An-Najah National University Faculty of Graduate Studies PERSONAL TRAITS, MOTIVATION, AND JOB PERFORMANCE OF PHYSICIANS AND NURSES IN PALESTINE By Farah Ghassan Abu Hait Supervisor Dr. Ahmad Hanani This Thesis is Submitted in Partial Fulfillment of the Requirements for the Degree of Master of Public Health Management, Faculty of Graduate Studies, An-Najah National University, Nablus, Palestine. 2024 ii PERSONAL TRAITS, MOTIVATION, AND JOB PERFORMANCE OF PHYSICIANS AND NURSES IN PALESTINE By Farah Ghassan Abu Hait This Thesis was Defended Successfully on 14/11/2024 and approved by Dr. Ahmad Hanani Supervisor Signature Dr. Kefah Zaben External Examiner Signature Dr. Mariam Al Tall Internal Examiner Signature iii Dedication Praise be to God for granting me success in this work To my beloved father, to my beloved mother; Who gave me constant support and Encouragement through the challenges of graduate school and life. I am truly grateful to have you in my life. To my dear sisters and brothers, and To my supervisors and everyone who supported me in completing this work, and to my supervisor, Dr. Ahmad Hanani. To everyone who helped me complete this work. iv Acknowledgments I would like to express my appreciation to Dr. Ahmad Hanani for his supervision and guidance throughout the completion of this thesis. I express my warm appreciation to my family, my esteemed parents, brothers and sisters, who have supported me throughout my educational journey. Special thanks to my friends for their constant support. v Declaration I, the undersigned, declare that I submitted the thesis entitled: PERSONAL TRAITS, MOTIVATION, AND JOB PERFORMANCE OF PHYSICIANS AND NURSES IN PALESTINE I declare that the work provided in this thesis, unless otherwise referenced, is the researcher’s own work, and has not been submitted elsewhere for any other degree or qualification. vi List of Contents Dedication ........................................................................................................................ iii Acknowledgments ........................................................................................................... iv Declaration ........................................................................................................................ v List of Contents ................................................................................................................ vi List of Tables .................................................................................................................. viii List of Figures .................................................................................................................. ix List of Appendices ............................................................................................................ x Abstract ............................................................................................................................ xi Chapter One: Introduction and Theoretical Background .................................................. 1 1.1 Introduction ................................................................................................................. 1 2.1 Problem Statement ...................................................................................................... 5 1.3 Significance of study .................................................................................................. 5 1.3.2 Applied significance ................................................................................................ 6 1.4 Aim of study ................................................................................................................ 6 1.5 Objectives ................................................................................................................... 6 1.6 Study hypothesis ......................................................................................................... 7 1.7 Concepts and Operational Definition ......................................................................... 8 1.7.1 Concepts Definition ................................................................................................. 8 1.7.2 Operational Definition ........................................................................................... 10 1.8 Previous Studies and Theoretical Background ......................................................... 11 1.8.1Personality Traits .................................................................................................... 11 1.8.2 Motivation and its relationship with job performance ........................................... 13 1.8.3 Motivation and its relationship with personality traits .......................................... 14 1.8.4 Personal traits on job performance ........................................................................ 15 1.8.5 Personality traits, motivation and job performance ............................................... 16 2.1 Summary ................................................................................................................... 18 Chapter Two: The Methodology ..................................................................................... 19 2.1 Study Design ............................................................................................................. 19 2.2 Study Setting ............................................................................................................. 19 2.3 Study population ....................................................................................................... 19 vii 2.4 Study sample ............................................................................................................. 20 2.5 Data Collection tool .................................................................................................. 20 2.6 Validity and Reliability of the Questionnaire............................................................ 21 2.6.1 Validity ................................................................................................................... 21 2.6.2 Reliability ............................................................................................................... 23 2.7 Data Collection Procedure ........................................................................................ 23 2.8 Statistical Analysis .................................................................................................... 25 2.9 Ethical consideration ................................................................................................. 25 Chapter Three: Results .................................................................................................... 27 3.1 Socio-demographic characteristics ........................................................................... 27 3.2 The relationship between demographic characteristics and five big personal traits among physicians and nurses in governmental and private hospitals in the northern West Bank of Palestine ............................................................................................... 28 3.3 The relationship between demographic characteristics and motivation, among physicians and nurses in governmental and private hospitals .................................... 33 3.4 The relationship between demographic characteristics and job performance among physicians and nurses in governmental and private hospitals .................................... 35 3.5 The level of personality among physicians and nurses in governmental and private Hospitals in the northern West Bank of Palestine ...................................................... 37 3.6 The level of motivation among physicians and nurses in governmental and private Hospitals in the northern West Bank of Palestine ...................................................... 38 3.7 The level of job performance among physicians and nurses in governmental and private Hospitals in the northern West Bank of Palestine .......................................... 38 3.8 The relationship between personal traits, motivation, and job performance among physicians and nurses in hospitals in the northern West Bank ................................... 38 Chapter Four: Discussion, Conclusion, and Recommendations ..................................... 41 4.1 Discussion ................................................................................................................. 41 4.2 Conclusion ................................................................................................................ 46 4.3 limitation of the study ............................................................................................... 47 4.4 Recommendations ..................................................................................................... 48 List of Abbreviations ...................................................................................................... 49 References ....................................................................................................................... 50 Appendices ...................................................................................................................... 55 ب ............................................................................................................................... الملخص viii List of Tables Table 3.1: Demographic characteristics of the study sample (n=498) ............................ 28 Table 3.2: The results of LSD post comparisons between the means of personality traits of the study sample according to education level variable (n= 498) .............. 29 Table 3.3: The results of LSD post comparisons between the means of personality traits of the study sample according to job title variable (n= 498) .......................... 31 Table 3.4: The results of LSD post comparisons in the agreeableness and conscientiousness traits of the study sample according to years of years’ experience variable (n= 498) .......................................................................... 32 Table 3.5: The results of LSD post comparisons in the agreeableness and conscientiousness traits of the study sample according to age variable (n= 498) ........................................................................................................................ 32 Table 3.6: (M, SD), and the summery of tow way ANOVA to determine the differences in motivation level and socio demographic ........................................................ 33 Table 3.7: The results of LSD post comparisons between the means of motivation level of the study sample according to education level, job title, years of experience, and variables (n= 498) .................................................................................... 35 Table 3.8: (M, SD), and the summery of tow way ANOVA to determine the differences in job performance and socio demographic (gender,job title variable and the other demographic variables without interaction .................................................... 36 Table 3.9: LSD post comparisons between the means of job performance of the study sample according to educational level variable .............................................. 37 Table 3.10: (M and SD) for the level of personality traits among Palestinian physicians and nurses ....................................................................................................... 37 ix List of Figures Figure 3.1: The effect of conscientiousness and extraversion on the motivation of Palestinian physicians and nurses ................................................................ 39 Figure 3.2: The affect of agreeableness and conscientiousness on the job performance of Palestinian physicians and nurses ................................................................ 