The effect of perceived organizational support and transformational leadership on turnover intention of health workers at Hospital X Mimika Regency Papua Research in Business & Social Science

This study examines the effect of perceived organizational support and transformational leadership on the turnover intention of health workers at Hospital X, Mimika Regency through mediating organizational commitment. This research was conducted in ten work units at Hospital X Mimika Regency, Papua. This study uses saturated sampling. Primary data was obtained by distributing questionnaires to 103 health workers. Data analysis used partial least square (SEM-PLS) structural equation modeling with Smart-PLS 3.0 application. The results show that the perceived organizational support and transformational leadership had a negative and significant effect on turnover intention. The results of this study show a positive significant effect of perceived organizational support and transformational leadership on turnover intention and a negative significant effect organizational commitment on turnover intention. This study also found that organizational commitment has not been able to mediate the effect of perceived organizational support on turnover intention. From these findings, it should be underlined that the turnover intention of health workers will be high, if the organization and leaders do not pay attention to the welfare and needs of health workers, such as bonuses or benefits and salaries that are in accordance with the level of education, workload, and years of service. Equitable training and fair career promotion, giving authority and delegation to health workers in the decision-making process, providing advice, evaluation, and positive feedback.


Introduction
The success of the organization in achieving its goals can be seen through the level of employee turnover in it. Employee turnover is one of the major challenges faced by organizations, including hospital organizations. Turnover will be a serious problem, if the outgoing workforce has the expertise, abilities, skills in their field and occupies a vital position in the company (Nugraha & Purba, 2018). The direct impact caused by turnover is that it results in an increase in costs that must be incurred by the organization in recruiting new employees (Fardid et al., 2018). Meanwhile, the indirect impact of turnover is a decrease in employee work productivity (Zaheer et al., 2019).
workload, work and family conflicts, few opportunities for participation in decision making decisions, low salaries, staffing problems, and limited leadership support are the main causes of turnover intention (Labrague et al., 2018;Chen et al., 2018;Yang et al., 2021).
Several previous studies related to employee turnover at hospitals in Indonesia shows significant results, which were quite high, as for the data namely: RSIA NUN Surabaya obtained a percentage of 22.2% (Kartika, 2018), Ananda Hospital Bekasi more than 10% (Amanda et al., 2021), Banyumas General Hospital, Central Java Province, from 2016 to 2018 it was reported that the hospital employee turnover rate was 25.9%, 22% and 13% (Anggara et al., 2020), and Dhuafa Hospital nurses obtained a percentage of 13% (Mardiana et al., 2014).
A high turnover rate was also experienced by Hospital X Mimika Regency in the last five years, namely 2017 to 2021. The employee turnover rate over a five year period is as follows: 1) the turnover rate in 2017 was 20 employees or 19, 41%, 2) the turnover rate in 2018 was 10 employees or 9.34%, 3) the turnover rate in 2019 was 20 employees or 17.24%, 4) the turnover rate in 2020 was 25 employees or 18 ,93%, and 5) the turnover rate in 2021 is 13 or 16.77%. The employee turnover rate data for Hospital X, Mimika Regency is not in line with what was conveyed by Gillies Dee Ann (1994:224) which states that the tolerable turnover is about 5-10%. Within five years, it was found that the turnover rate of health workers including: general practitioners, specialists, nurses, midwives, laboratory health workers and pharmacy continued to experience a significant increase. As for the number of nurses and midwives who came out within five years as many as 221 people, laboratory and pharmacy work units as many as 72 people, as well as general practitioners and specialist doctors as many as 65 people. High turnover rate in health workers is a serious problem for hospitals because health workers have an important role in improving maximum health services so that they are able to increase awareness, willingness, and ability to live healthy people who can create the highest degree of health as an investment for the development of productive human resources socially and economically as well as one of the elements of general welfare.
