International Journal of Healthcare Management

ISSN: 2047-9700 (Print) 2047-9719 (Online) Journal homepage: http://www.tandfonline.com/loi/yjhm20

Evaluating the relationship between work

engagement, work alienation and work
performance of healthcare professionals

Nazan Kartal

To cite this article: Nazan Kartal (2018): Evaluating the relationship between work engagement,
work alienation and work performance of healthcare professionals, International Journal of
Healthcare Management, DOI: 10.1080/20479700.2018.1453969

To link to this article: https://doi.org/10.1080/20479700.2018.1453969

Published online: 21 Mar 2018.

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INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT, 2018
https://doi.org/10.1080/20479700.2018.1453969

Evaluating the relationship between work engagement, work alienation and

work performance of healthcare professionals
Nazan Kartal
Department of Healthcare Management, Hacettepe University, Ankara, Turkey

ABSTRACT ARTICLE HISTORY

The purpose of this study was to determine the effect of work engagement and work alienation Received 27 November 2017
on performance. Participants included 493 health professionals working in public, university, Accepted 13 March 2018
and private hospitals. Analyses revealed a meaningful and positive relationship of the
KEYWORDS
engagement level of health professionals and its sub-dimensions with their performance, Work engagement; work
and of work alienation and its sub-dimensions with performance. A regression analysis alienation; job performance;
revealed that the level of participants’ engagement and alienation had a significant influence health professionals
on performance (P < 0.01). Further, among the vigor dimension of engagement and the
powerlessness and meaninglessness dimensions of alienation explained 28% of the total
variance. These findings reveal that health professionals’ vigor levels increase their
performance, and powerlessness and meaninglessness levels decrease their performance.

Introduction emphasize on positive organizational behavior con-

Positive psychology, purported by the psychologist
Seligman in the field of organizational behavior, was
introduced to challenge the notion that psychology
only examines pathological and negative behavior
after 2000s [1,2]. Rogers (1947, 1959), Maslow, May,
and Fromm, who are particularly representative of
the humanistic psychology (phenomenology) move-
ment, have also presented work in the field of positive
psychology [3]. For the first time, the concept of posi-
tive psychology was used by Maslow in 1954 [4], and
since then, it has been developed to complement the
missing aspects of clinical psychology, beyond repair-
ing adversities. Since World War II, psychology has
started to spread in a wide range of therapeutic con-
texts, concentrating on repairing the individual damage
caused by the disease and creating positive qualities [5].
Psychology has been criticized mainly for the mental
illness and distress oriented perspective, and it has
been found that these criticisms are also related to
occupational health psychology [6]. In occupational
health psychology, traditionally, individual and organ-
izational interventions are based on the so-called
‘medical illness’ perspective, that is, interventions are
implemented only if there is a problem [7]. Thus, the
basic aim of interventions is to correct tensions.
Now, although organizational health psychology is
not viewed as only pertaining to the solution of nega-
tive and undesirable situations, it is very important to
focus on the positive aspects of psychology and to
develop the positive aspects of individuals [8]. Studies
on organizational performance have now begun to
cepts and positive emotions such as optimism, trust,
and engagement [5,9–11].
Many researchers have attempted to define engage-
ment. According to academic studies, it comprises
energetic behavior (vigor), emotional (dedication),
and cognitive (absorption) components [12]. In every-
day life, work engagement refers to participation,
agreement, passion, desire, concentration, effort, and
energy focus [12]. Unlike traditional approaches, Ash-
forth and Humphrey [13] it is now explained that work
engagement is motivated by using employees’ hands,
minds, and heart in coordination with each other.
Vigor, one of the three dimensions of work engage-
ment, refers to the self-willingness to work, resistance
to difficulties, and energy and mental endurance [14].
Thus, a person with high vigor is highly motivated in
the face of tedious situations and difficulties at work
[15]. Dedication, on the other hand, pertains to the
feelings of importance, inspiration, honor, and stimu-
lation with reference to one’s work [14]. The concept
of dedication shares many similarities with job involve-
ment, which is known as the attachment to and identi-
fication with one’s work [16]. Finally, absorption
indicates that the employee is fully engrossed in his
work despite fast time and difficulties that may force
him to move away from his work [14].
An engaged employee has a sincere and passionate
bond with her/his job and organization. These people
exhibit high performance, are energetic and willing,
do not throw away their work, work more to specialize
in their fields, depend on their organizations and team,

