Perception of service quality and job satisfaction of Ayurvedic medical officers in Jaffna District, Sri Lanka

Sarvananthan T

Provincial Department of Indigenous Medicine, Northern Provonce.

Abstract

Based on the previous literature it is confirmed that Performance-based service quality and job satisfaction are major antecedents of behavioral intentions in the healthcare sector. Here, the study deals with the same variables under the framework of Ayurveda healthcare. Objectives: The study is an attempt to analyzing the relationship between the service quality, and job satisfaction. Researcher gathered data from AMOs with various aspects through questionnaires. Statistical package for social science (SPSS) version was used for the data analysis. As well as the main variables such as pay, work itself, promotion, supervision, work group and working condition. According to this analysis, pay, work itself, promotion were positively affected while supervision, work group and working condition were negatively affected job satisfaction of AMOs. The study concludes that, Jaffna district Ayurvedic institutions are providing poor facilities for AMOs. It is recommended that the hospital directors need to ensure job satisfaction of the AMOs in order to provide better quality services to the patients.

Key words: Job satisfaction, Ayurvedic Medical Officers, Ayurvedic Institution

1.     Introduction

Differentiation in service delivery makes uniqueness in the service era especially under the circumstances of competitive market conditions. By making innovative service strategies, much management can enable the business to long-term performance benefits. High service quality can be treated as one of the superior service strategies for the success of any business. The rapidly changing environment in the business retail services accompanies an endless competition in the market among the service providers of different sectors. Today, high service quality has become a general agreement between the service providers to create a competitive advantage for their business. The quality of goods can be easily measured in terms of durability and the number of defects on a product. Generally, there are three important features to differentiate a service from a product, such as, intangibility, heterogeneity, and inseparability of production and consumption, which makes it extremely difficult to measure the quality of services. Service quality has gained a significant role in researches from decades ago.

Human resources should considered a significant organizational asset. Human Resources management (HRM) is a comprehensive, integrated system/ process for effectively and efficiently managing work force. The generic purpose of HRM is to generate and retain an appropriate and contented work force who gives the maximum individual contribution to effectiveness of work in the hospital. It exists to maintain and improve the productive contribution of HR in hospitals.

The hospital work and the design of jobs can have a significant effect on staff. Attention needs to be given to the quality of work life. Medical officers in Ayurvedic institutions need to understand how best they can make the work more satisfying. The biggest management challenge faced today is how to engage the doctors towards better quality service. In order to increase patient satisfaction Human of a hospital is considered an important factor. Hospital administrations wish to keep well-trained and effective workforce. Ayurvedic medical officers, who are satisfied with their job, may exert increased effort to raise/ improve their performance towards the patients.

Nowadays, in medical services, competition is very high. Therefore, every hospital has to compete with other. In order to achieve a competitive advantage, a hospital has to retain/ maintain a satisfied and committed work force. There is a need for the hospital to keep their doctors satisfied to achieve its objectives. In other words, a hospital has to keep a very committed workforce to achieve its ultimate goal. To make the best use of personnel as a valuable resource of the hospital, attention must be given to the relationship among the staff. Attention also need to be given to the quality of work environment.

Ayurvedic hospitals are service-oriented institutions. Every hospital should try to increase their staffs’ Job satisfaction. It is on this basis that the researcher selected this area for the research study.

1.1   Introduction to Health and Ayurveda

The term “Ayurveda" combines the Sanskrit words ayur (life) and veda (science or knowledge). Thus, Ayurveda means the science of life. Many Ayurvedic practices predate written records and were handed down by word of mouth. Two ancient books such as Caraka Samhita and Sushruta Samhita written in Sanskrit more than 2,000 years ago, are considered the main texts on Ayurvedic medicine.

Ayurvedic medicine continues to be practiced in India, where nearly 80 percent of the population uses it exclusively or combined with conventional (Western) medicine. It is also practiced in Sri Lanka, Bangladesh, Nepal, and Pakistan (National Centre of Complementary and Alternative Medicine, 2008).

