the present study. Pretesting was done
on eight subjects not included in the study with the aim to
check its clarity, comprehension and flow. The final data
collection tool was slightly modified that comprised of
34-item [Table 1]. The reliability of the tool was checked

Data collection
Considering operational feasibility, a total of 200 staff
members, 50 in each category, that is, doctors, nurses,
technicians, and support staff were covered using systematic
random sampling from the universe. Only permanent
government employees were included in the study thus
Table 1: Study instrument (job satisfaction scale)
Statement
I feel I am being paid a fair amount for the work I do
There is really too little chance for promotion on my job
My supervisor is quite competent in doing his/her job
I am not satisfied with the benefits I receive
When I do a good job, I receive the recognition for it that I should receive
Many of our rules and procedures make doing a good job difficult
I like the people I work with
I sometimes feel my job is meaningless
Communications seem good within this organization
My supervisor is unfair to me
The benefits we receive are as good as most other organizations offer
I do not feel that the work I do is appreciated
My efforts to do a good job are seldom blocked by red tape
I find I have to work harder at my job because of the incompetence of people I work with
I like doing the things I do at work
The goals of this organization are not clear to me
I feel unappreciated by the organization when I think about what they pay me
People get ahead as fast here as they do in other places
My supervisor shows too little interest in the feelings of subordinates
The benefit package we have is equitable
There are few rewards for those who work here
I have too much to do at work
I enjoy working with my coworkers
I often feel that I do not know what is going on with the organization
I feel a sense of pride in doing my job
I feel satisfied with my chances for salary increases
There are benefits we do not have which we should have
I like my supervisor
I have too much paperwork
I dont feel my efforts are rewarded the way they should be
I am satisfied with my chances for promotion
There is too much bickering and fighting at work
My job is enjoyable
Work assignments are not fully explained

132

Strongly agree

Agree

Undecided

Disagree

Strongly disagree

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Jaiswal, et al.: Job satisfaction amongst hospital staff

and found acceptable using Cronbachs alfa test (0.85).

Content validation was done using jurys opinion method.[6]
Data management and statistical analysis
A summated rating scale format was used with a 5-point
continuum of Strongly Disagree, Disagree, Undecided, Agree
and Strongly Agree responses with respective weightage of
1, 2, 3, 4 and 5 points. As the items had been written in both
positive and negative directions, scoring was reversed for the
negative items in order to provide uniformity in statistical
calculations. Hence, from the perspective of data analysis, a
higher choice for each of the 34-item indicated a very good
job satisfaction score. Data management was undertaken
using Statistical Package for Social Sciences (SPSS) version
15.0 (Chicago, IL) to calculate descriptive statistics.
Exploratory factor analysis using principal component
technique with varimax rotation and multivariate analysis
using stepwise regression procedure was applied for the
analysis. Job satisfaction index for each respondent was
worked out with the formula mentioned below and were
classified into five groups according to the level of job
satisfaction. The class intervals were generated with the
ratio of the difference between the maximum and minimum
obtained score and the number of the class interval.

A higher score indicated greater job satisfaction.

Factor analysis
The data were summarized in terms of frequency
distributions. However, in the absence of any consensus
among the responses and also considering the large number
of variables in the present study, factor analysis was used.
This technique aided in reducing 34 possibly correlated
variables into 9 uncorrelated and critical factors-related to
job satisfaction. Principal component and varimax analysis
were used as an extraction and rotation method respectively.
The results of factor analysis may be interpreted as follows:
The Kaiser-Meyer-Olkin (KMO) measure of sampling
adequacy test indicates the degree to which the variables
are related, which is helpful in evaluating if using a factor
analysis makes sense.[7] The success of factor analysis also
depends on significant correlations between variables. In this
context, Bartletts test for sphericity was highly significant
indicating that random sample comes from a universe where
many variables are correlated.
Once the adequacy of factor analysis is established, the
next step is to identify the amount of information in every
Medical Journal of Dr. D.Y. Patil University | March-April 2015 | Vol 8 | Issue 2

