Evaluation of the satisfaction of Ministry of Health workers in the sacred places during Hajj season, 1424 H

The Saudi Ministry of Health (MOH) is continuously aspiring to improve health services during hajj. However, each year MOH staff posted for hajj assignment face uncertain demands and expectations, passing through many stages, beginning with selection, on to reception at Makkah, transportation, residence, work environment and finally reward. This study was conducted to evaluate the satisfaction of healthcare workers (HCW) throughout the hajj assignment stages.

A cross-sectional study design was used. The study population was all the MOH workers posted for hajj duty at the sacred places. A stratified random cluster sampling technique was used, whereby healthcare facilities were considered the primary sampling unit and healthcare workers were the secondary sampling unit. For data collection, a bilingual (Arabic-English) self-administered questionnaire was designed, after modifying some international job satisfaction questionnaires.

The study sample was 717 HCW. Their mean age was 36.8 years (Standard Deviation ± 9.01). Males represented 75.3%; Saudis represented 55.5% followed by Arabs 23.2% and non-Arabs 21.3%. Nurses constituted the most common category 280 (39.1%), followed by doctors 202 (28.2%), and the rest constituted technicians, administrators, pharmacists, and health inspectors. 37.4% were allocated to work at Arafat, 40.3% at Mina, and 22.3% at Makkah; 58.3% were in Hospitals, 30% at Primary health care centers, 6.4% at Preventive medicine (Mina), and 5.3% at Emergency department (Mina). Regarding the number of participations in hajj duty 32.4% 1st time, 18.1% 2nd, 12.2% 3rd, 8.5% 4th, 8.1% 5th, and 21.6% more than 5. Regarding original work base, 33.4% were from the Western region, 30.3% from Riyadh, 15.1% from the South, 10.3% from Qaseem, 8.9% from Eastern region, and 2.1% from Northern region.

Those reporting overall satisfaction "fully satisfied and satisfied" constituted 91.1% of HCW (See figure 1).

Satisfaction of HCW by hajj assignment stages showed that 86.2% were satisfied by the selection process, 84.5% by work environment, 67.8% by reception and transportation, 55.9% by residence, and the lowest was financial compensation 31.6%. Overall satisfaction demonstrated by willingness to participate in future hajj seasons was highly significantly associated with selection, reception, residence, work environment and financial compensation (all p-values <0.001). The highest percentage of dissatisfaction was detected for the work environment (37.8%), followed by the selection process (36.4%), and the lowest percentage of overall dissatisfaction was for financial compensation (13.1%).

The overall dissatisfaction level was remarkably low (9%). Identifying the dissatisfactory factors for each stage was thought to be helpful in increasing the satisfaction level in the future or at least maintaining it. Regarding dissatisfactory factors for each stage, the highest dissatisfaction percentage for workers at the selection stage was with those who reported insufficient time to prepare themselves before going to hajj (43.1%). For reception stage, those who were not satisfied about the personnel treatment at reception reported the highest dissatisfaction percentage (77.9%). The most dissatisfactory factor about the residence stage was reported by those who were not satisfied about the cleanness of the residence (86.5%). Those who were not satisfied regarding work environment reported highest dissatisfaction with the relationships among each other and with their supervisors (55.1% and 50.0%, respectively, P<0.001)

Individual factors in each hajj assignment stage in association to overall dissatisfaction are represented in table 1.

Workers who chose friendly treatment as their best reward following hajj assignment represented the highest percentage of overall satisfaction (95.7%, P=0.016).

If 50% is assumed as the cutpoint between high and low levels of overall satisfaction, then (91%) is considered a very high percentage of satisfaction, which is against the general perception that most MOH workers are dissatisfied with their hajj assignments. Satisfaction levels were high for most of the hajj assignment stages. This high level of satisfaction may be attributed to improvement of the health care facilities provided to HCW during hajj duty in the form of new buildings and availability of necessary appliances at the accommodation areas. The authors believe that the most important reason behind this high satisfaction rate may be Islamic spiritual drive, since many of the respondents stated by writing on the questionnaire (I participated to serve the guests of Al Rahman and I am seeking the reward from Allah). Unfortunately, no question about this spiritual aspect was included in the questionnaire. It was clear that the majority of HCW assigned to hajj duty were young and male to cope with the stressful work demand. The distribution of the job categories and numbers of workers in each type of facility was rational with the goals of MOH in providing health services during hajj, where nurses and doctors represent the highest categories of HCW consecutively, and hospitals were allocated the highest number of workers.

The statistical associations between the factors of each stage namely selection, reception, transportation, residence, work environment and financial compensation and the overall satisfaction, significantly reveal that the highest level of overall dissatisfaction was among those dissatisfied with the work environment, whereas the financial Compensation had the lowest overall dissatisfaction level. Also, when the associations between the same factors and the indirect satisfaction measures (will you participate in the next hajj season? And will you recommend for your colleagues to participate in hajj?) were investigated, the same result was detected, in which, those who were not satisfied with the work environment reported the highest percentages of not recommending for their colleagues participation in hajj duty and also in unwillingness to participate in future Hajj seasons. Also, results of this study reveal that, in spite of the importance of financial compensation, however, in case of hajj duty, the Islamic spiritual motivation and seeking the re-ward from Allah carries the highest priority.

The findings of this study support McCaslin's findings regarding the importance of a good work environment, accommodation and transportation with job satisfaction, whereby financial compensation was among the least factors associated with job satisfaction.[1] Unpleasant relationships with supervisors and colleagues showed the highest significant dissatisfaction factors in relation to the work environment, which is concordant to several other job satisfaction studies.[2,3]

This study significantly proved that the work environment dissatisfaction factors especially uncomfortable relationships among the workers as well as with their supervisors are the main determinants in increasing overall dissatisfaction. The high percentage of HCW who choose friendly treatment as the best reward following hajj assignment points to the importance of good relationships among workers in increasing job satisfaction level. This study demonstrates the necessity of providing enough information for posted HCW about their duties during hajj, and the importance of having well-trained personnel at the reception station in Makkah. Attention should be given to the level of cleanliness of HCW residences.