Moderating Role of Tri Hita Karana on Work Systems, Engagement, and Turnover Intention in Bali Hospitals

Anak Agung Media Martadiani, Made Setini, Daru Asih, Made Panji Satrya Wiradarma

Abstract


High nurses’ turnover intention remains a critical issue in healthcare organizations, affecting service quality and organizational sustainability. This study aims to examine the effect of High-Performance Work Systems (HPWS) and employee engagement (EE) on turnover intention (TOI), with Tri Hita Karana (THK) as a moderating variable. This study employs a quantitative approach using data collected from 150 nurses working in private hospitals in Denpasar. The data were analyzed using Partial Least Squares–Structural Equation Modeling (PLS-SEM). The results indicate that HPWS has a significant negative effect on TOI (? = -0.45, p = 0.001), and EE also shows a significant negative effect (? = -0.50, p = < 0.001), suggesting that effective HR practices and higher EE reduce employees’ intention to leave. In addition, THK has a significant negative direct effect on TOI (? = -0.30, p = 0.006) and strengthens the relationships between HPWS and TOI as well as between EE and TOI. These findings highlight the importance of integrating HR practices, psychological engagement, and cultural values in reducing turnover intention. This study contributes to the human resource management literature by incorporating local cultural values into employee retention and offers practical implications for developing culturally aligned retention strategies in healthcare.


Keywords


Employee Engagement; High-Performance Work Systems; Nurse Retention; Organizational Culture; Tri Hita Karana; Turnover Intention

Full Text:

PDF

References


Aboalganam, K., Alhanatleh, H., Al-Okaily, M., Alghizzawi, M., Khaddam, A., & Almajali, D. (2024). Examining antecedents’ factors influencing the customer co-creation value using open-sooq app in Jordan. Uncertain Supply Chain Management, 12(3), 2005-2022. https://doi.org/10.5267/j.uscm.2024.2.005

Ananda, A. S., Murwani, I. A., Tamara, D., & Ibrahim, I. I. (2023, May). Adoption of digital marketing toward digital transformation in Indonesian micro-and small-sized enterprises. In 2023 8th International Conference on Business and Industrial Research (pp. 877-882). IEEE. https://doi.org/10.1109/ICBIR57571.2023.10147569

Ardiana, P. A., Sujana, I. K., Natalia, S. A. P. D., & Yanthi, K. D. L. (2026). Tri Hita Karana: Balinese local wisdom and its role in the triumph over corruption. Journal of Accounting & Organizational Change, 22(1), 127-148. https://doi.org/10.1108/JAOC-11-2023-0182

Boxall, P. (2012). High?performance work systems: What, why, how and for whom?. Asia Pacific Journal of Human Resources, 50(2), 169-186. https://doi.org/10.1111/j.1744-7941.2011.00012.x

Buayai, P., Ru-Zhue, J., Rungruang, P., Usman, B., & Aujirapongpan, S. (2025). Developing soft skills of Gen Z accountants in the open innovation era: The roles of absorptive capability and self-learning capability. Journal of Open Innovation: Technology, Market, and Complexity, 11(2), 100525. https://doi.org/10.1016/j.joitmc.2025.100525

Damayanti, N. N. S. R. (2019). The effect of work engagement and self-efficacy on job burnout of credit analyst. International Journal of Applied Business and International Management, 4(3), 113–120. https://doi.org/10.32535/ijabim.v4i3.689

Dewanto, M. H., & Arijanto, A. (2025). The influence of work-life balance, green transformational leadership, and learning organization on sustainable employee performance mediated by job satisfaction in management consulting firms. Formosa Journal of Multidisciplinary Research, 4(7), 3323–3342. https://doi.org/10.55927/fjmr.v4i7.355

Do, T. H. N., & Do, N. B. (2024). Which factors help SMES’ performance recover post-pandemic? The role of learning capability, intellectual capital, and technological innovation. Studies in Business and Economics, 19(2), 78-95. https://doi.org/10.2478/sbe-2024-0026

Fang, L. (2023). Examining the effects of digital leadership strategies on enhancing organizational innovation performance. Journal of Logistics, Informatics and Service Science, 10(4), 318-335. https://doi.org/10.33168/JLISS.2023.0422

Gana, F., Lay, E., Dethan, F. M., & Foeh, R. (2024). Service digitalization innovation model as development strategy and policy at Bank NTT Indonesia. Journal of Infrastructure, Policy and Development, 8(8), 3053. https://doi.org/10.24294/jipd.v8i8.3053

Gandomkari, H., Mohammadi, N., & Rezghirostami, A. (2023). Prioritizing factors affecting green human resources management, using fuzzy network analysis in the organization. International Journal of Human Capital in Urban Management, 8(4), 573-584. https://doi.org/10.22034/IJHCUM.2023.04.10

Gkinton, E., Telonis, G., Halkiopoulos, C., & Boutsinas, B. (2022, September). Quality of life and health tourism: A conceptual roadmap of enhancing cognition and well-being. In International Conference of the International Association of Cultural and Digital Tourism (pp. 651-666). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-031-26829-8_41

