the sustained profitability of an organization depends on its workforce job satisfaction and organizational commitment ( 1 ) .
employees job satisfaction enhances their motivation , performance and reduces absenteeism and turnover ( 1- 4 ) .
job satisfaction is an employee s attitude about his or her job and the organization in which s / he performs the job .
employee job satisfaction is correlated with received salaries , benefits , recognition , promotion , coworkers and management support , working conditions , type of work , job security , leadership style of managers , and demographic characteristics such as gender , marital status , educational level , age , work tenure , and number of children ( 5 - 8 ) .
organizational commitment shows the psychological attachment of an employee to the organization ( 9 ) . according to meyer and colleagues ( 2002 ) there are three types of organizational commitment : affective , continuance and normative commitment .
affective commitment relates to an employee s emotional attachment to the organization and its goals .
continuance commitment shows cognitive attachment between an employee and his or her organization because of the costs associated with leaving the organization .
finally , normative commitment refers to typical feelings of obligation to remain with an organization ( 10 ) .
leadership behavior of managers plays a critical role in employees  job satisfaction and commitment ( 5 , 11 , 12 ) .
it is the process of influencing a group of people towards achieving organizational goals ( 13 ) .
leadership is the ability of a manager to influence , motivate , and enable employees to contribute toward organizational success ( 14 ) .
managers can utilize various leadership styles to lead and direct their employees including autocratic , bureaucratic , laissez - faire , charismatic , democratic , participative , transactional , and transformational leadership styles .
good human resource management drives employee satisfaction and loyalty ( 4 , 15 , 16 ) .
satisfied and committed employees deliver better care , which results in better outcomes and higher patient satisfaction ( 17 - 19 ) .
very little research in the literature is available on the links between managers leadership behavior and employees job satisfaction and organizational commitment .
these studies were mostly conducted in western countries and limited to health care organizations . however ,
where job satisfaction and organizational commitment were investigated , leadership behavior of managers was not analyzed .
this study aimed to overcome this gap by investigating these variables in a group of hospitals in iran .
research has been conducted to identify how leadership behaviors can be used to influence employees to achieve better organizational outcomes ( 20 ) .
however , there are no known studies related to the links between these subjects in the health care organizations of the country .
the results of this research provide a better understanding of the relationship between leadership styles of managers and employees job satisfaction and commitment .
figure 1 presents a conceptual model of relationships between leadership , job satisfaction and organizational commitment .
the model proposes that leadership is positively related to job satisfaction , which is positively related to organizational commitment .
therefore , i propose the following hypotheses : hypothesis 1 : the greater the employees job satisfaction , the greater their commitment . hypothesis 2 : there is a positive relationship between managers leadership style and employee s job satisfaction and commitment .
this research investigates the relationship between perceptions of hospital managers and employees regarding the leadership behavior of hospital managers , and how this is related to the job satisfaction and organizational commitment of employees in isfahan university hospitals ( iuhs ) , isfahan , iran .
employee questionnaire package contained a cover letter , and questionnaires related to employees job satisfaction , organizational commitment and the leadership style of hospital manager .
managers questionnaire package included a cover letter , their leadership styles , job satisfaction and organizational commitment .
the job satisfaction scale ( specter 1997 ) utilized a likerttype scale with six response alternatives ranging from  strongly disagree  ( weighted 1 ) tostrongly agree  ( weighted 6 ) for each of the 36 items to measure job satisfaction ( 21 ) .
aspects of job satisfaction addressed are with : ( a ) pay , ( b ) promotion , ( c ) supervision , ( d ) fringe benefits , ( e ) contingent rewards , ( f ) operating conditions , ( g ) co workers , ( h ) nature of work , and ( i ) communication ( 4 items in each domain ) .
organizational commitment scale ( meyer et al . 1991 ) contained three eight - item components which were rated on a 6-point likert type scale ( from strongly disagree=1 to strongly agree=6 ) .
aspects of organizational commitment addressed were affective , continuance , and normative commitment ( 22 ) .
