Abstract
BACKGROUND AND OBJECTIVES:
The quality of working life in healthcare settings deserves considerable attention due to the vital importance of services delivered in healthcare businesses and organizations, and the direct effect of the employees’ mental and physical health on the chance of medical errors and the quality of healthcare services. Accordingly, leisure time in the workplace and how workers spend their leisure time are significantly influential.
PURPOSE:
This mixed methods research aimed to develop a model for leisure time management for employees in a selected group of hospitals.
DESIGN/METHODOLOGY/APPROACH:
The exploratory sequential mixed methods design with two phases was used. The qualitative part was based on grounded theory. Qualitative data were identified through 16 semi-structured interviews with selected academic experts and managers of selected hospitals in Shiraz, followed by coding process in three distinct stages. The results were the extraction and design of related categories in the form of causal condition, the central phenomenon, strategies, intervening conditions, contextual conditions, and consequences of employee leisure time management model. After identifying each of the selected template categories, each template element was selected and described in detail during the coding process. The qualitative results were tested in a quantitative section using a researcher-made questionnaire. To do so, 420 study participants were selected. Then, quantitative data and structural equation modeling were analyzed using inferential statistical methods and Amos 22 software, respectively.
FINDINGS:
Our qualitative data resulted in a conceptual model, design of related categories in the form of causal condition, the central phenomenon, strategies, intervening conditions, contextual conditions, and consequences of employee leisure time management. The quantitative results of the study indicated that the designed model was well fitted and finally confirmed.
CONCLUSION:
The results of this study reveal that hospital employees, especially therapeutic sections, need high-quality time for leisure and mental, spiritual and physical rest. Yet, time management should be based on special circumstances.
Introduction
It is widely accepted that today’s stressful working conditions have drawn more attention to the importance of recovery, well-being and productivity of employees. Work recovery is the process to regain energy and muster the mental capacity [1]. The tensions caused by interaction with customers, work-life imbalance, or any stressful conditions, can undermine the morality, personal and collective health among the employees, and increase conflict and anxiety as well. One of the most important tasks and concerns of human resource managers is to maintain health and motivation among the employees by paying attention to their various psychological needs and financial expectations [2, 3]. Therefore, some organizations are trying to introduce fun and recreation in their environment [4, 5]. If there is a proper plan for recreational activities, they could boost job satisfaction and employee commitment. Providing recreation in the workplace seems to be an effective strategy for making a balance between work and life. According to studies carried out by the World Health Organization (WHO), recreation and leisure at the workplace have a positive effect on the performance of the employees.
Having a time to rest and recreation is one of the essential physical and psychological needs of the employees, especially the recent generation of the employees [5, 6]. This generation, unlike its predecessors does not consider work as the top priority in life and demands enough time for leisure [7–10]. Leisure refers to a state of mind in which a person feels mentally relieved and unoccupied, a feeling that can occur in any environment or circumstance [11]. In sectors such as healthcare, recovery and retention of mental and physical strength of employees are considered as top priorities. Such a decision is the result of demanding work conditions, shortage of human resources, time and psychological pressures, and high level of patient demand. Without maximizing the energy and mental capacities of the employees, the societies confront with work overload and stressful and challenging working conditions which can be detrimental to physical and mental health both in short-term and long-term [1, 12]. Prolonging rest times for employees of emergency departments prolongs the duration of work without injury and accident. Also, planning rest times for employees is considered as an effective tool to manage job fatigue and safety in the workplace [13].
