1. Introduction

The specific nature of healthcare quality presents an ongoing challenge in finding solutions that encourage continuous improvement in all aspects of organizational functioning that can contribute to enhancing patient well-being. Undoubtedly, the most crucial element in this extremely complex web of causes and relationships is healthcare workers. This literature review analyzes this issue from the perspective of the role that management professionalism plays in stimulating healthcare worker satisfaction in the United States.

The Crucible of Job Satisfaction and Occupational Stress

Job satisfaction forms the foundation of healthcare workers' professional journey, exerting an influence that extends far beyond their personal well-being. High levels of job satisfaction correlate with better patient outcomes, reduced intentions to leave work, and increased organizational commitment. Conversely, low job satisfaction often leads to a range of negative consequences, including higher turnover rates, deterioration in quality of care, and intensifying occupational stress. [1][2].

The demands and emotional strain inherent in healthcare roles forge a breeding ground for occupational stress. Excessive workloads, lack of support, and scarce resources coalesce into a potent force that tests the resilience of even the most dedicated HCWs. Research has illuminated the pervasive nature of burnout among nurses, a consequence of high job demands and inadequate support, which ultimately erodes mental health and impairs job performance[3][4].

The Sanctuary of Organizational Support and Work Environment

Perceived organizational support (POS) emerges as a beacon of hope, shaping HCWs' job satisfaction and retention. POS encapsulates employees' perceptions of how deeply the organization values their contributions and prioritizes their well-being. Supportive work environments that foster recognition, fair compensation, and opportunities for professional development significantly enhance job satisfaction and curtail turnover intentions [5][6].

Effective leadership weaves the threads of a supportive work environment, elevating HCWs' engagement and job satisfaction. Transformational leadership, which champions employee development, motivation, and engagement, has proven its mettle in elevating job satisfaction, bolstering patient safety, and mitigating adverse events. Leaders who embody transformational behaviors ignite the interests of their employees, cultivate acceptance of organizational goals, and forge collaborative efforts [7][8].

The ability of HCWs to voice their concerns resonates as a critical element in maintaining a healthy work environment and safeguarding patient safety. However, many HCWs, particularly doctors, often find themselves muted by fears of professional repercussions and a lack of trust in the system's capacity to address their concerns. Environments that foster open communication and provide avenues for voicing concerns can amplify employee engagement, job satisfaction, and organizational commitment[9][10][11].

The COVID-19 Pandemic: A Catalyst for Change

The COVID-19 pandemic put healthcare organizations' management professionalism to the test and exposed problems that were often hidden or marginalized. Increased workload, heightened job safety risks (primarily virus infection), and moral dilemmas contributed to rising stress levels and negatively impacted the mental health of a significant portion of healthcare workers. These issues were not only publicized in the media but also became the subject of in-depth scientific studies. These studies documented the impact of organizational leaders' attitudes and engagement, work overload, and exposure to infection, which led to an escalation of burnout and, consequently, increased employee turnover.[12][13].

The pandemic highlighted the importance of resilience and stress-coping mechanisms, as well as the fundamental role of leaders in guaranteeing stability and building a sense of security.

Work-life balance (WLB) is a key element of healthcare workers' well-being, enhancing job satisfaction and overall quality of life. Achieving harmony between professional and personal spheres acts as the most effective remedy for stress. During the COVID-19 pandemic, the shift to remote work leading to blurred boundaries between work and home life created additional challenges in maintaining work-life balance. Studies have shown the profound impact of WLB on employee satisfaction, motivation, and likelihood of changing jobs.[14].

Conclusion

Human resource management practices weave an intricate web, influencing employees’ well-being, trust, and job satisfaction. Effective HRM practices, such as trainings and professional development programs, empowerment, and innovative performance appraisals, cast a positive impact on HCWs' satisfaction. Integrating HRM with Lean Management and Six Sigma (LM&SS) can catalyze performance enhancement and elevate employee well-being, although separating these approaches may offer more flexibility and yield better outcomes for healthcare organizations[15][16].

The well-being and performance of HCWs in the United States are intrinsically linked to a constellation of interconnected factors, including job satisfaction, occupational stress, organizational support, leadership, employee voice, the impact of COVID-19, work-life balance, and HRM practices. Addressing these factors through comprehensive organizational strategies, supportive leadership, and effective HRM practices can profoundly elevate HCWs' job satisfaction, mitigate burnout, and ultimately, enhance patient care outcomes. As the healthcare landscape continues to evolve, future research must remain resolute in exploring these dimensions, paving the way for more effective interventions and support systems that empower and uplift HCWs[17].

