MBA-HCM Theses and Dissertations (2019)
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- ItemBrand loyalty and its influence on prescription behaviour by medical officers and clinical officers in Kiambu level 5 and Ruiru Sub-county hospitals(Strathmore University, 2019) Muhuni, JamesIn accommodating the healthcare need of patients, medical and clinical officers in any health centre must provide prescriptions that meet their demands. There has been an increasing debate on the motivational factors which describes how physicians prescribe drugs for their patients, more so with the increased anti-hypertensive rate in Kenya with specific focus in Kiambu County. While this could be as a result of brand loyalty developed by either the patients or physicians, little literature is available in the field of healthcare management to back-up the belief, more so in Kenya. To try and answer this phenomenon, the study aimed to investigate brand loyalty and its influence on the prescription behaviour of anti-hypertensive drugs by medical officers and clinical officers in Kiambu Level 5 and Ruiru Sub County Hospitals. The specific objective were to determine the influence of brand image, brand commitment and brand experience on prescription behaviour of anti-hypertensive drugs. Theory of brand equity and theory of planned behaviour contributed to the study. The study adopted a descriptive research design with a target population of 21 medical officers and 34 clinical officers in the two hospitals combined, totalling to 55 respondents. Census survey was carried out on the 55 respondents to make the sample size of the study. As such, the sample size of the study was 55 respondents. The study relied on primary data which were gathered using questionnaire as the primary data collection instrument. Pilot testing was done using three respondents from Kiambu level 5 hospital which is not part of the target population. Data was analysed using quantitative methods, descriptive statistics, inferential statistics as well as use of SPSS. To ensure that analysis was appropriate, diagnostic tests was performed such as linearity test and normality test. The study findings established that of the three variables, only brand experience and brand image had a positive relationship with prescription behaviour of anti-hypertensive drugs by medical and clinical officers whereas, brand commitment had a negative relationship. The study recommended that hospitals need to take into consideration the influence that brand loyalty could be having on the prescription behaviour of their behaviours especially due to rising uptake of anti-hypertensive drugs in the country, especially in Kiambu.
- ItemA Comparison of capitation and fee for service provider payment mechanisms and their effects on cost of healthcare: a case study of the Avenue Hospital, Nairobi(Strathmore University, 2019) Ochieng, Teddy BrianIncreasing health costs globally have resulted in more patients seeking pre-payment mechanisms for health insurance to avoid catastrophic expenditures. Insurers use capitation and fee for service models for reimbursement, but there is insufficient evidence on which is efficient or cost effective. This study uses retrospective panel data from the Avenue Hospital’s electronic medical records (EMR) to compare reimbursement costs using capitation and fee for service models by four Kenyan insurance companies. The costs were compared across similar illnesses in patients presenting at the outpatient department analyzing 3,694 patient visits over a six-month period. The mean costs for treating diseases were used for the analysis, which entailed comparing mean capitation costs to mean fee for service payments. The data was extracted using excel, sorted and filtered, then analyzed in pivot tables and pivot charts. Descriptive analysis was used to derive means and percentage counts that were presented in tables and bar graphs. The analyses revealed that capitation costs are 7.8% lower than the mean costs under the fee for service model. This difference was significant for three out of the four illnesses analyzed, the exception being hypertension. The results of the study concluded proved that payment of health costs by capitation was cheaper than fee for service. This in essence leads to a conclusion that capitation is a cheaper form of insurance than fee for service schemes. The results of the study can be used for further research on cost reduction in provider payment schemes and also inform policy on the relevance of insurance and utilization management in capitation in reducing health costs.
