An Investigation of Healthcare Professionals' Motivation in Public and Mission Hospitals in Meru County, Kenya

Public service motivation, public sector preference and employment of Kenyan medical doctor interns: a cross-sectional and prospective study

BACKGROUND

Kenya grapples with a paradox; severe public sector workforce shortages co-exist with rising unemployment among healthcare professionals. Medical schools have increased trainee outputs, but only 45% of newly qualified/registered doctors were absorbed by the public sector during 2015-2018. In such a context, we explore what influences doctors' career choices at labour market entry, specifically understanding the role of public service motivation (PSM).

METHODS

We conducted a cross-sectional and prospective study of interns and recently graduated doctors to examine PSM, their intention to work in the public sector and their final employment sector and status. We surveyed them on their PSM and job intentions and conducted a prospective follow-up survey of the interns, around one year later, to understand their employment status.

FINDINGS

We recruited 356 baseline participants and followed up 76 out of 129 eligible interns. The overall PSM score was high among all participants (rated 4.50/5.00) irrespective of sector preferences. 48% (171/356) of the participants preferred to work in the public sector immediately after internship, alongside 16% (57/356) preferring direct entry into specialist training-commonly in the public sector. Only 13% (46/356) and 7% (25/365) preferred to work in the private or faith-based sector. Despite the high proportion of interns preferring public sector jobs, only 17% (13/76) were employed in the public sector at follow-up and 13% (10/76) were unemployed, due to lack of job availability.

CONCLUSION

High PSM scores irrespective of sector preferences suggest that doctors are generally committed to serving the 'public good'. Many intended to work in the public sector but were unable to due to lack of job opportunities. Policymakers have an opportunity to tackle workforce gaps in the public sector as young doctors continue to express a preference for such work. To do this they should prioritise creating adequate and sustainable job opportunities.

What Drives Paramedics to Serve in Rural and Remote Communities?

In this study, we investigated the motivations of paramedic staff serving in rural and remote communities, given the consistent shortage of healthcare workers in these areas. Using a modified Global Motivation Scale (GMS) questionnaire, we surveyed 450 paramedics in Saudi Arabia, analyzing data from 379 respondents (response rate: 84.2%) with SPSS 29. Chi-square tests explored demographic links to motivation, and ANOVA compared mean scores across groups (p < 0.05). The results showed a moderate overall motivation (M = 3.37, SD = 0.82), with high intrinsic motivation (M = 3.67, SD = 0.96) and relatively high extrinsic motivation, notably in integration (M = 3.48) and identification (M = 3.41). Age and gender significantly influenced motivation (p < 0.05), with individuals aged 24-30 years exhibiting markedly lower motivation. ANOVA confirmed the age, gender, marital status (unmarried), and EMS experience (5-10 years) as significant factors, while the education, job title, and employment site had no significant impact. Scheffe's post hoc test revealed age-related differences and emphasized the importance of EMS experience. This study suggests that both intrinsic factors and external pressures contribute to the lower motivation in adults in their mid-twenties in rural areas. Experience, particularly in EMS, significantly impacts motivation levels. We recommend tailored interventions that focus on intrinsic motivation and address external pressures to improve retention and care quality.

Improving Organizational Commitment among Healthcare Employees in Angola: The Role of Psychological Capital and Perceived Transformational Leadership

While previous studies conducted in sub-Saharan African countries have focused on verifying standards of clinical care and assessing challenges faced by healthcare professionals, the present study fills a gap in the literature in that it explores the factors that may drive the organizational commitment of healthcare professionals in Angola. This study aimed to analyze the relationship between psychological capital and organizational commitment through perceived transformational leadership. Therefore, using the quantitative methodology, a self-report questionnaire was applied to 342 healthcare professionals (174 male, 168 female) from different public and private hospitals located in three large cities in Angola. The results confirmed that psychological capital is positively related to affective commitment and that perceived transformational leadership is a mediating variable of this relationship. Therefore, this study highlights the role of psychological capital and perceived transformational leadership in improving affective commitment in challenging environments.

Analysis of the influence of occupational, sociodemographic and health factors on the demotivation of the intensivist

Introduction

Understanding motivation, identifying motivational factors of health professionals, and recognizing how managers and leaders can successfully motivate healthcare professionals is a growing concern.

Objectives

To assess the occupational, sociodemographic, and health factors that influence the occurrence of demotivation in the intensive care unit professionals.

