Ahmad Abdulrauf Mirza  ( Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz University, Jeddah, Saudi Arabia )
Ahmed Hassan Badrek-Amoudi  ( Department of Surgery, Umm Al-Qura University, Makkah, Saudi Arabia )
Mian Ushman Farooq  ( Department of Strategic Planning and Institutional Advancement, King Abdullah Medical City, Makkah, Saudi Arabia )
Hussam Ahmed Senan  ( Department of Otolaryngology, Head and Neck Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia )
Rakan Hamzah Aun  ( Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia )
Abdulrahim Abdulraoof Mirza  ( Department of Surgery- Division of Urology, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia )
Mohammed Saleh Binsaad  ( Umm Al Qura University, Makkah, Saudi Arabia )
Mohamed Amine Haireche  ( WAX Clinical Research Skills Limited, Birmingham, United Kingdom )
Ziad Abdulaziz Al-Ahmadi  ( Department of Internal Medicine, King Abdulaziz Medical City, Jeddah, Saudi Arabia )
Mohammed Aiman Halawani  ( Umm Al Qura University, Makkah, Saudi Arabia )

Objective: To assess the job satisfaction of surgical healthcare professionals working during Hajj, and to determine the potential predictors of overall job satisfaction in Hajj and non-Hajj periods.

Methods: A multicenter cross-sectional study was conducted at King Abdullah Medical City, King Faisal Hospital and Al-Noor Specialist Hospital, Makkah, Saudi Arabia, from August 27 to September 5, 2018, which represented the period of 10 days following the Hajj season in that year. All surgeons who were employed during Hajj were interviewed regarding their job satisfaction in-Hajj versus non-Hajj periods using the Warr-Cook-Wall job satisfaction scale. A stepwise multiple linear regression was carried out to analyse predictors of overall job satisfaction in both Hajj and non Hajj periods separately. SPSS 16 was used for data analysis.

Results: Of the 146 participants, 28(19.18%) were consultants, 61(41.78%) specialists and 57(39.04%) were residents. Overall job satisfaction scores in Hajj period was 5.53 ±1.19 compared to 5.40±1.33 in non-Hajj period (p>0.05). During Hajj period, the participants were significantly more satisfied in terms of "amount of variety in work" (p<0.05), while they were significantly dissatisfied with regard to "physical work in g cond ition", "hours of work" an d "attention paid to suggestions" (p<0.05).

Conclusion: The variety of cases encountered by surgeons during Hajj contributed significantly to job satisfaction. However, lack of attention to physicians' suggestions, extended hours of work and physical working condition during Hajj were potential factors causing less Job satisfaction during Hajj duty.

Keywords: Job satisfaction, Surgeons, Hajj, Pilgrimage, Mass gathering, Medicine. (JPMA 70: 1371; 2020).

https://doi.org/10.5455/JPMA.28809

 

Introduction

 

Hajj is one of the biggest mass gatherings in the world¹ that requires huge organisational and material efforts, including health services for the visitors. The Saudi authorities have assigned 25,000 health workers and prepared 25 hospitals, 155 permanent and seasonal health centres and 100 highly equipped mobile intensive care units (ICUs) to medically assist more than 3 million pilgrims at the 4 major rituals' localities: Mina, Arafat, and the two Holy Mosques of Makkah and Madinah.^2-4 These seasonal health facilities have an inpatient capacity of 5000 beds, including 500 intensive care (IC) beds, where all health services are free of charge, including surgeries.2 Each new Hajj season brings new challenges that add to the experience of the staff and the authorities.^1,5 However, like in every other healthcare system, the quality of care in Hajj depends on several parameters, including the wellbeing of clinicians and their job satisfaction. There is rising evidence that job satisfaction of clinicians impacts the quality of healthcare and patients' satisfaction; as well as malpractice is significantly associated with low job satisfaction.^6-8 In order to improve the quality of care, many studies have investigated the job satisfaction and the associated factors among practitioners of different specialties.^8-12 In addition, many instruments have been used to measure job satisfaction in healthcare professionals.^13-15 However, no published results have so far focussed on job satisfaction of surgeons working during the Hajj. The current study was planned to assess the level of satisfaction of surgical healthcare professionals during Hajj. In addition, the potential determinants of satisfaction and dissatisfaction in correlation with the working conditions during Hajj and non-Hajj periods were investigated.

