A Study of the Quality of Work Life Among Magnetic Resonance Imaging Technologists in National Guard Health Affairs Hospitals in KSA

Quality of Work Life (QWL) is a multi-dimensional discipline concerned with the quality of life at the workplace. Objectives: This work aimed to assess the level of QWL of Magnetic Resonance Imaging Technologists (MRITs) at National Guard Health Affairs Hospitals (NGHA) in the Kingdom of Saudi Arabia and identify the correlation between QWL dimensions and Job and Career Satisfaction (JCS). Methodology: This study used the 32-item WRQoL-2 tool, a questionnaire consisting of 6 subscales; Job and Career Satisfaction (JCS), Control at Work (CAW), Home-Work Interface (HWI), General Well-Being (GWB), Stress at Work (SAW) and Work Conditions (WCS). Results: The study respondents were 57 MRITs working in NGHA hospitals across KSA with a 100% response rate. We found a high level of QWL among MRITs (66.2%, 3.31/5). The level of JCS was high (71.6%, 3.59/5) with a signi�cant correlation between JCS and WCS, CAW, HWI, and GWB. There was an inverse relationship between SAW and JCS. Conclusion: Further research in the �eld of QWL is needed to diagnose shortcomings affecting the quality of healthcare services in KSA.

with the work organization 6) work and total living space 7) constitutionalism in the work organization 8) social relevance to work-life 1 .QWL is a construct that has been much analyzed and con rmed to increase staff professional growth, productivity, and achievement 4 .QWL has numerous dimensions; work-life balance, work environment, participative management, job satisfaction, reward and recognition, proper grievances handling, welfare facilities, and organizational commitment 5 .

Job and Career Satisfaction:
When studying QWL, we must differentiate between career satisfaction and job satisfaction.Job satisfaction is a subjective condition; happiness that arises from the responsibility; independence and strength of the work experience.Job satisfaction relates to achievement and maintenance of such success, whereas job dissatisfaction is a signi cant cause for large team turnover and defection 6 .There is an interconnection between job satisfaction and absenteeism, turnover rate, conscientiousness, and staff commitment 7 .A model of job satisfaction that contains four elements: job performance, company performance, role perceptions, and job-related factors 8 .There are four variables that may affect the perception of staff of quality of work-life: meaningfulness, pessimism regarding a change in the organization, job satisfaction, and self-con dence 9 .These four qualities of work-life variables were positively associated with staff perception of job satisfaction.
Career satisfaction is de ned as the well-being of staff in the physical and external dimensions of the work, incorporating career progression and opportunities for the staff 10 .Staff that are able to maintain a satisfying life by reducing pressure and con ict and providing a social connection between staff and the work environment report a high level of QWL in this area.

Control at Work and Home-Work Interface
The conceptual framework of QWL can be viewed through four dimensions: work environment, work context, work life-home, and lifework design 4 .The work environment can be de ned as the impact of societal changes on professional practice.The work context incorporates the setting of practicing work and the effect of the work environment on staff.The work-life/ home life dimension is the integration and compromise between home life and work life.The life-work design deals with the composition of the work and identi es the actual work being done.For instance, the availability of supplies, work tasks, security, education, sta ng ratios, and individual success are parts of the quality of the work-life equation 11 .

Work Conditions and Stress
Ensuring excellent work conditions and reducing stress is critical to improving productivity and job satisfaction, and reducing turnover, robust quality of work life is a necessity to attract new staff and encourage them to remain committed.Enhancing the quality of work-life may bene t team performance; reduce absenteeism, burnout, and lower staff turnover rates.It is also used to enhance work conditions to enable staff to become more active and vital within the organization.Therefore, procedures and policies that create the experience 12,7,9 of work should include more satisfying tasks for staff.Policies and procedures could consist of elements to promote independence, belongingness or loyalty, skill development, provide external rewards; and giving credit for achieved work.Human resources recruitment and sta ng may be positively impacted by the staff's QWL.It is a means to provide attention to the needs and demands of staff with a view towards their needs at the job and their lives outside of work 13 .
Quality of work-life can be utilized to bolster the strength of staff, reduce stress, enable them to meet performance requirements and improve experiences at work 13 .QWL is positively in uenced by supportive visionary leadership, in setting effective management of resources and in raising collaboration levels between staff 14 .

