https://orcid.org/0000-0003-1893-3039
Abstract
Work rules are an important guiding principle that regulates professional behaviour in organizational settings, however, the mechanism through which work rules affect physicians’ compassion satisfaction and career satisfaction remains unknown. Additionally, existing literature mainly focuses on direct associations, overlooking team support’s potential mediating role. This creates a research gap regarding team support as a mediator between work rules and both compassion and career satisfaction, requiring further scholarly investigation. Hence, the present study aims to investigate team support as a mediator between work rules and both compassion and career satisfaction in Obstetrics and Gynaecology (Obs and Gynae) physicians. A cross-sectional survey was distributed to 347 participants between 24 and 60 years (M = 31.22; SD = 6.81) in tertiary care hospitals. Participants were approached through purposive and convenient sampling techniques. A structural equation modelling through AMOS was analysed to study the complex interlinkages among the variables. The study found significant mediation of team support between work rules and career satisfaction (b = 0.077, 95% CI = 0.052, 0.106, P = 0.000). Also, an indirect significant path of team support is found between work rules and compassion satisfaction (b = 0.032, 95% CI = 0.020, 0.044, P = 0.000). Teamwork has far-reaching implications for healthcare professionals’ well-being, team dynamics, patient care quality, and the overall effectiveness of healthcare organizations. Filling this research gap enables healthcare professionals to foster more supportive work environment, benefiting both physicians and the patients they serve.
INTRODUCTION
In the fast-paced world of healthcare, work rules serve as fundamental guidelines shaping professional conduct and organizational operations. Work rules play a pivotal role in ensuring compliance with quality standards, safety measures, and legal requirements (Lizzaraga et al. 2009; Copeland,et al. 2021). Though their significance is generally understood, their complex use in obstetrics and gynaecology (Obs and Gynae) highlights their versatility and the need for more research. The complex nature of this field including high-risk pregnancies, sensitive patient interactions, reproductive health, and child birth are among the difficulties brought on by the intricacies of this profession (de Alwis, Binder and Hannan 2021; Donley 2021). Adherence to work rules is crucial in managing high-risk pregnancies such as eclampsia, haemorrhage, and hysterectomy where the health of both the unborn child and mother is vital (Rosen et al. 2018; Shareef et al. 2022; Bao et al. 2022).
Moreover, studies (for instance, Martin et al. 2024) have been conducted on challenges that healthcare professionals experience, such as burnout and stress, very little of it has been done on how to lessen these consequences (Phillips-Wren and Adya 2020). Positive characteristics including coping mechanisms, team support, compassion satisfaction, and career satisfaction can be highlighted in order to improve physician well-being, resilience, and patient care outcomes. Furthermore, it is crucial to create a supportive environment for all healthcare professionals because the well-being of physicians has a significant impact on the larger healthcare workforce and system. Additionally, resilient physicians are better able to maintain the highest standards of ethics and professionalism, guaranteeing the best possible service.
One of the positive characteristics is the compassion satisfaction. This refers to the satisfaction they derive from their work by providing and taking compassionate actions to improve the lives of others (Sacco and Copel 2018). Another positive characteristic is the career satisfaction which encompasses achievements in patient care, medical innovations, and financial security (Leigh et al. 2002; Meilianti et al. 2022; Olaniran et al. 2022). Career satisfaction includes achievement of goals emphasizing the importance of continuous professional development for physicians. Physicians’ clinical abilities and satisfaction are improved when they engage in continuous learning to stay up to date on medical advancements and patient care guidelines (Batorowicz and Shepherd 2008; Wang et al. 2017). In this context, the current study aims to examine the interaction of work rules, team support, and physicians’ career satisfaction and compassion satisfaction.
Central to our inquiry is the concept of team support as a potential mediator between work rules and physicians’ satisfaction levels. Team support in Obs and Gynae is vital for positive patient outcomes (Sansregret et al. 2023). According to research, teamwork training can improve the attitudes and effectiveness of the team, which improves productivity, cooperation, and leadership (Egbase et al. 2018; Goodier and Goodier 2019). Initiatives such as team training have the potential to enhance cognitive abilities, decision-making, and obstetric patient outcomes (Neuhaus, Lutnæs and Bergström 2022). This emphasizes the importance of teamwork and situational awareness to avert unfavourable outcomes. For instance, coordination between several medical teams is necessary for cytoreductive surgery while treating advanced ovarian cancer (Soukup et al. 2020). As part of this teamwork, work rules including clear protocols for postoperative care are required, along with specialist teams tasked with managing any complications (Goodier and Goodier 2019; Obermair, Simunovic and Janda 2020). The extant body of literature mostly focuses on direct linkages; nevertheless, there is a major lacuna concerning the mediating function of team support. This gap in the literature highlights the need for more in-depth academic research on the complex dynamics at work within healthcare teams. In order to close this gap, our study aims to investigate team support as a mediator between work rules and both career satisfaction and compassion satisfaction among Obs and Gynae professionals.