variable that is retained by the technique. Ideally, we

would want the information retained to be 100%. However,
there is always a certain amount of loss in the information.
Criteria of retaining factors with an Eigen value of 1.0 or
more had been used in the present study (Guttman-Kaiser
rule). Varimax rotation was used since it alters the pattern
of the factor loadings and hence improves interpretation.
All the variables with factor loading of 0.60 and above are
considered as significant under each factor.[8] All those
variables, in each rotated factor that have high loading,
are considered to be closely related variables. After careful
examination of these variables in each factor, an attempt
was made to identify commonness and delineate some kind
of a hypothetical construct. On the basis of this analysis,
appropriate domain was identified to label the clustering
variables. While labeling the factors adequate care was taken
in terms of loading of items as well as their signs.

Results
Socio-personal profile of respondents
The average age (years) of respondents was: Doctors (48.68;
8.53), nurses (40.72; 7.76), technicians (38.4; 10.65) and
support staff (43.24; 9.52). The gender ratio was extremely
skewed in favor of males in the case of technicians (90:10)
and support staff (88:12) while it was relatively less skewed
in favor of male (58:42) in case of doctors. However, nurse
category with reversely skewed sex ratio showed female
preponderance (2:98). Nearly 80% of the doctors were
post-graduate, 96% of nurses had general nursing midwifery
qualification; nearly 50% of technicians were graduate, and
52% of support staff had education of at least 10th standard.
The average work experience (years) was: Doctors 19.09
(9.77), nurses 17.2 (8.420), technicians 14.84 (10.45) and
support staff 14.84 (10.45). The staff in each category did
not differ significantly on above parameters except gender.
Level of job satisfaction
The mean job satisfaction index was computed to be highest
for nurse (0.68) followed by doctor (0.66), support staff
(0.63) and technician (0.62). Level of job satisfaction index
is shown in Table 2. It was noted that higher proportion of
nurses were satisfied in comparison to other staff.
Determinant of job satisfaction
The job satisfaction data of respondents produced a KMO
value of 0.847 which is meritorious and confirms that factor
analysis is indeed a good procedure to use for data reduction.
Nine factors were extracted from the correlation matrix
accounting for 68.09% [Table 3] after subjecting data to
principal component analysis and varimax rotation.
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Jaiswal, et al.: Job satisfaction amongst hospital staff

Table 2: Distribution of health staff (n = 200) according to level of job satisfaction

Level of job satisfaction
Highly satisfied (0.75-0.84)
Satisfied (0.66-0.74)
Somewhat satisfied (0.57-0.65)
Dissatisfied (0.48-0.56)
Highly dissatisfied (0.39-0.47)

Doctor (n = 50) (%)

14 (28)
11 (22)
12 (24)
07 (14)
06 (12)

Nurse (n = 50) (%)

08 (16)
26 (52)
14 (28)
02 (4)
0 (0)

Technician (n = 50) (%)

01 (2)
13 (26)
26 (52)
06 (12)
04 (8)

Supportstaff (n = 50) (%)

03 (6)
18 (36)
26 (52)
03 (6)
0 (0)

Total n (%)
26 (13)
68 (34)
78 (39)
18 (9)
10 (5)

Table 3: Eigen values, percentage of variance accounted by critical nine factors

Component
1
2
3
4
5
6
7
8
9

Total
6.441
3.853
2.723
2.324
2.044
1.793
1.496
1.337
1.142

Initial eigen values

Percentage of variance
18.944
11.333
8.009
6.834
6.013
5.273
4.401
3.933
3.358

Cumulative %
18.944
30.278
38.287
45.121
51.134
56.407
60.808
64.740
68.099

Total
4.315
3.458
2.957
2.577
2.449
2.148
1.993
1.787
1.470

Rotation sums of squared loadings

Percentage of variance
Cumulative %
12.693
12.693
10.171
22.864
8.697
31.560
7.579
39.139
7.202
46.341
6.317
52.658
5.861
58.519
5.256
63.775
4.324
68.099

