UNIVERSITY OF BERGEN

Department of Administration and Organization Theory

AORG 351

Master’s Thesis in Public Administration

Spring 2020

Employees’ Perception on The Impact of Work Environment on Job

Performance:

A Case of Bugiri Hospital in Uganda

Patricia Nakiwala
 Declaration

I, Patricia Nakiwala, hereby declare that this thesis is my own original work and has

not been submitted to any other university for a similar or any other degree award

……………………………………………

Signature

……………………………………………

Date

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 Acknowledgement

A number of people have provided constructive advice concerning the contents of this

thesis. I would like to take this opportunity to thank my supervisor Associate Professor

Martina Vukasovic for her insightful and critical comments that helped me shape this

work. To Associate Professor Dr. Kari Tove Elvbakken and Prof. Ishtiaq Jamil, thank

you for your constructive critique and comments during the various presentations of

this work.

I am further grateful to the University of Bergen for granting me the opportunity needed

to pursue this master’s program.

My fieldwork wouldn’t have been possible without the support and cooperation of

informants. I say a big thanks to you all. I would like to extend my heartfelt appreciation

for the guidance I received from the senior and junior staff including my course-mates

at the University of Bergen.

I dedicate this thesis to my lovely family, especially my lovely mother Gladys

Nakayenga and my father Joseph Lutaaya S, for their financial support; they are a

source of inspiration and mentors in my life. I extend my sincere gratitude to my lovely

husband Steven Ivan S for his support, care and love. Finally, I am grateful to the

almighty God for blessing me with good health, wisdom, and passion to persist in

fulfilment of the master’s programme in Public Administration.

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 Table of Contents

Declaration ........................................................................................................ 1
Acknowledgement ............................................................................................. 2
List of tables ....................................................................................................... 5
List of figures ...................................................................................................... 6
Abstract ............................................................................................................. 7
CHAPTER ONE .................................................................................................... 9
INTRODUCTION .................................................................................................. 9
1.0 Introduction ...................................................................................................... 9
1.1 Background of the Study ................................................................................. 10
1.2 Research Problem ........................................................................................... 11
1.3 Objectives of the study .................................................................................... 13
1.3.1 General objective of the study ......................................................................... 13
1.3.2 Specific Objectives of the study. ....................................................................... 13
1.4 Research Questions ......................................................................................... 13
1.5 Justification of the study ................................................................................. 14
1.6 Scope of the study ........................................................................................... 14
CHAPTER TWO ................................................................................................. 15
LITERATURE REVIEW AND THEORETICAL FRAMEWORK .................................... 15
2.0 Introduction .................................................................................................... 15
2.3.1 Performance indicators as per WHO definition................................................ 23
2.4 Definition of Concepts ..................................................................................... 25
2.4.1 Work Environment .......................................................................................... 25
2.4.2 Job Performance ............................................................................................. 26
2.5 Theories of the study ....................................................................................... 27
2.6 Variables of the study...................................................................................... 32
2.8 Hypotheses of the study .................................................................................. 34
CHAPTER THREE ............................................................................................... 38
RESEARCH METHODOLOGY .............................................................................. 38
3.2 Study Population ............................................................................................. 40
3.3 Sample size and selection ................................................................................ 41
3.4 Sampling Techniques and Procedure ............................................................... 41
3.5 Data collection methods.................................................................................. 42

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3.6.1. Validity............................................................................................................ 43
3.7 Data Collection Procedures ............................................................................. 45
3.9 Ethical Consideration....................................................................................... 45
CHAPTER FOUR ................................................................................................ 47
PRESENTATION OF FINDINGS............................................................................ 47
4.0 Introduction. ................................................................................................... 47
4.1 Demographic characteristics............................................................................ 47
4.2 Employees’ perception on work environment ................................................. 53
4.3 Factors affecting employee performance......................................................... 61
4.3.1 Correlation analysis............................................................................... 67
4.4 Ways of improving employee job performance. .............................................. 70
CHAPTER FIVE .................................................................................................. 74
DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS ................................... 74
5.0 Introduction .................................................................................................... 74
5.1 Discussion of findings ...................................................................................... 74
5.1.1 Perception of the work environment............................................................... 74
5.1.2 Factor affecting employees’ performance ....................................................... 77
5.1.3 Improving employee performance .................................................................. 78
5. 3 Recommendations .......................................................................................... 81
5.4 Limitations of the study ................................................................................... 82
References ....................................................................................................... 83
APPENDICES ..................................................................................................... 94
Appendix I.: Questionnaire tool for primary respondents ............................................ 95
Appendix II: Interview Guide tool ................................................................................ 97

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 List of tables

Table 1: Summarized table showing the linkage of the research questions, hypotheses,
operationalization of variables and theories ........................................................................... 36
Table 2: Showing demographic characteristics; categorised by education & sex .................. 49
Table 3: Showing the relationship between the independent variables and dependent variable
.................................................................................................................................................. 67
Table 4: Showing the hypothesis that working conditions will have direct positive effect on job
satisfaction ............................................................................................................................... 69
Table 5: Showing suggested ways of improving on employees’ performance......................... 70

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 List of figures

Figure 1: Conceptual Framework showing the relationship of independent variable, dependent

variable and Intervening variable ........................................................................................... 34
Figure 2: Showing demographic characteristics: categorised by gender and age ................. 48
Figure 3: Showing demographic characteristics; categorised by education, gender& age ... 50
Figure 4: Showing departments of participants ...................................................................... 51
Figure 5: Showing duration of participants at the hospital .................................................... 52
Figure 6: Showing departments of participants; categorized by period worked .................... 53
Figure 7: Showing employee satisfaction on the work environment ....................................... 54
Figure 8; Showing employee perception of the work environment; categorized by gender ... 55
Figure 9: Showing employee perception of the work environment; categorized by department
.................................................................................................................................................. 56
Figure 10: Showing reasons for employee satisfaction on the work environment .................. 57
Figure 11: Showing categorised reasons for employee satisfaction on the work environment
.................................................................................................................................................. 58
Figure 12: Showing employee satisfaction levels on key work environment aspects .............. 60
Figure 13: Showing employee job performance trend since 2016 .......................................... 62
Figure 14: Showing employee job performance trend since 2016; categorised by duration
worked ...................................................................................................................................... 63
Figure 15: Showing factors affecting employee job performance ........................................... 64
Figure 16: Showing factors affecting employee job performance; categorised by gender ..... 66
Figure 17: Showing suggested ways of improving on employees' performance categorized by
gender ...................................................................................................................................... 72

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Abstract

Public organizations have to stretch beyond their traditional roles and discover new

ways of working. They should create a work environment where people feel like they

have a purpose, enjoy what they do, have pride in what they do and can reach their

potential. This study aimed at assessing how employees perceive the effect of work

environment on their job performance at Bugiri Hospital in Uganda. Specifically; to

assess how the physical work environment (such as: office building) affect job

performance, to understand the other factors affecting employee performance; and to

suggest possible ways of improving upon hospital employees’ performance.

It was a case study of Bugiri Hospital in Uganda. The study employed both qualitative

and quantitative methods. Emphasis was given to quantitative approach; this is

because quantitative research design would help the researcher to test the laid

hypothesis about work environment. The 123 hospital workers were led through a

questionnaire; The 3 deep dive interviews with the key informants included one

interview with an administrator, one interview with the senior doctor and one

interview with a district official. It is assumed that there is a positive relationship

between the work environment conditions and performance of employees at Bugiri

Hospital (i.e. employees who perceive their work environment as undesirable and

inappropriate, their corresponding level of satisfaction and performance will

decrease).

The study revealed that there is lack of care in improving the standard of the hospital,

which continues to negatively affects the performance of workers even though

workers. This therefore confirms to the hypothesis that work environment factors

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affect the performance of employees in each organization. The results indicate that the

main reason for lack of enthusiasm among staff is overcrowding of patients at the

hospital, which is as a result of lack of enough staff and absenteeism.

In conclusion based on the findings, the study revealed that hiring more staff and well

equipping the hospital would boost their morale to work to their full potential. Apart

from such extrinsic motivational factors, employees are also interested at pay rise and

improving their welfare.

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 CHAPTER ONE

INTRODUCTION

1.0 Introduction

This study analysed employees’ perception of the impact of work environment on job

performance at Bugiri Hospital in Uganda. Bugiri General Hospital serves Bugiri

district and parts of the districts of Iganga, Busia, Namayingo Mayuge and

Namutumba (UMOH, 2016). Over the years, the hospital infrastructure has

deteriorated, the equipment has become antiquated and hospital has become under-

staffed. The remaining workers are overworked, underpaid, poorly funded and under-

motivated (Womakuyu, 2012). I chose this hospital as my field of data collection

because of its nature of service delivered to the public; the hospital offers several

health-care services to the public. Bugiri hospital is regionally well known by the

public as a hospital built immediately off the colonial era during the late president

Obote’s regime, however, its deteriorating state caught my interest for the selection

for my research. Secondly, dealing with ill and poor people is not an easy task since

some patients can be dirty, hungry, can’t afford other services, unlike other urban

institutions where the medical staff deal with people who are financially stable; thus,

motivating me to explore and deeply understand how employees working in this

institution perceive the impact of work environment on job performance.

This study has three different types of variables (independent, dependent and

intervening variable). The independent variable is related to the workplace

environment, specifically the physical work environment. Job performance is the

dependent variable, and this was measured in terms of availability of staff, competence

and productivity. The intervening variable is job satisfaction.

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 Besides introducing the study, this chapter presents the background to the study,

statement of the problem, general objectives, and specific objectives of the study. It

also includes research questions, justification and scope of the study. The thesis is

organized into five chapters: the first chapter is introduction, and the other five

chapters are literature review, methodology, analysis and presentation of results and,

finally, summary, discussion, conclusion and recommendations.

1.1 Background of the Study

Creating a work environment in which the employees are productive is essential to

increase performance for the organization. Well designed and organized offices and

work areas make significant differences to how people feel about their work. Working

environment is argued to impact immensely on employees’ performance either

towards negative or positive outcomes (Chandrasekar, 2011). Lambert et al (2001)

found that environmental factors are important determinants of job satisfaction. The

level of salary, promotion, appraisal system, climate management, and relation with

co-workers are the very important factors. In short, it is the quality of the employee’s

work environment that most impacts on the level of employee’s motivation and

subsequent performance. When employees are physically and emotionally fit, they

will have the desire to work and their performance outcomes shall be increased. More

so, a proper workplace environment helps in reducing the number of absenteeism and

thus can increase the employees’ performance which leads to increased performance

at the workplace (Boles, Pelletier, & Lynch, 2004).

The human resources crisis coupled with poor performance of health workers in the

health sector in developing countries is receiving increased global attention (Dieleman,

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 Gerretsen, & wilt, 2009). This has resulted into policymakers and planners realizing

that it is simply not possible to achieve the Millennium Development Goals (MDGs)

if health workers' availability and performances are not addressed more effectively.

These authors further argue that poor performance leads to inappropriate care, which

contributes to reduced health outcomes.

In Uganda, human resource management challenges have been reported, among these

challenges is weak performance management of health care workers ( (Lutwama,

Roos, & Dolamo, 2013). The value for money audit for the health sector programmes

that was carried out in Uganda in the year 2008 revealed a number of weaknesses in

performance management of employees in the health care sector in the different

districts (Auditor General Uganda, 2006). The audit also revealed significant staffing

gaps with many of the 112 districts in Uganda failing to attract and retain qualified

health care workers. In addition, the districts did not have clear policies on staff

training, transfers and rotation. There was irregular and inadequate support

supervision, and staff appraisals were occasional to report performance (MOH, 2008).

This study will make some contribution to the existing literature: It offers an overview

of the recent understanding of health workers’ perception of their work environment

and the study further provides more knowledge of the relationship between work

environment and job performance. The study identified work environment factors that

induce higher performance and job satisfaction among employees of Bugiri Hospital.

