RUNNING HEAD: RESEARCH PAPER 1
Research Paper
School of Business, Liberty University
BMAL 500 - B07: Organizational Behavior
October 9, 2022
RESEARCH PAPER 2
Abstract
The providers in the Geriatrics Division of the VA Pittsburgh Healthcare System are
experiencing job dissatisfaction as a result of issues caused by the coronavirus pandemic. These
concerns are not limited to the VA Pittsburgh Healthcare System but rather have global influence.
The research article Rana et al. (2022) was utilized to provide context to how the coronavirus
fostered job dissatisfaction amongst healthcare workers. A problem-solving, integrative
framework was then utilized to evaluate the organizational behavior of the VA Pittsburgh
Healthcare System and identify potential solutions. Maslow’s Need Hierarchy Theory provided a
framework for determining the needs of the providers within the Geriatrics Division. Strengths of
the Myers-Briggs 4-letter personality preference of (ENTJ) Extravert, Intuitive, Thinker, and
Judger for implementation of a recommended plan are discussed.
Keywords: Job dissatisfaction, Healthcare provider, Maslow’s Need Hierarchy Theory
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Step One
VA Pittsburgh Healthcare System
The Veterans Health Administration, established in 1921, is the largest integrated health
care system in the United States. Both active service members and veterans are able to receive
care at a Veterans Health Administration facility. In the Pittsburgh market, the VA Pittsburgh
Healthcare System (VAPHS) has one acute care hospital (University Drive campus) that has the
capability of providing care for 250 inpatient veterans (intensive care, step down, floor,
behavioral health), one skilled nursing home (Community Living Center (CLC) that has the
capability of providing care for 152 inpatient veterans (hospice, memory care, COVID
observation, rehab, skilled nursing, long term care), as well as ambulatory care services
(outpatient primary care). In 2020, the VAPHS employed 3,893 clinical, administrative, and
facilities roles (U.S. Department of Veterans Affairs, 2022). The Geriatrics Division of VAPHS
employs 5 physicians and 15 full practice authority nurse practitioners. The Geriatrics Division
provides care for veterans across all three care settings.
Synopsis of the Organizational Challenges
The mission of the Veterans Health Administration is “To fulfill President Lincoln's
promise “To care for him who shall have borne the battle, and for his widow, and his orphan” by
serving and honoring the men and women who are America’s Veterans” (U.S. Department of
Veterans Affairs, 2021). In order to achieve this mission and meet the medical needs of the
veterans in the greater Pittsburgh area, the VAPHS must employee a substantial number of
personnel. Due to a multitude of federal employees retiring, a lengthy on-boarding process, and
numerous job vacancies (which have increased significantly during and in the aftermath of the
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coronavirus pandemic), the VAPHS employees are being tasked to continue daily operations with
limited staffing and minimal supportive services.
One area in particular within the VAPHS that has suffered due to staffing is the Geriatrics
Division. This group has had five providers leave the division within the past year. Once a
provider leaves their position, it typically takes a year for the position to be filled. The lag time in
hiring a new provider is partly due to the centralization of human resources. Prior to the
coronavirus pandemic, human resources for each care setting (hospital, skilled nursing home,
ambulatory care) were located on site. The division managers were able to meet with human
resources in person and answer questions in real time so as to move the process along. Human
resources have since been outsources, they work remotely, and cover larger territories. This has
contributed to delays in posting of positions as well the timeliness of the hiring process due to
unclear communication and the need to wait for clarification. Once a candidate is selected, the
credentialing process and background check usually takes three to six months. Orientation to the
VAPHS, Geriatric Division, and care setting is roughly two months. To date, two candidates are
in the on-boarding process, interviews are currently being held for one position, and the other
two positions have yet to be posted. This lengthy process creates a void within the Geriatrics
Division and only increases the frustrations by the remaining providers as they know that no
immediate help is foreseeable.
