Health Services Management Research

http://hsm.sagepub.com/

A study of the relationship between job satisfaction, organizational commitment and

turnover intention among hospital employees
Ali Mohammad Mosadeghrad, Ewan Ferlie and Duska Rosenberg
Health Serv Manage Res 2008 21: 211
DOI: 10.1258/hsmr.2007.007015

The online version of this article can be found at:

http://hsm.sagepub.com/content/21/4/211

Published by:

http://www.sagepublications.com

On behalf of:

European Health Management Association

Additional services and information for Health Services Management Research can be found at:

Email Alerts: http://hsm.sagepub.com/cgi/alerts

Subscriptions: http://hsm.sagepub.com/subscriptions

Reprints: http://www.sagepub.com/journalsReprints.nav

Permissions: http://www.sagepub.com/journalsPermissions.nav

>> Version of Record - Nov 1, 2008

What is This?

Downloaded from hsm.sagepub.com by guest on June 7, 2013

Health Services Management Research 21: 211–227. DOI: 10.1258/hsmr.2007.007015
# 2008 Royal Society of Medicine Press

A study of the relationship between job

satisfaction, organizational commitment
and turnover intention among hospital
employees

Ali Mohammad Mosadeghrad*†, Ewan Ferlie† and Duska Rosenberg†

*Health Policy and Management, School of Health, Tehran University of Medical Sciences, Iran;
†
School of Management, Royal Holloway University of London, UK

The purpose of this descriptive, co-relational and cross-sectional study was to gain a
better understanding of the relationships between job satisfaction and organizational
commitment of employees, and their impact on turnover intention at Isfahan Hospitals,
Isfahan, Iran, in 2005. Data were collected by the distribution of two questionnaires
among 629 employees of these hospitals through a stratified random sampling method.
The results of the paper indicate that hospital employees are moderately satisfied with
their jobs and committed to their organization. Employees’ job satisfaction and
organizational commitment were closely inter-related and correlated with turnover
intention (P , 0.001). The positive correlation between the two was expected, but there
was also unexpected correlation with turnover intention. This may be due to external
factors, such as job market conditions, which may influence perceived opportunities for
career advancement elsewhere. The impact of such external factors is outside the scope
of this study, but will have to be investigated in further research. As job satisfaction and
organizational commitment have strong correlation with turnover, it is very important
to reinforce them by applying the right human resource policies.

Introduction effectiveness and efficiency. Organizations

Organizations are social systems where human
resources are the most important factors for
Ali Mohammad Mosadeghrad BSc MSc, Lecturer, Health
Policy and Management, School of Health, Tehran
University of Medical Sciences, Iran and Doctoral
Researcher, School of Management; Ewan Ferlie MA PhD,
Professor (Management), School of Management; Duska
Rosenberg MA PhD, Professor (Information and
Communications Management), School of Management,
Royal Holloway University of London, Egham, Surrey
TW20 0QS, UK
Correspondence to: Ali Mohammad Mosadeghrad
Email: m.mosadeghrad@rhul.ac.uk
cannot succeed without their employees’
efforts and commitment. Employees’ satisfac-
tion with their jobs and commitment to their
organizations has been viewed as major deter-
minants of organizational effectiveness.1
Job satisfaction and commitment are critical
to retaining and attracting well-qualified per-
sonnel. Concerns about employees’ job satisfac-
tion and organizational commitment are just as,
or even more, critical in the knowledge-based
sectors, such as the health-care industry as they
are in other business sectors. These factors are
especially important in professionalized and

