Role ambiguity and role conflict effects on employees’ emotional exhaustion in healthcare services in Tanzania

Mwakyusa, John R. P.; Mcharo, Evelyne Willy Article Role ambiguity and role conflict effects on employees’ emotional exhaustion in healthcare services in Tanzania Cogent Business & Management Provided in Cooperation with: Taylor & Francis Group Suggested Citation: Mwakyusa, John R. P.; Mcharo, Evelyne Willy (2024) : Role ambiguity and role conflict effects on employees’ emotional exhaustion in healthcare services in Tanzania, Cogent Business & Management, ISSN 2331-1975, Taylor & Francis, Abingdon, Vol. 11, Iss. 1, pp. 1-12, https://doi.org/10.1080/23311975.2024.2326237 This Version is available at: https://hdl.handle.net/10419/326139 Standard-Nutzungsbedingungen: Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. 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If the documents have been made available under an Open Content Licence (especially Creative Commons Licences), you may exercise further usage rights as specified in the indicated licence. https://creativecommons.org/licenses/by/4.0/ Cogent Business & Management ISSN: 2331-1975 (Online) Journal homepage: www.tandfonline.com/journals/oabm20 Role ambiguity and role conflict effects on employees’ emotional exhaustion in healthcare services in Tanzania John R. P. Mwakyusa & Evelyne Willy Mcharo To cite this article: John R. P. Mwakyusa & Evelyne Willy Mcharo (2024) Role ambiguity and role conflict effects on employees’ emotional exhaustion in healthcare services in Tanzania, Cogent Business & Management, 11:1, 2326237, DOI: 10.1080/23311975.2024.2326237 To link to this article: https://doi.org/10.1080/23311975.2024.2326237 © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. View supplementary material Published online: 04 Apr 2024. Submit your article to this journal Article views: 9002 View related articles View Crossmark data Citing articles: 10 View citing articles Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=oabm20 ManageMent | ReseaRch aRticle Cogent Business & ManageMent 2024, VoL. 11, no. 1, 2326237 Role ambiguity and role conflict effects on employees’ emotional exhaustion in healthcare services in Tanzania John R. P. Mwakyusa and evelyne Willy Mcharo Department of Marketing, university of Dar es salaam, tanzania ABSTRACT this study investigated the effect of role conflict and role ambiguity on emotional exhaustion among healthcare service employees in hospital settings. a questionnaire utilizing a 5-point likert scale was administered to 181 employees of Kairuki Memorial hospital. Out of these, 131 questionnaires were considered valid for data analysis. Descriptive and regression analyses were conducted using sPss software. the findings indicated that role ambiguity had a positive and significant association with emotional exhaustion. conversely, the association between role conflict and emotional exhaustion was negative but not significant. it should be noted that, unlike previous studies that focused on specific healthcare professionals, this study included all professionals working in the hospital setting, acknowledging that exposure to a stressful environment may differ based on one’s profession. however, as this study relied on a cross-sectional survey conducted in a single hospital, caution should be exercised in generalizing the findings. the study contributes to the literature on human resources management by shedding light on the effect of role ambiguity and role conflict. it also offers recommendations for managing emotional exhaustion by addressing the underlying causes of role ambiguity identified in the study. IMPACT STATEMENT this study aimed to examine how role conflict and role ambiguity impact the mental exhaustion of healthcare workers in private hospitals in tanzania. analysis revealed that role ambiguity significantly contributes to mental exhaustion, while the relationship between role conflict and mental exhaustion was negative and not statistically significant, suggesting it could be due to chance. it’s important to consider that this study encompassed healthcare professionals from various roles, acknowledging that different professions may experience different levels of stress. however, as the study relied on a single survey conducted in a specific hospital, caution is needed when generalizing the findings to other settings. this study enhances our understanding of human resources management by highlighting the effects of role ambiguity and role conflict on emotional exhaustion. it also offers recommendations for managing emotional exhaustion by addressing the factors identified in the study. healthcare workers in hospital