The Role of Internal Environment in Jordanian Ministry of Health in Migration of Specialist Doctors

The aim of this study was to determine the role of internal environment in Jordanian ministry of health in migration of specialist doctors. In order to achieve this goal, a questionnaire was designed. It consists of (30) thirty clauses reflect all the dependent and independent variables. The study sample consists also of (120) Specialists who left the Jordanian Ministry of Health (J.M.O.H). Grynbach constancy coefficient reached 88%. Percentages, Means, standard deviation, (ANOVA), and leaner regression analysis were used to test the hypothesis. The study found that; there is a strong relationship between all the internal environment components in the (J.M.O.H) and migration of specialist doctors. All the internal environment components effect the migration of specialist doctors. The descending order of the effects of the internal environment components are as follows: salaries and incentives, equipment, furniture and office design, administrative style, systems and procedures, lighting and conditions, and finally the nature of the prevailing relations. The study also found that there is a difference in the migration between specialist doctors due to gender, marital status, age, and experience. According to the study findings, the researcher recommends the following; the hospital managers must give more attention to the internal environment conditions, initiate a new suitable salary scale, and give special training programs in hospital administration for those doctors.


Introduction
The organizational internal environment affecting on human resources in many ways; such as productivity, satisfaction, motivation, turnover...etc.So, the internal environment plays a big role in achieving the goals of the organizations, and of course, the hospitalis one of them.Because of that, the high management must give more attention and concentration to all internal environment components in order to achieve the goals.The internal environment plays an important role within the governmental hospitals in achieving job satisfaction for the workers and medical team including the specialist doctors.The hospitals constitute an important direct contact point with patients and their families aiming to meet their needs of good diagnosis process and psychological and physical treatment, and for that to be achieved, the presence and appointment of efficient and highly skilled and experience specialist doctors are vital.Nevertheless, the most important thing is to maintain these doctors and prevent them from leaving.The process of maintaining the specialists would be achieved by providing appropriate internal environment to encourage the ultimate performance, the best potential, and the longest working hours, and to lift their spirits and improve their level of income to be similar with their peers in other Jordanian health sectors and even with health sectors in the surrounding Countries.Otherwise, if the high management doesn't meet the suitable internal environment, the level of performance, satisfaction, motivation, creativity, and the level of medical services are expected to face dropdown.In addition, the turnover rate in the Jordanian Ministry of Health hospitals is expected to be high, which meanshigh level of migration outside the Jordanian Ministry of Health.Due to the researcher's long experience working in the administration of the Jordanian Ministry of Health; he believes that providing suitable internal environment components for the specialist doctors is of high importance in order to encourage them to continue to work in the Jordanian Ministry of Health.The researcher also believes that the specialist doctors suffer from the unfairness in compensations, performance appraisal, and career opportunities etc., which lead to dissatisfaction, discontent, and lack of commitment.For these reasons, this study came to focus on the extent of the effect of the internal environment in the Jordanian Ministry of Health on the migration of specialist doctors

