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\title{Factors Influencing Job Satisfaction in Public Healthcare Sector of Pakistan}
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             \author[1]{Dr. Faraz Ahmed  Wajidi}

             \author[2]{Raja Muhammad  Ali}

             \affil[1]{  University of Karachi}

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\date{\small \em Received: 15 December 2012 Accepted: 2 January 2013 Published: 15 January 2013}

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\begin{abstract}
        


Job satisfaction is found to be one of the most important factors determining the quality of work, productivity, turnover and organizational performance. It is said to be associated with working conditions, time pressure, opportunities for career development, management support, compensation and promotional policies of the organizations. In the recent past, the public healthcare professionals of Pakistan were not seen to be satisfied with the organizational policies. In this respect, the current study is conducted to evaluate the factors which cause job satisfaction in public healthcare of Pakistan. A survey was conducted with a sample of 200 healthcare professionals from the twin cities of Islamabad and Rawalpindi. The results of the study conclude that opportunities for career development, working time and promotional schemes of the organizations have high associations with job satisfaction whereas work environment was found to have low significance towards job satisfaction.

\end{abstract}


\keywords{working conditions, time pressure, opportunities for career development, management support, compensation and promotional policies.}

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\section[{Introduction}]{Introduction}\par
he productivity and efficiency of human resource depend upon dynamic factors which range from personal factors to organizational policies. Job satisfaction is one of the most important factors which impact the productivity of human resources. In any organization, human resource is considered as one of the most important assets which serves as an engine in the organization for providing a sustainable source of energy and service delivery. In the healthcare sector, Pakistan has been facing certain shortfall of professionals.  {\ref Hafeez et al (2010)} has suggested that private healthcare sector of Pakistan is well established and organized and has appropriate working conditions. Contrary to this, they also evaluated that the employees in the public health care sector face certain issues and challenges which impact their job satisfaction level on a large scale. Job satisfaction refers to the comprehensive phenomenon which encompasses individual's feelings and emotions towards his or her job (Robbins¸2008). In addition, it also determines the extent to which employees in an organization like of dislike their jobs. \hyperref[b8]{Franco et al (2000b)} suggest that job satisfaction and environment satisfaction are interrelated phenomenon. \hyperref[b15]{Nassab (2008)} defines job satisfaction as the extent to which an individual is satisfied with the actual work (reporting, communicating, surgery, plumbing etc) that they do in the organization. Contrary to this, environment satisfaction is associated with the coworkers' attitudes, supervisors, working conditions and physical space in the organization ( \hyperref[b22]{Van et al., 2002)}. Job satisfaction can be measured through a single-item scale or through a complex and multi-item scale.\par
In the healthcare sector, the job satisfaction of professionals plays an effective and strong role in their performance and is further reflected in the health and satisfaction of the patients. In addition, the job satisfaction of health care professionals also determines the quality of services delivered by them to the respective communities (Garcia-Pena et al, 2000). In the earlier studies strong association has been found in the poor working conditions and organizational factors and job dissatisfaction and social factors have been recognized as an important source of job satisfaction.\par
In the public healthcare sector, the subject of job satisfaction is very relevant because of the fact the organizational factors and employee's health and stress has great influence on their job satisfaction \hyperref[b1]{(Adams et al, 2000)}. This is because of the expectations of the healthcare organizations associated with the professionals to deliver high quality health services \hyperref[b15]{(Nassab, 2008)}.\par
Job satisfaction has been investigated as one of the most important factors for improving employee productivity within an organization. Several earlier studies have been conducted regarding investigation of employee job satisfaction in the healthcare professions. However, very few studies have been conducted in perspective of Pakistan. At present, the situation of healthcare professionals in the public sector of Pakistan seems to be less satisfied with the policies of the healthcare institutions. Several media reports confirm that there have been many strikes and protests by the healthcare professionals in Pakistan in the recent past. This has raised the continuous threat of attrition to the public healthcare sector. Therefore, it is very important to conduct the research on public health care professionals to evaluate the factors which have caused the health professionals to be less satisfied with the jobs. In this regard, this particular study has been conducted to investigate the specific factors and issues which cause satisfaction or dissatisfaction in health care professionals.  
