NON-MONETARY REWARDS AND EMPLOYEE ENGAGEMENT: A STUDY OF HEALTH SECTOR

This study was conducted in order to investigate and identify the types of incentives (non-monetary) that leads to employee engagement among employees in health sector. Nonmonetary rewards included training and development, pleasant working environment, preferred lunch hours, business cards and secretary. The study is conducted on 193 respondents at a private sector hospital. Respondents comprised of doctors, nurses and paramedical staff. Data was collected using self-administered questionnaire and responses were recorded using 5-points Likert scale. First the overall responses were analyzed and then individual group responses were analyzed by using regression analysis. The result revealed that only a part of respondents show positive results towards non-monetary rewards and there were differences in the responses towards each subset of non-monetary reward.


Introduction
Being a Human Resource Manager is a challenging task.The stress of hiring the right person is one aspect of HRM whereas, engaging and retaining the top performing employees is an extremely difficult task.However, due to uncertainty and economic instability, the firms are facing financial constraints.The loss of profitability and unpredictable scenario is shifting firms' attention from investing in HR towards cost cutting and layoffs.Therefore, the more vulnerable the firms are, the more talented human capital will leave company for better opportunities (Scott, McMullen, Royal, & Stark, 2010).HR issues associated with employee engagement and commitment has become topic of discussion in the twenty-first century (Saks, 2006).HR being a sensitive part of an organization needs to be dealt very carefully (Drucker, 2002).
Employee engagement helps organizations in attaining competitive advantage.This implies that HR is an asset that is very hard to imitate.Baumruk (2004) believes that employee engagement can be a tool to measure the organization's strength.Employee engagement is defined as, "the harnessing of organization members' selves to their work roles; in engagement, people employ and express themselves physically, cognitively, and emotionally during role performances" (Kahn, 1990, p. 694).According to the series of surveys conducted by Gallup, reporting that only 32% of employees are engaged in U.S. whereas, only 13% employee engagement worldwide (Mann & Harter, 2016).Employees in an organization are engaged, not engaged or actively disengaged.Engaged employees are the builders of organization whose efforts focused on excellence in their roles.Employees that remain not engaged perform the tasks that are spelled to them and they are not concerned with the organization goals.Whereas, actively disengaged employees are those who are not working themselves and are the source of de-motivation to the performers (Anitha, 2014).

Background
Employee engagement has surfaced in 1990s and since then it has gained the attention of researchers and managers.However, the major contribution in this area of research started from 2006 and onwards (Welch, 2011).Since then, research has identified various contributors (determinants) of employee engagement; for example, Rich, Lepine, and Crawford (2010), Miles (2001) found work environment to be one of the significant determinant of employee engagement.Thus, the management that is able to create a supportive work environment tends to achieve high employee engagement.Management in an organization that is having people-oriented approach are able to display concern for employees, their needs and wants, encouragement and employee engagement, support and feedback, and creates a problem solving mechanism (Dash, 2013).Another variable that is a major determinant of employee engagement is leadership (Walumbwa, Avolio, Gardner, Wernsing, & Peterson, 2008).Teamwork and peer support (Markos & Sridevi, 2010), training and development (Akhter, Raza, Ashraf, Ahmad, & Aslam, 2016;Anitha, 2014), compensation (Saks, 2006), policies, structure and organizational system (Macey & Schneider, 2008), and workplace wellbeing are reported to be the significant determinants of employee engagement (Rath, Harter, & Harter, 2010).These variables and significance of these variables are tested and confirmed separately in previous researches as well as together by Anitha (2014).The research reported positive contribution except for compensation; policies and organization system were negative in relation (2014).
Though, the studies conducted in this area are very elaborative and has contributed in understanding this phenomenon.However, one of the areas that needs further investigation is of rewards and its relation to employee engagement.Saks (2006) reported significant relationship between reward (as antecedent) and employee engagement.Rewards are of two types i.e. monetary and non-monetary rewards however, the concern has always remained of monetary reward whereas, Bhattacharya and Mukherjee (2009) recommended the role of non-financial rewards as an important antecedent for engaging employees.For an interpersonal harmony and working family, the role of peers and team is considered to be a key player in many HR functions.Similarly, it is reported to be a major contributor in employee engagement as well (Abdullah & Wan, 2013).
Several techniques are used by and implemented by employers to increase the employee's engagement as it directly affect the performance of individual as well as organization (Alfes, Shantz, Truss, & Soane, 2013).Thus, in this nexus, the main focus remained on increasing employee engagement and satisfaction of employees.Jobs has been redesigned (Tims, Bakker, Derks, & van Rhenen, 2013), performance management systems are established (Mone & London, 2014), organizations became more focused towards developing organization citizenship behavior (OCB) (Alfes, et al., 2013), however, a very little efforts are made in terms of understanding the linkage of reward with engagement.This study focuses on finding the relationship between employee engagement and rewards.Though reward is a broad category itself and few researches in past has studied monetary reward whereas, there is little or no work from the perspective of non-monetary rewards.
Monetary and non-monetary rewards which were developed to enhance the motivation level of the employees (Zaidi & Abbas, 2011).Non-monetary rewards can be intangible or tangible irrespective of its form.One thing is clear that it does not include direct cash imbursement to staffs such as enjoyable working environment, training and development.

