Workload and Leadership in Indonesian Hospitals: Implications for Performance
Abstract
The sustainability of hospitals in Indonesia is increasingly challenged by structural workload pressures and managerial leadership effectiveness, particularly within the post-pandemic and universal health coverage environment. Although prior empirical studies have examined workload and leadership independently, limited research integrates these determinants within a unified hospital performance framework. This study aims to systematically review empirical evidence on how workload and leadership influence hospital performance through job satisfaction in Indonesian hospital settings. A systematic literature review was conducted on peer-reviewed articles published between 2019 and 2025. Fifteen eligible studies were analyzed using thematic synthesis. The findings demonstrate that excessive workload consistently reduces job satisfaction and increases turnover intention, whereas supportive and participative leadership enhances employee morale and performance stability. Job satisfaction functions as a mediating governance mechanism linking organizational conditions to institutional performance outcomes. This study contributes to hospital management literature by positioning job satisfaction as a strategic performance indicator and proposing a monitoring-oriented managerial framework to strengthen organizational resilience in Indonesian hospitals.
References
Agustina, R., Dartanto, T., Sitompul, R., Susiloretni, K., Suparmi, Achadi, E. L., Taher, A., Wirawan, F., Sungkar, S., Sudarmono, P., Shankar, A. H., Thabrany, H., Susiloretni, K. A., & Khusun, H. (2019). Universal health coverage in Indonesia: Concept, progress, and challenges. The Lancet, 393(10166), 75–102. https://doi.org/10.1016/S0140-6736(18)31647-7
Angraeni, W. O. N., Etika, E., Yuniati, Y., Hidayati, H., & Syarif, S. (2025). Pengaruh beban kerja, kepuasan kerja, kepuasan gaji dan pengaruhnya terhadap turnover intention pada tenaga kesehatan. Jurnal Penelitian Pendidikan, 3(2). https://doi.org/10.61099/junedik.v3i2.113
Bakker, A. B., & Demerouti, E. (2017). Job demands–resources theory: Taking stock and looking forward. Journal of Occupational Health Psychology, 22(3), 273–285. https://doi.org/10.1037/ocp0000056
Barney, J. B. (1991). Firm resources and sustained competitive advantage. Journal of Management, 17(1), 99–120. https://doi.org/10.1177/014920639101700108
Bass, B. M., & Riggio, R. E. (2006). Transformational leadership (2nd ed.). Psychology Press.
Chaniago, H., & Efawati, Y. (2024). Individual Innovative Behavior Model: The Role of Entrepreneurial Leadership in Uncertain Times. Quality-Access to Success, 25(202). https://doi.org/10.47750/QAS/25.202.19
Chaniago, H., & Efawati, Y. (2026). Individual absorptive capacity as a stepping stone for digitalization, digital transformation, and small business performance; Entrepreneurial perspectives. Contaduría y administración, 71(2), 1-36. https://doi.org/10.22201/fca.24488410e.2026.5126
Chaniago, H., Hidayat, H., & Efawati, Y. (2025). Intrinsic Motivation and the Use of Artificial Intelligence (AI) in the Public Sector: Evidence from Indonesia. Revista Brasileira de Políticas Públicas, 15(2). https://doi.org/10.5102/rbpp.v15i2.10066
Efawati, Y., Rinawati, Andriani, R., Mubarok, A., (2024). Manajemen Strategi. Bandung: Edukasi Riset Digital, PT.
Efawati, Y. (2020). The influence of working conditions, workability and leadership on employee performance. International Journal Administration, Business & Organization, 1(3), 8-15. https://doi.org/10.61242/ijabo.20.40
Hartono, H., et al. (2025). The effect of workload, job stress, and job satisfaction on the performance of health workers. Journal of Health and Social Sciences, 9(1). https://doi.org/10.33751/jhss.v9i1.102
Hellín Gil, M. F., Ruiz Hernández, J. A., Ibáñez-López, F. J., Seva Llor, A. M., Roldán Valcárcel, M. D., Mikla, M., & López Montesinos, M. J. (2022). Relationship between job satisfaction and workload of nurses in adult inpatient units. International Journal of Environmental Research and Public Health, 19(18), 11701. https://doi.org/10.3390/ijerph191811701
Jones, B. F., et al. (2022). Measuring healthcare worker satisfaction in the operating room. Annals of Surgery Open, 3(1), e129. https://doi.org/10.1097/AS9.0000000000000129
Kagan, I., Hendel, T., & Savitsky, B. (2021). Personal initiative and work environment as predictors of job satisfaction among nurses. BMC Nursing, 20, 87. https://doi.org/10.1186/s12912-021-00615-1
Marunduh, D. L. S., Suprapto, S. I., & Suhita, B. M. (2025). Implementation of interprofessional collaboration practice on health worker satisfaction in Bali Royal Hospital. STRADA: Jurnal Ilmiah Kesehatan, 14(2), 161–173. https://doi.org/10.30994/sjik.v14i2.1178
Niinihuhta, M., & Häggman-Laitila, A. (2022). A systematic review of nurses’ leadership and nursing staff well-being. International Journal of Nursing Practice, 28(2), e13040. https://doi.org/10.1111/ijn.13040
Nurain, A., Chaniago, H., & Efawati, Y. (2024). Digital behavior and impact on employee performance: Evidence from Indonesia. Journal of technology management & innovation, 19(3), 15-27. http://dx.doi.org/10.4067/S0718-27242024000300015
Penconek, T., Tate, K., Bernardes, A., Lee, S., Micaroni, S. P. M., Balsanelli, A. P., de Moura, A. A., & Cummings, G. G. (2021). Determinants of nurse manager job satisfaction: A systematic review. International Journal of Nursing Studies, 118, 103906. https://doi.org/10.1016/j.ijnurstu.2021.103906
Perdana, B. (2023). Analysis of health worker satisfaction in improving health worker performance at Al Islam Hospital. Journal of Information Management and Health Administration, 6(1). https://doi.org/10.32585/jmiak.v6i1.3969
Putri, N., Rachman, A., & Efawati, Y. (2026). Analisis Manajemen Sumber Daya Manusia, Sarana Prasarana, Sistem Informasi Kesehatan dalam Efisiensi Pelayanan Puskesmas Suak Ribe. RIGGS: Journal of Artificial Intelligence and Digital Business, 4(4), 1180-1191.