1.2 Research Problem

Chandrasekar (2011) argues that, in majority of organizations, employees perceive

workplace environment as unsafe and unhealthy. These comprises of poor air

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circulation, poor personal protective equipment, inappropriate furniture, inadequate

security measures in fire emergencies (absence of fire extinguishers), unnecessary

noise, unfitting lighting and poorly designed workplace (Chandrasekar, 2011, s.1). The

author further reports that “People working in such an environment are prone to

occupational disease and it impacts on employee’s performance” (p.1). Thus,

performance is decreased due to workplace environment. Mostly people spend fifty

percent of their lives within indoor environments, which deeply influence their mental

status, actions, abilities and also their performance (Sundstrom, 1994).

In Uganda’s case, performance of employees in the public health sectors has been

reported to be below expectation; several factors contribute to poor employee

performance. For instance, Tashobya and his colleagues reveal that financing

conditions, where very little is spent on basic health care inputs (for example:

medicines, health workers’ salaries and health centre maintenance) in rural areas has

an implication on the performance of employees (Tashobya, Ssengooba, & Cruz,

2006) . Tashobya and colleagues further point out that as a result, the coverage of

services is limited, quality is poor in terms of performance and, combined with the

existence of patient charges, these services represented poor value for money. Not

surprisingly, prospective health care consumers tended to stay away, choosing either

to self-treat or to attend alternative commercial health sector providers.

It is widely accepted that the work environment has an impact - positive or negative -

on employee performance. The work environment strongly influences the extent to

which employees are engaged in their work and committed to the organization.

Disengaged workers produce mediocre results; highly engaged workers produce

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 extraordinary results (Ollukkaran & Gunaseelan, 2012). So, it is necessary to study the

impact of the work environment in an organization on the performance of its

employees.

1.3 Objectives of the study

1.3.1 General objective of the study

The study aimed at assessing how employees perceive work environment in relation

to their job performance at Bugiri Hospital, Uganda

1.3.2 Specific Objectives of the study.

• To investigate employees’ perception of the work environment of Bugiri

Hospital

• To identify factors affecting the job performance of Bugiri Hospital employees

• To suggest ways of improving the performance levels of public hospital

employees.

1.4 Research Questions

In order to fulfil the objectives of the study, the study aimed at answering the following

research questions:

• What is the perception of Bugiri hospital staff on their work environment?

• What factors affect the performance of Bugiri hospital employees?

• Explain the various ways of improving job performance of Bugiri hospital

employees?

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1.5 Justification of the study

This topic of study is something that is not very well studied in Uganda; therefore, the

study is important in providing better understanding of how employees’ perception of

work environment can affect their performance in a public health sector. In addition,

the study will make room for employees to voice their level of job satisfaction which

helps in formulating training needs (Newstrom & Davis, 1997). Additionally, the

outcome of the research was used to alert the management of Bugiri Hospital of

employees’ level of satisfaction and dissatisfaction with reference to specific work

environment features. Moreover, the study will serve as background information for

similar research in the future.

It is argued that job satisfaction has important implications for organizational

productivity (Wright & Davis, 2003). “It is assumed that the benefits that employees

receive from their organization influences the effort, skill, and creativity that

employees are willing to provide their employer” (p.70)

1.6 Scope of the study

In terms of geographical scope, the study was conducted at Bugiri Hospital, Uganda.

Content scope explored how hospital employees (including health personnel and

support staff) relate their perceived work environment with their job performance and

job satisfaction.

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 CHAPTER TWO

LITERATURE REVIEW AND THEORETICAL FRAMEWORK

2.0 Introduction

A literature search was conducted to identify any empirical examination of the impact

of work environment on job performance. The first element of the literature search

consisted of searching electronic databases for any relevant study published between

1980-2020. A second element of literature search was manual literature search of the

linkage among work environment, job performance and job satisfaction. A literature

review was done using research articles by different authors on impact of work

environment on job performance. A literature review was conducted using the

following databases: Google Scholar, Pub Med, and MEDLINE. Search terms namely:

work environment, health workers, job performance, were used to obtain the relevant

articles.

Tasks carried out under this section are; conceptualization and review of relevant

previous literature on work environment, job performance and how these two concepts

are linked to job satisfaction, hypotheses were well pointed out under this section. This

section further describes the conceptual framework and the theories related to factors

affecting staff performance in organizations.

2.1 Physical work environment and job performance.

In its simplest form, work environment can be defined as the settings, situations,

conditions and circumstances under which people work (Oludeyi , 2015). It is further

elaborated by Briner (2000), as a very broad category that encompasses the physical

setting (e.g. heat, equipments etc.), characteristics of the job itself (e.g. workload, task

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complexity), broader organizational features (e.g. culture, history) and even aspects of

the extra organizational setting (e.g. local labour market conditions, industry sector,

work-home relationships).

Ollukkaran & Gunaseelan (2012), explained that work environment can be identified

as the place that one works, which means the milieus around a person. It is the social

and professional environment in which a person is supposed to interact with several

people. The work environment has a significant impact upon employee performance

and productivity. Bindu and others in their report further added that, by work

environment we mean those processes, systems, structures, tools or conditions in the

workplace that impact favourably or unfavourably on individual performance. The

work environment also includes policies, rules, culture, resources, working

relationships, work location, and internal and external environmental factors, all of

which influence the ways those employees perform their job functions.

It is demonstrated by Ramli (2019), that the work environment has positive effect

toward the job satisfaction and employee’s performance, and job satisfaction do have

a positive involvement on the employee’s performance.

For more clarity, Ramli (2019) explained that by improving a good work environment

for employees, job satisfaction of employees of private hospitals in Jakarta can follow

these enhancements. Therefore, communication must be made open between leaders

and employees and between employees and their fellow employees, so that employees

feel satisfied and will have a positive impact on performance. Especially if the

employees have the opportunity to improve their careers and competencies in general.

Therefore, the hospital management needs to make improvements or increase the

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competence of the employees, so they feel comfortable working in such a work

environment.

Elok, Ekowati, Supriyanto, & Mukaffi (2019), argues that presence of work discipline

on the work environment and employee performance is very important, this is because

work discipline is a reinforcement of performance or benchmarks. With the existence

of employees who are always disciplined in their work, of course, they will further

improve performance in the company. A comfortable environment makes employees

to be more disciplined (Elok, Ekowati, Supriyanto, & Mukaffi, 2019).

The work environment has effect on the performance level of employees. Absence of

office building, drugs, equipment can affect the performance of the employees

(Asigele, 2012).

The latter further narrates that there is a positive significant relationship between

performance of the reproductive and child health providers and the working

environment elements; such as presence of office building, availability of drugs and

availability of equipment. Their findings indicate that the physical component of the

work environment have the strongest effect on the performance level of employees.

Element such as level of distraction (noise), work interaction and privacy are not

considered important by the reproductive and child health workers.

Organization structure may be considered the anatomy of the organization, providing a

foundation within which the organization function; yet buildings have halls, stairways,

entries, exits, walls, and roofs (Dalton, Todor, Spendolini, Fielding, & Porter, 1980).

The latter argue further that a specific structure of a building is a major determinant of

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the activities of the people within it and that similarly, behaviour in organizations is

influenced by the organizing structure(ibid:49).

“Perhaps if considered in isolation, each ambient feature of the physical environment

may not have predictable effects on performance, but repeated distraction from a

collection of such features may be negatively associated with performance; moreover,

distraction as a negative attribute is also expected to be negatively related to satisfaction

with the physical work environment” (Lee & Brand, 2005, s. 324). “Although

adaptability is not a new concept, the pace and types of change we are experiencing

only continue to grow, which has caused research sponsors, academic researchers, and

practitioners in organizations to become increasingly interested in understanding and

enhancing adaptability in the workplace” (Pulakos, Arad, Donovan, & Plamondon,

2000, s. 612).

“In order for these public institutions to be able to provide the needed services in a

sustainable manner, there is need to have in place mechanisms to ensure that their

performance is optimally sustained” (Matte, 2017, s. 2).

Colquitt, LePine, & Wesson (2016), describe that the relationship of job satisfaction to

employee performance is very close so that the effects of both must be considered by

the organization. Employees who are satisfied will increase their performance, so that

the positive effects for the company will increase while the negative effects such as

employee turnover will decrease (Ramli, 2019). The author further added in his report

that there is a positive and significant impact between job satisfaction and employee

performance, so the company must make its employees have the opportunity to be more

advanced in work and feel that the salary compared to responsibilities is appropriate,

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 and employees feel safe about the continuity of their work at this company will make

him feel satisfied at work, so that the end is that the employees will work optimally to

improve their performance.

The work environment factor that needs the most improvement was incentive for

creative results. Whilst health professionals do not consider that their work

environment adequately provides ‘incentive for creative results’, it is not one of the

most important factors for health professionals. A person does not generally enter a

health profession (in the public sector as an employee) for significant financial rewards

(or incentives) (Lukersmith & Limerick, 2013).

2.2 Factors affecting employees’ job performance

The review identified factors affecting working conditions in public hospitals as related

to increased patients loads, HIV and AIDS epidemic, long working hours, shift work,

physical infrastructure and shortage of staff. The review revealed that unsatisfactory

working conditions have negative impact on the physical and psychosocial wellbeing

of employees (Manyisa & Aswegen, 2017).

Routineness is the working condition or job environment of any organization of an

employee (Kayal & Baisakhi, 2016, s. 188). The latter contend that job satisfaction

depends on routineness. Important to note is that routine jobs have low task variety—

there is low frequency of unexpected and novel events—and are more predictable in

nature, but difficulties also arise as employees often face greater uncertainties and

factors beyond their control when they complete their tasks (Gong, Boh, Wu, & Kuo,

2019).

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According to the World Health Organization, the African continent is currently facing

a severe human resource crisis in the health sector which appears to have affected the

delivery of quality and efficient healthcare services. Sub-Saharan Africa has the lowest

health worker-to-population ratio in the whole world (Houston, 2005) and (Friederike,

2009)

Human resource management (HRM) has been broadly defined as “a field of

organizational activity and professional practice” (Tabassi & Abu, 2009, s. 473).

“Despites the immense importance of Human Resource Management (HRM) practices

towards the realization of employees job performance in particular and organizational

performance in general, many organizations do not give emphases to its effective

utilization so as to ensure organizational performance in developing countries like

Nigeria” (Tabiu & Nura, 2013, s. 248). As an important factor of production, human

resources have an uncontroversial effect on the profitability and productivity of an

organization; reason being that decisions that will affect employee satisfaction taken

by managers may be extremely helpful for a company, or on the contrary, may cause

considerably high costs (Bayram , 2018).

Development may include some forms of training but typically refers to formal

education, job experiences, relationships, and personality and skill assessments that

help employees prepare for future jobs or positions (Irakoze, 2018). In Bangladesh for

example, human resource management is additionally key and extensive way to deal

with overseeing individuals and the work place, culture and environment (Uddin,

Naher, Bulbul, Neser, & Rahman, 2016).

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2.3 Ways of improving job performance.

To motivate employees, organizations have implemented performance-based pay,

practices to help balance both work and family and various forms of information

sharing. Management’s challenge is to create a work environment that attracts keeps

and motivates its workforce (Ollukkaran & Gunaseelan, 2012).

Manyisa & Aswegen (2017), indicated in their review that, provision of a positive

working environment is crucial for the wellbeing of the employees, the patients as well

as the organization. The literature review revealed strategies that will help mitigate the

barriers to good working conditions. Manyisa & Aswegen (2017) suggest that

management has to find a way to address issues of excessive workloads, irregular

shifts and long working hours as these have been found to be the major predictors of

job dissatisfaction, high levels of burnout, low morale, fatigue and emotional

exhaustion among health care workers(pg.29).

Provision of adequate infrastructure is of high importance as poor infrastructure has

been found to be associated with the increased level of job satisfaction and a potential

risk factor for nosocomial infections. (Manyisa Z. M., 2015).