Considering the fact that leisure time both outside and inside of the workplace, time is a new topic in human resource study; however, the majority of the research focuses on the positive effects of this concept on personal and organizational outcomes. Furthermore, those related studies focus on one activity during leisure time with a theoretical framework while they insist on entertainment and recreation aspects; therefore, it is necessary to perform a comprehensive research about leisure time in the workplace. The present study, with its contextual conditioned-theory method, investigates leisure time at the workplace from the viewpoint of health sector employees, particularly in hospitals. Obviously, leisure time in hospitals and medical environments is totally different from other governmental organizations with more opportunity to select their rest time. The reason is that in such contexts, one moment of ignorance might cause a risk for life of humans, so it is a painful job to make an effective plan with a good leisure time and without stress and concerns for hospital staff. On the other hand, the compression and tension of the work and stressful nature of the hospital environment [3, 14] give a real importance to leisure time as the motivation and purpose of this study.
Literature review
People’s tendency for leisure time and leisure activities has increased during the past thirty years. This increasing change was more observed in 1971–1980 [10, 15]. At the beginning, studies on leisure were considered as a social problem by specialists and researchers of social sciences. This became important when the allocated time to work was decreased in industrial communities, and people found time for leisure. Thus, sociologists entered the home environment and non-working time of people to find out how they spend their leisure time. In this way, the science and research on leisure was created [11]. This time has been referred to as recreation, leisure, free time, available time, creativity, selfishness, and hedonism. Each person had personal interpretations for leisure time and its activities. Therefore, it is difficult for specialists to represent a uniform definition for leisure and its activities. According to Webster Dictionary, the term “leisure” means “free time”, the time that a person is free of any obligation to do any work and considers it as a time for which the person does not receive money. However, Dumezedlier (1959) believes that “leisure” means the time that a person allocates for his/her tranquility, recreation and personal development without any obligation or commitment to job. Given David Steindl-Rast’s viewpoint, “leisure” is equilibrium between work and rest; hence, it is different from idleness or laziness. It is an activity that a person performs outside the official time and work time to maximize the sense of pleasure at his/her free time [16].
From the standpoint of process-oriented economists and individual-oriented economists, leisure has two relatively different definitions. Traditional or process-oriented economists believe that “leisure” is having the time when no work is done. Individual-oriented economists who have a positive view toward this issue believe that “leisure” is a short time for a coffee or a catnap during the day that can be considered as appropriate refreshment. The group of economists who observe the human in human status and keep aloof the instrumental view believe that leisure time does not led to doing work or production of a service or product but it is a high quality time that is spent for being with friends, family or art. Hansen, an individual-oriented economist, indicates that leisure is non-working time that helps health, happiness and development of a perfect human [15].
In many definitions, leisure has been regarded as vacation, and it has been defined as the time when work and studying are stopped. But “leisure” can at least have three distinct meanings. First, it means the time remaining from all routine works at the workplace and home tasks and activities related to personal health and communications. In the second meaning, it can be regarded as an expression for showing specific activities for relaxation and personal and group refreshment. Finally, in the third meaning, leisure is applied to conceived mental situation where people feel mental freedom and leisure. This sense might arise in any environment or condition [11]. The third meaning is taken into account in this study.
Given the proposed definitions, leisure is one part of living time of people. It seems that it is versus working time due to doing interesting and personal activities. The reason is that working time in some organizational sciences is interpreted as the time that the person has sold to the firm and has received money or other items in lieu of it, and performing personal and non-working activities are not allowed in such times [16]. But if we consider leisure as a mental situation in which a person is not mentally involved in work problems and does refreshment and mental rest, we no longer can expect it to occur outside the firm and work environment. Considering the importance of leisure in recent years among people both in personal and work life, this issue has also been considered by organizations, human resource managers and researchers of the field. Human resource specialists explored this concept and its effects from two dimensions: paying attention to employees’ leisure outside the firm and work time and paying attention to this issue during the work time and at the workplace.
Leisure time at or outside the workplace
The results of studies which considered employees’ leisure outside the workplace illustrate positive effects of paying attention to leisure activities. These results are job satisfaction, job efficiency, lower levels of absenteeism, job enthusiasm, welfare, reduction of therapeutic costs, reduction of job burnout and increased job effectiveness [1, 17–23].
