A phenomenological study of Filipino Medical Technologists’ forces for perceived job satisfaction amidst COVID-19 pandemic in the Philippines

Introduction

Background

Job satisfaction is highly associated with the feelings and perception of an employee towards the work environment where unmet expectations can lead to disappointments, causing satisfaction to be unachieved (1). In laboratory settings, the quality of service relies on qualified personnel, emphasizing the importance of the permanency and retention of experienced healthcare professionals. Likewise, they are important in generating shorter turnovers, increased productivity, and marked profit (2). However, it was found that there is an increasing lack of skilled medical technologists, emphasizing on the need to retain said trained individuals rather than recruit (3). Nowadays, medical technologists face different situations in their respective laboratories that affect their daily performance and occupational satisfaction. These issues vary for each staff, identifying job satisfaction as subjective (4,5). Hence, the detection of factors that reduce satisfaction becomes necessary to improve occupational contentment.

Various work elements affect the overall job satisfaction. An appropriate workplace contains several aspects, namely the physical, psychological, and social workplaces. All of which affect the job satisfaction of employees in their own ways (6). Aside from this, work motivation also plays a vital role on keeping the employees on track to achieve personal and organizational goals (7). From fulfilling the personal needs, to proper work system, reasonable workload, and working environment, everything affects individual’s motivation to accomplish a task (8,9). Furthermore, collegial relationships and teamwork were known to positively enhance job engagement and satisfaction (10). Teamwork can mitigate heavy workload, reduce stress, and increase efficiency (11). On another note, increasing psychological safety among team members, which is considered as a relevant element of teamwork, facilitates unity, and gives the members a comfortable environment to engage in interpersonal learning and enhance task performance (12). Higher occurrences of teamwork are crucial in attaining job satisfaction due to effective communication, challenging the professional growth and development of skills of involved personnel, which were wholly rooted to the influences of their colleagues. Job retention and general job satisfaction levels can rise accordingly by addressing and inculcating teamwork among healthcare professionals. The cultivation of teamwork is demonstrated to decrease the level of personnel dissatisfaction which may result in lower productivity and resignation. Moreover, addressing these work elements may aid in improving the job satisfaction amongst healthcare professionals. We present this article in accordance with the SURGE reporting checklist (available at https://jphe.amegroups.com/article/view/10.21037/jphe-22-104/rc).

Rationale and knowledge gap

The COVID-19 pandemic is a global crisis and countries across the globe were called to respond to the situation (13). The capacity of a country’s response towards health crisis and emergency were challenged by this global health phenomenon. Healthcare workers (HCWs) were at the center of the response team, providing diagnosis, treatment, and care among patients.

However, in the Philippines, HCWs were underappreciated (14) and underpaid even before the pandemic (15). In the Southeast Asian region, the Philippines was found to have the lowest salary for both nurses and medical technologists which is approximately 50–57% lower than Vietnam—which ranked 6^th out of the 7 countries surveyed (16). Amidst the pandemic, many HCWs have demanded a “time-out” since many have experienced physical, emotional, and psychosocial stress due to the burden of COVID-19 cases and the heavy hospitalization rate (17,18). The underpaid COVID-19 benefits like the special risk allowances—an extra allowance for healthcare frontliners serving COVID-19 patients, and unreasonable delays in the salaries made the situation even worse (19). In addition, many institutions have reported a crisis in terms of understaffing, and it has affected the current workload pressure—resulting in delayed COVID-19 response, burnout, and poor quality of health services (20,21). The Philippines needs 106,000 nurses, 67,000 physicians, and 4,500 medical technologists in both public and private health institutions (22). Despite these calls for additional workers, many nurses and even other healthcare professionals chose to resign from their posts due to the overwhelming COVID-19 situation (23), and some even applied for a position abroad and migrate (15). Likewise, a lot of HCWs are experiencing the medical “brain drain” phenomenon (24) which is a phenomenon describing the substantial emigration of educated individuals to seek more favorable job opportunities abroad or a higher standard of living (25).

Understanding the other reasons behind this phenomenon and the true perception of Filipino HCWs specifically medical technologists towards job satisfaction may reveal a lot of key opportunities to address in improving the overall work perception of Filipino medical technologists.

Objective

This study explored the lived experiences of Filipino medical technologists. It purports to answer the central question: “What is the perceived job satisfaction of Filipino medical technologists?”. Specifically, this study wants:

• To define job satisfaction as comprehended by Filipino medical technologists;
• To identify the factors/forces associated with the job satisfaction of Filipino medical technologists.

Methods

Research design

This is a phenomenological research that aims to capture the job satisfaction of Filipino medical technologists. It involves the analysis of deliberately selected Filipino medical technologists and the illumination of the similarities and differences in each situation. In particular, a transcendental approach which originated from the philosophies of Husserl and Heidegger and further elaborated by Merleau-Ponty (26), was applied in attempting to unravel and describe the essence of the lived experiences of the respondents (27,28). Following the Husserl’s descriptive philosophy, researchers remained objective and kept any personal biases away from describing the emerged patterns in the study. In the same manner, the researchers were also guided by the Heidegger’s interpretative philosophy, allowing a comprehensive search for certain meanings and value in the lived experiences of the respondents. The application of both philosophies provides a more thorough and reliable analysis of respondents’ lived experiences (29,30). They are particularly useful in the examination of ambiguous and subjectively sentimental topics (30). In addition, the application of Colaizzi’s method (31) was made since it follows both philosophies and it allows the researchers to validate data at the end of the analysis (32). Furthermore, inclusion and exclusion criteria were set to sufficiently identify appropriate sample size at one given time that accommodates both the purpose of the study and the phenomenon.