QWL for Healthcare Personnel
The factors pertaining to the broader healthcare environment affect healthcare service quality, so it is in the interests of healthcare administrators to provide the best quality work environment to their staff in order to achieve the organizations vision, mission and goals successfully 14 .There is a recent interest in healthcare organizations all over the world in regards of raising QWL levels to bolster the organizational performance and to result in satis ed patients 12 .A high level of QWL is essential for healthcare organizations to attract and retain talented and quali ed healthcare personnel.High levels of QWL ensure staff are more committed, engaged, satis ed and willing to offer their best efforts.QWL is essential to healthcare organizations who manage highly technical professionals, because the high performance is the core of the success of the organizations and the impacts the satisfaction and wellbeing of patients 15 .
Many healthcare organizations are investigating issues of retention and recruitment via accomplishing a high quality of work-life aesthetic 16 .Another primary dimension is the quality of attention given to the patient, which relates signi cantly to the quality of work-life situation for technologists and other healthcare personnel.Job satisfaction has been linked to raising the quality of service at healthcare organizations.In the health-care setting, QWL is linked to leadership, work policies, and other aspects; each of which has a contemplative impact on how staff see their place in their organizations.QWL aims to promote and sustain the satisfaction of staff to increase productivity and to accomplish an organization's objectives 13 .There is a growing body of research evaluating the QWL for healthcare professionals; nevertheless, no studies have dealt with QWL for MRITs in KSA.Our search on Medline, CINAHL, Web of Science and PubMed yielded no results in this regard.Therefore, we chose to review published literature focused on nurses for the similarities in the work environment of nurses and MRITs, such as work conditions, pressure, and working hours.Powerful QWL can in uence the commitment and contribution of the staff in healthcare organizations.

Quality of Nursing Work Life (QNWL)
A number of studies addressed QWL in the medical sector.One aimed to identify the relationship between QWL and turnover intention in nurses working in healthcare centers in KSA 16 .The study used Brooks' scale for Quality of Nursing Work Life (QNWL) as a tool; surveying 508 nurses in the Jizan region and found dissatisfaction among the respondents regarding their QWL; 203 nurses expressed an intent to leave their jobs -a potential turnover rate of 40%.The average score on the Brooks' scale for respondents was (139.45/252), a low QWL score.The same scale (QNWL) was used to evaluate QWL and nursing turnover intention for 364 nurses working in King Fahad Medical City (KFMC) and King Faisal Specialist Hospital and Research Center (KFSH&RC) 17 .The results revealed a dissatisfaction in QWL among the nursing staff of both hospitals with a percentage of 54.7% and the turnover intention rate was very high 94%.Both studies reveal QWL dissatisfaction among nursing staff in KSA and high turnover intention rates.Another study aimed to measure the correlation between QWL and work engagement in KSA.The sample consisted of 207 nurses working in hospitals in the Eastern region of KSA and found a correlation between the three dimensions of job engagement: absorption, dedication and vigor 18 (see Figure 1).
Place Figure 1 here please Aims: This study is concerned with the quality of work life for MRITs and how it affects the work environment in the healthcare organization.Identifying the level of QWL helps in determining whether the current circumstances are ideal for MRITs or if there are potential improvements that could be made in conditions where MRITs work.

MRITs
Magnetic Resonance Imaging Technologists (MRITs) are quali ed healthcare staff managing radiology imaging equipment, which doctors require to diagnose and treat patients.We have used a similar methodology as previously used to study QWL in nursing staff.MRITs and nurses work equivalent working hours, have similar work conditions and deal with similar challenges and pressures in various aspects of their work responsibilities, with an intense workload, the necessity of interaction with different specializations and facing delays throughout practice, as well as performing non-work-related duties such as supporting family.Other challenges they face center around career progression, training, nancial bene ts, and exible scheduling, all issues potentially impacting their quality of work-life.

