Factors affecting the work passion of physicians during the COVID-19 pandemic: a qualitative study in Thailand

ABSTRACT

Purpose

This qualitative study explores the factors influencing physicians’ work passion during the COVID-19 pandemic in the Thai medical context.

Methods

Using an appreciative inquiry (AI) approach, we conducted qualitative interviews with 30 physicians from a public hospital in Thailand to investigate the factors that influence passion for their professional work (work passion).

Results

Our analysis revealed 12 codes influencing physician work passion, which were grouped into four themes: job factors (meaningful work, challenging tasks, task accomplishment, autonomy, work-life balance); organizational factors (fairness, positive environment); relationship factors (having a role model, psychological support, collaboration, recognition and respect); and individual factors (spiritual drive).

Conclusion

These findings contribute to developing knowledge about work passion among physicians and provide information to develop effective strategies to harness and manage work passion, thus improving clinical practice and healthcare outcomes. This qualitative study sheds light on the factors that influence physician work passion during the COVID-19 pandemic in Thailand, providing valuable information for future research and guiding the development of strategies to optimize work passion and its impact on clinical practice.

KEYWORDS:

• COVID-19
• Thai medical context
• qualitative study
• work passion
• appreciative inquiry

Introduction

The COVID-19 pandemic has greatly impacted work environments, forcing people to change their routines and way of life. Whether employees are in front-line roles, service providers, or healthcare professionals, work arrangements and conditions have significantly altered their health and wellness (Lulli et al., 2021). The coronavirus pandemic is an essential phenomenon that affects healthcare workers (HCWs) and their professional passion for their work (work passion). Numerous studies have examined the effects of COVID-19 on healthcare personnel (Giorgi et al., 2020; Sheraton et al., 2020; Sigahi et al., 2021). The pandemic changed the health of healthcare professionals, their daily routine, and their professional and personal identities (Chemali et al., 2022). The meta-analysis revealed that during the COVID-19 pandemic, healthcare personnel face a significant mental health burden. Anxiety, depression, and sleep issues increased by 30%, 31%, and 44%, respectively (Marvaldi et al., 2021). Scott et al. (2023) reported that the prevalence of mental disorders in healthcare workers during the COVID-19 pandemic was high 14.3% for anxiety, 13.7% for depression, and 7.9% for post-traumatic stress disorder. Tong et al. (2023) conducted a systematic review and meta-analysis of 19 studies on the effects of the COVID-19 pandemic on mental health among frontline healthcare workers (HCWs). The results showed that the overall prevalence of insomnia, stress, anxiety, and depression among HCWs was high, particularly among physicians. Majid et al. (2023) in a scoping umbrella review that summarized the mental health outcomes of published evidence syntheses on HCWs worldwide during the COVID-19 pandemic, found that HCWs continue to fear the risk of infecting their family and friends, placing them in a precarious situation that requires them to balance risk and social deprivation. In Thailand, Chinvararak et al. (2022) investigated the mental health of Thai HCWs during the COVID-19 pandemic. The results showed significant levels of emotional exhaustion, depersonalization, and decreased personal success in 16.3%, 16%, and 53.5% of the respondents. Anxiety, depression, and posttraumatic disorders were also present in 33.1%, 13.8%, and 2.3% of the respondents, respectively (Chinvararak et al., 2022). For the well-being and quality of care of HCWs during a pandemic, targeted preventive and psychological support should be provided to this population. There is an immediate need for research in this area to prevent and support strategies in the event of future health crises.

Three different areas of passion have been studied: a passion for activities (Vallerand et al., 2003), an entrepreneurial passion (Cardon et al., 2009), and a passion for work (Perttula & Cardon, 2011). Passion for work is a psychological condition marked by intensely positive emotions, an innate desire to work, and a sense of meaningful connection to one’s job in the workplace (Perttula & Cardon, 2011). Zigarmi et al. (2009) defined employee work passion as the positive emotional state that results from employee appraisal of their work. Work passion, specifically in the context of healthcare organizations, has significant benefits both for organizations and for human resource development. Understanding the factors that influence work passion among physicians is crucial, especially during the COVID-19 pandemic, as it can help healthcare organizations and human resource development personnel develop strategies to cope with and improve that passion.

Passion drives people to invest more effort and develop innovative solutions to the challenges they face. This increased dedication and commitment can lead to improved job performance. Dubreuil et al. (2014) found that concentration and vitality at work were positive predictors for workers with high performance. Houlfort et al. reported that work passion is related to increased organizational commitment, work satisfaction, and a decreased tendency for turnover (2015). When individuals are passionate about their work, they derive a sense of fulfilment and purpose from their roles. Passion prevents burnout because passionate workers deeply care about their work; the challenge for them would appear to remain harmoniously passionate about their work (Vallerand et al., 2010). When individuals are passionate about their work, they are more likely to experience a sense of satisfaction and fulfilment, which can buffer the negative effects of stress and exhaustion. The relationship between a harmonious passion for work and the intention to leave the organization was mediated by work satisfaction. Employees with harmonious passion appear to experience higher levels of work satisfaction, and consistent with research on turnover determinants, work satisfaction was inversely related to intentions to leave the workforce. Therefore, an employee who is satisfied will tend to remain with the organization (Houlfort et al., 2015).

Studying work passion among physicians during the COVID-19 pandemic is of very importance due to the significant impact of the pandemic on work environments and the well-being of healthcare professionals. The pandemic has disrupted routines and brought unique challenges and circumstances to employees in various sectors, including healthcare (Lulli et al., 2021). Healthcare workers, including physicians, have faced unprecedented changes in their daily routines, professional identities, and personal lives (Chemali et al., 2022).The mental health burden on healthcare personnel during the pandemic has been substantial, with higher levels of anxiety, depression, and sleep issues (Marvaldi et al., 2021). Studies have shown significant levels of emotional exhaustion, depersonalization, and decreased personal success among healthcare workers (Chinvararak et al., 2022). By identifying these factors, targeted preventive and psychological support strategies can be developed to address the specific needs of physicians and ensure their well-being during health crises (Marvaldi et al., 2021). Research in this area is urgently needed to inform interventions and support systems for healthcare workers, including physicians, and to improve the resilience and effectiveness of the healthcare workforce in future health crises (Lulli et al., 2021). In the face of the COVID-19 pandemic, understanding the factors affecting the work passion of physicians is very important for healthcare organizations and human resource development personnel to provide human resource strategies to improve the passion for the work of physicians.

