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May 2019 -
Volume 17, Issue 5

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From the Editor

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Original Contribution

Job satisfaction in PHC Kuwait
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Huda Youssef Al-Ghareeb, Rihab Abdullah Al-Wateyan
DOI: 10.5742MEWFM.2019.93640

Falls in Older People with Diabetes Mellitus: a study from Kurdistan of Iraq
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Asso Amin, Zana A Mohammed, Osama Shukir Muhammed Amin, Raed Thanoon, Saman H Shareef, Thomas James Oakley, Teshk Shawis
DOI: 10.5742MEWFM.2019.93641

Effects of oxytocin therapy on amount of breast milk in postpartum period in Maternity Teaching Hospital

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Ismail Bilal Ismail
DOI: 10.5742MEWFM.2019.93642

Case Report

The crescent trachea: a new radiological sign of subclinical tracheal compression in patients with large goitres
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Jason Toppi, Yik Seng Tham, Stephen Kleid
DOI: 10.5742MEWFM.2019.93643

What is the relationship between irritable bowel syndrome, smoking, hypertriglyceridemia, and fasting plasma glucose?
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Mehmet Rami Helvaci, Abdulrazak Abyad, Lesley Pocock
DOI: 10.5742MEWFM.2019.93644

Prevalence and Risk Factors of Childhood Abuse among Hadhramout University Students in Yemen
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Fauzia Faraj Bamatraf DOI: 10.5742MEWFM.2019.93645

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The Wael Al-Mahmeed & IAS Research Training Grants and Fellowships for the MENA Region
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Middle East Quality Improvement Program
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May 2019 - Volume 17, Issue 5

Job satisfaction in PHC Kuwait

Received: March 2019; Accepted: April 2019; Published: May 1, 2019
Citation: Huda Youssef Al-Ghareeb, Rihab Abdullah Al-Wateyan. Job satisfaction in PHC Kuwait. World Family Medicine. 2019; 17(5): 4-15. DOI: 10.5742MEWFM.2019.93640

Abstract


Background:
Job satisfaction of staff is an important issue for performance of a health care system. The aim of our study was to assess employee satisfaction in Kuwait regarding their opinion of their job, training and development, adequacy of resources, interaction with patients and co-workers, degree of supervision and evaluation from supervisor and manager, overall experience regarding quality and safety, to determine the views and preferences of the health care personnel regarding the current health system, and the recent introduction of accreditation programme to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors (the key enablers and challenges to the implementation of accreditation) to identify possible strategies to improve implementation of accreditation in PHC in Kuwait and to identify the barriers and problems the employee faces in the primary health care centers in Kuwait and make appropriate recommendations in the light of the results of this study to help the decision-makers in solving the problems which can contribute to the development of policies regarding the health system and improve the quality and safety in PHC centers.

Methods:
This comparative cross sectional study was conducted in Kuwait in one year (September 2016 to September 2017) in 60 PHC centers in five health regions in Kuwait and surveyed 7,253 staff members who are working at the Primary Health Centers (physicians, nurses, pharmacists and assistant pharmacists, lab technician, x-ray technician, administrative) by using a designed self-administered employee satisfaction questionnaire.

Results:
The response rate for all staff was 55%; the highest respondent rate was for nurses ( 74%) and the lowest respondent rate was for administrative staff (34% ) and assistant nurses (34% ).

Conclusions: The presented results contribute to an understanding of factors that influence levels of satisfaction between primary health care staff and interventions need to be implemented in order to improve the level of job satisfaction among healthcare professionals.

Implementing accreditation is an important first step towards improving the quality and safety in PHC centers.

Key words: Job satisfaction, staff, accreditation, primary healthcare centres, Kuwait


INTRODUCTION

Kuwait is one of the leading countries that has adopted and implemented the PHC approach in the Middle East.

Primary health care services cover a wide range of health care that is provided for patients who are not admitted to the hospital. The growth of these services has been driven by patient desire to receive a service that is accessible at an appropriate cost, with a focus on health promotion and disease prevention (1). Primary health care centers serve the health care needs of their community and thus are integral to the well-being of these communities (1).

One increasingly employed method for promoting quality at the healthcare organizational level is accreditation (2, 3,4).

Accreditation of PHC practices was reported to increase emphasis on the role of PHC within the healthcare system and to ensure quality control and improvement (2, 5).

In 2012, the Kuwait Ministry of Health (MOH) launched the Primary Healthcare (PHC) Canadian accreditation program to improve quality across the continuum of care.

Accreditation contributes to increased job satisfaction among physicians, nurses, and other providers (6).