Despite the reduction in the number of providers, the Geriatrics Division was expected to
continue to provide care to the same number of veterans. Additionally, the veterans managed by
this division have had increasing medical complexity as many contracted the coronavirus. The
Geriatrics Division was also tasked with attempting to manage the veterans in place due to
limited availability of beds within the hospital and skilled nursing home. To complicate matters
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further, this division was not able to have the veterans evaluated by specialty services in-person
in order to mitigate potential exposure to the coronavirus. Rather, the veterans were evaluated
through telemedicine and thus required the on-site provider to conduct the evaluation for the
specialist. Collectively these factors increased the workload for each of the remaining providers
of the Geriatrics Division. And yet, the Geriatrics Division was still expected to provide high-
quality care in a timely manner that continued to achieve predetermined metrics (30-day
rehospitalization rates, number of emergency room transfers, number of facility associated
infections, and bed days of care per treating specialty). According to Schlak et al. (2022),
“inadequate numbers of health care providers is associated with negative outcomes, including
higher rates of hospitalization, lower patient-rated health quality, and even higher mortality” (p.
999). Unfortunately, the Geriatrics Division was not able to achieve their goals which added to
the stress the group was already experiencing.
According to Kroeger et al. (2002), people are adaptive creatures and should be able to
adjust their approach and behaviors to accommodate the present demand. While this was true for
this division initially, they essentially reached a breaking point after months of continued
stressors without and end in sight. Thus, the increased workload, lack of supportive services,
expectation to maintain prior standards of care, and supply chain issues has resulted in the
remaining providers of the Geriatrics Division experiencing job dissatisfaction. Unfortunately,
“Provider burnout and job dissatisfaction are directly related to patient outcomes and health care
costs” (Schlak et al., 2022, p. 999). This only further compounds the issue at hand. For without a
solid infrastructure, the mission of the Veterans Health Administration will not be achievable by
the Geriatrics Division.
Individual and Roles
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The Associate Chief of Geriatrics and Extended Care Services (ACOG), an inpatient
Medical Director, and an outpatient Medical Director collectively make up the leadership team
for the Geriatrics Division of the VAPHS. “Effective According to Goodhue and Harris (2019),
leadership is a crucial component of a healthy work environment; the presence and actions of a
leader may be the more influential factor in the health care work setting” (p. 74). As such, each
of these leadership positions directly impacts job satisfaction (or dissatisfaction).
The Geriatrics Division of the VAPHS is overseen by the ACOG. This position “provides
executive leadership and assumes continuing and substantial responsibility for the coordination
and evaluation of integrated programs that cross service and discipline lines and influence
organizational mission, vision, values and strategic priorities” (USA Jobs, 2022). The ACOG is
also responsible to ensure that the clinical delivery of care is in alignment with that of the
VAPHS and that benchmarks are met or exceeded (compared to community, state, and national
level). The ACOG’s influence is tangible in all aspects of the Geriatrics Division. And yet, this
position lacks front line provider experience so the ACOG must rely on two Medical Directors
(one oversees the inpatient care setting, one oversees the outpatient care setting) to provide
clinical context.
The inpatient and outpatient Medical Directors are responsible for the day-to-day
operations of the Geriatrics Division. Essentially, they make the trains run on time. Their
responsibilities include ensuring that staff have appropriate training, that there is adequate
staffing, and that providers have access to essential supplies. The Medical Directors are also
responsible to provide direct patient care/clinical coverage. This ensures that they have firsthand
knowledge of the challenges that the providers of the Geriatrics Division face on a daily basis.
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In order to better support the providers of the Geriatrics Division, the ACOG and the
Medical Directors established a fifteen-minute daily meeting so as to do a morning check in with
the group. These meetings allow for dissemination of pertinent information as well as provide an
open forum for providers to discuss challenges. Additionally, Microsoft TEAMs was
implemented at the VAPHS and a designated channel was established for the providers of the
Geriatrics Division. This allows for the group to be notified of issues in real time and foster
solutions. This approach is consistent with the sediments of Kroeger et al. (2002); “The more
people involved in solving a problem, the longer it may take, but the higher the commitment and
the better the end result” (p. 122).