According to Sushruta sanhita when bodily humours are in dynamic equilibrium, the metabolic processes are in dynamic equilibrium, all the tissues are functioning in harmony, all the excretory material is expelled out adequately, the soul, and the ten sense organs and the mind are happy in the perfect state of health.

The broad aim of health policy of Sri Lanka is to increase life expectancy and improve quality of life. It is to be achieved through addressing issues of inequities of health service provision, care of elderly and disabled, substance abuse and malnutrition. Health Master Plan is a living document formulated non-communicable diseases, with help of JICA, which is the first step in ten years journey for effective changes in and around the health system to address health needs of the population (Health Master Plan, 2007.)

New pressures on health systems are emerging in most countries as public expectations and demands for health care increase. One response to this is the recognition that health services must mobilize the resources available in a more efficient and effective way. Health is a dynamic, ever-changing process of achieving individual potential in physical, mental, emotional, social, spiritual and environmental well-being. (World Health Organization, 1998).

1.2 Job Satisfaction

Job satisfaction/the attitude that results from the appraisal of one 's job as attaining or enabling the attainment of one's important job values (Jonl.Pierce, 1996). Luthans (1989) highlighted that job satisfaction is a result of employee, perception of how their job provides those things, which we viewed as important. Since most people spend nearly half of their working lives at their work place, the importance of work satisfaction can be well understood. Additionally job satisfaction usually indicates or results in satisfaction in life in general (Chandan, 1998).

Mullins Lauri (1996) has said that job satisfaction is more of an attitude, an internal state. It could for example be associated with a personal feeling achievement either quantitative or qualitative. Robbins (1994) discussed that the job satisfaction refers to an individual's general attitude toward his or her job. A person with a high level of job satisfaction holds positive attitude toward the job, a person who is dissatisfied with his or her job hold negative attitude about the job.

Robbins (2005) defines that job satisfaction refers to a collection of feelings that an individual holds toward his or her job. A person with a high level of job satisfaction holds positive feelings toward the job. A person who is dissatisfied with his or her job holds negative feelings about the job. When people speak of employee attitudes, more often than not they mean job satisfaction. Luthans (1989) emphasized that Job satisfaction is a result of employee perception of how well their job provides.

(Hoppock 1935) defined job satisfaction as a combination of psychological, physical and environmental circumstances that causes a person to say, I am satisfied with my job Nasurdin and Ramayah (2003) indicated that an organizational reward contributes to job satisfaction. Task rewards are intrinsic rewards directly associated with the job such as interesting and challenging work, variety and opportunities to use one's skills. Organizational rewards are the tangible rewards that are visible to others such as pay, promotion and comfortable working conditions.

Locke (1969) gives a comprehensive definition of job satisfaction as cognitive, affective and evaluative reactions or attitudes and states it is a pleasurable or positive emotional state resulting from the appraisal of one's job experience. Job satisfaction is the attitude that results from the appraisal of one's job as attainment of one's important job values. Overall job satisfaction is a combination of facet satisfactions that describes a person's overall affective reaction to a set of work and work-related factors (Mullins and Lauri 1996).

Locke (1969) state; job satisfaction is a combination of various factors that make a favorable inner feeling to an individual. Hwang and Chi (2005) have summarized that the study presents an empirical exploration into the correlations among internal marketing, employee job satisfaction, and organizational performance of the international hotels.

Futrell (1977) has summarized in their study that there are empirical relationships among three types of job attitudes and the relationship of job performance and job design characteristics to these attitudes. The result of a factor analysis indicated that higher order needs satisfaction, job involvement and intrinsic motivation. Attitudes are distinct and independent of each other.

Linz (2005 & 2006) has summarized his study and explores the extent to which employee performance is conditioned by attitudes toward work, by degree of job satisfaction, and by the extent of organizational commitment. In the long-term employee, performance is assumed to be governed by the extent to which career goals are met.

Putman (2002) concluded that the two attributes, job satisfaction and job performance, are too closely linked to one another, and that they affect each other. If a person is highly satisfied with his/her job, this would lead the person to want to do a good job and to perform well. On the other side is the person's ability level.

