The effect of leadership on public service motivation: a multiple embedded case study in Morocco

Challenges faced by human resources for health in Morocco: A scoping review

BACKGROUND

Human resources for health (HRH) play a pivotal role in effective health system operation, yet various impediments challenge sustainable development. This scoping review aimed to explore these challenges and potential solutions in aligning the health workforce to meet the evolving healthcare needs of the Moroccan population.

METHODS

We conducted a scoping review searching PubMed, Science Direct, Cairn and Google Scholar for relevant articles published between 2014 and 2023. Additionally, non-peer-reviewed literature sourced from Ministry of Health consultations and allied websites was included.

RESULTS

Among the nineteen studies meeting our inclusion criteria, the majority were cross-sectional and predominantly focused on challenges faced by nurses. While some papers delineated multiple HRH challenges (5/19), the rest addressed specific challenges. The identified challenges span organizational and personal levels. Organizationally, the focus was on training, lifelong learning, continuing education, health coverage and shortages, and job satisfaction. At a personal level, HRH in the public health sector encountered challenges such as burnout, stress, and broader occupational health concerns.

CONCLUSIONS

The reviewed publications underscored a spectrum of challenges necessitating robust policy interventions. Despite promising developments in the Moroccan healthcare system, addressing the unequal urban-rural HRH distribution, augmenting funding, and enhancing HRH quality of life stand as pivotal imperatives.

Individual, organizational and system circumstances, and the functioning of a multi-country implementation-focused network for maternal, newborn and child health: Bangladesh, Ethiopia, Malawi, and Uganda

Better policies, investments, and programs are needed to improve the integration and quality of maternal, newborn, and child health services. Previously, partnerships and collaborations that involved multiple countries with a unified aim have been observed to yield positive results. Since 2017, the WHO and partners have hosted the Quality of Care Network [QCN], a multi-country implementation network focused on improving maternal, neonatal, and child health care. In this paper, we examine the functionality of QCN in different contexts. We focus on implementation circumstances and contexts in four network countries: Bangladesh, Ethiopia, Malawi, and Uganda. In each country, the study was conducted over several consecutive rounds between 2019-2022, employing 227 key informant interviews with major stakeholders and members of the network countries, and 42 facility observations. The collected data were coded using Nvivo-12 software and categorized thematically. The study showed that individual, organizational and system-level circumstances all played an important role in shaping implementation success in network countries, but that these levels were inter-linked. Systems that enabled leadership, motivated and trained staff, and created a positive culture of data use were critical for policy-making including addressing financing issues-to the day-to-day practice improvement at the front line. Some characteristics of QCN actively supported this, for example, shared learning forums for continuous learning, a focus on data and tracking progress, and emphasising the importance of coordinated efforts towards a common goal. However, inadequate system financing and capacity also hampered network functioning, especially in the face of external shocks.

The effects of positive leadership on quality of work and life of family doctors: The moderated role of culture

Background

Quality of work and life (QWL) of family doctors is highly valued in improving access and equity of healthcare; however, the current low level of QWL in many countries and regions needs to be improved urgently.

Methods

This study explored the effect of positive leadership on the QWL of family doctors, as well as the moderating role of culture, via analysis of data from 473 valid questionnaires of family doctors in China as a sample using SEM, hierarchical linear regression, and a simple slope test.

Results

The empirical results show that positive leadership promoted the QWL of family doctors by improving their achievement motivation and coordinating supportive resources. In addition, our hierarchical linear regression analysis found that the interactive items of positive leadership and culture had a positive effect on achievement motivation (β(a)  = 0.192), QWL (β(b)  = 0.215) and supportive resources (β(c)  = 0.195). Meanwhile, culture had a moderated mediating effect on the relationship between positive leadership and QWL via the achievement motivation of family doctors and supportive resources.

Conclusion

These findings suggest that the interaction among multiple factors, including environmental factors, individual physiological features and culture, may influence the impact of positive leadership on the QWL of family doctors. The possible reasons of these findings and theoretical and practical implications are discussed in this study.

Public Service Motivation and Determining Factors to Attract and Retain Health Professionals in the Public Sector: A Systematic Review

(1) Background: The motivational determinants of health professionals to choose and remain in the public sector have been increasingly addressed, including the customized approach of Public Service Motivation (PSM). However, to date, no systematic research overview has been performed in this domain, leaving the body of literature unstructured. This article fills this gap by assessing the motivational factors of choice for the public sector in the health field, and the conceptual and methodological trends of this research stream. (2) Methods: This study follows the PRISMA protocol to ascertain patterns in past research and inform researchers, practitioners, and policymakers. Eighty-nine documents published between 1998 and 2021 were retained after selecting them according to their theme and outlined goals. (3) Results: Common motivational determinants are remuneration, available resources, work conditions, and frequency of contact and interaction with patients. The PSM construct and scale are often employed as main frameworks, but there is also a concern in assessing motivation drawing on psychological constructs that reflect the challenging line of work and environment that is health care, such as presenteeism, stress, and perception of hindrances. (4) Conclusions: By focusing on health professionals’ motivation, this study contributes to a timely systematization in challenging times for health institutions and their human resources.