In their literature review report, (Manyisa & Aswegen, 2017) described that it is also

important in improving working conditions and towards the achievement of the

organizational goal. It is therefore imperative that the necessary resources be made

available to employees so that they can complete their tasks on time. Failure to develop

long term strategies that will address the challenges will lead to chronic inadequate

hospital staffing as more nurses and doctors, particularly the younger ones, intend to

leave their professions and pursue greener pastures. Improving communication,

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interpersonal relationships between management and staff and the allocation of

resources may help in improving the present situation and in the creation of an

environment that is conducive to high quality patient care.

Organizations must make its employees have the opportunity to be more advanced in

work and feel that the salary compared to responsibilities is appropriate, and

employees feel safe about the continuity of their work at the organization, which will

make him feel satisfied at work, thus, working optimally to improve their performance

(Ramli, 2019). Idowu (2020), found that flexible work-hour arrangements improved

employee performance, increased retention of employees and reduced employee work

stress. It is recommended that a proactive strategy be adopted by organizations to

improve the alignment between flexible work-hour agreements and other human

resource policies such as recruitment, promotion, training, rewards and performance

assessment.

Asigele (2012), reported that, since physical components can enhance the performance

level of reproductive and child health employees, it is advisable to take appropriate

steps for providing better office building and enough drugs and equipment. This will

contribute towards increase in output and exceptional improvement in employees’

performance. The latter further noted that providing working environment to its

employees, which is conducive in terms of facilities, equipment, drugs, better

interaction opportunities and good refreshment.

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 According to Adjei, Odoom & Opoku (2016, s.50-51), “Motivation is relevant for

organizational performance; thus, a motivated worker is physiologically stable,

psychologically balanced, and socially minded to effectively perform his/her duties

with the needed attention”. They further argue that “Motivation is a good thing; if

managers and administrators appreciate what drives workers to give an effective work

performance, resources will be channeled to get the maximum output from employees”

(pp.51). “Health workers are motivated by intrinsic and extrinsic factors: thus,

appreciating key financial and nonfinancial motivating factors is relevant for effective

work performance among health workers” (Adjei, Odoom, & Opoku, 2016, p. 51).

Sellers, et al (2015, p.22) argue that “First, governmental public health must make a

high priority of succession planning”. Additionally, “Preserving institutional

knowledge, preparing midlevel managers to lead, and retaining high-performing

individuals must be key objectives of the workforce and succession planning” (Sellers,

et al., 2015, ss. 22-23).

2.3.1 Performance indicators as per WHO definition

2.3.2 Availability

“Improved performance is assessed by looking at the availability of staff, as well as

their competences, productivity and responsiveness” (Dieleman & Hammeijer, 2006,

s. 8).in terms of presence at work (as opposed to absence). Dielema & Hammeijer

(2006) further argue that “Absenteeism by health providers is a frequently occurring

phenomenon in many health facilities, especially in resource-poor areas” (p.16).

“When staff cannot concentrate and stay on their work because of personal problems,

it can benefit a health facility to offer support” (p.25).

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2.3.3 Competence

“Competence encompasses knowledge, skills, abilities, and traits. It is gained in the

healthcare professions through pre-service education, in-service training, and work

experience. Competence is a major determinant of provider performance as

represented by conformance with various clinical, non-clinical, and interpersonal

standards. Measuring competence is essential for determining the ability and readiness

of health workers to provide quality services” (Kak, Burkhalter, & Cooper, 2001, s.

1).

“Although competence is a precursor to doing the job right, measuring performance

periodically is also crucial to determine whether providers are using their competence

on the job. A provider can have the knowledge and skill, but use it poorly because of

individual factors (abilities, traits, goals, values) or external factors (unavailability of

drugs, equipment, organizational support)” (Kak, Burkhalter, & Cooper, 2001, s. 1)

2.3.4 Productivity

Defined in terms of the relationship between health workers' outcomes achieved

(health status protection or improvement for individuals or populations) and the health

human resource inputs (time, effort, skills and knowledge) required. The modern

healthcare sector makes up roughly one-tenth of the economic activity of modern

economies, and labour inputs make up a relatively large share of its costs, relative to

other industries. It is thus understandable that the measurement, tracking and

improvement of labour productivity in this industry, or if one prefers, Health Human

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 Resources Productivity should be of policy concern. An employee's workplace

environment is a key determinant of their level of productivity. How well the

workplace engages an employee impacts their level of motivation to perform.

2.4 Definition of Concepts

2.4.1 Work Environment

According to Oludeyi (2015), “Many scholars have attempted conceptualizing the

concept work environment: In its simplest form it can be defined as the settings,

situations, conditions and circumstances under which people work” (Oludeyi , 2015,

s. 33). Oludeyi further quotes (Briner, 2000) elaborating work environment “as a very

broad category that encompasses the physical setting (e.g. heat, equipments etc.),

characteristics of the job itself (e.g. workload, task complexity), broader organizational

features (e.g. culture, history) and even aspects of the extra organizational setting (e.g.

local labour market conditions, industry sector, work-home relationships)” (Oludeyi,

2015, s.33).

Opperman (2002) was quoted in Oludeyi (2015, s. 33), defining Workplace

environment “as composition of three major sub-environments which include the

technical environment, the human environment and the organizational environment.

The technical environment refers to tools, equipment, technological infrastructure and

other physical or technical elements of the workplace. The human environment can be

interpreted as the network of formal and informal interaction among colleagues, teams

as well as boss-subordinate relationship that exist within the framework of

organizations. Such interaction (especially the informal interaction), presumably,

25
 provides avenue for dissemination of information and knowledge as well as cross-

fertilization of ideas among employees” (Oludeyi, 2015, s.33).

“An attractive and supportive work environment can be described as an environment

that attracts individuals into the health professions, encourages them to remain in the

health workforce and enables them to perform effectively” (Wiskow, Albreht, &

Pietro, 2010, s. 7). According to the authors, "the purpose of providing attractive work

environments is to create incentives for entering -and remaining in- the health

professions, and to provide conditions that enable health workers to perform

effectively (to achieve high-quality health services)” (pp.6).

2.4.2 Job Performance

Rotundo & Sackett (2002), define performance as those actions and behaviours that

are under the control of the individual and contribute to the goals of the organization.

Employee performance generally refers to the amount of output generated from job

execution by an employee over a particular period of time in an organization

(Dhammika, 2013). In this study, employee performance is presented as the dependent

variable.

Performing service providers are defined according to the World Health Organization

(WHO) definition in the World Health Report of 2006 as a workforce that “works in

ways that are responsive, fair and efficient to achieve the best health outcomes

possible, given the available resources and circumstances” (WHO, 2006, s. 67).

Performance can be defined as a combination of equipments and staffs being available,

competence, productive and responsiveness (WHO, 2006).

26
2.5 Theories of the study

The following theories guided this study

2.5.1 Public service motivation theory

Perry & Wise (1990), were the first who formulated the concept of Public Service

Motivation (PSM). In their study "The motivational bases of public service", they have

defined PSM as "an individual's predisposition to respond to motives grounded

primarily or uniquely in public institutions and organizations" (Perry & Wise, 1990, s.

368). According to Perry & Wise (1990) and Brewer (2002), three groups of motives

comprise the basis of PSM;

1. Instructional motives. An individual believes that his or her personal interests coincide

with the majority's. Such motives allow people to participate in political processes,

they relate with special or personal interests, etc.

2. Norm-based motives. The desire to serve the public interest, loyalty to the government,

patriotism, and duty.

3. Affective Motives. These are grounded in human emotions, are characterized by a

desire and willingness to help others.

PSM impacts public sector workers' activities in two ways: Affects the decision to act

in organization and the decision to act for the organization. “Motivated public servants

are more committed to their work, they strive to attain goals and objectives as well as

they can, to contribute to public welfare, to help each other and citizens, they

voluntarily assume responsibility for their actions, participate in making a social

policy, etc.” (Vaisvalavviciute, 2009, s. 323). PSM therefore enables to focus on public

interests in administrative work. Perry & Wise (1990) argue that individuals with a

high sense of the public interest are more likely to select career in public service.

27
 Furthermore, Brewer & Selden (1998), note that individuals with a high sense of public

interest are more willing to protect the public interest. Crewson (1997), states that they

exhibit higher levels of organizational commitment; In the opinion of Naff & Crum

(1999), they enjoy higher job satisfaction and are less likely to leave their jobs. Thus,

it can be argued that the importance of motivation is very high in public service. it

affects not only the civil servants' activities, their needs, interests, job satisfaction and

are less likely to leave their jobs.

The theory of Public Service Motivation asserts that:

a) The greater an individual’s public service motivation, the more likely the

individual will seek membership in a public organization. (Perry and Wise, 1990,

s.370)

b) In public organization, public service motivation is positively related to

individual performance. (Perry and Wise, 1990, s.370)

c) Public organization that attracts members with high level of public service

motivation are likely to be dependent on utilitarian incentives to manage individual

performance effectively. (Perry & Wise, 1990, ss. 370-371)

d) Many research findings have found out that the level of individual’s public

service motivation has significant behavioural implication that influences

performance (Brewer & Selden, 1998; Perry & Wise, 1990)

2.5.2 Human Relations Theory

The Human Relations and Neo-Human Relations Approach “emerged as a result of

the many criticisms of the classical approach, especially because it focused on tasks,

28
productivity and organizational structure rather than people” (Adeniyi & Olusoji,

2014, s. 9). Furthermore, Adeniyi & Olusoji (2014) quote (Mullins, 2011; Kuye et al.,

2010), mentioning that “During the early part of the 20th century, especially as a result

of the great depression in the 1920s and 1930s, more attention shifted to employee

behaviour and social factors at work. This led to the human relations and neo-human

relations (behavioural) approach” (p.9). The Human Relations Theory “developed as

a result of focus on the human side of management and it sought to understand how

social and psychological dynamics interacted with the work environment in

influencing productivity and performance, thereby creating effective human relations”

(Adeniyi & Olusoji, 2014, s. 9).

“The human relations approach, which is sometimes referred to as neo-classical

approach, is built around the research work of Professor Elton Mayo and his colleagues

at the Western Electric Company's plant in U.S.A, between 1924 and 1932 and this

work has been known as the Hawthorne experiment” (Robbins & Coulter, 2009;

Mullins, 2005 as quoted by (Adeniyi & Olusoji, 2014, s. 9). Additionally, Adeniyi &

Olusoji (2014) quote Roethlisberger & Dickson, (1939), “both of whom were part of

the Hawthorne set of experiments, the research centred on the effects of physical

working conditions on worker productivity and efficiency” (p.9). “The researchers

concluded that additional concern given to the workers, and evident interest in them

shown by management, were the core factors for the higher productivity” (Adeniyi &

Olusoji, 2014, s. 9).

“The result of the Hawthorne experiment led to more interest from researchers in the

social sciences with background in sociology, psychology and anthropology, and they

29
relied on more sophisticated research methods to explain what motivate employees at

work”. These researchers known as “behavioral scientists” or “behaviorists” built the

platform for new management theory ideas and a major focus was the adjustment of

the employee's complex character within the work organization” (Adeniyi & Olusoji,

2014, s. 9).

“Contributors to this approach, according to Mullins (2005) are Abraham Maslow,

Douglas McGregor, Frederick Herzberg, Rensis Likert, David McClelland and Chris

Argyris” (Adeniyi & Olusoji, 2014, s. 9).

Based on the possibility that workers who receive special attention will perform better

simply because they received that attention. According to mayo, who states that the

concept of “social man” motivated by social needs, wanting reward, on-the-job

relationships, and responding more to work – group pressures than to management

control, therefore, in this research work, the Human Relation School of thought is

considered to be the most suitable theory in explaining this topic following its

discovery that workers perform effectively, efficiently and excellently at work if the

work environment is conducive.

In a nutshell, the concept that managers need to become involved with workers at a

more individual level is at the core of human relations theory and is what differentiates

it from scientific management theory. Factors such as peer pressure, and the desire for

harmony within the group, override any economic considerations. Mayo argues that

managers need to encourage good communication with workers and develop a

connection with their employees, which runs counter to Taylor and Ford’s claims that

managers need to focus on organizational goals and completely control the workers.