211
Downloaded from hsm.sagepub.com by guest on June 7, 2013
Health Services Management Research
service-based organizations, such as hospitals
where long-term specialist training and reten-
tion issues are highly important.
Employees who experience job satisfaction
are more likely to be productive and stay on the
job.2 Job dissatisfaction has been found to be a
strong and consistent predictor of intention to
leave as well as turnover.3 – 6 Employees’ job
satisfaction is also found to be positively
related to patient satisfaction in health-care set-
tings.7 Employees’ commitment is a valuable
asset in an organization. Research has shown
that increased commitment improves employ-
ees’ job satisfaction, motivation, performance
and creativeness, and reduces absenteeism and
turnover.8 – 10
Justification for the need to investigate
employees’ job satisfaction and organizational
commitment is exemplified in the seemingly
observed relationship between the lower levels
of job satisfaction and commitment, and nega-
tive symptoms of absenteeism, grievance
expression, tardiness, low morale and high
turnover. Job satisfaction and organizational
commitment are important indicators to man-
agers because of the desire to retain a stable
and committed workforce. Researchers are
keenly interested in understanding the factors
that influence an individual’s decision to stay
or leave an organization.
Iran’s health system is passing though a
period of transformation. Since early 2000 the
Ministry of Health has been working on a
comprehensive health-care reform programme,
especially in hospitals. One of the aims of this
reform programme is to strengthen health-care
management. However, human resource mana-
gement is still not what it should be and the
human aspects relating to employee satisfac-
tion and organizational commitment, which
affect productivity, are neglected.
There are a small number of research
studies in the literature that have examined
the associations between job satisfaction,
organizational commitment and turnover
intention. Most of these studies have been
based on data collected in Western countries
and, also, limited to health-care employees.
However, where job satisfaction has been
found to be a direct predictor of turnover,
organizational commitment has not been ana-
lysed. This study aims to overcome this by
focusing on issues such as employee attitudes,
like satisfaction and commitment, and the
extent to which these factors contribute to
212
Downloaded from hsm.sagepub.com by guest on June 7, 2013
their intention to leave the organization.
There are no known studies related to the
links between these subjects in the health-care
organizations of Iran.
The results of this research will allow a better
understanding of the relationship between
employees’ job satisfaction and their organiz-
ational commitment, and their impact on turn-
over intention. The results will also enhance our
understanding of the determinants of these two
important employee attitudes. It is anticipated
that a better understanding of these issues and
their relationships can aid further research, pin-
point better strategies for recruiting, promotion
and training of future hospital employees, par-
ticularly in Iran but probably in other societies
as well.
Literature review
Organizational commitment
Organizational commitment reflects a multi-
dimensional psychological attachment of an
individual to the organization,11 which plays a
positive role in retention of members in the
organization. Meyer and Allen12 defined
organizational commitment as:
A psychological state that characterizes the
employee’s relationships with the organization
and has implications for the decision to continue
membership in the organization.
Meyer and Allen12 differentiated organiz-
ational commitment into three components:
affective, continuance and normative commit-
ment. Affective commitment refers to employ-
ees’ perceptions of their emotional attachment
to their organization and its goals.13
Employees with high affective attachment to
organization have strong motivation to con-
tribute to the organization goals because they
see them as theirs.14 According to Kate and
Masako,11 individual and organizational
factors may influence the level of affective
commitment. Individual factors include, for
example, factors such as personality, values
orientation, education or age, while organiz-
ational factors include believing that employ-
ee’s roles and job goals are clearly defined and
receive management support.
Continuance commitment represents cognitive
attachment between employees and their organ-
izations because of the costs associated with
leaving the organization.13,11 It is based on the
 Relationship between job satisfaction, organizational commitment and turnover intention
assumption that individuals do not leave an
organization if they would lose their benefits,
take a pay cut, incur job search expenses and risk
of being unemployed.15 The level of investment
employees have accumulated in an organization
and lack of alternative jobs outside the organiz-
ation are the most important factors that may
lead to continuance commitment. If employees
believe that fewer work opportunities exist
outside their organizations, the perceived costs
of leaving current organizations will be higher,
and they will develop a stronger sense of con-
tinuance commitment to their organizations.16
Finally, normative commitment refers to
typical feelings of obligation to remain with an
organization.13 Normative commitment is based
on an ideology or a sense of obligation;
employee feels obligated to stay with the organ-
ization because it is the moral and right thing to
do. Factors that may influence the level of nor-
mative commitment are education, age and
related factors.11 Normative commitment could
be based on organization investment in an
employee who then feels a ‘moral’ obligation to
stay with the organization, based on employee’s
social or cultural norms and believes that one
should be loyal to one’s organization.
Job satisfaction
Job satisfaction is an attitude that people have
about their jobs and the organizations in which
they perform these jobs. Job satisfaction is
defined as ‘the extent to which people like or
dislike their jobs’.17 It is an employee’s affective
reaction to a job, based on a comparison
between actual outcomes and desired outcomes.
Job satisfaction is generally recognized as a
multifaceted construct that includes employees’
feelings about a variety of both intrinsic and
extrinsic job elements. Intrinsic elements of job
satisfaction, derived from internally mediated
rewards, such as the job itself and opportunities
for personal growth and accomplishment; and
extrinsic elements of job satisfaction, resulting
from externally mediated rewards such as satis-
faction with pay and benefits, company policies
and support, supervision, co-workers, job secur-
ity and chances for promotion.18
Job satisfaction, organizational commitment
and intention to leave
A positive association between job satisfaction
and organizational commitment has been
Downloaded from hsm.sagepub.com by guest on June 7, 2013
consistently reported by studies.19 – 22 The links
between organizational commitment and job
satisfaction are complex and it is not clear
whether satisfaction is a precursor to commit-
ment or whether commitment influences one’s
level of satisfaction. The dominant view in the
literature supports the causal precedence of
satisfaction over commitment.23 – 25 There is
also evidence indicating that high levels of
commitment to the organization cause job
satisfaction.26,27 Several other studies have
concluded that a reciprocal effect exists
between satisfaction and commitment.28,29
A fourth group of studies finds no evidence of
causal relationship in either direction.30
Numerous studies have reported that job
satisfaction31,32 and organizational commit-
ment33 – 35 are negatively related to turnover
intention. According to Tett and Meyer,8 organ-
izational commitment and job satisfaction are
different, and each contributed uniquely to
turnover intentions. Job satisfaction correlated
more strongly with turnover intention, whereas
organizational commitment had the strongest
correlation with actual turnover.
The theoretical framework of the study
There are a variety of individual, social, cultural,
organizational and environmental factors that
can influence a person’s level of job satisfaction
and organizational commitment. Individual
factors include age, gender, marital status, per-
sonality, education, intelligence and abilities.
Social factors include relationships with co-
workers, group working and norms, and oppor-
tunities for interaction. Cultural factors include
underlying attitudes, beliefs and values.
Organizational factors include organization
structure, policies and procedures, supervision
and styles of leadership, management systems,
and working conditions. Finally, environmental
factors include economic, social, technical, poli-
tical and governmental influences.
This study aims to investigate the role of
individual, social, and organizational factors,
and employees’ level of job satisfaction, organi-
zational commitment and turnover intention
with a sample of Iranian hospital employees.
It was not possible to examine all aspects of
this hypothesized model within the confines
of the present study. Thus, the study is con-
fined to testing hypothesized relationships
between job satisfaction, organizational
213
Health Services Management Research
commitment and turnover intention, and the
other relevant variables, which relate to job
satisfaction and commitment.
As shown in Figure 1, the relationship
between job satisfiers and employees’ out-
comes is moderated by individual and cultural
factors. The initial hypothesis is that job satis-
faction is positively related to organizational
commitment, which is negatively related to
turnover intention. Therefore:
Hypothesis 1: The greater the employees’
job satisfaction, the greater their organizational
commitment or vice versa.
Hypothesis 2: The greater the employees’
job satisfaction and commitment, the lower
their turnover intention.
Methodology
The study utilized descriptive correlation
design and cross-sectional survey methodology.
Purpose and objectives
The purpose of this paper is to examine the
relationships between job satisfaction, organi-
zational commitment and turnover intention
among hospital employees in Isfahan, Iran.
Figure 1 Hypothesized relationship between job satisfaction, organizational commitment and turnover intention
214
Downloaded from hsm.sagepub.com by guest on June 7, 2013
This survey investigates possible causes for
low levels of job satisfaction and commitment
as precedents for turnover and decision to
leave the workforce. This study also focuses
on revealing homogeneous demographic
characteristics these employees exhibit, which
affect their satisfaction and commitment level
and turnover intention.
Setting
Hospital care in Iran is provided by a network
of regional hospitals located in the main cities.
This includes government-financed Ministry
of Health hospitals (MOH), the Social Security
organization-affiliated hospitals (SSO) and
private hospitals.36 The study was carried out
in six hospitals: three public MOH (two teach-
ing and one non-teaching), one SSO (semi-
public hospital) and two private hospitals.
The six hospitals of the study were selected to
represent the three dominant hospital-care
systems in Iran.
Participation
At the time of the study (2005), these hospitals
employed 2411 full-time employees. Seven
 Relationship between job satisfaction, organizational commitment and turnover intention
hundred and forty employees were selected
for this research after a pilot study using the
following formula (N ¼ 2411, d ¼ 0.03,
z ¼ 1.96 and s ¼ 0.50). Employees who had
less than six months of work experience were
excluded from this study.
NZ2 S2
n¼
Nd2 þ Z2 S2
Instruments
A survey instrument was designed to measure
and identify demographic characteristics,
levels of job satisfaction and commitment
among employees of hospitals and their inten-
tion to leave the organization. A cover letter
briefly explained the purpose of the study and
the mechanisms to maintain confidentiality.
Further explanations were given when
requested. The respondents received and
answered the questionnaires at their work
place. Participation was voluntary. The ques-
tionnaire consisted of three sections as follows:
† Section 1 – Demographics: As hospital
employees deal with very specific tasks on
a daily basis, there may be a link between
individuals’ demographic characteristics
and their job satisfaction to a particular
type of work. Therefore, demographic
data on employees were also gathered.
The questionnaire gathered data relative to
participants’: (a) gender; (b) marital status;
(c) age; (d) years working in the hospital;
(e) education level; (f) employment status;
(g) department they work in; and (h)
monthly salaries received. We chose these
characteristics based upon a review of
related literature.
† Section 2 – Job Satisfaction Scale: A self-
developed questionnaire was used to
assess the level of job satisfaction among
hospital employees according to nine sub-
scales. First, the domains of job satisfaction
were defined. To accomplish this, a litera-
ture review was conducted to identify the
dimensions of job satisfaction.17,37,38 From
each study, a list of dimensions was
created. Using a Delphi technique, the
organizational behaviour and management
experts’ opinions were used in completing
this list. The nine most common job satis-
faction domains were chosen for inclusion
Downloaded from hsm.sagepub.com by guest on June 7, 2013
in the questionnaire. These included: sal-
aries and benefits, recognition and pro-
motion, management and supervision,
co-workers, task requirement, organization
policies, working conditions, nature of the
job and job security (Table 1). This ques-
tionnaire had 36 items (4 items in each
domain). A further four items were also
included in the questionnaire: employees
asked about their overall job satisfaction,
ability to do their job well, intention to
leave the organization if they received a
good offer from other health-care organiz-
ations and if they would recommend the
hospital to others for work. The question-
naire utilizes a Likert-type scale with six
response alternatives ranging from
‘Strongly disagree’ (weighted 1) to
‘Strongly agree’ (weighted 6) for each of
the 40 items. In part II of the question-
naire, employees were asked to specify the
importance of those nine dimensions of
job satisfaction according to their personal
interests on a six-point scale from ‘less
important’ (weighted 1) to ‘very import-
ant’ (weighted 6).
† Section 3 – Organizational Commitment Scale.
This variable was measured using Meyer
and Allen’s12 Organizational Commitment
Scale, which contains three six-item com-
ponents: affective, continuance and norma-
tive commitment (Table 2). Ratings were
completed on a six-point scale from
Table 1 Definition of job satisfaction dimensions
Salaries and benefits: remuneration, pay and fringe
benefits for the work done
Recognition and promotion: the opportunity to
advance; achievements
Management and supervision: competence of
supervisor and way the boss handles employees
Co-workers: relationships with co-workers; quality
of interactions
Task requirement: what employees need to do their
job well, such as education, resources and some
degree of autonomy
Organization policies: satisfaction with organization
policies and rules
Working conditions: all facets of the work environ-
ment, safety
Nature of the job: job identity, meaningful work;
level of responsibility and authority and
Job security: steady employment of the job
215
Health Services Management Research