40 Figure 3.3: The effect of motivation on the job performance of Palestinian physicians and nurses ........................................................................................................... 40 x List of Appendices Appendix A: IRB approval ............................................................................................. 55 Appendix B: Task facility of the General Administration of Health Education and Scientific Research .................................................................................... 56 Appendix C: Tools of the study ...................................................................................... 57 Appendix D: Tables ........................................................................................................ 63 Table D.2: The validity of Internal consistency for the study tools ......................... 63 Table D.2: Reliability coefficients of study tool ...................................................... 64 Table D.3: Means, standard deviations, and the summery of tow way ANOVA to determine the differences in personality traits, according to socio demographic (gender,job title variable and the other demographic variables without interaction (n= 498) .................................................... 64 Table D.4: Means and standard deviations for the level of motivation among Palestinian physicians and nurses (n= 498) ............................................ 66 Table D.5: Means and standard deviations for the level of job performance among Palestinian physicians and nurses (n= 498) ............................................ 66 Table D.6: The relationship between personality traits, motivation and job performance among Palestinian physicians and nurses (n= 498). Pearson correlation coefficient ............................................................................. 67 Table D.7: Summary of stepwise regression results to determine the effect of personality traits on the motivation of Palestinian physicians and nurses ................................................................................................................. 67 Table D.8: Summary of stepwise regression results to determine the effect of personality traits on the job performance of Palestinian physicians and nurses ....................................................................................................... 67 Table D.9 :Summary of simple regression results to determine the effect of motivation on the job performance of Palestinian physicians and nurses ....................................................................................................... 68 xi PERSONAL TRAITS, MOTIVATION, AND JOB PERFORMANCE OF PHYSICIANS AND NURSES IN PALESTINE By Farah Ghassan Abu Hait Supervisor Dr. Ahmad Hanani Abstract One of the most critical factors in determining access and quality of treatment for individuals or communities is the effectiveness of healthcare professionals. Against the backdrop of persistent challenges and amazing resilience in Palestine's unique sociopolitical situation, understanding the intricate links between personality traits and capacity to work among healthcare workers is critical. The im of this study is to examine the relationship between personality traits, motivation, and job performance of employee (physicians/nurses) at governmental and commercial hospitals in the northern West Bank. A cross-sectional study was conducted using a convenience sampling method among physicians and nurses from hospitals in the northern West Bank, 498 participants. The results were indicated that there was a statistically significant relationship at p ≤ 0.05 between demographic variables due to (the variable type of hospital and years of experience) and personal traits, motivation, and job performance. Furthermore, the study's findings showed that a positive correlation between the personality traits of Palestinian physicians and nurses (extroversion, agreeableness, openness, and conscientiousness) and their levels of motivation and job performance, with correlation values ranging from 0.22 to 0.41 (p ≥ 0.01). Additionally, the results showed a negative correlation (r = -0.13, - 0.17, and p ≤ 0.05) between the traits of neuroticism, motivation, and job performance. Additionally, the results showed that the primary factor influencing Palestinian physicians and nurses' motivation is their conscience (R2 = 0.171; p ≤ 0.05). However, the combination of extraversion and conscientiousness was the second factor affecting Palestinian nurses' and physicians’ motivation (R2 = 0.197). While. 0the primary factor influencing how well Palestinian physicians and nurses perform on the workplace is their agreeableness (R2 = 0.156; p > 0.05). Furthermore, the combination of conscientiousness and agreeableness represented the second factor affecting how well Palestinian nurses and physicians performed on the workplace (R2 = 0.194; p < 0.05). Personality traits such as conscientiousness, extraversion, and agreeableness play a significant role in enhancing xii motivation and job performance among healthcare workers, while neuroticism negatively impacts performance, particularly among doctors, highlighting the importance of targeted support and development programs in improving workplace outcomes. Keywords: Personal traits, Motivation, Job Performance, hospitals, Physicians, nursing, Palestine 1 Chapter One Introduction and Theoretical Background 1.1 Introduction The performance of medical professionals is critical in ensuring the provision of high- quality patient care in the fast-paced and demanding sector of healthcare (Hashmi et al., 2024). The intricate and demanding nature of healthcare environments, particularly in geopolitically complex places such as Palestine, necessitates a detailed examination of the variables that influence physicians' and nurses. The study is to seek how personal traits, motivation, and job performance interact in Palestinian healthcare settings. The personal characteristics and motivations of healthcare practitioners are strongly relationship to the efficacy of healthcare delivery. Personal traits such as empathy, good communication, adaptability, and adaptation play an important part in determining a medical practitioner's success. The duties and obligations of healthcare professionals have changed significantly, so it is important to have a comprehensive understanding of the difficulties they face, as the work environment has the ability to have both positive and negative impacts on employee morale (Hojat et al., 2015). Healthcare professionals operate in a unique setting with significant risks, strong emotions, and a continual need for accuracy and cooperation. To raise the standard of healthcare service generally, it is necessary to comprehend the factors influencing employee motivation and how this impacts their output at work (Chmielewska et al., 2020). It therefore has a significant impact on employee output and job performance, as a result, there are many facets and a complex interaction between motivation and personality traits (Vainieri et al., 2019). A person's objectives and ability to reach them might be influenced by their personal traits. Studies have indicated that people with particular personality types are more likely to be driven towards internal objectives (Collegenp, 2023). 2 Consequently, recognizing motivation internal or external as a critical factor influencing job performance across a range of industries, including healthcare (Deci et al., 2017). In order to enhance the entire health care system in Palestine, where medical professionals often work under challenging conditions, it is critical to understand the specific factors that either facilitate or obstruct their performance. Personality traits play a significant role in personality studies, particularly when it comes to predicting performance. As a trait that sets one person apart from another and indicates whether a person would behave differently in certain professions than in others (Diener & Lucas, 2024). Personality traits affect patient safety because they have been connected to how healthcare workers manage stress, burnout, and job performance. Organizations might benefit from personality qualities as they can reveal how individuals react to certain characteristics (Bataweel, 2023). Analyzing personality and individual variations is a crucial part of psychology. Each individual is distinct in the way that their personality traits interact with one another and how they each act in social settings. Individual differences include those in sexual orientation, political views, religious beliefs, professional interests, and mental capacities (Diaz, 2022). Hence, personality was described by Eysenck as "the total of what is real or the potential behavioral tendencies of an organism, which are influenced by genetics and environment (Diaz, 2022). the personality of employees is vital to every organization. Psychology's use of the five personality dimensions to characterize human personality offers a rigorous conceptual and measurement framework for personality research. Hard labor, diligence, responsibility, organization, and perseverance are traits of consciousness. Talkativeness, extroversion, and aggression are characteristics of extraversion, whereas neuroticism is characterized by agreeableness, flexibility, insecurity, and self-assurance (Delima, 2020). Conversely, it has been demonstrated that employees who are open to new experiences have personalities that are correctly characterized by innovation traits by agreeableness, flexibility, insecurity, and self-assurance (Diaz, 2022) .Therefore the way healthcare 3 services are delivered is significantly impacted by the personal traits of the staff. Customers seem to prefer conscientiousness and agreeableness in employees because they see them as more trustworthy and sympathetic, which results in greater assessments of service quality, according to the literature that is currently available (Rutz et al., 2020). The term "job performance" describes an essential function that establishes objectives and plans of action for accomplishing organizational goals as well as the extent to which outputs are produced (Delima, 2020). The healthcare industry is one of the most important sectors that gets equal criticism with regard to performance and service delivery. "Job performance" (JP) typically refers to a person's ability to carry out their work in an efficient manner. It is the most important indicator of an organization's performance and has attracted attention from academics recently (Adhikara et al., 2022). Traditionally, the way an employee performs his given tasks has been the main factor used to assess his work performance. An employee needs to be willing to go above and beyond what is assigned to them in order to accomplish the aims and objectives that organizations have set for themselves in recent years. One way to assess an employee's performance at work is to look at their output or make sure that policies and procedures are being followed correctly (Delima, 2020). However, maintaining access to affordable healthcare poses significant challenges for healthcare providers. To do this, they have to adapt and improve their performance. To do this, organizations need to influence employees' job performance. Therefore, it is important to understand the basic elements of job performance, which include understanding their personal traits and enhancing their motivation about working in the healthcare sector, in addition to ways to improve these elements (Chmielewska et al., 2020). The process (or activity) and the outcome were the two points of view that were utilized to conceptualize performance for this aim. Process is focused on a certain aspect of the process, such as behavior; The activity that individuals carry out while working that is pertinent to the objectives of the company is the behavioral component (Rababah, 2019). 