- ItemEffect of devolution of health services on availability of medicines for Non-Communicable Diseases: a case study of the Makueni County Referral Hospital(Strathmore University, 2019) Wanjohi, EricKenya has witnessed a rapid epidemiological shift, with a surge in non-communicable diseases (NCDs) like diabetes and cardiovascular diseases, which often require lifelong treatment and can lead to impoverishment. One driver of excessive expenditure is medicines and related products. To prevent impoverishment from NCDs, counties must strengthen the management of commodities. However, frequent stock-outs at public facilities suggest weaknesses in supply chain management. This study sought to establish the effect of devolution of health services on the availability of medicines for NCDs at the Makueni County Referral Hospital in Makueni County. To achieve this, the study employed a mixed methods approach. First, the availability of selected medicines for NCDs was described before and after devolution (2011-2012 and 2017-2018). Then, the reasons underlying observed patterns, and staff perception on factors that may have influenced availability, both examined through in-depth interviews. The study found that three cardiovascular products, nifedipine, enalapril and hydrochlorothiazide were mostly unavailable pre-devolution. Post devolution, availability of nifedipine and hydrochlorothiazide improved substantially with enalapril availability remaining a challenge post devolution. Tracer diabetes medicines, metformin and glibenclamide had steady availability pre and post-devolution period. However, Insulin had good availability post devolution. Asthma drugs (salbutamol inhaler, salbutamol nebulising solution and budesonide inhaler) had higher stock out post-devolution.The relatively affordable amoxicillin, paracetamol and ibuprofen had good pre- and post-devolution availabilities, with ceftriaxone, a much more costly antibiotic, only having good availability post-devolution. Reasons for the increased availability included increased funding, better structured quarterly orders, better collaboration across actors, better public participation and an overall increase staff numbers. The study recommends that other health financing avenues be sought and that the county government reviews medicines budgets frequently. The study also recommends that county government should encourage public participation so as to know areas that need improvement.
- ItemChallenges to blood donor notification on transfusion transmissible infections: a case study of Lodwar County and Referal Hospital Blood Bank Satelite(Strathmore University, 2019) Nataba, AliceBlood donor notification on transfusion transmissible infections (Hepatitis B/C, HIV and syphilis) status is a mandated requirement of blood bank healthcare workers. Transfusion-associated transmissible infections notification faces many challenges despite national blood bank efforts in blood donor notification. The current study was aimed to determine challenges faced by healthcare workers in Lodwar county and referral hospital blood satellite Centre. The study was done retrospectively where secondary data of blood donor records between January 2017 and December 2018 were analyzed. Primary data was collected through a survey questionnaire that was administered to healthcare workers working in Lodwar county and referral hospital blood bank satellite to identify challenges faced in blood donor notification. The study population for primary data comprised of all healthcare workers working in the blood bank satellite, Lodwar county and referral hospital chief executive officer and the deputy equal, Turkana county laboratory coordinator and deputy director for medical services in the office of medical director for medical services. A total of three thousand nine hundred and ninety six donors donated blood out of which two hundred and ninety seven were TTI positive and only ten were notified. Two hundred and twenty four males and seventy-three females were positive for the TTIs in both study years, more male were TTI positive compared to female, TTI positivity for 2017 was higher compared to 2018 while HBV positivity was higher than that of other TTIs. Donor notification challenges were, factors in relation to procedures, people and policies as the major contributors to the challenges faced by healthcare workers in blood donor notification in order of importance respectively. A number of the respondents agreed that procedure related challenges majorly contributed to lack of donor notification and these were either due to lack of donor appointments, absence of standard operating procedures, difficulty in reaching donors, lack of donor notification implementation structure and lack of donor awareness of their need to be notified. Some of respondents agreed that people challenges affected donor notification due to shortage of human resource, high workload, lack of support supervision, and lack of donor appointments. The respondents agreed that policies surrounding issues like lack of operational structure, lack of current updates on donor notification process, and lack of scheduled clinic days for donor notification were some of challenges making donor notification ineffective. Some of the respondents were neutral on provision related challenges with only a few agreeing with it. Provision and place related challenges were as not as important or highly contributing to challenges faced by healthcare workers in donor notification. Given that only 7.4% of donors were notified it means there were challenges to donor notification and this study recommended the blood bank to put up structure in relation to the three major factors associated with their challenges at the blood bank management and other stakeholder’s management level. There are donors who are TTI positive and yet they are not notified as required by the blood transfusion services guidelines clearly showing that there are challenges faced by healthcare workers in donor notification. There is no clear explanation why TTI positivity was high in 2017 than in 2018, this could be attributed by may be change of donor age population, may be most of the donors were from a family replacement source of which this study did not explore. High positivity of TTI in males than in females could be due to male population who seek out for blood donation than their female counter parts, it is not clear also why iv HBV positivity was higher than the