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วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 Work morale of health center staff in Krabi province, Thailand
Sanya Raksarat*
Prathurng Hongsranagon**
Piyalamporn Havanond***
Background
Morale has been defined by a number of researchers. Mendel (1987) defined it as
a feeling, a state of mind, a mental attitude, and an emotional attitude. Washington and Watson
(1976) stated that morale is the feeling a worker has about his/her job based on how the worker
perceives him/herself in the organization and the extent to which the organization is viewed as
meeting the worker’s own needs and expectations. Bentley and Rempel (1980) conceptualized
morale as “the professional interest and enthusiasm that a person displays towards the
achievement of individual and group goals in a given job situation” (cited in Lumsden, 1998: 1).1
Guion (1958)2 emphasized that "morale is the extent to which an individual's needs are satisfied
and the extent to which the individual perceives that satisfaction as stemming from his total job
situation."
Studies of work morale have a very long history in social science research. The
studies deal with several aspects of the work situation which are associated with high or low
employee morale. Major areas of the work situation included supervision (the supervisor,
worker autonomy), rewards (pay, promotions), the job itself (amount and type of work), the
organization (organization policy, goal attainment) and interpersonal relations (fellow workers)
(Hetherington and Soma, 1997)3

* นักวิชาการสาธารณสุข ระดับชํานาญการ สํานักงานสาธารณสุขอําเภอปรายพระยา จังหวัดกระบี่
** อาจารย ดร. และผูชวยคณบดีฝายวิชาการ วิทยาลัยวิทยาศาสตรสาธารณสุข จุฬาลงกรณมหาวิทยาลัย
*** นักสถิติ วิทยาลัยวิทยาศาสตรสาธารณสุข จุฬาลงกรณมหาวิทยาลัย
1 Lumsden, Linda.1998. “Teacher Morale.” ERIC DIGEST. No.120.
2 Guion, R,M., “Some definitions of morale.” Personnel Psychology. 2 (1958): 59-61.
Hetherington, R.W. and Hewa Soma.” Taking the measure of morale: Structure and job satisfaction in a multi-hospital system.” The International Journal of Sociology and Social Policy. 17 (5)
Journal of Demography, Volume 25, Number 1, March 2009 that serve the health needs of patients in their areas. The first and foremost goal of the centers is to better the residents’ health outcomes. As such, the services provided by the centers have to be of a high standard. Though there are a number of elements affecting good health service provision, morale of the staff at work is one of the major elements (Hart et al, 2000)4 The (1) Identify the major dimensions of morale of workers in the health center staff of Krabi, Thailand (2) Develop a scientifically sound instrument for the measurement of work morale with an explicit rationale for the interpretation of the results (3) Establish procedures for the improvement of work morale in the staff. This article is divided into five sections, introduction, materials and methods, main findings, discussion, and recommendations. It is expected that this study will motivate more interest in the topic of work morale among Thailand health personnel. 1. Introduction
a. The province of Krabi, Thailand
Krabi province is located in the west of southern Thailand, 814 kilometers from
Bangkok. It borders the provinces of Nakornsrithammarat, Phang Nga, Suratthani, Trang, and
the Andaman Sea. With an area of 4,708,512 square kilometers, Krabi possesses rich natural
resources such as forests, mountains, wild life, and coral reefs. At present, there are 408,898
residents in 126,323 households. Of the population, 65.2% are Buddhist, 32.11% Muslim, and
0.82% Christian. There are eight Amphurs in Krabi, Muang, Nua Klong, Klong Tom, Kao
Panom, Aow Luek, Plai Phraya, Lam Tub, and Koh Lanta. Climatically, there are two seasons
in Krabi, hot and rainy. In its strategic development plan, Krabi claims itself to be “the center

4 Hart et al., “Development of the School Organisational Health Questionnaire: A measure for
assessing teacher morale and school organisational climate.” British Journal of Educational
Psychology 70 (2000): 211-228.
วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 for eco-seashore & health tourism, and the center for sustainable agricultural resources based on quality of life and good governance”.[http://www.thaitambon.comand http://www.krabi.go.th]5 In 2007-2008, a whole of Krabi province possesses a total of 241 staff in eight
health centers dotted around the districts of Muang (45 staff), Nua Klong (34), Klong Tom (42),
Kao Panom (31), Aow Luek (32), Plai Phraya (22), Lam Tub (9), and Koh Lanta (26). The duty of
the centers is to take care of the health and well-being of patients in the area through close
contact with the local people. All centers are operated under the supervision of the Thailand
Ministry of Public Health. One of the centers’ key missions is to serve the patients in the areas
of curative care, health prevention, health promotion, and rehabilitation – the four cornerstones
of public health services. In addition, the major role that Krabi health centers play is to be
responsive to local health problems, to appropriately manage and allocate available resources,
to effectively serve patients, to promote patients’ self-care, and to be responsible for training
and promotion of primary health care and community development.
In 2007, the top five causes of morbidity per 100,000 of the population in Krabi in
out-patient departments (OPD) were associated with: the respiratory tract system, the digestive
and oral tract system, the cardio-vascular system, endocrine, nutrition and metabolism, and the
muscular and skeletal system. In the same year, the top five causes of morbidity per 100,000 of
the population in Krabi in in-patient departments (IPD) were: complications of pregnancy,
labor, delivery, peri-natal and other obstetric conditions, other intestinal infections, endocrine,
nutrition and metabolism, other diseases of the digestive system, and hypertension [http://www.krabi.go.th ]6

5 [Online available from http://www.thaitambon.com and http://www.krabi.go.th, accessed on
2008 June 2, pp. 1-93].
6 [Online available from http://www.krabi.go.th, accessed on 2008 June 2, pp. 1-93].
Journal of Demography, Volume 25, Number 1, March 2009 c. Review of literature on morale & factor analytical technique
Though there is a very limited amount of literature regarding factor analysis
techniques conducted with healthcare personnel in the Thai context, some international
research on work morale in different occupations can serve as a springboard for this study.
Hart
(2000)7 aimed to identify organizational factors that accurately assessed teacher morale and those that were likely to underpin the experience of morale. The “School
Organisational Health Questionnaire” to assess teacher morale and school climate was used in
three studies with 1,520 teachers. Exploratory and confirmatory factor analyses were
employed to establish the questionnaire's factor structure. Correlation analyses were used to
examine the questionnaire's convergent and discriminate validity. Eleven separate dimensions
of school organizational climate were appraisal and recognition, curriculum coordination,
effective discipline policy, excessive work demands, goal congruence, participative decision-
making, professional growth, professional interaction, role clarity, student orientation, and
supportive leadership.
The study by Hetherington and Hewa (1997)8 examined the impact of bureaucratic
structure on morale among hospital staff. Formalization, centralization, stratification, and
complexity were treated as the means at the command of management for attaining
organization objectives. The prediction, based on the axiomatic theory of organizations of
Hage (1965) was that there would be a negative impact on morale regarding formalization,
centralization, and stratification and a positive impact on morale relating to task complexity.
Data were collected through a questionnaire survey of in-patient medical care unit staff in eight
member hospitals of a government-operated multi-hospital system. A total of 478 samples were
included in this study. With the dimensions originally developed by Gross et al. (1958) and
7 Hart et al., “Development of the School Organisational Health Questionnaire: A measure for
assessing teacher morale and school organisational climate.” British Journal of Educational Psychology
70 (2000): 211-228.
8 Hetherington, R.W. and Hewa Soma, “Taking the measure of morale: Structure and job
satisfaction in a multi-hospital system.” The International Journal of Sociology and Social Policy 17 (5)
(1997): 1-51.
วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 further developed by Aiken and Hage (1966), factor analysis was this time used to categorize a total of sixteen items into three factors as an index for morale – satisfaction with supervision, satisfaction with career, and satisfaction with workload. The findings were further discussed within the broader context of the theory of bureaucracy of Weber (1945) as a blueprint for modern organizational structure with an adaptation to non-industrial organizations such as hospitals. Coughlan (1970)9 firstly sought to identify the major dimensions underlying the morale of elementary and secondary school teachers and then to construct a psychometrically-sound instrument for measuring these dimensions, at the same time developing an explicit rationale for the interpretation of findings. By definition, morale assumes a dynamic complexity in the structure which best lends itself to the factor analytic approach to define it. A self- reporting questionnaire, the “School Survey,” was constructed to measure the 1,199 teachers’ perceptions of important factors in their work environments. The findings showed thirteen factors-board functioning, system administration, work load, materials and equipment, buildings and facilities, principal relations, colleague relations, community relations, instructional program, student development, performance appraisal, financial incentives, and professional autonomy. These were organized into four categories-administrative operations, working relationships, school effectiveness, and career fulfillment. The purpose of the work of Baehr and Renck (1950)10 was to summarize previous factorial studies of the “Employee Inventory” and to report the results of the latest research of factors underlying employee morale. Inclusive items were related to financial and non-financial incentives, on-the-job and off-the-job satisfaction, physical and social environment, and individual and group satisfaction. The samples involved 1,060 work groups from fifty-nine
9 Coughlan, R.J., “Dimensions of Teacher Morale.” American Educational Research Journal
7 (2) (1970): 221-234.
