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South Asian Journal of Management Sciences
Vol. 10, No.2, (Fall 2016) 30 - 38
DOI:10.21621/sajms.2016102.03
2074-2967 © 2016 The Authors. Published by ORIC, Iqra University. This is an open access article under the
CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/).
The effect of loneliness at work; work stress on work alienation and work alienation on
employees’ performance in Turkish health care institution
Santas, G1., Isik, O2 and Demir, A3
ABSTRACT
This study aims to determine the effect of loneliness at work and work stress on
work alienation and work alienation on employee performance among
employees in Turkish healthcare institutions. Data collection tools were
composed of Loneliness at Work Scale Work Stress Scale, Work Alienation
Scale and Performance Scale. The study results revealed that work alienation
was influenced by work stress (ρ=0.689) and loneliness at work (ρ=0.433)
positively. These influences were statistically significant (p<0.05). In addition,
it was found that work alienation had a negative and statistically significant
effect on performance (ρ=-0.264) (p<0.05). The performance of health
employees decreased with increasing work alienation. It should be noted that
low job performance of these employee may lead to irreversible consequences
such as death or disability. Viewed from this perspective, the determined factors
that cause work alienation in employees (health institutions) play significant
role and health institutions are required to take precautionary measures.
Keywords: Loneliness at work, work stress, work alienation, employees work
performance, health care institution.
Introduction
Employees are key success factor for production in any organization. Owing to the
coexistence of many professional groups with different needs, expectations and the need for
cooperation in healthcare services; employees and human relations in institutions have
become more important. The skills and knowledge of the employees are significantly shaping
the effectiveness, productivity and quality of healthcare services provided. It may create an
obstacle for achieving the objectives of organization. Hence, it is believed that a deeper
analysis of different organizational variables may provide a new perspective in determining
organizational problems.
________________________
Authors’ Affiliation:
Institute Name: Hacettepe Universitesi,
2 Hacettepe Universitesi,
3Afyon Kocatepe Universitesi
Department: Health Management, 2Health Management, 3Health Management
Country: Ankara, Turkey, 2Ankara, Turkey 3Afyon, Turkey
Corresponding Author’s Email: gulcan.kahraman@hacettepe.edu.tr
*The material presented by the author does not necessarily portray the view point of the editors/ editorial board
and the management of ORIC, Iqra University, Karachi.
Gulcan Santas, Oguz Isik and Azime Demir
31 South Asian Journal of Management Sciences
Loneliness at work, work stress, work alienation, and performance are among the topics that
have the potential to affect human relations and organizational outcomes in professional life.
Loneliness is defined as „„a complex set of feelings encompassing reactions to the absence of
intimate and social needs‟‟ (Ernst & Cacioppo, 1998, p.1). When an employee faces
difficulties in establishing social relations and social support in work environment, loneliness
emerges at workplace (Dogan, Cetin, & Sungur, 2009). Based on the existing literature,
emotional loneliness and social loneliness are two types of loneliness at workplace. While
emotional loneliness focuses on one-to-one relationship with individuals, social loneliness
happens in relationships with more than one person (Kaymaz, Eroglu, & Sayilar, 2014; Ernst
& Cacioppo, 1998).
Work alienation is another variable examined in this research. It stems from the
mismatch between the values of employees with the requirements of job roles (Mottaz, 1981;
Wegner, 1975). Hirschfeld and Feild (2000) define work alienation as not dealing with the
work. Alienated employee breaks the bonds of his/her work as cognitively and emotionally
(Nair & Vohra, 2010).
When an individual‟s psychological response exceeds his/her capacity or resources,
work stress reveals (Zhang, LePine, Buckman, & Wei, 2014). Work stress is named as
occupational stress, job stress, industrial stress, job strain, etc. in different studies. Employee
performance is associated with the business activities of employees (Borman & Motowidlo,
1993). It is about spending time and effort to satisfy the requirements of employees by
assuming the duties and responsibilities in an organization (Barutcugil, 2002).