The high level of turnover that occurs in hospitals shows that organizations must consider hospital employees as human assets that must be taken into account. Hospitals must know what factors can affect the turnover intention of health workers. Turnover intention can be minimized with strong support from the organization and supportive leadership practices. Perceived organizational support helps employees get the various resources needed in delivering workforce-based services, which in turn can increase employee confidence and ability to serve patients (Wen et al., 2019). Perceived organizational support includes employees' need for approval, respect and social identity which results in high performance expectations, thereby making employees feel supported and valued by the organization. Employees who have a high perceived organizational support will have more positive feelings about their organization, which in turn can increase job satisfaction, positive spiritual status, and reduce stress on employees (Akgunduz & Sanli, 2017). Previous research shows the impact of perceived organizational support on turnover intention (Akgunduz & Sanli, 2017;Ye et al., 2017;Zeffane & Bani Melhem, 2017;Jolly et al,. 2021;Ganji et al., 2021). According Gyensare et al. (2016) transformational leadership is more effective in improving employee welfare and minimizing turnover intention. Transformational leaders focus on innovative communication, development, distribution of work, assisting employees in dealing with work stress and anxiety in the workplace, and autonomy in the workplace which can reduce friction which in turn can instill followers to stay with the organization (Kim et al., 2021). Study Park & Pierce (2020); Gordon et al. (2019); Ariyabuddhiphongs & Kahn (2017); Amankwaa & Anku-Tsede (2015) shows the impact of transformational leadership on turnover intention. The more employees perceive their boss to be supportive, the less likely they are to leave their jobs.
However, several previous studies have shown that there is an inconsistency between perceived organizational support and turnover intention (Shafique et al., 2018;Nadeem et al., 2019;Wong & Wong, 2017;Paul & Hung, 2018), and research inconsistencies between transformational leadership and turnover intention (Kim et al., 2021;Gyensare et al., 2016;Eberly et al., 2017). These inconsistent results provide a gap for researchers to form a new conceptual model and close the research gap by adding another variable as a mediating variable, namely organizational commitment in bridging the relationship between perceived organizational support and transformational leadership on turnover intention. Previous research Suifan et al. (2017); Yao et al. (2019); Labrague et al. (2018); Wong & Wong (2017); Kalidass & Bahron (2015); shows the effect of organizational commitment on turnover intention. Organizational support, career development, inter-unit support, top management support, senior support, compensation, employee welfare and work-life balance have a positive influence on retention within the organization (Aboramadan et al., 2020). In addition, the quality of the relationship between leaders and employees also encourages employees to be committed to the organization. Study Eliyana et al. (2019); Ribeiro et al. (2018) shows that transformational leadership has a strong influence on employee commitment to remain in the organization. Luthans (2011) explains that organizational commitment is a strong willingness of employees to remain group members in the organization, willingness to keep working in achieving organizational goals, and willingness to accept organizational values and goals. Employees who show commitment will tend to take extra steps to improve the quality of their work, and not engage in counterproductive behavior.
Perceived organizational support emerged as a strong predictor of employee commitment. Organizational commitment is conceptualized as a positive response felt by employees to the work experience provided by the organization (Panaccio & Vandenberghe, 2009). Career development, inter-unit support, top management support, senior support, compensation, employee welfare and work-life balance have a positive influence on retention within the organization (Aboramadan et al., 2020). In addition, the quality of the relationship between leaders and employees also encourages employees to be committed to the organization.

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Research by Eliyana et al. (2019); Ribeiro et al. (2018) shows that transformational leadership has a strong influence on employee commitment to stay in the organization.
Although research on perceived organizational support and transformational leadership has been well-known in organizational behavior this decade, very few research of perceived organizational and transformational leadership in health sectors. Furthermore, the study of health workers in type D hospitals in Indonesia is also still very rarely discussed. Therefore, it can bring up theories and empirical questions that require answers to understand, so that the understanding of perceived organizational support and transformational leadership becomes wider in the health environment. Perceived organizational support and transformational leadership in type D hospitals can be more unique and different from other types of hospital. The indicators in this study are a combination of three previous studies namely: rewards, career, working conditions, and welfare (Eisenberger et al., 1986); Rhoades & Eisenberger, 2002;Ye et al., 2017), thus gaining an understanding of the broader perceived organizational support in the health sector.
This study aims to further investigate the role of organizational commitment in mediating the effect of perceived organizational support and transformational leadership on turnover intention of health workers at Hospital X Mimika Regency, Papua.