The research gap identified in the literature on work passion is related to the lack of studies that specifically investigate the factors that influence the work passion of physicians during a critical time, such as the COVID-19 pandemic. Previous research on physician work passion has been limited (Luo et al., 2014; Ruddy, 2019), and given the significant impact of the pandemic on healthcare professionals, it is crucial to understand and manage work passion in this context. This research gap highlights the need to further explore the factors that influence physician work passion during the pandemic.

The specific research gap that this study aims to address is the exploration of factors that influence physician work passion in the context of the COVID-19 pandemic. The focus of the study is to discover and understand the various factors and experiences that influence work passion among Thai physicians during the ongoing pandemic. To achieve this, the research used an appreciative inquiry (AI) approach to gain in-depth insights into the key factors that shape work passion among physicians in the Thai medical context during the COVID-19 pandemic.

AI is an approach that aims to harness the unique creativity of organizations by emphasizing their strengths rather than becoming defensive and problem-focused (Cooperrider & Whitney, 2005). AI can be used as a tool for research inquiry in the search for what provides life, what drives developmental potential, and what is of profound significance during a problematic situation in the organization. For example, Laszlo et al. (2020) demonstrated how leaders and organizations could address forthcoming difficulties by employing AI-based techniques that emphasize sustainable value (such as a pandemic and many other social and global challenges).

AI revolves around ensuring inclusion, respecting diverse perspectives, and maintaining transparency in the process. It is crucial to involve all stakeholders and create a safe space for open dialogue and participation. Additionally, ethical concerns can arise when selecting respondents or sharing sensitive information during the AI process. Respecting confidentiality and obtaining informed consent are important ethical considerations (Clouder & King, 2015).

Limitations of the AI method include the potential for bias and overemphasis on positive aspects, which can result in overlooking critical issues or challenges. It is important to strike a balance between appreciating strengths and addressing areas that require improvement (Clouder & King, 2015). Furthermore, AI may not be suitable for all research contexts or organizational cultures, and its effectiveness may vary depending on the specific situation (Shuayb et al., 2009).

The research question that guides this study is: “What are the key factors influencing physician work passion in the Thai medical context during the COVID-19 pandemic?” By addressing this research gap and answering the research question, this study will discover and understand the various factors and experiences that influence physician work passion in the specific context of Thailand during the ongoing pandemic.

Material and methods

The researchers conducted a qualitative study exploring factors affecting the work passion of physicians during the COVID-19 pandemic. This study was approved by the Ethics Committee on Human Research (EC2/4) of the National Institute of Development Administration (NIDA under protocol code No. ECNIDA 2021/0134). Ethical considerations included respecting the rights of the respondents, creating informed consent, and maintaining confidentiality, anonymity, and transparency. Each respondent had the right to leave the study. All respondents were informed that their recorded information would be deleted after being transcribed and coded to protect their anonymity. The personal information of the respondents was anonymous in this process. Participants declared their consent, and a consent form was obtained from respondents prior to the interviewing process. This study was carried out in Bangkok, Thailand. The chosen hospital was a general and teaching hospital. This facility specializes in cancer treatment and treats patients with various conditions, including COVID-19.

Respondents

In this study, a purposive sampling procedure was utilized to select the respondents, as described by Patton (2002) This approach is commonly used in qualitative research to select individuals who have specific characteristics or experiences relevant to the study objectives. One way to foster reproducibility is to have a methodical procedure that lists in detail the inclusion criteria used for selecting respondents (Tongco, 2007). This study includes a detailed explanation of the selection criteria and the implementation method of the purposeful sampling procedure The target group consisted of 30 physicians working in a public hospital in Bangkok, Thailand. The procedure involved the following steps.

Potential respondents had to meet these three criteria: (a) active employment status at the hospital; (b) willingness to share experiences in an interview lasting 45–60 minutes; and (c) demonstrated work passion by either recommendations or achievements.

Two approaches were used to identify physicians who met criterion (c) above:

Approach 1: Physicians and nurses from the 10 hospital departments were asked to provide the names of three passionate physicians. The respondents were informed about the characteristics of passionate physicians, which aligned with the five dimensions of work intentions: intent to remain in the organization, organizational commitment, job commitment, discretionary effort, and employee endorsement (Zigarmi & Nimon, 2011).

Approach 2: Physicians employed at the selected hospital who had received at least one work-related compliment from patients through comment boxes or letters to the hospital director in the previous year, as well as physicians who had been awarded the hospital’s best employee of the year in the previous year.

By combining these approaches, the researchers aimed to identify physicians who demonstrated work passion based on recommendations, achievements, and recognition within the hospital. The criteria for the selection of the respondents were defined based on the specific objectives and the focus of the study. The researchers deemed these criteria relevant, as they were directly related to the concept of work passion and its impact on physicians in the context of the study. The criteria ensured that the selected respondents were currently employed, willing to share their experiences, and had a demonstrated high level of work passion based on recommendations, achievements, and recognition. The purposive sampling procedure and the defined criteria allowed the researchers to select a sample of 30 physicians who met the eligibility criteria. It is important to note that data saturation was achieved, indicating that further analysis did not reveal any new information.

Data collection

The 4D appreciative inquiry (4D-AI) model is a framework used for organizational change. It is a strengths-based approach that focuses on exploring what gives life to human systems when they function at their best. The 4D-AI model consists of four phases: discovery, dream, design, and destiny (Cooperrider & Whitney, 2005). In the discovery phase, respondents consider the “best of what is.” The second phase is the dream phase, in which respondents imagine “what could be” if the best events and experiences identified in the first phase occurred more frequently. In the design phase, respondents co-create what has succeeded and create ideas for the future. In the destiny phase, individuals use their vision to generate change (Cooperrider & Whitney, 2005).

Interview questions in the 4D-AI model were developed based on these four phases to guide the data collection process. The questions were designed to elicit information that aligned with the principles and goals of each phase. For example, discovery phase questions inquired about the organization’s strengths and success stories, while dream phase questions explored aspirations and future possibilities. In the design phase, the questions focused on practical strategies and action plans, and in the destiny phase, the questions addressed the implementation and sustainability of positive changes.