Accreditation is a process whereby an organization is assessed on a set of pre-determined standards. It intends to promote quality improvement through diverse approaches; they are either mandated by the government, voluntary or initiated by independent agencies (7).

Employees are considered as the wealth of each organization. Effectiveness and performance of organizations depend upon effectiveness and performance of the human workforce of that organization (8).

So the term “satisfaction” is a complex notion because it involves not only the personal experience and expectations, individual and social values but is also related behaviours, such as motivation, faithfulness, professional fulfillment, etc. and contains different meanings for each individual. In spite of this multi-lateral and complex structure, it is vital to ensure the satisfaction of the employees in the sectors like health care sector where intense, often long term, and emotionally charged labor and human relations take place, and thus measurement of this elusive and variable quality is necessary (9).

Job satisfaction is the contentment that employees get from the work they do and from the physical environment and the “atmosphere” existing in the environment. Because job satisfaction is an emotional notion, its perception differs from person to person (10).

Healthcare worker job satisfaction is a very important parameter that influences productivity as well as quality of work. This complex phenomenon is an attitude towards one’s job that has an impact not only on motivation, but also on career, health and relations with co-workers. Healthcare worker job satisfaction has a great impact on quality, effectiveness, and commitment to work and at the same time on healthcare costs (11).

Due to the importance of human resources in providing quality PHC services, it is integral for PHC leaders to assess their Quality of work life (QWL) and to understand their organizational and career intentions. Such procedures may assure the continuity and improvement of the health services being provided (12).

The study of primary care clinics is important because clinics are often the entry point for patients into a given medical system (13).

METHODS

Study design, setting, and duration:
This descriptive cross-sectional study was conducted over a period of one year (September 2016 to September 2017) in 60 PHC centers in five health regions in Kuwait, for all staff employees who are working at the Primary Health Centers (physicians, nurses, pharmacists and assistant pharmacists, lab technician, x-ray technician, administrative) by using a designed self-administered employee satisfaction questionnaire whereas semi-structured interviews were conducted with directors. The researcher was personally responsible for the distribution and collection of all questionnaires.

The number of staff members for each clinic was taken from the health statistics section in primary care central department of the Ministry of Health (MOH).

Sample:
Questionnaires were distributed to 60 PHC centers in the five Governmental Health regions to all full time PHC centers employees (physicians, nurses, technical and administrative staff). The respondents are those who completed more than 50% of the items of the questionnaire and the selected 60 PHC centers were representative of 106 PHC centers in Kuwait.

Inclusion and exclusion criteria:
The inclusion criteria were all employees at the PHCs who were available at the time of the study and willing to participate. The exclusion criteria were those who were not available, such as those who were on leave and those who decided to exercise their right not to participate.

Data collection Tool:
Components and details of the instrument:
Following permission from the MOH in Kuwait to conduct the study with ethical approval the survey was sent to the PHC centers through the principal investigator.

Data collection was conducted using a self–administered structured Questionnaire adapted from a tool used by Canadian accreditation with minor changes to the wording.

Only 3,969 of the 7,253 staff answered the questionnaire and returned it completed after distribution to 60 PHC centers in five health regions in Kuwait.

The highest percentage of staff response rate per health region was from Hawali (60%) and the lowest from Jahra (44%) as shown in Table 1.

A total of 74% of respondents were nurses,70% were X-ray technicians, 69% were lab and assistant technicians, 65% were pharmacists and assistant pharmacists, 59% were physicians and 34% were assistant nurses and administrative staff as shown in Table 2.

Overall grades of safety and Quality for all staff were all above 50% as shown in Table 3.

RESULTS

Only 3,969 of the 7,253 staff answered the questionnaire and returned it completed after distribution to 60 PHC centers in five health regions in Kuwait.

The highest percentage of staff response rate per health region was from Hawali (60%) and the lowest from Jahra (44%) as shown in Table 1.

A total of 74% of respondents were nurses,70% were X-ray technicians, 69% were lab and assistant technicians, 65% were pharmacists and assistant pharmacists, 59% were physicians and 34% were assistant nurses and administrative staff as shown in Table 2.

Overall grades of safety and Quality for all staff were all above 50% as shown in Table 3.

Separating the studied domains in physician job satisfaction questionnaire the main score of job satisfaction by order of preference obtained was as following: Safety and health 59.9±16.03; Your overall experience 41.5±12.1; Job nature (your job) 36.2±9.9; Your supervisor/manager 28.9 ± 6.2; Your Co-worker 16.5 ± 3.4; Training and development 7.3 ± 1.9; Your overall opinion: (Quality grade2.2 ± 0.83, Safety grade 2.1 ± 0.81 ). The highest and lowest domains were safety and health and Training and development respectively as shown in Table 4.

