Designing an Employee Retention Model for Internal Customers of Social Security Organization Hospitals to Enhance Commitment and Reduce Occupational Risk

Abstract

This study aimed to design and validate an employee retention model for internal customers of Social Security Organization hospitals with an emphasis on enhancing commitment and reducing occupational risk. An exploratory mixed-methods design was employed. In the qualitative phase, grounded theory based on the systematic Strauss and Corbin approach was used, involving semi-structured interviews with 10 experts and managers from Social Security Organization hospitals. Qualitative data were analyzed using MAXQDA through open, axial, and selective coding. In the quantitative phase, the extracted model was validated using a researcher-made 27-item questionnaire administered to 380 employees and managers of Social Security Organization hospitals. Partial least squares structural equation modeling was applied to analyze the quantitative data using SmartPLS. Structural model analysis showed that causal conditions had a significant effect on the central phenomenon of employee retention (β=0.645, t=7.312, p<0.001). Contextual conditions (β=0.263, t=2.191, p=0.028) and intervening conditions (β=0.332, t=3.905, p<0.001) also significantly predicted the central phenomenon. The central phenomenon significantly affected strategies (β=0.640, t=7.008, p<0.001), while strategies significantly predicted outcomes (β=0.636, t=5.518, p<0.001). The R² values for the central phenomenon, strategies, and outcomes were 0.645, 0.640, and 0.636, respectively, indicating moderate-to-strong explanatory power. Furthermore, the GOF value of 0.743 indicated strong overall model fit. The findings indicate that employee retention in Social Security Organization hospitals results from the systematic interaction of causal, contextual, and intervening conditions, which influence organizational outcomes through employee-retention mechanisms and appropriate managerial strategies. Accordingly, strengthening job security and fairness, organizational support, empowerment, participative management, and occupational risk reduction may enhance organizational commitment, improve employee retention, and contribute to more effective hospital performance.