other TTIs. This could be because of high risk involved in HBV transmission and cultural/ social practices. Recommendation for this study is since donors are not notified as required; the blood bank needs to put up measures for effective donor notification by addressing the factors causing the challenges to donor notification. TTI positivity should be further studied to include age and find reasons as to why males have more TTIs than their female counter parts, why HBV is highly positive than other TTIs and why their was a high TTI positivity in 2017 than in 2018 and also expand years of secondary data sample to more than two years, there is need to increase scope of study to include other blood bank satellites in Kenya in order to meet the required study population minimum standards. A low number of study population was small since donor population was selected for only two years, it was also only focusing on TTI positivity and notification, there was no segregation of TTI according to ages and which age group was mostly affected or were positive for the TTIs. The study population for primary data did not meet the required statistical data analysis threshold and may not actually represent a considerable true factors contributing to lack of donor notification challenges by healthcare workers and also the case study was limited to one blood bank satellite. Other researchers are encouraged to pursue the same research problem or topic but have to include a more elaborate scope of study to include other similar blood bank satellites in Kenya in order to increase geographical and study population coverage. Prevalence on TTI positivity can be done for all satellites unlike the previously limited studies done in Nyeri and Kisumu alone in order to widen the research area findings in all satellites. TTI positivity should be studied to ascertain which age group or gender is mostly positive with blood donor TTIs, this will help in policy formulation for development of interventions aimed to address specific issues on donor notification of positive TTI status, due to high HBV positivity in blood donor blood and in males, there need to study the reasons as to why HBV is higher than other TTIs and why the males are the mostly affected. Other research studies could focus on blood transfusion policies that support blood donation through research policy formulation especially on donor notification guidelines for school going donors.
- ItemUsing lean operations to reduce wastes in the medication administration process at the Gertrude’s Children’s Hospital, Nairobi, Kenya(Strathmore University, 2019) Nyarangi, Wambugu NaomiLean operations can help to reduce waste and improve workflow, resulting in fewer medical errors, cost savings, reduced medication turnaround times, and reduced product verification and delivery time in the healthcare industry. This study sought to describe the current medication processes at Gertrude's Children’s Hospital, to identify wastes in the medication administration processes, and, to develop and validate a novel medication process that minimizes identified wastes and improves safety and quality throughout the process. The study employed a descriptive cross-sectional design. The study employed a census approach in the recruitment of study respondents. Both quantitative and qualitative data. Data were obtained using a self-administered structured questionnaire from the frontline staff involved medication administration process and via in-depth interviews. Value Stream Mapping tool was used to analyze the medication administration process and process mapping was done to display the process flow. Data were analyzed using descriptive and inferential statistics. Regression analysis was done to identify factors contributing to waste in the medication process. Statistical Package for Social Sciences (SPSS) was used to analyze quantitative data. Qualitative data from the in-depth interviews were analyzed thematically and a framework approach was used in the analysis. Overall, the targeted population was all employees involved in the frontline of the medication administration process (n=60). The study excluded two staff on leave schedule and together with a non-response rate of 10.3% (6) a total of 52 staff (18 pharmacists, 18 nurses, and 16 doctors) were enrolled in the study. Among the respondents 63.5% (n=33) were females and 36.5% (n=l9) were males. The results of the study established that there was a positive relationship between organizational, people (staff and patients), technological, environmental, and task-related factors with timely medication administration but the relationship was insignificant. Thematic analysis revealed that process engineering on the technology system by putting process alerts will help in reducing medication turnaround times. In conclusion, the factors leading to medication delays were poor communication, lack of teamwork, and inadequate staffing. The study, therefore, recommended there is a need for the hospital management to look into outpatient staffing ratios to have adequate staff, to enhance a culture of teamwork among staff, and put in place in the technology system, some process alerts in the system to give prompts for action on the computerized order system
- ItemChallenges facing the implementation of managed healthcare in private hospitals in Kenya: a case of Avenue healthcare(Strathmore University, 2019) Mbugua, MargaretMHC has confirmed the capability of eliminating surplus medical expenditures and improving the effectiveness as well as the quality of medical care delivery specifically in the USA. However, despite the existence of MHC for a number of years, the concept is yet to fully take root in developing countries in Asia and Africa, where out of pocket payments make the greatest percentage of healthcare financing. In Kenya, health insurance represents less than 20% of the total insurance premiums and statistics indicate less than 10% of all healthcare finances are subjected to risk pooling through health insurance. This study examined the challenges encountered in the implementation of MHC in private hospitals in Kenya. The study was carried out at Avenue Healthcare in Nairobi County and involved the medical workers at the facility. The study was anchored on the Kutzin descriptive framework and the traditional indemnity model, and employed a cross-sectional descriptive design. The population was made of the 9 Avenue Healthcare Centres in Nairobi