mangers leadership scale ( likert , 1967 ) had 35 items of which 15 items determined a manager s employee oriented dimension ( consideration ) and 20 items determined the task oriented dimension ( initiating structure ) of leadership style ( 23 ) .
each statement included a five - point likert scale ( from very rarely = 1 to often = 5 ) . according to likert ( 1967 ) ,
the four distinct practices that leaders use to affect employee and organizational performance include : exploitative authoritative , benevolent authoritative , consultative and participative management .
the author developed a persian translation of these questionnaires by applying a sequential forward and backward translation approach .
the final test version questionnaires were then pilot tested , using a random sample of 40 hospital employees ( not included in the sample ) and found to be well accepted and easy to fill in .
the translated questionnaires were found to be understandable and could be completed in about 20 min .
the reliability coefficient was .8749 for job satisfaction , .7784 for organizational commitment , .8767 for leadership style questionnaire from the view point of employees and .8139 for leadership style from the view point of managers questionnaires .
950 persons were selected for this survey ( n=6405 , d=0.03 , z= 1.96 and s= 0.51 ) . finally , 832 questionnaires were returned and from those , 814 questionnaires were completely filled ( 85.68 % return rate ) .
all data were analyzed using spss ( the statistical package for the social sciences ) software . in order to normalize the likert scale on 1- 6 scales for each domain of job satisfaction and commitment questionnaires ,
the sum of raw scores of items in each domain was divided by the numbers of items in each domain and for overall job satisfaction and commitment , sum of raw scores of items were divided by 36 and 24 respectively .
scores of 2 or lower on the total scale indicate very low , scores between 2 and 2.99 indicate low , scores between 3 and 3.99 indicate moderate , scores between 4 and 4.99 indicate high and scores of 5 or higher indicate very high job satisfaction or organizational commitment .
the scores of employee oriented and task oriented dimensions of leadership were varied between 15 - 75 and 20- 100 .
this research investigates the relationship between perceptions of hospital managers and employees regarding the leadership behavior of hospital managers , and how this is related to the job satisfaction and organizational commitment of employees in isfahan university hospitals ( iuhs ) , isfahan , iran .
separate questionnaires were sent to managers and employees . employee questionnaire package contained a cover letter , and questionnaires related to employees job satisfaction , organizational commitment and the leadership style of hospital manager .
managers questionnaire package included a cover letter , their leadership styles , job satisfaction and organizational commitment .
the job satisfaction scale ( specter 1997 ) utilized a likerttype scale with six response alternatives ranging from  strongly disagree  ( weighted 1 ) tostrongly agree  ( weighted 6 ) for each of the 36 items to measure job satisfaction ( 21 ) .
aspects of job satisfaction addressed are with : ( a ) pay , ( b ) promotion , ( c ) supervision , ( d ) fringe benefits , ( e ) contingent rewards , ( f ) operating conditions , ( g ) co workers , ( h ) nature of work , and ( i ) communication ( 4 items in each domain ) .
organizational commitment scale ( meyer et al . 1991 ) contained three eight - item components which were rated on a 6-point likert type scale ( from strongly disagree=1 to strongly agree=6 ) .
aspects of organizational commitment addressed were affective , continuance , and normative commitment ( 22 ) .
mangers leadership scale ( likert , 1967 ) had 35 items of which 15 items determined a manager s employee oriented dimension ( consideration ) and 20 items determined the task oriented dimension ( initiating structure ) of leadership style ( 23 ) .
each statement included a five - point likert scale ( from very rarely = 1 to often = 5 ) . according to likert ( 1967 ) ,
the four distinct practices that leaders use to affect employee and organizational performance include : exploitative authoritative , benevolent authoritative , consultative and participative management .
the author developed a persian translation of these questionnaires by applying a sequential forward and backward translation approach .
the final test version questionnaires were then pilot tested , using a random sample of 40 hospital employees ( not included in the sample ) and found to be well accepted and easy to fill in . the translated questionnaires were found to be understandable and could be completed in about 20 min .
the reliability coefficient was .8749 for job satisfaction , .7784 for organizational commitment , .8767 for leadership style questionnaire from the view point of employees and .8139 for leadership style from the view point of managers questionnaires .
