An integrated framework of employee satisfaction and service quality for public healthcare professionals in KwaZulu-Natal
Tawana, Brian Aubrey Kgopiso
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Introduction: The antecedents and consequences of employee satisfaction and service quality have been researched widely and within multiple contexts. However, there still exists a gap in the body of knowledge on the antecedents and consequences of employee satisfaction and how these influence talent retention and service quality, with specific reference to an urban and a rural context, referring to professional employees in the public health sector of KwaZulu-Natal (KZN), South Africa. Research purpose: From a theoretical and methodological point of view, the purpose of this research was to determine, explore, and distinguish the antecedents and consequences of employee satisfaction. This was done in to establish a framework regarding how it relates to the retention of professional healthcare employees as well as service quality within an urban and rural context of public healthcare facilities in KZN. Motivation for the study: The transformation of public healthcare in South Africa has long been the focus of the National Department of Health, which aims to ensure quality healthcare at its facilities. These facilities are, however, still suffering from a lack of adequately qualified employees. Rural health facilities, in general, have suffered from a lack of talent, with subsequent poor quality service delivery. Concerns about the retention of healthcare professionals in South Africa have been voiced, and it is of critical importance to address the loss of, and lack of healthcare employees (National Department of Health Policy Paper, 2012). Professional healthcare employees have been blamed for not wanting to accept positions in rural areas, and the Department of Health has tried to attract workers without distinguishing the antecedents and consequences of employee satisfaction, and how these could relate to service quality and the retention of talent. Research design, approach, and method: The research design for the study was a mixed-method sequential design, involving a quantitative phase, followed by a qualitative phase. A quantitative survey using a structured questionnaire, inclusive of the following constructs: Work environment, Fulfilment, Work satisfaction, Job satisfaction, Employee retention, and Service quality, was administered to a sample of urban and rural healthcare professionals in KZN (N = 405). In addition, the researcher conducted three focus group discussions with ten, eight, and six participants respectively. Participants for the focus group discussions were selected purposively from two hospitals and one clinic, and the interviews were conducted to further explore meanings derived from the survey findings that could perhaps not be explained statistically. The qualitative data generated from these focus group interviews were transcribed and analysed using constant comparative analysis. Ethical conduct and rigour were maintained throughout the study. Main findings and contribution: The results showed significant differences between urban and rural healthcare professionals' work satisfaction. The qualitative data findings were in support of the quantitative findings, and explained why employee satisfaction was not a threat to retention, despite the facilities being in rural settings, and why these employees did not show the tendency of mobility reported in general, and between rural and urban settings in other provinces in South Africa. It also provided deeper insights into why healthcare workers in KZN are reasonably satisfied to work in the rural areas to provide healthcare services. These are: tribalism ('caring for my people'), family responsibility (especially women), and locality (home nearer to work). An integrative framework was developed, indicating organisational factors that influence individual factors, and, combined with contextual factors, influence service delivery. Organisational factors comprise the following : Work environment, Compensation, Supervision, Work duties, and Development opportunities. Individual factors comprise: Fulfilment, Work satisfaction, Job satisfaction , and Retention, and, together with the contextual factors of urban and rural environments, distinguish the outcome level of perceived quality of service delivery. Significant relationships were found to exist between the antecedent and outcome variables for both sample groups. Employee satisfaction in general was found to be surprisingly high among the professional health workers in KZN, despite several challenges reported in literature. The contextual relevance and factors in employee satisfaction, service quality, and retention of talent were clearly indicated by the results of this study. Limitations/future research: The results of the study can only be generalised to the public health sector professionals in KZN, and not to employees in other provinces or public sectors. There is a need for further research on how tribalism affects employee satisfaction and service quality, and how this could be utilised as a factor of retention in, specifically, developing countries where there is an urban-rural divide. The primary research objective of the study was met. The study contributes an integrated framework for employee satisfaction and service quality in the public health sector in KZN, which is a province in South Africa with distinct rural and urban healthcare contexts.