Staffing and Job Stress on Motivation of Employees in Al Ihsan General Hospital

Motivation has a very important role for the employees of the hospital in order to provide excellent service to the community. The importance of motivation, one of which is associated with the appropriate placement of human resources. This is done with the hope if the employee works in the right place and at the right position, then job motivation will increase. Based on the hypothesis, motivation of employee influenced job stress and heavy work environment can have an impact on employee stress. This research was conducted at Al Ihsan Hospital with a population of 75 employees. The data were obtained using a questionnaire and interview techniques. Data analysis is using structural equation modeling with the help of PLS analysis tools. The results showed that staffing and job stress have a significant effect on job motivation.


INTRODUCTION
The organization's progress is determined by the performance and effectiveness of employee works.Therefore, every organization expects their employees to be able to carry out their duties effectively.All that can be achieved if the employees have a strong motivation to come forward and always try to give their best performance in their job.Motivation also plays an important role in achieving an organization's objectives.
As a non-profit institution, hospitals are increasingly required to improve quality services.Since the hospital holds the status of Public Service Agency in 2010, the number of visits and examinations in almost all medical supporting installations increased.Al Ihsan Hospital is inseparable from the problems in the field of human resources.Al Ihsan Hospital is a health-care facility for the community in conducting services includes outpatient services, emergency care, inpatient care and other medical support services.Al Ihsan Hospital is required to improve services to the public in line with the discourse of the West Java Provincial Government that makes Al Ihsan Hospital as the main referral hospital in West Java in the next few years.
Al Ihsan Hospital is located in Bandung Regency.People who use the health service of Al Ihsan Hospital are not only the people of Bandung regency it self, but there are also people from the bordering regions near Bandung Regency.Al Ihsan Hospital has become a very important role, especially in fulfill the health services for the people of West Java Province.Aware of this, the current Al Ihsan Hospital is conducting various improvements and enhancement both in quality and quantity of services.Associated with problems in human resources, one of the factors to be considered are employee motivation factors as medical support in five units of the installation that are: 1) Laboratory Installation Unit, 2) Radiology Unit, 3) Pharmacy Installation Unit, 4) Medical Rehabilitation Installation Unit, 5) Medical Records Unit.
There are many theories about motivation, one of which is the need theory of McClelland.Observations and preliminary interview conducted with some of the employees stating that the problems arising in relation to medical support employee motivation is most of the employees are likely still in the need for affiliation (Naff) motivation.Need of affiliation make employees tends to eliminate the atmosphere that could potentially cause competition or rather choose a cooperative situation than a competitive one.The need for cooperation and coordination is required in terms of serving the visit and examination of patients in the medical support installation unit.employee growing.It is hard because every employee must ensure that the quality of service received by the public.Ideally, every increase in the quantity of work must be adjusted by the number of employees in each unit of the installation, so that the performance of employees to service quality is maintained properly.With 75 employees and 2,282 patients per day, then 1 medical support employees in 5 installation units serve an average of 30 patients per day, or a ratio of 1:30.While the ideal amount of an employee of medical support to serve patients every day are 20 patients, or a ratio of 1:20.This clearly indicates that the average medical support staffs in 5 installation units get excessive workloads.Although during this time, Al Ihsan Hospital apply the policy of hiring freelance employee in all existing installation units, but only to help the work of regular employees and contract workers.The quite heavy workload is still felt both by permanent and contract employees.With the addition of a quite heavy workload, it is concerned that motivation of employee is lowered due to not being able to manage themselves well in doing their job.
Consideration factors in the staffing of an employee in the field and the specific task whether the initial placement, transfer, and promotion are very important concern for the organization.However, in its application, careful consideration in staffing is a very difficult process and proportionally has less attention from management.The difficulty of finding the human resources that have particular qualifications for the post and the accuracy of placing each position in the medical supporting installation unit are the obstacles faced by the management of Al Ihsan Hospital.Often the conditions to occupy a position or fill vacant positions are not being met for their professionalism strict regulations governing the placement of an employee at the hospital.There are several factors that indicated a problem in medical support staffing in Al Ihsan Hospital, that are: 1) Difficulty in finding the human resources that meet the occupational requirements, 2) The number of workers are still lacking, 3) The system scheduling/ shift of employee is not optimal due to the lack of number of employees.The accuracy and adequacy of placing an employee in the right position is one important factor in the effort to evoke the passion, motivation and morale of employees.Another variable that indicates cause low motivation of employee is job stress.Job stress provides an important role in maintaining and increasing employee motivation.Job stress is defined as the pressure felt by employees for work tasks that they cannot fulfilled.Stress arises when an employee cannot fulfill what the job demands.There are some factors trigger job stress may be indicated happen to the employees of medical support in Al Ihsan Hospital, that are: 1) The workload is quite heavy, which is caused by an increase There are a significant increase of the percentage of total number of visits and inspections of medical support installation occurred in 2012 to 721,454 patients (total number in 2011 was 592,898 patients), an increase of 21.68%.But in 2014 showed a decrease in the number of visits and services by 2.80% to 832,798 patients (total number in 2013 was 856,866 patients).With a total number of 832,798 patients in 2014, the number of visits per day was able to reach 2,282 patients (Figure 2).
Every increase in the number of visits and inspections directly affects the amount of work that increasing, making the quantity of the workload of each in the number of visits and inspections conducted in installation units of medical support; 2) The dual role, which often involve the employees such as participation in the composition of event committees organized by the hospital.Employees demanded the addition number of employees to cope with the excess workload.In addition, the employees demanded an increase in employee welfare because the workload is quite heavy and the absence of additional headcount.