THEORETICAL FRAMEWORK AND EMPIRICAL RESEARCH
The present study used Job Demands-Resource (JD-R) model (Bakker and Demerouti 2007) and Naturalistic Decision-Making (NDM) theory (Klein and Zsambok 1997; Klein 2008) to comprehend the intricate relationship between work rules influencing naturalistic decision process, team support, compassion satisfaction, and career satisfaction. The NDM theory explains how professionals make decisions under stress and with limited information. The NDM theory describes how these experts deal with demanding and complicated work rules. For example, obstetricians with expertise frequently rely on their intuitions when determining how work rules affect their personal well-being and patient care (Klein 2015). Within this particular context, ‘decision-making’ refers to the decisions and actions made by healthcare professionals based on how they understand workplace rules. This may entail asking for scheduled adjustments or asking co-workers or senior physicians for emotional support. However, according to Bakker and Demerouti (2007), the JD-R model describes how job characteristics impact employees’ performance and well-being. It suggests that although work-related demands may be exhausting and demanding, job-related resources may be motivating and energizing (Demerouti et al. 2001; Crawford, LePine and Rich 2010). It distinguishes job resources (aspects that facilitate the achievement of work goals and lessen the negative effects of job demands) and job demands (aspects of the job that require effort). Depending on their effect, work rules can be viewed as both job demands and job resources: Job demands include excessive workloads, high expectations, or little control over working hours. Healthcare professionals may experience stress and burnout as a result of these factors (Costa and Pinto 2017; Rypicz et al. 2023). Job resources include encouraging work environments, open discussion, and team support. They assist medical professionals in managing the demands of their jobs and enhancing their well-being (do Carmo Fernandes and Martins 2023).
The key to understanding how NDM and JD-R interact in this study is comprehending how Obs and Gynae healthcare professionals view and respond to work regulations (JD-R) as either demands or resources. When work rules are perceived as demands of the job, healthcare workers may choose to take action for self-preservation, external assistance, or stress management. An expert obstetrician, for example, uses knowledge and intuition (NDM) to handle a problem during an emergency childbirth (Gregory et al. 2017). The significance of collective decision-making and pattern identification as emphasized by the NDM theory (Klein 2015) and the expertise of team members who specialize in anaesthesia, midwifery, and nursing is essential (Harris et al. 2022). The JD-R model also emphasizes supportive teamwork as a resource that promotes career satisfaction. The study aims to firmly integrate NDM and JD-R theories to reveal the precise and nuanced ways in which healthcare professionals in Obs and Gynae perceive work rules. Fig. 1 explains the overall NDM and JD-R model.
Model showing visualization of NDM theory and JD-R Model.
Work rules, team support, and compassion satisfaction
To foster teamwork and collaboration, clear and well-communicated work rules can serve as a framework (Enright 2021). However, overly strict work rules that limit autonomy and teamwork can create a rigid or authoritarian environment, weakening collaboration (Aveling et al. 2018; Pursio et al. 2021). Team support involves the extent to which employees perceive assistance, cooperation, and help from their colleagues (Olivola et al. 2022). Team support can be viewed as a job resource in the JD-R model that offers social support and mitigates the negative effects of job demands (Schaufeli 2017). When work policies highlight the importance of supportive interactions and allow employees to engage in meaningful helping behaviours, career satisfaction increases (Moynihan and Pandey 2007). Yet, rules that prioritize efficiency and productivity above all else may undermine the sense of purpose that comes with working in the helping professions (Upton 2018). This occurs when the emotional side of providing care is overlooked.
Promoting work rules that prioritize patient care and emphasize empathy and compassion can increase compassion satisfaction. This shows that healthcare workers experience a feeling of fulfilment and purpose in giving compassionate care to their patients when work rules promote patient care and empathy.
This gives medical personnel more motivation to provide compassionate treatment, which gives them a sense of purpose and fulfilment. Research (Panagaou et al. 2023; Unjai et al. 2022) has demonstrated that physicians who adhere to these work rules report feeling more compassion satisfaction. By defining clear rules and expectations, these guidelines reduce uncertainty and allow medical staff to put patients’ needs first. The emphasis on patient care encourages clinicians to feel happy and fulfilled. Based on available empirical evidence, the following claims are suggested:
(i) Work rules have a significant positive and direct effect on compassion satisfaction.
(ii) Work rules have a significant positive and indirect effect on compassion satisfaction through team support.
Work rules, team support, and career satisfaction
In addition to increasing a sense of belonging and collaboration, a supportive team environment can also improve career satisfaction. The dynamics of the workplace and factors specific to the job, such as work rules, have a significant influence on career satisfaction. Several studies in organizational and occupational psychology have established a clear link between demanding job conditions and diminished career satisfaction. Long-term exposure to demanding work conditions can result in burnout and a decrease in career satisfaction (Bakker and Demerouti 2007). By encouraging teamwork and support, which are acknowledged job resources, supportive work rules can indirectly increase career satisfaction. Existing research in organizational studies and healthcare management has shown that supportive workplaces with strong teamwork and positive dynamics help healthcare professionals feel more satisfied with their careers (Garman et al. 2011). The existing research propose following:
(iii) Work rules have a significant positive and direct effect on career satisfaction.
Additionally, for healthcare professionals including physicians of Obs and Gynae, team support can have a significant and direct impact on compassion satisfaction. An influential example of the relationship between team support and compassion satisfaction is the implementation of multidisciplinary teams for complex cases, such as uterine rupturing, eclampsia, and hysterectomy (Scott et al. 2020). The teamwork including nurses, specialists, midwives, perinatal psychologists, and Obs and Gyane physicians may collaborate to manage this critical case. The specialists bring their expertise, skills, and knowledge to manage high-risk pregnancy cases (Smith et al. 2020). This enhances the confidence and satisfaction among team members, knowing they are providing suitable care to the patient. Also, the collaborative nature of the team divides the responsibility of care among the team members (Allaire et al. 2020). As a result of this shared responsibility, team members experience less individual stress and burnout, which increases both compassion satisfaction (Batalha et al. 2022) and job satisfaction (Goh et al. 2020). The existing studies suggest the following proposition:
(iv) Team support has a significant positive relationship with compassion satisfaction.
