Impact of job satisfaction on employee turnover : An empirical study of Autonomous Medical Institutions of Pakistan

e Health sector in the Pakistan is facing many problems to provide the Health facilities to the masses spread over the country. e most challenging problem is the shortage of Doctor’s as compared to the population. Most of the professional Doctor’s prefers to serve in the abroad instead to serve in Pakistan. ere are the many determinants of turnover in the Health Department. e objective of this study is to investigate the factors such as Pay, Promotion, Job Safety and Security, Nature of the Work that e ect the job satisfaction level and that are the cause of turnover of employee’s in the Autonomous Medical Health Institutions in the Pakistan. e factors of job satisfaction are such as Pay, Promotion, Job Safety and Security, Nature of the Work. e sample of the research is consist of 200 doctors, nurses, administrative and accounts sta working in Autonomous Medical Health institutions in the Punjab. Out of total 270 Questionnaires distributed in the Autonomous Medical Institutions of the Punjab 200 were received back and used for analysis. For data analysis/results the SPSS 20.0 is used.


INTRODUCTION
In the organization the Human Resources are the life blood of life. It is di cult for the organization to compete in the current era of competition without the loyal and competent Human Resource. e loyal employees are the most productive and a source for the development of the organization and vice versa. It becomes challenge for the Human Resource Managers to retain the employees for long period and to minimize the turnover in the organization. e high turnover of employees in the organization increases the cost of hiring new workforce and decrease the productively. An organization can gain the competitive advantage due to retaining of quali ed, productive and loyal work force. e turnover is the most focused area by the scholars, academicians, researchers and the human resource managers. e employee retention is also considered the input for improving the nancial performance of the organization (Raikes & Vernier 2004). e outcome of the increased level of turnover in the organization is also in the form of indirect cost like burden on the existing workforce, loss of social capital and low morale. (Des & Shaw 2001). e increasing trend of turnover enhances the cost and reduces the productivity and e ciency of the organization. Hence, it is crucial to study the factors a ecting the turnover in the organizations.
For the opulence of the organization the human resource management becomes a momentous aspect for the organization. ese are the human who are the foundation for the development and achieving the objectives of the organization. In this modern age, human are considered the most precious assets that impact on the performance. (Kabene et al, 2006). In the health sector, doctors are the most valuable assets and prominent role for the achieving the government objective to provide the maximum health facilities to the public. .Like other assets, human assets requires the proper management. Hence without the developed system of human resource, it is di cult to manage and retained the doctors.
ere is the emerging issue in Pakistan is the doctor's strikes against the government in the hospitals that their demands are not ful lled. e young doctor's protests also a ect the patients in the hospitals. Due to the absence of the doctors, 60% clinics and hospitals were shut down and resultantly 500 patients were expired. (Kazmi,2011). Moreover again on 16th April 2012, there was strike in the hospitals and demanded the service structure from the government. As per daily-times newspaper 2 July 2012, there is the service structure for the doctors but is not implemented with letter and spirit which requires improvement according to Masood sheikh. With the proper implementation of the service structure 13000 doctors awaited from the last 16 to 20 years will be promoted in the next grade. Hence, this is the most crucial issue and requires the government attention as the government has to provide the health facilities to the public. e patients are only treated by the doctors and there is no alternative available. (FRANKLIN, 2006). e employee turnover, absentism, is the outcome of the job dissatisfaction. e employee job satisfaction is very vital for the organization to retain the employees for the longer period. e objective of this paper is to nd out the factors like Pay, Promotion, Job Safety and Security, Nature of the Work that e ect the level of job satisfaction. Furthermore the e ect of job satisfaction on turnover of Medical Sector employees from Pakistan to abroad and retaining the employees for the longer period in the Department.

LITERATURE REVIEW
In this section the factors a ecting the turnover in the organization are explained.

Impact of Rewards/pay on Job satisfaction and Employee Turnover
e scholars studied the public sector managers to nd out the determinants of job satisfaction and it was concluded that the job satisfaction level of a employee is signi cantly e ected by the compensation practices in the organization (Sokoya 2000). Opkara (2002) in the study found that there are the certain factors that in uence the level of job satisfaction of the employee. ese are the compensation, promotion opportunities, the work itself, relationships with co-workers and the supervision. e pay was considered the dominant factor in measuring the job satisfaction of employee. Similarly another study was conducted by the Frye (2004) and it was concluded that the compensation is the most critical factor for the organizations to magnetize the right workforce and retain them for the long period of time. In addition to that the compensation is positively correlated with the job satisfaction of a employee in the organization. Another study was also conducted that to found the e ect of pay on the job satisfaction and it was concluded that the there is positive relationship between job satisfaction and pay (Nguyen et al. 2003) It was found that the lower level of compensation is the cause of employee turnover (Abassi and Hollman 2000). e study also concluded that improper recruitment, bad working conditions, less compensation has negative e ect on the employee turnover (Milman 2002). Furthermore the job satisfaction increases with better pay and fringe bene ts and decreases the turnover of the employees (Beilock and Capelle 1990). In the context of Literature Review we Hypothesis: H1: Pay is positively correlated with the job satisfaction. H2: Pay is negatively correlated with the employee turnover.

