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THE ROLE OF CLINICAL INSTRUCTION AS HIGH-INVOLVEMENT WORK

SYSTEMS IN IMPROVING JOB SATISFACTION

OF PHYSICAL THERAPISTS

Doctoral Dissertation Research

Submitted to the Graduate Faculty of

Argosy University, Phoenix Campus

Graduate School of Business and Management

In Partial Fulfillment

of the Requirements for the Degree of

Doctor of Education

Organizational Leadership

Bini Thomas

January, 2019

THE ROLE OF CLINICAL INSTRUCTION AS HIGH-INVOLVEMENT WORK

SYSTEMS IN IMPROVING JOB SATISFACTION

OF PHYSICAL THERAPISTS

Bini Thomas

iii

THE ROLE OF CLINICAL INSTRUCTION AS HIGH-INVOLVEMENT WORK

SYSTEMS IN IMPROVING JOB SATISFACTION

OF PHYSICAL THERAPISTS

Doctoral Dissertation Research

Submitted to the Graduate Faculty of

Argosy University, Phoenix Campus

Graduate School of Business and Management

In Partial Fulfillment

of the Requirements for the Degree of

Doctor of Education

Organizational Leadership

Bini Thomas

Dissertation Committee Approval:

Dale Mancini, Ph.D., Chair Date

Katherine Noone, Ed. D., Member

Dale Mancini, Ph.D., Department Chair

ABSTRACT

Satisfied and committed clinical instructors enhance educational experiences for their

students. High-performance work systems provide employees with additional

opportunities that improve motivation and job satisfaction through engagement,

empowerment, autonomy, and meaningfulness of work. Understanding the factors that

motivate physical therapists to become clinical instructors could help leaders to prevent

future workforce shortages and could facilitate work quality and productivity. This

quantitative study examined the relationship between job satisfaction and a high-

performance work system consisting of clinical instruction in physical therapy

professionals in the state of Florida. The study examined the role of clinical instruction

as a high-performing function providing intrinsic motivation, using the Minnesota Job

Satisfaction Questionnaire short form. The results showed that there was a significant

increase in job satisfaction for staff physical therapists when they were assigned the

additional responsibility of clinical instruction. The results also provided validation in

designating the clinical instructor role, its individualistic nature, and subsequently its

theorized definition as a high-performance work system that increases overall job

satisfaction among physical therapists. Physical therapists were more likely to display

increased satisfaction when challenging, meaningful, and rewarding tasks were assigned.

Situational leadership may be useful for leaders to facilitate job satisfaction in physical

therapists. Further research is recommended to identify the high-performance work

system tasks leading to job satisfaction specific to managerial roles. Further research to

analyze similar high-performance work system functions such as management, clinical

leadership, and administrative leadership in physical therapy is also recommended.

ACKNOWLEDGEMENT

Several people have assisted me in completing this dream of mine. I would like

to acknowledge some of them here.

I thank God for bringing me this far and for showing me that every weakness I

have in me is an opportunity for God to strengthen me. My help came from you, the

maker of heaven and earth.

My heartfelt appreciation to my dissertation chair, Dr. Dale Mancini, for letting

me run with my ideas and for never holding me back. Your wisdom, guidance, and

promptness made me get to this point much quicker than I had anticipated. I would like

to thank my committee member, Dr. Katherine Noone, for asking the right questions that

got me thinking from all angles. Thank you, Dr. James Liddy, for your guidance with

statistical analysis and Dr. Dan Kirkpatrick for your editorial support.

I acknowledge my family for supporting me and for being understanding when I

did not have a lot of time. Thank you to my friends, Dr. Kline and Dr. Knettle, for

encouraging me and guiding me through this process. I owe my gratitude to my students

for making me think about different aspects of clinical instruction. I am very thankful to

all physical therapists and physical therapist assistants who have inspired me to take a

closer look at job satisfaction.

To my middle school teacher, who later became my mother-in-law, Mrs.

Marykutty Thomas, you are one of the best teachers I have ever had! You have inspired

me to be in academia, and I thank you for that.

DEDICATION

To the three most important people in my life:

My father Francis: Pappa, you have held me high, and have never let me go, even

when I had failed you miserably. Your silent strength and unwavering love were just

what I needed. You encouraged me to become self-reliant and independent. I love you

and I miss you and I wish you were here to see this.

My mother Susamma: Mommy, you have showed me the value of perseverance

and determination. You continue your fight with such grace and inner strength, which is

a constant reminder of how trivial my challenges are when compared to yours. Thank

you for being a great role model.

My husband Sathish: Ichaya, you are my love and my life. You have provided

me inspiration and encouragement to pursue education. I have never met anyone with as

many degrees as you have! Thank you for all your help at home, when I had immersed

myself in schoolwork. Thank you for the gentle and not-so-gentle reminders that I had to

focus and study. Thank you for the lessons in statistics and for letting me get mad at you

when I did not grasp the concepts. Thank you for standing by me, for all the sacrifices

that you have made, and above all, thank you for your love. You have given me all that I

could never dream of. You are the best thing that has happened to me and I cherish our

life together. Finally, I DO have time to go out and celebrate!

vii

TABLE OF CONTENTS

Page

LIST OF TABLES ......................................................................................................................... ix

LIST OF FIGURES .........................................................................................................................x

CHAPTER ONE: INTRODUCTION ..............................................................................................1 Background of the Study ................................................................................................................ 3 Purpose of the Study ....................................................................................................................... 6

Statement of the Problem ................................................................................................................ 7 Research Questions and Hypotheses .............................................................................................. 7 Research Methodology ................................................................................................................... 9

Significance of the Study to Physical Therapists .......................................................................... 10 Operational Definitions for the Study ........................................................................................... 10 Conclusion .................................................................................................................................... 12

CHAPTER TWO: REVIEW OF THE LITERATURE .................................................................14

Theoretical Background and Framework ...................................................................................... 15 Hackman and Oldham Job Characteristics Model ........................................................................ 16

Maslow’s Hierarchy of Needs Theory .......................................................................................... 18 Situational Leadership Theory and HIWS .................................................................................... 18

Motivation ..................................................................................................................................... 20 Motivation and Job Satisfaction.................................................................................................... 22

Job Satisfaction ............................................................................................................................. 23 Need for Leaders to Establish Job Satisfaction............................................................................. 23 Contributors to Job Satisfaction .................................................................................................... 24

Deterrents to Job Satisfaction ....................................................................................................... 28 Positive Outcomes of Job Satisfaction in an Organizational Environment .................................. 30

Physical Therapy Profession ......................................................................................................... 32 Physical Therapy Education ......................................................................................................... 35

Clinical Education in Physical Therapy ........................................................................................ 36 Role of Clinical Instructors in Physical Therapist Education ....................................................... 37

Importance of Developing Clinical Instructors ............................................................................. 38 Collaboration in Clinical Education for Job Satisfaction and Job Performance ........................... 39 High-Performance Work Systems ................................................................................................ 40 Employee Engagement and Organizational Effectiveness of HPWS ........................................... 42 High-Involvement Work Systems in HPWS ................................................................................ 42

Clinical Instruction as HIWS ........................................................................................................ 43 Gaps in Literature for HIWS and Clinical Instruction .................................................................. 45 Conclusion .................................................................................................................................... 46

CHAPTER THREE: METHODOLOGY ......................................................................................48 Purpose of the Study ..................................................................................................................... 48 Establishment of the Research Questions ..................................................................................... 49 Research Method and Design ....................................................................................................... 51

viii

Research Instrument...................................................................................................................... 53 Sampling Method .......................................................................................................................... 55 Inclusion and Exclusion Criteria ................................................................................................... 56 Selection Procedure ...................................................................................................................... 56

Data Collection ............................................................................................................................. 57 Data Processing and Analysis ....................................................................................................... 59 Confidentiality .............................................................................................................................. 60 Conclusion .................................................................................................................................... 61

CHAPTER FOUR: RESULTS ......................................................................................................62

The Characteristics of the Sample ................................................................................................ 64 Demographics ............................................................................................................................... 65

Statistical Analysis ........................................................................................................................ 72 Research Question One ................................................................................................................. 77 Research Question Two ................................................................................................................ 79 Research Question Three .............................................................................................................. 82

Findings......................................................................................................................................... 83

CHAPTER FIVE: DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS ...............86

Summary of Findings .................................................................................................................... 87 Research Hypotheses .................................................................................................................... 87

Conclusions and Implications ....................................................................................................... 90 Limitations and Delimitations ....................................................................................................... 93

Recommendation for Further Research ........................................................................................ 95 Conclusion and Remarks .............................................................................................................. 96

REFERENCES ..............................................................................................................................98

APPENDICES .............................................................................................................................110 Appendix A. MSQ Short Form .................................................................................................. 111

Appendix B. Informed Consent ................................................................................................. 122

LIST OF TABLES

Table 1. The MSQ Short Form ......................................................................................................54

Table 2. Item Statistics ...................................................................................................................69

Table 3. Descriptive Statistics........................................................................................................70

Table 4. Descriptive Statistics for Groups of Interests ..................................................................71

Table 5. One-Way Analysis of Variance .......................................................................................73

Table 6. Grouping Information Using the Tukey Pairwise and 95% CI .......................................74

Table 7. Analysis of Variance for Overall Job Satisfaction...........................................................75

Table 8. Analysis of Variance for Intrinsic Job Satisfaction .........................................................76

Table 9. Descriptive Statistics for the Two Groups .......................................................................83

Table 10. Estimation for Difference ..............................................................................................84

LIST OF FIGURES

Figure 1. Gender distribution .........................................................................................................65

Figure 2. Primary practice area ......................................................................................................66

Figure 3. How long have you been practicing as a PT? .................................................................66

Figure 4. Official title description ..................................................................................................67

Figure 5. Have you worked as a primary instructor in the past five years? ...................................67

Figure 6. Have you worked as a lead PT in the past five years? ...................................................68

Figure 7. Scatterplot of overall vs. intrinsic ...................................................................................72

Figure 8. Interval plot of being able t, the chance ........................................................................73

Figure 9. Main effects plot for overall data means ........................................................................76

Figure 10. Main effects plot for intrinsic data means ....................................................................77

Figure 11. Interaction plot for overall data means .........................................................................79

Figure 12. Interaction plot for intrinsic data means .......................................................................81

CHAPTER ONE: INTRODUCTION

Physical therapists are health care professionals who maintain, restore, and

improve movement, activity, and health enabling individuals of all ages to have optimal

functioning and quality of life while ensuring patient safety and applying evidence to

provide efficient and effective care (American Physical Therapy Association [APTA],

n.d). Physical therapists promote health, wellness, and fitness in addition to reducing risk

and slowing as well as preventing functional disabilities (APTA, 2018a). With the aging

population of Baby Boomers, the demand for physical therapy will be sustained through

the coming years to provide access to patients (Curtis & Newman, 2014).

During the course of physical therapy education, the students are required to

complete full-time clinical affiliations under a clinical instructor (CI), who is part of the

clinical community. Clinical education is an integral part of physical therapy education,

where students are placed in various clinical settings with a CI (Giberson, Black, &

Pinkerton, 2008; Pabian, Dyson, & Levine, 2017). The CI is responsible for facilitating

the integration of theoretical knowledge that the students acquired in the classroom into

contextual, social, and interactive skills (Greenfield et al., 2012; Hall, Poth, Manns, &

Beaupre, 2015; Plack, 2008). Under the supervision of the CI in the clinic, students

develop the skills, behaviors, and confidence necessary to enter the profession as entry-

level clinicians (Giberson et al., 2008; O’Brien et al. 2017). The CI also facilitates the

acquisition of new skills as well as professional integration and socialization by providing

supervision, evaluation, and feedback regarding the performance of the student in the

clinical setting (Hall et al., 2015).

It is critical that CIs are satisfied with what they do, and are motivated to

undertake students for clinical supervision (Hall et al., 2015). Uhl-Bien, Schermerhorn,

and Osborn (2014) defined job satisfaction as “an attitude reflecting a person’s positive

and negative feelings toward a job, co-workers, and the work environment” (p. 84).

Satisfaction with one’s profession can affect motivation at work, career decisions,

personal health, and relationships with others (Uhl-Bien et al., 2014). Stumpf, Tymon,

Favorito, and Smith (2013) cited that motivation is increased with meaningful work and

affects satisfaction, engagement, and commitment of employees.

High-performance work system (HPWS) is a group of work management

practices through additional involvement of employees in highly-demanding functions,

thereby improving competence and attitudes of the employee (Appelbaum et al., 2001;

Mao, Song, & Han, 2013). Ollo-López, Bayo-Moriones, and Larraza-Kintana (2016)

explained HPWS as a homogeneous set of mutually reinforcing practices that can

improve the abilities and motivation of a workforce and improve organizational

performance by providing them the opportunity to live up to their full potential.

Perceived organizational support and HPWS have a relationship, established through job

satisfaction, that resulted from the utilization of their own resources and skill set (García-

Chas, Neira-Fontela, & Varela-Neira, 2016).

Satisfied employees tend to be more productive and creative (Uhl-Bien et al.,

2014). There are studies regarding physical therapists (PTs) who work in different

settings (Alperovitch-Najenson, Treger, & Kalichman, 2014; Anderson, Gould-Fogerite,

Pratt, & Perlman, 2015) that identify the specific type of work setting that promotes job

satisfaction. There are studies that cite workload and other administrative policies as

factors leading to job satisfaction in PTs (AlEisa, Tse, Alkassabi, Buragadda, & Melama,

2015; Wittig, Tilton-Weaver, Patry, & Mateer, 2003). However, there is limited research

on the effect of HPWS as a factor for job satisfaction in PTs.

The initial chapter of this dissertation provides an overview of existing research

on the factors that contribute to job satisfaction for CIs in physical therapy. This chapter

also includes information about the background of the research study, objective of the

study, statement of the problem, the purpose of the study, research questions, hypotheses,

methodology, operational definitions, significance, and relevance of the study to physical

therapy, and the limitations of the study.

Background of the Study

The profession of physical therapy was established in the early 1900s during the

polio epidemic, consisting of reconstructive aids or technicians who worked under

physicians (Curtis & Newman, 2014; Moffat, 2003; Paglialuro, 2012). The education of

reconstructive aides evolved during World War I to a three-month training program in

massage and muscle reeducation to help soldiers and later evolved into professional

training for practitioners to become PTs in the 1950s (Curtis & Newman, 2014; Moffat,

2003; Paglialuro, 2012). Physical therapists have embraced additional responsibilities

such as supervision and delegation of support personnel and direct access for patients to

meet the changing needs of healthcare (Furze, Tichenor, Fisher, Jensen, & Rapport,

2016). Along with these changes, the educational preparation has transitioned from

baccalaureate degrees for PTs to entry-level post-baccalaureate degrees in the 1980s and

to a clinical doctorate in physical therapy in 1996 (Curtis & Newman, 2014; Furze et al.,

2016).

According to the most recent aggregate data report by the Commission on

Accreditation in Physical Therapy Education (CAPTE), 29% of the weeks in physical

therapy professional education are dedicated to clinical education and 45% of the total

contact hours in the professional education is spent in clinical education (CAPTE, 2018).

The evaluative criteria for accreditation of education programs for the preparation of PTs

and the normative model of physical therapist professional education emphasize the

importance of structuring high-quality clinical education experiences to ensure that

graduates of professional physical therapist education programs are clinically competent

upon graduation (Giberson et al., 2008). The adaptability of the student to the clinical

setting, and the ability of the CI to provide an optimal learning environment for the

student are factors that contribute to the student’s success as a clinician (O’Brien et al.,

2017).

Employment of PTs is projected to grow 28% from 2016 to 2026, much faster

than the average for all occupations (Bureau of Labor Statistics, 2018a). Landry et al.

(2016) projected an undersupply of between 25,000 and 46,000 PTs by the year 2020.

With the growing demand for PTs, there must be an adequate number of CIs who support

the learning experiences of physical therapy students. Therefore, it is crucial that the

clinical education component of physical therapy education is supported by leaders to

ensure that an adequate number of future clinicians graduate and enter the clinical arena.

It is critical that CIs are satisfied with what they do, and are motivated to

undertake students for clinical supervision. CIs that are satisfied and committed in their

job will enhance the educational opportunities for physical therapy students by being

good role models who mentor and educate competent future clinicians. Recker-Hughes,

Dungey, Miller, Walton, and Lazarski (2015) cited that the CI’s teaching skills, the

organizational culture, and the educational institution’s support can all influence the

quality of the clinical education. To thrive as a CI, employees must be in an environment

that supports the efforts exerted by the employee toward clinical education (Recker-

Hughes et al., 2015).

The CI role is considered as empowerment of an employee to extend his or her

ability beyond regular tasks, which is in alignment with the fundamental characteristic of

the function (Coleman-Ferreira, Millar, Fogg, & King, 2012). HPWS can be clarified as

an organizational architecture that brings work, people, and customer requirements

together, which facilitates an employee perception of enhanced outcome through

increased job satisfaction and intrinsic motivation (Choi, 2008). HPWS has an effect on

employee engagement and organizational effectiveness because of the multifaceted

intrinsic and extrinsic motivation developed by resource empowerment, employee

growth, and employee learning (Wadhwa, 2012). Mihail and Kloutsiniotis (2016)

examined HPWS with an individual-centric approach and termed it a high-involvement

work system (HIWS). In this research study, HPWS and HIWS terms are used

interchangeably in accordance with the contextual nature of the study to examine the

individual nature of clinical instruction.