 

Subjects and Methods

 

This multicenter cross-sectional study was conducted at King Abdullah Medical City (KAMC), King Faisal Hospital (KFH) and Al-Noor Specialist Hospital (NHS), Makkah, Saudi Arabia, from August 27 to September 5, 2018, which represented the period of 10 days following the Hajj season in that year. After approval by the review committee of King Abdulaziz University, Jeddah, Saudi Arabia, all residents, specialists and consultants of surgical specialties who were regularly employed in the three hospitals for a minimum period of six months and had also performed the special Hajj duty were considered as the study population. The total number of participants to be included in the study was carried out first by the attainment of study population list with their names and job locations followed by calculating the percentage of each hospital's eligible surgeons from the total study population. The total number of study participants were then stratified and surveyed. After verbal informed consent from each participant, data was collected using a questionnaire to conduct face-toface interviews. The questionnaire had two parts. The first part explored demographic data, job designation and the healthcare centre. The second part explored the core of the study and consisted of a short version of Warr-Cook- Wall (WCW) job satisfaction scale. It had 11 relevant items out of the original 15. For each of these items, satisfaction level was measured using a 7-point Likert scale ranging from 1=extreme dissatisfaction to 7=extreme satisfaction. The 11 WCW items retained were: "physical working condition", "your immediate boss", "your colleagues and fellow workers", "amount of responsibility", "hours of work", "freedom to choose your own method of work", "opportunity to use abilities", "attention paid to suggestions", "recognition you get for good work", "rate of pay", "amount of variety in work".¹⁵ Another item, "overall satisfaction", was included as the outcome variable. The questionnaires were dispensed by eight medical students of Umm-al-Qurra University, Makkah, who volunteered to carry out data collection. These medical students were informed of the objectives of the study, and were trained over two 30-minute sessions regarding the data collection tool and the methodology of data attainment. The data, including the satisfaction levels, was assessed and recorded at the same time by the students for two distinct non-Hajj and Hajj periods. The manually-collected data was transferred to computer by the researchers. Data had been saved with deidentification in order to ensure confidentiality of the participants. Data quality checks had been done by data analyst, and queries about any missing values were returned to the respective volunteer for resolution. The data was analysed using SPSS 16. It was subjected to descriptive analysis. Measurement data was expressed as mean ± standard deviation (SD), while categorical data was detailed as frequencies and percentages. Job satisfaction score was taken as a continuous variable and was subjected to normality evaluation by Shapiro-Wilk normality test. Questionnaire stability, that is, internal consistency, was measured by Cronbach's alpha. Face validity of the questionnaire was confirmed by a research consultant, biostatistician and a surgeon. Differences between Non-Hajj and Hajj job satisfactions scores were analysed using paired student's t-test for continuous variables. Stepwise multiple linear regression was performed using overall job satisfaction (12th question) as the dependent variable, and questions 1-11 were considered independent variables. Regression analysis was carried out for Hajj and Non-Hajj periods separately. P<0.05 was considered statistically significant.

 

Results

 

Of the 174 subjects approached, 150(86%) responded, but 4(2.6%) of these questionnaires were excluded because of deficient/missing data, and the final sample stood at 146(97.3%). Of them, 63(43.2%) belonged to NHS; 118(80.8%) were males; and 79(54.5%) were non-Saudis. The mean age of the sample was 37.47±9.94 years. Of the total, 28(19.18%) were consultants, 61(41.78%) were specialists and 57(39.04%) were residents (Table 1).

The mean response of matched pairs was 0.12±1.4 and was normally distributed. The Cronbach's alpha reliability of the 12-item scale was 0.91, indicating that the scale has good reliability. Participants were significantly more satisfied about "variety of work" during Hajj period than the non-Hajj period (p<0.05). However, they were significantly dissatisfied with respect to "physical working condition", "hours of work" and "attention paid to suggestions" (p<0.05). Over all job satisfaction was higher during Hajj than the non-Hajj period, but the difference was not significant (p=0.29) (Table 2).