CONTACT Nazan Kartal nazankartal18@gmailcom Department of Healthcare Management, Hacettepe University, Ankara 06800, Turkey
© 2018 Informa UK Limited, trading as Taylor & Francis Group
2 N. KARTAL
are fully aware of their responsibilities, and accept
responsibility for any work they do [17].
Work engagement has been reported to be associ-
ated with concepts such as job burnout [18,19], worka-
holism [20], organizational commitment [21],
organizational engagement [22,23], job satisfaction
[24,25], job involvement [11,26,27], flow [28], and
job performance [15,29,30].
From an organizational perspective, while work
engagement leads to employee efficacy, employee pro-
motion, advocacy of the organization against outside
pressures, customer loyalty, successful organizational
change, managers’ self-efficacy, balance, and harmony.
On the other hand, from an individual perspective, it
leads to increase in meeting expectations, employee
health and well-being, demand-driven effort, and job
performance [31]. In complex healthcare systems,
physician engagement, satisfaction, and retention are
optimized by the collegial work environment and
healthy practice environment requisite to harmonious
teamwork quality patient care, and organizational suc-
cess [32].
Alienation, in concept, is derived from the Latin
pronoun ‘alienato’ and verb ‘alienarer’ [33]. These
terms mean leaving one’s ownership to another and
dissolving or separating between two things, respect-
ively [34]. ‘Alienare’ means replacing something,
removing it, or replacing it with another [35]. Kongar
[36] summarized the term alienation as ‘the loss of har-
mony with the social, cultural, and natural environ-
ment of the individual, as well as the diminishing
cohesiveness of the individual following the removal
of the environmental control over the individual’ p.464.
It is believed that the origin of the concept, dating
back to the earliest period in human history, is based
on theological concepts [37], and the use of the term
extends as far as Adam and Eve [38]. Alienation was
first used in connection with the worship of idols,
with reference to the individual being alienated by
such rituals owing to the power and potential ascribed
to idols [39]. According to Ozbudun, Markus, and
Demirer [40], it is thought that the concept of alien-
ation, which has been used in the Hellenistic sense of
integration with ‘one and only God’, and which has
been transmitted from pagan mystics to Christianity
in the same sense, can be compared with the term
‘Vahdat-i vucud’ used in Islamic literature. Alienation
was formerly used to describe mental patients [38],
which, according to Fromm [41], is evident from the
use of the words ‘aliéné’ in French and ‘alinenada’ in
Spanish.
Nowadays, people live in an environment that is
undergoing social and spiritual changes. Starting with
the Industrial Revolution and spreading to other fields,
these rapid changes cause serious problems. In
response to these changes, the situation of depression
and dissatisfaction observed in relation to human
nature and the society is increasing [42]. Researchers
have examined the concept of alienation from various
perspectives. For example, while Karl Marx explained
alienation from a socialist standpoint, Feurbach dealt
with the alienation between the individual and God.
Work alienation has been conceptualized in differ-
ent ways, but the most accepted classification is that
of Seeman [43,44]. According to Seeman [43], there
are five sub-dimensions of alienation, as indicated in
his work ‘On The Meaning of Alienation’. These are
powerlessness, meaninglessness, normlessness, iso-
lation, and self- estrangement. The feeling of power-
lessness, the expectations of the individual, and the
possibilities that are thought to be realized are deter-
mined by others, and it is inevitable for the person to
feel incapable of changing it [44]. According to
Kanungo [45], meaninglessness refers to when workers
do not understand the intricate aims of other workers
and do not take interest in each other’s work. Accord-
ing to Merton, normlessness is the feeling that the indi-
vidual cannot adapt to the collective in terms of
appropriate means for achieving goals (as cited in
[46]. As a result of the sense of normlessness, an alie-
nated individual who accepts the aims but is not inter-
ested in the legal meaning of those aims becomes
trapped in isolation. Seeman [43] described this feeling
of self-estrangement as ‘any behavior of the individual
that is incompatible with the anticipations of the future
and the person behaves differently from those expec-
tations’ p.789–790.
Work alienation has been reported to be associated
with many concepts, including job performance,
organizational citizenship behavior, absentism, health
problems, counter-productive behaviors, and cyber-
loafing. Alienation to work can disrupt the organiz-
ational climate and impair intra-organizational
performance. If alienation is caused by organizational
and managerial troubles, workers can collectively
choose the path of organizational silence [47].
The concept of performance is often used in human
resource management, and its exact boundaries and
content have not been sufficiently explained [48]. It
often refers to the level of productivity and effective-
ness that is individually demonstrated to achieve the
goal in an individual sense. However, when defined
in terms of the institution, it has also been explained
as the amount of goods or services produced at a cer-
tain time [49]. Performance, whether individual or
organizational, can be explained as the degree to
which a person or organization achieves the goal in
any activity [50]. Performance depends not only on
the knowledge, skills, and efforts of the individual,
but also on the organization’s ability to provide the
necessary environment for this effort and success
[51]. Job performance is the result of an employee