Separating the studied domains in Nurse job satisfaction questionnaire the main score of job satisfaction by order of preference obtained was as following: Safety and health 70.3±15.4; Job nature (your job) 43.0± 9.04; Your overall experience 41.1±10.9; Your Co-worker 17.0± 2.6; Your supervisor 12.6 ±2.1; Training and development 8.06 ± 1.6; Your overall opinion: (Quality grade 1.5 ±0.61, Safety grade 1.5 ± 0.67). The highest and lowest domains were Safety and health and Training and development respectively, as shown in Table 5.

Separating the studied domains in pharmacists and assistant pharmacists job satisfaction questionnaire, the main score of job satisfaction by order of preference obtained was as following: Job nature (your job) 41.2± 10.5; safety and health 38.2 ±7.9; Your overall experience 35.6 ±10.4; Your Co-worker 17.2± 2.9; Your manager (head of the clinic) 16.1±3.3; Your supervisor 12.8 ±0.11; Training and development 7.2 ± 1.9; Your overall opinion: (Quality grade 2.2 ±0.82, Safety grade 2.1±0.84 . The highest and lowest domains were Job nature (your job) and Training and development respectively, as shown in Table 6.

Separating the studied domains in administrative job satisfaction questionnaire, the main score of job satisfaction by order of preference obtained was as following: Job nature (your job) 30.5 ±8.4;, Your overall experience 18.2±5.5; Your manager (head of the clinic) 15.9±3.9; Safety and health 15.1± 4.3; Your supervisor 11.9±3.1; Your Co-worker 11.7±3.1; Training and development 7.3 ±2.3; Your overall opinion: (Quality grade 3.6±1.08, Safety grade 3.7±1.1). The highest and lowest domains were Job nature (your job) and Training and development respectively as shown in Table 7.

Separating the studied domains in Lab job satisfaction questionnaire ,the main score of job satisfaction by order of preference obtained was as following: Job nature (your job) 30.8 ±8.1; Your overall experience 17.3±5.4; Your manager (head of the clinic) 14.4±4.3; Safety and health 13.9± 4.5; Your supervisor 12.5±2.8; Your Co-worker 11.7±2.8; Training and development 7.4±2.2; Your overall opinion: (Quality grade 3.4±1.06, Safety grade 3.4±1.06). The highest and lowest domains were Job nature (your job) and Training and development respectively (Table 8).

Separating the studied domains in Assistant nurse job satisfaction questionnaire, the main score of job satisfaction by order of preference obtained was as following: Job nature (your job) 31.3 ±7.5; Your overall experience 19.2 ±4.8; Your manager (head of the clinic) 16.2±3.7; Safety and health 16.1± 3.08; Your supervisor 12.0±2.6; Your Co-worker 11.9±0.49; Training and development 7.6±1.6; Your overall opinion: (Quality grade 3.9±0.79, Safety grade 3.8±0.90). The highest and lowest domains were Job nature (your job) and Training and development respectively (Table 9).

Separating the studied domains in X-ray technician job satisfaction questionnaire, the main score of job satisfaction by order of preference obtained was as following: Job nature (your job) 34.6 ±6.1; Your overall experience 20.0 ±4.1; Your manager (head of the clinic) 17.2±2.45; Safety and health 16.9±2.9; Your Co-worker 13.2±2.09; Your supervisor 12.4±2.4; Training and development 8.5±1.6; Your overall opinion: (Quality grade 4.2±0.68, Safety grade 4.3± 0.7). The highest and lowest domains were Job nature (your job) and Training and development respectively as shown in Table 10.

Click here for Tables 1- 11

DISCUSSION

The results of the present study demonstrated that job satisfaction differs among different staff because of different dimensions which indicates that several dimensions are potential areas for improvement but with prioritization.

This study demonstrated the positive impact of accreditation on PHC centers in several areas of quality and performance.

Regarding the Job nature, all the staff were satisfied with ‘understanding their job description’, ‘ their decision to what to do in their work’, ‘their ability to make improvement in their work’, ‘the use of their skills to improve their job’, ‘receiving good recognition about their work ‘,’ having enough time to do what is expected of them in their job ‘ except administrative 40% (4.08±.86), ‘taking their opinion regarding changes affecting their job’ except physicians 49% (3.2±1.06), ‘the availability of materials ,supplies and equipment in their work’ except physicians 43% (3.04±1.1) and pharmacists 39% (2.9±1.1), only nurses and pharmacists were satisfied with ‘having enough staff to handle the workload’ in comparison to physicians who were not satisfied 42%( 2.9±1.2).