10 Baehr, M.E. and Renck R., “The Definition and Measurement of Employee Morale.”
Administrative Science Quarterly 3 (1950):157-184.

Journal of Demography, Volume 25, Number 1, March 2009 different companies completing the survey questionnaire. From factor analysis of thirty selected inventory items, five of the basic factors in the structure of morale were identified. They were: These five factors could be used as core items of attitude survey questionnaires developed
especially for particular types of employees, such as professional or retail employees, and/or
for particular types of industries, such as manufacturing and/or merchandising.
The study of Richardson and Blocker (1963)11 aimed at evaluating the morale of
sixty-six college staff through the use of factor analysis with a “Differential Morale Attitude
Inventory” survey. The original twelve categories included communication, confidence in
administration, relations with immediate supervisor, relations with fellow employees, relations
with students, status and recognition, identification with institution, professional growth and
advancement, adequacy of salary, adequacy of fringe benefits, work environment, and work
load. With seventy-four items combined with an attitude inventory, this study found four factors
as an index for faculty morale, supervision, self-integration, institutional environment, and
employment rewards. Compared to the “Employee Inventory” of Baehr and Renck (1950), the
dimension of supervision was identifiable with organization and management and immediate
supervision, self-integration was in contrast to fellow employees, institutional environment was
paralel to job satisfaction, and employment rewards were directly comparable to material rewards.

11 Richardson, R.C. Jr. and Blocker, C., “Note on the application of factor analysis to the
study of faculty morale.” Journal of Educational Psychology 54 (4) (1963): 208-212.
วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 Taking these literatures as a good foundation and by consolidating other key elements influencing work morale previously stated in the books by Hirantok 1988,12 Davis 1967,13 and Gilmer 1987,14 this paper has made an attempt to identify the factors for the measurement of work morale among health center staff in Krabi province, Thailand, into seven dimensions, namely, household economic status, opportunities for advancement, relationship with supervisor, relationship with peers, intrinsic aspects of the job (knowledge and competency of health center staff in relevance to assigned tasks and subsequent job performance), job satisfaction, and work conditions. These factors are not only commonly identified by past literatures, but also holistically cover appropriate dimensions in regards to work morale for further investigation in this research. 2. Materials and methods
a.
Instruments
The instrument used for this study was a self-administered questionnaire that contained three main parts.15 The first part collected demographic data of the participants. The completion of the items in this part was done in two ways, by filling in the blank spaces provided and by multiple choices. The data was concerned with age, gender, marital status, level of education, job position, job status (permanent or temporary staff), line of command, length of work experience, and household monthly income. The second part contained seven dimensions of forty-nine work morale items. Data was collected by the completion of a 5-point rating scale ranging from “lowest” to “highest”. The third part involved the completion of an open-ended question – “How would you like executives of the Thailand Ministry of Public Health
12 Hirantok, U. 1988. Principles of Human Resource Management. Bangkok: Odien Store
Printing House.
13 Davis, K. 1967. Human Relation at Work: The Dynamics of Organization Behavior. New
York: MaGraw Hill.
14 Gilmer, B.V.H., Deci, E.L., and Glaser, R. 1987. Industrial and Organization Psychology.
New York: McGraw Hill.
15 Kasemsin, Sompong. 1978. Modern Human Resource Management 3rd ed. Bangkok:
Thai Wattanapanich Printing House.