Internal Work Environment
Al- Qaryouti (2000), defined the internal environment as, the values and trends within the administrative regulations and their impact on the employees organizational behavior, and on the overall management process.Al- Dahan (1992), defined the internal environment as; the technology used in work as well as in business and management techniques and other physical components procedures.Aladely (1995) also defined the internal environment as, the factors and the characteristics of the organization within which the employees work, such as; rules, regulations, procedures, salaries, incentives, sanctions, and relations prevailing works in addition to working conditions.Internal work environment can be divided into three groups, as indicated by Goudh (2010).Those three groups are: the physical work environment, which consists of; lighting, conditioning, cleaning, working hours, and the break.The second group is the social and psychological work environment, which consists of personal relationships between colleagues at work, and between subordinates and supervisors.The third group is the organizational work environment, which consists of the organizational characteristics, the organizational culture, the characteristics of the job, and the available resources including salaries and incentive properties.In abroad literature the internal environment was divided into two main parts: the first part consists of the following elements: Organizational Structure; which contributes in influencing the behavior of employees and their morale, the good organizational structure acclimates with all internal and external variables, that encourage the workers to be creative, innovative, satisfied and productive.On the contrary, the structural inflexibility negatively affects the performance and morale of the employees in the organization.The second element is regulations and procedures; the clarity of the regulations and procedures in the work contributes to improve the loyalty and productivity, on the other hand the lack of clarity leads to decrease morale, satisfaction and performance (Qubaisi, 2006).Another element is the management style; which varies from organization to another depending on the vision and the concentration of the high management.Centralization and decentralization, autocracy, democracy, or/and participation are all examples of management styles.Whatever the perception of the style of management, the successful style is the one which is consistent with the development and nature of the organizational work and at the same time brings satisfaction and loyalty to the organizations, and achieves their goals.On the other hand, the bad management style is a disaster for the organization, leading to failure to achieve the objectives, dissatisfaction and increase turnover (Al-nemer, others. 2011).Equipment and appliances used; using of modern technological equipment increases the efficiency and effectiveness of the employees performance in any organization especially in the private hospitals, where this equipment serves as a very important source of attraction.In addition, this equipment gives the hospital opportunity to compete and attract talent specialist doctors.Its absence or inappropriateness increases the turnover among the specialist doctors towards well-equipped hospitals (Diab, 2010).Salaries and Incentives; justice in wages, salaries, incentives and all other financial compensation that workers can get in their organizations in return to their efforts is very important and necessary, because the presence of justice and equality will greatly contribute to the commitment of employees to work in the organization, as well as to their compliance to the positive behaviors at work within this organization.Either feeling of injustice or the lack in salaries and incentives will lead to lack of commitment, feeling of dissatisfaction, low performance, and decreased loyalty to the organization (Al-Qahtani, 2008).Nature of the organizational relationships; they contribute to motivate the workers to handle the situations and work as a team and contribute the coordination and cooperation to achieve the goals of the organization.In addition, the presence of a friendly atmosphere could create learning environment that helps in the commitment of employees to work in the organization.The lack of such relations could lead to a lack of commitment and loyalty to the organization as well as the low level of performance and productivity (Rashid, 2004).The second part of the internal environment in the organization is the physical work environment, which consists of the following components: lighting, heating, and conditioning; these physical components affect significantly the performance and commitment of employees, the experiments carried out by the (Elton Mayo At Hawthorne plant) have shown the the importance of providing these components is represented by providing suitable convergence, normal situation, increased performance, productivity and concentration and decreased of work errors (Abdel-Aal, 2008).Furniture and Offices Design; the well-designedoffice with high-quality, comfortably colors furniture, large areas, well ventilationand well lighting leads to an increase in comfortableness, performance and productivity as well as a decrease in turnover rate (Hareem, 2013).Facilities and services; providing personal and official facilities and services has a large role in increasing the organizational sense and loyalty, these facilities may affect the level of performance, satisfaction among the employees in the organization, and have a retrograde effect the turnover rate (Qaryouti, 2000).

Migration of Human Resources
The qualified and experienced workers maintaining is one of the important and necessary high management functions in any organization.Decreasing turnover rate especially in the category of specialist doctors, for example, helps to improve the hospitals performance (Jackson, 2004).The concept of leaving work or turnover called some times, migration of human resources.Hareem, 2013; divided the work leaving (migration) into two parts obligatory leaving and optional leaving.The obligatory leaving is not considered under the concept of migration because it came as a result of death, restructuring, or any other obligatory reasons, so there's no choice for the worker's on it.The optional leaving is actually what can we call migration, because it occurs own selection of professionals such as resignation, leave work without permission (job loss) or any other optionally reason.In general, the organizations seek to decrease the turnover rates or at least attempt making it at the lowest levels especially among experience and skilled workers.There are many reasons for the migration of human resources, some reasons relate to the internal environment, and other reasons relate to the external environment circumstances (Harem, 2013).

Previous Studies
1) Study by (Eadan & Abbas, 2009), the impact of the internal environment on the decision-making an Empirical Study on governmental-owned companies,the study found a strong correlation between the administrative systems and the available information and making decisions.
2) Study by (Al thamaly, 2002) the relationship between the organizational commitment and the internal environment; it's found that the followings; training programs, the centralized decision-making, and the teamwork, are increased the organizational commitment.
3) Study by (Daúda & Tayeb, 2007) the impact of internal and external environment analysis on the strategy formulation, it's found that the internal and external environment has a great significance affecting the formulation of any strategy in the organization.The greater knowledge of analyzing the internal and external environment leads to achieve the goals of the organization very effectively.
4) Study by (Al-Qahtani, 2001), the role of organizational internal environment on the loyalty, the study found that the incentives, administrative style, salary increases, and clarity of the roles for each employee, all of these play an important role in increasing the loyalty and organizational commitment.
5) Study by (Alnosoh,2005) the impact of environmental changes in the competitive position of the organizations ,an imperical study on private hospitals in Aden governorate of Yemen, The study reveals the presence of an effect of the internal environment on the competition to win a position in the hospitals in Aden, as well as a positive correlation between the internal environment variables and the increased market share, the study also found that the use of modern technology was one of the most important internal environmental factors that leads to increase the market share and improve the competitive situation.
6) Study by (Alkhshali ,2002) the effect of leadership style of the scientific departments heads in the Jordanian private universities on the members loyalty, the study found a strong correlation relationship between leadership styles and the Organizational Commitment, some styles positively correlations while other styles negatively correlate.
7) Study by (Shammari, 2013), the role of the internal environment in achieving the organizational commitment of employees of the border guard command, the study reached the following conclusion; the team spirit, participation in decision-making, fair promotion opportunities, providing the capabilities, and the presence of incentives, all of which have had strong impact on loyalty and organizational commitment.