The reason behind dissatisfaction is the shortage of physician staff which affects the nature of a PHC doctor’s work and the expectation from the supervisors would be higher in checking and providing the materials, supplies and equipment.

Regarding Staff Training and development, all the staff were satisfied in ‘receiving good training in their job’ (highest for nurses and X-ray technicians and lowest for pharmacists and administrative staff)’ all the staff were satisfied in ‘having good opportunities to improve their care’ (highest for X-ray technicians and nurses and lowest for physicians and pharmacists).
The majority of Staff were more satisfied with the training and development domain.

Regarding co-worker opinion, all the staff were satisfied in ‘people treating each other with respect’, ‘supporting one another in the department’, ’a feeling of belonging to this co-worker’, in addition physicians, nurses and pharmacists were satisfied ‘when they work together as a team to get the work done when a lot of work needs to be done quickly’.

The majority of staff were satisfied with ‘working with co-workers’ domain.

Regarding supervisor/manager opinion, all the staff were satisfied with ‘fair treatment from their supervisor /manager’ (highest for pharmacists and nurses and lowest for assistant nurses and lab technicians), ‘providing the staff with feedback about job performance’ (highest for nurses and lowest for administrative staff and assistant nurses),’ asking supervisor/manager if they face any difficulties’ (highest for nurses and lowest for administrative staff), in effective application of supervisor /manager on the organization’s goals’ (highest X-ray technicians and nurses and lowest for lab and administrative staff), ‘commitment of providing high quality care’ (highest for X-ray technicians and nurses and lowest for lab and administrative staff), ’regarding action of supervisor/manager on staff feedback’ (highest X-ray technicians and nurses and lowest administrative staff), ’in commission of supervisor /manager to provide a safe and healthy workplace’ (highest in X-rays technicians and nurses and assistant nurses and lowest in administrative staff).

The majority of staff were satisfied with their opinion for their supervisor/manager domain.

Regarding Safety and health, it differed according to each staff position as pharmacists had their own questions:All the staff were satisfied ‘in taking effective action in the organization to prevent violence in the workplace’ (highest X-ray technicians and nurses and lowest lab technician), in ‘taking effective action in the organization to prevent abuse in the workplace’ except Lab technicians 48% ( 3.2±1.1), in ‘making balance between staff family and personal life with their work performance’ (highest in X-ray technicians and assistant nurses and lowest in Lab technicians and physicians). Administrative, lab technicians, assistant nurses and X-ray technicians were satisfied in ’work in a safe clinic’ (highest in X-ray technicians and lower in lab technicians).

Regarding the other statements of safety and health applied for physician and nurses, both groups were satisfied with ‘doing things to improve patient safety’, ‘mistakes have led to positive changes in their clinic’, ‘evaluate their effectiveness after the staff make changes to improve patient safety’, ‘Patient safety is never sacrificed to get more work done’, ‘Staff worry that mistakes they make are kept in their personnel file’, ’procedures and systems are good at preventing errors from happening’, ‘staff are given feedback about changes put into place based on event reports’, ‘Staff will freely speak up if they see something that may negatively affect patient care’, ‘staff are informed about errors that happen in their departments’, ‘Staff feel free to question the decisions or actions of those with more authority’, ‘staff discuss ways to prevent errors from happening again in their clinic’.

Physicians were unsatisfied regarding their ‘feeling about that mistakes were held against them’ 42% (3.2±.96), Physicians and nurses were unsatisfied in ‘presence of patient safety problems in their clinics’ physician 32% (2.7±1.1), nurses 40% (2.9±1.1), Physicians and nurses were unsatisfied in ‘Staff fear to ask questions when something does not seem right’ physicians 22% (2.5±1.06) and nurses 42% (3.0±1.6), nurses are unsatisfied in ‘letting the same mistakes happen again and again in the nursing general department’ 15% (2.1±1.03).

Regarding safety and response to mistakes in pharmacy, pharmacists and assistant pharmacists were unsatisfied in ‘this pharmacy places more emphasis on prescription than on patient safety ‘35% (2.7±1.2), ‘staff feeling that their mistakes are held against them’ 39% (2.8±1.1).

There are several safety culture dimensions which are potential areas for improvement but with prioritisation; letting the same mistakes happen again and again in the nursing general department (15%). Physicians and nurses were unsatisfied with regarding Staff fear to ask questions when something does not seem right (22%). Physicians and nurses were unsatisfied with regarding presence of patient safety problems in