Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

What is the job satisfaction and active participation of medical staff in public hospital reform: a study in Hubei province of China

Contributed equally
Human Resources for Health201513:34

https://doi.org/10.1186/s12960-015-0026-2

Received: 23 April 2013

Accepted: 29 April 2015

Published: 16 May 2015

Abstract

Background

In China, public hospital reform has been underway for almost 5 years, and 311 pilot county hospitals are the current focus. This study aimed to assess the job satisfaction and active participation of medical staff in the reform. A total of 2268 medical staff members in pilot and non-pilot county hospitals in Hubei, China, were surveyed.

Methods

Questionnaires were used to collect data. The Pearson chi-square statistical method was used to assess the differences between pilot and non-pilot county hospitals and identify the factors related to job satisfaction as well as the understanding and perception of the reform. Binary logistic regression was performed to determine the significant factors that influence the job satisfaction of medical staff in pilot county hospitals.

Results

Medical staff members in pilot county hospitals expressed higher satisfaction on current working situation, performance appraisal system, concern showed by leaders, hospital management, and compensation packages (P < 0.05). They were exposed to work-related stress at a higher extent (P < 0.05) and half of them worked overtime. Within pilot county hospitals, less than half of the medical staff members were satisfied with current job and they have evidently less satisfaction on compensation packages and learning and training opportunities. The working hours and work stress were negatively related to the job satisfaction (P < 0.05). Satisfaction on the performance appraisal system, hospital management, compensation packages, and learning and training opportunities were positively related to job satisfaction (P < 0.05). Medical staff in pilot county hospitals exhibited better understanding of and more positive attitude towards the reform (P < 0.05).

Conclusions

Pilot county hospitals have implemented some measures through the reform, but there still are deficiencies. The government officials and hospital administrators should pay attention to influencing factors of job satisfaction and focus on the reasonable demands of medical staff. In addition, the medical staff in pilot county hospitals exhibited a better understanding of the public hospital reform programme and showed more firm confidence, but there still were some medical staff members who hold negative attitude. The publicity and education of the public hospital reform still need improvement.

Keywords

Medical staff China Public hospital reform Working situation Satisfaction Understanding Perception

Background

In October 2008, a draft of Healthcare Reform Plan was published by the Chinese government, and comments were solicited from the whole society. In this way, the general public was able to participate in policy-making in China, and this initiative is unprecedented [1,2]. In March 2009, China’s Healthcare Reform Plan was formally released to reduce the residents’ economic burden for medical services, mitigate the difficulties in affordability and accessibility of medical service, and provide safe, effective, convenient, inexpensive health services for universal coverage. The short-term goals of the health-care reform comprise five key programmes: expedite the establishment of a basic medical security system, initiate a national basic drugs system, improve the primary health-care service system, promote the gradual equalization of basic public health services, and implement a pilot programme of public hospital reform.

The pilot reform of public hospitals includes the following contents: improve health service systems and establish medical cooperative activities between urban and rural, substantially increase financial investment into hospitals, remove the provision of commercial hospital services, reform the compensation system of public hospitals, restructure the management systems of public hospitals, enhance income distribution and incentive programmes, and encourage social organizations to open hospitals [3]. Former premier Wen Jiabao considered public hospital reform as one of the most important and challenging tasks in the new health reform. Public hospitals are the principal medical and health service institutions in China. As such, these institutions are essential for public welfare in medical and health services. Therefore, public hospital reform is an important factor for the realization of health-care reform in China.

The pilot programme of county hospital reform is the threshold and emphasis of public hospital reform, and county hospitals are currently in focus. China’s Ministry of Health selected 311 county hospitals on a national scale as pilot hospitals, and 20 of the 311 are located in Hubei province. These 311 pilot county hospitals must take the lead to carry out the measures and contents of public hospitals reform mentioned above, while the rest of the county hospitals could remain original.

County hospitals are considered as flagships of three-tiered rural health-care systems and the main provider of health services; these services include treatment and emergency services, disease prevention, vaccination, health education, maternal and child health-care services, and reproductive services for rural residents [4], who account for more than 50% of the total Chinese population, and some urban residents. In China, a county hospital is generally equipped with 300 to 500 beds and approximately 400 to 600 medical staff members, providing health services for approximately 0.5 million individuals in an area of 2000 to 4000 km2.

Medical staff is the direct provider of hospital services and key element in the development of health services. The work performance, attitude, and commitment of medical staff directly influence the outcomes of health service delivery, such as medical safety, service quality, doctor–patient relationship, patient satisfaction, and hospital management, particularly the operating efficiency and effectiveness of a hospital. Medical staff members in pilot county hospitals are also responsible for the implementation and promotion of the reform policies as well as the generation of support for the reform.

To our knowledge, studies on the working situation, satisfaction, and attitude towards the reform of medical staff in pilot county hospitals in China in this specific period are few [5,6], let alone on comparison between pilot and non-pilot county hospitals. The purposes of this study are to describe and compare the working situation, satisfaction, and attitude towards the reform of medical staff in pilot county hospitals with those of medical staff in non-pilot county hospital in Hubei province and to analyse and determine the influencing factors of medical staff in pilot county hospitals. We aim to improve job satisfaction and arouse active participation in public hospital reform, to provide high-quality medical services to residents.

Methods

Study population

County hospitals were selected by sampling at several stages. Considering that Hubei province is a large area in central China, we initially selected seven cities in east, south, west, north, northwest, northeast, and central Hubei according to geographical locations and economic development levels. They are Wuhan city, Jingzhou city, Yichang city, Xiangyang city, Shiyan city, Suizhou city, and Jingmen city, respectively. There are 20 pilot county hospitals in Hubei province. Two pilot counties and one non-pilot county were then randomly selected from each of the seven cities. One county hospital was finally chosen from each of the 21 counties. Thus, this study comprised 21 county hospitals, including 14 pilot county hospitals and 7 non-pilot county hospitals.

In each selected county hospital, 110 medical staff members, including doctors, nurses, and medical technicians (personnel in pharmacy, clinical laboratory, and radiology department) were randomly chosen and considered as subjects of the study. A total of 2310 medical staff members from 1531 in pilot county hospitals and 737 in non-pilot county hospitals were investigated and 2268 valid answer sheets were returned, resulting in a response rate of 98.18%. This study was approved by the Ethics Committee of Tongji Medical College, Huazhong University of Science and Technology (IRB No: FWA00007304). The medical staff was aware of this study and willing to participate. The privacy of the investigated medical staff was strictly protected by filling in the questionnaires anonymously.