Work breaks, rest breaks, leisure, workplace recreation, workplace leisure behavior, fun at workplace, and fun at work are subjects of studies which consider leisure at the workplace. These subjects have been considered through two functional and non-functional approaches. In Wisdom’s research (2012), employees’ leisure activities are non-functional. According to Wisdom, such activities can be detrimental for firms and people’s performance although he believes that leisure activities are tasks such as surfing the internet, personal telephone conversations and watching news and television and points out that it is unsystematic and contrary to professional ethics [16]. Lebbon (2013) explored the effect of leisure behaviors at the workplace and concluded that leisure behaviors of more than 40 percent of their work time will have a negative and converse relationship with employees’ job performance and efficiency [40]. In Shrivastava’s study (2018), addiction to the internet at workplace can have a negative effect on personal and work life of employees [24]. The common point in all studies in which employees’ leisure is considered inefficient is lack of any program to manage leisure time, and spending it idly. This is the main problem in the present study.
However, those studies which considered leisure activities at the work environment to improve welfare conditions of employees in the firms have mentioned its positive effects in various aspects [4, 25–30]. According to World Health Organization reports, entertainment and recreation at the workplace improve personnel’s performance and their quality of life, as well [4]. Specialists and researchers in social sciences pay considerable attention to the leisure activities regarding the reduction of the work time and more free moments. Leisure can be defined as a conceived mental situation where people feel mental freedom and leisure. This sense might arise in any environment or condition [11].
Lebbon (2013) mentions in his research that if the leisure behaviors of employees reduce to less than fifteen percent of the work time, it affects their performance positively [40]. Other studies suggest the positive effect of sport facilities and conditions of physical activity inside or near the workplace on employees’ health and improvement of employee’s performance in organizations [18, 19]. Epstein (2016) refers to the rest time and leisure at workplace with work pause or pause. He believes that these words can describe an enormous range of activities. Also, this pause and rest might improve overall performance in spite of the short-term cost. Park (2019) insists on the importance of the rest breaks during work time, and reduction of the problems in the spheres of the health and fitness in shift works with long hours [31]. Galdwell (2019) refers to the necessity of a short nap after work fatigue and its effect on reduction of errors and increased safety that make a fatigue management strategy in work environments [32].
Research questions
The purpose of the present study was to develop a contextual conditioned-theory for various aspects of leisure time management at the workplace. In this regard, the research questions are as follows: What are the essential elements in this process (causal conditions, central phenomenon intervention condition, contextual condition, strategies and consequence)? What is a conceptual model for leisure time management in the workplace? Does this conceptual model have an acceptable fitness for its elements?
Methods
This was an applied research carried out using an exploratory-survey method in two phases: qualitative and quantitative.
Qualitative procedure
To explore the various aspects and examples of leisure time at the workplace, we used a qualitative approach, particularly “Grounded Theory Technique”.
The statistical population of the qualitative section should be aware of the research subject. Since all hospitals and medical employees are acquainted with the concept of leisure time at hospital and understand its importance, they could participate in this interview and respond to the questions. The interviewees were selected from various specialties and occupational ranks, so the criteria of the interview were based on the knowledge and experience of the employees in health and hospital environment. The statistical sample of this phase included 16 people working in health sector and academic experts determined through saturation principle (Glaser & Strauss, 1967) (Strauss & Corbin, 1998). The opinions of the interviewees were saturated after the 12th interview, and the interview process finished after the 16th interview. Due to the variety of managerial policies, the interviewees were selected from various departments (support, office affairs, medical) and different hospitals (private and public). The interviews were performed by face-to-face, in-depth, and open-ended questions from 30 to 60 minutes. The notes were taken simultaneously with recording the interviews and those records were transcribed afterwards. Then, the important variables were recognized through open and axial-coding technique and the dimensions of the variables were extracted through selective coding, causal condition, central phenomenon, contextual condition, strategies, intervening condition and consequence.
