Research On The Influence Mechanism And Incentive Strategy Of Family Doctor Team Members’ Work Input Based On The Work Requirement-resource Model

[Purpose]As the gatekeeper of residents’health,the work input of family doctors’team members directly affects the service quality and patients’medical safety.In this study,through literature research and expert consultation to determine the concept model of the impact of work requirements resources on the work engagement of family doctor team members.And through empirical investigation,statistical analysis and other steps,test the impact of various factors on the intensity of work input and path coefficient,establish the mathematical model that ultimately affects the work input of family doctor team members.Based on the key influencing factors,the optimization path is proposed from multiple dimensions in order to continuously increase the positive experience of family doctors’team members in the process of work,and provide certain reference for the development of family teams,and the formulation of health policies.[Methods](1)Literature research methodThrough the review and summary of the theoretical and empirical research literature on family doctor system,family doctor team,work requirement resources,work input,incentive model,etc.,we can lay a solid theoretical foundation for the conceptual model framework,definition selection of key dimensions,and incentive strategy of this research.(2)Research method of conceptual model frameworkOn the basis of literature research,combined with the current situation of family doctors’team development in China,an initial conceptual model framework based on the theory of work demand resource is established,and the basic categories and structural dimensions of work demand resource and work input are preliminarily defined.(3)Expert consultation and panel discussionThrough expert consultation to modify and adjust the conceptual model framework and the design of each dimension of work requirements resources,a conceptual model of work input impact mechanism based on the work requirements resources model with reasonable structure,accurate dimension and suitable promotion is obtained.(4)Empirical research method427 family doctors from 22 community health service centers in six central urban areas of Wuhan were selected by stratified proportional sampling method for field investigation.Through in-depth investigation of general practitioners,nurses,public health doctors,etc.in the family doctor team,to understand the current situation of their work input;and in-depth interviews with the heads of primary medical and health institutions,team leaders,etc.,to understand the problems in the development of the family doctor team and the strategies to be optimized for collection.(5)Mathematical statisticsSPSS 22.0 and Amos 22.0 software were used for statistical analysis,Cronbach’sαwas used for statistical analysis the reliability coefficient was used to test the reliability of each scale of the questionnaire;factor analysis and correlation analysis were used to test the validity of the questionnaire;descriptive statistical analysis,one-way ANOVA,correlation analysis and multiple linear hierarchical regression were used to analyze the influencing factors of the work input of family doctor team members;structural equation model was used to verify the family doctor team The relationship between the conceptual model of team work input and the measured data,and the factors that have direct and indirect effects on team work input are carefully observed.[Results](1)Through the careful analysis of domestic and foreign literature and the comprehensive consultation of experts in different research fields,the final conceptual model of the impact mechanism of work demand resources on work input is obtained.The conceptual model is scientific,applicable and innovative.(2)The work status questionnaire of family doctors team members has good reliability and validity.Cronbach’sαcoefficients of the scales of work requirements,work resources and work inputs were 0.91,0.91 and 0.92,respectively,indicating that the questionnaire had good reliability;kmo values of the scales of work requirements,work resources and work inputs in factor analysis were 0.88,0.89 and 0.92,respectively,and the contribution rate of common factor variance of each scale was 74.75%,67.37%,77.40%,indicating that the questionnaire has a good structure validity;the correlation coefficient between each item and the total score of the sub dimension,and between the sub dimension and the overall score is basically above 0.6,indicating that the questionnaire has a good content validity.(3)The work requirement score of family doctors’team members is in the middle level,with the average score of 3.25±0.76 for each item and the high score of quantitative workload(3.50±0.87);the overall score of work resources is in the middle level,with the average score of 3.44±0.60 for each item,the highest score of social support(3.66±0.72)and family doctors’team culture(3.63±0.76),and the highest score of work autonomy(3.00±0 74)was the lowest;the score of work input was in the middle level,8.9%of the high input population,the lowest score of vitality dimension(2.90±0.88);the highest score of focus dimension(3.15±0.18).(4)There were significant differences in gender,age,working years,education background,income level and employment style among family doctors’team members(P<0.05).And the work input was influenced by the dimensions of work quantitative load,social support,family doctor team culture and career development(P<0.05).(5)After reasonable modification,all fitting indexes of the constructed structural equation model reach good fitting standard(X~2/df is 2.78,GFI is 0.97,a,GFI is 0.94,NFI is 0.97,RFI is 0.98,IFI is 0.98,CFI is 0.98,TLI is 0.97,RMSEA is 0.06).The model can effectively explain the internal relationship among various factors in the working input mechanism of family doctor team members.The results of structural equation model show that:the effect of work requirements on work input is negative(-0.13),which is mainly reflected in quantitative workload(0.77),emotional workload(0.67),work family conflict(0.83);the indirect effect of work requirements on each dimension of work input is also weak,and the value of indirect effect is-0 11,-0.12,-0.11;the impact of work resources on work input was positive(0.57),suggesting that it had a strong positive impact,mainly reflected in social support(0.88),family doctor team culture(0.82),career development(0.64).Work resources also have indirect effects on the vitality,dedication and focus of each dimension of work input.The indirect effect values are all positive,and the indirect effect values are 0.47,0.5 and 0.48 respectively.The correlation coefficient between work requirements and work resources is negative,and the path coefficient is-0.27.[Conclusions](1)The established conceptual model is scientific,applicable and innovative in the field of family doctor research.The questionnaire designed has good reliability and validity,which can effectively measure the work requirements,work resources and work input of family doctor team members.(2)In this study,the family doctor team members’work input was in a moderate state,with high level of dedication and low level of work vitality.The work input of family doctor team members is formed by the comprehensive effect of demographic variables,work requirements,work resources and other factors.Through the research,we found that the key factors affecting the work input of family doctors are quantitative workload,social support,family doctors team culture and career development.(3)Based on the analysis of the formation mechanism of the work input of the family doctor team,by finding out the key factors and according to the ERG theory,this paper puts forward the development strategy of promoting the work input of the family doctor by the integration of the incentive subject,the incentive level and the incentive mechanism.In the future,we should pay attention to the unity of the difference and linkage of the incentive subject,the survival needs,the relationship needs and the development needs It is necessary to improve the work input level of the family doctor team as soon as possible,so as to effectively play an incentive role.