Table 2 Definition of organizational commitment capabilities and understanding of hospital

dimensions employees in Iran. The panel was also asked
to eliminate items or questions they found to
Affective commitment: psychological attachment to be irrelevant to the Iranian culture and make
organization; suggestions on how to simplify the items that
Continuance commitment: costs associated with were not relevant. After some modifications
leaving the organization; and were made, the instruments were resubmitted
Normative commitment: perceived obligation to to the experts. The experts unanimously re-
remain with the organization commended the use of the modified instru-
ments for this study.

‘strongly disagree’ (weighted 1) to ‘strongly

agree’ (weighted 6). The translation fol- Reliability of research instruments
lowed an established forward–backward Internal consistency reliability was measured
translation procedure, with independent by Cronbach’s coefficient a as 0.9210 for job
translations and counter-translation. satisfaction questionnaire and 0.8383 for
organizational commitment questionnaire. The
results in Table 3 show that the values of
Access and ethical approval Cronbach’s a derived for the constructs
Ethical approval of the study was gained from ranged between 0.70 and 0.89, indicating a
the Isfahan Medical University’s Research high reliability of the scales.
Ethics Committee. The main ethical issues
involved in this study were respondents’ Acceptability of research instruments
rights to self-determination, anonymity and
confidentiality. For this reason, respondents Acceptability was assessed in terms of refusal
were given full information on the nature of rates and rates of missing responses. A total of
the study through a letter, which was distribu- 629 (85%) hospital employees filled in the ques-
ted with the questionnaire. The questionnaire tionnaires. Organization-specific response rates
data were kept confidential and respondents
were assured of their right to withdraw at any
time. The names of the respondents were not Table 3 Internal consistency analysis
recorded and so all the data were rendered Constructs Number of Cronbach’s
anonymous. items a
Salaries and fringe 4 0.81
Pilot study benefits
A pilot study was undertaken to test the rele- Recognition and 4 0.80
vance and clarity of the questions, and to promotion
refine them as needed to avoid misunder- Management and 4 0.73
standing. A small sample of 40 randomly supervision
selected hospital employees, who were not Co-workers 4 0.78
included in the sample, received the question- Task requirement 4 0.70
naires. The questionnaires were found to be Working conditions 4 0.72
understandable, acceptable and could be com- Nature of work 4 0.74
pleted in about 15 min. Organization policies 4 0.72
Job security 4 0.70
Overall job satisfaction 40 0.92
Validation of research instruments Affective commitment 6 0.86
Continuance 6 0.71
Content and face validity were established by
commitment
a panel of experts consisting of management
Normative 6 0.89
and organizational behaviour experts. The
commitment
panel was asked to review the content of the
Overall organizational 18 0.83
items in each of the instruments and deter-
commitment
mine if the items were within the linguistic

216
Downloaded from hsm.sagepub.com by guest on June 7, 2013
 Relationship between job satisfaction, organizational commitment and turnover intention
varied from 87% to 94%. Missing data analysis
showed that 90.3% respondents had no missing
values for the entire set of 58 items.
Data collection
Stratified random sampling method was used.
Data collection was undertaken in the last
two weeks of October 2005. Informed consent
was obtained from all subjects following
receipt of information on the purpose of
the study, assurances of anonymity and
confidentiality.
Data analysis
All data were analysed using the statistical
package for the Social Sciences (SPSS 11, SPSS
for Windows, ‘V’11 [SPSS, Inc]). Appropriate
statistical procedures were used for descrip-
tion and inference. The missing values were
checked prior to further statistical analysis. In
order to normalize the Likert 1– 6 scales for
each domain of job satisfaction and organiz-
ational commitment questionnaires, the sum
of raw scores of items in each domain was
divided by the number of items in each
domain and for overall job satisfaction and
commitment, sum of raw scores of items were
divided by 40 and 18, respectively. The possi-
ble justified scores varied between 1 and
6. Scores of 2 or lower on the total scale indi-
cate very low, scores between 2 and 2.99 indi-
cate low, scores between 3 and 3.99 indicate
moderate, scores between 4 and 4.99 indicate
high and scores of 5 or higher indicate very
high job satisfaction or commitment.
The differences between groups were tested
with the chi-square, independent t-test,
Mann-Whitney and Kruskal-Wallis tests. The
correlation coefficients were calculated to
evaluate the relationship between variables.
Forward conditional logistic regression analy-
sis was used to identify the most important
predictor domains in global satisfaction and
commitment. Data were presented as the
mean + standard deviation (SD) and percen-
tage (P , 0.05 were considered as significant).
Results
Characteristics of the respondents
As described in Table 4, over half of
the respondents were women (54.3%) and
over three-fourths (78.8%) were married.
Downloaded from hsm.sagepub.com by guest on June 7, 2013
Most (63.8%) had at least a college degree. Just
over half (56.9%) had a monthly income
,2,000,000 Rials (poverty line in Iran in 2005;
equivalent to 250 US$). A total of 51.4% of
employees had permanent employment. In
public, semi-public and private hospitals,
52.2%, 89% and 19.5% of employees, respect-
ively, had permanent job contracts. The age of
these hospital employees ranged from 18 to
73, with an average age of 35.29 + 8.58
(mean + SD). Nearly three-fourth of respon-
dents (71.9%) were ,40 years old. The
average age of the employees’ in public, semi-
public and private hospitals was 37, 34 and 33
years, respectively. On an average, employees
had 12.2 years of work experience,
respectively.
Job satisfaction
Total job satisfaction of the respondents was
measured on a six-point scale, where 6 stood
for highly satisfied and 1 for highly dissatis-
fied. Overall, hospital employees were satis-
fied with their job showing a mean score of
3.51 + 0.74 (moderate satisfaction) compared
with the possible range of 1.20 – 5.61.
Approximately, 1.6, 23, 45, 28.8 and 1.6% of
hospital employees had, respectively, very low,
low, medium, high and very high satisfaction
with their job.
Within the nine items of the Job Satisfaction
Scale, the three dimensions of the job with
which respondents were most satisfied were:
co-workers, nature of the job and task require-
ment. Respondents were least satisfied with
the salaries and benefits, working conditions,
recognition and promotion and job security
(Table 5).
As indicated in Table 5, co-workers, salaries
and benefits, management and supervision,
nature of job and job security were the most
important facets of job satisfaction from the
points of view of the employees. The differences
in the gap scores (perception minus expectation,
P 2 E ¼ gap) for all the nine dimensions of job
satisfaction were studied. This gap was more in
salaries and fringe benefits, working conditions,
and recognition and promotion, and less in
nature of work, task requirement and co-
workers dimensions of job satisfaction.
The differences between values of employ-
ees’ job satisfaction in different hospitals
were statistically significant (P , 0.05).
217
Health Services Management Research