950 persons were selected for this survey ( n=6405 , d=0.03 , z= 1.96 and s= 0.51 ) . finally , 832 questionnaires were returned and from those , 814 questionnaires were completely filled ( 85.68 % return rate ) .
all data were analyzed using spss ( the statistical package for the social sciences ) software . in order to normalize the likert scale on 1- 6 scales for each domain of job satisfaction and commitment questionnaires , the sum of raw scores of items in each domain was divided by the numbers of items in each domain and for overall job satisfaction and commitment , sum of raw scores of items
scores of 2 or lower on the total scale indicate very low , scores between 2 and 2.99 indicate low , scores between 3 and 3.99 indicate moderate , scores between 4 and 4.99 indicate high and scores of 5 or higher indicate very high job satisfaction or organizational commitment .
the scores of employee oriented and task oriented dimensions of leadership were varied between 15 - 75 and 20- 100 .
data were collected from 814 persons including 665 employees , 127 first line managers ( head of departments ) , 11 middle managers ( hospital managers ) and 11 senior managers ( hospital presidents ) . as table 1 shows about half of the respondents were males ( 48.4% ) .
the majority ( n=340 ) of participants ranged between 31 and 40 years of age .
approximately 82% ( n=667 ) of the participants were married and 39.9% ( n=325 ) had earned bachelor s degrees . additionally , 51.5% , 87.4 % , 90.9% and 90.9% of employees , first line , middle and senior managers had permanent employment . the mean age for employees , front line , middle and senior managers were 34 , 42 , 46 and 45 years respectively .
employees , front line , middle and senior managers on the average , had 11 , 19 , 20 and 18 years of working experiences respectively .
front line , middle and senior managers on the average had 9 , 12 and 9 years of managerial experiences respectively .
hospital employees were satisfied overall with their job with a mean score of 3.260.56 on a 6 scale ( moderate satisfaction ) compared with the possible range from 1.52 to 5.61 .
employees , first line , middle and senior managers scored a mean of job satisfaction of 3.21 , 3.40 , 3.97 and 3.73 respectively .
within the nine items of the job satisfaction scale , the three dimensions of the job with which respondents were most satisfied were : supervision , nature of the job and co workers .
respondents were least satisfied with the benefits , contingent rewards , communication , salaries , working conditions , and promotion ( see table 3 ) .
a difference existed in perceptions between employees and managers pertaining to what aspects of the job are important to employees job satisfaction .
employees reported that managers loyalty to employees , job security , good pay and good working conditions were the most important motivators for them .
however , managers thought that sufficient salaries , recognition and job security were most important to employees .
the mean score of employees job satisfaction in general and specialized hospitals was 3.19 and 3.37 respectively .
the mean score of employees job satisfaction in hospitals with the specialty in burn ( 3.08 ) , psychiatry ( 3.29 ) , and cancer ( 3.31 ) were low and in hospitals with the specialty in ophthalmology ( 3.42 ) and cardiology ( 3.52 ) was high .
employees in specialized hospitals receive more monetary benefits than those employees in general hospitals because of the type of expensive services provided to patients .
employee s job satisfaction in therapeutic and diagnostic departments was statistically lower than administrative and ancillary departments ( p<0.01 ) .
the mean score of employees job satisfaction in the central storage department ( 4.21 ) , secretarial unit ( 4.05 ) , public relations office ( 3.91 ) , social worker office ( 3.90 ) and material supply department ( 3.66 ) were high and in the psychiatry ward ( 2.55 ) , pediatrics ward ( 2.63 ) , dialysis ward ( 2.75 ) , urology ward ( 2.85 ) and medical records department , ( 2.88 ) were low .
there was strong correlation between the job satisfaction of employees and their gender , marital status , age , tenure , organizational position and received salaries ( p<0.01 ) .