Guo, J., & Zhang, T. (2024). Research on cultural and creative product design from the perspective of sustainable development based on traditional philosophy. European Journal for Philosophy of Religion, 16(4), 70-88. https://doi.org/10.24204/ejpr.2024.4651

Hair, J. F. (2021). Next-generation prediction metrics for composite-based PLS-SEM. Industrial Management & Data Systems, 121(1), 5-11. https://doi.org/10.1108/IMDS-08-2020-0505

Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2019). When to use and how to report the results of PLS-SEM. European Business Review, 31(1), 2-24. https://doi.org/10.1108/EBR-11-2018-0203

Hapsari, N. K. T., Kepramareni, P., Puspitawati, N. M. D., & Suardhika, I. N. (2025). Organizational citizenship behavior as mediator: Competence and commitment effects on performance. International Journal of Applied Business & International Management, 10(2), 330–346. https://doi.org/10.32535/ijabim.v10i2.4069

Haq, F. U., Suki, N. M., Setini, M., Masood, A., & Khan, T. A. (2025). Adopting green AI for SME sustainability: Mediating role of green investment and moderation by green servant leadership. Sustainable Futures, 101002. https://doi.org/10.1016/j.sftr.2025.101002

Hawamdeh, N. A. (2024). The influence of humble leadership on employees’ work engagement: The mediating role of leader knowledge-sharing behaviour. VINE Journal of Information and Knowledge Management Systems, 54(6), 1252-1269. https://doi.org/10.1108/VJIKMS-03-2022-0083

Ingram, T., & Kra?nicka, T. (2023). The interplay of dynamic capabilities and innovation output in family and non-family companies: The moderating effect of environmental dynamism. Entrepreneurial Business and Economics Review, 11(2), 63-86. https://doi.org/10.15678/EBER.2023.110203

Jia, K., Zhu, T., Zhang, W., Rasool, S. F., Asghar, A., & Chin, T. (2022). The linkage between ethical leadership, well-being, work engagement, and innovative work behavior: The empirical evidence from the higher education sector of China. International Journal of Environmental Research and Public Health, 19(9), 5414. https://doi.org/10.3390/ijerph19095414

Jora, R. B., Mittal, P., Kaushal, S., & Raghuvaran, S. (2023, March). Tech-enabled sustainable HR strategies: Fostering green practices. In 2023 9th International Conference on Advanced Computing and Communication Systems (ICACCS) (Vol. 1, pp. 2496-2501). IEEE. https://doi.org/10.1109/ICACCS57279.2023.10113050

Knezovi?, E., & Drki?, A. (2021). Innovative work behavior in SMEs: The role of transformational leadership. Employee Relations: The International Journal, 43(2), 398-415. https://doi.org/10.1108/ER-03-2020-0124

Kwayu, S., Lal, B., & Abubakre, M. (2018). Enhancing organisational competitiveness via social media-a strategy as practice perspective. Information Systems Frontiers, 20(3), 439-456. https://doi.org/10.1007/s10796-017-9816-5

Moraga, M. V., Favila, Q. Y. S., Magtibay, C. G. M., Palanca, J. F. E., & Yvanovich, M. S. (2025). Analysis of the factors influencing intention to purchase sustainable local craft products: A structural equation modeling approach. Review of Integrative Business and Economics Research, 14(2), 705-719.

Muthu, S. S. (2025). Assessment of social sustainability management in various industrial sectors. In Assessment of Social Sustainability Management in Various Sectors (pp. 1-4). Springer Nature Switzerland. https://doi.org/10.1007/978-3-031-81029-9_1

Normal, I. N., & Setini, M. (2022). Absorption capacity and development of photocatalyst green ceramic products with moderation of green environment for sustainability performance of developing industries. Sustainability, 14(17), 10457. https://doi.org/10.3390/su141710457

Pradnyani, N. L. P. N. A., Riasning, N. P., & Datrini, L. K. (2018). Hasil penelitian pengaruh kecerdasan dan budaya etis organisasi terhadap prilaku etis auditor di provinsi Bali. Krisna: Kumpulan Riset Akuntansi, 9(2), 63-70. https://doi.org/10.22225/kr.9.2.2018.63-70

Rahmayani, M. W., Hakim, A., Hernita, N., & Riyadi, W. (2024). Making decisions about purchases based on varying consumer behavior concerning product quality evaluations. International Journal of Accounting and Finance in Asia Pacific, 7(2), 87-101. https://doi.org/10.32535/ijafap.v7i2.2953

Raja, L., & Manoharan, G. (2024, June). Nurturing green human resource management in facilitating organizational effectiveness. In 2024 3rd International Conference on Computational Modelling, Simulation and Optimization (ICCMSO) (pp. 188-192). IEEE. https://doi.org/10.1109/ICCMSO61761.2024.00047