Despite the sphere of influence and level of respect that leadership of the Geriatrics
Division has, they are still at the mercy of human resources for hiring additional providers. Even
though they implemented procedures, such as mandated masking, protective eye wear, and
coronavirus swabbing twice a week, the Medical Directors were unable to completely prevent
veterans from contracting the coronavirus. Additionally, the supply chain issues were not unique
to the Geriatrics Division as healthcare systems globally were impacted.
Step Two
Individually increased workload, lack of supportive services, expectation to maintain
prior standards of care, or supply chain issues would present disruptions in the flow of veteran
care. When these factors are compounded, they create a work environment with unobtainable
goals. The research article Rana et al. (2022) utilized Maslow’s Need Hierarchy Theory to
provide context to how the coronavirus fostered job dissatisfaction amongst healthcare workers.
Research Article
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The Coronavirus-2019 (COVID-19) pandemic has placed an inordinate amount of stress
on medical health professionals due to potential risk of exposure, lack of/inadequate personal
protective equipment, exhaustion, emotional stress, and isolation. To complicate the matter, the
healthcare systems they serve were ill equipped to manage the extreme demand by the multitude
of critically ill patients seeking care. The COVID-19 pandemic thus has resulted in a prolonged
occupational stress for medical health professionals that continues to be prevalent after three
years. The Rana et al. (2022) study evaluated perceived job satisfaction as a mediating variable
that directly impacted the relationship between performance appraisal and reinforcement on
performing job tasks. A purposive sample of 550 medical health professionals via telephone
survey was conducted; there was a 100% response rate. The Rana et al. (2022) study revealed
that perceived job satisfaction mediates the relationship between performance appraisal and
reinforcement on job tasks by medical health professionals. Thus, medical health professionals
who experience job dissatisfaction will have a poorer performance appraisal and be less likely to
excel in their job tasks. If corrective action is not taken, medical health professionals, healthcare
systems, and the patients they serve will all suffer devastating losses.
Maslow’s Need Hierarchy Theory
Maslow’s Need Hierarchy Theory “states that motivation is a function of five basic
needs: physiological, safety, love, esteem, and self-actualization” (Kinicki, 2021, p. 164). The
five needs are met sequentially; thus, one cannot move up the hierarchy until the current function
is met. As such, once an individual’s basic physiological needs are met (i.e. food, water, air) then
safety needs will arise. The staged graduation of each of the basic needs will continue until self-
actualization is achieved (Kinicki, 2021).
Maslow’s Need Hierarchy Theory in Context of the Research Article
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Maslow’s Need Theory, when applied to the healthcare arena, provides a stepwise
guideline that leaders can use to motivate employees. Rana et al. (2022) endorses that
“motivation is a complex and vigorous process where insight and learning is necessary to
execute any function” (p. 2347). Motivation can occur in various forms and functions such as
financial incentives, access to medical conferences, time off, providing a desired schedule, or
even have access to new medical equipment. Motivation combined with a healthcare provider’s
intrinsic motivation will directly influence both their performance and job satisfaction level. As
such, leadership would be wise to evaluate the roles and responsibilities for each job and
individualize a developmental plan for each employee that would promote growth and enhance
their skill set. This plan should incorporate factors would motivate the employee as well as
determine what is needed to foster job satisfaction. “Perceived According to Rana et al. (2022),
job satisfaction tends to center around cognitive aspect of association which builds job
performance/productivity and strengthen individual’s wellbeing of representative work identity”
(p. 2347).
