Remuneration, Job Satisfaction, and Performance of Health Workers During the COVID-19 Pandemic Period at the Dr. Soetomo Hospital Surabaya, Indonesia

Introduction

During COVID-19 pandemic, the sustainable health-worker performances were very significant for a hospital services. The hospital management maintained the physical and mental readiness of the health workers to sustain their spirit and performances for serving an overwhelming number of patients. During COVID-19 Pandemic, several health-workers experienced burnout because they were tired or dissatisfied with the existing system in the hospital. This phenomenon revealed that employee performance and satisfaction issues were still a challenge for a sustainable hospital management service.^1–3

Previous research has shown that compensation (remuneration) will not directly lead to employee satisfaction.^4–6 One factor that influenced the satisfaction was motivation. The motivation made employees work according to system procedures and expected to fulfill customers’ wishes.⁴ This is also supported by Rahayu and Ruhamak’s research findings which showed that remuneration did not affect employee satisfaction.⁵ Other research also showed that remuneration was the right step to increase employee satisfaction, although it must be seen in more detail implementation in the remuneration system.⁶

The Decree of the Minister of Indonesian Health No. 625 of 2010 urged every public hospital must implement remuneration as an incentive for all employees. Dr. Soetomo Hospital management has been applied since 2012 and in 2014, as a response to the implementation of the National Health Insurance (JKN) program, the remuneration system for the Regional General Hospital Dr. Soetomo refined to Modified Personal Scoring (MPS). The remuneration system utilized an aggregate under the JKN program, financed through packages with no service fees. Furthermore, in 2018, the remuneration system re-refined to the Modified Total Remuneration (MTR) system. This is to make the remuneration system more based on performance appraisal by the policy of the President Director of the Regional General Hospital, Dr. Soetomo, in 2019. Supported by East Java Governor Regulation Number 2 of 2020 relating to the Performance Assessment System for Civil Servants, the system had combined to Additional Employee Income regulation (Work Achievement) which has been implementing until recently.

Theoretically, the remuneration system impacts the quality of employee performance, increases productivity, increases loyalty, prioritizes customer satisfaction, and avoids corruption.⁷ This can be interpreted if the remuneration is not given proportionally, resulting in performance cannot be achieved optimally. Therefore, the increase in remuneration will only benefit the organization if it is followed by the implementation of performance-based Human Resource management so that it becomes clear what the main tasks and responsibilities of employees are and the targets to be achieved.

Based on the Government Regulation of the Republic of Indonesia Number 30 of 2019 concerning the Performance Assessment of Civil Servants and the PANRB Ministerial Regulation No. 6 of 2022 concerning the Government Employee Management Performance, the intended performance assessment in government organizations is to use the Employee Performance Target (called SKP). SKP is a performance plan and target self-prepared by the employee, and must have a target. The target must be achieved within a certain period. Furthermore, theoretically, an employee’s potential is not only seen in quantity, but what is important is quality, which includes the skills to produce something new, develop creativity, take the initiative, solve problems, predict, think proactively, and adapt to change (Nasution 2019).⁸

Previous studies that examined remuneration, job satisfaction, and performance found that many problems arise that always lead to health workers. For example, the shortage of health workers, incompetent health workers, and others.⁹ Health workers, as part of the hospital’s human resources, are the essential factor in the success or failure of the hospital. Over time, it is necessary to review the remuneration system that has been running, whether it is related to the satisfaction of health workers, and whether to improve the performance of health workers.^10–17

Conceptual Frameworks

Remuneration is wages given to employees based on their contribution to the organization by performing their best. Remuneration is an essential aspect for employees and the organization itself. The literature shows that remuneration can lead to motivation and encouragement from someone always to work more diligently. In addition, remuneration can play a role in creating high performance. The provision of remuneration can be an effective step to spur employees to perform because the performance will directly impact the number of rewards received. In other words, remuneration is a bond between an organization and its employees and an attraction for employees. Job satisfaction is felt by an individual regarding what he does, for example, in the form of an emotional attitude from the individual, whether he likes or loves his Job. In an organization, job satisfaction needs attention because human resources are the essential factor for an organization to achieve its goal successfully.¹⁸