30
 According to Mayo, Taylor and Ford’s techniques would boost productivity, but only

to a certain level. In order to go above this level, workers needed to feel that they are

valued more than simply on a monetary basis. Therefore, according to Mayo

employees are more productive when provided with feedback related and allowed to

provide input into the work process. Thus, Workers need recognition for a job well

done and reassurance that their opinion matters in the workplace to be motivated to

perform.

2.5.3 Goal-setting Theory

The goal-setting theory had been proposed by Edwin Locke in the year 1968. This

theory suggests that the individual goals established by an employee play an important

role in motivating him for superior performance. Skills required include the ability to

engage employees in mutual goal setting, clarify role expectations and provide regular

performance feedback. Time and energy will also need to be given to providing

relevant performance incentives, managing processes, providing adequate resources

and workplace training. It also advice that in order to drive the organization to peak

performance, managers and supervisors must put out front the human face of their

organization. Principle here is the human-to-human interaction through providing

individualized support and encouragement to each employee (Salaman, Storey, &

Billsberry, 2005).

Employees’ goals achievement in this theory is by creating of work environment

attractive, comfortable, satisfactory and motivating to employees to give them a sense

of pride and purpose in what they do. How working environment is designed and

occupied affects not only how people feel, but also their work performance,

31
 commitment to their employer, and the creation of new knowledge in the organization

(Taiwo, 2010).

2.6 Variables of the study

Job Performance is the dependent variable, while the independent variables include

the following: physical work environment; routineness; job specificity; human

resource development; and the performance feedback. The intervening variable is job

satisfaction.

2.6.1 Working Definition of Variables

(a) Routineness. As a job characteristic, “routineness concerns the degree of

predictability an employee confronts on a daily basis” (Wright & Davis, 2003, s. 73).

In other words, are the employee’s daily tasks the same every day or do they instead

provide for a variety of experiences and require a variety of skills? “Research suggests

that workers who experience a greater variety of tasks, allowing workers to apply a

variety of skills to an array of new and different work challenges, also experience less

tedium and enhanced job satisfaction” (Wright & Davis, 2003, s. 73)). As employees

perceive their job becoming more routine, their corresponding level of performance

and job satisfaction will decrease, all else being equal.

(b) Job specificity. According to Wright & Davis (2003), Job specificity deals with

worker perceptions regarding the clarity with which job duties and their relative

importance are defined. This goes further to the ability for the employee to clearly

evaluate their success and failure in performing these duties. "Previous research has

supported the positive effect that role or task clarity plays in determining employees'

job satisfaction" (Wright & Davis, 2003, s. 74)). As employees understand more

clearly what is expected of them in their jobs, tension associated with role ambiguity

32
 decreases and the likelihood of successfully completing their responsibilities

increases. The resulting comfort level translates into a higher degree of job

performance.

(c) Human Resource Development. “HRD concerns worker perceptions of

opportunities in the organization for training, future career growth, and general skill

development” (Wright & Davis, 2003, s. 74). HRD programs play an important role

in influencing employee job satisfaction by reducing work stress or dissatisfaction by

reducing skill-related impediments to job performance. Wright & Davis (2003), argue

that, as individuals sense a long-term role within the organization’s goal achievement,

especially one that involves their own individual growth, their job satisfaction was

enhanced.

(d) Feedback. Workers receive job-related feedback from supervisors, co-

workers, etc. regarding their individual job performance. “From an organizational

perspective, much of this feedback is often expected to occur through hands-on

coaching or periodic formative or summative performance evaluations that may help

to define and clarify job performance expectations” (Wright & Davis, 2003, s. 74).

Such feedback not only provides a mechanism to guide action but also develops the

necessary skills or judgments specific to an employee’s job. Feedback can define the

employee’s current responsibilities in obtaining the organization’s goals as well as

whatever potential roles the employee may be able to play in the future.

2.7 Conceptual Framework

Based on the above literature, the employees’ perception of the impact of working

environment on job performance can be conceptualized and depicted in Figure 1.

33
 The conceptual framework in figure one shows how work environment is directly

linked to both job performance and job satisfaction, and the link between job

satisfaction and performance. Significant factors of workplace environment

(independent variable) in an institution are; physical work environment, routineness,

job specificity, Human Resource Development and performance feedback. These have

a direct effect on job performance (dependent variable). Workplace environment has

a close link to job satisfaction (mediator/intervening variable). Job satisfaction is

further linked to job performance

Figure 1: Conceptual Framework showing the relationship of independent variable,

dependent variable and Intervening variable

2.8 Hypotheses of the study

a. There is a positive relationship between the physical working conditions and

performance of employees at Bugiri Hospital (i.e. Employees who perceive their

34
 physical work environment as undesirable and inappropriate, their corresponding

level of satisfaction and performance will decrease).

b. Hospital administration and condition perceived by employees will have a direct,

positive effect on their performance and job satisfaction.

c. The level of motivations employees receive on the job will have an indirect,

positive effect on employee job performance and satisfaction

35
 Table 1: Summarized table showing the linkage of the research questions, hypotheses,

operationalization of variables and theories

Research Hypotheses (H) Operationalization of variables Theories

Questions

What is the H1: There is a positive Physical work environment Physical Human

perception of relationship between the work environment was operationalized Relations

Bugiri hospital physical working in two ways; Theory

staff on their conditions and 1.Office design-which includes workspace

work performance of employees and work tools used in the workplace for

environment? of Bugiri Hospital. comfort, efficiency and safety to enhance

(i.e. Employees who workflow, efficiency, effectiveness,

perceive their physical productivity and engagement.

work environment as

undesirable and 2. Environment Condition-Workplace

inappropriate, their environment conditions include;

corresponding level of temperature, lighting, ventilation, noise

satisfaction and level. These factors impact on employees’

performance will decrease) wellbeing and work processes

What factors H2: Hospital Human Resource Development. Public

affect the administration perceived This was measured in terms of availability Service

performance of by employees will have a of opportunities for job-related training, Motivation

Bugiri hospital direct, positive effect on performance feedback program, also theory

employees? (PSM)

36
 employee performance and whether employees are being kept up to

job satisfaction. date in important work skills.

How best can H3: The level of Performance improvement. Goal-Setting

Bugiri hospitals motivations employees Performance was improved in the Theory.

improve the receive on the job will have following ways; -Availability further

performance of an indirect, positive effect studies to help employees do a better job

its employees? on employee job -Accessibility of information from

performance and supervisors about how well employees

satisfaction are performing at work

-Availability of more motivational

benefits and renumerations.

37
 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction

The purpose of the methodology section was to describe the research procedure. Both

quantitative and qualitative research designs were used, with much emphasis on the

quantitative method. A case study was used to explore the views of employees (heads

of departments, health workers and support staff) of Bugiri Hospital on the study

objectives. The primary source of data for the study was collected during a field study

from May 2020 to July 2020. On addition, observation and review of documents

pertaining to performance of the hospital was made. This chapter presents the research

design and the rationale for its adoption. Furthermore, detail account is given on the

strategy of inquiry for this study, the technique used in selecting the participants for

the study is also discussed; issues of validity and reliability and ethical issues are

further discussed.

3.1 Research Design

Yin (2014), describes research design as a ‘blueprint’ for research, which deals with

at least four problems: (1) what questions to study; (2) what data is relevant; (3) what

data to collect and (4) how to analyse the results. In short, it is a plan for selecting

sources and type of information to use in answering the research questions. The three

major design in social science according to Creswell (2014) are; qualitative,

quantitative and mixed method design. Bryman (2012), suggested that the difference

among the designs are seen in the theory position, epistemological position and

ontological position. Explaining further on the difference, he pointed out to the fact

that in qualitative research, a theory is generated out of the study while the reverse is

38
true of a quantitative research. Also, qualitative research stresses on the views of its

participants to understand the social world while quantitative research adopts the

natural scientific model (Bryman A. , 2012, s. 380).

Furthermore, to Creswell (2014), qualitative design relies on text and image data.

Qualitative design places emphasis on words rather than numerical data in data

collection and analysis. Quantitative design collects and analyses quantifiable data

(Creswell, 2014). Mixed method design on the other hand, incorporates the features of

both quantitative and qualitative research in terms of data collection and analyses. The

mixed method design is used to overcome the limitation of qualitative and quantitative

designs.

This study employed both qualitative and quantitative methods. However, like already

mentioned above, much emphasis was given to quantitative approaches, this is

because; quantitative research design would help a researcher to test the laid

hypothesis about work environment. Secondly, it is less time consuming than

qualitative design/method. On the other the element of qualitative design helped to

create more room and platform for the respondents to express their views on the impact

of work environment on job performance. Apart from the data that was collected

during the interviews, I will get the opportunity to gather data from other sources.

Also, hospital reports on the number of output (patients discharged) was gathered on

the assessing the performance of the medical staff. The use of these other sources of

data enables the study in dealing with issues of validity and reliability of the data

collected (Yin, 2003).

39
 The other reason for adopting an explanatory study is the fact that much has not been

written on employees’ perception of the impact of the workplace environment on job

performance at Bugiri Hospital. Also, because of the exploratory nature of qualitative

study, I was able to gather data from diverse views on the research topic. Moreover,

the small sample size of the study will serve as a gateway for gathering in-depth

information about the research topic, for example unstructured qualitative interviews

will serve this purpose.

For quantitative methodology I will employ a cross-sectional study during the data

collection process whereby the respondents were selected from three different

departments, that is; the Clinical Department, Nursing Department and Support

Services Department. The goal is to obtain a sample that is representative of the larger

population, thus making it easier to generalize the results from the study.

Furthermore, evidence would suggest that, rather than restricting the opportunities for

research by only utilising either qualitative or quantitative methods, a mixed methods

approach provides researchers with a greater scope to investigate educational issues

using both words and numbers, to the benefit of educational establishments and society

as a whole (Almalki, 2016).

3.2 Study Population

The study will target various staff members from the three departments at the Bugiri

Hospital. These will include medical workers who are directly involved in providing

treatment to patients, heads of departments and other administrators (other mid-level

managers), as well as support staff (drivers, office attendants, cleaners). This

population is targeted because they will provide valid data on how the workplace

environment affects their performance. On the quantitative aspect, the study will

40
 obtain responses from representatives of medical workers (nurses, health attendants)

and support staff. On the qualitative aspect, the study will obtain rich information on

the deeper understanding of the study through collection of intensive views from

selected heads of departments. Heads of departments were selected because they

recommend, implement, and supervise performance in the institution. They are in the

middle ground, partly administration and partly employees, so they are more likely to

provide reliable data on performance levels.

3.3 Sample size and selection

Sample size is the segment of the population that the researcher selects for the study

(Bryman, 2012). It is this definition that guided the study sampling and arriving at the

study sample size Therefore, from the estimated total number of employees at the

hospital of approximately 180 employees, a sample of 123 primary respondents of

both medical workers and non-medical workers were used by answering

questionnaires for the purpose of gathering data from which the findings in the

subsequent chapter were generated.

3.4 Sampling Techniques and Procedure

Both random and non-random sampling techniques were used to select a representative

sample. Creswell (2003), defined random sampling as a subset of individuals that are

randomly selected from the population. The goal is to obtain a sample that is

representative of the larger population. Random sampling strategies give every

individual in the population a chance to be part of the sample. This reduces bias and

increases the representativeness of the sample. Purposive sampling was used to select

41
 3 key hospital staff who provided informed data in regards the main study objective.

These will include, 1 hospital administrator, 1 senior doctor and 1 district health

official; this sampling method was used to collect in-depth responses from respondents

who were well informed about the research problem.

3.5 Data collection methods

The study employed both quantitative and qualitative data collection methods. Data

was collected through surveys, interviews, document review.

This research relied on both primary and secondary sources to achieve its objectives.

