Supervisors and subordinates relationship impact on job satisfaction and efficiency: The case of obstetric clinics in Greece

Abstract

The purpose of this research is to investigate supervisors and subordinates relationship factors and their impact on job satisfaction and employee performance. The research examines private and public obstetric clinics through a sample of 100 subordinates and 30 supervisors, using a structured questionnaire based on a five-point Likert scale. The research results show that the main factor that affects job satisfaction and employee performance is the relationship developed between supervisors and subordinates. Furthermore, the research results show that recognition of the work and open communication with the supervisor affect positively subordinates' psychology. It is also proved that team spirit and equal treatment between the subordinates ultimately lead in the development of subordinates and the success of the supervisors. Finally, the importance of the factors of honesty and trust between supervisors and subordinates is confirmed

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International Journal of Strategic Innovative Marketing
Vol. (2016) DOI: 10.15556/IJSIM.03.03.001
1
Supervisors and subordinates
relationship impact on job satisfaction
and efficiency: The case of obstetric
clinics in Greece
Tsitmideli G.1, Skordoulis M.1, Chalikias M.1a, Sidiropoulos G.1,
Papagrigoriou A.1
1Piraeus University of Applied Sciences, School of Business and Economics, Business
Administration Department, Egaleo, Greece
a) Corresponding author: mchalikias@hotmail.com
Abstract: The purpose of this research is to investigate supervisors and subordinates
relationship factors and their impact on job satisfaction and employee performance. The
research examines private and public obstetric clinics through a sample of 100
subordinates and 30 supervisors, using a structured questionnaire based on a five-point
Likert scale. The research results show that the main factor that affects job satisfaction and
employee performance is the relationship developed between supervisors and subordinates.
Furthermore, the research results show that recognition of the work and open
communication with the supervisor affect positively subordinates’ psychology. It is also
proved that team spirit and equal treatment between the subordinates ultimately lead in the
development of subordinates and the success of the supervisors. Finally, the importance of
the factors of honesty and trust between supervisors and subordinates is confirmed
Keywords: Subordinate, supervisor, job satisfaction, employee performance, obstetric
clinic.
1. Introduction
Contemporary business environment is becoming more and more competitive, which
makes it difficult for any king of business to survive. Human resources are of great
importance for the survival and the development of any modern business. Many
business executives declare that the main factors connected to low employee
efficiency deal with the reduction of their personal motivation and the decrease of
their mood to work. Due to the fact that human capital is one of the most important
resources for the success of a business (Chalikias et al., 2014; Skordoulis et al.,
2015), employees’ satisfaction should be taken into account.
According to Spector (1997), motivation concern “the total actions undertaken
from both the administration and the supervisors to maintain high employees’

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satisfaction in order that they behave in a certain way”. As it is mentioned, employees
with high levels of motivation may achieve higher levels of productivity and
satisfaction from their job.
Lots of researchers consider that job satisfaction is necessary for the prosperity
of a business, while others believe that employee satisfaction is an unnecessary
luxury (Valvi & et. al., 2009). According to Spector (2000), job satisfaction has a
major influence on the prosperity of a businesses and is presented through the
increase of the employee performance.
A factor that determines the correlation between job satisfaction and employee
performance is whether the first is examined as an independent variable or not.
According to Vroom (1964), the effect of job satisfaction in person’s behavior is the
job performance.
According to Jewell & Siegall (1990), there is a positive correlation between job
satisfaction and employee performance; more specifically, satisfied employees seem
to be more productive. On the other hand, work displeasure means job stress and
professional exhaustion (DeMato, 2004).
Employee satisfaction is a multidimensional term which represents the overall
attitude of a person and the feelings for specific aspects of his job (Kreither &
Kinicki, 2010; Skordoulis et al., 2014). Herzberg et al. (1959), found that employee
satisfaction is in high levels in the first years of an employee’s job, then declines
with a culmination about 20 years of work, while is increased again when it is close
to 30 years until the end of the employee’s service.
In health care sector, cooperation and balanced relationship between employees
imposes them to work together and provide high quality nursing services. One of the
main health care sectors is this of obstetric which consists of clinics that provide
obstetric and gynecological services. Nowadays, competition and economic crisis
have a big impact on the survival of nursing and obstetric institutions. For this
reason, staff must be satisfied from their job in order to be more efficient. The
relationship between employees and supervisors is particularly important in this
sector because high employee performance levels in an obstetric clinic is associated
with the best of services. This high employee performance is of vital importance as
the quality of offered services can turn into a competitive advantage for an
organization (Drosos et al., 2015).
Health care sector in Greece includes diagnostic centers and clinics which are
divided into large multipurpose clinics or smaller one. There are both public and
private clinics (Pothos et al., 2014). A special category includes obstetric and
gynecological clinics operating in the private or public sector. According to ICAP
GROUP (2010) 13.7% of private health services are private gynecological clinics; the
market leader among obstetric clinics is IASO clinic holding a 37.7% of the market
share.
The purpose of this research is to examine the relationship between supervisors
and subordinates of the obstetric clinics sector and its impact on job satisfaction
and efficiency.
2. Research methodology
Due to the nature of this research, two separate questionnaires were designed. On
the one hand, 100 questionnaires were given to subordinates and 30 questionnaires
were given their supervisors.
The majority of the questions included in the questionnaires were closed
questions and used five-point Likert Scale.