there was no statistically significant correlation between job satisfaction of employees and their graduation levels and type of employment : permanent or contract employment ( p>0.05 ) . in order to determine the main factors that cause satisfaction and/or dissatisfaction with work , the relationship between total job satisfaction and job satisfy factors was analyzed .
calculations of spearmen s ratios revealed the strongest correlation between total job satisfaction and such characteristics as salaries , .687 ; fringe benefits , .685 ; promotion , .673 and communication , .637 . on the other hand work conditions , .468 ; nature of the job , .502 ; supervision , .536 ; and co workers , .554 had less effect on employees job satisfaction respectively .
the mean score of employees satisfaction of job factors and organizational factors related to job satisfaction was 4.39 and 3.05 on a 6 scale respectively .
organizational , job and individual factors overall explained 99.3 % of the variance in employees job satisfaction .
organizational factors explained the largest amount of the variance ( 94% ) , followed by job factors and individual factors .
regards to organizational factors , pay explained the largest amount of the variance , followed by coworkers , promotion , communication , supervision and benefit .
the mean score of respondents organizational commitment was 3.980.49 on a 6 scale ( moderate ) .
the mean score of organizational commitment of employees , first line , middle and senior managers was 3.97 , 4.07 , 4.12 and 4.03 from 6 credits respectively .
the mean score of affective , continuance , and normative commitment were 3.880.69 , 3.740.61 , and 4.320.38 respectively .
the mean score of organizational commitment in employees with relevant educational background towards their job was higher than those without any relevance .
a negative association was seen between employees organizational commitment and their educational levels ( r = -0.126 , p=0.001 ) .
significant differences were obtained between age , tenure , organizational position , type of employment , received salaries and organizational commitment ( p<0.05 ) . temporary employment and amount of salaries
the employee s organizational commitment in therapeutic and diagnostic departments was higher than administrative and ancillary departments .
significant differences were not obtained between employees organizational commitment and their gender , and marital status .
the kruskal wallis test revealed that the total organizational commitment scores was not differed among twelve hospitals ( p=0.61 ) . in correlation analysis between organizational commitment and its three dimensions , affective commitment , 0.809 ; continuance commitment ,
0.741 ; and normative commitment , 0.417 respectively had positive and the highest effect on employees organizational commitment .
the results of the simultaneous multiple regression model indicate that organizational , job and individual factors overall explained 54.5% of the variance in employees organizational commitment .
organizational factors explained the largest amount of the variance ( 46% ) , followed by job factors and individual factors .
this is primarily the result of the effect of the employee s education , the more educated employee reporting less commitment . the mean score of employee - oriented dimension of leadership style in first line , middle and senior managers were 52  6.35 , 54  3.89 , and 54  5.00 ( from 75 credit ) respectively .
the mean score of task - oriented dimension of leadership style in first line , middle and senior managers were 68 9.25 , 69 6.70 , and 70 7.20 ( from 100 credit ) respectively .
0.78% , 4.74% and 94.48% of first line managers had exploitative - authoritative , benevolent - authoritative and participative leadership styles .
from the viewpoint of employees the mean score of hospital managers employee - oriented and task - oriented credits were 46 ( out of 75 credits ) and 65 ( out of 100 credits ) . from the viewpoint of hospital
managers the mean score of their employee - oriented and task - oriented credits were 54 and 69 .
in other words , from the view point of employees , hospital managers were more task - oriented and from the view point of the hospital managers themselves , they were more employee - oriented .
there was no correlation between leadership style of managers and their demographic variables except age and managerial experience years .
pearson correlation coefficients indicate a significant statistically relationship between hospital managers management experience years and their employee oriented ( p= 0.024 and r=0.736 ) and task oriented ( p= 0.023 and r=0.706 ) dimensions of leadership style . there was a statistically significant relationship between employees job satisfaction and their organizational commitment ( p<0.001 and r=0.623 ) indicating that the employees who are more satisfied with their job are also more committed to the health care service .
