Organizational Loyalty Among Medical Science Faculty Members: A Qualitative Study in Southern Iran

Organizational loyalty is a psychosocial condition that reflects employees’ commitment and dedication to their organization. It includes an ethical obligation (1) and serves as a key indicator of societal progress and the ability to contribute effectively to knowledge production, which in turn leads to increased staff efficiency (2). Theoretically, Meyer and Allen identified three components of commitment: (A) Affective commitment, reflecting a desire; (B) continuance commitment, reflecting a need; and (C) normative commitment, reflecting an obligation to maintain employment in an organization (3). A psychological contract is a set of perceptions regarding what managers and workers owe their organizations and vice versa (4). Loyalty, as a mediator, reduces employee turnover (5), which can be costly and time-consuming for organizations to manage. Loyal employees tend to be more engaged, motivated, and committed to their work (6). Organizational loyalty often leads to long-term employee tenure, enabling individuals to accumulate valuable knowledge and expertise. This accumulated knowledge benefits the organization by contributing to institutional memory and can be transferred to other employees, ultimately enhancing organizational effectiveness. Loyalty also fosters a positive organizational culture (7). A culture of loyalty promotes trust (8), collaboration, and strong relationships among employees. Finally, organizational loyalty is linked to employee engagement and satisfaction (9, 10). Loyal employees experience a sense of fulfillment and pride in their affiliation with the organization, contributing to increased job satisfaction and overall well-being.

The level of employee loyalty in an organization profoundly affects its core competitiveness, which is closely linked to company performance and organizational innovation (11). Additionally, leadership style impacts employee performance (12) and reduces turnover (13). It has been shown that there is an inverse relationship between organizational undermining and loyalty to the organization (14). In Egypt, a study showed that 67.7% of professors exhibit organizational loyalty, which is higher among university faculty members compared to researchers outside the university (15). Alshemari et al. found that ethical and calculation items indicated a high level of organizational loyalty (16). Another study showed a positive correlation between burnout, organizational commitment, organizational loyalty, and the tendency to leave the service (17). It was shown that nurses’ intention to leave their profession was significantly influenced by factors such as educational status, age, experience, job stress, job satisfaction, professional commitment, and organizational factors (18). Among the various components of the transformational leadership style, intellectual stimulation was found to have the strongest impact on the organizational identity of faculty members (19). Additionally, it has been shown that intelligent leadership increases organizational loyalty (20). Arqawi et al. demonstrated a statistically significant relationship between the levels of procedural and interactive justice among department heads at Palestine Technical University-Kadouri (21). Abdulrahman showed that the overall degree of organizational loyalty among faculty members in Jordanian universities was "moderate". "Emotional loyalty" ranked first, followed by "moral loyalty", while "continuing loyalty" ranked last (22). However, feelings regarding integration into academic life and the hope of finding more favorable research conditions elsewhere do exist (23).

Medical universities in Iran experienced a golden era during the last half of the century. However, these institutions now face several challenges. In the nursing domain, shortages and burnout are primary issues, along with management problems (24, 25). Over the last decade, additional problems have arisen, such as health sector reform, budget deficits, and issues with insurance institutions (26). The brain drain of faculty members in medical universities is another challenge (27). There is a shortage of faculty members in deprived regions and a lack of willingness to transfer to type I universities (28). A new challenge confronting the Iranian health system is the increasing reluctance to enroll in specialty residency programs (29).

It can be proposed that there is a certain level of organizational loyalty among faculty members to the University of Medical Sciences. Although studies have focused on the determinants of loyalty and the managerial and organizational effects on loyalty, there has been no study on the nature and experience of loyalty among faculty members. The present study aimed to explore the reasons for this issue. Therefore, the question addressed in this study is: What are the reasons for organizational loyalty among faculty members in medical universities?