The existing literature revealed that the phenomenon of work alienation is increasing
among health employees at an alarming rate (Tastan, Isci, & Arslan, 2014; Usul & Atan,
2014; Yetis, 2013; Philips & Arikian, 2001). Loneliness is often associated with alienation
(Kanungo, 1982) and considered as among organizational factors that lead to work alienation
(Simsek, Celik, Akgemci, & Fettahlioglu, 2006). The relationship between two variables has
not been studied empirically in health institutions. Given the nature of health care in terms of
requiring teamwork, establishing social relationship is important at workplace. When
employees have poor and peaceless human relations in delivering healthcare service; his / her
attitude to the work may deteriorate. Employee may break the bonds of his/her work as
cognitively, emotionally and get alienated from his / her work. The existing literature reveals
that work stress may trigger work alienation (Egin, 2015; Erkilic, 2012; Isikhan, 2004).
Owing to the excess number of patients, time pressure and overwork experienced in
healthcare, work stress is considered as another organizational factor of work alienation in the
model. This study focuses on how work alienation arising from social and emotional
loneliness and work stress affects performance among employees in health institutions. Work
alienation leads to decreased job involvement and less likely to exert time and energy on the
job (Sulu, Ceylan, & Kaynak, 2010; Armstrong-Stassen, 2006; Ashforth & Lee, 1990;
Omran, 1983). As the work alienation increases, the employee performance is affected
negatively (Chiaburu, Thundiyil, & Wang, 2014). Employees in health sector determine the
size and scope of healthcare services. Hence, it should be noted that low work performance
among health employees may lead to the non-recoverable results such as death or disability
of the patients etc. Viewed from this perspective, it seems important to explore these
variables in health employees.
This study proposes to examine the effect of loneliness at work i.e. work stress on
work alienation and work alienation on employee performance among employees in health
institutions.
The effect of loneliness at work; work stress on work alienation and work alienation on employees’ performance
in Turkish health care institution
Vol 10, No. 2, (Fall 2016) 32
Hypotheses
Following hypotheses have been developed to investigate the study:
H1: Loneliness at work has a significant effect on work alienation.
H2: Work stress has a significant effect on work alienation.
H3: Work alienation has a significant effect on performance.
Research Methodology
The population of the study consists of 850 employees working at a university hospital in
Turkey known as Afyon Kocatepe University Ahmet Necdet Sezer Research and Practice
Hospital. Sample size was calculated as 267 employees. The data was collected by restricted
non-probability sampling. All survey data was collected via self-administered surveys and
participation was voluntary.
Measures
Wright, Burt, and Strongman (2006) scale on loneliness at work was used in this study and
were scored with a five-point Likert scale ranging from “strongly disagree (1)” to “strongly
agree (5)” and consisted of 16 items. The items measure emotional deprivation (1-9) and
social companionship (10-16).
Work stress was measured by using the Work Stress Scale developed (House & Rizzo,
1972). This scale measures the psychological and psychosomatic symptoms of an employee
associated with stress, which is experienced in the workplace. The scale was translated into
Turkish by Efeoglu (2006) and applied in the healthcare industry. The scale consists of 7
items and a single dimension. These items were scored with a five-point Likert scale ranging
from “strongly disagree (1)” to “strongly agree (5)”.
The Work Alienation Scale was built upon the measure used by Kaya and Serceoglu
(2013) and the scale measures the level of work alienation in a single dimension and consists
of 6 items. The items were scored with a five-point Likert scale ranging from “strongly
disagree (1)” to “strongly agree (5)”.
Kirkman and Rosen (1999) performance scale was used to measure employee
performance. The scale consists of 4 items and a single dimension. These items were scored
with a five-point Likert scale ranging from “never (1)” to “always (5)”. The data in this study
was evaluated by SPSS (Statistical Package for the Social Sciences) and AMOS. Structural
Equation Model (SEM) was used in the study.