METHOD
Research related to motivation to work has been done both in profit and non-profit organizations.Motivation of employee shows as an important factor because employees as a unique resource.Motivation theory discusses the urge for employee to work based on the process of motivation and what are the factors that can create job motivation (Mathis & Jackson, 2006).One theory to explain the factors of motivation is the McClelland's theory of needs.This theory focuses on three needs that are need for power, need for achievement, and need for affiliation.
Need for achievement is a strong incentive to succeed.This impulse directs individuals to fight harder in obtaining personal achievement rather than awarded.This then caused them to do something that is more efficient than before.Need for power is a desire to have an influence, become influential and controlling other people.Such individuals become more responsible, striving to influence other people, happy to be placed in competitive situations and tend to be more concerned with the effect obtained than effective performance.Then the need for affiliation is the need to acquire good social relationships in the work environment.This requirement is characterized by having a high motive for friendship, prefers cooperative situation and want relationships that involve a high level of mutual understanding.
Robbins & Coulter (2007) suggests other theories about the factors that affect job motivation expressed by F. Herzberg.According to his theory, motivation of employee can be caused by intrinsic (internal) factors and extrinsic (external) factors.Intrinsic factor comes from within, such as job satisfaction, self capacity, up to the stress of work which may arise as a result of not being able to control themselves.Extrinsic factor is the quality that exists outside themselves, such as employee placement process.
Staffing should be based on the accuracy and adequacy of employees, but it also must be based on job description and job specification which has been determined and guided by the principle of "the right man on the right place" (Shah et al., 2011).The principle should be implemented consistently so that employees can work in accordance with the capabilities  2013) that proper staffing is a motivation that leads to enthusiastic high morale for employees in completing the work.So, the proper placement is the key to obtaining optimal work of each employee in addition to morale, creativity, and initiative will flourish.Martin (2011) found that when employees don't placed in the right position, they tend to feel uncomfortable and then quit their job.On the other side, the study of Chen et al. (2010), Hegney et al. (2003), Sanali et al. (2013), and Pooja (2013) state that the heavy workload of nurses have caused the motivation and performance of employees decreased dramatically.
Job stress experienced by employees can be affected by factors that originated in the work and outside of work.If this job stress leads to negative and destructive stress, it will have negative effect on motivation of employee (Sanali et al., 2013).This is consistent with the views expressed by Jacobs et al. (2013) who argued relationship between job motivation and job stress is the stress that is too low or too high will result in a lack of motivation in the work.For a manager, pressures that are given to employees must be observed so the stress caused is still in the stage of reasonableness.
The statement was supported by a number of previous studies have been done on the effect of job stress on job motivation.Research conducted by Kouloubandi et al. (2012) and Olaniyi (2013) which states that job stress has a significant influence on employee motivation.Job stress really affects a decrease in job motivation, which in turn can decrease performance of employee.Based on some previous research, it can be described the relationship between staffing, job stress, and motivation of employees as in Figure 3.This study uses quantitative methods.The population in this study is all permanent and contract employees at five medical support installation unit.The population in this study amounted to 75.Table 1 is presented the distribution of respondents and the percentage is based on each installation unit.be seen in Table 3. From the Table 2, it can be seen that job stress caused of personal otherwise most reliable when considering the composite reliability, but is not reliable when referring to the value of Cronbach's alpha.
Figure 4 shows the path coefficient of staffing and job stress on motivation of employee at Al Ihsan Hospital.The results for the overall hypothesis test can be seen in Table 4 that staffing and job stress effect on motivation of employees are 59.7%.