\section[{Objectives of Study}]{Objectives of Study}\par
The aim of the study is to examine the factors in detail which cause job satisfaction or job dissatisfaction in healthcare professionals of public sector or Pakistan. In this respect, it reviews certain organizational and personal factors which influence the job satisfaction of healthcare employees. Moreover, it also proposes certain recommendations to the management of public healthcare organizations to improve the job satisfaction in employees because it ultimately impacts the job performance of employees. 
\section[{III.}]{III.} 
\section[{Literature Review}]{Literature Review}\par
While the performance of workers is limited by or dependent on worker competencies and availability of resources, the presence of these factors is not the surety of the high work performance of employees. \hyperref[b15]{Nassab (2008)} suggests that the performance of workers and job satisfaction is reliant on the willingness of employees to work diligently, regularly, carry out important tasks and remain flexible towards several tasks. The health facility managers and policy makers of the health sector must ensure that the employees are willing to work in the organization and understand the particular work policies. The work performance or productivity of employees is largely determined by the job satisfaction and furthermore, it impacts the quality of work. This complex arrangement assesses the attitudes of individuals towards jobs that not only impacts the job motivation but also influences the coworker's relations, career development and health conditions of employees. Several [previous studies have evaluated that the job satisfaction not only depends on the nature of an individual's work but also on his or her expectations on the particular job. In some specific jobs such as healthcare jobs, there are some subjective expectations of professionals that may bring some risks. Therefore, it is important for the management to cater and understand these factors and issues in an effective way. Specific to the healthcare industry, the job satisfaction of employees impacts the efficiency and effectiveness of work, quality of work and also on the healthcare cost. Besides the importance of healthcare professionals for the healthcare system and patients, the job satisfaction of professionals in this industry is highly correlated with the human relations within the organization, absence from work and quality of services delivered by the professionals. In several countries, job satisfaction surveys are conducted on a regular basis to collect data regarding satisfaction of employees with particular tasks and organizations. Furthermore, the data collected through these surveys may provide substantial help to the management to take specific actions for improving job satisfaction of employees. \hyperref[b3]{Bovier and Pernegar (2003)} have suggested that in the healthcare sector, employees face a certain level of risk for discontent with the work. \hyperref[b2]{Allen and Mellor (2002)} noted that complex timings of work, burnout and high stress level are the determining factors in well being of professionals and workers in the healthcare sector and also impact the professional satisfaction of workers in this industry. Across the world, many studies have evaluated the factors impacting the job satisfaction in healthcare professionals such as level of education, age, gender, nature of work, nature of the organization, compensation policies, working hours, work experience and promotional policies \hyperref[b0]{(Ali and Mohammad, 2006)}.\par
Job satisfaction is not as simple as it seems by its appearance. It has a very complex relationship with several variables. \hyperref[b5]{Castle et al (2006)} suggest that a health care professional may be satisfied with salary and promotions but simultaneously dissatisfied with the relationships with co-workers. This complex association of job satisfaction with different factors may also influence the job performance of employees. \hyperref[b24]{White (2000)} suggests that satisfied employees tend to be more creative, productive and committed to the organization as compared to the dissatisfied employees. Research by DeStefano et al (  {\ref 2005}) have elaborated a direct and positive correlation between patient satisfaction and staff satisfaction in health care organizations.\par
In the healthcare organizations, explaining job satisfaction has remained a complex and enduring issue. Many authors have elaborated the positive association between job performance and job satisfaction. However, the research in this area has provided several contrasting outcomes; job satisfaction is found to be associated with several factors such as rate of absenteeism, employee turnover and union activity \hyperref[b17]{(Pillay, 2008)}.\par