This qualitative study was conducted in 2022 in southern Iran. The field of study includes governmental medical universities in Shiraz, Yasuj, Jahrom, Bandar Abbas, Fasa, and Bushehr, collectively known as the 5th region of medical education in Iran. This region has its own policies regarding medical education and fulfills its mission in accordance with the Ministry of Health and Medical Education in Iran. Participants included clinical faculty members from these universities, encompassing all physicians in all departments and resident students. Therefore, all faculty members specializing in clinical fields, including subspecialties, were included as participants in the research. Inclusion criteria were being a faculty member with two or more years of work experience, not working in the private sector, not wanting to work there, and being interested in participating in research. Researchers aimed to include participants from a diverse range of specialties and groups. Purposeful and snowball sampling methods were used in this study. After identifying participants, the research objectives were discussed with them. If they were willing to participate, a time was scheduled for the interview. Based on saturation criteria, 23 clinical faculty members participated in this study (Table 1). Data were gathered through face-to-face and telephone interviews. Telephone interviews were mainly conducted for academic staff members who were difficult to reach or who did not have time for face-to-face interviews. The interview protocol was prepared based on the main question: What is organizational loyalty? Do you consider yourself a loyal faculty member? Why? Please explain your reasons for this loyalty. Based on the responses, additional questions were also asked. Content analysis was conducted in this study. Content analysis can be categorized into three approaches (30), and we used conventional content analysis. In this study, content analysis introduced by Lindgren et al. was used. A step-by-step approach was employed for data analysis, involving selecting meaning units (de-contextualization), condensing and coding, and creating categories and themes on different levels (re-contextualization) (31). Our analysis was conducted inductively. Abstract codes were used and interpreted in the process of analysis. Before coding, authors read the data several times to gain a comprehensive understanding of the subject. Finally, the authors attempted to explore a conceptual schema regarding organizational loyalty.

This schema was not introduced in the mentioned method, but the authors explored it to gain a better understanding of the subject. Trustworthiness and rigor standards were ensured in this study. Credibility, transferability, confirmability, authenticity, and dependability were considered during data collection and analysis (32). An appropriate methodology, research questions, and interview protocols were used throughout the study. The standards for qualitative research reporting (SRQR) guidelines (33) were used to enhance the reporting and methodological quality.

Many participants complained about inefficiencies in medical universities. According to them, these universities face numerous defects and inefficiencies at the management level. Lack of attention to the needs of academic staff members, failure to pay fees on time, disproportionate promotion conditions, and organizational pressures weaken their overall experience. Participants reported encountering a weak and ineffective structure in medical science universities, causing some academic staff to leave the organization and seek opportunities in the private sector or abroad. Poor management at various levels, from macro to micro, has led to high levels of burnout, resignations, and retirements among academic staff members. Despite this, the participants in the research were individuals who remained in their organization and continued their activities. Organizational loyalty, as referred to in the current research, is the act of remaining employed in universities of medical sciences despite numerous challenges and deficiencies in management. Three main themes related to this type of organizational loyalty are organizational spirituality, social capital, and organizational affiliation (Table 2).

The goal of this study was to explore the reasons for organizational loyalty among clinical faculty members of medical universities in southern Iran. We conducted a study among faculty members who have chosen to remain in governmental clinics and hospitals despite several challenges. We identified three reasons related to organizational loyalty: Organizational spirituality, social capital, and organizational affiliation. As shown in Egypt, loyalty is higher among university faculty members compared to researchers outside the university (15). Generally, being a faculty member is associated with higher loyalty to the organization, warranting further research. It appears that organizational loyalty at a personal level is related to how individuals interpret their responsibilities toward the organization and society. Our participants exhibited emotional loyalty, which is achieved by creating a strong emotional attachment to the medical universities. For faculty members, the medical university is a second home. They have spent several years working in the organization, sometimes even serving food, which forms an emotional connection to the organization. Other studies addressing topics such as justice management and leadership are not relevant to our findings.

Evidence shows that organizational justice, including distributive, procedural, and interpersonal justice, plays a role in the emotional exhaustion – organizational loyalty link (34). This is a main issue in the context of this study as well. However, our findings explored the dynamics of this matter at the micro-level of medical universities, which led to faculty member loyalties. These dynamics function despite the multifaceted challenges faced by medical universities. Nevertheless, our participants remained engaged in the context and continued their affiliation and work. Initially, spirituality is the main reason. Workplace spirituality has a direct effect on organizational commitment and an indirect effect on organizational commitment through the mediator variable, work engagement (35). Our participants view medical universities as a context that enriches their spiritual life. Helping the poor and vulnerable and feeling indebted to the organization that supported and nurtured them form the basis of this spirituality. It is clear that clinics and hospitals are not typically associated with spirituality, but their functions do include an understanding of spirituality. "I am a doctor who is dedicated to helping people, and this organization has provided me with the opportunity to do so". As noted, "an employee being loving, owning and owing to the organization" (36).