If the person is struggling in performing the job, it may give the appearance that the person is a poor performer even though he/she may be excreting a great deal of effort n tying to perform the job. This person's frustration then in turn leads to poor job satisfaction.

Job satisfaction/dissatisfaction of a doctor affects his behavior with co-workers, administration and particularly the patients. Quality of medical care and doctor-patient relationship is also dependent on the level of job satisfaction. A number of studies on the topic under investigation were found in the literature. Working freedom, salary and fringe benefits are the major factors contributing towards job satisfaction but are most dissatisfied with the workload and the reforms. In another study, it is found that doctors were most satisfied with the autonomy and, working physician’s environment but the clerical workload was a source of dissatisfaction (Ghazali, et al.2007).

2.  Methodology

2.1 Research Approach

The research study will be carried out as a survey study to find out the job satisfaction of the

Ayurvedic Medical Officers in Jaffna district, Sri lanka.

2.2 Population Sample and Sample Selection Procedure

The target population is all the government Ayurvedic Medical Officers in all Ayurvedic institutions in Jaffna district.

2.2.1 Sample Frame

Altogether 42 Ayurvedic institutions are in the Jaffna district and 59 Ayurvedic Medical Officers are working in them.

 2.2.2 Inclusion Criteria:-

Selected only Government Ayurvedic Medical Officers at the Ayurvedic Institutions in Jaffna District.

2.2.3 Exclusion Criteria:-

Omitted who were  extend cooperation in collecting the data in the Ayurvedic Institutions.

2.3. Data

Collected both primary & secondary data for the study of research.

2.3.1.Primary data

Primary data were collected through questionnaires method. The researcher includes (in this dissertation as a primary data gathering the information though issuing) two different questionnaires, i.e issued to the Ayurvedic Medical officers and the questionnaires filled by the interviewer. Five points Likerts scales were used to collect the data from questionnaire survey. The scales are strongly agree (5), agree (4), neither agree nor disagree (3), disagree (2) and strongly disagree (1).

2.3.2. Secondary data

Secondary data were taken from reports, handbooks, circulars, magazines, journals, annual reports, past research data and specific web pages.

2.4. Questionnaire

A questionnaire, which included questions on perceptions and was presented to the all Ayurvedic Medical Officers and the interviewer, filled their answers. This questionnaire consist of two sections. The first section of the questionnaire is designed to collect the personal data of the respondent. The second section of the questionnaires was designed to identify job related factors.

2.5 Operationalization

Tale 2.1: Operational framework

3.      Results

To conduct effective research, fifty-nine Ayurvedic Medical Officers were selected from the Jaffna district. Data have been categorized according to various criteria in accordance with the variables mentioned in the conceptual model. The researcher has examined the descriptive statistics and explains the relationship and comparisons by using different statistical methods through statistical package for social science (SPSS).

3.1   Data presentation

The data presentation is carried out based on the independent variable of Job Satisfaction (JS).Independent variables that affect the JS are Pay, Work-itself, Promotion, Supervision, Work Group and Working Conditions.

3.2   Descriptive Statistical analysis

Table 3.1 Age category

Source: Survey Data, 2013

According to the table 3.1, 19 Ayurvedic Medical Officers (32.2 percent) are between 25 to 34 years old, while another 19 Ayurvedic Medical officers (32.2 percent) are between35 to 44 years old in addition to that 21Ayurvedic Medical Officers (35.6 percent) are between 45 to 54 years old.

Table 3.2 Gender category

Source: Survey Data, 2013

According to the table 3.2, 17 Ayurvedic Medical Officers (28.8 percent) are male. While another 42 Ayurvedic Medical Officers (71.2 percent) are female. Female doctors are more like to continue the course of Ayurvedic Medicine. But male doctors are not attached in the course of Ayurvedic Medicine due to the long term period (5yr).