Questionnaire

Adapting the Minnesota Satisfaction Questionnaire based on the actual situation of medical staff members of county hospitals in China, this study formulated a questionnaire and its index system through questionnaire investigation, literature survey, and Delphi expert consultation. The questionnaire consisted of three parts: Part 1, sociodemographic information; Part 2, working situation and satisfaction; and Part 3, understanding and perception of the reform. Through reliability statistics, Cronbach’s alpha is 0.913.

Part 1 included sociodemographic information of gender, age, educational background, position, professional title, and years in professional working experience.

In Part 2, working situation included two aspects: the number of hours spent at work every day and the work stress one felt. For the number of hours, six options were provided from “≤8 h” to “≥12 h”. For work stress, five options were provided from “no pressure” to “extreme pressure”. In Part 2, satisfaction included six aspects: current job, performance appraisal system, concern showed by leaders, hospital management, compensation packages, and learning and training opportunities. For these aspects, five options (numbered from 1 to 5) were provided to express satisfaction degree: 1, very satisfied; 2, satisfied; 3, moderate/acceptable; 4, dissatisfied; and 5, very dissatisfied.

In Part 3, investigation on the understanding and perception of the reform included the following: understanding of the specific contents of the public hospital reform programme, perceived level of reform promotion, changes experienced before and after the reform introduction in 2008, and the perception of the effect of the public hospital reform.

Statistical analysis

EpiData3.1 was used to establish a database, and double machine inputting method was used to enter the collected data into the computer. PASW Statistics 18.0 was used to perform statistical data analysis. The sociodemographic factors of the investigated medical staff were summarized using a descriptive statistical analysis method. The Pearson chi-square statistical method was used to assess the differences between medical staff in pilot county hospitals and medical staff in non-pilot county hospitals in working situation, satisfaction on job and wok-related factors, and the understanding and perception of the reform. The Pearson chi-square statistical method was also used to analyse the factors influencing job satisfaction and the understanding and perception of the reform in pilot county hospitals. Binary logistic regression was then performed to determine significant factors influencing job satisfaction in pilot county hospitals. The dependent variable (the outcome of interest) in logistic regression included the following: 1 “satisfied” (very satisfied, satisfied, moderate) and 0 “otherwise” (dissatisfied, very dissatisfied). We substituted the variables with statistical significance determined from the Pearson chi-square statistical test into the binary logistic regression model for calculation (P < 0.05). Odds ratio (OR) was reported at a 95% confidence interval (CI) where appropriate. All of the tests were conducted at 5% significance level.

Results

Sociodemographic characteristics of the investigated medical staff in pilot and non-pilot county hospitals

The investigated medical staff members were mainly comprised of females (66.58%). The largest proportion of age of the medical staff ranged from 25 to 34 (38.27%). The largest proportion of educational background was bachelor’s degree (48.19%), and the largest proportion of professional title was middle title (43.83%; Table 1). In this study, different professional titles showed various professional skill levels of the medical staff members. In China, a medical staff member needs to undergo and pass a special qualification examination and assessment to achieve his (or her) professional title corresponding to a particular professional skill level.
Table 1

Sociodemographic characteristics of medical staff in pilot and non-pilot county hospitals

Characteristic

Pilot county hospitals

Non-pilot county hospitals

Total

Medical staff (n= 1531)

Percentage (%)

Medical staff (n= 737)

Percentage (%)

n

%

Gender

      

 Male

552

36.05

206

27.95

758

33.42

 Female

979

63.95

531

72.05

1510

66.58

Age

      

 24 and below

150

9.80

63

8.55

213

9.39

 25–34

527

34.42

341

46.27

868

38.27

 35–44

559

36.51

212

28.77

771

33.99

 45–54

268

17.50

107

14.52

375

16.53

 55 and above

27

1.76

14

1.90

41

1.81

Educational background

      

 Technical secondary school and below

188

12.28

48

6.51

236

10.41

 Junior college

547

35.73

216

29.31

763

33.64

 Bachelor’s degree

737

48.14

356

48.30

1093

48.19

 Master’s degree or above

59

3.85

117

15.88

176

7.76

Position

      

 Doctor

599

39.12

280

37.99

879

38.76

 Nurse

661

43.17

357

48.44

1018

44.89

 Medical technician

271

17.70

100

13.57

371

16.36

Professional title

      

 No title

24

1.57

11

1.49

35

1.54

 Junior title

513

33.51

333

45.18

846

37.30

 Middle title

729

47.62

265

35.96

994

43.83

 Senior title

265

17.31

128

17.37

393

17.33

Years in professional working experience

      

 1–5 years

288

18.81

196

26.59

484

21.34

 6–10 years

214

13.98

141

19.13

355

15.65

 11–15 years

227

14.83

81

10.99

308

13.58

 16–20 years

307

20.05

135

18.32

442

19.49

 20 years and above

495

32.33

184

24.97

679

29.94

City

      

 Wuhan city

220

14.37

108

14.65

328

14.46

 Jingzhou city

218

14.24

105

14.25

323

14.24

 Yichang city

215

14.04

98

13.30

313

13.80

 Xiangyang city

220

14.37

104

14.11

324

14.29

 Shiyan city

219

14.30

108

14.65

327

14.42

 Suizhou city

219

14.30

105

14.25

324

14.29

 Jingmen city

220

14.37

109

14.79

329

14.51

Working situation, job satisfaction, and satisfaction on work-related factors of medical staff in pilot and non-pilot county hospitals

In pilot county hospitals, 51.86% of the medical staff members work for more than 8 h a day and 55.39% are exposed to considerable pressure or extreme pressure. The percentages of medical staff members in pilot county hospitals dissatisfied or very dissatisfied with current job, performance appraisal system, concern showed by leaders, hospital management, compensation packages, and learning and training opportunities were 17.37%, 15.55%, 10.65%, 6.53%, 35.41%, and 47.42%, respectively.