Table 4 Percentage of participants and the mean score of their job satisfaction and commitment
Demographic Percent of Job satisfaction Organizational
parameters sample commitment

Mean SD Mean SD
Gender
Male 45.7 3.59 0.68 4.03 0.66
Female 54.3 3.44 0.78 3.93 0.70
Marital status
Single 21.2 3.38 0.70 3.77 0.64
Married 78.8 3.54 0.72 4.03 0.69
Education
Illiterate 0.5 4.17 0.70 4.21 0.49
Under diploma 8.5 3.67 0.74 4.36 0.77
Diploma 27.2 3.50 0.68 3.97 0.68
Post-diploma 16.9 3.66 0.69 4.15 0.59
Bachelor’s degree 40.6 3.41 0.79 3.81 0.69
Master’s degree or GP 4.7 3.56 0.67 3.84 0.50
Doctoral degree 1.6 3.54 0.81 4.34 0.49
Area of work
Managerial and clerical 19.1 3.73 0.75 4.15 0.59
Ancillary or logistic 17.1 3.75 0.74 4.13 0.72
Therapeutic 51.2 3.31 0.66 3.86 0.71
Diagnostic 12.6 3.69 0.72 3.99 0.57
Age (years)
, 20 0.7 4.48 0.78 3.91 1.13
20–30 34.9 3.40 0.72 3.81 0.66
31–40 36.3 3.56 0.75 4.01 0.70
41–50 24.4 3.53 0.73 4.10 0.65
. 50 3.7 3.86 0.64 4.27 0.66
Tenure (years)
, 1 (6 months –1 year) 6.4 3.28 0.78 3.83 0.67
1–5 23.1 3.35 0.74 3.77 0.71
6–10 21.4 3.59 0.75 3.94 0.59
11–15 16.2 3.48 0.69 4.02 0.71
16–20 11.4 3.78 0.61 4.29 0.65
21–25 14.6 3.44 0.78 4.00 0.64
26–30 6.4 3.64 0.63 4.13 0.69
. 30 0.5 4.45 0.08 4.84 0.38
Received wages (in Rials)
, 2,000,000 56.9 3.48 0.76 3.93 0.69
. 2,000,000 43.1 3.57 0.71 4.04 0.66

Employees’ job satisfaction in private hospitals
was higher than public and semi-public hospi-
tals. The differences between values of
employees’ job satisfaction in these hospitals
were statistically significant (P , 0.01). In
private hospitals, employees have more satis-
faction with co-workers, and less satisfaction
with wages and benefits. Employees in social
security hospital are more satisfied with sal-
aries, benefits, recognition and promotion than
their colleagues in public and private hospi-
tals, but they are less satisfied with working
conditions (Table 6). SSO provides more
benefits to employees. Health-care services in
SSO hospitals are free of charge for people
under SSO insurance programme. Therefore,
these hospitals are always overcrowded.
Furthermore, customers in these hospitals
have a kind of ownership sense and are more
demanding than patients in other hospitals.

218
Downloaded from hsm.sagepub.com by guest on June 7, 2013
 Relationship between job satisfaction, organizational commitment and turnover intention

Table 5 The mean score of employees’ expectation and and computer centre (4.01) were high and in
perception about job satisfying factors (on a 6-scale) cardiology ward (2.89), pathology department
(2.97), psychiatry ward (2.99), obstetrics ward
Job satisfying factors P E P –E (3.04), urology ward (3.20), medical records
Salaries and fringe benefits 2.57 5.01 22.44 department (3.27) and paediatrics ward (3.30)
Recognition and promotion 2.88 4.85 21.97 were low.
Management and supervision 3.84 4.96 21.12 There was a strong correlation between the
Co-workers 4.54 5.15 20.61 job satisfaction of employees’ and their
Task requirement 4.17 4.76 20.59 gender, marital status, age, years of work
Working conditions 2.59 4.86 22.27 experience, organizational position, type of
Nature of work 4.37 4.94 20.57 employment (permanent or contract employ-
Organization policies 3.24 4.80 21.56 ment) and salaries received (P , 0.05).
Job security 3.11 4.89 21.78 As regards differences according to age and
Overall job satisfaction 3.51 4.91 21.40 seniority, we observed a curvilinear relation-
ship: scores were higher for the lowest and
highest ages and seniority ranges. There was
statistically significant correlation (reverse)
When the participants were stratified by the between job satisfaction of employees’ and
type of hospitals, teaching or non-teaching their graduation levels (P , 0.05). Supervisors
hospital, there were significant differences in or managers represented 15.7% of our sample.
the total job satisfaction scores (P , 0.05). Supervisors’ job satisfaction was found to be
It was 3.43 + 0.68 in the teaching hospitals significantly higher (m ¼ 3.64) compared with
and 3.57 + 0.78 in the non-teaching hospitals. their staff (m ¼ 3.48). Job satisfaction appeared
The differences were because of working con- to increase with the level of hierarchy.
ditions and management and supervision In order to determine the main factors that
dimensions of job satisfaction (Table 7). cause satisfaction and/or dissatisfaction with
The employees’ job satisfaction in thera- work, the relationship between total job satis-
peutic and diagnostic departments was lower faction and job satisfying factors was analysed.
than administrative and ancillary departments. Calculations of Spearman’s ratios revealed the
A statistical significant association was seen strongest correlation between total job satisfac-
between employees’ job satisfaction and their tion and such characteristics as management
area of work or specialty (P , 0.001). The and supervision, recognition and promotion,
mean score of employees’ job satisfaction in job security and task requirement. On the
the cash office (4.46), medical equipment office other hand, working conditions and co-
(4.35), administrative office (4.34), secretarial workers had less significant effect on employ-
unit (4.10), material supply department (4.08) ees’ job satisfaction, respectively. As Table 8

Table 6 The mean score of employees’ job satisfaction in public, semi-public and private hospitals (on a 6-scale)
Job satisfying factors Public hospital Social security Private hospital
hospital

