Employee Satisfaction in The Health Care SectorA C

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Employee Satisfaction in the Health Care SectorA

Comparative Study of Private and Public Health
Care Organisations in th....
Article in Journal of Health Management · March 2010

DOI: 10.1177/097206340901200103
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Employee Satisfaction in the Health Care Sector: A Comparative

Study of Private and Public Health Care Organisations in the UAE
Belal Barhem, Hassan Younies and Mustafa Younis
Journal of Health Management 2010; 12; 19
DOI: 10.1177/097206340901200103
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Employee Satisfaction in the Health Care Sector 19
Employee Satisfaction in the Health

Care Sector: A Comparative Study
of Private and Public Health Care
Organisations in the UAE
Belal Barhem, Hassan Younies and Mustafa Younis
Health care workers play a vital role in patients’ well-being. Their satisfaction is an important
issue for all health care managers. Health care providers can be categorised into two groups on
the basis of their financial goals and sources of funding. The two categories are: not-for-profit
(NFP) publicly funded organisations; and for-profit (FP) privately funded organisations.
In the United Arab Emirates (UAE), FP and NFP health care organisations operate under
similar government regulations and workforce diversity. However, the objectives and source
of funds for FP and NFP health care organisations always affect the management style and
decisions. These differences—in addition to differences related to job satisfaction and personal
development—such as medical equipment, materials, facilities and the availability of support
staff, have an impact on the satisfaction of health care workers.
In our study, we investigate the major factors affecting health care workers’ satisfaction
level within private and public health organisations in the UAE. Differences in satisfaction
level based on gender, ethnicity, work type and organisation size are studied. The findings of
the study show a medium level of satisfaction in the private and public sectors, with differences
in all satisfaction dimensions between both sectors except for nature of job. Organisation size,
too, seems to affect the satisfaction level.
Introduction
The United Arab Emirates (UAE) proposes a unique working environment.

The workforce in the UAE comes from almost every corner of the world,
imposing a multicultural environment (Al-Shaikh 2001). The workforce
Acknowledgement: This research was supported by a UAE University, Grant # 02-03-4-11/06.
The authors would like to thank the anonymous reviewers for their comments.
Journal of Health Management, 12, 1 (2010): 19–38

SAGE Publications Los Angeles z London z New Delhi z Singapore z Washington DC
DOI: 10.1177/097206340901200103

20 Belal Barhem, Hassan Younies and Mustafa Younis
diversity brings with it diverse working ethics, cultural backgrounds,

working behaviour and attitudes. Managers need to use a customised set of
motivational tools that work with their workers’ backgrounds. In addition
to that, there are many similarities between UAE and the other Arab gulf
countries in terms of workforce diversity and labour laws. Any study about job
satisfaction in UAE can serve as a template for other Arab gulf countries.
Employees’ experience at work is the major source of their positive or
negative feeling towards their jobs. If employees’ job expectations are met,
they would be satisfied, else job dissatisfaction occurs. Different dimensions
of job satisfaction exist, including job itself, recognition and wages. Zellars
et al. (2001) reported that collective efficacy was associated with higher
levels of job satisfaction among nurses. Khurshid et al. (2005) reported a
relationship between dissatisfaction and turnover among nurses. Other lit-
erature showed that job satisfaction has an effect on turnover and retention,
absenteeism and performance (Hellman 1997; Strachota et al. 2003,
among others).
Schermerhorn et al. (2003: 164) integrated motivation, performance and
satisfaction into one model. While performance and satisfaction appear to be
separate in this model, they are interrelated. A higher job satisfaction level
would result in higher work performance (Schermerhorn et al. 2003: 14).
The relationship between motivation and satisfaction is more clear in the
two-factor theory by Herzberg (1968). The theory states that the opposite
of job satisfaction is no job satisfaction and the opposite of dissatisfaction
is no job dissatisfaction. The theory differentiates between two kinds of
motivational factors that lead to satisfaction and dissatisfaction. The first
are external factors which affect employee dissatisfaction, while the latter are
internal factors that affect employee satisfaction. While the first term can
be related to material factors, the second is related to non-material working
conditions such as management style, recognition and leadership style.
The differentiation of these two factors was also discussed in Deci (1975).
Deci proposed two kinds of motivational factor, intrinsic and extrinsic
factors. Behaviours which are motivated by the need for competence and
self-determination are considered intrinsic factors, while those which are
motivated by reward are considered extrinsic factors. The relationship between
the intrinsic and extrinsic motivation is discussed in Dremer (1975).
Organisations could influence these intrinsic and extrinsic factors through
a reward and recognition system. According to Hansen et al. (2002: 67): ‘An
organization needs a reward strategy for the specific behaviours driven by