Through Pearson chi-square statistical analysis, the results showed that medical staff in pilot and non-pilot county hospitals exhibited significant differences in work stress and satisfaction on the following aspects: current job, performance appraisal system, concern showed by leaders, hospital management, and compensation packages (P < 0.001; Table 2).
Table 2

Working situation, job satisfaction, and satisfaction on work-related factors of medical staff in pilot and non-pilot county hospitals

Working situation and satisfaction

Pilot county hospitals (n= 1531)

Non-pilot county hospitals (n= 737)

Total

χ 2

P

n

%

n

%

n

%

The number of hours spent at work everyday

        

 8 h and below

737

48.14

394

53.46

1131

49.87

  

 9 h

407

26.58

171

23.20

578

25.49

  

 10 h

219

14.30

103

13.98

322

14.20

  

 11 h

46

3.00

14

1.90

60

2.65

  

 12 h

37

2.42

16

2.17

53

2.34

  

 12 h and above

85

5.55

39

5.29

124

5.47

7.582

0.181

The degree of work stress

        

 No pressure

31

2.02

168

22.80

199

8.77

  

 Slight pressure

411

26.85

157

21.30

568

25.04

  

 Moderate pressure

241

15.74

150

20.35

391

17.24

  

 Considerable pressure

682

44.55

198

26.87

880

38.80

  

 Extreme pressure

166

10.84

64

8.68

230

10.14

299.217

<0.001

Satisfaction on current job

        

 Very satisfied

136

8.88

38

5.16

174

7.67

  

 Satisfied

564

36.84

205

27.82

769

33.91

  

 Moderate

565

36.90

313

42.47

878

38.71

  

 Dissatisfied

239

15.61

158

21.44

397

17.50

  

 Very dissatisfied

27

1.76

23

3.12

50

2.20

38.744

<0.001

Satisfaction on performance appraisal system

        

 Very satisfied

34

2.22

12

1.63

46

2.03

  

 Satisfied

475

31.03

101

13.70

576

25.40

  

 Moderate

784

51.21

404

54.82

1188

52.38

  

 Dissatisfied

197

12.87

180

24.42

377

16.62

  

 Very dissatisfied

41

2.68

40

5.43

81

3.57

111.369

<0.001

Satisfaction on concern showed by leaders

        

 Very satisfied

76

4.96

11

1.49

87

3.84

  

 Satisfied

517

33.77

134

18.18

651

28.70

  

 Moderate

775

50.62

433

58.75

1208

53.26

  

 Dissatisfied

133

8.69

117

15.88

250

11.02

  

 Very dissatisfied

30

1.96

42

5.70

72

3.17

109.148

<0.001

Satisfaction on hospital management

        

 Very satisfied

77

5.03

13

1.76

90

3.97

  

 Satisfied

608

39.71

162

21.98

770

33.95

  

 Moderate

746

48.73

417

56.58

1163

51.28

  

 Dissatisfied

83

5.42

118

16.01

201

8.86

  

 Very dissatisfied

17

1.11

27

3.66

44

1.94

145.094

<0.001

Satisfaction on compensation packages

        

 Very satisfied

20

1.31

8

1.09

28

1.23

  

 Satisfied

264

17.24

40

5.43

304

13.40

  

 Moderate

705

46.05

227

30.80

932

41.09

  

 Dissatisfied

460

30.05

336

45.59

796

35.10

  

 Very dissatisfied

82

5.36

126

17.10

208

9.17

189.192

<0.001

Satisfaction on learning and training opportunities

        

 Very satisfied

34

2.22

11

1.49

45

1.98

  

 Satisfied

246

16.07

101

13.70

347

15.30

  

 Moderate

525

34.29

252

34.19

777

34.26

  

 Dissatisfied

481

31.42

247

33.51

728

32.10

  

 Very dissatisfied

245

16.00

126

17.10

371

16.36

4.193

0.38

Analysis and determining of the significant factors influencing the job satisfaction of medical staff in pilot county hospitals

In pilot county hospitals, only 45.72% of medical staff expressed that they were very satisfied or satisfied with current job. About 36.90% of medical staff felt moderate, and 17.37% felt dissatisfied or very dissatisfied with current job. Medical staff was evidently less satisfied with compensation packages (18.55% only) and learning and training opportunities (18.29% only) than other work-related aspects (Table 3).
Table 3

Assessment on the factors related to job satisfaction of medical staff in pilot county hospitals

Sociodemographic characteristics, working situation, and satisfaction on work-related factors

Job satisfaction of medical staff in pilot county hospitals (n= 1531)

χ 2

P

Very satisfied

Satisfied

Moderate

Dissatisfied

Very dissatisfied

n

%

n

%

n

%

n

%

n

%

Gender

            

 Male

44

7.97

210

38.04

196

35.51

88

15.94

14

2.54

  

 Female

92

9.40

354

36.16

369

37.69

151

15.42

13

1.33

4.588

0.332

Age

            

 24 and below

14

9.33

48

32.00

65

43.33

21

14.00

2

1.33

  

 25–34

45

8.54

169

32.07

216

40.99

84

15.94

13

2.47

  

 35–44

40

7.16

211

37.75

207

37.03

93

16.64

8

1.43

  

 45–54

30

11.19

123

45.90

75

27.99

37

13.81

3

1.12

  

 55 and above

7

25.93

13

48.15

2

7.41

4

14.81

1

3.70

44.291

<0.001

Educational background

            

 Technical secondary school and below

32

17.02

64

34.04

61

32.45

28

14.89

3

1.60

  

 Junior college

49

8.96

210

38.39

209

38.21

75

13.71

4

0.73

  

 Bachelor’s degree

54

7.33

278

37.72

265

35.96

122

16.55

18

2.44

  

 Master’s degree or above

1

1.69

12

20.34

30

50.85

14

23.73

2

3.39

39.668

<0.001

Position

            

 Doctor

40

6.68

208

34.72

215

35.89

116

19.37

20

3.34

  

 Nurse

58

8.77

242

36.61

257

38.88

98

14.83

6

0.91

  

 Medical technician

38

14.02

114

42.07

93

34.32

25

9.23

1

0.37

42.361

<0.001

Professional title

            

 No title

3

12.50

7

29.17

12

50.00

2

8.33

0

0.00

  

 Junior title

40

7.80

159

30.99

216

42.11

86

16.76

12

2.34

  

 Middle title

68

9.33

288

39.51

256

35.12

107

14.68

10

1.37

  

 Senior title

25

9.43

110

41.51

81

30.57

44

16.60

5

1.89

21.666

0.041

Years in professional working experience

            

 1–5 years

26

9.03

81

28.13

123

42.71

52

18.06

6

2.08

  

 6–10 years

17

7.94

64

29.91

91

42.52

35

16.36

7

3.27

  

 11–15 years

13

5.73

93

40.97

89

39.21

30

13.22

2

0.88

  

 16–20 years

27

8.79

111

36.16

113

36.81

50

16.29

6

1.95

  

 20 years and above

53

10.71

215

43.43

149

30.10

72

14.55

6

1.21

38.586

0.001

City

            

 Wuhan city

17

7.73

87

39.55

81

36.82

33

15.00

2

0.91

  