The collaborative team provides valuable teaching and mentoring opportunities for practitioners dedicated to education. These include hands-on training with residents, case discussions, and teaching rounds (Ellis and Sevdalis 2019). The skills and knowledge sharing among the group members including young residents’ trainees of Obs and Gyane is a source of profound career satisfaction. Similarly, research evidence (Mestdagh et al. 2019; Matsuo 2020; Storm et al. 2021) highlight the importance of proactive support among team members which is a symbol of professional development. Participation in collaborative seminars, workshops, and conferences with other specialists ensures that the practitioners keep themselves updated on the latest research advancements. The practitioner remains engaged and content with their career trajectory as long as they are committed to skill improvement (Mlambo, Silén and McGrath 2021). Furthermore, positive patient outcomes, such as satisfied patients with successful deliveries and skilful surgeries are the result of the Obs and Gynae team members’ collaborative efforts (Hussain and Sethi 2020). Healthcare workers derive a sense of purpose and career satisfaction from witnessing the tangible positive outcomes they achieve in patients’ lives. This connection between their efforts and the impact on patients reinforces their dedication to their profession. Therefore, it is reasonable to consider that:
(v) Team support has a significant positive relationship with career satisfaction.
Team support also mediates the relationship between work rules and career satisfaction, serving as a critical bridge in understanding how work rules impact professionals’ career satisfaction. According to the mediation mechanism, healthcare professionals’ perceptions of encouraging work rules improve their sense of collaboration and teamwork. As a result of the positive team dynamics, healthcare professionals feel a sense of accomplishment and enhanced job engagement (Demerouti et al. 2001; Xanthopoulou et al. 2007). Hence, it is reasonable to consider that:
(vi) Work rules have a significant positive and indirect effect on career satisfaction through team support.
Rationale of the study
Past studies in the field of Obs and Gynae have primarily focused on patient experiences and outcomes, emphasizing the role of healthcare quality (e.g. Javid, Perveen and Nazar 2023) while overlooking the well-being of healthcare professionals who follow the strict work rules. This study recognizes that the career satisfaction and compassion satisfaction of physicians have a direct impact on patient care. Hence, it is necessary to study the mechanism of professionals’ well-being. Furthermore, Obs and Gynae is inherently interdisciplinary, involving nurses, midwives, gynaecologists, obstetricians, and other specialists. However, past studies (e.g. Haris et al. 2022) did not effectively capture the collaborative dynamics of team support within the framework of work rules and well-being. However, prior research (for instance, Haris et al. 2022) failed to adequately capture the cooperative dynamics of team support within the framework of well-being and work rules. Therefore, the goal of this study is to provide a comprehensive approach to determining how workplace rules affect the well-being of healthcare workers, with a focus on the critical role of team support. Furthermore, the study intends to significantly contribute by utilizing structural equation modelling (SEM) to investigate the relationships between work rules, team support, career satisfaction, and compassion satisfaction in the context of Obs and Gynae. In contrast to the traditional statistical techniques used in previous studies, this methodology allows for a more naunced comprehension of these issues. By using this approach, the study aims to significantly advance healthcare research meeting the growing need for in-depth and comprehensive studies.
This study examines the association between work rules as predictor, career satisfaction, and compassion satisfaction as outcome variables while team support is regarded as a mediating variable. The selection of outcome measures is consistent with a theoretical framework outlining the relationships between the study variables and the research questions. Obs and Gynae needs outcome measures that are distinctive to its field because it is a specialty with distinct emotional characteristics, interpersonal dynamics, and decision-making processes (Bao et al. 2022; Kanavi et al. 2023).
METHODS
Participants
Participants were approached in a face-to-face mode within their respective hospitals including labour room, maternity wards, out-patient departments (OPD), obstetric emergency departments, and doctors’ room. Purposive convenience (Andrade 2021) and snowball sampling (Berndt 2020) techniques were used to collect the data. Purposive sampling was used since the specific criteria for selecting the participants was having varying levels of work experience and job roles (e.g. residents, senior physicians, consultants). Convenience sampling was used since participants were selected based on their availability and accessibility within hospital settings, particularly in labour rooms, OPD, and doctors’ rooms. Convenient sampling was conducted taking advantage of researcher pre-existing relationships with nearby hospitals and healthcare facilities. First author personally contacted co-workers and acquaintances to let them know about the study and extend an invitation to participate as the author had developed links with these organizations. We successfully reached possible volunteers who fit the study’s inclusion requirements by networking and doing personal outreach. Additionally, snowball sampling was also used since it serves as a valuable strategy particularly in hospital settings when there were challenges to approaching the target population of Obs and Gyane physicians. The identification of initial participants of Obs and Gyane helped in actively assessing the other participants. Hence, the initial participants were actively involved in the research, recommending potential research participants to other Obs and Gyane co-workers. This referral network grew iteratively, connecting with Obs and Gynae specialists who were hard to find if used conventional sampling techniques.
Daniel Soper a priori sample size calculator was used to calculate the sample size for SEM to determine the appropriate sample size for model testing through AMOS (Soper 2021). The minimum sample size to detect the effect size was 91 while the recommended sample size was 137. However, a larger sample size is preferable for more conclusive evidence. A total of 413 participants were approached, however, some declined to participate while others partially filled out the distributed questionnaires. Consequently, a total of 347 participants completely filled out the questionnaires without leaving any statement. Potential demographic characteristics including age, gender, education, designation, and location of hospital settings were examined among participants who completed the study and those who did not complete. This helped in the assessment of non-completion bias. Non-significant differences were obtained in these demographic variables between the two groups (P > 0.05). This implies that the study’s participants were statistically comparable to those who did not participate in terms of age, gender, education, designation, and location of hospital setting. Hence, non-completion bias relating to these variables is not likely to pose a significant problem for the study.