extrinsic motivation and a recognition strategy for those behaviours driven

by intrinsic motivation’.
Other factors such as organisation size could have an effect on job satis-
faction. Holland et al. (1987) show that hospital size, with the ability to
get up the job ladder has a positive influence on motivation. Hayes’ (1993)
two-part questionnaire revealed the need to satisfy top management nurses.
Respondents agreed that long-term employees have a need for special training,
continuing education and job enrichment. In addition, the survey showed
that good working relationships, good benefits and an environment of pro-
fessional practice are the most important factors that affect retention.
Some evidence of gender differences as a factor affecting career develop-
ment is provided by the study of Walsh and Borkowski (1995). The study by
Khurshid et al. (2005) reveals that the most satisfying factors were: working
with an internationally reputable organisation, patients’ positive feedback
and the availability of required material or equipment. Another study by
Timmreck (2001) finds that autonomy, clinical decision making, considerate
scheduling and professional growth are very important factors in promoting
job satisfaction in health care organisations. In health care organisations, the
employees are mostly looking for continuous development through training
courses and other development tools.
All the above mentioned studies investigated different motivating vari-
ables in the health care sector in different environments, mainly in countries
where the workforce is homogeneous or the workforce working conditions
do not vary widely. Our study will investigate a set of factors influencing the
level of job satisfaction in the diverse UAE health care environment, with
comparative aspects which have never been explored hitherto. To conduct
the study, the researchers adopted the following objectives: first, to compare
the levels of job satisfaction in private and public health care organisations
in UAE; second, to determine the major factors influencing motivation in
private and public health care organisations in the UAE and finally, to test
the relationship between motivation and demographic variables.
Health Care in the UAE
The UAE is a federation of seven emirates, varying in population and wealth

distribution. The population distribution and breakdown according to gender
and nationality are shown in Table 1 and Table 2, respectively.

Table 1
Population Distribution in the UAE
Emirate Male Female Population

Abu Dhabi∗ 1,199,000 479,000 1,678,000
Dubai 903,000 403,000 1,306,000
Sharjah 434,000 244,000 678,000
Ras Al-Khaimah (RAK) 121,000 84,000 205,000
Ajman 153,000 105,000 258,000
Al-Fujeira 79,000 48,000 127,000
Umm al-Qaiwain(UAQ) 40,000 28,000 68,000
Source: 2004 Statistics, Ministry of Health.

Note: ∗Abu Dhabi’s population is distributed over three main regions, Abu Dhabi, Al Ain
and the western region.
Table 2
Population Breakdown in the UAE
Category Male (%) Female (%) Total (%)

UAE citizens 50.6% (418,057) 49.3% (406,864) 21.9% (824,921)
Other nationalities 72.3% (2,128,986) 27.7% (815,173) 78.1% (2,944,159)
Total 67.6% (2,547,043) 32.4% (1,222,037) 100% (3,769,080)
Health care is a major concern for the UAE government. It works hard to
develop this service to ensure that the highest level of health care is delivered
to the people, but, at the same time, the government has recently encouraged
the private sector to invest in health services and 20 new private hospitals are
expected in the UAE in the next two years. Health care in UAE can be divided
into public and private sectors, where the public sector plays the leading
role in health care delivery and services. A comparative study of the quality
of UAE public and private health care systems revealed that public health
care outscored the private sector (Jabnoum and Chaker 2003).
The majority of health care workers are expatriates. Table 3 shows the
manpower, by nationality, in the public and private health care sectors
(UAE 2004). The UAE citizens are fully covered by the government through
the public health care system and, when necessary, by overseas treatment,
while non-UAE nationals must pay for all health care services in the private
sector and a subsidised fee in the public sector.

Table 3
Health Care Workers Breakdown into Private and Public Sectors
Nationality Public Private

Citizens 4,165 –
Non-citizens 11,751 6,923
The distribution of medical clinics and hospitals in the UAE present the
same ratios as shown in Table 4.
Table 4
Distribution of Medical Clinics and Hospitals in the UAE
Government hospitals
Emirate Private hospitals Private clinics Public hospitals other than MOH
Abu Dhabi 11 432 12 7
Dubai 13 485 2 6
Sharjah 3 383 5 0
Ajman 1 75 1 0
UAQ 0 13 1 0
RAK 1 71 4 0
Al-Fujeira 0 21 2 0
Total 28 1,479 27 13
Source: 2001–2004 Statistics, Ministry of Health.
The huge growth in the UAE private health sector is the result of govern-
mental policies to rely more on the private sector in providing such services.
Table 5 presents some statistics of growth in the private health sector in
the UAE.
Table 5
Growth of the Private Health Care Sector
Subject 2001 2004 Growth

Total number of employees in the private health care system 5,715 9,180 60%
Number of private hospitals 23 29 26%
Number of private clinics and centres 1,148 1,479 28.8%
Source: 2001–2004 Statistics, Ministry of Health.