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The sampling method which was used to achieve the research objectives is the
stratified sampling. Each strata was one of the five bigger obstetric clinics in Attica
(MITERA clinic, LITO clinic, ELENA clinic, ALEXANDRA clinic and REA clinic). The
sample percentage which was extracted was representative of the size of each clinic.
3. Research results
3.1. Demographics of the sample
From the sample of 100 employees who are subordinates and took part in the
survey, 22 were employed in MITERA clinic, the 17 employees in LITO clinic, the 19
employees in IASO clinic, 13 worked in ELENA clinic, 18 were employees in
ALEXANDRA clinic and 11 were working for REA clinic. The above data are
presented in Table 1.
Table 1. Demographics of 100 the subordinates
Demographics
Percentage
Obstetric Clinic
REA clinic
MITERA clinic
LITO clinic
IASO clinic
ELENA clinic
ALEXANDRA clinic
11%
22%
17%
19%
13%
18%
Gender
Male
Female
35%
65%
Age
26-30 years old
31-45 years old
46-60 years old
>61 years old
7%
36%
44%
13%
Current department
Nursing
Administrative
52%
48%
Years of working experience
<1 year
1-5 years
6-10 years
>10 years
13%
53%
21%
13%
Years of collaboration with current
supervisor
<1 year
1-5 years
6-10 years
>10 years
23%
54%
16%
7%
Based on the above table’s data, as far as the subordinates are concerned, we
can concluded that:
• Women responded with almost twice number compared to men.
• Age has a range of 26 to 45 years old.
• The period time of working in the clinic, for the majority of respondents ranges
from 1 to 5 years.
• The percentages of employees in the administrative and the nursing
departments are almost the same).
• The majority of the respondents collaborate with their supervisor from 1 to 5
years.

SUPERVISORS AND SUBORDINATES RELATIONSHIP IMPACT ON JOB SATISFACTION AND
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For the present research, a sample of 30 managers who worked in public and
private maternity hospitals in Attica was used. Specifically, 8 (26.7%) of them
worked for MITERA clinic, 6 (20%) for LITO clinic, 6 for REA clinic, 4 (13.3%) for
IASO clinic, 3 (10%) for ALEXANDRA clinic and finally 3 for ELENA clinic.
Table 2. Demographics of the 30 supervisors
Demographics
Percentage
Obstetric Clinic
REA clinic
MITERA clinic
LITO clinic
IASO clinic
ELENA clinic
ALEXANDRA clinic
20%
26,7%
20%
13,3%
10%
10%
Gender
Male
Female
47%
53%
Age
26-30 years old
31-45 years old
46-60 years old
>61 years old
10%
66,7%
20%
3,3%
Current department
Nursing
Administrative
Scientific
16,7%
46,7%
36,7%
Years of working experience
<1 year
1-5 years
6-10 years
>10 years
13%
53%
21%
13%
Years of working experience as a supervisor
<1 year
1-5 years
6-10 years
>10 years
16,7%
36,7%
23,3%
23,3%
3.2. Factors which influence job satisfaction and employee performance
According to the responses on the question about the extent to which the
relationship between supervisors and subordinates affects job satisfaction and
performance, it was found that this effect is the highest among all the other factors.
Business policies seem to have the least influence on job satisfaction and
employee performance. These results are compatible with the factors that cause
motivation for performance according to Herzberg’s motivation theory (1959).
The factor concerning the relationship with the supervisor (i.e the interpersonal
relationships that are developed between a supervisor and a subordinate) is a
promoter factor. In contrast, the factor which describes enterprise policies, namely
the way which a company is organized and managed, is a displeasure factor. On the
one hand they create resentment and they reduce job satisfaction when there aren’t
at work; on the other hand they don’t provide motivation for high performance.
Job description factors concerns the content of a job and the duties of an
employee; 32% of the respondents seem to be affected at a great extent while 6% of
them, very little.
The factors concerning job certainty and chances for development are the next
factors affecting performance according to the respondents.