Maslow’s Need Hierarchy Theory applied to the Geriatrics Division of the VAPHS
While the height of the coronavirus pandemic seems to be behind us, the ramification
from this virus continues to negatively influence the job satisfaction of the providers of the
Geriatrics Division of the VAPHS. This division has been unable to move beyond the second
need (safety) and thus cannot progress to self-actualization. According to Kinicki (2021), safety
“consists of the needs to be safe from physical and psychological harm” (p. 165). Providers in
the Geriatrics Division witnessed firsthand what the coronavirus can do to one’s medical
condition. Unfortunately, many of the geriatric veterans who contracted coronavirus died. Thus,
the providers felt a real threat that they could contract this virus despite taking all necessary
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precautions. This further pledged their thoughts and instilled fear that they could also take the
virus home with them and infect their loved ones. As such, the providers in this division have
been unable to achieve their productivity and quality metric goals which translated into low
ratings on their annual reviews. According to Rana et al. (2022), “Performance appraisal,
reinforcement and job tasks are few ways through which employers can identify perceived job
satisfaction of the employees and its significance is imperative for collective and growth and
wellbeing of medical healthcare employees” (p. 2351). Moving forward, leadership of the
Geriatrics Division would be wise to abandon the stick and embrace a carrot approach.
Step Three
Some of the identified issues contributing to job dissatisfaction for the providers of the
Geriatrics Division of the VAPHS are outside of the control of their leadership group. Thus, these
items are likely to be resolved at best. One area in particular is that of supply chain management.
The leaders of the Geriatric Division could meet with supply chain leaders to determine if
alternative items could be sourced as well as to determine the time frame for the arrival of
currently ordered items. Additionally, the providers of the Geriatric Division could be asked to
rank the need of each supply so that their leaders can focus on obtaining the items of highest
need.
Ideally, the leaders of the Geriatrics Division will be able to solve the issues of increased
workload, lack of supportive services, and expectation to maintain prior standards of care.
Leadership of this group should meet with providers both individually and as a collective group.
A brainstorming session may yield creative solutions to these on-going issues. This approach is
consistent with Ecclesiastes 4:9-10; “Two are better than one, because they have a good return
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for their labor: If either of them falls down, one can help the other up. But pity anyone who falls
and has no one to help them up” (New International Version, 1978/2011).
Leadership of the Geriatrics has the ability to cap the number of veterans/patient panel
size that each of the providers are responsible for. They can also limit the number of admissions
a provider receives on any given day. While it is not ideal to have veterans transitioned to the
community (rather than receiving care at a VA facility), this practice is ultimately the best for all
parties involved. It ensures safe practice ratios for the provider and grants the veteran access to
necessary care. Once additional providers are on-boarded, leadership could increase the census
capabilities.
Staffing issues are not isolated to the Geriatrics Division; rather, this is something present
throughout all healthcare systems. Unfortunately, staffing has only gotten worse in the aftermath
of the coronavirus pandemic. As such, supportive services that were previously readily available
are no longer able to function at the same level. At the VAPHS, volunteer services would
transport veterans to and from their on-campus appointments. However, this resource is no
longer available as many volunteers quite due to fear of contracting the coronavirus. This group
does not have the bandwidth to continue to provide this service. A such, it places the burden of
transportation on the nursing staff to get veterans to/from their appointments on time. One way in
which to alleviate this issue is to have a designated transportation person on each nursing unit.
They would be responsible for transporting all of the veterans with on-campus appointments.
Another option would be to allow veterans to transport themselves if they were mentally and
physically able to do so.
The expectation to maintain prior standards of care will prove to be the greatest
challenge. Medical practitioners take a Hippocratic oath to do no harm and put the patient’s
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interests above all others. This may be unachievable without having an adequate amount of
allotted time to spend with the veteran due to increased workload as well as lack of access to
supportive services and necessary supplies. Again, leadership could set a limit on the number of
veterans a provider panel could consist of. This approach may temporarily resolve the issue. It is
unlikely to be fully solved until veteran acuity level and the infrastructure of the VAPHS returns
to pre-coronavirus levels. As such, the providers of the Geriatrics Division should embrace the
sediments of Colossians 3:23-24 as the healthcare system works to correct the faulty
infrastructure; “Whatever you do, work at it with all your heart, as working for the Lord, not for
human masters, since you know that you will receive an inheritance from the Lord as a reward. It
is the Lord Christ you are serving” (New International Version, 1978/2011).