4 Furthermore, work performance - also known as job performance - is intended to take into account individual differences in occupational achievement. In the workplace, job performance is important, which is seen as being linked to increased productivity (outcome) (Rababah, 2019). Regarding the relationship between personal traits and job performance, Delima (2020) indicated the existence of a direct relationship, which means that a decrease in an employee’s personal traits will inevitably lead to a decrease in job performance. This shows that a big number of people have different personalities that impact how effectively the organization runs as a whole. Emotional, biological, social, and cognitive variables are all involved in motivation, which is what drives behavior. In common discourse, the term "motive" is frequently used to describe the reasons behind an individual's behavior. The desire of an individual to accomplish a particular objective is referred to as motivation, which is a behavior determinant. One of the things that might motivate healthcare professionals to work towards accomplishing the objectives of the WHO health system, which include enhancing patient equity and health, is motivation Muthuri (2020) compared to workers with clear, challenging goals, employees with ambiguous goals typically work more slowly, produce worse results, show less interest, and complete fewer tasks. Workers are more engaged and productive when their goals are clear. According to the fundamental principle of motivation, an individual's level of abilities and motivation determines their level of performance (Rosak-Szyrocka, 2015). One of the main problems that HR departments still face in modern businesses is motivating and retaining staff. In order to try to accomplish this goal, it becomes necessary to ascertain how personality and motivation relate to one another and how much the former influences the latter (Nuckcheddy, 2018). Workers are proactive by nature, which means they take the situation on board without becoming down on it. They create their own work in order to maintain motivation and high output. Understanding the core elements of personality traits that influence the motivation and performance of healthcare practitioners is crucial when aiming to enhance team dynamics (Rababah, 2019). 5 Everybody who needs quality care can get it when and when they need it from a well-run health system. Health care professionals need to have a clear grasp of their scope of practice in order to help them navigate the complex world of patient care (Desmond Wiggins et al., 2022). This study seeks to investigation of the relation between the personality traits, motivation and job performance of (physicians and nurses) in Palestine. 2.1 Problem Statement In contemporary healthcare environments, the seamless functioning of medical teams of physicians and nurses is crucial to ensure optimal patient care protocols and overall hospital efficacy. However, little is known about the complex relationships that exist between the personal traits, work productivity, and motivating factors of these healthcare personnel. More investigation into this link is required given the knowledge that personality trait’s and motivational factors significantly influence the collaborative dynamics and overall productivity of medical teams. Although there is literature on individual factors including motivation, character traits, and job performance in healthcare settings (Delima 2020; Gur & saks 2020). There is a dearth of comprehensive research that specifically addresses the unique milieu of hospitalized medical teams and incorporates these components. Furthermore, a number of reasons, such as a range of patient demographics, growing expectations, and technology improvements, are causing the healthcare business to change swiftly. Consequently, a more thorough understanding of the intricate relationships between motivation and personal traits and job performance is needed for physicians and nurses. 1.3 Significance of study The theoretical and applied significance of the study among physicians and nurses in improving healthcare delivery, workforce management, and policy formulation on healthcare development is great. It also deepens the understanding of factors that affect healthcare professionals and theoretically and practically contributes to the realm by: 6 1.3.2 Applied significance  Inform training programs on motivations and personality traits among health professionals.  Leads the leadership of the hospitals in management strategies that best optimize team dynamics and individual needs.  Facilitates employee engagement initiatives that help improve job satisfaction and overall well-being.  Offers strategies to reduce burnout and turnover, improving staff retention. Promotes cost-effective healthcare delivery through performance enhancement, reduction of errors, and productivity gains. 1.4 Aim of study Investigation of the relation between the personality traits, motivation and job performance of (physicians and nurses) in Palestine. 1.5 Objectives  To examine the relationship between demographic characteristics (age, gender, educational level, type of hospital, work experience and job tittle) and five big personal traits (Neuroticism, Extraversion, Agreeableness, Openness and Conscientiousness), among physicians and nurses in governmental and private hospitals in the northern West Bank of Palestine.  To examine the relationship between demographic characteristics (age, gender, educational level, type of hospital, work experience and job tittle) and motivation level, among physicians and nurses in governmental and private hospitals in the northern West Bank of Palestine  To examine the relationship between demographic characteristics (age, gender, educational level, type of hospital, work experience and job tittle) and job performance among physicians and nurses in governmental and private hospitals in the northern West Bank of Palestine  To assess the level of personality traits among physicians and nurses in governmental and private Hospitals in the northern West Bank of Palestine. 7  To assess the level of motivation among physicians and nurses in governmental and private Hospitals in the northern West Bank of Palestine.  To assess the level of job performance among physicians and nurses in governmental and private Hospitals in the northern West Bank of Palestine.  To investigate the relationship between the five big personal traits (Neuroticism, Extraversion, Agreeableness, Openness and Conscientiousness), motivation, and job performance among physicians and nurses in governmental and private Hospitals in the northern West Bank of Palestine. 1.6 Study hypothesis H0: There is no statistically significant relationship at (p ≤ 0.05 between demographic characteristics (gender, age, experience, type of hospital, educational level and job tittle,) and five big personality traits (Neuroticism, Extraversion, Agreeableness, Openness and Conscientiousness) among Palestinian physicians’ hospitals in Palestine. H0: There is no statistically significant relationship at (p ≤ 0.05 between demographic characteristics (gender, age, experience, type of hospital, educational level and job tittle,) and motivation among Palestinian physicians whose working at the northern cities’ hospitals in West Bank of Palestine. H0: There is no statistically significant relationship at (p ≤ 0.05 between demographic characteristics (gender, age, experience, type of hospital, educational level and job tittle,) and job performance among Palestinian physicians whose working at the northern cities’ hospitals in West Bank of Palestine. H0: There are statistically significant differences in the level of personality traits among physicians and nurses working in governmental and private hospitals in the northern West Bank of Palestine. H0: There are statistically significant differences in the level of motivation among physicians and nurses working in governmental and private hospitals in the northern West Bank of Palestine. 8 H0: There are statistically significant differences in the level of job performance among physicians and nurses working in governmental and private hospitals in the northern West Bank of Palestine. H0: There are no statistically significant differences relations at p ≤ 0.05 between personal traits (Neuroticism, Extraversion, Agreeableness, Openness and Conscientiousness), motivation, and job performance of members of the medical team (physicians and nurses) in governmental and private hospitals in the northern West Bank. 1.7 Concepts and Operational Definition 1.7.1 Concepts Definition Personality: It is a unique style of feeling, thinking, and acting. Moods, attitudes, and opinions are all part of personality, which comes through in social interactions. It encompasses both innate and learned behavioral traits that set an individual apart and are evident in how they interact with their surroundings and social group. Although the term "personality" has been defined in a variety of ways, two primary interpretations have emerged as psychological concepts. In this view, the study of personality focuses on categorizing and interpreting generally stable human psychological traits. The first is related to the consistent differences that exist among individuals. The second interpretation highlights the characteristics that set psychological individuals apart from other sorts of persons and that bind all people together. It instructs the personality theorist to look for the universal patterns that define human nature and the variables affecting life's trajectory (Philip-S-Holzman, 2024). Five big Personality traits: The Five Factor Model (FFM), sometimes referred to as the Big Five or the Big Five personality characteristics, is a well-established framework for comprehending human nature. These traits are (Darby, 2024):  Openness: This quality includes traits like creativity, wisdom, and a wide variety of interests. Individuals with high openness tend to be more daring and imaginative.  Conscientiousness: High degrees of thinking, strong impulse control, and goal- directed behavior are characteristics of this feature. Those that are highly conscientious are often well-organized and detail oriented. 9  Extraversion: Excitability, sociability, talkativeness, assertiveness, and a high degree of emotional expressiveness are some of the traits that make up this attribute. Extraverts are frequently more gregarious and vivacious.  Agreeableness: This characteristic includes qualities like compassion, love, trustworthiness, and other prosocial actions. High agreeableness scorers are usually more helpful and understanding.  Neuroticism: Emotional instability, anxiety, moodiness, impatience, and melancholy inclinations are all part of this feature. Negative emotions are more common in those with high neuroticism. Personality traits: Personality traits are described as long-lasting patterns of thinking, feeling, and acting that clearly distinguish an individual from others. These traits are relatively stable across different situations and also over time, influencing how every individual perceives, interacts with, and responds to their environment. The widely accepted Five-Factor Model (Big Five) outlines the primary traits as openness, conscientiousness, extraversion, agreeableness, and neuroticism (Dang et al., 2024). Motivation: The internal and external forces that drive people to initiate, sustain, and focus their efforts to achieve their career goals and maintain high levels of work engagement are collectively referred to as motivation. Which consists of extrinsic motivations (rewards, recognition, job stability) and internal motivations (personal fulfillment, professional development) are essential. Motivation is also influenced by elements including organizational culture, work environment, and job autonomy (Dagne et al., 2015). Job performance: A person's ability to perform technological duties or activities that advance technological task performance is the essence of an organization. Task performance and contextual performance are the two components that make up job performance, and both are necessary for an organization to function well. Therefore, job performance is determined by predetermined standards and pertains to the efficacy and efficiency with which physicians and nurses carry out their roles and obligations in the healthcare setting. So Clinical competence, protocol adherence, patient care quality, 10 teamwork, communication skills, and stress management capacity are critical components of healthcare professionals' work performance (Zaman et al., 2022). 