Participants’ age ranged from 23 to 60 years (M = 31.22; SD = 6.81). Further, regarding hospital location, individuals from the Government sector included (n = 139) while those from private (n = 123) and semi-government sector were (n = 83). Moreover, the demographic of designation includes the residents’ trainees (n = 229), senior physicians including the registrar (n = 76) and consultants (n = 22). Designation refers to the specific job positions or titles held by the practitioners who are participating in the study. t is a method of classifying or categorizing the participants according to their roles in the healthcare environment. For instance, resident trainees are individuals who have completed medical school and are undergoing four years of specialized training in Obs and Gynae in a hospital. Senior physicians including registrars are the ones who have completed medical school, four years of residency training in Obs and Gyane, and have several years of work experience. The term registrar refers to the physician who is in a senior training position and monitors the role of junior physicians. Consultants are typically specialized and experienced physicians who provide expert advice and care to patients. Non-significant differences were found on the demographic variables including hospital location, marital status, and designation of participants.
MEASURES USED IN THE STUDY
Team support questionnaire
This questionnaire was developed by Batorowicz and Shepherd (2008) to measure teamwork as a support in decision-making process. Team support refers to a group of professionals who collaborate to provide mutual support and encouragement. This network facilitates effective clinical decision-making, promotes innovation, and allows for receiving and giving advice to increase individual competency levels (Batorowicz and Shepherd 2008). We used five items subscale of team decision-making support. The five items were succinct while still being thorough in capturing the key components of team decision-making support. Our analysis revealed a Cronbach’s alpha of 0.92 for the team support subscale, indicating high internal consistency reliability. This finding is consistent with previous studies, such as Sabuncuoğlu et al. (2021), that has reported Cronbach’s alphas ranging from 0.83 to 0.92 for the same subscale. This demonstrates the robustness and reliability of the team support measure across different research contexts. The scale is graded on a Likert scale from 1 (not at all) to 7 (to a great extent). The scale has a high level of internal consistency and reliability (range of Cronbach alpha = 0.83 to 0.91). Higher scores show better team support and low scores revel less team support. One of the items of the scale is ‘help you stay up to date with equipment and new technology in the field of clinical practice’.
Work rules
An adapted scale of factors affecting decision-making was used (Lizarraga et al. 2009) to measure the importance of variables in individuals’ decision-making. One of the subscales ‘work rules’ was used to test the hypothesized relationship among variables. These work rules are described as the rules that strike a delicate balance between demands of the job, personal interests, demands of the hospital, goals of the hospital, and the relationship with co-workers when making crucial decisions regarding patient management (Lizzaraga et al. 2009). The term ‘work pressure’ as in the original Lizzaraga et al. (2009) was refined for clarity to align with the concept of ‘work rules’, based on expert recommendations. This adjustment was made during the validation process of the scale, which was conducted as part of another project. Additionally, Lizzaraga et al. (2009) identified retained factors following Exploratory and Confirmatory Factor Analysis. Among these factors, they referred to one as ‘work pressure’, which they specifically equated with the concept of ‘work rules’. In their words, they wrote: Work pressure, which corresponds to work rules (361).
The subscale has good reliability and internal consistency ranging between 0.78 and 0.89. The scale has 9-point Likert scale option where 1 denotes least important and 9 denotes the most important. Higher scores on the measure show better adherence to work rules while low scores show less degree of adherence to work rules. An example item is ‘When I make an important decision, for me, it is essential to take the goals of the work into account’.
Compassion satisfaction
Compassion satisfaction was measured through the subscale of Professional quality of life (Stamm 2010 adapted by Galiana et al. 2020). The total scale has nine items, where items 2, 6, 7, 1, 4, and 8 measure compassion fatigue, and items no. 3, 5, and 9 measure compassion satisfaction. Compassion satisfaction is the pleasure derived from helping others. In our study settings, it refers specifically to the pleasure derived from assisting patients within the realm of Obs and Gynae healthcare practice. High scores show better compassion satisfaction. An example item of compassion satisfaction is ‘My work makes me feel satisfied’. The instrument has satisfactory psychometric properties showing internal consistency between the items ranging from 0.70 to 0.83.
Career satisfaction
Greenhaus, Parasuraman and Wormley (1990) developed the career satisfaction scale. It is the feeling of accomplishment, progress towards larger career goals, financial security, moving up the career ladder, and continuous improvement in skills. Five-point Likert scale is used to rate the scale items. Score of 1 indicates ‘strongly disagree’ and 5 indicates ‘strongly agree’. The scale assesses subjective feelings of success in relation to many aspects of well-being and work behaviour (work goals, achievement, and development; for instance, Ng et al. 2005; Abele and Spurk 2009). Good psychometric properties (alpha = 0.85) were reported by previous longitudinal study that used the scale at three different time points (Spurk, Abele and Volmer 2011). Higher scores show better career satisfaction. An example item is ‘I am satisfied with the success I have achieved in my career’.
PROCEDURE
Ethical approval was obtained from the institute before data collection. Data were collected between September 2022 and January 2023. Following approval from the relevant head of department in each hospital, all professionals were invited on a voluntary basis to participate in the study. Using references and personal connections, the snowball sampling technique was also used to contact some of the participants. Participants gave their consent after being informed of the study’s objectives and before any data were collected. The option to withdraw was given to participants if they felt uncomfortable. They were assured that their responses would remain confidential, and that the data would solely be used for educational and research purposes.
