| Background:The authorized strength system of large government-run hospitals is the personnel management method in the old era of the planned economic system in China.This personnel management method,which targeted at the units and implemented by the government departments,has no longer fit into the reality and requirements of China's new socialist market economy,and may not only hinder the implementation and promotion of China's reform of the health care system,but also hamper the development of health services in China.The cancellation of the authorized strength system of large government-run hospitals is in line with the needs of large government-run hospitals at the current stage of reform;it is conducive to the rationalization and fairness of the distribution of staff salaries in large government-run hospitals in China;and it is conducive to the rational redistribution of employees and human resources in China's healthcare service industry;It is also conducive to the promotion of the liberation and development of the modern hospital's productivity in China.Therefore,the cancellation of this old personnel management system of large government-run hospitals is the general trend of the development of China's medical and health system reform.However,as the most sensitive topic and garet difficulty in the reform of public hospitals,this reform measures may confront enormous challenges and require rigorous policy analysis and research.Otherwise,it will affect the job satisfaction of employees in public hospitals and undermine the stability of employees in the curent medical service industry.Objective:There are four main purposes of this study:1)to better understand the current status,characteristics,and influencing factors of employee job satisfaction in the best provincial comprehensive government-run tertiary hospitals.2)to understand the awareness and attitudes of employees of provincial comprehensive tertiary hospitals towards the reform of abolishing the old establishment systems in public hospitals;analyze the differences and influencing factors in cognitive and attitude among different staff groups.3)to verify the possible and the nature of correlation between job satisfaction of employees in provincial comprehensive tertiary hospitals and the cognition of employees in canceling the current establishment system.4)Multi-perspective thinking and analysis were used to better understand the ideas of reform and future plans for public hospitals and provide reference for relevant administrative units or medical institutions to formulate more scientific,reasonable,and practical reform policies,suggestions and policy guidance so as to stabilize the workforce of provincial teriary hospitals and to assist the reform of cancelling the authorized strength system in large government-run hospitals.Methods:1.Sampling processThis study took Jiangxi province as an example.Firstly,we selected all the large provincial government-run comprehensive tertiary hospitals in Nanchang,the capital city of Jiangxi province.Secondly,the sample size of each hospitals was calculated.according to the total number of employees(with 10%)in provincial government-run comprehensive tertiary hospitals.Thirdly,all the in-service staff of all hospitals are stratified according to different departments,kinds of work,number and structure of personnel(doctors,nurses,administration,support personnel,etc.),and the number of samples at each layer is determined in proportion.Finally,the selection of survey participants is carried out within each layer groups.2.Survey methodsQuestionnaires were issued by the qualified research team who went through a uniform training from investigators.The survey respondents filled in their own answers based on their actual situation and their understanding of the questionnaire.The survey was taken in an anonymous form and the completed questionnaire was retrieved and verified by the investigators.3.Survey tools and contentThe study used the Chinese version of "Minnesota Job Satisfaction-Simplified Edition" scale and the self-designed questionnaire "Awareness investigation of cancelling the authorized strength system for the employees from provincial comprehensive tertiary hospitals".The "Minnesota Job Satisfaction-Simplified Edition" scale consists of 20 items,is divided into internal,external and overall satisfaction.The self-designed questionnaire includes the basic information of the survey respondents(sex,age,income,etc.)and the employee's awareness of the cancellation of the authorized strength system(concerns,awareness,and attitudes towards the cancellation of the authorized strength system).4.Data entry and analysisThe members of the research team checked the questionnaires for logical verification according to the uniform standards and removed the questionnaires with poor quality to ensure the accuracy of the data.Database was created by.using EpiData version 3.1.The members of the research team double-entered the qualified questionnaire into two different files and was cross-checked twice.The information was verified by comparing it with the original questionnaire if the files did not match.Database collation and analysis were completed by the Statistical Package for the Social Sciences(SPSS)version 23.0.The p-value of less than 5%was considered to be statistically significant.Descriptive statistics frequencies,proportions,composition ratios and mean±standard deviation were used for statistical description,t-tests and logistic regression models were employed to run all statistical inferences.Results:1.Sample characteristicsIn this study,a total of 1200 questionnaires were issued in four provincial comprehensive tertiary hospitals,1131 were recovered,and the recovery rate was 94.25%,of which 1029 were valid questionnaires,and the effective questionnaire rate was 90.98%.Among them,women accounted for 56.07%.The proportions of people under 30,30-44,and 45-60 were 25.17%,54.42%,and 20.41%,respectively.The proportion of employees with bachelor's and master's degrees accounted for 27.41%and 40.52%respectively.These with an average monthly income between 3000 and 5,000 yuan accounted for 20.60%,and that between 5001 and 7000 yuan was 33.33%,and that over 7,000 yuan accounted for 43.83%.And 30.71%of the respondents were nurses,36.83%were doctors,11.95%were medical technicians,and 13.12%were administrative staff.There were 55.39%of the employment forms for the staff were officially hired by the authorized strength system.2.Job satisfaction and influencing factors among the employees of provincial comprehensive tertiary hospitalsThe average score of the overall self-evaluation job satisfaction of the employees from the best provincial comprehensive hospitals in Jiangxi province was 86.40±15.41,the average score of internal job satisfaction was 52.03±9.80,and the average score of external job satisfaction was 25.44±4.59.The employees with lower satisfaction were mainly:employees aged 30-44 years old(OR=0.60,p<0.001)and 45-60 years old(OR=0.67,p<0.01);bachelor's degree(OR=0.39,p<0.001)and master's degree(OR=0.28,p<0.001);employees with an average monthly income between 5001 and 7000 yuan(OR=0.33,p<0.01);employees with primary