Li Huiwen, Yuan Beibei, Wang Dan, Meng Qingyue
China Centre for Health Development Studies, Peking University, Beijing, China.
China Centre for Health Development Studies, Peking University, Beijing, China
BMJ Open. 2019 Nov 21;9(11):e028619. doi: 10.1136/bmjopen-2018-028619.
Although China has made remarkable progress in strengthening its primary healthcare system, lack of well-performed primary health workforce is still the bottleneck of deepening the reform. The objective of this review is to understand the current profile of Chinese primary care workers (PCWs) and their motivating factors of performance and propose targeted policy suggestions on improving their work performance.
Systematic review.
A systematic search of PubMed and MEDLINE was conducted to identify articles published from January 1, 2000, to June 2, 2018. Quality assessment and data extraction for the studies closely relevant to performance of PCWs in China were conducted by two reviewers independently. A preliminary framework containing different levels of factors influencing PCWs' motivation based on existence, growth and relatedness (ERG) theory guided the synthesis analysis. In addition, we used a random-effects model to pool individual studies on job satisfaction and estimate the overall job satisfaction of PCWs.
A total of 36 articles were included; 16 (23 882 participants) in the meta-analysis. Regarding the individual level of motivation, 3 overarching themes and 12 subthemes were developed. The subthemes of financial incentives, career advancement and work itself were frequently mentioned and have more influences on PCWs' performance. Moreover, the healthcare system reform policies have inevitable and complex impacts on different levels of human needs, and then influences on the motivation and performance of PCWs. Meta-analysis showed that the overall job satisfaction score among PCWs was 3.30, just reaching a satisfied rating and varied in different regions.
This study suggests low work satisfaction among PCWs in China, with financial incentives and career advancement being two most important motivating factors. Efforts to improve the work performance in PCWs should give priority to these motivating factors and systematically take into account the health policy's impacts on performance of PCWs.
尽管中国在加强基层医疗体系方面取得了显著进展，但基层卫生人力表现不佳仍是深化改革的瓶颈。本综述的目的是了解中国基层医疗工作者（PCWs）的现状及其工作表现的激励因素，并就提高其工作绩效提出有针对性的政策建议。
系统综述。
对PubMed和MEDLINE进行系统检索，以识别2000年1月1日至2018年6月2日发表的文章。由两名审稿人独立对与中国PCWs绩效密切相关的研究进行质量评估和数据提取。一个基于生存、成长和关系（ERG）理论的包含不同层次影响PCWs动机因素的初步框架指导了综合分析。此外，我们使用随机效应模型汇总关于工作满意度的个体研究，并估计PCWs的总体工作满意度。
共纳入36篇文章；16篇（23882名参与者）纳入荟萃分析。关于个人动机水平，确定了3个总体主题和12个子主题。经济激励、职业发展和工作本身的子主题被频繁提及，对PCWs的绩效有更大影响。此外，医疗体系改革政策对不同层次的人类需求有不可避免且复杂的影响，进而影响PCWs的动机和绩效。荟萃分析显示，PCWs的总体工作满意度得分为3.30，刚刚达到满意评级，且在不同地区有所差异。
本研究表明中国PCWs的工作满意度较低，经济激励和职业发展是两个最重要的激励因素。提高PCWs工作绩效的努力应优先考虑这些激励因素，并系统地考虑卫生政策对PCWs绩效的影响。