settings often experience significant emotional exhaustion due to their demanding work, which involves caring for vulnerable and critically ill patients (hamid & abdullah, 2020; Poku etal., 2020). studies conducted in different countries have highlighted the prevalence of emotional exhaustion among healthcare professionals. For instance, nurses in ghana reported high rates of emotional exhaustion (Poku et al., 2020), while tanzanian health professionals exhibited higher levels of distress compared to their sudanese counterparts (hamid & abdullah, 2020). this issue is more expensive than in developing countries, as studies in the United states have also shown burnout among physicians and nurses (shanafelt etal., 2015). emotional exhaustion has negative consequences such as low productivity, dissatisfaction, and depression and is associated with high workload and inadequate nurse-topatient ratios (Filho etal., 2019; tanna, 2022). Role conflict and role ambiguity significantly contribute to emotional exhaustion among healthcare professionals. the healthcare environment is often unhealthy, further intensifying emotional exhaustion © 2024 the author(s). Published by informa uK Limited, trading as taylor & Francis group. CONTACT [email protected] Department of Marketing, university of Dar es salaam, P.o. Box 35046, Dar es salaam, tanzania. https://doi.org/10.1080/23311975.2024.2326237 this is an open access article distributed under the terms of the Creative Commons attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. the terms on which this article has been published allow the posting of the accepted Manuscript in a repository by the author(s) or with their consent. ARTICLE HISTORY Received 2 May 2023 Revised 24 February 2024 accepted 28 February 2024 KEYWORDS Role ambiguity; role conflict; emotional exhaustion; healthcare services REVIEWING EDITOR ala Omar Dandis, Marketing, applied science Private University, Jordan SUBJECTS sociology & social Policy; employment Relations; industry & industrial studies; health conditions; Occupational health and safety; Quality of life 2 J. R. P. MWaKYUsa anD e. W. MchaRO (lópez-cabarcos etal., 2021). the recent cOViD-19 pandemic has compounded and added to new stressors, including increased workload, exposure to infection, and witnessing high levels of illness and death. in most instances, healthcare professionals are facing challenges due to inadequate nurse and doctor-to-patient ratios, which can lead to decreased healthcare quality (tanna, 2022). the consequences of emotional exhaustion include work-related infections, medication errors, poor nurse-physician relationships, and attrition (Poku et al., 2020). Job demands have been identified as a cause of emotional exhaustion, and sustained job demands can lead to high emotional exhaustion among employees (Panari et al., 2019). Role conflict and role ambiguity are crucial in understanding emotional exhaustion as they influence professional relationships and job satisfaction (Rovithis etal., 2017). Role ambiguity occurs when employees lack clear expectations or information needed to perform their roles, while role conflict arises when individuals face conflicting expectations from different roles (Robbins & Judge, 2015). these factors can result in occupational stress, poor performance, and decreased organizational efficiency (garrosa et al., 2008). While some studies have explored the effects of role conflict, role ambiguity, on emotional exhaustion in various sectors (amilin, 2017; Dasgupta, 2012; essawy, 2016), there is a dearth of studies specifically focused on healthcare settings covering medical and non-medical employees. studying these relationships at each specific health facility is deemed necessary. this approach is so decided as usually, each health facility addresses its employees’ challenges differently, considering its available financial and administrative resources. Private healthcare facilities are known to be inundated with enormous challenges not found within public hospitals in general and health centres in particular. it is argued that understanding healthcare professionals’ experiences and perceptions of role conflict and role ambiguity in a private hospital can provide specific and valuable insights into emotional exhaustion. therefore, this study examines the effect of role conflict and ambiguity on emotional exhaustion among healthcare service employees in tanzania, specifically within Kairuki Memorial hospital. By exploring these factors, the study seeks to contribute to the existing literature and shed light on the emotional well-being of hospital employees. given the conflicting findings on the connection between role