1. Introduction
A hospital is an important engine for social progress. For this reason it must constantly change its operational strategy to accommodate new ideas and challenges that faces society. A successful modern hospital makes effort to attract and retain highly skilled clinical and non-clinical staff since effective, quality and reliable health service delivery depends on high quality, committed, and emotionally and psychologically sound workers. The effect of the 2019 novel coronavirus disease (COVID-19) on hospital personnel in recent times testifies to the importance of health professionals in contemporary hospitals. As stated in Xu et al. [
1], even though the history of modern medical practice documents overwhelming concerns about the welfare, satisfaction and commitment of health professionals, the emergence of COVID-19 has exacerbated this concern. All over the world, frontline workers have been overstretched as they navigate healthcare pathways to ameliorate the social and economic burden of COVID-19. This daunting healthcare demands require a well-motivated and satisfied workforce despite the scare resources and poor remunerations that can create employee burnout [
1].
Long before COVID-19, Africa had its own challenges with availability and quality of health professionals but the situation has worsened with the global pandemic. Health professionals in Africa often lack motivation as results of high workload, poor remuneration, poor working environment, discrimination etc [
2]. Ghana is one of the African countries that face severe challenges with health professionals. In 2019, Ghana was added to the list of countries with severe health professional challenges by the World Health Organization (WHO). The WHO further predicted that the persistence of the challenge can significantly affect quality health service delivery [
3]. This is because Ghana has one of the lowest health worker-to-population ratio in the whole world. Poor job satisfaction and lack of managerial support is largely responsible for the brain drain of health workers from Ghana and other African countries to developed countries [
4] Within Ghana, health professionals persistently move from the poor rural to urban areas causing severe challenges to rural health service delivery [
5]. This may explain why Ghana is among the countries with high infection and mortality of COVID-19 in Africa [
6]
For decades, researchers have investigated the drivers of employee motivation and wellbeing, yet concrete solutions continue to elude even the most developed medical system in Africa. Bakker and Demerouti’s [
7] job demands-resources (JD-R) model is one of the models often used to explain the drivers of employee engagement, burnout, satisfaction and performance in the work place. This model assumes that the source employee wellbeing or satisfaction is job or occupation specific but the sources can be categorized into job demands factors and job resource factors. Bakker and Demerouti [
7] argue that high job demand causes both mental and physical exhaustion which leads to depletion of energy and health problems for employees or health impairment. Conversely, job resources help to foster engagement and stimulate higher role performance. When employees have adequate job resources, it buffers the impact of job demand on stress, thus confirming the motivation potential of availability of job resources.
Unfortunately, in the context of hospitals in Africa, both job demand factors and job resources factors remain a major problem that contemporaneously influences dissatisfaction and performance [
8]. For this reason, health professionals in Africa often rely on other sources of motivation to nourish their psychological, emotional and mental wellbeing and satisfaction for the work they do. Job autonomy and Luthans et al.’s [
9] psychological capital theory (PsyCap) provides a good indicator of the source of employee motivation and satisfaction in the context of hospital employees in Africa as a whole and Ghana in particular. Luthans et al. [
9] explains psychological capital as a person’s positive psychological state of development that enables him to develop strong hope, self-efficacy, resilience and optimism in the pursuit of work. Luthans et al. [
10] further contends that PsyCap answers the question of who one is which eventually gives impetus to what he or she wants to achieve. Hope—as a component of psychological capital—refers to an individual’s motivation to succeed at a specific task in a set context and the way or means by which that task may be accomplished, in other words, the goals, pathways and agency to completing a given task [
11].
On the other hand, the concept of optimism refers to a person’s expectation of a positive outcome [
12] whereas the resilience component of psychological capital refers to a person’s ability to bounce back from adversity, uncertainty, risk or failure, and adapt to changing and stressful life demands [
13,
14]. Finally, the self-efficacy aspect of psychological capital includes an individual’s confidence in his capability to mobilize motivation, cognitive resources and courses of action to achieve high levels of performance [
15]. According to Luthan et al. [
16] positive psychological capital facilitates the individual’s motivational predispositions through cognitive resources that also help the individual to experience rewards from the present moment as well as raising future fortunes.