2. Materials and Methods

This study employed a mixed methods research approach, integrating qualitative and quantitative elements to provide a comprehensive analysis. The triangulation of data involved combining qualitative content analysis with quantitative data examination to achieve a fuller understanding. Additionally, the multi-faceted analysis leveraged diverse analytical methods, enabling more versatile and multidimensional results.

Sample

The data for this study was derived from GlassDoor, a globally renowned platform for employee reviews. The reviews considered were published between January 2023 and April 2024. The exclusive reliance on Glassdoor for data collection is acknowledged as a limitation that could introduce bias or distortions due to the platform's user base and review dynamics. To mitigate this, the study applied a mixed-methods approach, combining qualitative and quantitative analyses to enhance the robustness of findings.

To estimate the sample size for the analyzed population of employees working in hospitals located in the United States, data was obtained from the Statista.com database. The information revealed that as of January 2024, the employment level in hospitals had reached 7.467 million employees [18]. To calculate the sample size required for a population of 7,467,000 with a confidence level of 99.9%, a margin of error of 2% (0.02), and a proportion of success of 0.5, the formula for sample size calculation in an infinite population was used. Since the population was large, the finite population correction was not implemented [19].

The expected sample size is approximately 6,778 to achieve the desired confidence level and margin of error.

The method used for this calculation is based on determining the sample size required to estimate a proportion with a specified level of precision (margin of error) and confidence. In this case, we want to ensure that our estimate of a proportion is within 2% of the true value with 99.9% confidence. This method is applicable for large populations where the finite population correction does not significantly alter the sample size.

The calculated sample size is crucial for ensuring the reliability and credibility of research results, and consequently, the cognitive value of conclusions drawn from it.

As a result of the conducted research, a thorough analysis of 6,900 employee opinions was carried out, which guaranteed the reliability of the research process. Detailed results of the analysis, including the distribution of job positions and overall ratings, are presented in the attached charts. Due to limitations on the length of the scientific article, it was decided to present only general data, leaving a detailed analysis of individual elements for presentation in subsequent publications dedicated to this issue.

Data Collection Process

The data collection process was conducted by trained students from the College of Business Administration (COBA) at the American University in the Emirates (AUE). The research team leader was directly responsible for meticulous monitoring. Students underwent thorough training to ensure uniformity of assessment and consistency of collected information.

The research team conducted a detailed qualitative analysis of each opinion. The main goal was to identify and classify aspects mentioned in the opinions into previously defined problem areas.

Problem areas were determined based on pilot studies and analysis of secondary sources. They included factors such as work environment, management professionalism, employee benefits, and development opportunities.

Students received ongoing support and the opportunity for consultation in case of encountering ambiguous indications.

Consistency checks were regularly conducted to verify the accuracy of classified data.

The calculated sample size is crucial for ensuring the reliability and validity of research findings.

As a result of the conducted research, it was possible to analyze 6,900 employee reviews, which allows to assume the accuracy of the research process in this regard. The number of reviews analyzed is a result of the cumulative individual targets set for each team member. The detailed outcomes of the analysis, including the distribution of job positions and overall ratings, are presented in the accompanying charts.

Scientific Value of Data

To obtain the highest quality data, rigorous data collection methods were applied, which were briefly described in the earlier part of the chapter. Focusing on qualitative analysis allowed for understanding the subtle nuances of employee experiences and issues raised by them, while statistical analysis provided a clear overview of the distribution of opinions across various occupational groups and satisfaction levels.

The applied approach, combining qualitative and quantitative methods, ensured a solid and in-depth understanding of the data, providing valuable insights into the studied issues. Detailed breakdowns and specific results can be found in the attached charts.

3. Results

The chart 1 presents the distribution of various categories related to healthcare professionals. Nurses make up the largest group, accounting for 31.3% of the total. Following them, Administrators represent 7.1%, while Management professionals comprise 6.6%. Other notable groups include Researchers and Scientists (5.5%), IT specialists (5.2%), and anonymous entries also at 5.5%. Smaller categories include roles such as PCT (Patient Care Technician), PTA: (Physical Therapist Assistant), CNA (Certified Nursing Assistant), CMA (Certified Medical Assistant) (4.6%), Radiology (3.6%), Therapists (2.7%), and Physicians (2.7%). The chart also includes a category labeled "Other," which represents 19.6% of the total, indicating a diverse range of additional roles. Lastly, Patient Access and Security roles are the smallest groups, making up 2.3% and 1.7%, respectively.