Subject and study site

Purposive sampling was utilized in the study following Creswell and Clark’s journal article (33) which recommends narrow and selective criteria to generate specific findings that can be applied to a wider population. Sample size was estimated considering the study of Creswell (34) which employed more than 10 respondents on conducting interviews for thematic analyses. This sample estimation is enough to demonstrate patterns and allow easier management of data (35). While there are no guidelines stating the correct number of participants to achieve the credibility of the study (36), the researchers primarily considered sample saturation in generating the sample size. The appropriate sample size of 12 or more was generated following Hennink and Kaiser’s paper on data saturation and variability (37). Likewise, this prevents any limitations in data encoding where there are no new codes/themes occur in the data (38). Consequently, only 13 registered Filipino medical technologists in any organizational position with at least three years of experience working in Department of Health, Philippines (DOH)-accredited private hospitals within the Metro Manila, Philippines were recruited. Chosen individuals were not required to be active members of any local or international professional organizations, have post-graduate education nor acquired specialized training. Conversely, medical technologists with less than 3 years of working experience in a DOH-accredited private hospital and other healthcare professionals were excluded in the study. Government HCWs and medical technologists were also excluded. There were no established exclusion criteria set to discriminate the age and gender. The locale of this study was set within the Metro Manila, Philippines only.

Instrumentation and data gathering

The research instrument was fractionalized into the Robotfoto and the aide-memoire in gathering and underpinning the collected data. Informed consents were distributed and collected prior to the participant’s enrollment in the study (see Appendix 1). Robotfoto is a personal data sheet seeking the professional endeavors of each participant. Respondents were asked to fill out the Robotfoto, containing their age, gender, educational qualification, work duration, years of experience, and employment classification (see Appendix 2). The salary was not included in the questionnaire since the researchers have agreed that this information would not make any difference due to the nature of the question. In general, the salary of a medical technologist in the Philippines is the same regardless of the institution and relatively lower as compared to other HCWs (17). All of the provided basic information including contact details were recorded in line with personal and data privacy to keep utmost confidentiality. Subsequently, the aide-memoire consisted of open-ended questions and sub-questions apropos of their perception of job satisfaction, relating to each criterion under the central question, “What is the perceived job satisfaction of Filipino medical technologists?”. Throughout the semi-structured one-time interview process using Google Meet^®, Facebook Messenger, and Zoom. All of the interviews were done in less than two hours and the sessions were recorded for transcribing purposes. Any information that may revealed or led to the identities of the participants and their workplace were excluded. Likewise, statements expressed in Filipino were directly translated to English and reviewed by all the researchers to ensure that the original meaning of the context has not been altered.

The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Research Ethics Committee of the Faculty of Pharmacy, University of Santo Tomas, Metro Manila, Philippines (approval No. FOP-ERC-2021-02-211). The participants were informed in writing about the nature and purpose of the study. Interviews were audio-recorded with permission from the respondents following the assurance that all of the information shared will remain confidential. Participants were also informed of their right to non-participation at any point during the conduct of the study without any justification.

Data analysis

Data was transcribed and analyzed through Colaizzi’s (31) seven-step systematic process of analysis, involving the cool and warm analyses. Among the methods of phenomenological analyses, Colaizzi’s method was chosen since it follows the same philosophies as Husserl’ and Heidegger’s and incorporates data validation (30). The search for common patterns elicited from specific experiences was validated through consultation with the respondents which is part of this seven-step process (32). Cool analysis was utilized in the process of transcribing interviews to form categories from significant statements, then warm analysis was used for thematizing (39).

The first step involved reading and rereading of the transcribed text for several times to gather the holistic gist for the purpose of attaining the ‘global sense’ as an aid to the subsequent steps. Then, identifying ‘significant statements’ through the process of discrimination followed. As this approach became ‘discovery-oriented’, unexpected significant statements that emerged within this step were noted while keeping an open attitude in treating these units. Subsequently, the formulation of meanings from the studied ‘significant statements proceeded’. Using the formulated meanings, subthemes were organized by correlating the formulated clusters of themes and central themes based on their commonality and relationship to each other. The establishment of a fundamental structure of the phenomenon followed through the removal of redundant, misused, and irrelevant information and the creation of a representative structure describing the relationship between the phenomenon and the generated themes. Finally, participant validation was done to establish evidence of trustworthiness. This was performed following the production of the extracted significant statements, its respective formulated meanings, thematic clusters, and the overall central themes to institute evidence of trustworthiness (40). Collected data were compiled into files and documents were sent to the participants via email to validate the content and authenticity (see Appendix 3), allowing the validation of the accuracy of the findings and providing necessary comments to further strengthen the validity of the study (41). Moreover, this ensures the reliability and unbiased nature of the analyzed data.

Results

Respondents’ profile

The demographics of the respondents (Table 1) consisted of young adults (69.24%) bracketing from 20 to 35 years of age; the rest of the age brackets were scattered among middle age groups (15.38%) and senior age groups (7.69%). The ratio of male to female participants can be equated to 5:8, while the random assortment of single to married participants can be proportioned into 8:4 (with only one participant who did not disclose his/her marital status), supporting the familial goals and sentiments of some selected participants.

