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Internal Customer Satisfaction in Health-CareOrganizations: A Multicriteria Analysis ApproachPanagiotis Manolitzasa, Vasileios Fortsasa, Evangelos Grigoroudisa & Nikolaos Matsatsinisa

a Decision Support Systems Laboratory, Technical University of Crete, Crete, GreecePublished online: 12 Aug 2014.

To cite this article: Panagiotis Manolitzas, Vasileios Fortsas, Evangelos Grigoroudis & Nikolaos Matsatsinis (2014) InternalCustomer Satisfaction in Health-Care Organizations: A Multicriteria Analysis Approach, International Journal of PublicAdministration, 37:10, 646-654, DOI: 10.1080/01900692.2014.903267

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International Journal of Public Administration, 37: 646–654, 2014Copyright © Taylor & Francis Group, LLCISSN: 0190-0692 print / 1532-4265 onlineDOI: 10.1080/01900692.2014.903267

Internal Customer Satisfaction in Health-Care Organizations:A Multicriteria Analysis Approach

Panagiotis Manolitzas, Vasileios Fortsas, Evangelos Grigoroudis,and Nikolaos Matsatsinis

Decision Support Systems Laboratory, Technical University of Crete, Crete, Greece

The main aim of the presented research is to assess personnel satisfaction at the GeneralHospital of Chania (GHC), Greece, during the current economic crisis period. Data analysis isbased on the MUltiplecriteria Satisfaction Analysis (MUSA) method, which is a multicriteriaanalysis model for collectively measuring customer satisfaction. The provided results are ableto evaluate quantitative overall and partial satisfaction levels and determine the weak and strongpoints of employee satisfaction. According to the presented results, the personnel of the GHCappear to be satisfied, particularly regarding the work content and the relation with co-workers,while higher dissatisfaction may be observed in other characteristics. The improvement actionsshould be focused on the provided means/tools, the salary/other benefits, and the organiza-tion’s human resources management, given that these are the characteristics having the lowestsatisfaction indices, while at the same time being the ones that are really important for thepersonnel.

Keywords: personnel satisfaction, hospital, multicriteria analysis, MUSA method

INTRODUCTION

The increasing importance of human resources for businessorganizations is evident in modern management systems.Though these systems adopt different approaches, employ-ees are considered as internal customers of the organizationand employee satisfaction as an important driver for organi-zational success (Grigoroudis & Siskos, 2010).

Health-care organizations are facing the challenge torespond to the public demand for more effective health-careservices. Modern organizations in this domain, particularlythe private ones, try to provide health-care services takinginto account the criteria of cost and quality. During the lastdecades many health-care organizations conduct patient sat-isfaction surveys in order to study their strengths and weak-nesses. Besides patient satisfaction, another crucial factor forthe competitive operation of a hospital refers to the internalcustomer (i.e., hospital’s staff). This is justified by numerous

Correspondence should be addressed to Panagiotis Manolitzas,Technical University of Crete, Chania, Crete 73100, Greece. E-mail:pmanol@gmail.com

recent researches that show that employee satisfaction can belinked to customer satisfaction, since employees’ perceptionof service quality positively relates to both job satisfactionand employee self-perceived service capability (Grigoroudis& Siskos, 2010). The linkage between internal and externalcustomer satisfaction is characteristically illustrated in thecycle of good service proposed by Schlesinger and Heskett(1991).

The main aim of the paper is to measure and analyzeemployee satisfaction in the General Hospital of Chania(GHC), Greece using multicriteria analysis. In particular, theMUltiplecriteria Satisfaction Analysis (MUSA) method isused in order to analyze satisfaction data. The main advan-tage of the method is its ability to handle qualitative (ordinal)data, while, at the same time, providing a complete set ofresults that are sufficient enough to analyze in detail thesatisfaction evaluation problem. The presented results arefocused on the assessment of employee satisfaction in theexamined health-care organization and the determination ofthe strengths and weaknesses of its human resources man-agement (HRM). Therefore, the hospital is able to havea clearer view of the personnel’s perceptions and developpolicies in order to improve their satisfaction.