Determining the content validity of the research
After finishing the selective coding, the extracted codes in the form of questionnaires were distributed among 18 professors and experts in health and medical sector, and organizational behavior. It should be noted that for determining content validity, CVR, and CVI some of these experts were interviewees. Finally, 15 questionnaires were completed and analyzed. After the final calculation of CVR and CVI, the unacceptable codes were eliminated and the remaining codes were contrived in the designed conceptual mode.
The following criteria were used to determine the rejection and acceptance principles in this research: Unconditional acceptance of the index; if CVR is equal or greater than 49%. According to the 15 respondents of the panel, this number was extracted through Lawshe’s Table. Acceptance of the index; if CVR level is between 0 and 49%, and the numeric mean of the rates is equal or greater than 1.5. This CVR shows that over half of the raters selected this choice: “Indispensable”; therefore, in such a case, the average judgment is closer to the choice “Essential”. Rejection of the index; if CVR is below zero, and the numeric mean of the judgments is below 1.5. When CVR is below 1.5, it means that less than half of the participants selected this choice: “Essential”; and the numeric mean of the judgments is closer to “Useful but not essential”.
After determining and calculating CVR, the questionnaire of Content Validity Index (CVI) was used for certainty of the criteria and tools to measure the content. CVI demonstrates the sophistication in judgments of validity or the fitness of the model, test and the tool.
Thus, the questionnaires were distributed among those 15 experts to calculate CVI, and they were asked to evaluate the remaining 46 questions according to the following three criteria based on the Likert Quadrat Spectrum Relevance, Simplicity, and clarity (1 = not clear, 2 = fairly clear, 3 = clear, 4 = crystal clear). The value of validity index for the selected codes of this research was 0.57 and according to the CVI of the confirmed codes in Content-Validity Segment, one code was eliminated which was related to the causal conditions with a value lower than 0.57.
Quantitative procedure
The paradigm model in the qualitative part was distributed among 420 participants through a questionnaire with 53 questions and 390 questionnaires were selected for final analysis. The inclusion criterion was holding a Bachelor’s degree or higher; therefore, the selected employees could respond to the questions regardless of their field of specialty. The sample numbers were calculated with structural equation modeling (5 to 15 times the number of questionnaire questions) using stratified random sampling for distribution of the questionnaires. This questionnaire is based on the 5-point Likert scale. The validity of the questionnaire was confirmed by content and structure methodology. The professors and experts confirmed the content and the structural section was confirmed by the structural equation modeling. The reliability was measured using the Cronbach’s alpha coefficient with Amos 22 software (Table 1). According to the results, the validity of the structure is acceptable.
Cronbach’s alpha coefficient
Cronbach’s alpha coefficient
Qualitative analysis
After analyzing the qualitative data and performing the three-step coding of the research, 51 axial codes were put into the categories of causal, central phenomenon and contextual conditions, intervening condition factors, strategies and consequences of leisure-time management in the workplace. In the content-validation step, the selected axial codes were distributed among some of the interviewees and academic experts in medical and organizational behaviors sectors in the form of questionnaires with respect to their opinions about these codes. As a result, one code was rejected from the 10 selected codes of causal conditions and 9 were accepted and in the strategy part, 3 codes were rejected from the 6 selected codes and 3 were accepted. In the consequence part, one code was rejected from 22 selected codes. The contextual and intervening conditions and the central phenomenon category were all confirmed. The results of the final analysis are included in Tables 2–7.
The calculated values for CVR and CVI coefficients and the numeric mean of the causal conditions
The calculated values for CVR and CVI coefficients and the numeric mean of the causal conditions
The Calculated values of CVR and CVI Coefficients and the numeric mean of the central phenomenon category
The calculated values for the coefficients of CVR and CVI, and the numeric mean for the contextual condition
The calculated values for the coefficients of CVR and CVI, and the numeric mean for the strategies
The calculated values for the coefficients of CVR and CVI, and the numeric mean for the Intervening Condition
The calculated values for the coefficients of CVR and CVI, and the numeric mean for the Consequences
Conceptual model of workplace leisure management.
