Motivation factors affecting the job attitude of medical doctors and the organizational performance of public hospitals in Warsaw, Poland

Barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease in Iran: a descriptive qualitative study

OBJECTIVES

Chronic obstructive pulmonary disease is a chronic disease with numerous complications. Therefore, its effective management depends on home-based pulmonary rehabilitation. The effectiveness of home-based pulmonary rehabilitation programmes in turn depends on patient adherence to them. The aim of this study was to explore the barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease.

DESIGN

Qualitative descriptive design.

SETTING

The lung care wards of Al-Zahra and Khorshid teaching hospitals and the comprehensive lung care clinic of Khorshid hospital, Isfahan, Iran.

PARTICIPANTS

Participants patients with chronic obstructive pulmonary disease (n=20), their family caregivers (n=15) and healthcare providers (n=14) recruited via purposive sampling.

RESULTS

The five main categories of the barriers to adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease were patient-related barriers, caregivers' caregiving burden, limited support for patients, healthcare providers' limited professional competence and ineffective home-based pulmonary rehabilitation planning.

CONCLUSION

Different and complex factors related to patients, families and healthcare providers can affect adherence to home-based pulmonary rehabilitation among patients with chronic obstructive pulmonary disease. Healthcare authorities can use the findings of this study to develop strategies to support patients with chronic obstructive pulmonary disease and their family caregivers and thereby reduce the physical and mental complications of Chronic obstructive pulmonary disease.

The effects of provider contract types and fiscal decentralization on the efficiency of the Polish hospital sector: A data envelopment analysis across 16 health regions

BACKGROUND

Expenditures on hospitals constitute a large proportion of total health expenditures. In Poland the share of hospital spending is higher than the European Union average. The efficiency of the Polish hospital sector merits investigation.

RESEARCH GOAL

The goal of this study is to estimate the relative technical efficiencies of Polish hospital regions, and to measure the impacts of provider contract types, fiscal decentralization, and the 2017 reform on the relative efficiencies.

METHODS

Using data from 16 hospital regions in Poland for the years 2007 to 2019, we estimate relative technical efficiencies and their determinants using a two-stage approach. In the first stage, we apply Data Envelopment Analysis, in which we assume variable returns to scale and an output orientation. In the second stage we use a truncated regression with double bootstrapping.

RESULTS

Our findings are threefold. First, fiscal decentralization may reduce technical efficiency, but the results was not statistically significant. Second, efficiency tended to be higher in regions where a greater proportion of nurses and midwives were offered employment as opposed to consulting contracts. Contract types offered to physicians were not statistically significant. Third, the 2017 reforms seem to have had a positive impact on efficiency to date.

CONCLUSION

Policy makers may wish to consider offering less fiscal autonomy and control to regions and encouraging employment contracts with nurses and midwives.

A MEDICAL AND SOCIOLOGICAL STUDY AMONG DOCTORS ON THE MOTIVATIONAL COMPONENT OF ENSURING THE QUALITY OF MEDICAL CARE IN HEALTH CARE FACILITIES

OBJECTIVE

Aim: To analyze the impact of medical reform on the motivational component of improving the quality of medical care in health care facilities in Sumy based on the results of a medical and sociological study of doctors.

PATIENTS AND METHODS

Materials and Methods: The study involved 154 doctors working in inpatient and outpatient departments of health care facilities in Sumy. Sumy in June-August 2023. The study used a systematic approach, bibliosemantic, comparative and statistical analysis, and logical generalization. The data were processed and statistically analyzed using Google Forms and Microsoft Excel 2010 for Windows.

RESULTS

Results: The study showed that 49 respondents (31.8%) are satisfied with the material and technical support at the workplace and working conditions. Almost all doctors (138 people (89.6%)) said that the actual amount of their salary does not correspond (partially or fully) to the workload at the workplace. Only 4.5% of them said that they receive extra payments for the quality of healthcare services, 21.4% of them said that they receive extra payments periodically, and 74.1% said that they do not receive extra payments at all. Despite the high level of workload and dissatisfaction with salaries, the majority of respondents (109 people (70.2%)) would not agree to change their profession to another one, even if the salary was higher. According to doctors, the most important incentives for improving the quality of healthcare services are: moral satisfaction from work and well-coordinated teamwork (76.6% of answers), financial incentives (74.7% of answers), opportunities for professional and career growth (48.7% of answers), respect from patients and society (46.8% of answers), and management recognition (13.6% of answers).