Research Methodology
This study investigates factors influencing health care employees’ satisfaction
and motivation in the health care organisations in the UAE. Data were col-
lected by a questionnaire consisting of three parts and 55 statements. The
first two parts were intended to measure the employees’ opinions about the
investigated variables using a 5-point Likert-type scale (ranging from ‘strongly
disagree’ to ‘strongly agree’), that is, the respondents were asked to respond
to each of the statements by indicating whether they agreed or disagreed
with them. While the third part was for collecting other demographic data
and respondents’ profile.
Because of the variance in wage structure between locals and expatriates
and the lack of a material reward system for expatriates, we focused our
study on the non-material satisfaction factors. The study investigated health
care employees’ opinions of their job satisfaction by assessing the overall
satisfaction level and the job satisfaction which related to non-material
motivators such as the nature of the job, organisational support, leadership
style, job clarity and career development in both the private and public
sectors. The study also tested the influence of personal differences on the
job satisfaction level.
To achieve the above objectives, the study would address the following
question:
H0: There are no significant difference between satisfaction levels in

private and public health care sectors
In addition, we will investigate whether the following variables: nature of the

job, organisational support, leadership style, job clarity and career develop-
ment are related significantly to job satisfaction level. Do these variables vary
significantly between the private and public sectors in the health care or-
ganisations in the UAE? Finally, is there any significant relationship be-
tween job satisfaction level and personal characteristics in the health care
organisations in the UAE?
Sampling Frame
The data were collected through a questionnaire which was distributed

randomly in the seven different emirates in the UAE. A set of questionnaires
were distributed to each emirate reflecting the percentage of health care
worker in that emirate. Private and public health organisations (a total of

18 hospitals) were covered in the operation. The questionnaires were delivered

and collected by hand in all the emirates to a convenient random sample
performing all types of tasks at all levels in the same organisation. A total
of 377 employees participated in the study, 129 from the private sector and
248 from the public sector. A couple of private hospitals in Dubai and Al-Ain
refused to cooperate with the researchers.
Table 6 presents the respondents’ profile: 63 per cent were from the public
sector and 35 per cent from the private sector. The statistics related to the
semi-public organisations will be ignored because of the small number of
respondents.
Table 6
Respondents’ Profile (n = 377)
Profile Category Frequency Per cent

Type Public 238 63.1
Private 132 35
Semi-public 7 1.9
Age <20 years 14 3.7
21–25 84 22.3
26–30 years 97 25.7
31–35 years 64 17
36–40 years 41 10.9
41–50 48 12.7
>50 years 29 7.7
Education Certificate/diploma 94 24.9
Professional 52 13.8
Bachelor’s 161 42.7
MD 24 6.4
Master’s 35 9.3
PhD 11 2.9
Experience <3 years 116 30.8
3–5 years 60 15.9
5–10 years 87 23.1
>10 years 114 30.2
Marital status Single 135 35.8
Married 227 60.2
Divorced 5 1.3
Separated 10 2.7
Gender Male 120 31.8
Female 257 68.2
(Table 6 continued )

(Table 6 continued )
Profile Category Frequency Per cent

Ethnicity Arab 184 48.8
Asians 84 22.3
Indians 72 19.1
Others 37 9.8
Children 1–2 126 33.4
3–5 86 22.8
6 or more 11 2.9
No children 154 40.8
Size <100 60 15.9
100–200 63 16.7
200–500 83 22
More than 500 171 45.4
Task Administration 76 20.2
Physician 80 21.2
Laboratorial 16 4.2
Nursing 135 35.8
Technician 35 9.3
Others 35 9.3
Respondents were chosen from all the different emirates. Forty-eight per cent
of the respondents were Arab participants and Asian people took second
place with 22 per cent. Most organisations prefer to hire staff from southeast
Asia and India because they are qualified and cost less than staff from
elsewhere. Sixty-eight per cent of the respondents were female and most of
the respondents were married, with no children. The level of education ranged
from secondary to post-graduate, with most staff holding a bachelor’s degree.
The ages of the sample ranged from 25 to over 50 years, but unfortunately, a
large portion of the respondents (31 per cent) reported less than three years
of working experience. Overwhelmingly, the majority (from both sectors)
were working in nursing, the second most popular occupation being that of
a physician. Respondents’ work experience ranged from three years to over
12 years (30 per cent of respondents). Most of the organisations represented
had more than 500 employees each.
Analysis and Results