Methods

We performed a cross-sectional study with health professionals from nine intensive care units in João Pessoa, Paraíba state, Brazil. Data were collected using an adapted version of the Health Care Establishment Questionnaire. We built a Logistic Regression model to analyze the influence of variables on the motivational state, and variables were selected by the Backward method. We used 80% of the sample for parameter estimation and the remaining 20% for testing and validation. We used the R software for the analyses, with a significance level of α ≤ 0.05.

Results

We identify that the variable with the greatest power over the intensivist's demotivation was shift work (odds ratio [OR] = 4.215, p = 0.006). The number of symptoms (OR = 1.206, p = 0.000) and working time (OR = 1.080, p = 0.031) were also significant risk variables. When the three variables were combined, the professional's chance of feeling unmotivated increased by 38 times (OR = 38.99, p = 0.000).

Conclusions

Based on these results, it is possible to identify aspects that will require organizational adjustments so that intensivists remain satisfied and motivated.

Experiences in the training of specialist family and community nurses: a qualitative study

Introduction

The specialist Family and Community Nurse Practitioner (FCNP) is a professional who, after a period of training, is qualified to be part of multidisciplinary teams in primary care. The aim of this study was to describe and understand the experiences of nurses during their training process in the specialty of Family and Community Nursing in Spain.

Methods

A descriptive qualitative study was carried out. Participants were recruited by means of convenience sampling from January to April 2022. Sixteen specialist nurses in Family and Community Nursing from different autonomous communities in Spain participated in the study. Twelve individual interviews and one focus group were conducted. Data were analyzed following a thematic analysis method in ATLAS.ti 9.

Results

The results showed two themes and six subthemes: (1) Residency period, more than a training: (a) Training during the residency period; (b) Specializing through a constant struggle; (c) Moderate optimism about the future of the specialty; and (2) A journey from illusion to disappointment: (a) Beginning of the residency: feeling special; (b) During the residency: between satisfaction and misunderstanding; (c) At the end of the residency: power and frustration.

Conclusions

The residency period is important in the training and acquisition of competencies for the Family and Community Nurse Practitioner. Improvements are needed to ensure quality training during residency and to help give visibility to the specialty.

Determinants of Public Health Personnel Spending in Spain

Public health is funded with government funds gathered from tax revenues, whether national, provincial or municipal. The health system therefore suffers during economic crisis periods, whether due to disinvestment, loss of purchasing power among health care personnel or the decrease in the number of professionals. This worsens the situation, as it is necessary to cover the needs of an increasingly elderly population and with a longer life expectancy at birth. The present study intends to show a model which explains the determination of the "Public Health Personnel Expenditure" in Spain for a determined period. A multiple linear regression model was applied to the period including the years 1980-2021. Macroeconomic and demographic variables were analyzed to explain the dependent variable. Variation in health personnel expenditure: "We included those variables which presented a high or very high correlation above r > 0.6. The variables which explain the behavior of Variation in health personnel expenditure". It was a determining factor in the present study to consider that the variables with the greatest repercussions on health policy were mainly macroeconomic variables rather than demographic variables, with the only significant demographic variable that had a specific weight lower than macroeconomic variables being "Birth Rate". In this sense, the contribution made to the scientific literature is to establish an explanatory model so that public policy managers and states in particular can consider it in their public spending policies, bearing in mind that health expenditures in a Beveridge-style health system, as Spain has, are paid with funds drawn from tax revenues.

Senior Managers' Experience with Health, Happiness, and Motivation in Hospitals and the Perceived Impact on Health Systems: The Case of Meru County, Kenya

Hospitals play a significant role in health systems. Studies among the health workforce have revealed their experiences with mental health challenges. In comparison, there is limited literature on their positive mental health. The purpose of this study was to explore senior managers’ experiences with health status, happiness, and motivation in hospitals and the perceived impact on the health system in Kenya. This qualitative study applied a phenomenological research design. Senior managers within the hospital management teams were selected using purposive sampling. Semi-structured interviews were carried out among senior managers across eleven hospitals in Meru County, Kenya. Among the eleven participants 63.6% were female and 36.4%, were male and the mean age was 44.5 years. The audio-taped data were transcribed and analyzed using Colaizzi’s phenomenological approach. The five themes revealed were: (1) Happiness in the health system; (2) Health status in the health system; (3) Motivation in the health system; (4) Challenges in the health system; (5) Possible solutions to the challenges in the health system. This study revealed the positive and negative impact of the three domains, challenges, and solutions, from the senior managers’ perspective. Healthy, happy, and motivated senior managers and healthcare workers are more responsive and perform better. Policy interventions and programs promoting happiness, health status, and motivation are necessary for strengthening the health workforce and health system.