Authors: Dr Nilanka Mudithakumara , Dr Senitha Asanka Liyanage

Abstract

Introduction: 

Emergency Department(ED) job satisfaction is a critical determinant of ED healthcare workers' well-being, staff retention, especially in the excessively overcrowded Low and Middle-income countries (LMIC), where both “job satisfaction” and “gender-based issues” are less discussed. This comprehensive audit was initiated at the Accident and Emergency Department (A&E) of Colombo South Teaching Hospital(CSTH), Sri Lanka, to identify specific domains of “gender disparity in job satisfaction” an evidence-based, targeted departmental intervention for quality improvement.

Methods: A single-centre, cross-sectional audit was conducted in early 2025 within CSTH A&E (average 400-500 patients per day). This audit included the permanent ED HCW, including physicians and nursing officers.

Data collected via an anonymous, voluntary, self-administered online/ printed questionnaire specified to LMIC ED context issues. Domains assessed included overall job satisfaction, gender bias, environment and work-life balance, burnout and compensation, workplace equity, unconscious bias, threats, expectations and support available.  

Results: A robust response of 82% was achieved (92 participants- 79.2% female HCW). 98% agreed duty equity, but lower equity in female leadership(75%) and performance skills (84.8%). Unconscious bias of patients and colleagues was the majority agreed upon. Gender based EM field leadership bias (64.2%) & favouritism (76%) were highlighted. But no significant(<1%) physical abuse or harassment was reported, and some (32.5%) have been exposed to gender based verbal discrimination. The yearning for care in pregnancy (75%) and lactation (55.5%) was noted. 45.6 % of female HCW are concerned about gender-based threats from the patients/bystanders.

A crucial gender-based disparity was highlighted, 95.7%  stated the need to develop standard welfare systems within the ED; whereas the overall job satisfaction scores were not statistically significant.

Conclusion: This comprehensive audit critically identifies specific disparities, even though no significant overall gender difference in job satisfaction, with a significantly lower job satisfaction of females in work-life balance and promotions. This audit emphasized gender-specific challenges of organised support systems.  Recommendations include gender-based unconscious bias awareness, flexible scheduling options for special categories, and an equitable and supportive environment.

Keywords: Gender based job satisfaction/ Gender equity