Literature Review
Theoretical and Conceptual Background Turnover Intention Meyer & Tett (1993) also said that turnover intention is an employee's conscious and intentional willingness to leave the organization. The tendency of an employee's intention to quit his job or move to another workplace according to his own will is called turnover intention (Mobley 2011). Furthermore Robbins & Judge (2017) describes turnover intention as the possibility of employees to leave the company due to low interest in work or the availability of other alternative jobs. Turnover is voluntary and involuntary. When employees decide to leave the organization of their own choice, it is called voluntary turnover. On the other hand, if an employee is expelled by the organization, it is called involuntary turnover (Price & Mueller, 1981). If employees who leave the organization have a high level of performance and are competent in their fields, this will be very detrimental. Losing employees who have high performance and are competent in their fields will hinder teamwork in the organization and will incur additional costs in the form of personnel renewal and training (Yin et al., 2022). It can be concluded that turnover intention is a great desire or intention of individuals to leave the organization when faced with an uncomfortable situation within the organization and do not get positive feedback from the organization where the individual works.

Perceived Organizational Support
According Rhoades & Eisenberger (2002) perceived organizational support refers to employees' perceptions of the extent to which the organization cares about their well-being. Employees who believe that the organization cares about their welfare will feel obliged to help the organization, this is reflected in the increased organizational commitment of employees to the organization (Karatepe et al., 2022). When the organization supports and treats employees fairly, develops a better perception of congruence with the values, goals, aspirations and climate of the organization, employees are more likely to stay with the organization (Afsar & Badir, 2017). Asghar et al. (2021) also explained that the practice of organizational support is one of the main predictors in increasing employee engagement and employee performance. This result is supported by several studies which found that the perceived organizational support has a negative and significant effect on turnover intention (Ye et al., 2017;Akgunduz & Sanli, 2017;Zeffane & Bani Melhem, 2017;Jolly et al, 2021;Ganji et al., 2021). Individuals who feel greater support from the organization have a tendency to feel reciprocated towards the organization. Study Aboramadan et al. (2020), Razzaq et al. (2019) explained that the perceived organizational support has a positive and significant influence on organizational commitment. The higher the organizational support for employees, the stronger the employee's commitment to the organization, which in turn will reduce their turnover intention.

H2: Perceived Organizational Support Has a Positive and Significant Effect on Organizational Commitment
Transformational Leadership Schermerhorn (1999) defines leadership as a process to motivate and influence others to work hard in order to realize and support organizational goals. On the other hand, Bass (1990) observe leadership as a process of interaction between individuals and groups that include structured or restructured situations, expectations and perceptions of members. Leadership that is able to make strategic changes is a hallmark of transformational leadership (Bass & Avolio, 1994;Bass, 1999;Bass & Riggio, 2006). Transformational leaders help followers to increase involvement in navigating situations with inspiration, and leading them with quality decisions, and triggering employee motivation towards work which ultimately affects their attitude to stay in the organization. Study Park & Pierce (2020), Gordon et al. (2019), Ariyabuddhiphongs & Kahn (2017), Amankwaa & Anku-Tsede (2015), Masta & Riyanto (2020) explained that transformational leadership has a negative and significant effect on turnover intention. The practice of transformational leadership is also one of the important factors influencing employee commitment because it provides the basis for change for the organization in the long term, which in turn will provide an important basis for achieving the higher goals of the organizational system. Study Eliyana et al. (2019), Ribeiro et al. (2018) found that there is a positive and significant relationship between transformational leadership and organizational commitment.
H3: Transformational Leadership Has a Negative and Significant Effect on Turnover Intention.