Leaders in healthcare organizations must be cognizant of the benefits of creating

an environment that is conducive to clinical education (Recker-Hughes et al., 2015). This

helps leaders to understand what motivates physical therapy CIs to facilitate the

education of future clinicians, thus, preventing a shortage of the workforce. Job

satisfaction can affect a person’s motivation at work, career choices, productivity,

creativity, personal health, and their interpersonal relationships (Kumar, Ahmed, Shaikh,

Hafeez, & Hafeez, 2013; Warner, 2001). Leaders must realize that productivity and work

quality improve significantly when employees are satisfied and motivated (Muscalu &

Ciocan, 2016).

Different leadership styles employ diverse methods of motivation to ensure

employee satisfaction. It is of note that the situational style of leadership utilizes job

characteristics as a method of motivation and is relevant to this study. Situational

leadership, as presented by Northouse (2012), emphasized that the competence and

commitment of the followers direct the actions of the leader. Chatalalsingh and Reeves

(2014) supported leaders providing the followers autonomy and additional ways to utilize

their skills as their skill level progresses. O’Reilly, Matt, and McCaw (2014) cited that

situational leadership is based on leaders adapting their behavior based on the situation,

and the abilities, and maturity of the follower.

The supportive and delegating nature of situational leadership is best utilized in

CIs. HIWS provide opportunities for the situational leader to identify, support and

delegate to top performers and engaged employees (McCleskey, 2014; Thompson &

Glasø, 2015). Identifying HIWS tasks, leaders can serve as motivators for the followers

to gain job satisfaction and improve organizational outcomes.

Purpose of the Study

The purpose of this study was to examine whether there was a relationship

between job satisfaction and HPWS such as clinical instruction in physical therapy

professionals in the state of Florida. The study specifically addressed the role of clinical

instruction as a high-performing function providing intrinsic motivation. The intrinsic

and extrinsic factors related to job satisfaction of PTs in Florida were analyzed to identify

the effects of clinical instruction as a HPWS function affecting intrinsic job satisfaction

among PTs. A secondary purpose of the study was to identify if CIs in physical therapy

have increased job satisfaction.

Statement of the Problem

Interesting work is one of the main predictors of job satisfaction showing a

positive correlation with the overall job satisfaction (Warner, 2001). It is critical that CIs

in physical therapy are satisfied with what they do, and are motivated to undertake

students for clinical supervision (Hall et al., 2015). Upon review of the literature, a gap

in the literature was identified regarding the use of HPWS as a tool to enhance employee

engagement in clinical environments. Another gap in literature was identified specific to

the field of physical therapy and HPWS. There is no current literature on the job

satisfaction of CIs in physical therapy from a HPWS perspective.

Research Questions and Hypotheses

The development of a research question assists researchers with seeking

information related to specific variables related to a phenomenon of interest (Creswell,

2014). This quantitative study was guided by the following research questions and

hypotheses:

RQ 1: Is there a relationship between HPWS such as clinical instruction and

overall job satisfaction among PTs?

Hypothesis 1A

Ho: There is no significant relationship between HPWS such as clinical

instruction and overall job satisfaction among PTs.

Ha: There is a significant relationship between HPWS such as clinical instruction

and overall job satisfaction among PTs.

Hypothesis 1B

Ho: There is no significant relationship between HPWS such as clinical

instruction and overall job satisfaction among staff PTs

Ha: There is a significant relationship between HPWS such as clinical instruction

and overall job satisfaction among staff PTs.

RQ 2: What effect, if any, does clinical instruction as a HPWS have on intrinsic

job satisfaction among PTs?

Hypothesis 2A

Ho: There is no significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among PTs.

Ha: There is a significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among PTs.

Hypothesis 2B

Ho: There is no significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among staff PTs

Ha: There is a significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among staff PTs

RQ 3: Is there an increase in job satisfaction for CIs in physical therapy when

compared to PTs who are not assigned any HPWS function?

Ho: There is no increase in job satisfaction for CIs in physical therapy when

compared to PTs who are not assigned any HPWS function.

Ha: There is increased job satisfaction for CIs in physical therapy when compared

to PTs who are not assigned any HPWS function.

The independent variable in the study was clinical instruction, and the dependent

variables were overall and intrinsic factors of job satisfaction in PTs.

Research Methodology

In the research study, a non-experimental quantitative design using a survey

was employed. The quantitative approach utilizes measured knowledge, provides a

scientific estimate based on numbers, and allows the researcher to make inferences

(Creswell, 2014) based on the data about “trends, attitudes, or opinions of a population”

(p. 155). The study began with a broad survey to generalize results to a population.

Creswell (2014) emphasized an advantage to the survey method because of its

ability to correlate the variables during the implementation phase of the research. Robson

and McCartan (2015) credited the survey method with the advantages of anonymity,

economy, immediate availability of results, and a high degree of data standardization.

The disadvantages cited by the authors include low response rates, potential inaccuracy in

respondent reporting, and potential respondent bias.

The research instrument used for this study was the Minnesota Satisfaction

Questionnaire short form (MSQ). The survey instrument MSQ used in this research has

been well established as a quantitative method and enabled a statistical analysis and

conclusion (Weiss, Dawis, & England, 1967). Correlation analysis, analysis of variance

(ANOVA), and a t-test were conducted on the data that were collected via the survey

instrument. In this quantitative study, based on the data collected, the established

hypotheses helped to make assumptions, and thus, inferences regarding the research

questions (Creswell, 2014).

Significance of the Study to Physical Therapists

Future recruitment of students, professional development for staff, stronger

community relations with academic institutions, increased staff productivity, and

improved quality of care are some of the incentives for leaders to promote followers to

become CIs (Ojha, Snyder, & Davenport, 2014; Recker-Hughes et al., 2015). However, a

gap remains in identifying factors that lead to job satisfaction in CIs in physical therapy.

Research in this area may be helpful for leaders in physical therapy to find ways for

clinicians to become satisfied with their roles.

Research in this area may also help leaders to understand what motivates physical

therapy CIs to facilitate the education of future clinicians and enable them to be great CIs

who shape and mold future PTs, thus, preventing a shortage in the workforce. Leaders in

physical therapy may be able to identify job satisfaction factors among PTs, which leads

to organizational commitment and longevity. Additionally, physical therapy

organizations may benefit from this research through the engagement and commitment

from their employees through HPWS such as clinical instruction.

Operational Definitions for the Study

The following critical operational terms were part of this study and are defined

here:

 Acute care: hospitals, where physical therapy is provided to individuals, admitted

“due to illness, surgery, accident, or recovery from a trauma” (APTA, n.d., para.

6).

 Clinical education: an integral part of the physical therapy education, where

students are placed in clinical settings with a CI (Pabian et al., 2017).

 Clinical instructor (CI): the responsible clinician for facilitating the integration of

theoretical knowledge that the students acquired in the classroom into contextual,

social, and interactive skills (Hall et al., 2015).

 Clinical setting: the type of facility where the clinical affiliation of a physical

therapy student is completed under the supervision of a licensed physical

therapist.

 Extrinsic factors: rewards external to the job including financial incentives,

benefits, authority, company policies, recognition, responsibility, security, and

variety (Snelgar, Shelton, & Giesser, 2017; Uhl-Bien et al., 2014; Weiss et al.,

1967).

 Inpatient rehabilitation: a facility where physical therapy is provided to

individuals admitted to the rehabilitation unit for intense therapy to improve the

person’s ability to care for himself or herself” (APTA, n.d., para. 7).

 Intrinsic factors: rewards linked to ability utilization, achievement, activity,

advancement, compensation, co-workers, creativity, autonomy, moral values,

social status, and working conditions (Snelgar et al., 2017; Uhl-Bien et al., 2014;

Weiss et al., 1967).

 Job dissatisfaction: “feeling of not being satisfied with their job” (Ivanovic &

Collin, 2009, p. 147).

 Job satisfaction: “an attitude reflecting a person’s positive and negative feelings

toward a job, co-workers, and the work environment” (Uhl-Bien et al., 2014, p.

84).

 Leadership: “a process whereby an individual influences a group of individuals to

achieve a common goal” (Northouse, 2012, p. 5).

 Outpatient: facilities that are independent physical therapist private practice

offices, physicians’ offices, and rehabilitation agencies” (Curtis & Newman,

2014, p. 36).

 Physical therapists: health care professionals who maintain, restore, and improve

movement, activity, and health enabling individuals of all ages to have optimal

functioning and quality of life while ensuring patient safety and applying

evidence to provide efficient and effective care (APTA, 2018a).

 Physical therapy: a profession that has established a theoretical and scientific

base and widespread clinical applications in the restoration, maintenance, and

promotion of optimal physical function (Curtis & Newman, 2014).

 Skilled nursing facility: a facility where physical therapy is provided to “elderly

patients and individuals needing long-term nursing care, rehabilitation, and other

services” (APTA, n.d., para. 9).

Conclusion

Satisfaction with one’s profession can affect motivation at work, career decisions,

personal health, and relationships with others (Uhl-Bien et al., 2014). Satisfied

employees tend to be more productive and creative (Uhl-Bien et al., 2014). Interesting

work is one of the main predictors of job satisfaction showing a positive correlation with

overall job satisfaction (Warner, 2001).

Previous studies have concluded that the primary intrinsic motivators among PTs

were professional development and personal satisfaction in helping educate students.

This study intended to examine the relationship between job satisfaction and HPWS such

as clinical instruction in physical therapy professionals. The study specifically addressed

the role of clinical instruction as a high-performing function providing intrinsic

motivation.

A secondary purpose was to identify if CIs in physical therapy have increased job

satisfaction, and if so, the contributing factors for that. A gap exists in identifying

satisfaction factors for CIs as well as HPWS contributing to satisfaction in PTs. Chapter

One of this dissertation provides a rationale for this research study that examined the

relationship between job satisfaction and HPWS such as clinical instruction in physical

therapy professionals. The next chapter includes an extensive literature review on the

factors contributing to job satisfaction and the underlying theories upon which this study

was based.

CHAPTER TWO: REVIEW OF THE LITERATURE

Job satisfaction can affect a person’s motivation at work, career choices,

productivity, creativity, personal health, and interpersonal relationships (Kumar et al.,

2013; Warner, 2001). Satisfied employees tend to be more productive and creative (Uhl-

Bien et al., 2014). Leaders in organizations have the ability to implement work practices

that may positively affect job satisfaction and motivation of their employees.

Tahir and Sajid (2014) discussed job satisfaction’s effect on reducing grievances,

turnover, and termination among college instructors and posited that job satisfaction

reduces absenteeism in employees (Jha & Dikshit, 2015; Schermerhorn, 2011; Tahir &

Sajid, 2014). Tadesse, Ebrahim, and Gizaw (2015) encouraged employers to focus on

job satisfaction to reduce absenteeism among employees. Mihail and Kloutsiniotis

(2016) confirmed that HPWS leads to job satisfaction.

The use of HPWS practices to retain and manage employees has been studied in

private and public sectors (Boxall & Macky, 2009; García-Chas et al., 2016) and in

different industries such as automotive, engineering, and banking (Choi, 2008; García-

Chas et al., 2016; Kundu, & Gahlawat, 2016; Riaz, 2016). Mihail and Kloutsiniotis

(2016) and Leggat, Bartram, Casimir, and Stanton (2010) underlined the importance of

healthcare managers to empower and to enhance the job satisfaction of their staff through

HPWS. The above studies validated the importance of autonomy leading to increased job

satisfaction in PTs.

Coleman-Ferreira et al. (2012) identified intrinsic motivation as the factor that

drove CIs in obtaining the APTA credentialing. The literature review on this topic

revealed that there has been limited research on job satisfaction of CIs and healthcare

workers as a result of intrinsic factors such as autonomy, decision making, and self-

efficacy. A gap in the literature was identified related to the job satisfaction of CIs and

was, thus, the basis for this study.

This chapter of the research includes an extensive review of the current literature

for the basis of this study. The literature review examined the contributing factors of job

satisfaction of CIs and the role of HPWS in enhancing job satisfaction. Additionally, the

gaps identified were presented for discussion.

Theoretical Background and Framework

This research study has led to a deeper understanding of the effect of clinical

instruction as a HPWS function in the job satisfaction of CIs in physical therapy. Aspects

of HPWS pertaining to physical therapy have been identified. However, it is unclear at

this time if the effects of HPWS on job satisfaction in physical therapy CIs are positive or

negative. A solid theoretical foundation is necessary to build on the purpose and scope of

the study as detailed (Creswell, 2014) to ascertain the findings and implications of the

study.

The leading theory upon which this research was built is the Hackman and

Oldham job characteristics model (JCM). In JCM, Hackman and Oldham (1980) posited

that job satisfaction is a result of the intrinsically motivating work environment and may

be achieved through variety and challenges at work. Maslow (1943) theorized that when

an individual’s hierarchical needs are met, job satisfaction is enhanced, especially if the

basic needs are met. Situational leadership theories based on Hersey and Blanchard’s

(1969) model and Fiedler’s (1967) contingency model were also foundations for this

study to highlight the role of leaders in elevating motivational levels of their employees.

Hackman and Oldham Job Characteristics Model

According to the JCM, the five core job characteristics are skill variety, task

identity, task significance, autonomy, and job feedback. Skill variety, task identity, and

task significance are linked to job performance and intrinsic motivation, which is a result

of the perception of meaningful work (Choi, 2008). Autonomy enables an employee to

be responsible and to have ownership, both factors that increase job satisfaction

(Bhatnagar, 2014).

Job feedback provides employees awareness and perception of necessary skills

and knowledge, thus, producing autonomy in the outcomes (Bhatnagar, 2014; Choi,

2008). Hackman and Oldham (1980) stated that these characteristics assist in influencing

three critical psychological states: experienced meaningfulness, experienced

responsibility for outcomes, and knowledge of the actual results. This psychological state

leads to work outcomes such as job satisfaction, reduced absenteeism, and work

motivation (Lunenburg, 2011).

Lazaroiu (2015) supported this concept and stated that employees who are

satisfied might consider work challenges as opportunities. Hackman and Oldham (1980)

argued that jobs could be tailored in such a way to ensure that employees feel their work

is relevant and useful, which leads to satisfaction. Bhatnagar (2014) supported JCM

stating that job enrichment warrants the need for autonomy and task variety in

employees, and facilitates more knowledge leading to feedback and recognition in

addition to better satisfaction with the work. This could lead to improved self-esteem and

fulfill the need for self-actualization.

Bhatnagar (2014) emphasized the necessity of health systems to focus on the

intrinsic needs of the employees, especially in an era of healthcare cost reduction

initiatives. As a task, clinical instruction may pose a challenge and deviation from

routine work for clinicians. Alternatively, to a physical therapist, clinical instruction may

be a meaningful and relatable task, which provides variety and may lead to intrinsic

motivation and job satisfaction. The responsibility of a CI to be the facilitator of the

learning process could lead to increased job satisfaction, which is the basis of this

research study.

CI has the ability to provide and acquire knowledge through clinical instruction,

which contributes to the purposefulness and meaningfulness of the work. Malarkodi,

Uma, and Mahendran (2012) supported the positive effects of autonomy on job

satisfaction. CIs have the autonomy to decide the learning conditions and are responsible

for the outcomes of the learning experience. This may contribute to professional

enrichment in CIs through self-development as well as a sense of giving back to the

profession. Thus, clinical instruction can fit into any and all of the five characteristics

described above under JCM.

According to Hackman and Oldham (1980), work autonomy is the independence

and discretion provided to an individual in selecting the procedures to accomplish his or

her tasks at work. Malarkodi et al. (2012) stated that complex tasks might act as a

motivator when employees are provided with work autonomy since the employees are

able to utilize their personal attributes for task accomplishment. Abilities, motivation,

and opportunities are the basis for HPWS (Choi, 2008), which are directly tied to the

described JCM model.

Maslow’s Hierarchy of Needs Theory

Hierarchy of needs theory by Maslow (1943) offered a pyramid of five individual

needs: physiological, safety, social, esteem, and self-actualization (Uhl-Bien et al., 2014).

The premise is that some needs are more important than others and take priority over the

others. Esteem and self-actualization are considered higher-order needs.

The need for esteem drives an individual to gain respect and recognition from

others along with a sense of competence (Uhl-Bien et al., 2014). Self-actualization needs

are the highest in this hierarchy, where the individual wants to grow and use his or her

abilities and creativity to the fullest extent (Uhl-Bien et al., 2014). This research study

evaluated the relevance of this theory in the job satisfaction factors of CIs.

Situational Leadership Theory and HIWS

Hersey and Blanchard Model

According to Hersey and Blanchard (1969), the leader’s style is adapted based on

task behaviors and supportive behaviors of the followers. O’Reilly et al. (2014) stated

that situational leadership is centered on leaders adapting their behavior based on the

situation and the abilities and maturity of the follower. Situational leaders can be task-

oriented or relationship-oriented and base their behavior on the willingness and readiness

of the employees (Schreuder et al., 2013).

According to Northouse (2012), situational leadership theory evaluates the

effectiveness of leadership to meet the readiness of the followers. Direction, coaching,

motivation, and collaboration are the four leadership styles that the situational leaders

possess (Northouse, 2012; Thompson & Glasø, 2015). The supportive and delegating

nature of situational leadership is best utilized in CIs. HIWS provide opportunities for

the situational leader to support and delegate to top performers and engaged employees to

improve organizational outcomes.

McCleskey (2014) explained the task-oriented leadership style based on the

Hersey and Blanchard model of situational leadership. Under this style, leaders define

the role and tasks of the followers based on their interests as well as emotional and

motivational needs. McCleskey (2014) also cautioned about challenges based on

consistency, continuity, and conformity in situational leadership. In situational

leadership, in contrast to having specific guidelines, leaders can identify the top

performers in each situation (McCleskey, 2014; Thompson & Glasø, 2015), and this can

identify HIWS tasks, which can serve as motivators for the followers to gain job

satisfaction.