Rizvi, Y. S., & Garg, R. (2021). The simultaneous effect of green ability-motivation-opportunity and transformational leadership in environment management: The mediating role of green culture. Benchmarking: An International Journal, 28(3), 830-856. https://doi.org/10.1108/BIJ-08-2020-0400

Said, M. M., & Soi, A. B. (2025). Expanding SME product export market through digital innovation in Indonesia. In Dynamic strategies for entrepreneurial marketing (pp. 253-270). IGI Global Scientific Publishing. https://doi.org/10.4018/979-8-3693-3936-7.ch012

Setini, M., Yasa, N. N. K., Supartha, I. W. G., Giantari, I. G. A. K., & Rajiani, I. (2020). The passway of women entrepreneurship: Starting from social capital with open innovation, through to knowledge sharing and innovative performance. Journal of Open Innovation: Technology, Market, and Complexity, 6(2), 25. https://doi.org/10.3390/joitmc6020025

Setyaningrum, R. P., Kholid, M. N., & Susilo, P. (2023). Sustainable SMEs performance and green competitive advantage: The role of green creativity, business independence and green IT empowerment. Sustainability, 15(15), 12096. https://doi.org/10.3390/su151512096

Tassang, A. E., Guoqing, S., Akintunde, T. Y., Sayibu, M., Isangha, S. O., Adedeji, A., & Musa, T. H. (2023). Social integration, solidarity, and psychological health of internally displaced persons in Cameroon: Exploring the role of community satisfaction. Heliyon, 9(10). https://doi.org/10.1016/j.heliyon.2023.e20361

Tran, T. T., Le, T. B. D., Lam, Q. T., & Do, T. T. (2025). Factors affecting the purchase intention of generation Z for sustainable fashion products in Vietnam. International Journal of Economics and Management, 19(2), 213–230. https://doi.org/10.47836/ijeam.19.2.05

Ummah, M. S. (2019). No ????????????????????? ?????????????????Title. Sustainability (Switzerland), 11(1), 1–14.

Välimäki, H., Niskanen, A., Tervonen, K., & Laurila, I. (2004). Indicators of innovativeness and enterprise competitiveness in the wood products industry in Finland. Scandinavian Journal of Forest Research, 19(sup5), 90-96. https://doi.org/10.1080/02827580410017898

Weber, P., & Kassab, E. A. (2024). The employee green behavior of green transformational leadership, green human resource management on the sustainable performance. Journal of Infrastructure, Policy and Development, 8(8), 4630. https://doi.org/10.24294/jipd.v8i8.4630

Wedasmara, I. D. G. A., Riana, I. G., Surya, I. B. K., & Dewi, I. G. A. M. (2026). How does role overload effect burnout: The mediating role of job stress?. Tennessee Research International of Social Sciences, 8(1), 20-32.

Wibisana, A. A. N. A., & Dewi, A. A. S. L. (2023, December). Tri Hita Karana as a concept of local wisdom in the development of sustainable tourism in Bali. In International Conference on “Changing of Law: Business Law, Local Wisdom and Tourism Industry”(ICCLB 2023) (pp. 65-72). Atlantis Press.

Xie, L., Guan, X., He, Y., & Huan, T. C. (2022). Wellness tourism: Customer-perceived value on customer engagement. Tourism Review, 77(3), 859-876. https://doi.org/10.1108/TR-06-2020-0281

Yuwanda, T., Gustina, L., & Bella, S. (2023). Increasing competitive advantage through creativity and innovative behavior: The moderating role of digital leadership. Mix: Jurnal Ilmiah Manajemen, 13(1), 63-77. https://doi.org/10.22441/jurnal_mix.2023.v13i1.005

Zirena-Bejarano, P. P., Zirena, E. M. C., & Malaga, A. K. C. (2024). Cognitive social capital and new product performance: indirect effect of potential absorptive and innovation capacity: A tourism-based study. European Journal of Management and Business Economics. https://doi.org/10.1108/EJMBE-01-2023-0019




DOI: https://doi.org/10.32535/ijabim.v11i1.4348

Refbacks

  • There are currently no refbacks.




Copyright (c) 2026 AA Media Martadiani, Made Setini, Daru Asih, Made Panji Satrya Wiradarma

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

International Journal of Applied Business and International Management (IJABIM)

ISSN 2614-7432 (Print) | ISSN 2621-2862 (Online)

DOI Prefix: 10.32535 by CrossRef

Published by AIBPM Publisher

JL. Kawi No. 23, Bareng, Kec. Klojen, Kota Malang, Jawa Timur, Indonesia

Email: journal.ijabim@gmail.com

Phone: +62 341 366222

Website: https://aibpmpublisher.com/

Governed by

Association of International Business and Professional Management

Email: admin@aibpm.org

Website: https://www.aibpm.org/

Indexed by

SINTA Garuda Google Scholar Dimensions ASEAN Citation Index

Visitor Statistics

Flag Counter

Web Analytics

View IJABIM Stats

Follow Us: