Influencing Factors And Mechanisms On The Organizational Attractiveness In Primary Health Care Institutions

Objective:The development of primary health care is the priority of China’s health care services,in which the poor configuration of primary medical staff as a provider of basic health services should not be ignored.Therefore,how to improve the organizational attractiveness of primary healthcare institutions,increase the stability of the health technician team,attract the health technicians to be employed,and reduce the staff turnover are the current problems that need to be solved urgently in primary healthcare institutions.However,through literature review,it can be found that there is lack of organizational attractiveness measurement tools applicable to healthcare institutions in the Chinese context,and there is a relative lack of research about the integral path and mechanism of the effects of organizational attractiveness.Therefore,the study focuses on the measurement of organizational attractiveness of healthcare institutions,and the current status of organizational attractiveness of primary healthcare institutions,the influencing factors and the effecting mechanisms.This study provides recommendations to improve the organizational attractiveness of primary health care institutions in China,improve the attraction,retention,motivation and development of employees,promote work enthusiasm,reduce turnover behaviors,as well as improve the quality of health services.Methods:(1)Construction of assessment scale: This study adopts the literature analysis method and Delphi expert consultation method to preliminarily formulate and optimize the theoretical framework and measurement items of the organizational attractiveness evaluation scale of medical institutions.Item analysis and exploratory factor analysis were used to further screen the entries,and Cronbach’s alpha coefficient,split-half reliability,retest reliability and validation factor analysis were used to test the reliability and validity.(2)Quantitative research: The study used purpose sampling method,based on the proportion of the number of community health service centers and township health centers in Jilin Province,each city(state)purposively selected 2 community health service centers and 6 township health centers,for a total of 18 community health service centers and 54 township health centers in 9 cities/states in Jilin Province.In November2022,with the support and cooperation of the health administration department of Jilin Province,after ensuring that informed consent was obtained,the questionnaires were administered to the on-the-job medical staff of the sample institutions.The main contents of the questionnaire included the personal characteristics of the participants(including sociodemographic characteristics,calling orientation,and work values),family characteristics(including family income level and work-family balance,etc.),work organization characteristics(including work characteristics,organizational environment characteristics,and perceived organizational support),policy and environmental characteristics(including policy characteristics,and the practice environment),of the employees psychological performance(including work engagement,organizational commitment,occupational burnout),employee behavioral performance(including job performance,turnover intention),healthcare service quality,and perceived organizational attractiveness.In April 2023,the information about human resource allocation,service delivery,annual income,and area of business space of the sample organizations in 2022 was obtained from the information system of the health administration department of Jilin Province.The study used SPSS 24.0 for descriptive analysis,univariate analysis,person correlation analysis and multivariate linear regression analysis.The fs QCA 4.1 software for fuzzy-set qualitative comparative analysis,R 4.3.1 for latent profile analysis,random forest regression analysis,and Tobit regression analysis,DEAP 2.1 software for data envelopment analysis,PROCESS Macro was used for mediation analysis,and Amos 24.0 software for path analysis.(3)Qualitative research: In order to further analyze the impact of policy environment factors on organizational attractiveness and to evaluate the organizational attractiveness of primary healthcare institutions from the multiple perspectives of current and potential employees,and to compensate for the shortcomings of quantitative research.The study used purposive sampling to select 32 primary health care staff(current employees)and 16 county-level hospital health care staff(potential employees)for semi-structured interviews.The interview data were primarily analyzed using the grounded theory analytical paradigm and coded in a bottom-up manner with the assistance of the qualitative analysis software Nvivo12.Results:(1)This study developed an assessment scale applicable to the organizational attractiveness of medical institutions in China,which contains a total of 29 items in five dimensions: economic value,developmental value,atmosphere value,work value,and basic value.The Cronbach’s α coefficient of the scale was 0.966,the split-half reliability coefficient was 0.924,and the test-retest reliability was 0.872.Results from confirmatory factor analysis revealed that the standardized factor loadings for each latent variable corresponding to the measurement items were all greater than 0.5.Additionally,the average variance extracted(AVE)for each dimension exceeded 0.5,and the composite reliability(CR)was higher than 0.7.Therefore,it can be concluded that the medical institution organizational attractiveness scale has good convergent validity and combinatorial reliability.(2)The overall score of primary health care medical staff’s perceived organizational attractiveness was 3.62±0.75(score range 1-5),which was in the medium range.Among the five dimensions,the lowest score was for economic value,at 3.21±0.92,while the highest score was for atmospheric value,at 3.89±0.71.The X scores for developmental value,work value,and fundamental value were 3.41±0.94,3.61±0.86,and 3.76±0.76,respectively.(3)The study analyzed the factors influencing the perceived organizational attractiveness of medical staff in primary health institutions.The results of the hierarchical linear regression analysis showed that work organization factors explained the highest degree of variation in organizational attractiveness at 61.4%.Among the individual factors,job title,institution type,personal work values,and calling orientation;among the family factors,self-assessed family income level;among the work organization factors,annual income,performance-based pay ratio,number of previous departures,whether or not training has been outside the institution in the past year,number of specialty departments,number of new medical technologies introduced in the past three years,the degree of drug provision to meet patients’ needs,the degree of satisfaction with occupational safety measures,and whether or not suffering from medical violence,perceived organizational support;among the policy environment factors,the effect of the title evaluation tilt policy for primary talents and the degree of title setting ratio to meet the demand were significant(P < 0.05).The importance of influencing factors on organizational attractiveness was ranked using a random forest regression model.The results showed that the perceived organizational support ranked first,followed by calling orientation,practice environment,and grouping of personal work values.The fuzzy-set qualitative comparative analysis method was used to explore the joint effects among variables.The results revealed that calling orientation,organizational support,the degree of title setting ratio to meet the demand,and the degree of satisfaction with occupational safety measures were the core conditions for high organizational attractiveness(consistency of solution = 0.950,coverage of solution= 0.773).Conversely,the absence of calling orientation,organizational support,the number of new medical technologies introduced in the past three years,and the degree of satisfaction with occupational safety measures were the core conditions for low organizational attractiveness(consistency of solution = 0.946,coverage of solution =0.696).