Journal of Demography, Volume 25, Number 1, March 2009 to act on the issue of work morale of health center staff?” This aimed to elicit the frank opinions of the participants on issues that affect work morale. To comply with standard research ethics, the participants were informed that they could refuse to take part in the study at any time. They were informed that all the data would be kept confidential, anonymous, and used only for academic purposes. Before conducting the main survey, a pilot study was completed to check the quality of the tool regarding its validity and reliability. Content validity was checked by three senior health officers at Krabi Provincial Health Bureau and two lecturers at the College of Public Health Sciences. Several items were re-worded to improve the clarity of the questionnaire instruments. Reliability was checked by conducting a field test of thirty public health staff in a nearby province. The reliability via Cronbach’s alpha was 0.95. b. Sampling technique
A sample of 241 staff in Krabi (during 2007-2008) was used in the study, the only
inclusion criterion being that they had worked at their respective health centers for a minimum
of six months. The participants were categorized as government officers and regular
employees. With regard to job position, they were identified as public health administrators,
public health technical officers, registered nurses, community health officers, and community
dental health officers. The data collection period was from February to April 2008.
c.
Data
analysis
Descriptive statistics used were frequencies, means, standard deviations, medians, and ranges, calculated from the demographic data. To identify the sets of factors that mostly explained the variance of the variables, factor analysis with Varimax rotation & Kaiser normalization were employed. The objective was to create correlated variable composites from the original forty-nine attributes to identify a smaller set of dimensions that explained most of the variances among the attributes. Inclusion of a variable (attribute) in a factor was based on the factor loadings, eigenvalues and the percentage of variance explained. (cited in วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 Raymond et al, 2000).16 After grouping for variables in small sets in accordance with the above mentioned method, one can see that in each new set, how the participants placed the importance on the variables differently by taking a look at the mean score of each new set. 3. Main findings
a.
Demographic
data
There were 215 completed surveys received from 241 participants, an 89.21% response rate. The participants’ demographic data is shown in Table 1.
16 Raymond et al., “An importance-performance analysis of hotel selection factors in the Hong
Kong hotel industry: a comparison of business and leisure travelers.” Tourism Management 21 (2000): 363-
377.
Journal of Demography, Volume 25, Number 1, March 2009 Table 1 Demographic data (n=215)
Lower than bachelor degree or equivalent Thai baht
US dollars*
วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 67.4% were female and 32.6% were male. Most (62%) were married and 75% had received education to bachelor degree level. Their average age was 34.4 years. The median time of the participants’ length of work experience was 10 years. 28.4% of them were the heads and 79.0% were state officers and their median monthly household income was 1,000 U.S. dollars (30,000 Thai Baht). b. Selection factors from factor analytical technique
The result of factor analysis suggested seven appropriate factors that explained
60.2 percent of total variance. Kaiser-Meyer-Olkin (KMO), the measure of sampling adequacy,
was 0.876 indicating that variables were interrelated and shared common factors. The
communalities with the average values of 0.60, the variance of original values could be
explained by the factors fairly. The internal consistency (Cronbach's alpha) was within
acceptable range of 0.713 to 0.9301 (please see details in Appendix 1). Table 2 shows the
results of the factor analysis.
Table 2 Results of factor analysis with Varimax rotation on health center staff’s work morale
(n=212)
Cronbach's
variance
* scale of 1 to 5 point, the higher the number the higher the morale. After having done the factor analysis with the 49 items of statement, it found that there were 7 factors involved. Each consisted of the set of questions that the participants placed the importance similarly. The authors then calculated the set mean. The low value was meant for the fact that the particular variable was the least appropriate. The lowest value was 1 and the highest was 5. Journal of Demography, Volume 25, Number 1, March 2009 Next, these factors were prioritized in terms of their relevance to the work morale of the participants as follows: income (Factor 3), opportunity for advancement (Factor 5), office physical conditions (Factor 6), elements facilitating good working surroundings (Factor 7), relationship with supervisor (Factor 2), job satisfaction (Factor 1), and relationship with colleagues (Factor 4), as shown in table 3. Table 3 Mean of factors classified by demographic data
Gender Factor3
Factor7 Factor2 Factor1 Factor4
Marital Status
Factor6 Factor7 Factor2 Factor1 Factor4
Age group (years)
Factor6 Factor7 Factor2 Factor1 Factor4
Education Factor3
Factor5 Factor6 Factor7 Factor2 Factor1 Factor4
วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 Table 3 (cont.)
