Understanding Healthcare Workers Job Satisfaction Through Maslow’s Hierarchy: A Qualitative Study in India

Understanding Healthcare Workers Job Satisfaction Through Maslow’s Hierarchy: A Qualitative Study in India | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Understanding Healthcare Workers Job Satisfaction Through Maslow’s Hierarchy: A Qualitative Study in India Kreeti Pal, Dechenla Tsering Bhutia, Rakesh Kumar Saroj, Sanjay Kumar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7526298/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 8 You are reading this latest preprint version Abstract In a demanding profession like health care services, the stress and pressure of work is an inherent part of the profession. Understanding the key concerns related to job satisfaction is crucial creating a congenial work environment for the health care workers and plays a vital role in standards of patient care and reduce attrition. This study sought to investigate the determinants of job satisfaction among different categories of health care workers i.e., doctors, nurses, technicians, physiotherapists, and administrators based on Maslow's hierarchy of needs as a model to understand their experiences. Method: A qualitative research was carried out in a tertiary care teaching hospital in a state in India. Seven independent focus group discussions (FGDs) were held, each involving members who were of the same professional category. The FGDs included - two for doctors, two for nurses, and one each for technicians, physiotherapists, and administrators. A total of 50 healthcare professionals took part in the seven FGDs. A thematic approach consistent with Braun and Clarke's approach was adopted in recording, transcribing, and analyzing the discussions. Participants' words naturally led to themes to emerge, but attention was also paid to how their experiences mapped onto Maslow's theory. To ensure an assurance of the accuracy and reliability of the study findings, checking back procedures were carried out by some participants. Outcomes : The dominant themes that emerged from Focus group discussions are: Resource Limitations and Workload, Economic and Job Security, Support and Workplace Relationships, Recognition and Value, Growth Opportunities, etc. While all the groups reported identical problems, there were particular problems faced by certain cadres which were distinctly different. Conclusion : Briefly, there are numerous unmet needs that medical professionals must navigate, ranging from basic needs such as equitable compensation and adequate staffing to more complicated issues of perceived value and opportunities for professional growth. It is crucial to address both the material and emotional components of their workplace in order to enhance overall job satisfaction. Thematic Analysis Focus Group Discussion Qualitative Study Healthcare Professionals Maslow’s Hierarchy Job satisfaction Figures Figure 1 Figure 2 Background Healthcare workers' job satisfaction is an important determinant of the effectiveness and performance of healthcare systems. Low morale in stressful settings such as hospitals results in employee burnout, turnover, and decreased patient care. In contrast, positive working conditions that meet the needs of staff can improve motivation, performance, and quality of care [ 1 , 2 , 5 ]. Studies note a positive association between patient and healthcare workers' satisfaction [ 3 ], whereas low morale has been found to be related to decreased quality and safety in care [ 4 ]. Maslow's hierarchy of needs [ 6 ] is also a helpful model for describing job satisfaction. It suggests that individuals need to fulfil fundamental needs like compensation, rest, and safety before progressing towards higher-order motivators such as belonging, esteem, and self-actualization. Translated to the health workforce, this model emphasizes the need for safe jobs, equitable workloads, peer support, esteem, and opportunities for professional development. Though supporting theories such as Herzberg's motivator-hygiene theory also advocate for the same perspective, evidence generally points towards the need to meet both lower and higher-order needs in order to maintain motivation and retention [ 7 , 8 , 9 ]. Gaps Identified and Rationale Single Cadre Focus Narrow: Current research tends to be centred on physicians or nurses, ignoring the experiences of other key personnel such as technicians, physiotherapists, and administrators [ 9 ]. Such siloed perspective hinders the formulation of broad policies. Overreliance on Quantitative Research: Most research is based on questionnaires and measures, which tend to overlook subtle experiences and contextual variables driving job satisfaction. Limited Use of Maslow's Framework in Context: Although Maslow's theory has been widely cited, few researchers have systematically applied it to research satisfaction among multiple healthcare professionals within one organizational facility. The present study fills the mentioned loopholes by applying qualitative research approaches to examine job satisfaction among several groups of hospital staff in one tertiary care facility. This is more effective at encapsulating collective and role-specific issues compared to quantitative measures. Thematic analysis based on Maslow's hierarchy offers a systematic but adaptable framework with which to evaluate both lower-level and higher-level needs, supporting more focused and integrated strategies for enhancing workplaces. Insight into diverse staff viewpoints of doctors, nurses, allied health workers, and administrators gives insights necessary for the development of comprehensive and sustainable interventions. This research aims to examine the determinants of job satisfaction across various cadres of hospital workers with Maslow's hierarchy of needs as guiding principles. Through qualitative analysis of experience across doctors, nurses, technicians, physiotherapists, and administrators, it identifies common themes and role-specific issues to inform policies that will enhance well-being, retention, and high-quality care. Methodology Study Design and Setting A qualitative study in the form of focus group discussions (FGDs) [ 10 ] was carried out among healthcare professionals. The study was conducted at the Central Referral Hospital, a 500-beded tertiary care teaching hospital in Sikkim, India. The hospital consists of a mix of healthcare workers, including doctors, nurses, paramedical technicians, physiotherapists, and administrative staff. We used FGDs to take advantage of group dynamics – enabling participants to reflect back and compare on experience, and to elicit rich discussions on common workplace issues. Seven FGDs were conducted in a University lecture hall/ departmental demonstration room within the hospital campus, each lasting around 40–60 minutes. Participants and Recruitment Participants were purposively sampled to represent five most significant cadres of hospital staff: doctors, nurses, laboratory/imaging technicians, physiotherapists, and hospital administrators. Homogeneous FGDs were held separately for each cadre to ensure easy discussion without hierarchical restraint (e.g., doctors and nurses were split into separate groups). Two FGDs for doctors and nurses were conducted (to deal with their larger numbers and different experiences), and one FGD each for the other cadres (technician, physiotherapist administrator), resulting in seven FGDs. Around 6–9 participants belonged to each group (average ~ 6), and a total of 50 people (13 doctors, 12 nurses were included, 6 technicians, 9 physiotherapists, 10 administrators) participated in the FGDs. Participants included junior staff (e.g. resident doctors, staff nurses) and senior staff (consultants, nurse supervisors, department managers), to ensure a range of perspectives. Inclusion criteria were 6 months of working experience at the hospital and willingness to share experiences. Participants were invited through departmental heads and personal invitations. All invitees provided informed consent before participation. To maintain confidentiality, no personal identifiers were recorded; participants are referred to by cadre (e.g., "Doctor", “Nurses”…) in the report. Data Collection A semi-structured FGD guide (Appendix-I) was employed to generate discussion, the guide was prepared with review of literature [ 11 , 12 , 13 ] and approved by subject experts. The main questions invited participants to comment on their understanding of job satisfaction and dissatisfaction, work motivators, work issues that affect their morale, relations with colleagues and management, and ideas for changing things for the better. Probes were employed to probe further into areas reflecting different levels of needs (e.g., " What about that makes it easy or difficult to do your job ?" for basic needs; " Do you feel valued and recognized ?" for esteem needs; " How do opportunities for growth here compare with your expectations? " for self-actualization). Each discussion was facilitated by researcher KP, supported by a note-taker. FGDs were facilitated in English (the institutional language) with occasional checking in the local language Nepali/Hindi) where appropriate. All discussions were audio-recorded using “Sony ICD-UX570 Digital Voice Recorder” with consent and transcribed verbatim. Transcripts were verified against recordings for accuracy. Field notes on group dynamics and non-verbal communication were added to provide context to the transcripts. Theoretical Framework Maslow’s hierarchy of needs was employed as a sensitizing framework throughout the research process. This meant that while coding and theme development were primarily data-driven (inductive), simultaneously attention was also given towards how expressed issues related to various need levels (physiological, safety, social, esteem, self-actualization). In the later stages of analysis, the emergent themes were interpreted in light of Maslow’s theory to understand whether and how different needs were being met or unmet for each cadre. This theoretical lens helped in structuring the findings and drawing connections with existing theory​. Data Analysis Reflexive thematic analysis, was employed according to Braun and Clarke’s six-step process [ 15 ]. At first, the transcripts were read several times for familiarization, then line-by-line inductive coding was conducted with NVivo 15 software (e.g., “staff shortage,” “no time for lunch,” “appreciation by patients,” “lack of promotion”) by first author. Later the related codes were grouped into subthemes and broader themes, which were refined through iterative discussion and constant reference to the transcripts. Maslow’s hierarchy guided interpretation—for example, codes on salary, workload, and working conditions were consolidated under unmet basic needs. In the fifth stage a constructed and labelled final themes and subthemes were identified, with five overarching themes, each with 3–4 subthemes, that captured different aspects of job satisfaction. Lastly, during the reporting stage, rich representative quotes for every subtheme were chosen to demonstrate the findings. Participant roles (e.g., Nurse, Technician) were indicated, but no personal identifiers were used. Coding decisions were reviewed collaboratively, discrepancies resolved by consensus, and preliminary findings were shared with a small participant sub-sample for member checking. COREQ guidelines for reporting qualitative studies were adhered to [ 14 ]. Ethical Considerations The study was approved by the Institutional Ethics Committee, Ref No.- SMIMS/IEC/2022 − 117 . All participants provided written informed consent and were assured that participation was voluntary and confidential. To protect anonymity, any potentially identifying details (e.g., specific department names or individuals mentioned in FGDs) were removed or generalized in the transcripts. Participants were encouraged to speak freely, and ground rules for respectful discussion were established at the start of each FGD. Audio recordings and transcripts are stored securely and accessible only to the researcher. Findings were shared with hospital leadership in aggregate form to inform organizational improvements, without attributing any comments to individuals. Results Participants described a wide range of factors influencing their job satisfaction. Despite differences in roles, there was striking convergence in many of the challenges expressed across cadres, Fig. 1 represents the key word/codes identified. In line with Maslow’s theoretical lens, the themes reflected needs spanning from basic resource-related issues to higher-order psychological needs. Figure 2 summarizes the five main themes and subthemes that emerged, detailed presentation of same with exemplar quotes from different staff cadres is presented in Table 1 . We present each theme in detail below, integrating verbatim quotes to illustrate commonalities and contrasts among doctors (D), nurses (N), technicians (T), physiotherapists (PT), and administrators (A). Table 1 Theme Chart Based on Maslow's Hierarchy of Needs Maslow's Level Themes Key Codes / Issues Cadres Mentioning It 1. Physiological Needs Compensation & Benefits salary, and other fringe benefits All cadres Working Conditions Basic office facilities, Administrators, Technicians, Nurses Workload working hours, role overload, number of staff posted Doctors, Nurses, Technicians 2. Safety Needs Job Security Stable employment, fear of job loss, long-term roles Doctors, Administrators, Physiotherapists Workplace Safety Aggression from patients/visitors, safety enforcement issues Nurses Management Efficacy Poor leadership responsiveness, favoritism, inconsistent rules Nurses, Technicians, Administrators Resources & Infrastructure Broken machines, slow supply chain, outdated IT systems All cadres 