Factors Affecting the Satisfaction of Women Employees in Health Sector: A Perception Study in Saudi Arabia

Introduction

The growing empowerment and increasing satisfaction of female workers in the health sector play a vital role in enabling Saudi women to excel and succeed in their careers. Saudi Arabia’s society has long been understood as masculine, which is characterized by setting explicit, strictly defined, and unique gender roles.^1–3 Subsequently, in such a collectivist society that mandates group conformity, including expecting individuals to adjust their career and personal aspirations to maintain the social order, women opting to pursue careers outside their predetermined domestic roles are perceived as social deviants challenging cultural traditions.^4,5 However, Saudi Arabia has progressed based on women’s empowerment, which scholars attribute to the determination and resilience of Saudi Arabian women in fighting for their rights and empowerment. The realization that women’s empowerment enhances the quantity and quality of human resource availability for development and aspirations.^2,3,6,7 Saudi has a long-term plan that outlines its goals and objectives for economic, social, and political development, with a focus on diversifying its economy and reducing its dependence on oil revenue.⁸ In regard to the health sector, Saudi aims to empower women in the health sector, by providing them with equal opportunities to contribute towards the growth and development of the healthcare sector. The goals include increasing the participation of women in the healthcare workforce, as well as promoting women’s leadership and empowerment in the sector.⁸

For women in the healthcare sector, research has identified several workplace-related factors empowering women that include institutional identification of barriers (gender discrimination, stereotypes, social restrictions) and addressing them and recognition of women in their work roles.^9–11 Besides, healthcare institutions have increased their gender equality awareness campaigns, but scholars also note that the adoption of gender parity policies has mostly relied on leadership and management views of gender equality amidst restrictive social-cultural norms.^9,12

Some studies report that women empowerment being observed in Saudi Arabia for women in the healthcare sector is more associated with increased education and training opportunities, which has made it possible for women to be promoted to senior leadership and management positions.^5,13–15 Nonetheless, their number in managerial positions continues to be low compared to that of men.^13,15 Conversely, there are arguments that gender parity in education and training opportunities is yet to be achieved, especially when it comes to the number of women attaining higher education levels such as doctorates or masters.^10,16,17 Such is attributed to some reports revealing their low involvement in strategic decision-making, except only when one is in a managerial position. However, Saudi women’s incessant fight for better education and job opportunities is being achieved. Some agreed that such has opened up numerous opportunities for more Saudi women to be involved in managerial positions and strategic decision-making processes.^12,18,19 However, whether these issues are more prominent in the healthcare sector in Saudi Arabia is unknown, which prompts the execution of this study.

The number of women employed in Saudi healthcare remains low, with statistics showing pharmacists, dentists, physicians, or allied personnel as comprising 37%, 36.4%, 36.3%, and 24.4%, respectively, of the entire workforce.²⁰ It is only in nursing that the majority of women are employed, which comprises 61.8%.²⁰ Nonetheless, although the number of women being employed in Saudi healthcare is increasing,^12,18,19 there is evidence of gender disparities in wages or salaries and allowances. For instance, a report by the World Economic Forum indicates that Saudi Arabia ranks 127th out of 146 countries in terms of equal pay, which is confirmed by Stoeger et al’s study that found significant gender pay disparities.^21,22 Therefore, despite progress toward women’s empowerment, gender equity in the workplace is yet to be achieved in terms of opportunities.^21–25 Besides, the majority of women still feel that although a majority of institutional barriers have been eliminated, they are yet to receive equal representation in various employment opportunities.^26–28 Therefore, it becomes essential to examine how women workers perceive their work environments with a specific focus on healthcare.

Materials and Methods

A cross-sectional study was conducted with a non-probability sampling method due to our inclusion and exclusion criteria. The study population consists of only Saudi biological females working in the governmental hospitals in the health sector wither they have medical, administrative, or technical staff in the governmental or non-governmental hospitals in Saudi Arabia.

This study was approved by the Institutional Review Board (IRB) office at Prince Sultan Military College of Health Science (IRB-2023-CLS-001). The data was collected through online questionnaires between December 2022 and February 2023, where standardized close-ended questions were asked via Google Forms in the five regions in Saudi Arabia. A total of 261 responses to the questionnaires were received. Informed consent was obtained on the first step of the online questionnaires.

