Health Care Manage Rev. 2022;47(2):155-167. doi: 10.1097/HMR.0000000000000284.
Health care professionals' work motivation is assumed to be crucial for the quality of hospital care, but it is unclear which type of motivation ought to be stimulated to improve quality. Motivation and similar concepts are aligned along a motivational continuum that ranges from (intrinsic) autonomous motivation to (extrinsic) controlled motivation to provide a framework for this mixed-methods systematic review.
This mixed-methods systematic review aims to link various types of health care professionals' motivation directly and through their work-related behaviors to quality of care.
Six databases were searched from January 1990 to August 2016. Qualitative and quantitative studies were included if they reported on work motivation in relationship to work behavior and/or quality, and study participants were health care professionals working in hospitals in high-income countries. Study bias was evaluated using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. The review protocol was registered in the PROSPERO database (CRD42016043284).
A total of 84 out of 6,525 unique records met the inclusion criteria. Results show that health care professionals' autonomous motivation improves their quality perceptions and work-related behaviors. Controlled motivation inhibits voicing behavior, but when balanced with autonomous motivation, it stimulates core task and proactive behavior. Proactivity is associated with increased quality of care perceptions.
To improve quality of care, policy makers and managers need to support health care professionals' autonomous motivation and recognize and facilitate proactivity as an essential part of health care professionals' jobs. Incentive-based quality improvements need to be complemented with aspects that stimulate autonomous motivation.
医疗保健专业人员的工作动机被认为对医院护理质量至关重要，但尚不清楚应该刺激哪种类型的动机来提高质量。动机和类似的概念沿着动机连续体排列，从（内在）自主动机到（外在）控制动机，为这项混合方法系统评价提供了一个框架。
这项混合方法系统评价旨在将各种类型的医疗保健专业人员的动机直接与其工作相关行为联系起来，并将其与护理质量联系起来。
从 1990 年 1 月至 2016 年 8 月，检索了 6 个数据库。如果研究报告了工作动机与工作行为和/或质量的关系，且研究参与者为在高收入国家医院工作的医疗保健专业人员，则纳入定性和定量研究。使用来自多个领域的标准质量评估标准评估研究偏倚初级研究论文。该审查方案在 PROSPERO 数据库（CRD42016043284）中进行了注册。
共有 84 篇文献符合纳入标准，而 6525 篇文献则被排除在外。结果表明，医疗保健专业人员的自主动机可以提高他们的质量感知和工作相关行为。控制动机抑制了表达行为，但当与自主动机平衡时，它会刺激核心任务和主动行为。主动性与增加的护理质量感知有关。
为了提高护理质量，政策制定者和管理者需要支持医疗保健专业人员的自主动机，并认识到并促进主动性是医疗保健专业人员工作的重要组成部分。基于激励的质量改进需要补充刺激自主动机的方面。