P E P–E P E P–E P E P –E
Salary and fringe benefits 2.35 4.94 22.59 3.24 4.99 21.75 2.53 5.20 22.67
Recognition and promotion 2.84 4.99 22.15 3.05 4.72 21.67 2.95 4.72 21.77
Management and supervision 3.77 4.88 21.11 3.88 5.07 21.19 4.05 5.04 20.99
Co-workers 4.55 5.21 20.66 4.41 5.14 20.73 4.64 4.99 20.35
Task requirement 4.08 4.57 20.49 4.18 4.80 20.62 4.49 5.22 20.73
Working conditions 2.59 4.74 22.15 2.49 4.67 22.18 2.67 5.36 22.69
Nature of work 4.39 4.91 20.52 4.16 4.87 20.71 4.50 5.11 20.61
Organization policies 3.20 4.76 21.56 3.23 4.64 21.41 3.30 5.05 21.75
Job security 3.11 4.87 21.76 3.07 4.71 21.64 3.14 5.13 21.99
Overall job satisfaction 3.45 4.87 21.42 3.56 4.84 21.28 3.63 5.09 21.46

219
Downloaded from hsm.sagepub.com by guest on June 7, 2013
Health Services Management Research

Table 7 The mean score of employees’ job satisfaction in teaching and non-teaching hospitals (on a 6-scale)
Job satisfying factors Educational hospitals Non-educational hospitals

P E P–E P E P –E
Salary and fringe benefits 2.39 4.85 22.46 2.68 5.11 22.43
Recognition and promotion 2.77 4.95 22.18 2.94 4.81 21.87
Management and supervision 3.67 5.01 21.34 3.99 4.93 20.94
Co-workers 4.47 5.21 20.74 4.60 5.11 20.51
Task requirement 4.01 4.69 20.68 4.32 4.81 20.49
Working conditions 2.66 4.68 22.02 2.55 4.98 22.43
Nature of work 4.42 4.94 20.52 4.35 4.94 20.59
Organization policies 3.20 4.85 21.65 3.25 4.76 21.51
Job security 3.10 4.76 21.66 3.12 4.97 21.85
Overall job satisfaction 3.43 4.88 21.45 3.57 4.93 21.36

shows, this relationship was statistically sig-
nificant in all the cases (P , 0.001).
The mean score of employees’ satisfaction of
job factors, organizational factors and social
factors were 4.37, 3.20 and 4.54 credit from 6,
respectively. The results of the simultaneous
multiple regression model indicate that organ-
izational, social, job and individual factors
overall explained 98.8% of the variance in
employees’ job satisfaction. Organizational
factors explained the largest amount of the
variance (94.3%), followed by job, social and
individual factors. With regards to organi-
zational factors, management and supervision
explained the largest amount of the variance,
followed by promotion, task requirement,
security, and salaries and benefits.
Organizational commitment
Employees were moderately committed to
their organizations, with a mean global score
of 3.98 + 0.68 on a six-scale. The overall
scores ranged from 2.05 to 5.67 (possible range
1 – 6). Organizational commitment was low,
medium, high and very high in 9.1, 41.7, 43.7
and 5.5% of hospital employees. The mean
score of affective, continuance and normative
commitment were 3.86 + 1.12, 3.97 + 0.73
and 4.13 + 0.64, respectively.
The employees’ organizational commitment
in therapeutic and diagnostic departments
was less than administrative and ancillary
departments. The differences between values
were statistically significant (P , 0.001). Total
organizational commitment scores were not
different among the six hospitals (P ¼ 0.54).
Some demographic variables were related to
one or more of the three commitment mea-
sures. Significant differences were obtained
between employees’ organizational commit-
ment and their marital status, age and years of
work experiences, type of employment and
salaries received (P , 0.03). Married (as
opposed to single) employees have shown
more affective, continuance and normative
commitment. Age and tenure were related to
affective and normative commitment. A nega-
tive association was seen between employees’
organizational commitment and their edu-
cational levels (r ¼ 20.156, P , 0.001), such
that those with fewer years of education
revealed more continuance commitment. This
could be explained by external factors, if there
are fewer opportunities for finding suitable or
better jobs outside the organization.
In correlation analysis between organiz-
ational commitment and its three dimensions,
affective, continuance and normative commit-
ment, respectively, had positive and the
highest effect on employees’ organizational
commitment in that order.
The results of the simultaneous multiple
regression model indicate that organizational,
social, job and individual factors overall
explained 44.7% of the variance in employees’
organizational commitment. Organizational
factors explained the largest amount of the
variance (33.3%), followed by job, individual
and social factors. With regards to organi-
zational factors, management and supervision
explained the largest amount of the variance,
followed by organization policies and job

220
Downloaded from hsm.sagepub.com by guest on June 7, 2013
 Table 8 Inter-correlations between job satisfaction, organizational commitment and intention to leave the organization
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1. Overall job –
satisfaction
2. Salaries and 0.648 –
fringe benefits
3. Recognition and 0.785 0.642 –
promotion
4. Management 0.794 0.423 0.626 –
and supervision
5. Co-workers 0.578 0.238 0.282 0.506 –
6. Task 0.743 0.362 0.474 0.615 0.567 –
requirement
7. Working 0.549 0.304 0.370 0.333 0.198 0.258 –
conditions
8. Nature of job 0.675 0.295 0.425 0.457 0.447 0.577 0.296 –
9. Organization 0.610 0.330 0.487 0.411 0.222 0.372 0.390 0.315 –
policies
10. Job security 0.773 0.415 0.563 0.606 0.358 0.494 0.507 0.429 0.551 –
11. Organizational 0.637 0.332 0.433 0.510 0.441 0.508 0.244 0.561 0.372 0.436 –
commitment
12. Affective 0.690 0.341 0.474 0.546 0.564 0.543 0.292 0.565 0.437 0.501 0.923 –

Downloaded from hsm.sagepub.com by guest on June 7, 2013

commitment
13. Continuance 0.326 0.185 0.210 0.310 0.229 0.271 0.069 0.299 0.145 0.273 0.690 0.453 –
commitment
14. Normative 0.328 0.140 0.187 0.203 0.308 0.290 0.149 0.397 0.153 0.231 0.669 0.525 0.303 –
commitment
15. Intention to 0.452 0.233 0.284 0.303 0.212 0.290 0.209 0.233 0.382 0.348 0.436 0.462 0.245 0.198 –
leave
16. Recommending 0.617 0.406 0.488 0.467 0.287 0.424 0.299 0.349 0.368 0.396 0.435 0.497 0.245 0.149 0.431 –
the organization
for work to
others