The survey method was used in this study. Data was collected from all relevant

sources, secondary (journals, periodicals, textbooks, websites, etc.) and primary

(questionnaires and interviews).

3.5.1 Primary Research Data

The main research collection tool of the primary data was done through administering

a structured questionnaire to discover the most important factor in the work

environment (i.e. job satisfaction, office design, performance feedback, environmental

conditions) are perceived by employees to be influencing their job performance. The

questions to be asked in the study were both closed ended and open-ended. Close-

ended questions were used because it allows answers within a limited set and it was

used essentially to gather information on attitudes and opinions and the open-ended

questions to allow flexibility on the part of respondents. An interview guide was also

used to collect data from the 3 key hospital staff (1 hospital administrator, 1 senior

42
 doctor and 1 district health official); this sampling method was used to collect in-depth

responses from respondents who had more knowledge about the research problem.

3.5.2 Secondary Research Data

Secondary data was also used as well. Secondary data is data already collected for

some other purposes. The secondary data sources include but are not limited to

published articles, books, reports related to the subject area, as well as internet sources.

These sources were generally used in the literature review chapters to develop the

arguments that serve as the basis for the empirical study.

3.6 Data Quality Assurance

Data collection instruments were subjected to validity and reliability tests to ensure

only high-quality data is obtained from the respondents.

3.6.1. Validity

Research validity in surveys relates to the extent at which the survey measures right

elements that need to be measured. In simple terms, validity refers to how well an

instrument as measures what it is intended to measure (Dudovskiy, 2016). Similarly,

(Bhattacherjee, 2012) defines validity as the degree to which an instrument measures

exactly the concept that it intended to measure.

This study involved two phases: designing the instrument and judging the evidence

(this is by my two supervisors and my examiner). At least three experts or they can also

be called judges (that is to say; my two supervisors and the Norwegian Centre for

Research Data (NSD) were used to validate the instrument through quantitative or and

qualitative content validity methods. During the designing of the proposal, I shared my

43
 research instrument with my supervisors (one supervisor commented on the interview

guide tool, and the other commented on the questionnaire tool), and also registered the

instrument with the NSD.

Content validity index (CVI) will then be used to calculate content validity

quantitatively (Chukwudum, 2016). The scale to be used was based on 1= Not relevant,

2=somewhat relevant, 3=quite relevant, and 4=highly relevant. Then, per item, the CVI

was calculated by adding the ratings given either 1or 2 or dividing by the number of

judges (supervisors) to get the proportion of agreement about the relevance of the item.

For instance, an item rated ‘Not relevant’ or ‘somewhat relevant’ by four out of five

judges would have a CVI index of 80. This means that the item is completely irrelevant

for the study in the instrument. However, if an item is rated ‘quite relevant’ or ‘highly

relevant, by four out of five, then judges would also have CVI of 0.8 but showing that

the item is relevant in the instrument (Zamanzadeh, et al., 2015)

3.6.2 Reliability

Dudocskiy (2016) defines reliability as the extent to which the same answers obtained

can be used by the same instruments more than once. He further argues that for any

research to be associated with high levels of reliability, should yield the same results,

using the same research methods under similar conditions when carried out by other

researchers.

Taherdoost (2016), defines reliability as the degree to which an instrument can produce

consistency and constant results over and again. An instrument is said to reliable when

similar results can be obtained during a repeat of the study under a similar environment.

44
 To ensure reliability and also to ensure that there’s trustworthy in the results, same

questions were repeatedly asked a number of respondents under the same conditions.

3.7 Data Collection Procedures

Prior to data collection from the respondents, the researcher obtained an introduction

letter from the University of Bergen. The introduction letter stated the importance,

processes and procedure of the research and why their participation is of great

significance to the health care system in the country. A consent letter stating the

significance of the study to the prospective respondents was issued. Self-administered

questionnaires and interview guide were used on selected respondents.

3.8 Data Analysis

After and during data collection, the researcher checked through the data, edited and

coded to obtain high quality data to derive strong findings in chapter 4. The data was

then entered into the computer in which it was analysed using slightly by Microsoft

Excel (used data cleaning and coding), after which it was exported into STATA. It is

from STATA that the researcher was able carefully analyse data and presented in the

form of tables, graphs and charts for interpretation. Correlation analysis was as well

used to determine the relationship between variables under study.

3.9 Ethical Consideration

Before administering the questionnaires and interviews to the staff of Bugiri Hospital,

an informal meeting was held with the management of the Hospital to seek permission

to conduct the study. Not only that but also the privacy of the respondents to the

questionnaire was considered (to ensure this a registration with the Norwegian Social

Science Data Services <NSD-this is an ombudsman for research data protection> was

45
 done prior to data collection). More importantly, the purpose for which the research

was conducted was explained to the respondents before giving them the questionnaire

to fill. The identity of the individual respondents to the questionnaire was another

ethical issue that was critically considered in this study.

Respondents should participate based on informed consent. The principle of informed

consent involves researchers providing sufficient information and assurances about

taking part to allow individuals to understand the implications of participation and to

reach a fully informed, considered and freely given decision about whether or not to

do so, without the exercise of any pressure or coercion (Saunders, Lewis, Thornhill, &

Bristow, 2012)

3.10 Summary of Methodology

The methodology chapter looked at how data was collected, analysed and presented.

The chapter also looked at the ethical consideration to the respondents as well as data

collection and analysis. The next chapter comes up with presentation of findings.

46
 CHAPTER FOUR

PRESENTATION OF FINDINGS

4.0 Introduction.

This chapter answers the research questions of the study which are categorised under

four sections; Demographic data that describe the sample that was presented first, to

give an overview of such participants and how their different traits affect the way they

look at their work environment. This was followed by a section on employee perception

on work environment - this provides the concept of work environment including

working conditions, office design, work related benefits, the administrators, and their

perception of the working conditions.

Third section on the factors affecting employee performance - this explains an overview

of the challenges faced by hospital workers, while tracking their performance levels

and how they deal such challenges. Lastly, a section on possible ways of improving the

performance of staff (leading to improved health service delivery in the hospital thus

health people in the community) is presented -.

4.1 Demographic characteristics

The respondents’ demographic features included three key characteristics, which were

the respondent’s gender, age and education background. These factors were geared to

influence perception of the work environment, factors affecting job performance and

cause effective strategies towards poor job performances especially in public hospitals.

47
 Figure 2: Showing demographic characteristics: categorised by gender and
age

Demographic charateristics of respondents

Categorised by gender and age
80

65.7
60.0
Percentage of respondents

60 57.7 58.1

42.3 41.9
40.0
40 34.3

20

0
18-28 29-39 40-50 50-60
Female Male
Source: Primary respondents (Bugiri Hospital Staff)

This data presented is only for respondents (primary-who are hospital employees).

Generally, the interviews were fairly spread all age groups and gender and not well

spread across the different education levels. Most of the interviewed respondents were

females (65%) with an age bracket of 29-39 years, followed by those (57%) in the

bracket of 40-50 years. On the other side, males interviewed were mostly (60%) in the

range of 18-28 years, followed by 58% in the age group of 50-60 years. All respondents

were randomly selected simply catching on anyone not purposive- and visited at their

work posts or at their quotas (homes) within the hospital premises. Majority females

were interviewed as with less males probably because they are much involved or

devoted to helping the sick than men.

48
Table 2: Showing demographic characteristics; categorised by education & sex

Sex
Education Female Male Total

Bachelors 11 7 18
16.18 12.73 14.63

Below diploma 35 15 50
51.47 27.27 40.65

Diploma 20 23 43
29.41 41.82 34.96

Masters 0 3 3
0.00 5.45 2.44

No formal education 2 7 9
2.94 12.73 7.32

Total 68 55 123
100.00 100.00 100.00
The highly educated (Bachelors and Masters) were less interviewed compared to those

with diploma and below, perhaps because the most educated are rarely available or are

few at the hospital especially the doctors.

“Self-confidence is one of the most important characteristics in understanding

employee behaviours. Confident employees show better job performance, have higher

job satisfaction, and more successful leadership behaviours. It is widely believed that

women have less self-confidence than men and this is considered a major reason for

women making slow progress in business world” (HeyIn et al, 2020: 1)

49
 Figure 3: Showing demographic characteristics; categorised by education,
gender& age

Demographic charateristics of respondents

Categorised by level of education, Gender & age
Female Male

18-28 100.0
18-28
33.3
66.7
17.4
29-39 34.8 50.0
29-39 50.0
47.8
9.1
6.7
22.7
13.3 40-50
40-50 23.3
27.3
40.9
56.7
5.6
23.1 16.7
50-60 38.5 50-60 38.9
38.5 38.9

0 20 40 60 80 100 0 20 40 60 80
Percentage of respondents
Bachelors Below diploma
Diploma Masters
No formal education
Source: Primary respondents (Bugiri Hospital Staff)

The most interviewed females are below the diploma of which the significant

percentage is for those females below 29 years of age. Followed by those with diploma

qualifications and scantily interviewed were above diploma. However, among female

interviewees non had a master’s degree.

The researcher tried so much to widen the study scope within the hospital by surveying

staffs across all hospital departments. The figure shows the distribution of respondents

by the researcher.

50
Figure 4: Showing departments of participants

Departments of participants
Intern 2

Dispensary 4

Family planning 5

Optics 5

Dental 6

Doctor 7

Laboratory 13

Maternity 16

Pediatrics 17

Nursing 23

Support Staff 25

0 5 10 15 20 25
Frequency
Source: Primary respondents (Bugiri Hospital Staff)

Many of the survey respondents were support staff (25), followed by the 23 nurses in

the nursing department, 17 paediatric staff, 16 maternity staff, 13 laboratory staff, 7

doctors, 6 dentists among others, including interns. Considering the number of staff in

each of these departments, the researcher evenly distributed the interviews to obtain

different views from different departments.

The study also captured the respondents’ time spent working at the hospital. This was

intentionally asked to determine their knowledge about the work environment of the

hospital and the trend of performance.

51
 Figure 5: Showing duration of participants at the hospital

Duration of participants at the hospital

50

40

30
Frequency

20

10

0
5 years & above 3 – 5 years 1 – 3 years 6months – 1 year
Source: Primary respondents (Bugiri Hospital Staff)

From the graph below, the survey involved respondents who have mostly been at the

hospital for more than 3 years, followed by those who have worked at the hospital for

1 to 3 years and those who have worked for less than a year were the least interviewed.

The findings of the study were therefore obtained from the well vast employees of the

hospital.

52
 Figure 6: Showing departments of participants; categorized by period
worked

Departments of participants
Categorised by period worked at the hospital

Dental
Dispensary
Doctor
Family planning
Intern
Laboratory
Maternity
Nursing
Optics
Pediatrics
Support Staff

0 20 40 60 80 100
Frequency

1 – 3 years 3 – 5 years
5 years & above 6months – 1 year
Source: Primary respondents (Bugiri Hospital Staff)

The long serving employees are from the optics department, followed by those working

in the dispensary, family planning section, general doctors, support staff, nursing

department, and paediatrics staff.

4.2 Employees’ perception on work environment

This survey looked at work environment and how it could affect employees’

performances. This section is associated to answering the question of; How does the

physical work environment affect the performance of employees? In this section the

researcher discussed the characteristics of working conditions, employee satisfaction

levels on the work environment, and reasons for their satisfaction levels.

53
 Figure 7: Showing employee satisfaction on the work environment

Employee satisfaction on the work environment

4.065%

7.317%
25.2%

6.504%

56.91%

Dissatisfied Neutral
Satisfied Very dissatisfied
Very satisfied
Source: Primary respondents (Bugiri Hospital Staff)

To achieve the research objective of “assessing how the physical work environment

(such as: office building) affect employees' job performance”. The study (Figure 7)

revealed that slightly above 60% of the respondents are satisfied with the working

condition at the public health facility, of these 56% are satisfied and 4% are very

satisfied. While nearly 40% indicated their dissatisfaction with the current working

conditions, including 25% who said are dissatisfied, 7% very dissatisfied and 6%

neutral (these are signs of dissatisfied). These findings signal the need for more

improvement on the work environment by the hospital to rise numbers to from “very

dissatisfied” to “very satisfied”. Though the majority are satisfied they are not very

satisfied meaning any negative change on the work environment will push them to the

dissatisfaction zone.