Reliability analysis of the study reported high reliability coefficients alpha, as
shown in Table 7. Cronbach’s Alpha, as a tool, scores the highest reliability

Table 7
Reliability Statistics for the Tool of the Study
Organisation Part Cronbach’s alpha No. of items

Private 1 0.955 37
2 0.876 6
Public 1 0.958 37
2 0.91 6
Total sample 1 0.956 37
2 0.90 6
Overall sample 0.867 43
level in Part 1 of the study in the public sector; the other reliability tests are
also statistically acceptable.
Table 8 summarises the cross-tabulation analysis for job satisfaction level
for the dependent variables for private and public health care employees in
the UAE. The table reveals that most of the employees in the public sector
feel a medium level of overall satisfaction with the nature of the job, or-
ganisational support and leadership style in a ratio of 0.44, 0.51, 0.38 and
0.39, respectively. On the other hand, private sector employees feel a medium
level of satisfaction with the nature of the job in a ratio of 0.55. In terms of a
high job satisfaction level, it exists in the public sector as a result of job clarity;
and in the private sector, as a result of overall satisfaction, organisational
support, leadership style, job clarity and career development.
Table 9 presents the cross-tabulation for the job satisfaction level for the
dependent variables per sector and ethnicity. The analysis revealed that most
of the Arab employees in the public sector feel a medium level of overall
satisfaction. In the private sector for the (Arabs) ethnicity, organizational
support and leadership style are on the high side and the nature of the job is
on the medium side. The majority of the Asians and Indian, in the private
sector, feel a high level of overall satisfaction compared to Asians in public
sectors. This may be due the fact that private sector, in UAE, is mostly
dominated by Asian and Indians.
The cross-tabulation analysis for satisfaction level with the dependent
variables for the sector and the nature of the job among health care employees
in the UAE is shown in Table 10. Most of the administrators and physicians
in both sectors experience a high level of job satisfaction, while most of the
laboratory staff express a medium level of satisfaction with the nature of
the job. The nursing staff in the public sector experience a medium level

Table 8
Cross-tabulation Analysis for the Satisfaction Level for the
Dependent Variables of Private and Public Health Care Employees in the UAE
Organisation
Dependent variables Level Public Private Semi-public Per cent Cumulative per cent Total
Overall satisfaction Low 54 (0.27) 16 (0.12) 1 18.8 18.8 71
Medium 105 (0.44) 40 (0.3) 4 39.5 58.4 149
High 79 (0.33) 76 (0.58) 2 41.6 100.0 157
Nature of the job Low 48 (0.2) 21 (0.16) 2 18.8 18.8 71
Medium 123 (0.51) 73 (0.55) 4 53.1 71.9 200
High 67 (0.28) 38 (0.29) 1 28.1 100 106
Organisational support Low 57 (0.24) 17 (0.13) 0 19.6 19.6 74
Medium 90 (0.38) 34 (0.26) 4 34 53.6 128
High 91 (0.38) 81 (0.61) 3 46.4 100 175
Leadership style Low 71 (0.3) 25 (0.19) 3 26.3 26.3 99
Medium 93 (0.39) 50 (0.38) 2 38.5 64.7 145
High 74 (0.31) 57 (0.43) 2 35.3 100 133
Job clarity Low 51 (0.21) 15 (0.11) 1 17.8 17.8 67
Medium 89 (0.38) 49 (0.37) 1 36.9 54.6 139
High 98 (0.41) 68 (0.52) 5 45.4 100 171
Career development Low 85 (0.36) 21 (0.16) 2 28.6 28.6 108

Medium 74 (0.31) 50 (0.38) 3 33.7 62.3 127
High 79 (0.33) 61 (0.41) 2 37.7 100 142
Total 238 132 7 100 377
Note: Figures in parenthesis indicate frequency and ratios.