Correlation is significant at the 0.05 level

Correlation is significant at the 0.01 level

221
Relationship between job satisfaction, organizational commitment and turnover intention
Health Services Management Research
security. Employees’ characteristics explain a
lower degree of variation in commitment. This
is primarily the result of the effect of the
employee’s age and education.
Relationships between job satisfaction,
organizational commitment and
intention to leave
Table 8 shows the correlations between these
three variables. As can be seen, there is a
positive correlation between job satisfaction
and organizational commitment (rs ¼ 0.637,
P , 0.001) indicating that those employees
who are more satisfied with their job are also
more committed to the health-care service.
This study observed an asymmetric relation-
ship where satisfaction had a stronger effect
on commitment than the reverse. The relation-
ship running from satisfaction to commitment
is much stronger than the relationship running
in the other direction.
The positive correlation between intention
to leave and organizational commitment
(rs ¼ 0.436, P , 0.001) and job satisfaction
(rs ¼ 0.452, P , 0.001) indicates that those who
are less satisfied with their job are less com-
mitted to their organization. The influence of
external factors needs to be investigated
further, particularly with respect to normative
and continuance commitment.
Furthermore, correlation analysis revealed
that job satisfaction dimensions such as nature
of the job, management and supervision, task
requirement, co-workers, job security, and
recognition and promotion had more effect
on employees’ organizational commitment.
Nature of the work, co-workers, and manage-
ment and supervision had the most effect on
affective commitment. Management and
supervision, nature of work and job security
had the most effect on continuance commit-
ment. Finally, nature of the job and co-workers
had the most effect on normative commitment.
On the other hand, affective commitment had
more effect on employees’ job satisfaction.
Employees’ job satisfaction and commitment
are significant predictors of turnover intention.
The results of the simultaneous multiple
regression model indicate that together, these
two variables explain 22.5% of the variance
in employees’ turnover intention. Job satisfac-
tion explained the largest amount of the
variance (19.2%) followed by commitment.
222
Downloaded from hsm.sagepub.com by guest on June 7, 2013
Figure 2 Relationship between job satisfaction, organiz-
ational commitment and turnover intention
Organizational factors explained 14% of the
variance in employees’ turnover intention
(Figure 2).
Factors that have a significant impact on
intention to leave are affective commitment,
job satisfaction, organizational policies, job
security, management and supervision, recog-
nition, amount of salaries received and the
department in which the employees work.
Factors that have a significant impact on
recommending the hospital to others by
employees as a good place for work are job
satisfaction, affective commitment, recognition
and promotion, management and supervision,
amount of salaries and task requirement.
Discussion
This study set out to assess the degree of job
satisfaction and organizational commitment
among Iranian hospital employees and
examine the relationships between those vari-
ables and employees’ turnover intention. From
the results of this study, the job satisfaction
level of hospital employees’ can be seen to be
in a medium scale, mainly because of salaries
and benefits, working conditions, recognition
and job security. It is recommended that par-
ticular attention be given to improve employ-
ees’ job satisfaction by addressing these issues
at the managerial level.
This study confirmed a positive relationship
existing between job satisfaction and organi-
zational commitment. Findings revealed that
employees who were more satisfied with their
job had higher levels of organizational commit-
ment. The result supported Hypothesis 1 that
job satisfaction is positively related to organi-
zational commitment. This finding is consistent
with the findings of other previous studies
in health-care settings.20 – 22 Furthermore, job
satisfaction and commitment were significantly
 Relationship between job satisfaction, organizational commitment and turnover intention
associated with employees’ intention to leave.
The results do not support Hypothesis 2 that
there is a negative relationship between turn-
over intention and employees’ job satisfaction
and commitment. This may be due to external
factors, such as job market conditions and
workforce mobility, which may influence per-
ceived opportunities for career advancement
elsewhere.
Several researchers have concluded that
employees’ job satisfaction generally and in
health-care organizations is shown to be corre-
lated with age, gender, marital status, number
of children, educational level and work experi-
ence (years).37 – 44 In this current study, vari-
ables such as employees’ age, gender, marital
status, work experience years, organizational
position, education level, type of employment
and salaries received, and benefits were seen
as having significant effects on their job
satisfaction.
A higher level of job satisfaction in illiterate
employees may be due to the fact that most of
these individuals are old and have been
working in the hospitals for many years.
Therefore, they are receiving higher pay
because of their length of service and the pri-
vileges that this brings. Also, they do not do
difficult jobs in hospitals. However, their
younger colleagues who do not have higher
education, have to do the hard and non-
professional jobs in hospitals, such as working
in the laundry, cleaning patients’ rooms and
so on.
The U-formed relationship between age and
seniority and job satisfaction requires two
kinds of explanation. Among younger employ-
ees, a higher level of satisfaction may be due
to the fact that inexperienced employees have
fewer duties and responsibilities, less pressure
and fewer demands from colleagues. They
may also be less exposed to work-to-family
conflicts. Among older employees, higher
satisfaction could be explained by a better
knowledge of hospital working, by benefits
linked to seniority and by fewer external
demands. It is also possible that older employ-
ees refocus their priorities to factors outside
the work setting, such as family and/or plan-
ning for retirement.
The current study showed that promotion
opportunities were another significant predic-
tor of job satisfaction and organizational com-
mitment among study participants. The
greater the chances are for advancement
Downloaded from hsm.sagepub.com by guest on June 7, 2013
within the organization, the higher it is likely
to be the level of organizational commitment
and job satisfaction expressed by the
employee. This finding is consistent with
other studies that have shown that the oppor-
tunity for personal and professional growth
and achievement is one of the best predictors
of job satisfaction and organizational commit-
ment.40,43,45 Unfair promotion policies per-
ceived by employees may negatively impact
their organizational commitment. It is there-
fore, recommended that managers provide
equal promotion opportunities for employees.
Management should put in place localization
programmes and initiatives that would
promote employees’ to key positions and
increase their involvement in decision-making.
Such steps will help to increase the level of job
satisfaction and commitment.
Tenure was significantly related to affective
and normative commitment. When the experi-
ence increases, commitment will rise as well;
but there is an exception in employees with
one to five years of work experience.
Employees in the first year of their job career
are highly committed to their organization,
especially because of continuance and affec-
tive commitments. The employees enter their
organizations with great expectations, but
when they realize that they may have overesti-
mated what they might be able to achieve,
their commitment may decrease.
Marital status was related to commitment,
especially affective commitment, as married
employees demonstrated more emotional
attachment than single employees. This could
again reflect a tendency for married employ-
ees’ to be more family-oriented and see the
organization as a kind of ‘family provider’,
as opposed to single employees who, being
more self-oriented, may view the employing
organization only as a source of income and
therefore feel less emotionally attached to it.
Education also showed a significant negative
correlation, such that those with fewer years of
education revealed more normative commit-
ment. These findings are also consistent with
several studies in which education was
found to have an inverse relationship with
organizational commitment.34,46 Amount of
salaries was correlated with continuance
commitment.