County and the unit of analysis was the 104 medical workers in these centres. This research used primary data, collected using a self-administered questionnaire developed based on the constructs of the literature review. The collected data were then analysed using descriptive and inferential statistics. The findings established that health workers' attitude affects implementation of MHC in private hospitals within Kenya and that there must be profound commitment and support by health workers for smooth implementation of MHC. The study also found that there is poor health workers' knowledge of the concept. The results show that the major costs drivers for MHC (MHC) programs are: administrative; operational, set-up, marketing and training. The regression results revealed a positive and statistically significant relationship between health workers' knowledge and attitude, costs of and implementation of MHC. The study concluded that implementation of MHC in private hospitals in Kenya is significantly influenced by health workers' knowledge and attitude and costs. The study recommends that the management of private hospitals in Kenya should involve medical workers in planning and implementation of MHC programs, develop training and development programs and ensure training is carried out frequently on MHC programs prior to implementing the programs.
- ItemFactors affecting the adoption of the Health Management Information System at St. Catherine's Hospital, Uganda(Strathmore University, 2019) Saku, HudhaifaHealth management information systems are essential in improving the performance of medical service delivery in health organizations. While changes have been made to improve the healthcare sector across the continent, much information is still needed to explain how HMIS works across hospital departments. This study sought to establish factors affecting the adoption of Clinic Master/HMIS across different departments at St. Catherine's Hospital. The specific objectives were; to establish how organizational factors, human factors, and technological factors affect the adoption of Clinic Master/HMIS across different departments at St. Catherine's Hospital. The study was based on the diffusion of innovation theory and the technology acceptance model theory. The research design was a cross-sectional survey of 109 respondents drawn from various departments in the hospital. The study findings revealed that technological factors had a statistically significant relationship with the adoption of HMIS/Clinic Master. Overall, the results of the study established that there was a positive relationship between human factors, organizational factors, and technological adoption of Clinic Master/HMIS in the hospital. However, human factors and organizational factors had an insignificant positive relationship with the adoption of the system. Future studies should try to determine whether other factors are affecting the adoption of HMIS in the hospital. The study also recommends that research should be carried out on the behavioral aspect of the doctors who do not use the system but rely on billers and cashiers to enter their reports and requests. The study recommends the need for standardization of HMIS implementation by policymakers in order to enhance adoption. This study looked at all the users of the system; whether clinical, non-clinical, or even para-clinical, unlike other studies which focused on mainly the clinical staff. This made it difficult to make hospital-level comparisons since different hospitals are in different adoption stages hence the focus on one hospital.
- ItemInfluence of pharmaceutical logistics management information systems as an enabler of Universal Health Coverage implementation in Nyamira County(Strathmore University, 2019) Wando, Stephen OdhiamboOne of the key determinants of the success of the UHC program in Kenya is likely to be the timely availability of pharmaceutical products at the facilities. However, there are currently no plans to assess the challenges faced by counties regarding the logistics of supplying pharmaceutical products. This prompted the researcher to conduct a study with the general objective being to establish the influence of pharmaceutical logistics management information systems as an enabler of universal health coverage implementation. The study utilized both qualitative and quantitative approaches in analysing the data. The population of the study was drawn from Nyamira County with 120 health facilities and the sample size was 74 respondents. The researcher adopted the use of the questionnaire in gathering information, the findings clearly indicate that there was no proper selection support system that ensures the high-quality product selection, appropriate quantity of the product to be selected, and the need satisfaction of the product also the County drug policy document are not being used irrespective of being a very important document, the procurement support system was discussed to check whether it accommodates the element of planning in terms of budget and supply planning though the one in place is not that effective in the County, forecast, and development a system using 9ispensed user data in the procurement support system in universal health coverage is not effective. Medical practitioners are even not aware of distribution data in the issue of the procurement support system and are not even aware of the forecast being done using distribution data, on the distribution support system, there are no written provisions for the redistribution of overstocked supplies, and a program accommodating policy of storing & issuing stock according to first to expire that should be addressed by the system and Utility support system that is in place to manage the use of inventory and ensure waste reduction is not efficient, the study recommends that for logistic management information system to be implemented in the UHC facilities the system must have the selection, distribution procurement, and utility system which is effective and the study further suggests that more studies be conducted on the influence of pharmaceutical logistics management information systems on the performance of the public hospital in Kenya. This will help give a holistic idea of the causes of logistic management process delays that could be due to the use of substandard systems used in record keeping, material handling, and Distribution or could be due to the use of poorly trained medical professionals.
