Organizational Culture, Job Satisfaction, and Turnover Intention among Hospital Staff: A Mixed-Methods SEM-PLS Study in a Type-C Hospital

Abstract

High turnover among healthcare workers remains a critical challenge in hospital management, particularly in resource-constrained settings. While organizational culture and job satisfaction are traditionally considered key determinants of retention, empirical evidence in developing country hospital contexts remains inconsistent. This study aims to examine the relationships between organizational culture, job satisfaction, and turnover intention among hospital staff using mixed-methods SEM-PLS approach.A cross-sectional explanatory sequential mixed-methods design was employed. Quantitative data were collected from hospital staff and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). Advanced model evaluation included effect size (f²) , predictive relevance (Q²), and model Fit (SRMR). Qualitative data were obtained through in-depth interviews and analyzed using thematic coding to enrich interpretation. Organizational culture significantly influenced job satisfaction (moderate effect size), but had no significant effect on turnover intention. Job satisfaction also did not significantly influence turnover intention,and no mediation effect was found. The model demonstrated adequate fit (SRMR < 0,08) and predictive relevance for job satisfaction , but weak predictive power for turnover intention. Qualitative findings revealed that turnover decisions were primarily driven by structural factors such as compensation and workload. The findings reveal a decoupling between organizational culture and employee retention , as well as a satisfaction-turnover paradox. Organizational culture and job satisfaction alone are insufficient to reduce turnover intention in hospital settings facing economic and workforce pressures.