The Job Description Index (JDI) is often used to measure job satisfaction. There are five important components in job satisfaction, including work in general (the Job itself), rewards (Pay), superiors (supervision), promotion opportunities (Promotion), and co-workers (co-workers).¹¹

Performance is the level of achievement of individuals at a particular time when carrying out their duties and functions compared to the expected work results and the targets to be achieved, originally planned and agreed upon together. Performance improvement will not be achieved if an organization has not carried out human resource management effectively, which can make individuals in the organization compete to improve their performance. The strategies to achieve organizational goals in cascading stages will be translated to the individual level. Based on the information obtained from the performance appraisal, the leader can observe these achievements as a consideration when making decisions or taking necessary actions.^18,19

Employee Performance Targets (SKP) are plans and targets to achieve performance. The employees make plans and targets, which must be completed within a certain period. Performance targets must be determined, known, and approved by the individual’s direct supervisor according to their primary tasks.^20,21

Based on Human Resource management theory, it is generally known that remuneration can affect employee satisfaction, motivation at work, and at the same time, the performance itself. Non-financial compensation is remuneration other than in the form of money. Characteristics of this compensation include the satisfaction gained from performing meaningful work-related tasks. In addition, the organization can implement programs to create pleasant working conditions and environments, such as tourism programs and the provision of canteen facilities, places of worship, and sports fields.^22–29

Motivation is generally known to have a positive influence on the performance of an employee. Although not the only factor that can shape performance. Employees are motivated when they get attention from the leadership and praise from the administration. If the motivation is good, the employee’s performance will also increase.^30,31 Job satisfaction is a positive feeling in a job. In addition, job satisfaction is also a driving factor for increasing employee performance and improving organizational performance.³²

Adamopoulos et al found that job satisfaction is complex, it depends on such knowledge, skills, and personal characteristics of an employee, motivation or energy, must work, the work environment, such as technology, materials, information, administrative hierarchy, management systems needed to perform a task. In addition, Adamopoulos et al’s research found that the theoretical study of job satisfaction influences environmental factors, such as job characteristics, salary, equality, and fairness in the workplace, which have a significant effect on individual satisfaction with their work. Equally important is the fact that factors such as frustration, alienation, technology, importance of the job, supervision, agreements, role conflicts, and interpersonal relationships with co-workers and superiors play a significant role in creating job satisfaction.³³

Based on the problems found, we aim to examine whether there is a relationship between remuneration, employee satisfaction based on the Job Description Index (JDI), and performance based on the achievement of Employee Performance Targets (SKP). Based on the conceptual framework we depicted the model (Figure 1) and we developed three hypotheses to be tested: H¹: Is there a relationship between remuneration and the achievement of Employee Performance Targets (SKP) at RSUD Dr. Soetomo?; H²: Is there a relationship between remuneration and employee job satisfaction at RSUD Dr. Soetomo; and H³: Is there a relationship between the achievement of Employee Performance Targets (SKP) with employee job satisfaction at Dr. Soetomo hospital.

Figure 1 The conceptual framework of hypotheses.

Methods

This study applied a quantitative approach using Employee Satisfaction Survey data, Performance Achievement Report data (SKP), and Remuneration Reports of the Regional General Hospital of Dr. Soetomo during 2019–2021. The data were utilized on three secondary databases: Personnel Database, Remuneration Database, and the Annual Employee Satisfaction Survey Database for the period 2019 to 2021 retrospectively. Based on these data, the three research hypotheses were tested. The population and samples of the study were Dr. Soetomo hospital employees.³⁴ The remuneration data used from the remuneration that received by health workers during 2019–2021; the job satisfaction data based on JDI (the Job itself, pay, Promotion, supervision, co-workers), and the performance data based on Performance achievements (SKP).^35,36 The overall sample consist of 716 health workers.