3. Belongingness & Love Needs Teamwork & Work Culture Friendly, collegial environment, senior–junior respect, “family-like” teams All cadres Interdepartmental Unity Desire for cross-team collaboration Physiotherapists, Administrators Recognition Approach Desire for inclusive recognition events, team-based acknowledgment Physiotherapists, Nurses 4. Esteem Needs Recognition & Appreciation Lack of formal recognition, blame culture, feeling undervalued All cadres Intrinsic Rewards Patient gratitude, pride in quality care, impact on patients Doctors, Nurses, Physiotherapists, Technicians Organizational Culture Ethical environment, no office politics, transparent communication Administrators, Doctors Fairness & Equity Equal task distribution, avoidance of favoritism Nurses, Administrators 5. Self-Actualization Autonomy & Responsibility Freedom in clinical decisions, departmental input Doctors, Physiotherapists Career Growth & Development Opportunities for promotion, leadership training, learning exposure All cadres Role Clarity & Onboarding Poor induction, unclear duties, academic-clinical balance Technicians, Physiotherapists Employee Involvement Exit interviews, feedback loops, empowerment in decisions Administrators, Nurses Preventing Stagnation Desire for evolving roles, new challenges over time Administrators Theme 1: Stressed Resources and Overwhelming Workload – Meeting Basic Needs to Enhance Care and Well-being Healthcare workers across different roles consistently reported a strong sense of responsibility toward their work, despite facing significant operational challenges. A common concern was the lack of access to basic necessities such as adequate rest, meals, and safety measures, which they felt directly influenced both their personal well-being and the quality of patient care. Many voiced the need for improved staffing and systems that would allow for scheduled breaks. One of the nurses remarked, " We are in the hospital so long without even a decent place to have lunch ," and another said, " With fewer personnel, we help one another taking turns so that someone can just grab tea or food in a flash while others see to the patients ." Although there was a feeling of teamwork and collaboration, the underlying fatigue issue was still apparent. Staff shared similar concerns, often citing the uneven workload. One of the staff said, " Ten people's work is placed on four of us ," indicating the stress generated by the understaffing and limited resources. Though staff were committed to delivering patient care, there was a hidden blame that the existing working conditions were physically and emotionally demanding. A few thought that a change in working conditions would have a positive impact on their potential to deliver efficiently. There was also a general consensus that the quality of care depended on the amount of institutional support present. " When healthcare workers are too pressured, it actually affects the quality of care ," said a doctor, while a physiotherapist tied patient satisfaction with how much time and attention the staff could deliver. These were sentiments that indicated that the willingness to provide good care was usually being affected by shortcomings in the system. Infrastructure and equipment issues were a significant area of concern. Technicians cited delays in the delivery of equipment and how improved logistical systems would enhance efficiency. Nurses cited a need for improved infrastructure and policy to enhance patient outcomes as well as work safety. Concerns about safety and workplace order were also discussed, particularly in relation to visitor management and security protocols. Staff expressed a need for better enforcement of rules to maintain a peaceful and safe environment. " We address everything face to face without an intermediary, which increases our stress ," said one technician. Aggressive incidents involving patient family members were reported, and staff complained of needing more formalized and standardized administrative action. In spite of these continuing challenges, some employees held a stimulated confidence that situations might be improved if tangible steps were taken e.g., filling jobs, creating specific resting areas, making systems more efficient, and following safety standards. As one nurse explained, " Proper staffing, infrastructure, and resources can reduce stress and improve job satisfaction ." While there were upbeat expressions, these were often clouded with immediate frustrations and a desire for tangible, systemic changes. Theme 2: Financial Strain and Job Security – Compensation and Stability Numerous participants freely shared frustration with wages, terming salaries as being too low for what they perform, particularly with respect to an escalating cost of living. For the majority, it wasn't about the money it was about fairness and being valued. A physician put it bluntly: " We need better salaries ," and a technician with ten years of experience added, " There's been no growth in pay… others performing similar work at other institutions get paid more. " Nurses communicated this as well, stating that higher-paying opportunities elsewhere caused staff to leave. These experiences reflect a broader issue in healthcare: when people feel underpaid, morale drops, and turnover rises. A few employees were especially annoyed by pay deductions that took less than they had anticipated. Junior doctors complained they didn't get the actual amount guaranteed, with inexplicable deductions cutting into take-home pay. Others reminded that overtime or night shifts weren't sufficiently paid, which seemed to make hours worked even less justifiable. As one nurse explained, " We do extra work, but it's hardly ever paid. It also affects our health ." Nevertheless, some of the staff found the local work to have its perks. For others, reduced costs of living and perks such as housing or leisure facilities balanced out reduced wages. One doctor explained, " Even when wages are higher somewhere else, living is more expensive too. Here, I save more ." Such a compromise made the arrangement more bearable for some, but not everyone. In addition to compensation, respondents also mentioned about lost benefits such as health insurance, paid time off, or pension schemes. These omissions left employees feeling insecure about their finances, particularly those in positions with non-permanent contracts. One of the nurses noted, " If we had health insurance and retirement benefits, we would feel more secure and committed ." Others had felt underpaid relative to peers both in other hospitals and even within the same hospital which further contributed to perceptions of injustice. Physiotherapists, specifically, complained of their work being undervalued relative to doctors, even though they were heavily involved with patient care. On the positive side, job security at this hospital was regarded as an asset. Many expressed that they felt more secure here than perhaps elsewhere in private institutions. One physician commented, " the present organisation gives us job security you don't find that in many private hospitals ." That feeling of stability was valued, particularly by those who had witnessed friends losing jobs elsewhere. Although some joked about having backup plans such as opening their own clinics, generally, individuals appreciated having a stable job in an unpredictable healthcare climate. Overall, pay and benefits were the primary areas of discontent many felt underpaid and under-supported, particularly when overtime was not compensated or benefits were absent. Meanwhile, job security provided some reassurance and kept employees on board despite monetary disappointments. A nurse encapsulated the equilibrium nicely: " Pay is significant, but the majority of us did not get into nursing for money we are here because we care ." Nevertheless, making sure fair and transparent compensation is a prerequisite to retaining staff motivated and content. Theme 3: Relationships and Support at Work – Meeting Social Needs A consistent message throughout all groups was that positive working relationships at work whether with colleagues, managers, or management contribute significantly to job satisfaction. Even when staff were overwhelmed by workload or underpaid, many reported that good teamwork and positive social relationships helped them through the day. One nurse summarized it succinctly: "A supportive team and good relationships with colleagues can make a big difference in job satisfaction." Among the nurses and physiotherapists in particular, teamwork and camaraderie were the major sources of resilience. Nurses explained how they covered for each other during peak shifts, taking a colleague from one with less workload: " If ICU is busy, we take one staff from a ward which has less patients… staff collaborate ," opined one nurse. Others explained how tight-knit teams minimized stress and burnout. Physiotherapists also defined their unit as being " like a family ," with joint meals and free time spent together away from work relations that made the job more enjoyable without official support. But this sense of community was not uniformly present in all departments. A few technicians and administrators reported feeling isolated, not often speaking to colleagues from other units. " Sometimes you don't even recognize people who've worked here for years," said one administrator, wishing for more cross-departmental relationships. A few participants indicated that team-building exercises could fill this gap and foster a greater sense of cohesion. Supervisor and senior relationships were another critical consideration. Junior doctors emphasized that respectful and supportive interactions with senior team members rendered their work environment much more tolerable. As one resident indicated, " When seniors respect us, we feel less overwhelmed ." Positive mentorship ensured that they felt more confident and receptive to learning. Conversely, mentorship and communication gaps from senior staff were reported by newer workers. Encounters with hospital administration were more ambivalent. Some employees, especially in physiotherapy, mentioned that they were supported by their departmental chiefs, especially when it was about personal requirements such as holidays or family issues. " It's not about work it's about them caring for us and our families too ," a physiotherapist noted. There, individuals felt secure, respected, and " like management has your back ." However, the same thought was not shared by other cadres. Nurses and technicians frequently reported feeling ignored by leadership. They spoke of meetings in which they brought up problems, only to have no action follow. " We report our issues to them, but nothing happens after that ," said one nurse. Another contributed, " Management tells us not to do some things, but does not provide us with the resources to do it differently ." These were illustrations of the lack of communication and responsiveness that made staff feel frustrated and unsupported. Overall, workplace relationships both peer-to-peer and with management had a significant impact on the feelings staff had about their jobs. Effective teamwork and empathetic leadership made even difficult conditions more tolerable, while inadequate communication and lack of management support contributed to dissatisfaction. As one physiotherapist put it, " Workplace should feel like a second home ," and in those areas where that feeling of belonging was present, morale was obviously better. These results confirm the need to encourage a positive, engaged workplace culture one where collaboration, mentoring, and open communication are daily habits. Theme 4: Feeling Valued – Recognition and Professional Respect (Esteem Needs) Staff were very clear that they are motivated and satisfied by being seen and valued for their work. Everyone from nurses to technicians to physicians commented on how much it means to be recognized and valued. As one physician said, " If our efforts aren't appreciated, it creates dissatisfaction ." This is the voice that most directly addresses esteem needs: the need to feel valued, competent, and respected. Most participants complained that they hardly ever got the recognition, particularly from management. Technicians complained most of all: " We do our best, sometimes go beyond, but it feels worthless ," one technician complained. Nurses complained similarly, reporting that they were often blamed for issues outside their control. For instance, when patients or visitors violated rules, nurses got the blame: " Visitors don't follow protocol… but nurses are blamed ," one nurse explained. Being constantly blamed left them feeling disrespected and demoralized. The other frustration was not being heard. Employees reported to bring up concerns or ideas at meetings only to have nothing done. " We speak out about our problems, yet nothing else is done afterwards ," said a nurse. Technicians also reported how tiresome it was to continually disturb management just to obtain standard work equipment, which made them feel unappreciated. For them, it was not about wanting to be praised it was about being respected and supported in getting their jobs done. Participants always spoke about needing even minor gestures of appreciation. Some intimated that straightforward things such as noting birthdays, work anniversaries, or public thanks could be a significant help. One administrator suggested an " employee of the month " scheme, while physiotherapists suggested team recognition as opposed to focusing on one individual. " It's better when the whole team is recognized, not an individual ," one person indicated. They feared individual recognitions would be competitive and devalue teamwork. Not everything was required to be recognized by the management. Great motivation was achieved