- ItemInfluence of pharmaceutical logistics management information systems as an enabler of Universal Health Coverage implementation in Nyamira County(Strathmore University, 2019) Wando, Stephen OdhiamboIt has been argued that least half of the world’s population cannot access essential health services. This is why in 2012, the UN General Assembly declared that countries should start implementing Universal Health Coverage (UHC) as a way of addressing this issue. Kenya is set to roll out UHC for the entire country by 2022, beginning with a pilot covering four counties: Kisumu, Machakos, Isiolo, and Nyeri. One of the key determinants of the success of the UHC programme in Kenya is likely to be timely availability of pharmaceutical products at the facilities. However, there are currently no plans to assess the challenges faced by counties regarding the logistics of supplying pharmaceutical products from the Kenya Medical Supplies Authority (KEMSA) to the facilities in the counties. This prompted the researcher to conduct a study with general objective being to establish the influence of pharmaceutical logistics management information systems as an enabler of universal health coverage implementation and the specific objectives being to establish the influence of Selection support systems as an enabler of universal health coverage implementation, to establish the influence of Procurement support systems as an enabler of universal health coverage implementation, to establish the influence of Distribution Support systems as an enabler of universal health coverage implementation and to establish the influence of Utility support systems as an enabler of universal health coverage implementation. The study utilized both qualitative and quantitative approach in analyzing the data. The population of the study was drawn from Nyamira County with 120 health facilities and the sample size was 74 respondents. The researcher adopted the use of the questionnaire in gathering information, the findings clearly indicate that there was no proper selection supports system that ensures the high quality product selection, appropriate quantity of the product to be selected and the need satisfaction of the product also the County drug policy document are not being used irrespective of being a very important document, procurement support system was discussed to check whether it accommodates the element of planning in terms of budget and supply planning though the one in place is not that effective in the County, forecast and development a system using dispensed user data in the procurement support system in universal health coverage is not effective. Medical practitioners are even not aware of distribution data in the issue of the procurement support system and are not even aware of forecast being done using distribution data, on distribution support system, there is no written provisions for the redistribution of overstocked supplies and a program accommodating policy of storing & issuing stock according to first to expire that should be address by the system and Utility support system that is in place to manage the use of inventory and ensure waste reduction is not efficient, the study recommends that for logistic management information system to be implemented in the UHC facilities the system must have selection, distribution procurement and utility system which is effective and the study further suggests that more studies be conducted on influence of pharmaceutical logistics management information systems on the performance of public hospital in Kenya. This will help give a holistic idea on the causes of logistic management process delays that could be due to the use of substandard systems used in record keeping, material handling and Distribution or could be due to the use of poorly trained medical professionals
- ItemAn Assessment of the purchasing arrangements of an employer in-house managed scheme: a case study of AAR Healthcare(Strathmore University, 2019) Mwaura, Njeri LilianKenya has made a commitment to achieve Universal Health Coverage (UHC) by 2022. The country is undertaking health financing reforms that will set it on the path to achieving this goal. While health financing reforms have typically focused on the resource generation and pooling function of the health system, there is increasing recognition of the importance of the purchasing function of the health financing system. Purchasing refers to the transfer of pooled funds to healthcare providers in exchange for healthcare services provided to citizens. Purchasing could either be passive, which means merely paying bills, or strategic, which means structured to enhance the health system goals of equity, efficiency, and quality. Healthcare purchasing in Kenya is carried out by 5 main entities namely 1) the national hospital insurance fund (NHIF), 2) the county health systems 3) private health insurance 4) community-based health insurance schemes, and 5) employer in-house medical schemes. Previous studies done in Kenya has assessed the purchasing arrangements of the first 4. There is however not study that has examined the purchasing arrangements of employer in-house medical schemes. To fill this knowledge gap, this proposed study examined the purchasing arrangements of employer in house schemes in Kenya. Specifically, the study used a qualitative case study approach to examine the extent to which the purchasing arrangements of the AAR in-house medical scheme are strategic. This study employed the conceptual framework