A structured online questionnaire was designed and prepared by the researchers according to the primary objective of the study with a three-point Likert scale (1 = agree, 2 = undecided, 3 = disagree). A panel of experts reviewed the questionnaire to ensure its clarity and appropriateness. The questionnaire completion time will be estimated to be approximately 10 min. A total number of 45 questions, including 7 questions assessing demographic and work-related questions, 12 questions assessing workplace environment, such as I have my own office that enables me to do my clerical work, the workplace environment is positive, and the administration provides comfortable rest areas and cafeterias that grant privacy. In addition, 14 questions were included to assess privileges and opportunities, for example prioritizing opportunities and advantages are given to Saudi females over others, women holding managerial and leadership positions, and excellent female workers get financial and moral rewards. Moreover, 12 questions were assessing doing work and decision-making for instance, woman contributes at my workplace in making decisions, the administration trusts in my work as a woman and Managers listen to my suggestions and viewpoints. A pilot study was conducted with 60 participants to test and measure the reliability of the questions. Cronbach’s alpha was used to assess the reliability and internal consistency of the questionnaire depending on the three themes were revealed a reliability coefficient (Cronbach’s alpha) of 0.785, 0.859, and 0.823, respectively. A mean score was calculated to determine the score for the three themes.

The data collected from the survey will be using Statistical Package for the Social Sciences (SPSS1) software (SPSS Inc., Chicago, IL, USA) version 26. Descriptive statistics will be calculated as frequency and percentage. The average of each theme will be calculated out of the total point of each domain points. Then, the mean score was to the nearest discrete number to represent the three-point Likert scale as (1 = agree, 2 = undecided, 3 = disagree). In addition, chi-square test was used to investigate the association between demographics and work-related questionnaires and the three domains of the study. Fisher’s exact test was used when one or more of the cell counts in the results table is less than five. A p-value was statistically significant at 0.05 level.

Results

The Demographic Characteristics of the Population

Table 1 shows the frequency and percentage of the demographic and work-related characteristics for the total number of 261 females who were included in the study. Most of our participants were aged between 25 and 34 years (59%) followed by females between the age of 35 and 44 years (30%). More than half of the females work in the governmental sector (53%), whereas (35%) of them work in military hospitals. Around (58%) hold clinical jobs and the rest occupy technical (17%) and administrative jobs (25%). Around (58%) are married females and (34%) are single. For the academic qualifications, there are (64%) with a Bachelor’s degree, (16%) with a Master’s degree, and (7%) with a Ph.D. and above. (37%) of our participants have more than 19 years of working experience and (31%) have from 5 years to less than 10 years.

Table 1 Demographic and Work-Related Characteristics for Women Working in the Health Sector in Saudi Arabia (N=261)

The Association Between Female Workers’ Satisfactions with the Factors Enabling Saudi Women in the Health Sector

When investigating the association of the satisfaction of female workers in the health sector with environmental factors, we found a significant association between job title, age groups, marital status, academic qualifications, and years of experience with the workplace environment (p-value= 0.029, <0.0001, <0.0001, <0.0001, and 0.0347), respectively. The results showed that 48% of females were satisfied with their work environment compared to those in administrative jobs and technical jobs. In addition, 49% of pleased females were between the age of 25 years and 34 years compared to other age groups. Additionally, 61% of married females agreed positively to questions asked in this domain compared to other marital statuses. In regard to academic qualifications, 60% of satisfied females hold a bachelor’s degree compared to other degrees. (37%) females who have more than 10 years of experience are more likely to be pleased compared to those with fewer years of experience (Table 2).

Table 2 The Association of Female Workers’ Satisfaction with the Environmental Factors to Enable Saudi Women in the Health Sector

In addition, when we asked about privileges and opportunities for females in the workplace, we found a significant association with work sectors, job titles, age groups, marital status, academic qualifications, and years of experience (p-value= <0.0001, 0.0005, <0.0001, 0.0002, <0.0001, and <0.0001), correspondingly. The results indicated that (57%) of satisfied females with privileges and opportunities were working in the governmental sectors in comparison with other military and private sectors, occupying clinical jobs in contrast to administrative and technical jobs, and aged between 25 and 34 years compared to other age groups. Moreover, 59% of satisfied females were married with a Bachelor’s degree in comparison to other marital statuses and academic qualifications. Thirty-eight percent females have more than 10 years of experience and were more pleased in contrast to those with fewer years of experience (Table 3).