ambiguity, role conflict, and emotional exhaustion or burnout (e.g. Barber & iwai, 1996; Kutanis & tunc, 2009), this research addresses the ongoing inconsistency in findings. the inconsistencies may arise from contextual and individual disparities among healthcare workers, influencing their diverse responses to challenging situations according to their cultural-specific resilience levels. conducting this study in the context of health services in tanzania will help fill this gap and contribute to the existing body of literature. Literature review Role theory Role theory suggests that roles in organizational settings are associated with specific social positions and are shaped by normative expectations (Matta etal., 2015). according to this theory, individuals’ behavior is influenced by how their roles are established and defined. however, when responsibilities and expectations are unclear, it can result in role ambiguity. Role ambiguity leads to dissatisfaction, indecisiveness, anxiety, and confusion, ultimately contributing to emotional exhaustion. employees experience role ambiguity when essential information for task performance is lacking, prompting the development of coping mechanisms and defensive strategies to manage stress. Role theory further posits that role ambiguity increases the likelihood of job dissatisfaction, anxiety, distorted perceptions, and diminished performance (ntopi et al., 2020). Role theory also addresses role conflict, which arises when an individual faces conflicting expectations from different roles. conflicting expectations can lead to stress, job dissatisfaction, and poor work performance (Kessler, 2013). the theory suggests that employees have multiple roles, each with rights and responsibilities. Role conflict occurs when fulfilling one role jeopardizes the fulfilment of others—the conflict applies to healthcare services and other sectors alike. Role conflict and role ambiguity have significant implications for emotional exhaustion, ultimately impacting job performance. therefore, role theory is a suitable theoretical framework for this study, as it explains the effects of role conflict and ambiguity on emotional exhaustion in healthcare service employees. cOgent BUsiness & ManageMent 3 JD-R Model the Job Demands-Resources (JD-R) Model, developed by researchers Bakker et al. (2005), proposes that high job demands and low job resources lead to stress and burnout, while positive job attributes can mitigate the effects of high demands and foster motivation and engagement. the JD-R model is a widely recognized conceptual framework in the study of job stress and burnout, addressing limitations of previous models such as the job demand-control (JD-c) model, the job demand-control-support (JD-c-s) model, and the effort-reward imbalance (eRi) model. according to the JD-R model, job characteristics can be categorized into two main types: job demands and job resources. Job demands refer to the physical, psychological, social, or organizational requirements of a person’s job that involve continuous effort or skill, and they are associated with various costs like job stress and role ambiguity. On the other hand, job resources are the material, psychological, social, or organizational factors that support individuals in achieving their work goals, reducing demands, and promoting personal growth, learning, and development. By employing the JD-R model, researchers gain a better understanding of individual job burnout, enabling them to explore job involvement and wellbeing within the framework and conduct comprehensive empirical studies. the model has been extensively applied in investigating stress and job burnout in professionals, including construction industry professionals, highlighting the interplay between job demands, job resources, and job performance. schaufeli and taris (2014) highlighted that several issues still need to be solved despite the widespread use of the JD-R theory to understand demand and resources. these include the epistemological status of the model, the definitions and distinctions between ‘demands’ and ‘resources’, incorporating personal resources, distinguishing between health impairment and motivational processes, addressing reciprocal causation, and extending the model’s applicability beyond the individual level. in this study, the JD-R model is utilized to analyze the theoretical aspects and develop a hypothetical model to examine the effect of role ambiguity and conflict on emotional exhaustion in healthcare services in tanzania. Conceptual framework the conceptual framework utilized in this study was based on the literature review. emotional exhaustion in healthcare services was identified