developed by the Resilient and Responsive Health Systems (RESYST) consortium to examine the purchasing actions of the AAR medical scheme across the three purchasing relationships, namely purchaser-government, purchasing-providers, and purchasing-citizens. Data was collected through a combination of in depth interviews and document reviews Respondents for the in-depth interviews were selected purposively to get individuals with in-depth knowledge of scheme. Relevant documents that contain information on the scheme were also obtained and analysed. Qualitative data was audio recorded, transcribed, importeded to NVIVO software, and analysed using a thematic approach. It was evidenced, by the findings put forward in this section that the purchasing mechanism in AAR Healthcare is passive as characterized by arbitrary fun allocation to the in-house scheme and nominal sourcing of providers. There was no evidence of strategic purchasing with regard to the acquisition or distribution of financing in the service provision process. The process was however deemed effective by all users. With regard to the second objective, it was evident that AAR Healthcare did not feature a specific purchasing entity as the purchasing functions were distributed between the HR, Procurement and Finance department. This therefore rendered the relationship between the purchaser and the other entities- citizens (employees), government and providers- as fragmented and uncharacterized; the system was essentially run as in-house health benefit scheme with the exception of contracted services given that the organization provided health services, such services were mainly sought in-house as opposed to through contracts with other providers. The main recommendation forthcoming from this study is that AAR Healthcare should consider a switch to strategic purchasing in effecting its healthcare provision function to employees. In achieving these, it will be necessary to first and foremost institute a designated purchaser for the fund; one that would be charged with orchestrating all functions involved with other actors in the purchasing function. Findings from this study can also be used to prescribe possible purchasing arrangements for employer managed schemes.
- ItemInfluence of employee engagement on job satisfaction: a case study of M.P Shah hospital(Strathmore University, 2019-07-30) Wang’ondu, Antonia Angela WanguiHealth management is increasingly gaining momentum not only in Kenya but across the region. Previous results have indicated that medical officers tends to move from one healthcare firm to the other. Further, the ever increasing nurses and doctors’ strike in the health sector in Kenya is a clear indication that there is a gap that need to be filled so as to improve the contribution of the influence of employees’ engagement on their job satisfaction in the healthcare organizations, not only in public but also private healthcare facilities. The purpose of the study was to assess the influence of employee engagement on job satisfaction at MP SHAH Hospital. The specific objectives were to identify the influence of employee reward, training and retention on job satisfaction. The study was supported by social exchange theory and McClelland’s theory of need. The research design was descriptive and cross-sectional survey. Target population for the study was 46 respondents which were made up of 20 medical officers and 26 senior and middle managers. The sample size of the study therefore was 46 respondents which was determined using non-probability convenience and snowball sampling methods. Structured questionnaires were used to gather primary data for the study. Data analysis was done using SPSS software as well as quantitative technique and multiple regression model was established to show the correlation and relationship between employee engagement and job satisfaction. On the first objective of the study, the study results showed that there is insignificant negative relationship between employee reward and job satisfaction. Moreover, the study established an insignificant positive relationship between employee training and job satisfaction. The study findings also established that employee retention statistically and significantly influences job satisfaction among medical officers with a strong positive correlation coefficient value within level of significance. The study recommend that the management of the hospitals should also pay much emphasis to employee engagement as a management tool that can be used to enhance job satisfaction in the hospital. Quality medical service delivery is key in any healthcare organization. Having frustrated medical officers therefore can affect the goal and objective of the health facility and as a result, the welfare of the medical officers must be considered at all times. The study also recommends that another study undertaken on the same study but on different sector, or in public health sector which has experienced rampant medical strikes for the last three years. In addition, other forms of employee engagement mechanisms should also be researched on in the future study since the variables used in the study as types of employee engagement techniques may not be the only ones. The study therefore concluded that employee retention had a statistical significant positive relationship with job satisfaction, employee reward had insignificant negative relationship with job satisfaction whereas employee training had insignificant positive relationship with job satisfaction.