Myers-Briggs Personality Test
Personality types greatly influence how one communicates, acts, and perceives the world.
The Myers-Briggs evaluates four dimensions (Extraversion/Introversion, Sensing/iNtuition,
Thinking/Feeling, Judging/Perceiving) to determine one’s personality type (16 different
personality types) (Kroeger et al., 2002). My 4-letter personality preference was that of (ENTJ)
Extravert, Intuitive, Thinker, and Judger. Individuals with the ENTJ personality type, such as
myself, “prefer to be very logical, detached, analytical, and driven by objective values” in regard
to their decision-making process (Kroeger et al., 2002, p. 37). These characteristics are very
useful in problem solving and implementation of practice change.
Conclusion
The providers in the Geriatrics Division of the VA Pittsburgh Healthcare System are
experiencing job dissatisfaction as a result of issues caused by the coronavirus pandemic.
Leadership of the Geriatrics Division need to address issues surrounding increased workload,
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lack of supportive services, expectation to maintain prior standards of care, and supply chain
issues if they hope to improve the providers’ morale and level of job satisfaction. Having
understanding of Maslow’s Need Hierarchy Theory will enable leadership of the Geriatrics
Division of VAPHS to determine what needs are/are not being met so that steps can be taken to
motive each individual provider within the group. Ultimately, steps need to be taken immediately
if leadership hopes to correct the work culture and job satisfaction level. Otherwise, these issues
will fester and create additional problems within the division.
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Reference
Goodhue, C. J., & Harris, D. G. (2019). Nurse practitioner job satisfaction and the healthy work
environment. AACN Advanced Critical Care, 30(3), 274-277.
https://doi.org/10.4037/aacnacc2019451
Kinicki, A. (2021). Organizational behavior: A practical, problem-solving approach plus
Connect. McGraw-Hill. ISBN: 9781264250790.
Kroeger, O., Thuesen, J. M., & Rutledge, H. (2002). Type talk at work: How the 16 personality
types determine your success on the job (Revised and Updated ed.). New York, NY: Dell
Publishing. ISBN: 9780440509288.
New International Version Bible. (2011). The NIV Bible. http://www.thenivbible.com (Original
work published 1978).
Rana, W., Mukhtar, S., & Mukhtar, S. (2022). Job satisfaction, performance appraisal,
reinforcement and job tasks in medical healthcare professionals during the COVID 19 ‐
pandemic outbreak. The International Journal of Health Planning and
Management, 37(4), 2345-2353. https://doi.org/10.1002/hpm.3476
Schlak, A. E., Poghosyan, L., Liu, J., Kueakomoldej, S., Bilazarian, A., Rosa, W. E., & Martsolf,
G. (2022). The association between health professional shortage area (HPSA) status,
work environment, and nurse practitioner burnout and job dissatisfaction. Journal of
Health Care for the Poor and Underserved, 33(2), 998-1016.
https://doi.org/10.1353/hpu.2022.0077
USA Jobs. (2022). Associate Chief of Staff-Geriatrics and Extended Care (Physician). Retrieved
from https://www.usajobs.gov/job/648904700
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U.S. Department of Veterans Affairs. (2022, August 24). About Us: At VA Pittsburgh Healthcare
System, we have a history of improving Veterans' lives. Retrieved from
https://www.va.gov/pittsburgh-health-care/about-us/
U.S. Department of Veterans Affairs. (2021, March 26). About VA: Mission, Vision, Core Values,
and Goals. Retrieved from https://www.va.gov/about_va/mission.asp
