| Background:Health human resources are the most important and active component of health resources. For the past few years, along with the development of socialism market-economic system, the competition in health market has been much stronger and the flow of health human resources has been more active. Chinese government has paid attention to the flow of health human resources and published a series of policies to guide the rational flow of health human rescources and optimize health recources allocation sincel983.Flow of personnel has a narrow meaning and a broad meaning. The narrow meaning is the flow between different organizations. That is job hopping. The broad meaning is the change from a work state to another. The work state can mean work post, work place, occupational nature, service objects and their characters, and so on. So turnover is the narrow meaning.At present, the researches at home and abroad on the flow of health staff focused on the following aspects:(1) Research on the state of personnel flow. (2) Research on the reason or factors of personnel flow. (3) Evaluation on the effects or impact of personnel flow. (4) Policy proposals for the flow of personnel. The effects of personnel flow are the key problems among three aspects because they can reflect success or failure of the flow. Now the researches on the flow effects of personnel focus on three levels at home and abroad:society, organization and individual. The effects were both positive and negative.The researches on the flow of personnel have three characteristics:(1) The researches focused on the society level or the organization level. And the few ones studied the flow effects of personnel on individual. (2) Theoretical researches were more than empirical ones. (3) The most researches focused on the flow of a broad meaning, but not turnover (a narrow meaning). However, turnover is the most important type of all types of flow, which influences the effects of individual flow mostly. (4) The methods of the researches on the individual flow effects of personnel were to inquire them about the overall feel of flow. Assessment indicator system and evaluation methodology about the flow effects of personnel were not formed. The flow effects of personnel can impact themselves directly, such as their performance quality, work effectiveness, their health of mind and body, and people's health. So we must pay more attention to the flow effects of personnel.The evaluation on the flow effects of the health staff by individual has some significance. (1) The evaluation can help health staff to analyze and recognize their flow effects. (2) If the flow effects of the health staff were bad, the evaluation can help to find the inferior staff or their weakness, and intervene them in time. (3) The evaluation is an important basis to guide the flow of the health staff reasonably. Objectives:The work states of the health staff, who flowed into county-level public hospitals because of turnover in the areas with different economic situations of Shandong province, were investigated to synthetically evaluate the flow effects of the health staff, to compare the work states among different turn-overs, and to compare the work states of the turn-overs with those of three control groups. The first control group was the turn-overs when they worked in original unit. The second control group was the health staff who hadn't change their jobs. The third control group was the medical personnel of the county hospitals in the Forth National Health Services Survey. Some policy recommendations were suggested to further improve the work states of the health staff, improve the quality of medical services, and guide the rational flow of the health staff. The specific objectives are as follows:(1) To understand the turnover situations of the health staff before they flowed into county-level public hospitals.(2) To analyze the demographic data of the turn-overs.(3) To compare the work states of the turn-overs when they worked in original unit with those when in current unit, to compare the difference between those who had changed their jobs and not, and to compare the work states of the turn-overs with the medical personnel of the county hospitals in the Forth National Health Services Survey.(4) To compare the work states among different turn-overs.(5) To synthetical evaluate the flow effects of the health staff.(6) To propose the relevant policy recommendations of improving the work states of the health staff, improving the quality of medical services, and guiding the rational flow of the health staff. Methods:Multistage stratified cluster random sampling method was adopted to survey the health staff of all the public hospitals in the nine counties of Weihai, Heze and Dongying in Shandong Province. Health staff were divided into two groups. One was turn-overs. The other was non turn-overs. The latter one was a control group. We described the basic composition of the health staff, turnover situation and the demographic characters of the turn-overs. Univariate analysis methods were adopted to compare the work states of the turn-overs when they worked in original unit with those when in current unit, to compare work states between those who had changed their jobs and not, to compare the work states of the turn-overs with the medical personnel of the county hospitals in the Forth National Health Services Survey, and to compare the work states among different turn-overs. With three evaluation methods (TOPSIS, the Sum of Relative Distance, and RSR) based on two weights (CRITIC weight and entropy weight),we synthetically evaluated the work states of the health staff and analyzed the results by described analysis, univariate analysis and multifactorial analysis. We analyzed the turnover intention of the health staff by univariate analysis and multivariate linear regression analysis. Main results:(1) The characters of turnover. The percent of the turn-overs among health staff were different in county-level public hospitals in different areas. Most of the people changed their work when they were young, just started their work, or their education, professional qualification and administrative duties were low, while the highly qualified and experienced personnel seldom changed their work. The main reasons of the turnover were still for individuals and their families. Promotion was the main type of the turnover.