as the dependent variable, while role ambiguity and conflict were considered the independent variables. Figure 1 illustrates the conceptual framework, outlining the relationship between role ambiguity and role conflict and their effect on emotional exhaustion. Hypotheses development Role ambiguity has effects on emotional exhaustion Role ambiguity, which refers to the lack of clarity and understanding of job expectations and responsibilities (Mañas et al., 2017), has been recognized as a psychosocial risk factor that can harm employees’ wellbeing. several factors cause the ambiguity. Puyod and charoensukmongkol (2021) found that workplace rumors and organizational formalization are positively associated with role ambiguity and emotional exhaustion. More studies have shown that role ambiguity is associated with adverse outcomes, including decreased motivation and increased emotional exhaustion (Panari et al., 2019). When employees are H1 H2 Role Ambiguity Role Conflict Employees’ Emotional Exhaustion Figure 1. Conceptual framework. source: authors’ construction based on literature review (2023). 4 J. R. P. MWaKYUsa anD e. W. MchaRO uncertain about their roles, it can lead to job dissatisfaction and burnout. in their study, Phungsoonthorn and charoensukmongkol (2022) examined the impact of mindfulness on emotional exhaustion in employees of private international universities in thailand during the cOViD-19 pandemic. they discovered that psychological hardiness fully mediated the connection between mindfulness and emotional exhaustion, while workload significantly diminished the influence of psychological hardiness on emotional exhaustion. the study conducted by Marjan et al. (2021) highlighted the growing concern for employees’ wellbeing during the pandemic. they found that mental load, perceived team support, and technology acceptance significantly impact work engagement. these findings show how remote work and technology implementation can affect employee wellbeing. in a study focused on frontline employees in the restaurant industry, essawy (2016) found a positive effect of role ambiguity on emotional exhaustion, indicating that higher levels of role ambiguity were associated with increased emotional exhaustion (ß = 0.82; sig = 0.000). the results suggest that when employees experience ambiguity in their roles, they are more likely to experience higher emotional exhaustion, characterized by persistent fatigue and depleted energy. similarly, Wu etal. (2019) conducted a study that specifically investigated the effects of role ambiguity on job burnout, particularly emotional exhaustion. their findings supported a negative and significant relationship, indicating that higher levels of role ambiguity were linked to increased emotional exhaustion among employees. this suggests that when employees face uncertainty and lack clarity in their roles, they are more susceptible to experiencing emotional exhaustion. however, chiara et al. (1996) observed a different pattern in their research. they found that the direct effect of role ambiguity on emotional exhaustion was not significant. instead, they discovered that the relationship between role ambiguity and emotional exhaustion was entirely mediated by work engagement. in other words, when employees were highly engaged in their work, the negative impact of role ambiguity on emotional exhaustion was reduced. the hypothesis can be stated as follows: h1: there is a positive relationship between employees’ role ambiguity and their emotional exhaustion. Role conflict has a positive effect on emotional exhaustion Role conflict in hospitals can create confusion and contribute to employee stress and burnout. Role conflicts occur when employees face contradictory expectations or demands, and individuals’ reactions to these conflicts can vary. One critical dimension of burnout is emotional exhaustion, characterized by chronic fatigue and low energy levels (Bui et al., 2022). Previous research has identified role conflict as a significant contributor to emotional exhaustion (edú-Valsania et al., 2022). however, studies examining the relationship between role conflict and emotional exhaustion have produced mixed results. For example, essawy (2016) found no significant direct effect of role conflict on emotional exhaustion, indicating that other factors may influence the relationship (ß = 0.10; sig = 0.400). in contrast, a study by Wu et al. (2019) focused on chinese construction project managers and revealed that role conflict negatively and significantly impacted job burnout, specifically emotional exhaustion. in their study, Kutanis and tunc (2009) utilized multiple regression analysis and discovered that