Problem Statement
After the review of many research studies and keeping those studies in mind, in the context of Pakistan, several studies conducted aiming monetary rewards and performance of the employee have yielded contradictory results.Some studies focused mainly on the training and development and its effect on the motivational level of employees.Thus, the need is felt to conduct a study to check for non-monetary incentives preparation and growth as well as pleasurable working environment.

Research Objectives
The objectives of this study are to:  Identify the non-monetary rewards that are determinants of employee engagement. Evaluate the effect of non-monetary rewards on employee engagement.

Review of Literature
Employee engagement is the amount of effort, enthusiasm of employees towards an organization.Worker is eager to place his unrestricted energies regardless of their position's obligations and takes positive actions towards improving organization's reputation (Shahzad, 2013).Furthermore, Employee engagement can be defined as worker's participation, work pleasure and obligation to the company that might support corporation in attaining improved consumer service over worker's working brilliance (Scott, et al., 2010).Thus, employee engagement can be described as high level of involvement, commitment, job satisfaction, and high rate of employee retention.An engaged employee values his/her work and enjoy the work.Furthermore, they feel pride in what they do as well as believe in the contribution they do in organization (Habib, 2013).The sense of ownership and belongingness creates conducive working environment where every employee is willing to help and attain organizational goals.Sharing responsibilities, teamwork, putting additional effort in organization and their jobs, information and knowledge sharing and many other positive aspects are high in engaged employee as compared to less engaged or not engaged employee (Macey & Schneider, 2008).
Monetary rewards are claimed to be one of the most stated reason for the employee's engagement.Monetary rewards can either be in the form of stock options to the employees or it can be in the form of pay raise for motivating employees.Pay-for-performance has been a deep-rooted concept in the organizations, which has an important influence on personnel's inspiration (Zani, et al., 2011).Financial inducements require better influence on the motivation of the employees in contrast to this other studies focused and stressed on non-monetary rewards and incentives according to the nonmonetary inducements carry better influence on worker's inspiration and engagement (ibid).Job and job related behavior is also a key factor that contribute in employee engagement (Habib, Kamran, & Jamal, 2015).Biswas and Bhatnagar (2013) study revealed that 67 percent of workers gave weight to "commendation and praise" from their instantaneous supervisor or boss" as the most effectual tool of motivation method.Robbins (2001) mentioned that when employee's performance is praised and appreciated and the organization rewards the employees fairly then the performance of the employees will increase and the productivity of the organization will also be rising towards achieving their goals, encouragement of employees will automatically leads employees towards motivation.
Non-monetary rewards are actually the non-cash benefits given by the business for retaining and motivating them for their outstanding work functioning (Woodruffe, 2006).Non-monetary rewards are viewed as more appreciated than financial rewards as it is highly viewed from the esteem and gratitude view on workers' accomplishment (Aguinis, Joo, & Gottfredson, 2013).In addition to the argument, Nelson (1996) revealed that there is solid connection among non-monetary inducements and personnel's job engagement.
Studies revealed Non-monetary inducements include training and development and pleasant working environment (Owolabi, Ajiboye, Bello, Aderibigbe, & Omotoso, 2014).Other studies showed that these non-monetary rewards are between the top favorites by the group Y which took birth later 1982 (Allen & Helms, 2002).Training and development was ranked on high for of global struggle and ambiguities that were born in the budget and in fact it had led extra stress on person investment (Akhter, et al., 2016).
Literature suggests that a non-monetary reward includes training and development, pleasant work environment and working conditions, furnished office, official colleague i.e. personal assistant or secretary, preferred lunch hours (Munroe 2015), and personal visiting cards (Business card).Based on these unique non-monetary reward options available for improving employee engagement, this study has the following framework:

Employee's Engagement
H: There is a positive relationship between non-monetary rewards and employee engagement.
Sub-hypotheses of the study are:

Research Methodology
To test the hypotheses and answer the research questions, this research was designed around positivist approach.Choosing the quantitative research techniques and primary source of data was appropriate for such research.Health sector served as a universe for this study whereas, private sector hospitals as population for the study.For the purpose of research, the most equip, organized and largest private sector hospital of Khyber Pakhtunkhwa was selected i.e.Rehman Medical Institute.Responses were collected by using self-administered questionnaire.Questionnaire consisted of seven variables (dependent and independent variables) and 28 items in total i.e. five items each to record response on employee's engagement, training and development, and pleasant working environment, whereas, four items to assess the response on preferred office furnishings, and three each for preferred lunch hours, business cards and own security.Five points Likert scale was used to record the answers of respondents.In total 200 questionnaires were distributed among doctors, nursing staff and medical staff.193 questionnaires were returned duly filled and found correct for data analysis (see the demographics in annexure 1).A pilot study of 28 questionnaires was conducted before undertaking the complete study.Unreliable items of the questionnaire were removed after the result of the pilot study.Reliability of the responses was tested using Cronbach's Alpha and found the instrument reliable (table 1).Demographic analysis was used to tabulate the frequencies based on gender, age, position occupied by respondent, experience and monthly income.For testing of hypothesis, regression analyses were conducted and a comparison within group was also part of analysis to see the contributing factors of employee engagement in each healthcare profession.

Findings and Analysis
Value of R-square is 0.228 (table 2) indicating that 22.8% of the model is explained by the independent variables.The descriptive variables in this study are significant in clarifying the dependent variable.However, this explanation is very less thus, indicating that non-monetary rewards are contributing but there are many other factors other than those included in this study.ANOVA results indicate that the model of this study was significant with p-value of less than 0.05 (see table 3).This relationship is also supported by Ftest value i.e. 11.036 and thus indicating that there is significant relationship between dependent and independent variables and thus, the first hypothesis is supported by the data.Model is significant if the F-value is between 4 and 16 and the probability value is less than .05.F-value for this model is 11.036 which is in the given range and P-value is .00<.05 confirms that the model is significant in explaining the relationship.
After model fitness, it was important to estimate the relationship of individual independent variable and to see how likely it is going to have effect on employee engagement.Constant value 1.762 showed (see table 4) that in absence of any contribution from all the independent variables, this was the average value of the dependent variable.Beta values showed the magnitude of variation explained by independent variables.All independent variables except preferred lunch hours have positive beta value.Variables in this study were directly associated with employees engagement.These variables are increasing employee's engagement.P-values showed the significance of the variables in explaining variations in the dependent variable.Training and development, preferred office furnishing and business cards are significant in explaining employee's engagement.Research hypothesis that non-monetary rewards have relationship with employee's engagement was accepted.Through this study, it was revealed that non-monetary rewards does have effect on employee engagement and the contribution from factors of nonmonetary reward cannot be denied in the private sector hospital.However, the relationship of preferred lunch hours and own secretary was found to be insignificant.Thus, H 1.4 and H 1.6 are not proved.
As this was the overall scenario and findings based on employees of a private sector hospital, there are differences in the employees from different fields i.e. doctors, nursing staff and paramedical staff.Overall results give the clear evidences in support of the hypotheses and research objectives; however, in order to understand the preferences in depth, it is necessary to analyze the individual professions separately.This study further compared the groups in the sample, medical staff, nurses and doctors.It was concluded that doctors have R-squared value of 0.589, medical staff have 0.753 and nurses have 0.478 (see table 5).Medical staff showed greater significance than other two groups.Nurses showed least significance in the group.From model summary, it was also concluded that doctors and nurses are not motivated through non-monetary rewards.Medical staff is very highly motivated through non-monetary rewards.Constant value was 2.344, which showed that in case of no contribution from the independent variables employees' engagement value would be 2.344.Preferred lunch hours and own secretary has negative co-efficient value.Pvalue suggested that only training, development and pleasant working environment have significant impact on employee's engagement.It was concluded that doctors are not motivated by non-monetary rewards like preferred office furnishings, business card and secretary Constant value 5.561 showed that dependent variable average value is 5.561 even when there was no contribution from independent variables (see table 7).Training and development, preferred office furnishing and preferred lunch hours have negative coefficients.P-value showed that training, development and business cards have significant association with employee's engagement.All other variables in this study were insignificant in explaining employee's engagement.Research hypothesis that non-monetary rewards have relationship with employee's engagement was rejected and it was concluded that nurses are also not motivated through non-monetary rewards.
The coefficient table (8) of paramedical staff shows different results.Constant value -.618 showed that dependent variable average value is -.618 even when there was no contribution from independent variables.Pleasant working environment and preferred lunch hours have negative coefficients.Pvalue showed that training and development, preferred office furnishing and business cards have significant association with employee's engagement.The other three variables in this study were insignificant in explaining employee's engagement.Research hypothesis that non-monetary rewards have relationship with employee's engagement was partially accepted and it was concluded that paramedical staff are motivated through non-monetary rewards.