Data analysis
IBM’s SPSS version 23 was utilized to conduct correlation analysis, investigating the relationships between work rules, team support, career satisfaction, and compassion satisfaction. To test the research model as hypothesized, we employed the SEM technique (Lohmöller and Lohmöller 1989), implemented through AMOS. Latent variables (82%) and the ability to model complex dependencies (95%) were viewed as the main benefits of using SEM. SEM makes it possible to analyse the relationship between latent variables, allowing researchers to investigate the relationships between psychological constructs without having to worry about measurement errors (Nachtigall et al. 2003). According to Hair, Gabriel and Patel (2014), SEM typically goes through the following fundamental stages as it develops: (1) The model’s elements are determined and defined operationally based on theory. This includes measurement, latent, or any additional variables. (2) Based on theoretical underpinnings and research objectives, create a hypothetical model (model specification), which may require creating multiple competing models. (3) Based on the operationalized variables of the model, examine model estimates and GFI. (4) Determine any necessary model modifications, then make the changes while providing theoretical support.
Initially, we identified the model components and operationalized variables based on the theoretical framework and literature review. This corresponds to the first two stages described by Hair, Gabriel and Patel (2014). Subsequently, we established hypothetical models, including structural models, aligning with our research objectives and theoretical underpinnings. The third stage, involving the examination of model estimates and goodness-of-fit indices (GFI), was conducted during the data analysis phase presented in our paper. However, as our study aimed to investigate relationships among study variables rather than compare competing theories, we did not develop alternative models. Instead, all potential hypotheses regarding the connections between constructs were included in the structural model, allowing for the evaluation of each hypothesis within a single model. Therefore, while our approach closely aligns with the steps outlined by Hair, Gabriel and Patel (2014), we made subtle adjustments to accommodate the specific objectives and focus of our study.
A structural model assessed the mediating role of team support in the relationship between (1) work rules and career satisfaction (2) work rules and compassion satisfaction. Since studies have found positive evidence of teamwork and team support in determining compassion satisfaction (Harr 2013; Pelon 2017; Sacco and Copel 2018) and career satisfaction (Mickan, 2005; Fleury, Grenier and Bamvita 2017; Ciasullo, Douglas and Palumbo 2022) among healthcare professionals.
RESULTS
Preliminary analysis
Initially, bivariate product-moment correlation was calculated to investigate the relationships among work rules, team support, career satisfaction, and compassion satisfaction. Mean and standard deviation (SD) were among the descriptive statistics tested with IBM SPSS Statistics version 23. Table 1 displays the correlations, estimates of reliability, and descriptive statistics of the study variables.
Correlation and descriptive statistics among variables of the study.
| Variables | M (SD) | α | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|---|
| 1. Team _Sup | 24.25 (6.57) | 0.92 | _ | .43** | .35** | .36** |
| 2. Com_Sat | 11.85 (2.42) | 0.71 | _ | .32** | .20** | |
| 3. CS | 17.06 (4.19) | 0.85 | _ | .26** | ||
| 4. WR | 35.12 (8.07) | 0.89 | _ |
| Variables | M (SD) | α | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|---|
| 1. Team _Sup | 24.25 (6.57) | 0.92 | _ | .43** | .35** | .36** |
| 2. Com_Sat | 11.85 (2.42) | 0.71 | _ | .32** | .20** | |
| 3. CS | 17.06 (4.19) | 0.85 | _ | .26** | ||
| 4. WR | 35.12 (8.07) | 0.89 | _ |
Note: WR = work rules; CS = career satisfaction; Com_Sat = compassion satisfaction; Team_Sup = team support.
**P < 0.01.
Correlation and descriptive statistics among variables of the study.
| Variables | M (SD) | α | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|---|
| 1. Team _Sup | 24.25 (6.57) | 0.92 | _ | .43** | .35** | .36** |
| 2. Com_Sat | 11.85 (2.42) | 0.71 | _ | .32** | .20** | |
| 3. CS | 17.06 (4.19) | 0.85 | _ | .26** | ||
| 4. WR | 35.12 (8.07) | 0.89 | _ |
| Variables | M (SD) | α | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|---|
| 1. Team _Sup | 24.25 (6.57) | 0.92 | _ | .43** | .35** | .36** |
| 2. Com_Sat | 11.85 (2.42) | 0.71 | _ | .32** | .20** | |
| 3. CS | 17.06 (4.19) | 0.85 | _ | .26** | ||
| 4. WR | 35.12 (8.07) | 0.89 | _ |
Note: WR = work rules; CS = career satisfaction; Com_Sat = compassion satisfaction; Team_Sup = team support.
**P < 0.01.
The questionnaires show adequate reliability and demonstrate strong consistency among the items within each scale. While the alpha value of 0.71 (compassion satisfaction) is slightly lower, it still meets the threshold for acceptable reliability. Overall, these findings suggest that the scales used in our study are internally consistent and provide reliable measurements of the constructs under investigation. Moreover, all variables show significant correlations with each other. Team support has a significant positive relationship with compassion satisfaction (r = 0.43**), career satisfaction (r = 0.36**), and work rules (r = 0.36**). Similarly, work rules also has a positive relationship with all variables showing direct and significant relationship. Hence all the hypotheses showing positive relationship among stuy variables are supported. An increase in one variable contributes to an equal increase in the other variable. A significant positive correlation between work rules and compassion satisfaction, as well as career satisfaction, suggests that when healthcare physicians experience more conducive and supportive work rules, their career satisfaction and compassion satisfaction tend to excel. Some common examples of this include improved quality of work, higher task completion rates, and increased productivity.