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Furthermore, factors such as the feeling of a fair reward and the stress level
seem to be connected with employees’ motivation.
As job satisfaction and employee performance at the clinic are concerned, it was
revealed that the main factor affecting them is the relationship developed between
senior managers and employees. The factor which affects less these constructs is
this of business policies along with the culture of the clinic. The following table
shows the factors affecting job satisfaction and employee performance the most. The
results confirm Herzberg's motivation theory in the obstetric sector.
Table 3. Job satisfaction and performance
Mean
Std. Deviation
Business Policies
3,52
1,01
Stress Level and Daily Pressure
3,67
1,01
The feeling that you rewarded fairly
3,7
1,11
Chances for development
3,8
0,92
Job Certainty
3,83
1,02
Job Description
3,98
0,89
Relationship with the supervisor
4,04
0,98
3.3. he impact of subordinates and supervisors relationship elements on job
satisfaction and performance
In this section we will try to find the elements’ of the relationship between
subordinates and their supervisors impact on job satisfaction and performance.
According to the research results, the factors that affect the most job satisfaction
and performance concern the recognition of employees by their supervisors, the
open communication with them as well as the collaboration with them. The following
table shows the impact of subordinates and supervisors relationship elements on job
satisfaction and performance.
Table 4. Elements of the relationship between supervisor-subordinate
Mean
Std. Deviation
Encouragement to materialize innovative programs
3,36
1,07
The possibility for developing skills through the
participation to educational programs
3,56
1,02
The possibility for undertaking more activities
3,59
0,95
Sharing responsibilities
3,6
0,88
Opportunities for continuing vocational education
3,65
1,03
The ability of supervisor to motivate
3,68
0,99
Detailed description of tasks and obligations
3,75
0,86
Encouragement to undertake initiatives
3,76
0,79
Achieving goals with teamwork and common effort
3,83
0,95
Support in difficult issues
3,85
0,94
Employees flexibility in the department
3,87
0,76
Collaboration with supervisor
4,01
0,75
Open communication with supervisor
4,08
0,87
The recognition of work by the supervisor
4,19
0,77

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3.4. Supervisors’ “socialized power” motives impact on job performance
The respondents seem to be affected by specific factors of their supervisors’ behavior
that are originated from the so-called motives of “socialized power”.
Specifically, the highest percentage of the employees answered that equal
treatment and team spirit are the factors that influence them the most to improve
their work performance. On the contrary, factors such as the possibility of taking
initiatives and the assignment of more responsibilities seem to have a low influence
in the development of subordinates.
Table 5. The extent to which job performance is affected by “socialized power” motives
Mean
Std. Deviation
Equal treatment
4,32
0,82
Team spirit
4,31
0,84
Reward by supervisors
4,28
0,81
The possibility for development
4,12
0,84
The supervisor must understand employees’ personal
peculiarities
3,8
1,21
Possibility of undertaking initiatives
3,61
1,03
Assigning more activities
3,53
1,08
3.5. The relationship between subordinates and their supervisors
The questionnaire responded by the supervisors, was designed to collect data
concerning their opinions regarding subordinates’ job satisfaction and department’s
increasing efficiency.
The departments’ supervisors were asked if they believe that there is a
correlation between job satisfaction and employee efficiency. According to Jewell &
Siegall (1990), there is correlation between job satisfaction and employee
performance and especially, the most productive employees are more satisfied with
their work. 18 supervisors strongly agreed with the fact that there is a correlation
between job satisfaction and employee efficiency.
Furthermore, a 50% of supervisors strongly agreed with the fact that job
satisfaction is necessary for welfare in a clinic. According to Spector (2000), job
satisfaction significantly affects businesses prosperity and is presented through the
increased employee performance. It makes sense that a satisfied employee is a
productive employee.
Supervisors, who motivate subordinates are aimed to take responsibility, to
make efforts for achieving goals. From the responses of subordinates it was
confirmed that 67% of them strongly agree with the fact that a supervisors’ role
leads in job satisfaction and subordinate's increasing performance. Also, 29 out of
30 departments’ supervisors agreed with the fact that subordinates’ activation is a
concern for senior management and goals achievement depends on the cooperation
with human resources.
3.6. Elements contributing to a balanced relationship between subordinates and
their supervisors
At this point supervisors were asked to express their opinions on the factors
contributing to a balanced relationship with their subordinates.

