Study On The Incentive Problems Of Health Technical Personnel In Primary Care Facilities In Rural Areas Of Zhejiang Province

ObjectivesThis study focuses on the human resources problem of primary care facilities in rural areas.The study aims to describe the development and current situation of health technical personnel,who work in township health centers(THCs)in Zhejiang Province,in the past 10 years after the new round of health system reform started.The study systematically analyzes the current situation of turnover intention,work motivation and work performance of health technical personnel in THCs,explores the impact of different incentive factors on turnover intention,work motivation and work performance.The goal of the study is to provide empirical evidence for the formulation of effective policies,improving human resources problem of primary care facilities in rural areas and promoting implementation of the "Healthy China 2030" planMethodsConsidering economic development,four counties,namely Ninghai,Wuyi,Jiangshan and Pan'an were selected.A multi-stage sampling method was employed in institution survey.Within each county,3 central THCs and 3 general THCs were selected,based on the economic status of the townships they located and their distance towards downtown of the county,and total of 24 THCs were involved.The survey content includes the current status of health technical personnel in THCs,the sociodemographic characteristics of inflow and outflow health technical personnel from 2010 to 2019,together with their time,pathways and reasons for inflow and outflow.Descriptive analysis and univariate analysis were used for the data analysis.The health technical personnel survey used a stratified cluster sampling design.All health technical personnel in THCs of the 4 counties were investigated with a sample size of 1843.The questionnaire consists of sociodemographic characteristics of health technical personnel,questionnaire for incentive factors,job satisfaction questionnaire,turnover intention scale,self-efficacy scale,occupational identity scale,work performance scale,and opinions on their careers in rural areas.Cronbach ? coefficient,exploratory factor and confirmatory factor analysis were used to evaluate the reliability and validity of the scales.Univariate analysis and multiple linear regression were used to assess the relationship between variables.To verify the theoretical hypothesis,structural equation models were appliedResultsThe institution survey analysis showed that(1)During 2010 to 2019,the total number of inflows was 590,more than that of outflows as 369,with the annual net inflow rate between 0.56%and 5.07%.The turnover rate among the health technical personnel in THCs was 108.61%(2)There were statistically significant differences in the constitutions of post,gender,professional titles and ages between inflow and outflow health technical personnel,while there were no statistically significant differences in the constitutions of their degrees Individuals with junior professional titles accounted for 73.7%of the inflow personnel,while 61.8%of outflow personnel are with the junior professional titles.The proportion of individuals with senior and intermediate professional titles in the outflow personnel was higher than that of the inflow personnel(3)Inflow personnel mainly came from fresh graduates(38.1%),open recruitment(30.7%),and peer institutions(26.9%).Outflow personnel mainly went to peer institutions(29.8%),superior hospitals(29.3%),or resigned(27.4%)(4)The main reasons for the inflow personnel choosing to work in THCs were the failure of hiring at superior hospitals(24.8%),only meeting the application requirements of primary care facilities(15.8%),steady employment(14.0%),easy access to authorized strength(12.5%).Among inflow personnel with different degrees,different ages,different pathways for inflow,there were statistically significant differences in the constitutions of reasons for inflow,respectively.The main reasons for the outflow personnel leaving THCs were that working in superior hospitals are conducive to development(17.3%),lack of personal accomplishment(12.0%),poor wages(10.9%),and heavy workload(9.0%).There were statistically significant differences in the constitutions of reasons for outflow among outflow personnel among those with different pathways for outflowThe health technical personnel survey analysis showed that(5)The highest score of incentive factors was recognition of residents(3.65±0.77),while the lowest score was interestingness of work(2.62±0.90).Except for recognition of residents and standardized management,all the other incentive factors were considered ideal by less than half of respondents,respectively.Six common factors were extracted through factor analysis,and the scores of these 6 dimensions from high to low were social and self approval(3.38±0.74),working and living condition(3.37±0.78),career development(3.3 1 ±0.83),regulation and management(3.30±0.82),education(3.18±0.86),together with financial incentives(3.07±0.85)(6)The proportion of health technical personnel in THCs who were satisfied with the overall job is 41.3%,and the score of turnover intention was 2.68±0.80.58.1%of health technical personnel have a tendency to leave the THCs in the next 5 years,while transferring to the superior hospitals would be their first choice.The score of self-efficacy(3.07±0.85)was located at the medium level.The scores of 4 dimensions of professional identity from high to low were occupational values(4.40±0.63),occupational values(4.28 ± 0.65),behavior inclination(4.25 ± 0.55)and professional cognition(3.63±0.84).In 3 dimensions of work performance,the scores of task performance and interpersonal facilitation reached the high level,while the score of work dedication was only at the medium level(7)The multiple linear regression model showed that social and self approval(?