1.7.2 Operational Definition The first tool was the Big Five Personality Test Scale -11 items (Watson, 2023), the second was the Employee Motivation Questionnaire -9 items (Mbindyo et al., 2019), and the third was a Performance Measure - 5 items (FZE, 2018). Personality traits: the personality traits of physicians and nurses were measured by developing a questionnaire about the Big Five personality traits and evaluating their responses to items (1-11) in the questionnaire, using a five-level Likert scale (Strongly agree - Strongly disagree). The items included questions that measured (anger, self- esteem, teamwork, influence on others, problem solving, love of visiting new places, and the individual’s commitment to his promises). Motivation: The level of motivation is measured through items (12-20) in the questionnaire, which target the factors that motivate physicians and nurses to perform their jobs, such as the desire to work hard, job security, professional burnout, the relationship with management, and the extent to which the employee’s values are compatible with the hospital’s values. The scale consists of a group of items that measure the following aspects: Intrinsic motivation: relates to personal motivation for work derived from pleasure or intrinsic value (e·g·, “These days I feel motivated to work as hard as I can”)· Extrinsic motivation: relates to motivation related to rewards or job security (e.g.·, “I'm only doing this job so I can get paid at the end of the month”)·. 1. Components of the scale: Stress and Emotional Depletion: Measures negative aspects of the work experience (e.g.·, “I feel emotionally drained at the end of each day”)· Overall job satisfaction: Focuses on the overall level of job satisfaction (e.g.: “I am very satisfied with my job”)· 11 Satisfaction with the job environment: includes relationships with management and co- workers, as well as alignment of personal values with the organization (e.g.·, “I am satisfied with my boss” and “I find that my values and the values of this hospital are very similar”)· 2. Similar measuring tools  Minnesota Satisfaction Questionnaire (MSQ): Measures overall and specific satisfaction with specific aspects of work, such as job security, environment, recognition, and salary·  Job Stress Scale: It measures the emotional and psychological stress that individuals experience at work·  Work Extrinsic and Intrinsic Motivation Scale - WEIMS: It measures internal and external motivation based on Self-Determination Theory· Job performance: is measured through items (21-25) in the questionnaire, which relate to the physicians and nurses sense of the need to perform well to achieve the hospital’s goals, understanding expectations from his role, the impact of good performance on productivity, and fairness of professional expectations. 1.8 Previous Studies and Theoretical Background 1.8.1 Personality Traits Personal traits of employees have a significant impact on how health care services are delivered. Research suggests that customers value conscientiousness and agreeableness in employees because they view them as more trustworthy and compassionate, which leads to higher ratings of service quality. The perception of service quality is also influenced by relationships between team members. A study conducted in Israel, Gur, Saks, & Stavi (2020) looked into the possible relationship with team connections serving as a mediator between the conscientiousness of healthcare personnel and their acceptance and assessment of service quality. Participation in decision-making, peer support, and trust are all aspects of these relationships. A total of 174 nurses were given questionnaires. The survey looked at two 12 personality traits: agreeableness and conscientiousness. The findings showed that the sole mediator between employee personality and evaluations of service quality was trust amongst team members. On the other wise, a study conducted in Poland by (Kwiatosz- Muc et al., (2021) who sought to assess the degree of self-efficacy and the intensity of personality traits in a group of anesthesia nurses working in five hospitals located in the southeast of Yolanda. An analysis was conducted on 143 correctly completed questionnaires. The findings showed that nurses typically receive high ratings for extraversion and conscientiousness. and low neuroticism-related scores. Individuals with high levels of conscientiousness, extroversion, and openness to new experiences tended to score highly on the sense of self-efficacy scale. The findings also demonstrated a link between personality characteristics and exposure to certain stressful work-related conditions. The results of a regression study indicated a strong relationship between sentiments of self-efficacy and conscientiousness and extraversion. In the same context, a study was conducted in Poland by Marcisz-Dyla et al. (2022) aimed to identifying the psychological and physical health, as well as the personality traits and coping mechanisms, of Polish surgeons and non-surgeons. The Resilience Rating Scale, the Type D Personality Scale, the Framingham Type A Scale, the Mini-COPE-Coping Inventory Scale, and the Well-Being Scale were among the scales and questionnaires utilized in the study. According to the study, surgeons report feeling more psychologically well-off. In relation to surgical specialty performance, the values of the domain of denial are greater and the values of the domain of conversion to religion are lower for those with an optimistic outlook on life and the capacity to mobilize in trying circumstances. While, Claes et al. (2018) sought to learn more about the personality traits of healthcare professionals who manage teams. It also sought to find out if Belgian physicians who aspire to be leaders have similar preferences, if their personalities are different from those of other healthcare workers, and if the Belgian physicians in our sample are different from the group of physicians in the USA. In addition to non-physicians who registered for the clinical leadership programmer, physicians working at the hospital participated in the study. Based on the Myers-Briggs Type Indicator, they investigated their preferences for four different aspects of personality (MBTI). An MBTI coach provided additional help after they completed their self-assessment to decide which MBTI profile best suited them. 13 Preferences for "thinking" were found to be significantly higher than those for "feeling." It was discovered that non-physicians were noticeably more adept at "sensing" and "judging" than physicians. There were no discernible variations between the physicians in the Belgian and American datasets. 1.8.2 Motivation and its relationship with job performance The job performance of healthcare professionals in hospitals is greatly influenced by motivation, which is a critical element. Given the special demands and challenges that the healthcare industry places on its workers, it is essential to understand and develop motivation in order to achieve the highest level of performance. A study conducted by Chmielewska et al., (2022) examined the connection between a few motivational variables that influence physicians’ inclination to work in public hospitals and the hospitals' organizational effectiveness. This study used questionnaires from the World Health Organization that were created to measure organizational performance levels in hospitals using the McKinsey model and to estimate motivation factors in accordance with Herzberg's theory of motivation. In 22 departments/units of general public hospitals in Warsaw, Poland, a survey of physicians (n = 249) with either surgical procedure specialization (surgical) or non-surgical procedure specialization (conservative) was done. Healthcare professionals (54 percent of whom are doctors) who participated in the survey indicated that "performance feedback" has the lowest impact on organizational performance, while the motivation factors related to "quality and supervision style" have the highest impact on the organizational performance of hospitals (Spearman rank correlation coefficient = 0.490; p ≤ 0.001). While study was conducted in Italy by Belle (2013), a field experimental was conducted on a sample of nurses in a public hospital in Italy with the aim of studying the relationship between public service motivation (PSM) and job performance. The research focused on the interaction between PSM, job performance, and two conditions: Exposure to beneficiary interactions and self- persuasion. The results of the study showed that participants' persistence, productivity, and attentiveness were all improved by both treatments. These beneficial effects were amplified by baseline PSM. Furthermore, it results in both cases. A rise in PSM, in part because Positive effects mediate Reaching out to the recipient regarding work performance. On the other wise, a study was conducted by Aduo-Adjei et al. (2016), 14 centered his research on investigating the role of motivation and figuring out how both external and internal motivators affect health professionals' performance at Korle Bu Teaching Hospital (KBTH). The study used a qualitative methodology, and fifteen health professionals including doctors and paramedics were chosen by purposive sampling. The study's primary conclusions showed that, in addition to external variables like pay, housing, and transportation, intrinsic motivators that affect health workers' work performance include job satisfaction, the availability of logistics services, and an enabling work environment. Furthermore, the ability to be motivated is essential for nursing employment. 1.8.3 Motivation and its relationship with personality traits There is a complex relationship between personality traits and motivation. For example, people with high scores on conscientiousness may be more driven to succeed at their jobs and provide careful and accurate medical care. Personalities with high agreeableness can be driven by the desire to help and work with others. Being receptive to new experiences may inspire people to learn new things and adapt to changing medical procedures. Furthermore, people who possess certain personality traits may display higher levels of intrinsic motivation, which is motivated by a sense of purpose and personal fulfillment. On the other hand, extrinsic motivations - such as financial rewards - may have a greater influence on others. A study was conducted by Sowunmi (2022) which emphasized the connection between personality traits, work satisfaction, and motivation. In Aru, Abeokuta, Neuropsychiatric Hospital, Ogun State, Nigeria. In order to study the relationship between personality traits, work satisfaction, and motivation, a cross-sectional study was conducted, workers that showed how personal traits, job happiness, and motivation relate to mental health professionals. Systematic proportional sampling was used to analyses 146 participants in total, yielding a 67.3% response rate. The majority of participants were married (80.8%), female (60.3%), and had at least a tertiary education (63%). The participants' average age was 40.29 ± 8.27, and their average duration of service was 13.63 ± 8.49. Consciousness (97.3%) and agreeableness (97.3%) were the most prevalent personality qualities, whereas neuroticism (55.5%) was the least. Significant positive correlations were found between high levels 15 of openness (0.01), conscientiousness (0.03), and agreeableness (0.01) with motivation. There was a statistically significant correlation between motivation Both gender differences (t=4.26; p≤0.001t = 4.26; p 0.001t=4.26; p≤0.001) and occupational status (t=−3.59; p≤0.001 t = -3.59; p ≤0.001t=−3.59; p≤0.001) were found to be statistically significant. Muntean, et al., (2022) conducted a pilot study in Romania aimed at exploring the relationships between motivation, personality traits, and the outcomes of national residency examinations among Romanian medical graduates. The study examined all dimensions of personality All personality dimensions, including extraversion (OR = 0.512, p = 0.03), conscientiousness (OR = 3.671, p = 0.004), agreeableness (OR = 2.791), p = 0.07), and emotional stability (OR = 4.863, p = 0.0003), were statistically related to the results obtained. The results showed that all personality dimensions were consistent with the Big Five model. By stimulating engagement and persistence, which are related to the conscientiousness and outcome dimensions, motivation also plays a significant influence on academic achievements. 