Table 9
Cross-tabulation Analysis of the Satisfaction Level for the Dependent Variables for
Sector and Ethnicity among Health Care Employees in the UAE
Arab Asian Indian Others

Ethnicity organisation Level Public Private Public Private Public Private Public Private
Overall satisfaction Low 34 6 11 7 5 3 4 0
Medium 62 8 16 15 12 13 15 4
High 55 18 8 26 14 20 2 12
Nature of the job Low 33 2 8 12 6 6 1 1
Medium 80 22 15 22 13 21 15 8
High 38 8 12 14 12 9 5 7
Organisational support Low 39 6 11 8 3 2 4 1
Medium 58 8 10 11 15 12 7 3
High 54 18 14 29 13 22 10 12
Leadership style Low 45 4 13 12 6 7 7 2
Medium 56 13 13 17 13 14 11 6
High 50 15 9 19 12 15 3 8
Job clarity Low 37 2 9 9 1 3 4 1
Medium 51 15 16 19 10 11 12 4

High 63 15 10 20 20 22 5 11
Career development Low 59 8 17 11 5 1 4 1
Medium 45 9 6 19 12 13 11 9
High 47 15 12 18 14 22 6 6
Table 10
Cross-tabulation Analysis for the Level of Satisfaction with the Dependent Variables for the
Sector and Nature of the Job among Health Care Employees in the UAE
Administration Physician Laboratorial Nursing Technician Other

Satisfaction Level Public Private Public Private Public Private Public Private Public Private Public Private
Overall satisfaction Low 6 2 11 3 3 1 26 3 6 2 2 5
Medium 17 10 19 4 4 4 52 13 9 4 4 5
High 25 16 28 15 1 1 16 20 3 11 6 13
Nature of the job Low 7 6 7 2 1 1 28 7 2 2 3 3
Medium 24 16 36 14 5 5 41 17 12 7 5 14
High 17 6 15 6 2 0 25 12 4 8 4 6
Organisational support Low 6 3 15 2 2 0 28 4 2 1 4 7
Medium 14 6 18 6 4 2 42 11 11 3 1 6
High 28 19 25 14 2 4 24 21 5 13 7 10
Leadership style Low 8 7 15 5 6 3 31 6 7 1 4 3
Medium 14 10 24 7 0 3 46 13 7 8 2 9
High 26 11 19 10 2 0 17 17 4 8 6 11
Job clarity Low 6 4 12 3 1 0 23 4 7 1 2 3
Medium 17 14 18 2 5 2 40 12 4 8 5 11
High 25 10 28 17 2 4 31 20 7 8 5 9

Career development Low 14 4 22 0 4 2 32 7 11 0 2 8
Medium 10 11 15 6 2 4 40 13 4 7 3 9
High 24 13 21 16 2 0 22 16 3 10 7 6
of overall satisfaction, but in the private sector, they feel a high level of
satisfaction; the technicians express the same opinions in the two sectors as
do the nursing staff. Most of the different employees in both the sectors ex-
perience a medium level of job satisfaction with the nature of the job, and a
majority in both sectors experience a high level of job satisfaction with the
organisational support.
In terms of the level of job satisfaction with the leadership style, the cases
differ according to profession. In the case of laboratory staff in the private
sector, we notice that none of the respondents show a high level of satisfaction,
nor are they satisfied with the career development prospects. In contrast, the
majority in both sectors experience a high level of job satisfaction with their
career development prospects.
Table 11 presents the means and standard deviation statistics for the job
satisfaction level in all dimensions for private and public health care employees
in the UAE. The general mean for overall satisfaction level for all sample
members is in the middle level (3.33). It is clear that the job satisfaction level
relating to the investigated variables is not the required level; the non-material
sources of satisfaction seem to be moderately significant to the health care
employees in the UAE. The public sector employees’ overall job satisfaction
is, on average, less than the satisfaction in the private sector.
Table 11
Means and Standard Deviation Statistics for the Job Satisfaction Level in all
Dimensions for Private and Public Health Care Employees in the UAE
General (n = 377) Private (n = 139) Public (n = 238)

Std. Std. Std.
Satisfaction Mean deviation Mean deviation Mean deviation
Overall satisfaction 3.3313 0.9033 3.5931 0.8868 3.1893 0.8841
Nature of the job 3.2069 1.0217 3.4318 1.0027 3.0882 1.0160
Organisational support 3.2129 0.7252 3.2500 0.7414 3.1975 0.7166
Leadership style 3.3826 0.8674 3.5114 0.8216 3.3093 0.8865
Job clarity 3.3270 0.9277 3.613 0.9285 3.1645 0.8897
Career development 3.1967 1.0336 3.447 0.9141 3.0665 1.0781
General mean 3.474 3.169
The private sector employees are more satisfied than the public sector in
all dimensions of the study with job clarity ranked first; contrastingly, in the
public health organisations, the employees ranked job clarity at lower level.

