Study On The Strategies For Training Of Managers And Motivation Of Workers In Primary Health Institutions In Shandong Province

Research BackgroundSince the outbreak of COVID-19 pandemic in 2019,the normalization of community epidemic prevention and control has made the strong power of the primary health system further visible.The development of primary health matters both for China and the rest of the world.The COVID-19 pandemic,a challenge to the health service system,also puts higher demands on the quality of primary health services in China.Since the new medical reform in 2009,ongoing advancement has been made in the primary health care service system in Shandong Province,and the positioning of primary health institutions has been increasingly rational.But for a long time there are problems such as poor management of primary health institutions,difficulty in recruitment and low vitality,which seriously hinder the primary health service system from getting further improvement.The talent team for primary health institutions includes both the team of the management and the team of health workers.The management are the strong leaders of the primary health service system,and the primary health workers are the direct providers of the primary health services.If we want to provide a higher quality of primary health services,we need to improve the management skills of the management and the motivation and team stability of the workforce.However,as the management for primary health are slow to make themselves more professional,their existing management knowledge can hardly meet the demand.Besides,primary health workers are not motivated enough,letting the brain drain become a major problem.Therefore,it is essential to clarify the specific strategies to enhance the management skills of the management for primary health through training and to identify the internal reasons that affect the work motivation of primary health workers,and to identify the internal management factors that affect work motivation.These are vital for improving the efficiency and ability of all primary staff,including the management,and thus improving the quality of primary health services.Purpose of the StudyThis study centers on two issues:first,to explore training needs and strategies to improve the management skills of the management for primary health institutions;and second,to propose strategies to make primary health workers more motivated by identifying the causes affecting work motivation.By studying these two issues,a comprehensive strategy is put forward for optimizing and improving primary health care services,in a bid to make the work of primary personnel more efficient,with a view to achieving the overall goal of delivering a higher quality of primary health services.The research falls into following parts.1.To the current work status and management training needs of the management for primary health in Shandong Province.2.To understand the work motivation of primary health workers in China and analyze the factors influencing their work motivation.3.To put forward training strategies to improve the management skills of the management for primary health and strategies to improve the work motivation of primary health workers.4.To propose policy recommendations for the coordinated development of primary workers and the management to help deliver a higher quality of health services.Materials and MethodsThe data of this study were obtained from the survey data of the key topic of health policy research in Shandong Province in 2020,"Research on the status quo and countermeasures of training and employment of the management for primary health in Shandong Province".The literature research method was used to understand the research progress at home and abroad.The questionnaire,developed through the focus group method and expert consultation method,included a self-made questionnaire and a job motivation questionnaire for primary health workers,and the Cronbach’s α of the motivation questionnaire was 0.9223,with P<0.05,and the reliability of the self-made questionnaire was comparatively better.The questionnaire was distributed in the form of a web-based questionnaire with multi-stage random sampling,and a total of 6 cities,Qingdao,Jinan,Heze,Tai’an,Binzhou and Liaocheng,and 72 primary health institutions,including 36 township health centers and 36 community health service centers each were engaged in answering the questionnaire.Among that,161 people,who were the directors/vice directors of township health centers and directors/vice directors of community health service centers,were surveyed,and 1605 primary health worker were also involved in the survey.Statistical analysis was conducted mainly via Stata 15,0 in this study.Descriptive analysis was employed to describe the basic information,including personal,work,and training information of the management of primary health institutions,as well as the information of training needs,and to describe the information of personal attributes,organizational management attributes,and job satisfaction of primary health workers.Differences in training needs of the management of primary health institutions in different positions were subject to univariate analysis.If the variable satisfies the normal distribution and the homogeneity of variance,the T-test or ANOVA is used,otherwise the rank sum test is used.The intrinsic dimensions of the job motivation questionnaire were verified by validation factor analysis.The influencing factors of job motivation were explored by stepwise regression analysis.Research ResultsIn this study,165 questionnaires were collected from the management of primary health institutions,161 of which were valid,representing an effective rate of 97.58%.1687 questionnaires were collected from primary health workers,1605 of which were valid,representing an effective rate of 94.15%.1.Status quo of training for the management of primary health institutionsThe training for the management is mainly conducted via short-term training and network training.74.53%and 42.86%of the management of medical institutions have participated in short-term training and network training in the past three years.With respect to training frequency,17.39%of them had only one short-term training,82.61%of them had 2-3 times of training,and each person had only one short-term training opportunity each year on average.Health administrative departments at municipal and county levels were the main organizers(24.84%)of such training,followed by provincial health administrative departments(24.84%).The main form of lectures was theoretical lectures(77.5%).12.5%was telemedicine network education,and another 5.59%was practical teaching.With regard to training content,management training accounted for 50.93%,physician skills training accounted for 35.40%,and 50.99%of the respondents’ training content was epidemic emergency training due to the current period when epidemic prevention and control are required.2.Training needs of the management of primary health institutionsBased