Objectives:
The current study assessed the quality of work-life and identi ed the degree and correlation with JCS among MRITs working in NGHA with a view to enhance the QWL and consequently raise the quality of healthcare services provided to patients, increasing patients' satisfaction and promoting the medical facilities in KSA.
Research Questions: 1. What is the level of QWL for MRITs? 2. What is the degree of JCS for MRITs?
3. Is there a correlation Between QWL and JCS for MRITs?

Methods And Methodology
Study Setting: NGHA is a division of the Ministry of the National Guard, one of the largest medical organizations in the Kingdom of Saudi Arabia, distinguishable by its ubiquitous existence in across the Kingdom and their high-quality imaging departments, in six hospitals situated in the cities of Riyadh, Dammam, Jeddah, Al-Ahsa, and Al-Madinah Al-Munawarah.

Study Design
The study used a cross-sectional design conducted between September and December 2019.The study used the WRQoL-2 as the data collection method 3 .This scale has been used in different studies in the medical context to measure QWL for various professions working in healthcare.
An electronic questionnaire was derived from the WRQoL-2 with permission and sent to study respondents through the (WhatsApp) mobile application.The study sample consists of all the MRITs, male or female, Saudi or non-Saudi, and staff on the job training under the Saudi Career Development Program (SCDP) in all six hospital locations in NGHA network.

Validity and Reliability of the Study Tool:
We conducted statistical tests to establish the distribution of the sample, it was found to be normal.We also conducted validity and reliability testing.The whole scale items and correlations with their subscales were signi cant at (p<0.01), denoting that all questionnaire items have internal consistency and interitems consistency (see Table 1).

Place Table 1 here please
To check the reliability of the study tool, the Cronbach α coe cient of 0.9 was calculated for the WRQoL-2 six subscales (see Table 2).We concluded here that the study tool is reliable to measure the QWL at MRITs.

Place Table 2 here please
Statistical Analysis: 1. Frequencies and percentages were calculated to describe study sample demographics. .One-Sample T-test was used to determine whether the average score of some items is higher or lower than the average approval score, which is 3.

Ethical Considerations
IRB approval was sought from King Abdullah International Medical Research Center (KAIMRC) in NGHA.
The study was conducted in full accordance with the protocol and current revision of the Declaration of Helsinki for Good Clinical Practice.Participation was obtained voluntarily through an approved consent form.The investigator assured privacy and con dentiality of respondents, including personal information.No data was used for any purpose other than what was stated.The current research was presented for approval with study number (SP19/462/R).Respondents were permitted to exit the study without any adverse effect.The researcher-maintained con dentiality and anonymity of data as no other parties were provided access to information.

Results
The sample size was (n=57) with a 100% response rate.MRI is a highly specialized eld and therefore the number of respondents, related to the specialty and working within the study setting, is considerably small.
Place Table 3 and Figure 2 here please 2-Age: 84% of the study sample were in the age group 25-44 years (n=48), followed by the age group 45-59 years, n=6, 11% and only three respondents were under age 25 years 5% (see Figure 3).
Place Figure 3 here please 3-Years of Experience: Of the respondents n=26 have 1-5 years of experience 45.6%, representing the largest group, followed by respondents who have 6-10 years of experience, n=14, 24%, followed by 11-20 years of experience, n=11, 19%.Only 2 respondents had more than 20 years of experience, 3.5% (see Figure 4).
Place Figure 4 here please 4-Hours of work: 70.2%, n=40 respondents work on a full-time basis with paid overtime, which denotes a shortage in the MRITs in NGHA hospitals.Seventeen respondents work full time with no overtime 29.8% (see Figure 5).
Place gure 5 here please 5-Disability Status: 56 respondents did not have any disabilities 98%, one respondent had a disability 1.8% (see Table 4).
Place Figure 7 here please Frequencies and percentages for all sociodemographic data were calculated (See Table 5).

