Selective Mediating Role of Quality of Work Life on Health Worker Performance in Decentralized Systems

Document Type : Descriptive & Survey

Authors

1 Department of Public Health, Faculty of Public Health, University of Northern Sumatra, Medan, Indonesia

2 Department of Industrial and Organizational Psychology, Faculty of Psychology, University of Northern Sumatra, Indonesia

3 Department of Occupational Safety and Health, Faculty of Medicine, Sebelas Maret University, Surakarta, Indonesia

10.58209/hehp.14.1.139
Abstract
Aims: This study analyzed whether quality of work life consistently mediates the relationships between organizational commitment, healthy work environment, motivational climate, career development, and health worker job performance in decentralized primary care systems.
Instrument & Methods: This explanatory quantitative study used validated measures to assess organizational commitment, workplace quality, motivation, career progression, quality of work life, and job performance among 320 primary healthcare workers in the local government of Aceh, Indonesia. Indirect and direct relationships were examined using partial least squares structural equation modeling.
Findings: Quality of work life significantly mediated the effects of motivational climate (β=0.147; t=3.467; p=0.001) and career development (β=0.105; t=2.974; p=0.003) on job performance, but did not mediate the effects of organizational commitment (β=0.01; t=1.106; p=0.269) or healthy work environment (β=0.006; t=0.86; p=0.39). Healthy work environment (β=0.216; t=6.279; p<0.001) and organizational commitment (β=0.423; t=6.569; p<0.001) significantly influenced job performance independently of quality of work life, while motivational climate had a marginal direct effect (β=0.115; t=1.878; p=0.06). The paths from organizational commitment (β=0.035; t=1.227; p=0.22) and healthy work environment (β=0.021; t=0.895; p=0.371) to quality of work life were not significant.
Conclusion: Quality of work life improves health professionals’ performance in decentralized health systems by selectively mediating the effects of motivational climate and career development, while organizational commitment and health environment influence performance through other direct pathways.

Keywords

Subjects

1- Tsofa B, Molyneux S, Gilson L, Goodman C. How does decentralisation affect health sector planning and financial management? A case study of early effects of devolution in Kilifi County, Kenya. Int J Equity Health. 2017;16(1):151.
2- Behzad I, Arezo KMN. Association between quality of work life and occupational stresses in personnel of social security organization in Hamadan province, IR Iran. J Med Res. 2014;3(4):42-5.
3- Zulkarnain Z, Ginting EDJ, Adnans AA, Sianturi MM. Organisational justice and work-family conflict: Impact to quality of work life. SA J Hum Resour Manag. 2024;22.
4- Chinomona R, Dhurup M. The influence of quality of work life on employee job satisfaction, job commitment and tenure intention in the small and medium enterprise sectors. S Afr J Econ Manag Sci. 2014;17(4):363-78.
5- Zulkarnain Z, Hadiyani S, Ginting EDJ, Fahmi. Commitment, employee engagement and readiness to change among oil palm plantation officers. SA J Hum Resour Manag. 2024;22.
6- Yulianto B, Saadah N, Suhron M, Prasetyo AKU. Sustainability awareness in dengue prevention as a result of the development of social capital model: SEM analysis. Health Educ Health Promot. 2025;13(3):1001-11.
7- Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002;288(16):1987-93.
8- Wei H, Roberts P, Strickler J, Corbett RW. Nurse leaders’ strategies to foster nurse resilience. J Nurs Manag. 2019;27(4):681-7.
9- Suhron M, Yusuf A, Subarniati R, Amir F, Zainiyah Z. How does forgiveness therapy versus emotion-focused therapy reduce violent behavior schizophrenia post restrain at East Java, Indonesia?. Int J Public Health Sci. 2020;9(4):314.
10- Bossert TJ, Mitchell AD. Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan. Soc Sci Med. 2011;72(1):39-48.
11- Suhron M, Amir F. Reduce violent behavior schizophrenia: A new approach using LT (Laughing therapy) and DRT (Deep relaxation therapy). Indian J Public Health Res Dev. 2018;9(8):1518.
12- Yulianto B, Saadah N, Suhron M, Prasetyo AKU. Sustainability awareness in dengue prevention through structural equation modeling analysis of social capital model. Health Educ Health Promot. 2025;13(3):487-94.
13- Cruz D, Lichten M, Berg K, George P. Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment. Front Psychiatry. 2022;13:800687.
14- Rubel MRB, Hung Kee DM, Rimi NN. High-performance work practices and medical professionals’ work outcomes: The mediating effect of perceived organizational support. J Adv Manag Res. 2021;18(3):368-91.
15- Gunawan RMB, Widodo W. Linking quality of work-life to turnover intention: The role of organizational citizenship behavior. JURNAL KONSELING DAN PENDIDIKAN. 2021;9(4):358.
16- Chami-Malaeb R, Menhem N, Abdulkhalek R. Higher education leadership, quality of worklife and turnover intention among Lebanese academics in COVID-19: A moderated mediation model. Eur J Train Dev. 2024;48(5/6):625-48.
17- Suhron M. Public health epidemiology research book. Indonesia: SABDA EDU PRESS; 2024.
18- Creswell JW, Creswell JD. Research design: Qualitative, quantitative and mixed methods approaches. 4th ed. Thousand Oaks CA: Sage; 2014.
19- Feldens T, Seghieri C, Fontana A, Berta P. Mediating effects between social capital and health care utilization in Italy-a structural equation model analysis. Popul Health Metr. 2025;23(1):75.
20- Mosadeghrad AM, Ferlie E, Rosenberg D. A study of the relationship between job satisfaction, organizational commitment and turnover intention among hospital employees. Health Serv Manag Res. 2008;21(4):211-27.
21- Avolio BJ, Zhu W, Koh W, Bhatia P. Transformational leadership and organizational commitment: Mediating role of psychological empowerment and moderating role of structural distance. J Organ Behav. 2004;25(8):951-68.
22- Anno EF. Effect of leadership and management inefficiencies on employee motivation and engagement in community-based organizations in Turkana, Kenya. IRASS J Arts Humanit Soc Sci. 2025;2(5):75.
23- Wu TJ, Zhang RX, Zhang Z. Navigating the human-artificial intelligence collaboration landscape: Impact on quality of work life and work engagement. J Hosp Tour Manag. 2025;62:276-83.
24- Gautam PK, Gautam DK, Bhetuwal R. Work-life balance, job satisfaction and turnover intentions among nurses. Int J Organ Anal. 2025;33(3):538-57.
25- Đulabić VLI. Reforms without reforming: Trends in local and regional governance and decentralization in croatia. Leg Rec Zapisi. 2025;1(16):112.
26- Leksono TMPM. Comparative analysis of state administrations in France and Germany. JURNAL ILMIAH RISET DAN PENGEMBANGAN. 2025;10(3):13-22.
27- Men S, Aimimtham S, Chamruspanth V, Nurmandi A, Sohsan I, Lawelai HYM. From centralization to decentralization: Organizational restructuring within a legislative context in the public sector. Corp Law Gov Rev. 2025;7(1):16.
28- Obeng HA, Atan T, Arhinful R. Exploring organizational politics, psychological well-being, work-life balance, and turnover intentions in Ghanaian hospitals: A conservation of resource theory perspective. BMC Health Serv Res. 2025;25(1):1053.
29- Sameri MJ, Alizadeh M, Baghlani F, Mahdavi S. Adaptive health systems: Innovations in crisis management during armed conflicts. Disaster Med Public Health Prep. 2025;19:e100.
30- Saadah N, Suhron M, Yulianto B, Rahayu TKU. Psychoeducation model for mothers of children with stunting. Health Educ Health Promot. 2025;13(4):669-77.
31- Amoadu M, Agyare DF, Doe PF, Abraham SA. Examining the impact of psychosocial safety climate on working conditions, well-being and safety of healthcare providers: A scoping review. BMC Health Serv Res. 2025;25(1):90.
32- Abu Safieh AM, Malak MZ, Abu-Sharour LM, Shehadeh A. Job-related stress, quality of work life, and quality of nursing care among critical care nurses. J Workplace Behav Health. 2025;40(2):195-212.
33- Suhron M, Sulaihah SAF. Strategic model of mental health nurse competence and caregiver in preventing relapse risk in schizophrenia patients. J Nurs Pract. 2026;9(2):416-26.
34- Nayak T, Sahoo CK. Quality of work life and organizational performance. J Health Manag. 2015;17(3):263-73.
35- Masihuddin A, Shaikh ZA, Nazish A. Humanistic medicine as a spiritual driver for improving the quality of work life of healthcare providers and managing improved health outcomes. 2025. p. 401-56.
36- Maryani L, Sinaga H, Juliyanti, Marbun RA, Saragih S. Enhancing patient safety: The impact of nursing work life quality on nurse performance in hospital inpatient wards. Multidiscip Sci J. 2025;8(1):2026066.
37- Ling FYY, Lew EJY. Strategies to recruit and retain generation Z in the built environment sector. Eng Constr Archit Manag. 2026;33(1):713-31.
38- Malik E, Shankar S. Exploring the potential of self-managed organizational structure in enhancing home-based healthcare services in India. Discov Health Syst. 2025;4(1):129.
39- Guerrero D, Asturias HM, Temporal AP. Job requirements and job resources as bases for a balanced employee well-being program. Perspect Sustain Dev Stud. 2026;1(1):1-28.
40- Das J. The disabled and elderly services: Demographic shifts, care provision models, and assisted living ecosystems. 2026.