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Emotional Labor as a Mediator between the Relationship of Public Service Motivation and Job Performance of Registered Medical Technologists

The status of level of commitment of registered medical technologists (RMTs) may be expressed in relation to emotional labor, which eventually affected job performance and delivery of laboratory results, more so, during a time of pandemic. A total of 106 Metro Manila-based RMTs participated in this descriptive correlational study that determined if emotional labor (EL) is a mediator between the relationship of public service motivation (PSM) and job performance (JP). The online survey questionnaire included identified Demographic Profile variables, Emotional Labor Scale, revised PSM Scale, and Individual Work Performance Questionnaire. Descriptive statistics, Pearson Product-Moment Correlation and ANOVA were utilized. Results showed that RMTs have average EL in terms of surface acting and high in terms of deep acting, naturally felt emotions, and emotional termination. In terms of PSM, the respondents have an average attraction to policy making and compassion, and have high levels of commitment to public interest, and self-sacrifice. The RMTs have very high JP in terms of task performance and contextual performance, and high counterproductive work behavior. Significant relationships were found among EL, PSM, and JP. However, EL and PSM are not found to be predictors of JP, hence, EL is not a mediator between PSM and JP. The results may serve as a basis for revision of laws or formulation of ad-ditional policies beneficial to healthcare workers. Formulation of programs or workshops engaging


Introduction
In a health care setting, interaction occurs between a health care practitioner and a patient, which includes the development of one's management of emotions.
While emotions are a common characteristic of human beings, each person differs widely in "the capacity to control one's own and others' feelings and emotions, to differentiate between them, and to use this knowledge to direct one's thoughts and behavior [1]".
Studies regarding emotional labor being a mediator to PSM and JP are limited. Literature regarding medical technologists as respondents of this type of study is also scarce since present studies regarding the concept of PSM had mostly associated respondents that worked in the field of public administration [2] [3] [4] [5]. The commitment to provide patients with timely and reliable laboratory results distinguished the Medical Technology profession as one grounded on public service. Training and preparation are needed for precise and accurate execution of different types of laboratory procedures. This level of commitment led RMTs to engage in emotional labor, which affected job performance in the laboratory as well as the drive to deliver reliable laboratory results rapidly. Emotional labor among RMTs could be a promising research study since this group of respondents has rarely been a topic of literature that concerns emotional labor, PSM, and job performance. The study presented the importance of emotional labor in healthcare settings and job performance outcomes. Amidst the on-going pandemic, medical professionals have a hard time coping with the extended work hours, lessened break time, lack of sleep, and patient interaction, which will affect the way they handle their jobs.
The findings of this study will discern if the respondents' motivation affects the way they interact with patients. This could aid hospitals and other institutions in assessing how to increase RMTs' job performance and allow them to manage their emotional labor.
Emotional labor (EL) is paid work, governed by the employer in compliance with the display regulations of the organization, and is an essential dynamic in the delivery of public service [6]. Emotional labor demands workers to give genuine and consistent emotions to work role expectations [7]. It is also defined as "the process of regulating one's emotions to produce organizationally-desired to display or falsify feelings rather than feel them. It is the effort to manage the emotions visible and shown to others, which are called surface aspects, mainly facial expressions, tone of voice, etc., which do not mainly reflect the person's inner feelings. On the other hand, deep acting is where service providers seek to honestly change emotional feelings to meet those needed by the job or organization. It is when a person puts the "role" that they are demanded, required, or expected [8].
Public service motivation (PSM) is an individual's predisposition to respond to motives grounded primarily or uniquely in public institutions and organizations [9]. This coincided more with the fact that PSM had been primarily associated more with public organizations or the public sector in general. Consequently, PSM has a prevalence among employees in the public sector compared to those in the private sector [3]. The Public Service Motivation Theory states that individuals with strong public service orientation are attracted to jobs in the government sector, as individuals with high PSM recognize similarities between their values and the values promoted by the public organization; thus, perceiving a sense of "fitting in".
Job performance (JP) is the measure of when an individual's objective corresponded with the result they produced [10]. In another study, job performance is defined as the amount of hard work a person is willing to put in for a job [11]. In theory, it is how much effort an individual was willing to put into their profession and whether or not it met a specified level set by the association. Job performance can be influenced by different factors including social, cultural, demographic, and job conditions [12]. In support to this statement, the condition of a workplace was most likely a reason for high staff turnover rate, poor satisfaction as well as job performance [13]. It was also mentioned that encouraging work conditions and environment leads to better work performance.
In testing if EL is a mediator, the researchers wanted to determine if the PSM The study is divided into seven sections. The first section, the Introduction, outlines the background and rationale of emotional labor, public service motivation, and job performance. The second section is the Conceptual Framework.
The third section consists of the Methods which explains the research process.
This section also contains the instrument used, and how the data were analyzed and interpreted. Results and Discussion is the fourth section which contains the presentation and discussion of the data collected through the survey questionnaires. The fourth section is further subdivided into seven more sections: the demographic profile, the description of the respondents, the relationship between EL, PSM, and JP, whether EL and PSM are predictors of JP, and finally, whether EL is a mediator. The fifth section is the conclusion of the study. The sixth and seventh sections are the Recommendations and Limitations of the study, respectively.