this study observed an asymmetric relationship where satisfaction had a stronger effect on commitment than the reverse .
satisfaction with job identity , .589 ; supervision , .463 ; communications , .442 ; contingent rewards , .367 ; promotion , .344 ; fringe benefit , .242 ; salaries , .235 and work conditions , .215 were found to have a significant relationship to organizational commitment . on the other hand ,
there was a statistically significant correlation between the job satisfaction of employees and the leadership style of managers .
this correlation between employees job satisfaction and employee - oriented and task - oriented dimensions of leadership style of hospital managers was at p<0.001 and p<0.01 levels .
the correlation co efficient between employee oriented and task oriented dimensions of leadership style and employees satisfaction factors showed that the most positive co - efficiency was between supervision and employee oriented dimension and the most negative co - efficiency was between fringe benefits and task oriented dimension of leadership style of managers . a positive
, significant correlation was shown among managers leadership style and employees commitment ( p<0.01 ) .
leadership behaviors were positively correlated with affective commitment ( strongest relationship ) and normative commitment .
the employee - oriented dimension of leadership had positive , statistically significant ( p < .01 ) correlations with affective commitment and normative commitment .
leadership behaviors explained 28% variance in employees job satisfaction and 20 % in their commitment .
employees oriented dimension of leadership explained the largest amount of the variance in these two variables .
this finding is consistent with the findings of other previous studies in health care settings ( 24 - 25 ) .
however , draper et al.s ( 2004 ) study showed a negative correlation between job satisfaction and dimensions of organizational commitment which is contrary to with the finding from the present study ( 26 )
. these differing results may be due to the differences in culture and the use of different instruments to measure commitment .
this can be related to having more control over the job , more decision - making latitude , higher salaries and benefits linked to seniority and more social recognition .
this study has also shown that there is a significant negative relationship between the education level of employees and their commitment with their organization .
employees who work with patients reported less job satisfaction but more commitment in this study .
job rotation could possibly be a good strategy for improving job satisfaction of these employees .
job enrichment can also be used as a motivational strategy to satisfy these employees through providing opportunities for personal achievement , challenge and recognitions .
higher commitment in employees in these wards could be because of investigation of this concept in an islamic country .
recognition and respect are highly important especially for employees who are in direct contact with patients , families , and peers .
managers recognition for good performance boosts employees morale and increases their satisfaction . a supportive management style , demonstrated through open communication , respect and recognition
it has been noted in this study that leadership , job satisfaction and commitment are closely interrelated .
these findings are consistent with earlier studies in health care organizations that demonstrate the connection between job satisfaction ( 27 , 28 , 29 ) and organizational commitment ( 30 , 31 ) with leadership .
these findings suggest that there is a positive relationship between the employee - oriented leadership behaviors and both affective commitment and normative commitment .
therefore , it can be said that participative leadership was not successful in iranian public hospitals .
mosadeghrad and tahery ( 2004 ) in their research in iranian public hospitals concluded that managers knowledge about leadership styles was low ( 32 ) . providing more information about leadership theories help managers understand the importance of applying the right leadership style in their organizations .
for instance , the effectiveness of participatory leadership can be examined from a cultural perspective . in low power distance cultures ,
managers in high power distance culture do not provide job enrichment and empowerment and employees do not necessarily want the responsibilities ( 35 ) .
managers in such a culture may use a more directive leadership style to communicate with their subordinates .
therefore , in high power distance cultures , participative leadership style could be viewed as weak and ineffective leadership style .
they prefer the managers to develop a vision and communicate it to them . since charismatic leaders help reduce uncertainty ,
there is a strong preference for visionary , honest , cooperative , generous , concerned , and modest leaders ( 36 ) .
organizational culture influences employees sense of engagement , identification and belonging and subsequently impact on their commitment . in an innovative , corporate and supportive culture ,
according to mosadeghrad and malek pour ( 2004 ) , 75% of isfahan university hospitals had mechanistic and bureaucratic structures .