The investigation by researchers in this area is highly important for examining the critical factors which influence the job performance of healthcare professionals \hyperref[b20]{(Seo, Ko \&}\hyperref[b20]{Price, 2004 and}\hyperref[b5]{Castle et al., 2006)}. Most of the studies which have established the relationship between job satisfaction and other critical factors have been conducted in developed countries. However, researchers from Asian and underdeveloped countries have also started to emerge. However, in these countries, the research in this area is mostly based on the theoretical findings while research on this area in western countries is based on empirical investigations. Therefore, there is need to carry out research to evaluate the empirical investigation on the factors causing job satisfaction in health care professionals.\par
In the healthcare sector, there are several problems such as growing demand of healthcare professionals, the cost of health care services and expectations of patients. With all these factors, stress has been building for the healthcare professionals which are causing job dissatisfaction in them. Uña Cidón et al (2012) has suggested that the job satisfaction brings a byproduct which is the quality of services delivered to patients. Therefore, management in healthcare organizations needs to incorporate factors which bring job satisfaction in employees. As the job satisfaction is multifaceted factor and is linked with the job performance, it is important to evaluate and explore the factors causing this relationship to establish.\par
To evaluate and explain the factors causing job satisfaction in healthcare professionals, the concept of motivation cannot be ignored. In many previous studies, factors causing motivation in employees in the work environment have been explored. In this regard, Vilm and Egle (2007) have noted that management needs to provide suitable work environment to workers for creating job motivation, job satisfaction and other desired results. Several studies have explored that salary, educational background and promotional strategies of organizations impact the job motivation which ultimately affects job satisfaction \hyperref[b5]{(Castle et al., 2006}). In addition, earlier studies have also explored that incentives and reward may not be sufficient to create job satisfaction in health care professionals. This creates a need to explore more hidden and intricate factors which cause job satisfaction in the healthcare sector. In some recent studies, working environment, support from senior professionals and managerial staff in healthcare organizations have found to be impacting positively on job satisfaction in employee (Jang et al, 2005 and Brooks-Carthon, et al. 2011).\par
For preventing persistent dissatisfaction of employees and to improve the working environment, Richer at al.  {\ref (2009)} suggest that management need to conduct an appreciative inquiry for creating radical changes in the organizations. \hyperref[b15]{Nassab (2008)} suggests that a supportive working environment is critical element for developing employee skills and enhancing their motivation and satisfaction level towards work. In addition, \hyperref[b0]{Ali and Mohammad (2006)} and \hyperref[b14]{Kokkinene et al (2007)} have also explored the relationship between management support, personnel management and job satisfaction. Contrary to this, Newman et al  {\ref (2002)} have explored that personal management may also lead to employee dissatisfaction. This shows the importance of personnel management and supportive management in healthcare organizations.\par
Many other studies have also elaborated that low wages and lack of effective pension, promotions and insurance schemes are associated with low level of job satisfaction in healthcare professionals \hyperref[b6]{(Case et al. 2002 and}\hyperref[b11]{Harris-Kojetin et al. 2004}). A study conducted by \hyperref[b13]{Kirpal (2004)} suggests that the policy makers need to identify their responsibility to point out the negative effects of certain factors as well as the worker's identity from a qualitative perspective. He further elaborated that the nature of work has been changing continuously and moving from rigid work structures to more flexible work practices. In addition, \hyperref[b15]{Nassab (2008)} pointed out that job satisfaction and dissatisfaction have a strong relationship with the mobility and turnover intentions of workers in the healthcare sector. Therefore, it is vital for the healthcare management to be aware of the fact that low level of compensation and workloads can cause dissatisfaction in employees. 
\section[{IV.}]{IV.} 
\section[{Theoretical Framework and Hypotheses}]{Theoretical Framework and Hypotheses}\par
On the basis of the above discussion, following theoretical framework has been developed to evaluate the factors impacting job satisfaction in healthcare professionals of the twin cities of Pakistan.  
\section[{Methods}]{Methods}\par
This particular research is based on the descriptive analysis of the factors which impact on job satisfaction in the public healthcare sector or Pakistan. This research was framed on the positivism philosophy with quantitative research methods. To evaluate the empirical evidence and test the hypothesis, primary data have been incorporated in the study.\par