Data Analysis

We applied descriptive statistical analysis to determine the maximum, minimum, and average values of the analyzed data. We used the Classical Assumption Test (the Data Normality Test and the Kolmogorov–Smirnov Test of Normality) to test the normal distribution of the data.^34,35 Furthermore, we applied Kruskal–Wallis’s One-Way Variance analysis to test the hypotheses and Pearson Product Moment Correlation Coefficient analysis to test the relationship between variables.^36,37 The statistical analyses in the present study were performed using IBM SPSS Statistics 26.0.

Research Ethics

Before study conducted, ethical approval was obtained from the Institutional Review Boards of the Dr. Soetomo Hospital (IRB ref no: 0946/LOE/301.4.2/VI/2022) and all participants provided informed consent.

Results

Survey respondents collected from 67 work units of Dr. Soetomo hospital. The number of samples in the survey were 716 people, consisting of 506 women and 210 men. Family status of respondents consist of 630 people (married), 71 people (unmarried), and 15 (widows/widowers). The number of respondent’s dependents were 278 people (with 1–2 dependents), 315 people (with 3–5 family dependents), 115 people (without any dependents), and 8 people (more than 5 dependents). The results of descriptive analysis of job satisfaction (JDI) showed in Table 1.

Table 1 Satisfaction Level of Overview of Working Condition, Income and Compensation, Opportunities for Promotion, with Supervision and with Co-Workers

The General satisfaction description on Working Conditions or Job in General (The Job Itself) showed that average 2.91 in 2019; 2.96 in 2020, and 2.83 in 2021. The satisfaction on Income and Compensation Received (Pay) showed the average of 2.89 in 2019, 2.96 in 2020, and 3.02 in 2021. The satisfaction on Opportunities for Promotion showed the average of 2.86 in 2019, 2.96 in 2020 dan 2.77 in 2021. The satisfaction level with supervision showed the average of 2.98 in 2019, 2.99 in 2020 and 3.03 in 2021. The satisfaction with Unit Worker (Co-workers) showed the average of 3.11 in 2019, 3.14 in 2020, and 3.11 in 2021.

The Employee Performance achievement during 2019–2021 depicted the average of 86.27, 85.86, and 99.08, consecutively. (Figure 2) The results of descriptive comparison analysis between satisfaction, remuneration, and performance based on SKP showed the increasing of Satisfaction with Pay, Supervision, and Performance, while the results showed the decreasing of Remuneration, Satisfaction with the Job, Promotion, and co-workers (Figure 2).

Figure 2 The employee performance achievement and employee satisfaction, remuneration, and performance in 2019–2021.

The results of Normality test (One Sample-Kolmogorov–Smirnov Test technique) showed that the data were not reached a normal distribution. In addition, the results of the Kruskal–Wallis test show that the Remuneration, Job Itself, Pay, Promotion, Supervision, and Performance variables have an Asymp. Sig value <0.05 indicates a difference between 2019–2021, while the Co-worker variable has an Asymp.Sig value. > 0.05, which means there is no difference in that period.

The results of correlation test between Employee Satisfaction, Remuneration, and Performance Based showed a positive correlation. However, the correlations were not significant between the remuneration variable and satisfaction based on the Job Itself; a significant positive correlation (unidirectional) is very weak between the remuneration variable and satisfaction based on Pay; a significant positive correlation (unidirectional) is very weak between remuneration variables and satisfaction based on Promotion; a significant positive (unidirectional) correlation is very weak between the remuneration variable and satisfaction based on supervision; positive correlation (unidirectional) which is not significant between the variable of remuneration and satisfaction based on co-workers; There is a significant positive correlation (unidirectional) between remuneration and performance variables (Table 2).

