The research was published in the International Journal of Management and Business Intelligence (IJBMI), Volume 4, Issue 3, 2026, and examined the factors affecting the performance of civil servant healthcare workers in eight community health centers (Puskesmas) throughout Tegal City. The findings are particularly relevant as several public health service indicators in the region have yet to meet national targets.
Public Health Targets Remain a Challenge
According to data from the Tegal City Health Office, several healthcare programs have shown encouraging results. Diabetes screening coverage reached 96.77 percent, while hypertension screening achieved 83.46 percent, both exceeding government targets.
However, obesity screening coverage remained critically low at only 9.55 percent. In addition, patient adherence to hypertension treatment reached just 45 percent, highlighting ongoing challenges in preventive and promotive healthcare services.
The researchers argue that these performance gaps are influenced not only by external factors but also by internal organizational conditions, including employee competence, leadership practices, workplace culture, and job satisfaction.
Study Involved All Civil Servant Healthcare Workers
The study employed a quantitative approach involving all civil servant healthcare workers across eight community health centers in Tegal City.
A total of 200 healthcare employees participated in the research through a census sampling method, ensuring that the entire target population was represented.
Data were collected using structured questionnaires that measured perceptions regarding transformational leadership, employee competence, organizational culture, job satisfaction, and performance. The researchers then analyzed the relationships among these variables to identify both direct and indirect effects on employee performance.
This comprehensive approach allowed the team to determine which factors most strongly influence healthcare service quality.
Competence Emerges as the Strongest Performance Driver
The findings indicate that healthcare worker competence is the most influential factor in improving performance.
Employees who possess strong technical skills, professional knowledge, and practical expertise are more likely to deliver healthcare services accurately, safely, and efficiently.
Key findings from the study include:
- Healthcare worker competence has a positive and significant effect on performance.
- Organizational culture positively and significantly influences performance.
- Job satisfaction positively affects healthcare worker performance.
- Transformational leadership positively influences job satisfaction.
- Competence contributes positively to job satisfaction.
- Organizational culture improves job satisfaction.
- Job satisfaction mediates the relationship between transformational leadership and performance.
- Job satisfaction also mediates the relationship between competence and performance.
- Job satisfaction mediates the relationship between organizational culture and performance.
- Transformational leadership does not directly affect healthcare worker performance.
Among all variables examined, competence showed the strongest impact on employee performance outcomes.
Leadership Improves Performance Through Satisfaction
One of the study’s most notable findings is that transformational leadership does not directly improve healthcare worker performance.
According to Dinda Nia Susanti and her colleagues from Pancasakti University Tegal, healthcare professionals generally possess strong ethical responsibilities and professional standards. As a result, changes in leadership style alone do not automatically translate into better clinical performance.
Nevertheless, leadership remains important because it creates an environment where employees feel valued, supported, and motivated.
Leaders who provide recognition, professional development opportunities, and personal support can significantly increase employee job satisfaction. This increased satisfaction subsequently encourages healthcare workers to perform at a higher level.
In other words, leadership influences performance indirectly by strengthening employees’ psychological wellbeing and workplace satisfaction.
Positive Organizational Culture Supports Better Healthcare Services
The research also highlights the critical role of organizational culture in enhancing healthcare performance.
A workplace culture characterized by collaboration, mutual support, open communication, and a strong public service orientation creates a healthier working environment for healthcare professionals.
Such conditions enable employees to focus more effectively on patient care while reducing the likelihood of service errors.
The researchers noted that healthcare workers who feel supported by colleagues and management are more likely to work efficiently as a team, leading to improved service quality and patient outcomes.
Job Satisfaction Serves as the Key Link
Another important finding is the strategic role of job satisfaction as a bridge connecting organizational factors to employee performance.
Job satisfaction was found to be the primary mechanism through which leadership, competence, and organizational culture affect performance.
This suggests that investments in employee training, professional development, supportive leadership, and positive workplace culture will have greater impact when accompanied by efforts to improve job satisfaction.
In healthcare settings, satisfied employees are more likely to provide attentive, patient-centered, and safety-oriented services.
Implications for Public Healthcare Management
The study offers valuable recommendations for policymakers, healthcare administrators, and local governments.
Continuous competency development should become a priority because it directly influences healthcare service performance. Regular training programs, professional certification opportunities, and clinical skill enhancement initiatives can help healthcare workers maintain high standards of care.
At the same time, healthcare leaders should focus on building supportive workplace cultures and adopting leadership approaches that enhance employee satisfaction.
According to the researchers, these combined efforts could help improve healthcare service quality and contribute to achieving national public health targets, including higher screening participation rates and better treatment adherence among patients.
Author Profiles
Dinda Nia Susanti, S.K.M. is a researcher affiliated with Pancasakti University Tegal, specializing in healthcare human resource management, organizational performance, and public health service development.
This study was conducted in collaboration with:
- Dr. Ahmad Hanfan, S.E., M.M., Pancasakti University Tegal, specializing in Management and Organizational Behavior.
- Abdulloh Mubarok, S.E., M.M., Pancasakti University Tegal, specializing in Human Resource Management and Organizational Development.
Research Source
Article Title: The Influence of Transformational Leadership, Health Worker Competence, and Organizational Culture on Health Worker Performance Through Job Satisfaction in All Community Health Centers in Tegal City
Authors: Dinda Nia Susanti, Ahmad Hanfan, Abdulloh Mubarok
Affiliation: Pancasakti University Tegal, Indonesia
Journal: International Journal of Management and Business Intelligence (IJBMI)
Volume and Issue: Vol. 4 No. 3 (2026)
Pages: 449–464
DOI: 10.59890/ijmbi.v4i3.5
Publisher URL: https://journalijmbi.my.id
The study demonstrates that improving public healthcare services requires more than medical infrastructure. Strong employee competence, a healthy organizational culture, and high job satisfaction are essential foundations for achieving sustainable improvements in healthcare performance.
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