Study Objectives
This study aims to achieve the following: o To identify if there is a difference between the migration of specialist doctors from the Jordanian Ministry of Health hospitals related to demographic variables (sex, marital status, age, and experience).
o Make appropriate recommendations in the light of the results of this study that could help the decision-makers.

The Importance of the Study
The importance of this study rises from the role of the specialist doctors in the saving the lives of patients and citizens, which are the most expensive things to be owned.The citizens and the patients consider the specialist doctors to be the ones who will provide them with the cure and treatment of the diseases.Thus, the importance of this study associates with the importance of the man himself, with the good health he needs, and the importance of this study lies in the possibility of providing a suitable internal environment that allows the specialist doctors to diagnose and treat creatively and with innovation in the framework of an appropriate work environment.

Study Problem
The Problem of this study wassummarized in a range of questions, which are: o Is there an effect of the internal environment components (combined) in the Jordanian Ministry of Health hospitals on the migration of specialist doctors?
o What are the most influential internal environment components on the migration of specialist doctors from Jordanian Ministry of Health hospitals?
o Is there a difference between the migrations of specialist doctors from the Jordanian Ministry of Health hospitals that are related to demographic variables (gender, marital status, age, and experience)?

Research Framework
The proposed framework for this study is illustrated in Figure 1.The framework shows the impact of the internal environment componentsin Jordanian Ministry of Health (organizational structure, regulations and procedures, administrative style, appliances and equipment, salaries and incentives, prevailing relations, lighting and conditioning, furniture and design clinic, and facilities and services) on migration of specialist doctors.

First hypothesis:
H0: There is no statistically significant effect of theimpact of the internal environment components (organizational structure, regulations and procedures, administrative style, appliances and equipment, salaries and incentives, prevailing relations, lighting and conditioning, furniture and design clinic, and facilities and services) in Jordanian Ministry of Health combined or separately on migration of specialist doctors.

Second hypothesis:
H0: There are no statistically significant differences between the migrations of specialist doctors from the Jordanian Ministry of Health hospitals that arerelated to demographic variables (gender, marital status, age, and experience).

Study's Methodology
The preliminary data will be obtained through a questionnaire that consists of (45) clausesreflect the dependent and independent variables for each independent variable around (4 to 5) clauses; the other variables was treated the same.

Study's sample and Population:
The study's population consists from all the specialist doctors in the Ministry of Health Hospitals; the questionnaire was distributed to the study sample (120) specialist doctors.Taking into our consideration that there're (33) hospitals for the ministry of health in Jordan with estimated (1000) specialist doctors, (M.O.H reports).

Data Collection Methods
The questionnaire was the main instrument of this study; It consisted of ( 45) clauses reflecting the dependent and independent variables and was designed according to likart scale, with the answers (strongly disagree, disagree, don't know, agree, strongly agree,), given the weights (1, 2, 3, 4, 5).The higher the mean, indicates to higher degree of consent on the clause.

Internal Consistency
Grynbach Alpha confection was obtained for internal consistency between the clauses attitude scales.As Grynbach coefficient reached 82 %, it is considered a high value indicates the study's instrument constancy.

Statistical Methods Used
The following statistical methods were used for statement attributes of the study sample and for examining the hypotheses of the study: frequencies, percentages, means, standard deviation, linear regression analysis, and ANOVA analysis.