Impact of Promotion on Job satisfaction and Employee Turnover
e scholars investigated the relationship of jobs satisfaction with demographic determinants as well as the other factors like job autonomy, leadership behavior and promotion system. I was concluded that the factors signi cantly a ect the job satisfaction of employees (Dawson, 1987). Furthermore the Nguyen, Taylor, & Bradley (2003) also found the satisfaction level of employee is a ected with existence of promotion opportunities in the organization.
An organization to retain its workforce for a long period of time has to make investment for the career advancement of Human Resource. (Hall & Moss, 1998;Hsu, Jiang, Klein & Tang, 2003;Steel et al., 2002;Woodru e, 1999). e absence of promotion and training opportunities is the cause for the talented employees to quit the organization. Due to high ratio of turnover the career growth in such organization are decreased. (Shore & Gri eth, 2003;Steel et al., 2002). e organizations require the brilliant workforce to get the competitive advantage and employees want to grow and develop their career. (Prince, 2005). In the light of previous research we hypothesis that: H3: Promotion is positively correlated with the job satisfaction. H4: Promotion is negatively correlated with the employee turnover. Hytter (2008) explained that the work environment is considered in the context of industrial environment like clamor, lifts etc. e attributes of work environment are di erent in the service sector as compared to industrial sector as it deals with the clients (Normann 1986). e working environment is considered the most signi cant factor of job satisfaction. (Spector 2008). e other researcher in their study found that work environment is also a superior predictor of employee job satisfaction in the organization setting (Reiner and Zhao, 1999;Carlan, 2007;Ellickson and Logsdon, 2001;Forsyth and Copes, 1994). Moreover variation exists in terms of pay packages, working conditions, incentives, recognition and fringe bene ts for the employees (Lavy, 2007). In the past studies it was found by the scholars that there are numerous factors are crucial in retaining the workforce. ese are like work life balance, work environment and career opportunities (Cappelli 2000:104). e Literature Review thus supported the hypothesis as under:

Impact of Working Conditions on Job satisfaction and Employee Turnover
It supports the following hypothesis: H5: e working conditions are positively correlated with the job satisfaction. H6: e working conditions are negatively correlated with the employee turnover.

Impact of Nature of work on Job satisfaction and Employee Turnover
e other important determinant of turnover is the nature of work. e focus on it has been ampli ed due to increase in the level of education in the country. Before this much attention was not given on it due to low level of awareness, education. e researchers found in their studies that the work has e ect the turnover intention and satisfaction level of employees in the organization settings. Ting (1997) Locke (1995) found the signi cant relationship of job satisfaction and turnover. Robbins et al. (2003, p. 77) refer to the work itself as "the extent to which the job provides the individual with stimulating tasks, opportunities for learning and personal growth, and the chance to be responsible and accountable for results." e work that related to the aptitude of employees is most fascinated for them. (Robbins,1993). It was found during the study of clerical employees in the banking sector that the turnover intention has negative correlated with nature of work (Koh and Goh 1995). In the Light of above supplement we Hypothesis as under: H7: e Nature of work is positively correlated with the job satisfaction. H8: e Nature of work is negatively correlated with the employee turnover.

Impact of Job satisfaction on Employee Turnover
In the Literature, the turnover topic is studied to nd out the relationship it with job satisfaction. Most of the researchers found the negative association between job satisfaction and turnover. (e.g., Cotton & Tuttle, 1986;Arnold & Feldman, 1982;Bluedorn, 1982;Mobley, 1982;Price, 1977, and many others), e job satisfaction is the critical factor in delivering the quality products/services and s ultimately for the success of the company (Silva 2006). e researchers found that job satisfaction is signi cant towards the turnover and absenteeism. (Koh, and Boo, 2004;Lee and Liu, 2007). Hence the Literature ropes to devise the following Hypothesis Instrument e questionnaire was divided into two sections; the rst section pertained to the questions of independent variables i.e. pay, promotion, job safety and security, working conditions, relationship with supervisor, nature of work mediating variable job satisfaction and dependent variable turnover.
e second section was about the demographic factors like age, designation, education, experience, gender, job relevancy and nature of job. e alpha range was found .901 that is ample. To get the response from the target population the Likert scale was used demonstrating a score of 1 for strongly disagree, 2 for disagree, 3 for undecided, 4 for agree and 5 for strongly agree.