 Jingzhou city

12

5.50

82

37.61

84

38.53

37

16.97

3

1.38

  

 Yichang city

20

9.30

78

36.28

73

33.95

40

18.60

4

1.86

  

 Xiangyang city

22

10.00

72

32.73

89

40.45

29

13.18

8

3.64

  

 Shiyan city

23

10.50

77

35.16

78

35.62

34

15.53

7

3.20

  

 Suizhou city

16

7.31

78

35.62

86

39.27

38

17.35

1

0.46

  

 Jingmen city

26

11.82

90

40.91

74

33.64

28

12.73

2

0.91

27.146

0.298

The number of hours spent at work everyday

            

 8 h and below

97

13.16

308

41.79

260

35.28

66

8.96

6

0.81

  

 9 h

26

6.39

148

36.36

155

38.08

74

18.18

4

0.98

  

 10 h

9

4.11

65

29.68

84

38.36

56

25.57

5

2.28

  

 11 h

1

2.17

13

28.26

23

50.00

7

15.22

2

4.35

  

 12 h

1

2.70

8

21.62

17

45.95

9

24.32

2

5.41

  

 12 h and above

2

2.35

22

25.88

26

30.59

27

31.76

8

9.41

141.127

<0.001

The degree of work stress

            

 No pressure

14

45.16

10

32.26

5

16.13

2

6.45

0

0.00

  

 Slight pressure

56

13.63

194

47.20

129

31.39

27

6.57

5

1.22

  

 Moderate pressure

29

12.03

91

37.76

96

39.83

25

10.37

0

0.00

  

 Considerable pressure

34

4.99

225

32.99

287

42.08

126

18.48

10

1.47

  

 Extreme pressure

3

1.81

44

26.51

48

28.92

59

35.54

12

7.23

222.417

<0.001

Satisfaction on performance appraisal system

            

 Very satisfied

22

64.71

4

11.76

6

17.65

1

2.94

1

2.94

  

 Satisfied

80

16.84

257

54.11

107

22.53

30

6.32

1

0.21

  

 Moderate

28

3.57

258

32.91

364

46.43

126

16.07

8

1.02

  

 Dissatisfied

5

2.54

42

21.32

74

37.56

67

34.01

9

4.57

  

 Very dissatisfied

1

2.44

3

7.32

14

34.15

15

36.59

8

19.51

483.816

<0.001

Satisfaction on concern showed by leaders

            

 Very satisfied

35

46.05

30

39.47

9

11.84

2

2.63

0

0.00

  

 Satisfied

79

15.28

258

49.90

132

25.53

47

9.09

1

0.19

  

 Moderate

19

2.45

132

17.03

363

46.84

135

17.42

12

1.55

  

 Dissatisfied

2

1.50

47

35.34

56

42.11

42

31.58

8

6.02

  

 Very dissatisfied

1

3.33

1

3.33

5

16.67

13

43.33

6

20.00

427.387

<0.001

Satisfaction on hospital management

            

 Very satisfied

38

49.35

30

38.96

9

11.69

0

0.00

0

0.00

  

 Satisfied

79

12.99

311

51.15

165

27.14

50

8.22

3

0.49

  

 Moderate

17

2.28

204

27.35

364

48.79

148

19.84

13

1.74

  

 Dissatisfied

1

1.20

18

21.69

25

30.12

31

37.35

8

9.64

  

 Very dissatisfied

1

5.88

1

5.88

2

11.76

10

58.82

3

17.65

466.78

<0.001

Satisfaction on compensation packages

            

 Very satisfied

11

55.00

7

35.00

1

5.00

0

0.00

1

5.00

  

 Satisfied

60

22.73

139

52.65

57

21.59

8

3.03

0

0.00

  

 Moderate

39

5.53

286

40.57

294

41.70

81

11.49

5

0.71

  

 Dissatisfied

24

5.22

123

26.74

186

40.43

116

25.22

11

2.39

  

 Very dissatisfied

2

2.44

9

10.98

27

32.93

34

41.46

10

12.20

363.14

<0.001

Satisfaction on learning and training opportunities

            

 Very satisfied

11

32.35

11

32.35

10

29.41

1

2.94

1

2.94

  

 Satisfied

42

17.07

114

46.34

69

28.05

20

8.13

1

0.41

  

 Moderate

48

9.14

218

41.52

178

33.90

76

14.48

5

0.95

  

 Dissatisfied

22

4.57

147

30.56

204

42.41

94

19.54

14

2.91

  

 Very dissatisfied

13

5.31

74

30.20

104

42.45

48

19.59

6

2.45

112.753

<0.001

Through Pearson chi-square statistical analysis, the results showed that factors related to the job satisfaction of medical staff in pilot county hospitals included age, educational background, position, professional title, years in professional working experience, the number of hours spent at work, work stress, and satisfaction on the following aspects: performance appraisal system, concern showed by leaders, hospital management, compensation packages, and learning and training opportunities (P < 0.05; Table 3).

To further determine the significant factors influencing the job satisfaction of medical staff in pilot county hospitals, we substituted the variables with statistical significance from the previous Pearson chi-square statistical analysis into the binary logistic regression model for calculation. The dependent variable Y in logistic regression included the following: 1 “satisfied” (very satisfied, satisfied, moderate) and 0 “dissatisfied” (dissatisfied, very dissatisfied). The independent variable X1 (age) included five grades from younger to older. The independent variable X2 (position) included “doctor”, “nurse”, and “medical technician”. The independent variable X3 (professional title) included four grades from lower to higher. The independent variable X4 (years in professional working experience) included five grades from shorter to longer. The independent variable X5 (educational background) included four grades from lower to higher. The independent variable X6 (the number of hours spent at work every day) included four grades from less to greater. The independent variable X7 (work stress) included two grades: 1 “no pressure or moderate pressure” (no pressure, slight pressure, moderate pressure) and 2 “great pressure” (considerable pressure, extreme pressure). The independent variables X8 (satisfaction on performance appraisal system), X9 (satisfaction on concern showed by leaders), X10 (satisfaction on hospital management), X11 (satisfaction on compensation packages), and X12 (satisfaction on learning and training opportunities) all included two grades: 1 “satisfied” (very satisfied, satisfied, moderate) and 2 “dissatisfied” (dissatisfied, very dissatisfied).