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To begin with, a supervisor is necessary to be informed about the successes and
the failures of his department. With the above statement, a 73% of the respondents
strongly agreed while a 3% of them strongly disagreed. In this way a leader can
organize and utilize the knowledge and information that accrues to achieve his goal.
An important factor is trust. A 70% of supervisors strongly agreed with the need
for trust and honesty between both the subordinates and the supervisors. The
importance of trust between the members can give to employees’ greater job
satisfaction.
If every employee knows what he is capable to do, then all the work will have
successfully ended. A 33% of the supervisors strongly agreed with the fact that
that each subordinate should know his own needs and abilities.
The following table depicts the supervisors’ views on the elements contributing to
a balanced relationship between them and their subordinates.
Table 6. The extent to which job performance is affected by “socialized power” motives
Mean
Std. Deviation
The number of things a supervisor be should informed
about, depends on his mood and trust to his subordinates
3,13
1,50
A supervisor must externalize his desires and peculiarities
3,5
1,04
A subordinate depends on his supervisor
3,63
0,76
A subordinate must know the external pressures on
supervisor’s goals
3,66
1,15
A subordinate must see the positive side of work even he
accepts critical comments by his supervisor
3,76
0,97
A subordinate must control his reactions towards the
supervisor
4,1
0,76
Each subordinate must know his own needs and abilities
4,1
0,88
There should be trust and honesty between both members
4,53
0,90
A supervisor is necessary to be informed for the successes
and failures of his department
4,63
0,81
3.7. Factors of a balanced relationship between supervisors and subordinates
There is a number of constructs associated with the balanced relationship between
supervisors and their subordinates. Due to the large number of these constructs, a
factor analysis will be carried out, in order to categorize them.
According to Table 7 data, the examined variables were categorized into four
dimensions which represent mutual recognition of needs and pressures (F1), the
development of a climate of confidence (F2), conflict situations (F3) and, distinct
rights and obligations of subordinates and supervisors (F5) respectively.
Kaiser Meyer Olkin measure of sampling adequacy value equals to 0.722, and
Bartlett’s Test of Sphericity p-value equals to 0; the aforementioned values indicate
that the performed factor analysis is valid and reliable.

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Table 7. Components matrix for the factors of a balanced relationship between supervisors and
subordinates
F1
F2
F3
F4
A supervisor must externalize his desires and peculiarities
0.760
A subordinate must know the external pressures on
supervisor’s goals
0.730
Each subordinate must know his own needs and abilities
0.689
There should be trust and honesty between both members
0.817
A supervisor is necessary to be informed for the successes
and failures of his department
0.813
A subordinate must control his reactions towards the
supervisor
0.776
A subordinate must see the positive side of work even he
accepts critical comments by his supervisor
0.692
A subordinate depends on his supervisor
0.847
The number of things a supervisor be should informed
about, depends on his mood and trust to his subordinates
0.664
3.8. Factors affecting job satisfaction and employee performance
As already mentioned, the subordinates took part in the research were asked to
express their views on the extent to which their job satisfaction and performance is
affected by various constructs. A factor analysis will be used in order to categorize
these constructs.
Table 8. Components matrix for the factors affecting job satisfaction and employee performance
F1
F2
Business policies
0.788
Chances for development
0.770
Job certainty
0.692
The feeling of being rewarded fairly
0.676
Job description
0.668
Stress level and daily pressure
0.833
Relationship with the supervisor
0.679
According to Table 8 data, the examined variables were categorized into two
dimensions which represent workplace characteristics (F1) and, emotional factors
developed in the workplace (F2) respectively.
Kaiser Meyer Olkin measure of sampling adequacy value equals to 0.764, and
Bartlett’s Test of Sphericity p-value equals to 0; the aforementioned values indicate
that the performed factor analysis is valid and reliable.
3.9. The impact of working department on the relationship between supervisors
and subordinates
In this section we will compare how the basic guidance principles for a balanced
relationship between supervisors and subordinates are affected by the working
department on the clinic.