The t test and the p values for satisfaction dimensions in terms of the
sector are shown in Tables 12 and 13 respectively. The differences in all
the satisfaction dimensions between the public and private health sectors in
the UAE were significant except for nature of job. In general, the overall job
satisfaction level in health care organisations in the public and private sectors
in the UAE shows a significant difference.
Table 12
Mean Tests for Satisfaction Level in Terms of the Sector
Mean
Satisfaction term Private Public t value sig 95% CI interval
Overall satisfaction 3.5931 3.1893 –4.200 0.00 –0.59289, –0.21476
Leadership style 3.5114 3.3093 –3.132 0.002 –0.55930, –0.12786
Nature of the job 3.4318 3.0882 –0.666 0.506 –0.20760, 0.10256
Job clarity 3.613 3.1645 –2.155 0.032 –0.38632, –0.01771
Organisational support 3.2500 3.1975 –4.543 0.00 –0.64361, –0.25473
Career development 3.447 3.0665 –3.427 0.001 –0.59873, –0.16215
Table 13
Mean Tests for Satisfaction Level in Terms of Gender
Mean
Satisfaction term Male Female t value sig 95% CI interval
Overall satisfaction 3.3057 3.343 –0.375 0.708 –0.23415, 0.15907
Leadership style 3.1063 3.2539 –1.301 0.192 –0.36955, 0.07427
Nature of the job 3.137 3.248 –1.381 0.168 –0.26802, 0.04691
Job clarity 3.372 3.3872 –0.148 0.0142 –0.20307, 0.17458
Organisational support 3.2667 3.3552 –0.863 0.389 –0.29029, 0.11323
Career development 3.1194 3.2328 –0.992 0.322 –0.33809, 0.11135
Thus, the answer to the first question—whether there were any differences
between job satisfaction levels among the health care employees in the private
and the public sectors in the UAE—is that the two sectors provide a general
medium level of job satisfaction with significant differences in satisfaction
levels, except for the nature of job.
In terms of the single dimensions of job satisfaction, we find no differences
according to gender. Male and female in both sectors reported no significant
mean differences for the different dimensions of job satisfaction.

Table 14 shows a significant difference between the satisfaction levels

according to organisation size, except for nature of job. Overall, satisfaction
levels are higher in smaller organisation than large ones. It seems that smaller or-
ganisations have better communication between management and employees,
with better results in leadership style, organisational support and a significant
difference in career development. Considering the fact that public organisation
are mainly the ones with 500 or more employees, we can conclude that private
sector outperforms public sector in all satisfaction dimensions except nature of
job. Further analysis shows that the highest satisfaction level in all dimensions
occur for organisation size between 100–200 employees.
Table 14
Mean Tests for Satisfaction Level in Terms of Organisation Size
Mean
Satisfaction term <100 >500 t value sig 95% CI interval
Overall satisfaction 3.5645 3.0746 3.692 0.000 0.22648, 0.75339
Leadership style 3.3375 3.0102 2.207 0.030 0.03313, 0.62140
Nature of the job 3.2208 3.1564 0.547 0.586 –0.16991, 0.29872
Job clarity 3.5292 3.1754 2.632 0.010 0.08677, 0.62069
Organisational support 3.6619 3.0827 4.246 0.000 0.30835, 0.85005
Career development 3.4139 2.9474 3.073 0.003 0.16537, 0.76767
Table 15 summarises the regression analysis for the relationship between

the dependent and independent variables for the overall job satisfaction
level. In general, the model which includes leadership style, job clarity,
organisational support, nature of job and career development can explain
at least 60 per cent of the changes in the total satisfaction. The first model,
including the leadership style factor, can alone explain 47 per cent of the
changes in the overall satisfaction. The job satisfaction level of the health care
employees in the UAE was determined mostly by the leadership style and job
clarity. The changes of all dependent variables were influenced significantly
by one or more independent variables.
Table 16 presents the regression analysis for the relationship between the
dependent and the independent variables for male and female employees.
Fifty per cent of the male employees’ satisfaction in both sectors is due to the
leadership style and 62 per cent is due to the leadership style and job clarity
considered together. The model better explains the satisfaction factors for
female employees than for male employees.