by many employees when patients or relatives showed them appreciation. " When patients say thank you, it makes all your struggle worth it ," shared a physician. Nurses concurred what encouraged them most was watching patients improve and knowing that they had some role in achieving this. This appreciation reaffirmed their purpose and professional identity. Others even felt that their profession within the community nurse or doctor was something to be proud of, no matter what the day-to-day difficulties. Participants, however, yearned for greater recognition from the organization. One nurse remembered how an earlier leader had organized a humble cup of tea during night duty " It felt like they cared ," she said. That small act, though now stopped, had a lasting effect. Others complained about the lack of recreational activities or acknowledgement of paramedical personnel, which left them feeling neglected. " We haven't had an outing or team activity in more than a decade ," a technician observed. Fairness also operated on a sense of esteem. Administrators and physicians cited how, when learning opportunities for advancement were not administered openly such as when great cases only favoured senior physicians there was disrespect to others. An administrator raised the example how without open feedback or evaluation methods, even diligent workers could also feel overlooked and demotivated. Respect, they contended, entails both fairness and ethics in communication. Briefly, the theme expresses the wide gap that exists between all the hard work employees put into their work and the appreciation received. Though acknowledgement from patients adds a touch of pride, it is still numerous who feel undermined by their institution. Simple regular acts of gratitude listening, showing appreciation for what is accomplished, celebrating birthdays could truly be the make-or-break issue. As one of the physiotherapists explained, "Feeling valued has a huge impact on motivation ." Without that, even zealous healthcare providers can start feeling invisible and second-guessing their role. This is congruent with the larger body of research indicating recognition, rather than money alone, retains and boosts staff in the healthcare environment. Theme 5: Self-Actualization and Growth (Potential for Development and Fulfillment) The last theme revolves around participants' desire for professional development, learning, and contribution aligning with the pinnacle of Maslow's hierarchy: self-actualization and esteem of higher order. Most healthcare providers across cadres had a keen desire to gain more knowledge, progress in their careers, and utilize their skills to the maximum. But scarce chances for training, advancement, mentoring, or innovation left most feeling " stuck ," underused, and in danger of disengagement. When development chances existed even modestly they made a major difference in morale, highlighting the internal motivation among employees to develop and contribute in meaningful ways. Another persistent subtheme was the absence of formal training or professional development. Some participants mentioned that building skills usually happened informally, not through formal institutional initiatives. One nurse commented, " No, we train ourselves by ourselves only; no such training session is given to us. I used to receive training for grooming when I was working in another hospital" (Nurse). Technicians also expressed frustration: " We would like some departmental training; there's no professional development here at all " (Technician), pointing out that without practical training especially for working with equipment learning stalled. Administrators also highlighted the need to endow employees with future-proof competencies: " Skill development opportunities should be provided… which is currently lacking in this organization " (Administrator). Career stagnation was another theme that was popular across groups. Members from groups spoke of long years of work without any growth. " I have been working here ten years… no growth ," said one technician (Technician), and a nurse described being " stuck in the same position for years " (Nurse). Physiotherapists observed that while the workplace provided early exposure and learning for new recruits, it was not ideal for experienced professionals because of few roles: " For me, this place is very good for exposure… but for people who have years of experience, I don't see many positions to grow into " (Physiotherapist). Administrative personnel signalled the lack of clear evaluation processes: " If appraisal criteria aren't communicated, an employee could work hard at the wrong things and feel demoralized " (Administrator). Such ambiguity broke down motivation and trust in the system. Onboarding and mentoring were also deemed lacking. Newly hired employees would often feel unsupported when integrating into positions, which could delay integration and satisfaction. " When I stepped out of being a student and into being an employee, I had so many doubts about myself. I needed a leading hand ," revealed an administrator (Administrator). A physiotherapist spoke of: " When I first came in, it was my first job, and I didn't know anything. induction activities were not conducted, policies briefing were not conducted " (Physiotherapist). These discrepancies indicated a more general problem with how the organization developed new talent. Some of the participants in their teaching capacity cited faculty development programs favorably: " Our department has had some leadership courses… they helped" (Physiotherapist), indicating that when such support was in place, it was highly valued. Participants also expressed concerns about the absence of support for academic or research development. Staff members who carried both clinical and teaching duties found it challenging to serve both without institutional support. Said one physiotherapist, " Time for academic and time for clinical should be separated so that our career growth won't get interrupted " (Physiotherapist). A physician also said, " We should stay informed about new developments and technologies… What's the point of being excited if we aren't making progress? " (Doctor). With the demands of services overwhelming them, other physicians felt they couldn't advance or even keep up with their profession. Even skill implementation became difficult in low-volume departments: " Few patients report at present… that is what troubles me " (Doctor). Low workload was also reported as demotivating by nurses: " There is no tension as there is not much patient load this is a negative point, we even feel like coming to work at least to deliver something and leave " (Nurse). These accounts showed that employees found meaning in being able to assist others, and meaningful participation was lost when job satisfaction was dulled. The aspiration for innovation and keeping abreast of new healthcare practices was particularly prevalent with physicians and physiotherapists. One senior physician cautioned, " If we don't keep up [with new developments], we risk falling further behind " (Doctor), citing lacunae in technology uptake (e.g., robotics, AI). Meanwhile, physiotherapists welcomed their department's diverse clinical configurations, which made them familiar with a range of techniques, albeit still demanding institutionalized opportunities for development beyond regular responsibilities. Members provided a few recommendations to do better in this regard. These were more regular training (both technical and soft skills), definite career ladders and appraisal structures, onboarding and mentoring, reserved time for research or postgraduate studies, and investment in infrastructure to enhance innovation. An administrator suggested " variations in roles and responsibilities… to keep work interesting " (Administrator), which is aligned with job enrichment strategies. Staff also called for hiring additional personnel to distribute workload more evenly, enabling time for professional development. Importantly, this theme intersected with others: when basic needs (e.g., adequate staffing) or esteem needs (e.g., recognition) were unmet, employees struggled to pursue growth. For example, nurses wanted to attend workshops but couldn’t be spared due to short staffing, while doctors lacked motivation to innovate if management never acknowledged their input. As one physiotherapist noted, " Human needs can never be satisfied… we have to pretend to be happy " (Physiotherapist), indicating a recognition of the perpetual quest for satisfaction, even in the face of institutional obstacles. Yet another participant provided a note of optimism: " When hospitals invest in their doctors, it shows they value their work" (Doctor). This feeling connected self-actualization to esteem opportunities for development were not merely about growth, but also about feeling valued and trusted. In general, Theme 5 emphasizes that most healthcare professionals are motivated by a strong inner desire to develop, learn, and make a difference. Yet, when systems fail to allow this development, morale suffers, and staff will disengage in spite of passion. Investing in education, mentorship, scholarly participation, and equitable systems of advancement is not simply a matter of enhancing retention rather, it is a way of respecting the professional dignity and promise of health care workers. As one physician well said, "98% [of job satisfaction] is how we approach our jobs" (Doctor) but that manner of approaching has to be fostered by infrastructures that enable individuals to excel. Discussion Through the lens of Maslow's hierarchy of needs, this study searched for the intricate factors that influence personnel's job satisfaction in a tertiary care hospital. The qualitative analysis provides light on how healthcare professionals perceive their workplace and the ways in which different organizational and psychosocial factors interact to influence their sense of well-being, motivation, and performance. The emergent themes map generally onto Maslow's (1943) hierarchical needs hierarchy, which includes physiological and safety needs (suitable staffing, equitable pay, and a secure working environment), social needs (staff camaraderie, respect at work), esteem needs (deference, gratitude), and self-actualization (opportunities for growth, autonomy, purposeful work). Our research also indicates, however, that moving through these levels is not strictly sequential or linear. Participants tended to be in multiple need states at once, and in certain situations, placed intrinsic motivators (e.g., patient care, self-improvement) before unmet basic needs. This lends credence to the updated views presented by [ 16 ], who advocated for a dynamic approach where needs are adaptive and interdependent in their contexts of prioritization. Basic Needs and Systemic Challenges At the most basic level, limitation of resources in the form of inadequate staffing, poor infrastructure, and a shortage of necessary supplies was highlighted by majority of the participants as a major source of dissatisfaction and hindered work performance. Numerous participants described how these shortages undermined patient care as well as individual well-being, perpetuating a cycle of disengagement and burnout. These results align with international literatures, [ 1 , 18 ] where researchers identified that nurse staffing levels were positively correlated with job satisfaction, burnout, and patient outcomes. Similarly, few studies also emphasize the long-term work stressors in healthcare settings as important indicators of professional dissatisfaction and emotional exhaustion [ 17 , 19 ]. Although pay was frequently cited as a source of dissatisfaction, it was rarely mentioned as the sole source of motivation. The respondents desired a compensation structure that took into account their professional commitment, qualifications, and workload. This is in line with Herzberg's two-factor theory, which contends that although pay is a necessary hygiene factor, motivation and satisfaction cannot be generated solely by it. Rather, a more nuanced perspective emerged, stating that financial incentives are important but not the only motivation factor. When financial compensation was coupled with opportunities for advancement, professional respect, and recognition, participants were more likely to express satisfaction. Psychosocial Climate and Interpersonal Dynamics A positive discovery was the team bonding and peer support as shields against work stress. The majority of the participants emphasized the strength of interpersonal connections among colleagues, which assisted positively towards their resilience and sense of belongingness. These are supported by studies emphasizing the importance of positive team dynamics in the development of nurse retention and the avoidance of burnout [ 12 , 20 ]. In present study, friendship often compensated for other organizational deficiencies but was not shared. Where hierarchical organizations were rigid or where there was poor communication between administrative and clinical staff, participants recorded increased alienation and dissatisfaction. Junior staff, in particular, indicated voice and agency issues, namely, inadequate participatory decision-making and feedback mechanisms. This is important because an absence of autonomy and recognition has consistently been correlated with reduced job satisfaction in health care [ 21 , 22 ]. Flattening structures, cultivating shared governance, and creating feedback loops within organizational culture may prove to be vital in preventing such issues. Recognition, Growth, and Meaning Beyond physical and social needs, the desire for esteem and self-actualization was a powerful stimulus to job satisfaction. Respondents typically cited affective rewards of patient care, professional