Since the work of Luthan et al. (2005), several researchers have applied the psychological capital theory to explain behavioral patterns among different employee groups. For example, a study conducted by Lu et al. [
17] found that psychological capital was positively related to job satisfaction and also found to predict job performance. The study noted that medical doctors who showed higher-order levels of psychological capital were confident in their abilities and executed their tasks successfully. Psychological capital and trust help to change the performance of individual performance to job satisfaction [
18]. Previous studies have focused on the interplay between motivation and job satisfaction as the panacea to high performance in the healthcare sector where productivity is not easy to measure. Job satisfaction ensures that hospital employees’ attitudes have very good impressions about the work they do in order to make total impact on the job. Job satisfaction comes from employees’ positive psychology, motivation, efficiency, and positive mood, which are urgently needed, in a resource-depleted healthcare system in Ghana. Moreover, Asiamah and Mensah [
19] argues that job satisfaction is negatively associated with nurses’ turnover intention which is indispensable qualities needed from hospital professionals in Ghana in the midst of the debilitating effect of numerous pandemic and epidemic that continues to plague the continent.
Psychological capital has also been linked to employee’s autonomy. Similarly, employee autonomy has been linked to satisfaction and performance. Hackman and Oldham [
20] define autonomy as the degree to which employees have control and discretion over how to carry out their duties. Virick et al. [
21] also defines perceived autonomy as the degree to which an individual, in accordance with his or her own free conduct, is not subject to external interference in a given situation and considers his or her conduct. Cai et al. [
22] theorized and examined how supervisor support for creativity or autonomy effectively activate the psychological capital associated with self-reported employee creativity. The authors concluded that PsyCap is most effective at enhancing creativity when both autonomy and job characteristics are high. Based on a study of 403 bank employees in Bangkok, Narumol et al. [
23], found out that positive psychological capital and job autonomy interact to generate intrinsic work motivation that stimulates higher employee performance. A more recent study by Li et al. [
24] complements the intricate relationship between psychological capital, job autonomy and other positive work outcomes. The study noted that psychological capital partially mediates the relationship between humorous leadership and employee workplace creativity. The authors further asserted work autonomy significantly moderates the relationship between employee’s psychological capital and employee creativity. The self-determination theory enforces the importance of job autonomy in these interactions by indicating that when an employee feels that his or her decision sourcing or acting is self-determining, the individual becomes intrinsically motivated as posited in the self-determination theory [
25]
Another study that explores the importance of job autonomy in stimulating positive work outcomes is the work of Asiabar et al. [
26]. They explored the proximal and distal consequences of telecommuting (psychological control or perceived autonomy) on work and family life. The results showed that job autonomy influenced several employee work attitudes and positive work outcomes such as performance, job satisfaction and turnover. Similarly, the job-characteristics model (JCM) has been used by Goldman, and Tabak [
27] to establish the relationship between autonomy of telecommuting employees and their job satisfaction. Complementing and extending prior studies, Jung [
28] found out that remote staff exhibited higher perception of autonomy which translated into strong organizational commitment and loyalty.
Examining the current literature, it is evident that while the relationship between job autonomy and other attitudes and outcomes have been investigated, the generalizability of the interaction between psychological capital and job autonomy to achieve higher satisfaction among healthcare professionals is barely addressed and remains a major gap that need to be addressed. Our work is particularly inspired by the earlier studies such as Burcharth et al. [
29] that argue that employee autonomy has the potential to mediate a wide range of positive employee outcomes such as innovation capability of employees. Modern healthcare systems require innovative employees instead of routine workers. Similarly the study is inspired by Katerndahl et al. [
30] who argues that psychological autonomy can positively mediate contributes to desirable employee behaviors such as competence, work-life balance and well-being which are important attributes in the hospital. Identify the extent to which satisfaction can be procured through psychological autonomy at the hospitals as this study seeks to achieve will be an important first step for advanced researchers to build on in the future.
This research fills this gap by empanelling and ensemble of more sophisticated mixed structural equation model to test the role of job autonomy for strengthening the direct effect of psychological capital on job satisfaction. The structural equation model is preferred as it guarantees robustness of inference compared with the traditional regression models that are dominant in the stock of current literature that have explored related subjects. After discussing the methodology for this research in the next section, the results are subsequently presented in the following section. Finally we discuss the findings, present the limitations and outline future research direction.
2. Materials and Methods
To achieve the objectives of the research, a quantitative research method based on survey research strategy was employed to collect data from qualified respondents in Ghana’s healthcare sector. As the study was based on individual experiences of healthcare professionals, the sample was procured from respondents who were selected randomly from the Korle-Bu Teaching Hospital, the Komfo Anokye Teaching Hospital, the Tamale Teaching Hospital, the Cape Coast Teaching Hospital and the Ho Teaching Hospital. These five hospitals are the main tertiary level hospitals in Ghana. In addition, data was collected from health professionals working at the 37 military hospitals. This institution is not a tertiary hospital but a very important military hospital in West Africa. It is the main referral hospital for national and regional emergency health services by the United Nations, the Red Cross and other international organizations.
