# 04 24_1 Krstic:tipska.qxd 33 Miroslava Krstic¹*, Vladimir Obradovic², Zorica Terzic Supic³, Dejana Stanisavljevic³, Jovana Todorovic³ 1 National Health Insurance Fund, Belgrade, Serbia 2 University of Belgrade, Faculty of Organizational Sciences, Belgrade, Serbia 3 University of Belgrade, School of Medicine, Belgrade, Serbia Management: Journal of Sustainable Business and Management Solutions in Emerging Economies 2019/24(1) Motivational Factors of Employees in Health Care Institutions in Serbia DOI: 10.7595/management.fon.2018.0022 Abstract: 1. Introduction Experiences from the past show that motives for work, action and other behaviour of individual or employee can be different. Motivated individuals achieve better performance, and the organization with such individuals has a higher efficiency (Ojokuku & Salami, 2011; Lazaroju, 2015). It is considered that three conditions must be fulfilled in order that the employees be motivated: sense of purpose, sense of responsibility, and knowledge of the results (Sindik, Tvarog & Globočnik Žunac, 2013). There is a strong link between health care workers motivation and the quality of health care (Top, Akdere & Tarcan, 2015). Leadership is often called guidance. It is a process in which a guide (leader) influences the group/team to fulfill the set goals (Northouse, 2012). The job of managers is not simple since people’s reaction to change is different. They must fight employees’ resistance with a clear strategy, vision, and direction (Robinson & Rose, 2004). *Corresponding author: Miroslava Krstic, e-mail: miroslavakrstic@hotmail.com Reserarch question: This paper investigates whether motivational factors have influence on the work of employees in health care organizations of Serbia and what factors affect employees. Motivation: Motivation and job satisfaction among different groups of workers in health care facilities in Serbia are an important issue. This study’s purpose is to assist health managers in their efforts to fulfill individual and organizational targets by highlighting the most preferred motivational factors among the employees. With good leadership and with the building of good motivational system the organization can increase its value and competitiveness. It has been shown that employees are more motivated and work under less stress if there is a support from their leader or manager (Jensen, 2010). Idea: The core idea of this paper is to evaluate the relationship between motivational factors and work of employees in health care institutions in Serbia. The central hypothesis of this study is what the managers within health care institutions have to do to improve motivation as well as their abilities for the fulfillment of both individual’s and organization’s needs. Data: The cross-sectional study included 217 physicians, nurses, technicians, health associates and non-medical staff in 21 facilities of primary, secondary and tertiary levels in Pozarevac, Belgrade, Nis, Pirot, Novi Sad, Zrenjanin, Krusevac, Varvarin and Novi Pazar. Tools: The research instrument was a questionnaire with questions regarding socio-demographic characteristics, participants’ characteristics and motivational factors. The data were analyzed using descriptive and analytical statistics.Findings: The most important motivational factors are: salary, good interpersonal relationships and team work, contribution to population’s health and patient’s satisfaction. Around 10% of the participants thought that work could be done well even without motivational factors’ presence. Employees from the areas outside Belgrade rated job security higher in comparison with employees from Belgrade. A study conducted at the University of llorin Teaching Hospital in 2011 showed that salary was the most important motivational factor, followed by job security (Ojokuku& Salami, 2011). Contribution: Salary is an important motivational factor for employees in health care facilities in Serbia. Managers should work on the improvement of motivational factors through acknowledgement of needs of individual employees as well as through involving employees into decision making. Key words: management, motivation, motivational factors, salary. JEL Classification: I12, I19 The process of inspiring human activity, directed to fulfillment of certain goals is called motivation. Motivation is presented with forces which cause the behaviour that leads to fulfillment of set goals (Miljković, 2007). The job of a leader and manager is to develop the feeling of common goal among all employees. It is also to liberate a creative potential of an employee through both tangible and intangible incentives. With good leadership and with building of good motivational system the organization can increase its value and competitiveness. It has been shown that employees are more motivated and work under less stress if there is a support from their leader or manager (Jensen, 2010, Loi, Ao & Xu, 2014; Kim & Barak, 2015), but also from co-workers (Tafvelin, Hyvonen and Westberger, 2014). Reward can be both material (De Gieter & Hofmans, 2015) and moral (Kamasheva, Valeev, Yagudin & Maksimova, 2015), and consequently, motivation can be moral or material. This is the reason why leaders must work on motivational factors and employees’ needs, as well as on environmental changes. Moral motives can also be called collective motives, which is specific for team work in health-care, while the material ones can be called personal (Barney & Griffin, 1992). Studies on employees’ motivation have always been a frequent research topic (Iliopoulos & Priporas, 2011). Motivation cannot be examined separately (Bonenberger, Aikins, Akweongo & Wyss, 2014), but must be observed through determinants and outcomes (Dieleman, Gerretsen B & van der Wilt, 2009; Willis-Shattuck, Bidwell, Thomas, Wyness, Blaauw & Ditlopo, 2008; Lu, Barriball Zhang & While 2012). Studies conducted in Serbia so far have not focused on leadership and motivation, including motivational factors of employees in health-care. There have been few studies on motivation and satisfaction of health care professionals conducted in Serbia, in Primary Health care centres and hospitals (Djordjevic, Petrovic, Vukovic, Mihailovic & Dimic, 2015; Stoiljković, 2012). Researchers also examined the differences in motivation between health care workers in private and public sectors (Babic, Kordic & Babic, 2014). These studies examined motivational theories, but not motivational factors, leadership and motivation. Considering that employees in health care facilities in Serbia usually cannot be motivated materially, it is leaders’ responsibility to find motivational factors, to inspire individuals to work in order to achieve the organization’s goals. Patients’ satisfaction can be a motivational factor (Judson, Volpp & Detsky, 2015). In that case, patients’ satisfaction can be considered as a multidimensional quality indicator, depending on the structure and processes in health care delivery, as well as on the characteristics of the patients, etc. (Vojvodic, Terzic-Supic, Santric- Milicevic, Wolf, 2017). On the other hand, in the present circumstances, health care facilities are not competitive, which is also a challenge for managers and leaders (Ojokuku & Salami, 2011). The aim of this study was to examine the motivation of employees in public health care facilities in Serbia in the achievement of organizational goals, as well as in leaders’ ability to find possibilities for improvement of motivational processes and fulfillment of needs of individuals and the organization. 2. Methods The cross-sectional study was conducted between June 2014 and February 2015 which included 217 physicians, nurses, technicians, health associates and non-medical staff in 21 facilities of primary, secondary and tertiary levels in Pozarevac, Belgrade, Nis, Pirot, Novi Sad, Zrenjanin, Krusevac, Varvarin and Novi Pazar. There were 7 primary health care centres, 5 general hospitals, 1 public health institute, 1 city institute for urgent medical care, 2 clinical centres, 1 clinical-hospital centre, 1 clinic, 1 institute and 2 specialist hospitals. The sample of these 21 institutions was selected randomly in order to cover different regions in Serbia and different types of health care institutions. The research instrument was a questionnaire, based on similar research (Steven, 2000). The participants were informed about the research aims and informed that the questionnaire was anonymous. The participants gave their oral consent for the research. It took them around 10 minutes to fill in the questionnaire. The first part of the questionnaire included five questions on socio-demographic characteristics: sex, age, residence, educational status, and profession. The second part was related to motivation and included three questions: motivational factors which influence the work and contribution of every participant most: level of job satisfaction; level of satisfaction with salary and level of satisfaction with personal career opportunities. The third part of the questionnaire included nine questions related to whether only material or only non- material factors influence the job well done and job devotion; or that participant would show better work results if they were better motivated or if managers fulfilled their promises. Data analyses were conducted using methods of analytical and descriptive statistics. Descriptive statistics was used in the analysis of absolute and relative numbers, average and median values, standard deviations and confidence intervals. Statistical significance of differences based on age, sex, health care facility, job 34 Miroslava Krstic, Vladimir Obradovic, Zorica Terzic Supic, Dejana Stanisavljevic, Jovana Todorovic 2019/24(1) position, education, job experience, type of job and residence was examined using Hi-square, Mann- Whitney and Kruskal-Wallis tests. The average score was shown on scale 1 to 5. The significance was set at 0.95 (95%) with 0.05 error margin. The SPSS 20.00 software was used for the analyses. 