Working Atmosphere and Job Satisfaction of Health Care Staff in Kenya: An Exploratory Study

Clinical diagnosis in paediatric patients at urban primary health care facilities in southern Malawi: a longitudinal observational study

Background

Despite health centres being the first point of contact of care, there are challenges faced in providing care to patients at this level. In Malawi, service provision barriers reported at this level included long waiting times, high numbers of patients and erratic consultation systems which lead to mis-diagnosis and delayed referrals. Proper case management at this level of care is critical to prevent severe disease and deaths in children. We aimed to adopt Emergency, Triage, Assessment and Treatment algorithm (ETAT) to improve ability to identify severe illness in children at primary health centre (PHC) through comparison with secondary level diagnoses.

Methods

We implemented ETAT mobile Health (mHealth) at eight urban PHCs in Blantyre, Malawi between April 2017 and September 2018. Health workers and support staff were trained in mHealth ETAT. Stabilisation rooms were established and equipped with emergency equipment. All PHCs used an electronic tracking system to triage and track sick children on referral to secondary care, facilitated by a unique barcode. Support staff at PHC triaged sick children using ETAT Emergency (E), Priority (P) and Queue (Q) symptoms and clinician gave clinical diagnosis. The secondary level diagnosis was considered as a gold standard. We used statistical computing software R (v3.5.1) and used exact 95% binomial confidence intervals when estimating diagnosis agreement proportions.

Results

Eight-five percentage of all cases where assigned to E (9.0%) and P (75.5%) groups. Pneumonia was the most common PHC level diagnosis across all three triage groups (E, P, Q). The PHC level diagnosis of trauma was the most commonly confirmed diagnosis at secondary level facility (85.0%), while a PHC diagnosis of pneumonia was least likely to be confirmed at secondary level (39.6%). The secondary level diagnosis least likely to have been identified at PHC level was bronchiolitis 3 (5.2%). The majority of bronchiolitis cases (n = 50; (86.2%) were classified as pneumonia at the PHC level facility.

Conclusions

Implementing a sustainable and consistent ETAT approach with stabilisation and treatment capacity at PHC level reinforce staff capacity to diagnose and has the potential to reduce other health system costs through fewer, timely and appropriate referrals.

Assessment of Job Satisfaction Level and Its Associated Factors among Health Workers in Addis Ababa Health Centers: A Cross-Sectional Study

Health workers account for the largest share of public expenditures on health and play an important role in improving the quality of health services. There is concern that poor health worker performance limits the effectiveness of health systems strengthening efforts. A cross-sectional study was conducted from September to October 2016 in Addis Ababa health centers. Data were collected from 420 healthcare workers using a pretested and structured questionnaire by trained data collectors. EPI Info 7 was used for data entry, and analysis was done by SPSS version 20. Bivariate and multivariate logistic analyses were used to identify factors associated with the outcome variable and to control confounders. $P$ values less than 0.05 were considered statistically significant. The overall job satisfaction level accounts for 53.8% with 95% CI of (48.9%, 59.0%). Marital status and professional qualification were the potent predictors of job satisfaction. Respondents who never married were 1.65 times more likely to be satisfied in their job than those married or divorced (AOR: 1.65 (95% CI: 1.02, 2.66)). Laboratory professionals and nursing professionals were 2.74 and 1.97 times more likely to be satisfied in their job compared to health officers (AOR: 2.47 (95% CI: 1.14, 6.59) and AOR: 1.97 (95% CI: 1.12, 3.48), respectively). More than half of the healthcare workers in the study area were satisfied in their job. Marital status and healthcare workers’ profession type were predictors of job satisfaction. Research studies indicate that there is a positive relationship between performance and job satisfaction. Accordingly, the present study aimed at determining the level of job satisfaction of health workers and its associated factors in the health centers of Addis Ababa, Ethiopia.

Assessing Patient Safety Culture: Application of the Safety Attitudes Questionnaire in a Kenyan Setting

Background:

Patient safety has recently been declared a global health priority. Achievement and sustenance of a culture of patient safety require a regular and timely assessment of the organization. The Safety Attitudes Questionnaire is a patient safety culture assessment tool whose usefulness has been established in countries, but a few studies have been published from Africa, more so, in Kenyan settings.

Objective:

To evaluate the reliability of the Safety Attitudes Questionnaire in assessing the patient safety culture in a Kenyan setting and to assess healthcare workers' perceptions of patient safety culture.

