Health, Spirituality and Medical Ethics

Introduction
The quality of work life (QWL) refers to any activity in an organization, a level that seeks to influence an organization even more through the growth and promotion of human dignity [1, 2]. Survival needs, relevance, and knowledge are the three main qualities of work life, particularly, survival needs include health and income while relevance needs include social needs and respect, and knowledge needs comprise meeting the needs of knowledge and aesthetics [3, 4]. The QWL is a comprehensive and multidimensional concept that as a key element in the culture of organizational excellence leads to the alignment between employees and organizations, which is necessary to take into account to promote the satisfaction of employees and their retention in every organization. In light of that, improvement in the quality of life  (QoL) of employees can boost their mental and physical health [5].
Considering the importance of the QWL of employees, it is necessary to study the factors affecting it. One of these influential factors is organizational intelligence. Organizational intelligence means acquiring comprehensive knowledge and information about all the factors that affect the organization. Intelligence is extremely influential on the efficiency and effectiveness of an organization [6]. By examining and strengthening the components of organizational intelligence, it is possible to improve the effectiveness of the organization by focusing on the abilities and planning to eliminate the weaknesses. Its characteristics and measurement of organizational information can be considered to support organizational decisions [7]. Organizational intelligence gives rise to the long-term excellence of organizations and communities and improves their performance. Organizational intelligence entails a set of techniques and tools, that facilitates the conversion of a large amount of data from various resources to significant information to support decision-making and improve an organization’s performance [8]. Kavosi et al. [9] reported that organizational intelligence has emerged as the main driving force for organizational efficiency and effectiveness.
Another factor influencing the QWL of the employees in the workplace is spirituality [10]. Spirituality in the workplace refers to enjoying a framework of organizational culture and values, which reflects the inner life, openness, attention, interaction, respect, modesty, compassion, and excellence from the viewpoint of the organization [11, 12]. Individuals experience spirituality in the workplace when searching for meaning in their workplace and are eager to interact with other people. In other words, spirituality in the workplace results in employees who perceive work as a place to earn income and as a place to accomplish their goals and tend to interact with others [13]. Accordingly, spirituality in the workplace is the individual’s perception of their workplace enabling them to find their goal in life, establish a relationship with their colleagues and other individuals related to their work, and align their beliefs with the organization they work for [14]. Spirituality enables employees to find their ultimate goal in life. In light of that, spirituality at the workplace is the perception of the employees of the workplace, which must be preserved by the meaning and enhance its values [15]. Spirituality in the workplace views employees as souls that need to be nourished and emphasizes human values. The spiritual phenomenon in the organization is currently crucially important and the absence of spirituality, particularly, the lack of attention to the dignity of employees as human beings transformed workplaces into cold and meaningless places [16, 17]. Supporters of spirituality in the workplace argue that spirituality is a powerful tool to develop a desirable feeling of meaning, goal, and communication in an organization, which can lead to personal satisfaction and effectiveness of the organization [18].
The crucial factor that can influence the organizational intelligence and spirituality in the workplace employees and lead to the improvement of the QWL is job involvement. Job involvement refers to the level of people’s enjoyment of what they do and is one of the most effective ways to increase employee productivity through improving work commitment and participation. Job involvement is among the variables that its development can lead to positive outcomes for the organization [19]. Job involvement defines the intensity of psychological empowerment of the individual with their job. Employees with low job involvement exhibit a lack of interest and enthusiasm toward fulfilling their tasks and tend to limit themselves and avoid extra roles to get involved at their work desks [20, 21]. Job involvement is one of the most crucial job variables regarded as a main factor in the lives of employees since they are mentally and emotionally affected by the degree of their involvement [22]. Job involvement is defined as a descriptive belief that is created at one time and related to the potential to meet the needs of an individual via their job [23]. Individuals with job involvement actively attend work, consider it an interest-based activity, regard their performance in the workplace as the basis for their self-esteem, and consider the job performance to be aligned with their self-concept [24].