Organizational Commitment
Organizational commitment is defined as a psychological relationship that employees have to remain willing to stay in the organization by accepting the values and goals of the organization and valuing them personally. Organizational commitment is one of the factors that determine employee relationships with organizations that can help organizations achieve success (Meyer & Allen, 1997). A high level of commitment from employees can be one way to minimize the consequences of turnover (Ramalho Luz et al., 2018). When employees are treated fairly and are satisfied with their work, they will generate positive emotions and good perceptions of the organization, which in turn creates a sense of obligation in employees to repay the organization, and one way is by being fully committed. Study Suifan et al. (2017), Wong & Wong (2017), Labrague et al. (2018), Yao et al. (2019), Kalidass & Bahron (2015) found that organizational commitment has a negative and significant effect on turnover intention. Organizational support can trigger an employee's sense of responsibility to support organizational achievement. Employees who have felt more support, assistance, and a sense of belonging from the organization are more likely to stay with the organization, show stronger engagement and contribute to organizational goals (Ye et al., 2017). Study Gaudet & Tremblay (2017), Fazio et al. (2017), Wong & Wong (2017) found that organizational commitment mediates the relationship of perceived organizational support to turnover intention. Transformational leaders are also able to encourage and influence employees through the inspiration and example of a leader (Tjahjono et al., 2018). Study Gyensare et al. (2016), Park & Pierce (2020), Ribeiro et al. (2018) found that organizational commitment mediates the relationship of transformational leadership to turnover intention.

Participants and data collection
Respondents in this study were health workers who were in ten work units of Hospital X Mimika Regency, Papua, namely: general practitioners, specialists, nurses, midwives, pharmacy, sanitation, nutrition, medical records, radiology, and laboratories. This study uses a probability sampling approach, where all elements in the population have the same opportunity to be selected as samples (Ferdinand, 2014:176). The probability sampling approach used in this study is saturated sampling. The sampling criteria in this study are as follows: 1) respondents are health workers who work in the work unit of general practitioners, specialist doctors, nurses, midwives, pharmacy, sanitation, nutrition, radiology, medical records, and laboratories at Hospital X Mimika Regency, Papua, 2) respondents are aged 20-49 years, and 3) have a minimum working period of 1 year. This research was conducted from February to April 2022 through the distribution of questionnaires directly to health workers and interviews by taking one sample of respondents from each work unit.

Data Analysis
Data analysis in this study used partial least squares (SEM-PLS) based Structural Equation Modeling with Smart-PLS 3.0 application.

Measurement
The indicators used to measure the four variables in this study were adopted from several previous studies. Four indicators of perceived organizational support were adapted from Eisenberger et al. (1986); Rhoades & Eisenberger (2002); Ye et al. (2017). The transformational leadership variable was measured using four indicators adapted from Bass & Avolio (1992); Bass & Avolio (1994); Park & Pierce (2020). The variable turnover intention was measured using three indicators developed by Mobley et al. (1978); Meyer & Tett (1993). Furthermore, the measurement of the organizational commitment variable uses three indicators adapted from Meyer & Allen (1997); Wombacher & Felfe (2017); Gaudet & Tremblay (2017). Measurements in this study used a Likert scale. The Likert scale is designed to test how strongly the respondents agree or disagree with the questions on the five-point Likert scale (Sekaran & Bougie, 2016: 207).