role conflict could account for the elevated levels of burnout experienced by healthcare professionals in turkey. it is thus argued that when employees face unclear or ambiguous roles within their work environment, they are more likely to experience higher levels of emotional exhaustion. the lack of clarity regarding job expectations, responsibilities, and objectives can contribute to employees’ feelings of exhaustion. Organizations can mitigate emotional exhaustion and enhance employee wellbeing and performance by clarifying and reducing role conflict. Based on these findings, it is hypothesized that: h2: there is a positive relationship between employees’ role conflict and their emotional exhaustion. Methods Measurement instruments the study adopted a quantitative methodological approach using a structured questionnaire. the questionnaire was divided into two sections. the first section dwelt on capturing the respondents’ cOgent BUsiness & ManageMent 5 demographics. the second section revolved around gathering information regarding role ambiguity, role conflict, and the emotional exhaustion of healthcare service employees, utilizing a five-point likert scale ranging from 1 (strongly Disagree) to 5 (strongly agree). Based on previous studies, the constructs were extracted and modified to meet the context of the study area (aleksandra, 2021; amilin, 2017; essawy, 2016; Raghda et al., 2022). a total of four construct items were used to evaluate employees’ perception of role ambiguity (amilin, 2017; essawy, 2016), five items evaluated role conflicts (essawy, 2016; Raghda et al., 2022), and emotional exhaustion was measured by five construct items (aleksandra, 2021). Data collection and Analysis the data collection period for this study took place from January to February 2023. a simple random sampling strategy was employed to select respondents from Kairuki Memorial hospital in Dar es salaam. in total, 181 questionnaires were collected. however, some incomplete or deemed unfit questionnaires for further analysis were excluded from the final sample. the data from the remaining 131 completed questionnaires were entered into the statistical package for social sciences software (sPss) version 20.0 for cleaning and analysis. Descriptive and multiple regression analyses were conducted to examine the relationship between the variables. the study model was described as follows: Y 1X 2X=++ +ββ β ε 0 12 Where by: Y = emotional exhaustion X1 = role ambiguity X2 = role conflict β0 = constant (coefficient of intercept) β1 = coefficient of role ambiguity β2 = coefficient of role conflict ε = error term Validity and reliability of data the study ensured construct validity by adapting scale items from previous research (e.g. aleksandra, 2021; Raghda et al., 2022), while face validity was assessed through expert evaluation for clarity and relevance. computed results indicated that all htMt values were below the threshold of 0.85, ranging from 0.43 to 0.64, suggesting adequate discriminant validity among the constructs (see table 1). the assessment of explanatory capability relies on the average variance extracted (aVe), which considers all observed variables. in order to meet the criteria for convergent validity, the aVe should exceed 0.50 (hair etal., 2014). in this study, all aVe values were 0.5 or higher, indicating that all constructs exhibited convergent validity (see table 2). the internal consistency reliability of the measures was assessed using cronbach’s alpha coefficient (cronbach, 1951). according to hair et al. (2021), cronbach’s alpha values Table 1. Heterotrait-Monotrait ratio (HtMt). emotional exhaustion Role ambiguity Role conflict emotional exhaustion Role ambiguity 0.61 Role conflict 0.43 0.64 Table 2. Construct reliability and validity. Variables Cronbach’s alpha CR aVe emotional exhaustion 0.85 0.93 0.87 Role ambiguity 0.95 0.96 0.87 Role Conflict 0.84 0.88 0.60 6 J. R. P. MWaKYUsa anD e. W. MchaRO typically range from 0 to 1, where 0.7 or higher indicates acceptable internal consistency. table 2 shows the alpha coefficients for the scales ranged from 0.84 to 0.95, indicating satisfactory levels of internal consistency reliability. Results the demographic characteristics of the respondents are provided in this section, including their gender, age, highest education level, years of experience at work, and profession. according to table 3, it was found that a minority of the respondents (42.3%) were male employees, indicating a relatively balanced gender representation at the hospital. Most respondents (35.4%) fell within the age range of 26-35 years, representing a highly productive age group. in terms of education level, the majority