3. Results Almost two thirds of the participants (63.6%) were females, while 36.4% were males. The highest proportion of the participants was in the age group of 37 to 42 year olds (24.9%) while the lowest was in the age group of 19 to 24 year-olds (0.9%). The highest proportion of the participants lived in Belgrade (33.8%). The proportion of employees from primary health care centres was 42.9%, that from general and specialist hospitals amounted to 32.7%, while 24.4% of the participants worked in the tertiary level health care facilities. Medical departments were represented by 49.3% of the participants. The most important motivational factor was salary, according to 22.6% of the participants. Team work and good interpersonal relationships were considered the most important motivational factor by 16.3% of the participants, while 13.8% did not want to state their opinion. Only 13.5% of the participants were motivated by contribution to population health or patients’ satisfaction, while 4.1% of them considered career advancement and improvement as a motivational factor. Almost 10% of the participants considered that the work can be done well even without motivation. Just over one third of the participants reported that they were satisfied with their job. An average score for job satisfaction was 3.35±0.981. Satisfaction with salary was reported by 18.4% of the participants, while 27.2% of them were partially satisfied. More than a half of the participants were unsatisfied with salary. An average score on salary satisfaction was 2.43±1.204. There were 14.3% of participants who were completely unsatisfied with personal career advancement, while 23% of them were partially unsatisfied. Almost one third of the participants were satisfied with career advancement, while 22.1% were partially satisfied, while 10.1% were completely satisfied. An average score on career advancement satisfaction was 2.91±1.203. Managers had better opinion about themselves after job well done compared to workers; they also considered that they would have more freedom in their job and that they would be praised by managers of the higher rank (Table 1). Table 1: Significant differences between the managers and the workers 35 Management: Journal of Sustainable Business and Management Solutions in Emerging Economies 2019/24(1) Opinion Number Median (IR) Z P If I work harder and do the job well, I will have a better opinion about myself 18 193 5(1) 4(2) 2.513 p<0.05 If I work harder and do the job well, I will have an opportunity to develop my skills and abilities 18 191 5 (1) 4 (2) 3.621 p<0.01 If I work harder and do the job well, I will have better job security 18 190 5 (1) 4 (1.25) 2.625 p<0.01 If I work harder and do the job well, I will have the opportunity for promotion 18 190 4 (2) 2 (3) 3.428 p<0.01 If I work harder and do the job well, I will have a belief I have done something valuable 18 192 5 (0.000) 4 (1) 3.424 p<0.01 If I work harder and do the job well, I will have more freedom at work 18 192 5 (1) 3 (2) 3.906 p<0.01 If I work harder and do the job well, I will get a praise from my manager 18 190 4 (2.25) 3 (2) 2.063 p<0.05 There was a statistically significant difference between participants with residence in Belgrade and those with residence outside Belgrade (p<0.01). Participants from Belgrade had better opinion about themselves after job well done and efforts they made. They considered that they would have more freedom in their work after a job well done, as well as that they would receive praise from their manager after it. (Table 2) Table 2: Differences in opinions between the participants who live in Belgrade and those who live outside Belgrade Salary and job security were important motivational factors for participants with residence outside Belgrade; they also valued higher co-workers’ opinion. Characteristics of participants from Belgrade and participants with residence outside Belgrade based on importance of motivational factors are given in Table 3. Table 3: Characteristics of participants from Belgrade and from outside of Belgrade based on assessment of importance of motivational factors Participants residing outside Belgrade were more satisfied with job and salary compared to participants in Belgrade. The difference was statistically significant (p<0.001). (Table 4). 36 Miroslava Krstic, Vladimir Obradovic, Zorica Terzic Supic, Dejana Stanisavljevic, Jovana Todorovic 2019/24(1) �������� � �� �� ������������ �� �� �� �� �� �� ���� ���� � ������� ���� ���� ���� ���� � ������ ���� ���� �� �� �� �� ���������� ����� ������ �� ����������������� ��� �������� ��� �� � ������������� ��� ������� �� � !!�!