The theoretical framework that guides the data collection process in AI assumed that focusing on strengths, positive experiences, and collective visioning would lead to transformative change. By structuring interview questions around the 4D-AI model, we aim to uncover the organization’s positive core, co-create a shared vision, and develop practical solutions that align with the organization’s desired future. The 4D-AI model provides a systematic approach to data collection that allows for a comprehensive understanding of the organization’s strengths and potential for positive change. The human resource development expert reviewed a set of semi-structured interview questions and provided feedback on clarity, relevance, and alternative language. The original questions were revised to align with the expert’s suggestions, improving clarity and relevance. The primary questions used during the interviews were as follows:

1. Let us talk about the best experiences you have had in your work as a physician.

2. Please share your experience as a physician that makes you feel the proudest and happiest.

3. Based on your best experience of work passion, what do you think are the influencing factors for work passion to occur?

4. When you are feeling down, what could make you gain new passion for work?

5. If you do not have to worry about anything, how do you like to see the success mental image for work? How would you like it to be?

6. In that successful mental image, what are you doing at that moment?

7. Please share organizational activities or strategies that inspire your passion for work.

8. What is the most important thing to inspire your passion for work, such as working in a dream organization?

The pilot test is an important step in research, particularly when working with physicians, as it allows researchers to assess and refine their interview questions before the main study. The purpose of the pilot test is to ensure that the interview questions are clear, relevant, and capable of eliciting meaningful responses from the respondents. By conducting a pilot test, researchers can identify any ambiguities in the questions and improve the interview questions. The pilot test results indicated that no modifications were required that should be made based.

After presenting pertinent information about the research and ensuring that the potential respondent had a sufficient understanding of the study, informed consent was obtained from each respondent. All respondents were given identical open-ended interviews in the same sequence to collect data. The questions included basic demographic questions, an initial question about their physician experiences, and questions related to the 4D-AI model (Cooperrider & Whitney, 2005).

Interview administration

Each interview is conducted in the Thai language and began with a permission request; informed consent and confidentiality were respected. The researchers encouraged the respondents to identify and describe the best experience of their work life to better understand their experiences. Researchers began the interviews by encouraging the respondents to think about their best experiences working as a physician. Respondents were asked to recognize and describe what worked well. Their responses gave them a sense of satisfaction, meaning, purpose, and happiness, and an opportunity to recall what made them feel alive in their work. The semi-structured interview guide was utilized during the interviews. The interviews ranged from 45 to 60 minutes and the interviews were conducted online using video conferencing (Google, 2022) and using a browser video recorder (Kandasoft, 2022) were recorded with a digital tape recorder and a google meet recorder. The interviews were transcribed verbatim. The identity and personal information of the respondent were not disclosed to anyone outside of the research team. The respondents were identified by number (e.g., respondent #1) to protect the confidentiality of the respondents.

Data analysis

In this study, a manual approach was adopted for transcribing verbatim interview and analysing the data, without utilizing transcription and analysis software. Thematic data analysis adhered to the six-step approach of Braun and Clarke (2006): (1) data familiarization, (2) code generation, (3) prospective theme generation, (4) thematic review, (5) theme naming and definition, and (6) report writing.

Becoming familiar with data refers to data immersion and iterative reading cycles, with each cycle generating additional insight. Coding for as many topics as possible and applying the code to a contextual segment constitutes code generation. To generate themes, the codes must be sorted into higher-level topics. Reviewing the themes requires interrogating the prospective themes by revisiting the component-coded data. The subsequent step involves refining the names of themes and ensuring that they share the same semantic plane. Writing the report necessitates narrating the intricate story of the themes, first describing the meaning within each theme with illustrative examples, and then possibly looking across themes to identify connective insights.

After acquiring an understanding of the respondent’s background, the primary author iteratively coded the data. Multiple code evaluations were conducted by the co-author throughout the procedure. Following the initial line-by-line coding, larger data extracts were coded by using a spreadsheet and a word processor for alphabetic sorting, allowing for the refinement of codes and the designation of multiple code categories. Following the classification of each respondent’s transcripts, the analysis compared codes and categories across all respondent data.

Throughout the data analysis, this iterative procedure was repeated for each new data set collected. Identification, analysis, and interpretation of data themes followed the classification of Braun and Clarke (2006). Within a data set, themes can represent a pattern or meaning. The identified codes and categories were organized into possible themes. Candidates for themes were discussed with the co-author to ensure that they were consistent with the respondent narratives documented in the dataset. The development of themes was refined based on input from the co-author. Disagreements were resolved through conversation. Throughout this process, themes were identified and labelled.

Member checking and peer debriefing are two important techniques used in qualitative research to improve the trustworthiness and validity of the study. For member checking, the researcher distributes copies of the completed analysis to respondents to determine if they agreed with the identified factors that influence physicians’ work passion (Birt et al., 2016). Respondents responded that they reviewed the documents and agreed with the analysis and no further comments were provided. Peer debriefing is a collaborative process that allows researchers to discuss their research design, data collection methods, analysis techniques, and preliminary findings with their peers (Spall, 1998). This peer debriefing provided an external perspective and critical review of the research process, minimizing biases and blind spots. It helped strengthen the research process, increased the rigour, and improved the validity and trustworthiness of the study, as suggested in Boonsathorn and Sirakiatsakul (2018), Hilton (2017), and Spall (1998).

Member checking and peer debriefing are techniques used to incorporate respondent feedback and insight into the analysis and interpretation of research findings. These techniques foster a sense of co-creation, ensuring that the research findings accurately reflect the respondents’ experiences and perspectives while also benefiting from the expertise and critical input of peers. By engaging in these techniques, researchers strengthen the validity and trustworthiness of their qualitative studies, allowing them to refine their analysis, interpretations, and conclusions.

Results

The respondents were 30 physicians: 20 men and 10 women. Respondents ranged in age from 28 to 61 years (mean 41). 24 respondents held bachelor’s degrees and 6 held master’s degrees. All respondents were employed full-time, almost half in managerial and operational roles. Respondents were identified by number (e.g., #1) to protect respondent confidentiality. The research results yielded numerous categories or topic areas that were then parsed and grouped into 12 formal codes and grouped into four themes that influence physicians’ work passion (see Appendix): job factors (meaningful work, challenging tasks, task accomplishment, autonomy, work-life balance), organizational factors (fairness, positive environment), relationship factors (having a role model, psychological support, collaboration, recognition, respect), and individual factors (spiritual drive). Summarize the key finding of this study is attached in Appendix. The details are as follows.