Findings and Discussions Findings
Based on the results of data processing, 72 respondents (69.9%) aged 20-29 years, 26 respondents (25.2%) aged 30-39 years, and 5 respondents (4.9%) aged 40-49 years. Based on gender, 81 respondents (78.6%) were female, and 22 respondents (21.4%) were male. Based on the latest education, 56 respondents (54.4%) have Diploma Three education, 39 respondents (37.95) have bachelor education, 4 respondents (3.9%) have master education, 3 respondents (2.9%) have Diploma Four education, and 1 respondents (1%) have high school/vocational education. Respondents consist of three statuses, namely, permanent employees, contract, and freelance. A total of 74 respondents (71.8%) were contract employees, 23 respondents (22.3%) were permanent employees, and 6 respondents (5.8%) were casual employees. Based on the level of position, 91 respondents (88.3%) were implementing staff, 8 respondents (7.8%) were heads of work units, and 4 respondents (3.9%) were assistants in charge. Furthermore, based on years of service, obtained as many as 76 respondents (73.8%) have a working period of 2-4 years, as many as 18 respondents (17.5%) have a working period of 4-6 years, and as many as 9 respondents (8.7%) have a working period of > 6 years.  Table 1 shows that the scale, magnitude, and suitability of the statistics in this study are acceptable. It is known that the average value of variance extracted (AVE) for the perceived organizational support variable is 0.691, the transformational leadership variable is 0.709, the organizational commitment variable is 0.680, and the turnover intention variable is 0.940. Thus, all indicators are declared valid because the results of the evaluation of the measurement model have met the AVE value, which is greater than 0.50.
Cronbach's Alpha coefficient values on four variables are obtained successively: 1) 0.950 on the perceived organizational support variable, 2) 0.962 on the transformational leadership variable, 3) 0.948 on the organizational commitment variable, 3) and 0.979 on the turnover intention variable. Furthermore, through Table 1, it is also known that the composite reliability values for four variables are: 1) 0.957 on the perceived organizational support variable, 2) 0.967 on the transformational leadership variable, 3) 0.955 on the organizational commitment variable, 3) and 0.984 on the turnover intention variable. It can be concluded that all constructs are reliable according to both Cronbach Alpha and Composite Reliability. The R-Square value of the turnover intention variable in the research model is 0.473.
The Goodness of Fit (Gof) value in this study was obtained through (AVE × R²) = (0.755 × 0.585) = 0.664. It can be concluded that the model has a large predictive relevance value for turnover intention which is explained through perceived organizational support, transformational leadership, and organizational commitment.  Figure 2, it is known that the perceived influence of organizational support on turnover intention has a negative and significant effect (β= -0.240, t= 2.066, p <0.05). The effect of perceived organizational support on organizational commitment has a positive and significant effect (β= 0.331, t= 2.913, p <0.05. Based on these findings, hypothesis 1 and hypothesis 2 are accepted. Furthermore, it is known that the effect of transformational leadership on turnover intention has a negative and significant effect (β= -0.264, t= 2.084, p<0.05. The findings also show that transformational leadership has a positive and significant effect on organizational commitment (β= 0.551, t= 4.356, p<0.05). Organizational commitment is also known to have a negative and significant effect on turnover. intention (β= -0.240, t= 2.333, p<0.05) Thus, hypothesis 3, hypothesis 4, and hypothesis 5 are accepted. Surprisingly, the research in Table 2 shows that there is no effect of perceived organizational support on turnover intention through organizational commitment (β= -0.080, t= 1.757, p>0.05). From the test, it can be seen that when the influence of the mediator is included, it is seen that the perceived organizational support does not have a significant effect on turnover intention. Therefore, hypothesis 6 is rejected. Furthermore, Table 2 shows that there is an effect of transformational leadership on turnover intention through organizational commitment (β= -0.132, t=2.051, p<0.05, so hypothesis 7 is accepted. After testing the mediation on the transformational leadership variable on turnover intention, the t value is obtained. t-statistics is 2.051. The value of the direct test is 2.084 while after testing the mediation the value of t-statistics is 2.051, which means that there is a decrease in the effect when you include mediation. Thus, it can be concluded that the effect of organizational commitment as a mediating variable is perceived organizational support and transformational leadership to turnover intention is partial mediation.