Table 3 The Association of Female Workers’ Satisfaction with the Privileges and Opportunities Factors to Enable Saudi Women in the Health Sector

Furthermore, the questions addressing doing work and decision-making were associated with work sectors, job titles, age groups, marital status, academic qualifications, and years of experience (p-value= 0.0004, 0.0002, 0.0001, 0.005, <0.0001, and <0.0001), respectively. Similar to the previous theme, most satisfied females were in the governmental sectors (56%), occupying clinical jobs (58%), between the age of 25 and 34 years (55%), who are married (58%), earned a Bachelor’s degree (63%) and have more than 10 years’ experience (40%) (Table 4).

Table 4 The Association of Female Workers’ Satisfaction with the Doing Work and Decision-Making Factors to Enable Saudi Women in the Health Sector

Discussion

From the results of this investigation, it is apparent that female demographic constitution such as age, marital status, education, profession, work experience, and workplace is critical in women’s perception regarding work environment, opportunities, and decision-making. The results are presented based on three themes, which match the objectives of this investigation. These themes include women empowerment factors related to the workplace environment, women empowerment factors related to privileges and opportunities and women empowerment for doing work and decision-making.

The findings of this investigation shed key insights relating to women’s satisfaction based on three key empowering factors prevalent in Saudi healthcare environments, which include teamwork, positivity, and concern. Emphasis on team spirit is observed to be a critical motivator for women, especially when they are engaged as a team with their male counterparts, which is consistent with scholarly reports that have cited women empowerment as characterized by women accessing equal work-based opportunities as men.^1,2,6,7 The findings seemingly suggest a symbiotic relationship when women work together with men, which then undoubtedly may lead to the production of exceptional results. Such a revelation implies that Saudi healthcare institutions may need to leverage such insight by enhancing gender-parity team spirits, which not only improves productivity but also enhances workplace satisfaction among women, which may also have ripple positive benefits to the organization.

Additionally, the results of this study illuminate the Saudi healthcare sector as having put considerable effort into enhancing women’s experiences at work, which is evident in the observed positive viewpoint of the medical sector among a majority of women. Just as Al-Qahtani et al’s and Alsubaie and Jones’s postulations emphasize the importance of a positive work environment in empowering women,^3,23 results from this investigation also point to the in-dispensability of creating a positive workplace environment. However, the findings of this study also suggest that the creation of such a positive work environment may require Saudi healthcare institutions to prioritize women’s satisfaction levels. For instance, the findings reveal that women cherish their personal circumstances being considered at work, which is consistent with previous literature that identifies the power of creating an environment that gives women more control of their work roles.^9,12 It then becomes affirmative that one of the areas that can be addressed to enhance Saudi women workers’ satisfaction would be the consideration of their contributions to both work dynamics (ie, teamwork) and the overall productivity of the healthcare organizations.

The results of this study reveal invaluable insights on how women worker’s satisfaction levels may have a bearing on equality when it comes to remuneration, which reflects Stoeger et al’s call on parity in salaries, wages, or allowances as key for women’s perception on women empowerment.²² It should be recalled that one of the key motivations to work is remuneration, which implies that when one is satisfied that they are well remunerated, the potential for them to be satisfied and work hard increases. The findings of this investigation illuminate that gender parity in remuneration is maintained within the healthcare sector, which has positively impacted female workers’ satisfaction, but such a revelation is contrary to previous reports indicating significant pay gaps between women and men.^21,22 However, such inconsistency between this study’s findings and previously reported data on gender pay gaps may be explained based on the industry-specific improvements. Subsequently, it becomes affirmative to allude that the Saudi healthcare sector may be outperforming other sectors in terms of pushing for fair and equitable remuneration for women, but such hypotheses may require sector-specific comparisons if plausible inferences were to be made.