54
 Figure 8; Showing employee perception of the work environment;
categorized by gender

Employee perception on work environment

Categorised by gender
63.6

60
51.5
Percentage

40
32.7

19.1
20
11.8 11.8
5.9
1.8 1.8
0
Female Male
Dissatisfied Neutral
Satisfied Very dissatisfied
Very satisfied
Source: Primary respondents(Bugiri Hospital Staff)

Categorically, of all the interviewed females the majority indicated were satisfied

(51.5%) and 5.9% were very satisfied. Howvere, slightly above 30% females were

dissatisfed, of which 19.1% showed their dissatisfication and 11.8% were very

dissatisfied, while 11.8% said were neutral.

Alternatively, most males (63.6%) said were satisfied and only 1% were very satisfied.

More like their female colleagues, 34% of males were dissatisfied with the hospital

work environment.

I think it depends on personal or individual observation, but to me it is a

favorable working condition rather environment. I have received few

complaints from hospital staff about hospital working environment. It is a good

working environment as all staff are offered free accommodation, the offices

are clean and very conducive for working, said hospital administrator.

55
 The work environment is good though some employees are having reported

some bad issues about the hospital. For instance, they so much complain about

the too many patients who are sometimes dirty, Senior medical superintendent

said

More categorically, the researcher further analyzed employees’ perception of work

environment by the hospital departments/positions. To give a deeper and better view of

the objective of the study. These study findings are illustrated in the figure below.

Figure 9: Showing employee perception of the work environment; categorized

by department

Employee perception on work environment

Categorised by Department

Dental
Dispensary
Doctor
Family planning
Intern
Laboratory
Maternity
Nursing
Optics
Pediatrics
Support Staff

0 20 40 60 80 100
Percentage

Dissatisfied Neutral
Satisfied Very dissatisfied
Very satisfied
Source: Primary respondents(Bugiri Hospital Staff)

Survey findings revealed in the graph above that, employees working the dental and

optics departments are more satisfied than others. However, none of these said was very

satisfied with the work environment. Findings also showed that family planning staff

56
and doctors are mostly not satisfied with the hospital work environment. While very

few staff members indicated they were very satisfied with their work environment.

These few are from maternity department, laboratory and support staff.

The researcher further probed to obtain respondents’ explanation or reasons for

indicating their feel (satisfaction level) on work environment. Several reasons were

revealed by the study as indicated in the graph below.

Figure 10: Showing reasons for employee satisfaction on the work environment

Employees satisfaction reasons on the work environment

Clean patients
Corruption/bribery
Poor administration
Unworthy trainings
Enough staff
Few/no benefits
Fueled ambulance
Power blackouts

Poor work schedule

Old structure
Availability of essential drugs
None
Good administration
Good staff cooperation
Conducive environment
Dirty environment
Work schedule
Well equiped
Over crowding

0 5 10 15
Count of respondents
Source: Primary respondents (Bugiri Hospital Staff)

The survey discovered the most work environment annoying issue (affecting job

performance) at the hospital as the overcrowding of patients as shown on graph above.

57
The second dissatisfying factor is the dirty work environment, followed by unrenovated

structure (old) and the poor work schedule.

“… there has been no such negative effect on my work, however, there is over

crowding by patients yet. There are few doctors in the hospital making it so

frustrating for medical workers. Yeah, this demotivates them, explained by a

support staff.

Individually, when others don’t properly perform their duties, we all fail as a

hospital. For instance, if nurses are not satisfied with the hygiene of patients,

we doctor get wrong information from nurses, Senior Medical Superintendent

said.

However, for the satisfied respondents, their main reason is well equipment of the

facility, followed by the good work schedule, conducive environment and good staff

cooperation.

Figure 11: Showing categorised reasons for employee satisfaction on the work
environment

58
 Reasons for employee satisfaction
Dissatisfied Neutral Satisfied

Over crowding 14.0 Well equiped 14.0

None 4.0 Conducive environment 12.0
Dirty environment 8.0 Work schedule 11.0
Good staff cooperation 8.0
Poor work schedule 4.0 Old structure 2.0 Good administration 7.0
Availability of essential drugs 6.0
Work schedule 2.0 Power blackouts 2.0
None 2.0
Unworthy trainings 1.0 1.0 Fueled ambulance 2.0
Enough staff 2.0
1.0 Dirty environment 2.0
Corruption/bribery 1.0 Few/no benefits 1.0 Over crowding 1.0
Clean patients 1.0

0 5 10 15

Very dissatisfied Very satisfied

Old structure 3.0

Good staff cooperation 2.0
Dirty environment 3.0

Poor administration 1.0 Good administration 2.0

Over crowding 1.0

Conducive environment 1.0
Few/no benefits 1.0

0 5 10 15 0 5 10 15
Count of respondents
Source: Primary respondents (Bugiri Hospital Staff)

The graph above shows the categorical reasoning of respondents in harmony with their

satisfaction level. On one side, the disgruntled employees noted overcrowding, dirty

environment, poor work schedule, old structure among others, as the reasons being their

feeling about the work environment. While the contented employees largely pointed

out well equipped hospital, followed by conducive environment, good work schedule,

good staff teamwork and good administration, as the reasons being their feeling towards

their work environment.

For more clarity, the researcher asked the hospital employees to express their feelings

on the discrete aspects of their work setting, including, work conditions, salary/benefits,

office design, working with fellow staff, the administration and training and

development. The survey findings therefore graphically outlined below;

59
Figure 12: Showing employee satisfaction levels on key work environment aspects

How satisfied are you with the following

(Responses = 123)
Working conditions Office design Hospital administration
Salary/benefits Working with fellow staff Training and development
67%

58%
51%
47%
45% 44%
39% 40%

28%
24%
20% 21%
19%
13% 15% 13%
8% 8% 9%
6% 6%
2% 2% 4% 3% 3% 4%
0% 1% 0%

Extremely satisfied Very satisfied Somewhat satisfied Slightly satisfied Not at all satisfied
Source: Primary respondents (Bugiri Hospital Staff)

The researcher therefore after interviews and analysis discovered (see graph above) that

most hospital staff are generally not satisfied with all these work environment aspects.

For instance, the survey discovered that most employees noted they are somewhat

satisfied and slightly satisfied with all the aspects of their work environment, followed

with the movement of figures towards the dissatisfaction sideways. With very few or

no respondents noting being very or extremely satisfied with these aspects, most

especially the working conditions (0%), training(0%) and office design (1%).

Of all the aspects of the work environment, the researcher discovered that training and

development is hurting employees the most compared to the other aspects, followed by

the hospital administration. While working with fellow staff is relatively boosting

60
 employees performance at the hospital. Perhaps this explains why a senior medical

worker had this to say,

“Individually, when others don’t properly perform their duties, we all fail as a

hospital. For instance, if nurses are not satisfied with the hygiene of patients,

we doctor get wrong information from nurses”.

4.3 Factors affecting employee performance

This section answers the survey question of, “What factors affect the performance of

Bugiri hospital employees?”. The section also covers the analysis of correlation

between the variables (Independent variables, dependent variable and intervening

variable). Furthermore, under this section the researcher intended to determine reasons

for employees’ poor performance. For a general view of this objective, the researcher

enquired the job performance trend of the hospital staff. See figure below for the

findings of this trend.

61
 Figure 13: Showing employee job performance trend since 2016

The job performance trend of Bugiri Hospital Staff

Responses = 123

16.26% 13.01%

6.50%

64.23%

Decreasing Moderately increasing

Not increasing Slightly increasing
Source: Primary respondents (Bugiri Hospital Staff)

On

answering this question, the researcher asked respondents how they (hospital staff)

have been performing for this last three years (since 2016). The survey revealed a

moderate increase (64%) in job performance since 2016 to late early 2020, followed by

respondents who observed a slight increase in the performance, 13% reported a

decreasing performance trend and only 6% have not observed any change (be it positive

or negative) in how employees perform their tasks.

Therefore, generally though some employees are not observing a positive performance

trend, many are witnessing a positive trend. However, considering these percentages

more effort is needed by the hospital management and government to rise performance

levels of all staff.

“Since I took over as the admin, things changed for the better. People have to

work, there has been reduced absenteeism – medical workers miss work when

they have serious reasons to do so. They request for permission to miss work.

62
 However, senior doctors and specialists are the ones that in most cases don’t

show up without getting permission, but we are trying so hard as a hospital to

handle them”, Hospital administrator explained.

To better understand this performance trend, the researcher categorised the thoughts by

duration/time spent at the hospital. The survey considered seeking information from all

employees, including those who have been at the facility for 6 months – 1 year, 1 -

3years, 3 – 5 years and 5 years and above. Respondents’ views are clearly presented in

the figure below.

Figure 14: Showing employee job performance trend since 2016; categorised
by duration worked

Job performance trend for the last 3 years

categorised by employee duration at the hospital

1 – 3 years 22.2 55.6 7.4 14.8

3 – 5 years 8.9 75.6 8.9 6.7

5 years & above 11.1 62.2 4.4 22.2

6months – 1 year 16.7 33.3 50.0

0 20 40 60 80 100
Percent of respondents

Decreasing Moderately increasing

Not increasing Slightly increasing
Source: Primary respondents (Bugiri Hospital Staff)

Results from the survey show that old staff at the hospital are observing a moderate

increase in job performance compared to new staff. Employees who have been at the

facility for less than a year are mainly (50%) observing a slight increase in the

63
performance and 33% are seeing a moderate increase. While for employees who have

been at the hospital from 1 year and above are mainly observing a moderate increase

in the performance of employees. To the contrary, the decreasing trend is highly

observed by staff who have been at the hospital for less than 3 years.

While many respondents think the performance trend is moderately increasing, they

have several factors affecting their performance. These reasons are listed in the figure

below.

Figure 15: Showing factors affecting employee job performance

Factors affecting employee performance

Bad weather
Noise pollution
Poor feeding
Poor power supply
poor water supply
Expand the hospital
Late salary payment
None
Un Cooperative patients
Delayed drug delivery
Many patients
Poor administration
Little benefits
Old structure
Poor hygiene
Poor transport facility
Poor housing
Little pay
Few staff
Inadeguate material supply

0 5 10 15 20 25
Count of respondents
Source: Primary respondents (Bugiri Hospital Staff)

Results from the survey revealed that level of performance of most hospital staff is low

mainly because of inadequate material supply, followed by few staff at the facility

64
 (perhaps the readily available), little pay, poor housing, poor transport, poor hygiene

and old hospital structure.

“Yes, it faces a number of challenges, like any government facility, Bugiri

hospital faces challenges like overcrowding- too many people are always

flocking the hospital for medical care, secondly, poor funding by the

government-this hospital receives very inadequate funding from the

government, for instance it receives only 20% of it is budget. The other major

challenge faced by the hospital is under staffing – very few staff are attached to

this hospital, it only currently has 3 senior medical personal and no key

specialists”, Hospital administrator narrated.

Similarly, another senior medical worker agreed with the finding, in his verbatim below, he

narrates that:

… all public institutions in this country are facing huge challenges. However, Bugiri hospital

specifically is faced with underfunding, corruption, general poor hygiene, overcrowding

patients, among others.

Additionally, the researcher categorised these factors by gender as a way for developing

better strategies to solve the problem.