CONCLUSION

Conclusions: The study has shown that today, in the context of health care system reform, there is practically no effective motivational component to improve the quality of health care in health care facilities in Sumy: 40.9% of people gave negative answers, 42.2% of people indicated only its partial existence. Regardless of the length of service, for all respondents, one of the most important motivational incentives is not only material but also moral factors and public recognition.

ANALYSIS OF THE RESULTS OF A MEDICAL AND SOCIOLOGICAL SURVEY OF HEALTHCARE PROVIDERS ON MOTIVATIONAL COMPONENT OF ENSURING THE HEALTHCARE QUALITY

OBJECTIVE

The aim: To identify the main motivational components of improving the healthcare quality in health care providers in Sumy.

PATIENTS AND METHODS

Materials and methods: The study involved data obtained from 187 doctors working in primary health care institutions, inpatient and outpatient departments of health care institutions in Sumy, during September-November 2020. The study used systematic, bibliosemantic approaches, comparative and statistical analysis, and logical generalization. The obtained data were processed and statistically analyzed with Google Forms and Microsoft Excel 2010 Windows.

RESULTS

Results: The analysis of data received from the surveyed group of respondents showed that 83 doctors (44.39%) have 11-15 years' work experience, 51 people (27.27%) - 6-10 years, 40 people (21.39%) have up to 5 years of work experience and 13 people (6.95%) - more than 15 years. Most doctors (114 people (60.96%)) work for one position, 39 people (20.86%) work for less than one, while 34 people (18.18%) work for more than one position. The number of doctors who indicated that they were mostly overworked during the working day was 123 (65.77%), another 46 (24.60%) indicated that they were overworked during the working day correspondingly to their workload at occupied position, and 18 respondents (9.63%) answered that they were not fully loaded. At the same time, 91.98% of people indicated that the actual amount of their salary does not correspond to the workload, and there is no financial stimulation system for medical care quality increasing (87.70% of responses).

CONCLUSION

Conclusions: The study showed that the healthcare facilities where the respondents work do not have an effective system of staff motivation for work quality (79.14% of responses). It was found that doctors are ready to work harder and better for additional pay, despite the high level of workload (88.24% of responses), and consider it necessary to introduce an effective stimulation system to improve the quality of medical services (96.79% of responses).

The Effect of Medical Choice on Health Costs of Middle-Aged and Elderly Patients with Chronic Disease: Based on Principal-Agent Theory

(1) Background: The discussion on how to reduce the health costs of chronic disease patients has become an important public health issue. Limited research has been conducted on how chronic disease patients' medical choice of public and private medical institutions affect health costs. (2) Methods: This study used the panel data composed of the China Health and Retirement Longitudinal Survey (CHARLS) from 2011 to 2018, adopted the quasi-natural experimental research method, and set up a control group and an experimental group that chose public medical institutions and private medical institutions, to analyze the association between the medical choice and health costs of chronic disease patients. (3) Results: Compared with chronic disease patients who chose private medical institutions, patients who chose public medical institutions increased their total cost by 44.9%, total out-of-pocket cost by 22.9%, and decreased the total out-of-pocket ratio by 0.117%, total drug cost out-of-pocket ratio by 0.075%, and drug cost ratio by 0.102%. (4) Conclusions: According to the triple principal-agent relationships, the resource advantages given by the government to public medical institutions, the salary incentive system of medical institutions, and the information asymmetry advantage held by physicians may be important factors for the increase in health costs for chronic disease patients.

Evaluating Organizational Performance of Public Hospitals using the McKinsey 7-S Framework

BACKGROUND

This study examined non-financial aspects of the organizational performance of public hospitals from the perspective of hospital physicians; the obtained results were analyzed to identify the necessary improvements in organizational performance.