development, and pride of accomplishment as they became proficient at their work. These motivators are aligned with Maslow's higher-order needs and suggest that the majority of healthcare workers perceive their work as a calling, not just work. Researches also identifies the importance of intrinsic motivation, autonomy, and work with meaning in sustaining engagement [ 23 , 24 ]. Nevertheless, the participants also identified that lack of opportunities for professional developments were deterrent to professional growth. The lack of continuing education, obscure career tracks, and lack of merit-based promotion were reasons for frustration. This is of concern, since inaction on fulfilling self-actualization needs has the potential to cause stagnation and turnover, especially among newer or more aggressive staff [ 25 ]. Formal professional development programs, career advancement programs, and mentorship can be viable solutions to such obstacles, as the same has been advocated by studies stating that Opportunity for self-development was biggest satisfier [ 26 ]. Contextualizing with Indian Healthcare Settings Although much of the findings tallies with the international trends, it is also necessary to take cognizance of the situation-specific issues of the Indian public health system. Indian healthcare workers are characteristically affected by chronic underfunding, bureaucratic constraints, and patient overload. Studies has identified these systemic stressors, and they are frequently worsened by institutional insensitivity to staff concerns [ 26 , 27 ]. For our research, the disjuncture between policy rhetoric (e.g., human resource strengthening) and implementation reality (e.g., vacant positions, lack of equipment) was a source of cynicism among our participants. Implications for Practice and Policy : These results indicate that any attempt to enhance job satisfaction and performance will have to take a multidimensional route. Interventions need to extend beyond salary adjustments or recruitment campaigns to institutional culture changes, participatory leadership, and systemic reform same has been justified by a study [ 28 ]. Health administrators ought to give high priority to: Resource sufficiency (staffing, infrastructure); Transparent and equitable remuneration systems; Developing career progression paths; and Acknowledging and celebrating contributions at all levels. Finally, job fulfilment among healthcare personnel is a matter of moral mandate and strategic urgency. A dedicated and satisfied staff is the underpinning on which to establish safe, sensitive, and productive healthcare. Conclusion This qualitative study, placed within Maslow's hierarchy of needs, provides rich, context-dependent insights into the multi-layered determinants of job satisfaction across various cadres of hospital staff, consistently emphasizing the need for a foundation of adequate resources, fair remuneration, and physical and psychological safety. These needs are not merely logistical concerns but prerequisites for long-term involvement, professional integrity, and compassionate care. Most importantly, experiences in each cadre were not distinct but highly intertwined. A strong leadership or managerial shift benefits the system as a whole, while infrastructure, identification, or leadership weaknesses harmed all roles. This argues in favour of cross-cadre, systemic interventions that address the common as well as the differential needs of multiple staff groups. Lastly, this study emphasizes the reality that health care professionals are not merely service providers but human beings going through a range of needs. Meeting those needs in their entirety is not merely an ethical imperative it's a strategic one. A satisfied and engaged workforce is the cornerstone of patient safety, clinical excellence, and institution resilience. As global health systems are struggling with growing workforce issues, this research contributes qualitative data to the contention that investing in staff well-being is the solution to providing sustainable, people-centred healthcare. Future research and policy need to continue employing integrative frameworks like Maslow's to capture the entire range of staff experiences and to create interventions that do not leave any cadre behind. Finally, to strengthen health systems from the inside, we first have to ensure that those who give care are seen, heard, and cared for at every point of their human and professional journey. Abbreviations FGDs Focus Group Discussions ICU Intensive Care Unit COREQ COnsolidated criteria for REporting Qualitative research Declarations Ethics approval and consent to participate : The study protocol was approved by the Institutional Ethics Committee of Sikkim Manipal University in India (Ref No.: SMIMS/IEC/2022-117). After being assured that their participation was entirely voluntary and confidential, each participant provided written informed consent. Additionally, they were informed that the conversations would be audio recorded, and their consent was obtained for the same as well. All procedures followed in this study adhered to the relevant ethical guidelines and regulation, including the principles outlined in the Declaration of Helsinki, ChatGPT and QuillBot tools were also used to enhance the manuscript's language, spelling, and grammar. After using these tools to assess and revise the publication's content as needed, the authors take up the full responsibility for its content. Clinical Trial Registration Number: Not Applicable Consent for Publication: Not Applicable Availability of data and material: The datasets collected and analysed in the present study are available from corresponding author on reasonable request. Competing interests: The authors declare no competing interests. Funding: The authors received no financial support for the research, or publication of the study. Authors' contributions : KP collected the data and wrote the main manuscript. DB and RS helped in final Coding decisions (data analysis). SK helped in data collection. All authors reviewed the final manuscript, and approved it. Acknowledgements: Sincere gratitude to all the participants who participated in this study, and all other healthcare professionals and staffs of the university who contributed indirectly in completing the studies. Authors' information: Kreeti Pal - Assistant Professor, Department of Hospital Administration, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University (SMU), Tadong, India. *corresponding author is - Kreeti Pal Dr. Dechenla Tsering Bhutia - Professor and Head Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University (SMU), Tadong, India. Dr Rakesh Kumar Saroj - Assistant Professor, School of Computational and Integrative Sciences, Jawaharlal Nehru University - New Delhi, India Dr Sanjay Kumar - Professor and Head Department of Physiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University (SMU), Tadong, India. 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Perspect Psychol science: J Association Psychol Sci. 2010;5(3):292–314. https://doi.org/10.1177/1745691610369469 . Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, West CP, Sloan J, Oreskovich MR. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377–85. https://doi.org/10.1001/archinternmed.2012.3199 . Bagheri SH, Kousha A, Janati, Asghari- Jafarabadi M. Factors Influencing the Job Satisfaction of Health System Employees in Tabriz, Iran. Health Promot Perspect. 2012;2(2):190–6. Leiter MP, Maslach C. Nurse Turnover: The Mediating Role of Burnout. J Nurs Adm Manag. 2009;17:331–9. http://dx.doi.org/10.1111/j.1365-2834.2009.01004.x . Tourangeau AE, Cranley LA. Nurse intention to remain employed: Understanding and strengthening determinants. J Adv Nurs. 2006;55(4):497–509. https://doi.org/10.1111/j.1365-2648.2006.03934.x . Adams A, Bond S. Hospital nurses' job satisfaction, individual and organizational characteristics. J Adv Nurs. 2000;32(3):536–43. https://doi.org/10.1046/j.1365-2648.2000.01513.x . Laschinger HK, Finegan J, Shamian J, Wilk P. Impact of structural and psychological empowerment on job strain in nursing work settings: expanding Kanter's model. J Nurs Adm. 2001;31(5):260–72. https://doi.org/10.1097/00005110-200105000-00006 . Lambrou P, Kontodimopoulos N, Niakas D. Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital. Hum Resour Health. 2010;8:26. https://doi.org/10.1186/1478-4491-8-26 . Gagné M, Deci EL. Self-determination theory and work motivation. J Organizational Behav. 2005;26(4):331–62. https://doi.org/10.1002/job.322 . Laschinger HK, Finegan J, Wilk P. New graduate burnout: the impact of professional practice environment, workplace civility, and empowerment. Nurs Econ. 2009;27(6):377–83. Rao KD, Bhatnagar A, Berman P. So many, yet few: Human resources for health in India. Hum Resour Health. 2011;10:19. https://doi.org/10.1186/1478-4491-10-19 . Kabene SM, Orchard C, Howard JM, Soriano MA, Leduc R. The importance of human resources management in health care: A global context. Hum Resour Health. 2006;4:20. https://doi.org/10.1186/1478-4491-4-20 . Mathauer I, Imhoff I. Health worker motivation in Africa: the role of non-financial incentives and human resource management tools. Hum Resour Health. 2006;4:24. https://doi.org/10.1186/1478-4491-4-24 . Additional Declarations No competing interests reported. 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2","display":"","copyAsset":false,"role":"figure","size":83603,"visible":true,"origin":"","legend":"\u003cp\u003eTheme categorization based on Maslow’s Hierarchy of needs.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7526298/v1/213d019d2be94cb43a11ad48.png"},{"id":94139232,"identity":"7f19abfb-7164-4896-a94b-844f55faf828","added_by":"auto","created_at":"2025-10-22 19:31:59","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1294878,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7526298/v1/66fb8cf6-2b9e-4828-9ea9-94e4ea1ab8a6.pdf"},{"id":94138110,"identity":"a4e8aca0-2558-4dbe-b339-37a596c51c32","added_by":"auto","created_at":"2025-10-22 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Low morale in stressful settings such as hospitals results in employee burnout, turnover, and decreased patient care. In contrast, positive working conditions that meet the needs of staff can improve motivation, performance, and quality of care [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Studies note a positive association between patient and healthcare workers' satisfaction [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], whereas low morale has been found to be related to decreased quality and safety in care [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMaslow's hierarchy of needs [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] is also a helpful model for describing job satisfaction. It suggests that individuals need to fulfil fundamental needs like compensation, rest, and safety before progressing towards higher-order motivators such as belonging, esteem, and self-actualization. Translated to the health workforce, this model emphasizes the need for safe jobs, equitable workloads, peer support, esteem, and opportunities for professional development. Though supporting theories such as Herzberg's motivator-hygiene theory also advocate for the same perspective, evidence generally points towards the need to meet both lower and higher-order needs in order to maintain motivation and retention [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eGaps Identified and Rationale\u003c/h3\u003e\n\u003cp\u003e\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eSingle Cadre Focus Narrow: Current research tends to be centred on physicians or nurses, ignoring the experiences of other key personnel such as technicians, physiotherapists, and administrators [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Such siloed perspective hinders the formulation of broad policies.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eOverreliance on Quantitative Research: Most research is based on questionnaires and measures, which tend to overlook subtle experiences and contextual variables driving job satisfaction.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLimited Use of Maslow's Framework in Context: Although Maslow's theory has been widely cited, few researchers have systematically applied it to research satisfaction among multiple healthcare professionals within one organizational facility.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e The present study fills the mentioned loopholes by applying qualitative research approaches to examine job satisfaction among several groups of hospital staff in one tertiary care facility. This is more effective at encapsulating collective and role-specific issues compared to quantitative measures. Thematic analysis based on Maslow's hierarchy offers a systematic but adaptable framework with which to evaluate both lower-level and higher-level needs, supporting more focused and integrated strategies for enhancing workplaces. Insight into diverse staff viewpoints of doctors, nurses, allied health workers, and administrators gives insights necessary for the development of comprehensive and sustainable interventions.\u003c/p\u003e\u003cp\u003eThis research aims to examine the determinants of job satisfaction across various cadres of hospital workers with Maslow's hierarchy of needs as guiding principles. Through qualitative analysis of experience across doctors, nurses, technicians, physiotherapists, and administrators, it identifies common themes and role-specific issues to inform policies that will enhance well-being, retention, and high-quality care.