Understanding the influence of compensation structures on ethical behavior is crucial for the organizational success of healthcare institutions and the well-being of patients. This study aims to uncover the intricate correlations, impacts, and mechanisms underlying the interaction between compensation systems and professional ethics within Tehrans teaching hospitals. By conducting a comprehensive survey and analysis, we examine factors such as customer behavior, ethics charters, conduct standards, ethics training, ethical leadership, decision-making, cultural and environmental ethics, and ethical infrastructure. The Organization for Economic Cooperation and Development (OECD) stands as a benchmark for practical management morality, striving to combat corruption and promote ethical conduct in its member states through the design of ethical infrastructures (Faghihi and Rezaeemanesh, 2005). Ethical issues in healthcare can range from substance abuse to conflicts of interest, quality control issues, discrimination in hiring and promotion, misuse of company accounts, layoffs, illegality, tax evasion, and loss of organizational loyalty underlying spiritual ethical issues (Binesh, 2011). The community also have societal expectations including adherence to professional ethics, morale, and trust, which foster interaction and cultural respect. Furthermore, these values are especially critical in fields such as medical, teaching, and engineering ethics. In the realm of ethics, moral responsibility towards both an organizations internal and external environment extends beyond labor rights; nonetheless, these rights operate within that very context (Hashemi, 2015). Recognizing the impact of compensation systems on employees professional ethics is pivotal. Thus, examining the role of these variables in each other drives the focus of this study. Compensation and reward systems can encourage ethical conduct and prevent employees from engaging in deviant behavior. On the other hand, competition for rewards can lead to unethical practices that employees deem it to be necessary for their success. Unfair laws and disproportionate compensation structures ignore the tendency to be fairer and earn more money, and cause deviance and immorality. 

By reforming compensation and reward systems, organizations can foster healthy competition, with clear payment criteria and adherence to ethical principles of equity and stability in pay and performance appraisals, while punitive measures can deter unethical behavior. Compensation for work performance signifies more than mere wages to include quality of life, indirect financial benefits, and advancement opportunities, such as life, health, and surgery insurance, academic scholarships, holidays, time off, sick leave, retirement, favorable working conditions, dining options, and the advantage of working at home, all of which are crucial for gratitude and motivation for better performance within the workforce (Keshavarzi, 2011). According to Melo, by designing compensation systems, employees feel that they are compensated for their services with fairness in relation to their colleagues in other organizations with similar jobs and differences. Respecting fair payment based on job responsibilities and compensation service is a key element in human resource management (Keshavarzi, 2011). Previous studies have established a link between compensation systems and professional ethics (Ahmadian, 2013; Nikomaram & Ashaghi, 2010). This study seeks to determine whether there is a correlation between competitive intelligence, compensation systems, and the professional ethics of employees in Tehrans teaching hospitals.

Research Background 

Primarily, the compensation system encompassing salaries and benefits is regarded as an integral component of the human resource maintenance system. It influences how effectively an organization can attract, retain, and motivate its staff. Numerous scholars believe that the most critical aspects of human resource management and the sensitivity surrounding the compensation function have remained controversial. While the term “compensation” is often seen as synonymous with office payroll in certain texts, its broader connotation includes supplementary services and non-financial perks that contribute to job satisfaction and employee well-being (Hashemi, 2015). Scientific and technological progress, whether achieved in the past or anticipated in the future, undoubtedly results from the endeavors of human resources, which consistently remain the primary driving force behind production and services. The compensation system stands out as among the most influential factors in terms of attracting, retaining, and motivating human resources (Zivdar, 2010). Religious ethics, along with the science of ethical living that assists individuals in discerning what actions to undertake and avoid, have always served as conscious norms and databases of judgment across various cultures, emphasizing the importance of ethical conduct in scientific etiquette. Throughout history, there has been a significant reverence for religious traditions and spiritual predecessors (Faghihi and Rezaeemanesh, 2004). Ethics, as a regulator of human interactions, has consistently held paramount importance. Within the realm of managing these internal mechanisms, operational staff are able to establish an ethical and moral framework for the organization without necessarily requiring an internal lever (Alvani, 2004). Morality, encompassing a set of values that define what should and should not be, plays a crucial role in driving organizational effectiveness. Within this framework, labor discipline, compassion, advice, humility, faithfulness, and adherence to good moral principles in management are emphasized in the Islamic ethics charter. Ensuring the fulfillment of these values becomes imperative in the organization (Mohammad et al., 2020; Abbas Zadeh, 2008).  