The employment record of the participants validates their credibility in participating (Table 2). The minimum work experience required falls under the three to five years bracket with a 38.46% occurrence, followed by six to eight years (30.77%), 12 or more years (23.08%), and 9 to 11 years (7.69%); this set of roster signifies that they met the basic criteria for the study. Along with this, 84.62% are employed and have a minimum undergraduate degree of medical technology. On another note, only 30.77% of participants have worked in only one laboratory or hospital, supporting the various literature stating the unsatisfactory attitude of workers towards their jobs. In addition, only 46.15% of respondents work for the basic number of hours per day; 15.38% work for nine to 12 hours and 23.08% work overtime. Although there is founded literature regarding the relation between promotion and satisfaction, the 5:5 ratio between junior medical technologists and senior medical technologists are unfounded due to the 30.77% workers with shorter duration work experiences.

Findings of the central question

The Fire Triangle of Job Satisfaction

‘The Fire Triangle of Job Satisfaction’ is a simulacrum generated from the syntheses made following the analysis of the lived experiences of Filipino medical technology respondents. It represents the three main concepts that emerged in the study that dictate the degree of satisfaction HCWs express toward their jobs, namely: the Force of Purpose, the Force of Pursuit, and the Force of People. This was used to depict how the aforementioned forces are needed to preserve job satisfaction. Similar to the fire triangle, if one of these forces were to deteriorate, the ‘fire’, that is job satisfaction, would eventually die out as well (Figure 1).

Figure 1 Simulacrum: ‘The Fire Triangle of Job Satisfaction’.

Force of Purpose: a reason for professional existence

The theme ‘Purpose’ revealed the participants’ reasons for becoming HCWs and exemplifying their core intents. With this, they believe that their undying love for their work, their service towards their patients, their ability to aid in diagnosis and healthcare, and their freedom to exercise their professional knowledge and skills are the cornerstones to continue working within the field.

Most respondents shared that the root of their job satisfaction is their inclination towards their career. The faculty of passion includes their unconditional affection for their vocation amidst persistent moments of hardships. Ultimately, the respondents find joy in performing the work they love; thus, they experience dissatisfaction when their work becomes routine as verbalized:

“When you are exhausted, … That’s when I think of saying, ‘I wish I didn’t pursue Medical Technology’, … sometimes when I am tired, I don’t want to do it anymore, but at the end of the day, you will still look for it (being a med tech). So, the only thing I can say is: this is really for me. This is half of my life” (R3).

“If you love what you do, you will still be satisfied no matter how difficult it gets… Working as a med tech: it is fun, it is fulfilling, as long as you really love what you are doing. However, it is exhausting” (R6).

“If you do not love your work…, then there is no reason for staying in that particular workplace” (R9).

“If it becomes a routine, that’s when your job satisfaction goes down” (R13).

Almost all the respondents have elaborated experiences that revealed their altruistic character as healthcare professionals through their act of service. They find fulfillment in their involvement in helping their patients recover, sharing their professional knowledge, serving their fellow countrymen, and aiding in patient diagnosis:

“When you are able to help patients… there are times when we interact with patients, and you will see them improving” (R10).

“The Philippines needs us… It’s like you will forget the compensation and the risk factors because the Philippines is short of healthcare workers… so that urges me to still work even though I am immunocompromised” (R5).

“More Filipinos need us medical technologists, or not only medical technologists but when it comes to the healthcare industry, because especially now in the pandemic, we are in need of more healthcare workers” (R2).

“You know you’re helping your fellow Filipinos… It is satisfying because in your own way, you know that in the way of your work, you are able to help. For example, now, during this pandemic, we perform the tests” (R3).

“It gets fulfilling when you’re able to help society because you’re a public servant… you are part of those who help patients recover” (R6).

“By doing your job, you are able to help doctors diagnose their diseases. Without us, doctors cannot make diagnosis for patients” (R6).

Ultimately, fulfillment is also derived in the execution of their lifelong journey of learning, thus giving life to the context of practice. This gives the respondents the satisfaction of knowing that the hard work they exerted into mastering various principles are bound to be applied in their practice and other fields. These are evident in these statements:

“I can’t grasp lectures very much, so I appreciate it more if I can apply it. There’s really a difference between lectures and application” (R10).

“I can just say that everything I’ve learned in the hospital, I can apply it in the future” (R11).

Force of Pursuit: a reason for betterment

The theme ‘Pursuit’ emerged from desiring needs associated with receiving certain rewards and benefits, procuring a certain amount of remuneration, extending one’s knowledge, and seizing a better future. The findings revealed that respondents seek to attain a certain level of privilege where their salary compensates for their workload. However, fringe benefits may be used as alternatives when salary cannot be equitable as shared by the respondents:

“For retention, employees would like to stay in the job if they are compensated well—when it comes to pay… So I think by doing that, wherein an employee would feel that he or she is important, and what he or she is doing is very helpful to the institution, and they are given good compensations, I think they would still stay” (R2).

“Job satisfaction, working here in the Philippines, isn’t that satisfactory because money-wise and workload, it’s not enough…, if I can’t satisfy my financial needs, my satisfaction as a working med tech here in the Philippines would be low” (R6).

“We have medicine allowance and hazard pay. If you get sick or if your dependents get sick, they also have benefits, so it’s not a loss on your part despite the low salary as compared to abroad” (R7).

“Free hospitalizations but that is already a big deal… The impact of benefit packages on employees is also big. That’s why they don’t want to leave” (R10).

The respondents also desire to pursue professional growth in their field through attending educational courses organized or funded by their respective institutions. Herewith, job satisfaction was equated to learning more about their field and other related areas. Moreover, the participants considered criticisms and negative feedback as tremendously valuable as they use these sentiments to further enhance themselves. This implies that respondents refuse to stagnate their knowledge, skills, and growth. As verbalized by the respondents:

“If I want to attend seminars and conventions to renew my license, it is supported by the institution. If I ask for anything that will improve the services of the laboratory, they are willing to give it” (R1).