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cdiv id=\"Sec4\" class=\"Section3\"\u003e\u003c/div\u003e\u003c/div\u003e\n\n\n\n\n\n\n\n"},{"header":"Methodology","content":"\u003ch2\u003eStudy Design and Setting\u003c/h2\u003e\u003cp\u003eA qualitative study in the form of focus group discussions (FGDs) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] was carried out among healthcare professionals. The study was conducted at the Central Referral Hospital, a 500-beded tertiary care teaching hospital in Sikkim, India. The hospital consists of a mix of healthcare workers, including doctors, nurses, paramedical technicians, physiotherapists, and administrative staff. We used FGDs to take advantage of group dynamics – enabling participants to reflect back and compare on experience, and to elicit rich discussions on common workplace issues. Seven FGDs were conducted in a University lecture hall/ departmental demonstration room within the hospital campus, each lasting around 40–60 minutes.\u003c/p\u003e\u003ch3\u003eParticipants and Recruitment\u003c/h3\u003e\u003cp\u003eParticipants were purposively sampled to represent five most significant cadres of hospital staff: doctors, nurses, laboratory/imaging technicians, physiotherapists, and hospital administrators. Homogeneous FGDs were held separately for each cadre to ensure easy discussion without hierarchical restraint (e.g., doctors and nurses were split into separate groups). Two FGDs for doctors and nurses were conducted (to deal with their larger numbers and different experiences), and one FGD each for the other cadres (technician, physiotherapist administrator), resulting in seven FGDs. Around 6–9 participants belonged to each group (average ~ 6), and a total of 50 people (13 doctors, 12 nurses were included, 6 technicians, 9 physiotherapists, 10 administrators) participated in the FGDs. Participants included junior staff (e.g. resident doctors, staff nurses) and senior staff (consultants, nurse supervisors, department managers), to ensure a range of perspectives. Inclusion criteria were 6 months of working experience at the hospital and willingness to share experiences. Participants were invited through departmental heads and personal invitations. All invitees provided informed consent before participation. To maintain confidentiality, no personal identifiers were recorded; participants are referred to by cadre (e.g., \"Doctor\", “Nurses”…) in the report.\u003c/p\u003e\u003ch3\u003eData Collection\u003c/h3\u003e\u003cp\u003eA semi-structured FGD guide (Appendix-I) was employed to generate discussion, the guide was prepared with review of literature [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and approved by subject experts. The main questions invited participants to comment on their understanding of job satisfaction and dissatisfaction, work motivators, work issues that affect their morale, relations with colleagues and management, and ideas for changing things for the better. Probes were employed to probe further into areas reflecting different levels of needs (e.g., \"\u003cem\u003eWhat about that makes it easy or difficult to do your job\u003c/em\u003e?\" for basic needs; \"\u003cem\u003eDo you feel valued and recognized\u003c/em\u003e?\" for esteem needs; \"\u003cem\u003eHow do opportunities for growth here compare with your expectations?\u003c/em\u003e\" for self-actualization). Each discussion was facilitated by researcher KP, supported by a note-taker. FGDs were facilitated in English (the institutional language) with occasional checking in the local language Nepali/Hindi) where appropriate. All discussions were audio-recorded using “Sony ICD-UX570 Digital Voice Recorder” with consent and transcribed verbatim. Transcripts were verified against recordings for accuracy. Field notes on group dynamics and non-verbal communication were added to provide context to the transcripts.\u003c/p\u003e\u003ch3\u003eTheoretical Framework\u003c/h3\u003e\u003cp\u003eMaslow’s hierarchy of needs was employed as a sensitizing framework throughout the research process. This meant that while coding and theme development were primarily data-driven (inductive), simultaneously attention was also given towards how expressed issues related to various need levels (physiological, safety, social, esteem, self-actualization). In the later stages of analysis, the emergent themes were interpreted in light of Maslow’s theory to understand whether and how different needs were being met or unmet for each cadre. This theoretical lens helped in structuring the findings and drawing connections with existing theory​.\u003c/p\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eReflexive thematic analysis, was employed according to Braun and Clarke’s six-step process [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. At first, the transcripts were read several times for familiarization, then line-by-line inductive coding was conducted with NVivo 15 software (e.g., “staff shortage,” “no time for lunch,” “appreciation by patients,” “lack of promotion”) by first author. Later the related codes were grouped into subthemes and broader themes, which were refined through iterative discussion and constant reference to the transcripts. Maslow’s hierarchy guided interpretation—for example, codes on salary, workload, and working conditions were consolidated under unmet basic needs.\u003c/p\u003e\u003cp\u003eIn the fifth stage a constructed and labelled final themes and subthemes were identified, with five overarching themes, each with 3–4 subthemes, that captured different aspects of job satisfaction. Lastly, during the reporting stage, rich representative quotes for every subtheme were chosen to demonstrate the findings. Participant roles (e.g., Nurse, Technician) were indicated, but no personal identifiers were used. Coding decisions were reviewed collaboratively, discrepancies resolved by consensus, and preliminary findings were shared with a small participant sub-sample for member checking. COREQ guidelines for reporting qualitative studies were adhered to [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003ch3\u003eEthical Considerations\u003c/h3\u003e\u003cp\u003eThe study was approved by the Institutional Ethics Committee, \u003cem\u003eRef No.- SMIMS/IEC/2022 − 117\u003c/em\u003e. All participants provided written informed consent and were assured that participation was voluntary and confidential. To protect anonymity, any potentially identifying details (e.g., specific department names or individuals mentioned in FGDs) were removed or generalized in the transcripts. Participants were encouraged to speak freely, and ground rules for respectful discussion were established at the start of each FGD. Audio recordings and transcripts are stored securely and accessible only to the researcher. Findings were shared with hospital leadership in aggregate form to inform organizational improvements, without attributing any comments to individuals.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e Participants described a wide range of factors influencing their job satisfaction. Despite differences in roles, there was striking convergence in many of the challenges expressed across cadres, Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e represents the key word/codes identified. In line with Maslow\u0026rsquo;s theoretical lens, the themes reflected needs spanning from basic resource-related issues to higher-order psychological needs. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the five main themes and subthemes that emerged, detailed presentation of same with exemplar quotes from different staff cadres is presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. We present each theme in detail below, integrating verbatim quotes to illustrate commonalities and contrasts among doctors (D), nurses (N), technicians (T), physiotherapists (PT), and administrators (A).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eTheme Chart Based on Maslow's Hierarchy of Needs\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaslow's Level\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eThemes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eKey Codes / Issues\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCadres Mentioning It\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Physiological Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCompensation \u0026amp; Benefits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003esalary, and other fringe benefits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAll cadres\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorking Conditions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBasic office facilities,\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdministrators, Technicians, Nurses\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorkload\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eworking hours, role overload, number of staff posted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDoctors, Nurses, Technicians\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Safety Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eJob Security\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStable employment, fear of job loss, long-term roles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDoctors, Administrators, Physiotherapists\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWorkplace Safety\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAggression from patients/visitors, safety enforcement issues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurses\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eManagement Efficacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePoor leadership responsiveness, favoritism, inconsistent rules\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurses, Technicians, Administrators\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResources \u0026amp; Infrastructure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBroken machines, slow supply chain, outdated IT systems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAll cadres\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Belongingness \u0026amp; Love Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTeamwork \u0026amp; Work Culture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFriendly, collegial environment, senior\u0026ndash;junior respect, \u0026ldquo;family-like\u0026rdquo; teams\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAll cadres\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eInterdepartmental Unity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesire for cross-team collaboration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePhysiotherapists, Administrators\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRecognition Approach\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesire for inclusive recognition events, team-based acknowledgment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePhysiotherapists, Nurses\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Esteem Needs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRecognition \u0026amp; Appreciation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eLack of formal recognition, blame culture, feeling undervalued\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAll cadres\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntrinsic Rewards\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePatient gratitude, pride in quality care, impact on patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDoctors, Nurses, Physiotherapists, Technicians\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOrganizational Culture\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEthical environment, no office politics, transparent communication\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdministrators, Doctors\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFairness \u0026amp; Equity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEqual task distribution, avoidance of favoritism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNurses, Administrators\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Self-Actualization\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAutonomy \u0026amp; Responsibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFreedom in clinical decisions, departmental input\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDoctors, Physiotherapists\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCareer Growth \u0026amp; Development\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOpportunities for promotion, leadership training, learning exposure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAll cadres\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRole Clarity \u0026amp; Onboarding\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePoor induction, unclear duties, academic-clinical balance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTechnicians, Physiotherapists\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmployee Involvement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExit interviews, feedback loops, empowerment in decisions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdministrators, Nurses\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePreventing Stagnation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDesire for evolving roles, new challenges over time\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdministrators\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 1: Stressed Resources and Overwhelming Workload \u0026ndash; Meeting Basic Needs to Enhance Care and Well-being\u003c/b\u003e\u003c/p\u003e\u003cp\u003eHealthcare workers across different roles consistently reported a strong sense of responsibility toward their work, despite facing significant operational challenges. A common concern was the lack of access to basic necessities such as adequate rest, meals, and safety measures, which they felt directly influenced both their personal well-being and the quality of patient care. Many voiced the need for improved staffing and systems that would allow for scheduled breaks. One of the nurses remarked, \"\u003cem\u003eWe are in the hospital so long without even a decent place to have lunch\u003c/em\u003e,\" and another said, \"\u003cem\u003eWith fewer personnel, we help one another taking turns so that someone can just grab tea or food in a flash while others see to the patients\u003c/em\u003e.