The results of the binary logistic regression analysis showed that the factors significantly influencing the job satisfaction of medical staff in pilot county hospitals included the number of hours spent at work, work stress, satisfaction on performance appraisal system, satisfaction on hospital management, satisfaction on compensation packages, and satisfaction on learning and training opportunities (P < 0.05; Table 4). In particular, the job satisfaction probability of the medical staff who worked for 9, 10, and 11 h every day were 0.483 times (OR = 0.483, 95% CI = 0.327–0.713, P < 0.001), 0.364 times (OR = 0.364, 95% CI = 0.230–0.576, P < 0.001), and 0.339 times (OR = 0.339, 95% CI = 0.202–0.568, P < 0.001) lower than that of the medical staff who worked for a maximum of 8 h, respectively. The job satisfaction probability of the medical staff who felt no pressure or moderate pressure was 2.384 times higher (OR = 2.384, 95% CI = 1.666–3.411, P < 0.001) than that of the medical staff who felt great work pressure. These results showed that working hours and work pressure were negatively related to job satisfaction in pilot county hospitals. The job satisfaction probability of the medical staff who were satisfied with the performance appraisal system was 2.243 times higher than that of the medical staff who were dissatisfied (OR = 2.243, 95% CI = 1.504–3.345, P < 0.001). The job satisfaction probability of the medical staff who were satisfied with hospital management was 2.043 times higher than that of the medical staff who were dissatisfied (OR = 2.043, 95% CI = 1.196–3.490, P = 0.009). The job satisfaction probability of the medical staff who were satisfied with compensation packages was 3.298 times higher than that of the medical staff who were dissatisfied (OR = 3.298, 95% CI = 2.410–4.513, P < 0.001). The job satisfaction probability of the medical staff who were satisfied with learning and training opportunities was 1.442 times higher than that of the medical staff who were dissatisfied (OR = 1.442, 95% CI = 1.050–1.980, P = 0.024). These results showed that satisfaction on performance appraisal system, hospital management, compensation packages, and learning and training opportunities were positively related to job satisfaction in county hospitals.
Table 4

Analysis on the multiple factors influencing job satisfaction of medical staff in pilot county hospitals

Medical staff in pilot county hospitals

Reference category

B

P

OR

95% CI

Age

24 and below

    

 25–34

 

−0.231

0.522

0.794

(0.392–1.610)

 35–44

 

−0.549

0.279

0.577

(0.213–1.562)

 45–54

 

−0.603

0.309

0.547

(0.171–1.748)

 55 and above

 

−0.91

0.279

0.403

(0.077–2.093)

Position

Medical technician

    

 Doctor

 

−0.368

0.201

0.692

(0.394–1.216)

 Nurse

 

−0.39

0.139

0.677

(0.404–1.136)

Professional title

No title

    

 Junior title

 

−0.249

0.719

0.779

(0.201–3.027)

 Middle title

 

−0.458

0.506

0.633

(0.164–2.437)

 Senior title

 

−0.417

0.555

0.659

(0.165–2.635)

Years in professional working experience

1–5 years

    

 6–10 years

 

0.36

0.242

1.434

(0.784–2.623)

 11–15 years

 

0.72

0.054

2.055

(0.989–4.272)

 16–20 years

 

0.601

0.200

1.823

(0.728–4.567)

 20 years and above

 

0.559

0.280

1.748

(0.635–4.817)

Educational background

Technical secondary school and below

    

 Junior college

 

0.344

0.228

1.411

(0.806–2.469)

 Bachelor’s degree

 

0.35

0.261

1.42

(0.771–2.615)

 Master’s degree or above

 

0.352

0.464

1.421

(0.554–3.644)

The number of hours spent at work everyday

8 h and below

    

 9 h

 

−0.727

<0.001

0.483

(0.327–0.713)

 10 h

 

−1.01

<0.001

0.364

(0.230–0.576)

 11 h and above

 

−1.083

<0.001

0.339

(0.202–0.568)

The degree of work stress

Great pressure

    

 No pressure or moderate pressure

 

0.869

<0.001

2.384

(1.666–3.411)

Satisfaction on performance appraisal system

Dissatisfied

    

 Satisfied

 

0.808

<0.001

2.243

(1.504–3.345)

Satisfaction on concern showed by leaders

Dissatisfied

    

 Satisfied

 

0.302

0.206

1.352

(0.848–2.157)

Satisfaction on hospital management

Dissatisfied

    

 Satisfied

 

0.715

0.009

2.043

(1.196–3.490)

Satisfaction on compensation packages

Dissatisfied

    

 Satisfied

 

1.193

<0.001

3.298

(2.410–4.513)

Satisfaction on learning and training opportunities

Dissatisfied

    

 Satisfied

 

0.366

0.024

1.442

(1.050–1.980)

Understanding and perception of the public hospital reform of medical staff in pilot and non-pilot county hospitals

In pilot county hospitals, only 35.92% of the investigated medical staff members expressed that they knew a lot or fully knew of the specific contents of the public hospital reform programme and policy. Only 50.29% of the investigated medical staff members expressed that they obviously perceived of the promotion of public hospital reform in their county. Approximately 59.24% of the investigated medical staff members expressed that obvious changes occurred in their hospitals since the reform began in 2008. Only 8.10% of the investigated medical staff members considered that the reform could significantly solve the main problems in public hospitals, and 68.32% considered that the reform could solve only part of the problems. Only 6.27% of the investigated medical staff thought that the reform could have evident effects that could solve the difficulty in the accessibility of medical service, and 71.52% thought that this reform could affect and alleviate this difficulty only to some extent. Only 7.25% of the investigated medical staff thought that the reform could have evident effects that could solve the difficulty in the affordability of medical service, and 66.75% thought that this reform could only alleviate this difficulty to some extent.

The Pearson chi-square test method was used to assess the differences in the understanding and perception of the reform between medical staff in pilot county hospitals and medical staff in non-pilot county hospitals. The results showed that medical staff in pilot and non-pilot county hospitals exhibited significant differences in all the aspects aforementioned (P < 0.05; Table 5)
Table 5

The understanding and perception of public hospital reform of medical staff in pilot and non-pilot county hospitals

The understanding and perception of public hospital reform

Pilot county hospitals (n= 1531)

Non-pilot county hospitals (n= 737)

Total

χ 2

P

n

%

n

%

n

%

The understanding degree of specific contents of the public hospital reform programme

        

 Fully know

70

4.57

14

1.90

84

3.70

  

 Know a lot

480

31.35

177

24.02

657

28.97

  

 Know some

484

31.61

304

41.25

788

34.74

  

 Know a little

424

27.69

201

27.27

625

27.56

  

 Know nothing

73

4.77

41

5.56

114

5.03

32.787

<0.001

The perceived level of the reform promotion in this county

        

 Perceive obviously

770

50.29

293

39.76

1063

46.87

  