Conceptual Framework
The framework shown on Figure 1 depicted the concept of the study. The variables were the emotional labor, public service motivation, and job performance of RMTs working in the public sector. Emotional labor was correlated with public service motivation, as indicated by the upward, single-sided arrow, and with job performance, as indicated by the downward, single-sided arrow. The double-sided arrow represented the correlation between public service motivation and job performance. With this design, the researchers were able to determine if emotional labor and public service motivation are predictors of job performance.

Research Design
The study utilized a descriptive correlational design in which the researchers were able to describe and interpret the current status of the RMTs based on their emotional labor, public service motivation, and job performance. Moreover, the relationship among the previously mentioned variables was also identified.

Subjects and Study Site
The study involved 106 male or female, registered medical technologist (RMT) with 2 -20 years of work experience under any type of medical institution in the government/public sector in Metro Manila. Purposive sampling was used in selecting the respondents of the study.

Data Gathering
Medical institutions were emailed the link and QR code of the online survey questionnaire, which they subsequently disseminated to their RMTs. The link was also sent to the RMTs who agreed to participate in the study through social media. The informed consent form was distributed along with the questionnaire.
The principle of voluntariness, and confidentiality were used to prioritize the data privacy and freedom of choice of the participants. An informed consent was obtained from the participants who are all of legal age. The researchers also eliminated any type of personal contact to reduce the potential transmission of infections inside and outside the healthcare facility. The participants of the study only revolved around humans. This study has been approved by the Fa-

Instrumentation
The research instrument was a four-part questionnaire.
Part A included a variety of questions regarding the age, gender, civil status, years of practice, and type of medical institution (private or public) the respondent is working in.
Part B is the emotional labor scale (ELS), a 16-item self-report questionnaire IWPQ version 1.0 has shown improved targeting for two out of three scales and was proven to measure workers at all levels of ability, discriminate between workers at a wider range on each scale, and detect changes in IWP more reliably compared to its previous versions [16].
The questionnaires used were subjected to a pilot testing to check the reliabil-

Data Analysis
To describe the emotional labor, public service motivation, and job performance of the RMTs, weighted mean, standard deviation, and percentage were utilized.
The test interpretation guides for ELS, PSM, and IWPQ scores are shown on

Description of RMTs in terms of Emotional Labor, Public Service Motivation, and Job Performance
As presented in Table 3  behavior [20]. The RMTs also tend to suppress or terminate emotions when facing problems while communicating with patients. This suggests that specific interpersonal factors such as conflicting expectations of patients force the accumulation and suppression of the emotions felt by medical personnel [21]. Table 4     Individuals who have high PSM tend to perform their tasks better and more efficiently, especially if they work in the public sector that is "characterized by attributes such as high task significance and providing public services [23]".
However, the RMTs concentrate more on the negative side of their work rather than the positive side. This suggests that the respondents are not performing well in terms of CWB and this may be due to multiple reasons [24]. A high frequency of CWB may result in a decrease of the quality of productivity of an employee and may produce lower than expected outcomes [24]. Table 6 shows the relationship between emotional labor and PSM. A significant correlation was found between deep acting and commitment to public interest (r = 0.429 at 5% level of significance). It is deduced that RMTs consider serving the public an important responsibility, which is why they would want to genuinely feel the feelings that are needed of them during their work. DA tends to emerge directly from a person's desire to make a difference in other people's lives [25].