Cronbach's alpha values were found to be 0.95 for Loneliness at Work Scale; 0.805
for Work Stress Scale; 0.77 for Work Alienation Scale and 0.835 for Performance Scale as
shown in Table 1. As Cronbach's alpha coefficient is closer to 1, the reliability of the scale
increases (Gliem & Gliem, 2003). Hence, it can be said that the scales provide the necessary
conditions for the reliability.
Table 1. Reliability Analysis of the Scales used in this study
Number of Items
Cronbach's Alpha
Loneliness At Work
16
0.950
Work Stress
7
0.805
Work Alienation
6
0.770
Performance
4
0.835
Gulcan Santas, Oguz Isik and Azime Demir
33 South Asian Journal of Management Sciences
The scales were assessed by Confirmatory Factor Analyses (CFA) as shown in Figure 1. The
goodness-of-fit index (GFI, value above 0.90), the comparative fit index (CFI, value above
0.80), and the root mean square error of approximation (RMSEA, value smaller than .10)
were examined to assess the adequacy of model fit in the study (Schumacher & Lomax,
2004). GFI was found as 0.90 for Loneliness at work; 0.97 for Work stress; 0.97 for Work
alienation and 0.99 for Performance. The root mean square error of approximation was found
as 0.075 for loneliness at work scale; 0.072 for Work Stress Scale; 0.072 for Work Alienation
Scale and 0.035 for Performance Scale. The value is acceptable between 0.05 and 0.08
(Byrne, 2009). Based on the results, this study shows that the data set obtained from the
scales is valid and the model has revealed a good fit to the data. In other words, the model
provides the necessary conditions for analysis.
Figure 1. The validity analysis of the Scales used in the study
CFA for Loneliness At Work Scale
CFA for Work Stress Scale
CMIN=251,240, df=101, p-değeri=0.000,
RMSEA=0.075, CFI=0.95, NFI=0.92,
TLI=0,94, AGFI=0.86, GFI=0.90
CMIN=28,616, df=12, p-değeri=0.000,
RMSEA=0.072, CFI=0.97, NFI=0.95,
TLI=0,95, AGFI=0.93, GFI=0.97
CFA for Work Alienation Scale
CMIN=21,360, df=9, p-değeri=0.000,
RMSEA=0.072, CFI=0.97, NFI=0.95,
TLI=0,95, AGFI=0.94, GFI=0.97
CFA for Performance Scale
CMIN=1,317, df=1, p-değeri=0.000,
RMSEA=0.035, CFI=0.99, NFI=0.99,
TLI=0,99, AGFI=0.98, GFI=0.99
Results
The sample consisted of 64.4 % females; 55.1 % were single, 13.5 % were doctors, 69.6%
were nurses and 16.9 % were allied health personnel. Majority of participants were of 24
The effect of loneliness at work; work stress on work alienation and work alienation on employees’ performance
in Turkish health care institution
Vol 10, No. 2, (Fall 2016) 34
years old and younger. 90 (33.7 %) were high-school graduates, 37 (13.9 %) had two-year
degree, 96 (36 %) had four-year degree and 41 (15.4 %) had post-graduate degrees.
Based on theoretical background, the causal relationships were transformed into a structural
equation by path diagrams. Before the assessment of structural models, the fitness of model
was analyzed statistically. The purpose was to ensure the representation of causal
relationships and the acceptability of the structural model. As shown in Figure 2, CMIN/df
(922.100/481=1.917), GFI (0.90) and RMSEA (0.059) are at acceptable level in the model.