Table 3.3 Civil Status

Source: Survey Data, 2013

According to the table 3.3, 14 Ayurvedic Medical Officers (23.7 percent) are single. While another 45 Ayurvedic Medical Officers (76.3 percent) are married, Ayurvedi Medicine course is six years period. Some time it will take eight years. So the Ayurvedic doctors age is increasing and proposal opportunity is decreasing.

Table 3.4 No. of Children of the doctors

Source: Survey Data, 2013

According to the table 3.4 ,22 Ayurvedic Medical Officers (37.3percent) have no children, while another 19 Ayurvedic Medical Officers (32.2percent) have one children, in addition to that 15 Ayurvedic Medical Officers (25.4percent) have two children, 2 Ayurvedic Medical Officers (3.4 percent) have three children, 1 Ayurvedic Medical Officer (1.7 percent) has more than four Children.

But according to the national population data of Sri Lanka democratic and health service- 2006-2007 more than 5 children -28.21%, 3- 4 children =34.43%, 1 -2 children -29.04%, no children =8.29

Table 3.5 Work Place According to the Distance

Source: Survey Data, 2013

According to the table 3.5, 09 Ayurvedic Medical Officers (15.3 percent) are situated in short distance. While another 50 Ayurvedic Medical Officers (84.7 percent) are situated in long distance.

The health service coverage of Sri Lanka is with in 5kms. According to that, the researcher decided with in 5kms is the short distance. More than 5kms is long distance. So according to my data Ayurvedic coverage of Jaffna District is below the stranded level.

Table 3.6 Designation of the Doctors

Source: Survey Data, 2013

According to the table 3.6, 24 Ayurvedic Medical Officers (40.7 percent) are MOICs. While another 35 Ayurvedic Medical Officers (59.3 percent) are MOs. MOIC is in-charge of the hospital. MO is doctor who is working in the hospital. Further MOIC is Top level manager. MO is middle level manager. MOIC is high status, high responsible person and the senior man and he has service experience when we compare with MO.

Table 3.7 Educational Qualification

Source: Survey Data, 2013

According to the table 3.7, 55 Ayurvedic Medical Officers (93.2 percent) are bachelors. While another 4 Ayurvedic Medical Officers (6.8percent) are master degree holders. Bachelors who are pass out fromn Sri Lanka Ayurvedic Institutions such as Colombo and Jaffina. Bachelor course duration is 5yrs. Master of special medicine in Gunapadam. Duration is 2yrs.

Msc in Bio statistics – duration is 2yrs.

M.Phil - in siddha medicine - duration is 2yrs.

Table 3.8 Period of Service

Source: Survey Data, 2013

According to the table 3.8, 16 Ayurvedic Medical Officers (27.1 percent) are below 05 years service, while another 35 Ayurvedic Medical Officers (0.3 percent) are 05-09 years services in addition to that 08 Ayurvedic Medical Officers (13.6 percent) are 10-15 years services.

When period of service increasing doctors can get higher post of Administration. For example, the doctor who has 3yrs service can get Central Ayurvedic Dispensary.The doctor who has 5yrs service can get Rural Ayurvedic Hospital. The doctor who has 12yrs service can get District Ayurvedic Hospital.

Table 3.9 Monthly Income

Source: Survey Data, 2013

According to the table 3.9, 17 Ayurvedic Medical Officers (28.8 percent) are below Rs.30, 000 family monthly income, 38 Ayurvedic Medical Officers (64.5percent) are Rs.31, 000-60,000family monthly income, 04 Ayurvedic Medical Officers (6.7 percent) are above Rs.61, 000 family monthly incomes.

Further According to the table 4.8 and 4.9 (cross tabulation). Less period of service doctors are get low level monthly income. Middle period of service doctors are get middle level monthly income. More period of service doctors are get high level monthly income.

Table 3.10 Descriptive Statistics

Source: Survey Data, 2013

Pay is chief component of job satisfaction; pay has a mean value of 2.59 out of five points. Therefore payments of the Ayurvedic Medical officers in Ayurvedic institutions in Jaffna district is high level. Further standard deviation of the pay out of five points is equal to 0.912. In addition, the lowest scale value for the pay is 01 whilst the highest value of the pay is 04.