In a clinical environment, clinical instruction can be perceived as a HIWS tool to

improve job satisfaction. The effects of clinical instruction on students were analyzed in

other studies (Coleman-Ferreira et al., 2012; Giberson et al., 2008). The meaningfulness

of educating a student and preparing a student to enter a profession is already inscribed in

the profession of teaching. Based on these characteristics, clinical instruction can be

considered a high-performing work system function that involves motivation and

autonomy.

Fiedler's Contingency Model

Fiedler’s (1967) contingency model is based on the leader’s situational control of

the effectiveness. Miller, Butler, and Cosentino (2004) cited Fiedler’s contingency model

and stated that leaders affect the motivational behaviors of followers. This is achieved

through the leader’s relationships with the followers, the objectiveness of the task, and

the situational favorability of the leader (Miller et al., 2004). Thus, leaders have the

ability to generalize the follower behavior (Miller et al., 2004; Uhl-Bien et al., 2014).

Situational Leadership and High-Involvement Work Systems

The literature search revealed that many of the studies on HPWS were based on

an organization-centric approach, which was driven by human resources practices. This

research study analyzed HPWS from a situational leadership perspective. The role of

HPWS was examined through a subset of HPWS using HIWS.

Mihail and Kloutsiniotis (2016) have emphasized the individualistic-centered

approach in HIWS by analyzing it as a psychological process at an individual level to

motivate an employee. Yoon, Sung, Choi, Lee, and Kim (2015) also examined the

mediating role of intrinsic motivators in situational leadership. This research study was

focused on the intrinsic nature of HIWS to augment the situational style of leadership to

enhance motivation.

Motivation

Motivation is defined as the “forces within an individual that account for the

level, direction, and persistence of effort expended at work” (Uhl-Bien et al., 2014, p.

100). Bhatnagar (2014) defined motivation as a psychological process that employees

develop to achieve their personal and professional goals and needs within the contexts of

the organization and the community. Stumpf et al. (2013) cited that motivation is

increased with meaningful work and affects satisfaction, engagement, and commitment of

employees.

Many factors contribute to motivation in individuals. Meaningfulness at work,

the ability to choose, control, and competence are factors that contribute to the intrinsic

motivation of employees (Stumpf et al., 2013). Zurmehly (2008) cited autonomy and

critical thinking as motivators to nurses in addition to developing competency.

Intrinsic and Extrinsic Motivation

Various theories divide motivation into extrinsic and intrinsic motivation.

Intrinsic motivation is what motivates an individual to be interested in tasks, self-direct,

and be engaged in the task because of one’s own interest thereby deriving pleasure and

satisfaction (García-Chas et al., 2016). Intrinsic motivation is directly related to

satisfaction and employee outcomes (Cho & Perry, 2012; García-Chas et al., 2016).

Extrinsic motivation refers to the lower order needs in Maslow’s hierarchy of

needs, and the intrinsic motivators are at the higher end of the hierarchical model. Ismail

and El Nakkache (2014) stated that intrinsic motivation creates a desire to work because

of the work itself while extrinsic motivation is stemmed from external factors such as

financial needs. Ismail and El Nakkache (2014) further proved that extrinsic motivation

has a socioeconomic effect on intrinsic motivation, thus, validating Herzberg’s position

that the need for satisfaction of lower needs is necessary to work effectively toward the

higher needs of motivation.

Herzberg’s two-factor theory explains the intrinsic motivators as achievement,

acknowledgment, responsibility, advancement, and the job itself. These factors are

critical in dictating employee behaviors because they are the basis for the satisfaction

spectrum in the dissatisfaction satisfaction continuum (Ibrahim & Aslinda, 2014).

According to Ibrahim and Aslinda (2014), the extrinsic factors demonstrate a reduced

scale of commitment to an organization when compared to the intrinsic factors.

Based on Herzberg’s theory, Labelle (2012) identified recognition, achievement,

inherent nature of work, responsibility, and opportunities for advancement as the five

factors contributing to job satisfaction through intrinsic motivation. In addition, these

factors also contribute positively to long-term job performance. However, the hygiene

factors, which are extrinsic, contribute to short-term changes in job performance (Labelle,

2012). In the clinical environment, clinical instruction provides the intrinsic factors of

recognition, inherent nature of work, and responsibility to the CI.

Motivation and Job Satisfaction

A number of studies have shown that job satisfaction is derived from the

underlying intrinsic and extrinsic motivational factors (Hee & Kamaludin, 2016; Ibrahim

& Aslinda, 2014; Rizwan, Aslam, Shahid, & Bashir, 2015). Herzberg’s two-factor theory

shows that a series of extrinsic factors reduce dissatisfaction. Intrinsic motivation has a

stronger mediating role in motivation according to Ibrahim (2011). Job satisfaction is

derived from meeting the intrinsic motivation of a highly-engaged and high-performing

employee.

Motivation and job satisfaction were cited to be affected by self-efficacy,

leadership, team dynamics, and financial as well as non-financial incentives (Bhatnagar,

2014). Uju-Echemnu and Manalastas (2013) posited that job characteristics and

satisfaction result from intrinsic motivation. Motivation is based on an individual’s

intrinsic values whereas job satisfaction is based on the goal achievement perception of

the individual (Bhatnagar, 2014). Therefore, it is prudent for leaders to understand

motivation and satisfaction factors, so that they can contribute to organizational

performance (Bhatnagar, 2014). Kumar et al. (2013) recommended that leaders should

redesign employees’ job descriptions to reflect opportunities for enrichment and interest

development.

HPWS utilizes an intrinsic reward practice, which motivates an employee.

Rizwan et al. (2015) demonstrated that the intrinsic rewards of a task would motivate an

employee. Health care workers have a relatively high impact on motivation through

intrinsic factors (Hee & Kamaludin, 2016). As discussed below, clinical instruction has

an intrinsic nature of motivation in a health care setting. It is construed as a task that

motivates an employee in an intrinsic manner.

Job Satisfaction

Job satisfaction is the attitude of the employee regarding the job opportunities,

pay, peers, and his or her managers (Bhatnagar, 2014). Uhl-Bien et al. (2014) defined job

satisfaction as “an attitude reflecting a person’s positive and negative feelings toward a

job, co-workers, and the work environment” (p. 84). Employee satisfaction denotes

“employees’ well-being and a mental satisfaction to economic, social, and psychological

balancing” (Jha & Dikshit, 2015, p. 112). Kumar et al. (2013) linked job satisfaction to

employee commitment, productivity, and work quality.

Perceived autonomy has been cited as the precursor to organizational commitment

and job satisfaction (Kumar et al., 2013). Saranya (2014) credited motivation as the

reason for productivity and organizational performance. Rodríguez, Van Landeghem,

Lasio, and Buyens (2017) and Zurmehly (2008) cited perceived job autonomy affects job

satisfaction. Robbins and Judge (2013) posited that satisfied workers are more

productive than others. Based on the literature, it can be stated that job satisfaction is a

perceived state of mind that includes empowerment, a sense of accomplishment, and

autonomy.

Need for Leaders to Establish Job Satisfaction

Job satisfaction is an indicator of work-life quality. Armstrong (2011) posited

that leadership practices within organizations are critical to the success of organizations.

A direct correlation between job satisfaction and productivity was established by

Armstrong (2011). Dyer, Dyer, and Dyer (2013) stated “leaders who create a safe space

for others to innovate begin by inspiring team members to show the courage to innovate

by asking for game-changing ideas” (p. 188).

Leaders must be cognizant that productivity and work quality improve

significantly when employees are satisfied and motivated (Muscalu & Ciocan, 2016).

Tadesse et al. (2015) encouraged employers to focus on job satisfaction to reduce

absenteeism among employees. Job satisfaction ensues when one performs in alignment

with one’s values (Bhatnagar, 2014). It is beneficial for leaders to understand that the

emotional state of the employee plays a role in job satisfaction (Lazaroiu, 2015).

Effective leaders can affect the interpersonal relationships and environment of the

employees to be conducive to satisfaction (Lazaroiu, 2015).

Identifying the appropriate satisfaction factors for CIs and PTs helps

administrators and leaders of the organization have the right tools to facilitate positive

team dynamics thereby contributing to organizational success. It assists in ensuring team

satisfaction and subsequently boosts student engagement and success by having

productive and satisfied CIs. For the physical therapy profession, having satisfied CIs

ensures their contributions back to the profession and enhances the competence of future

clinicians. Lazaroiu (2015) supported that leaders are responsible for establishing the

emotional well-being of their employees to enhance job satisfaction.

Contributors to Job Satisfaction

Organizational Environment

Organizational culture and organizational environment are critical contributors to

employee job satisfaction. A positive organizational image is cited as a contributor to job

satisfaction (Passier & McPhail, 2011). Hur, Han, Yoo, and Moon (2015) stated that

perceived organizational support has a significant influence on the job satisfaction of an

employee.

Compatibility with the social environment increases job satisfaction in an

organization. Duffield, Roche, Blay, and Stasa (2011) stated that positive worker-leader

relationships contribute to job satisfaction. When the values and attitudes of the

organization and employees align, employees tend to be more satisfied (Northouse,

2012).

Autonomy

Autonomy is a critical contributor to job satisfaction, especially for high-

achieving employees. It enables them to work independently reinforcing their confidence

and enabling them to provide their best. Autonomy and decision-making abilities enable

employees to do what is needed thereby giving them a sense of accomplishment (Tahir &

Sajid, 2014; Zurmehly, 2008). Professional autonomy in PTs encompasses

determination, regulation, and evidence-based decision making by an individual

(Alperovitch-Najenson, Sheffer, Treger, Finkels, & Kalichman, 2015; Childs & Aiken,

2011). The ability to choose a preferred work setting and working hours contributes to

professional autonomy in PTs (Alperovitch-Najenson et al., 2015; Tahir & Sajid, 2014).

Professionalism and Professional Interaction

Interaction with other professionals within the field and the commitment and

engagement that results from positive association with other professionals are cited to be

positive factors of job satisfaction among healthcare workers (Boxall & Macky, 2009;

Lopopolo, 2002; Winn, Chisolm, & Hummelbrunner, 2014). Health care workers give

emphasis of professionalism and professional interaction in their work environment.

Professional guidelines and practices provide a feeling of belongingness to their

profession and perception of organizational support. The professionalism of peers and

leaders influences the attitude of the employee, thus, contributing to job satisfaction

(Schwendimann, Dhaini, Ausserhofer, Engberg, & Zuniga, 2016).

Educational Level

Educational level has been cited to contribute to job satisfaction (Plessis, Visagie,

& Mji, 2014; Zurmehly, 2008). This is partly because of the realization of their higher

level of needs such as self-esteem. Additionally, there are more opportunities for

advancement in many organizations for people with higher education levels, thus,

contributing to improved job satisfaction (Plessis et al., 2014; Zurmehly, 2008). In

addition, higher levels of education may lead to critical thinking in employees (Zurmehly,

2008).

Employee Stability in Employment

The stability of the workforce contributes to job security, knowledge retention,

reduction in retraining, and continuation of job responsibilities. For employees, stability

is perceived as job security as well as process stability, which are both conducive to job

satisfaction. Employee retention leads to organizational commitment and ownership

(Winn et al., 2014).

Teamwork

Teamwork increases camaraderie and support for each other. Teamwork results

in positive work culture and reduces absenteeism (Tahir & Sajid, 2014). Tahir and Sajid

(2014) discussed job satisfaction’s effect on reducing grievances, turnover, and

termination among college instructors. Job satisfaction reduces absenteeism in

employees (Jha & Dikshit, 2015; Schermerhorn, 2011; Tahir & Sajid, 2014). Tadesse et

al. (2015) encouraged employers to focus on job satisfaction to reduce absenteeism

among employees.

Professional Development and Training

Training and development are crucial in job satisfaction (Jha & Dikshit, 2015;

Passier & McPhail, 2011). High-achieving employees seek to improve their skill set and

knowledge continually. The knowledge retention in an organization paves the way for its

success through the generation of new ideas and innovation.

Availability of Resources and Work-Life Balance

The allocation of resources to meet the workload demands contribute to job

satisfaction (Schwendimann et al., 2016). Plessis et al. (2014) studied the effects of

burnout on the job satisfaction of PTs and found that lack of resources is one of the

critical factors contributing to dissatisfaction among employees. The work-life balance is

another related factor contributing to job satisfaction (McGowan & Stokes, 2015;

Northouse, 2012; Plessis et al., 2014; Sliwinski et al., 2014).

Employee Empowerment and Engagement

Employee engagement is important in gaining job satisfaction. Communication is

one of the ways to engage employees according to Curtis and Newman (2014). Rewards

and recognition for task accomplishment also contribute to job satisfaction in employees

(Collins, 2013). Empowerment of employees leads to engagement, which in turn,

positively influences job satisfaction (Cicolini, Comparcini, & Simonetti, 2014).

Personal Satisfaction

When people are generally satisfied emotionally and spiritually, they tend to be

satisfied with their work (Cascio, 2012; Saranya, 2014; Tahir & Sajid, 2014). Mafini

(2014) posited that life satisfaction increases with decreased amounts of stress and leads

to job satisfaction. In the case of clinical instruction, when educating others in the

respective fields, mentors, and CIs may gain the satisfaction of giving back to the

profession (Tahir & Sajid, 2014).

Deterrents to Job Satisfaction

Organizational Culture

Organizational culture has a broad effect as a deterrent on job satisfaction

(Collins, 2013). Lack of trust with management, negativity in the workplace, and

employee disengagement because of any number of factors are all challenges that can

lead to job dissatisfaction. Yao Wu (2010) stated that organizational challenges could

significantly contribute to dissatisfaction. Allen (2016) stated that workplace bullying

could lead to dissatisfaction at work.

Excessive Work Load, Limited Resources, and Inadequate Staffing

Excessive workload and inadequate staffing are related factors affecting job

satisfaction negatively (Plessis et al., 2014; Sliwinski et al., 2014; Wong, Odom, & Barr,

2014). Limited resources cause workplace dissatisfaction according to Schwendimann et

al. (2016). All these factors contribute to burnout from stress and strain, which in turn,

reduces job satisfaction (Sliwinski et al., 2014).

Job Stress

Job stress can happen because of the inherent nature of the work or because of

other factors. Excessive paperwork and job stress are cited as reasons for decreased job

satisfaction (Plessis et al., 2014; Sliwinski et al., 2014). The stress levels of physicians

and police officers were studied by Yao Wu (2010) and were found to lead to job

dissatisfaction. In addition, poor resource allocation and management can lead to job

stress, which causes reduced job satisfaction (Schwendimann et al., 2016).

Lack of Professionalism

Job satisfaction is a direct outcome of the expectation of an employee.

Professional employees expect professionalism from their peers and leaders. Lack of

professionalism gives the perception of inadequacy in an organization and thereby

reduces job satisfaction (Schwendimann et al., 2016), as was found to be the case among

healthcare workers (Zurmehly, 2008).

Leadership Styles

The need for leadership to focus on improving job satisfaction has been

established in the discussion above (Duffield et al., 2011; Lazaroiu, 2015; Muscalu &

Ciocan, 2016). Effective leadership improves motivation and thereby job satisfaction.

Lack of leadership and clarity in the organizational path lead to a lack of trust in

leadership, hence, job dissatisfaction (Muscalu & Ciocan, 2016). Lack of autonomy can

detrimentally affect perceived empowerment and, in turn, job satisfaction (Tahir & Sajid,

2014; Zurmehly, 2008).

Job Turnover

Excessive turnover is a cause and effect on job satisfaction, which can create a

vicious cycle. Studies have shown that job dissatisfaction can lead to job turnover

(Strömgren, Eriksson, Bergman, & Dellve, 2016; Tahir & Sajid, 2014). In return, job

turnover creates instability in the workplace, which further creates job dissatisfaction.

Human Resource Practices

A number of HR practices can be deterrents to job dissatisfaction. Recruitment

can be a challenge when the recruited employee does not have the best fit for the position

causing job dissatisfaction (Cascio, 2012; Schwendimann et al., 2016). Proper

compensation and perception of justice in pay are also essential to maintain job

satisfaction (McGowan & Stokes, 2015; Sliwinski et al., 2014).

Physical Demands and Length of Service

One of the reasons for job dissatisfaction is the length of service (Sliwinski et al.,

2014), where the employee becomes stagnant and is not stimulated enough. Physical

demands of the job and health concerns can be deterrents as well (Brewer et al., 2016;

Dirlam & Zheng, 2017; Sliwinski et al., 2014). The physical strain on the

musculoskeletal systems of PTs has been identified as a deterrent for job satisfaction

(Darragh, Campo, & King, 2012; Sliwinski et al., 2014).

Lack of Recognition

Social recognition and rewards are significant contributors to satisfaction

(Schwendimann et al., 2016). Strömgren et al. (2016) identified the effects of recognition

and encouragement on health care professional job satisfaction. Shin and Lee (2016)

examined the effect of involving nurses in decision making and thereby improving

performance.

Positive Outcomes of Job Satisfaction in an Organizational Environment

A number of significant positive outcomes occur when employees have job

satisfaction. Multiple studies have demonstrated that the quality and quantity of output

improve with increased job satisfaction. De Menezes (2012) studied job satisfaction

resulting from empowerment and its effect on the quality of the product and stated that

job satisfaction improves the quality of a product. Job enrichment has also been

correlated with improved job satisfaction, which in turn, has a direct effect on the quality

of the outcome (Brewer et al., 2016). Brewer et al. (2016) also posited that job

satisfaction has a direct relationship with the quality of patient care among nurses.