Methods:

A descriptive quantitative approach was utilized whereby the Safety Attitudes Questionnaire was administered to 241 healthcare workers in two public hospitals. The Cronbach’s α was calculated to determine the internal consistency of the SAQ. Descriptive and inferential statistics were used to analyze and describe the data on patient safety culture.

Results:

The total scale Cronbach’s alpha of the SAQ was 0.86, while that of the six dimensions was 0.65 to 0.90. The overall mean score of the total SAQ was 65.8 (9.9). Participants had the highest positive perception for Job Satisfaction with a mean score of 78.3 (16.1) while the lowest was evaluated for Stress Recognition with a mean score of 53.8 (28.6).

Conclusion:

The SAQ demonstrated satisfactory internal consistency and is suitable for use in the Kenyan context. The perception of patient safety culture in the Kenyan hospital is below international recommendations. There is a need for implementation of strategies for the improvement of the organization culture in Kenyan hospitals.

Perceived organizational culture and its relationship with job satisfaction in primary hospitals of Jimma zone and Jimma town administration, correlational study

BACKGROUND

The concept of Organizational Culture (OC) which refers to the pattern of values, norms, beliefs, attitudes and assumptions may not be articulated through verbal language. However, it shapes the way people behave and the way things get done in an organization. The management of organizational culture is increasingly viewed as necessary part of health system reform. Major cultural transformation of an organization must be secured alongside structural and procedural changes in order to achieve desired quality and performances improvements in health systems. It is therefore essential to understand organizational culture, job satisfaction level of the health workers and the link between them.

METHODOLOGY

Facility based cross sectional study was conducted in four primary hospitals of Jimma zone and town administration. A self-administered questionnaire was used to collect the data. The collected data were checked for completeness, entered and documented into Epi-data version 3.1 and Exported to SPSS version 21 for analysis. Finally descriptive statistics, Paired t-test and multiple linear regression analysis were used to assess the relationship between organizational culture and job satisfaction and the results were presented using tables and charts.

RESULT

It was indicated from the finding that, the dominant existing organizational culture typology in the primary hospitals was Hierarchy culture (MS = 22.31, ±2.82).and the preferred organizational culture typology was Innovative culture (MS = 26.09, ±4.72). The health workers had low to medium level of job satisfaction where only (29.40%) of the health workers were very satisfied with their hospital physical working environment. Existing perceived clan culture had positive and significant correlation with health workers' satisfaction in relation to work relation dimension (r = .16, p < 0.002).

CONCLUSION

while acknowledging all limitation of observational study we reached to the conclusion that an employees of the respective primary hospitals would prefer to work in environment characterized by innovative and clan culture and their satisfaction level is medium so that the managers should undertake major cultural transformation and must work to improve the job satisfaction level of health workers within their respective hospitals.

Job Satisfaction and Associated Factors among Anesthetists Working in Amhara National Regional State, Northwest Ethiopia, May 2017: A Multicenter Cross-Sectional Study

Background

Job satisfaction is an important determinant of health staff's motivation, retention, and performance. Difficulties in critical decision-making and problems with lack of respect and recognition lead to lower job satisfaction level among anesthetists. It leads to high turnover intention, dropout from the profession, burnout, impaired health status of anesthetists, and lower work performance.

Objective

The aim of this multicenter cross-sectional study was to assess the level of job satisfaction and associated factors among anesthetists working in Amhara National Regional State.

Methods

A multicenter cross-sectional study was conducted from April 1 to June 30, 2017. Ninety-eight anesthetists that were working in Amhara National Regional State Hospitals were involved in this study. The structured questionnaire was scored on five-point Likert scales. Data were analyzed using Statistical Package for Social Sciences version 20. Binary logistic regression was used to measure statistical significance between dependent and each independent variable. Variables with P value of ≤0.2 on crude analysis were taken into multivariate analysis, and P value 0.05 and 95% CI was used as cut off point.

Result

98 out of 104 participants were involved in this study with a response rate of 94.3%. The overall level of job satisfaction was 46.9%. Anesthetists in academic working position were satisfied with the odds of about 2.3 (AOR = 2.269; CI = 1.137–6.740) compared to those in clinical working position. Anesthetists were least satisfied with coworker relationships (37.8%), work schedule (43.9%), professional opportunity (46.9%), and recognition (49%) while they were most satisfied from their control of responsibility (59.2%), social interaction (55%), and salary and benefits (51%).