Place Table 5 here please
The Level of QWL for MRITs Mean and standard deviation were calculated for the study responses.The One-Sample T-test was used to identify the degree of QWL for each subscale and identify the overall degree of QWL for MRITs (see Table 6).
Place Table 6 here The study sample of MRIT's was found to have a high level of QWL.The overall mean for study responses was (3.31/5.00);four subscales were statistically signi cant at the level of (p<0.01).The study responses were higher than the average approval level of (3), which con rms that QWL for MRITs was high (see Table 6) (see Figure 8).
Place Figure 8 here please The highest scores among the six dimensions of WRQoL-2 were found for WCS, followed by GWB, SAW and lastly HWI.All four dimensions were high for MRITs, as the mean for them ranged between 3.28-3.60.
The evaluation rate was between 65.6% to 70.2%.All were statistically signi cant at (p <0.05).

The Level of JCS for MRITs
The One-Sample T-test was conducted for statements 1, 3, 8, 11, 18, 20 as corresponding to JCS on the WRQoL-2 Scale.The mean for the responses was (3.59/5), indicating a high level of JCS for the study sample.This was signi cantly correlated at (p <0.01).(see Table 7).
Place Table 7 here please Correlation Between QWL and JCS for MRITs Using Pearson's Correlation Coe cient, we found a positive correlation between JCS and the other subscales of WRQoL-2 (GWB, HWI, CAW, WCS and SAW) (see Table 8).There was a statistically signi cant correlation between JCS and all subscales at the (p <0.01) level.This means that when work conditions, well-being, control at work, etc. improve, there is an increase in job and career satisfaction.
There was an inverse correlation between SAW and JCS as the signi cance level was a negative value at (p <0.01) level (see Table 8).When "Stress at Work" increases, JCS decreases.
Place Table 8 here please QWL and Gender: There were no statistically signi cant differences at the level of signi cance (p<0.05) for the subscales HWI, CAW, WCS and SAW.The overall score of WRQoL-2 was not statically signi cant for gender.We found statistically signi cant differences for the subscales JCS, GWB according to gender variable (p<0.01); in favor of male gender (see Table 9).
Place Table 9 here please QWL and Age: Using the ANOVA test, we found a statistically signi cant difference between the overall level of WRQoL-2 and Age.The HWI, CAW and WCS subscales were statistically signi cant by age group at (p <0.01).The JCS, GWB and SAW subscales did not return any signi cance (see Table 10).
Place Table 10 here please To identify differences between age groups for the HWI, CAW, WCS subscales, Scheffe's post hoc test was conducted (see Table 11).There was a signi cant difference among the study respondents in regard to HWI, CAW, WCS in the 45-59 years group.This indicates a correlation between QWL and older age.
Place Table 11 here please