achieving his/her duties within a certain period of time
[52].
Until today, there has been substantial research on
performance management. Most of these studies sup-
port the relationship between all organizational out-
puts, including those based on work engagement and
performance [53]. In other words, jumping is defined
as emotional dissemination, and positive or negative
experiences are referred to as person-to-person tran-
sition [54]. For most organizations, performance is a
result of individual or collective effort. Therefore, col-
leagues are attracted to each other’s work engagement,
which in turn can lead them to perform better [55].
Human capital has a meaningful and positive impact
on performance outcomes [29], which improves effec-
tiveness when aligned with institutional strategy and
engagement [56].
Increased health expenditures in a growing popu-
lation, an increasing number of private hospitals, an
increase in the number of private hospitals, the emer-
gence of new diseases, and increased awareness of qual-
ity health services have resulted in an increase in the
burden on hospitals and health professionals [57]. In
the face of this difficult situation, healthcare pro-
fessionals, especially in nursing services, are struggling
with workplace stress, exhaustion, and burnout while
dealing with productive, cost-effective, and advanced
patient care [58]. Several studies suggest that it would
be useful to examine health behaviors, especially
nurses’ work engagement [15]. Being an optimist and
adopting a positive organizational behavior style
directly affects the performance of health professionals.
Many organizations fail due to lack of commitment as
committed workforce key to high job performance
[59]. Further, irrespective of the field of work, it is
clear that the high performance of employees drives
organizational success [29,60]. Yet it is worth noting
that aspects such as motivation cannot be easily quan-
tified and therefore must be inferred from behavior and
body language in conjunction with responses [61]. This
also makes measuring performance difficult.
Researchers often mention the negative relationship
between work alienation and job performance [62].
However, not many studies have examined the negative
relationship between alienation and job performance in
both health and other areas work areas. A study con-
ducted by Clark et al. [63] on 104 responsible nurses
and temporary or contracted nurses working in a hos-
pital in Central and Western America found a negative
relationship between work alienation and job perform-
ance levels. Further, it was revealed that an employee
looking for feedback would exhibit higher performance
if he/she engages with work [63]. Kaynak, Toklu, Elci,
and Toklu [64] reported that work alienation nega-
tively affected those working in the small and medium
sized goods and services sector in Kocaeli. Tekingün-
düz, Kurtuldu, and Eğilmez [65] also found a negative
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 3
and significant relationship between job performance
and work alienation in health professionals working
in public hospitals. Huang [66] studied volleyball coa-
ches in high schools in Taiwan and China and found
that work alienation had a significant and negative
effect on productivity. Mulford, Waldner-Haugrud,
and Gajbhiye [67] also found a negative relationship
between productivity of farmers and level of alienation
to work [68]. Together, these studies indicate that the
job performance of alienated employees deteriorates.
In fact, based on these findings, it is possible to under-
stand work alienation better. Nevertheless, the elimin-
ation of the existing deficiencies in terms of measuring