The comparison between the values of indexes and their fitness show an acceptable value for all indexes. (Table 8)
The indexes of the fitness for the constituent elements of the conceptual model
The indexes of the fitness for the constituent elements of the conceptual model
Causal conditions
Leisure time in workplaces is necessary due to the humans’ variety of needs in different dimensions. According to Edward Boyle, one of the most essential responsibilities of the management in any organization is paying attention to the needs and demands of the employees, especially the need for rest time and break from work to allow physical and mental recovery [15]. Portela (2018) insists on recovery and reduction of the negative effect of the physical activities in the work time with leisure time activities, as supported by Park (2019) [31]. Shengwei, Lee and Liu investigated employees’ health improvement in the workplace. Other codes identified in the category of causal conditions include improved work problem resolution and effective decision-making capability, work crisis management, reduced rate of human error, and enhanced work focus and precision [6, 33]. Galdwell (2019) refers to the necessity of a short nap after work fatigue and its effect on the reduction of errors in the workplace [32].
In medical affairs, where decisions and their outcomes have direct impacts on human life and health, it is even more important to prepare the conditions as much as possible for people to make the best possible decisions. Certainly, leisure management reduces the rate of fatigue-induced human errors which may undermine decision-making about treatments and the quality of procedures. These results are in agreement with Blasche [28] and Michishita [29].
Central phenomenon
Leisure can refer to a variety of activities. But in our interviews with the employees, it is considered as a possibility to have a facility with the necessary comforts for an undisturbed and relaxed rest, including a place with natural light, open-air windows, sufficient sunlight, proper ventilation and temperature, natural elements such as flower pots or being in a natural environment such as hospital garden, and use of exciting or relaxing colors in employees resting rooms. In a study by Kaplan [34], the results demonstrated the positive effect of greenery and natural elements in the workplace on the well-being and effectiveness of employees. Resting spaces can be equipped with games and entertainment tailored proportional to the organization’s culture, and audio-visual and virtual communication gadgets to improve the mental recovery of employees. The library facilities with a variety of specialized and non-specialized books will allow the employees to use a part of their rest time to find more about work-related issues arising during treatments, which will help them become more mentally relaxed during treatment processes. However, the issue that was most emphasized by the interviewees was the access to open air and sunlight even for a brief period.
Bisswas and Biernat referred to the accessibility of the leisure and sport facility, its vicinity to the workplace and the positive effect on increasing the employees’ physical activities and their health [19, 35].
Contextual conditions
The presence of a suitable contextual condition work for workplace leisure programs such as managers’ supportive attitude, mutual trust between managers and employees and a strong culture of collaboration and organizational citizenship among the employees were found to be among the contextual conditions, which are needed for workplace leisure management. Managers are completely in charge of the changes, and the introduction of new cultures in the organization and no plan or program will succeed without their acceptance and support. Concerning contextual conditions, the interviewees stated that there could be no genuine and effective leisure time unless there is perfect empathy and cooperation between colleagues and, of course, there is a sufficient workforce to make it possible. If these conditions are met, then an employee can take a rest and actually enjoy his rest without worrying about work, fully confident that the activities are being done properly in his absence. Researchers in [36] also reported the positive effect of support from managers and colleagues on leisure satisfaction in tourism employees.
Strategies
The three strategies identified in this research for workplace leisure management are: proper planning of leisure time in the organization, adoption of precise monitoring and supervision policies, and giving employees the freedom to choose how to spend their leisure time. To be effective, planning for the employees’ leisure must be done with the cooperation and participation of the employees themselves. The plans for meeting the needs of the employees and how they spend their leisure time cannot be devised behind closed doors and without attention to their tastes and requests. Brajša has shown that the pattern of leisure activities varies with age and gender [37]. Further, several studies on different generations of workers have shown that millennials (GenMe/GenY), who are born between 1981 and 2000, do not consider work as the centerpiece of their life and attribute more importance to fun and leisure [7–10]. Supervisory and monitoring policies for leisure programs should be precisely defined prior to implementation, preferably with direct input from department heads and even based on the employees’ surveys.