Job Factors

Meaningful work

Meaningful work refers to the sense that one’s work is significant, meaningful, and beneficial to oneself, patients, society, or the country. Respondents reported that their work is meaningful to them and that their profession is essential, beneficial, and valuable to themselves or others. For example, an ophthalmologist described an event after performing eye surgery on an elderly and indigent patient; the valuable moment occurred when his patient could see the face of her grandchild:

I cannot forget my elderly cataract patient for whom I did cataract surgery. After the surgery, she was overjoyed when she saw her grandson’s face. I am very appreciative of improving the rest of her life. (#29)

Moreover, one respondent explained that work is valuable to him because being a physician allows him to utilize his knowledge to improve the treatment of his patient to international standards and can improve healthcare in Thailand. “I want to give good treatment to our patients. I want our country to compete with other nations in patient care.” (#5)

Challenging Task

A challenging task refers to the perception that one’s work is challenging in treatment, problem-solving, hard labour, acquiring new abilities, and various tasks. Respondents reported that they enjoyed undertaking challenging and novel tasks. For example, a surgeon stated that challenging tasks increase his passion:

My passion is challenging tasks. When my boss assigns me to do challenging tasks like setting up a vaccine center during the COVID-19 pandemic. Although I face a difficult task, when it succeeds, I am overjoyed. I want to try it myself. It is inspiring to come across new problems. (#1)

Task Accomplishment

Task accomplishment refers to a perception that work results, such as the outcome of treatment or surgery, met the expectations of the individual or the patient. Respondents indicated that they are passionate about their jobs when their tasks are accomplished. For example, an obstetrician described a feeling of happiness when her work met the patient’s expectations, such as the treatment outcome of the infertile couple.

Being an obstetrician is my best job I’ve ever had. Mom and Dad both cried as soon as I delivered the baby. We’re both happy and in the same place at the time. What makes us happy is that this treatment was successful for us. My work allows me to be fulfilled. (#23)

Moreover, another respondent mentioned that passion came up when work achieved the desired results:

The part that keeps me passionate and happy at work every day is that I get happiness back from the patients. Because it is the best thing I have seen at work when I see patients improve, it helps me be delighted. (#7)

Autonomy

Autonomy refers to the perception of self-direction and freedom to work, make decisions, and solve problems. Respondents indicated that they are passionate about their jobs when they have the power to make decisions, select options, and solve problems related to their work and tasks. The research results indicate that autonomy is a significant factor that influences physicians’ work passion. Respondents expressed their passion for their work when they have the freedom to make decisions, select options, and solve problems related to their work and tasks.

A respondent emphasized the importance of decision-making powers when asked what helps to foster a passion for work. The respondent described how having control over systems and the ability to speak up and offer solutions increased her passion. Having decision-making authority allowed her to shape the organization and create a pleasant work environment.

When I have decision-making power, it enhances my passion. My actions flow, and systems are under my control. I came across a problem that I needed to solve. The ability to speak up to improve the treatment of my patients. I can come up and determine how to make this hospital a pleasant place to work. (#6)

One respondent, when asked to imagine a dream job, depicted a work environment with autonomy that increased his work passion. He recognized the value of giving autonomy to team members and empowering his team to make decisions, which he considered important for personal growth and career advancement.

I believe that autonomy must come first. I also worked on it with my team. I believe that this matter has been handled in this manner so that we can release power. Autonomy, in my opinion, is essential. My team must be given autonomy, which is critical. (#21)

Respondents consistently expressed their joy and passion for work when they had the autonomy to make decisions. They appreciated the freedom to work on problem-solving, reflect on themselves, and tackle challenges independently. The ability to make decisions and have space to think and learn fuelled their motivation and passion.

I was fortunate to meet a good boss who allowed me to work on problem-solving, allowing us to reflect on ourselves. Dare to consider problems. For example, if I encounter a problem at work, I am free to work on it and solve it. Being able to make decisions at work fuels my passion for my job, and I have space to think and learn. (#1)

Additionally, one respondent mentioned that his passion for work stemmed from his ability to make decisions and select options. They expressed satisfaction and a strong desire to work because they had chosen to pursue medicine independently. The absence of obstacles and the ability to solve problems on their own contributed to their enjoyment and engagement in their work.

I chose to be a physician on my own. I’m happy and have a strong desire to work because I have decided my work for myself. I love working if I enjoy it. When I work in an area that I am interested in and am passionate about. I have the authority to solve the problem by myself. It may make me enjoy my work. (#27)

Overall, the research findings highlight that autonomy plays a crucial role in influencing physicians’ work passion. The respondents perceive autonomy as important because it empowers them in their work, allowing them to make decisions, select options, and solve problems. Autonomy provides them with a sense of control, opportunities for personal growth, and the ability to shape their work environment, ultimately leading to greater motivation and passion.

Work-life balance

Work-life balance refers to the feeling that one can successfully balance work and personal time and the requirement for daily activities such as rest, hobbies, and health care. Respondents indicated that they are passionate about their jobs when they have a work-life balance. Having a work-life balance plays a significant role in nurturing work passion. When people can effectively balance their work and personal life, they experience less stress, better well-being, and greater job satisfaction. This, in turn, increases their passion for their work. By having time for rest, pursuing personal interests, and maintaining meaningful relationships, people feel more fulfilled and energized, positively influencing their motivation and commitment to their profession.

When people have a healthy balance between work and home, it allows them to allocate time and energy to various aspects of their lives, including rest, hobbies, relationships, and self-care. When asked to imagine a dream job, a cardiologist said:

My job is now a dream job. Passion gets a ten out of ten from me. We work extremely hard. We are on call, but we maintain a healthy work-life balance. Saturdays and Sundays are the rest days. There’s no work involved. Traveling abroad is possible without having to worry about anything. (#17)

Moreover, a surgeon found passion when he could manage his time at work and prioritize interactions with family and friends in his personal life:

My work helps me balance my life. It is possible to strike a balance so I can spend time with our families. I can take care of my parents. I can see my girlfriend and me capable of allocating time that will give us a passion for work and the energy to work fully. (#26)

Having a work-life balance positively influences the passion of physicians for their work in several ways. First, it prevents burnout and promotes overall well-being. Second, it provides an opportunity for personal growth and fulfilment. Lastly, it enables physicians to bring their best self into their professional roles. By prioritizing their well-being and personal lives, physicians can approach their work with renewed energy, empathy, and dedication, positively influencing their work passion.