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INTERNAL CUSTOMER SATISFACTION IN HEALTH-CARE ORGANIZATIONS 647

LITERATURE REVIEW

Employee satisfaction is probably the most frequently stud-ied concept in organizational sciences. It is defined as anemployee’s general attitude toward his/her job (Robbins& Coulter, 1996), a pleasurable or positive emotional stateresulting from the appraisal of one’s job or job experiences(Locke, 1976), or an affective (emotional) reaction to one’sjob, resulting from the incumbent’s comparison of actualoutcomes with those that are desired, expected, or deserved(Cranny, Smith, & Stone, 1992).

Regarding the health-care sector, numerous studies thatassess the satisfaction of hospital staff may be found in thecurrent literature. Many of these studies reveal the positiverelation between job satisfaction and quality of patient care,while there is also a relation between quality of care andleadership (Aiken, Smith, & Lake, 1994; Norrish & Rundall,2001). Sibbald, Bojke, and Gravelle (2003) argue that theproportion of general practitioners intending to quit directpatient care in the next 5 years rose from 14% in 1998 to22% in 2001. Furthermore, their research shows that that themost important factors in order to quit are the increased age,the job dissatisfaction, the family status (i.e., have no chil-dren under 18 years of age), and the ethnic minority status.Similarly, the most important factors for physician satisfac-tion are their income and the relationships with other col-leagues, like nurses and administrative staff (Konard, 1999;Landon, Reschovsky, & Blumenthal, 2003; Mello et al.,2004). In order to measure employee satisfaction in health-care organizations, other researchers take into account addi-tional factors, like satisfaction with resources, autonomy,relationships with patients, pay, status, and flow of work(Ben-David, 1958; Demlo, 1975; Mechanic, 1972, 1975).

In this context, physicians’ satisfaction is a crucial factorfor the operational development of a health-care organiza-tion. Lower satisfaction levels may negatively affect the qual-ity of the provided health-care services (Gazewood & Longo,2000; Stoddard, Hargraves, & Reed, 2001; Williams &Skinner, 2003; Zuger, 2004). Therefore, physicians’ satisfac-tion may affect the way health care is delivered, along withthe health status and the satisfaction of patients (Blendon,Schoen, & Donelan, 2001; Demlo, 1975). According to oth-ers studies, job dissatisfaction is the most import factorthat may lead a general practitioner to resign (Lichtenstein,1984; Mein et al., 2000; Sibbald et al., 2003; Sibbald, Enzer,Cooper, Rout, & Sutherland, 2000). In this context, Bovierand Perneger (2003) developed a 17-item instrument, whichaims to evaluate five main satisfaction factors: patient care,work related burden, income, relation with colleagues, andpersonal rewards. The results of this research reveal that themost critical factors for physician satisfaction are the profes-sional relationships and the personal rewards. Other studiesin this area focus on describing changes in career satisfac-tion and examining market and practice factors associatedwith changes in physician satisfaction (Landon et al., 2003).

Extensive research shows that factors like income have asignificant impact on dissatisfaction of physicians (Pathmanet al., 2002), while Mechanic (2003) notes that the majorityof physicians are satisfied with their careers. On the otherhand, several researchers argue that physicians with special-ties in geriatric medicine, dermatology, and pediatrics aremore satisfied than physicians with other specialities (Leigh,Kravitz, Schembri, Samuels, & Mobley, 2002).

Similarly, nursing personnel may significantly contributeto the operational development of a health-care organizationand the promotion of health-care services, and thus it canbe considered as an important factor for the efficiency of ahealth-care organization. In their study, Sjogren, Fochsen,Josephson, and Lagerstrom (2005) show that the workingcondition and the income are the most critical factors fornurses’ retention. It should be noted that in some coun-tries, like the USA, excessive paperwork, such as billingmany different insurance companies for payment, and fear ofmalpractice litigation are important reasons for job dissatis-faction for doctors. In order to measure nurses’ satisfaction,several researchers examine additional factors, like interac-tion with co-workers or patients, leadership styles, organi-zational policies, recognition, self-growth and promotion,stress, work load, variation in work hours, and demographicvariables (Adams & Bond, 2000; Aiken et al., 2001; Best &Thurston, 2004; Blegen, 1993; Flanagan & Flanagan, 2002;Hoffman & Scott, 2003; Lee, 1998; Lundh, 1999; Nolan,Brown, & Naughton, 1998; Nolan, Nolan, & Grant, 1995;Price, 2002; Shader, Broome, Broome, West, & Nash, 2001;Stamps, 1997; Tzeng, 2002a, 2002b; Upnieks, 2003).