 Perceive not obviously

578

37.75

370

50.20

948

41.80

  

 Perceive nothing

46

3.00

22

2.99

68

3.00

  

 Have no idea

137

8.95

52

7.06

189

8.33

32.378

<0.001

The perceived level of changes brought by reform since 2008

        

 Change obviously

907

59.24

231

31.34

1138

50.18

  

 Change not obviously

494

32.27

374

50.75

868

38.27

  

 Change nothing

65

4.25

100

13.57

165

7.28

  

 Have no idea

65

4.25

32

4.34

97

4.28

181.017

<0.001

If public hospital reform could solve the problems faced by public hospitals

        

 Solve the main problems

124

8.10

38

5.16

162

7.14

  

 Solve only part of the problems

1046

68.32

491

66.62

1537

67.77

  

 Solve nothing

136

8.88

94

12.75

230

10.14

  

 Have no idea

225

14.70

114

15.47

339

14.95

13.797

0.003

If public hospital reform could solve the difficulty in accessibility of medical service

        

 Have obvious effects

96

6.27

27

3.66

123

5.42

  

 Have some effects

1095

71.52

469

63.64

1564

68.96

  

 Have no effect

175

11.43

132

17.91

307

13.54

  

 Have no idea

165

10.78

109

14.79

274

12.08

32.783

<0.001

If public hospital reform could solve the difficulty in affordability of medical service

        

 Have obvious effects

111

7.25

24

3.26

135

5.95

  

 Have some effects

1022

66.75

428

58.07

1450

63.93

  

 Have no effect

226

14.76

175

23.74

401

17.68

  

 Have no idea

172

11.23

110

14.93

282

12.43

47.353

<0.001

Discussion

Medical staff members in pilot county hospitals were exposed to work-related stress to a higher extent

In this study, medical staff members in pilot county hospitals were exposed to work-related stress at a higher extent than those in non-pilot county hospitals. This result could be attributed to the increasing number of patients, higher requirements for technical level and comprehensive quality of medical staff, and reform measures of hospital administration system caused by the public hospital reform [6]. Because of the health reform, the basic social health insurance system has been improved and medical cost and expenses have been reasonably controlled. The medical demand of the population is released and medical staff members would see more patients/day. In China, many jobs require employees to work for only 8 h a day, but the results of this study showed that more than half of the medical staff members (51.86%) work for more than 8 h a day in pilot county hospitals. This finding showed that overtime working is common for medical staff in pilot county hospitals, which may increase the work stress.

Pilot county hospitals have implemented some reform measures and got some positive effects, but there still are deficiencies

Medical staff members in pilot county hospitals were more satisfied on current job, performance appraisal system, concern showed by leaders, hospital management, and compensation packages than those in non-pilot county hospitals. This finding suggested that the pilot county hospitals have implemented some reform measures to improve performance appraisal system and management system, to concern more on their staff, and to increase income and job satisfaction with this reform. These measures have showed some positive effects. However, there was no significant difference between satisfaction on learning and training opportunities of medical staff in pilot county hospitals than that in non-pilot county hospitals. This suggested that pilot county hospitals have not implemented sufficient effective measures to provide enough learning and training opportunities to medical staff.

Medical staff members in pilot county hospitals have evidently less satisfaction on compensation packages and learning and training opportunities

Within pilot county hospitals, medical staff members were evidently less satisfied with compensation packages and learning and training opportunities than with other work-related aspects. These indicated that medical staff members considered that current remuneration did not match the amount of work, and the learning and training opportunities currently provided for them did not satisfy the demands. At present, the average annual income of medical staff in county hospitals in China is basically the same as the average annual income of urban workers. But in many other counties, the income of medical staff is generally higher than that of other professions and is four or five times the income of urban workers. The income level of medical staff in county hospitals in China is well below the international situation. Hence, medical staff urgently needs improvement. In China, the income levels of medical staff in different county hospitals are basically the same. Therefore, dissatisfaction on current remuneration of medical staff in county hospital is a common problem.

Significant influencing factors of job satisfaction of medical staff in pilot county hospitals have been determined

Job satisfaction originates in the organizational psychology literature but has been adopted by some researchers in the field of human resources for health [7-9]. Locke defined this concept as “a pleasurable or positive emotional state resulting from the appraisal of one’s job or job experiences” [10]. In the field of health care, job satisfaction of medical staff determines the quality of service delivery to patients [11,12]. Poor job satisfaction is associated with absenteeism, employee turnover in an organization, and eventual exhaustion [13,14].

To assess job satisfaction, we further analysed the factors influencing the job satisfaction of medical staff in pilot county hospitals by univariate and multivariate analyses. Univariate analysis results showed that sociodemographic characteristics (including age, educational background, position, professional title, and years in professional working experience), working situation (including the number of hours spent at work every day and work stress), and satisfaction on some work-related factors (including satisfaction on performance appraisal system, concern showed by leaders, hospital management, compensation packages, and learning and training opportunities) were related to the job satisfaction of medical staff in pilot county hospitals.

However, multivariate analysis results showed that only the number of hours spent at work, work stress, and satisfaction on performance appraisal system, hospital management, compensation packages, and learning and training opportunities were significantly associated with job satisfaction of medical staff in pilot county hospitals. None of the sociodemographic characteristics exhibited a significant correlation. It indicated that the influence on job satisfaction of medical staff caused by sociodemographic characteristics in this study was weaker than that caused by working situation and satisfaction on work-related factors. This phenomenon could be attributed to great changes in the working situations of medical staff and work-related factors in pilot county hospitals in China as a result of the implementation of the health-care reform and hospital reform. Therefore, sociodemographic characteristics did not strongly influence job satisfaction, whereas working situations and satisfaction on work-related factors were statistically significant.

The results of multivariate analysis indicated long hours spent at work each day and high work-related stress encountered could result in less job satisfaction. By comparison, a high satisfaction on performance appraisal system, hospital management, compensation packages, and learning and training opportunities could indicate high job satisfaction. These findings are consistent with those in earlier studies on job satisfaction [14-28]. For example, health workers in Ghana overwhelmingly identify low salaries as the main source of dissatisfaction on an interviewer-administered questionnaire [29]. Kumar and co-workers found that factors influencing the satisfaction level include low salaries, lack of training opportunities, improper supervision, and inadequate financial rewards. Marinucci and co-workers conducted a survey in seven sub-Saharan African countries [30], and the result shows that professional development and training opportunities are the most important factor resulting in job satisfaction as indicated by approximately 90% of the total interviewees. Peters and his co-workers conducted a survey in India and found that many employees rate “training opportunities” as one of the motivating factors [31]. A review of 12 empirical studies on the motivation of developing and developed countries has found that seven major job characteristics are important determinants of job motivation, including opportunities for personal development, pay/rewards, management practices, and organizational policies [32]. A study in Vietnam has also found that the main motivating factors of health workers include the following: the appreciation expressed by their managers, competitive income, and training [33].

