Correlation of Organizational Systems: Leadership, Salary Systems, Policies, and Human Resources in Improving Performance: Study in Rural Areas of Indonesia

Aim: Healthcare services in remote areas present unique challenges to achieving organizational performance goals due to limited access and infrastructure. This study aims to analyze organizational factors that influence organizational performance in Sampang Regency, based on the McKinsey 7S Framework and Gibson's model. Method: This study uses a cross-sectional design with regression-based modeling analysis with 213 nurses through stratified random sampling. The instrument was a validated 130-item questionnaire that assessed organizational factors (leadership, salary, services, policies, and human resource management) and organizational performance. Data were analyzed using Spearman's rank correlation for bivariate analysis and ordinal regression for multivariate analysis. Results: Bivariate analysis showed that all organizational factors significantly affected health organization performance (p<0.001). However, the multivariate analysis showed a significant impact of leadership on organizational performance (Exp(B)=6.82, 95% CI: 3.72–12.51, p<0.001); the model accounted for 92.6% of the performance variation (Nagelkerke R²). Conclusion: Leadership is a significant factor in improving the performance of healthcare organizations. Improving organizational performance in remote areas is more important than other factors, such as salaries and rewards, policies, services, and human resource management. The findings of this study strengthen the McKinsey 7S Framework's proposition that the element "style" is the key to aligning the other elements.