Work status
Factor6 Factor7 Factor2 Factor1 Factor4
Work position
Factor6 Factor7 Factor2 Factor1 Factor4
c,d p-value= 0.002 e,f p-value= 0.038 g,h p-value= 0.022 i,j p-value= 0.010 Income Factor3
Factor7 Factor2 Factor1 Factor4
a,b p-value= 0.035 c,d p-value= 0.039 e,f p-value= 0.030 g,h p-value= 0.02 i,j p-value= 0.011 k,l p-value= 0.027 Table 3 shows the statistically significant differences between baseline characteristics of the participants with different factors. Factor 3 - income: on this issue, the differences found were between gender and different income levels (p<0.05). Factor 5 – opportunity for advancement : on this issue, the difference found was between work position (p<0.05). Factor 6 – Office physical conditions & factor 7 – elements facilitating good working surroundings: on these issues, the differences found were between age group and income (p<0.05). Factor 1 – job satisfaction: on this issue, the differences found were between marital status and education; and work position and income (p<0.05). Journal of Demography, Volume 25, Number 1, March 2009 colleagues: on this issue, the differences found were among age group, work position, and income (p<0.05). There was no difference found in factor 2 - relationship with supervisor. c. Open-ended
question
Table 4 shows the frequencies of the top five responses to the open-ended question “How would you like executives of the Thailand Ministry of Public Health to act on the work morale of health center staff?” Table 4 The frequencies of the top five responses to the question “How would you like
executives of the Thailand Ministry of Public Health to act on the work morale of health
center
1. Adjustment of salary rates or wage ranges appropriate to the present economic situation 2. Arrangements for more kinds of welfare, for instance per diem and rewards to staff 3. Increase in personnel to match existing work load required 4. Executives should provide orientation to staff or visit health centers on a regular basis 5. There should be continual training to review knowledge
4. Discussion
As Richardson and Blocker (1963)17 stated that the technique of factor analysis
could provide the opportunity to improve both the methods used in assessing the subject’s
morale and the clarity with which these assessments were reported to the administrations.
17 Richardson, R.C. Jr. and Blocker, C., “Note on the application of factor analysis to the study of faculty morale.” Journal of Educational Psychology 54 (4) (1963): 208-212.
วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 The above findings respond to the first objective of the study in identifying the seven major dimensions of work morale. They are prioritized from the most to the least relevant regarding work morale: (1) (4) elements facilitating good working surroundings (5) Table 5 lists the dimensions of work morale found in this study and those from other studies in the literature review. Table 5 List of the dimensions of work morale from the literature review and from this study for
comparison
Dimensions identified from
Author(s)
Focus of research
factor analysis
Teacher morale and school Eleven identified factors for climate through the use of school climate included: (1) “School Organizational Health appraisal and recognition (2) Questionnaire” curriculum coordination (3) effective discipline policy (4) excessive work demands (5) goal congruence (6) participative decision-making (7) professional growth (8) professional interaction (9) role clarity (10) student orientation, (11) supportive leadership Hetherington and Hewa (1997) Hospital staff morale versus Sixteen items were categorized structure with prediction based with supervision (2) satisfaction on Hage’s 1965 axiomatic Journal of Demography, Volume 25, Number 1, March 2009 Table 5 (cont.)
school teacher morale for the under 4 groups: (1) administrative construction of psychometrically- operations (2) working sound instrument through financial incentives in thirty selected inventory items, the factors influencing were (1) organization and management (2) immediate supervision (3) material rewards (4) fellow employees (5) job satisfaction Richardson and Blocker (1963) Faculty morale through the use From seventy-four items, the of “Differential Morale Attitude four core factors were Inventory” survey (1) supervision (2) self-integration (3) institutional environment (4) employment rewards Raksarat, Hongsranagon and Health center staff morale categorized under the items of (1) income (2) opportunity for advancement (3) office physical conditions (4) elements facilitating good working surroundings (5) relationship with supervisor (6) job satisfaction (7) relationship with colleagues วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 income factor in this study is parallel to employment rewards and material rewards; opportunity for advancement is in line with professional growth; office physical conditions and elements facilitating good working surroundings (under work conditions) are consistent with institutional environment; relationship with supervisor matches satisfaction with supervision, working relationship, and supervision; job satisfaction is congruent with satisfaction with career, career fulfillment, and job satisfaction; and relationship with colleagues is comparable to fellow employees and working relationship found in other research literatures mentioned for comparison. The findings also answer the study’s second objective of providing an explicit rationale for the interpretation of the results from factor measurement, especially the statistically significant differences between baseline characteristics. The findings indicate the group whose