Table 2 The Correlation Between Employee Satisfaction, Remuneration, and Performance Achievement (SKP) in 2019–2021

Discussion

The study examined three hypotheses to reveal whether there was a relationship between remuneration, employee satisfaction based on the Job Description Index (JDI), and performance based on the achievement of Employee Performance Targets (SKP). Based on the correlation test results between employee satisfaction, remuneration and performance based indicates that there is a positive correlation. The remuneration has a positive and significant relationship with performance. It is proved by the significance value or Sig. (2-tailed) of 0.000 < from 0.05 or 0.01. The results of this study align with research conducted by Febrianti, which suggests that remuneration has a positive relationship with the performance of Dharmais Cancer Hospital employees.³⁹ The same thing was also stated by Hidayat, who said that the remuneration system has a significant relationship to the performance of nurses.⁶ According to Dlugacz, performance can be assessed based on the value created (value-based) for the organization.⁴⁰ Value relates to improving service quality, reducing waste, and increasing hospital revenues.⁴¹

Remuneration correlates with job satisfaction and has been widely discussed by previous research. Remuneration has a significant effect on nurse job satisfaction, but motivational variables also significantly affect job satisfaction.¹⁶ In this study, motivation is not a variable under investigation. Until now, no reference has been found to explain the correlation between remuneration and job satisfaction of each factor based on the Job Description Index (JDI: the Job itself, pay, Promotion, supervision, co-workers).

During 2019–2021, the analysis results indicated that remuneration has a positive correlation but insignificant to employee satisfaction on the Job itself. The job component is related to how employees feel about their current work. Work provides opportunities for employees to learn according to their interests and the opportunity to be responsible. For example, do the staff feel their current Jobs are exciting and fun and provide opportunities to develop competencies and responsibilities? Based on the five factors related to Satisfaction, Dr. Soetomo Hospital management must give more attention to the Job itself.⁴³

According to Luthans, job satisfaction regarding job content, or job satisfaction, is the primary source of satisfaction.⁴⁴ The same thing was also conveyed by Gatot and Adisasmito said that the job satisfaction of inpatient nurses at Gunung Jati Hospital, Cirebon, was dominated by the content of the Job itself. In particular, the factor of granting autonomy and recognition.¹⁸ The efforts are needed to internalize the hospital’s culture and values, for example, through socializing the hospital’s vision, mission, and values during a morning briefing. In addition, management internalizes the code of conduct so that employees understand what they have to do and better understand their roles in achieving hospital goals.

The results of this research analysis show that data from 2019–2020 shows that remuneration has a positive but insignificant relationship to employee satisfaction with Pay. In 2021 compositely showed that remuneration has a positive and significant relationship to employee satisfaction with Pay. It illustrates that from year to year, satisfaction based on Pay to remuneration has increased. Apriliani & Hidayah stated that the better the remuneration the hospital provides, the nurses’ job satisfaction will increase.¹⁶ This is in line with research conducted by Kalalo et al, which showed a significant relationship between compensation and nurse job satisfaction.²⁰ The Dr. Soetomo hospital management continuously tries to improve the performance-based remuneration system. It can be seen from the remuneration regulations at Dr. Soetomo hospital, which since 2014 has always been dynamic, have been updated according to the latest regulatory developments. Even in 2020, it proved that employee remuneration could be more than 100 million IDR. It is proof that those who work hard with excellent performances will also get more remuneration than other employees.

The analysis of this study indicates that the data from 2019–2021 compositely show that remuneration has a positive and significant relationship to employee satisfaction based on Promotion. It is attested by evidence showing the significance value or Sig. (2-tailed) of 0.000 < from 0.05 or 0.01. With a correlation coefficient of 0.136. The results of this study support research from previous studies, which state that the benefits of giving promotions to high-performing or outstanding employees and giving promotions to Employees who have competence present job satisfaction.^20,38,41 However, of this study’s five other satisfaction components, promotion-related satisfaction was the lowest. As is known, Promotion is a vital part of the career development process in the company. Satisfaction with job promotions is an employee’s feeling about the possibility that a person can develop through Promotion. Hospital Dr. Soetomo, as a hospital belonging to the East Java Provincial Government, must comply with the regulations drawn up and challenge itself. One is regulation related to human resource development and Promotion. Hospitals cannot quickly and easily change and enforce new rules.