Data analysis procedure
Many scholars are the view that statistical packages are the most reliable instruments to get the precise and inclusive results on the large scale. (Buglear, 2005). Due to reliability and accuracy most of the scholars in their research has used the statistical packages like SPSS. In the current study to nd out the results of data, the SPSS with 20 versions is used. (version 11 was used by Okpara, 2004).

Response rate
In the Autonomous Medical Institution's of the Punjab 250 questionnaires were distributed and 200 were received back. e 80% response was received from the target sample.

Demographics frequency table
e information regarding the demographics are elaborated in the given below table. Source: own calculation e questionnaire consists of mixture of the respondents included in the demographic section. In the sample most of the employee's age range is 25-31 years. ese employees have the less tenure in the service as the minimum age to quality the Public Sector job in Pakistan is 18 years. e satisfaction level in these employees is less as compared to the employees has the more years in the employment. e other brackets of age are also included in the sample. In the Pakistan there is not much trend of female employment in the labour market as in the sample there is majority of male. e major portion in the sample consist of Master Degree holders because the sample consist of doctors, paramedics, accounts and admin sta and most of the them have the master quali cation. In the Public Sector of Pakistan, the compensation paid to the employees range in BPS 7-16 is less as compared the employees of BPS 17 to onward. e employees of BPS 7-16 cover the maximum portion of sample as the turnover ratio of these employees is higher as compared to employees in BPS 17 and above. e intention to leave the job in employee's has less tenure is higher as compared to employee's has more tenure in the Department. e major portion of the sample covers the employees having the tenure of 1-5 years. e maximum employees are recruited on permanent basis in the Health Department; hence the 68.5% in the sample are permanent employees. e job satisfaction is the mediation factor under the reference study and the method of Judd and Kenny (1981) and Baron & Kenny (1986) Table-II.   Table 2 Regression equations of exogenous variables and mediation variable job satisfaction and the endogenous variable employee turnover. To nd out that the job satisfaction is the mediating variable and has its signi cance with the Pay, Promotion, Working conditions, Nature of the Work and the Employee Turnover in the Autonomous Institutions of the Health Department we have performed the regression analysis in the equation 1a, 2a and 3a.
To investigate the e ect of exogenous variables on the mediation variable job satisfaction the regression of equation No. 1a was used and found that the level of job satisfaction is a ected by the Pay, Promotion, Working Conditions, Nature of the Work. Moreover the results of the exogenous variables on the endogenous variable Employee Turnover were also found signi cant as predicted in the equation 2a. At the end in the equation 3a the relationship of Employee Turnover with the mediating variable job satisfaction and exogenous variables was also concluded and found that the job satisfaction is the mediating variable. As the beta of pay is .250 in the equation 1a and decreased in the equation 2a with -.147 and 3a with -0.010. e said equations results stated that the job satisfaction is the mediating variable in such case and the employee with the low level of job satisfaction resulted into the increase in the rate of employee turnover.
We have regressed the Employee Turnover on the independent variables and the mediating variable job satisfaction. e results indicate that the Beta in the equation 2(a) was -.147 and in the equation 1(a) was .250. It predicts that the job satisfaction is the mediating variable in this model.

CONCLUSION AND RECOMMENDATIONS
e said study pertained to the employees of the Autonomous Medical Institutions of Health Department in the Province of Punjab in order to nd out the factor a ecting the job satisfaction level and the impact of job satisfaction on the employee turnover. e ndings suggested that the variables like Pay, Promotion, Working Conditions and Nature of Work are the prominent for the job satisfaction level of the employees. e management of the Autonomous Medical Institutions may take the appropriate steps to enhance the job satisfaction level of employees. Furthermore it is suggested management should take into the account of the factors such as Pay, Promotion, Working Conditions and Nature of Work in order to minimize the turnover level of the employees in the Autonomous Medical Institutions.

Limitation and future directions of the study
We have conducted the research by taking the variables Pay, Promotion, Working Conditions and Nature of Work in this study. In order to more general results, the other factors may also be included in the future research. e sample size was also limited that can also be increased to nd out other determinants. A comparative study of public and private hospitals may also be conducted to nd out the di erences in both sectors.