Significant Relationship between Emotional Labor and Public Service Motivation
This statement further supports that by providing genuine service, the RMTs are able to fulfill their duty towards their patients. However, one study mentioned that DA is not necessarily associated with CPI [6]. This is because high levels of CPI will lead to more emotional labor efforts only if the worker believes that the efforts are to the community's interest which cannot be relied on consistently as customers may only represent specific or special interests. Another significant correlation is found between surface acting and compassion (r = 0.204 at 5% level of significance). It is inferred that RMTs put on an act to deal with patients appropriately despite feeling sympathetic to the patient. By emotionally detaching oneself to the patient, one will be able to support and guide the patient in their treatment [26]. In addition, being emotionally involved with patients can lead to over-treating which puts patients at more risk. And, not being able to show the required emotions is seen as unprofessional. Moreover, those who fake emotions (SA) in their job are prone to experience compassion fatigue [27]. High levels of SA are associated with compassion fatigue and burnout [28]. Table 7 presents the relationship between emotional labor and job performance,

Significant Relationship between Emotional Labor and Job Performance
wherein it was found that there is a correlation between surface acting and CWB (r = 0.359 at 5% level of significance). This suggests that when employees put on an act while interacting with patients, they complain and discuss the negative aspects of their work to coworkers as well as people outside the organization.
Utilization of SA promoted work deviance behavior by increasing the experience of negative emotions and decreasing the experience of positive emotions [29].
Studies have found that SA and CWB are significantly correlated [30] [31]. Employees would strive to fulfill their organizational mandate; thus, would engage in dramaturgical "thought and act" [4]. These employees experience emotional labor as a result, which would then affect their job performance. Table 8 shows the relationship between public service motivation and job performance. Table 7. Test of significant relationship between emotional labor and job performance.  Table 8. Test of significant relationship between public service motivation and job performance.

Variables
Task In the correlation between attraction to policy making and task performance (r = 0.257 at 5% level of significance), it is deduced that a person's desire to serve the public is increased when he or she performs well at work. When an individual's task performance was effective, he or she would feel more convinced to serve the public [32]. In addition, when an individual is motivated, they desire to be more involved in policy making, and if they are demotivated, their performance is negatively affected [33].
A significant correlation between attraction to policy making and CWB (r = 0.206318 at 5% level of significance) is found. This indicates that the respondents want to be involved in the policy making of public programs as they may be aware of the negative aspects of their work situation, especially concerning the conditions of their patients. There is very limited research concerning significant correlation between attraction to policy making and CWB. Individuals engage in policy making or policy formation due to the reinforcing factor it gives to one's self-esteem, and being an influence to a public policy is a "central motive" within attraction to policy making [33]. Additionally, CWB is a deviant behavior wherein not only the job performance of the individual is affected, but the overall efficiency of the organization is affected as well [34].
A significant correlation was found between commitment to public interest and task performance (r = 0.446 at 5% level of significance). It is deduced that when respondents provide service for the public, they perform better in terms of task performance. Employees' who are more engaged in their work tend to perform better and have "extra-roles" which indicates that there is a positive correlation with work engagement and job performance [35]. In addition, committed employees guarantee an overall better service, higher productivity and usually generate higher profit margin [36].
The significant correlation between commitment to public interest and contextual performance (r = 0.390 at 5% level of significance) suggests that when an Open Access Library Journal individual considers serving the public as an important duty, they would be motivated to constantly hone their skills in order to better serve their clients. The contextual performance of an employee depends on their predispositions and volition, which indicates that if the employee is altruistic in nature, they will naturally have a tendency to refine their skills [35]. Commitment as a variable is crucial in the building of a strong contextual work performance [37].
Compassion and the contextual performance of RMTs is shown to have a significant relationship (r = 0.041 at 5% level of significance), as supported by other studies as well [38] [39]. This suggests that a compassionate individual is more motivated in performing at their job. Contextual performance depends on an individual's compassion towards others [39]. Additionally, the willingness of RMTs to be dependent on other people by sharing their suffering and encouraging their colleagues motivates them to perform better at work [40].
The results show a significant correlation between compassion and counterproductive work behavior (r = 0.257 at 5% level of significance). It is inferred that RMTs have a difficulty in containing their feelings especially concerning the underprivileged; thus, they often focused and talked about the negative aspects of their work. High workload and stress in the workplace lead to CWB and loss of compassion among employees in the medical field [41]. High physical and emotional demands of the workplace also lead to CWB and compassion fatigue [42].
The results of this study also showed a significant relationship between selfsacrifice and task performance (r = 0.441 at 5% level of significance). It is inferred that by putting their duties first before themselves, RMTs were able to perform their work well with minimal time and effort. Going above and beyond one's own self-interest (self-sacrifice) may help achieve a cooperative goal [43] [44]. Self-sacrificial leadership has also been discovered to be a key predictor of enhanced performance [45]. It has been proven that self-sacrificial leaders are more likely to elicit trust and positive behaviors, such as increased work motivation, task performance, and organizational citizenship behavior [46]. A significant relationship between self-sacrifice and contextual performance (r = 0.417 at 5% level of significance) indicates that when RMTs give up their own interests to help others, their contribution to the overall well-being of their collective, team or group increases. Public service motivation positively impacts organizational effectiveness [47]. Organizational effectiveness could be translated to effective contextual performance as a collective; thus, people with high PSM have significant self-efficacy and perceived importance to do public service, motivating them to self-sacrifice in order to benefit the collective good.

