Relation between Agile Healthcare Organization and Nursing Staff’s Job Enrichment

Background: Agile health care organization is proactive and purposeful answer to erratic and continuous alterations in the environment, which enables hospitals to continue and devolved in competitive market. So, managers of healthcare organizations required to be significantly more agile, flexible and provide the highest level of patient and nursing staff needs, expectations, and demands. Agile health care organization plays a mediating role to promote professional growth and achievement of goals transition into advanced practice, and job enrichment for nursing staff. Aim: To assess the relation between agile healthcare organization and job enrichment of nursing staff. Design: Descriptive correlational research design. Setting: Tanta University International Teaching Hospital .Sampling: All (n=41) head nurses and a stratified proportional random sample (n=286) of nursing staff. Tools: Tool I: agile healthcare organization questionnaire. Tool II: job enrichment questionnaire. Results: Nursing staff 56.3% showed high level of overall agile healthcare organization. Also 63.6% of nursing staff showed high level of overall job enrichment. A highly strong statistical significant correlation between levels of overall agile healthcare organization and nursing staff job enrichment at r=0.533 (p<0.001). Conclusion: There was a strong statistical significant correlation between overall agile healthcare organization and nursing staff job enrichment. Recommendation: Nursing administration required to provide periodical in-service training programs to sustain nursing staff idea of remaining adaptable and agile in the current competitive environment.


Introduction
Changing of patients diseases pattern, new discoveries for treatment and new technology make nursing staff continually adjust to changes in order to keep their organization agile in a highly competitive environment (Akkaya&Tabak,2020).Whil e healthcare organizations required to meet the demands, expectations, and wishes of both patients and nursing staff to achieve the highest possible standard.As well as it required for operating successfully in today's continuously evolving and expanding global business environment.
Yet, an agile healthcare organization is the weighted conscious answer to unpredictable changes In addition to continue to grow and develop in a competitive environment.An agile healthcare organization required to have a several of general features.For examples features of cooperative systems, employee empowerment, flexible approaches, modern technology, customer orientation, ongoing learning, creativity, and innovation (Cai, Liu, Huang, and Liang, 2019).The agile healthcare organization creates for nursing staff workplace culture that increasing their involvement in decisionmaking and avoiding collisions.Three important elements are needed for healthcare organization to be agile, one including agile sensing, agile decisionmaking, and agile acting.
Agile sensing is the strategic surveillance of environmental events that can impact competitive work, organizational strategy, and the performance of nursing staff in the future.The agile sensing include activities such as accessing information related to the events that reveal environmental change, and omitting of trivial information (Shakhour, 2021).
Agile decision-making is the ability to collect, accumulates, restructure, and evaluate relevant information according to a variety of sources.It aims to explain the implications of the healthcare organization without delay and identify opportunities and threats based on the interpretation of events (Şahin, & Alp, 2020).Agile acting is a set of activities for reassembling organizational resources and modifying working processes on the basis of decision-making principles in order to address the change that occurs in the surrounding environment (Sahu, et al., 2023).When agility is applied to healthcare organizations by effective leaders, it will be able to resist the rising competition effectively and enhance nursing staff professional practice and job enrichment (Rahnema, & van Durme, 2021).The term "job enrichment" refers to the gradation of jobs that builds the opportunity for nursing staff to become familiar with the feelings of responsibility, self-governance, the job itself, achievement, development, Task significance refers to how important the task is to the overall efforts of the organization or to the world at large.If nursing staff can see that the task significance is very high, it will serve as a driving force and motivational tool for them to increase and exert more effort on their jobs (Sundari & Narayanamma, 2021).
The autonomy is described as the degree of liberty, freedom, independence, impartiality, objectivity, and administrative ability in accomplishing the task given to them.Finally, feedback is a unique and very important aspect of career development which entails a regular review of the performance of nursing staff in the organization.It doesn't stop there but goes further to communicate back to them (Mohd Zin, Ibrahim, Aman-Ullah, and Ibrahim, 2023).

Significance of the study
In recent years, nursing academics and practitioners have turned to agile organization as a new management technique.It aids them in maintaining organizational survival and sustainability in the face of the world's competitiveness and unpredictability, which subsequently enables nursing staff to practice, enrich their job, and fulfills patient outcomes.While job enrichment is a way to increase nursing staff, performance, enhance their job satisfaction, and bestow a sense of responsibility.As well as lead to motivate them by giving the opportunity to use their capabilities and improve their capacities.Therefore, the current study aims to assess the relation between agile healthcare organization and nursing staff job enrichment at Tanta University International Hospital.

Aim of the Study
Assess the relation between agile healthcare organization and job enrichment of nursing staff.

Research question
What is the relation between agile healthcare organization and job enrichment of nursing staff?

Subjects and Method Study design:-A descriptive correlational research design
Setting:-The present study was conducted at Tanta University International Teaching Hospital, which is affiliated to Ministry of Higher Education and Scientific Research.Tanta University International Teaching Hospital.The hospital total bed capacity was 465 beds distributing in 14 departments Subject:-All head nurses (n=41) and a stratified proportional randomized sample (n=286) from total number 1104 of nursing staff.

Tools of data collection
To achieve the aim of the study, the data and collected using two tools: -Low level of job enrichment < 60 %.

Methods
1-An official permission was obtained from the Dean of Faculty of Nursing and the authoritative personnel of Tanta University International Teaching Hospital.

2-Ethical and legal considerations
a.An approval was obtained from the nursing Scientific Research Ethical Committee before conducting the study with a code number (188-1-2023).b.Nature of the study didn't cause harm to the entire participants c.Informed consent was obtained from nursing staff after explanation of the study aim.d.Confidentiality and privacy was maintained regarding data collection and participants had right to withdrawal from the study at any time.3-Tools I and II were developed by the researcher and translated to Arabic that presented to a jury of five experts in the area of specialty to check content validity of its items.

4-
The experts' responses were presented in four points rating scale ranging from (4-1): 4=strongly relevant, 3=relevant, 2=little relevant and 1=not relevant.Necessary modifications were done.The face validity value of tool (I) part 2 that entailed nursing staff assessment of agile healthcare organization was 99.2 % and for tool (II) 99.3 %.That named nursing staff' job enrichment.5-A pilot study was carried out on 10% of subject (n=33) after the development of the tools.The subjects of pilot study were excluded from the main study sample.6-Reliability of tools was tested using Cronbach Alpha Coefficient test.The reliability value of tool (I) nursing staff assessment of agile healthcare organization was 0.934 and for tool (II) 0.879 nursing staff' Job enrichment.7-Data collection phase: The data were collected from nursing staff by the researcher using tool (I) and tool (II).8-The appropriate time for data collection varied according to the type of work and workload for each department.The estimated time needed to complete the questionnaire items from the nursing staff was between 15-20 minutes.The data was collected over a period of five months, starting from April 2023 until the end of August 2023.

Statistical analysis of data
The collected data were organized, tabulated and statistically analyzed using SPSS software statistical computer package version 20. (Armonk, NY: IBM Crop).

Results
Table (

Figure (1):
Nursing staff overall levels for their agile healthcare organization Highlights nursing staff overall levels for their agile healthcare organization.More than half of nursing staff showed high level of overall agile healthcare organization.While about one third of them showed moderate level and less than one quarter showed low level.Levels of nursing staff dimensions about their job enrichment.Nursing staff 71.3% and 62.4% showed high level in tasks significance and, tasks identity dimensions respectively .While, 59.3% and 57.8% of nursing staff showed high level of skill variety and feedback dimensions of job enrichment respectively.But 43.1% and 24.2% of nursing staff showed moderate and low levels of autonomy dimensions respectively.

Table (4): Relation between nursing staff overall levels of their agile healthcare organization and their personal data.
Relation between nursing staff overall levels of agile healthcare organization and their personal data.There wasn't statistically significance relation between overall levels of nursing staff responses of their agile healthcare organization and their personal data.Except for their position at  2 =9.210 ,( p= 0.010 ).Table (5): Relation between nursing staff overall levels of their job enrichment and personal data.Relation between nursing staff overall levels of job enrichment and personal data.There was statistically significance relation between overall levels of their job enrichment and personal data regarding their age at  2 2=12.965,(MCp= 0.010) , their position at  2 2 =6.768,( p= 0.034) and for their years of experience at  2 2 =12.844, (MCp = 0.033) .

Figure (3):Correlation between nursing staff levels of agile healthcare organization and job enrichment.
Represent correlation between nursing staff levels of agile healthcare organization and levels of their job enrichment.There is a strong statistical significant correlation between levels of overall nursing staff agile healthcare organization and their job enrichment at r=0.533 (p<0.001).

Figure (3):Correlation between nursing staff levels of agile healthcare organization and job enrichment (n=327) Discussion
Today, for retaining and maintain sustainability and competitive challenges, it is require to manage and continuous direct healthcare Organizations to remain in agile form (Gaikwad and Sunnapwar, 2020) (Anvari, 2021).Being agile is a vital for ensuring better performance in environmental issues; ensure high level of patient satisfactions and corporate goals of healthcare organizations (Shojaei, 2020).Additionally, agile management promotes concept of continuous improvement and efforts to systematically identify any changes and developments in healthcare organizations (Lou, Mao, and Zhang, 2022) and (Chavez, Sadiq Jajja, Lecuna, and Fynes, 2020).Agile healthcare organizations are those that can identify and adapt quickly to changing circumstances in their environment.It has elements that differentiate it from a traditional health organization.The agile health organization balances different forms of organizational structure but favours the decentralize connected and multidisciplinary forms.So it fights the inertia of bureaucracy with a culture of creativity, teamwork and autonomy.Nursing staff represent the healthcare team work who have an enormous impact on how well healthcare services are given.Job enrichment is one strategy to improve nursing staff performance and providing them opportunities for their personal accomplishment and growth.As well as, increase their productivity and satisfaction.Job enrichment is a design of job that increases the volume of nurses autonomy, control, skill varieties and responsibility which invariably helps to reduce rigidity, tediousness, lack of creativity and nurses` dissatisfaction.Apparently, agile healthcare organization and nursing staff job enrichment have become important firm competencies that can have profound impacts on satisfaction of patient and nursing staff performance, and should be implemented as management criterions in hospital units.The current study aimed to assess the relation between agile healthcare organization form and nursing staff job enrichment.

Agile organization
Agile healthcare organization as a system has been further emphasized by the senseresponse process (agile sensing is linked with scanning for new information, the response is linked to decision making that deals with information interpretations and agile acting deals with deploying a plan to act) that views the three strategic tasks as being the central nervous system of the organization as conceptualized by Park (2019).Proactively agile organizations predict and detect the emerging trends within the healthcare environment in a timely manner to gain the maximum benefit.Moreover, the agile organization concept within this study will be conceptualized based on its dimensions.The present study revealed that more than half of nursing staff reported high overall agile level of their healthcare organization.Most properly, this due to recently healthcare organizations adapted with the current digital age and increasing the demand for technological adjustment such as electronic health record system.Yet it converted to use new devices in dealing with the patients, adjusted and start to apply agility principles to have quickly changing requirements.As well as incorporate feedback from patients, nursing staff and other stakeholders.Really, the managers increased their operational competitive capabilities at the highest level to maximize their healthcare organization performance.Actually the successful healthcare organizations with high sensing capability can reconfigure its resources and mobilize them toward the detected organization opportunities.While if the organization cannot sense healthcare opportunities will be missed, resources will be unexploited, and consequently, the response capability will not be activated.So the agile healthcare organizations expected to establish numerous communication channels within the internal and external healthcare environment in order to collect the right strategic information about the competitor and the customers including patients in a timely manner.As well as started to adopt disruptive technologies such as blockchain to accomplish data efficiency; data access flexibility, interconnection, transparency, security, and more.Such innovative technologies can maximize the sensing ability of their healthcare organizations, since sensing is considered as its system input.Nagib,et al .,(2022)study organizational agility the pathway to career aspirations among staff nurses at selected hospitals.Support the present study, and found high level of organizational agility this outcome could be explained by the Cairo hospital management's efforts to remain adaptable, respond quickly and wisely to predictable and unforeseen changes, especially when dealing with the COVID-19 pandemic, and quickly adjust to environmental demands, such as making changes to the current work practices and processes that were felt and understood by nurses.OKTAY, (2020) investigate organizational agility perceptions of business people in a low-income province and support the present result of study.The findings show that for an organization to be agile, its top management must be adaptable and proactive in taking the required safeguards against unforeseen opportunities and threats.Experienced managers also play a crucial role in an organizational agility.Also consider the fact that organizations with higher numbers of employees may be managed by more professional and experienced managers than organizations with fewer employees, as a result of research it can be said that organizations with a higher number of employees are perceived as more agile.Elsayed, and Abdel-Ghani, (2020) study about learning organization and its influence on organization resilience and creativity in Mansoura Oncology Centre.The research findings revealed that organization agility level was high.This might be the result of the hospital maintaining its integrity, effectively coming up with different solutions based on the circumstances, and developing substitutes in order to take advantage of unfavourable circumstances.Conversely, Hussein.,etal ( 2022) study about organizational agility the pathway to job enrichment among nurses, not support current study.The overall level of nurses' perception was moderate, this may be interpreted by efforts of the hospital management to maintain flexible and to react promptly and wisely against predictable and unpredictable changes, especially when dealing with the COVID-19 pandemic.Also due to the quickly adjust to environmental demands, such as making modifications to the existing work practices and processes according to what felt and understood by nurses.

Job enrichment
Job enrichment in present study is a work redesign strategy that aims at increasing the motivation potential of jobs, mainly through making jobs more interesting.It has equally been seen to be an approach for enhancing nursing staff job satisfaction.It have ability to meet nursing staff psychological and social needs leading to enhanced their productivity ,reduced their absenteeism, and reduced their supervisor conflicts.The purpose of job enrichment is to fulfill the demands of nursing staff by providing them with the chance to utilize their competencies (skills, knowledge, and range of abilities) in order to meet organizational goals.It has five dimensions of jobs are skill variety, task identity, task significance, autonomy, and feedback.The present study revealed that more than half of nursing staff reported high level of overall job enrichment, high level of skill variety, tasks identity and task significance dimensions.
Most properly, from the researcher point of view this may be due to nurses perceived that hospital management continuously gives the nursing staff the chance to do challenging task.Also offers more autonomy and freedom in executing the related responsibility.As well as in choosing the way to perform the work and adds variety and challenge to nursing staff daily routine.Beside that the hospital management set training programs for developing nursing staff skills and abilities.Additionally, frequent updating to nursing staff knowledge and skills which lead to enhance and induce motivation and enrichment to them.AGHEDO, (2023) Study about job enrichment and organizational efficiency, a study of Niger flour mills calabar, Nigeria, a descriptive research, Support the current study and indicated high level of nursing staff enrichment and favorable correlation between job enrichment in terms of nursing staff autonomy and career growth and organizational efficiency.This clearly supports the concepts that job enrichment contributes to job satisfaction and nursing staff engagement and resulting in organizational efficiency.The study recommended that nursing staff should be given considerable level of autonomy in areas such as decision making, responsibilities and control in order to contribute to organizational efficiency.Also, Ozigbo, & Daniel, (2020) study the effects of job enrichment on employee performance, it study the non-teaching staff of University of Abuja, FCT, and reported high level of enrichment.When nursing staff jobs are enriched, their job dissatisfaction and lower commitment tends to disappear.As well as reported a significant positive relationship exists between job depth, job training dimension of the job enrichment and organizational performance.While suggested that employees should be given more tasks acknowledged in order to strengthen their dedication to their institutions goals and objectives.On the other hand, Hussein , et al (2022) Study about organizational agility: The Pathway to Job Enrichment among Nurses, found that more than half of nurses reported that job enrichment level was moderate.At the same time about quarter of nurses reported that job enrichment level was high because their hospital management always give them high autonomy, and to support their initiative to provide high-quality work and job excellence.This was done by enhancing the work environment and enrich their job with needed resources to create opportunities for skill development.But, Siddiqui, & Bisaria, (2020) study employee job satisfaction-correlate of job enrichment: An empirical overview concluded that less than half of nurses had moderate job enrichment and Asl, et al., (2019) examining the relationship between job enrichment and performance stated that total level of job enrichment was low as reported by less than two thirds of studied nurses

Relations and correlations
The study result showed that there was no statistically significant relation between overall levels of nursing staff responses of their agile healthcare organization and their personal data.Except for their work position, this may be attributed to that the agile healthcare organization is more influenced by knowledge, skills, motivation, capabilities of the nursing staff to respond rabidly to organizational technologies, changes and uncertainties.This finding confirmed by Kamal, (2022).Who conducted study about organizational agility and teamwork as perceived by nursing staff found that participants' perceptions of organizational agility did not differ significantly by their personal data.And also, supported by Oktay, (2020) study to investigate organizational agility perceptions; revealed that the perception levels of people regarding organizational agility and the subdimensions that form the scale did not differ significantly except in favor of age.While Hussein , et al (2022) state there was a positive highly statistical significant correlation between total job enrichment as reported by nurses and their age, years of experience and education qualification.Current study results represent there was strong statistical significance correlations between agile healthcare organization and job enrichment.Apparently the present hospital appear acting as an agile healthcare organization having enriched nursing staff who are enthusiastic, active, committed and motivated to enhance and complete their role effectively and accomplish their tasks completely.Again Hussein , et al (2022) support the current study and stat there was a highly statistically significant correlation between total scores of healthcare organizational agility and total job enrichment scores Conclusion Nursing staff of present study reported that Tanta University International Teaching Hospital had high overall level as an agile healthcare organization.More than half of nursing staff represented high level for its agile sensing and agile acting dimensions.Also, they showed high level of overall job enrichment, especially task significance, task identity, skill Varity and feedback dimensions.Highly Sahu, A.K., Sahu, N.K., Antony, J. and Tortorella, G.L. (2023)."Decisionmaking framework for supplier selection using an integrated MCDM approach in a lean-agile-resilient-green environment: Evidence from Indian automotive sector", The TQM Journal,35 (4)

1): Nursing staff personal characteristic. Illustrates
had less than ten years of experience with mean score 11.45 ± 8.77.Nursing staff 50.8% worked in departments, and 49.2% worked in Intensive Care Units (ICUs).

.,Nafei (2019). The
role of organizational agility in reinforcing job engagement .International Business Research.