Intervening conditions
The suitability of leisure program regarding the type of work and workload is one of the most important factors that can affect this program. Undoubtedly, given the variety of therapeutic and non-therapeutic services offered in the healthcare field, and especially in hospitals, it is impossible to devise a common plan for all hospital departments. The type of conditions and facilities provided for the leisure time of the employees should be tailored to the type of work, the intensity of work stress, and the type of department. For example, the type and timing of leisure activities provided for the employees of the emergency department or ICU should be quite different from those provided to the employees of administrative and support departments and even other less stressful departments. The daily rate of direct interactions with patients and their family members is an important intervening condition factor, as well. Park and Bramante insists on the importance of the rest breaks during work time and reduction of problems in the spheres of health and fitness in shift works with long hours [5, 31].
Consequences
Implementation of the leisure time management plans and patterns has personal, organizational, and social outcomes. The most important consequences that were strongly emphasized by a large number of interviewees are the mental and physical recovery for employees. According to many health care workers, when a person can take a break from a challenging and stressful work environment, he can return to his job with ease of mind, more energy and convalesced strength. Naturally, this break from work can reduce and even prevent many fatigue-induced behaviors such as aggressiveness and medical errors. Most of the outcomes identified in this study are a subset of the effects of physical and mental work recovery. Apart from caring about and fulfilling physical, mental and spiritual needs and according to people’s opinions, considering leisure-time and providing facilities for spending this period fruitfully is a respect by organizational administrators to the significance of the employees. However, as noted by the interviewees, to be effective, it must be able to induce complete relaxation and isolation from work stresses.
The results of similar studies show that well-managed entertainment facilities in the workplace reduces visits to physicians and improves the physical and mental capacity of employees, which ultimately lead to higher work output [4, 37–39].
In the quantitative section, it was determined that all elements of the proposed conceptual model have acceptable and suitable goodness.
Finally, it is emphasized that the main effective factors on leisure time management and its strategies and total results have been mentioned in this study based on the accomplished qualitative survey. Mainly, it can be stated that some conditions and requirements are universal because they are a general response to basic needs of humans in all cultures and countries, such as spending work breaks for physical and mental refreshment, and creating a quiet and joyful mental environment. But definitely, some circumstances like decoration of the bedroom, creating a space for group games and recreations and playing effective music or short films during the rest time can not only be different given the type of culture and religion in the society, but even the type of a manager’s attitude in this case can be effective. Hence, this study proposes a general conceptual model and explores major aspects of leisure time management and it is the responsibility of domestic and local decision-makers of therapeutic systems in any society to naturalize the conditions for its provision and planning.
Conclusion
According to investigation in various aspects of leisure-time management at work, this research concludes that hospital employees require an effective leisure-time to rest in the workplace since there are occupational stress, work load, and the mental pressure as the natural parts of this job; therefore, the managers and decision makers of the health sector should understand this fact and provide the required facilities and conditions for the employees of health-care systems besides supporting the idea. Therefore, employees can enjoy complete relaxation and recreation and full mental separation from occupational concerns and processes, and recover themselves mentally, physically and spiritually and return to their work with energy and higher efficiency.
In order to improve employees’ leisure conditions at the hospital, it is suggested to provide a totally separate space which is preferably far from therapeutic sections in a green environment with the required possibilities for resting and a short nap without any stress and at the same time a breathtaking and happy space for boosting employee morale. Also, the use of natural plants and the sunlight must be considered by hospital managers and executors. The suggestions of the research are explained in the segments of central phenomenon category, contextual condition, and the strategies.