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Using factor analysis results, we will compare the factors using an analysis of
variance (ANOVA) test. In order to run the ANOVA test we first have to confirm the
normality and the homogeneity of the data. Data normality is confirmed by the
Kolmogorov-Smirnov test as the p-value is equal to 0.410; likewise, data
homogeneity is confirmed by Levene’s test as the p-value is equal to 0.390 which
means that equal variances are assumed. These results confirm that an ANOVA test
can be carried out.
According to Table 9 data no differences between employees in nursing and
administrative departments on the relationship factors with their supervisors are
recorded (p-values > 0.05).
Table 9. ANOVA table for balanced relationship factors
Sum of Squares
df
Mean Square
F
Sig.
Mutual recognition of roles and
perspectives
Between
Groups
1.753
1
1.753
1.766
0.187
Within
Groups
97.247
98
.992
Total
99.000
99
Development of a climate
confidence in the range of a
labor equity
Between
Groups
0.006
1
.006
0.006
0.938
Within
Groups
98.994
98
1.010
Total
99.000
99
Facing conflict situations by
establishing of a framework
Between
Groups
0.619
1
.619
0.617
0.434
Within
Groups
98.381
98
1.004
Total
99.000
99
Institutional framework with
distinct rights and obligations of
subordinates and supervisors
Between
Groups
0.895
1
.895
0.894
0.347
Within
Groups
98.105
98
1.001
Total
99.000
99
3.10. The impact of gender on the factors affecting job satisfaction and employee
performance
Gender is one of the most important variables associated with job satisfaction.
Certainly, there are different sources of satisfaction for both genders. For women,
these factors can be interpersonal relationships, fair supervisor or the interest for
their work. On the other hand, factors affecting job satisfaction and employee
performance of men can be the climate of confidence and self-recognition (Schultz &
Schultz, 1994; Spector, 2000). Al Zuhani & Kishk (2006) found that women appear
to be more dissatisfied with their jobs because they are experiencing intense conflict
between their personal and professional lives. According to Vaskova (2006), women
seem to be affected from emotional factors of the working environment such as
fairness, interpersonal relationships and relationships with their supervisor, unlike
men, who are more affected by job characteristics such as fair payments and
advancement opportunities.

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Using an ANOVA we will examine if there is a difference on how the factors
affecting job satisfaction and employee performance between men and women. The
statistical tests carried out show that the data are normally distributed and
homogeneous; thus an ANOVA test can be performed.
Data in Table 10 show that, compatibly with the aforementioned researchers’
results, there are statistically significant differences between men and women.
However, these differences concern only the factor of workplace characteristics (p-
value = 0.037).
Figure 1 shows that men are more positive than women which means that
women’s job satisfaction and performance are affected more than these of men by
the workplace characteristics.
Table 10. ANOVA table for the factors affecting job satisfaction and employee performance
Sum of Squares
df
Mean Square
F
Sig.
Workplace characteristics
Between
Groups
4.329
1
4.329
4.481
0.037
Within
Groups
94.671
98
.996
Total
99.000
99
Emotional factors developed in
the workplace
Between
Groups
0.692
1
0.692
0.690
0.408
Within
Groups
98.308
98
1.003
Total
99.000
99
Figure 1. Means plot for the differences on workplace characteristics factor by gender.
4. Conclusions and agenda for future research
The research results show that in modern obstetric clinics a balanced relationship
between supervisors and subordinates is ascertained despite the working
department. Trust and honesty should prevail between them.
According to the statistical analysis carried out, the subordinates’ responses
show that their job satisfaction and performance are eventually affected by the
relationship that is developed between them and their supervisors. Furthermore, the

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supervisors’ responses showed that the achievement of corporate goals and the
welfare of the clinic are influenced by the relationship between them and their
subordinates as well.
The second conclusion can be drawn is that the about the behavioral features of
a supervisor may influence the effectiveness of a department. Three are the most
important behavioral features with the highest effect namely, the rewards for a great
performance, the recognition of an excellent service and the use of development
inspection method by monitoring the work of each employee. Moreover, employees
seem to be efficient when they enjoy the favors of their supervisors.
Concerning the examination of the extent to which the motivation of socialized
power leads in subordinates’ development, it was revealed that equal treatment and
team spirit affect employees in obstetric clinics the most. Thus, supervisors should
take seriously into account this finding as it is important for the success of their
departments.
Furthermore, the research results show that the existence of honesty and trust
contribute to a balanced relationship between a subordinate and a supervisor. This
was confirmed by both the subordinates and the supervisors.
Moreover, it should be noted that the assignment of activities is particularly a
negative factor that constricts the increase of employee performance. The most likely
reason is the pressure and anxiety that exists in health sector which makes
employees negative in undertaking more duties.
Based on the research results there are several avenues for further research. The
investigation of the relationship between supervisors and subordinates should be
carried out not only in health care industry but also in others. A comparison
between obstetric clinics sector and other sectors of health care industry would to
useful results which could be used for example in the administration of general
clinics operating various departments. Last but not least, a comparison between
public and private clinic would be useful as well.
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