\" Although there was a feeling of teamwork and collaboration, the underlying fatigue issue was still apparent.\u003c/p\u003e\u003cp\u003eStaff shared similar concerns, often citing the uneven workload. One of the staff said, \"\u003cem\u003eTen people's work is placed on four of us\u003c/em\u003e,\" indicating the stress generated by the understaffing and limited resources. Though staff were committed to delivering patient care, there was a hidden blame that the existing working conditions were physically and emotionally demanding. A few thought that a change in working conditions would have a positive impact on their potential to deliver efficiently.\u003c/p\u003e\u003cp\u003eThere was also a general consensus that the quality of care depended on the amount of institutional support present. \"\u003cem\u003eWhen healthcare workers are too pressured, it actually affects the quality of care\u003c/em\u003e,\" said a doctor, while a physiotherapist tied patient satisfaction with how much time and attention the staff could deliver. These were sentiments that indicated that the willingness to provide good care was usually being affected by shortcomings in the system.\u003c/p\u003e\u003cp\u003eInfrastructure and equipment issues were a significant area of concern. Technicians cited delays in the delivery of equipment and how improved logistical systems would enhance efficiency. Nurses cited a need for improved infrastructure and policy to enhance patient outcomes as well as work safety.\u003c/p\u003e\u003cp\u003eConcerns about safety and workplace order were also discussed, particularly in relation to visitor management and security protocols. Staff expressed a need for better enforcement of rules to maintain a peaceful and safe environment. \"\u003cem\u003eWe address everything face to face without an intermediary, which increases our stress\u003c/em\u003e,\" said one technician. Aggressive incidents involving patient family members were reported, and staff complained of needing more formalized and standardized administrative action.\u003c/p\u003e\u003cp\u003eIn spite of these continuing challenges, some employees held a stimulated confidence that situations might be improved if tangible steps were taken e.g., filling jobs, creating specific resting areas, making systems more efficient, and following safety standards. As one nurse explained, \"\u003cem\u003eProper staffing, infrastructure, and resources can reduce stress and improve job satisfaction\u003c/em\u003e.\" While there were upbeat expressions, these were often clouded with immediate frustrations and a desire for tangible, systemic changes.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eTheme 2: Financial Strain and Job Security \u0026ndash; Compensation and Stability\u003c/h2\u003e\u003cp\u003eNumerous participants freely shared frustration with wages, terming salaries as being too low for what they perform, particularly with respect to an escalating cost of living. For the majority, it wasn't about the money it was about fairness and being valued. A physician put it bluntly: \"\u003cem\u003eWe need better salaries\u003c/em\u003e,\" and a technician with ten years of experience added, \"\u003cem\u003eThere's been no growth in pay\u0026hellip; others performing similar work at other institutions get paid more.\u003c/em\u003e\" Nurses communicated this as well, stating that higher-paying opportunities elsewhere caused staff to leave. These experiences reflect a broader issue in healthcare: when people feel underpaid, morale drops, and turnover rises.\u003c/p\u003e\u003cp\u003eA few employees were especially annoyed by pay deductions that took less than they had anticipated. Junior doctors complained they didn't get the actual amount guaranteed, with inexplicable deductions cutting into take-home pay. Others reminded that overtime or night shifts weren't sufficiently paid, which seemed to make hours worked even less justifiable. As one nurse explained, \"\u003cem\u003eWe do extra work, but it's hardly ever paid. It also affects our health\u003c/em\u003e.\"\u003c/p\u003e\u003cp\u003eNevertheless, some of the staff found the local work to have its perks. For others, reduced costs of living and perks such as housing or leisure facilities balanced out reduced wages. One doctor explained, \"\u003cem\u003eEven when wages are higher somewhere else, living is more expensive too. Here, I save more\u003c/em\u003e.\" Such a compromise made the arrangement more bearable for some, but not everyone.\u003c/p\u003e\u003cp\u003eIn addition to compensation, respondents also mentioned about lost benefits such as health insurance, paid time off, or pension schemes. These omissions left employees feeling insecure about their finances, particularly those in positions with non-permanent contracts. One of the nurses noted, \"\u003cem\u003eIf we had health insurance and retirement benefits, we would feel more secure and committed\u003c/em\u003e.\" Others had felt underpaid relative to peers both in other hospitals and even within the same hospital which further contributed to perceptions of injustice. Physiotherapists, specifically, complained of their work being undervalued relative to doctors, even though they were heavily involved with patient care.\u003c/p\u003e\u003cp\u003eOn the positive side, job security at this hospital was regarded as an asset. Many expressed that they felt more secure here than perhaps elsewhere in private institutions. One physician commented, \"\u003cem\u003ethe present organisation gives us job security you don't find that in many private hospitals\u003c/em\u003e.\" That feeling of stability was valued, particularly by those who had witnessed friends losing jobs elsewhere. Although some joked about having backup plans such as opening their own clinics, generally, individuals appreciated having a stable job in an unpredictable healthcare climate.\u003c/p\u003e\u003cp\u003eOverall, pay and benefits were the primary areas of discontent many felt underpaid and under-supported, particularly when overtime was not compensated or benefits were absent. Meanwhile, job security provided some reassurance and kept employees on board despite monetary disappointments. A nurse encapsulated the equilibrium nicely: \"\u003cem\u003ePay is significant, but the majority of us did not get into nursing for money we are here because we care\u003c/em\u003e.\" Nevertheless, making sure fair and transparent compensation is a prerequisite to retaining staff motivated and content.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eTheme 3: Relationships and Support at Work \u0026ndash; Meeting Social Needs\u003c/h2\u003e\u003cp\u003eA consistent message throughout all groups was that positive working relationships at work whether with colleagues, managers, or management contribute significantly to job satisfaction. Even when staff were overwhelmed by workload or underpaid, many reported that good teamwork and positive social relationships helped them through the day. One nurse summarized it succinctly: \"A supportive team and good relationships with colleagues can make a big difference in job satisfaction.\"\u003c/p\u003e\u003cp\u003eAmong the nurses and physiotherapists in particular, teamwork and camaraderie were the major sources of resilience. Nurses explained how they covered for each other during peak shifts, taking a colleague from one with less workload: \"\u003cem\u003eIf ICU is busy, we take one staff from a ward which has less patients\u0026hellip; staff collaborate\u003c/em\u003e,\" opined one nurse. Others explained how tight-knit teams minimized stress and burnout. Physiotherapists also defined their unit as being \"\u003cem\u003elike a family\u003c/em\u003e,\" with joint meals and free time spent together away from work relations that made the job more enjoyable without official support.\u003c/p\u003e\u003cp\u003eBut this sense of community was not uniformly present in all departments. A few technicians and administrators reported feeling isolated, not often speaking to colleagues from other units. \"\u003cem\u003eSometimes you don't even recognize people who've worked here for years,\"\u003c/em\u003e said one administrator, wishing for more cross-departmental relationships. A few participants indicated that team-building exercises could fill this gap and foster a greater sense of cohesion.\u003c/p\u003e\u003cp\u003eSupervisor and senior relationships were another critical consideration. Junior doctors emphasized that respectful and supportive interactions with senior team members rendered their work environment much more tolerable. As one resident indicated, \"\u003cem\u003eWhen seniors respect us, we feel less overwhelmed\u003c/em\u003e.\" Positive mentorship ensured that they felt more confident and receptive to learning. Conversely, mentorship and communication gaps from senior staff were reported by newer workers.\u003c/p\u003e\u003cp\u003eEncounters with hospital administration were more ambivalent. Some employees, especially in physiotherapy, mentioned that they were supported by their departmental chiefs, especially when it was about personal requirements such as holidays or family issues. \"\u003cem\u003eIt's not about work it's about them caring for us and our families too\u003c/em\u003e,\" a physiotherapist noted. There, individuals felt secure, respected, and \"\u003cem\u003elike management has your back\u003c/em\u003e.\"\u003c/p\u003e\u003cp\u003eHowever, the same thought was not shared by other cadres. Nurses and technicians frequently reported feeling ignored by leadership. They spoke of meetings in which they brought up problems, only to have no action follow. \"\u003cem\u003eWe report our issues to them, but nothing happens after that\u003c/em\u003e,\" said one nurse. Another contributed, \"\u003cem\u003eManagement tells us not to do some things, but does not provide us with the resources to do it differently\u003c/em\u003e.\" These were illustrations of the lack of communication and responsiveness that made staff feel frustrated and unsupported.\u003c/p\u003e\u003cp\u003eOverall, workplace relationships both peer-to-peer and with management had a significant impact on the feelings staff had about their jobs. Effective teamwork and empathetic leadership made even difficult conditions more tolerable, while inadequate communication and lack of management support contributed to dissatisfaction. As one physiotherapist put it, \"\u003cem\u003eWorkplace should feel like a second home\u003c/em\u003e,\" and in those areas where that feeling of belonging was present, morale was obviously better. These results confirm the need to encourage a positive, engaged workplace culture one where collaboration, mentoring, and open communication are daily habits.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eTheme 4: Feeling Valued \u0026ndash; Recognition and Professional Respect (Esteem Needs)\u003c/h2\u003e\u003cp\u003eStaff were very clear that they are motivated and satisfied by being seen and valued for their work. Everyone from nurses to technicians to physicians commented on how much it means to be recognized and valued. As one physician said, \"\u003cem\u003eIf our efforts aren't appreciated, it creates dissatisfaction\u003c/em\u003e.\" This is the voice that most directly addresses esteem needs: the need to feel valued, competent, and respected.\u003c/p\u003e\u003cp\u003eMost participants complained that they hardly ever got the recognition, particularly from management. Technicians complained most of all: \"\u003cem\u003eWe do our best, sometimes go beyond, but it feels worthless\u003c/em\u003e,\" one technician complained. Nurses complained similarly, reporting that they were often blamed for issues outside their control. For instance, when patients or visitors violated rules, nurses got the blame: \"\u003cem\u003eVisitors don't follow protocol\u0026hellip; but nurses are blamed\u003c/em\u003e,\" one nurse explained. Being constantly blamed left them feeling disrespected and demoralized.\u003c/p\u003e\u003cp\u003eThe other frustration was not being heard. Employees reported to bring up concerns or ideas at meetings only to have nothing done. \"\u003cem\u003eWe speak out about our problems, yet nothing else is done afterwards\u003c/em\u003e,\" said a nurse. Technicians also reported how tiresome it was to continually disturb management just to obtain standard work equipment, which made them feel unappreciated. For them, it was not about wanting to be praised it was about being respected and supported in getting their jobs done.\u003c/p\u003e\u003cp\u003e Participants always spoke about needing even minor gestures of appreciation. Some intimated that straightforward things such as noting birthdays, work anniversaries, or public thanks could be a significant help. One administrator suggested an \"\u003cem\u003eemployee of the month\u003c/em\u003e\" scheme, while physiotherapists suggested team recognition as opposed to focusing on one individual. \"\u003cem\u003eIt's better when the whole team is recognized, not an individual\u003c/em\u003e,\" one person indicated. They feared individual recognitions would be competitive and devalue teamwork.