• Develop guidelines for selecting/recruiting employees; provide better compensation
• Conduct performance appraisals & periodic assessment; provide proper supervision & in-service training 

The majority of janitorial staff have several dependents in their families and draw a low salary.

These findings were made in an updated review article on ‘An assessment of the job satisfaction of janitorial staff in two tertiary care hospitals in the Kandy District’ which was authored by R.P. Weliwita and S.S. Dolamulla (both attached to the Health Ministry) and published in the Sri Lankan Journal of Medical Administration's 24th Volume's Second Issue, last month.

The assessment of job satisfaction among janitorial staff in healthcare institutions is, as explained in S. Khamlub, M. Harun-Or-Rashid, M.A.B. Sarker, T. Hirosawa, P. Outavong and J. Sakamoto's ‘Job satisfaction of healthcare workers at health centres in the Vientiane Capital and Bolikhamsai Province, Lao People's Democratic Republic’, a multifaceted inquiry that encapsulates both the well-being of the workforce and its consequential impact on the quality of healthcare delivery. 

Defining job satisfaction within the territory of janitorial services involves, according to Spiceworks' "What is job satisfaction? Definition, factors, importance, statistics and examples", an exploration of the elements that contribute to their contentment and fulfilment in their roles. The significance of janitors in elevating the quality of hospital environments is paramount. Beyond their traditional role as custodians of cleanliness, janitorial staff substantially contribute to, as acknowledged in J. Storr, C. Kilpatrick and K. Lee's "Time for a renewed focus on the role of cleaners in achieving safe healthcare in low- and middle-income countries", the creation of a sanitary and organised space, thereby directly influencing the well-being of patients, healthcare professionals, and support staff. 

Weliwita et al.'s research employed a descriptive, cross sectional study design. It was conducted in two teaching hospitals (THs) within the Kandy District, namely, the Peradeniya TH and the Sirima Bandaranaike Specialised Children's Hospital (Teaching) also in Peradeniya. This study utilised a mixed methods approach, combining both quantitative and qualitative methods. A purposive sampling strategy was employed. The total staff of the janitorial services was considered as the sample for this study. Data collection comprising a quantitative component involving structured questionnaires tailored for janitorial and nursing staff. Additionally, a qualitative component involved key informant interviews with select janitorial staff members. The study utilised two distinct questionnaires, one for the janitorial staff and another for the nursing staff.

Results

The data revealed that the Peradeniya TH has 64 janitorial staff, constituting 64.6% of the total, while the Children's Hospital (Teaching) has 35 janitorial staff, representing 35.4%. The total population size of the janitorial staff considered in this study is 99, encompassing both the Hospitals. The gender related distribution reveals that the majority of the sample consists of male participants, comprising 84/84.8% while females constitute 15/15.8%. This gender distribution pattern is observed consistently across both the TH and the Children's Hospital (Teaching). The age-based distribution indicates a varied representation within the sample with participants aged 41-60-years constituting the largest proportion at 78/78.6%, followed by the age group of 18-40 years, accounting for 10/10.2% while those over 61-years of age make up 11/11.2% of the overall sample. This age distribution is consistent across both the Hospitals. The monthly family income distribution within the sample is categorised as: Rs. 25,001-50,000, Rs. 50,001-75,000, and more than Rs. 75,000. Across both the Hospitals, the majority of the participants fall into the Rs. 25,001-50,000 bracket, comprising 40.3% at the TH and 35.5% at the Children's Hospital (Teaching). The Rs. 50,000-75,000 bracket has the second largest representation, with 23.9% at the TH and 23% in the Children's Hospital (Teaching). The educational background of the sample is presented as — up to Grade Six and up to the General Certificate of Education Ordinary Level (GCE O/L). Across the TH and the Children's Hospital (Teaching), a substantial proportion of participants have completed education up to Grade Six, constituting 57.6% of the overall sample while a smaller proportion has education up to GCE O/L, accounting for 40.9% of the total sample. 