                                                Chart 1. Distribution of various categories related to healthcare professional

                                           Source: created by authors.

                                          Chart 2. Distribution of ratings across a five-star GlassDoor scale

                                          Source: created by authors.

The chart 2 illustrates the distribution of ratings across a five-star scale. The highest proportion of responses falls into the 5-star category, with 37.8% of respondents giving the top rating. Following closely, 31.2% of participants rated their experience with 4 stars. A significant portion, 19.7%, gave a 3-star rating, indicating a more neutral or average experience. Lower ratings were less common, with 6.4% of respondents giving 2 stars and only 4.9% giving the lowest rating of 1 star. This distribution suggests that a majority of respondents had a positive experience, while a smaller fraction reported dissatisfaction.

                                                Chart 3. Factors that positively influence employee satisfaction in hospital environments

                                                Source: created by authors.

The chart 3 The delineates factors that positively influence employee satisfaction in hospital environments, stratified by the institution's overall rating from 1 star (lowest) to 5 stars (highest). These positive factors encompass: Financial Compensation, Workplace Culture, Career Growth, Additional Perks, Life Balance, and Leadership.

1-star and 2-star hospitals: In the lowest-rated institutions, Financial Compensation and Leadership emerge as the most salient factors affecting satisfaction, with approximately 40-45% of employees identifying these aspects as crucial. This suggests that adequate remuneration and effective leadership are primary sources of satisfaction in lower-quality hospitals. Workplace Culture and Life Balance demonstrate less significance, fluctuating around 20-25%.

3-star hospitals: In moderately-rated hospitals, the impact of positive factors becomes more evenly distributed. Career Growth and Additional Perks gain prominence, reaching levels of approximately 30-35%. Financial Compensation and Leadership remain significant factors, albeit with a slight decrease in influence compared to lower-rated hospitals.

4-star and 5-star hospitals: Higher-rated hospitals exhibit a more balanced distribution across all factors. Workplace Culture and Life Balance increase in importance, attaining levels of approximately 30-35%. Financial Compensation and Leadership maintain similar levels of influence as observed in 3-star hospitals. Career Growth and Additional Perks also remain significant factors, though their impact is marginally reduced compared to 3-star institutions.

In conclusion, the chart demonstrates that as hospital ratings improve, the influence of individual factors on employee satisfaction becomes more equilibrated. In the highest-rated hospitals, all factors exhibit comparable levels of impact on employee satisfaction, suggesting a comprehensive approach to human resource management in these institutions.

                                                Chart 4. Factors that negatively impact employee satisfaction in hospital environments

                                                Source: created by authors.

The chart 4 illustrates factors that negatively impact employee satisfaction in a hospital setting, broken down by the hospital's overall rating from 1 star (lowest) to 5 stars (highest). These negative factors include: Low Pay, Management Flaws, Operational Stress, Career Limits, Work Stress, and Turnover.

1-star and 2-star hospitals: In the lowest-rated hospitals, Low Pay and Management Flaws are the most significant issues, with about 50-60% of employees citing these as major problems. This suggests that poor compensation and ineffective management are the primary sources of dissatisfaction in lower-quality hospitals.

3-star hospitals: In average-rated hospitals, the impact of negative factors becomes more evenly distributed. Operational Stress and Work Stress gain prominence, while Low Pay and Management Flaws decrease slightly but remain significant issues.

4-star and 5-star hospitals: In higher-rated hospitals, the overall impact of negative factors decreases substantially. However, Career Limits, Work Stress, and Turnover become relatively more prominent issues. This suggests that even in well-rated hospitals, employees still face challenges related to career growth, work-related stress, and job retention.

Analysis of the data leads to several significant conclusions that illuminate the specifics of employee satisfaction in US hospitals. The first aspect is, of course, compensation, which is generally the primary motivation for undertaking professional responsibilities. Interestingly, however, the impact of compensation on employee satisfaction is inversely correlated with the overall rating of the hospital as an employer. In the case of top-rated hospitals, satisfaction is based more on non-material motivational instruments than in lower-rated hospitals, although adequate compensation always remains important. Stimulating satisfaction through material mechanisms is decidedly more challenging but simultaneously more effective and usually more efficient and significantly less expensive, particularly over a longer time horizon. What, then, do hospital employees expect to feel satisfied?

Leadership quality and management effectiveness emerge as priority factors. Highly-rated hospitals are characterized by strong leadership, which positively influences employee morale and engagement. Unfortunately, in lower-rated facilities, the lack of such support leads to frustration and dissatisfaction, particularly in cases where employees must meet especially challenging demands.

Another crucial factor is work-life balance. Employees highly value the ability to balance professional obligations with personal life. High levels of operational stress, particularly noticeable in lower-rated facilities, negatively impact staff well-being and, consequently, satisfaction.

It is also worth noting the developmental potential concerning employees' professional competencies. In low and medium-rated hospitals, this issue seems less significant, but in the highest-rated facilities, it clearly gains importance.

Organizational culture is another aspect that significantly influences satisfaction. Hospitals providing a friendly work environment that promotes collaboration and respect attract satisfied employees. On the other hand, additional benefits are appreciated, but their role appears to be more supplementary than decisive.

Finally, it is worth noting the problem of high employee turnover. This factor remains a challenge even for the best hospitals, underscoring the complexity of maintaining a stable team in such a demanding work environment.

The presented analysis emphasizes the multifaceted nature of employee satisfaction in the healthcare sector and indicates the continually changing priorities of personnel management in hospitals. This unequivocally implies the necessity for further research regarding the identification of causal relationships between factors determining employee satisfaction and overall hospital performance.

4. Discussion

The discussion focuses on key factors identified as influencing healthcare worker satisfaction. By organizing the analysis around these specific elements, the discussion aims to provide a clear and focused understanding of the various aspects that contribute to or affect employee satisfaction in US hospitals. This approach not only facilitates a more comprehensive examination but also ensures high applicability of the insights gained in addressing the needs and challenges faced by hospitals.

The obtained results can be analyzed from two perspectives. On one hand, they provide a deeper understanding of the critical factors influencing employee satisfaction. On the other hand, they highlight where the root causes of issues that impact work efficiency and employee engagement should be sought. Although the topic of employee satisfaction is frequently analyzed and considered from various angles, the rapidly evolving social changes, driven by both demographic and technological factors, necessitate ongoing monitoring of this vital issue.

In the context of healthcare services, employee satisfaction takes on an even greater significance, as it directly affects the ability to deliver services to patients and their families, who represent a particularly vulnerable group of clients. This connection underscores the importance of maintaining a satisfied and motivated workforce to ensure the highest standards of care and support are consistently met. Continuous assessment and adaptation to the changing landscape are essential to address emerging challenges and sustain the overall effectiveness of the healthcare system.

Leadership:

Leadership demonstrates the most significant increase in mentions from 1-star to 5-star hospitals. Effective leadership is paramount for high employee satisfaction, as it fosters a supportive and empowering work environment, enhances open communication, and provides clear direction and purpose. Numerous studies have consistently shown that good leadership practices significantly boost employee morale, engagement, and overall job satisfaction[20][21][22]. For example, transformational leadership, which involves inspiring and motivating employees through a shared vision, has been linked to higher levels of job satisfaction, organizational commitment, and reduced turnover intentions. Leaders who engage in transparent and two way communication, provide constructive and timely feedback, and recognize employee achievements and contributions create a positive, collaborative work culture that promotes job satisfaction, personal growth, and a sense of belonging. When employees feel valued, supported, and empowered by their leaders, they are more likely to be fulfilled, committed, and satisfied in their roles, ultimately benefiting the organization as a whole.[23]

Workplace Culture:

Workplace culture also sees a steady increase in mentions, indicating that a positive, inclusive, and supportive work environment is vital for employee satisfaction. A strong workplace culture that values diversity, equity, and inclusion can enhance employee engagement and retention. Organizations that cultivate a culture of trust, respect, and collaboration are more likely to see higher levels of employee satisfaction. Research indicates that employees who perceive their workplace culture as inclusive and supportive are more committed to their organizations and exhibit lower turnover intentions [5][24][25].

Career Growth:

Opportunities for career advancement show a significant rise in mentions with higher ratings. Employees value clear career paths and opportunities for professional development, which contribute to higher job satisfaction and motivation. Providing employees with training, mentorship programs, and clear advancement opportunities not only boosts their job satisfaction but also enhances their loyalty to the organization. Career development initiatives that align with employees' personal and professional goals foster a sense of purpose and motivation[26][27][28].

In this context, it is particularly noteworthy to consider the findings from a comprehensive study conducted by Work Institute in 2021. The analysis, which examined 22,000 exit interviews, unequivocally demonstrates that for healthcare professionals, the most significant impetus for changing employers is the desire for career advancement and professional development [29].