Compassion satisfaction is positively related to team support (r = 0.43**). This demonstrates the beneficial effects of a supportive team on the emotional health of healthcare professionals, which frequently fall within the moderate to strong effect size range. Similarly, team support has also a positive relationship with career satisfaction (r = 0.35**). This effect size is within the range of moderate values, pointing to a significant relationship.
The relationship between supportive team dynamics and helpful workplace policies is further highlighted by the correlation between team support and work rules (r = 0.36**). The magnitude of the effect echoes the positive relationship between well-designed work rules and compassion satisfaction. The following mediation analyses are supported by these bivariate correlations.
Structural model assessment
A good fitting model is obtained as the values of fit indices are in acceptable range: CMIN/df = 14.721, GFI = 0.980, CFI = 0.955, IFI = 0.961, RMSEA = 0.053, AIC = 30.721. The squared multiple correlation was .19 for career satisfaction, this shows that 19% variance in career satisfaction is accounted by work rules. However, the squared multiple correlation was .14 for compassion satisfaction, this shows that 14% variance in compassion satisfaction is accounted by work rules. The SEM is shown in Fig. 2, however, the mediation analysis summary is presented in Table 2.
Mediation of team support between work rules and career satisfaction and work rules and compassion satisfaction (N = 347).
| Relationship | β coefficient (effect) | Bootstrap confidence interval | SE | t | Decision | |
|---|---|---|---|---|---|---|
| Lower bound | Upper bound | |||||
| Direct effect | ||||||
| WR -> CS | 0.028 | −0.023 | 0.081 | .027 | 1.026 | |
| WR -> Com_Sat | 0.046 | 0.018 | 0.076 | .016 | 2.898** | |
| WR -> Team_Sup | 0.293 | 0.204 | 0.354 | .041 | 7.180*** | |
| Team_Sup -> CS | 0.263 | 0.214 | 0.320 | .033 | 7.934*** | |
| Team_Sup -> Com_Sat | 0.109 | 0.073 | 0.147 | .020 | 5.521*** | |
| Indirect effect | ||||||
| WR -> Team_Sup -> CS | 0.077 | 0.052 | 0.106 | .015 | 5.133 | H(vi) supported |
| WR -> Team_Sup -> Com_Sat | 0.032 | 0.020 | 0.044 | .008 | 4.00 | H(ii) supported |
| R square | ||||||
| CS | 0.19 | |||||
| Com_Sat | 0.14 | |||||
| Model fit | ||||||
| CMIN/df = 14.721, GFI = 0.980, CFI = 0.955, ILI = 0.961, RMSEA = 0.05 | ||||||
| Relationship | β coefficient (effect) | Bootstrap confidence interval | SE | t | Decision | |
|---|---|---|---|---|---|---|
| Lower bound | Upper bound | |||||
| Direct effect | ||||||
| WR -> CS | 0.028 | −0.023 | 0.081 | .027 | 1.026 | |
| WR -> Com_Sat | 0.046 | 0.018 | 0.076 | .016 | 2.898** | |
| WR -> Team_Sup | 0.293 | 0.204 | 0.354 | .041 | 7.180*** | |
| Team_Sup -> CS | 0.263 | 0.214 | 0.320 | .033 | 7.934*** | |
| Team_Sup -> Com_Sat | 0.109 | 0.073 | 0.147 | .020 | 5.521*** | |
| Indirect effect | ||||||
| WR -> Team_Sup -> CS | 0.077 | 0.052 | 0.106 | .015 | 5.133 | H(vi) supported |
| WR -> Team_Sup -> Com_Sat | 0.032 | 0.020 | 0.044 | .008 | 4.00 | H(ii) supported |
| R square | ||||||
| CS | 0.19 | |||||
| Com_Sat | 0.14 | |||||
| Model fit | ||||||
| CMIN/df = 14.721, GFI = 0.980, CFI = 0.955, ILI = 0.961, RMSEA = 0.05 | ||||||
Note: WR = work rules; CS = career satisfaction; Com_Sat = compassion satisfaction; Team_Sup = team support.
**P < 0.01; ***P < 0.001.
Mediation of team support between work rules and career satisfaction and work rules and compassion satisfaction (N = 347).
| Relationship | β coefficient (effect) | Bootstrap confidence interval | SE | t | Decision | |
|---|---|---|---|---|---|---|
| Lower bound | Upper bound | |||||
| Direct effect | ||||||
| WR -> CS | 0.028 | −0.023 | 0.081 | .027 | 1.026 | |
| WR -> Com_Sat | 0.046 | 0.018 | 0.076 | .016 | 2.898** | |
| WR -> Team_Sup | 0.293 | 0.204 | 0.354 | .041 | 7.180*** | |
| Team_Sup -> CS | 0.263 | 0.214 | 0.320 | .033 | 7.934*** | |
| Team_Sup -> Com_Sat | 0.109 | 0.073 | 0.147 | .020 | 5.521*** | |
| Indirect effect | ||||||
| WR -> Team_Sup -> CS | 0.077 | 0.052 | 0.106 | .015 | 5.133 | H(vi) supported |
| WR -> Team_Sup -> Com_Sat | 0.032 | 0.020 | 0.044 | .008 | 4.00 | H(ii) supported |
| R square | ||||||
| CS | 0.19 | |||||
| Com_Sat | 0.14 | |||||
| Model fit | ||||||
| CMIN/df = 14.721, GFI = 0.980, CFI = 0.955, ILI = 0.961, RMSEA = 0.05 | ||||||
| Relationship | β coefficient (effect) | Bootstrap confidence interval | SE | t | Decision | |
|---|---|---|---|---|---|---|
| Lower bound | Upper bound | |||||
| Direct effect | ||||||
| WR -> CS | 0.028 | −0.023 | 0.081 | .027 | 1.026 | |
| WR -> Com_Sat | 0.046 | 0.018 | 0.076 | .016 | 2.898** | |
| WR -> Team_Sup | 0.293 | 0.204 | 0.354 | .041 | 7.180*** | |
| Team_Sup -> CS | 0.263 | 0.214 | 0.320 | .033 | 7.934*** | |
| Team_Sup -> Com_Sat | 0.109 | 0.073 | 0.147 | .020 | 5.521*** | |
| Indirect effect | ||||||
| WR -> Team_Sup -> CS | 0.077 | 0.052 | 0.106 | .015 | 5.133 | H(vi) supported |
| WR -> Team_Sup -> Com_Sat | 0.032 | 0.020 | 0.044 | .008 | 4.00 | H(ii) supported |
| R square | ||||||
| CS | 0.19 | |||||
| Com_Sat | 0.14 | |||||
| Model fit | ||||||
| CMIN/df = 14.721, GFI = 0.980, CFI = 0.955, ILI = 0.961, RMSEA = 0.05 | ||||||
Note: WR = work rules; CS = career satisfaction; Com_Sat = compassion satisfaction; Team_Sup = team support.