Facilities for the job garnered a high level of satisfaction at both the Hospitals, with mean satisfaction levels of 1.022 (TH) and 1.008 (Children's Hospital [Teaching]). This suggests contentment among janitorial staff regarding the facilities provided for their work. In the realm of sanitary equipment, janitorial staff at the TH reported a mean satisfaction level of 0.726 while their counterparts at the Children's Hospital (Teaching) recorded a mean satisfaction level of 0.736. Though indicating a relatively lower satisfaction level, it remains comparable to other aspects. Support from colleagues received positive perceptions at both the Hospitals, as evidenced by the mean satisfaction levels of 1.054 (TH) and 1.067 (Children's Hospital [Teaching]), reflecting a supportive work environment. Satisfaction levels regarding the time allocated for meals and tea were marginally higher at the Children's Hospital (Teaching) compared to the TH, indicating a relatively positive response. Welfare facilities yielded comparable satisfaction levels among the janitorial staff at the TH and the Children's Hospital (Teaching), suggesting similar contentment with the provided welfare facilities. Both the TH and the Children's Hospital (Teaching) demonstrated positive satisfaction levels concerning support from the Hospital staff. Job appreciation was perceived positively by the janitorial staff at both the Hospitals. Satisfaction with the travel distance was generally high. Regarding income related satisfaction, both Hospitals exhibited high levels of contentment. Job duties related satisfaction remained notably high at both the Hospitals. Overall job satisfaction was reported as high. These findings collectively indicate positive perceptions among janitorial staff regarding various job satisfaction related measures in both the Hospitals.

Discussion

The majority of participants being male, with a substantial representation in the age group of 41-60-years and an emphasis on the Rs. 25,001-50,000 monthly income category, provide a foundational understanding of the demographic landscape. The positive perceptions expressed by the janitorial staff regarding the facilities, the sanitary equipment, support from colleagues, the time allocated for meals and tea, the welfare facilities, the support from the Hospital staff, job related appreciation, the travel related distance, the income, and the job duties related satisfaction underscore the overall contentment within the workforce. The relatively higher satisfaction levels regarding the travel distance and the income indicate the significance of these aspects in shaping job satisfaction among janitors in the healthcare sector. Support from colleagues emerges as a notable strength, contributing to a positive work environment for the janitors in both the Hospitals. This collaborative atmosphere fosters job satisfaction and has the potential to positively impact the overall Hospital performance. Identifying and leveraging these strengths can be instrumental in designing initiatives to further enhance teamwork and support mechanisms among janitorial staff. The significance of support from colleagues, high satisfaction levels in critical aspects like travel related distance and the income, and the positive overall job satisfaction reported in both the Hospitals point to the resilience and commitment of the janitorial staff. 

Conclusion

One key issue was disproportionate staffing. Also, it was found that there are no proper indicators to monitor and evaluate the process. In both the Hospitals, issues with regard to sex, age and wages were identified as these aspects can demotivate the staff and can affect the efficiency, quality and productivity of the work. Though overall job satisfaction is satisfactory, the majority draw a low salary while having several dependents in their families. It was found that though the majority of the staff members have a poor level of education, their knowledge on work is satisfactory and this was seen with regard to knowledge on the spread of diseases. Both the Hospitals were lacking in the usage of monitoring tools to assess the quality of work and the correct use of equipment, which infers that the supervision of those by the middle level and immediate supervisory staff is low. Employee retention and pay are key areas that must be considered in strategic human resource management as they contribute to job satisfaction directly and indirectly.

Therefore, Weliwita et al. made several key recommendations for improving the management of janitorial staff outsourcing in a healthcare setting: develop guidelines for selecting and recruiting employees based on the demand, age limits, and minimum qualifications to avoid discrepancies and demotivation; introduce better compensation methods to motivate staff, as this area has been neglected; implement a relevant performance appraisal system to assess janitorial work and further motivate the staff; recommend the periodic assessment of janitorial work by the ultimate authorising officer (e.g., Ministry of Health or the Provincial Health level) to evaluate cost effectiveness at the institutional level; provide proper supervision by upper and middle-level managers periodically, using checklists, direct observations, etc., to improve performance; and arrange in-service training for janitorial staff to enhance their knowledge of cleaning techniques and the correct use of personal protective equipment as such will also contribute to job satisfaction.