Discussion
We assessed the level of QWL and identi ed the JCS and differences for gender and age in the six subscales of the WRQoL-2 for MRITs at NGHA hospitals.
WRQoL-2 has been used by studies conducted in China, Taiwan, Turkey, Iran, Uganda, and the UK.These studies were conducted to identify problems and factors that affect QWL, to be able to put forward remedies and solutions to enhance the working conditions, the working environment, the job-life interference, as places whose staff have high levels of QWL contribute more to productivity and excellence at the workplace.
Place Table 12 here please In comparison to the ndings of these international studies, our study shows that job and career satisfaction in MRITs at NGHA hospitals is highest (3.59), followed by the study on nurses in Taiwan (3.75) 23 , followed by the study on nurses in Uganda (3.53) 24 .In relation to CAW, three studies scored (3.39), and the current study came second, scoring (3.15/5).This indicates a similarity between all the studies that used WRQoL-2 tool for the CAW dimension.In our study the HWI dimension score was (3.28/5), whereas it was (3.52) in Zhao et al. 25 , Edwards et al. 26 and (2/5) in Mazloumi et al. 27 .For the GWB dimension, the current study scored (3.51), which is the highest among the nine studies (see Table 12).This is an indicator that the well-being of medical staff in KSA is considerably higher than healthcare personnel in other developing countries.The overall results of the current study show that the MRITs working in NGHA hospitals have a high degree of JCS; the study respondents are satis ed with their jobs.
The current study differed slightly from a previous study on nursing staff in Al-Madinah region hospitals in KSA 28 .This could be because the study on Al-Madinah region hospitals focused on a single region, whereas the current study was conducted across KSA.The mean for the work-life-home dimension in the study on Al-Madinah region was (3.37) whereas in the current study the mean HWI is (3.28).
In our study, female respondents scored low levels of General Well-Being (3.31/5), comparable with results of other studies that found low levels of General Well-Being for females (3.23/5) 29 and the overall WRQoL scores were similar for females in both studies (3.19) in the current study, and (3.22) 29 .This rea rms our assumption that the work environment of MRITs is similar to that of surgical residents, and that they face similar issues with their QWL.
Respondents of the male gender were found to have higher mean scores than females in terms of job satisfaction and in total WRQoL contradicting a previous study that found moderate QWL among nurses 30 .The SAW dimension was found to be unrelated to gender, as male and female respondents had proportionate stress at work.
In our study, we found that age and gender were signi cantly correlated with QWL.Respondents in the age group (45-59) had higher levels of WRQoL in the HWI dimension.This is similar to ndings of previous studies; that older age had a positive effect on QNWL, work context and the work environment 17,28 .This may be due to the ability of older and more senior staff with years of work experience to adapt their home and work lives and create a balance and feel satis ed with their roles, their ability to overcome hardships, achieve job promotions and ask for better pay.
The results from our study contradict a study from 2012, which found QWL dissatisfaction 16 , which may also be related to the study being conducted in a single region in the south of the Kingdom, where there is a shortage of medical workforce resulting in increased workplace stress.
There were studies that measured QWL among other professions in the Kingdom, such as a study conducted on Yanbu industrial city staff, found that respondents had a high level of job satisfaction.It identi ed factors that affect the level of job satisfaction, such as wages and remuneration, workgroup factors, and decision-making factors 31 .

Summary And Conclusions:
The current study is the rst study that is conducted on MRITs in Kingdom of Saudi Arabia.We aimed to determine the level of QWL and degree of job and career satisfaction for MRITs working in NGHA.The study showed a high level of QWL and signi cant correlations between QWL and speci c subscales.
Older age and years of work experience contributed signi cantly to higher QWL scores.These ndings are similar to previous research ndings on nursing staff and can potentially be adapted to evaluate QWL for other types of healthcare professionals or medical technicians in KSA.Identifying shortcomings will help healthcare administrators bridge the gaps in this eld and nd means to build and sustain the QWL for healthcare professionals for the potential enhancements to quality of healthcare and patient satisfaction.
analyzed the data and wrote the manuscript.The second author supervised the conduct of the work, reviewed all components of the project, edited and advised on conceptualization, data collection and analysis, and co-edited the manuscript for submission.Acknowledgements: The authors acknowledge the support of the National Guard Health Affairs in enabling the research project.

2 .
Mean was calculated to nd high and low responses of the study respondents on each subscale.3.Standard deviation was used to identify extent of deviation of responses for each subscale.4.Pearson correlation coe cient was used to measure validity of the study tool.5.Alpha-Cronbach coe cient was used to measure reliability of the study tool.

Table 2
Reliability of the Study Tool

Table 3
Distribution of the Study Respondents According to " Gender Variable."

Table 9
WRQoL Subscales According to Gender Variable ** Signi cant at 0.01

Table 11
Scheffe post ad hoc Test for three Subscales