the effect of work alienation on job performance would
be beneficial for future investigations.
Methodology
Population and sampling
The universe of the present study consisted of one uni-
versity, one public, and one private hospital operating
in the metropolitan area of Ankara. The target popu-
lation comprised physicians, nurses, other health pro-
fessionals and administrative personnel working at
these hospitals during the data collection period
(1 December 2015 to 17 March 2016). Other health
professionals included health workers such as mid-
wives, pharmacists, biologists, psychologists, dietitians,
laboratories, laboratory technicians, medical tech-
nicians, radiology technicians, sterilization unit staff,
paramedics, assistant health personnel, medical sec-
retaries, and health officers. In December 2015, 3562
people worked in these three hospitals. During the
data collection process, 493 questionnaires were
obtained according to the size of the sample from the
distributed questionnaires and stratification was done
for each hospital. Accordingly, 325 people from the
university hospital, 116 from the public hospital, and
52 from the private hospital were interviewed.
Data collection tool
The Utrecht Work Engagement Scale (UWES), devel-
oped by Schaufeli and Bakker [19], was translated
into Turkish and used to assess work engagement.
The scale comprises the following sub-scales: vigor
(Item 1–6), dedication (Item 7–11), and absorption
(Item 12–17). Additionally, the ‘Work Alienation
Scale’ developed by Mottaz [69] was translated and
used to measure work alienation. Items 1–7 on this
scale represent the dimension of powerlessness, 8–14
pertain to meaninglessness, and 15–21 assess self-
estrangement. The ‘isolation’ dimension was added to
this scale based on the findings of an explanatory factor
analysis. To measure employee performance, Kirkman
and Rosen’s [70] ‘Performance Scale’ of the 5-item
4 N. KARTAL
Likert Scale was used by Erdoğan (2011), based on
Fuentes, Albacete-Saez, and Llorens-Montes [71] and
Rahman and Bullock [72] scales. It was adapted to
Turkish by Çöl [73].
Data analysis
Statistical Package for the Social Sciences (SPSS) 20.0
program, which is preferred in the social sciences,
was used to examine the data. Prior to the analysis of
the data, validity and reliability analyses were per-
formed. Subsequently, the correlation analysis and
multiple regression analysis were used in the data
analyses.
Validity and reliability analysis
In this study, an explanatory factor analysis was con-
ducted to assess validity and reliability. Additionally,
Cronbach’s alpha coefficients were calculated. The
explanatory factor analysis examined whether the fac-
tor structure of the translated versions of the work
engagement and work alienation scales differed from
the original. Tayfun and Çatır [74] used the job per-
formance scale with health professionals, but the num-
ber of items was small. That research was included in
the analysis of the 6 items after it was subtacted the
first item of the scale.
The factor analysis was conducted with varimax
rotation on the 17-item alienation scale. The analysis
revealed a 3-factor structure like the original scale.
Three items (Item 2, 7, and 12) with factor loadings
less than 0.49 were excluded from the analysis and var-
imax rotation was applied to the remaining 14 items.
Again, a 3-factor structure was identified. The total
variance explained by the three factors was 64.666%,
with a KMO value of 0.921 and Bartlett Sphericity
Test value of 3595.535 (P < 0.01). The varimax rotation
factor analysis of the 21-item work alienation scale
revealed a 4- rather than 3-factor structure. Three