Results and Testing Research Hypothesis
Table 1 show that (88%) are male, (12%) are female, the greater percentages (67%) are between (41-50) years old, and the lowest percentages (4%) are between (51-60) yearsold.It is also noticed that the higher percent (95%) are married, and that (28%) of the study sample have (1-5) years' experience, (56%) have (6-10) year experience, and (12%) of the study sample have (11-15) year experience, only (8%) have16 years and more.3 show the result of testing the first hypothesis; There is no statistically significant effect of the internal environment components (organizational structure, regulations and procedures, administrative style, appliances and equipment, salaries and incentives, prevailing relations, lighting and conditioning, furniture and design clinic, and facilities and services) in Jordanian Ministry of Health combined or separately on migration of specialist doctors.The results in table 2 show a strong correlation between all the internal environment components in the Jordanian Ministry of Health and specialist doctor's migration, the correlation coefficient reaching (0.808).The salaries and incentives component was one of the highest correlation degrees (0.902).The lowest correlation degrees were the prevailing relations (0.578).The internal environment components effect the Migration of specialist doctors (according to correlation coefficient) in descending order were as follows: salaries and incentives, appliances and equipment, facilities and services, furniture and design clinic, administrative style, regulations and procedures, organizational structure, lighting and conditioning, and finally prevailing relations.To confirm the result a multiple regression analysis was conducted as in table 3, which shows that there is an effect of the internal environment components (organizational structure, regulations and procedures, administrative style, appliances and equipment, salaries and incentives, prevailing relations, lighting and conditioning, furniture and design clinic, and facilities and services) in Jordanian Ministry of Health on Migration of specialist doctors.For combined (F) was (26.76) with (0.001) significant, and (R2) was (0.388).To be sure of this result, the (T) accounted value (8.12) was greater than the tabled value, this value lead toreject the first null hypotheses and accepted the alternative hypotheses.Also table 3 shows that there's an effect from each internal environment component on migration of specialist doctors, with significant less than (0.05) for the entire internal environment component.According to the result shows in table 3 we can order the effects of the internal components on migration of specialist doctors decreasingly as follows: salaries and incentives, appliances and equipment, facilities and services, furniture and design clinic, administrative style, regulations and procedures, organizational structure, lighting and conditioning, and finally prevailing relations.The (ANOVA) analysis results in Table 4 show that there are differences in effects of the internal environment components on migration of specialist doctors due to the demographic variables, gender, age, marital status, and experience.The significant is less than (0.05), so we accept the alternative hypothesis which states that; There are statistically significant differences between the migrations of specialists doctors from the Jordanian Ministry of Health hospitals that are related to demographic variables (gender, marital status, age, and experience).

The Results of This Study
-There is a strong correlation between all the internal components of the environment in the Jordanian ministry of health and the migration of specialist doctors, the most strength correlation was between salaries and incentives, and the migration of doctors.The lowest factor associated with the migration of doctors was the nature of the prevailing relations.
-The effects of the internal environment components on migration of specialist doctors were decreasingly ordered as follows; salaries and incentives, appliances and equipment, facilities and services, furniture and design clinic, administrative style, regulations and procedures, organizational structure, lighting and conditioning, and finally prevailing relations.
-There are differences between the migrations of specialist doctors from the Jordanian ministry of health that are related to demographic variables (gender, marital status, age, and experience).

Recommendations
1) In light of the results of the study, the researcher suggests the following recommendations: 2) The managers in the Jordanian Ministry of Health must give more attention to providing suitable internal environment for the specialist doctors and for the other medical members in order to insure medical serviceswith a high quality.
3) Offer a salary scale which is commensurate with the salaries offered in Jordanian University hospital, the Jordanian armed forces hospitals, and private health sector.
4) Increase the retirement age in the public sector by creating rules and regulations that state so.5) Give special training programs in hospital administration for specialist doctors to develop their skills in management.
6) Initiate and improve of incentives and rewards systems for specialist doctors.
7) Provide special services and facilities of comfortableness in the days of clinics for doctors.
8) Provide the most developed medical technology in sufficient quantities to proportionate with the levels of action.

Results Discussions
The results of this study are consistent with the results of some other studies that have dealt with this subject such as (Eadan & Abbas, 2009), which found a strong correlation between the administrative systems and the available information and making decisions.Daúda & Tayeb (2007) found also that the internal and external environment has a great significance affecting the formulation of any strategy in the organization.Al-Qahtani (2001) found that the incentives, administrative style, salary increases, and clarity of the roles of each employee play an important role in increasing the loyalty and organizational commitment.Alnosoh (2005) reveals the presence of an effect of the internal environment on the competition to win a position in the hospitals in Aden, as well as a positive correlation between the internal environment variables and the increased market share; the study also found that the use of modern technology was one of the most important internal environmental factors that leads to increase the market share and improve the competitive situation.Alkhhali (2002) found a strong correlation between leadership styles used and organizational commitment.Some styles positively correlate and other styles are negatively, which means that the internal environment in any organization effects the migration, productivity, and commitments.
To identify the effect of the internal environment components (combined) in the Jordanian Ministry of Health hospitals on the migration of specialist doctors.o To find out what are the most influential internal environment components on the migration of specialist doctors from Jordanian Ministry of Health hospitals.

Figure
Figure 1.Study framework

Table 1 .
Show general characteristics of the members of the study sample

Table 2
and table

Table 2 .
The Person correlation between dependent and independent variables

Table 3 .
The multiple linear regression analysis

Table 4 .
The (ANOVA) analysis for demographic variables