on the system theory,in this study,the training needs of the management of primary health institutions were investigated from three aspects:subjective willingness of the management,objective needs of job requirements,and employee perspectives.Subjective willingness of the management.On the question of whether you are willing to receive management training,only 5(3.11%)said they were not willing to participate because of "heavy workload,no time" and "old age,learning ability declining".In terms of the desired frequency of training,65.38%of the management wanted to receive short-term training 2-3 times a year.In terms of time arrangement,most of the management wanted each training to last 2-7 days(78.21%).With regard to training organizers,17.95%wanted the training to be organized by municipal or county administration.With respect to the desired training methods,17.95%and 40.38%chose group case discussion and practical teaching,respectively.For the form of training assessment,43.59%of the management wanted to receive practical assessment,while 27.56%wanted to receive theoretical assessment.For reward and incentive policy,half of the management hoped that the training experience and assessment results could be linked to personal performance,another 23.08%hoped that they could be linked to promotion opportunities,and 56.41%hoped that they could get the corresponding training or assessment certificates.Objective needs of job requirements:personnel management,financial management and party building management were the most important job requirements of the dean and director,followed by the industry conduct building,logistics and information management.However,the work requirements for the vice president/deputy director were more dispersed,in which the most important ones in turn were personnel management,division of labor and collaboration management,as well as logistics service management.The main management requirements for the dean/director were emergency management of public health emergencies,accounting for 54.55%,management of family doctor contracting services,accounting for 52.73%,and medical quality and safety,accounting for 52.73%.The main business management requirements for the vice president/vice director were management of family doctor contracting services and emergency management of public health emergencies.Employee perspective:Primary health employees believed that the weakest part in administrative management of medical institutions at present is division of labor and collaboration management and personnel management.Both division of labor and collaboration and personnel management are important links in human resource management.Employees believed that the institutions need to make improvements in human resource management.Medical quality and safety and telemedicine services were believed to be the weakest part in business management.With respect to the importance of management knowledge,primary health workers,like the management,considered performance management theory and pragmatism to be the most important,followed by management communication and team building.3.Factors influencing the motivation of primary health workersPersonal factors:there were differences in motivation of primary health workers in different age groups.As they age,their satisfaction gradually decreased,and the difference was statistically significant,(χ2=27.523,P<0.001).There were also differences in satisfaction of workers with different titles,with the most satisfaction in associate senior titles,followed by junior titles and below,and the least satisfaction in intermediate titles(χ2=34.078,P<0.05).There were also differences in the satisfaction of employees in different job types(χ2=8.272,P<0.05),with the least satisfaction in management positions,followed by professional and technical positions,and the most satisfaction in workplace positions.Working environment factors:convenience of life,hospital management level,training opportunities,promotion opportunities,and equipment support were all factors that affect the evaluation of motivation.The higher the convenience of life,the more training and promotion opportunities,and the better the equipment support,the higher the satisfaction of primary health workers.This means the higher the motivation,the more statistically significant(P<0.05)the difference would be.For interpersonal relationship attributes,the results of the study showed that the relationship between leaders,superiors,respect or recognition from the masses,and interpersonal relationships with colleagues all posed an impact on motivation.Specifically,the better the relationship with the leaders,the more respect and recognition from the masses,and the better the relationship with colleagues,the higher their satisfaction,and the difference was statistically significant(P<0.05).management factors:In addition,the better the president’s management ability,the better the institutional system,the better the institutional management effect,and the higher their motivation and positive behavior(P<0.05).Conclusions and RecommendationsAs there were comparatively few training opportunities for the management of primary health institutions,it was difficult to meet the demand.The training was conducted in a single form,mainly through theoretical lectures,which was difficult to combine with the actual application needs,and the training effect was poor.The idea of "valuing medical care more than management skills" still existed.The training management mechanism was not sound,the content was not systematical,the training focus was not clear,and there was a lack of unified assessment and incentive mechanisms.The lack of incentive in income and welfare security,unclear development and promotion paths,few training opportunities,and inadequate internal management system all posed a negative impact on the motivation of primary health workers.Based on the findings and conclusions of the study,the following policy recommendations are proposed.1.We should improve the management capacity of the management of primary health institutions by changing traditional concepts,attaching more importance to management training,offering more training opportunities and enriching training contents.We should also establish strict training management rules,set up training assessment and reward mechanisms,and make innovations in training methods in light of national policies.2.We should make primary health workers more motivated by improving their personal income and welfare guarantee,offering more training opportunities,strengthening job identification,and perfecting personal development and incentive mechanisms3.Strategic suggestions based on system theory:We should unify the selection and appointment of the management,clarify the promotion paths of primary employees,strengthen the cultural construction of primary organizations and promote internal self-improvement.We should also optimize the assessment procedures of primary health organizations and reduce the tedious work at the primary level.