Undoubtedly, boosting the morale in the public sector can play a significant role in elevating the quality of services provided by public organizations. Moreover, this effort can enhance the legitimacy these organizations play in public (Alvani and Yaghobi, 2004). Mohammadi et al. (2006) have studied the organizational life cycle stages and its relationship with compensation systems.  The findings represented a positive correlation between the organizational life cycle and the compensation system. Additionally, the study revealed that organizations exhibit different behaviors at each stage of the life cycle of payments (both team-based and individual-based). Soltani, (2016) examined the relationship between the compensation system, mental health services, and employee accountability in executive agencies in Zarand. The outcomes of the study demonstrated a direct correlation between compensation and non-financial services related to the business environment, particularly concerning mental health. However, there appears to be no link between direct financial services, and indirect and job-related non-financial services, with mental health. Howang et al. (2001) explored the conceptual model of the payroll system in Taiwans travel agencies. This model delves into the mediating role of prospect theory brokers and attributes of the sales force and explores the relationship between the assumptions of agency theory and the structure of compensation contracts. Mohajerani and Shohodi, (2014) initiated a study focused on modeling the correlation between ethics, spirituality at work, and social responsibility among nurses in public hospitals in Tehran. The findings showed a significant positive relationship between ethics and spirituality at work, further extending to social responsibility. The examination of the relationship between ethics and social responsibility confirmed the mediating role of spirituality and the indirect meaningful impact of professional ethics on fostering social responsibility among nurses. Abolhassani, (2014) in a study, investigated the relationship between professional ethics, commitment, and organizational citizenship behavior within the context of the banking industrys financial performance. The analysis underscored that there is a noteworthy relationship between the variables of professional ethics, commitment, organizational citizenship behavior, and the financial performance of banks. Herbah and Nonak, (2007) in their study have highlighted that professional ethics contribute positively to organizational outcomes. For instance, the ethical values held by managers exhibit a direct and meaningful link with procedural justice, organizational commitment, job satisfaction, and adaptive employee behavior. Baker & Li, (2010) examined the correlation between job satisfaction and professional ethics. The findings indicate that employees are eager to be fully engrossed in jobs and it leads to favorably fulfilling their job duties and job responsibilities. This positive cycle of resources consequently generates positive effects on professional ethics. This study treats professional ethics as the dependent variable, and the compensation system as the predictive variable. The compensation system is determined based on various aspects such as entitlements, cash benefits, non-cash perks, suitable job features, and ultimately the working conditions for both employees and managers within an organization. In this research, we employ the current (Robbins and DeCenzo model, 1997; Islam MT, and Alam MJ., 2019) to measure the compensation system. Compensation categories include: 1. Direct funding, including salaries, wages, cash bonuses, and commission. 2. Supplementary services, including insurance coverage, benefits, and social assistance. 3. Job-related non-financial services, including work challenges, responsibilities, and the opportunity for progress and success. 4. Non-financial services related to the business environment, including the presence of rational policies, supportive leadership, reduced workdays, extended weekends, favorable working conditions, flexible time options, remote work opportunities, meal allowances, choice of benefits, collaborative job sharing, and harmonious teamwork (Abbaspour, 2005). To assess professional ethics in this study, we utilize the Kadozir model (2002); focusing on eight components such as accountability, hegemony, honesty, respect for others, respect for values and social norms, justice, and loyalty toward empathizing with others. Ahmadian, (2013) has demonstrated a significant relationship between professional ethics and the compensation system. Nikomram and Ashaghi, (2010) have endorsed the correlation between the compensation system and professional ethics.