“Job satisfaction is when you get the training, the support, and the professional development in the workplace. As a medical technologist, it’s nice to know more, especially the things that you didn’t know before” (R12).

“I am not confining nor limiting myself, reasoning that: ‘This is all I can and will do’. or ‘I am fine with my daily routine of extracting blood’. So, if I encounter something like ‘Oh, this is challenging’, I would go for it because this is for my future” (R4).

“Sometimes, there are patients who expect a certain level of service from you, yet you fall short, but the one thing you have to do when it comes to that is improve” (R2).

“So if there are criticisms, no matter how painful, you have to accept it and change for the better” (R3).

“Negative feedback builds you… it will be your stepping stone to remind you of your mistakes and to remember to improve on it” (R5).

Some respondents conveyed their ideas on professional growth as promotion and career role change. They coined the term ‘level up’ as the concept of how their quest for knowledge is manifested in their advancement in social standing or in theoretical and practical competency, as expressed:

“If you are the type of worker seen with potential, that is the time you can say you are able to advance into other levels. I was able to bring my career as a medical technologist to a higher level” (R2).

“Professional growth can be seen as: you, as a med tech, having the desire to level up” (R3).

“If I were given an opportunity to work in the field of research, I would grab it so that I may improve on myself. Aside from being a medical technologist, there are other fields we can explore. This is not only limited in the hospital laboratory setting; you can venture into cosmetics, stem cells, genomes, genetics, forensics, so on… I dream of becoming a scientist, so I must further my studies” (R10).

“Of course, your knowledge is enhanced… It’s like a different level in being a medical technologist” (R11).

Due to lack of opportunities, the respondents seek to acquire experiences in the Philippines for pursuing work abroad. Their experiences have been deemed as steppingstones to a better future. They dream of working in countries where they will be better appreciated and compensated in their practice. As shared by the respondents:

“A lot of medical professionals apply in other countries because the biggest factor is the salary here in the Philippines. What happens is the Philippines becomes a training ground for medical professions… But if you know or talk to a lot of people, you will get depressed, especially if you find out how much other medical technologists earn abroad and how they are treated. In other countries, we are treated as scientists” (R6).

“… as a med tech in the Philippines, you are not well-compensated. Everyone whom you will talk to only work here for the experience, then they will apply abroad and work there because you are more appreciated and better compensated in other countries unlike in the Philippines” (R8).

“I’m not optimistic. If you’re planning to be a med tech here in the Philippines for the rest of your life, I wouldn’t recommend that… You either go to another country or go to med school” (R13).

Force of People: a reason to belong

The theme ‘People’ manifests the desire of HCWs for an appreciative and supportive environment. This encompasses the value of societal and patient recognition and authentic relationships, fostering care and enjoyment inside the workplace. A sense of fulfillment arises from subtle recognition received through simple remarks, acknowledgement, and tokens of appreciations from by patients, as stated by the respondents:

“When patients come back to you and say, ‘Thank you po!’, especially this time of pandemic when med techs are working as frontliners” (R3).

“You’re just a nobody to them…but in reality, we’re the unsung heroes… they don’t see the med techs fighting with the viruses” (R5).

“During blood extraction when patients tell you, ‘Ma’am my blood is hard to extract’. then you immediately extracted their blood in one shot” (R11).

Maintaining good relationships inside the workplace supports a good work environment and allows better performance, thereby impacting job satisfaction Respondents primarily described relationships to be like family, thus increasing their job retention as seen in the following responses:

“I can say I am satisfied with my work when I become friends with them… Since every time I need something, or every time I am in need, … They are there. They don’t think twice about helping me” (R1).

“The work environment becomes lighter, where everyone is being helpful… Generally, your workplace is nice, you’ll be more productive and more focused…” (R2).

“We act as a family here. Our chief med tech is like our mom, she shares everything she knows… So everything is developed… the skills in the laboratory, and even decision making” (R5).

“I think another reason for job satisfaction is if your colleagues are okay… You won’t think of leaving your job. But if they’re not okay, no matter how high your salary is, you’ll still leave” (R12).

Teamwork is proven to increase job satisfaction by alleviating work burdens by acting as a buffer between work-related stress and burnout that result in work exhaustion and depersonalization. While this is true for most medical professions, the conducted study has shown that teamwork as a factor affecting work satisfaction is not commonly shared among HCWs, as articulated by the respondents:

“We work at our own discretion. No one will mind you” (R4).

“There are moments that I do not want to be in a group or prefer to be surrounded by either one or two people because frequently, the more people that are working in the laboratory, the higher the incidence of having disorderliness in the workplace” (R6).

Discussion

The findings of this study have found the emergence of three major themes—forces of purpose, pursuit, and people in the perceived job satisfaction of the participants. Each theme reveals the lived experiences of medical technologists working in the Philippines. As reflected in their responses, the findings suggest that these areas may aid in the improvement of the quality of Filipino workplace, fair and relevant compensation, and building a harmonious and collaborative environment among health allied professionals.

Many Filipino HCWs including medical technologists and nurses were exposed to heavy workloads and understaffing amidst the pandemic (15). As a result, it created a stressful environment, and some experienced burnout (42). The findings of this study have revealed that despite these stressful and chaotic working conditions, Filipino medical technology respondents have demonstrated harmonious passion and sense of purpose related to job fulfillment. It roots in personal internalizations which integrate activities into identity and purpose (43). Furthermore, it provides an insight that HCWs denote a lack of passion with lower job retention and satisfaction. The notion of ‘routinary work’ was mentioned as the loss of passion when boredom conquers the pleasantness of the job (44). Likewise, participants view their passion as their driving force to achieve job satisfaction and success—preventing career burnout (43). Aside from passion, higher levels of job satisfaction among knowledge workers are also attained when HCWs are challenged in their problem-solving, skill variety, and specialization (45). The majority of the responses revealed that the application of their abilities in the medical technology practice, verification of the automated results through manual testing, and consultation with other laboratory personnel, amplify their job satisfaction. Consequently, HCWs may experience higher job satisfaction when work-related learnings can be applied (46).

Participants also mentioned that providing quality patient care also contributes to their sense of fulfillment. Caring for and being involved in the patient’s clinical conditions proved to be a major influence on the job satisfaction of HCWs (47). Especially during this pandemic, the greater demand for more HCWs also served as their reason for continuing their service. However, it should be noted that working locally in the Philippines and abroad are two separate concepts. The respondents may have agreed that working here would entail a low salary, heavy workload, underpaid benefits, and even delayed compensation as compared to the benefits attained from working overseas (15). Above all, the respondents have shared their willingness to serve the country despite these consequences—a demonstration of a true sense of nationalism.

The study participants also highlighted the essence of reasonable compensation, career opportunities, and professional growth. Most respondents were dissatisfied with their financial and non-financial compensations, hindering them from attaining the quality of life that they want to achieve. Ultimately, low salaries and lack of financial compensation led to low satisfaction (9,48). As reflected in the findings, respondents stated that tolerance to these low and delayed compensations can only be achieved only if they will be properly compensated through fringe benefits—medical assistance, meal allowances, transportations subsidy, etc. Likewise, through the provision of these fringe benefits, a greater sense of commitment among employees could be derived (49) and thus, could increase the job satisfaction of the employees (50). An emphasis must be given to these financial compensations as they were deemed relevant to intrinsic rewards as salary represents respect and value for one’s service, a higher salary equates to being highly valued (51). In terms of professional growth, participants view this as a productive endeavor in career promotions or to ‘level up’ their professional standing as termed by some participants. Continuing professional development (CPD) courses, educational grants, feedback and criticism, job rotations, and promotional opportunities are some of the ways in achieving professional growth. These training opportunities are important factors that contribute to job satisfaction (52). However, in the Philippine setting, this training is not offered for free which also adds to their financial burden and hinders opportunity among the HCWs (53). As a result, this kind of working condition hinders individuals from fulfilling their needs and cultivates a working environment that leads to low job satisfaction. Likewise, many HCWs are now considering migration not only to have better compensation and working conditions but also to achieve professional growth without sacrificing their own funds (54). The same standpoint was also given by the respondents as they seek to pursue their profession in higher-earning countries that provide better working conditions. While some might consider this as a professional migration, it is inevitable that this will affect the supply of HCWs serving the country. With this, the Philippines is experiencing a brain drain (55) which is a major public health issue where skilled professionals emigrate to attain a better quality of life (56).

Interventions in providing the best compensation, educational efforts, research opportunities, prioritizing and achieving Sustainable Development Goals (SGDs) for Filipino HCWs, and policies protecting their safety and security are some of the actions needed to be taken in order to combat the brain drain phenomenon (53,57). Some literature would also argue that higher salaries no longer suffice in retaining workers and therefore, government sectors must prioritize policies and/or people (56). The findings of this study suggest that recognition, good working relationships, and camaraderie may aid in improving the quality of the Filipino working environment.

HCWs revealed that they receive recognition from two sources: their patients and society. Patient recognition plays a huge factor in job satisfaction as it reinforces good service and work performance. A patient’s expression of appreciation is common after experiencing good treatment, sequentially boosting the staff’s self-esteem, and reducing burnout (58). “Thank you” letters indicate achievement, resulting in a sense of honor, appreciation, and satisfaction (59). Meanwhile, Filipino HCWs shared their sentiments of feeling underappreciated as compared to other HCWs from other countries, and it negatively affects their job satisfaction. It was proven that ‘unfair treatment’ is one of the greatest demotivating factors affecting job fulfillment (60). Similarly, the need for government support on motivational considerations, such as recognition and growth, are recommended for the development of healthcare outcomes (61). Based on the findings of this study, the respondents expressed demotivation from the lack of Philippine government support represented by the absence of a budget for primary healthcare and the updated legislature for HCW benefits and CPD policies. In terms of relationships, respondents mentioned that they are willing to make necessary adjustments to cultivate an environment that could bring out the best in them. Likewise, existing research has shown that relationships may reduce stress leading to underperformance (62). Having strong, harmonious, and familial relationships with colleagues also provided an additional reason for HCWs to stay in their jobs. Otherwise, any unhealthy relationships in the workplace will cause employees to leave (63). Lastly, the findings of this study suggest that teamwork affecting job satisfaction is unestablished among HCWs due to the nature of the profession. To support this, collaboration must be restricted in certain professions as this promotes de-synchronicity, resulting in impaired decision-making and co-responsibility (64). To wit, the shortcomings brought about by flawed collaboration are compensated by electronic transformation. This is attributed to the advancement of technology, leading to increased use of automated machines and a decreased need for manual labor, thereby reducing the need for teamwork (65).

Conclusions

As this study sought to answer the central research question: ‘What is the perceived job satisfaction of HCWs?’ the common participant experiences were categorized into the three P’s, namely Purpose, Pursuit, and People to identify how the respondents defined job satisfaction. Factors from common experiences, expectations, and circumstances were categorized under each theme, identifying the factors associated with their job satisfaction.