Increased job satisfaction has a direct effect on the quantity of outcomes and

increased productivity because of improved job performance. Arnold et al. (2016)

examined the effects of costs related to productivity and found that increased job

satisfaction improved productivity through reduced costs. Arnold et al. (2016) further

illustrated that job satisfaction reduced absenteeism, thus, increased productivity.

The organizational commitment of an employee is increased because of improved

job satisfaction. Lee (2016) found that job satisfaction is the highest predictor for

organizational commitment for community-based organizations and can be a challenge to

gain. Ouyang, Zhou, and Qu (2015) examined job satisfaction through empowerment

and cited it as a critical factor contributing to organizational commitment.

The organizational commitment indirectly affects employee retention and

employee ownership. Job satisfaction also has a direct correlation with employee

retention (Brewer et al., 2016). Brewer et al. (2016) showed that job satisfaction through

intrinsic factors is critical in retaining nurses, which is typically an industry with high

turnover. Vandana (2017) posited that job satisfaction and organizational health are

interrelated and have a direct relationship with employee retention.

Job satisfaction has a positive effect on individual employees’ behavior in an

organization. Burtaverde (2015) argued that an employee with higher job satisfaction has

higher honesty and integrity. Regts and Molleman (2016) examined the socioeconomic

outcome with increased job satisfaction and showed that the social aspects of an

individual employee are more favorable in the work environment when job satisfaction is

high. These positive behaviors contribute to a better organizational culture.

Another aspect of the social environment that is affected by job satisfaction is

work-life balance and stress. Ampadu (2015) studied stress levels and their relationship

with job satisfaction and determined that there is a mutually dependent and direct

relationship between job stress and job satisfaction. The result is that better job

satisfaction enables the employee to manage higher stress in an organization.

Job satisfaction plays a critical role in the performance of people in the health care

industry, where there is a strong presence of work stress and sometimes a lack of positive

results to reinforce the effort. Pillay (2008) stated that the performance of doctors

serving in underprivileged areas as directly influenced by the job satisfaction they derived

from a number of intrinsic factors. Tsounis, Niakas, and Sarafis (2017) examined the

social effects of the job satisfaction of substance abusing treatment professionals and

showed that there was a direct relationship between job satisfaction and clinical ratios as

an outcome measure.

Strömgren et al. (2016) examined different clinicians and found that increased job

satisfaction provided a better quality of patient care in all fields. Fiabane, Giorgi,

Sguazzin, and Argentero (2013) studied different professionals in clinical settings and

found that PTs had the highest stress in their job and they were more disengaged in

comparison to others. This shows that an engaged employee has less stress and more job

satisfaction.

Physical Therapy Profession

Historical Perspective of the Physical Therapy Profession

The World Confederation for Physical Therapy describes the profession as “not

limited to direct patient/client care but also includes: advocating for patients/clients and

for health, supervising and delegating to others and leading” (p. 2). The profession of

physical therapy was established in the early 1900s during the polio epidemic, consisting

of reconstructive aids or technicians who worked under physicians (Curtis & Newman,

2014; Moffat, 2003; Paglialuro, 2012). The training of reconstructive aides evolved

during World War I to a three-month training program in massage and muscle

reeducation to help soldiers and later evolved into professional training for practitioners

to become PTs in the 1950s (Curtis & Newman, 2014; Moffat, 2003; Paglialuro, 2012).

Following World War II, the APTA was formally founded in 1947, which

established standards for educational training, policies, and resolutions pertaining to

rehabilitation science (Curtis & Newman, 2014). Because of the demands on PTs, the

House of Delegates for the APTA voted in 1964 to approve the position of physical

therapist assistants (PTA); thus, the first PTA program was established in 1967

(Carpenter-Davis, 2003). The APTA provided the following information about PT and

PTA:

Physical therapists are health care professionals who maintain, restore, and

improve movement, activity, and health enabling individuals of all ages to have

optimal functioning and quality of life while ensuring patient safety and applying

evidence to provide efficient and effective care. In addition, physical therapists

are involved in promoting health, wellness, and fitness through risk factor

identification and the implementation of services to reduce risk, slow the

progression of or prevent functional decline and disability, and enhance

participation in chosen life situations. Physical therapist assistants provide

physical therapy services under the direction and supervision of a licensed

physical therapist and implement selected components of patient/client

interventions (treatment), obtain data related to the interventions provided, and

make modifications in selected interventions either to progress the patient/client

as directed by the physical therapist or to ensure patient/client safety and comfort.

(APTA, n.d)

Current State of the Profession

Employment of PTs is projected to grow 28% from 2016 to 2026, much faster

than the average for all occupations (Bureau of Labor Statistics, 2018b). With the aging

population of Baby Boomers, the demand for physical therapy will be sustained through

the coming years to provide access to patients (Curtis & Newman, 2014). The APTA

(2017) called upon PTs to provide services with quality, collaboration, value, innovation,

consumer-centricity, access/equity, and advocacy.

Vision 2020

In 2000, APTA (2018b) came up with Vision 2020, which advocated for PTs to

become autonomous practitioners with direct access for patients. APTA had the

following vision statement for physical therapy:

Physical therapy, by 2020, will be provided by physical therapists who are doctors

of physical therapy and who may be board-certified specialists. Consumers will

have direct access to physical therapists in all environments for patient/client

management, prevention, and wellness services. Physical therapists will be

practitioners of choice in patients’/clients’ health networks and will hold all

privileges of autonomous practice. Physical therapists may be assisted by

physical therapist assistants who are educated and licensed to provide physical

therapist directed and supervised components of interventions. (APTA, 2018b)

The CAPTE is the accrediting body for all entry-level physical therapy programs

in the United States (Hinman, Peel, & Price, 2014). According to CAPTE (2018), all

accredited entry-level physical therapy programs confer doctoral degrees, which is in

alignment with the Vision 2020 brought forth by APTA. All states and the District of

Columbia have granted direct access to physical therapy (APTA, 2018b; McCallum &

DiAngelis, 2012). However, in spite of apparent cost reductions, insurance payers

restrict consumers’ ability to directly access physical therapy in some states (Ohaja,

Snyder, & Davenport, 2014).

Direct Access

Direct access has provided PTs the professional autonomy and highlights

“professionalism, self-determination, self-regulation, and evidence-based decision-

making” (Childs & Aiken, 2011). The Federation of State Boards of Physical Therapy

(FSBPT, 2017) supports professional autonomy through legislative specifications on

examination and licensure, regulatory statutes, and disciplinary action. Each state has its

own practice act that contains regulations, laws, and supervision guidelines for physical

therapy professionals.

PTs treat a variety of patients and function in diverse roles and practice settings.

PTs act in the role of a leader as well as a follower. McCallum and DiAngelis (2012)

proposed that it would benefit the leaders to understand the motivating factors of the

followers, to be able to bridge the gap between the operational and clinical aspects of the

profession.

Physical Therapy Education

PTs have embraced additional clinical responsibilities such as supervision and

delegation of support personnel and direct access for patients to meet the changing needs

of healthcare (Furze et al., 2016). Along with these changes, the educational preparation

has transitioned from baccalaureate degrees for PTs to entry-level post-baccalaureate

degrees in the 1980s and to a clinical doctorate in physical therapy in 1996 (Curtis &

Newman, 2014; Furze et al., 2016).

The physical therapy program curriculum consists of a didactic portion and

clinical affiliations in various settings. During the course of physical therapy education,

the students are required to complete full-time clinical affiliations in different facilities

under a CI, who is part of the clinical community. The evaluative criteria for

accreditation of education programs for the preparation of PTs and the normative model

of physical therapist professional education have outlined guidelines for clinical

education experiences for physical therapy programs (Giberson et al., 2008). These

documents emphasize the importance of structuring high-quality clinical education

experiences to ensure that graduates of professional physical therapist education

programs are clinically competent upon graduation.

Upon graduation from an accredited program, the student must pass the National

Physical Therapy Examination (NPTE) to be licensed. According to FSBPT (2017),

passing scores on the NPTE “reflect the level of performance required to provide safe and

competent physical therapy services by PTs and physical therapist assistants” (p. 1). The

NPTE defines minimal competence as “the minimal knowledge, judgment, technical, and

interpersonal skills required to safely practice physical therapy. It includes skills and

knowledge on examination, evaluation, diagnoses, prognosis, intervention, and outcome

assessment” (FSBPT, 2017, p. 1).

Clinical Education in Physical Therapy

Most health care professions have a clinical education component as a

requirement (Hall et al., 2015; Ojha et al., 2014; Pabian et al., 2017). Clinical education

is an integral part of physical therapy education, where students are placed in clinical

settings with a CI who is part of the clinical community (Giberson et al., 2008; Pabian et

al., 2017). According to the most recent aggregate data report by CAPTE, 29% of the

weeks in physical therapy professional education are dedicated to clinical education and

45% of the total contact hours in professional education are spent in clinical education

(CAPTE, 2018).

Under the supervision of the CI in the clinical setting, students develop the skills,

behaviors, and confidence necessary to enter the profession as entry-level clinicians

(Giberson et al., 2008; Ojha et al., 2014). The CI is responsible for facilitating the

integration of theoretical knowledge that the students acquired in the classroom into

contextual, social, and interactive skills (Greenfield et al., 2012; Hall et al., 2015; Plack,

2008). The CI also facilitates the acquisition of new skills as well as professional

integration and socialization by providing supervision, evaluation, and feedback

regarding the performance of the student in the clinical setting (Hall et al., 2015).

It is a challenging task to place a student in an ideal environment where the

student can succeed in gaining the skill sets required to excel as a clinician. Many

variables influence the success of a student. The adaptability of the student to the clinical

setting and the ability of the CI to provide an optimal learning environment to the student

are factors that contribute to the student’s success as a clinician (Ojha et al., 2014).

Role of Clinical Instructors in Physical Therapist Education

CI’s are role models who provide a nurturing and meaningful clinical experience

to the students so that students are guided in critical thinking and clinical decision making

through active learning (Greenfield et al., 2012). Recker-Hughes et al. (2015) cited that

the CI’s teaching skills, the organizational culture, and the educational institution’s

support can influence the quality of clinical education. To thrive as a CI, employees must

be in an environment that supports the efforts exerted by the employee toward clinical

education (Recker-Hughes et al., 2015).

It is critical that CIs are satisfied with what they do, and are motivated to

undertake students for clinical supervision. Hall et al. (2015) identified CI feelings of

stress as one of the factors deterring one from becoming a clinical instructor. The stress

was attributed to added workload and apprehension about lack of one’s own knowledge

and the student’s knowledge. Professional role and responsibility were identified by Hall

et al. (2015) where self-reflection and the drive to stay current in professional trends in

addition to an appreciation for their efforts were influencing factors for CIs.

Hall et al. (2015) cited employer support through additional staffing, training

opportunities, and, recognition for CIs as a means to encourage clinical supervision. The

employee must be supported by the leaders to be able to navigate the political nuances of

the organization (Plack, 2008). In citing the characteristics of an exemplary CI, Buccieri,

Pivko, and Olzenak (2013) stated that CIs must be self-motivated and dedicated to self-

improvement.

The desire to influence future clinicians, problem-solving, making a difference,

and using one’s own skills and knowledge to develop others are all cited as intrinsic

motivators among faculty and nurses (Overman, 2001; Zlotnick et al., 2016). In addition,

the CI must have certain personal traits and values that allow him or her to be open to

new ways of problem-solving with students (Buccieri et al., 2013). The characteristics;

such as being engaged in the current trends of the profession, seeking professional

development opportunities, motivation, as well as dedication to self-improvement and

self-reflection; are all aligned with HIWS (Buccieri et al., 2013; García-Chas et al.,

2016). A sense of validation, empowerment, and broadening perspectives were cited as

motivating factors for CIs by McCallum, Mosher, Jacobson, Gallivan, and Giuffre

(2013).

Importance of Developing Clinical Instructors

Leaders in healthcare organizations must be aware of the benefits of creating an

environment that is conducive to clinical education (Recker-Hughes et al., 2015) and

invest in resources. Future recruitment of students, professional development for staff,

stronger community relations with academic institutions, increased staff productivity, and

improved quality of care are some of the incentives for leaders to promote followers to

become CIs (Ojha et al., 2014; Recker-Hughes et al., 2015).

In addition, clinicians are exposed to leadership opportunities and develop their

supervisory skills as potential leaders within their organizations (Ojha et al., 2014).

Employee engagement is improved with additional time spent in teaching students, which

indirectly improves customer satisfaction (Ojha et al., 2014).

As in any profession, practicing PTs have a professional obligation to contribute

to the well-being of the growth of the profession, nurture and mentor successors, and

provide added value to the profession through their experience and expertise. The

opportunities for clinical instruction meet this altruistic and ethical need for a self-

motivated professional irrespective of the organization for which they work. Wong et al.

(2014) posited that guiding students through complex decision making with real patients,

demonstrating a patient-centered approach, and teaching communication and patient

education strategies are best applied through active engagement with older adults under

the guidance of a skilled practitioner.

Collaboration in Clinical Education for Job Satisfaction and Job Performance

Collaboration among individuals in the workplace creates a team environment

that provides faster access to knowledge, facilitates information sharing, and ensures

multi-directional information flow that allows employees to achieve goals collectively

(Rao, 2016). This enhances learning and fosters the creation of new ideas and

information, which can be crucial for students. The advantage of collaboration is that

people share their knowledge, skills, abilities, and ideas to deliver better results

(Kandukuri & Nasina, 2017). When CIs are satisfied, they tend to collaborate with

students to enhance their learning experience. McCallum et al. (2013) posited that

collaborative training among health professionals leads to increased knowledge about

other professional roles and facilitates the development of collaborative relationships

during work.

High-Performance Work Systems

Concepts of High-Performance Work Systems

HPWS is a group of work management practices through additional involvement

of employees in highly-demanding functions, thereby improving competence and

attitudes of the employees (Appelbaum et al., 2001; Mao et al., 2013). It can be further

clarified as an organizational architecture that brings work, people, and customer

requirements together, which facilitates an employee perception of enhanced outcome

through increased job satisfaction and intrinsic motivation (Choi, 2008). The high-

performing work system is a relatively new concept that has evolved in the last few

decades.

From an organizational perspective, HPWS can be conceived as a formalized

human resource practice to motivate people and improve job satisfaction by focusing on

abilities, motivation, and opportunities (Choi, 2008). The use of HPWS practices to

retain and manage employees has been studied in different industries globally (Choi,

2008; García-Chas et al. (2016); Kundu, & Gahlawat, 2016; Riaz, 2016). In the

manufacturing industry, García-Chas et al. (2016) studied the impact of HPWS on

engineers in the manufacturing sector to ascertain the motivational effects of HPWS on

engineers.

Choi (2008) examined the use of HPWS in multiple industries in South Korea.

Kundu and Gahlawat (2016) studied multiple organizations in a wide variety of

disciplines to assess the effects of HPWS as an organizational HR practice. Riaz (2016)

has examined the effects of HPWS in the manufacturing and banking sectors to analyze it

from a human capital perspective. In HPWS, employees get more freedom to apply their

skills. Mao et al. (2013) argued that employees perceived that HPWS factors influence

employee attitudes and job satisfaction through reconfigured behavioral scripts and

autonomy.

Role of Intrinsic Motivation in HPWS

The literature review on job satisfaction clearly demonstrates that intrinsic

motivational factors contribute to the overall satisfaction in a job environment. Although

Maslow’s hierarchical model and other studies on motivation have emphasized intrinsic

factors, the research on using HPWSs as an intrinsic factor contributing to job satisfaction

is relatively new (García-Chas et al., 2016). HPWS affects organizational performance

by effective and productive outcomes through employees. García-Chas et al. (2016)

further showed that perceived organizational support and HPWS have a relationship,

established through job satisfaction that resulted from the utilization of their own

resources and skills set.

Empowerment and HPWS

The HPWS has a moderating role in an individual’s self-determining role by

providing an opportunity for an individual to work for his or her own perceived benefits

(Cho & Perry, 2012). HPWS has created an organizational environment of

empowerment and self-management under a complex and global organizational culture.

This helps facilitate organizations to adapt to change more effectively (Hinrichs, 2001).

HPWS could integrate people with tools and could create a shared purpose that crosses

the boundaries of the typical organizational domains. This improves the perceived value

of one’s work and its effects on the overall organizational performance contributing to

the intrinsic motivation of an employee.

Employee Engagement and Organizational Effectiveness of HPWS

Wadhwa (2012) examined HPWS and its effects on organizational effectiveness

measured by employee experience, turnover, customer satisfaction and loyalty, and

financial performance and concluded that HPWS superseded the influence of HR

practices. When employees are engaged in HPWS, they experience a reduction in the

unpredictability associated with jobs. This is partly because of the multifaceted intrinsic

and extrinsic motivation developed by resource empowerment, employee growth, and

employee learning (Wadhwa, 2012).

HPWS also contributes positively to a sense of participation, competence, and

self-determination (Hinrichs, 2001), which are the desired outcome of HPWS functions.

Employee perspectives of both HPWS and autonomy contribute positively toward the

organization and to job satisfaction of employees whereas skill variety had no effect on

job satisfaction (Mao et al., 2013). By allowing more latitude and autonomy, leaders can

positively influence job satisfaction and employee attitudes (Mao et al., 2013).

The above-mentioned factors contribute to the engagement of employees at work.

Utilizing clinicians in a hybrid role of provider and leader is essential during the 21st-

century era of healthcare reform (Fulop, 2012). Clinicians who have an awareness of the

needs of the organization, as well as the needs of the patient care staff, can effectively

bridge the gap between the clinical and business operations of healthcare organizations.