technical titles(OR=0.60,p<0.05),employees with middle technical titles(OR=0.41,p<0.001),employees with sub-advanced technical titles(OR=0.59,p<0.01),and advanced technical title groups(OR=0.58,p<0.01).Compared with health care workers,the overall job satisfaction of medical technicians(OR=1.75,p<0.01),administrative staffs(OR=1.77,p<0.01),support personnel and other employees(OR=7.13,p<0.010)obtained the higher overall job satisfaction.3.Awareness and influencing factors of abolishing authorized strength system among the employees of provincial comprehensive tertiary hospitalsIn this study,53.94%of the tertiary hospital workers stated that they were not concerned about the personnel system reform of Chinese government-run hospitals,and 28.47%of the respondents said they had not heard of the personnel system reform that the provincial comprehensive tertiary hospitals will "cancel the authorized strength system," Nevertheless,59.48%of the respondents expressed support for public hospitals to cancel the authorized strength system.There was a positive correlation between the staffs concern rate of cancellation and the awareness rate(rs=0.657,p<0.001),yet there is no correlation between the support rate and the attention rate and awareness rate.There were 93.29%of workers indicated that they will not resigned if the public hospital cancels the authorized strength system.The population that did not support abolishing authorized strength system were mainly the following employees:female employees(OR=1.59,p<0.001);employees aged 30 to 44 years old(OR=1.49,p<0.01);and employees with a bachelor's degree(OR=1.32,p<0.05).)and master's degree(OR=1.07,p<0.05);workers with an average monthly income between 5001 and 7000 yuan(OR=2.33,p<0.05);workers with an intermediate technical title(OR=3.51,p<0.001)and sub-advanced technical title(OR=2.92,p<0.001).The doctors(OR=0.57,p<0.01)and these staffs who has not obtained the authorized strength(OR=0.17,p<0.001)have the lower proportion in disagree the cancellation of the authorized strength system.4.Correlation between job satisfaction and supportive attitude for cancellation of the authorized strength systemThe simple correlation results of unadjusted model indicate there was a positive correlation among internal job satisfaction(B = 2.89,95%CI:1.68-4.10),external job satisfaction(B = 1.57,95%CI:1.01-2.13),and overall job satisfaction(B = 4.99,95%CI:3.09-6.88)of the employees and whether to support the provincial comprehensive hospitals to cancel the authorized strength system.After adjusting for all potential confounding variables,we still found the positive correlation among internal job satisfaction(B = 4.27,95%CI:3.05-5.50),external job satisfaction(B =2.30,95%CI:1.73-2.86),and overall job satisfaction(B = 7.18,95%CI:5.25-9.11)of the employees and whether to support the provincial comprehensive hospitals to cancel the authorized strength system.The final parimonious model showed the strong positive correlation among internal job satisfaction(B = 4.25,95%CI:3.03-5.46),external job satisfaction(B = 2.23,95%CI:1.67-2.79),and overall job satisfaction(B = 7.03,95%CI:5.13-8.95)of the employees and whether to support the provincial comprehensive hospitals to cancel the authorized strength system.Conclusions:The employees from the best provincial comprehensive tertiary hospitals are generally satisfied with the current working conditions and are within the scope of"acceptable",but the satisfaction with the pay and the workload of the work is "not satisfied",which should be taken seriously.The most important factors affecting job satisfaction are respondents' age,marital status,education level,the average monthly income,disparate administrative levels and different titles,professional degrees,and whether they were employed by the government.Among them,the respondents' age,educational level,average monthly income,disparate administrative levels and different titles,professional degrees are the common influencing factors which affect the overall job satisfaction,internal job satisfaction and external job satisfaction of the employees in provincial comprehensive tertiary hospitals.Whether or not they were employed by the government is the common factor for the workers' overall job satisfaction and internal job satisfaction,marital status is the main factor for the workers' external job satisfaction.Most employees in provincial tertiary hospitals did not show uncertainty about the personnel system reform of Chinese government-run hospitals that try to abandon the old institution establishment personal system.Yet,a large number of employees from the best provincial comprehensive hospitals in Jiangxi province had the supportive attitude to the personnel system reform of Chinese government-run hospitals that try to abandon the old institution establishment personal system,which indicated that abolishing the institution system in government-run hospitals has the certain base for the cancellation of their establishment in the best provincial comprehensive tertiary hospitals.The main reasons that majority of employees from the best provincial comprehensive hospitals in Jiangxi province who support the personnel system reform of Chinese government-run hospitals that try to abandon the old institution establishment personal system were:first of all,to make the distribution of staff more equitable and reasonable,and secondly to ensure that staffs receive more equal opportunities for career development and to enable the flow of the talent.The main reason for employee to oppose the public hospitals' cancellation is that the difficulty in adjusting employee welfare pay adjustments for internal and external staff,the difficulty to manage personnel placement and appeasement problems,and fear that the cost of seeking medical treatment for patients will become higher.Respondents' age,gender,education level,average income,specific jobs,the level of technical titles and whether they were employed by the government were the most important demographic factors that affecting whether or not the employees from the best provincial comprehensive hospitals support the personnel system reform of Chinese government-run hospitals that try to abandon the old institution establishment personal system.There is a positive relationship between employees' job satisfaction in the province's comprehensive tertiary hospitals and whether they support the personnel system reform of Chinese government-run hospitals that try to abandon the old institution establishment personal system,which means that workers with higher job satisfaction are more likely to support the public hospitals in canceling the old institution establishment personal system.Therefore,in order to promote the reform of the personnel system in public hospitals,the stakeholders must first consider the working conditions of public hospital employees,and strive to improve the job satisfaction of employees in public hospitals in all aspects through effective and scientific management methods,which will effectively promote and implement public hospitals to abolish the old institution legislation of authorized strength. |
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