In general, manpower is the most crucial vital factor for the performance of an organization and all modern organizations invest a great deal in recruiting, training, developing, and keeping their employees to preserve human resources as the most crucial competitive advantage in today’s hectic world. However, they are constantly concerned about losing their human capital and incurring a loss since losing a workforce equals losing the experiences they have gained through the years. In light of that, organizations must spare no effort to support their employees by enhancing the quality of their work life and minimizing attrition. In light of that, it can be argued that the QWL is the most crucial job feature for employees. Taking into account the fundamental role of employees in accomplishing the goals of an organization, as well as various problems and issues employees face in the workplace, it is necessary to develop plans to improve the quality of their work life. According to the mentioned materials, the present study aimed to investigate the relationship between the QWL with organizational intelligence and workplace spirituality among employees of the Red Crescent Society mediated by job involvement. According to the mentioned objectives, the theoretical model of the current research is presented in Figure 1.
Methods
In this descriptive and correlational study, the relationship between variables is examined through structural equation modeling. The statistical population comprises all employees of the Red Crescent Society of Yazd Province, Iran, in 2022-23. Using random sampling, 304 participants were selected to complete the questionnaires of the study. The sample size was 300 employees based on the number of research variables (10 variables and 30 samples for each variable). The sample size was sufficient based on the research variables and sampling formula in structural equation modeling. In total, considering the possibility of receiving incomplete questionnaires, 320 questionnaires were distributed among the employees. Finally, 304 employees filled out the questionnaires completely and entered the research process. The inclusion criteria comprised a minimum of one year of job experience, an age range between 22 to 45 years old, consent to participate in the research, and a response to all research questions. The exclusion criteria consisted of unwillingness to participate in the research and failure to respond to all items of the questionnaire.
Instruments
QWL questionnaire (QWLQ): Walton [25] developed QWLQ. It comprises eight categories and 32 items. The following are the categories of this questionnaire: Adequate and fair compensation (questions 1, 2, 3, 4 and 5); safe and healthy working conditions (questions 6, 7 and 8); the opportunity to growth and security (questions 9, 10, and 11); constitution in the work organization (questions 12, 13, 14, 15, 16 and 17); social integration in the work organization work (questions 18, 19 and 20); total life span (questions 21, 22, 23, 24 and 25); social relevance of work life (questions 26, 27, 28 and 29); and the opportunity to use and develop human capacities (questions 30, 31 and 32). This questionnaire is scored based on the Likert scale, i.e. very little (1 point) to very much (5 points), and the high score of each dimension indicates the high point of that dimension. Khaksari et al. [26] confirmed the validity of the QWLQ (content validity index [CVI]=0.98, content validity ratio [CVR]=0.98). Moreover, the authors reported a Cronbach α of 0.88 for the QWLQ [26]. In our research, the Cronbach α for this tool was 0.86.
Organizational intelligence questionnaire: Albrecht [27] designed an organizational intelligence questionnaire with 49 items. It is scored according to the 5-point Likert scale (ranging from totally agree 5 to totally disagree 1). It includes seven dimensions, i.e. strategic vision, appetite for change, shared fate, alignment and congruence, heart, and knowledge deployment. Rasouli et al. [28] confirmed the validity of the organizational intelligence questionnaire (CVI=1.00, CVR=0.99). The reliability of the organizational intelligence questionnaire was reported 0.86 using Cronbach α [28]. In our study, the reliability of this questionnaire was 0.79 using Cronbach α.
Workplace spirituality scale (WSS): Milliman et al. [29] developed a workplace spirituality scale to measure spirituality in the workplace. It includes three components and 20 items. This scale is designed on a 5-point Likert scale (totally disagree, i.e. score 1 to totally agree, i.e. score 5) and the highest score indicates a higher level of spirituality. Ahadi Shoar et al. [30] confirmed the validity of the QWLQ (CVI=0.98, CVR=0.96). Moreover, the authors reported a Cronbach α of 0.95 for the workplace spirituality scale [30]. In this research, the reliability of the WSS was 0.79 using Cronbach α.
Measurement of job and work involvement: The measurement of job and work involvement questionnaire designed by Kanungo [31] comprises 10 questions and one component, which measures the level of an individual’s job involvement. This questionnaire is designed on a 5-point Likert scale (very much, i.e. 5 to very little, i.e. 1). Questions 2 and 7 are reverse-scored. The total score of job involvement can range from 10 to 50 [32]. The validity of the Persian version of the measurement of job and work involvement was confirmed by Iranian authors (CVI=0.99, CVR=0.97) [33]. The Cronbach α of this tool was reported at 0.83 [32]. In our research, Cronbach α for this tool was 0.81.
Data analysis
Skewness and kurtosis values were considered to check the normality of the data. In addition, Pearson’s correlation coefficient was used to check the correlation between the study variables. Structural equation modeling (SEM) was employed to study the relationship between the variables. The path analysis was used to evaluate the proposed model using SPSS software, version 27 and AMOS software, version 25. The significance level of the research was considered to be α=0.05.
Results
The findings concerning the demographic variables suggested that the mean age of employees ranged between 32.52±4.16. Among them, 265(87.17%) were male and 39(12.83%) were female, among which 259(85.20%) were married and 45(14.80%) were single. Table 1 shows the Mean±SD, kurtosis, skewness, and Pearson correlation coefficient of research variables. The results of the Pearson correlation coefficient pointed out there was a significant correlation between the variables (P<0.001). Figure 2 shows the initial model developed to describe the QWL based on organizational intelligence, workplace spirituality, and job involvement.
Considering the data in Table 2, the root mean square error of approximation (RMSEA=0.394) showed that the initial model needs to be revised. After the elimination of one of the paths (organizational intelligence to QWL) in the final model, the root mean square error of approximation amounted to (RMSEA=0.054), which indicates the good fitting of the model. Figure 3 shows the modified model.
Based on the data in Table 3, there was a direct relationship between organizational intelligence and job involvement in employees of the Red Crescent Society (P<0.001), a direct relationship between workplace spirituality and QWL (P<0.001), and a direct relationship between workplace spirituality and job involvement (P=0.004). The relationship between job involvement and QWL was positive and significant (P<0.001). The results showed that there was no significant relationship between organizational intelligence and QWL in employees of the Red Crescent Society (P=0.168).
The results suggested the indirect significance of organizational intelligence to QWL with a mediating role of job involvement (P<0.01). Furthermore, the indirect path of workplace spirituality to QWL with a mediating role of job involvement was significant (P<0.01) (Table 4).
Discussion
This study aimed to investigate the mediating role of job involvement in the relationship between organizational intelligence and workplace spirituality with QWL in employees of the Red Crescent Society. The results suggested there was a significant relationship between the QWL and all direct paths except for organizational intelligence. The relationship between indirect paths with the QWL was significant through job involvement. The first finding indicated that the relationship between organizational intelligence and the QWL was not significant. This finding is inconsistent with the results of Derikvand and Ebadollah Amoughin [33]. The lack of consistency in results might be due to differences in the research population, and the sample size, as well as employing different questionnaires and research tools to examine the variables. The results pointed out that the QoL enjoys a dynamic multidimensional structure, which currently includes concepts such as job security, reward system, promotion opportunities, training, and participation in decision-making. Organizational intelligence is among the influential factors in the QWL. Organizational intelligence helps evaluate the organizational capabilities, understand the integration in the organization and the workplace, and realize the weaknesses and strengths of the organization. Modern organizations face a competitive environment and severe technical changes, which affect job opportunities. In light of that, the absence of QWL can lead to a lack of job satisfaction, an increased lack of motivation and heart, as well as organizational commitment, and increases the rate of incidents, decreases in job responsibility, and results in work challenges and lack of productivity, all of which are among the main causes of lack of proper and desirable performance in organizations [33].