The aforementioned studies reveal the importance of mea-suring employee satisfaction in a continuous improvementcontext for a health-care organization. Furthermore, thesestudies may identify the most important employee satis-faction dimensions that should be considered in a relevantsurvey.

SCOPE OF RESEARCH AND SATISFACTIONCRITERIA

The scope of the presented study is to evaluate the person-nel’s satisfaction of the GHC “St. George.” The hospitalis situated on the outskirts of the city of Chania (Greece),near Mournies village. It was established in 2000 and hasa capacity of 465 beds. The total operating departments are36 that are developed in 50,000 m2 of covered space. Thehospital is a General Public Health Unit, providing first andsecond degree health care to the residents of the prefecture ofChania. In an annual basis, the GHC has more than 100,000emergency patient visits and 120,000 external patient visitsfor medical exams, while the total number of inpatient visitsis 25,000 and the number of surgeries is about 5500.

The mission of the GHC includes the following: (i) healthpromotion and medical coverage of first and second degree

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648 MANOLITZAS ET AL.

health care, equivalently for all citizens, independently fromtheir economic, social, and professional status according tothe rules of the National Health System, (ii) growth and pro-motion of medical research, and (iii) application of medicalspecialization programs, continuous education of doctors, aswell as specialization and training of other smaller healthunits in the prefecture of Chania.

The presented survey was conducted between March andJune 2011. It should be emphasized that the aim of the studyis to evaluate employee satisfaction during a period char-acterized by the current economic recession. As a result,the main finding should help the GHC’s management todevelop improvement actions that take into account resourcelimitations.

The main satisfaction dimensions considered in thestudy include the following: (1) work content, (2) workenvironment (workplace, safety, etc.), (3) work condi-tions (working hours, workload, etc.), (4) provided means/tools (e.g., medical devices), (5) salary and other bene-fits, (6) potential of personal development, (7) training, (8)communication/updating (e.g., access to necessary informa-tion, communication with other departments or the hospital’smanagement), (9) relation with co-workers, and (10) per-sonnel management policy. Table 1 presents the previoussatisfaction criteria, along with relevant references fromprevious studies.

The hospital’s personnel expressed their satisfaction pref-erences using a five-point Likert scale (dissatisfied, some-what dissatisfied, neither satisfied nor dissatisfied, somewhatsatisfied, satisfied). After the required validity tests, thefinal sample consists of 215 questionnaires. Regarding theprofile of the sample, 39.8% belongs to the medical staff(physicians), 35.2% to the nursery staff (nurses), 22.7%to the administrative staff, while the remaining 2.3% tothe technical staff (technicians), as shown in Figure 1.Concerning the working experience, the majority of thepersonnel has a working experience of more than 5 years(58.3%), 31.9% has an experience ranging from 1 to 5 years,

Medical39.81%

Nursery35.19%

Administrative22.69%

Technical2.31%

FIGURE 1 Personnel categories.

up to 1 year9.72%

1 to 5 years31.94%

more than 5years

58.33%

FIGURE 2 Working experience.

while it is important to note that only 9.7% has a workingexperience which is less than a year (Figure 2).

THE MUSA METHOD

The MUSA method is a multicriteria approach that has beendeveloped in order to measure and analyze customer satis-faction (Grigoroudis & Siskos, 2002; Siskos, Grigoroudis,

TABLE 1Satisfaction Criteria

Criteria Authors

Work content Ben-David (1958), Demlo (1975), Mechanic (1975), Mechanic (2003)Work environment Sibbald et al. (2003), Sjorgen et al. (2005), Adams and Bond (2000), Lee (1998), Lundh (1999), Nolan et al. (1995),

Price (2002), Tzeng (2002a, 2002b), Tovey and Adams (1999), Kuhar, Miller, Spear, Ulreich, and Mion (2004)Work conditions Mello et al. (2004), Konard (1999), Landon (2003), Sjogren et al. (2005), Adams et al. (2000), Nolan et al. (1995),