items (Item 8, 16, and 20) with factor loading less
than 50%, and Item 6 were excluded from the analysis,
because it was more than factor. Finally a 4-factor
structure with 17 items was obtained. The total var-
iance explained by this 4-factor structure was 54.54%,
with a KMO value of 0.838 and Bartlett sphericity
test value of 2278.249 (P < 0.01).
The Cronbach’s alpha values for the engagement
scale was high, at 0.91 for total scale, 0.84 for the
vigor and dedication dimensions, and 0.85 for the
absorption dimension. The Cronbach’s alpha value
for the entire work alienation scale was high, at 0.81,
and those for its dimensions were as follows: power-
lessness: 0.76, meaninglessness and self-estrangement:
0.70, isolation: 0.71. The Cronbach’s alpha value for
the job performance scale was high, at 0.77.
Results
The minimum, maximum, mean, and standard devi-
ation values for the study variables have been presented
in Table 1. Among the work engagement dimensions,
the highest score was observed for dedication (3.55 ±
0.91), and the lowest was for vigor (3.19 ± 0.86). The
average work engagement level of the employees was
moderate (3.31 ± 0.79). Among the alienation dimen-
sions, the highest score was observed for self-estrange-
ment (3.35 ± 0.87), followed by powerlessness (2.83 ±
0.89). The lowest score was on the meaninglessness
(2.21 ± 0.83) dimension. The overall average of the
alienation of the participants was moderate (2.82 ±
0.59). Finally, the mean performance level of the health
professionals was high (3.96 ± 0.71).
To evaluate correlations among the study variables,
Alpar’s [75] specified intervals were used. Accordingly,
a positive and very high correlation was found between
the subscales of work engagement and work engage-
ment (r = 0.582–0.916). Additionally, the sub-dimen-
sions of work alienation behaviors were positively
and highly correlated with each other and with the
total work alienation behavior score (r = 0.185–
0.747). Further, there was a positive and moderate
relationship between performance level and overall
work engagement (r = 0.451, P < 0.01), while its corre-
lation with work alienation was moderate (r = −0.393,
P < 0.01).
In an established regression model, the Durbin Wat-
son coefficients should be below 2.5 or even under 1.5.
It is desirable that the Variation Inflation Factor (VIF)
values are below 10. Failure to meet these requirements
is indicative of multiple connectivity or autocorrelation
[76]. The results of the present multiple regression
analysis have been presented in Table 2. Job perform-
ance had a significant impact on the participants’ levels
of work engagement and work alienation. The esti-
mates established by the regression model showed
that this model is meaningful and usable (F = 48.445,
P < 0.01). It accounted for 28.4% of the total variance
in health professionals’ performance levels.
The t-test results on the meaningfulness of the
regression coefficients revealed that the vigor and
absorption dimensions had a positive relationship,
while the powerlessness and meaningless dimensions
had a negative relationship. However, there was no sig-
nificant relationship between absorption and perform-
ance. This indicates that an increase in health
professionals’ vigor leads to an increase in their per-
formance level (t = 3.639, P < 0.01). In contrast, an
increase in the level of powerlessness (−3.058, P <
0.01) and meaninglessness (−5.908, P < 0.01) nega-
tively influenced their performance levels. According
to the β coefficients, meaninglessness, vigor, powerless-
ness, and absorption could be identified as variables
that predict employees’ performance.
 INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 5