Employees with permanent contracts noti-
fied higher levels of job satisfaction and
organizational commitment than temporary
223
Health Services Management Research
employees. These findings suggest that types
of employment may have an independent
effect on employees’ job satisfaction. Further
research is necessary to overcome various
shortcomings of this study, and to assess the
role either job security or level of income and
social protection.
This study also demonstrates that those
employees who work with patients had less job
satisfaction and as a result less commitment.
Employees working in cardiology, psychiatry,
pathology, obstetric, urology and paediatric
wards had less satisfaction. Job rotation could
possibly be a good strategy for improving job
satisfaction of these employees. Lower levels of
job satisfaction in employees working in the
medical record department is likely due to the
specific nature of the jobs they perform.
Automation is not used in these hospitals and
these employees have to perform their tasks
manually. Documentation, repetition of duties
and low salaries are the most important
sources of dissatisfaction of employees in this
department. It is recommended that manage-
ment use job enrichment as a motivational
strategy to satisfy these employees.
Another major finding as the cause of
employee job dissatisfaction is the lack of
respect and recognition they receive from hos-
pital management. Recognition and respect
are highly important, especially for employees
who are in direct contact with patients,
families, peers and other health-care team
members. Respect and recognition from man-
agers for good performance is vital in increas-
ing job satisfaction and is central to boosting
commitment.
It is interesting to mention that employees’
expectations about their jobs in private hospi-
tals are greater than in public and semi-public
hospitals. Type of organization shapes the
employees’ expectation. Employees in public
hospitals know about the limitations and diffi-
culties in their organization, so will modify
their expectations and demands.
The strongest direct predictors of intention
to leave, based on this study, are low organiz-
ational commitment (particularly affective
commitment), lack of job satisfaction and its
dimensions (especially organizational pol-
icies), lack of job security, and management
and supervision. Thus, managers should try to
improve employees’ commitment by increas-
ing their job satisfaction and thus reduce their
intention of leaving the organization.
224
Downloaded from hsm.sagepub.com by guest on June 7, 2013
Conclusions
In a cross-sectional study, the relationship
between employees’ job satisfaction and
organizational commitment, and their turn-
over intention in Isfahan Hospitals, Isfahan,
Iran were explored. This study revealed a posi-
tive relationship between employees’ job satis-
faction and organizational commitment, and a
relationship between job satisfaction, commit-
ment and intention to leave the organization.
This research has found that job satisfaction
and organizational commitment appear to be
predictors of turnover intention but moderat-
ing factors, such as individual and cultural
characteristics, play a significant role in both
turnover intention and actual turnover.
The findings show that hospital employees
are moderately satisfied with their jobs.
Factors that may influence the level of employ-
ees’ job satisfaction are demographic variables
of gender, age, marital status, education, years
of work experience, organizational position,
monthly salary, type of employment, type of
hospital, employees’ organizational commit-
ment (and its three dimensions) and the nine
subscales of job satisfying factors, as indicted
in Table 5. Management and supervision, rec-
ognition and promotion, job security and task
requirement are the best predictors of job satis-
faction among hospital employees. Specific job
satisfaction dimensions indicate that highest
dissatisfaction level occurs in the area of
working conditions, salaries and benefits, rec-
ognition and job security. Thus, areas of dissa-
tisfaction can be interpreted as signals that
change is needed.
The findings also revealed that hospital
employees are moderately committed to their
organization. Factors that may influence the
level of employees’ organizational commit-
ment are demographic variables of gender,
age, marital status, education, years of work
experience, monthly salary, type of employ-
ment, employees’ job satisfaction (and its nine
dimensions) and the three subscales of organi-
zational commitment dimensions. Affective,
continuance and normative commitment are
the best predictors of organizational commit-
ment among hospitals employees.
Implications for management
There are several practical implications that
can be derived from our findings. As job
 Relationship between job satisfaction, organizational commitment and turnover intention
satisfaction and organizational commitment
have strong correlation with job performances,
it is very important to reinforce them by
applying the right human resource policies.
If employees are highly satisfied with their
work, supervision, co-workers, policies and
pay, and derive high level of overall job satis-
faction with their jobs they are more likely to
be committed to the organization than if they
are not satisfied.
The results of this study revealed that
management and supervision are important
predictors of job satisfaction, organizational
commitment and turnover intention among
hospital employees. A supportive manage-
ment style, demonstrated through open com-
munication, respect and recognition can
greatly improve the satisfaction of employees
on the job. Management might be able to
increase the level of commitment in the organ-
ization by increasing satisfaction with policies,
work conditions, equal compensation and
equal promotion. Changes in organizational
variables, such as benefit scales, employee
input in policy development and work
environment, could then be made in an effort
to increase employees’ job satisfaction, organi-
zational commitment and decrease subsequent
turnover.
This study revealed that hospital employees’
commitment is more because of normative
commitment. The employees commit to and
remain with the organization because of feel-
ings of obligation. In other words, employees
think that they ought to remain with an organ-
ization because they think it is morally right to
do so. It could be because of investigation of
this concept in an Islamic country where
working in a hospital is a holy job. Nursing
and providing services for patients is strongly
recommended in Islam. So, management
should implement policies that will increase
employees’ affective commitment. Policies
such as treating the employee with respect
and consideration, improving their quality of
work, defining the job and responsibilities of
employees, designing, stimulating and chal-
lenging jobs, providing high-quality infor-
mation to employees about organization’s
plans and activities, providing appropriate
working environment, fair assessment and
promotion, compensation and benefits can be
helpful.
In summary, employees are the most
important resource of an organization.
Downloaded from hsm.sagepub.com by guest on June 7, 2013
Nevertheless, managers spend a minimal
amount of time learning more about human
behaviour, communication, and how their atti-
tudes and behaviours impact employee’s per-
formance. Management requires a keen
understanding of human nature, the basic
needs, wants and abilities of people. Managers
at any level cannot motivate an employee;
they must create the environment for individ-
uals to motivate themselves. It is in the interest
of an organization to retain employees and
minimize turnover. However, many hospital
managers have little understanding of how to
satisfy their employees and how these employ-
ees’ satisfaction levels influence their intent to
leave their positions. In fact, because of this
limited understanding, managers’ efforts
towards employees’ satisfaction can some-
times create more dissonance than cohesion
between employees and management, leading
to excessive employee turnover. Possessing
knowledge and information about employee
motivation helps managers understand how
employees can be involved to achieve process
improvement. More understanding of the
needs and wants of their employees, as well as
a better understanding of the impact of their
own managerial behaviour on others would
help them in terms of improving performance
in the workplace.
Limitations and implications for
future research
In this study, employees’ participation was
voluntary and was conducted at six hospitals
in Isfahan city, Iran an Islamic country. So, the
findings should be interpreted with caution as
the participants were hospital employees from
a particular province of Iran and do not rep-
resent all hospital employees in this country.
More studies of Iranian health-care employees