Financial Compensation and Additional Perks:

While financial compensation is an important factor, its increase in mentions is less dynamic compared to non-material factors like leadership and culture. Competitive pay is necessary but not sufficient on its own to achieve high employee satisfaction. Although adequate compensation is essential for attracting and retaining talent, it is the non-material factors that often play a more significant role in long-term job satisfaction. Employees are more likely to be satisfied when they feel their compensation is fair and aligned with their contributions, but they also need to feel valued and supported in other ways.

Additional perks such as bonuses, health benefits, and other incentives see an increase in mentions as ratings improve. These benefits enhance job satisfaction by providing employees with a sense of security and appreciation. Comprehensive benefits packages that include health insurance, retirement plans, and wellness programs contribute to employees' overall well-being and job satisfaction. Perks that address employees' personal needs and preferences can also play a crucial role in enhancing their engagement and loyalty[30][31]

Life Balance:

Work-life balance is highly valued, with its mentions significantly increasing in higher ratings. Policies that support flexible working hours and remote work contribute positively to employee satisfaction. Employees who can effectively balance their work and personal lives are more likely to experience higher job satisfaction and lower stress levels. Organizations that offer flexible work arrangements, such as telecommuting and flexible schedules, enable employees to manage their responsibilities more effectively, leading to improved morale and productivity. Similar observations can be found in numerous scholarly publications highlighting the increasing significance of work-life balance. Similar observations can be found in numerous scholarly publications emphasizing the growing importance of work-life balance, not only in healthcare but also in other sectors characterized by high stress levels. [32][33][34][35].

An equally crucial area of analysis pertains to the factors negatively impacting employee satisfaction.

Management Flaws:

Management flaws, such as poor leadership and lack of support, show a sharp decrease in mentions from lower to higher ratings. This indicates that effective management is crucial for preventing dissatisfaction and fostering a positive work environment. Poor management practices, including lack of communication, micromanagement, and inadequate support, can lead to frustration and disengagement among employees. Addressing these issues through leadership development programs and management training can significantly improve employee satisfaction.

Research indicates that a considerable number of American employees may not be fully engaged in their work. According to the "State of American Workplace Report" [36], only 21% of employees strongly agree that their performance is managed in a way that motivates them to excel. Furthermore, a smaller proportion of employees strongly agree that they have opportunities within their workplace to learn and develop professionally.

According to research, the quality of management and leadership accounts for at least 70% of the variance in team engagement. [37] Additionally, when organizations expand, employees may experience a disconnect from the company's mission, feeling like they lack a clear understanding of how their role aligns with the organization's vision and strategies.

Work and Operational Stress:

High work stress is frequently cited in lower ratings and decreases in higher ratings. This suggests that reducing work-related stress through better workload management and support systems is critical for improving employee satisfaction. High levels of work stress can lead to burnout, decreased productivity, and higher turnover rates. Organizations can mitigate stress by ensuring manageable workloads, providing mental health resources, and fostering a supportive work environment[38][39].

Operational stress shows a high frequency in lower ratings, decreasing as ratings improve. Effective operational management and adequate resources can significantly reduce stress and enhance job satisfaction. Ensuring that employees have the necessary tools, resources, and support to perform their jobs effectively can alleviate operational stress and improve overall satisfaction[40][41].
Career Limits:

Mentions of career limits are prevalent in lower ratings, indicating that a lack of advancement opportunities is a major dissatisfaction driver. Providing clear career paths and development opportunities is essential for maintaining high employee morale. Employees who feel stuck in their current positions without opportunities for growth are more likely to become disengaged and seek employment elsewhere [42][29].

Low Pay and Turnover:

Low pay and high turnover are mentioned frequently in lower ratings but are less dynamically correlated with overall job satisfaction compared to management flaws and work stress. While important, addressing pay and turnover alone may not be sufficient to significantly boost satisfaction. The healthcare industry is experiencing major transformations due to new employee expectations at all levels of the organization. In primary, lower-tier hospitals, basic expectations such as management skill and above average pay are usually all that is required. These issues are what creates the dissatisfaction, retention and performance problems.

Promotion of teams and diversity leads to positive organizational culture which brings richer satisfaction. With clear career paths_define, investments in progression will also increase.Ensuring competitive compensation is necessary, but organizations must also address the underlying non-material factors that contribute to job satisfaction [43][44].

Funding

This research received no external funding.

Informed Consent Statement

Not applicable

Conflict of Interest

None declared