Discussion and conclusion

−0.393**
0.442**

0.353**
0.451**
−0.382**
−0.418**
−0.305**
−0.107*
0.370
JP

1
This study aimed to determine the levels of health pro-
fessionals’ work engagement and alienation and
measured their effects on the job performance level

−0.573**

0.393**
−0.663**
−0.403**
−0.626**
0.747**
0.612**
0.738**
0.695**
of the participants. Within this scope, a questionnaire
WA
survey was conducted with 493 health professionals

1
working in a university hospital, public hospital, and
private hospital in the metropolitan area of Ankara.
According to the results of the analysis conducted

0.695**
−0.242**
−0.336**
−0.123**
−0.266**
0.255**
0.185**

0.107*
0.25**
within the scope of the research, the level of alienation
I

1
and engagement to work was found to be moderate and
the level of job performance was found high. Similarly,
Özer et al. [77] conducted a similar study on 388 phys-
0.738**
−0.508**
−0.589**

−0.305**
−0.418**
−0.576**
0.515**
0.411**

0.235**

icians and nurses working in a public hospital, and

SE

found that the levels of alienation of employees were

1

moderate. Abiodun et al. [78] conducted a survey of

228 nurses working in general and special branch hos-
pitals to determine the relationship between various
0.612**
−0.404**
−0.480**

−0.418**
−0.278**
−0.443**
0.386**

0.411**
0.185**

dimensions such as job security, employee perform-

M

ance, and the performance levels of nurses were

found to be moderate.
The present analysis revealed that the level of work
0.747**
−0.520**
−0.515**

−0.382**
−0.376**
−0.543**

0.386**
0.515**
0.255**

engagement and alienation had a significant effect (P <

P

0.01) on the individual performances of the health pro-

1

fessionals. In the established regression model, vigor

and absorption, sub-dimensions of engagement, had
0.916**

−0.626**
0.851**

0.451**
0.841**

−0.543**
−0.443**
−0.576**
−0.266**

a positive relationship with performance. In contrast,

WE

powerlessness and meaningless, sub-dimensions of

1

work alienation, had a negative relationship with per-

formance. The correlation analysis results supported
Table 1. Correlation among work engagement, work alienation, and performance variables.

these findings. However, there was no significant

0.644**

−0.403**
0.582**

0.353**
0.841**
−0.376**
−0.278**
−0.418**
−0.123**

relationship between absorption and performance.

A

These findings indicate that while vigor may improve

health professionals’ job performance, an increase in
powerlessness and meaninglessness may decrease
0.685**

0.370**
0.582**
0.851**
−0.515**
−0.480**
−0.589**
−0.336**
−0.663**

their performance.
D

Similarly, in a study on 291 persons working at the

1

headquarters of two different banks [79], the corre-

lation of job performance with vigor was 0.335, that
with dedication was 0.342, and that with absorption
0.685**

0.442**
0.644**
0.916**
−0.520**
−0.404**
−0.508**
−0.242**
−0.573**

was 0.362, thus indicating a positive relationship.

V
1

However, in their study on 200 volunteers working

at AKUT (Search and Rescue Association) in Turkey,
Caymaz, Erenel, and Gürer [80] reported that there
0.86
0.91

0.71
0.97
0.79
0.89
0.83
0.87
0.81
0.59
SD

was no significant relationship between vigor and per-

formance. Specifically, according to the regression
analysis the authors conducted, these volunteer
Mean
3.19
3.55

3.96
3.26
3.31

employees were not able to develop a feeling of devo-

2.83
2.21
3.35
2.76
2.82

Significant correlation at 0.01 level.

Significant correlation at 0.05 level.

tion in the physical sense, while they were devoted to

emotionally charged tasks. Further, they reported that
job performance was correlated with dedication (r =
Work Engagement (WE)

Self−estrangement (SE)

Work Alienation (WA)

0.094) and vigor (r = 0.028).

Job Performance (JP)
Meaninglessness (M)
Powerlessness (P)

In the study by Karatepe, Karadas, Azar, and Nader-

Absorption (A)
Dedication (D)

iadib [81], work engagement was positively correlated

Isolation (I)
Variables
Vigor (V)