65
Figure 16: Showing factors affecting employee job performance; categorised
by gender

Issues affecting employee performance

categorised by gender
Female Male

Expand the hospital Bad weather

Many patients None
Noise pollution Old structure
Poor feeding
Poor power supply
Expand the hospital
None Little pay
Poor housing poor water supply
Poor transport facility Late salary payment
Poor hygiene Many patients
Poor administration Poor hygiene
Little benefits Un Cooperative patients
Delayed drug delivery
Old structure
Poor transport facility
Few staff Poor housing
Little pay Inadeguate material supply
Inadeguate material supply Few staff

0 5 10 15 20 0 2 4 6 8 10
Count of respondents
Source: Primary respondents (Bugiri Hospital Staff)

Though inadequate material supply is generally the main affecting factor, this is not the

case with male employees. To them, few staff at the hospital is most hurting issue

affecting job performance among the hospital staff, then followed by inadequate

material supply. Similarly, poor housing, poor transport, and delayed drug delivery are

among the top affecting reasons among male respondents.

While among female employees, with inadequate material supply being the topmost

affecting factor, the other main factors are little pay, few staff (comes in third among

females), followed by old structure and little benefits.

66
4.3.1 Correlation analysis

A Spearman's correlation was run to assess the relationship between the survey

variables. The independent variables, the dependent variable and the intervening

variable. A spearman’s correlation was used instead of Pearson correlation because of

the ordinal nature of the variables under test. Pearson's correlation cannot be run due to

violations of normality especially when ordinal variables are being used. The

correlation coefficient that will be used is the Spearman’s correlation coefficient, this

is a non-parametric statistic and will be used, because the data has violated parametric

assumptions, such as non-normally distributed data (Field, 2009).

Correlation coefficient was computed to assess the relationship between the

independent variables, the dependent variable and the intervening variable. The

independent variables included working conditions, hospital management, salary,

training and the office design; while job performance is the dependant and job

satisfaction being the intervening variable.

The relationship between the independent variables and dependent variable is shown in

the table below;

Table 3: Showing the relationship between the independent variables and dependent

variable

67
 Job_pe~e Workin.. Hospit~t Office~2 Salary Training

Job_perfor~e 1.0000

Working_co~s 0.2068* 1.0000

0.0217

Hospital_m~t 0.1264 0.0891 1.0000

0.1637 0.3272

Office_des~2 0.1885* 0.1799* 0.2629* 1.0000

0.0368 0.0465 0.0033

Salary 0.1185 0.1608 0.1152 -0.0226 1.0000

0.1918 0.0757 0.2043 0.8041

Training 0.1039 0.1715 0.2638* 0.1513 0.2065* 1.0000

0.2528 0.0578 0.0032 0.0948 0.0219

Spearman’s Rho correlation analysis. Note * Correlation is significant at the .05 level.

Considering the above analysis, there is a strong positive relationship between job

performance and the working conditions, which was statistically significant, rs =

0.2068, p = 0.0217. There is a positive relationship between the physical working

conditions and performance of employees at Bugiri Hospital (i.e. Employees who

perceive their physical work environment as undesirable and inappropriate, their

corresponding level of satisfaction and performance will decrease). On the other hand,

though there is a positive relationship between job performance and hospital

management, there is no statistically significant correlation between the two variables,

rs = 0.1264, p = 0.1637. the correlation coefficient is not statistically significant p > .05.

The second hypothesis of the study was that, the hospital administration and working

conditions perceived by employees will have a direct positive effect on job

satisfaction. See table below for this presentation.

68
 Table 4: Showing the hypothesis that working conditions will have direct positive effect

on job satisfaction

Job_sa~n Workin.. Hospit~t Office~2 Salary Training

Job_satisf~n 1.0000

Working_co~s 0.4844* 1.0000

0.0000

Hospital_m~t -0.0646 0.0891 1.0000

0.4780 0.3272

Office_des~2 0.0092 0.1799* 0.2629* 1.0000

0.9195 0.0465 0.0033

Salary 0.2298* 0.1608 0.1152 -0.0226 1.0000

0.0106 0.0757 0.2043 0.8041

Training 0.2158* 0.1715 0.2638* 0.1513 0.2065* 1.0000

0.0165 0.0578 0.0032 0.0948 0.0219
Spearman’s Rho correlation analysis. Note * Correlation is significant at the .05 level.

The spearman correlation test shows that there is a statistically significant and strong

positive correlation between job satisfaction and working conditions, rs = 0.4844, p =

0.000 (p < .05). Similarly, there is a positive correlation between employee satisfaction

and salary/benefits (rs = 0.2298, p = 0.0106) and trainings for professional

development (rs = 0.2158, p = 0.0165).

The researcher further analysed to ascertain the correlation between job performance

(dependent variable) and job satisfaction (intervening variable). From the non-

parametrical correlation test below,

. spearman Job_satisfaction Job_performance, stats(rho p) star(0.05)

Number of obs = 123

Spearman's rho = 0.1673

Test of Ho: Job_satisfaction and Job_performance are independent

Prob > |t| = 0.0644

69
 There was a positive correlation between the two variables, r = 0.1673, p = 0.0644.

However, there is no statistically significant relationship between the dependent and

intervening variable, as p > .05. Overall, there was a small positive correlation between

job satisfaction and job performance. Increase in job satisfaction were slightly

correlated with increase in job performance among hospital workers.

4.4 Ways of improving employee job performance.

This section is intended to answer the question of improving job performance of Bugiri

hospital employees. Respondents were tasked by the researcher to suggest possible

ways of boosting their performance at the hospital. The result from these conversations

are illustrated in the table below.

Table 5: Showing suggested ways of improving on employees’ performance.

Improving performance Freq. Percent Cum.

Constant power supply 1 0.81 0.81

Improve on staff welfaare 14 11.38 12.20
Improve on hygiene 15 12.20 24.39
Renovate the hospital 16 13.01 37.40
More drugs 5 4.07 41.46
Expand the hospital 1 0.81 42.28
More hospital equipment 26 21.14 63.41
Hire more staff 26 21.14 84.55
Salary increase 19 15.45 100.00

Total 123 100.00

The survey findings show purchasing more hospital equipment (21%) and hiring more

staff (21%) as the most suggested solutions by the respondents. The hospital should

perhaps tackle these two first. The other solutions as suggested by respondents included

70
salary increment, hospital renovation, improving on the hospital hygiene, improving

staff welfare among others.

“As a hospital and the district, we have continuingly written to the health

ministry and engaged the district headquarters to increase funding to at least

50% of our budget, allocate more staff to the hospital and to increase on

medical staff benefits”, said the hospital administrator.

Similarly, a senior doctor expressed that;

“….. the hospital and the district administration have combined efforts to see

positive changes in the facility, they are lobbying for more funding from the

government and from NGOs. Secondly, we are using and encouraging interns

to our hospital, this will reduce on overcrowding and over working staff, we

have laid down strict rules on time (arrival and departure). We have constantly

written to ministry to increase on staff, increase on medical supply plus

increasing workers’ salary”.

71
Figure 17: Showing suggested ways of improving on employees' performance categorized by
gender

Ways of job performance improvement

Categorised by gender

Constant power supply

Expand the hospital
Hire more staff
Improve on hygiene
Improve on staff welfaare
More drugs
More hospital equipment
Renovate the hospital
Salary increase

0 20 40 60 80 100
Percentage

Female Male
Source: Primary respondents (Bugiri Hospital Staff)

For the two main suggestions revealed by respondents, the figure above indicate female

employees as the main advocators of purchasing more hospital equipment than males,

and nearly an equal percentage (50%) of both sexes are agitating for hiring of more

staff. This is in support with what a secretary in the office of the health inspector’s

office said;

As a mother and a born of this community, I feel so much for that hospital, we

need to renovate the hospital and if availed with enough funds we should

expand it. Secondly, there is need for more beds, more passionate doctors and

constant supply of drugs.

72
On the other hand, only female employees are calling for availability of constant power

supply and expansion of the hospital. While it is only males who are suggesting for the

supply of more drugs to the hospital to provide better treatment to patients. However,

generally all employees are striving for improvements that will better the health service

delivery other than thinking about themselves. Apart from increasing salary and

improving staff welfare, all the other suggestions are geared towards improving the

hospital and thus better service delivery.

73
 CHAPTER FIVE

DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS

5.0 Introduction

The findings provide support for previous reports by researchers on work environment

related to employee job performance and satisfaction. The results from this study allow

us to further register the benefits of work environment and identify factors that may

affect job performance.

Findings from this study show that excellent work environment is associated with

overall job performance and satisfaction. This link may be explained by the hypotheses

that there is a positive relationship between the physical working conditions and

performance of employees (i.e. Employees who perceive their physical work

environment as undesirable and inappropriate, their corresponding level of satisfaction

and performance will decrease). Further research to explore this relationship is critical

as many health facilities especially the public ones, are trying hard to improve on their

working environment to retain and to improve employee performance amidst scanty

funds.

Chapter five therefore provides an argument of the main study findings and where

applicable, links the literature to the research outcomes.

5.1 Discussion of findings

5.1.1 Perception of the work environment.

The first research objective investigated employees’ perception of the work

environment at Bugiri hospital. From the investigation done, it is demonstrated that the

work environment has positive effect toward the job satisfaction and employee’s

74
performance, and job satisfaction do have a positive involvement on the employee’s

performance, (Ramli, 2019)

A conclusion can therefore be drawn from the results presented in chapter four and

which pertains to the first research objective.

The study generally revealed that though employees are satisfied with their work

environment, very few are too enthusiastic about it. More than half of the respondents

are satisfied with the work environment, very few said were very satisfied with it. While

a significant number was not happy about the hospital environment. This perhaps

signals a possibility of many if not all hospital staff being dissatisfied soon if no

improvements are made at the hospital. Including those who are so enthusiastic about

their profession.

Ramli (2019), stated that by improving a good work environment for employees, job

satisfaction of employees of private hospitals in Jakarta can follow these enhancements.

He further adds that, communication must be made open between leaders and

employees and between employees and their fellow employees, so that employees feel

satisfied and will have a positive impact on performance. Especially if the employees

can improve their careers and competencies in general. Therefore, the hospital

management needs to make improvements or increase the competence of the

employees, so they feel comfortable working in such a work environment.

With the existence of a conducive and comfortable work environment, will create

enthusiasm from employees in work and will improve performance and work discipline

in each of his job. Comfortable work environment, adequate facilities, and good

employee relations. Will affect employee performance. When employees feel

75
comfortable with the environment in which they work will certainly bring them to be

more disciplined and can improve their performance in achieving the goals of the

company/agency (Elok, Ekowati, Supriyanto, & Mukaffi, 2019).

From the results, overcrowding of patients at the hospital is the main reason for lack of

enough enthusiasm among staff, this perhaps happens due to lack of enough staff or

absenteeism.

Similarly, Manyisa & Aswegen (2017), expressed that, the following sub-themes

emerged from this main theme: increased patients’ workloads, long working hours,

shift work, poor infrastructure and staff shortages, budgetary constraints as well as the

strategies for improving working conditions in public hospitals. They further added,

the increase in patient admissions in public hospitals is probably due to the high costs

of private hospitals, rapidly growing urban populations, poverty and the associated

diseases, as well as the escalation of Human Immunodeficiency Virus (HIV) and

Acquired Immune Deficiency Syndrome (AIDS).

Similarly, Ramli (2019), noted that improving the work environment can reduce

complaints and absenteeism while increasing employee performance.

The research conducted by Ali (2015) states that the work environment in the agency

can have a positive and significant influence on employee performance.

It is therefore imperative to conclusively note while confirming to the first hypothesis

of the study that; there is a positive relationship between the physical working

conditions and performance of employees at Bugiri Hospital (i.e. Employees who

perceive their physical work environment as undesirable and inappropriate, their

corresponding level of satisfaction and performance will decrease).

76
5.1.2 Factor affecting employees’ performance

From the results presented in chapter four, numerous findings emerged. One of the most

important outcomes of the research is, irrespective of the devastating levels of work

environment satisfaction, there is a moderate increase in the job performance trend of

employees for the last three years, as presented in figure 8. Though there is a moderate

increase in the job performance among hospital employees for the last three years,

figure 15 in chapter four revealed inadequate material supply, understaffing and little

payments are mainly affecting employees’ performance.