For the Hajj period, in the first step of the stepwise regression model, the item 'Opportunity to use abilities' showed the highest score of explained variance in overall job satisfaction, followed by 'hours of work' (Table 3).

For non-Hajj period, in the first step of the stepwise regression analysis, the item 'recognition you get for good work' showed the highest score followed by "opportunity to use abilities" (Table 4).

 

Discussion

 

It is important to assess and improve job satisfaction among healthcare providers during Hajj, as this enhances the quality of care provided to the pilgrims and reduces the risk of working stress, burnout and malpractice.^6-8,16 The current study explored for the first time the level and predictors of job satisfaction among surgeons working during Hajj. Working as a healthcare provider during Hajj may be an exciting experience and an excellent learning opportunity, as it represents the largest mass gathering in the world, with people coming from almost all the countries.¹ This brings a diversity of clinical cases, notably in surgery where a large variety of procedures can be carried out in a single working day. In this study, working during Hajj versus non-Hajj was associated with higher satisfaction regarding variety of work among surgeons; although it was not a predictor of overall job satisfaction. In line with this observation, several studies demonstrated that variety of work is an important component of professional fulfilment and a preventive factor against turnover intention.^11,17 On the other hand, working during Hajj is often associated with increased amount of responsibility and workload which may constitute the major factor that counterweighs variety of work on the satisfaction scale. During Hajj period, there is limited number of physicians providing care for a large flow of pilgrims. Results of this study confirm that physical working condition (flow of work) is a major concern for surgeons working during Hajj as they were remarkably dissatisfied with the Hajj condition. Besides, it was one of the significant predictors of overall job satisfaction during Hajj. The other concerning element perceived by the physician working during Hajj was "attention paid to their suggestions". This factor, as well as opportunity to use ability, which was the strongest predictor of overall job satisfaction, are related to working autonomy and decision latitude, which was demonstrated to be an important factor of job satisfaction among several categories of social and health workers.^16,18,19 In the current study, "satisfaction about working hours" was another concern of the physicians working in this pilgrimage and was also demonstrated to be a predictor of overall job satisfaction both in Hajj and non-Hajj periods. Several studies have addressed the importance of working hours as a major determinant of job satisfaction and working stress; especially among female practitioners who were more prone to stress and burnout, and display more concern about job demands on family and social life.^9,18-20 Furthermore, it was previously demonstrated that working >40 hours per week was associated with high rates of turnover intention among physicians.¹¹ During Hajj, the extended hours in the duty (12 hours) may be not appropriate for all physicians, and should be as much as possible adapted on a case-by-case basis to prevent burnouts or resignations.^7,16 Income was not significantly different in Hajj and non- Hajj periods. The extra payment earned by the physicians during Hajj might not be adequately compensating and encouraging for healthcare workers to take part in Hajj duties. The additional workload and longer shifts in Hajj might counterweigh the extra payment received. This can be noticeably expected as income was one of the significant positive predictors of overall job satisfaction both in Hajj and non-Hajj periods.

 

Conclusion

 

There was no remarkable change in job satisfaction during Hajj and non-Hajj periods. By contrast to non-Hajj period, physicians were less satisfied with regard to the physical working condition, extended hours of work and attention paid to their suggestions; however, they were more satisfied in terms of the variety of work. The three strongest predictors of overall job satisfaction during Hajj were "opportunity to use ability", "hours of work" and "income".

Acknowledgement: The authors are thankful to Ghada M. Beyari, Nada Bukhar y, Wajd M. Benjabi and Abdulrahman J. Bakhsh, medical students/interns enrolled at Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia for their contribution in data collection during Hajj 1439H/2018AD. The authors express their sincere thanks to Prof. Ahmed A. Aljohaney for reviewing the study protocol.

 

Disclaimer: None.

Conflict of Interest: None.

Source of Funding: None.

 

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