**P < 0.01; ***P < 0.001.
Structural equation model showing indirect effect of team support on work rules, career satisfaction, and compassion satisfaction.
The results reveal a significant indirect effect of team support between work rules and career satisfaction (b = 0.077, P = 0.000). However, the direct effect of work rules on career satisfaction in the presence of mediator does not remain significant (b = 0.028, P > 0.05) The significant paths are bold in the table. Hence, team support mediated the relationship between work rules and career satisfaction. Moreover, a significant indirect effect of team support is also found between work rules and compassion satisfaction (b = 0.032, P = 0.000). Furthermore, a significant direct effect is also found between work rules and compassion satisfaction (b = 0.046, P < 0.05) supporting partial mediation in this case.
DISCUSSION
The present study was conducted with the purpose to examine the mediating role of team support in the relationship between work rules, career satisfaction, and compassion satisfaction. Initially, we calculated the Cronbach’s alpha values for all scales that ranged from 0.71 to 0.92, indicating good internal consistency reliability. Specifically, alpha values of 0.85 (career satisfaction), 0.89 (work rules), and 0.92 (team support) were obtained for three of the scales, respectively, which fall within the acceptable range and demonstrate strong consistency among the items within each scale. While the alpha value of 0.71 (compassion satisfaction) is slightly lower, it still meets the threshold for acceptable reliability. Overall, these findings suggest that the scales used in our study are internally consistent and provide reliable measurements of the constructs under investigation.
We hypothesized that team support is positively related to compassion satisfaction and career satisfaction. Previous studies (Owen and Wanzer 2014; Sacco and Copel 2018) support our findings. Work rules also showed a significant positive relationship with team support, compassion satisfaction, and career satisfaction. Our results match with the previous studies (Babiker et al. 2014; Yılmaz and Üstün 2018) where individuals having support from teamwork were found to be high on compassion satisfaction exhibiting better professional quality of life. Our results show effect sizes that are comparable to or slightly larger than those previously reported in healthcare-related studies. For instance, the association between compassion satisfaction and team support (r = 0.43**) is consistent with earlier studies (e.g. Zhou et al. 2021).
Work rules positively related to team support (r = 0.36**). The effect size is comparable to or slightly larger than what is typically reported (e.g. Arendt, Kugler and Brodbeck 2023), suggesting a strong connection in our study even though this relationship is consistent with the body of existing literature. Similarly work rules have significant positive relationship with compassion satisfaction, a pattern that has been seen in prior research (e.g. Baek et al. 2020), with regard to the correlation between work rules and compassion satisfaction The results are in line with the previous literature and as expected since research (e.g. Soukup et al. 2021) indicates that healthcare professionals value a supportive team environment, it has a positive effect on how satisfied they feel with their ability to help others. It is in line with the notion that professionals are more likely to experience fulfilment from helping others, a key component of compassion satisfaction when co-workers offer emotional support and collaboration. The expectation that a supportive team can improve overall career satisfaction is also supported by a positive relationship between team support and career satisfaction. Professionals’ satisfaction with their career choices and the work environment can be positively influenced when they feel supported by their peers (Moreau and Mageau 2012). The idea that supportive teams frequently coincide with the implementation of constructive work rules and policies is in line with the positive correlation between team support and work rules.
A positive correlation between team support and career satisfaction lends credence to the idea that a helpful team can enhance overall career satisfaction. When professionals feel encouraged by their peers, it can have a favourable impact on their career choices and the work environment (Moreau and Mageau 2012). The notion that supportive teams often align with the adoption of constructive work rules and policies aligns with the observed positive relationship between team support and work rules. A positive team environment can affect professionals’ perceptions of constructive work rules, which can raise their level of satisfaction (Renee Barnett and Bradley 2007; Maan et al. 2020). The premise that well-designed work rules might enhance physicians’ emotional well-being and capacity for altruism is supported by the substantial link found between work rules and compassion satisfaction (Schneider et al. 2022).