Conclusion and Recommendation

Job satisfaction of anesthetists was low, and we suggest that facilitation of professional development, creation of smooth relationship in working environment, increasing the number of anesthetists, and recognition of the anesthesia professional are of paramount importance to increase job satisfaction of anesthetists.

Challenges and opportunities for healthcare workers in a rural district of Chad

Background

Trained healthcare workers are an essential resource for effective health systems. However, healthcare workers’ perspective on healthcare, the challenges they face to provide quality health services, and opportunities to improve motivation and providing adequate care are rarely investigated in resource-constrained settings of sub-Saharan Africa.

Methods

All reachable nurses of Abou Deia, a primarily rural district in the south-eastern part of Chad, were invited to participate. In-depth interviews were conducted to assess current challenges and opportunities faced in daily work, including factors that influence motivation and social wellbeing. Particular emphasis was placed on paediatric care.

Results

Eight nurses were interviewed. Main work challenges pertained to overall workload, a lack of training and support regarding a serious case mix to be managed on their own, adverse working conditions, issues related to the local communities, and the impact of postings on nurses’ private life. Poor working conditions and perceived lack of recognition emerged as the main demotivating factors. Motivation to improve nurses’ skills so that they can provide good care, coupled with small, suggested changes in working conditions and health care organisation provide opportunities worth exploring to improve health workers’ satisfaction, motivation and the care they can provide.

Conclusions

Health workers in a predominantly rural district in Chad face a wide variety of challenges, and hence their perspectives need to be taken into account to improve health services interventions that aim at enhancing quality of care. Nurses’ willingness to further develop skills and knowledge, proactive search of solutions to remedy stock-outs of drugs and other medical devices, and motivational factors to improve the quality of care represent important opportunities for improving health services for all.

Job satisfaction and turnover intentions among health care staff providing services for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania

BACKGROUND

Option B+ for the prevention of mother-to-child transmission (PMTCT) of HIV (i.e., lifelong antiretroviral treatment for all pregnant and breastfeeding mothers living with HIV) was initiated in Tanzania in 2013. While there is evidence that this policy has benefits for the health of the mother and the child, Option B+ may also increase the workload for health care providers in resource-constrained settings, possibly leading to job dissatisfaction and unwanted workforce turnover.

METHODS

From March to April 2014, a questionnaire asking about job satisfaction and turnover intentions was administered to all nurses at 36 public-sector health facilities offering antenatal and PMTCT services in Dar es Salaam, Tanzania. Multivariable logistic regression models were used to identify factors associated with job dissatisfaction and intention to quit one's job.

RESULTS

Slightly over half (54%, 114/213) of the providers were dissatisfied with their current job, and 35% (74/213) intended to leave their job. Most of the providers were dissatisfied with low salaries and high workload, but satisfied with workplace harmony and being able to follow their moral values. The odds of reporting to be globally dissatisfied with one's job were high if the provider was dissatisfied with salary (adjusted odds ratio (aOR) 5.6, 95% CI 1.2-26.8), availability of protective gear (aOR 4.0, 95% CI 1.5-10.6), job description (aOR 4.3, 95% CI 1.2-14.7), and working hours (aOR 3.2, 95% CI 1.3-7.6). Perceiving clients to prefer PMTCT Option B+ reduced job dissatisfaction (aOR 0.2, 95% CI 0.1-0.8). The following factors were associated with providers' intention to leave their current job: job stability dissatisfaction (aOR 3.7, 95% CI 1.3-10.5), not being recognized by one's superior (aOR 3.6, 95% CI 1.7-7.6), and poor feedback on the overall unit performance (aOR 2.7, 95% CI 1.3-5.8).

CONCLUSION

Job dissatisfaction and turnover intentions are comparatively high among nurses in Dar es Salaam's public-sector maternal care facilities. Providing reasonable salaries and working hours, clearer job descriptions, appropriate safety measures, job stability, and improved supervision and feedback will be key to retaining satisfied PMTCT providers and thus to sustain successful implementation of Option B+ in Tanzania.

Relationships of work characteristics to job satisfaction, turnover intention, and burnout among doctors in the district public-private mixed health system of Bangladesh

Background

Work design integrates work characteristics having organizational, social and job components which influence employees’ welfare and also organizational goals. We investigated the effects of work characteristics and other predictors to job satisfaction, turnover intention, and burnout in doctors of the public primary, public secondary and private facilities of the district health system of Bangladesh.