An organization is a field of belonging. It is clear that the satisfaction of faculty members is related to organizational leadership and management (37). However, our study showed that organizational loyalty is rooted in two fundamental elements: Spirituality and social capital. Many of our participants were faculty members who were welcomed by the private sector but remained in the governmental system. They had an emotional attachment to their organization and were unwilling to leave despite the problems and challenges. Such belonging was rooted in individual and organizational characteristics that provided them with a sense of satisfaction beyond material concerns and organizational obstacles. This is an organizational identity that emerges from its values, practices, and discourse. It is shaped by workplace and individual spirituality, guided by the leader and other members, and influenced by the environment, organizational culture, and knowledge management. This relates to a culture of gratitude towards the organization, as well as a commitment to improving its services and sacrificing for the people. We believe that spirituality, within the context of our culture, is deeply ingrained in the widespread social system that has significantly influenced our organization. On the other hand, social capital in this context is also a cultural issue. It has been shown that social capital significantly influences the planning of employee loyalty and retention (38). In the context of the study, there were formal relationships, as well as deep informal interpersonal relationships, trust, and cooperation between faculty members. This network sometimes extends to include their families, leading to satisfaction and enabling medical universities to function effectively. Despite all the studies that have highlighted deficiencies and challenges in the management of these organizations, medical groups and interpersonal relationships lead to a shared sense of identity, value, trust, and cooperation. Medical universities are considered the second home for faculty members. In the context of the study, it was shown that there is a dynamic relationship between the individual, interpersonal, and macro-levels of an organization that preserves social capital (39). Based on our findings, we can say that micro-level relationships include significant elements of social capital, as our participants have stated.

Let’s revisit the research question: Why do the participants still have a positive perception of the University of Medical Sciences, despite management problems? Why do they tend to stay despite financial problems and sometimes family pressures? They not only enjoy their roles but also strive to remain if given the chance. We base our answer on three themes. Considering the concepts of spirituality, capital, and dependence, it can be said that staying in these universities stems from a profound sense of affiliation. This dependence is primarily rooted in a person's prolonged presence at the university. Regarding the theme of spirituality, it can be argued that the university serves as a pathway for self-actualization. Faculty members are in contact with esteemed colleagues and, regardless of material concerns, are dedicated to the pursuit of knowledge. They study science beyond mere management or material matters, focusing on maintaining the department, educating students and future doctors, and ultimately assisting patients. What is better than this? Figure 1 shows the conceptual schema of organizational loyalty.

Figure 1.

Conceptual schema of the organizational loyalty

As shown in Figure 1, organizational loyalty in this study is related to two elements: Personal and social. On a personal level, faculty members experience spirituality that involves self-actualization and a sense of existential survival. These are intangible benefits of being a faculty member at medical universities. Faculty members who stay and work in medical universities generally enjoy these meaningful experiences. On the social level, individuals encounter beneficial aspects not related to management and leadership, but rather to the organizational atmosphere itself. Being enrolled in a medical university entails having high status, both informal and formal capital, and trust. These factors contribute to organizational loyalty, which, in turn, results in sacrifice, dedication to the organization, professionalism, and the preservation of affiliation.

It’s clear that modern organizations cannot survive solely on loyalty. Additionally, loyalty is related to macro-level conditions such as justice, payment systems, quality of management, and leadership in organizations. Therefore, despite this study’s emphasis on the micro-level of organizational loyalty, macro-level factors are also important. It has been shown that loyalty includes three main dimensions (36); however, we demonstrated that loyalty is rooted in the deep layers of physicians, such as spirituality and existence. We believe that our findings explain the formation of loyalty. Our findings confirm postmodern theories of loyalty. In this approach, loyalty is a personal interpretation rather than the result of formal organizational control (40), as other studies have referred to some personal and organizational conditions that affect organizational loyalty (12, 13, 18). We believe that these factors impact loyalty; however, each person has specific goals regarding their presence in the organization. Therefore, alongside personal and organizational factors, organizational affiliation, spirituality, and social capital in the organization are important too. Employees’ feelings towards the organization are more important than issues such as payment, management, justice, and leadership. However, the duration and survival of organizational loyalty are related to environmental conditions. Evidence-based conceptualization is suggested for future studies in this field. Modern organizations encompass various dimensions beyond those defined by the bureaucratic framework, necessitating specific management and leadership approaches. One of the most crucial aspects of an organization, particularly in today’s era, is understanding and familiarity with employees’ relationships with their organization. The present study demonstrates that clinical faculty members of medical universities have developed a strong connection with the organization, its functions, and its social capital. These factors contribute to organizational affiliation and loyalty. In fact, our participants emphasized the consequences of being present in medical universities. Despite facing numerous challenges, they were satisfied with being accepted into medical universities. Regardless of management and leadership patterns, an organization can be judged by its employees based on how well it functions for them. If these functions contribute to promoting and enhancing organizational spirituality and developing social capital, the likelihood of employees leaving the organization will be reduced. We believe that in the 21st century, these elements can contribute more to the growth, promotion, and maintenance of the organization and its workforce. The main finding of this study is that despite the importance of organizational leadership and management, several micro-level issues function as cohesive forces within the organization, fostering and enhancing organizational loyalty. In this regard, new theoretical approaches are needed.