High-Involvement Work Systems in HPWS

The literature survey identified a number of studies that were undertaken in

different industries that promoted HRM practices using HPWS. Kundu and Gahlawat

(2016) studied the effects of HPWS and found a negative correlation between HPWS and

employee intention to leave. Ollo-López et al. (2016) established that there was a

relationship between positive job satisfaction and HPWS. Further, the authors attempted

to establish a relationship between job satisfaction and HPWS focusing on the subset of

practices such as HIWS.

Boxall and Macky (2009) explained HIWS as practices that make up autonomous

teams that provide them with job rotation and decision-making powers as well as avenues

for both downward and upward communication. The individualistic contributions of

HIWSs on organizational performance were supported by García-Chas et al. (2016). This

conceptual model can be used to define the job function of clinical instruction as a HIWS,

which is a critical subset of the HPWS.

Clinical Instruction as HIWS

Mihail and Kloutsiniotis (2016) employed a different approach in HPWS as a

contributor to job satisfaction. Instead of considering HPWS as a HRM-initiated process,

Mihail and Kloutsiniotis (2016) examined HPWS with an individual-centric approach

and termed it HIWS. The role of HPWS in patient care and health care services was

examined using clinicians and nurses for the sampling data.

Mihail and Kloutsiniotis (2016) concluded that affective commitment is

influenced by the HPWS function at the individual level. For the current research, this

study provided insight and theoretical analysis about the individualistic nature of clinical

instruction on job satisfaction because of its HIWS nature. Within the context of HIWS

and given the absence of studies in the clinical instruction arena, this research should

provide the theoretical background in designating the CI role, its individualistic nature,

and subsequently its theorized definition as a HIWS.

In addition, the role of the CI has characteristics pertinent to HPWS such as

autonomy, empowerment, and engagement. CI’s role is considered the empowerment of

an employee to extend his or her ability beyond regular tasks, which is in alignment with

the fundamental characteristic of the HPWS function (Coleman-Ferreira et al., 2012).

The JCM identifies the five core characteristics; skill variety, task identity, task

significance, autonomy, and job feedback (Hackman & Oldham, 1980); and can

contribute to the meaningfulness of work and job satisfaction as cited by Lunenburg

(2011).

Leggat et al. (2010) defined the HPWS under four characteristics: autonomy,

competence, impact, and meaning. HPWS provides autonomy in the execution of tasks

where the employees have the freedom to perform their tasks. This assumes that HPWS

practice needs highly-skilled employees, who are competent to perform these tasks

independently.

As stated earlier, the higher-end hierarchical needs are satisfied using HPWS.

Traditionally, more competent employees pursue the higher-end needs and are capable of

functioning in a higher and more involved capacity. In addition, these tasks must be

meaningful to the employees. The perception of the meaningfulness and the effect of the

contribution satisfy the high-end needs of the employee through HPWS. The skill and

ability to mentor a student and the in-depth knowledge of the subject matter ensure that

only competent employees can perform this role. It has been further validated by the

credentialing program of the APTA (Coleman-Ferreira et al., 2012).

The effects of clinical instruction on a student were analyzed in other studies

(Coleman-Ferreira et al., 2012; Giberson et al., 2008). The meaningfulness of educating

a student and preparing a student to enter a profession is already inscribed in the

profession of teaching. Based on these characteristics, clinical instruction can be

considered a high-performing work system function that involves motivation and

autonomy. The role of autonomy, task variety, and task significance (Coleman-Ferreira

et al., 2012) of clinical instruction elevate it to a HPWS.

The CIs interact directly with the educational institution, thus, enjoying

autonomy. A thorough analysis of the functional elements of clinical instruction shows

that all these characteristics qualify clinical instruction as a HPWS function. In the study,

the tool that was used measured all these factors with structured questions.

Based on the theoretical framework available in the literature as discussed above,

clinical instruction can be theorized as a HIWS, which is a critical subset of HPWS (Ollo-

López et al., 2016). Further, clinical instruction exhibits the characteristics of the

operational model of a HPWS as defined by Choi (2008), classifying clinical instruction

as an operating job function. In addition, clinical instruction satisfies the functional

definitions of the HPWS as defined by Leggat et al. (2010).

Gaps in Literature for HIWS and Clinical Instruction

Upon review of the literature, a gap was identified regarding the use of HPWS or

HIWS as a tool to enhance employee engagement in clinical environments although the

intrinsic nature of the patient care has been well established (García-Chas et al., 2016;

Wadhwa, 2012). Mihail and Kloutsiniotis (2016) stated that HPWS has a substantial

effect on the perception of social identification of health care professionals. In addition,

the authors showed that the clinicians feel psychologically empowered because of the

nature of HPWS enabling the perception of providing high-quality patient care (Mihail &

Kloutsiniotis, 2016). Therefore, it is evident that HPWS has a mediating role for quality

of care.

Upon reviewing the literature, another gap in literature was identified specifically

in the field of physical therapy and HPWS. The mediator role of intrinsic motivation

resulting from HPWS has been established by García-Chas et al. (2016). Choi (2008)

established the three aspects of HPWS for organizational effectiveness: ability enhancing,

motivation-enhancing, and opportunity enhancing. These three aspects can be closely

linked to clinical instruction function as a HPWS in a physical therapy setting.

Conclusion

The purpose of this section of the literature review was to identify the need for

this study as well as to define the role of clinical instruction within the theoretical

framework of HPWS. From a theoretical perspective, HPWS is a group of practices

initiated by human resources management. HIWS is a subset function evolved from

HPWS, which exhibits the characteristics of HPWS, yet, operates at an individual level.

Based on the above, this study used clinical instruction as a HIWS contributing to HPWS.

Upon reviewing the literature, a gap in literature was identified regarding the use

of HPWS as a tool to enhance employee engagement in clinical environments. Another

gap in the literature was identified specifically in the field of physical therapy and

HPWS. There is no current literature on the job satisfaction of CIs in physical therapy

from a HIWS perspective.

Research in this area is helpful for leaders to identify ways to empower clinicians

to be satisfied with their roles and enable them to be great CIs who shape and mold future

clinicians. Leaders in physical therapy are able to identify job satisfaction factors among

CIs and benefit from this research through the engagement and commitment from their

employees. Clinicians and leaders who have an awareness of the needs of the

organization, as well as the needs of the patient care staff, can effectively bridge the gap

between the clinical and business operations of healthcare organizations.

CHAPTER THREE: METHODOLOGY

This study used quantitative methods to analyze the data on job satisfaction of

PTs to assess the effects of clinical instruction as a high-performing function that

motivates PTs. The focus of this study was the role of clinical instruction as a high-

performing work system with job satisfaction being the phenomenon of interest in the

study. As stated by Robson and McCartan (2015), the establishment of the phenomenon

opens the door to the participant’s thoughts and feelings, which was helpful in directing

the future actions of the researcher. The methodology was designed to quantify job

satisfaction using a valid and reliable instrument.

Purpose of the Study

The purpose of the study was to examine if a physical therapist derived more

satisfaction, specifically intrinsic satisfaction, when assigned the role of a CI. This was

based on the theoretical definition of clinical instruction as a high-performing function in

a physical therapy setting. A quantitative method was selected to establish a causal

relationship between clinical instruction and job satisfaction as recommended by

Creswell (2014).

The situational leadership theory encourages leaders to provide motivation to

high-performing employees based on situational factors so that the employees are

committed and provide higher value to the organization. HPWS operates under the

assumption that high performers are motivated when they are assigned roles and tasks

that can motivate them intrinsically. Clinical instruction is a high-performing task that

can be used to improve job satisfaction. Chapter Two identified that clinical instruction

could be a HPWS motivational tool for a situational leader in a physical therapy setting.

The researcher looked to identify whether there was further evidence that a CI would

derive higher job satisfaction through intrinsic factors when compared to their peers in a

physical therapy setting.

The objective of this study was to determine if job satisfaction (i.e., dependent

variable) was positively or negatively influenced by clinical instruction (i.e., independent

variable) as a job assignment. The independent variable (i.e., clinical instruction) was

hypothesized as a high-performing functional system, which had an effect on the

dependent variable (i.e., job satisfaction) through intrinsic motivation. In addition, the

study examined whether there was a relationship between intrinsic job satisfaction

(dependent variable) and clinical instruction as a job assignment. Additionally, the study

hypothesized that clinical instruction as a job assignment would increase the job

satisfaction of a physical therapist. The study evaluated whether PTs who were CIs had

increased job satisfaction compared to the PTs who did not have a high-performance

work assignment.

Statistical analysis was conducted on the data collected to accept or refute five

hypotheses developed based on the purpose and objective of this study. Based on the

results, the primary researcher attempted further analysis of generalization and

comparison using statistical methods to recommend any additional studies.

Establishment of the Research Questions

The following research questions and hypotheses were queried for this study:

RQ 1: Is there a relationship between HPWS such as clinical instruction and

overall job satisfaction among PTs?

Hypothesis 1A

Ho: There is no significant relationship between HPWS such as clinical

instruction and overall job satisfaction among PTs.

Ha: There is a significant relationship between HPWS such as clinical instruction

and overall job satisfaction among PTs.

Hypothesis 1B

Ho: There is no significant relationship between HPWS such as clinical

instruction and overall job satisfaction among staff PTs

Ha: There is a significant relationship between HPWS such as clinical instruction

and overall job satisfaction among staff PTs.

RQ 2: What effect, if any, does clinical instruction as a HPWS have on intrinsic

job satisfaction among PTs?

Hypothesis 2A

Ho: There is no significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among PTs.

Ha: There is a significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among PTs.

Hypothesis 2B

Ho: There is no significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among staff PTs

Ha: There is a significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among staff PTs

RQ 3: Is there an increase in job satisfaction for CIs in physical therapy when

compared to PTs who are not assigned any HPWS function?

Ho: There is no increase in job satisfaction for CIs in physical therapy when

compared to PTs who are not assigned any HPWS function.

Ha: There is increased job satisfaction for CIs in physical therapy when compared

to PTs who are not assigned any HPWS function.

The quantitative approach utilizes measured knowledge, provides scientific

estimates based on numbers, and allows the researcher to make inferences (Creswell,

2014) based on the data about “trends, attitudes, or opinions of a population” (p. 155).

According to Creswell (2014), the use of hypotheses enables the primary investigator to

analyze the data to differentiate characteristics between groups using established

statistical principles and methods. The inferential statistical analysis further examines the

variations in the two groups of a population to validate or refute the hypotheses.

The Minnesota Satisfaction Questionnaire short form (MSQ), which is a well-

established instrument, was used via a self-administered electronic survey method to

gather the statistical data needed for the study. The survey used 20 questions on the

MSQ, which specifically examined job satisfaction levels of PTs. Further, these 20

questions were used to assess the source of motivation based on intrinsic and extrinsic

factors. An additional section was developed to gather the metadata relating to

demographic factors. This included the gender, license status, experience level, job

setting, job roles, and other related factors pertinent to the study. Three additional

questions were added that assisted in defining the population to guide the analysis of

survey results.

Research Method and Design

The study used a fixed non-experimental design using surveys because non-

experimental designs detach the researcher from the subjects to be more effective in

identifying the attitudes of participants (Robson & McCartan, 2015). Typically, non-

experimental designs are best suited for measuring the relationship between two variables

(Robson & McCartan, 2015). The investigator used a predictive cross-sectional design

for this study.

The use of surveys can be perceived as a research strategy rather than a method in

a non-experimental cross-sectional study (Creswell, 2014). Robson and McCartan

(2015) credited the survey method with the advantages of anonymity, economy,

immediate availability of results, and a high degree of data standardization. The survey

allows the participants to remain anonymous while providing truthful responses and

allows the researcher the ability to collect data quickly and cost-effectively (Robson &

McCartan, 2015). The survey enables the researcher to generalize the results developed

from the data to the population (Creswell, 2014). In addition, the survey provides a

“simple and straightforward method to study the attitudes beliefs and motives” (Robson

& McCartan, 2015, p. 241).

The researcher acknowledges certain limitations in using surveys for data

collection. Participants may misunderstand questions, which may influence their

responses. The response rate and accuracy, as well as the seriousness, may be influenced

by the professionalism of the participant as well as his or her personal bias (Robson &

McCartan, 2015). However, in this study, the investigator believes these limitations were

alleviated in part because of the population consisting of licensed professionals who were

well educated and cognitively intact. In addition, having an instrument with proven

validity minimized the limitations through proven questions.

The fixed non-experimental design of this study required the use of an instrument-

based questionnaire with questions related to factors contributing to job satisfaction.

Since the study measured intrinsic job satisfaction as a variable, the instrument needed to

be able to differentiate the intrinsic and extrinsic variables. Additional demographic data

were collected for each participant for inclusion and exclusion as well as the designation

of assigned high-performing functions. The collected data were used for statistical

analysis (Creswell, 2014). The statistical analysis was included in Chapter Four of this

dissertation.

Research Instrument

The investigator used the Minnesota Satisfaction Questionnaire short form (MSQ)

for measuring job satisfaction of PTs for this study. In a quest for greater understanding

of work adjustment issues with vocational rehabilitation, Weiss et al. (1967) developed

the MSQ. As a survey instrument, the MSQ examines an employee’s satisfaction under

intrinsic, extrinsic, and general satisfaction categories through 20 statements, which are

rated on a Likert scale between 1 and 5 with 1 indicating very dissatisfied and 5

indicating very satisfied (Gunter, 2015). Participants chose “very dissatisfied” if that

aspect of job provided significantly less than expected and chose “very satisfied” if the

job aspect provided significantly more than expected (Weiss et al.). Based on the

literature, it can be stated that job satisfaction is a perceived state of mind that includes

empowerment, a sense of accomplishment, and autonomy. The scale measures

achievement, activity, advancement, autonomy, and many other factors that are outlined

in Table 1.

Table 1

The MSQ Short Form

Intrinsic Factors Extrinsic Factors

Ability utilization

Achievement

Activity

Advancement

Compensation

Co-workers

Creativity

Independence

Moral values

Social status

Social service

Working conditions

Authority

Company policies

Recognition

Responsibility

Security

Supervision—human relations

Supervision—technical

Variety

Note. All factors noted are also related to general satisfaction.

The MSQ was selected as the instrument for this study because it takes only 5 to

10 minutes to complete and has been designed at a fifth-grade reading level (Weiss et al.,

1967). This tool met standards of reliability and validity, which were acceptable to the

purpose of this study. It had 12 items that measure intrinsic job satisfaction and 8 items

that measure extrinsic job satisfaction (Li, Wang, Gao, & You, 2017). MSQ was well

established as a quantitative method, enabled a statistical analysis and conclusion, and

had acceptable internal consistencies for reliabilities of the intrinsic and extrinsic factors

(Weiss et al., 1967).

In this study, a relationship was examined between job satisfaction and clinical

instruction. A secondary objective was to examine the relationship between job

satisfaction and intrinsic factors when the job’s assignment involved a high-performing

function. The MSQ form helped to gather both these data elements in its design.

MSQ has the capability to provide insight into the general satisfaction factors and

to further categorize those to intrinsic and extrinsic factors. This was an appealing factor

in the choice of this instrument. In addition, the demographic section of the MSQ was in

alignment with the questions pertinent to a physical therapist population and required

only very minimal modifications. A copy of the MSQ is included in Appendix A.

There were subsequent advantages in using the MSQ short form. First of all, it

could be easily converted to an electronic survey using the popular tool SurveyMonkey.

This made the research efficient, economical, and fast. In addition, the electronic survey

avoided human error in the data conversion for analysis (Creswell, 2014). Robson and

McCartan (2015) noted that the use of electronic surveys helped the researcher to remain

separated from the study, which is required for a fixed design non-experimental study. In

addition, the researcher believed that the electronic format incorporated state of the art

technology and the ability to reach an increased number of respondents.

Sampling Method

The participants in this study were selected through a sampling method of

convenience based on public records provided by the state of Florida. The emails of the

licensed PTs are public records in the state of Florida. This email list from the state of

Florida was used to generate a participant list. The sample included a general

population of actively practicing male and female PTs in various settings, who were

adults over the age of 18, and included many ethnic groups and races.

Upon obtaining Argosy University’s institutional review board (IRB) approval,

convenience sampling procedures were used to send the MSQ questionnaire to the

potential participants. Voluntary participation was solicited via email with an

informed consent letter screen prior to the initiation of the survey. Respondents were

evaluated for demographic and role-specific segmentation. The sample was readjusted

based on qualification data used in the questionnaire. This sampling method ensured

that the participants were selected in a specific, but diverse fashion.

Inclusion and Exclusion Criteria

Licensed PTs who were currently practicing in the state of Florida over the age of

18 were included in this research study. PTs who were non-residents of Florida were

excluded from the study. Family members and friends of the primary researcher were

excluded from the study to reduce sampling bias. Additionally, self-employed PTs and

independent contractors were excluded from the study since their flexible schedules and

monetary benefits may have contributed to enhanced job satisfaction. Only PTs who

listed a personal email were contacted, and those who had a business email were

excluded from the study.

Selection Procedure

The state of Florida has a significant population of PTs in a variety of practice

settings in both rural and urban areas, hence, the reason for being selected to conduct the

study. The participants were employees of multiple organizations and were practicing

in a variety of settings. This ensured vertical representation with multiple organizations

in the same industry and horizontal representation from multiple practice settings.

The education level of the participants ranged from baccalaureate to doctorate.

The sample was representative of the general population of PTs as a whole in the state of

Florida, thus, could be generalized to other states in the United States. The inclusion and

exclusion criteria as described above minimized any potential risk for bias in any manner

when selecting the sample.