The technique of the research is based on the survey which is conducted with the healthcare professionals in the public health care sector of Pakistan. With a close end questionnaire, 200 healthcare professionals were selected from public healthcare organizations in the twin cities of Islamabad and Rawalpindi. The sampling technique for the study was convenience based. The sample subjects who were conveniently accessible and who were primate to the researcher were selected in the study.\par
Before conducting the actual survey with the selected sample subjects, pre-testing was conducted through pilot study to check the sequence, language, format and comprehension of the close end questionnaire. After conducting this pre-testing, the questionnaire was modified in terms of language and sequence of questions to make it easy and understandable by the sample subjects.\par
The final and actual phase of data collection was more elaborated and modified. By calculating Cronbach alpha, the internal reliability and validity of the research instrument was rechecked. It was found to be acceptable for conducting a real survey. The participants of the study were selected through convenience sampling but at the same time diversity in the sample selection was further ensured by targeting sample subjects of different subfields of the healthcare sector. Moreover, further categorization of the sample was also made on the basis of work experience, postgraduate qualification, age and workplace (public sector). Before the selection of sample subjects, all participants were ensued about the confidentiality of their provided data. In addition, they were also ensured about anonymity in data collection because no one was forced to take part in the research without his or her consent.\par
For the data analysis purpose, the Statistical Package for Social Sciences (SPSS), 17 th Version was selected. Through this statistical software, descriptive and inferential statistics were performed on the data to test hypothesis. 
\section[{VI.}]{VI.} 
\section[{Data Analysis and Interpretation}]{Data Analysis and Interpretation}\par
Data collected through survey tool has been analysed statistically. The results of the analysis revealed that the overall model of the study was significant. The analysis results are as follows:\par
Variables Entered/Removed b Model Variables Entered Variables Removed Method The above table reveals that the professional opportunities, promotions, compensation and working environment were significant towards job satisfaction. Moreover, time pressure was found to be associated with the job satisfaction in health care professionals. The results of the study have revealed that the promotions have higher significance towards job satisfaction in the public healthcare professionals. After this, professional opportunities were found to be influencing the job satisfaction in public healthcare professionals. The work environment and compensation were the least influencing element towards job satisfaction.\par
The results of the study have certain similarities and contradictions with the previous studies. The results of this study are similar to the earlier studies in the sense that attractive COMPENSATION policies influence the job satisfaction in a positive way \hyperref[b6]{(Case et al. 2002;}\hyperref[b0]{Mohammad, 2006;} {\ref Kisa, 2006 and} {\ref MacDermid et al, 2008)}. However, contrary to \hyperref[b6]{Case et al. (2002)}, this study found that working environment which also encompasses management support does not have high level significance towards job satisfaction as compensation and promotional schemes do. 
\section[{VII.}]{VII.} 
\section[{Conclusion and Recommendations}]{Conclusion and Recommendations}\par
The results of the study have evaluated that the job satisfaction in healthcare professionals is highly associated with certain factors which need to be developed and focused by the healthcare management. The study concludes that attractive promotional schemes have a high level influence on the job satisfaction of healthcare professionals. In addition, opportunities for professional development also influence the job satisfaction while Work Environment has lower impact on the job satisfaction of employees in the public healthcare sector. Earlier studies have reported that job satisfaction further impacts on the quality of services rendered by the healthcare professionals. The management of public healthcare institutions of Pakistan needs to improve the Work Environment. In addition, healthcare professionals must be given attractive compensation, opportunities for career development and promotions. This research was conducted on a small sample which limits its generalizability. The future researchers need to expand the scope of this study by focusing on a large sample so that its results can be generalized to the entire public health care sector of Pakistan.\begin{figure}[htbp]
\noindent\textbf{}\includegraphics[]{image-2.png}
\caption{\label{fig_1}Factors}\end{figure}
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