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Objectives : The aim of this study was to identify the relationship between Organizational Citizenship Behavior (OCB) and quality of service (QoS) on pay satisfaction for employees at small-and medium-sized hospital that adopted an annual salary system. Methods : The subjects were 136 employees working at 2 Small-and Medium-sized Hospitals in Seoul and Daejeon. The data were collected from May 11 to May 22, 2015 using a structured questionnaire. For data analysis, descriptive statistics, Pearson correlation coefficient, t-test, ANOVA and Scheffé test were used with the SPSS 21 package. Results : The mean score for pay satisfaction perceived by the employees at small-and medium-sized Hospitals that adopted an annual salary system was 1.74. The mean score for OCB and QoS was 4.02 and 4.43, respectively. The pay satisfaction perceived by the employees at small-and medium-sized Hospitals that adopted an annual salary system were positively related to the OCB. Pay satisfaction was positively related to the QoS; however, it was not statistically significant. The OCB and QoS showed a significant difference in age, marital status, and education level. Conclusions : Small and Medium sized Hospitals have to develop an efficient pay management system which evaluates the CSFs and KPI of every department or staff member.