Data Collection

An electronic online survey was used for this study because of its anonymity,

economy, immediate availability of results, and a high degree of data standardization

(Creswell, 2014; Robson & McCartan, 2015). The survey enabled the researcher to

generalize the results developed from the data to the population (Creswell, 2014). Using

SurveyMonkey was an advantage for the researcher because of the ease of dissemination

and immediate availability of data for analysis.

Surveys allow participants to remain anonymous while providing truthful

responses and allow the researcher the ability to collect data quickly and cost-effectively

(Robson & McCartan, 2015). In addition to the anonymity that the survey offered for

this research study, participants also received a letter of informed consent with details of

the study for them to make an informed decision to consent or decline to participate.

This letter also provided participants with the ability to leave the survey if so desired.

The researcher acknowledged certain limitations in using surveys for data

collection. Participants may have misunderstood questions, which may have influenced

responses. The response rate and accuracy, as well as the seriousness, may have been

influenced by the professionalism of the participant as well as his or her personal bias

(Robson & McCartan, 2015). However, in this study, the investigator believes that these

limitations were alleviated in part because of the population characteristic of licensed

professionals who were highly educated and of sound judgment. In addition, having an

instrument with proven validity minimized the limitations through proven questions. It

was determined by the researcher that the advantages of the survey technique overrode

the above-stated limitations.

Approval to Conduct the Study

Several measures were taken by the primary researcher to ensure that the research

was conducted in accordance with the policies and procedures of Argosy University. The

primary investigator, the dissertation chair, and the dissertation committee member

completed the Collaborative Institutional Training Initiative prior to commencement of

the research. An IRB portfolio was submitted to Argosy University’s IRB committee.

Argosy University’s IRB committee evaluated the research project and ensured that

ethical standards for the protection of human subjects were maintained in this research

study through an approval certificate.

Consent

The study determined whether there was a relationship between job satisfaction

and high-involvement job responsibilities such as clinical instruction in physical therapy

professionals. This research involved human participants, therefore, required IRB

approval (Argosy University, 2014). The data were collected through a survey

instrument; therefore, the research was categorized as non-invasive. The data themselves

were of a minimum risk to the participant. This required an expedited review from the

IRB.

Research consists of collecting data from people and writing about people

(Creswell, 2014). The IRB committee required the researcher to assess the potential

for risk to participants in a study, such as physical, psychological, social, economic, or

legal harm (Creswell, 2014). The researcher did inform the participants about the

details of the study including the purpose of the research, participant’s rights and

benefits, the anticipated duration of the study, potential risks, and confidentiality of the

information (Creswell, 2014). Participants were aware of the design being used in the

study, the use of quantitative research, and its underlying intent. Legally effective and

voluntary informed consent from participants was integrated into the survey and was

obtained and documented by the researcher to ensure the ethical aspects of the study

(Creswell, 2014).

The emails of the licensed PTs are public records in the state of Florida, and the

email list from the state of Florida was used to generate a participant list in a fair and

equitable fashion. Participants were provided detailed information on the study and its

intent so that they were able to make an informed decision to participate. Voluntary

participation was solicited, and participants were informed that they should not feel

pressured to complete the survey. There was a statement on the survey indicating that

the completion of the survey was indicative of the implied consent of the participant.

Data Processing and Analysis

The primary researcher obtained the approval from Argosy University’s IRB and

delivered the MSQ short form with modified demographic information electronically to

the participants. The form was delivered through an electronic mail, which included a

request to complete informed consent prior to completing the study (Appendix A). Once

the survey was completed, statistical analysis was performed after cleaning up data for

exclusions.

Statistical Package for the Social Sciences

The Statistical Package for the Social Sciences (SPSS) is an intuitive tool and was

used for the statistical analyses in this study (Robson & McCartan, 2015). SPSS provides

the ability to aggregate and analyze the data at a very granular level addressing each

question if needed. This helped the primary investigator to delineate the effects of

intrinsic and extrinsic factors more effectively. In addition, SPSS helped to make the

analysis based on demographic data by grouping and subgrouping the population.

The hypotheses were tested using various descriptive statistics followed by

correlation analysis and ANOVA testing. The overall analysis was undertaken by the

descriptive statistics at a granular level and aggregate level for intrinsic, extrinsic, and

overall factors. A correlation analysis was conducted on the data that were collected via

the survey instrument.

The primary analysis was conducted using multifactor ANOVA and one-way

ANOVA with respect to the first two research questions. A two-tailed t-test was used to

analyze the third hypothesis. Additional statistical analysis was used to determine further

generalization and validity of the findings. In this quantitative study, based on the data

collected, the established hypotheses helped to make assumptions and inferences

regarding the research questions (Creswell, 2014).

Confidentiality

This research was conducted in a confidential manner and maintained all

personally identifiable information and information collected through the survey was

confidential. This was a voluntary study and participants had the ability to withdraw

from the study at any time for any reason. The results were collected through

SurveyMonkey and were stored on their website per the regulations and policies

established by SurveyMonkey.

All participants were coded alpha numerically to ensure that identifying

information was not divulged. There was no way to identify the name or work setting of

individual participants. All spreadsheets and documents related to data collection were

password protected to ensure confidentiality and remained in the personal computer of

the primary researcher.

Conclusion

Chapter Three consists of a detailed description of the research methods that were

employed in this research study. The research questions and the hypothesis statements

are presented as part of this chapter. The sampling method, data collection, and data

analysis are described in great detail in this chapter. IRB application, consent, and

confidentiality are also discussed to outline how the participants were protected during

this study. The study was designed in such a way that the results from the study could be

generalized to PTs in other geographical areas in the United States.

CHAPTER FOUR: RESULTS

In this chapter, the results of the data analysis are compiled and presented to test

the hypothesis for its acceptance or rejection. The purpose of this study was to examine

if there is a relationship between job satisfaction and HPWS such as clinical instruction in

physical therapy professionals in the state of Florida. The study specifically addressed

the role of clinical instruction as a high-performing function providing intrinsic

motivation. The intrinsic and extrinsic factors related to job satisfaction of PTs in Florida

were analyzed to identify the effects of clinical instruction as a HPWS function affecting

intrinsic job satisfaction among PTs. A secondary purpose of the study was to identify

whether CIs in physical therapy had increased job satisfaction.

The researcher selected the participants through a sampling method of

convenience based on public records provided by the state of Florida. The emails of the

licensed PTs are public records in the state of Florida. This email list from the Florida

state licensing board’s public database was used as the source for contact information for

the population of interest. The sample included a general population of actively

practicing male and female PTs in various settings, who were adults over the age of 18

and included all ethnic groups and races.

The survey was sent to 9910 participants. There were 966 responses received.

Two hundred ninety-six of them were excluded based on the three exclusion criteria. The

exclusion criteria eliminated the self-employed PTs, those who did not have an active PT

license to practice in the state of Florida, those who did not practice physical therapy

currently in the state of Florida, and friends and family members of the primary

researcher. In addition, anyone with a business email was excluded from the initial

request to participate in the survey.

The data were compiled and analyzed using a sample size of 670 acceptable

responses. The study was completed with the Minnesota Satisfaction Questionnaire short

form with additional demographics, exclusion criteria, and grouping variables. The

demographic factors such as gender as well as professional practice information of title,

practice setting, and roles were collected in addition to the responses for 20 questions

related to job satisfaction.

The data were analyzed using a number of statistical methods ranging from

descriptive statistics analysis, ANOVA, two-sample t-tests, Cronbach’s alpha, and

Pearson’s correlation coefficient for testing the hypotheses identified for the research

study.

The following five hypotheses were tested to address the three research questions

identified in the study:

RQ 1: Is there a relationship between HPWS such as clinical instruction and

overall job satisfaction among PTs?

Hypothesis 1A

Ho: There is no significant relationship between HPWS such as clinical

instruction and overall job satisfaction among PTs.

Ha: There is a significant relationship between HPWS such as clinical instruction

and overall job satisfaction among PTs.

Hypothesis 1B

Ho: There is no significant relationship between HPWS such as clinical

instruction and overall job satisfaction among staff PTs

Ha: There is a significant relationship between HPWS such as clinical instruction

and overall job satisfaction among staff PTs.

RQ 2: What effect, if any, does clinical instruction as a HPWS have on intrinsic

job satisfaction among PTs?

Hypothesis 2A

Ho: There is no significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among PTs.

Ha: There is a significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among PTs.

Hypothesis 2B

Ho: There is no significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among staff PTs

Ha: There is a significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among staff PTs

RQ 3: Is there an increase in job satisfaction for CIs in physical therapy when

compared to PTs who are not assigned any HPWS function?

Ho: There is no increase in job satisfaction for CIs in physical therapy when

compared to PTs who are not assigned any HPWS function.

Ha: There is increased job satisfaction for CIs in physical therapy when compared

to PTs who are not assigned any HPWS function.

The Characteristics of the Sample

A total of 9910 invitations were sent to potential participants who had a license to

practice as a physical therapist in the state of Florida. A total of 966 applicants agreed to

participate in the study. Of the 966 respondents, 296 were eliminated based on the

exclusion criteria because they were self-employed, did not practice physical therapy in

the state of Florida at the time, or they did not have an active PT license in the state of

Florida at the time of the survey. The remaining 670 participants (69.4%) met all of the

inclusion criteria as defined for the study and completed the entire survey and constituted

the sample for the research study.

Demographics

The demographic information of the data shown in Figure 1 revealed the

distribution of the participants’ gender, and the results yielded 75.4% females compared

to 24.6% males.

Figure 1. Gender distribution.

The following Pareto charts show the demographic information of the sample.

The practice settings are shown in Figure 2. The largest primary practice setting was

outpatient rehabilitation at 37.2%, followed by acute care hospital and home care, which

were both at 17.6%. Of the participants, 13.6% were employed at a skilled nursing

165

505

100

200

300

400

500

600

Male Female

Fr eq

u en

facility (SNF), 4.5% were employed at an inpatient rehab facility (IPR), and 9.5% of the

participants were employed in other settings.

Figure 2. Primary practice area.

More than half of the participants (55%) had been practicing as a physical

therapist for over 15 years; 22.9% of the participants had less than 5 years of experience

as a PT; 11.6% had 6-10 years of experience, and 10.4% had 11-15 years of experience

as a PT. The number of years of experience is shown in Figure 3.

Figure 3. How long have you been practicing as a PT?

249

118 118 91

100

150

200

250

300 Fr

eq u

en cy

153

78 70

369

100

150

200

250

300

350

400

0 - 5 6 - 10 11 - 15 > 15

Fr eq

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Over 54% stated that their official title description was a staff therapist; 40.5%

had performed in the role of a senior PT, lead PT or supervisor, manager, or director.

Figure 4 shows the official titles of the sample.

Figure 4. Official title description.

When asked if they worked as a primary instructor in the past 5 years, about 50%

said yes (Figure 5).

Figure 5. Have you worked as a primary instructor in the past 5 years?

362

79 91 102

100

150

200

250

300

350

400

Staff Therapist Lead Physical therapist

Senior Physical therapist

Manager, Director, or Supervisor

Other: Please specify:....

Fr eq

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338

332

329

330

331

332

333

334

335

336

337

338

339

Yes No

Fr eq

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When asked if they worked as a PT lead in the last 3 years, 54% stated yes

(Figure 6).

Figure 6. Have you worked as a lead PT in the past five years?

Analysis of Reliability

A descriptive analysis of the data collected for the MSQ survey using Cronbach’s

alpha to assess the internal consistency of the responses and is shown in Table 2. The

overall alpha was 92%, which indicates a very high measure of reliability. Heo, Kim,

and Faith (2015) supported the power of Cronbach’s alpha to determine the consistency

of research of this type. Tavakol and Dennick (2011) stated that a value higher than 0.9

shows good consistency for experimental research. In this particular dataset, Cronbach’s

alpha was 0.91 suggesting a high measure of internal reliability and consistency. All the

20 questions indicated an alpha greater than 0.91, which indicates that the data had high

reliability at all levels.

362

308

280

290

300

310

320

330

340

350

360

370

Yes No

Fr eq

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Table 2

Item Statistics

Omitted Variable

Adj.

Total M

Adj.

Total

Item-Adj.

Total Corr

Squared

Multiple Corr

Cronbach’s

Alpha

Being able to keep busy all the 74.89 12.31 0.4236 0.2324 0.9218

The chance to work alone on the 75.03 12.35 0.3121 0.1581 0.9241

The chance to do different thin 75.04 12.08 0.5863 0.4349 0.9187

The chance to be “somebody” in 75.30 12.01 0.6128 0.4681 0.9181

The way my boss handles his/her 75.57 11.81 0.6638 0.7106 0.9170

The competence of my supervisor 75.50 11.89 0.6331 0.6822 0.9177

Being able to do things that do 74.93 12.07 0.5900 0.4145 0.9186

The way my job provides for ste 74.77 12.14 0.5494 0.3688 0.9195

The chance to do things for others 74.50 12.29 0.5840 0.5085 0.9196

The chance to tell people what 75.34 12.28 0.4366 0.2583 0.9216

The chance to do something that 74.75 12.08 0.6671 0.5859 0.9173

The way company policies are pu 75.80 11.86 0.6843 0.5291 0.9164

My pay and the amount of work I 75.73 11.94 0.5680 0.4005 0.9195

The chances for advancement on 76.05 11.92 0.6308 0.4729 0.9177

The freedom to use my own judgment 74.90 12.04 0.6630 0.6423 0.9172

The chance to try my own method 74.93 12.07 0.6342 0.6103 0.9178

The working conditions 75.15 11.95 0.7082 0.5592 0.9161

The way my co-workers get along 74.89 12.25 0.4366 0.2650 0.9217

The praise I get for doing a go 75.55 11.87 0.6717 0.5658 0.9167

The feeling of accomplishment I 74.96 12.00 0.7114 0.6033 0.9162

Descriptive analysis was completed based on the 20 questions on the MSQ short

form. The mean and standard deviation for each question are listed in Table 3. The

highest score was 4.63 for the question that states they get an opportunity to do things for

other people followed by their opportunity to use their abilities to the fullest at 4.39. This

may be derived from the independent nature of PTs and their autonomy in providing

patient care. Pay, company policies, and promotional opportunities scored the lowest

indicating that extrinsic motivation was not the primary job satisfier for PTs.

Table 3

Descriptive Statistics

Question Description M SD

Q1 Being able to keep busy all the time 4.25 0.81

Q2 The chance to work alone on the job 4.11 0.92

Q3 The chance to do different things from time to time 4.10 0.97

Q4 The chance to be “somebody” in the community 3.83 1.03

Q5 The way my boss handles his/her workers 3.56 1.24

Q6 The competence of my supervisor in making decisions 3.64 1.18

Q7 Being able to do things that don’t go against my conscience 4.21 0.98

Q8 The way my job provides for steady employment 4.36 0.91

Q9 The chance to do things for other people 4.64 0.63

Q10 The chance to tell people what to do 3.80 0.85

Q11 The chance to do something that makes use of my abilities 4.39 0.86

Q12 The way company policies are put into practice 3.34 1.14

Q13 My pay and the amount of work I do 3.41 1.21

Q14 The chances for advancement in this job 3.09 1.14

Q15 The freedom to use my own judgment 4.24 0.92

Q16 The chance to try my own methods of doing the job 4.20 0.91

Q17 The working conditions 3.98 0.99

Q18 The way my co-workers get along with each other 4.25 0.91

Q19 The praise I get for doing a good job 3.58 1.15

Q20 The feeling of accomplishment I get from the job 4.18 0.92

A summary of the different groups of interest and the descriptive statistics related

to those groups are given in Table 4. For each of the categories, the mean of the intrinsic

motivation score was found to be higher than the overall job satisfaction. The trend

indicates that the PTs derived more satisfaction from intrinsic factors than extrinsic

factors.

Table 4

Descriptive Statistics for Groups of Interests

Overall Job Satisfaction Intrinsic Job Satisfaction

N M SD M SD

# All PTs 670 3.96 0.63 4.19 0.59

All PTs with clinical instruction as HPWS 338 4.05 0.61 4.28 0.55

Staff PTs 362 3.88 0.65 4.11 0.61

Staff therapists with clinical instruction as

HPWS 159 4.05 0.62 4.27 0.54

Staff therapists with CI and no other

HPWS 104 4.12 0.61 4.33 0.51

Staff therapists with no CI and no other

HPWS 155 3.764 0.62 4.00 0.59

Figure 7 shows that there was a positive relationship between overall job

satisfaction and the intrinsic variables. Conducting a Pearson correlation between these

two variables resulted in r = 93.5 and p = 0.000. This shows that there was a strong

positive correlation between overall job satisfaction and intrinsic measurements. So, it

can be assumed that a positive influence on intrinsic motivation triggered a higher overall

job satisfaction for PTs.

Figure 7. Scatterplot of overall vs. intrinsic.

5.04.54.03.53.02.52.0

intrinsic

o v e ra

Scatterplot of overall vs intrinsic

Statistical Analysis

Two separate statistical analyses were conducted. One-way ANOVA was used on

the 20 questions to identify if any of the questions were statistically different.

Multifactor ANOVA was used to identify if there were any effects between the

dependent and independent variables with respect to satisfaction using overall and

intrinsic as dependents variables. The following six factors were the independent

variables:

 gender;

 primary practice;

 how long they have been practicing;

 job title;

 being a primary CI; and

 lead, senior, or management role.

One-way ANOVA

Table 5 includes the results from the one-way ANOVA, with an F = 112.43 and p

= 0.000, which indicates that there was a statistical difference between the 20 questions.

Table 5

One-Way Analysis of Variance

Source df Adj SS Adj MS F-Value P-Value

Factor 19 2120 111.590 112.43 0.000

Error 13380 13280 0.993

Total 13399 15400

The interval plot in Figure 8 shows the average satisfaction for each question.