Figure 2. The output of structural equation model presenting the effect of
loneliness at work and work stress on work alienation and work
alienation on performance
CMIN=922.100, df=481, p-değeri=0.000, RMSEA=0.059, CFI=0.91, NFI=0.82,
TLI=0.90, AGFI=0.80, GFI=0.90
After ensuring the fitness of model, Table 2 presents the evaluation of structural equation
model. The study results revealed that work stress and loneliness at work were related to the
work alienation. It was found that work alienation was influenced by work stress (ρ=0.689)
and loneliness at work (ρ=0.433) positively. These influences were statistically significant
Gulcan Santas, Oguz Isik and Azime Demir
35 South Asian Journal of Management Sciences
(p<0.05). In addition, it was found that work alienation had a negative and statistically
significant effect on performance (ρ=-0.264) (p<0.05).
Table 2. The effect of loneliness at work and work stress on work alienation and work
alienation on performance
Estimate
S.E.
C.R.
p
Hypothesis
Loneliness at Work
--->
Work Alienation
0.433
0.072
6.04
***
H1 Accepted
Work Stress
--->
Work Alienation
0.689
0.224
4.918
***
H2 Accepted
Work Alienation
--->
Performance
-0.264
0.058
-3.406
***
H3 Accepted
*** p<0.01
Discussions and Conclusion
Given the lack of studies with combination of these variables in existing literature, it is
expected that this research will contribute to existing literature in healthcare industry.
According to the results of this study, work stress had a positive and statistically significant
effect on work alienation (ρ=0.689) (p<0.05), which is consistent with the study of Yadav
and Nagle (2012) as they found that there was a relationship between work stress and work
alienation. Employees getting alienated from organization, experience higher level of stress.
Erkilic (2012) also found that organizational alienation was influenced by work stress
positively (r=0.623). It can be said that employees in Turkish healthcare institutes also get
alienated with increasing work stress at workplace, where they spend a large part of their
lives.
Another finding of the study is that loneliness at work had a positive (ρ=0.433) and
statistically significant effect on work alienation (p<0.05). In the literature, there has been no
practical study to examine the relationship between two variables. Theoretical studies
suggested that loneliness at work was among the organizational reasons of work alienation
(Elma, 2003; Simsek, Celik, Akgemci, & Fettahlioglu, 2006; Kanungo, 1982). Owing to
having a complex and matrix organization structure, the relationship in health institutions
require teamwork. There are employees from different professions at each stage of health
care delivery to patients. Besides different professions, interpersonal relationships is
considered to reflect the service quality produced and delivered. Hence, it is believed that
weak and annoying employee relationships in working environment may reflect in the work
of the employees and these employees get disoriented from their work.
In this study, it was found that performance was influenced by work alienation negatively
(ρ=-0.264) and was statistically significant (p<0.05). Kanungo (1982) suggested that work
alienated employees experienced dissatisfaction and had been directed to unproductive
behavior such as sabotage, goldbricking etc. Cevik (2009) also indicated that alienated
employees did not work to improve themselves in terms of physical, mental aspects and did
their job only as necessity. The study of Chiaburu, Thundiyil, and Wang (2014) was also
consistent with this result with the other related studies, highlighting the intensity of work
alienation in employees at healthcare institutions (Tastan et al. 2014; Usul and Atan, 2014;
Yetis, 2013; Philips and Arikian, 2001). It should be noted that low job performance of these
employees may lead to irreversible consequences on the clients (patients).
Besides theoretical studies, applied research studies are needed to determine the causes of
loneliness at work and work stress in health institutions. There are limitations on the
The effect of loneliness at work; work stress on work alienation and work alienation on employees’ performance
in Turkish health care institution
Vol 10, No. 2, (Fall 2016) 36
generalization of these results for all health employees as the sample is a composition of
employees in a province of Turkey and working at a university hospital. It is believed that
future studies with larger sample would reveal more effective results.
Declarations
Competing Interests
The author declares that they have no competing interests.
Funding
There are no financial disclosures or disclaimers related to this manuscript.
Authors’ Contribution
Santas G. contributed in the study design, literature search, review of the manuscript, and
manuscript preparation. Isık O. was involved in the the study design, analysis of the data,
and review of the manuscript. Demir, A. was also involved in the literature search, data
collection and review of the manuscript.
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