Suggestions for improving job satisfaction of medical staff in pilot county hospitals

Therefore, the government officials and hospital administrators should pay attention to these influencing factors and focus on the demands of medical staff in pilot county hospitals. What should be done most at present mainly include three aspects [34,35]. 1) The hospital administrators should have more concern for the working situation of medical staff in pilot county hospitals, properly assign and arrange work, and appropriately reduce workload and work stress to promote job satisfaction and active participation of medical staff in pilot county hospitals. 2) The government officials and hospital administrators should improve the system of compensation packages, promote income levels, and make the income match the workload and technical value of medical staff in pilot county hospitals. 3) More learning and training opportunities should be provided and created to medical staff in pilot county hospitals, in order to help them to improve their professional level and meet their individual development requirements. 4) More physical and mental health considerations and better performance appraisal system and management system should be provided for medical staff in pilot county hospitals, in order to promote their job satisfaction. 5) In a previous study, the participation of medical staff in decision-making significantly affected job satisfaction [28]; as such, democratic management can be applied in pilot county hospitals.

Medical staff in pilot county hospitals exhibited better understanding of the public hospital reform programme and more positive attitude towards it, but it still needs improvement

The results of the data analysis showed that the medical staff in pilot county hospitals exhibited a better understanding of the specific contents of the public hospital reform programme, more optimistic perception of the changes caused by the reform, and more firm confidence and positive attitude towards the reform compared with the medical staff in non-pilot county hospitals. These findings indicated that the reform measures implemented in pilot county hospitals have resulted in some positive effect, and the medical staff in pilot county hospitals experienced more advantages from this reform. However, there still were some medical staff members in pilot county hospitals who showed insufficient understanding and perception of the reform and hold negative attitude towards the effect of the reform. These findings suggested that the understanding, perception, and attitude towards public hospital reform of the medical staff in pilot county hospitals still need improvement. Therefore, 1) the government should provide more implementing rules of the reform policy, to make the reform policy more clearly and operable; 2) the government officials and hospital administrators can guide medical staff members with different individual characters by using different methods to learn the knowledge and importance of this reform in pilot county hospitals; 3) to promote the active implementation of public hospital reform, government officials and hospital administrators should guide and encourage the medical staff in pilot county hospitals to take part in the reform, and make more publicity on the benefits of the reform utilizing multiple forms, such as conferences, posters, and TV shows.

Possible limitations

In this study, there were three possible limitations: first, the cross-sectional design with job satisfaction. It was difficult to establish a causal conclusion, and the longitudinal survey might be carried out to confirm the causal conclusion in our future study. Second, the measurements were performed by a self-administrated method. Then, it is possible that the respondents might have overreported or underreported their level of job satisfaction and satisfaction on work-related factors and understanding and perception of the reform. Third, given that the study was conducted only in counties of Hubei province, the findings of the study may or may not be generalized to medical staff working in other areas in China.

Conclusions

The results in this study indicated that pilot county hospitals have implemented some measures to improve the performance appraisal system and management system, provide adequate care for their medical staff, and increase medical staff’s income and job satisfaction through the reform. Pilot county hospitals have experienced some positive effects but there still are deficiencies. Within pilot county hospitals, work stress increased and less than half of the medical staff members were very satisfied or satisfied with current job. To promote the job satisfaction of medical staff in pilot county hospitals, the government officials and hospital administrators should pay attention to these influencing factors of job satisfaction and focus on the reasonable demands of medical staff in pilot county hospitals.

In addition, the medical staff members in pilot county hospitals exhibited a better understanding of the public hospital reform programme and showed more firm confidence and positive attitude towards the reform than the medical staff members in non-pilot county hospitals. These findings indicated that the reform measures implemented in pilot county hospitals have resulted in some positive effect, and the medical staff in pilot county hospitals experienced more advantages from this reform. However, there still were some medical staff members in pilot county hospitals who showed insufficient understanding and perception of the reform and hold negative attitude towards the effect of the reform. These findings suggested that the understanding, perception, and attitude towards the public hospital reform of the medical staff and the publicity and education of the reform in pilot county hospitals still need improvement.

Notes

Declarations

Acknowledgements

This research was supported by the National Natural Science Foundation of China (No. 71073062). We also thank Australian health policy expert Dr Chris Scarf and Mrs Ana Scarf for their help with this article.

Authors’ Affiliations

(1)
School of Health and Medicine Management, Tongji Medical College, Huazhong University of Science and Technology
(2)
School of Health Management, Guangzhou Medical University
(3)
The London School of Economics and Political Science