Research involves a systematic examination directed towards uncovering and cultivating a set of organized knowledge (Bast, translation Sharifi and Taleghani, 200281). This study adopts a descriptive approach because it describes the situation of variables and the correlation between them. Besides, it follows a survey-based methodology due to the aspects of concurrency relationships among the variables for testing and clarification. The sample comprised a total number of 1218 employees of Tehrans teaching hospitals. The Morgan table is used for sampling, leading to a diverse subset of 292 individuals. To gather the required data, two questionnaires were utilized throughout this study. Data collection involved a two-part questionnaire: the first part captured demographic information such as gender, age, work experience, and education level, while the subsequent section of the questionnaire contained designed questions aimed at measuring variables. To assess the questionnaire alignment, the current Robbins and DeCenzo model, (1997) was employed. Four components of the compensation system were evaluated: direct financial services, indirect financial services, job-related non-financial services, and non-financial services related to the business environment. In addition, professional ethics were measured based on Kohlbergs, (1968) framework, using a 25-question questionnaire consisting of components like interest, regulatory adherence, administrative practices, professionalism, and independent measures. The questionnaire was meticulously constructed and employed the Likert scale for nuance measurement. Each question had five levels of response options: strongly agree, agree, somewhat agree, disagree, and strongly disagree. To ensure a comprehensive array of tests, content validity was employed to assess the validity of measures. Content validity evaluates how well an instrument (like a test) covers all relevant parts of the construct it aims to measure. Typically, the content validity of tests is determined by experts in the subject matter (Skaran, translation Saebi and Shirazi, 2010). For evaluating the compensation system, Soutodehs, (2010) questionnaire with a factor of 0.94 was used. Content validity, ascertained by experts, confirmed the questionnaires coverage of the constructs. As well as to assess the professional ethics of staff, a questionnaire by Razavi, (2015) is utilized, which demonstrated a proven factor of 0.92. The reliability of the instruments was established with Cronbachs alpha values of 0.88 for the compensation system and 0.86 for professional ethics. The occurrence of data was described to characterize the variables using frequency distribution and descriptive statistics. For the data analysis to test this hypothesis and research questions regarding this approach, the Partial Least Squares (PLS) software and Smart PLS 2 were used. The normality of the data distribution was assessed using the one-sample Kolmogorov-Smirnov test. For data analysis, SPSS version 19 and Smart PLS 2 were carried out, with a significance threshold set at 0.05.

Demographic variables results 

The demographic analysis of the 292 participants revealed a gender distribution of 91 (31.2%) female, 188 (64.4%) male, and 13 cases unspecified (Table 1). Age-wise, among the 292 individuals assessed, 63 (21.6%) were 25 or younger, 54 (18.5%) fell between 26-30, 105 (0.36%) were aged 31-40, 62 (21.2%) were over 41 years old, and 8 individuals did not provide their age (Table 2). Regarding work experience, it was found that among the 292 cases evaluated, 77 (26.4%) had 5 years or less of experience, 100 (34.2%) had 6-10 years, 55 (18.8%) had 11-20 years, and 53 (18.2%) had 21 years or more. 7 people did not mention a record of their work experience (Table 4). Lastly, for education level, out of the 292 evaluated, 70 (24%) held a diploma, 63 (21.6%) had an associate degree, 81 (27.7%) possessed a bachelors degree, and 75 (25.7%) had a masters degree, and three individuals did not specify their education level (Table 3).

Table 1: Frequency distribution of the respondents by gender.

The results of the research hypotheses

Main Hypothesis 1 

Employees compensation significantly influences professional ethics in Tehrans teaching hospitals. The significant coefficient Z between the compensation and professional ethics variables is 17.142. The value exceeds 1.96, confirming the impact of compensation on professional ethics. The standardized path coefficient between the compensation variable and professional ethics is 0.522, which further quantifies the direct effect of compensation on professional ethics

