Extrinsic and intrinsic determinants of quality ofwork life David Lewis Research Scientist, Father Sean O'Sullivan Research Centre, Hamilton, Ontario, Canada Kevin Brazil St Joseph's Health-care System Research Network, Ontario, Canada Paul Krueger St Joseph's Health-care System Research Network, Ontario, Canada Lynne Lohfeld St Joseph's Health-care System Research Network, Ontario, Canada Erin Tjam St Joseph's Health-care System Research Network, Ontario, Canada Background Quality of work life In the scientific management tradition, satisfaction with quality of work life (QWL) was thought to be based solely on ``extrinsic'' traits of the job: salaries and other tangible bene fits, and the safe ty and hygie ne of the workplace. By contrast, the human relations approach stresses that, while extrinsic rewards are important, ``intrinsic rewards'' are key predictors of productivity, efficiency, absenteeism and turnover. These intrinsic rewards include traits specific to the work done, the ``task content'': skill levels, autonomy and challenge. A third option, called the ``orientations to work'' approach, suggests that a focus on extrinsic or intrinsic rewards is contingent on the person: some people will place a greater emphasis on the former than will others. Just who will prefer what is predictable in part by these individuals' past histories and ``occupational cultures,'' which are indicated in turn by their education, occupation, and demogra phics (Goldthorp e et al., 1966; Krahn and Lowe, 1998; Crompton and Harris, 1998; Gallie, 1990; Rose, 1994). The research on which these findings are based, however, has commonly been directed at workers in ``the three Ms'' ± male- dominated, manual, manufacturing industries ± and it is not clear whether it also applies to health care, where there is a higher proportion of female staff; work is professional, semi-professional, or clerical; and organizations provide services rather than producing goods (Clegg and Dunkerley, 1980; Clegg and Hardy, 1996; Micklethwait, 1998). Moreover, the research can be criticized for its ambiguity: so-called ``extrinsic'' factors like pay, for example, carry both an instrumental weight ± they are means-to-an-end in that they provide the wherewithal to support leisure and home lives ± and an expressive one, in that they may be seen as a clue about how one is valued by an organization. Reference to these dynamics has been muted in health-care organizations. QWL in health care has been described in published studies as referring to the strengths and weaknesses in the total work environment (Knox and Irving, 1997). These studies have shown that low job satisfaction is a major cause of turnover among health-care providers (Yoder, 1995; Curry et al., 1985; MacRobert et al., 1993). In addition, job satisfaction may affect quality of service and organizational commitment (MacRobert etal., 1993; Beall et al., 1994; Alpander, 1990; Joseph and Deshpande, 1997; van de Looij and Benders, 1995). This in turn has been viewed as exacerbating shortages of health-care providers (Goodell and Van Ess Coeling, 1994). These considerations have produced an increased emphasis in recent years on studying job satisfaction among health-care providers (Sinkkonen, 1994). Blegen (1993) conducted a meta-analysis, which included 48 studies looking at work satisfaction and included more than 15,000 nurses. The results of this analysis revealed that job satisfaction was associated strongly with reduced work stress, organizational commitment, communication with supervisor, autonomy, recognition, fairness, locus of control, years of experience, education and professionalism. Knox and Irving (1997) report another meta-analysis concerning nurses and QWL, which indicated that autonomy is significantly associated with QWL. Thus, the QWL factors resulting from these two meta-analyses include: reduced work stress; organizational commitment and belonging; positive communicatio n; autonomy ; recognition; predictability of work activities; fairness; clear locus of control; organizational decisions; education; professionalism; low role conflict; job performance feedback; opportunities for advancement; and equitable pay levels. [ix] Leadership in Health Services 14/2 [2001] ix±xv # MCB University Press [ISSN 1366-0756 ] Keywords Quality of working life, Surveys, Factor analysis, Health care, Canada Abstract The objective of this research was to test whether extrin sic, intrinsic or ``prior'' traits best predict satisfaction with quality of work life (QWL) in health care. Extrinsic traits are salaries and other tangible benefits; intrinsic traits includ e skill levels, autonomy and challenge. Prior traits are those ofthe individuals involved, such as their gender or employ ment status. A survey of employees was condu cted in seven different health- care settings located in the south centra l region of Ontario , Canada . A total of 65 quest ions were gathere d into scales measuring such factors as co-worker support, supervisor support and teamwork and communication. These were factor- analyzed into intrinsic and extrinsic variables, and regressed against a satisfaction scale, with socio- demographic variables included. Based on the results, the following conclusions can be drawn: objectively identifi able traits of an organization ± pay, benefits and supervisor style ± play the major role in determining QWL satisfaction. Decision-makers with an interest in improving QWL in a health-care institution can focus on these traits and pay correspondingly less attention to enhancing staff autonomy or discretion. This study was funded by a grant from the St Joseph's Health-care System