Extraction method: Principal component analysis

A graphic presentation of the Eigen roots obtained at

successive factor extraction is shown in Figure 1. Scree-plot
is one of the criteria for deciding the number of factors to be
retained for analysis and preserve all factors falling before
break-point or elbow. The Eigen values, percentage of
variance accounted for by nine factors and the cumulative
percentage are presented in Table 3. Due to space constraint
and less significance, rest of the factors is not indicated in
the table.
It is evident from Table 2 that out of 34-item, 9-item
explained maximum proportion of variability (68.09%). The
interpretation of the rotated items was achieved by selecting
only those items which had a significant factor loading, that
is, 0.6. The concepts conveyed by these items were used
to define the factor. Rotation converged in 14 iterations.
Table 4 gives a comprehensive summary of factor analysis
undertaken on 34-item statements.
In decreasing order, the factors that respondent strongly
felt (in terms of percentage mean score) were identified
as follows: Highest proportion (75.6%) showed that
respondents felt that good co-workers lead to higher job
satisfaction. Even though the working environment as well
as pay packages appears to be good, there exists quite a few
lacunae as far as benefits; supervisory roles and management
is concerned. In order to assess the impact of each factor
and its corresponding interaction with job satisfaction
score, multivariate analysis using stepwise regression
procedure was performed. The best model arrived in 14
134

Figure 1: Scree-plot showing Eigen value and factor

iterations had an R2 = 0.938 (P < 0.001). This implied that

93.8% variation in job satisfaction score was explained by
the variables in the regression equation. The significant
explanatory variables are given in Table 5. It was observed
that job satisfaction score increased by 0.133, 0.110, 0.027
and 0.032 units respectively with a unit increase in factor
score of communication, benefits, working condition and
co-workers.
Similarly, a unit increase in the organizational supervision
system, workload, rewards, pay/salary and career prospects
decreased job satisfaction score by 0.118, 0.093, 0.035, 0.034
and 0.017 units respectively. The significance of interactive
effects of variables and designation highlighted the fact that
above-mentioned units of increase/decrease are not the
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Jaiswal, et al.: Job satisfaction amongst hospital staff

Table 4: Share of data variability and factor loading contributed by key nine factors
Factor
I

II

III

IV

V
VI
VII
VIII
IX

Statement
number
9
16
24
34
1
17
26
6
12
14
3
10
19
7
23
22
29
20
27
2
18
21

Factor
loading
0.955
0.860
0.716
0.773
0.724
0.800
0.881
0.688
0.727
0.618
0.622
0.828
0.708
0.634
0.649
0.620
0.809
0.785
0.695
0.770
0.883
0.811

Concept

Percentage of
explained variance %
12.69

Cronbach

0.8821

Mean
score
11.76

Total maximum
score
20

Percentage of
mean score
58.8

Pay/salary

10.17

0.6657

9.41

15

62.7

Working
condition

8.69

0.7357

8.72

15

58.1

Organizational
supervision
system

7.58

0.6408

8.46

15

56.4

Co-workers

7.20

0.7319

7.56

10

75.6

Workload

6.32

0.8658

6.37

10

63.7

Benefits

5.86

0.9206

5.15

10

51.5

Career
prospects

5.26

0.6046

6.88

10

68.8

Rewards

4.33

3.73

74.6

Communication

Table 5: Impact of each factor on job satisfaction

Model

Constant
Communication
Organizational supervision system
Workload
Benefits
Rewards
Working condition
Pay/salary
Co-workers*Doctor
Co-workers
Career prospects
Rewards*technician
Rewards*support staff
Support staff
Technician

Un-standardized
coefficient
B
SE
3.235 0.007
0.133 0.005
0.118 0.005
0.093 0.005
0.110 0.005
0.035 0.007
0.027 0.005
0.034 0.005
0.055 0.013
0.032 0.008
0.017 0.005
0.051 0.012
0.050 0.012
0.054 0.013
0.054 0.013

P value

457.369
24.935
23.018
19.887
20.485
5.171
5.821
6.472
4.348
3.903
3.551
4.214
4.148
4.208
4.182