The results of this investigation also note women worker’s satisfaction as aligned to the availability and accessibility to equitable professional development and training opportunities at work, whose importance is also mirrored in previous studies.^5,13,14 This investigation reports that women workers in the healthcare sector are satisfied that they have equal training and development opportunities as men, which is also observed to be attributed to the number of women holding managerial and leadership positions. Nevertheless, the study’s findings contradict recent discoveries that such parity in terms of training opportunities and occupation of leadership positions is yet to be realized in Saudi Arabia.^10,16,17 Subsequently, what these insights suggest is that the Saudi healthcare sector has substantively enhanced access and availability of work-related opportunities for women, which is observed to increase women workers’ satisfaction levels, which is key in efforts towards Saudi goals.

The results of this investigation also shed key insights on the role of being able to do work and make decisions on women workers’ satisfaction. Workers reveal that most women felt their contribution to workplace decision-making was valued is consistent with prior findings that observed that when women are offered an opportunity to contribute to strategic decisions, their satisfaction, as well as productivity, improved.^12,18,19 It appears therefore that involvement in decision-making processes among female workers is a motivation, which then explains the observed higher levels of satisfaction irrespective of their job title (administrative, clinical, technical), workplace (government, military, private), or work experience. Arguably, the basic meaning of decision-making-based motivation as observed in this investigation is that when an employee becomes aware that they can exert influence, or can control specific decisions at the workplace, their satisfaction levels increase. However, such may also attract the question of the nature of decision-making that women are involved in. For instance, the findings highlight the possibility that being involved in strategic decision-making is likely to enhance satisfaction levels compared to low-level decision-making, which is in agreement with other studies’ arguments of women’s involvement in strategic decision-making has a more empowering implication.^12,18,19 What such suggests is that irrespective of the decisions that women make, being listened to including their suggestions and viewpoints being considered is crucial in enhancing women workers’ satisfaction levels. Moreover, the findings of this study also highlight that the feeling that one receives fair work assignments as men have a profound effect on women workers’ satisfaction level, but such a revelation ignores the differential abilities of men and women in specific work roles.

The findings of this investigation have key implications for Saudi Arabia’s healthcare sector in terms of human resource issues and policymaking. The findings highlight the Saudi healthcare sector as having made significant progress in women’s representation. Such creates a positive message throughout the healthcare sector, where a majority of women may pursue their careers in this industry due to the perceived or reported levels of gender representation and equity. Moreover, considering that previous reports had indicated continuing inequality in opportunities for women in the workplace, the current investigation does not counteract such inferences for other sectors, but rather only highlights the trend in the healthcare sector. What such suggests is that current policies towards eliminating women discrimination in the workplace should be reviewed and those relevant ones applied specifically to healthcare, which can help merge the inherent hypotheses with the realities reported in this study to further enhance women workers’ satisfaction to facilitate the realization for Saudi goals.

Conclusion

This investigation has insinuated that although Saudi women continue to face disparities in the workplace in terms of treatment, training and development, and career progression opportunities, there seems to be significant progress in the healthcare sector. The study has revealed that when the work environments are adjusted to reflect the status and aspirations of women, it becomes possible to derive a higher level of satisfaction among these women. In particular, the investigation has noted the indispensability of a work environment defined by teamwork, positivity, equitable opportunities, involvement in decision-making, and being valued as invaluable factors that enhance women workers’ satisfaction.

The implications of this study’s findings are in guiding Saudi healthcare organizations to start prioritizing establishing equitable work environments, which may have a strong influence on the satisfaction and productivity levels of women. Besides, the findings offer insights that highlight the healthcare sector as having made significant progress in enshrining the rights and interests of women in their work environment, hence the need for policies that further strengthen this. Therefore, through this study, Saudi healthcare organizations should establish and effectively implement workplace policies and standards that encourage and treat women similarly to men in all scopes of work.

Although the sample size, including the quantitative method used, was a key strength of this study, several limitations were observed. The use of quantitative surveys with closed-ended questions limited the depth of insights derived from this investigation. Subsequently, future studies should consider adopting both surveys and interviews to facilitate the generation of both qualitative and quantitative data that could offer more in-depth insights into female workers’ satisfaction within the Saudi healthcare sector.