Work-itself is important component of job satisfaction: Work itself has a mean value 3.56 out of five points. Therefore work itself of the Ayurvedic Medical officers in Ayurvedic institutions in Jaffna district is high level. Further standard deviation of the work itself out of five points is equal to 0.14. In addition, the lowest scale value for the work itself is 03 whilst the highest value of the work itself is 4.2.

Promotion is smaller (low) component of job satisfaction: Promotion has a mean value of 1.58 out of five points. Therefore promotion of the Ayurvedic Medical officers in Ayurvedic institutions in Jaffna district is low level.

Further standard deviation of the promotion out of five points is equal to 0.131. In addition, the lowest scale value for the promotion is 01 whilst the highest value of the promotion is 2.33.

Supervision is more than average component of job satisfaction: Supervision has a mean value of 2.86 out of five points. Therefore supervision of the Ayurvedic Medical officers in Ayurvedic institutions in Jaffna district is high level.

Further standard deviation of the supervision out of five points is equal to 0.144. In addition, the lowest scale value for the supervision is 02 whilst the highest value of the supervision is 3.67.

Work group is below average component of job satisfaction; the factor work group has a mean value of 1.98 out of five points. Therefore, work group of the Ayurvedic Medical officers in Ayurvedic institutions in Jaffna district is low level. Further standard deviation of the work group out of five points is equal to 0.601. In addition, the lowest scale value for the work group is 01 whilst the highest value of the work group is 04.

Condition of work is component of job satisfaction: working condition has a mean Value of 2.61 out of five points. Therefore working condition of the Ayurveda Medical officers in Ayurvedic institutions in Jaffna district is high level.

4.      Discussion

The results have highlighted that some factors are positively affected for the Ayurvedic medical officers while some factors are negatively affected for their job satisfaction.

4.1 Factors that affect for the Job Satisfaction of the Ayurvedic Medical Officers

4.1.1 Pay

Normally pay is not a motivate for professional worker but in my study pay is/average the satisfaction of the Ayurvedic medical officers in level of determinant factor, For Jaffna district.

Result highlighted that salary and other payments are highly influential on determine job satisfaction of the Ayurvedic medical officers and it will help to provide a better quality service for the poor and innocent patients. Further, there should be viable programs to increase the pay system of the Aurvedic medical officers like western medical officers.

However that during the questionnaire survey most of the Ayurvedic Medical Officers highlighted that they are getting poor payment facilities. Few Ayurvedic Medical Officers highlighted that they are average payment level. A few Ayurvedic Medical Officers are said that their payment system is correct. So according to the factor of pay

Ayurvedic Medical Officers are commonly disagree about their payment system this will lead to poor job satisfaction to them. In this connection Jaffna district Ayurvedic hospital directors have taken necessary actions to improve the Ayurvedic medical Officers payment system such as holiday payment, overtime for doctors and other suitable allowances to increase their job satisfaction to provide quality services.

4.1.2 The work itself

During the questionnaire survey, most of the Ayurvedic Medical Officers highlighted that they are less work itself. For example, few Ayurvedic Medical Officers have poor duty minded manner. So according to the factor of work itself Ayurvedic Medical Officers are commonly agree about their work itself system. It is gave more than stranded level of quality service.

Therefore, the Ayurvedic hospital directors have to take necessary actions to improve the relevant facilities and introduce more work itself system to further development.

4.1.3 Promotion

Promotion is also a major determinant for the job satisfaction of the Ayurvedic medical officers. During the questionnaire survey, most of the Ayurvedic Medical Officers highlighted that there is inadequate promotion in their Ayurvedic institutions. In addition, very difficult to get promotions based on several reasons. However, there are a very few Ayurvedic Medical Officers are satisfied about their promotion. Commonly Ayurvedic Medical Officers are suffering from promotion system. It will lead poor job satisfaction to them.