Additionally, the six hospitals were chosen because they receive the highest inflow of patients on a daily basis and their staff are more susceptible to emotional and psychological crisis due to work load, work schedules and poor conditions of services that are generally low in a developing sub-Saharan country such as Ghana. Moreover, recent strike actions and media complaints about poor working conditions and resignations by dissatisfied healthcare professions have largely emanated from workers in these main hospitals in Ghana.
Further, even though clinicians are considered premium staff in healthcare facilities; the hospital work is interdependent on both clinical and non-clinical staff. Doctors cannot work in the absence of nurses, laboratory technicians, hospital administrators, and other allied health workers. Thus, these categories of healthcare workers are subject to similar workload, work schedule but different conditions of service. In the case of non-clinicians, their service conditions are far below their clinical counterparts, hence, they show more dissatisfaction. To that extent these healthcare workers often lose the needed to work in a difficult work environment such as a hospital and may occasionally require reassurance of managerial psychology to reboot their enthusiasm. An initial number of 400 respondents (both clinical and non-clinical staff) were selected, contacted and agreed to participate in the research but only 385 questionnaires were actually returned. This represents nearly 95% successful rate.
Table 1 shows the total number of clinical and non-clinical staff sampled in each of the hospitals.
A questionnaire data collection instrument was designed based on indicators that have been previously used to carry out similar work. It was self-administered to the respondents between March 2019 and December 2019. Respondents signed a consent form before participating in the research. Prior to administering the questionnaires, it was pre-tested on an initial sample (21 respondents) that did not form part of the final sample but within the population.
The results from the pre-test sample were used to reword the questionnaire and fine-tune other parts to improve their reliability. As the study involved a human sample, written ethical approval was obtained from the Jiangsu University Research Ethic Committee and the Ghana’s Ministry of health Research Ethics Committee before carrying out the data collection. A closed-ended style of response was used to design the questionnaire. This means that each question had alternative responses from which respondents could make a choice. Using this approach helped to speed up the data collection since the respondents work in a very fast moving environment and had no much time. Secondly, a closed ended approach was used because it can help to improve the coding of the data. There were six constructs in all namely psychological capital (hope, optimism, resilience, and self-efficacy) and job autonomy and job satisfaction. These were coded as follows:
2.1. Psychological Capital and Job Autonomy
Positive psychological capital or simply psychological capital has been conceptually identified as consisting of four positive psychological resources of self-efficacy, hope, optimism, and resilience [
10]. According to Luthans, et al. [
31] psychological capital has been established to give competitive advantage to firms or institutions through the development of people’s hope, optimism, resilience and self-efficacy. The level of freedom employees experience in terms of decisions making at the workplace is referred to as job autonomy. Experiencing job autonomy is seen as a factor that promotes work [
32]. Saragih et al. [
33] posits that there is a lot of creativity and accomplishment of tasks when employees experience high job autonomy when their psychological capital is well developed. Further, it has been established that employees who experience job autonomy are well encouraged which pushes them to go beyond their limit to get the best out of them [
34]. It is hypothesized from the above that:
Hypothesis 1a (H1a): hope will positively influence job autonomy;
Hypothesis 1b (H1b): self-efficacy will positively influence job autonomy;
Hypothesis 1c (H1c): resilience will positively influence job autonomy;
Hypothesis 1d (H1d): optimism will positively influence job autonomy.
2.2. Job Autonomy and Job Satisfaction
There are various determinants of employee job satisfaction and one of them is job autonomy. Hackman and Oldham [
20] defined job autonomy as “the degree to which the job provides substantial freedom, independence, and discretion to the employee in scheduling the work and in determining the procedures to be used in carrying it out” (p. 162). The linkage between job autonomy and job satisfaction can best be explained using the JD-R model. In this model, the jobs people engaged in are divided into job demands and job resources. While job demands concern itself with the cost in physiology, social, psychological, or organizational sides of the job like emotional demands, job resources lessen the impact of job demands and its costs to stimulate some level of learning, growth and development [
7].
In the JD-R model, job autonomy is aligned with job resource which seeks to prevent the negative impact job demands will bring. Therefore, absence of job autonomy raises the negativities of absenteeism, stress, repetitive strain, and ill health whereas presence of job autonomy leads to higher employee job satisfaction [
7]. Many researches have established the important relationship job satisfaction has with job autonomy. Taylor et al. [
35] found that job satisfaction can be explained by autonomy to a great extent.
The conclusions by researchers on the influence of job autonomy on job satisfaction has been quite consistent, the findings have been mostly that job autonomy leads to job satisfaction [
35,
36] on the same assumption, a lack of autonomy will result in higher levels of stress which in turn can lead to dissatisfaction in one’s work [
7]. It is postulated that:
Hypothesis 2 (H2): Job autonomy will positively influence employees’ job satisfaction.