The relationship between different types of leadership, client's identity, and self-confidence and auditors' impartiality

Purpose

This paper aims to assess the effect of different leadership types, the client's identity and auditors' self-confidence on auditors' impartiality.

Design/methodology/approach

This paper is a descriptive-survey type, and the collected data are based on a predesigned questionnaire distributed in January 2020. The PLS software is used for data analysis, and the statistical population of this paper includes employed auditors in enlisted audit firms on the Official Association of Auditors. When the parameters were insignificant, the obtained probability from the model fitting was used for hypothesis testing, and the appropriateness of the model was assessed via the structural equations.

Findings

The results show a significant relationship between charismatic, transformational, participatory, delegating and bureaucratic leadership and auditors' impartiality. There is also an association between the client's identity and the auditor's impartiality. The client's identity mediates the relationship between transformational leadership and the auditor's impartiality. Moreover, there is a significant relationship between self-confidence and auditor's impartiality.

Originality/value

This paper enjoys an innovative method in the field of behavioural auditing. The effect of transformational leadership on auditor's impartiality with the mediatory role of the client's identity shows the in-depth client–auditor relationship has been taken for granted and not examined previously, so the results of this paper can lend a helping hand to audit firms to enhance the organisational performance.

How medical dominance and interprofessional conflicts undermine patient-centred care in hospitals: historical analysis and multiple embedded case study in Morocco

Background

In Morocco’s health systems, reforms were accompanied by increased tensions among doctors, nurses and health managers, poor interprofessional collaboration and counterproductive power struggles. However, little attention has focused on the processes underlying these interprofessional conflicts and their nature. Here, we explored the perspective of health workers and managers in four Moroccan hospitals.

Methods

We adopted a multiple embedded case study design and conducted 68 interviews, 8 focus group discussions and 11 group discussions with doctors, nurses, administrators and health managers at different organisational levels. We analysed what health workers (doctors and nurses) and health managers said about their sources of power, perceived roles and relationships with other healthcare professions. For our iterative qualitative data analysis, we coded all data sources using NVivo V.11 software and carried out thematic analysis using the concepts of ‘negotiated order’ and the four worldviews. For context, we used historical analysis to trace the development of medical and nursing professions during the colonial and postcolonial eras in Morocco.

Results

Our findings highlight professional hierarchies that counterbalance the power of formal hierarchies. Interprofessional interactions in Moroccan hospitals are marked by conflicts, power struggles and daily negotiated orders that may not serve the best interests of patients. The results confirm the dominance of medical specialists occupying the top of the professional hierarchy pyramid, as perceived at all levels in the four hospitals. In addition, health managers, lacking institutional backing, resources and decision spaces, often must rely on soft power when dealing with health workers to ensure smooth collaboration in care.

Conclusion

The stratified order of care professions creates hierarchical professional boundaries in Moroccan hospitals, leading to partitioning of care and poor interprofessional collaboration. More attention should be placed on empowering health workers in delivering quality care by ensuring smooth interprofessional collaboration.

How does social support affect public service motivation of healthcare workers in China: the mediating effect of job stress

Background

This study aimed to examine relations between social support, job stress, and public service motivation (PSM), also assessed how social support and job stress affect PSM in China based on the job demands-resources (JD-R) theory.

Methods

The survey investigated a sample of 973 healthcare workers employed in public hospitals in Beijing, Xiamen, and Guangzhou in 2017 (including doctors, nurses, medical technicians, and administrators). Correlation analysis and Structural equation modeling (SEM) were used.

Results

Challenge stress and hindrance stress were directly negatively associated with PSM. Supervisor support was significantly positively associated with PSM, and the path from coworker support to PSM was significant. Supervisor support was significantly negatively associated with hindrance stress, and coworker support was significantly negatively associated with challenge stress. Hindrance stress and challenge stress significantly mediated the relations between supervisor support and PSM, and between coworker support and PSM respectively. PSM might be raised by increasing supervisor support and coworker support and by limiting hindrance stress and challenge stress.

Conclusion

Our study suggests that administrators of public hospitals should be mindful of the intense job stress of healthcare workers and undertake interventions targeting challenge stress and hindrance stress. Also, public hospital administrators should encourage and assist supervisors in their leadership functions. Besides, administrators of public hospitals should emphasize coworker support and good employee relationships.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11028-9.