1.8.4 Personal traits on job performance Personality qualities and work performance are closely related in the nursing and medical fields, this is because a variety of personal traits, competencies, and skills interact with systemic environmental influences (Günaydi, 2021). Acknowledging and fostering these qualities can help healthcare professionals succeed in their jobs and be more productive overall. A study was conducted by, Rababah (2019) conducted a study in Jordan with the goal of examining the impact of personal traits (the Big Five) on job satisfaction and performance. Additionally, the study sought to determine the degree to which job satisfaction influences job performance in the hospitals. Using structural equation modelling, data for 1,200 employees across 52 hospitals in Jordan were examined. The study discovered that while neuroticism has a detrimental impact on job satisfaction, characteristics like conscientiousness, extraversion, agreeableness, and openness have favorable benefits. Furthermore, there is a strong correlation between personality traits and job performance. Performance at work is significantly impacted by job happiness as well. These ideas are supported by empirical analyses, which also assess personality 16 factors as potential predictors of job performance and job satisfaction. According to the results of a study conducted by Delima (2020) personal traits have a good relationship with job performance. Additionally, awareness has traits that are directly associated to job performance for employees with greater weights. Employees' job performance is positively and significantly impacted by agreeableness, extroversion, conscientiousness, and openness to experience; employees' job performance is negatively and significantly impacted by neuroticism. While another study was conducted that analyzed the impact of proactive personality at job Performance in midwives by Uktutias et al. (2022) including 151 midwives, and random samples were used. The results of the analysis showed that individuals' job performance is affected by their proactive personalities. Proactive midwives are able to challenge themselves to grow as individuals, which improves their effectiveness in providing health care, especially to infants and young children. Very proactive personality. More professional and efficient midwifery services have an impact on midwives' ability to carry out their jobs more effectively, so midwives are urged to take the initiative to learn new things. 1.8.5 Personality traits, motivation and job performance The interaction of motivation and personal qualities can influence how healthcare workers approach their work, deal with obstacles, and contribute to the overall performance of a healthcare facility. Hospitals should take these things into account when recruiting, training, and setting up an atmosphere that supports the professional and personal development of their physicians and nurses. maintaining high levels of job performance can also be facilitated by identifying and resolving burnout and offering continued support. On the other wis, a study by silvestre (2022) investigated the association between employee personality traits, motivation, and performance in a Philippine pharmaceutical company using a descriptive correlational design study. I thus investigated the possibility of using motivation and personality traits to forecast medical sales representatives' job success. Using stratified and worldwide sampling, 125 medical sales representatives who were hired in the NCR were chosen for the study. The Big Five personality test by McCrae and, the Work Motivation Questionnaire, and the Performance Appraisal Questionnaire were the three instruments employed in this work. It has been demonstrated that there is a favorable correlation between work performance and 17 personality traits and motivation, but not between personality and motivation. However, there wasn't much of a bond between the first two structures. Additionally, the findings showed that favorable working circumstances and tangible rewards were important determinants of job performance. With the exception of the association between personality traits and motivation in the setting of sales, which requires more research, the bulk of conclusions are confirmed by the literature review. To further enhance the performance of medical sales agents, a general company performance improvement plan should be created. On the other hand, Cob et al. (2021) talked about how personality traits, motivation, learner autonomy, and leadership style affect how well employees perform at work. An additional goal of this research is to determine the key variables influencing work performance. This study's population comprised 16,960 employees of University Technology MARA (UiTM), and 600 participants were selected using a stratified sampling technique. The findings demonstrated that 37 percent of job performance is influenced by personality attributes, motivation, learner autonomy, and leadership style. A statistically significant association between learner independence, motivation, leadership style, and personal traits and job performance was found via SEM analysis. Furthermore, the study's findings indicate that the primary variable influencing work performance is employee motivation. The study demonstrates that when learner autonomy, motivation, personality attributes, and leadership style are all in good shape, individual work performance can be enhanced. In 2017, specifically in China, conducted a cross-sectional study including 1,523 physicians from eight tertiary hospitals in Harbin, China, according to, Guo et al. (2021) physicians' drive for achievement, work output, organizational dedication, character attributes, and other demographic factors were among the types of data gathered. The findings showed that organizational commitment somewhat mediates the direct effects of accomplishment motivation on job performance, and that achievement motivation directly affects job performance. Furthermore, findings demonstrated that, through organizational commitment, agreeableness and conscientiousness modify the intensity of the associations between achievement motivation and job performance. 18 2.1 Summary All studies that were discussed personality traits, motivation, and performance, it was noted that most of them study two variables or relationship between two variables to each other, while in this study all variables were studied, linked to each other, and the effect of one on the other was found. Regarding the methodology, most of the previous studies chose the study population, either a nursing community only, or a community of physicians only, or they addressed the health workers in general. While in this study, it was distinguished by the fact that it brought together the nursing staff and the physician staff only, and studied their personal traits, motivation, and job performance. In this study, the Big Five personality traits were analyzed and linked to demographic characteristics and also linked to motivation and performance to determine the extent to which motivation and job performance are affected by them. While in previous studies, some of them discussed the Big Five personality traits, but the studies did not address the impact of each trait on the dependent variables in the studies. 19 Chapter Two The Methodology In this chapter, the methods used by the researcher to achieve the goal of this study are explained. Was consists of the study design, environment, participants, tools used, study sample, sampling methodology, and data collection mechanism. The researcher also discussed the most important ethical considerations that were followed before conducting this study. 2.1 Study Design A cross-sectional descriptive correlational study. Data was collected from participants using the convenient sampling technique. 2.2 Study Setting The study was conducted between March and April 2024 at governmental and private hospitals in the northern West Bank. The governmental hospitals included Watani Hospital- Nablus, Tubas Turkish Hospital, Khalil Suleiman Hospital - Jenin, Thabet Thabet Hospital - Tulkarm, Darwish Nazzal Hospital - Qalqilya). The private hospitals were included Arab Specialized Hospital - Nablus, Nablus Specialized Hospital - Nablus, St. Luke's Hospital - Nablus, An-Najah National University Hospital - Nablus, Al-Amal Hospital- Nablus, Al-Razi Hospital- Jenin, and Al-Isra Hospital - Tulkarm). 2.3 Study population In Palestine, the annual health report of the Ministry of Health indicates that there are 8,106 physicians working in the health sector in the West Bank, 10,557 male and female nurses, and 802 physicians working in the government sector in general and affiliated with the Ministry of Health. There were 2,652 male and female nurses in the government sector (PHIC & MOH Planning Unit , 2023). All physicians and nurses working in the hospitals under this study in the northern West Bank were included. The number population of physicians (general and specialists) reached 304, while the number population of nurses in general was 2,000 nurses (PHIC & MOH Planning Unit , 2023). 20 Inclusion criteria  All physicians and nursing staff working in the hospitals included in this study, regardless of educational level or job position.  Palestinian nationality  Informed consent form approved. Exclusion criteria Physicians and nursing with less than one month of experience will be excluded. 2.4 Study sample Convenience sampling techniques were used by all (physicians& nursing staff) in the hospitals included in this study. 328 nurses and 172 physicians were participating in this study. 