Discussions
Overall, the effect of the independent variable on the dependent variable can be known through the R-Square value. The R-Square value of the turnover intention variable is known to be 0.473, which means that the perceived organizational support, transformational leadership, and organizational commitment can explain the variation of the turnover intention variable by 47.3%, while the rest is explained by other variables outside the research model. Furthermore, the R-Square value of the organizational commitment variable was 0.697, which means that the perceived variable of organizational support and transformational leadership was able to explain the organizational commitment variable of 69.7%, while the rest was explained by other variables outside the research model. Thus it is concluded that the model used in the study is categorized as strong.
Surprisingly, this study found that the organizational commitment variable was not able to mediate between the perceived organizational support variables on turnover intention. From indirect testing, it can be seen that when the influence of the mediator is included, it can be seen that the perception of organizational support does not have a significant effect on turnover intention. These findings are not in line with research Gaudet & Tremblay (2017), Fazio et al. (2017), Wong & Wong (2017) found that organizational commitment was able to mediate the relationship of organizational support to turnover intention. The findings in the field indicate that the support provided by Hospital X Mimika Regency to health workers is still very lacking, causing a decrease in the strong commitment of health workers to remain in the organization. One of the factors that make health workers tend to consider their commitment to the organization is age. Respondents are dominated by productive age. Productive age allows health workers to seek more lucrative opportunities in other organizations, with the expectation that they will receive salaries, bonuses and benefits commensurate with their contributions. In addition, respondents of productive age prefer challenges, a good team work environment, a supportive leader, and the opportunity to participate in the decision-making process. The working period of the majority of respondents is 2-4 years and most of them are contract employees with a percentage of 71.8% is also a factor that affects the organizational commitment of health workers. In terminating employment, contract workers are easier than permanent workers. Health workers stated that if they did not get and feel support from the organization, they would not renew their work contracts. Furthermore, the majority of respondents are Diploma Three graduates who are also a factor influencing the commitment of health workers. Health workers stated that they needed training from the organization in improving skills, in order to further improve their professionalism in serving patients. However, in practice, this is not in line with what is obtained by health workers. The training provided by the hospital has not been evenly distributed to all health workers, so that it affects the performance of health workers. Afsar & Badir (2017) argues that when the organization supports and treats employees fairly, develops a better perception of congruence with the values, goals, aspirations and climate of the organization, then employees are more likely to stay with the organization. Conversely, if employees do not get support from the organization in terms of self-development, working conditions, rewards, and welfare, it can create a decrease in employee confidence in the organization which can lead to turnover intention.  (2017). Perceived organizational support supports the creation of strong loyalty from employees. The results shows that allowances or bonuses or salaries are not in accordance with education level, workload, years of service, and skills, but only meet the standards of government regulations regarding regional minimum wages. Health workers with undergraduate, nurse, and pharmacist education are given relatively the same salary as health workers with diploma four, diploma three, and high school education. In addition, the salary between new employees and old employees who have worked for more than 5 years, does not have a significant difference, even tends to be equal. The training is not evenly distributed to all health workers, the absence of an organized health workforce development plan makes it difficult for health workers to meet professional organization credit points, and and the lack of trust by the organization for health workers in equipping their work according to the job, so this makes health workers feel less valued and cared for by the hospital, which in turn causes a desire to leave the organization. The strong commitment of employees to stay in the organization is a positive response to the work experience offered by the organization. Perceived organizational support makes employees feel compelled to reciprocate with the organization. This is because support is a socioemotional source such as affiliation, approval, and respect, which causes high affective commitment in employees (Rhoades & Eisenberger, 2002). The results of this study indicate that the perceived organizational support has a positive and significant effect on organizational commitment. This finding is in line with research (Panaccio & Vandenberghe, 2009;Aboramadan et al., 2020;Razzaq et al., 2019).
Leadership in an organization is a determining factor for the success or failure of an organization, because successful leadership shows that the management of an organization has been carried out successfully. Leadership that is able to make strategic changes is a hallmark of transformational leadership (Bass & Avolio, 1994;Bass, 1999;Bass & Riggio, 2006;Chemers, 1997). Transformational leadership causes employees to feel that the leader supports, respects and cares for them and leads to attachment among organizational members which can create strong organizational commitment to the organization. The results of this study indicate that transformational leadership has a negative and significant effect on turnover intention. This finding is in line with research Park & Pierce (2020); Amankwaa & Anku-Tsede (2015); Gordon et al. (2019); Ariyabuddhiphongs & Kahn (2017). The results shows that there was discomfort and dissatisfaction with the leadership style of hospital leaders felt by health workers. In addition, health workers feel that the leadership has not been able to become their role model in achieving organizational goals. Leaders do not give attention, advice and evaluation of work results, which causes reduced motivation of health workers at work. The lack of clarity of rewards from the leadership for their contributions has also made health workers not try to increase their capacity, tend to be passive, and just wait for the end of the contract to find a better place. Hospital leaders can also easily dismiss and find replacements, thus making health workers feel that their position is not safe in the hospital, therefore when their contracts are finished, health workers prefer not to renew their contracts. The results also show that transformational leadership has a positive and significant effect on organizational commitment (Eliyana et al., 2019;Ribeiro et al., 2018). Transformational leadership can move employees to achieve goals beyond self-interest for the common good (Bass, 1985). Employees will feel trust, admiration, loyalty, and respect for the leader, thus creating motivation in them to do more than what is expected (Yukl, 1999:286).
Employees will tend to retaliate and have an obligation to reciprocate the organization when employees are treated fairly. One way to do this is to increase engagement, which is defined as an increase in organizational commitment (Bernerth & Walker, 2012). This study shows that organizational commitment has a negative and significant effect on turnover intention (Suifan et al., 2017;Labrague et al., 2018;Yao et al., 2019;Kalidass & Bahron, 2015). Organizational commitment is very interesting because it has been proven to reduce the desire to change employees (Sahi & Mahajan, 2014). The results shows that health workers choose to stay at Hospital X not only because of the benefits such as free medical treatment, savings and loan cooperatives, and free ambulances, but because of the work environment that makes them feel at home and happy while working. Health workers stated that they have a good relationship with co-workers. Health workers also stated that it was like having a new family in the hospital to share their joys and sorrows, both in terms of stress due to work, role conflicts, or those from outside of work. This study also shows that organizational commitment is able to mediate the effect of transformational leadership variables on turnover intention. Transformational leadership consisting of Idealized Influence, Inspirational Motivation, Intellectual Stimulation, and individual consideration encourages health workers to have a strong sense of attachment to hospitals. This is because the support, influence and motivation given by the leader tends to create the involvement of health workers in understanding and dealing with job demands. The findings are supported by previous research Gyensare et al. (2016), Park & Pierce (2020), Ribeiro et al. (2018) found that organizational commitment mediates the effect of transformational leadership on turnover intention.