The analysis of this study indicates that the data from 2019–2021 compositely show that remuneration has a positive and significant relationship to employee satisfaction based on supervision. This is evidenced by the significance value or Sig. (2-tailed) of 0.000 < from 0.05 or 0.01. With a correlation coefficient of 0.161. This finding is in line with Ilyas’ research that the factors directly related to the performance of a doctor are income, benefits of supervision, career development, and training. Supervision is defined as direct observation or supervision of the implementation of routine work. It is hoped that the hospital leadership can clarify a good and scheduled supervision policy. This must also be supported by the employee’s direct supervisor in creating personal communication and socializing organizational policies, so they are easy to understand.

The analysis of this study indicates that the data from 2019–2021 compositely show that remuneration has a positive but not significant relationship to employee satisfaction with co-workers. This is evidenced by the significance value or Sig. (2-tailed) of 0.160 > from 0.05 or 0.01. However, compared to other satisfaction components, satisfaction based on co-workers from year to year is always the highest. This is also in line with the results of the Safety Culture Survey conducted yearly at RSUD Dr. Soetomo. The 2021 Safety Culture Survey results report shows that cooperation in work units is the highest indicator, with 3.36 points.

The analysis shows that job satisfaction has a positive and significant relationship to performance, especially job satisfaction based on Pay and supervision. This is evidenced by the significance value or Sig. (2-tailed) of 0.009 and 0.000 > of 0.05 or 0.01. However, there is also a positive and insignificant relationship related to job satisfaction based on the Job itself, Promotion, and co-workers. This is evidence that job satisfaction is related to employee performance. The results of this study are consistent with research that states that job satisfaction will improve performance because, with job satisfaction, employees will further increase their loyalty and work productivity to get maximum work results.³³ Optimal performance will be able to enhance the performance of an organization or agency. However, Fitria stated that job satisfaction is not the only factor that can affect performance.¹³ Partially and together, other factors such as remuneration, motivation, and satisfaction will affect performance.

This study uses secondary data, which has the consequence of data limitations. Furthermore, Dr. Soetomo Hospital has various health workers’ specialties, so the work unit variations vary with different conditions. However, this study provides new analysis on the relationship between remuneration and job satisfaction based on 5 JDI parameters: The Job itself, pay, Promotion, supervision, co-workers, and performance based on employee work targets in all healthcare professions hospital units.

Conclusion

It concludes that the correlation between remuneration and employee satisfaction based on the Job Description Index has a positive and significant relationship, especially on job satisfaction based on pay and supervision. The correlation of remuneration to performance achievement (SKP) has a positive and significant relationship. The correlation of employee satisfaction based on the JDI of performance Achievement (SKP) has a positive and significant relationship. No statistically significant found between job satisfaction based on the Job itself, Promotion, and co-workers.

The theoretical implication of the study brings out that contributing to development of hospital administration related to the relationship of remuneration, employee satisfaction based on the Job Description Index (JDI) and performance based on the achievement of employee performance targets (SKP). The Practical implication of the study directs the hospital management to obtain information as a basis and input in making various policies related to the implementation of remuneration, performance achievement and employee satisfaction.

The suggestions for hospital management should pay more attention to human resource management, especially Promotion. Management needs to coordinate with relevant stakeholders to develop or review regulations that pay more attention to opportunities and fairness of Promotion for hospital employees. Management also needs to maintain a system that is already running well, such as the management of a performance-based remuneration system, internalization of organizational culture and values, and a supervisory system for employees.