hospital managers should consider the structure and culture of the organization in choosing the appropriate leadership style ( 37 , 38 , 39 , 40 , 41 ) .
maslow s ( 1954 ) believes that human needs form a five - level hierarchy ranging from physiological needs , safety , love , and esteem to self - actualization ( 42 ) .
according to maslow s theory of hierarchy of needs , once individuals have satisfied one need in the hierarchy , it ceases to motivate their behavior and they are motivated by the need at the next level up the hierarchy . in this study ,
employees job satisfaction in relation to their salaries and benefits and working conditions was low .
once these primary and basic needs are met , they would think about participating in management decision making processes .
the participative management is not a good leadership style for these hospitals at the moment , unless managers meet their employees basic needs , improve employees organizational maturity , promote a culture of teamwork , cooperation and participation and upgrade organizational structure accordingly .
hospital managers should understand the impact of varying leadership styles on employees job satisfaction and commitment level .
thus , education and training should be provided to develop effective leadership behaviors to have a more positive effect on their employees job satisfaction and organizational commitment .
research regarding the impact of leadership style of hospital managers on employees job satisfaction and commitment is relatively new in iranian health care organizations .
the purpose of this study was to contribute to a better understanding of the relationship between leadership behaviors of managers and these two employees work - related attitudes .
this research documented the level of job satisfaction and organizational commitment among employees and the type of leadership style of managers in iranian hospitals .
this research also contributed to the knowledge of factors influencing job satisfaction and organizational commitment .
the findings showed that hospital employees were moderately satisfied with their jobs and committed to their organization .
employees were mostly dissatisfied with salaries , benefits , rewards , work conditions , and communication .
these include demographic variables of age , years of work experiences , marital status , gender and organizational position , monthly salary , type of hospital , employees organizational commitment , leadership style of managers and the nine subscales of job satisfy factors , as indicted in table 3 .
factors that may influence the level of employees commitment are demographic variables of age , years of work experiences , educational levels , organizational position , and type of employment , monthly salary , leadership style of managers and the nine subscales of job satisfier factors , as indicted in table 3 . in this study , employee oriented leadership explained significant variance in employees job satisfaction and commitment . the current research was limited to a group of public hospitals in iran .
more studies of the iranian health care employees especially within hospitals that are not as hierarchical as the public hospitals surveyed in the current study are needed .
more studies which involve hospital employees from other countries would enrich the literature on hospital employees job satisfaction and commitment .
the results of such studies can be very helpful in developing strategies to improve the global retention of hospital personnel .
 conflict of interest : none declared.introductionemployees job satisfaction and commitment depends upon the leadership style of managers . 
 this study clarifies further the relationships between leadership behaviors of managers and two employees work - related attitudes - job satisfaction and organizational at public hospitals in iran . 
 a better understanding of these issues and their relationships can pinpoint better strategies for recruiting , promotion , and training of future hospital managers and employees , particularly in iran but perhaps in other societies as well.methodsthis cross - sectional study was conducted using self - administered questionnaires distributed among 814 hospital employees and managers through a stratified random sampling.results and discussionthe dominant leadership style of hospital managers was participative style . 
 hospital employees were moderately satisfied with their jobs and committed to their organization . 
 salaries , benefits , promotion , contingent rewards , interpersonal relationships and working conditions were the best predictors of job satisfaction among hospitals employees . 
 leadership , job satisfaction and commitment were closely interrelated . 
 the leadership behavior of managers explained 28% and 20% of the variations in job satisfaction and organizational commitment respectively.conclusionthis study clarifies the causal relations of job satisfaction and commitment , and highlights the crucial role of leadership in employees job satisfaction and commitment . 
 nevertheless , participative management is not always a good leadership style . 
 managers should select the best leadership style according to the organizational culture and employees organizational maturity . 
1. INTRODUCTION
2. METHODOLOGY
Purpose and objectives
The empirical setting
Instruments
Validation of research instruments
Reliability of research instruments
Data Collection
Analysis of Data
3. RESULTS
4. DISCUSSION
5. CONCLUSION