work morale is most negatively affected is that made up by persons working as community health officers or registered nurses with an income of between 233-466 U.S. dollars (7,000-14,000 Thai baht) (below median) or with an income of 1,000 U.S. dollars and more (30,000 Thai baht and more) (median level) in the age group of less than 29 years old or in the 30-39 years bracket (since mean age is 34.4 years). This group is specifically affected in terms of income, opportunity for advancement, and office physical conditions and elements facilitating good working surroundings. The significance of the income factor may be attributed to the fact that Krabi generally has a high cost of living. According to Thailand’s national tourism strategic planning, the provinces of Phang Nga, Phuket, Ranong, Trang, and Krabi are recognized as key tourist attraction spots in southern Thailand - the sand-sea-sun destination. The provinces are known by a series of names – the “Andaman Paradise” and the “Southern Emerald” are two examples. The focus is on the “World Class Tropical Paradise” with “Premium Exclusive Exotic Hospitality and Courtesy”. Krabi itself is regarded as the “Natural beach and resort with serenity”. Its well-known sites are Lanta Island and Pee Pee Island. Daily expenditure by tourists staying in Krabi for years 2002-2007 was 80-90 U.S. dollars per person. This positioning as a leading tourist destination attracting international tourists contributes to Krabi’s high cost of living. In addition to this, Krabi accounts for 35% of the national area devoted to the production of palm Journal of Demography, Volume 25, Number 1, March 2009 oil, a fuel being actively promoted as a substitute for diesel. The province is also a leading site for rubber plantations, fisheries, and major trade and business center. All these elements indicate a prosperous area with an accompanying high cost of living [http://www.krabi.go.th].18 In this study, it should be noted that this income factor is of considerable concern to the participants as indicated by the 2 most frequent responses to the open-ended question (see Table 4). The significance of the opportunity for advancement in the findings reflects the participants’ desire to improve their professional situation. The participants’ median length of work experience was found to be 10 years, a stage at which workers are contemplating their employment futures and prospects. Employers need to be aware of these feelings of long-tenured staff regarding their continuing training and education. Of the four “entities” of an organization – people, tasks, systems, and computers – people are the first that is regarded as the most important asset of an organization as it is this one that completes the tasks. Systems and computers are only necessary to support people in doing this (Chen et al., 1996).19 This concern about continual training is evident in the participants’ fifth response to the open-ended question (see Table 4). Responding office physical conditions and elements facilitating good working surroundings, it is important that there is a reasonable match between working personnel and their working environment to ensure effective work performance. Krabi health centers were built on average 10 years ago and evidently require renovation, redesign, and/or reconstruction. The third objective of the study was to establish procedures for the improvement of work morale for health center staff in Krabi. The most relevant factors were found to be income factor, opportunity for advancement factor, and a combination of office physical conditions and elements facilitating good working surroundings factor. These factors require the attention and intervention on the part of the executive external to the health centers themselves. The other
18 [Online available from http://www.krabi.go.th, accessed on 2008 June 2, pp. 1-93]
19 Chen et al., “Employee commitment to the implementation of flexible manufacturing systems.”
International Journal of Operations & Production Management 16 (7) (1996): 4-13.
วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 factors, relationship with supervisor, staff job satisfaction, and relationship with colleagues, are factors that are within the control of health center staff. The personnel of the health centers need to develop both vertical (heads and assistants) and horizontal (colleagues in different positions) lines of communication to foster self-initiated improvements in work morale that require no monetary and/or external contributions. 5. Recommendations
This
research employing a factor analysis approach to measuring work morale in organizational members in the context of health centers in Thailand. Morale and positive experiences of workers make great contributions to their quality of life (Hart et al, 2000).20 Poor morale can negatively affect workers’ performance (Hetherington and Soma, 1997).21 The foremost goal of health centers is to better the health outcomes of their patients and the challenge for policy-makers and executive is to consider the findings of the study in the quest to improve the services offered. From past literature reviews, it has been emphasized that monetary and non-monetary incentives should be used together to optimize employee’s work morale. In fact, the approach for these incentives is recommended to be on a “tailor-made” basis (instead of “one-size-fit-all principle) so as to reflect the actual needs and requirement of targeted employees.
20 Hart et al., “Development of the School Organisational Health Questionnaire: A measure for
assessing teacher morale and school organisational climate.” British Journal of Educational Psychology
70 (2000): 211-228.