2.5 Data Collection tool The data collection tool utilized in this study was designed in Arabic to ensure clarity and cultural relevance for participants. The data were subsequently processed and presented in English tables for academic analysis and broader accessibility. This study consists of three important areas for collecting data on which the research question is focused: the first is a tool for measuring personal traits, the second is a tool for measuring motivation, and the third is a tool for measuring performance. After that, these measures were collected in one questionnaire, and it was answered using a five-point Likert scale. The questionnaire was divided into two parts. First part: demographic characteristics (gender, level of education, type of hospital, job, years of experience, age). Second part: The questionnaire is answered using a five-point Likert scale and is divided into three sections: The first section: about personality traits. This section deals with the Big Five personality traits (Neuroticism). Extraversion, Agreeableness, Openness & Conscientiousness) 21 Section Two: Addressing specific motivation satisfaction with specific aspects of work, such as job security, environment, recognition, and salary. Job Stress Scale: It measures the emotional and psychological stress that individuals experience at work. Section Three: Discuss the performance using assesses perceptions and personal opinions, enabling precise analysis of respondents' attitudes and viewpoints 2.6 Validity and Reliability of the Questionnaire 2.6.1 Validity Validity determines whether a measuring instrument accurately captures the object of interest in the measurement. It is necessary to prove the validity of the tool (Middleton, 2019), the questionnaire was sent in its first form to the dissertation supervisor and to the Public Health Department at (An-Najah University). First scale: Personality Traits Scale According to the study conducted by Watson (2023), titled Personality Assessment, various methods for assessing personality were discussed, with a focus on analyzing the validity of these methods to ensure accurate and reliable measurements. The validity of the scale varies depending on the type used, and the key findings are as follows: Objective Tests: These tests exhibit relatively high validity, especially when using well- established tools that rely on self-reports and informant ratings Validity is strengthened by the alignment between test results and real-life behaviors observed by others. Projective Tests: These tests face challenges in terms of validity, as they depend on expert interpretation of results However, they provide significant value when used alongside other measures to examine unconscious processes. Behavioral Measures: These methods offer high external validity due to their ability to link actual behaviors to field observations. The study emphasized their effectiveness in predicting real-world behaviors. 22 Implicit Techniques: Although their use is limited, their validity depends on their capacity to reveal unconscious traits that cannot be directly expressed. Overall Validity The study emphasized that selecting the appropriate scale depends largely on the purpose of the assessment While validity may vary across methods, combining multiple approaches enhances overall validity. Watson (2023) highlighted the importance of employing diverse measures to provide a comprehensive understanding of personality traits, noting that higher validity is achieved when results are cross-verified using multiple tools· Second scale: Motivation Qu0estionnaire items (Mbindyo et al., 2019). The internal validity of the instrument was assessed using reliability analysis and factor analysis. The value of Crombach's alpha = 0.0.76. This value indicates that the tool has acceptable internal consistency, which enhances the reliability of the results drawn from it. Third scale: Performance Measure, FZE (2018), the researcher indicated in his study that the tool has validity and reliability. The tool was evaluated for its adequacy in relation to the objectives it was devised to measure. Its validity was established in a pilot study on 35 physicians and nurses other than those who formed part of the main study sample. This assured internal consistency by computing Pearson's correlation coefficients between the score of each item and the total score of the study tool. The results obtained showed the Pearson correlation coefficients of statements with the total scores, which represent components of study: personal traits, motivation, and job performance, were statistically significant. The results in table D.1 Appendix C ,were showed that there was a statistically significant relationship at the level (p ≤ 0.01) between the total score of each study tool and its related items, as the values of the Pearson correlation coefficient ranged between (0.55 - 0.89). Based on these results, the three tools are valid and measure what is intended to be measured. 23 2.6.2 Reliability A pilot study was conducted with 35 participants, not included in the final sample, to test the tool's cultural relevance and suitability. Cronbach's alpha values were calculated to ensure the reliability of the questionnaire items. The internal consistency questionnaire of the relationship between personality traits, motivation, and job performance. These reliability values demonstrate the importance of the tool in achieving the objectives of the study. The results indicated that the values of Crombach alpha reliability coefficient for the study tools, which include personal traits, motivation, and job performance (0.92, 0.86, 0.88), respectively as shown in table D.2 Appendix D. Based on these results, the study tools are reliable and achieve the study objectives. 2.7 Data Collection Procedure For the purpose of this study, data were collected using an Arabic questionnaire. The results have been translated and presented in English tables to align with the study's academic context. The questionnaire was distributed and participants' responses were received through an online survey created using Google Forms via email to the target population – physicians and nurses, working in governmental and private hospitals in the northern West Bank, Palestine. a Google Form link was emailed to participants, who completed the survey at their convenience. This method was chosen for its accessibility in reaching the target population. A Likert scale is a device applied in a survey or research to determine the level of agreement, satisfaction, or perception. The following table defines response levels from "very low" to "very high" using a 5-point Likert scale. Calculating the Interval The interval length is calculated using the formula: Interval Lengths Highest Value on the Scale−Lowest Value on the Scale/Number of Points on the Scale. 24 Below is an application of how to calculate the interval of the study tool, which consists of combining (three scales personal traits, motivation, and performance). Highest value = 5 Lowest value = 1 Number of points = 5 Interval Length=5−15=0.8\text{Interval Length} = \frac{5 - 1}{5} = 0.8 Interval Length=55−1=0.8 Highest value = 5 Lowest value = 1 Number of points = 5 Interval Length=5−1/5 = 0.8 Defining the Categories Range for each level of scale: From the length of the interval, the range for each level of the tool is 0.8. Level 1-very low: The lowest value, 1, to 1+0.8=1.8 1+0.8=1.8. Final range: 1.80 and below. Level 2-low: Starts at 1.81 and ends at 1.81+0.8=2.60. Level 3-moderate: Starting at 2.61 and ending at 2.61+0.8=3.40. Level 4-high: Ranges from 3.41 to 3.41+0.8=4.20. 25 Level 5-very high: From 4.21 and above. Description In fact, each category represents a different level based on responses. For instance, 1.81−2.60If the mean score of the participants falls within this range, the level is referred to as "Low." 3.41−4.20 If the score ranges between, the rating described is "High". 5. Difference Between Values: The difference between each boundary of a category above is equal and is the same as the length of an interval (0.8). This indicates that, within the five points of this scale, the ranking has an equal distribution of 0.8. 2.8 Statistical Analysis The data were analyzed using SPSS (26) through the application Descriptive statistics include means and standard deviations. Pearson’s correlation coefficient was used to determine the relationship between personality traits, motivation, and job performance. As well as verifying the internal consistency of the three study tools. Stepwise linear regression to determine the effect of personality traits on motivation and job performance. Simple linear regression to determine the effect of motivation on job performance. An independent t-test was used to determine differences in personality traits depending on the variables of gender and hospital type. One-way ANOVA to determine differences in study tools according to independent variables. LSD as a post-test to identify sources of significant differences in post-comparisons when needed. 2.9 Ethical consideration Approvals to conduct the study were sought from various authorities. The graduate study was approved and the IRB at An-Najah National University, Nablus, Palestine, gave approval for the study and granted ethical clearance on February 22, 2024. Further, the researchers sought approval from the Department of Health Education and Scientific 26 Research, Palestinian Ministry of Health on April 22, 2024. An informed consent form was provided, explaining the purpose of the study and assuring participants of their right to withdraw at any time. Participation in the study was voluntary, and participants were informed that the data collected would be used strictly for scientific research purposes, with privacy maintained throughout. Once approval of administrations for targeted hospitals taken, and informed consent from the participants was obtained. 27 Chapter Three Results In this chapter, the socio-demographic characteristics of the study participants are described. We also show the relationship between demographic characteristics (gender, educational level, type of hospital, job) and the level of personal traits, motivation, and job performance in detail. The relationship between personality traits, motivation, and job performance of nursing staff and physicians in hospitals in the northern West Bank was also studied 3.1 Socio-demographic characteristics The data was subjected to a descriptive analysis and split into ratios and numbers in order to determine the distribution of the variable values.. Table (3.1) presents the demographic analysis of the nursing &physician’s personnel as it was found in this study. According to the findings 38.2% of the study's respondents The age of the respondents was ranging from 30 to 40 years. The male respondents in the study comprised 54.4%, while female respondents were 45.6%. It has been observed from the study that 51.8% of the respondents showed the highest preference for nursing staff and doctors holding a bachelor's degree. Similarly, 55% of the responses have come from nursing staff and physicians working in private hospitals. It was also determined that 40.6% of respondents were registered nurses. Additionally, the highest response rate, 37.8%, was from nursing staff and physicians who had 6 to 10 years of work experience. 28 Table 3.1 Demographic characteristics of the study sample Independent variables Level of variable Frequency % Gender Male 271 45.5 Female 227 54.4 Total 498 100% Education level Diploma 125 14.2 Bachelor 300 4..1 Postgraduate studies 73 25.1 Total 498 100% Hospital type Government sector 224 54 Private sector 274 44 Total 498 100% Job title Practical nurse 126 14.2 Register nurse 202 5..1 General physicians 100 1. Specialist physicians 70 25 Total 498 100% Years of experience 1-5 years 123 15.1 6- 10 years 225 54.1 Above 10 years 150 2..2 Total 498 100% Age Under 30 years 120 15.1 30-40 years 212 51.4 Above 40 years 166 22.2 Total 498 100% 3.2 The relationship between demographic characteristics and five big personal traits among physicians and nurses in governmental and private hospitals in the northern West Bank of Palestine To determine the differences according to job title and the other variables as illustrated Tow - way ANOVA test was used. Personality traits The results shown in table D.4 appendix D were as the following: Gender: No statistically significant differences at (p ≤ 0.05) were found in the personality traits including (neuroticism, extraversion, agreeableness, and conscientiousness) and the job performance level among Palestinian physicians and nurses whose working at the 29 northern cities’ hospitals in West Bank of Palestine due to gender variable. In contrast, statistically significant differences were found among them in the openness trait for male workers, and in the motivation level for female workers. Education level: There were no statistically significant differences at (p ≤ 0.05) in neuroticism trait among physicians and nurses due to their education level. Also, LSD post hoc test in table (3.2), revealed statistically significant differences (diploma vs BA) in extraversion and openness traits among the study sample in favor of (BA), and for (diploma) in agreeableness trait, motivation level, and job performance. In addition, (diploma Vs. postgraduate studies), there were statistically significant differences at (p ≤ 0.05) in extraversion and openness traits among the study sample in favor of (postgraduate studies), and no significant differences were noticed in the other traits. The comparisons (Bachelor Vs. postgraduate studies), there were statistically significant differences at (p ≤ 0.05) in conscientiousness trait, motivation level, and job performance for (postgraduate studies), and no significant differences were noticed in the other traits. Table 3.2 LSD post comparisons between the means of personality traits of the study sample according to education level variable Personality traits Means Diploma Bachelor Postgraduate studies Neuroticism 3.03 - -0.32* -0.18 3.35 - 0.14 3.21 - Extraversion 3.61 - -0.31* -0.29* 3.92 - 0.02 3.90 - Agreeableness 3.99 - 0.19* 0.10 3.80 - -0.09 3.89 - Openness 3.45 - -0.35* -0.45* 3.80 - -0.10 3.90 - Conscientiousness 3.79 - 0.07 -0.16 3.72 - -0.23* 3.95 - * Significant differences at (p ≤ 0.05). 