��� ��" #� $�"�#� �� �%� �&%�%�� ���������� ����� ������ �� ����������������� ��� � ������� ������������������ ������� �� ��������� !'� � ��%�� �� � !���%�� ��" #� ��" #� ����'� �&%�%�� ���������� ����� ������ �� ����������������� ���������� ������(������ !)� � ��)�� �� � !��! �� ��" #� ��" #� $���$� �&%�%�� ���������� ����� ������ �� ����������������� ���� �� ������� ���������������� � !)� � ��)�� �� � !��! �� �" #� ��" #� ��')'� �&%�%�� ���������� ����� ������ �� ����������������� ��� ���������� ����� ������� � *� � �� ���� �%� ���% �� �� � !!�')�� ��" #� ��$�"�#� ���)� �&%�%$� ���������� ����� ������ �� ����������������� �������� �������� ������� !'� � �$$�� ���� !���$�� ��"�#� ��" #� ���)�� �&%�%�� ���������� ����� ������ �� �����������������*��� ��� ���� ��������� *��� !)� � ��)�� �� � !��! �� ��" #� ��"��#� $�%'�� �&%�%�� �� �������� � �� ������ �� �� �� ������ �� ����� �������� �� ������ �� ����� �� ������ �� �� �� ��� �� ��� �� �� �� �� �� �� ������� ��� ��������� ��� ������� ���� ������� ������ ������ ������ ������� ������� ��� ��� ��� !�"��� ��� ������� ���� ������� ������ ������ ������ #������ ������� ��� �������! "��� ���������"� � �$� ������� ���� ������� ������ ������ ������ �%����� ������� ��� � ���&���" � '��(� ��� ������� ���� ������� ������ ������ ���$�� �%����� ������� ��� ������ "��"� � �� �)'��(����� ��� ������� ���� ������� ������ ������ ����$� ������� ������� ��� ������ "��"� � ���� �*���� ��� ������� ���� ���$��� ������ ������ ��$�$� ������� ������� ��� � �" *����"��&� �$� ������� ���� ������� ������ ������ ������ ������� Table 4: Level of job and salary satisfaction of participants from Belgrade and those from outside of Belgrade Level of job satisfaction (χ2=16.457, p<0.01) Level of salary satisfaction (χ2=24.979, p<0.01) If they were managers, participants would use: salary and other forms of rewarding (26%) and praise (22.8%) as motivational factors (Table 5). Table 5: Motivational factors which participants would use if they were managers There was a statistically significant difference between the opinions of non-medical workers and health care workers. Non-medical workers considered, in a significantly higher percentage, that they would secure their job through hard work (z-3.661; p<0.001).The difference between health care workers and non-medical workers was significant in regard to the importance of contribution to population health and patient satisfaction (H=15.948; p<0.01). Participants with higher education considered, in higher percent, that they would be promoted after a job well done (z=3.139; p<0.01). There was a statistically significant difference in stating importance of possibilities for job promotion between participants with different educational levels (z=3.139; p<0.01). Participants with a lower educational level valued co-workers’ appreciation higher (z=2.788; p<0.05) as was the case with job security (z=2.488; p>0.01), compared to the participants with higher educational level. There was no significant difference between participants in: good interpersonal relationships, salary, working conditions, job security and job satisfaction. There was a statistically significant difference between participants younger than 36 years and older than 36 regarding the importance of opportunities for education and job promotion (H=6.148; p<0.05). 4. Discussion The results of this study show that all groups of the participants (based on age, sex, city/town they work in, job position, educational level and department they work in) considered salary to be the most important motivational factor, whereas the second rated most important factors were good interpersonal relationships and team work. These awere followed by contribution to population health and patient satisfaction. The study named: Chinese primary care providers and motivating factors on performance has showed that the most important motivating factors for primary care providers are improvement of performance, followed by professional development, training opportunities, living environment, benefits, working conditions and 37 Management: Journal of Sustainable Business and Management Solutions in Emerging Economies 2019/24(1) ������ ��� ���� �� �������� ���� �� �� �� �� ���� �� ����� ���� ��������� �� ��� ���� � ����� � ����� �������� �� ��� ���� �� ������ �� ����� ���� ���� �� ������ �� ������ �������� ��� ���� �� � ���� � ������ ���� �� �� ����� ���� ��������� �� ��� ���� �� ������ �� ��� �� �������� �� ��� ���� �� ������ �� ������ ���� ���� � ����� �� ������ �������� ��� ���� �� ������ � ������ ����������� ����� � �� ���� ��� ������������ � �� � ������� ��� ��� ������������������� �� ��� ������������� ��� � ��� !�������������������� � � �"� �����#��������$����������������������� ������%������� �� �"� &������������������ � � �"� '�����#%��������#���������������������(� ����������� � )��� *���������������������� � "��� +����������� �����������������,� �� � "��� � income. (Hung, Shi, Wang, Nie & Meng, 2013). A study conducted at the University of llorin Teaching Hospital in 2011 showed that salary was the most important motivational factor, followed by job security (Ojokuku & Salami, 2011). A small percentage of the participants named job security as an important motivational factor in our study. Surprising results were also that participants with a lower educational level were more motivated by personal promotion and education in comparison with participants with a higher educational level. On the other hand, continuous medical discoveries require continuous medical education. The results of this study show that opportunities for education and job promotion are important motivational factors. This study showed that participants do not consider goal setting to be an important motivational factor. Our research shows that 9.7% of the employees in health care facilities in Serbia believe that work can be done well even without motivational factors presence. It is probably because work in health care facilities is specific and cannot be done by everyone. The most important motivational factor among health care workers was contribution to population health and patient satisfaction. Successful interventions toward patients, acquiring new knowledge and making advancements are the most important issues affecting job satisfaction of health care professionals (Babic, Kordic & Babic, 2014). In the research conducted in Australia during 2000, lack of motivation was recorded among all participants, without any difference as to age, life stages, or between younger and older participants (Steven, 2000). At the same time, managers in health care facilities in Belgrade had more difficulties in motivating their employees. More than a half of the participants reported dissatisfaction with salary. Considering that in this study and in other research works salary was the most important motivational factor (Wong, Gardine, Lang &Coulon, 2008), the high percentage of job satisfaction was not expected. Health care professionals with higher education were satisfied with all the individual aspects of professional satisfaction in comparison with health care professionals with secondary or higher vocational qualifications. The most satisfied were the health workers in the management positions, male, older than 60, as well as those aged 50 to 59 and with 30 years of service (Velickovic, Visnjic, Jovic, Radulovic, Sargic, Mihajlovic, &Mladenovic, 2014). Participants with residence outside Belgrade were more satisfied with their job and salary compared to participants from Belgrade. A possible reason for this may lie in the fact that there are higher expenses of living in Belgrade compared to other areas in Serbia, and that it is more difficult to find a job outside Belgrade than in Belgrade. Our research showed that employers’ opinion is very important for participants who work outside Belgrade, while participants from Belgrade do not consider this important. All participants, without any difference in age, sex, educational level, job position or department are satisfied with their work and consider job satisfaction important. A study conducted in Norway showed that work validation, praise and feedback are important factors associated with job satisfaction (Northouse, 2012). Research has showed that praise, good relationship with managers, and good working conditions are important motivational factors which should be used by managers, but that they are not the most important. Employees with lower educational level consider praise after a job well done more important than employees with higher education. Our study showed significant differences between managers and workers. The analysis of satisfaction in public health care facilities in Serbia in 2014 (Horozovic, Stojanovic, Stankovic, & Tomasevic, 2014) available at: http://www.batut.org.rs/download/izvestaji/Analiza_zadovoljstva_zaposlenih_u_ZU_2014.pdf, shows that 14.2% of employees are managers and that they are more satisfied with their job. The main strength of this study is that it includes all different types of health care facilities on different levels of health care. The study on understanding and motivating health care employees (Benson &Dundis, 2003) concluded that motivating employees was not a problem, even in cases of increased demands with fewer resources. Management have to make the employee feel secure, needed, and appreciated and take into consideration the needs of the individual, the new technology that provides challenges and opportunities for meeting those needs, and to provides training to meet both sets of needs, enhance employee motivation. This research was carried out in 2014 and 2015, when health workers did not go overseas to such an extent. The situation today is completely different and a large number of doctors and nurses go to the countries of the European Union because of personal dissatisfaction here, and better conditions and better salary abroad. One of the main reasons for employees’ preference the jobs in the hospital sector was the chance to enjoy during the interaction with consumers and the expectation of a high level of autonomy (Nedeljkovic, Hadzic,&Cerovic, 2012). 