The categories under the theme, Purpose, namely: passion, service, and practice, are acknowledged as intrinsic factors affecting job satisfaction. Experiences relative to passion showcased the respondents’ powerful inclination to work, promoting happiness, contentment, fulfillment, and well-being. Service provides them with the opportunity to provide the best patient care that they can offer. Also, practice equips them with the freedom to practice the knowledge they have acquired throughout the years. Moreover, the findings prove that HCWs are satisfied with their work by experiencing consistent spurs of innate motivation in their daily activities.

The theme Pursuit includes the discipline privileges, professional growth, and opportunity and focuses on the personal goals of the respondents. Privilege manifested poorly and HCWs were under compensated in services they rendered, thus failing to satisfy their needs and their job satisfaction. As the respondents were willing to compromise their desires for higher salary, findings suggest that fringe benefits can serve as an alternative to elevate job satisfaction and retention. Professional growth is expressed through deliberate investment to broaden their intellectual and practical capacities and their desire to learn more and progress in their career status. Opportunity is exhibited as most seek to practice the profession in other countries that offer higher salaries, better benefits, and greater professional opportunities, thereby emphasizing on the Philippine brain drain.

The theme People recognizes the role of HCWs to build healthy interactions within their work environment. This relates to the feeling of fulfillment rooted on patient and collegial exchanges. Recognition from patient and societal appreciation remains indispensable in promoting satisfaction as it signifies good service and work performance. Relationships demonstrated through the strong bonds with their colleagues allow them to experience job satisfaction and retention, some even more so than their salaries.

Ultimately, this study highlights the unsung heroes of this pandemic who are currently engaged in the medical frontline, depicting job demands and satiety as crucial to their continuing service to the country. It is evident that the medical technology practice in the Philippines is both a personal and professional challenge especially during the pandemic. It is important to mitigate these problems in order to improve the quality of life and professional practice of the Filipino HCWs in the Philippines. Holistic programs that consider the said factors may be implemented accordingly to advocate better working conditions—increased salary, better benefits, and professional support. Future endeavors following this study may start conducting on-site interviews in an extended duration to accommodate non-verbal communications and enable a more comprehensive method of data validation.

Acknowledgments

Funding: None.

Footnote

Reporting Checklist: The authors have completed the SURGE reporting checklist. Available at https://jphe.amegroups.com/article/view/10.21037/jphe-22-104/rc

Data Sharing Statement: Available at https://jphe.amegroups.com/article/view/10.21037/jphe-22-104/dss

Peer Review File: Available at https://jphe.amegroups.com/article/view/10.21037/jphe-22-104/prf