Qtait, M. (2023). Systematic review of head nurse leadership style and nurse performance. International Journal of Africa Nursing Sciences, 18, 100564. https://doi.org/10.1016/j.ijans.2023.100564
Roshida, D. S., Paskarini, I., & Martiana, T. (2023). Leadership style influence on nurses’ burnout: A systematic review. The Indonesian Journal of Public Health, 18(2), 341–352. https://doi.org/10.20473/ijph.v18i2.2023.341-352
Syafrizal, R., Yulihasri, Y., & Putri, Z. M. (2021). Hubungan kepuasan kerja dengan kinerja perawat di rumah sakit. Jurnal Ilmiah Universitas Batanghari Jambi, 21(3), 1135. https://doi.org/10.33087/jiubj.v21i3.1716
Sari, D. F., Wahyudi, B., & Efawati, Y. (2025). Pengaruh Keseimbangan Kehidupan Kerja (Worklife Balance) dan Kepuasan Kerja terhadap Komitmen Organisasi pada Karyawan Rumah Sakit Erni Medika Jambi. AKADEMIK: Jurnal Mahasiswa Ekonomi & Bisnis, 5(3), 1737-1747.
Sari, S. N. R., Syaodih, E., & Efawati, Y. (2025). Pengaruh Budaya Organisasi, Gaji dan Tingkat Stres terhadap Employee Engagement di Puskesmas Sukawati 1 Gianyar. MAMEN: Jurnal Manajemen, 4(4), 711-723.
Susilawati, R. M., Purwadhi, P., & Efawati, Y. (2024). Analisis Strategi Pengembangan Klinik Bamma Pasuruan Yang Berdaya Saing. Innovative: Journal Of Social Science Research, 4(6), 8382-8400.
Tahang, A. S., Rohendi, A., & Efawati, Y. (2026). Performance Evaluation of Simrs Utilization in Optimizing Patient Services at the PKU Muhammadiyah Clinic in Nort Lombok. Jurnal Manajemen, Akuntansi, Ekonomi, 4(3), 1213-1226.
Wahyuhadi, J., Hidayah, N., & Aini, Q. (2023). Remuneration, job satisfaction, and performance of health workers during the COVID-19 pandemic period. Psychology Research and Behavior Management, 16, 701–711. https://doi.org/10.2147/PRBM.S396717
Wiliyanarti, P. F., Fahrudda, A., & Rahmawati, N. (2025). The effect of participative leadership style and workload on employee satisfaction in the hospital. Qanun Medika, 9(02). https://doi.org/10.30651/jqm.v9i02.26718
World Health Organization. (2022). Working for Health 2022–2030 Action Plan. World Health Organization.
Copyright (c) 2026 Muhammad Almy Firasghani, Andiani, Willy Anugroho
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish in this journal agree to the following terms:
- The authors confirm that they are the authors of the submitted article, which will be published (online) in the journal IJABO (International Journal Administration, Business & Organization) by the Asosiasi Ahli Administrasi Indonesia (A3i), Bandung, Indonesia. The author’s name will be evident in the article. The publisher makes all decisions regarding the layout and distribution of the work.
- Authors guarantee that the work is their own original creation and does not infringe any statutory or common-law copyright or any proprietary right of any third party. In case of claims by third parties, authors commit themself to defend the interests of the publisher and shall cover any potential costs.
- Authors retain copyright and grant the journal the right of first publication, with the work simultaneously licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0). This license allows the redistribution and reuse of papers provided the authorship is properly credited.
- Authors can enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., posting it to an institutional repository or publishing it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as this can lead to productive exchanges and earlier and greater citations of published work.