Table 15
Regression Analysis for the Relationship between
Overall Satisfaction and the Independent Variables
Model R R-square Adjusted R-square Std. error of the estimate

1 0.688(a) 0.473 0.472 0.54106
2 0.774(b) 0.6 0.597 0.47236
3 0.787(c) 0.619 0.616 0.46118
4 0.794(d) 0.631 0.627 0.45471
5 0.798(e) 0.637 0.632 0.45134
Notes: (a) Predictors: (Constant), Leadership style

(b) Predictors: (Constant), Leadership style, Job clarity
(c) Predictors: (Constant), Leadership style, Job clarity, Organisational support
(d) Predictors: (Constant), Leadership style, Job clarity, Organisational support,
Nature of job
(e) Predictors: (Constant), Leadership style, Job clarity, Organisational support,
Nature of job, Career development.
Table 16
Regression Analysis for the Relationship between the
Dependent and the Independent Variables for Male Employees
Model–male R R-square Adjusted R-square Std. error of the estimate

1 0.706(a) 0.498 0.494 0.56324
2 0.786(b) 0.618 0.612 0.49338
3 0.799(c) 0.638 0.629 0.48249
4 0.810(d) 0.656 0.644 0.47208
Model–female
1 0.766(a) 0.588 0.587 0.59274
2 0.837(b) 0.700 0.698 0.50699
3 0.843(c) 0.711 0.707 0.49873
4 0.846(d) 0.716 0.711 0.49549

Career development.
Regression analysis for the public sector health employees’ satisfaction

reveals that 66 per cent of the changes in the satisfaction level are due to

leadership style and job clarity (Table 17). The whole model can explain
68 per cent of the change in the overall satisfaction; while in the private
sector, the first model which includes job clarity can explain 55 per cent of
the changes in the dependent variable and the second model which includes
job clarity and leadership style can explain 46 per cent of the changes in the
dependent variable. The results comply with the mean test results.
Table 17
Regression Analysis for the Relationship between the
Dependent and the Independent Variables for the Sector
Model R R-square Adjusted R-square Std. error of the estimate

Public 1 0.740(a) 0.547 0.545 0.5002
2 0.815(b) 0.664 0.661 0.43153
3 0.820(c) 0.673 0.669 0.42672
4 0.825(d) 0.68 0.675 0.4229

Nature of job.
Private 1 0.584(a) 0.341 0.336 0.57281

2 0.678(b) 0.460 0.452 0.52046
3 0.706(c) 0.498 0.486 0.50394
4 0.721(d) 0.519 0.504 0.49501
Notes: (a) Predictors: (Constant), Job clarity

(b) Predictors: (Constant), Job clarity, Leadership style
(c) Predictors: (Constant), Job clarity, Leadership style, Nature of job,
(d) Predictors: (Constant), Job clarity, Leadership style, Nature of job, Organisational
support
The changes in the job satisfaction level of health care employees due to
the dependent variables in the public sector are more closely related to the in-
dependent variables investigated in the study. Sixty-eight per cent of the changes
in the overall job satisfaction level in the public sector is due to the independent
variables, while the changes in the same variable in the private sector
(R 2 = 0.52) are caused less by the independent variables. However, 34 per
cent of the changes in the overall job satisfaction in the private sector are due
in the first place to the independent variable of job clarity.

Conclusion/Recommendations
The general mean for the satisfaction level for all sample members shows
a medium level of satisfaction for both the private and public sectors.
There were differences in all the satisfaction dimensions between the public
and private health sectors in the UAE, except in the case of job nature. Public
sector should act to improve the satisfaction level of its employees.
The same difference was also found in satisfaction according to organ-
isation size, as reported by Holland et al. (1987). However, it seems that
medium-sized health care organisations, with a size of 100–200 employees,
provide better non-material satisfaction factors to their employees than bigger
organisations of public sector. Medium-sized private sector organisation
seems to provide better management style and more chance to its employees
to move up the job ladder than the large-sized public sector organisations.
The health authorities should investigate the management style currently
in place. The study did not reveal any significant difference in satisfaction
levels in terms of gender.
Most of the administrators, in both the sectors, experienced a high level of
job satisfaction, due to the dependent variables investigated in the study. The
majority of the physicians in the two sectors also feel a high level of overall
job satisfaction, while most of the laboratory staff expressed a medium level
of satisfaction as a result of the nature of the job. Nursing staff in the public
sector experience a medium level of overall satisfaction but in the private
sector, they have a high level of overall satisfaction; the technicians express
the same opinion as the nursing staff in the two sectors. Arab employees in the
public sector feel a medium level of overall satisfaction; in the private sector,
they feel satisfaction with the nature of the job, organisational support and
leadership style. The majority of the Asians in the private sector feel a medium
level of satisfaction with most of the dependent variables. The health care
managers in the UAE should give more attention to the employees of Asian
origin to increase their feeling of job satisfaction. However, most of the Indian
employees in the private sector feel a high level of satisfaction. The other
nationalities reported a medium level of job satisfaction, due to the factors
investigated, in both sectors. The results do not lead to the conclusion that
maximum reliance should be placed on the Indian health care employees;
we recommend hiring qualified staff from elsewhere, even if it increases
operating costs.