<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001

dependent variable: job satisfaction. SE: Standard error

same for every designation. While co-workers showed a

positive relation with the job satisfaction score for nurses,
technicians and support staff, it had an inverse relation in
case of doctors. This inverse relation showed a decrease of
0.023 units in job satisfaction score with a unit increase in
co-workers score. Inverse relation was also noted between
rewards and job satisfaction score. This inverse relation
became even more acute for technicians and support staff
when compared to doctors and nurses that is, for technicians
Medical Journal of Dr. D.Y. Patil University | March-April 2015 | Vol 8 | Issue 2

and support staff, a unit increase in the rewards score

decreased the job satisfaction score by 0.086 times while for a
nurse/doctor it was 0.035 times only. Overall, job satisfaction
score for doctors and nurses was 3.235 but was significantly
lower at 3.181 for technicians and support staff.

Discussion
Our study showed highest job satisfaction (mean score) for
nurses followed by doctors, support staff and technicians.
Proportion of job satisfaction rate was also highest (68%)
among nurses [Table 1]. A plausible explanation for
this finding among the nurses might be that the nature
of the job and working environment in government of
India funded public hospitals is perceived to be good.
The other explaining factors might be very good salary
(proportionate to working hours) in comparison to their
colleagues working in the private sector; favorable and
safe working condition; flexible assignments; flexible duty
hours; good collaboration between occupational groups;
leave provision like maternity leave, child care leave and
compensatory leave, etc. Higher job satisfaction amongst
nurses when compared to doctors was also reported at
Nicosia General Hospital (Cyprus). [9] The reasons for
technicians being the least satisfied in our study could be
wide variation of educational qualification among them,
improper recruitment policy, improper deployment, very
few career growth opportunities, lesser option for trainings,
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Jaiswal, et al.: Job satisfaction amongst hospital staff

etc. The access to capacity building program was highly

limited which restricted their career advancement.
Our study found that the proportion of doctors satisfied with
their job was only 50% [Table 1] that is comparable to the
findings even among Norwegian doctors[10] and Japanese
physician;[11] both studies found the same satisfaction rate
of 50%. However, higher job satisfaction among physicians
was noticed in Switzerland (77%) and Canada (75%).[12,13]
Some Indian studies reported higher proportion (70%)
of satisfaction among physicians working at tertiary care
institute in Delhi, India.[14] Another study also found same
satisfaction rate amongst physicians working at Employee
State Insurance hospital. [15] About two-thirds of the
physicians were satisfied with their job was also reported by
another Indian study conducted at Chandigarh.[16]
But dissatisfaction rate of 50% (including 24% somewhat
satisfied) among doctors in this public sector hospital needs
to be examined from a diverse perspective. The explaining
factors for dissatisfaction could be many like existence
of multiple cadres, underutilization of technical skills of
doctors (especially general duty medical officer cadre having
post-graduate qualification, but not posted in their respective
departments), lack of autonomy regarding decision about
patient treatment, limited opportunities, in-commensurate
remuneration (by the presence of comparison effects in the
job satisfaction function whereby some characteristics of the
respondents job are compared with the job characteristics
of some reference groups or with the respondents own
expectation about their jobs). Job dissatisfaction among
doctors may also be a reflection of the changing role of
doctors in evolving society.
Nine critical factors of job satisfaction were derived from
factor analysis that is comparable to numerous studies in
different parts of the world. For assessing the impact of these
factors on job satisfaction stepwise regression procedure was
performed, and 93.8% variation in the job satisfaction score
was explained by the variables in the regression equation.
It was found that dependent variable job satisfaction had a
positive relation with independent variables communication,
benefits, working conditions and co-workers for all
categories except doctors in which co-workers showed a
negative correlation. Negative correlation was noted with
independent variables, organizational supervision system,
workload, rewards, pay/salary and career prospects. While
there is a growing body of research that supports positive
and negative association between dependent and some
independent variables, it was hard to find any references
(beyond our work) on the negative effects of some
independent variable like pay, rewards and career on job
136