Programme theory and linked intervention strategy for large-scale change to improve hospital care in a low and middle-income country - A Study Pre-Protocol

In low and middle-income countries (LMIC) general hospitals are important for delivering some key acute care services. Neonatal care is emblematic of these acute services as averting deaths requires skilled care over many days from multiple professionals with at least basic equipment. However, hospital care is often of poor quality and large-scale change is needed to improve outcomes. In this manuscript we aim to show how we have drawn upon our understanding of contexts of care in Kenyan general hospital NBUs, and on social and behavioural theories that offer potential mechanisms of change in these settings, to develop an initial programme theory guiding a large scale change intervention to improve neonatal care and outcomes.  Our programme theory is an expression of our assumptions about what actions will be both useful and feasible.  It incorporates a recognition of our strengths and limitations as a research-practitioner partnership to influence change. The steps we employ represent the initial programme theory development phase commonly undertaken in many Realist Evaluations. However, unlike many Realist Evaluations that develop initial programme theories focused on pre-existing interventions or programmes, our programme theory informs the design of a new intervention that we plan to execute. Within this paper we articulate briefly how we propose to operationalise this new intervention. Finally, we outline the quantitative and qualitative research activities that we will use to address specific questions related to the delivery and effects of this new intervention, discussing some of the challenges of such study designs. We intend that this research on the intervention will inform future efforts to revise the programme theory and yield transferable learning.

Programme theory and linked intervention strategy for large-scale change to improve hospital care in a low and middle-income country - A Study Pre-Protocol

In low and middle-income countries (LMIC) general hospitals are important for delivering some key acute care services. Neonatal care is emblematic of these acute services as averting deaths requires skilled care over many days from multiple professionals with at least basic equipment. However, hospital care is often of poor quality and large-scale change is needed to improve outcomes. In this manuscript we aim to show how we have drawn upon our understanding of contexts of care in Kenyan general hospital NBUs, and on social and behavioural theories that offer potential mechanisms of change in these settings, to develop an initial programme theory guiding a large scale change intervention to improve neonatal care and outcomes.  Our programme theory is an expression of our assumptions about what actions will be both useful and feasible.  It incorporates a recognition of our strengths and limitations as a research-practitioner partnership to influence change. The steps we employ represent the initial programme theory development phase commonly undertaken in many Realist Evaluations. However, unlike many Realist Evaluations that develop initial programme theories focused on pre-existing interventions or programmes, our programme theory informs the design of a new intervention that we plan to execute. Within this paper we articulate briefly how we propose to operationalise this new intervention. Finally, we outline the quantitative and qualitative research activities that we will use to address specific questions related to the delivery and effects of this new intervention, discussing some of the challenges of such study designs. We intend that this research on the intervention will inform future efforts to revise the programme theory and yield transferable learning.

Unravelling the role of leadership in motivation of health workers in a Moroccan public hospital: a realist evaluation

OBJECTIVES

This study aimed at opening the black box of the relationship between leadership and motivation of health workers by focusing on a high-performance hospital in Morocco.

DESIGN

We adopted the realist evaluation approach and used the case study design to test the initial programme theory we formulated on the basis of a scoping review on complex leadership. We used the Intervention-Context-Actors-Mechanism-Outcome Configuration as a heuristic tool to identify plausible causal configurations.

SETTINGS

Since 2000, the Ministry of Health in Morocco initiated many reforms in the frame of the governmental deconcentration process called 'advanced regionalisation'. The implementation of these reforms is hampered by inadequate human resource management capacities of local health system managers. Yet, the National 'Concours Qualité', a national quality assurance programme implemented since 2007, demonstrated that there are many islands of excellence. We explore how leadership may play a role in explaining these islands of excellence.

PARTICIPANTS

We carried out a document review, 18 individual interviews and 3 group discussions (with doctors, administrators and nurses), and non-participant observations during a 2-week field visit in January-February 2018.

RESULTS

We confirmed that effective leaders adopt an appropriate mix of transactional, transformational and distributed leadership styles that fits the mission, goals, organisational culture and nature of tasks of the organisation and the individual characteristics of the personnel when organisational culture is conducive. Leadership effectiveness is conditioned by the degree of responsiveness to the basic psychological needs of autonomy, competence and relatedness, perceived organisational support and perceived supervisor support. Transactional and overcontrolling leadership behaviour decreased the satisfaction of the need for autonomy and mutual respect. By distributing leadership responsibilities, complex leaders create an enabling environment for collective efficacy and creative problem solving.

CONCLUSIONS

We found indications that in the Moroccan context, well-performing hospitals could be characterised by a good fit between leadership styles, organisational characteristics and individual staff attributes.