Workload, Knowledge, and Medical Record Documentation Compliance: The Mediating Role of Work Motivation in a Rural Hospital

Background: Complete and accurate medical records support continuity of care, legal accountability, and health insurance claims. In resource-constrained rural hospitals, documentation shortcomings may delay reimbursement and compromise service management. Understanding workforce factors associated with documentation compliance is therefore important. Objective: This study examined the associations of workload and documentation knowledge with medical record documentation compliance, including indirect associations through work motivation, among medical and paramedical personnel at a rural Indonesian hospital. Methods: A quantitative cross-sectional study involved 83 doctors, nurses, and midwives working in inpatient and emergency units at RSUD Waibakul, Central Sumba. Workload, knowledge, and motivation were measured using respondent questionnaires, while ward supervisors rated documentation compliance. Structural equation modeling using partial least squares assessed the proposed relationships. Results: Workload was not significantly associated with documentation compliance (β = −0.162; reported p = 0.064), but was negatively associated with work motivation (β = −0.376; p = 0.001). The indirect workload–compliance association through motivation was significant (β = −0.141; reported p = 0.011). Knowledge was positively associated with compliance (β = 0.357; p < 0.001), as was motivation (β = 0.375; p < 0.001). Neither the knowledge–motivation association (reported p = 0.089) nor the indirect knowledge–compliance association through motivation (reported p = 0.082) was statistically significant. Conclusion: Documentation knowledge and work motivation were positively associated with supervisor-rated compliance, while workload showed an indirect association through motivation. These findings support carefully considering targeted documentation training, supportive motivation practices, and routine workload assessment. Causal interpretations remain limited by the cross-sectional, single-hospital design.