Discussion
Results show that non-monitory rewards has very little impact on the on Doctor's and Nurses' level of engagement and where as it has positive impact on the level of engagement of the Medical Staff of the Rehman Medical Institute.Research scholars agree to the fact that financial rewards are valuable but the reasonable usage of non-monetary rewards is finest choice for the increasing engagement of the employees (Zani, et al., 2011).Few of the research scholars state that both monitory and non-monitory rewards effect the level of engagement of the employees.According to Woodruffe (2006), nonmonetary rewards are non-cash benefits offered by corporation to keep incentive and encourage them for their outstanding performance.This research result is supported by Nelson (2001) who stated that there is a durable connection of association between non-monetary incentives and employees' job engagement.The reason for employees to prefer non-monetary incentive might be due to the fact that it brings greater satisfaction psychologically.Employees would feel that non-monetary incentives show greater respect and appreciation on employee's accomplishment (Gale, 2002).Employees nowadays are struggling for higher self-development and improvement and at the same time, they will also seek for jobs which offer them a more pleasant working environment.

Conclusion
Analysis showed that non-monetary rewards have very little impact on employee's engagement.This research study examined its impact on three different groups, which were doctors, nurses and medical staff.Research findings were that nurses and doctors are not motivated through non-monetary rewards.Medical staff was highly motivated through non-monetary rewards.
The result shows that Doctors and Nurses are not motivated by the nonmonitory rewards offered by the institute which includes training and development of the employees, pleasant working environment provided to them, a preferred office furnishing to Doctors and nurses also does not motivate their engagement level.Business cards and having own secretary also does not have positive impact of the level of engagement of doctors and Nurses while all the above features have positive impact upon the engagement level of medical staff.Employee engagement is a regular activity for manager.Every profession and field has its own variables, therefore, the managers need to shift focus and keep options open.

Figure 1 :
Figure 1: Theoretical FrameworkThus, this study hypothesizes that; H a : Training and development has significant positive relation with employee engagement; H b Pleasant working environment positively influences employee engagement; H c Preferred office furnishing has a positive relationship with employee engagement; H d Preferred lunch hours can positively contribute to employee engagement;H e : Issuing business (visiting) cards have a positive impact on employee engagement; and H f Providing secretary or assistant has a significant positive impact on employee engagement.

Table 1
Reliability Statistics of the Sample

Table 2
Model Summary

Table 3
ANOVA Statistics of the Model

Table 5
Comparison within Groups

Table 6
Coefficients of Doctors

Table 7
Coefficients of Nursing Staff

Table 8 :
Coefficients Value of Paramedical Staff