Regression analysis shows that the factors could explain 65–71 per cent of
the overall satisfaction. This can be explained by the lack of material factors
(reward and recognition) in this study. As shown in Younies et al. (2008), health
care workers in UAE ranked material factors prior to non-material factors.
The regression analysis shows that the factors used in this study can
better explain the satisfaction of female employees than the male employees.
Female employees are usually concerned with job environment more than the
material rewards. Similar analogy can be applied to the regression analysis in
public and private sectors. The analysis shows that other factors play a role
in the private sector health care workers’ satisfaction. Public sector health
care workers in UAE, in general, are better paid than the private sector, and
material factors are more fulfilled than their peers in private sector.
The necessary governmental development in the health care rules and
regulations in the UAE can override such divergence. Trade unions can pro-
vide a convenient reference to protect the employees’ rights and contribute
to increase their job satisfaction.
The UAE should implement a serious new strategy to ensure development
in the human resource (HR) aspect of this sector. It is not enough to provide
the latest technology and equipment in the health care services to guarantee
excellent service. The employees who work on this technology need to feel
satisfied, otherwise their performance will not be according to the best
standards and the results will be reflected in their treatment of patients.
The UAE government can issue new rules to provide the proper tools
to develop the careers of public health care employees. It is a fact that the
majority of public health employees are foreigners, and the government
rules specify direct HR development for UAE national employees. The gov-
ernment needs to play a role, also, in developing the careers of non-local
employees. In addition, the other material satisfaction dimension needs to
be taken into account.
References
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Belal Barhem is Assistant Professor in College of Business Administration, Abu Dhabi University,
P.O. Box 1790, Al Ain, U.A.E. E-mail: belalb@hotmail.com
Hassan Younies (corresponding author) is Assistant Professor in School of Management,
New York Institute of Technology, P.O. Box 5464, Abu Dhabi, U.A.E. E-mail: hassan.
younies@gmail.com
Mustafa Younis is Professor in School of Health Sciences, Jackson State University, 350 W.
Woodrow Wilson Ave, Suite # 2301-A, Jackson, MS 39213, USA. E-mail: mustafa.
younuis@jsums.edu
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Employee Satisfaction in the Health Care SectorA

Article in Journal of Health Management · March 2010

Belal Barhem Hassan Younies

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Employee Satisfaction in the Health Care Sector: A Comparative

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Employee Satisfaction in the Health

Belal Barhem, Hassan Younies and Mustafa Younis

The United Arab Emirates (UAE) proposes a unique working environment.

Journal of Health Management, 12, 1 (2010): 19–38

Journal of Health Management, 12, 1 (2010): 19–38

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diversity brings with it diverse working ethics, cultural backgrounds,

Journal of Health Management, 12, 1 (2010): 19–38

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extrinsic motivation and a recognition strategy for those behaviours driven

Health Care in the UAE

The UAE is a federation of seven emirates, varying in population and wealth

Journal of Health Management, 12, 1 (2010): 19–38

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Emirate Male Female Population

Source: 2004 Statistics, Ministry of Health.

Category Male (%) Female (%) Total (%)

Source: 2004 Statistics, Ministry of Health.

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Nationality Public Private

Source: 2004 Statistics, Ministry of Health.

Source: 2001–2004 Statistics, Ministry of Health.

Subject 2001 2004 Growth

Source: 2001–2004 Statistics, Ministry of Health.

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H0: There are no significant difference between satisfaction levels in

In addition, we will investigate whether the following variables: nature of the

The data were collected through a questionnaire which was distributed

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18 hospitals) were covered in the operation. The questionnaires were delivered

Profile Category Frequency Per cent

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Profile Category Frequency Per cent

Analysis and Results

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Organisation Part Cronbach’s alpha No. of items

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Note: Figures in parenthesis indicate frequency and ratios.

Arab Asian Indian Others

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Administration Physician Laboratorial Nursing Technician Other

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General (n = 377) Private (n = 139) Public (n = 238)

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