are needed with samples, which are large
enough to detect statistically significant
associations between the variables under
investigation.
Another potential limitation of this study
includes cross-sectional nature of the design,
which does not allow for an assessment of
impact or cause and effect. Perhaps, most
valuable would be prospective cohort of hos-
pital employees, which are able to detect
changes in employees’ job satisfaction and
commitment. If these studies also incorporated
225
Health Services Management Research
interviews with subjects, this would increase
our understanding of the factors within hospi-
tal services as a job which influences job satis-
faction and commitment. Future research also
needs to explore the effects of variables that
were not measured in the current study, which
can also directly or indirectly influence feel-
ings of job satisfaction and commitment, such
as the organization’s structure and culture.
From a methodology perspective, the
reliance on the Delphi method that involves
consulting the domain experts in the instru-
ments design may present additional limit-
ations. It would be beneficial if future studies
were to enhance the reliability of the method
by other means, for example, relying more
heavily on the model illustrated in Figure 1.
As more results become available from the
surveys, their findings can further define the
relationships between job satisfiers, moderat-
ing factors and employees’ outcomes in differ-
ent real-life contexts. Such an enhancement
may also serve to articulate important aspects
of expert knowledge, thus providing a more
explicit formulation of the cause-effect and
correlation types of relationship.
Furthermore, this study may serve as a
foundation for future studies in different
countries, on a larger scale. More studies,
which involve hospital employees from other
countries, would enrich the literature on hos-
pital employees’ job satisfaction and commit-
ment, which in turn could generate strategies
to improve the global retention of new hospi-
tal managers and employees.
Acknowledgements
This study was the result of a phase of a
research funded by Ministry of Health, Iran.
The authors gratefully acknowledge the hospi-
tal managers and employees for their assis-
tance in performing this research.
References
1 Lok P, Crawford J. The effect of organizational
culture and leadership style on job satisfaction and
organizational commitment. J Manage Dev
2003;23:321– 38
2 Irvine DM, Evans MG. Job satisfaction and turnover
among nurses: integrating research findings across
studies. Nurs Res 1995;44:246– 53
3 Hellman CM. Job satisfaction and intent to leave.
J Soc Psychol 1997;137:677–89
226
Downloaded from hsm.sagepub.com by guest on June 7, 2013
4 Lum L, Kervin J, Clark K, Reid F, Sirola W. Explaining
nursing turnover intent: job satisfaction, pay
satisfaction, or organizational commitment? J Org Behav
1998;19:305– 20
5 Ito H, Eisen SV, Sederer LI, Yamada O, Tachimori H.
Factors affecting psychiatric nurses’ intention to leave
their current job. Psychiatr Serv 2001;52:232–4
6 Sourdif J. Predictors of nurses’ intent to stay at work in
a university health centre. Nurs Health Sci 2004;6:59– 68
7 Morana C. Employee satisfaction: a key to patient
satisfaction. Perioper Nurs Q 1987;3:33– 7
8 Tett RP, Meyer JP. Job satisfaction organizational
commitment turnover intention turnover: path analyses
based on meta-analytic findings. Pers Psychol
1993;46:259– 93
9 Ðordević B. Employee commitment in times of radical
organizational changes. Econ Organ 2004;2:111 –17
10 DeConincka J, Bachmann D. An analysis of turnover
among retail buyers. J Bus Res 2005;58:874–82
11 Kate W, Masako T. Reframing Organizational Commitment
within a Contemporary Careers Framework. Ithaca, NY:
Cornell University, 2002
12 Meyer JP, Allen NJ. Commitment in Work Place: Theory,
Research and Application. Thousand Oaks, CA: Sage,
1997:67
13 Meyer JP, Stanley DJ, Herscovitch L, Topolnyutsky L.
Affective, continuance, and normative commitment to
the organization: a meta-analysis of antecedents,
correlates, and consequences. J Vocation Behav
2002;61:20– 52
14 Shore LM, Tetric LE. A construct validity study of the
survey of perceived organizational support. J Appl
Psychol 1991;76:637–43
15 Murray LP, Gregoire MB, Downey RG. Organizational
commitment of management employees in restaurant
operations. Hosp Res J1991;14:339–48
16 Meyer JP, Allen NJ, Smith CA. Commitment to
organization and occupations: extension and test of a
three-component conceptualization. J Appl Psychol
1993;78:538– 51
17 Spector PE. Job Satisfaction: Application, Assessment,
Causes, and Consequences. Thousand Oaks, CA: Sage,
1997
18 Misener TR, Haddock KS, Gleaton JU, Ajamieh AR.
Toward an international measure of job satisfaction.
Nurs Res 1996;45:87–91
19 Knoop R. Relationships among job involvement, job
satisfaction, and organizational commitment for
nurses. J Psychol 1995;129:643– 9
20 Al-Aameri AS. Job satisfaction and organizational
commitment for nurses. Saudi Med J 2000;21:531–5
21 Ingersoll G, Olsan T, Drew-Cates J, et al. Nurses’ job
satisfaction, organizational commitment, and career
intent. J Nurs Admin 2002;32:250–63
22 Wu L, Norman IJ. An investigation of job satisfaction,
organizational commitment and role conflict and
ambiguity in a sample of Chinese undergraduate
nursing students. Nurse Educ Today 2006;26:304– 14
23 Mueller CW, Boyer EM, Price JL, Iverson RD.
Employee attachment and non coercive conditions of
work: the case of dental hygienists. Work Occup
1994;21:179– 212
24 Gaertner S. Structural determinants of job satisfaction
and organizational commitment in turnover models.
Hum Resour Manage Rev 1999;9:479–93
25 Landsman MJ. Commitment in public child welfare.
Soc Serv Rev 2001;75:386–419
 Relationship between job satisfaction, organizational commitment and turnover intention
26 Vandenberg RJ, Lance CE. Examining the causal order
of job satisfaction and organizational commitment.
J Manage 1992;18:153–67
27 Lund DB. Organizational culture and job satisfaction.
Bus Indus Market 2003;18:219– 36
28 Lance CE. Evaluation of a structural model relating job
satisfaction, organizational commitment, and
precursors to voluntary turnover. Multivariate Behav Res
1991;26:137– 62
29 Mathieu JE. A Cross-level nonrecursive model of the
antecedents of organizational commitment and
satisfaction. J Appl Psychol 1991;76:607– 18
30 Curry JP, Wakefield DS, Price JL, Mueller CW. On the
causal ordering of job satisfaction and organizational
commitment. Acad Manage 1986;29:847–58
31 Currivan DB. The causal order of job satisfaction and
organizational commitment in models of employee
turnover. Hum Resour Manage Rev 1999;9:1053– 4822
32 Griffeth RW, Horn PW, Gaertner S. Meta-analysis
of antecedents and correlates of employee turnover.
J Manage 2000;26:463
33 Mowday RT, Porter LW, Steers RM.
Employee-Organization Linkages: The Psychology of
Commitment, Absenteeism, and Turnover. New York:
Academic Press, 1982
34 Mathieu JE, Zajac DM. A review and meta-analysis
of the antecedents, correlates, and consequences of
organizational commitment. Psychol Bull
1990;108:171–94
35 Horn PW, Griffeth RW. Employee Turnover. Cincinnati,
OH: South-Western, 1995
36 Mosadeghrad AM. Handbook of Hospital Professional
Organization and Management (1). Tehran: Dibagran
Tehran, 2004
37 Bodur S. Job satisfaction of health care staff employed
at health centres in Turkey. Occup Med 2002;52:353–5
Downloaded from hsm.sagepub.com by guest on June 7, 2013
38 Eker L, Tuzun EH, Daskan A, Surenkok Ö, Predictors
of job satisfaction among physiotherapists in Turkey.
J Occup Health 2004;46:500– 5
39 Hespanhol A, Pereira AC, Pinto AS. Job satisfaction in
Portuguese physicians in general medicine. Aten
Primaria 1999;24:456–61
40 Al-Ahmadi HA. Job satisfaction of nurses in Ministry
of Health Hospitals in Riyadh. Saudi Med J
2002;23:645– 50
41 Chu C, Hsu HM, Price JL, Lee JY. Job satisfaction of
hospital nurses: an empirical test of a causal model in
Taiwan. Int Nurs Rev 2003;50:176–82
42 Seo Y, Ko J, Price JL. The determinants of job
satisfaction among hospital nurses: a model estimation
in Korea. Int J Nurs Stud 2004;41:437– 46
43 Lyons KJ, Lapin J, Young B. A study of job satisfaction
of nursing and allied health graduates from a
Mid-Atlantic university. J Allied Health 2003;32:10–17
44 Mosadeghrad AM, Yarmohammadian MH. A study of
relationship between managers’ leadership style and
employees’ job satisfaction. Int J Health Care Qual Assur
Incorp Leadership Health Serv 2006;19:pxi–xxviii
45 Wittig PG, Tilton-Weaver L, Patry BN, Mateer CA.
Variables related to job satisfaction among professional
care providers working in brain injury rehabilitation.
Disabil Rehabil 2003;25:97–106
46 Morris J, Sherman JD. Generalizability of an
organizational commitment model. J Vocation Behav
1981;24:512– 6
Further reading
Meyer JP, Allen NJ. A three component conceptualization
of organizational commitment. Hum Resour Manage Rev
1991;1:61– 89
227