30 Hospital type: There were no statistically significant differences at (p ≤ 0.05) in the personality traits including (neuroticism, agreeableness) among Palestinian physicians and nurses whose working at the northern cities’ hospitals in West Bank of Palestine due to hospital type variable. In contrast, statistically significant differences were found among them in the traits of extraversion, openness, conscientiousness, motivation level, and job performance in favor of private sector. Job title: there were statistically significant differences at (p ≤ 0.05) in all personality traits except conscientiousness trait and the motivation level among physicians and nurses due to the job title variable, and no significant differences were notice between them in the job performance. LSD post hoc in table (3.3), test revealed that physicians (general and specialist doctors) had significantly higher score of neuroticism trait in comparison with nurses. In the extraversion and openness traits, qualified nurses had significantly the lowest score compared to register nurses and physicians. In the agreeableness trait, qualified nurses had significantly the highest score compared to physicians and register nurses had significantly higher score than specialist physicians. Finally, qualified nurse and specialist physicians had statistically and significantly higher score in the level of motivation compared to general physicians. 31 Table 3.3 The results of LSD post comparisons between the means of personality traits of the study sample according to job title variable (n= 498) Personality traits Means Practical nurse Register nurse General physician Specialistphysician Neuroticism 3.02 - -0.14 -0.56* -0.41* 3.16 - -0.42* -0.27* 3.58 - 0.15 3.43 - Extraversion 3.62 - -0.35* -0.23* -0.22* 3.97 - 0.12 0.13 3.85 - 0.01 3.84 - Agreeableness 3.99 - 0.12 0.19* 0.31* 3.87 - 0.07 0.19* 3.80 - 0.12 3.68 - Openness 3.46 - -0.47* -0.26* -0.21* 3.93 - 0.21* 0.26* 3.72 - 0.05 3.67 - * Significant differences at (p ≤ 0.05). Years of experience: There were statistically significant differences at (p ≤ 0.05) in the traits of agreeableness and conscientiousness, and the motivation level among Palestinian physicians and nurses due to years of experience variable. In contrast, no significant differences were found in the traits of neuroticism, extraversion, and openness, the job performance level due to this variable. LSD post hoc test in table (3.4), revealed that the physicians and nurses with experience above 10 years had statistically and significantly high score in the traits of agreeableness and conscientiousness and the motivation compared to those with experience under 10 years 32 Table 3.4 LSD post comparisons in the agreeableness and conscientiousness traits of the study sample according to years of years’ experience variable . Personality traits Means 1-5 years 6-10 years Above 10 years Agreeableness 3.73 - -0.12 -0.26* 3.85 - -0.14* 3.99 - Conscientiousnes 3.65 - -0.11 -0.34* 3.76 - -0.13 3.89 - * Significant differences at (p ≤ 0.05). Age: There were statistically significant differences at (p ≤ 0.05) in the traits of agreeableness and conscientiousness, and the motivation level among Palestinian physicians and nurses due to age variable. In contrast, no significant differences were found in neuroticism, extraversion, and openness traits, and the job performance level due to this variable. LSD post hoc test in table (10), revealed that the physicians and nurses aged above 40 years old had statistically and significantly high score in the traits of agreeableness and conscientiousness, the level of motivation in comparison with those aged under 30 years old. Table 3.5 LSD post comparisons in the agreeableness and conscientiousness traits of the study sample according to age variable . Personality traits Means <30 years 30- 40 years >40 years Agreeableness 3.73 - -0.14 -0.22* 3.87 - -0.08 3.95 - Conscientiousness 3.64 - -0.12 -0.25* 3.76 - -0.13 3.89 - * Significant differences at (p ≤ 0.05). 33 3.3 The relationship between demographic characteristics and motivation, among physicians and nurses in governmental and private hospitals The results in table (3.6) showed that there were statistically significant differences at (p ≤ 0.05) in the level of motivation among Palestinian physicians and nurses whose working at the northern cities’ hospitals in West Bank of Palestine due to the variables of gender in favor of female, and hospital type in favor of private sector. Also, statistically significant differences were noticed in level of motivation according to the variables of education level, job title, years of experience, and age variable. Table 3.6 (M, SD), and the summery of tow way ANOVA to determine the differences in motivation level and socio demographic Motivation level Independent Variable Nurses ALL (Nurses) Physicians ALL (Physicians) p-value Gender Male 3.35 ± 0.42 3.42 ± 0.42 3.35 ± 0.45 3.38 ± 0.45 0.017* Female 3.48 ± 0.41 3.46 ± 0.45 All Education Level Diploma 3.45 ± 0.46 3.52 ± 0.52 3.34 ± 0.40 3.44 ± 0.53 0.025* BA 3.37 ± 0.45 3.48 ± 0.58 Post-graduate - Hospital Type Government 3.42 ± 0.41 3.42 ± 0.43 3.30 ± 0.45 3.38 ± 0.45 0.012* Private 3.42 ± 0.38 3.48 ± 0.49 Job Title Practical Nurse 3.45 ± 0.46 3.42 ± 0.43 General Physicians 3.30 ± 0.41 0.012* Registered Nurse 3.39 ± 0.40 Private Physicians 3.48 ± 0.49 All ALL 3.38 ± 0.45 Experience 1–5 Years 3.27 ± 0.47 3.45 ± 0.41 3.30 ± 0.51 3.44 ± 0.53 0.006* 6–10 Years 3.48 ± 0.41 3.38 ± 0.50 >10 Years 3.45 ± 0.38 3.44 ± 0.53 Age <30 Years 3.25 ± 0.47 3.48 ± 0.42 3.32 ± 0.51 3.46 ± 0.53 0.006* 30–40 Years 3.48 ± 0.42 3.35 ± 0.36 >40 Years 3.45 ± 0.38 3.46 ± 0.53 * Significant differences at (p ≤ 0.05). 34 To determine the sources of differences in the level of motivation according to these variables, LSD as a post hoc test was applied as illustrated in the table (3.7) showed that: Gender: The result in the table showing a statistically significant difference in motivation between male and female participants, with females showing slightly higher motivation. Education Level: The result showed a significant difference in motivation across different education levels, with those having postgraduate studies showing the highest motivation. Hospital Type: The result showing a significant difference in motivation between those working in government hospitals and those in private hospitals, with private sector workers showing slightly higher motivation. Job Title: The result showing a significant difference in motivation based on job title, with specialist physicians having the highest motivation and general doctors the lowest. Years of Experience: The result showed a significant difference in motivation based on years of experience, with those having more experience (6+ years) showing higher motivation. Age: The result showed a significant difference in motivation across different age groups, with older age groups (30+ years) showing higher motivation. 35 Table 3.7 LSD post comparisons between the means of motivation level of the study sample according to education level, job title, years of experience, and variables . Means Education level Diploma Bachelor Postgraduate studies 3.45 - 0.09* -0.04 - 3.36 - -0.13* - 3.49 - - Means Job title Qualified nurse Register nurse General doctor Specialist doctor 3.45 - -0.06 0.15* -0.03 3.39 - 0.09 -0.09 3.30 - -0.18* 3.48 - Means Years of experience 1-5 years 6-10 years Above 10 years - 3.28 - -0.16* -0.17* - 3.44 - -0.01 - 3.45 - - Means Age categories Under 30 years 30- 40 years Above 40 years - 3.27 - -0.16* -0.19* - 3.43 - -0.03 - 3.46 - - * Significant differences at (p ≤ 0.05). 3.4 The relationship between demographic characteristics and job performance among physicians and nurses in governmental and private hospitals The results in table (3.8) showed that there were no statistically significant differences at (p ≤ 0.05) in the level of job performance among Palestinian physicians and nurses whose working at the northern cities’ hospitals in West Bank of Palestine due to the variables of gender, job title, years of experience, and age. Whereas there were statistically significant differences at (p ≤ 0.05) in the level of job performance among the study sample due to hospital type variable in favor of private sector, and according to educational level variable. 36 Table 3.8 (M, SD), and the summery of tow way ANOVA to determine the differences in job performance and socio demographic (gender,job title variable and the other demographic variables without interaction Performance Independent Variable Nurses ALL (Nurses) Physicians ALL (Physicians) p- value Gender Male 3.48 ± 0.55 3.53 ± 0.53 3.44 ± 0.55 3.42 ± 0.59 0.799 Female 3.56 ± 0.50 3.39 ± 0.61 All Education Level Diploma 3.58 ± 0.54 3.74 ± 0.50 3.38 ± 0.55 3.53 ± 0.66 0.006* BA 3.45 ± 0.50 3.53 ± 0.69 Post-graduate - Hospital Type Government 3.51 ± 0.59 3.53 ± 0.53 3.32 ± 0.55 3.42 ± 0.59 0.008* Private 3.54 ± 0.49 3.57 ± 0.64 Job Title Practical Nurse 3.58 ± 0.54 General Physicians 3.40 ± 0.55 0.269 Registered Nurse 3.49 ± 0.51 Private Physicians 3.42 ± 0.59 All 3.53 ± 0.53 3.42 ± 0.59 Experience 1–5 Years 3.46 ± 0.47 3.52 ± 0.41 3.45 ± 0.65 3.53 ± 0.66 0.130 6–10 Years 3.52 ± 0.41 3.38 ± 0.50 >10 Years 3.58 ± 0.38 3.53 ± 0.66 Age <30 Years 3.46 ± 0.61 3.57 ± 0.52 3.47 ± 0.63 3.44 ± 0.66 0.952 30–40 Years 3.57 ± 0.52 3.37 ± 0.56 >40 Years 3.53 ± 0.48 3.44 ± 0.66 * Significant differences at (p ≤ 0.05). To determine the sources of differences in the level of job performance according to educational level variable, LSD as a post hoc test was applied as illustrated in the table (3.9) showed that there were statistically significant differences at (p ≤ 0.05) in the level of job performance due to the variable of educational level in favor of diploma, and postgraduate studies 37 Table 3.9 LSD post comparisons between the means of job performance of the study sample according to educational level variable variable Means Diploma Bachelor Postgraduate studies Job performance 3.58 - 0.16* -0.04 3.42 - -0.20* 3.62 - * Significant differences at (p ≤ 0.05). 