of participants held a Bachelor’s Degree (37.7%), followed by a college Diploma (33.8%), college certificate (13.1%), Master’s Degree (12.3%), and Doctorate Degree (3.1%). Regarding years of experience, one-third of the respondents (33.8%) had worked at the hospital for over five years. When considering the profession distribution, the respondents included receptionists (10%), medical doctors (17.7%), nurses (43.8%), accountants (6.2%), human resources personnel (8.5%), laboratory technicians (9.2%), and other professions (4.6%). Multiple regression analysis the multiple regression analysis was used to test whether role ambiguity and conflict affect emotional exhaustion. the results of the regression are as follows; Role ambiguity effect on emotional exhaustion a multiple regression analysis was conducted to assess the effect of role ambiguity on emotional exhaustion. the results revealed a significant negative relationship between role ambiguity and emotional exhaustion. Based on the coefficient values presented in table 4, the regression coefficient for role ambiguity was found to be 0.398, with a corresponding t-value of 3.863 and a significance value of 0.000. as a result, the hypothesis was accepted at a 95% confidence level. the results imply that Table 3. Demographic characteristics of the respondents. Characteristics Category Frequency(n = 131) Percent (%) Gender Male 55 42.3 Female 75 57.7 Age 18-25 30 23.1 26-35 46 35.4 36-45 25 19.2 46-55 21 16.2 above 55 8 6.2 Education Level College certificate 17 13.1 College diploma 44 33.8 Bachelor degree 49 37.7 Master degree 16 12.3 Doctorate 4 3.1 Years of Experience Less than 1 25 19.2 1-2 30 23.1 3-5 31 23.8 above 5 44 33.8 Profession Receptionist 13 10.0 Medical doctor 23 17.7 nurse 57 43.8 accountant 8 6.2 Human resource 11 8.5 Laboratory technician 12 9.2 others 6 4.6 source: sPss output based on Field Data (2023). cOgent BUsiness & ManageMent 7 role ambiguity has a notable positive effect on emotional exhaustion, indicating that higher levels of role ambiguity are associated with increased emotional exhaustion among healthcare service employees. Role conflict effect on emotional exhaustion the effect of role conflict on emotional exhaustion was examined using multiple linear regression analysis. the results revealed a regression coefficient of 0.149, a t-test value of 1.355, and a p-value of 0.178. since the p-value is greater than 0.05, the hypothesis is not accepted. the value this indicates that no significant relationship exists between role conflict and emotional exhaustion among healthcare service employees in this study. Model summary the model summary in table 3 provides information on how well the regression model fits the data using the R2 test. in this study, the R2 value of 0.211 indicates that 21.1% of the variance in emotional exhaustion can be explained by the predictors, which are role ambiguity and role conflict. the R-value represents the multiple correlation coefficient, indicating the strength of the relationship between the predictors and the outcome variable. Analysis of variance the analysis of variance tests whether the means of two or more groups are significantly different from each other. table 5 indicates the analysis of variance findings as follows: the Fvalue is (16.9), DF (2,127), and P-value is (0.000). the P value of less than 0.05 (p < 0.05) shows that the variables were statistically significant. therefore, the model was significant. Coefficients the coefficient table provides information about the size and direction of the relationship between the predictor variables (role ambiguity and role conflict) and the response variable (emotional exhaustion). it reveals the regression coefficients, which indicate the magnitude of the effect of each predictor on the outcome variable. in this case, the coefficient table would display the values for the regression coefficient of role ambiguity and its statistical significance, as well as the regression coefficient of role conflict and its statistical significance. these coefficients help determine the strength and direction of the relationships between the predictor variables and emotional exhaustion. therefore, the regression model is; Emotional Exhaustion Y 1 398 X 149 X () =++.. . 919 0 0 12 Table 4. anoVa.a Model sum of squares Df Mean square F sig 1 Regression 27.470 2 13.735 16.977 .000b Residual 102.749 127 .809 total 130.219 129 aDependent variable: emotional exhaustion. bPredictors: (constant), role conflict, role ambiguity. Table 5. Model summary. Model R R square adjusted R square std. error of the estimate 1 .459a.211 .199 .89947 aPredictors: (constant), conflict average, role ambiguity average.