Figure 8. Interval plot of being able t, the chance t.

Notes. 95% CI for the mean. The pooled standard deviation was used to calculate the

intervals.

Table 6 includes the results of using the Tukey pairwise comparison method.

“The chance to do things for others” yielded the highest overall satisfaction with M =

4.63. “Chances for advancement” had M = 3.09, which was the lowest score.

Table 6

Grouping Information Using the Tukey Pairwise and 95% CI

Factor N M Grouping

The chance to do things for others 670 4.6388 A

The chance to do something that 670 4.3866 B

The way my job provides for ste 670 4.3612 B C

Being able to keep busy all the 670 4.2507 B C D

The way my co-workers get along 670 4.2463 B C D

The freedom to use my own judgment 670 4.2373 B C D

Being able to do things that do 670 4.2090 B C D

The chance to try my own method 670 4.2030 B C D

The feeling of accomplishment I 670 4.1791 C D

The chance to work alone on the 670 4.1060 D E

The chance to do different thin 670 4.0955 D E

The working conditions 670 3.9836 E F

The chance to be “somebody” in 670 3.8313 F G

The chance to tell people what 670 3.7955 F G

The competence of my supervisor 670 3.6388 G H

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The pooled standard deviation is used to calculate the intervals.

The praise I get for doing a go 670 3.5836 H I

The way my boss handles his/her 670 3.5627 H I

My pay and the amount of work I 670 3.4060 I J

The way company policies are put 670 3.3358 J

The chances for advancement on 670 3.0851 K

Note. Means that do not share a letter were significantly different.

Multifactor ANOVA on Overall Job Satisfaction Measures

Table 7 shows the ANOVA results for the overall variable. Participant’s current

primary practice setting (F = 3.66 and p = 0.003), title (F = 4.77, p = 0.001), being a

primary instructor (F = 18.28, p = 0.00), and being a PT lead or senior (F = 4.30, p =

0.039) were all statistically significant.

Table 7

Analysis of Variance for Overall Job Satisfaction

Source df Adj SS Adj MS F-Value P-Value

What is your gender? 1 0.016 0.01644 0.04 0.834

What is your current primary practice 5 6.834 1.36685 3.66 0.003

How long have you been practice 3 1.862 0.62058 1.66 0.174

Which is the closest to your office 4 7.128 1.78204 4.77 0.001

Have you worked as a primary clinician 1 6.834 6.83354 18.28 0.000

Have you worked as a lead PT or 1 1.606 1.60605 4.30 0.039

Error 654 244.441 0.37376

Total 669 268.487

Figure 9 displays the main effects of the significant factors. The primary practice

areas were:

 outpatient rehabilitation,

 acute care hospital,

 home care,

 inpatient rehabilitation, and

 skilled nursing facility/long-term care/extended-care facility.

Skilled nursing facility had the lowest mean (3.71) compared with the other four

practice areas:

 official title;

 staff therapist;

 lead physical therapist;

 senior physical therapist; and

 manager, director, or supervisor.

Being a lead PT or senior PT had the lowest mean (3.87). As the primary

instructor, those who said yes had a satisfaction mean = 4.05. Being a PT lead, those

who responded yes had a higher satisfaction level.

Figure 9. Main effects plot for overall data means.

Multifactor ANOVA on Intrinsic Satisfaction Measures

Table 8 shows the ANOVA results for the intrinsic variable. Their current

primary practice (F = 6.02 and p = 0.000), their title (F = 4.62, p = 0.001), being a

primary instructor (F = 18.36, p = 0.00), and being a PT lead or senior (F = 4.01, p =

0.046) were all statistically significant.

Table 8

Analysis of Variance for Intrinsic Job Satisfaction

Source df Adj SS Adj MS F-Value P-Value

What is your gender? 1 0.062 0.06161 0.20 0.658

What is your current primary practice 5 9.452 1.89037 6.02 0.000

How long have you been practice 3 1.390 0.46336 1.48 0.220

Which is the closest to your of 4 5.801 1.45036 4.62 0.001

Have you worked as a primary clinician 1 5.763 5.76324 18.36 0.000

Have you worked as a lead PT or 1 1.258 1.25834 4.01 0.046

Error 654 205.307 0.31392

Total 669 229.424

Figure 10. Main effects plot for intrinsic data means.

Figure 10 displays the main effects of the significant factors. The designations in

the x-axis are the same as in the case of the plot for overall job satisfaction. The

following are the results of the statistical analysis of intrinsic motivation.

Skilled nursing facility had the lowest mean (3.91) when compared with the other

four practice areas. Management roles such as senior or lead had the lowest mean for

intrinsic satisfaction at 4.13. However, for this population, when they had clinical

instruction as an assigned role, their score increased to 4.29. Those who responded “yes”

to being a lead or senior PT in the past five years had a higher satisfaction level.

Testing of Hypotheses

In this section, the hypotheses listed in Chapter Three were tested using statistical

methods. This was done to gain an in-depth analysis of the data collected by the MSQ

form to assess the outcomes of the questions addressed in this research.

Research Question One

Research question one addresses the effects of the HPWS such as clinical

instruction on the job satisfaction of the PTs. It is formalized as follows:

RQ 1: Is there a relationship between HPWS such as clinical instruction and

overall job satisfaction among PTs?

Research question one was addressed through two hypotheses. The first

hypothesis, hypothesis 1A, focused on all of the population, which included all PTs in the

sample. Subsequently, a second hypothesis, hypothesis 1B, was used to increase the

granularity, narrowing to staff PTs so that it pinpointed the research question to clinical

instruction avoiding the other PTs who may have belonged to management and

administration, as those functions could be perceived as a different type of high-

performance work function.

Hypothesis 1A

Ho: There is no significant relationship between HPWS such as clinical

instruction and overall job satisfaction among PTs.

Ha: There is a significant relationship between HPWS such as clinical instruction

and overall job satisfaction among PTs.

The above hypothesis was tested using a multifactor ANOVA test. The plot in

Figure 11, generated from the data, shows the relationship between staff, lead, and senior

PT with respect to clinical instruction and job satisfaction. The multifactor ANOVA

considered the title and clinical instruction as factors affecting job satisfaction.

In addition, it was observed that the staff and lead PTs have higher job

satisfaction when assigned primary clinical instruction as a function. However, the senior

PTs did not have a similar significant increase in job satisfaction. The staff PTs with

clinical instruction had a mean satisfaction of 4.04 compared to others with a mean of

3.75. In addition, a simple one-way ANOVA considering all population showed that the

null hypothesis could be rejected with an F-value of 15.372 and p = 0.000.

Figure 11. Interaction plot for overall data means.

In conclusion, the null hypothesis was rejected for the overall population of PTs.

At a granular level, this hypothesis was rejected for lead therapists and staff therapists.

However, it failed to be rejected for senior therapists.

The results indicate that for the overall population of PTs when clinical

instruction was added as an HPWS, the overall job satisfaction of the therapist increased.

However, when only managerial roles were considered, although there was an increase in

job satisfaction with clinical instruction, it was not significant from a statistical

perspective.

Hypothesis 1B

Ho: There is no significant relationship between HPWS such as clinical

instruction and overall job satisfaction among staff PTs.

Ha: There is a significant relationship between HPWS such as clinical instruction

and overall job satisfaction among staff PTs.

The multifactor ANOVA test addressed this hypothesis and rejected the null

hypothesis. The results from the ANOVA test showed an F-value of 17.847 with a

significance of 0.000, which indicated that the null hypothesis could be rejected. This is

displayed in Figure 11. The staff PT who had a clinical instruction role had a mean of

4.04 compared to others with a mean of 3.87. The research shows that for staff PTs the

overall job satisfaction increased significantly when they were assigned a clinical

instruction role.

Research Question Two

Research question two addressed the intrinsic nature of job satisfaction. So, for

this question, the data related to the 12 questions addressing intrinsic motivation were

used for analysis.

RQ 2: What effect, if any, does clinical instruction as a HPWS have on intrinsic

job satisfaction among PTs?

This research question was addressed with two hypotheses. The first hypothesis

addressed all the PTs as a group and the score related to intrinsic job satisfaction. The

second hypothesis addressed the staff PTs and their score related to intrinsic job

satisfaction.

Hypothesis 2A

Ho: There is no significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among PTs.

Ha: There is a significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among PTs.

A multifactor ANOVA test shows the results for each subset as follows. The

following interaction plot displays the relationship between the staff, lead, and senior PTs

with respect to their clinical instruction and intrinsic job satisfaction. The staff PT who

also had the role of clinical instruction was found to have higher job satisfaction.

The mean value for intrinsic job satisfaction was 4.25 for staff CIs when

compared to the mean value of 4.0 for others. The senior PT roles did not exhibit a

significant relationship with clinical instruction. However, the average intrinsic

satisfaction for senior PT was significantly higher than the other two groups as seen in

Figure 12.

Figure 12. Interaction plot for intrinsic data means.

The multifactor ANOVA results showed that this hypothesis was rejected for

senior PTs and lead PTs. The results showed that job satisfaction resulting from the

intrinsic motivation for a senior PT or lead PT did not increase significantly when they

were assigned the additional role as a CI.

Hypothesis 2B

This hypothesis addresses job satisfaction of the staff PTs resulting from intrinsic

motivation.

Ho: There is no significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among staff PTs

Ha: There is a significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among staff PTs

As stated in the results of the multifactor ANOVA test, the null hypothesis was

rejected. So, the multifactor ANOVA test showed that there was a significant increase in

intrinsic job satisfaction for staff PTs when clinical instruction was a part of their job

responsibilities.

Research Question Three

The third research question was formulated to evaluate whether the increased job

satisfaction, if any, for therapists with clinical instruction was because of the clinical

instruction only or whether it was influenced by other additional functions or

responsibilities in recent years, which can be construed as a high-performing function.

The research question was formalized as:

RQ 3: Is there an increase in job satisfaction for CIs in physical therapy when

compared to PTs who are not assigned any HPWS function?

The hypothesis was developed to determine if there was a difference in job

satisfaction of staff therapists who did not have any HPWS and those who had just

clinical instruction without any other HPWS functions.

Hypothesis 3

Ho: There is no increase in job satisfaction for CIs in physical therapy when

compared to PTs who are not assigned any HPWS function.

Ha: There is increased job satisfaction for CIs in physical therapy when compared

to PTs who are not assigned any HPWS function.

To determine the effects of the clinical instruction, a two-sample t-test on the

overall job satisfaction of staff PT was conducted. The results showed that there was a

significant difference in job satisfaction for staff PT when they were assigned the

additional responsibility of clinical instruction. The two-sample t-test showed the

following results.

Group one consisted of staff PTs who acted in the role of a primary CI in the past

five years, and had no other HPWS functions. Group two consisted of staff PTs with no

other HPWS function including clinical instruction. For the two-sample t-test, it is

assumed that μ₁= mean of group one and μ2 = mean of group two. Ho: μ₁ - µ₂ ≥0. Equal

variances are assumed for this analysis.

Table 9

Descriptive Statistics for the Two Groups

Sample N M SD SE Mean

Group one 104 4.121 0.609 0.060

Group two 155 3.764 0.624 0.050

The estimation for the differences to find pooled statistics and confidence

intervals is given in Table 10.

Table 10

Estimation for Difference

Difference Pooled SD 95% CI for Difference

0.3571 0.6181 (0.2028, 0.5114)

The t-value for the specified degrees of freedom (257) was 4.56, which generated

a p-value of 0.000. The null hypothesis was rejected with a p-value of 0.000, which

showed that the group of PTs who had clinical instruction as the only high-performing

work function had increased overall job satisfaction when compared to a staff therapist

without any HPWS.

Findings

Presented in this chapter are the statistical conclusions of the data gathered from

the 670 responses received for the study. The results from this study may be helpful for

leaders in physical therapy to find ways for clinicians to become satisfied with their roles,

which would lead to organizational commitment and longevity. It may also help leaders

to understand what motivates physical therapy CIs to facilitate the education of future

clinicians, thus, preventing a shortage of the workforce. Additionally, physical therapy

organizations may benefit from this research through the engagement and commitment

from their employees through HPWS such as clinical instruction.

The findings of the five hypotheses related to the three research questions can be

summarized as follows. The null hypothesis for hypothesis 1A was rejected for lead PTs

and staff PTs. It showed that the average job satisfaction of PTs was higher in staff

therapists and lead therapists when they were assigned the role of clinical instruction.

However, senior PTs did not have a significant increase in job satisfaction because of

clinical instruction. This was further explained in the results of hypothesis testing 2A

where the increase in intrinsic job satisfaction for senior and lead PTs are not significant

because of the clinical instruction as an HPWS.

Hypothesis 1B and 2B tested the overall job satisfaction and intrinsic job

satisfaction of staff therapists. In both cases, the null hypothesis was rejected. Testing of

hypothesis 1B and 2B proved with a very high confidence level of more than 99.999%

that clinical instruction as a HPWS could improve the intrinsic and overall job

satisfaction of staff PTs.

The null hypothesis for 3A was rejected with very high confidence indicating that

there was a significant increase in job satisfaction when clinical instruction was assigned

as a job responsibility for a staff therapist who did not have any other additional

responsibilities.

In Chapter Five, the results of this study are discussed in more detail in the

context of the topic of research. Further, Chapter Five presents conclusions on this

research study and the implication of using clinical instruction as a high-performing work

system and includes recommendations for additional research.

CHAPTER FIVE: DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS

The purpose of this study was to examine if there was a relationship between job

satisfaction and HPWS such as clinical instruction in physical therapy professionals in

the state of Florida. The study specifically addressed the role of clinical instruction as a

high-performing function providing intrinsic motivation. The intrinsic and extrinsic

factors related to job satisfaction of PTs in Florida were analyzed to identify the effects of

clinical instruction as a HPWS function affecting intrinsic job satisfaction among PTs. A

secondary purpose of the study was to identify if CIs in physical therapy had increased

job satisfaction. This chapter summarizes the results of the study based on the survey

administrated to the participants of the study.

The literature review suggested that HPWS could improve the employee

perception of enhanced outcome and thereby increase job satisfaction and intrinsic

motivation (Choi, 2008). Ollo-López et al. (2016) established that there was a

relationship between positive job satisfaction and HPWS. Wadhwa (2012) established

that HPWS superseded the influence of HR practices.

When employees are engaged in HPWS, they experience a reduction in the

unpredictability associated with jobs. This is partly because of the multifaceted intrinsic

and extrinsic motivation developed by resource empowerment, employee growth, and

employee learning (Wadhwa, 2012). Furthermore, the literature review suggested that

clinical instruction may act in an individual-centric role as a high-performance function

because of the empowerment, autonomy, and engagement (Coleman-Ferreira et al.,

2012).

Upon reviewing the literature, a gap in the literature was identified regarding the

use of HPWS as a tool to enhance employee engagement in clinical environments.

Another gap in the literature was identified specifically in the field of physical therapy

and HPWS. There is no current literature on the job satisfaction of CIs in physical

therapy from a HIWS perspective. A gap existed in identifying satisfaction factors for

CIs as well as the role of HPWS in contributing to satisfaction in PTs.

Summary of Findings

In this study, 670 PTs were surveyed using the MSQ short form to measure their

job satisfaction. In addition, the questionnaire collected demographic data on years of

experience, gender, and practice testing. The statistical group identification information

was gathered by asking three questions: their title, their role as a primary CI in the past

five years, and their role as a lead, senior, or any other management positions. These

were used as the independent variables for further analysis to examine and test the

hypothesis.

SPSS software was used to analyze the data and to conduct several tests including

the independent t-test, one-way ANOVA, multifactor ANOVA, two-sample t-tests,

Cronbach’s alpha, and Pearson’s correlation. In addition, descriptive statistics were

calculated at each question level as well as identified group level.

Research Hypotheses

For this study, there were three research questions addressed through five

hypothesis tests.

Ho 1A: There is no significant relationship between HPWS such as clinical

instruction and overall job satisfaction among PTs.

Ho 1B: There is no significant relationship between HPWS such as clinical

instruction and overall job satisfaction among staff PTs

Ho 2A: There is no significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among PTs.

H0 2B: There is no significant effect of clinical instruction as a HPWS affecting

intrinsic job satisfaction among staff PTs

H0 3A: There is no increase in job satisfaction for CIs in physical therapy when

compared to PTs who are not assigned any HPWS function.

The Results of the Research Hypotheses

The first research hypothesis H0 1A was rejected for the overall job satisfaction of

therapists who practiced as lead with F = 4.77 and p = 0.001. However, it failed to be

rejected for the management staff. The analysis was conducted using a multifactor

ANOVA test using all three factors for analysis. A one-way ANOVA analysis using

clinical instruction as the single factor rejected the null hypothesis with p = 000 and F =

15.75.

The results indicate that for the overall population of PTs when clinical

instruction was added as an HPWS, the overall job satisfaction of the therapist increased.

However, when only managerial roles were considered, although there was an increase in

job satisfaction with clinical instruction, it was not significant from a statistical

perspective.

The possible reason for the diminished effect for management staff from clinical

instruction could be that management by itself was an intrinsic motivator. Therefore, the

increased satisfaction was already contributed by their management roles as evidenced in

Figure 11. The subsequent increment in job satisfaction derived from clinical instruction

may not be as significant as in the case of other clinicians.

Hypothesis H0 1B was rejected for the overall job satisfaction of staff PTs with a p

= 0.000. The job satisfaction of staff PTs had a mean of 4.05, which was significantly

higher than those who did not have the function of clinical instruction, which was 3.87.

The research showed that for staff PTs, the overall job satisfaction increased significantly

when they were assigned a clinical instruction role. This could be attributed to the

recognition and self-actualization derived from the role in shaping future clinicians. The

ability to do things for others by being CIs may have added meaningfulness of work and

job satisfaction and may have contributed to this conclusion.