The results of the study showed that compensation has a direct impact on the professional ethics of employees in Tehrans teaching hospitals.  The outcomes of the study are in line with the results of (Ahmadian, 2013; Nikomaram and Ishaghi, 2010).  Ahmadian, (2013) has achieved a significant relationship between the compensation system and professional ethics. The correlation between the compensation system and professional ethics has been approved (Nikomaram and Ishaghi, 2010).  If the compensation system is fair and equitable and people in the organization are satisfied with the compensation system, unethical behavior and moral vices will decrease and professional ethics will be promoted. The results of the study showed that direct financial services have a direct impact on the professional ethics of employees in Tehrans teaching hospitals.  The findings of the study correspond with the results of (Ahmadian, 2013; Nikomaram and Ishaghi, 2010). They have suggested in their research that financial services are directly and significantly correlated with professional ethics. If you have sufficient staff in the organization for direct financial services, as well as the services are deemed fair and equitable, more effort should be made to comply with ethical principles and adhere to professional ethics. The results of the study showed that supplementary services have a direct impact on the professional ethics of employees in Tehrans teaching hospitals. The conclusion of the study is consistent with the results of (Nikomaram and Ishaghi 2010; Danaeefard et al., 2010). Nikomaram and Ishaghi, (2010) have confirmed an indirect relationship between financial services and professional ethics. Also, Danaeefard et al. (2010) earned a significant positive indirect correlation between financial services and professional ethics. If employees receive fair and equitable financial services without discrimination, they will pay more attention to moral values and compliance with ethics, and professional ethics will grow. The results of the study showed that job-related non-financial services have a direct impact on the professional ethics of employees in Tehrans teaching hospitals.  The findings of the study are consistent with the results of (Ahmadian, 2013). Ahmadian, (2013) has found in his research that job-related non-financial services have a positive effect on professional ethics. When employees in the organization receive job-related non-financial services, and their efforts are rewarded, either directly or indirectly, they will be more inclined to attitude and behavior ethics, and adherence to professional steps. 5. The results of the study showed that non-financial services related to the business environment have a direct impact on the professional ethics of employees in Tehrans teaching hospitals.  The outcomes of the study align with the results of (Hassani and Haidari, 2014).  

Hassani and Haidari, (2014) have found in their research that job-related non-financial services can affect ethics.  When employees receive non-financial services related to the business environment, and injustice and discrimination are not observed, their work will be more ethical, and their duty will adhere to moral values. They will also grow due to professional ethics.

The test results demonstrated the direct impact of compensation on the professional ethics of employees in Tehrans teaching hospitals. Likewise, it is recommended that all the rights and benefits of their employees be remunerated in both cash and non-cash forms, ensuring timely and equitable distribution. Benefits should be awarded fairly and proportionally, taking into account employees features and attributes. Moreover, it is essential to consider appropriate positions and working conditions for both service personnel and administrators. By providing a positive work environment for employees and managers, it becomes possible to enhance morality among the staff. 

The test results indicated that financial services exert a direct effect on the professional ethics of employees in Tehrans teaching hospitals.  Thus, it is proposed to grant employees sufficient rights and provide bonuses to employees by the level of service they deliver to customers. Additionally, it is suggested to offer financial benefits to staff commensurate with the service they perform, proportionate to their respective fields of work and the intensity of their efforts. This approach aims to elevate professional ethics within healthcare organizations. The test results confirmed the direct influence of supplementary services on the professional ethics of employees in Tehrans teaching hospitals. Therefore, it is suggested that the staff take advantage of supplementary insurance, educational missions, and scholarships. Furthermore, offering consulting services, facilities, and accommodations to the staff can reinforce and emphasize professional ethics. The test results revealed that job-related non-financial services directly affect the professional ethics of employees in Tehrans teaching hospitals. It is proposed that appropriate tasks be entrusted to enthusiastic individuals. Despite existing challenges in boosting the motivation of employees and fostering a greater sense of responsibility among them, it is essential to provide employees with opportunities for advancement and success, so that they adhere to ethical principles. The test results signified that non-financial services related to the business environment have a direct impact on the professional ethics of employees in Tehrans teaching hospitals. 

Consequently, it is suggested to establish compatibility among partners, ensure collaborative efforts between units, and uphold the dignity of individuals and their families. In addition, reasonable policies should govern the workplace, and comprehensive rules and regulations should be in place to bolster staff professional ethics. Ultimately, creating an environment where employees are motivated by ethical considerations can lead to improved patient care quality, staff satisfaction, and overall hospital performance.

We are grateful to all the dear professors for providing their information regarding this research. 

The authors declared no conflict of interest.