DISCUSSION
The effect of staffing and job stress on the motivation of employees working in the medical support of Al Ihsan Hospital are 59.7%.Staffing showed that the right man on the right job to have the greatest impact on motivation of employees, by 35.4%, while the subsequent influence comes from job stress because of personal business that is equal to 34.2%.The influence of stress from task demand due to personal is positive whereas the effect of job stress because of work to be negative.This indicates that employee stress caused by the bad influence of work, whereas the stress or pressure because of problems outside of work actually have a positive impact on employee motivation.
There are many studies that prove that the ability of medical personnel to provide quality services will decrease when employees feel frustrated and angry (Bickford, 2005).This will further impact on employee turnover (Jacobs et al., 2013 andMartin, 2011).The results of this study support previous research which states that medical personnel will refuse to work better if the workplace environment is not supportive.The results of this study indicate that the excessive workload and job stress has a negative impact on motivation of employees.The research by Sanali et al. (2013) showed that the improper placement of employees and patients ratio unbalanced causes nurses to not feel motivated so the performance become problematic.Conditions such as these contribute to the lack of services to patients.From these results, it can be seen that the employees need a quieter working environment with staffing into account the balance between the ability of employees to the demands of the job.In addition, the compensation also becomes their concern (Jacobs et al., 2013).

CONCLUSION
Motivation of employees have important role to produce the best services to the patients.Staffing especially HR placement that are based on the principle of the right man on the right job, play an important role to enhance motivation of employees.Similarly, the stress of work, stress from work plays poorly on job motivation.The results showed that hospitals need to pay attention to both dimensions.In addition, the hospital needs to pay attention to aspects of the provision of fair renumeration and decent as well as aspects of the reward for employees who excel.Al Ihsan Hospital also needs to consider the workload as a source of stress that can lead to employees working through how to make a proper calculation of the ratio between the number of employees by the total number of visits and examination of patients in each of the medical support installation unit to reduce the workload.The aspects that accompany the accuracy and adequacy in staffing and quantify sources of work stress will affect the increase of job motivation.
Staffing and Job Stress on Motivation of Employees in Al Ihsan General Hospital There is a positive effect of the placementright man on the right place dimension-on job motivation H3 Job stress because of task demand -> employee motivation -0,233 3,746 There is a negative effect of job stress on job motivation H4 job stress because of personal -> employee motivation 0,342 3,644 There is a positive effect of job stress on job motivation

Table 5 .
Results of Hypotheses Testing