METHODS

This was a cross-sectional study of multidisciplinary public hospitals on a group of 249 randomly selected physicians from 22 in-patient departments or clinics operating in the Warsaw region. The study data was collected using the structured World Health Organization questionnaires (to be filled out by respondents) assessing the hospital's organizational performance variables qualified according to the McKinsey 7-S Framework. Epidata software version 3.1 was used for data entry, and the analysis was carried out in the SPSS software, version 19. The results of the organization evaluation are presented in the McKinsey 7-S Framework diagram. Key elements of the performance factors were grouped into 'stens', and the sten values were expressed as arithmetic means. Normal distribution of the stens was validated with the Kolmogorov-Smirnov test. 95% confidence intervals were calculated. The significance of differences between the analyzed stens was compared with the paired Student t-test. The interdependence of the variables was determined using the Pearson's correlation coefficient.

RESULTS

The results revealed a significant difference (p <0.05) in the respondents' assessment of social (a mean score of 2.58) and technical (a mean score of 2.80) organizational aspects of the hospital operation. Scores for all variables were low. The social elements of an organization with the lowest score included 'staff', and in it the aspect - 'efforts are made to inspire employees at the lowest levels of the organization', 'skills' involving the learning style followed by the management/managerial staff, and 'management style' (average scores of 2.38, 2.56, 2.61, respectively).

CONCLUSION

Consistently with the existing literature, social factors were shown to play a more significant role in the management and they therefore deserve careful attention and more recognition when identifying and improving the key aspects affecting the organizational performance of public hospitals. Technical elements (strategy, structure, system) are important, but were demonstrated to have limited effect on the organizational operations geared towards ensuring effective functioning of a public hospital.

Working Conditions and Satisfaction with Working Conditions among Slovenian Family Medicine Trainees: A Cross-sectional Study

Introduction

In order to achieve a high standard in training programmes for future family medicine specialists, it is essential to have good tutors with well-organised family medicine practices. Proper working conditions for young doctors are essential for their satisfaction and future professional development. The aim of our study was to check the current working conditions of family medicine trainees in the practical modular part of the training programme in Slovenia, and to determine their satisfaction with working conditions.

Methods

A cross-sectional study was conducted. The data was collected through a questionnaire distributed to 105 family medicine trainees undergoing the practical modular part of their training programme.

Results

The study showed that the following 7 out of 25 organisational and labour law factors are significantly associated with a trainee’s general satisfaction with working conditions: the location where work with patients takes place, the privacy of the premises, the accessibility of the main tutor, a constant patient population, suitable places for rest, paid out-of-hours substitutions, and appropriate pay grade.

Conclusion

The results we obtained can be used to address certain aspects of trainees’ working conditions in Slovenia that need improvement. By determining which working conditions significantly affect a trainee’s satisfaction, we have the opportunity to modify these conditions and thereby improve the training programme. This could result in a less stressful and more efficient residency programme.

State Incentives and Sustainable Motivation System in the Health Sector

Now that the pandemic has entered the second phase, in which countries are adapting to the crisis, governments need to determine incentives that will contribute to the sustainability of the health system and human health. Regarding this, human resources are a significant factor, which affects the sustainability of any system, and it is important to establish a relevant motivation system that will withstand the challenges that society will face in the coming period. The aim of this paper is to analyse three dimensions of state incentives (employment program, COVID-19 bonus, training opportunities) and to examine their influence on healthcare workers’ motivation and the sustainability of the health system in the Republic of Serbia. The empirical research was conducted on a sample of 207 respondents employed in the tertiary level of healthcare. Data analysis included exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and structural equation modelling (SEM). The research results confirmed the existence of all three incentives and indicated that state incentive “training opportunities” has the strongest effect on the motivation of health workers and the sustainability of the healthcare system.