The results indicated that the relationship between workplace spirituality and QWL was significant. This result is consistent with similar research findings [34]. Bagheri Majd et al. [34] stated that workplace spirituality, directly and indirectly, affects the employees’ productivity with the mediating role of QWL. It signifies that workplace spirituality is the foundation of individuals’ beliefs, which influences their performance. Workplace spirituality enables individuals to perform their daily routine activities and job responsibilities wholeheartedly and upon perceiving the value and sense of life. Furthermore, spirituality and ethics in the workplace can boost creativity, honesty, trust, organization commitment, work ethics, and participation, and improve the job attitude and QWL of employees, which is directly and indirectly related to the QWL [34]. High levels of workplace spirituality lead to positive thinking, the feeling of happiness, an increase in reliance on God, and hope, and decreases job anxiety and stress. The reduction of this stress improves the QWL.
Following the results, the relationship between job involvement and QWL was significant. This result is consistent with similar research findings [35]. This finding suggests when employees realize that issues such as job involvement and its application are taken into consideration in an organization, they decrease their absence of work, improve job performance, and boost their participation in decision-making. In light of that, in case of lack of involvement of employees with the job and its goals, it is impossible to accomplish its goals. Job involvement and the feeling of commitment give rise to a strong spirit. When the needs of the members of an organization are met and they can fulfill their job responsibilities in peace, it results in the development of a strong spirit and boosts the quality of their work life. Elevating the QoL in organizations reduces conflicts and strengthens mental peace and motivation for development. Therefore, job involvement can enhance the QWL [35].
Furthermore, the results revealed that the relationship between organizational intelligence and QWL with a mediating role of job involvement was significant. The indirect hypothesis indicated that for organizational intelligence to affect the QWL, first, the job involvement of employees should be enhanced. Furthermore, the results revealed that the relationship between organizational intelligence and QWL with a mediating role of job involvement was significant. As argued by the direct hypothesis, there is a significant and direct relationship between organizational intelligence and QWL. The indirect hypothesis demonstrated that workplace spirituality enhances job involvement in employees, which results in the improvement of the QWL. In general, organizations constantly seek solutions to enhance employees’ efficiency and reduce their work fatigue to improve the quality of their professional lives. QoL is a personal and situational concept. Job as a social health determinant is crucially influential in the daily lives of individuals. In light of that, employees’ health is enormously important in the productivity of organizations.
Considering that the statistical population is limited to the employees of the Red Crescent Society of Yazd Province, generalizing the research results to other organizations and cities must be carried out with caution. Other limitations of the present study include the following: The cross-sectional nature of the research, the use of self-report questionnaires to collect data, the limited variables investigated in the research, and the lack of effect sizes as a statistical limitation.
Conclusion
The findings revealed that job involvement and workplace spirituality were positively related to the QWL of employees. Following the research results, it can be argued that organizations must support, strengthen, and improve the QWL, organizational intelligence, and workplace spirituality as crucial factors among their main goals to boost work commitment and job involvement of their employees, and as a result, enhance their productivity.
Ethical Considerations
Compliance with ethical guidelines
The study was approved by the Ethics Committee of Islamic Azad University, Ahvaz Branch (Code: IR.IAU.AHVAZ.REC.1402.033).
Funding
This article was extracted from PhD dissertation of Rahman Sheikhi Ghalehsardi, approved by Department of Psychology, Islamic Azad University, Ahvaz Branch.
Authors' contributions
Conceptualization and supervision: Alireza Heidari and Parviz Asgari; Methodology: Rahman Sheikhi Ghalehsardi and Alireza Heidari; Data collection: Rahman Sheikhi Ghalehsardi and  Zahra Eftekhar Saadi; Data analysis: Parviz Asgari and Alireza Heidari; Investigation and writing: Alireza Heidari, Rahman Sheikhi Ghalehsardi and Zahra Eftekhar Saadi; Funding acquisition and resources: Rahman Sheikhi Ghalehsardi and Alireza Heidari.
Conflict of interest
The authors declared no conflict of interest
Acknowledgments
The authors appreciate the collaboration of all employees of the Red Crescent Society of Yazd Province in the present study.