satisfaction. Other advantage of our study over other is that

we have found not only established positive and negative
relations between variables, but also established the extent of
change in job satisfaction with respect to change in factors.
There are a number of plausible explanations for these
negative correlation findings. The negative correlation
between pay and job satisfaction found in our study could be
explained on the basis of equity discrepancy or relative
deprivation which implies that it is not only the absolute
level of pay that matters to workers, but also the level of
pay in relation to what they expect or what others receive.
An alternative explanation relies on the idea that income is
evaluated relatively to some comparison level and not in an
absolute sense. It is also possible that this result stems from
the un-observability of some variables that are correlated
with both pay and job satisfaction. It is also possible that
higher paid worker as a result of the promotion will be doing
harder work, having more stress, more responsibility, but
in-commensurate authority and so will be less satisfied. This
especially is true in the case of doctors.
A significant positive moderate association (r = 0.65) with
working environment on job satisfaction was found among
healthcare professionals in the public sector of Pakistan.[17]
It may be surprising that one unit increase in rewards and
career aspects also decreases job satisfaction. A plausible
explanation for this finding may be that there are very few
rewards like specialized training, foreign assignment etc.,
and that also for a very limited numbers of professionals thus
creating inequality and it is also possible that respondents
included in our study may be those who are not getting the
rewards thus decreasing overall job satisfaction. This finding
contrasts the results of most researchers. A recent study
conducted in Tanzania reported poor job satisfaction in their
health system due to poor rewards system, discouraging
working environment and weak communications in the
staff.[18] Our study found a negative correlation between
co-workers and job satisfaction for doctors that is very
unusual and did not get any supportive evidence from the
review of the literature. Jahrami et al. found a positive
relationship with co-workers and job satisfaction (mean
17.7, 3.4; range: 10-24) and same was found by Wada et
al. (corrected odds ratio 1.28, 95% confidence interval:
1.07-1.45).[11,19]
A strong association of job satisfaction among physicians
and collaboration between occupational groups was also
reported by a researcher in Germany.[20] The possible
reasons for such surprising finding in our study may be
that doctors being most intellectual and visionary among
all staff members see their co-workers as competitor in
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Jaiswal, et al.: Job satisfaction amongst hospital staff

their professional development. Prevailing diverse cadre

and/or social cast based reservation may also be a reason.
The reasons for working condition as a critical factor in
our study could be the autonomy and appreciation which
every healthcare provider aspire and administrator should
consider this factor while formulating a policy for good
working condition. The study has explored some surprising
findings of job satisfaction, which needs to be reviewed in
the context of distribution of satisfaction against prevailing
political/sociodemographic characteristics to support or
contradict study findings.

3.

Limitations

8.

Study limitations include nonconfirmation of the causal

relationship because of cross-sectional designs of study.
Only 10% of the total population was taken and nonsampled
staff might have had a different response, and the results
cannot be extrapolated. Further, findings presented in this
study are based upon purely subjective rating and based on
self-assessment of respondents, which was not externally
validated and might be influenced by the respondents lack
of knowledge with the subject matter.

Conclusions

4.
5.
6.

7.

9.
10.
11.
12.
13.

Our study documented that majority of staff working in

this public sector hospital were satisfied with their jobs
however there is scope for further enhancement within
a realistic range. Various factors of job satisfaction were
defined along with their inter relation and also supported
two-factor theory. Monitoring of job satisfaction could be
undertaken on a regular basis to find out the factors that
need improvement. By enhancing job satisfaction, hospital
administrator and managers can improve not only the
mental, psychological and social well-being of work-force,
but also the financial health of an organization. We envisage
sharing results of our study with authorities to act upon
accordingly.

14.

References

20.

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Visser MR, Smets EM, Oort FJ, De Haes HC. Stress, satisfaction
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2003;168:271-5.

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How to cite this article: Jaiswal P, Gadpayle AK, Singhal AK,

Sachdeva S, Modi RK, Padaria R, et al. Job satisfaction among
hospital staff working in a Government teaching hospital of India.
Med J DY Patil Univ 2015;8:131-7.
Source of Support: Nil. Conflict of Interest: None declared.

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