Organizational Factors

Fairness

Fairness refers to the sense that compensation is proportional to jobs and skills. Receive equitable, fair, and transparent welfare, advancement, and work performance assessments. Respondents mentioned fairness on the job, such as receiving pay based on the job and receiving welfare with equality, fairness, and transparency. In one interview, a respondent emphasized the importance of fairness in terms of welfare and compensation. She mentioned that having welfare benefits, including support for parents, serves as an encouragement for work passion.

Welfare and compensation, such as having welfare for parents, are part of the encouragement of work passion. This position is stable and pays a fair wage. It could be part of the encouragement that makes me feel like I am doing the right job. (#2)

Moreover, another respondent also mentioned the fairness of career advancement. He highlighted the need for fair career advancement opportunities.

We will not be people who act to please others and grow. No shortcut requires you to pamper someone to progress. Because there will be a shortcut to use the line if you use the word special. (#5)

Fairness creates an environment where physicians feel valued, recognized, and treated equitably, fostering their motivation, commitment, and passion for their profession. When fairness is upheld, physicians are more likely to be inspired and perform at their best.

Positive environment

A positive environment refers to the feeling of working among people with determination, energy, a positive mindset, and dedication to work. Respondents indicated that they are passionate about their work when they work in a positive environment. When asked about the factor that helps physicians have a passion for work, some respondents described working among people who are passionate and energetic about work. For example, a respondent said:

Working with some like colleagues whose commitment and energy will complement each other fuels my passion for work. (#6)

A surgeon highlighted the importance of a positive work environment in enhancing work passion. He emphasized the importance of creating a culture of passion in which physicians embrace a vibrant culture and have a strong sense of purpose.

When we live in a community of passionate physicians, we will embrace a vibrant culture. Begin by putting people to work and creating a culture of passion. Because we are passionate about what we do, we have a great working environment. (#1)

Relationship factors

Having a role model

A role model is someone who can be emulated, because of their behaviour, example, or success. Several respondents referred to role models and anecdotes about them that helped them work diligently, be dedicated, and grow as professionals. Respondents stated that they are passionate about their work because they have role models who inspire them to be good physicians.

One respondent mentioned Prince Mahidol Adulyadej of Songkla’s words about the medical profession, which he had taken as a model for his work: “True success is not in the learning, but in its application to the benefit of mankind” is one of the principles from Prince Mahidol Adulyadej of Songkhla, the father of modern Thai medicine and public health (Dangprapai, 2016).

Being a physician necessitates sacrifice. According to Prince Mahidol, “Our soul is for the benefit of mankind.” If you need to give up yourself, your time, or your comfort for the sake of others, do so. Considering his words, I have a strong passion for working. (#4)

The COVID-19 pandemic has had a significant impact on healthcare workers, leading to a surge in patient numbers, increased workload, resource constraints, and a higher risk of exposure to the virus. One respondent mentioned King Rama IX’s words as a concept for her work when asked about her inspiration for working during the coronavirus outbreak. She kept in mind the teachings of her role model when she took care of patients during the pandemic and showed remarkable resilience, dedication, and commitment to patient care, despite immense pressure and uncertainty.

The words of King Rama IX give me a strong passion for working. I believe his words are the power that drives me to do what is right. Doing good deeds is what I should do. I do not often come across a crisis like the Covid pandemic crisis in this life. If we make it through, we will look back and be proud of ourselves one day. (#24)

One respondent, when asked how she regained her passion when she felt burned out at work from the workload or negative atmosphere, replied that thinking about her role models reignites her passion.

Sometimes my passion faded from tiredness of workload and negative atmosphere at work. When I thought about my role model such as King Rama IX or my medical teacher, my passion would return. (#9)

King Rama IX, or King Bhumibol Adulyadej of Thailand, was the ninth monarch of the Chakri Dynasty and the longest-reigning monarch in Thai history (Rungrojsuwan, 2022). The Thai people and others residing in Thailand adored him, as evidenced by the common phrases “We Love the King” and “People’s King” (Thaikruea & Chairinkam, 2016). His speeches drew a great deal of attention across the country, as the Thai people anticipated hearing the king’s valuable ideas, which have helped improve their quality of life (Rungrojsuwan, 2022).

Psychological support

Psychological support is the feeling of being supported by family, friends, co-workers, and supervisors. Respondents stated that they are passionate about their work because they have psychological support. One respondent described the support received from her supervisor. The supervisor provides support by encouraging the respondent to try new things and take on challenging tasks. This support not only fuels their passion but also fosters their professional development.

Having a good supervisor who supports me motivates me to work hard. When my boss provides me with support, the workplace will be a better place to work. He encouraged me to try new things and take on increasingly difficult tasks. He will help to make the workplace a better place to work. (#11)

In addition to supervisor support, respondents also mentioned the importance of psychological support from family, friends, and colleagues in promoting their work passion. Another respondent highlighted the role of family in supporting work passion. Talking to his mother and friends when feeling stressed provides them with good advice, support, and inspiration to be energetic at work. Recognition of his mother’s pride in his work as a physician acted as a powerful motivator.

Family is the person who helps to promote my work passion. When I’m tired, I’ll talk to my mother and friends. Simply ask to ventilate and speak with someone when things are very stressful. My mother always says that she is proud that I am a physician. When I run out of energy, my mother will encourage and empower me greatly. (#22)

A cardiologist emphasized the significance of both family and co-workers’ support in maintaining work passion. The availability of a support system helps her feel that she is not alone and provides her with the strength to continue. The respondent appreciates the support, especially when faced with challenges or complex situations.

The thing that makes me have work passion even more, is the support from my family and coworkers. When I get support, it makes me feel like there is still someone who can help us. (#2)

Based on the interviews, it is evident that psychological support from family, supervisors, colleagues, and friends significantly influences work passion. The understanding, encouragement, and assistance received from these sources act as motivators, helping respondents overcome challenges, stay motivated, and maintain their passion for their work.

Collaboration

Collaboration refers to the perception that one’s job and those of one’s co-workers are collaborative for the patient’s benefit. Respondents stated that they are passionate about their work because they have work collaboration. The respondents mentioned that collaborating with their co-workers and combining their efforts for the benefit of patients and medical staff enhances their passion for work. A surgeon emphasized the importance of collaboration at work.

Work collaboration is essential to me, each team member develops passion in their unique way. We should get together and share our ideas with others. If it is successful and well-received, it can arouse passion. (#1)

Another respondent shared vision of a dream job, which revolved around happiness and collaboration. He expected nurses, co-workers, and everyone he worked with to collaborate and work in the same direction for the patient’s well-being.

This is my dream job, and I hope everyone has happiness at work. I expect nurses, coworkers, and anyone else I work with to work together. I think we will be active on behalf of the patient if we work in the same direction. I think that passion is at the heart of everything. (#30)

Another surgeon discussed his dream job, emphasizing the value of collaboration between physicians in the same field. He highlighted the importance of involving multiple professionals to assist with surgeries, as it improves efficiency and reduces the likelihood of problems. He shared an example of how a standard cystectomy can be performed more quickly and effectively when two surgeons work together.

The most important that physicians in the same field should work together to help patients, and that when things are hard, it is important to bring the surgeon in to help with the surgery. This helps the operation go more quickly and avoids problems. For example, a standard cystectomy takes 4–5 hours by one surgeon or an intern, but only 3 hours with two. This approach makes me feel very happy in work here. (#15)

Collaboration among colleagues fosters work passion and improves patient outcomes by combining their knowledge, skills, and efforts, creating a supportive and cohesive work environment where ideas are shared and problems are addressed collaboratively. Additionally, collaboration creates a sense of fulfilment for physicians, as it allows them to learn from each other, share best practices, and collectively contribute to the advancement of medical knowledge and practice. The examples shared by the respondents demonstrate the positive impact of collaboration on patient care and creating a sense of fulfilment.

Recognition and respect

Recognition and respect refer to a perception of receiving gratitude, significance, respect, approval, and appreciation from others. Respondents mentioned that they are passionate about their work because they have recognition and respect. One respondent shared an event in which she saved the life of a cancer patient who was the head of a family. The patient expressed immense gratitude for the physician’s efforts. This recognition and appreciation from the patient filled the respondent with passion for their work, knowing that their actions had a significant impact on someone’s life.

I saved the life of a cancer patient nearing the end of his life. He comes to work as the family’s head to keep the family fed while the sickness subsides. He was overjoyed. He was just grateful that he had returned to his everyday life, being the head of the family and spending time with his loved ones for the past three years. I am filled with passion for my work when I think of this case. (#9)

Another respondent was dedicated to providing care for a tuberculosis patient who had been abandoned by his family. When the patient was near death, the respondent was informed that the patient had remembered the medical student and referred to him as an excellent physician, inspiring others to provide excellent care to every patient.

This amazing event occurred during my medical student time last year. My patient had tuberculosis, and no one came to see him. My friends and I visited this case every day for about a month. Half a year later, someone told me that when he was near death. He remembered my name and stated that “this young physician is an excellent physician.” With tears in my eyes, I realized I’d never felt anything like this before. It’s the first time I’ve felt that it will be remembered if I do something good. and leave a lasting impression on me. A passion drove me to provide excellent care to every patient. (#25)

Recognition for their work was highlighted by one respondent as an important factor in driving their passion. The respondent expressed a desire that efforts to be acknowledged and rewarded and found motivation in the supportive words and appreciation received from others.

If I am successful at something, I would appreciate it if my efforts were recognized and rewarded. Simply looking at my work will reveal just how significant I am. My motivation to attempt it as a reward for myself comes from the words of support and appreciation I receive from others. (#29)

Another respondent reflected on the feeling of receiving the hospital’s best personnel award. He described happiness and pride in being recognized by others and seeing their value acknowledged.

I am happy because it’s one of those things that I do, and then there are other people who see the value in myself. As a result, I felt that receiving one of these rewards is something that heals the mind, in the sense that at least someone sees the value in me. It certainly made me proud. (#28)

Individual Factors

Spiritual drive

Spiritual drive refers to the perception that one’s effort has mental or spiritual value, moral or religious virtue, such as merit making or doing good and exhibiting compassion for fellow humans. Respondents indicated that they are passionate about their work because they have a spiritual drive. The concept of merit is fundamental to Buddhist ethics. It is a force that accumulates as a result of good deeds, actions, or beliefs. Merit-making is essential to Buddhist practice; merit produces favourable outcomes, determines the quality of the next life, and contributes to a person’s progress towards enlightenment. The respondents expressed their belief that their work has spiritual or moral value and is driven by virtues such as merit-making, doing good deeds, and showing compassion towards others.

One respondent expressed passion for working as a volunteer physician during the COVID-19 pandemic, focusing on doing good and helping others. She found satisfaction in assisting patients and expressed no fatigue or exhaustion from her efforts.

I have the passion and dedication of my time as a volunteer physician to take care of Covid patients in home isolation. I believe that treating COVID patients is a great way to make merit. I believe that there will be no more chances to do great good in this life Helping others is a good thing. I enjoy assisting a hundred people in this manner. I’m not tired at all afterward. (#7)

Respondents viewed their profession as an opportunity to have a positive impact on people’s lives and contribute to their well-being.

I am pleased and proud of my medical career because I am committed to doing good. As a physician, I have many merits to make during our time as physicians. Whether in this life or the next, life will reward us for our efforts. (#12)

Spiritual drive was also related to compassion and empathy for patients. Many respondents emphasized the importance of showing compassion, being empathetic, and considering patients as individuals who are suffering. These values served as reminders to keep their passion for work alive. One respondent described work as a way of showing compassion and empathy to patients as follows:

I write a few words on post-it notes and tape them to the front of my computer. The first word of compassion is to be compassionate to the patient, and I must first be compassionate to myself. Another word to write is the word of empathy. I should have empathized with the patients and their families. It’s almost as if it’s a reminder to keep my passion for my work alive. (#24)

In summary, the research results yielded numerous categories or topic areas that were then parsed and grouped into 12 formal codes that influence physician work passion and grouped into four themes: job factors (meaningful work, challenging tasks, task accomplishment, autonomy, work-life balance), organizational factors (fairness, positive environment), relationship factors (having a role model, psychological support, collaboration, recognition, respect), and individual factors (spiritual drive).

Discussion

This study aimed to determine the factors affecting the work passion of a public hospital in Thailand. The top three ranking findings influencing work passion were meaningful work, achievement of tasks, recognition, and respect. Meaningful work was essential in creating passion at work, consistent with many scholars (Wagner & Harter, 2006; Zigarmi et al., 2009). Task achievement was associated with passion, consistent with Fernet et al. (2014), who showed that participating in decision-making and having some influence on activities fosters passion.

Moreover, most of the respondents mentioned that recognition and respect enhance their passion. Respondents feel passionate when they receive appreciation and recognition for their work; Maslow’s hierarchy of needs can explain this factor. This finding supports the study by Ensour et al. (2020).

Interestingly, in this study, seven emerging factors affecting the work passion of physicians differ from the factors of passion for work of employees that were reported by Zigarmi et al. (2011) as follows: 1) work-life balance, 2) task achievement, 3) having a role model, 4) psychological support 5) recognition and respect 6) positive environment 7) spiritual drive

Most of the respondents mentioned that work-life balance enhances work passion for physicians and positively contributes to the level of job satisfaction level (Azmi et al., 2021; Kaliannan et al., 2016). Additionally, managing borders flexibly and accommodating different roles enables the individual to experience greater satisfaction by participating in tasks and activities relevant to one’s roles (Clark, 2000; Rothbard, 2001).

Furthermore, most of the respondents mentioned that their role model improved their passion for work. Role models inspire physicians through their embodiment of qualities such as sacrifice, dedication, compassion, and selflessness, fostering work passion and excellence in their profession. In this study, respondents shared specific instances that highlight the profound impact of role models on their dedication to work. The words of Prince Mahidol emphasized sacrificing for the greater good, while King Rama IX’s speech emphasized doing good and persevering through challenges. Medical teachers and professors also served as role models, imparting valuable lessons on patient care and professional commitment. This result was consistent with earlier research showing the importance of role models for personal and professional growth (Passi et al., 2013). Physician role modelling plays an important role in the formation of professional identity, professional behaviours, professional development, and career aspirations (Passi & Johnson, 2016).

Furthermore, most of the respondents mentioned that psychological support improves their passion for work. Psychological support plays a vital role in enhancing the work passion of physicians during the COVID-19 pandemic. The respondents in this study received support from various sources, such as family, supervisors, colleagues, and friends. The support of a supervisor encouraged them to take on challenging tasks and support their professional development. Family and friends provided valuable advice, support, and inspiration to be energetic at work. Supportive co-workers, senior physicians and nurses also contributed significantly to work passion by helping and fostering appreciation.

This support system helped respondents navigate challenges, stay motivated, and maintain their commitment to their medical profession. This finding is consistent with the previous study that psychological support is essential for the development of physician well-being. Physicians need to feel supported and connected because they are exhausted, have lost many patients, and are far from their families. Relationships become crucial to the psychological health of medical professionals (Hartzband & Groopman, 2020).

Furthermore, most of the respondents mentioned that a positive work environment enhances their passion for work. Respondents emphasized the importance of working with colleagues who are passionate, energetic, and committed, as this fuels their own passion for work. The creation of a culture of passion, where physicians embrace a vibrant environment and have a strong sense of purpose, was highlighted as essential. In addition, a positive work environment fosters teamwork, effective communication, and understanding among colleagues. Unity, positive assistance, and the absence of excessive conflicts also contribute to a positive work environment. Such an environment enhances happiness and motivation. Having a positive work environment helps physicians overcome challenges and adversities.

This result follows previous findings showing that interactions between group members increase social capital and performance (Peñalver et al., 2019). However, when these connections occur in an environment where everyone is passionate about their jobs, the team grows more powerful and is better able to accomplish its goals. An earlier study demonstrated that the factor that fosters the ability of physicians to overcome hardship depends on having a strong sense of passion at work (Salas-Vallina et al., 2022).

Finally, respondents feel passionate when spiritual drive enhances their passion for their work. Spiritual drive is a significant factor in enhancing physicians’ passion for work in the Thai medical context, with a strong connection to compassion and empathy towards patients. This finding is consistent with the report by Puchalski et al. (2014) that spirituality and compassion are interconnected, as compassion is seen as a spiritual practice and an act of love, and clinicians who embrace their own spirituality are better equipped to show compassion towards their patients by embodying transcendence, meaning, purpose, service, connectedness, and transformation. Respondents in the study believed that their work had spiritual and moral value, driven by virtues such as merit and compassion. They saw their medical careers as opportunities to accumulate merits and positively impact lives, consistent with the suggestion that clinicians should consider their own spiritual histories and be aware of how this influences the treatment they provide to patients (Sulmasy, 2002). Spirituality allowed physicians to recognize the worth of each patient, leading to a holistic and patient-centred approach to care (Koenig, 2012). It also fostered a deeper understanding of suffering and empathy for patients, promoting self-reflection and the ability to see through patients’ eyes (Puchalski et al., 2014). Connecting spirituality, compassion, and empathy nourished physicians’ work passion, providing a sense of purpose and dedication to their profession. By incorporating spirituality into their practice, physicians could provide compassionate care, resulting in improved patient outcomes and well-being. This finding is consistent with the previous study by Anandarajah and Roseman (2014), who reported that physicians believed compassion was necessary for a physician, regardless of the personal spiritual views of their patients. They connected spiritual values that underlie compassion, religion, and secularism. Many physicians considered practicing medicine a spiritual discipline, allowing them to develop compassion.

Limitations

There are some limitations to this study. First, this research is qualitative and consists of in-depth interviews with physicians practicing in a public hospital in Thailand, the results may be transferred to similar contexts, depending on the context and nature of participants provided. The study findings should be applied to physicians like the respondents, who work in public hospitals. Second, the respondents and the interviewer were familiar with each other. Therefore, the researcher used member checking and peer review for the validity of the data analysis. Third, due to the coronavirus pandemic, this study was conducted using only online interviews; the physical distancing between respondents and interviewers in that setting may have affected adequate monitoring of potentially relevant nonverbal data, such as facial expressions, body language, and emotions.

Implications

Implications for theory

This study contributes to the theory of work passion by addressing the following gaps in the literature. It improves our understanding of the factors affecting work in a Thai context and healthcare setting, as well as the factors affecting the work passion of physicians during the COVID-19 pandemic. Understanding the factors that influence work passion among physicians has theoretical implications for the development of a measuring instrument in the future. By identifying and measuring the twelve factors, researchers can create a reliable instrument to assess the influencing factors for work passion among physicians that can help practitioners assess and manage work passion for physicians. It also contributes to the use of AI as a data collection method, which is a positive approach that emphasizes the strengths of an organization’s strengths and aims to inspire change. The 4D appreciative inquiry (4D-AI) model, consisting of discovery, dream, design, and destiny phases, enhances the understanding of factors affecting work passion by encouraging respondents to reflect on positive experiences, envision a desired future, co-create ideas, and generate change.

Implications for human resource development

The findings of this study on factors that influence physicians’ work passion during the COVID-19 pandemic have important implications for human resource development. Managers and human resource developers can address these factors through various strategies. These interventions directly address the underlying factors and contribute to improving work passion among physicians. For instance, implementing a comprehensive psychological support programme can directly address the factor of psychological well-being and work passion. This programme can include training leaders in effective communication, coaching, and feedback techniques, which can foster a supportive and encouraging work environment. Furthermore, role modelling plays a crucial role in fostering passion among physicians. Organizations can actively promote role modelling by establishing mentorship programmes and creating platforms to share role models. By providing opportunities for physicians to interact with successful role models, organizations can inspire and motivate them to excel in their work, thus enhancing their work passion. The balance of work and family is another critical factor that affects work passion among physicians, as highlighted in the study. Human resource developers can develop policies that address concerns about work-life balance, such as implementing flexible work schedules and initiatives that support healthy work-life balance. By empowering physicians with more control over their schedules and supporting their personal responsibilities, organizations can create an environment that values their well-being and ultimately enhances their work passion.

Conclusions

This qualitative study aimed to explore the factors that influence physicians’ work passion during the COVID-19 pandemic in the Thai medical context. Through appreciative inquiry (AI), interviews were conducted with 30 physicians from a public hospital in Thailand. The analysis revealed 12 factors grouped into four themes: job factors, organizational factors, relationship factors, and individual factors. These findings contribute to existing knowledge on physicians’ work passion and provide insights for developing effective strategies to enhance clinical practice. Healthcare organizations and leaders can foster and manage work passion among physicians by creating supportive work environments, promoting work-life balance, and implementing psychological support programmes.

This study contributes to the literature by filling gaps in understanding of factors influencing physicians’ work passion in the Thai medical context during a pandemic crisis. It also contributes to the development of human resources by supporting organizational strategies and suggesting interventions. Future research directions may include the inclusion of various respondents, such as patients and other healthcare professionals, to gain a comprehensive understanding of work passion. Interviews with physicians in various workplace settings and countries can further enrich our understanding of the dynamics of work. Additionally, conducting experimental studies or action research can explore the effects of identified factors on work passion through interventions and organizational development initiatives.

Potential research questions and methodologies for future investigations may include: 1) How does the presence of role models influence physicians’ work passion in different healthcare settings? 2) What are the specific strategies and interventions that effectively promote work-life balance and enhance work passion among physicians? 3) How do different forms of psychological support, such as coaching or peer support programmes, affect the work passion and well-being of physicians? 4) What are the long-term effects of organizational development interventions that target work passion on physician satisfaction, patient outcomes, and healthcare system performance?

By addressing these research gaps and considering the suggested methodologies, future studies can advance the understanding of physicians’ work passion, inform practical interventions, and ultimately contribute to enhancing the work passion of physicians.

Ethical approval

This study was approved by the Ethics Committee on Human Research (EC2/4) of the National Institute of Development Administration, under (NIDA protocol code No. ECNIDA 2021/0134)

Acknowledgments

We acknowledge Mr. Leo Atwood for his assistance.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data availability statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This study was conducted as part of a Ph.D. dissertation of Kamoltip Lertchaisataporn entitle ‘Development of Physician’s Work Passion Inventory’ in the Human and Organization Development Innovation Doctoral Program at the National Institute of Development Administration, Bangkok, Thailand and received research support from the National Institution of Development Administration.

Notes on contributors

Kamoltip Lertchaisataporn

Kamoltip Lertchaisataporn is a Ph.D. student in the Human and Organization Development Innovation Doctoral Program at the Graduate School of Human Resource Development, National Institute of Development Administration, Bangkok, Thailand. She conducted this study as part of her Ph.D. dissertation, titled 'Development of Physician's Work Passion Inventory,' within the Human and Organization Development Innovation doctoral program at the National Institute of Development Administration, Bangkok, Thailand. Her dissertation advisor for this study is Wasita Boonsathorn, an Associate Professor at the Graduate School of Human Resource Development, National Institute of Development Administration.

Wasita Boonsathorn

Wasita Boonsathorn is an Associate Professor at the Graduate School of Human Resource Development, National Institute of Development Administration, Bangkok, Thailand. She served as a dissertation advisor for Kamoltip Lertchaisataporn during her Ph.D. studies and conducted this study. WB obtained a Ph.D. in Communication Arts and Sciences from the Pennsylvania State University (PSU) and a MD in Speech Communication, and a BA (English) from Chulalongkorn University. Current focus interests are work passion, organizational communication, conflict management, and cross-cultural communication.

Appendix

Summarize the key finding of this study: Key factors leading to work passion for physicians during a pandemic crisis

Table

Themes	Codes	Description
Job Factors
	1. Meaningful Work	perception that one’s work is significant, meaningful, and beneficial to oneself, patients, society, or country.
	2. Challenging Task	perception that one’s work is challenging in treatment, problem-solving, hard labour, acquiring new abilities, and various tasks.
	3. Task Accomplishment	perception that the results of the completed work, such as the outcome of treatment or surgery, met one’s or the patient’s expectations. The work or project is completed as expected, or the organization reaches its desired objective.
	4. Autonomy	perception of autonomy to make decisions and to be free to work and solve problems.
	5. Work-Life Balance	feeling that one can successfully balance work and personal time and the requirement for daily activities such as rest, hobbies, and health care. Family and friend interactions in private life are appropriate.
Organizational Factors
	1. Fairness	sense that compensation is commensurate with jobs and skills. Receive equitable, fair, and transparent welfare, advancement, and work performance assessments.
	2. Positive Environment	feeling of working among people with determination, energy, positive mindset, and dedication to work.
Relationship Factors
	1. Having a Role Model	feeling that being told a story or having a role model helps them work diligently, be dedicated, and grow. Apply as a working guide the lessons learned from the role model.
	2. Psychological Support	feeling of being supported mentally, understanding, and encouragement from close persons such as family, supervisors, colleagues, and friends.
	3. Work Collaboration	perception that one’s job and those of one’s co-workers are collaborative for the patient’s benefit.
	4. Recognition and Respect	perception of receiving gratitude, significance, respect, approval, and appreciation from others.
Individual Factors
	Spiritual Drive	perception that one’s effort has a mental or spiritual value, moral or religious virtue, such as making merit or doing good. Exhibited compassion towards fellow humans.