(2) The effects of the turnover had both advantages and disadvantages. The advantages mainly reflected in the following aspects:The diversity of job skills were increased; The work significance was increased; The job autonomy was improved; The degree of the work feedback was increased; The individual capacity was improved by the work; The work satisfaction was increased; The intension of dimission was reduced; The job involvement was increased; The job burnout was dropped; The average monthly income was increased. The disadvantages mainly reflected in the following aspects: The workload was increased; The negative emotions were increased; The job control was decreased; The work stress was increased; The extent of the work affecting the family was increased; The work intensity was greater; The patients trust was reduced; The medical tangle was increased; The working environment deteriorated.(3) The overall effect of the turnover was better. The work states of the turn-overs when they worked in current units were best, those who had not changed their work were better, and the worst were the turn-overs when thet worked in their original units. The feature of the good work states of the turn-overs were as following:downward turn-overs, female, older, department of pediatrics, traditional Chinese medicine or others, with at or below special secondary academic credentials. The feature of the bad work states of the turn-overs were as following:upward turn-overs, male, younger, surgical department, gynae department, or medical department, academic credentials at or above undergraduate. The turn-overs whose scores of synthetical evaluation in current units were higher than in original units had the following characteristics:their income improved, their work intensity reducing, owning more active work attitude and morale, the better job characteristics. The turn-overs whose scores were lower than before shows the following feature:larger work intensity, worse work emotion, work greatly affecting family and worse work feeling and attitude.(4) The overall work states of those who had not changed their work were worse than turn-overs. It was demonstrated as follows:The job autonomy was low; The satisfaction with the direct supervisor and the overall satisfaction was low; The turnover intention was high, especially "I always want to leave the hospital" and "Next year I will likely find a new job". The percentage of the moderate degree of the job burnout was high. In particular, the extent of reduced personal accomplishment was high; The extent of the family affected by the work was small, mainly because the pressure conflict was small; The longest continuous working time last week and the number of night shifts per month were both high. The average monthly income was low; The wish to improve individual income, work ability, and work conditions was more than turn-overs; The esteem degree of the patients and residents was low; The confidence degree of the patients was low; The evaluation on the practice environment of non turn-overs was worse than that of turn-overs.(5) The higher turnover intentions were, the lower synthetical evaluation scores of the work states were. The risk factors of the turnover intention were as following:medical department, bad assessments of the practice environment, low degree of the diversity of job skills, small level of improving the individual's capacity, low degree of job satisfaction, high degree of job autonomy, high requirement for the expression of individual emotions, high working pressure, high job burnout. There were no differences of the turnover intension between turn-overs and non turn-overs. Suggestions:(1) It ought to guide the rational flow of the health staff from macro level. From social level, first, it should improve the laws, regulations, policies and systems. Second, it should create a policy environment of attracting talents, selecting talents, rewarding talents, and evaluating talents that matches with the socialist market economy. Third, it needs to implement all polices to encourage the health professionals to grass-roots organizations and work in the underdeveloped areas. Fourth, a good social atmosphere of professional ethics should be established.From the employer level, first, in order to make the useful talents "get in", it need promote the flexible policy actively such as:implementing system of employment under contract, opening recruitment, employing on the basis of competitive selection, and the combination of full-time and part-time. Second, in order to "retain" the talents, it should do as following:to provide a good remuneration package and living conditions; to implement human-based management; to focus on the management of the existing talents and introducing talents; to create a good working environment; to change the previous employment mechanism that constrained by administration into constrained by demand and values; to draw up the effective incentive mechanism; to emphasis on career planning of the health staff. Third, for the rational flow of health staff, it should establish the dismissal and resignation system, unclog personnel' export and make the personnel system more flexible. (2) It ought to find the key personnel who are prone to change their work, and then the measures of intervention and guidance could be taken timely. Different measures and guidance should be taken to cope with the crises such as:the crisis of probationary period, the promotion crisis in active service for two years and the job burnout crisis in active service for five years.(3) It should provide the conditions for the turn-overs to play good working conditions. To help the turn-overs to adapt to the changes of the job characteristics as soon as possible; to acquaint the turn-overs with their work emotions and feeling; to help the turn-overs to solve family problems; to concern about the attitude of the turn-overs; to resolve the relative problems that may affect the turn-overs.(4) It ought to pay more attention to the work states of the health staff who had not changed their work. Significance and innovation:At present, a variety of domestic and international literatures show that the empirical researches on the turnover effects of the health staff at personal level are very few, and most researches referred to the level of society and units. So they ignored the influence of turnover on the health staff themselves. Therefore, this study can make up the gap and has some innovative and practical significance. The conclusions of this study has an important role and the positive and practical significance for further improving the work states of health staff, improving the quality of medical services, and guiding the rational flow of health staff. |
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