Job demands and resources and their relationship with satisfaction and thriving at work in a sample of Chinese doctors: a cross-sectional study

OBJECTIVES

The current study aimed to evaluate the status quo of perceived job demands and resources respectively among Chinese doctors, to examine the mediating role of work-family conflicts in the relationship between perceived job demands and various indicators of well-being, and to test the mediating role of psychological attachment in the relationship between perceived job resources and thriving at work among Chinese doctors.

DESIGN

A cross-sectional online survey study.

SETTING

Online questionnaires were administered across 30 provinces.

PARTICIPANTS

A total of 2617 doctors provided sufficiently complete responses to be used in the study.

RESULTS

Perceived job demands (M=3.843, SD=0.791) of participants were positively associated with work-family conflicts (B=0.454, p<0.001) and negatively associated with job satisfaction (B=-0.065, p<0.001) and life satisfaction (B=-0.261, p<0.001). Work-family conflicts partially mediated the relationship between job demands and life satisfaction and fully mediated the relationship between job demands and job satisfaction. Perceived job resources (M=2.474, SD=0.740) among Chinese doctors were positively associated with psychological attachment (B=0.988, p<0.001) and thriving at work (B=0.582, p<0.001). Furthermore, psychological attachment partially mediated the relationship between perceived job resources and thriving at work.

CONCLUSION

Doctors in China with high-level job demands tended to exhibit increased work-family conflicts, which in turn threatened their job and life satisfaction. On the contrary, doctors with greater job resources were more likely to thrive at work by increasing their degree of psychological attachment. The current study suggested that Chinese health policymakers and hospital administrators should provide a work environment with a dynamic equilibrium between doctors' job demands and resources.

The Antecedents of Psychological Empowerment and Its Impact towards General Physician Job Performance

BACKGROUND: The emergence of new infectious diseases such as SARS-CoV-2 (Coronavirus Disease 19) creates a burden to the healthcare system especially to the front liners such as medical doctors. The job performance of the general practitioners related to quality of care to SARS-CoV2 patients. AIM: ​​The purpose of this study is to analyze the antecedents of psychological empowerment towards job performance, mediated by service orientation. These antecedents could be seen in hospital perspectives and professional life.   METHODS: This is a quantitative survey study using a cross-sectional approach. 185 samples purposively obtained from the general practitioners who work at SARS-CoV-2 Reference Private Hospital in Jakarta and surrounding area. Data collection using online questionnaires and analyzed by SmartPLS 3.3.3™ . RESULTS: There are nine hypotheses that are supported in this research. The strongest predictor of psychological empowerment is the training opportunities, followed by relationships with fellow doctors and autonomy at work. Psychological empowerment has been proven to have a direct impact on job performance, while service orientation has been found as a mediation in this relationship. CONCLUSION: Psychological empowerment has been proven as an important construct to predict job performance, therefore hospital management has to pay more attention to psychological empowerment for GPs during the pandemic. Training opportunities should be prioritized by the board of directors of the hospitals, they should allocate time and the resources to facilitate the training opportunity. KEYWORDS: Psychological empowerment, service orientation, job performance, general practitioner, SARS-CoV-2 referral private hospital.

Job satisfaction behind motivation: An empirical study in public health workers

The health sector is characterized as labor-intensive, which means that the effectiveness of an organization that operates within its context is inextricably linked to the level of employee performance. Therefore, an essential condition, in order to achieve higher standards, in terms of the effectiveness of the health units, as well as set the foundations of a solid health system, is to take maximum advantage of the full potential of human resources. This goal can only be accomplished by providing the appropriate incentives, which will naturally cause the adoption of the desired attitude and behavior. In the case of Greece, there is not enough research relative to the needs of health workers and, consequently, the incentives that can motivate them. This article aims to investigate the dynamics that may be behind health workers at a public hospital in Northern Greece. Data were collected from 74 employees in the hospital and were analyzed using ANOVA analysis. The results show that key motivators for the employees can be considered the relationships with their colleagues and the level of achievement, while the level of rewards and job characteristics play a secondary role. These results make it clear that, in order for the hospital's management to be able to improve the level of employee performance, it should ensure the establishment of a strong climate among employees, and also acknowledge the efforts made by them.