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The mediating roles of leader–member exchange and perceived organizational support in the role stress–turnover intention relationship among child welfare workers: A longitudinal analysis. Children and Youth Services Review, 52,135-143. DOI: 10.1016/j.childyouth.2014.11.009 39 Management: Journal of Sustainable Business and Management Solutions in Emerging Economies 2019/24(1) Salary was the single most important motivational factor, followed by good interpersonal relationships and team work. Participants were motivated for work, but were only partially satisfied with salary and job, as well as with interpersonal relationships. A vast majority of the participants considered that they would do their job better if they were more motivated, while some of them considered that job could be done well even without motivation. Our participants did not recognize the organizations’ goal as motivational factors. Health care managers should work on human resource development, leadership development and development of motivational factors, take into consideration the needs of the individual. To motivate their employees, health care institutions should make them feel secure, appreciated and needed, and reward them with good salary. The results obtained can be used for further research because of the significance of this topic, especially in the situation where a large number of health care workers from Serbia go abroad. It is very important for the success of the hospital organizations that employees believe they are as important to organization as the customer and that their significance as an internal customer is institutionalized into organizational practices (Nedeljkovic, Hadzic&Cerovic, 2012). It can be said that the situation in relation to motivational factors is different all around. The research (Willis-Shattuck, Bidwell, Thomas, Wyness,,Blaauw&Ditlopo, 2008) shows that motivational factors are undoubtedly country specific, but financial incentives, career development and management issues are core factors. Nevertheless, financial incentives alone are not enough to motivate health workers. Conclusion [14] Lazaroiu, G. (2015). Employee motivation and job performance. Linguistic and Philosophical Investigations, 14:97. [15] Loi, R., Ao, O.K. & Xu, A.J. (2014). Perceived organizational support and coworker support as antecedents of foreign workers’ voice and psychological stress. International Journal of Hospitality Management, 36, 23-30. [16] Lu, H., Barriball, K.L., Zhang, X., While, A.E., (2012). Job satisfaction among hospital nurses revisited: a systematic review. International Jousnal of Nursing Studies. 49, 1017–1038. DOI: 10.1016/j.ijnurstu.2011.11.009 [17] Bonenberger, M., Aikins, M., Akweongo, P., & Wyss, K. (2014). The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study. Human resources for health, 12(1), 43. DOI: 10.1186/1478-4491-12-43 [18] Miljkovic, S., (2007). Motivacija zaposlenih i modifikovanje ponašanja u zdravstvenim organizacijama, ActaMedicaMedianae; 46(2), 53-62. [19] Nedeljkovic, M., Hadzic, O., &Cerovic, S. (2012). Organizational changes and job satisfaction in the hospitality industry in Serbia. UTMS Journal of Economics, 3(2), 105. [20] Northouse, P., (2012). Leadership-Theory and Practice, California, USA: SAGE Publications. [21] Ojokuku, R.M., Salami, A.O, (2011). Contextual influence of health workers motivations on performance in University of Ilorin Teaching Hospital. American Journal of Scientific and Industrial Research; 2(2), 216-223. DOI: 10.5251/ajsir.2011.2.2.216.223 [22] Robinson, G., Rose M., (2004). A Leadership Paradox: Influencing Others by Defining Yourself: Revised Edition, Bloomington, USA: Author House [23] Sindik, J., Tvarog, S., Globočnik Žunac, A., (2013). The concept of a self-induced linked discouraging at work: The difference of employees in the public and private sectors. Zbornik Instituta za kriminološka i sociološka istraživanja; 32(1), 29-47. [24] Steven, W.P., (2000). The learning organization: motivating employees by integrating TQM philosophy in a supportive organizational culture, Leadership & Organization Development Journal 21(8), 373-378. [25] Stoiljkovic, M., (2012). Radno zadovoljstvo i radna motivacija zaposlenih u državnom sekotru zdravstvene zaštite Srbije, Pravno-Ekonomski Pogledi, 2. Available at: http://www.pepogledi.org/Arhiva/2012_02/05%20Dr%20Miloje%20Stoiljkovic%20- %20RADNO%20ZADOVOLJSTVO%20I%20RADNA%20MOTIVACIJA%20ZAPOSLENIH%20U%20DRZ AVNOM%20SEKTORU%20ZDRAVSTVENE%20ZASTITE%20SRBIJE.pdf [26] Tafvelin, S., Hyvönen, U. and Westerberg, K. (2014). Transformational leadership in the social work context: The importance of leader continuity and co-worker support. The British Journal of Social Work, 44(4), 886-904. DOI: 10.1093/bjsw/bcs174 [27] Top, M., Akdere, M. and Tarcan, M. (2015). Examining transformational leadership, job satisfaction, organizational commitment and organizational trust in Turkish hospitals: public servants versus private sector employees. The International Journal of Human Resource Management, 26(9), 1259- 1282. DOI: 10.1080/09585192.2014.939987 [28] Velickovic, V. M., Visnjic, A., Jovic, S., Radulovic, O., Sargic, C., Mihajlovic, J., & Mladenovic, J. (2014). Organizational commitment and job satisfaction among nurses in Serbia: A factor analysis. Nursing outlook, 62(6), 415-427 DOI: 10.1016/j.outlook.2014.05.003 [29] Vojvodic K., Terzic – Supic Z., Santric – Milicevic M., Wolf W. G. (2017), Socio-economic inequalities, out- of-pocket payment and consumer’ satisfaction with primary health care: Data from the national adult consumers’ satisfaction survey in Serbia 2009-2015., Frontiers in Pharmacology, 8,147. DOI: 10.3389/fphar.2017.00147. [30] Willis-Shattuck, M., Bidwell, P., Thomas, S., Wyness, L., Blaauw, D., Ditlopo, P., (2008). Motivation and retention of health workers in developing countries:a systematic review. BMC Health Serv Res, 8,247 DOI: 10.1186/1472-6963-8-247. [31] Wong, M., Gardiner, E., Lang, W., Coulon, L., (2008) Generational differences in personality and motivation: Do they exist and what are implicants for the workplace?, Journal of Managerial Psychology, 23(8), 878 – 890. Received: 2018-03-18 Revisions requested: 2018-05-04 Revised: 2018-09-05 Accepted: 2018-09-11 40 Miroslava Krstic, Vladimir Obradovic, Zorica Terzic Supic, Dejana Stanisavljevic, Jovana Todorovic 2019/24(1) 41 Management: Journal of Sustainable Business and Management Solutions in Emerging Economies 2019/24(1) Miroslava Krstic Republic Health Insurance Fund of Serbia e-mail: miroslavakrstic@hotmail.com Miroslava Krstić graduated from the Faculty of Economy at the University of Belgrade, where she also completed her master degree in 2006. She earned her masters degree at the School of Medicine and the Faculty of Organization Sciences in 2016, while she acquired a PhD degree at the Faculty of Law of the University of Belgrade in 2016. She works at the Republic Health Insurance Fund of Serbia since 2007. Vladimir Obradovic University of Belgrade, Faculty of Organizational Sciences e-mail: obradovicv@gmail.com Vladimir Obradovic is an associate professor at the University of Belgrade, Faculty of Organizational Sciences. In his teaching and research work he has achieved substantial results: over 80 papers published in national and international congresses and journals, as well as several monographs. For his scientific results, he has been awarded the highest scientific rank from the Serbian Ministry of Science. He has been engaged at all levels of education on the courses in the Management field. He also works as a consultant in several public, non-governmental and profit organizations. Vladimir is an active member of a number of international professional and academic associations. Zorica Terzic-Supic University of Belgrade, School of Medicine e-mail: zoricaterzic37@gmail.com Zorica Terzic-Supic graduated from the School of Medicine, University of Belgrade, where she defended her MSc thesis and then earned her PhD degree. She is a specialist in Social Medicine and she works as a professor of Social Medicine, School of Medicine and Centre School of Public Health and Health Management, University of Belgrade. She is engaged in education of undergraduate and postgraduate students in the fields of Social Medicine, Public Health, and Health Management. Dejana Stanisavljevic University of Belgrade, School of Medicine e-mail: sdejana8@yahoo.com Dejana Stanisavljevic graduated from the School of Medicine, University of Belgrade, where she defended her MSc thesis and later earned her PhD degree. She is a specialist in Medical Statistics and Informatics and works as a professor of Medical Statistics and Informatics, School of Medicine and Centre School of Public Health and Health Management, University of Belgrade.She is engaged in education of undergraduate and postgraduate students in the fields of Biostatistics and Biomedical Informatics. Jovana Todorovic School of Medicine, University of Belgrade e-mail: jole6989@hotmail.com Jovana Todorovic graduated from the School of Medicine, University of Belgrade. She earned her master degree in Physical activity, health and exercise therapy in 2016. At the moment she is a Phd student. She is engaged in education of undergraduate and postgraduate students in the fields of Social Medicine, Public Health, and Health Management. 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