Conclusions
The results of this study indicate that the perceived organizational support and transformational leadership directly has a negative and significant effect on turnover intention. The direct effect of organizational commitment on turnover intention has a negative and significant effect. Furthermore, this study also found that perceived organizational support and transformational leadership have a positive and significant effect on organizational commitment. The results of the indirect influence test in this study also found that organizational commitment was able to mediate the effect of transformational leadership on turnover intention. Interestingly, organizational commitment has not been able to become a mediating variable between perceived organizational support and turnover intention. This shows that good/strong organizational support or low organizational support has an effect on turnover intention without mediating organizational commitment. The lack of support causes health workers to feel dissatisfied with their work and causes a decrease in the strong commitment of health workers to stay in the organization. Respondents are dominated by productive age, The working period of the majority of respondents is 2-4 years and most of them are contract employees, and majority of respondents are Diploma Three graduates be a factor that affects the commitment of health workers to the organization.
Hospital X Mimika Regency must increase support for employees, especially health workers. Hospital X Mimika Regency can provide bonuses or allowances and salaries in accordance with the level of education, workload, and years of service of health workers. Hospital X Mimika Regency must pay attention to the self-development planning of health workers by providing equitable training and fair career promotion for health workers. Both leaders and hospital management can provide authority and delegation to health workers in the decision-making process both within the organization and work units. Leaders can invest time in helping health workers achieve organizational goals, provide advice, evaluate, and ask for positive feedback that can build relationships between leaders and health workers, and give appreciation for contributions to the achievements of health workers. Hospital leaders and management need to find solutions and be able to communicate well to health and non-health workers about mistakes made, without having to reprimand directly in public, dismiss and find replacements to fill vacancies.
This study has several limitations, including: 1) the study was conducted during the Covid-19 pandemic which entered the third wave, causing health workers to not be optimal in filling out questionnaires, causing bias in respondents' answers, 2) sampling in 10 work units made it difficult for researchers to find time for health workers to distribute questionnaires, 3) the sample is small because it only consists of 103 respondents. Therefore, with the limitations of the research above, this study has several suggestions for future research, namely: 1) further research can conduct research on health workers and employees in an organization through semistructured in-depth interviews, so as to obtain accurate research results, 2) sampling for further research can be focused on only one field of work, so as to save time, 3) further research can be carried out at type a, b, or c hospitals in districts/cities/provinces that have adequate human resources.