Tzeng (2002a, 2002b), Tovey and Adams (1999), Penz et al. (2008), Kuhar et al. (2004), Adamson, Kenny, andWilson-Barnett (1995), Tourangeau, Cummings, Cranley, Ferron, and Harvey (2010)

Provided means/tools Ben-David (1958), Demlo (1975), Mechanic (1972, 1975), Blendon et al. (2001)Salary and other benefits Mello et al. (2004), Konard (1999), Landon et al. (2003), Sjogren et al. (2005), Aiken et al. (2001), Nolan et al.

(1995), Price (2002), Tzeng (2002a, 2002b), Kuhar et al. (2004), Adamson et al. (1995), Tourangeau et al. (2010)Potential of personal development Bovier and Perneger (2003), Mechanic (2003), Aiken et al. (2001), Lundh (1999), Nolan et al. (1998), Price (2002)Training Aiken et al. (2001), Lundh (1999), Nolan et al. (1998), Price (2002Communication/updating Ben-David (1958), Demlo (1975), Mechanic (1972, 1975)Relation with co-workers Sibbald et al. (2003), Mello et al. (2004), Konard (1999), Landon et al. (2003)Personnel management policy Bovier and Perneger (2003)

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Zopounidis, & Saurais, 1998). The method is used for theassessment of a set of marginal satisfaction functions insuch a way that the global satisfaction criterion becomes asconsistent as possible with customers’ judgments. Thus, themain objective of the method is the aggregation of individualjudgments into a collective value function.

The MUSA method assesses global and partial satis-faction functions Y∗ and X∗

i respectively, given customers’ordinal judgments Y and Xi (for the ith criterion). Theassumption of an additive utility model is the main principalof the method, and it is represented by the following ordinalregression analysis equation:

Y∗ =n∑

i=1

biX∗i − σ+ + σ− (1)

where Y∗ is the estimation of the global value function Y∗,n is the number of criteria, bi is a positive weight of the ithcriterion, σ+ and σ− are the overestimation and the underes-timation errors, respectively, and the value functions Y∗ andX∗

i are normalized in the interval [0,100].In this context, the customer satisfaction measurement

problem may be formulated as an optimization problemusing goal programming techniques, and thus, the estima-tion model can be written in a linear programming (LP)formulation, as follows:

⎧⎪⎪⎪⎪⎪⎪⎪⎪⎪⎪⎪⎪⎪⎪⎪⎨⎪⎪⎪⎪⎪⎪⎪⎪⎪⎪⎪⎪⎪⎪⎪⎩

[min] F =M∑

j=1σ+

j + σ−j

subject ton∑

i=1

xji−1∑

k=1wik −

yj−1∑m=1

zm − σ+j + σ−

j = 0 for j = 1, 2, . . . , M

α−1∑m=1

zm = 100

n∑i=1

αi−1∑k=1

wik = 100

zm, wik, σ+j , σ−

j ∀ m, i, j, k(2)

where M is the size of the customer sample, while yj and xji

are the jth level on which variables Y and Xi are estimated(i.e., global and partial satisfaction judgments of the jth cus-tomer). Furthermore, the following transformation equationsare used for the decision variables of LP (2):

{ zm = y∗m+1 − y∗m for m = 1, 2, . . . , α − 1wik = bix

∗k+1i − bix∗k

i for k = 1, 2, . . . , αi − 1and i = 1, 2, . . . , n

(3)

where y∗m is the value of the ym satisfaction level, x∗ki is the

value of the xki satisfaction level, and α and αi are the number

global and partial satisfaction levels.

The MUSA method includes also a post-optimality analy-sis stage in order to overcome the problem of model stability.The final solution is obtained as the average of the near opti-mal solutions of LP (2), which maximize the weights of then satisfaction criteria (Grigoroudis & Siskos, 2002).

An analytical development of the method is given byGrigoroudis and Siskos (2002, 2010) while several realworld applications can be found in Mihelis, Grigoroudis,Siskos, Politis, and Malandrakis (2001), Grigoroudis, Politis,and Siskos (2002), and Grigoroudis and Siskos (2003).

The MUSA method is able to provide a large numberof results that are sufficient enough to analyze in detail thesatisfaction evaluation problem. One of the most importantresults of the method refers to the criteria weights bi, whichrepresent the relative importance of the assessed satisfactioncriteria (value trade-offs among the criteria). The methodalso provides a series of normalized indices that may helpthe analysis of the satisfaction measurement problem. Themost characteristic example refers to the average satisfactionindices, which show, in the range 0–1, the level of customers’overall or marginal satisfaction; they may be considered asthe basic average performance indicators (globally or percriteria) for the business organization.

Moreover, in the context of the MUSA method, a seriesof action diagrams may be developed, based on the afore-mentioned results. These “Performance/Importance” dia-grams are developed through the combinations of criteriaweights and satisfaction indices (Figure 3); they are simi-lar to Strengths-Weaknesses-Opportunities-Threats (SWOT)analysis and may represent the strong and the weak pointsof the business organization, indicating which satisfactiondimensions should be improved.

It should be noted that these diagrams are rather dynamic,since they are able to illustrate only the current situation ofinternal/external customer behavior. As shown in the pre-sented application, changes in the environment may stronglyaffect customer preferences and expectations, and modifythe identification and prioritization of critical satisfactiondimensions.

RESULTS AND COMMENTS

The results of the descriptive statistics show that the overallsatisfaction level of the personnel is rather low, given that themajority of personnel was neither satisfied nor dissatisfied(34.9%), 29.8% of the sample was rather dissatisfied, andonly 6% answered that they are satisfied.

Regarding the satisfaction criteria, the most importantfindings can be summarized as follows:

• For the criterion of work content, the majority of thepersonnel (32.6%) answered that they are satisfied,while only 2.3% were dissatisfied.

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Transfer resources(high performance/low importance)

Leverage opportunity(high performance/high importance)

Company’s resources may bebetter used elsewhere

They may be used as advantageagainst competition

Status quo(low performance/low importance)

Generally, no action is required

Action opportunity(low performance/high importance)

These criteria need immediateattention

Low High

Hig

hL

ow

IMPORTANCE

PER

FOR

MA

NC

E

FIGURE 3 Action diagram.

TABLE 2Weights and Average Satisfaction Indices

Average satisfaction indices (%)

Criteria Weight (%) All employees Medical personnel Nursing personnelAdministrative–technical

personnel

Work content 6.3 79.58 83.60 78.38 74.03Work environment 6.3 71.20 70.72 72.72 69.87Work conditions 7.6 33.91 33.38 33.68 35.21Provided means/tools 14.6 15.82 15.49 12.83 20.70Salary and other benefits 11.1 12.25 14.18 9.87 12.19Personal development 7.5 26.54 27.96 22.64 29.58Training 9.2 26.51 26.67 26.68 26.00Communication/updating 9.8 28.73 31.01 23.22 32.52Relations with co-workers 7.1 87.23 88.01 90.33 81.37Personnel management policies 20.5 14.78 12.31 13.61 20.93Overall satisfaction 31.48 21.18 28.24 36.05

• For the satisfaction dimensions related to the workenvironment and the work conditions, the majority ofthe personnel (28.8%) appears rather satisfied fromthe work environment, while a percentage of 13.5%answered that they are dissatisfied from the workconditions.

• Regarding the criterion of the relations with co-workers, the majority (43.7%) answered that they aresatisfied, while only a tiny 1.9% answered that they aredissatisfied.

• Concerning the dimensions of salary and personnelmanagement policy, the majority of the personnelappears dissatisfied or rather dissatisfied (35% and33%, respectively).

• As regards the personnel training, only 8.4% of respon-dents answered that they are satisfied.

• Finally, for the criteria of provided means/tools andpersonal development, the majority of employeesanswered that they are neither satisfied nor dissatisfied(3.02% and 30.7%, respectively), while a tiny percent-age answered that they are satisfied (7.4% and 7.9%,respectively).

Table 2 shows the main results of the MUSA method,where it may observed that the overall satisfaction levelfor the personnel is very low, having an average index of31.4%. Regarding the satisfaction criteria, the personnelis quite satisfied, according to the results of the averagesatisfaction indices, from the work content, the relations withco-workers, while the work environment appears to have alower satisfaction level. Significantly low satisfaction levelsappear for the dimensions related to the work conditions, the

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INTERNAL CUSTOMER SATISFACTION IN HEALTH-CARE ORGANIZATIONS 651

salary, the provided means, the personal development, thetraining, the communication, and the personnel managementpolicy.

Regarding the importance of the satisfaction criteria, itis clear that the employees consider really significant thecriteria of personnel management policies (with a weightof 20.5%), as well as the provided means/tools and thesalary (with weights ranging from 11% to 14%). On theother hand, lower levels of importance appear for the sat-isfaction dimensions of the work environment, content andconditions, the personal development, as well as the relationswith co-workers (weights range from 6% to 7.5%).

Segmentation analysis has also been performed in orderto obtain a clear view about the satisfaction of different per-sonnel groups and identify particular employee clusters withdistinctive preferences and expectations in relation to thetotal set. In particular, the average satisfaction indices havebeen calculated for three employee groups: medical, nurs-ing, and administrative/technical personnel. As shown inTable 2, the overall satisfaction of physicians and nurses islower compared to the administrative and technical person-nel. This finding is mainly justified by the lower satisfactionlevels observed for the criterion of personnel managementpolicies in the case of medical and nursing staff. Thiscriterion, as already mentioned, is the most important sat-isfaction characteristic. Furthermore, the comparative anal-ysis of the employee satisfaction results may reveal thefollowing:

• The administrative/technical personnel is less satisfiedin the criterion of relation with co-workers comparedto the other employee groups. However this particu-lar characteristic appear to have the highest averagesatisfaction index for all employee types.

• Regarding the criteria of communication/updating andpersonal development, the nursing personnel seems tobe less satisfied, although all employees have signifi-cantly low satisfaction levels.

• It seems that the nursing personnel is more satisfiedthan other employees with regard to the criterion ofwork environment. Similarly, the medical personnelis more satisfied than the other groups regarding thecriterion of work content. In general, the aforemen-tioned criteria appear to have relatively high averagesatisfaction index for all employees.

• Although the characteristics of salary/other benefitsand means/tools have overall the lowest average sat-isfaction indices, physicians appear more satisfiedcompared to nurses for the first criterion, while theadministrative/technical staff is more satisfied com-pared to nurses for the second criterion.

• Finally, there are no significant differences in thethree employee groups regarding the average satis-faction indices for the criteria of training and workconditions.

Per

form

ance

ImportanceHighLow

Hig

hL

ow

Personal development

Work conditions

Training

Work content

Communication/updating

Relations with co-workers

Personnelmanagement

policies

Work environment

Salary andother

benefits

Provided means/tools

FIGURE 4 Relative action diagram for the GHC.

The previous differences show that the nursing personnel ismore satisfied with criteria that are relevant with the gen-eral working conditions, while the medical personnel appearmore satisfied with their job, taking into account factors likecontent, salary, and development.

The action diagram of the study clearly shows that thereis a significant gap regarding the examined personnel sat-isfaction (Figure 4), that is, the characteristics which thepersonnel considers most important have the lowest satisfac-tion level, while those that the personnel is rather satisfiedhave lower weights. The main findings of Figure 4 maysummarized in the following:

1. The criteria of salary, provided means/tools, and per-sonnel management policy are in the action opportu-nity quadrant, given the fact that they have relativelylow performance and high importance. These partic-ular criteria should be improved, since they play animportant role in the improvement of the personnelsatisfaction.

2. The criteria in the status quo quadrant are those of thework conditions, the personal development, as well asthe training (the criterion of communication/updatingis marginally located in this quadrant). These charac-teristics, despite the fact that they do not have a highlevel of importance, they can be considered potential“threats” due to the fact that the personnel satisfactionis low.

3. Criteria such as the work content and the environment,as well as the relations with co-workers, are in thetransfer resources quadrant. These characteristics arenot considered important by the personnel, despite thefact that they have relatively high levels of satisfaction.