2.3. Measurement of Psychological Capital
Psychological Capital: PsyCap was measured using Luthans et al.’s [
31] psychological capital questionnaire (PCQ). With this scale, PsyCap is conceptually identified as consisting of four positive psychological resources of self-efficacy, hope, optimism, and resilience. There are 24 questions in this scale and are calibrated on a six-point Likert scale measure. The responses range from 1 (strongly disagree) to 6 (strongly agree).
Measurement of Autonomy: The self-determination theory’ questionnaire proposed by Deci and Ryan [
37] was used to measure the autonomy construct. This questionnaire uses a five point Likert scale to calibrate the responses. A strongly agree responses is denoted with the value 5 whereas a strongly disagree responses is denoted with the value 1. Examples of some of the questions on this scale include; “I feel a sense of choice and freedom in the things I undertake”, “I feel that my decision reflects what I really want”. This questionnaire has also been validated in current research studies such as [
3,
8].
Measurement of Job Satisfaction: Job satisfaction was measured with the Minnesota Satisfaction Questionnaire (MSQ) developed by the University of Minnesota. The responses are also ranked on a five point Likert scale where 1 denotes very dissatisfied and 5 denotes very satisfied. The MSQ has two versions namely a shorter version and a longer version. This study applied the short version. The short form of the MSQ can be seen as a composite of a number of job facets. Scores are created by summing items so as to show each participant’s satisfaction level ranging from 20 to 100. A score of 60 would indicate moderate, a score ranging from 61 to 79 would indicate ‘moderate to not fully satisfied’ and a score of 80 and above would indicate satisfied. This questionnaire has been widely used in measuring employee job satisfaction in contemporary studies with robustness of inference [
38,
39].
2.4. Data Analysis
To test the hypotheses, a structural equation regression model was constructed based on the conceptual framework presented in the earlier sections of the research. Descriptive statistics was first computed to determine the mean, standard deviation and skewness of the constructs. The latter is necessary in determining the normality of data to determine the type of inferential analysis to carry out. Based on the results a Pearson product moment correlation coefficient was computed to determine the existence of possible multicolinearity among the variables. A mixed structural equation model was then constructed to establish the relationship between psychological capital, job autonomy and employee job satisfaction among the selected respondents. Using a structural equation model was preferred to the traditional regression model since it produces more robust outcome. It is the only known statistical procedure that is able to determine the coefficient of regression in a multivariate regression as if these multiple various acted independently. All data analysis was done by SPSS for Windows Ver. 22.0, and AMOS version 22 software and a two-tailed probability value of <0.05 was considered to be statistically significant.
4. Discussions and Conclusions
In the extant literature, employee job satisfaction is well established as a major factor to stimulate positive organizational behaviors. A major source of positive organization behavior is that healthcare professionals resist control but desire some degree of autonomy as a basic psychological need. Throughout the extant literature, numerous factors have been listed as important drivers of employees’ job autonomy. This study focused on the validity in the extent to which psychological contract attributes can influence employee’s autonomy to promote job satisfaction. Data was collected from 385 health professionals in Ghana and a structural equation model was applied to analyze the relationships. The results show a positive relationship between hope and job autonomy. Similarly, optimism and self-efficacy largely influences job autonomy of the healthcare professionals. The only exception was resilience which recorded a positive but insignificant effect on employee’s autonomy. The findings implies that a relationship exist between psychological capital and job autonomy which translates into job satisfaction among health professionals in Ghanaian hospitals [
43]. The results further confirm that job autonomy mediates the relationship between psychological contract indicants such as hope, resilience and optimism and job satisfaction.
The results of this study affirm several findings in the previous literature. Job autonomy has been found to be linearly related to job satisfaction relative to other professions [
44,
45,
46,
47]. Similarly, Iliopoulou and While [
43] found out that overall, nurses reported acting moderately autonomously. They argued that professional autonomy is generally considered a highly desirable nursing attribute and a major factor in nurse job satisfaction. In the critical care environment, a high level of accountability, responsibility and autonomy are required to optimize outcomes of critically unstable patients. In most public institutions, the relationship between leaders and their followers is mostly determined by the traditions and structure of the organization, those organizations that follow procedures do not have lot of this autonomy, however, flatter organizations use autonomy, empowerment, and participation to succeed [
48].
The level of autonomy that employee exercises or enjoys break the gap between higher and lower authority in the organization, gives people the independence to perform their duty. When employees exercise greater professional autonomy, they become more creative and innovative, generate new ideas and solve problems more easily. Professional autonomy helps employees to build confidence and develop quality relationships among employees and superiors based on trust. Most importantly, greater autonomy strengthens job satisfaction. An increased in autonomy reduces the level of discontent since individual employees have different psychological needs in their area of work.