The findings of the study support the notion that the suggested model fits the data well. This is supported by the fit index values falling within an acceptable range, affirming the consistent accuracy and reliability of the model (see Table 1). The results unequivocally show that the suggested theoretical model appropriately captures the relationships between the variables being studied. This shows that the study’s data aligns seamlessly with the model, and the observed patterns overwhelmingly confirm the hypothesized relationships. Although the fit indices selected suggest that the model is acceptable, it is important to consider the study’s context and research objectives when interpreting these findings. Participants who perceive themselves as adhering to work rules, and who also report experiencing team support show better compassion and career satisfaction. It is plausible that physicians who diligently perceive as following work rules (for instance, goals of the hospital, balance between personal interests and job demands, relationship with co-workers when making crucial decisions regarding patient management) experience a greater level of compassion satisfaction. This may be attributed to a greater sense of purpose and fulfilment brought on by a greater sense of alignment with the fundamental goals and values of the healthcare organization (Lizzaraga et al. 2009). Furthermore, such adherence to workplace regulations may foster a more positive and harmonious work environment, fostering camaraderie among healthcare teams and fostering a shared commitment to providing high-quality patient care.
Significant indirect effect of team support between work rules and career satisfaction as well as between work rules and compassion satisfaction were found in the present study (see Table 2). Literature (Collin 2009; Harr 2013) has supported the fact that multidisciplinary teams provide aid against strict work demands hence leading to better professional quality. Similarly, research evidence (Steinhardt et al. 2003; Dougherty et al. 2009) also supports the positive role of teamwork between workplace stressors and career satisfaction. One of the predictors of career satisfaction is the relationship between workplace employees (Barnett and Bradley 2007; Spurk, Abele and Volmer 2015). If the relationship is satisfactory and more team involvement is present for the accomplishment of any difficult task, this ultimately leads to better career satisfaction. However, poor relationships among workers and a lack of team support lead to poor career satisfaction (Hayes, Bonner and Pryor 2010; Charoensukmongkol, Moqbel and Gutierrez-Wirsching 2016).
Our study makes a substantial contribution to the field by shedding light on how team support influences the relationship between adherence to work rules and compassion satisfaction. Furthermore, our results demonstrate that healthcare workers who receive a high level of team support have strong relationships between perception of adherence to work rules and career satisfaction. This emphasizes how vital it is to create a positive team environment to reduce stress at work caused by a variety of pressures, including time pressure, workloads, and difficult circumstances, and to increase employee satisfaction with regard to following work rules.
These results are consistent with earlier studies that highlight the critical role that team support plays in medical teams (McLaney et al. 2022). According to our findings, healthcare organizations must prioritize teamwork in order to manage patient cases successfully, which will eventually enhance patient outcomes and raise staff members’ levels of compassion satisfaction. Healthcare organizations can achieve synergistic benefits through the cultivation of a cooperative and interdisciplinary collaborative culture, which will ultimately lead to patients receiving more complete and coordinated care. Additionally, this strategy encourages healthcare professionals to feel more fulfilled and satisfied in their careers.
Theoretical and practical implications
This study applies the JD-R model to improve our understanding of the healthcare environment. It is in line with the model’s emphasis on how job resources, job demands, and employee well-being interact (Zeng et al. 2022). The study shows how work rules affect career satisfaction and compassion satisfaction, with team support acting as a mediator. This emphasizes how important team assistance is in reducing the difficulties caused by work restrictions, which strengthens the model’s application in healthcare settings.
The findings of the study directly affect healthcare organizations, especially in terms of how obstetricians and gynaecologists are expected to follow work rules. These guidelines should take into account the particular requirements of their line of work, give patient care top priority, handle complaints, promote cooperation, and respect moral standards (Adeyemo, Morelli and Kennedy 2022). Proactively reaching out to peers in related professions and actively participating in team consultations, for instance, can enhance patient outcomes. Empirical suggestions encompass arranging frequent team gatherings to augment cooperation, delineating explicit protocols for data sharing, and cultivating a hospitable work environment that fosters open communication and cooperative efforts. The study suggests that a productive workplace could be fostered by positive reinforcement and acknowledging team members’ accomplishments. When healthcare personnel in Obs and Gynae adapt such methods, it improves communication, teamwork, and support, ultimately leading to improved patient satisfaction.
Limitations of the study
The findings of the study might lack generalizability as the data was collected from only two cities, limiting the broader applicability of the results to the entire country. Additionally, convenient sampling was used which might be pragmatic under limited resources, but it makes it more difficult to accurately draw conclusions about causality or extrapolate results to a larger population. Cause-and-effect link between the study variables could not be determined because of the cross-sectional design. It is plausible that team support could also have an impact on physicians’ compliance with work rules. It is necessary to conduct additional longitudinal research to clarify the temporal dynamics and potential bidirectional influences between team support and adherence to work rules, as causation cannot be drawn from the cross-sectional character of the study.
CONCLUSION
This study elucidates the complex interplay between Obs and Gynae work rules, career satisfaction, compassion satisfaction, and team support. Our findings underscore the significance of work rules in shaping healthcare professionals’ experiences and satisfaction levels. Notably, adherence to workplace policies emphasizing teamwork, organizational goals, patient care, and ethical standards correlates with higher levels of compassion satisfaction, consistent with previous research (Eldh et al. 2016; Ruiz‐Fernández et al. 2020). Additionally, our study highlights the association between workplace rules supporting autonomy, work–life balance, and professional development with increased career satisfaction among healthcare professionals. These insights underscore the importance of fostering work environments that align with physicians’ values and career aspirations to enhance overall satisfaction.
Consent to Participate
Informed consent was obtained from all participants included in the study.
Consent for Publication
Participants gave their consent for the publication of their data, provided that their identity will not be revealed.
Data Availability
Data could be provided on request.
Ethical Approval
The Institutional Review Board of the Department of Behavioral Sciences, School of Social Sciences and Humanities, NUST, has permitted to conduct this study (Ref. No. 0988/Ethic/01/S3H/070/DBS). Participants were fully informed and consented to investigate and publish the findings of the study.
Funding
The authors received no funding to conduct this study.
References
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