21 Hetherington, R.W. and Hewa Soma, “Taking the measure of morale: Structure and job
satisfaction in a multi-hospital system.” The International Journal of Sociology and Social Policy 17 (5)
(1997): 1-51.
Journal of Demography, Volume 25, Number 1, March 2009 For instance, Andrew Ballentine, Nora McKenzie, Allen Wysocki, and Karl Kepner 22 elaborated that workplace motivators include both monetary and non-monetary incentives. While monetary incentive is designed so as to reward employees for their job performance by the use of money, it is traditionally aimed to maintain a positive motivational environment for employees. Non-monetary incentive, on the other hand, is to reward employees for job performance through opportunities. This includes flexible work hours, training, pleasant work environment, and sabbaticals. Problem with monetary incentives include the fact that it encourages compliance (more than risk-taking), discourages employees from being creative, circumvents problems at work, serves as extrinsic (more than intrinsic) motivator, as well as disrupts good relationships among peers and subsequently, workplace environment. Non-monetary incentives, in fact, differ among different career stage and proximity to retirement. Elder employees prefer retirement income with part-time/ temporary jobs. Younger employees focus on job satisfaction and work environment. The authors recommended a balance between monetary and non-monetary incentives to satisfy the diverse needs and interests of employees. Cheryl Zobal 23 stated that compensation plays a key role in an organization as it is a kind of motivator among employees. It can be (1) base pay and base pay adjustments; (2) other financial rewards; and (3) non-financial rewards, the last two of which vary according to factors such as employee’s performance. In particular, non-financial compensation refers to any type of non-monetary award which can be given for many reasons, i.e the demonstration of a desired behavior or the
22 Andrew Ballentine, Nora McKenzie, Allen Wysocki, and Karl Kepner, “The Role of Monetary
and Non-Monetary Incentives in the Workplace as Influenced by Career Stage.” EDIS document HR 016,
a publication of the Department of Food and Resource Economics, Florida Cooperative Extension Service,
Institute of Food and Agricultural Sciences, University of Florida. 2003.
23 Cheryl Zobal, “The ‘ideal’ team compensation system – an overview: Part I.” Team Performance
Management 4 (5) (1998): 235-249.
วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 accomplishment of a particular goal. It can be formal, instituted by the company or unit, or informal and spontaneous, generated by the team and/or team members within the organization. In fact, compensation is not about the money per se as it communicates the degree to which an organization values its employees as well. In order to be effective as a working organization, the use of customization, covering the understanding of organization’s culture, its business strategy, and its desired behaviors, becomes a necessity to design an appropriate reward strategy, whereby the base pay, other financial rewards, and non-financial rewards should all integrate into the organization’s motivation strategy. Susan J. Linz, Linda K. Good, and Patricia Huddleston24 in their paper of a cross-sectional study with purposive sampling would want to well-define measures of morale which influences employee performance, especially in Russia workers context. With data collection in 1995 and again in 2002, the authors found the subject’s expectation in monetary rewards having a higher influence than that of non-monetary one. Of interest, the practical implications from this research was made in such a way that if companies are not financially able to provide monetary rewards, managers can focus on developing a work environment that is friendly and fosters mutual respect. Carefully crafted feedback mechanisms can contribute to an employee’s sense of accomplishment. Steven H. Appelbaum, and Rammie Kamal25 described that while small business was defined as any firm with less than 100 employees, their research objective was to determine what variables would give small businesses an advantage to attract and maintain employees while optimizing employee’s performance. Though income or pay was a key effective factor, job satisfaction (intrinsic issues) via job enrichment, employee recognition, internal pay equity, and the use of skilled managers, when increased, could enable small firms to heighten productivity and attractiveness to its employees. In other words, employee motivation through non-monetary 24 Susan J. Linz, Linda K. Good, and Patricia Huddleston, “Worker morale in Russia: an exploratory study.” Journal of Managerial Psychology 21(5) (2006): 415-437.
25 Steven H. Appelbaum, and Rammie Kamal, “An analysis of the utilization and effectiveness of non-financial incentives in small business.” Journal of Management Development 19 (9) (2000): 733-763.