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jphe.amegroups.com/article/view/10.21037/jphe-22-104/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Research Ethics Committee of the Faculty of Pharmacy, University of Santo Tomas, Metro Manila, Philippines (approval No. FOP-ERC-2021-02-211). The participants were informed in writing about the nature and purpose of the study. Interviews were audio-recorded with permission from the respondents following the assurance that all of the information shared will remain confidential. Participants were also informed of their right to non-participation at any point during the conduct of the study without any justification.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Mabaso CM, Dlamini BI. Impact of compensation and benefits on job satisfaction. Research Journal of Business Management 2017;11:80-90. [Crossref]
2. Villanova University. How Important is Job Satisfaction in Today’s Workplace? [Internet]. Available online: https://www.villanovau.com/resources/hr/importance-of-job-satisfaction-in-the-workplace/
3. Small K. Retention strategies for medical technologists: addressing the shortages and vacancies in the clinical laboratory [Internet]. Doctoral dissertation, East Tennessee State University [cited 2023 Feb]. 2299 p. Available online: https://dc.etsu.edu/etd/2299/
4. Phipps AR. Strategies to Retain Employees in Clinical Laboratories [Internet]. Walden University; 2016 [cited 2023 Mar]. Available online: https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=3855&context=dissertations&httpsredir=1&referer=
5. Lu H, Barriball KL, Zhang X, et al. Job satisfaction among hospital nurses revisited: a systematic review. Int J Nurs Stud 2012;49:1017-38. [Crossref] [PubMed]
6. Agbozo GK, Owusu IS, Hoedoafia MA, et al. The effect of work environment on job satisfaction: Evidence from the banking sector in Ghana. Journal of Human Resource Management 2017;5:12-8. [Crossref]
7. de Oliveira Vasconcelos Filho P, de Souza MR, Elias PE, et al. Physicians' job satisfaction and motivation in a public academic hospital. Hum Resour Health 2016;14:75. [Crossref] [PubMed]
8. Kian TS, Yusoff WF, Rajah S. Job satisfaction and motivation: What are the difference among these two. European Journal of Business and Social Sciences 2014;3:94-102.
9. Zhang LF, You LM, Liu K, et al. The association of Chinese hospital work environment with nurse burnout, job satisfaction, and intention to leave. Nurs Outlook 2014;62:128-37. [Crossref] [PubMed]
10. Goetz K, Marx M, Marx I, et al. Working Atmosphere and Job Satisfaction of Health Care Staff in Kenya: An Exploratory Study. Biomed Res Int 2015;2015:256205. [Crossref] [PubMed]
11. Mijakoski D, Karadzinska-Bislimovska J, Milosevic M, et al. Differences in burnout, work demands and team work between Croatian and Macedonian hospital nurses. Cognition, Brain, Behavior. An Interdisciplinary Journal 2015;19:179-200.
12. Ortega A, Van den Bossche P, Sánchez-Manzanares M, et al. The influence of change-oriented leadership and psychological safety on team learning in healthcare teams. J Bus Psychol 2014;29:311-21.
13. Pollard CA, Morran MP, Nestor-Kalinoski AL. The COVID-19 pandemic: a global health crisis. Physiol Genomics 2020;52:549-57. [Crossref] [PubMed]
14. Cordero DA Jr. The Saga of Filipino Healthcare Workers During the COVID-19 Pandemic. Asia Pac J Public Health 2022;34:889. [Crossref] [PubMed]
15. Alibudbud R. When the "heroes" "don't feel cared for": The migration and resignation of Philippine nurses amidst the COVID-19 pandemic. J Glob Health 2022;2:03011. [Crossref] [PubMed]
16. Yumol DT. Filipino nurses, med techs lowest paid in Southeast Asia [Internet]. Cable News Network Philippines; 2020 [cited 2023 Mar]. Available online: https://www.cnnphilippines.com/news/2020/9/4/Filipino-nurses--med-techs-lowest-paid-in-Southeast-Asia-.html
17. Biana HT, Joaquin JJB. COVID-19: The need to heed distress calls of healthcare workers. J Public Health (Oxf) 2020;42:853-4. [Crossref] [PubMed]
18. Dela Cruz E. Philippines to update COVID-19 strategy as healthcare workers seek 'timeout' [Internet]. Reuters; 2020 [cited 2023 Mar]. Available online: https://www.reuters.com/article/us-health-coronavirus-philippines-idUSKBN24Y07D
19. Magsambol B. Overworked, underpaid health workers are walking away as Delta ravages PH [Internet]. Rappler; 2021 [cited 2023 Mar]. Available online: https://www.rappler.com/newsbreak/in-depth/overworked-underpaid-health-workers-walking-away-delta-variant-ravages-philippines/
20. Aytona MG, Politico MR, McManus L, et al. Determining staffing standards for primary care services using workload indicators of staffing needs in the Philippines. Hum Resour Health 2022;19:129. [Crossref] [PubMed]
21. Nakpil D. ‘Understaffed’ PH health workers, frontliners continue to man defense lines [Internet]. Cable News Network Philippines; 2020 [cited 2023 Mar]. Available online: https://www.cnnphilippines.com/news/2020/3/17/health-worker-shortage-philippines-coronavirus.html
22. Magsambol B. Philippines lacks 106,000 nurses – DOH [Internet]. Rappler; 2022 [cited 2023 Mar]. Available online: https://www.rappler.com/nation/philippines-shortage-nurses-hospitals-doh/
23. Morales NJ, Lema K. Overwhelmed Philippines hospitals hit by staff resignations [Internet]. Reuters; 2021 [cited 2023 Mar]. Available online: https://www.reuters.com/world/asia-pacific/overwhelmed-philippines-hospitals-hit-by-staff-resignations-2021-08-16/
24. Laforga BM. Medical 'brain drain' comes back to haunt virus-stricken Philippines [Internet]. Philippine Institute for Development Studies; 2020 [cited 2023 Mar]. Available from https://pidswebs.pids.gov.ph/CDN/NEWS/04_02_business_world.pdf
25. Young J. The Economic Impact of Brain Drain [Internet]. Investopedia; 2021 [cited 2023 Feb]. Available online: https://www.investopedia.com/terms/b/brain_drain.asp#:~:text=Brain%20drain%20is%20a%20slang,a%20higher%20standard%20of%20living
26. Van Manen M. Researching lived experience: Human science for an action sensitive pedagogy. 2nd ed. New York: Routledge; 2016 Jun 16.
27. Errasti-Ibarrondo B, Jordán JA, Díez-Del-Corral MP, et al. Conducting phenomenological research: Rationalizing the methods and rigour of the phenomenology of practice. J Adv Nurs 2018;74:1723-34. [Crossref] [PubMed]
28. Neubauer BE, Witkop CT, Varpio L. How phenomenology can help us learn from the experiences of others. Perspect Med Educ 2019;8:90-7. [Crossref] [PubMed]
29. Smith JA, Osborn M. Interpretative phenomenological analysis as a useful methodology for research on the lived experience of pain. Br J Pain 2015;9:41-2. [Crossref] [PubMed]