\u003c/p\u003e\u003cp\u003eNot everything was required to be recognized by the management. Great motivation was achieved by many employees when patients or relatives showed them appreciation. \"\u003cem\u003eWhen patients say thank you, it makes all your struggle worth it\u003c/em\u003e,\" shared a physician. Nurses concurred what encouraged them most was watching patients improve and knowing that they had some role in achieving this. This appreciation reaffirmed their purpose and professional identity. Others even felt that their profession within the community nurse or doctor was something to be proud of, no matter what the day-to-day difficulties.\u003c/p\u003e\u003cp\u003eParticipants, however, yearned for greater recognition from the organization. One nurse remembered how an earlier leader had organized a humble cup of tea during night duty \"\u003cem\u003eIt felt like they cared\u003c/em\u003e,\" she said. That small act, though now stopped, had a lasting effect. Others complained about the lack of recreational activities or acknowledgement of paramedical personnel, which left them feeling neglected. \"\u003cem\u003eWe haven't had an outing or team activity in more than a decade\u003c/em\u003e,\" a technician observed.\u003c/p\u003e\u003cp\u003eFairness also operated on a sense of esteem. Administrators and physicians cited how, when learning opportunities for advancement were not administered openly such as when great cases only favoured senior physicians there was disrespect to others. An administrator raised the example how without open feedback or evaluation methods, even diligent workers could also feel overlooked and demotivated. Respect, they contended, entails both fairness and ethics in communication.\u003c/p\u003e\u003cp\u003eBriefly, the theme expresses the wide gap that exists between all the hard work employees put into their work and the appreciation received. Though acknowledgement from patients adds a touch of pride, it is still numerous who feel undermined by their institution. Simple regular acts of gratitude listening, showing appreciation for what is accomplished, celebrating birthdays could truly be the make-or-break issue. As one of the physiotherapists explained, \u003cem\u003e\"Feeling valued has a huge impact on motivation\u003c/em\u003e.\" Without that, even zealous healthcare providers can start feeling invisible and second-guessing their role. This is congruent with the larger body of research indicating recognition, rather than money alone, retains and boosts staff in the healthcare environment.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eTheme 5: Self-Actualization and Growth (Potential for Development and Fulfillment)\u003c/h2\u003e\u003cp\u003eThe last theme revolves around participants' desire for professional development, learning, and contribution aligning with the pinnacle of Maslow's hierarchy: self-actualization and esteem of higher order. Most healthcare providers across cadres had a keen desire to gain more knowledge, progress in their careers, and utilize their skills to the maximum. But scarce chances for training, advancement, mentoring, or innovation left most feeling \"\u003cem\u003estuck\u003c/em\u003e,\" underused, and in danger of disengagement. When development chances existed even modestly they made a major difference in morale, highlighting the internal motivation among employees to develop and contribute in meaningful ways.\u003c/p\u003e\u003cp\u003eAnother persistent subtheme was the absence of formal training or professional development. Some participants mentioned that building skills usually happened informally, not through formal institutional initiatives. One nurse commented, \"\u003cem\u003eNo, we train ourselves by ourselves only; no such training session is given to us. I used to receive training for grooming when I was working in another hospital\"\u003c/em\u003e (Nurse). Technicians also expressed frustration: \"\u003cem\u003eWe would like some departmental training; there's no professional development here at all\u003c/em\u003e\" (Technician), pointing out that without practical training especially for working with equipment learning stalled. Administrators also highlighted the need to endow employees with future-proof competencies: \"\u003cem\u003eSkill development opportunities should be provided\u0026hellip; which is currently lacking in this organization\u003c/em\u003e\" (Administrator).\u003c/p\u003e\u003cp\u003eCareer stagnation was another theme that was popular across groups. Members from groups spoke of long years of work without any growth. \"\u003cem\u003eI have been working here ten years\u0026hellip; no growth\u003c/em\u003e,\" said one technician (Technician), and a nurse described being \"\u003cem\u003estuck in the same position for years\u003c/em\u003e\" (Nurse). Physiotherapists observed that while the workplace provided early exposure and learning for new recruits, it was not ideal for experienced professionals because of few roles: \"\u003cem\u003eFor me, this place is very good for exposure\u0026hellip; but for people who have years of experience, I don't see many positions to grow into\u003c/em\u003e\" (Physiotherapist). Administrative personnel signalled the lack of clear evaluation processes: \"\u003cem\u003eIf appraisal criteria aren't communicated, an employee could work hard at the wrong things and feel demoralized\u003c/em\u003e\" (Administrator). Such ambiguity broke down motivation and trust in the system.\u003c/p\u003e\u003cp\u003eOnboarding and mentoring were also deemed lacking. Newly hired employees would often feel unsupported when integrating into positions, which could delay integration and satisfaction. \"\u003cem\u003eWhen I stepped out of being a student and into being an employee, I had so many doubts about myself. I needed a leading hand\u003c/em\u003e,\" revealed an administrator (Administrator). A physiotherapist spoke of: \"\u003cem\u003eWhen I first came in, it was my first job, and I didn't know anything. induction activities were not conducted, policies briefing were not conducted\u003c/em\u003e\" (Physiotherapist). These discrepancies indicated a more general problem with how the organization developed new talent. Some of the participants in their teaching capacity cited faculty development programs favorably: \"\u003cem\u003eOur department has had some leadership courses\u0026hellip; they helped\"\u003c/em\u003e (Physiotherapist), indicating that when such support was in place, it was highly valued.\u003c/p\u003e\u003cp\u003eParticipants also expressed concerns about the absence of support for academic or research development. Staff members who carried both clinical and teaching duties found it challenging to serve both without institutional support. Said one physiotherapist, \"\u003cem\u003eTime for academic and time for clinical should be separated so that our career growth won't get interrupted\u003c/em\u003e\" (Physiotherapist). A physician also said, \"\u003cem\u003eWe should stay informed about new developments and technologies\u0026hellip; What's the point of being excited if we aren't making progress?\u003c/em\u003e \" (Doctor). With the demands of services overwhelming them, other physicians felt they couldn't advance or even keep up with their profession. Even skill implementation became difficult in low-volume departments: \"\u003cem\u003eFew patients report at present\u0026hellip; that is what troubles me\u003c/em\u003e\" (Doctor). Low workload was also reported as demotivating by nurses: \"\u003cem\u003eThere is no tension as there is not much patient load this is a negative point, we even feel like coming to work at least to deliver something and leave\u003c/em\u003e\" (Nurse).\u003c/p\u003e\u003cp\u003eThese accounts showed that employees found meaning in being able to assist others, and meaningful participation was lost when job satisfaction was dulled.\u003c/p\u003e\u003cp\u003eThe aspiration for innovation and keeping abreast of new healthcare practices was particularly prevalent with physicians and physiotherapists. One senior physician cautioned, \"\u003cem\u003eIf we don't keep up [with new developments], we risk falling further behind\u003c/em\u003e\" (Doctor), citing lacunae in technology uptake (e.g., robotics, AI). Meanwhile, physiotherapists welcomed their department's diverse clinical configurations, which made them familiar with a range of techniques, albeit still demanding institutionalized opportunities for development beyond regular responsibilities. Members provided a few recommendations to do better in this regard. These were more regular training (both technical and soft skills), definite career ladders and appraisal structures, onboarding and mentoring, reserved time for research or postgraduate studies, and investment in infrastructure to enhance innovation. An administrator suggested \"\u003cem\u003evariations in roles and responsibilities\u0026hellip; to keep work interesting\u003c/em\u003e\" (Administrator), which is aligned with job enrichment strategies.\u003c/p\u003e\u003cp\u003eStaff also called for hiring additional personnel to distribute workload more evenly, enabling time for professional development. Importantly, this theme intersected with others: when basic needs (e.g., adequate staffing) or esteem needs (e.g., recognition) were unmet, employees struggled to pursue growth. For example, nurses wanted to attend workshops but couldn\u0026rsquo;t be spared due to short staffing, while doctors lacked motivation to innovate if management never acknowledged their input. As one physiotherapist noted, \"\u003cem\u003eHuman needs can never be satisfied\u0026hellip; we have to pretend to be happy\u003c/em\u003e\" (Physiotherapist), indicating a recognition of the perpetual quest for satisfaction, even in the face of institutional obstacles. Yet another participant provided a note of optimism: \"\u003cem\u003eWhen hospitals invest in their doctors, it shows they value their work\"\u003c/em\u003e (Doctor).\u003c/p\u003e\u003cp\u003eThis feeling connected self-actualization to esteem opportunities for development were not merely about growth, but also about feeling valued and trusted. In general, Theme 5 emphasizes that most healthcare professionals are motivated by a strong inner desire to develop, learn, and make a difference. Yet, when systems fail to allow this development, morale suffers, and staff will disengage in spite of passion. Investing in education, mentorship, scholarly participation, and equitable systems of advancement is not simply a matter of enhancing retention rather, it is a way of respecting the professional dignity and promise of health care workers.\u003c/p\u003e\u003cp\u003eAs one physician well said, \"98% [of job satisfaction] is how we approach our jobs\" (Doctor) but that manner of approaching has to be fostered by infrastructures that enable individuals to excel.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThrough the lens of Maslow's hierarchy of needs, this study searched for the intricate factors that influence personnel's job satisfaction in a tertiary care hospital. The qualitative analysis provides light on how healthcare professionals perceive their workplace and the ways in which different organizational and psychosocial factors interact to influence their sense of well-being, motivation, and performance.\u003c/p\u003e\u003cp\u003eThe emergent themes map generally onto Maslow's (1943) hierarchical needs hierarchy, which includes physiological and safety needs (suitable staffing, equitable pay, and a secure working environment), social needs (staff camaraderie, respect at work), esteem needs (deference, gratitude), and self-actualization (opportunities for growth, autonomy, purposeful work). Our research also indicates, however, that moving through these levels is not strictly sequential or linear. Participants tended to be in multiple need states at once, and in certain situations, placed intrinsic motivators (e.g., patient care, self-improvement) before unmet basic needs. This lends credence to the updated views presented by [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], who advocated for a dynamic approach where needs are adaptive and interdependent in their contexts of prioritization.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eBasic Needs and Systemic Challenges\u003c/strong\u003e\u003cp\u003eAt the most basic level, limitation of resources in the form of inadequate staffing, poor infrastructure, and a shortage of necessary supplies was highlighted by majority of the participants as a major source of dissatisfaction and hindered work performance. Numerous participants described how these shortages undermined patient care as well as individual well-being, perpetuating a cycle of disengagement and burnout. These results align with international literatures, [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] where researchers identified that nurse staffing levels were positively correlated with job satisfaction, burnout, and patient outcomes. Similarly, few studies also emphasize the long-term work stressors in healthcare settings as important indicators of professional dissatisfaction and emotional exhaustion [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e\u003cp\u003eAlthough pay was frequently cited as a source of dissatisfaction, it was rarely mentioned as the sole source of motivation. The respondents desired a compensation structure that took into account their professional commitment, qualifications, and workload. This is in line with Herzberg's two-factor theory, which contends that although pay is a necessary hygiene factor, motivation and satisfaction cannot be generated solely by it. Rather, a more nuanced perspective emerged, stating that financial incentives are important but not the only motivation factor. When financial compensation was coupled with opportunities for advancement, professional respect, and recognition, participants were more likely to express satisfaction.