3.5 The level of personality among physicians and nurses in governmental and private Hospitals in the northern West Bank of Palestine To explore the level of personality traits, motivation and job performance for nursing staff and physicians in hospitals of the northern West-Bank. descriptive statistics (means, standard deviations, and percentages) were calculated for each item and the domain to which it belongs as presented in the table (3.10). Level of personality The results in table (3.10) showed that the most common personality traits among Palestinian physicians and nurses whose working at the northern cities’ hospitals in West Bank of Palestine was agreeableness, as the mean of response was high (3.86), followed by extraversion trait, as the mean of response was high (3.84). Whereas the least common trait among them was neuroticism, as the mean of response was moderate (3.25). Table 3.10 (M and SD) for the level of personality traits among Palestinian physicians and nurses N Personality traits Mean* SD Level 1 Neuroticism 3.25 0.95 Moderate 2 Extraversion 3.84 0.78 High 3 Agreeableness 3.86 0.63 High 4 Openness 3.73 0.81 High 5 Conscientiousness 3.77 0.65 High * Maximum degree of response is (5). 38 3.6 The level of motivation among physicians and nurses in governmental and private Hospitals in the northern West Bank of Palestine The results in table D.4 appendixes D showed that the level of motivation among Palestinian physicians and nurses whose working at the northern cities’ hospitals in West Bank of Palestine was moderate, as the mean of response for the total score was (3.40). In addition, the highest response was on the statement (6) (I am satisfied with my work), as the mean of response was high (3.63), Whereas the lowest response was on the statement (2) (I only do this work until I get my salary at the end of the month), as the mean of response was moderate (2.88). 3.7 The level of job performance among physicians and nurses in governmental and private Hospitals in the northern West Bank of Palestine The results in table D.5 appendix D a showed that the level of job performance among Palestinian physicians and nurses whose working at the northern cities’ hospitals in West Bank of Palestine was high, as the mean of response for the total score was (3.49). In addition, the highest response was on the statement (3) (I agree that good job performance increases the level of productivity), as the mean of response was high (3.87), Whereas the lowest response was on the statement (5) (The hospital administration is concerned severe about my job performance), as the mean of response was moderate (2.84). 3.8 The relationship between personal traits, motivation, and job performance among physicians and nurses in hospitals in the northern West Bank To find out the relation between personality traits, motivation and performance, the Pearson correlation coefficient was applied as shown in table D.6 appendix D showed that there were statistically significant and positive relationship between personality traits (extraversion, agreeableness, openness, and conscientiousness) and each of motivation and job performance levels among Palestinian physicians and nurses, as the values of correlation ranged between (0.22- 0.41; p ≤ 0.01). Also, a statistically significant and positive relationship was found between the levels of motivation and job performance among them (r= 0.58; p ≤ 0.05). finally, neuroticism trait was negatively and significantly 39 correlated with motivation and job performance (r= -0.13, and -0.17; p ≤ 0.05) respectively. To determine the effect of personality traits on motivation and job performance, a stepwise regression was used as shown the table D.7 appendix D. The results showed that the main factor of personality trait affecting on the motivation of Palestinian physicians and nurses was the conscientiousness (R2= 0.171; p ≤ 0.05). Furthermore, conscientiousness and extraversion traits represented together the second factor affecting on the motivation of Palestinian physicians and nurses (R2= 0.197; (p ≤ 0.05) as shown in (Fig. 3.1). Figure 3.1 The effect of conscientiousness and extraversion on the motivation of Palestinian physicians and nurses The results of stepwise regression in table D.8 appendix D showed that the agreeableness personality is the main type of personality traits that has an affect on job performance of Palestinian physiciansand nurses was the (R2= 0.156; p ≤ 0.05). Furthermore, agreeableness and conscientiousness traits represented together the second factor which effect on the job performance of Palestinian physicians and nurses (R2= 0.194; p ≤ 0.05) as shown in (Fig. 3.2). 40 Figure 3.2 The affect of agreeableness and conscientiousness on the job performance of Palestinian physicians and nurses The results of stepwise regression in table D.9 appendix D showed a statistically significant affect of motivation on the job performance of palestinian physicians and nurses was the agreeableness (R2= 0.333; p ≤ 0.05) as shown in (Fig. 3.3). Figure 3.3 The effect of motivation on the job performance of Palestinian physicians and nurses 41 Chapter Four Discussion, Conclusion, and Recommendations In this chapter, a discussion, conclusions, and recommendations werepresented. 4.1 Discussion This study was considered an important study, especially in areas such as Palestine, where health care professionals often work under difficult conditions. Understanding the personal traits and motivations of workers in the medical field (physicians and nurses) may provide valuable insights into their job performance, which ultimately affects the quality Providing health care. The current study was aimed to examine the relationship between personal traits, motivation, and job performance among workers in the medical field (physicians and nurses) in hospitals. The public and private sectors in the northern West Bank, where the results were discussed. In addition, the results were compared with previous studies in order to come up with a number of important recommendations that would help decision makers in interpreting the relationship between personal traits, motivation, and performance among workers in the medical field. Socio-demographic characteristics According to the results obtained, it was found that the response of males to the study was 54.4%, which is more than the response of females, This did not agree with study by Sowunmi (2022) which showed that the response rate for females was 60.3% compared to 39.7% for males, meaning that the response of females to the study was greater The reason is that the female is greatly interested in developing her work, so she is interested in participating in research so that she can convey her point of view and improve ways of working, while In Palestinian context, gender dynamics are complex and multifaceted, so researchers and policy makers should strive to address barriers to participation and promote gender equality in all aspects of research and education. The results of the analysis of demographic characteristics were indicated that those who responded most to the study were people holding a bachelor’s degree in the specialty, as their participation rate in the study reached 51.8%, meaning more than half of the sample. The result of this study was consistent with to, Sowunmi (2022) this is because they can better access 42 information about research opportunities through academic networks, professional associations and online platforms, due to their increased awareness of the benefits of participation. Since it is directly related to their academic or professional interests, this may be one of the reasons why they tend to participate in studies that align with their areas of expertise or address topics that interest them. Also, with regard to years of experience, the results of this study indicated that people who have worked for 6-10 years are 37.8% more responsive to the study, and this is due to Those who have worked in their field for six or ten years are often in the middle of their careers, having amassed a substantial amount of experience and knowledge. At this point, individuals might be more contemplative about their career choice, open to possibilities for professional growth, and eager to take part in studies into the variables influencing job performance. Those who have worked for six to ten years may find a lot of resonance with the research study's issue, which is the personality traits, motivation, and job performance of healthcare professionals. They might believe that the study closely relates to their goals, struggles, and experiences in their employment as nurses and physicians. The level of motivation among physicians and nurses working in hospitals The results showed that the level of motivation among physicians and nurses working in hospitals was average, with the highest response being to the statement (I am satisfied with my work), Therefore, in order to address these challenges, we follow a multi-faceted approach that includes improving working conditions, providing appropriate support and appreciation, reducing administrative burdens, and promoting a culture of well-being and flexibility within healthcare institutions. This was confirmed by Kitsios & Kamariotou (2021) a study that indicated that relationships with co-workers and the degree of achievement can be considered the primary motivators for employees, with job attributes and compensation coming in second place. 43 The level of job performance among physicians and nurses working in hospitals The results indicated that the level of job performance among physicians and nurses working in hospitals was high, and that job performance is affected by several aspects, including the task, contextual and adaptive performance. This is because when nurses and doctors receive ongoing training and professional development opportunities, it can increase their level of satisfaction with their work and motivate them to perform better. Continuous learning opportunities help them develop their skills and continue to develop in their field. This was confirmed by a study by Krijgsheld, Tummers, & Scheepers, (2022), which indicated that the level of performance increases based on several factors, the most important of which is contextual and adaptive performance. Personality Traits The results of this study showed that the gender variable causes statistically significant differences in (the trait of openness) tending in favor of males. The reason for this is that males are often encouraged to be more innovative and curious due to traditional customs. There are higher degrees of openness, Cultural traditions impact behaviours and attitudes connected to innovation and openness, with particular focus on how males foster new experiences in contrast to women's conventional roles (Rahmi, 2024). The results of this study, were contradicted by a study conducted by Özkarar-Gradwohl & Turnbull (2021) there are statistically significant differences in (the trait of neuroticism) attributed to the gender variable in favor of males. While another study by Balducci (2023) contradicted the results of the current study, which indicated that there are statistically significant differences in the trait of acceptance due to the gender variable in favor of females. The findings revealed a statistically significant relationship between each of the Big Five personality traits and the educational level variable. Since extroversion, openness, and neuroticism are correlated with bachelor's degree holders, it may be inferred that these individuals experience significant levels of stress due to their high levels of responsibility. Additionally, these are persons with the qualities (extraversion and openness) because of their orientation towards learning, training, or interpersonal communication, the results of Wang (2023) were consistent with the results of the current study, as they indicated that there is a relationship between major personality traits and educational level. 44 The relationship between personality traits (extroversion, agreeableness, openness, and conscientiousness) and motivation The results showed that there is a positive relationship between personality traits (extroversion, agreeableness, openness, and conscientiousness) and motivation, and the reason for this is Positive emotions are often experienced by extroverts at higher levels, which can