Hypothesis H0 2A failed to be rejected with a mean of 4.29 for those with clinical

instruction and a mean of 4.13 for those who did not work as a CI. The results showed

that the PTs who were in management, lead, or senior roles had significantly higher

intrinsic job satisfaction even in the absence of the clinical instruction function because

of the influence from other HPWS functions such as their managerial roles.

The null hypothesis for the test for intrinsic motivation for staff therapists, H0 2B,

was rejected because the mean for staff therapists with clinical instruction was 4.29

compared to others with a mean of 3.99. The results showed that there was a significant

increase in intrinsic job satisfaction for staff PTs when clinical instruction was a part of

their job responsibilities. This validated the grounding purpose of the research,

investigating the effects of HPWS in increasing intrinsic motivation, leading to higher job

satisfaction among PTs. The results for the above four hypotheses showed that clinical

instruction triggered an increase in intrinsic job satisfaction, which in turn, increased

overall job satisfaction.

Hypothesis H0 3A was rejected with a p-value of 0.000, which showed that the

group of PTs who had clinical instruction as the only high-performing work function had

increased overall job satisfaction when compared with staff therapists without any

HPWS. The results showed that there was a significant difference in job satisfaction for

staff PT when they were assigned the additional responsibility of clinical instruction. By

eliminating all other HPWS from the work dynamics of a physical therapist, the robust

increase in job satisfaction can be attributed to a single factor, which is clinical

instruction.

In a typical healthcare organizational environment, there may be limited

opportunities for advancement to managerial roles. Clinical instruction may provide

clinicians with an additional opportunity to derive job satisfaction at a level close to that

of management roles. The factors of clinical instruction such as autonomy, competence,

impact, engagement, and meaning as defined by Leggat et al. (2010) may have

contributed to the increase in job satisfaction. The results also allow this research to

provide validation in designating the CI role, its individualistic nature, and subsequently

its theorized definition as a HIWS that increases overall job satisfaction among PTs.

Conclusions and Implications

The responses from the survey using the MSQ short form were measured using

Cronbach’s alpha, which indicated that there were high reliability and consistency. Heo

et al. (2015) supported the power of Cronbach’s alpha to determine the consistency of

research of this type. Tavakol and Dennick (2011) stated that a value higher than 0.9

shows good consistency for experimental research.

The analysis, in general, showed that the overall satisfaction had a direct

relationship with intrinsic satisfaction with a Pearson correlation coefficient of 93.5 with

a p = 0.000. This further clarified that job satisfaction for PTs was driven by intrinsic

motivation in a significant manner. Therefore, leaders in the physical therapy profession

should focus on intrinsic motivation as a vehicle to maintain low absenteeism and lower

turnover (Brewer et al., 2016; Tadesse et al., 2015).

The demographics of the population showed some insights into the profession of

physical therapy. More than half of the respondents had more than 15 years of

experience in the profession. More than half of the sample was in the role of staff PTs.

Although clinical instruction is a voluntary task with no additional monetary

compensation, more than 50% of the respondents were found to have performed in that

role in the past five years. This shows that PTs were driven to give back to the

profession, which was triggered by intrinsic motivation.

Of the 20 questions in the MSQ survey, the highest score was for the question of

“chance to do things for other people.” The lowest score was for the question of

opportunities for advancement in the profession. Almost all questions related to intrinsic

motivation had higher scores than the questions related to extrinsic motivation with the

exception of the question “my coworkers get along with each other.” From these

descriptive data, it can be concluded that the professionals were intrinsically motivated

and were altruistic in nature. This also demonstrated that the ability to do things for

others added meaningfulness of work and job satisfaction as cited by Lunenburg (2011).

The scores for the highest three questions; chance to do things, use of one’s

abilities, and keeping busy all the time; all indicated that challenging tasks were a

motivating factor for PTs. This aligned with the definition and characteristics of HPWS.

PTs were more likely to display more satisfaction when assigned tasks that were

challenging and rewarding (Lazaroiu, 2015).

The objectiveness of the task as stated in Fiedler’s (1967) contingency model may

be very important in motivating PTs. According to Fiedler’s contingency model, leaders

affect the motivational behaviors of the follower (Miller et al., 2004). Leaders have the

ability to generalize the follower behavior through their relationships with the follower,

the objectiveness of the task, and the situational favorability of the leader (Miller et al.,

2004; Uhl-Bien et al., 2014).

Situational leadership and task-oriented leadership enable a leader to provide

more satisfaction to the employees (Hackman & Oldham, 1980). HPWS is a very useful

tool in motivating an employee in this regard. This is in alignment with the JCM’s five

core characteristics of skill variety, task identity, task significance, autonomy, and job

feedback (Hackman & Oldham, 1980).

The six questions that scored lowest were all questions related to hygiene factors.

The five questions that scored the highest were all related to job characteristics in the

JCM model. Thus, leaders should focus on autonomy, task identity, and task significance

to motivate PTs.

The results of the hypothesis testing in this study clearly demonstrated that

clinical instruction could be an effective motivator for staff PTs who are not in

managerial or lead positions. This is because of the motivation triggered by the

perception of the meaningfulness of the task. In this study, clinical instruction was

theorized as a HIWS, which is a critical subset of HPWS (Ollo-López et al., 2016). The

operating job functions of clinical instruction can be used as an effective tool to motivate

employees by a situation leader.

In health care, it is a challenge to provide yearly salary increases because of the

steady rise of health care costs for the past few years. The clinician to patient ratio and

supervisor to employee ratio are increasing, as the professional environment is becoming

more standardized and process-oriented. For an individual leader, this limits the ability

to motivate an employee through extrinsic factors such as pay or promotion. The results

of the study showed that leaders should focus on task-oriented leadership to tailor their

motivational techniques using HPWS systems. This study clearly showed that providing

an opportunity for clinical instruction could be an effective tool for motivating a physical

therapist because of its operating role as a HPWS.

The study concluded that staff PTs who were CIs derived more job satisfaction

through intrinsic factors. From an academic perspective, CIs are facilitators of active

learning and are critical in the professional training of emerging clinicians. The skill and

ability to mentor a student and the in-depth knowledge in the subject matter ensure that

only competent employees who provide direct patient care can perform the role of a CI.

Job satisfaction that resulted from the utilization of their own resources and skill sets

provides for perceived organizational support as cited by García-Chas et al. (2016).

From an academic perspective, this provides incentives for most competent and

committed employees to become CIs, thereby increasing the overall quality of

professional education.

Limitations and Delimitations

The researcher acknowledges several limitations to this research study. The 670

participants constituted only a small portion of PTs in the United States. The study was

restricted to the state of Florida; therefore, the sample may not represent the entire group

of PTs in the United States. This may affect the generalizability of the study to PTs

outside of the state of Florida.

However, the profession of physical therapy is uniform in its best practices across

the county. So, the variation in job satisfaction for clinical instructions in other states

was minimal. Although there may be slight variations in the physical therapy education

at various educational institutions, these variations were minimal, as CAPTE has

standards for educational instruction in physical therapy. Therefore, the study could be

generalized outside of the population in this research study.

The tool that was used for the quantitative data collection was MSQ, a well-tested

survey instrument with established reliability and validity. The dimensions used for job

satisfaction were tested for validity. Although perhaps irrelevant on the overall outcome

of the study, it could be perceived that the limitation includes the exclusion of the test for

validity and reliability of the instrument. In addition, the instrument was slightly

modified to measure the job satisfaction based on the HPWS aspects of the study and

could be considered a limitation triggered by necessity and construed as a limitation for

the overall study.

The study considered HPWS from a different perspective when compared to

previously published research. The use of administration and community outreach as

HPWS functions of motivation was established in the literature. However, in this

research, the focus was reversed with the assumption that clinical instruction was a

HPWS function in the field of physical therapy leading to job satisfaction. This could be

considered a limitation of the construct of the study, but formulated accurately in

conjunction with the question of interest.

In addition, the collection method was a self-reporting method, which may

introduce a perception of bias by itself. Another limitation was the invitation method for

participation, which remained open for only 14 days, and therefore, may have provided

limited opportunities to respond in the allotted period. The primary researcher was also

aware of the potential inaccuracy in respondent reporting, and potential respondent bias

as limitations of this study.

The study was limited to the HPWS of PTs; hence, it may not be

generalized further to other professions. However, the underlying principles and

literature surveys make it comparable with other health care professions in

general, hence, can be generalized with proper exploratory analysis. The fixed

design of the survey technique may have inhibited the evolution of the study

methods based on the initial findings as identified by Robson and McCartan

(2015). External validity of the research may be affected in this study because of

the researcher making incorrect inferences from the population sample as

identified by Creswell (2014).

Recommendation for Further Research

Hypotheses 1A and 1B showed that the effectiveness of clinical instruction as a

HPWS was not significant for managerial roles. The job satisfaction for this group was

shown to be at a higher level. A research study identified the HPWS tasks leading to job

satisfaction specific to managerial roles that may be beneficial. This may give further

insight into the dynamics of HPWS in managerial roles.

Clinicians in skilled nursing facilities had the lowest mean (3.91) for overall

satisfaction and intrinsic satisfaction when compared with those in the other four practice

settings. Further research is recommended to examine the motivational factors for the

population in this setting. It may be beneficial to investigate this, especially in the

context of situational leadership.

This study treated the HPWS at an individual level and task level for PTs. The

theoretical framework was derived from the motivational theories as stated in the

literature review. Additional studies may be needed to explore this approach for other

professions where a specific role or task can be used as a HPWS. Further research could

be conducted to analyze similar HPWS functions such as management, clinical

leadership, and administrative leadership in physical therapy. This may facilitate the

development of situational leadership skills in a clinical environment.

Conclusion and Remarks

This study explored the use of clinical instruction as a HPWS to increase job

satisfaction of PTs through intrinsic motivation. The review of the literature examined

clinical instruction as a HPWS and identified a gap in job satisfaction factors for CIs as

well as the role of high-performance work systems in contributing to satisfaction in PTs.

The results of the study validated the theorized framework of designating clinical

instruction as a HIWS.

This study linked the JCM model as well as Hershey and Blanchard’s situational

leadership model with HPWS through task characteristics that create perceptions of the

meaningfulness of jobs triggering intrinsic motivation. The results suggested that leaders

should identify HPWS functions such as clinical instruction for successful situational

leadership. It has also shed light on the task characteristics for job satisfaction analyzing

the questions on the MSQ.

PTs as professionals are altruistic in nature. It appears that PTs are motivated

more by intrinsic factors than hygiene factors. The mean scores of the MSQ indicated the

professional nature of services that PTs provide. The results also indicated the

importance of the perception of serving others, compassion, and caring, which are all part

of the value-based behaviors of the profession.

The primary researcher hopes that this study assists leaders of physical therapy

further in motivating clinicians in the current dynamic health care environment. In

addition, the primary researcher hopes that academic programs in physical therapy will

gain tools from this study in developing competent CIs through facilitating intrinsic

motivational factors for PTs. The primary researcher would like to see the results from

the study being used to entice competent CIs, who can provide clinical instruction to

students and support the profession to prevent a shortage of PTs.

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APPENDICES

111

APPENDIX A

MSQ Short Form

112

APPENDIX A

MSQ Short Form

The Minnesota Satisfaction Questionnaire Short Form

The purpose of this questionnaire is to give you a chance to tell how you feel about your

present job as a physical therapist, what things you are satisfied with and what things you

are not satisfied with.

On the basis of your answers and those of people like you, we hope to get a better

understanding of the things people like and dislike about their jobs.

On the next page, you will find statements about your present job.

 Read each statement carefully.

 Decide how satisfied you feel about the aspect of your job described by the

statement.

Keeping the statement in mind:

-if you feel that your job gives you more than you expected, check the box under

“Very Satisfied”

-if you feel that your job gives you what you expected, check the box under

“Satisfied”

-if you cannot make up your mind whether or not the job gives you what you

expected, check the box under “Neither Satisfied nor Dissatisfied”

-if you feel that your job gives you less than you expected, check the box under

“Dissatisfied”

-if you feel that your job gives you much less than you expected, check the box under

“Very Dissatisfied”

113

• Remember:

-Keep the statement in mind when deciding how satisfied you feel about that aspect

of your job.

-Do this for all statements. Please answer every item.

-Be frank and honest. Give a true picture of your feelings about your present job.

 Are you self-employed and/or own the company or clinic that you work for? *

o Yes (“Yes” response disqualifies and dismisses participant from

survey/study)

o No

 Are you currently licensed to practice as a physical therapist in the state of

Florida? *

o Yes

o No (“No” response disqualifies and dismisses participant from

survey/study)

 Are you currently practicing as a physical therapist in the state of Florida? *

o Yes

o No (“No” response disqualifies and dismisses participant from

survey/study)

 Gender: Please Check One *

o Male

o Female

 Describe your primary practice area: *

114

o Outpatient Rehabilitation

o Acute Care Hospital

o Home Care

o Inpatient Rehabilitation

o Skilled Nursing Facility/Long-Term Care/Extended-Care Facility

 How long have you been practicing as a physical therapist? *

o 0-5 years

o 6-15 years

o Greater than 15 years

 Which is the closest to your official title at your current role?

o Staff Therapist

o Lead Physical therapist

o Senior Physical therapist

o Manager, Director, or Supervisor

o Other: Please specify:....

 Have you worked as a primary clinical instructor in the past five years?*

o yes

o no

 Have you worked as a Senior PT or Lead PT in past five years?*

o Yes

o No

1. Being able to keep busy all the time

a. Very Satisfied

115

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

2. The chance to work alone on the job

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

3. The chance to do different things from time to time

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

4. The chance to be “somebody” in the community

a. Very Satisfied

b. Satisfied

c. Neutral

116

d. Dissatisfied

e. Very Dissatisfied

5. The way my boss handles his/her workers

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

6. The competence of my supervisor in making decisions

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

7. Being able to do things that don’t go against my conscience

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

117

8. The way my job provides for steady employment

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

9. The chance to do things for other people

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

10. The chance to tell people what to do

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

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11. The chance to do something that makes use of my abilities

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

12. The way company policies are put into practice

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

13. My pay and the amount of work I do

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

14. The chances for advancement on this job

a. Very Satisfied

119

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

15. The freedom to use my own judgment

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

16. The chance to try my own methods of doing the job

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

120

17. The working conditions

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

18. The way my co-workers get along with each other

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

19. The praise I get for doing a good job

a. Very Satisfied

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

20. The feeling of accomplishment I get from the job

a. Very Satisfied

121

b. Satisfied

c. Neutral

d. Dissatisfied

e. Very Dissatisfied

122

APPENDIX B

Informed Consent

123

APPENDIX B

Informed Consent

Letter of Informed Consent

This research is being conducted by Bini Thomas, who is a student in

the Graduate School of Business and Management at Argosy University

Online working on a doctoral dissertation. This study is a requirement to

fulfill the researcher’s degree and will not be used for decision making by

any organization.

The title of this study is Relationship between Job

Satisfaction and Clinical Instruction as High-Performance Work

Systems among Physical Therapists (Argosy University IRB

Approval # XXXXX)

 The purpose of this study is to examine if there is a relationship

between job satisfaction and high-performance work systems

such as clinical instruction in physical therapy professionals in

the state of Florida.

 I was asked to be in this study because I am currently licensed and

practicing as a physical therapist in the state of Florida.

 A total of XXXX people have been asked to participate in this study.

 If I agree to be in this study, I will be asked to complete an online survey

about my professional setting, how I feel about my present job, what things I

am satisfied with and what things I am not satisfied with as well as some non-

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identifying, general demographic questions.

 This study will take approximately ten minutes of my time to

complete the online survey.

 The risks associated with this study are minimal to none.

 There will be no direct personal benefits to participants in this study.

The potential benefits to the profession will be collection and

analysis of data to provide additional evidence to support an

understanding of the factors contributing to job satisfaction in PTs in

the state of Florida.

 I will receive no compensation, monetary or otherwise, for

participating in this study.

 The information I provide will be treated confidentially, which means

that nobody except the principal investigator, Bini Thomas, will be

able to tell who I am.

 The records of this study will be kept private. No identifiers

linking you to the study will be included in any sort of report that

might be published.

 The records will be stored securely and only Bini Thomas, principal

investigator, will have access to the records.

 I have the right to get a summary of the results of this study if you

would like to have them. You I can get the summary by contacting

Bini Thomas at [email protected].

 I understand that my participation is strictly voluntary. If I do not

125

participate, it will not harm my relationship with Bini Thomas. If I

decide to participate, I can refuse to answer any of the questions that

may make me uncomfortable. I can withdraw at any time without my

relations with the principal investigator, or my job being affected.

 I can contact Bini Thomas, principal investigator at

[email protected] and the dissertation chair Dr. Dale

Mancini at [email protected] with any questions about this

study.

I understand that this study has been reviewed and certified by the

Institutional Review Board, Argosy University Online. For problems or

questions regarding participants’ rights, I can contact the Institutional

Review Board Chair, Dr. Nancy Hoover at [email protected].

I have read and understand the explanation provided to me, and I

have had all my questions answered to my satisfaction. By continuing with

the study, I am giving my voluntary consent to participate.

By clicking on “Yes, I agree to participate,” you are voluntarily consenting to

participate in this research survey.

If you do not wish to participate, please exit the survey.

 Yes, I agree to participate

mailto:[email protected]

1. 2019-02-26T21:22:55-0500
2. Katherine M. Noone
1. 2019-02-27T09:39:05-0500
2. Dr. Dale Mancini
1. 2019-02-27T09:39:50-0500
2. Dr. Dale Mancini