4. It should be noted that there are no strong points,meaning that there are no satisfaction characteristicsin the leverage opportunity quadrant (high importanceand high performance).

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CONCLUSIONS AND DISCUSSION

The scope of the presented study is the satisfaction evalua-tion of the level of the GHC, the identification of the strongand weak points of the personnel satisfaction, and the deter-mination of possible improvement actions. Furthermore,through personnel segmentation analysis, the study identi-fies particular employee groups with distinctive preferencesand expectations.

The analysis of satisfaction data is based on the MUSAmethod, which is a multicriteria analysis approach. Themain advantage of the method is its ability to handle qual-itative (ordinal) information. Moreover, the results include,among others, criteria weights (importance of satisfactiondimensions), average satisfaction indices (performance ofsatisfaction dimensions), and action diagrams (categoriza-tion of the characteristics, aiming at the determination ofpotential improvement actions). It should be noted that forthe examined satisfaction evaluation problem, multicriteriadecision analysis has been applied in a very limited numberof studies (Grigoroudis & Siskos, 2010).

The analytical results of the presented study confirmthe importance of measuring employee satisfaction in thehealth-care industry and the influence of the economicenvironment in the HRM practices. More specifically, thefindings presented in the previous section show that the over-all employee satisfaction level is very low, mainly becauseof the higher dissatisfaction appearing in the criteria ofsalary/benefits and provided means/tools. It is importantto note that these characteristics are related to the hospi-tal’s resources and the dissatisfaction observed is somewhatexpected, since the survey conducted during the current eco-nomic recession in Greece that affects resource availabilityin public hospitals.

However, high dissatisfaction is also observed inother characteristics that are related to the general HRMpractices of the organization, like personal development,communication/updating, and training. This means thatdespite resource unavailability, there are significant improve-ment margins in specific employee satisfaction dimensions.In this context, several previous research efforts emphasizethe importance of educational programs for improving thehospital personnel, taking into account factors like commu-nication, usage of new technologies, etc. For example, Sarris,Pierrakos, Amitsis, Kyriopoulos, and Soulis (2006) study thequality and the effectiveness of life long vocational trainingprograms in health-care sector. Their analysis reveals thatthe improvement of employee satisfaction should be focusednot only on the implementation of training programs,but also on the quality of theses programs, taking intoaccount several factors, like program structure, skills, scopeof the program, and the qualifications of the instructors.Regarding the criterion of communication, in which GHC’semployees appear rather dissatisfied, we should emphasize

its importance and contribution to the effectiveness of theprovided health-care services. According to Bitsiori (2013),the effective communication contributes significantly toreducing errors in health-care services, increasing patients’satisfaction, and moreover providing high quality health-careservices.

On the other hand, the personnel appears rather satisfiedregarding the criteria of the relation with co-workers, thework content, and, in a smaller degree, the work environ-ment. Taking into account the previous findings, the man-agement of the hospital should focus potential improvementactions primary not only on the criteria of salary/benefitsand provided means/tools, which may require additionalresources that nowadays are unavailable, but also on thecharacteristics of communication, training, and HRM poli-cies. Moreover, the satisfaction analysis performed for thedifferent types of employees may give additional specificimprovement actions regarding the medical, nursing, andadministrative/technical personnel.

Another important finding of the study is the “gap”regarding the preferences/expectations and the perceptionsof the personnel, that is, what employees want and whatthey get. In particular, as shown in the action diagram, theemployees of the GHC are less satisfied from the mostimportant criteria (e.g., salary and other benefits, providedmeans/tools, personnel management policies), while theyappear to have relatively higher satisfaction levels from cri-teria that comparatively are not considered very important(e.g., work content, work environment, relations with co-workers). This indicates the inefficiency of the applied HRMpolicies.

Future research in the context of the presented studyshould focus on the establishment of a permanent employeesatisfaction barometer. Given the rapid changes of the eco-nomic environment and the labor market, this tool mayhelp the hospital’s managers not only to have a clear viewof the satisfaction level of employees, but also to developpolicies that may improve HRM practices. In addition, anemployee satisfaction barometer may evaluate the effective-ness of HRM improvement plans. In any case the presentedapproach may be considered as a decision tool for themanagement of the hospital.

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