It should indicate that Ayurvedic hospital directors must take necessary steps to give proper promotion in future. It will lead to better quality services for the patient.

4.1.4 Supervision

During the questionnaire, survey most of the Ayurvedic Medical Officers highlighted that, they are facing too much unfriendly supervision in their Ayurvedic institutions. A few Ayurvedic Medical Officers highlighted that they are under normal supervision. Commonly most of the Ayurvedic Medical Officers did not like rude and bureaucratic supervision. Therefore, they feel poor satisfaction about their job. .

4.1.5. Work Group

During the questionnaire survey, that few Ayurvedic Medical Officers are highlighted that they do not receive much support from other work groups and there exist relationship that is more problematic. Most of the Ayurvedic Medical Officers are highlighted that collaborative work group is necessary to give better quality service for the poor patients who come all the way from their home spending money time and efforts. Therefore, the Ayurvedic hospital directors have to take necessary actions to improve group works and team works in respective Ayurvedic institutions to improve their work efficiency and performance.

According to result, study of work group is low level so this is around less than average level.

4.1.6 Working Condition

During the questionnaire survey that most of the Ayurvedic Medical Officers are highlighted that, their working conditions are poor. In their Ayurvedic institutions, few Ayurvedic Medical Oficers have highlighted that they are working standard, working condition. A few of them highlighted that their working condition is good. These types of working condition also affect the Ayurvedic Medical Officers job satisfaction.

Therefore, the directors of Ayurvedic institution have to take necessary actions to improve the relevant facilities and introduce good working system in their hospital. It will indirectly help Ayurvedic Medical Officers to provide better quality services.

The overall level of job satisfaction seems not enough for Jaffna district Ayurvedic institutions, but they want to further improve it, in order to obtain maximum output from Ayurvedic Medical Officers. During the questionnaire survey most of the Jaffna district patients have highlighted that they are suffering from poor special clinic services, such as Ayurvedic medicine, poor laboratory facilities etc. this statement also indicate Ayurvedic Medical Officers are offering poor quality servicers to the patients.

5.      Conclusion and Recommendation

Many researchers have undertaken studies regarding job satisfaction in different fields and observed the types of relationships (positive, negative). This study tried to test the research question that , what are the factors that influence the job satisfaction of the Ayurvedic Medical Officers? After completing the data presentation and analysis, found that there exist positive and negative outcome of job satisfaction. The results indicate there are three factors (pay, work itself, promotion) are weak positive factors affecting and other three factors (supervision, work group, working condition) are weak negative affecting job satisfaction. The quality service derived through job satisfaction. That means if Ayurvedic Medical Officers satisfied about their OPD, Ward, Clinic treatment they feel good satisfaction. This will provide good quality service.

The findings of this study have shown that Jaffna district Ayurvedic institutions are providing poor facilities for Ayurvedic medical officers therefore their job satistaction exists at low level. Since the medical officer' s satisfaction exists at low level and patient also exists at low level of service quality.

According to the findings obtained from this research hospital directors need to pay more attention about ensuring the job satisfaction of the Ayurvedic Medical Oficers in order to provide better quality services for the poor and patients in Jaftna district.

Recommendations

Following key recommendations will be useful for further improvement.

Ayurvedic institutions should develop good relationship among Ayurvedic Medical Officers. Through which, job satisfaction of Ayurvedic Medical Officers is enhanced. As a result, quality service will be at high level.

Ayurvedic institutions should induce Ayurvedic Medical Officers to perform well. This can be achieved by providing rewards, motivations, and other benefits.

Ayurvedic institutions should provide unbiased promotion. Promotions should be provided based on the qualification and experience of Ayurvedic Medical Officers.

Ayurvedic institutions should include hours of work, over time, loan etc.

Proper working environment should be designed and developed. In that Ayurvedic institutions should provide adequate facilities such as proper lighting, proper ventilation facilities, appropriate equipment, work breaks and work sharing to Ayurvedic Medical Officers to do their works.

Ayurvedic institutions should design good grievances, handling procedures, disciplinary procedures, etc            

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