=0.286,P<0.001),financial incentives(?=0.236,P<0.001),regulation and management(?=0.088,P=0.032)had significant positive effects on j ob satisfaction.Job satisfaction(?=-0.270,P<0.001),social and self approval(?=-0.142,P<0.001),as well as regulation and management(?=-0.122,P=0.010)had significant negative effects on turnover intention.Social and self approval(?=0.293,P<0.001),working and living condition(?=0.082,P=0.031),education(?=0.139,P<0.001)and financial incentives(?=0.077,P=0.038)had significant positive effects on self-efficacy.Furthermore,social and self approval had significant positive effects on,professional cognition(?=0.390,P<0.001),behavior inclination(?=0.244,P<0.001),occupational values ?=0.303,P<0.001),and occupational values(?=0.200,P<0.001),all of 4 dimensions of professional identity Financial incentives ?=0.199,P<0.001)and education ?=0.132,P<0.001)had significant positive effects on professional cognition.Working and living condition had significant positive correlation with both behavior inclination(?=0.149,P<0.001)and occupational values(?=0.082,P=0.046).In addition,self-efficacy had significant positive correlation with all of 4 dimensions of professional identitySocial and self approval(?=0.211,P<0.001),together with working and living condition(?=0.147,P<0.001),had significant positive effects on task performance.Both social and self approval(?=0.181,P<0.001),and working and living condition(?=0.134,P<0.001)could also positively affect work dedication.Interpersonal facilitation was positively correlative with regulation and management(?=0.139,P=0.006),social and self approval(?=0.166,P<0.001),and working and living condition(?=0.120,P=0.004),but was negatively correlative with financial incentives(?=-0.104,P=0.010).Professional cognition ?=0.122,P<0.001)only had significant positive correlation with work dedication.Self-efficacy(?=0.163,P<0.001),occupational values(?=0.248,P<0.001),occupational values(?=0.094,P<0.001),and behavior inclination(?=0.070,P=0.004)had significant positive effects on work dedication,but they also had significant positive effects on the other 2 dimensions of work performance(8)Structural equation model showed that job satisfaction played as a mediator between incentive factors and turnover intention.Job satisfaction(?=-0.269,P<0.001),social and self approval(?=-0.307,P<0.001),together with career development(?=0.296,P=0.021)could reduce turnover intention directly.Financial incentives had no significant direct influences on turnover intention,but it could reduce turnover intention indirectly through job satisfaction(?=0.242,P<0.001)Both self-efficacy and professional identity played as a mediator between incentive factors and work performance.Professional identity played as a mediator between self-efficacy and work performance.At the same time,self-efficacy played as a mediator between incentive factors and professional identityProfessional identity could increase work performance directly(?=0.615,P<0.001)Self-efficacy not only had a direct influence on work performance(?=0.101,P<0.001),but also could indirectly increase work performance through professional identity(?=0.393,P<0.001).Education(?=0.343,P<0.001)as well as social and self approval(?=0.423,P<0.001)could increase work performance indirectly through self-efficacy Meanwhile,social and self approval also had an indirect influence on work performance through professional identity(?=0.400,P<0.001).There is a significant negative correlation between self-efficacy and regulation and management(?=-0.420,P<0.001)ConclusionsIn the past 10 years since the new round of health system reform,the number of health technical personnel in THCs in Zhejiang Province increased,but the growth trend had slowed down.There was a severe problem of the high mobility of personnel.The human resources of THCs were challenged by the instability of personnel with junior professional title and the run off of high-quality talent.The gap in development opportunities between superior hospitals and THCs was considered to be the main reason for the brain drain from THCs.Social and self approval,regulation and management,and financial incentives could help reduce the turnover intention of health technical personnel in THCs,and there was a risk that career development would increase their turnover intention.Social and self approval,financial incentives,education as well as working and living condition had a positive effect on promoting the motivation of health technical personnel in THCs.Social and self approval,together with education were conducive to improving work performance of health technical personnel in THCs.