Emotional Labor and Public Service Motivation as Predictors of Job Performance
As can be gleaned from

Emotional Labor as a mediator on the relationship between Public Service Motivation and Job Performance
Since the causal variable, which is the PSM, was not found to be a predictor of the mediator, which is the EL, the mediation analysis was no longer continued. Hence, emotional labor is not a mediator on the relationship between the public service motivation and job performance.
However, a study by Adam and Kim (2020) states otherwise wherein emotional labor, particularly deep acting, significantly mediates the relationship between PSM and job performance. Deep acting is suggested to complement PSM in order to increase an employee's job performance. In comparison, this study utilized more recent questionnaires in measuring the involved variables compared to Adam and Kim (2020). However, a smaller sample size composed of RMTs was used in this study, compared to the larger sample size of civil servant respondents of Adam and Kim (2020) [4].
There is limited research regarding the mediating role of emotional labor on the relationship between PSM and job performance. However, there are studies about emotional labor being a mediator between the relationship of other variables [54] [55] [56].

Conclusion
The results of this study may contribute to the construction and improvement of future test instruments for directly measuring the relationship of the three variables, yielding more generalizable findings that are acceptable to any degree of inquiry. Results may also serve as a basis for revision of laws concerning employee rights and work hours, and for policy formulations of hospitals that take into account the amount of emotional fatigue RMTs experience on a daily basis. Implementation of training or workshops by hospitals and other institutions, with the results of this study as basis, can further refine the factors that may lead to better performance of RMTs. The assessment of job performance and personal motivations of RMTs can be improved through the findings of this study, by knowing the factors that influence an individual's performance. Universities may also take note of the findings of the study by modifying curriculums to include courses that impart knowledge about the emotional factors a student needs to monitor to produce quality performance once they become RMTs.

Recommendations
Future researchers are recommended to increase the number of respondents and area of coverage to increase the generalizability of results, find a more accurate way to measure job performance, as the study only provided a subjective evaluation of the job performance of the respondents, and use the same set of questionnaires to measure the variables to limit disparity in results. Future researchers may also check for other variables that influence the usage of the different strategies that may affect emotional labor.

Limitations
This study has various limitations, such as the study's area coverage, the participants' years of practice, and the insufficiency of sample size due to the current pandemic situation.
The study's respondents were limited to RMTs who had 2 -20 years of practice and were working in public or government medical institutions in Metro Manila during the duration of the study. Responses collected among the respondents may have been different due to differences in work experience and load. The research ran from August 2020 until June 2021. The data gathering coincided with the COVID-19 pandemic; thus, repeated pleading to the institutions and to RMTs was done in order to accommodate the questionnaire of this study. In mediation analysis, an inadequate sample size may not have the statistical power to detect a practical effect size, leading the researchers to mistakenly infer that an effective intervention is ineffective [57]. Thus, the number of respondents may have affected the result, but then, it is the present work condition which made it difficult to obtain a higher number of respondents. Open Access Library Journal dividuals and institutions listed below, whose invaluable assistance and cooperation made this research study possible.
Mr. Jiovanni T. Diaz, RMT, MSMT, thesis adviser, for sharing his time and expertise, guiding the researchers throughout the entire research, and giving words of inspiration and motivation.
Tondo Medical Center for taking the time in accommodating their requests and providing us with respondents.
The respondents for giving their valuable time in answering the questionnaire and giving significant data beneficial to the success of the study.
Ms. Sheena Mai A. Galman, PhD, JD, statistician, for the constant suggestions, feedback and relevant inputs in the study especially in the analysis and interpretation of data.
Ms. Joanna R. Reyes, English editor, for checking the grammar, punctuation, spelling and providing suggestions on how to improve the paper's sentence structure.

Conflicts of Interest
The authors declare no conflicts of interest.