(4)In order to further analyze the mechanism of influencing factors between different levels of organizational attractiveness of primary health care institutions,combined with multifactor analysis results,the paths of influencing factors of organizational attractiveness were analyzed by selecting calling orientation from individual factors,work-family balance from family factors,organizational support from organizational factors,and practice environment from environmental factors.The results showed that perceived organizational support and practice environment were able to influence organizational attractiveness both directly(P < 0.05)and indirectly positively(P < 0.05)through the simple mediating and chain mediating effects of workfamily balance and calling orientation,with the indirect effects accounting for 30.96%and 59.72% of the total effect,respectively.(5)Analysis of the consequences of organizational attractiveness in primary healthcare institutions revealed the following results: At the individual level,organizational attractiveness positively predicted primary healthcare staff’s work engagement,organizational commitment,and job performance(P < 0.05),while negatively predicting work burnout(P < 0.05).At the level of employee behavior,organizational attractiveness positively predicted job performance(P < 0.05)and negatively predicted turnover intention(P < 0.05).At the organizational level,organizational attractiveness positively predicted the quality and efficiency of service delivery(P < 0.05).(6)The path analysis of the impact of organizational attractiveness in primary healthcare institutions on employees and organizations showed the following: At the psychological level of employees,organizational attractiveness had direct positive impact on work engagement(effect=0.675)and organizational commitment(effect =0.564),and direct negative impact on work burnout(effect =-0.079).Additionally,it indirectly influenced organizational commitment and work burnout through the XII mediating effect of work engagement(effect= 0.210/-0.079).At the level of employee behavior,while the direct impact of organizational attractiveness on job performance was not significant,it indirectly influenced job performance through the simple and chained mediating effects of work engagement,organizational commitment,and work burnout(effect = 0.473).Similarly,the direct impact of organizational attractiveness on turnover intention was not significant,but it indirectly influenced turnover intention through the simple and chained mediating effects of work engagement,organizational commitment,and work burnout(effect =-0.054).At the organizational level,organizational attractiveness not only had a direct positive impact on service quality(effect = 0.213),but also indirectly influenced service quality through the simple and chained mediating effects of work engagement,organizational commitment,work burnout,and job performance(effect=0.423).(7)The qualitative research findings complimented the quantitative findings from the perspectives of both current employees(primary healthcare staff)and potential employees(county-level hospital medical staff).Firstly,through interviews with current employees,the study found that policy environmental factors(such as financial investment,healthcare insurance payment,medical consortium/integrated healthcare system,and essential drug system)not only directly influenced the organizational attractiveness of primary healthcare institutions but also indirectly affected it through the mediating role of internal organizational conditions(such as income,patient volume,and business development).Secondly,through interviews with potential employees(county-level hospital medical staff),the study found that potential employees perceived that the organizational attractiveness of primary health care institutions was at relatively low levels and was influenced by multiple factors including individual,family,organizational,and policy environmental aspects.Conclusion:(1)This study developed an organizational attractiveness evaluation scale for medical institutions,which could provide a measurement tool for the organizational attractiveness of medical institutions.(2)The organizational attractiveness of primary healthcare institutions in Jilin Province needs to be improved.More health technicians can be attracted by improving the performance compensation system and meeting their career development needs.(3)Factors at the level of work organization have the highest explanatory power for the organizational attractiveness of primary healthcare institutions,among which the sense of organizational support is the most important variable affecting organizational attractiveness.This suggests that primary managers should attach importance to internal organizational construction,optimize supporting facilities,actively develop medical services,and broaden career development paths for primary medical staff.(4)Good practice environment and organizational support help improve the workfamily balance and calling orientation of primary medical staff,thereby enhancing their perceived organizational attractiveness.Therefore,all sectors of society should jointly create a favorable practice environment,and organizations should formulate familyfriendly policies and cultivate the calling orientation of medical staff to effectively enhance the organizational attractiveness of primary healthcare institutions.(5)Organizational attractiveness has a positive impact on the psychological and behavioral performance of primary healthcare staff and the service quality of the organization.By improving the organizational attractiveness of primary healthcare institutions,not only can it reduce employees’ burnout and tendency to leave,but also promote employee engagement,increase the level of organizational commitment,and achieve the enhancement of work performance and healthcare service quality.(6)Qualitative research has found that the impact of policy and environmental factors on the organizational attractiveness of primary medical and health institutions cannot be ignored.Policies such as targeted admission medical students,preferential promotion of primary talent,and the implementation of integrated healthcare systems have indeed played a role in attracting health technicians and require further implementation and improvement.Moreover,government financial investment,healthcare insurance systems,and essential drug policies directly affect the income and service delivery levels of primary healthcare institutions,indirectly influencing their organizational attractiveness,which should be taken seriously by policy makers and primary management personnel.