with job performance (r = 0.238). According to these

results, it is evident that energetic, self-dedicated, and
**
*
6 N. KARTAL
Table 2. Regression analysis results for estimating health professionals’ attitudes toward job performance based on level of work
engagement and alienation.
Variables B Std. Error
(Constant) 3.991 0.217
Vigor 0.167 0.046
Absorption 0.072 0.037
Powerlessness −0.112 0.037
Meaninglessness −0.217 0.037
R = 0.533 R 2 = 0.284 Durbin Watson = 1.931
F = 48.445 P < 0.001
focused employees tend to exhibit high performance.
Salanova, Agut, and Peiró [82] pointed out a significant
effect of engagement on performance among individ-
uals working in restaurants and hotels. Bakker and
Bal’s [83] study showed that teachers who were
engaged were able to perform better in an individual
and organizational sense. Thus, an increase in the
level of engagement affects employee performance
positively.
Studies in the related literature have achieved simi-
lar results on alienation and performance. For instance,
Kaynak, et al. [64] reported a significant and negative
relationship (R 2 = 0.18) between work alienation and
performance among persons working in small and
medium sized public and private enterprises in Kocaeli.
In a study that aimed to determine the drivers and con-
sequences of work alienation, a negative relationship
(r = −0.16) was found between the level of alienation
and the performance (r = −0.16) of 283 employees
working in a firm that provided construction and con-
sultancy services in the UK [84]. These studies show
that work alienation has a devastating effect on per-
formance, including employee attitudes, job goals,
and social relations.
Healthcare institutions focus on services, and there-
fore, they are complex organizations. If the service they
provide is incomplete and faulty, it disrupts the pur-
pose of providing effective healthcare services and the
general operation. Negative behaviors such as alien-
ation to work and work engagement, which are new
concepts in the organizational behavior literature,
respectively influence individuals, their unit, and the
whole institution negatively or positively. This situ-
ation leads to an organizational issue by becoming an
individual. In fact, the healthcare providers in such
positive or negative situations can also be affected.
Therefore, it is necessary to reduce situations that effect
employees and their performance negatively, such as
alienation to work, and to provide an encouraging
environment for employees.
Given that the present sample exhibited a moderate
level of engagement and alienation, it is promising that
their performance will be very high. Both positive and
negative behavior that will affect the performance of
employees should be considered The individual may
be bored by constantly engaging in the same job,
Β t P VIF
18.387 0.000
0.203 3.639 0.000 2.112
0.098 1.957 0.051 1.717
−0.141 −3.068 0.002 1.449
0.254 −5.908 0.000 1.259
which may lead to a decrease in performance. Work
rotation may be effective in avoiding this. In this con-
text, by applying job enrichment, extending the indi-
viduals’ work, and giving them the authority to
provide satisfaction can be beneficial both in terms of
performance and work engagement.
The level of engagement of health professionals has
a positive and significant effect on employee perform-
ance. Therefore, in order to increase the performance
levels of individuals, it is possible to try to increase
the level of attractiveness of the job. Again, business
improvement and development work could help in
this regard. Similarly, the level of alienation to work
has a negative and significant impact on individual per-
formance. Therefore, attempts to reduce the level of
alienation could help improve work performances.
Healthcare industry has entered into a domain of
maturing demands in improving its proficiency [85].
Many successful organizations not only manage change
but pro-actively recognize the need for change, master
the implementation, and accelerate everyone involved
through the change process [86]. That is why it is
necessary for organizations to try to gain various beha-
viors such as job engagement in order to increase the job
performance and organizational performance.
Implications for practice
The results of this study underscore the importance of
maintaining engagement and minimizing alienation at
work. The implication, therefore, is that, to improve
health professionals’ current engagement level, and
also reduce their level of alienation, management of
hospitals need to pay attention to improve job per-
formance in the hospitals.
Acknowledgements
Many thanks are due to the health professionals in the hos-
pitals where this study took place for their considerable
assistance and understanding. I am also very grateful to
the editor and anonymous reviewers of their extensive
insights and advice.
Disclosure statement
No potential conflict of interest was reported by the author.

Ethical approval
Ethical approval was obtained from the General Sec-
retariat of the Public Hospitals Association, which
the university hospital and the private hospital had
the chief physician and the public hospital, to be able
to conduct the research.
Notes on contributor
Nazan Kartal graduated from Ankara University, Depart-
ment of Healthcare Management in 2013. In 2017, she
holds a Master’s degree from Hacettepe University and
now continues to pursue her PhD education there. She is a
Research Assistant in the Faculty of Economics and Admin-
istrative Sciences, Department of Healthcare Management at
Hacettepe University in Turkey.
ORCID
Nazan Kartal http://orcid.org/0000-0002-5416-7952
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