Journal of Demography, Volume 25, Number 1, March 2009 incentives can help increasing higher output, lower turnover rates and a greater overall synergy
in increasing firm’s efficiency and bottom line. Joan Brannick26 explained that out of the seven
strategies to retain top talents of the company, especially amid economy slow down, namely,
(1) hire for attitude, train for skill (2) align applicant expectations (3) use a great employee
profile to drive retention (4) create an employee value proposition (EVP) that delivers what it
promises (5) count what counts (6) drive employee ownership of employee retention, and (7)
avoid a “one size fit all” approach to employee retention, attractive compensation was one
headline under the strategy of EVP stated above. Attractive compensation emphasized the
money part which can provide purchasing power and lifestyle of people, while recognition and
fairness also play a key role as talent’s expectation lies in being recognized and being valued
for what they have done for the company.
In this time study, it is obvious that the human-related and/or non-monetary factors
of the Krabi province context are significant and lie within the sphere of the workers themselves.
The authorities also need to play their role in satisfying the monetary aspects of the work morale
situation. With both workers and authorities combining their efforts, an improvement of work
morale among Krabi province health center staff can actually take place, and healthy work
place for the organization and its members will be promoted, all of which, in turn, would greatly
benefit the services offered to the patients in the area of responsibility by the health centers.
Acknowledgement
The authors would like to express their sincere appreciation to Mrs. Nathawan
Deelertyuenyong, from the College of Public Health Sciences, Chulalongkorn University, who
has kindly supported the production process of this manuscript.
26 Joan Brannick, “Seven strategies for retaining top talent.” Journal of Business Strategy,
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วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 Appendix 1 factor analysis with Varimax rotation on health center staff’s work morale (n = 212)
Cronbach's
variance Mean*
Communalities Loading
The work under your responsibility is challenging and you are motivated to work The assigned job is interesting and useful You participate in giving suggestions regarding your job You can use your initiative and personal capability in your job Your present job is what you are skillful at Your opinions are accepted and are used to improve the job You are free to express your ideas fully You are satisfied in the knowledge and capability of your existing peers Your present position is appropriate to your knowledge and capability Cronbach's
variance Mean*
Communalities Loading
The supervisor is equally fair to all subordinates The supervisor supports and promotes the advancement The supervisor takes good care of you and helps you when you face any problems The supervisor honors you and gives you an opportunity to work to your fullest The supervisor trusts you in performing your job The supervisor is a person with whom you can seek advice or suggestions Cronbach's
variance Mean*
communalities
Your present income is appropriate when compared with your tenure Your income is sufficient for your present cost of living Your present income is appropriate to your monthly household expenditure Your present income is appropriate when compared with other organizations with Your present income is appropriate to the work load and your job responsibility Other types of welfare help your income to be sufficient for your present cost of living You need to earn extra income in addition to your regular work Journal of Demography, Volume 25, Number 1, March 2009 Cronbach's
variance Mean*
communalities
Peers at the health centers work collaboratively and help in solving problems for When you have personal or work issues, you always tend to consult your peers Your peers are always willing to spend time with you when you require it In your health center, there is always assistance in case of trouble You have a chance to party with your peers beyond work hours or on some special You and your peers honor one another when expressing opinions and also listen to Cronbach's
Variance Mean*
communalities
You have opportunities to express yourself regarding your own work performance You have opportunities to be promoted to higher positions with fairness You have opportunities to be selected for training or for field trip study You have opportunities to be trained to develop your knowledge and capability You have opportunities for advancement in your line of command You have opportunities to further your level of study Cronbach's
Variance Mean*
communalities
The health center building has enough space for you to work The health center you are working for has public facilities that enable you to work The health center you are Working for has proper controls of noise, light, and The health center you are working fir has an acceptable hazard prevention system The health center you are working for has an acceptable hazard prevention system The health center you are working for has an acceptable hazard prevention system The health center you are working for has an acceptable hazard prevention system The health center you are working for has an acceptable hazard prevention system The health center you are working for has an acceptable hazard The health center you are working for has an acceptable hazard วารสารประชากรศาสตร ปที่ 25 ฉบับที่ 1 มีนาคม 2552 Cronbach's
variance Mean*
communalities
You tend to get cooperation from your peers in your work The health center you are working for has adequate materials and equipments with Your can use your knowledge and capability in your work to its fullest extent Your opinion and suggestions are well accepted by the supervisor You have fair opportunities for job advancement *All items were recorded on a scale of 1 to 5 point, the higher the number the higher the morale.

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