Methods

A quantitative study using a self-administered questionnaire containing mostly structured items was conducted among the public and private doctors with a sample size of 384 from 29 out of a total 64 districts of Bangladesh during October and November 2015. All variables including work characteristics and outcomes of interest were based on literature and measured on 5-point Likert scale. Multivariate analysis of variance, bivariate correlation, and multiple regression were the models operated through SPSS version-21.

Results

A total of 354 doctors responded. No significant differences were found between public primary and secondary level doctors on combined work characteristics and outcomes variables, which however differed significantly between the public and private doctors. Organizational support was the strongest predictor adversely affecting job satisfaction, turnover intention and burnout of both the public and private doctors; private doctors’ experienced more support. The effects of health-professional politics on the public doctors were alarming.

Conclusion

Work design of the Bangladesh’s health system is in need of ample development. Doing so, improvement in organizational supports is crucial; however, other work characteristics components are also important for enhancing doctors’ welfare and health system productivity.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2369-y) contains supplementary material, which is available to authorized users.

PREDICATORS OF SATISFACTION AND DISSATISFACTION OF MEDICAL WORKERS WITH THEIR WORK IN MEDICAL INSTITUTION

The resulting criterion of assessment of staff management effectiveness in health protection institution is a satisfaction of medical workers with their work. So, it is important to know the predictors of satisfaction and dissatisfaction with the work. The aim of the research was in determination of the predictors of satisfaction and dissatisfaction with the work in medical institution. There was carried out the interrogation of 395 doctors (52 %) and hospital nurses (48 %) of the institutions of Kyiv city (Ukraine) by the form (response 81 %), formed of 12 questions and 3 answers “Yes”, “No”, “Not decided) (α of Cronbach 0,82). Pearson’s consent coefficient (χ2) was used for determination of the differences in the answer structures. The reliable difference in the index of general satisfaction of doctors (95 % DІ: 69,87 %; 76,31 %) and hospital nurses (95 % DI: 70,10 %; 75,39 %) was not revealed. Analogously there were not revealed such differences in the index of general dissatisfaction of doctors (95% DІ: 17,97 %; 24,09 %) and hospital nurses (95 % DІ: 16,76 %, 21,80 %). The structures of answers to the question about patients’ attitude did not reliably (р<0,05) differ (94,12 % of doctors, 79,52 % of hospital nurses answered “YES”), about improvement of medical help at material stimulation by patients (20 % of doctors, 13,25 % of hospital nurses – “YES”), about the choice of own profession again (41,18 % of doctors, 20,48 % hospital nurses – “NO”). It was determined that the predicators of medical workers’ satisfaction with their work are an attitude of colleges, patients, leader, climate in collective, and the ones of dissatisfaction – a salary, management system, labor conditions.

Quality management: where is the evidence? Developing an indicator-based approach in Kenya

INTRODUCTION

The 2030 Sustainable Development Agenda emphasizes the importance of quality of care in the drive to achieve universal health coverage. Despite recent progress, challenges in service delivery, efficiency and resource utilization in the health sector remain.

OBJECTIVE

The Ministry of Health Department of Standards and Regulations sought to operationalize the Kenya Quality Assurance Model for Health. To this end, the European Practice Assessment (EPA) was adapted to the area of Reproductive and Maternal and Neonatal Health.

METHODS

The adaptation process made use of a ten step-modified RAND Corporation/University of California Los Angeles (UCLA) Appropriateness Method. The steps included a scoping workshop, definition of five critical domains of quality in the Kenyan context ('People, Management, Clinical Care, Quality & Safety, Interface between inpatients and outpatients care'), a review of policy documents, management and clinical guidelines, grey and scientific literature to identify indicators in use in the Kenyan health system and an expert panel process to rate their feasibility and validity.

RESULTS

The resulting 278 indicators, clustered across the five domains, were broken-down into 29 dimensions and assigned measure specifications. A set of data collection tools were developed to furnish the indicators and piloted at two health facilities. They were subsequently finalized for use in 30 health facilities in 3 counties.

CONCLUSIONS

The integrative and indicator-based aspects of the EPA process could be readily adapted to facilitate the operationalization of a practical quality assurance approach in Kenya.