References

  1. Liu Y. Reforming China’s health care: for the people, by the people? Lancet. 2009;373:281–3.View ArticlePubMedGoogle Scholar
  2. Li L. The challenges of healthcare reforms in China. Public Health. 2011;125:6–8.View ArticlePubMedGoogle Scholar
  3. Zhu C. Launch of the health-care reform plan in China. Lancet. 2009;373:1322–4.View ArticleGoogle Scholar
  4. National Health and Family Planning Commission of the People’s Republic of China. National plan for rural health system construction and development. 2006. http://www.nhfpc.gov.cn/zhuzhan/wsbmgz/201304/965d43777b6e4a2993ff139c08ce534d.shtml. (in Chinese) Accessed 6 May 2015.
  5. Ding H, Sun X, Chang WW, Zhang L, Xu XP. A comparison of job satisfaction community health workers before and after local comprehensive medical care reform: a typical field investigation in Central China. PLoS One. 2013;8, e73438.View ArticlePubMedPubMed CentralGoogle Scholar
  6. Hou JL, Li N, Lu L, Li JZ, Ma J. Research on job satisfaction degree primary healthcare workers after health care system reform in Shanghai City. Chin Hospital Manage. 2013;33:10–2.Google Scholar
  7. Tzeng H. The influence of nurses’ working motivation and job satisfaction on intention to quit an empirical investigation in Taiwan. Int J Nurs Stud. 2002;39:867–78.View ArticlePubMedGoogle Scholar
  8. Pillay R. Work satisfaction of professional nurses in South Africa: a comparative analysis of the public and private sectors. Hum Resour Heal. 2009;7:15.View ArticleGoogle Scholar
  9. Sibbald B, Enzer I, Cooper C, Rout U, Sutherland V. GP job satisfaction in1990 and 1998: lessons for the future? Fam Pract. 1987;2000(17):364–71.Google Scholar
  10. Locke E. The nature and causes of job satisfaction. In: Dunnette M, Hough L, editors. The handbook of industrial and organizational psychology. Palo Alto, CA: Consulting Psychologists Press; 1976. p. 1319–28.Google Scholar
  11. Haas JS, Cook EF, Puopolo AL, Burstin HR, Cleary PD, Brennan TA. Is the professional satisfaction of general internists associated with patient satisfaction? J Gen Intern Med. 2000;15:122–8.View ArticlePubMedPubMed CentralGoogle Scholar
  12. Bodur S. Job satisfaction of health care staff employed at health centres in Turkey. Occup Med (Lond). 2002;52:353–5.View ArticleGoogle Scholar
  13. McManus IC, Keeling A, Paice E. Stress, burnout and doctors’ attitudes to work are determined by personality and learning style: a twelve year longitudinal study of UK medical graduates. BMC Med. 2004;2:29.View ArticlePubMedPubMed CentralGoogle Scholar
  14. Visser MR, Smets EM, Oort FJ, De Haes HC. Stress, satisfaction and burnout among Dutch medical specialists. CMAJ. 2003;168:271–5.PubMedPubMed CentralGoogle Scholar
  15. Zhang YM, Feng XS. The relationship between job satisfaction, burnout, and turnover intention among physicians from urban state-owned medical institutions in Hubei, China: a cross-sectional study. BMC Health Serv Res. 2011;11:235–48.View ArticlePubMedPubMed CentralGoogle Scholar
  16. Hills D, Joyce C, Humphreys J. Validation of a job satisfaction scale in the Australian clinical medical workforce. Eval Health Prof. 2011;35:47–76.View ArticlePubMedGoogle Scholar
  17. Nylenna M, Gulbrandsen P, Førde R, Aasland OG. Unhappy doctors? A longitudinal study of life and job satisfaction among Norwegian doctors 1994-2002. BMC Health Serv Res. 2005;5:44.View ArticlePubMedPubMed CentralGoogle Scholar
  18. Pathman DE, Konrad TR, Williams ES, Scheckler WE, Linzer M, Douglas J. Career Satisfaction Study Group. Physician job satisfaction, dissatisfaction, and turnover. J Fam Pract. 2002;51:593.PubMedGoogle Scholar
  19. Murrells T, Robinson S, Griffiths P. Is satisfaction a direct predictor of nursing turnover? Modelling the relationship between satisfaction, expressed intention and behaviour in a longitudinal cohort study. Hum Resour Heal. 2008;6:22.View ArticleGoogle Scholar
  20. Lambrou P, Kontodimopoulos N, Niakas D. Motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital. Hum Resour Heal. 2010;8:26–34.View ArticleGoogle Scholar
  21. McGlynn K, Griffin MQ, Donahue M, Fitzpatrick JJ. Registered nurse job satisfaction and satisfaction with the professional practice model. J Nurs Manage. 2012;20:260–5.View ArticleGoogle Scholar
  22. Pillay R. Work satisfaction of medical doctors in the South African private health sector. J Health Organ Manag. 2008;22:254–68.View ArticlePubMedGoogle Scholar
  23. Taylor K, Lambert T, Goldacre M. Career destinations, job satisfaction and views of the UK medical qualifiers of 1977. J R Soc Med. 2008;101:191–200.PubMedPubMed CentralGoogle Scholar
  24. Wenderlein FU. Work satisfaction and absenteeism of nursing staff–comparative study of 1021 nurse trainees and nurses. Gesundheitswesen. 2003;65:620–8.View ArticlePubMedGoogle Scholar
  25. Sara DG, Joeri H, Roland P. Revisiting the impact of job satisfaction and organizational commitment on nurse turnover intention: an individual differences analysis. Int J Nurs Stud. 2011;48:1562–9.View ArticleGoogle Scholar
  26. Gardulf A, Orton ML, Eriksson LE, Undén M, Arnetz B, Kajermo KN, et al. Factors of importance for work satisfaction among nurses in a university hospital in Sweden. Scand J Caring Sci. 2008;22:151–60.View ArticlePubMedGoogle Scholar
  27. Tellez M. Work satisfaction among California registered nurses: a longitudinal comparative analysis. Nurs Econ. 2012;30:73–81.PubMedGoogle Scholar
  28. Janus K, Amelung VE, Baker LC, Gaitanides M, Schwartz FW, Rundall TG. Job satisfaction and motivation among physicians in academic medical centers: insights from a cross-national study. J Health Polit Policy Law. 2008;33:1133–67.View ArticlePubMedGoogle Scholar
  29. Agyepong I, Anafi P, Asiamah E, Ansah EK, Ashon DA, Narh-Dometey C. Health worker (internal customer) satisfaction and motivation in the public sector in Ghana. Int J Health Plann Manage. 2004;19:319–36.View ArticlePubMedGoogle Scholar
  30. Kumar R, Ahmed J, Shaikh BT, Hafeez R, Hafeez A. Job satisfaction among public health professionals working in public sector: a cross sectional study from Pakistan. Hum Resour Health. 2013;11:2.View ArticlePubMedPubMed CentralGoogle Scholar
  31. Peters DH, Subrata C, Prasanta M. Job satisfaction and motivation of health work in public and private sectors: cross-sectional analysis from two Indian states. Laura Steinhardt Hum Resour Health. 2010;8:27.View ArticlePubMedGoogle Scholar
  32. Dolea C, Adams O. Motivation of health care workers-review of theories and empirical evidence. Cah Sociol Demogr Med. 2005;45:135–6.PubMedGoogle Scholar
  33. Dieleman M, Cuong PV, Anh LV, Martineau T. Identifying factors for job motivation of rural health workers in North Viet Nam. Hum Resour Health. 2003;5:10.View ArticleGoogle Scholar
  34. Luo Z, Bai X, Min R, Tang C, Fang P. Factors influencing the work passion of Chinese community health service workers: an investigation in five provinces. BMC Fam Pract. 2014;15:77.View ArticlePubMedPubMed CentralGoogle Scholar
  35. Sun Y, Luo Z, Fang P. Factors influencing the turnover intention of Chinese community health service workers based on the investigation results of five provinces. J Community Health. 2013;38:1058–66.View ArticlePubMedGoogle Scholar

Copyright

© Fang et al.; licensee BioMed Central. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Advertisement