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003ePsychosocial Climate and Interpersonal Dynamics\u003c/strong\u003e\u003cp\u003eA positive discovery was the team bonding and peer support as shields against work stress. The majority of the participants emphasized the strength of interpersonal connections among colleagues, which assisted positively towards their resilience and sense of belongingness. These are supported by studies emphasizing the importance of positive team dynamics in the development of nurse retention and the avoidance of burnout [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In present study, friendship often compensated for other organizational deficiencies but was not shared. Where hierarchical organizations were rigid or where there was poor communication between administrative and clinical staff, participants recorded increased alienation and dissatisfaction.\u003c/p\u003e\u003c/p\u003e\u003cp\u003eJunior staff, in particular, indicated voice and agency issues, namely, inadequate participatory decision-making and feedback mechanisms. This is important because an absence of autonomy and recognition has consistently been correlated with reduced job satisfaction in health care [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Flattening structures, cultivating shared governance, and creating feedback loops within organizational culture may prove to be vital in preventing such issues.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eRecognition, Growth, and Meaning\u003c/strong\u003e\u003cp\u003eBeyond physical and social needs, the desire for esteem and self-actualization was a powerful stimulus to job satisfaction. Respondents typically cited affective rewards of patient care, professional development, and pride of accomplishment as they became proficient at their work. These motivators are aligned with Maslow's higher-order needs and suggest that the majority of healthcare workers perceive their work as a calling, not just work. Researches also identifies the importance of intrinsic motivation, autonomy, and work with meaning in sustaining engagement [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003c/p\u003e\u003cp\u003eNevertheless, the participants also identified that lack of opportunities for professional developments were deterrent to professional growth. The lack of continuing education, obscure career tracks, and lack of merit-based promotion were reasons for frustration. This is of concern, since inaction on fulfilling self-actualization needs has the potential to cause stagnation and turnover, especially among newer or more aggressive staff [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Formal professional development programs, career advancement programs, and mentorship can be viable solutions to such obstacles, as the same has been advocated by studies stating that Opportunity for self-development was biggest satisfier [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eContextualizing with Indian Healthcare Settings\u003c/strong\u003e\u003cp\u003eAlthough much of the findings tallies with the international trends, it is also necessary to take cognizance of the situation-specific issues of the Indian public health system. Indian healthcare workers are characteristically affected by chronic underfunding, bureaucratic constraints, and patient overload. Studies has identified these systemic stressors, and they are frequently worsened by institutional insensitivity to staff concerns [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. For our research, the disjuncture between policy rhetoric (e.g., human resource strengthening) and implementation reality (e.g., vacant positions, lack of equipment) was a source of cynicism among our participants.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eImplications for Practice and Policy\u003c/b\u003e: These results indicate that any attempt to enhance job satisfaction and performance will have to take a multidimensional route. Interventions need to extend beyond salary adjustments or recruitment campaigns to institutional culture changes, participatory leadership, and systemic reform same has been justified by a study [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Health administrators ought to give high priority to: Resource sufficiency (staffing, infrastructure); Transparent and equitable remuneration systems; Developing career progression paths; and Acknowledging and celebrating contributions at all levels.\u003c/p\u003e\u003cp\u003eFinally, job fulfilment among healthcare personnel is a matter of moral mandate and strategic urgency. A dedicated and satisfied staff is the underpinning on which to establish safe, sensitive, and productive healthcare.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis qualitative study, placed within Maslow's hierarchy of needs, provides rich, context-dependent insights into the multi-layered determinants of job satisfaction across various cadres of hospital staff, consistently emphasizing the need for a foundation of adequate resources, fair remuneration, and physical and psychological safety. These needs are not merely logistical concerns but prerequisites for long-term involvement, professional integrity, and compassionate care. Most importantly, experiences in each cadre were not distinct but highly intertwined. A strong leadership or managerial shift benefits the system as a whole, while infrastructure, identification, or leadership weaknesses harmed all roles. This argues in favour of cross-cadre, systemic interventions that address the common as well as the differential needs of multiple staff groups.\u003c/p\u003e\u003cp\u003eLastly, this study emphasizes the reality that health care professionals are not merely service providers but human beings going through a range of needs. Meeting those needs in their entirety is not merely an ethical imperative it's a strategic one. A satisfied and engaged workforce is the cornerstone of patient safety, clinical excellence, and institution resilience. As global health systems are struggling with growing workforce issues, this research contributes qualitative data to the contention that investing in staff well-being is the solution to providing sustainable, people-centred healthcare. Future research and policy need to continue employing integrative frameworks like Maslow's to capture the entire range of staff experiences and to create interventions that do not leave any cadre behind. Finally, to strengthen health systems from the inside, we first have to ensure that those who give care are seen, heard, and cared for at every point of their human and professional journey.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eFGDs\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eFocus Group Discussions\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eIntensive Care Unit\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCOREQ\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCOnsolidated criteria for REporting Qualitative research\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u0026nbsp;\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Institutional Ethics Committee of Sikkim Manipal University in India (Ref No.: SMIMS/IEC/2022-117). After being assured that their participation was entirely voluntary and confidential, each participant provided written informed consent. Additionally, they were informed that the conversations would be audio recorded, and their consent was obtained for the same as well. All procedures followed in this study adhered to the relevant ethical guidelines and regulation, including the principles outlined in the Declaration of Helsinki, ChatGPT and QuillBot tools were also used to enhance the manuscript\u0026apos;s language, spelling, and grammar. After using these tools to assess and revise the publication\u0026apos;s content as needed, the authors take up the full responsibility for its content.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Registration Number:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u0026nbsp;\u003c/strong\u003eThe datasets collected and analysed in the present study are available from corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe authors received no financial support for the research, or publication of the study. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e: KP collected the data and wrote the main manuscript. DB and RS helped in final Coding decisions (data analysis). SK helped in data collection. All authors reviewed the final manuscript, and approved it.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eSincere gratitude to all the participants who participated in this study, and all other healthcare professionals and staffs of the university who contributed indirectly in completing the studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eKreeti Pal - Assistant Professor, Department of Hospital Administration, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University (SMU), Tadong, India. *corresponding author is - Kreeti Pal\u003c/li\u003e\n \u003cli\u003eDr. Dechenla Tsering Bhutia - Professor and Head Department of Community Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University (SMU), Tadong, India.\u003c/li\u003e\n \u003cli\u003eDr Rakesh Kumar Saroj\u003csup\u003e\u0026nbsp;\u003c/sup\u003e- Assistant Professor, School of Computational and Integrative Sciences, Jawaharlal Nehru University - New Delhi, India\u003c/li\u003e\n \u003cli\u003eDr Sanjay Kumar - Professor and Head Department of Physiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University (SMU), Tadong, India.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH. 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Hum Resour Health. 2006;4:24. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/1478-4491-4-24\u003c/span\u003e\u003cspan address=\"10.1186/1478-4491-4-24\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Thematic Analysis, Focus Group Discussion, Qualitative Study, Healthcare Professionals, Maslow’s Hierarchy, Job satisfaction","lastPublishedDoi":"10.21203/rs.3.rs-7526298/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7526298/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn a demanding profession like health care services, the stress and pressure of work is an inherent part of the profession. Understanding the key concerns related to job satisfaction is crucial creating a congenial work environment for the health care workers and plays a vital role in standards of patient care and reduce attrition. This study sought to investigate the determinants of job satisfaction among different categories of health care workers i.e., doctors, nurses, technicians, physiotherapists, and administrators based on Maslow's hierarchy of needs as a model to understand their experiences.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethod: A\u003c/b\u003e qualitative research was carried out in a tertiary care teaching hospital in a state in India. Seven independent focus group discussions (FGDs) were held, each involving members who were of the same professional category. The FGDs included - two for doctors, two for nurses, and one each for technicians, physiotherapists, and administrators. A total of 50 healthcare professionals took part in the seven FGDs. A thematic approach consistent with Braun and Clarke's approach was adopted in recording, transcribing, and analyzing the discussions. Participants' words naturally led to themes to emerge, but attention was also paid to how their experiences mapped onto Maslow's theory. To ensure an assurance of the accuracy and reliability of the study findings, checking back procedures were carried out by some participants.\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutcomes\u003c/b\u003e: The dominant themes that emerged from Focus group discussions are: Resource Limitations and Workload, Economic and Job Security, Support and Workplace Relationships, Recognition and Value, Growth Opportunities, etc. While all the groups reported identical problems, there were particular problems faced by certain cadres which were distinctly different.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e: Briefly, there are numerous unmet needs that medical professionals must navigate, ranging from basic needs such as equitable compensation and adequate staffing to more complicated issues of perceived value and opportunities for professional growth. It is crucial to address both the material and emotional components of their workplace in order to enhance overall job satisfaction.\u003c/p\u003e","manuscriptTitle":"Understanding Healthcare Workers Job Satisfaction Through Maslow’s Hierarchy: A Qualitative Study in India","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-22 19:23:49","doi":"10.21203/rs.3.rs-7526298/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"62898169262149080882851061426859757306","date":"2025-10-23T14:47:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-23T04:33:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"322868637086636975914123210495255489703","date":"2025-10-13T10:36:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-09T07:37:53+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-07T04:07:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-19T03:31:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-17T18:23:20+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-09-17T18:19:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f8d7772f-5e8d-43b4-9dbd-3c432d881ad9","owner":[],"postedDate":"October 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-22T19:23:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-22 19:23:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7526298","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7526298","identity":"rs-7526298","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}