This matches with several findings of other researchers. For example, Manyisa &

Aswegen, (2017) reported that workload, HIV/AIDS epidemic, shift work, long

working hours, poor infrastructure, inadequate resources and shortage of staff were

found to be the main factors attributed to poor working conditions.

This is related to the study by Asigele (2012) who noted that inadequate facilities and

equipment impact negatively on service delivery and the quality of patient care.

Shortage of appropriate administrative equipment and lack of necessary skills hampers

appropriate stock control, sometimes causing stock outs and making theft of medicines

easier than it might otherwise be. He further explained that without availability of

drugs, even the best trained providers cannot perform effectively, and this may

jeopardize the quality of service offered by health providers and as a result it may lead

to prolonged diseases and even death of patients.

The researcher also discovered that work conditions like hygiene, nature of office, the

status of the hospital structures, and staff housing affect employee performance. This

finding relates to earlier studies conducted by other researchers.

77
 For instance, Ollukkaran & Gunaseelan (2012), reported that workplace environment

in most of the industry is unsafe and unhealthy. These includes poorly designed

workstations, unsuitable furniture, lack of ventilation, inappropriate lighting, excessive

noise, insufficient safety measures in fire emergencies and lack of personal protective

equipment. People working in such environment are prone to occupational disease and

it impacts on employee’s performance. They added that, thus productivity is decreased

due to the workplace environment. It is the quality of the employee’s workplace

environment that most impacts on their level of motivation and subsequent

performance.

5.1.3 Improving employee performance

Findings by Adjei, Odoom, & Opoku, (2016) revealed that job satisfaction, logistic

provision, and an enabling work environment are intrinsic motivating factors that affect

the work performance of health workers; extrinsic factors such as financial reward,

accommodation, and transportation also impact work performance. Furthermore,

motivation is key to the work performance of nurses.

This relates to this study as it mainly discovered that hospital employees are agitating

for; more hospital equipment and hiring more staff as extrinsic motivational factors.

While the intrinsic motivational factors discovered in this study are pay rise and general

staff welfare.

Public health sector employers and organizations should adopt sustainable strategies

which target the important work environment factors to support employee creativity

and so enhance service quality, productivity, performance and growth. (Lukersmith &

Limerick, 2013).

78
 Lukersmith & Limerick (2013) further described that work environment factor that

needs the most improvement was incentive for creative results. Whilst health

professionals do not consider that their work environment adequately provides

‘incentive for creative results’, it is not one of the most important factors for health

professionals. A person does not generally enter a health profession (in the public sector

as an employee) for significant financial rewards (or incentives). Whilst there may be

incentives other than financial, the participants are likely to perceive incentives for

creative results to be linked to financial incentives. Public sector employees have

limited opportunity to engage in productivity or results based financial incentives. Most

participants in the study were employed in the public sector, which may have influenced

the importance rating.

5.2 Conclusion

There is a large body of research which has established the link between work

environment factors and job performance. Motivating the public hospital staff will

enhance their performance in the use of narrative; good working conditions, recruiting

more staff, better pay, good welfare, usage of enough and advanced equipment, training

and development.

Moreover, exciting and supporting health workers will also assist especially public

hospitals to continue services, growth and provide quality services in an increasingly

cost-effective environment of the country’s health care system.

The Spearman’s correlation coefficient was used to investigate the relationship between

the selected variables, that is (independent variables, dependent variable and

79
intervening variable). The Spearman’s correlation results show that; Firstly, there is a

positive relationship between the physical working conditions and performance of

employees at Bugiri Hospital. However, it should be noted that, though there is a

positive relationship between job performance and hospital management, there is no

statistically significant correlation between the two variables. Secondly, there is a

positive correlation between employee satisfaction and salary/benefits. Thirdly, there

was a small positive correlation between job satisfaction (intervening variable) and job

performance (dependent variable), as increase in job satisfaction slightly correlated

with increase in job performance among hospital workers. It is concluded that all the

hypotheses are upheld.

It is recommended that a proactive strategy be adopted by organizations to improve the

alignment between flexible work-hour agreements and other human resource policies

such as recruitment, promotion, training, rewards and performance assessment (Idowu,

2020).

The study results suggest to the government, private hospital employers and other

organizations that health workers consider themselves to be satisfied and passionate

about their job. However, there is room for improvement in public health care settings

to inspire their job satisfaction and performance.

It is the quality of the employee’s workplace environment that most impacts on their

level of motivation and subsequent performance. How well they engage with the

organization, especially with their immediate environment, influences on a great extent

their error rate, level of innovation and collaboration with other employees,

80
 absenteeism and ultimately, how long they stay in the job (Ollukkaran & Gunaseelan,

2012).

Inadequate facilities and equipment impact negatively on service delivery and the

quality of patient care. Shortage of appropriate administrative equipment and lack of

necessary skills hampers appropriate stock control, sometimes causing stock outs and

making theft of medicines easier than it might otherwise be (Manyisa & Aswegen,

2017). The review revealed that unsatisfactory working conditions have negative

impact on the physical and psychosocial wellbeing of employees. To mitigate these

factors, the review has revealed various strategies that could help improve working

conditions in public hospitals.

5. 3 Recommendations

The present study is based on samples of selected employees of Bugiri hospital in

Bugiri municipality in Bugiri district. The findings presented here may not be

generalizable to other settings owing to limitations of sample characteristics & size.

Further studies with more detailed and comprehensive work environment scale with

larger sample size and different characteristic is suggested for better understanding of

the concept in Ugandan public hospitals. Though the researcher did not set out to assess

performance nor productivity per staff, the results have several implications for hospital

management which aim at improving performance and productivity of staff. Factors of

hiring more staff to avoid crowding and purchasing more hospital equipment like beds,

computers, laboratory equipment among, were highlighted as particularly important to

improve job performance.

81
 More intrinsic motivational factors such as pay rise and improving employee welfare

were identified as particularly important. A good office design, good working

conditions, hygiene environment and good administration were acknowledged as being

critical for job performance.

5.4 Limitations of the study

The generalization of this study findings is limited, especially by the fact that the

researcher conducted the study in only one public hospital (Bugiri Hospital). Though

the researcher managed to meet the target sample size, and a cross gender and

departmental approach was used to minimize the impact of nonparticipating employees,

non-generalization of findings still remains a limitation.

The researcher also recognizes that many hospital workers were concerned about the

confidentiality of their responses and recognize that some may have feared to fully

express their feelings, for instance in the workplace environment questions, for fear that

their employers would read the concerns they expressed. Others with low levels of job

satisfaction may have declined to participate because of confidentiality concerns or lack

of interest. The researcher limited this potential bias by keeping the survey anonymous

and assuring all respondents that raw data would not be shared with their employers or

any third party.

Finally, the researcher also faced a challenge of availability of respondents, it was hard

to get hospital staff to respond to questions. Especially, the senior medical doctors, they

were very hard to secure an interview with. The research resolved this challenge by

following them to their residence especially over the weekend when they are regarded

less engaged.

82
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 APPENDICES

Hello, my name is Patricia Nakiwala and I am conducting research as fulfillment of the requirement of the

award of a master’s degree in Public Administration at the university of Bergen. I kindly ask for your

participation by responding to some questions about your experience as an employee of Bugiri Hospital. I

will keep your answers completely anonymous so please feel free to answer openly. This interview is

completely voluntary. Do you have 5 minutes to talk to me?

Section A: Characteristics of respondents Codes

1 Sex (Observe and record, 1. Male

don’t ask) 2. Female

2 What is your age? 1. 18-28

2. 29-39

3. 40-50

4. 50-60

5. 60 Above

3 What is your level of 1. No formal education

education? 2. Below diploma

3. Diploma

4. Bachelors

5. Masters

6. PHD

4 Department/Position ……………………………………………

……………………………………...

5 Duration in Bugiri Hospital 1. 6months – 1 year

2. 1 – 3 years

3. 3 – 5 years

4. 5 years & above

94
 Appendix I.: Questionnaire tool for primary respondents

Section B: Work environment and job performance Codes

5 What is the most important factor in the 1. Job Satisfaction

work environment? 2. Office design

3. Performance feedback

4. Environmental conditions

6 What has been the trend of performance 1. Increasing

at Bugiri Hospital over the last three 2. Reducing

years (2016-2019)? 3. Constant/stagnant

4. Don’t know

How do you agree with the following statements?

(1 = Strongly disagree; 2 = Disagree; 3 =Neutral; 4 = Agree; 5 = Strongly agree)

Strongly Disagree Neutral Agree Strongly 1

disagree agree
Statements

7 Workplace environment has influence

on the performance level of employees

at Butabika hospital

8 There is a relationship between work

environment and job performance of

employees of Butabika Hospital

9 How satisfied are you with the work 1. Very dissatisfied

environment at Bugiri hospital? 2. Dissatified

3. Neutral

4. Satisfied

5. Very satisfied

10 Please explain why?

95
 Section C: Factors affecting employee performance

On the scale of 1-5, tick in the appropriate box on how you agree or disagree with the statements below.

(1 = Strongly disagree; 2 = Disagree; 3 =Neutral; 4 = Agree; 5 = Strongly agree)

Statements 1 2 3 4 5 Codes

11 Job satisfaction is the most important factor in employee

performance

12 Office design is important for comfort, efficiency, and safety of

employees at work.

13 Goal clarity among the employees helps to improve their

performance

14 Knowledge of the structure helps an employee to know what to

do in given situations and hence improve his/ her performance

15 Performance feedback is important for the improvement of an

individual’s performance

16 Ability, training and experience improve an individual’s

capability to perform

17 The use of modern technology triggers performance of

employees

18 Availability of opportunities to practice new different things at

work helps to improve an employee’s job performance

19 Environmental conditions such as; temperature, lighting,

ventilation, noise level are important factors on employees’

wellbeing and work processes

20 Suggest any other factors that affect your level of performance as

an employee of Bugiri Hospital?

THANK YOU VERY MUCH!!!

96
 Appendix II: Interview Guide tool

For exploring the impact of work environment on job performance of employees

Respondents: Supervisors and Department Heads

1. How would you describe the work environment of Bugiri Hospital?

2. How has it affected you and the health worker’s service delivery?

3. How has the work environment influenced the medical worker’s hospital attendance

and medical care offered to patients?

4. What influence has the workplace environment had on medical worker’s enthusiasm

in service delivery?

5. In your view, what motivates medical workers to perform? also what motivates you to

perform?

6. Does the hospital face challenges in running its activities? and what are some of the

challenges faced?

7. What possible measures have been taken against some of the challenges faced by the

hospital?

8. What is your recommendation on work environment and job performance of

employees of Bugiri hospital?

THANK YOU VERY MUCH!

97
 Appendix III: Letter of introduction

UNIVERSITY OF BERGEN

Department of Administration and Organization Theory

To

Bugiri Hospital

P.O.Box 97, Bugiri Jinja-Tororo Rd,

Bugiri,Uganda

15.03.2020

LETTER OF INTRODUCTION
Dear Sir/Madam
This letter is to introduce Ms. Patricia Nakiwala 09.03.1991. She is pursuing an MPhil degree in
Public Administration at the Department of Administration and Organization Theory, University of
Bergen, Norway.
Ms. Patricia Nakiwala has completed one year of course work and is now doing research for his
thesis on the topic:

"EMPLOYEES' PERCEPTION ON THE IMPACT OF WORK ENVIRONMENT ON JOB PERFORMANCE: A

CASE OF BUGIRI HOSPITAL IN UGANDA"

The thesis is supervised by Associate Professor Dr. Kari Tove Elvbakken.

Yours sincerely

Cathrine Bustad Jensen

Higher Executive Officer
Department of Administration and Organization Theory
Christies Gate 17
University of Bergen
55 58 21 54

Christiesgt. 17-19 Telephone +47-55 58 21 54 Telefax +47-55 58 98 90

N-5007 BERGEN E-mail: cathrine.bustad@uib.no

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