30. Reiners GM. Understanding the differences between Husserl’s (descriptive) and Heidegger’s (interpretive) phenomenological research. J Nurs Care 2012;1:119. [Crossref]
31. Colaizzi PF. Psychological research as the phenomenologist views it. In: Existential-Phenomenological Alternatives for Psychology. New York: Oxford University Press; 1978:48-71.
32. Shosha GA. Employment of Colaizzi's strategy in descriptive phenomenology: A reflection of a researcher. European Scientific Journal 2012;8:31-43.
33. Creswell JW, Clark VL. Designing and conducting mixed methods research. 3rd ed. California: Sage Publications; 2017 Aug 31.
34. Creswell JW. Mixed-method research: Introduction and application. In: Handbook of Educational Policy. Massachusetts: Academic Press; 1999:455-72.
35. Clarke V, Braun V. Successful qualitative research: A practical guide for beginners. Successful qualitative research. London: Sage Publications Ltd.; 2013:1-400.
36. Vasileiou K, Barnett J, Thorpe S, et al. Characterising and justifying sample size sufficiency in interview-based studies: systematic analysis of qualitative health research over a 15-year period. BMC Med Res Methodol 2018;18:148. [Crossref] [PubMed]
37. Hennink M, Kaiser BN. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc Sci Med 2022;292:114523. [Crossref] [PubMed]
38. Urquhart C. Grounded theory for qualitative research: A practical guide. California: Sage Publications Ltd.; 2022 Sep 23.
39. Moreno AA, Daño JC. From Dystopia to Utopia: The Perceptions of Ostomy Clients. Malaysian Journal of Medical Research 2018;2:1-7. (MJMR). [Crossref]
40. Sy MG, Calimag MM, de Sagun RQ, et al. We Got to Move it, Move it: The Lived Experiences of Family Carers of Youth with Chronic Neurodevelopmental Disorders as They Enter into Adult Health Care. Journal of Medicine University of Santo Tomas 2020;4:486-99. [Crossref]
41. Wirihana L, Welch A, Williamson M, et al. Using Colaizzi's method of data analysis to explore the experiences of nurse academics teaching on satellite campuses. Nurse Res 2018;25:30-4. [Crossref] [PubMed]
42. Rillera Marzo R, Villanueva Iii EQ, Chandra U, et al. Risk perception, mental health impacts and coping strategies during COVID-19 pandemic among Filipino healthcare workers. J Public Health Res 2021;10:jphr.2021.2604.
43. Curran T, Hill AP, Appleton PR, et al. The psychology of passion: A meta-analytical review of a decade of research on intrapersonal outcomes. Motivation and Emotion 2015;39:631-55. [Crossref]
44. Gaither C. Lost Passion vs Burnout: Do You Know the Difference? [Internet]. LinkedIn; 2015 [cited 2023 Mar]. Available online: https://www.linkedin.com/pulse/lost-passion-vs-burnout-do-you-know-difference-gaither-md-faafp/
45. Viñas-Bardolet C, Guillen-Royo M, Torrent-Sellens J. Job characteristics and life satisfaction in the EU: A domains-of-life approach. Applied Research in Quality of Life 2020;15:1069-98. [Crossref]
46. Riisgaard H, Nexøe J, Le JV, et al. Relations between task delegation and job satisfaction in general practice: a systematic literature review. BMC Fam Pract 2016;17:168. [Crossref] [PubMed]
47. Atefi N, Abdullah KL, Wong LP, et al. Factors influencing registered nurses perception of their overall job satisfaction: a qualitative study. Int Nurs Rev 2014;61:352-60. [Crossref] [PubMed]
48. Gile PP, Buljac-Samardzic M, Klundert JV. The effect of human resource management on performance in hospitals in Sub-Saharan Africa: a systematic literature review. Hum Resour Health 2018;16:34. [Crossref] [PubMed]
49. Valaei N, Rezaei S. Job satisfaction and organizational commitment: An empirical investigation among ICT-SMEs. Management Research Review 2016;39:1663-94. [Crossref]
50. Rožman M, Treven S, Čančer V. Motivation and satisfaction of employees in the workplace. Business Systems Research: International journal of the Society for Advancing Innovation and Research in Economy 2017;8:14-25.
51. Morgan JC, Dill J, Kalleberg AL. The quality of healthcare jobs: can intrinsic rewards compensate for low extrinsic rewards? Work, Employment and Society 2013;27:802-22. [Crossref]
52. Hanaysha J, Tahir PR. Examining the effects of employee empowerment, teamwork, and employee training on job satisfaction. Procedia-Social and Behavioral Sciences 2016;219:272-82. [Crossref]
53. Thompson M, Walton-Roberts M. International nurse migration from India and the Philippines: the challenge of meeting the sustainable development goals in training, orderly migration and healthcare worker retention. J Ethn Migr Stud 2019;45:2583-99. [Crossref]
54. Bludau H. Global healthcare worker migration. InOxford Research Encyclopedia of Anthropology. 2021 Feb 23. Available online: 10.1093/acrefore/9780190854584.013.23110.1093/acrefore/9780190854584.013.231
55. Lu JL. Analysis of brain drain in the Philippines: The case of professionals. International Journal of Sociology Study 2014;2:93-9.
56. Afzal S, Masroor I, Shafqat G. Migration of health workers: a challenge for health care system. J Coll Physicians Surg Pak 2012;22:586-7. [PubMed]
57. Castro-Palaganas E, Spitzer DL, Kabamalan MM, et al. An examination of the causes, consequences, and policy responses to the migration of highly trained health personnel from the Philippines: the high cost of living/leaving-a mixed method study. Hum Resour Health 2017;15:25. [Crossref] [PubMed]
58. Alshmemri M, Shahwan-Akl L, Maude P. Herzberg’s two-factor theory. Life Science Journal 2017;14:12-6.
59. Day G, Robert G, Rafferty AM. Gratitude in Health Care: A Meta-narrative Review. Qual Health Res 2020;30:2303-15. [Crossref] [PubMed]
60. Martins Pereira S, Hernández-Marrero P. "In Memory of Those Who Left": How "Thank You" Letters Are Perceived and Used as a Team Empowerment Motivational Factor by a Home-Based Palliative Care Team in the Azorean Islands. J Palliat Med 2016;19:1130-1. [Crossref] [PubMed]
61. Daneshkohan A, Zarei E, Mansouri T, et al. Factors affecting job motivation among health workers: a study from Iran. Glob J Health Sci 2014;7:153-60. [Crossref] [PubMed]
62. Adnan Bataineh K. Impact of work-life balance, happiness at work, on employee performance. International Business Research 2019;12:99-112. [Crossref]
63. Hudgins TA. Resilience, job satisfaction and anticipated turnover in nurse leaders. J Nurs Manag 2016;24:E62-9. [Crossref] [PubMed]
64. Wei H, Sewell KA, Woody G, et al. The state of the science of nurse work environments in the United States: A systematic review. Int J Nurs Sci 2018;5:287-300. [Crossref] [PubMed]
65. Souza GC, Peduzzi M, Silva JA, et al. Teamwork in nursing: restricted to nursing professionals or an interprofessional collaboration? Rev Esc Enferm USP 2016;50:642-9. [Crossref] [PubMed]