The Impact of Organizational Justice on Turnover Intention Among Primary Healthcare Workers: The Mediating Role of Work Motivation.

BACKGROUND

Adequate staffing of primary healthcare workers (PHCWs) is essential for strengthening healthcare systems, yet high turnover intention among these workers presents a significant challenge. While existing strategies primarily target economic incentives and career progression, this study proposes that enhancing organizational justice could offer a novel and impactful approach to retention. Drawing on equity theory and self-determination theory, the study examines how organizational justice influences turnover intention and the mediating roles of both the intensity and type of work motivation.

METHODS

This is a cross-sectional study design. A multi-stage cluster sampling method was utilized to administer a questionnaire survey to 1,200 PHCWs from 36 primary health institutions in Shandong Province, China.

RESULTS

Multivariate linear regression analysis revealed that organizational justice significantly reduces turnover intention among PHCWs (β = -0.435, p < 0.001). Among its three dimensions, distributive justice (β = -0.203, p < 0.001) and procedural justice (β = -0.177, p < 0.01) had significant impacts on turnover intention, whereas interactional justice did not. The study also confirmed the mediating role of work motivation, with work motivation type accounting for 18.2% of the total effect, exerting a greater influence than work motivation intensity, which accounted for 13.8% of the total effect.

CONCLUSION

This study finds that organizational justice, especially distributive and procedural justice, reduces turnover intention among PHCWs in China. Work motivation mediates this effect, with motivation type having a stronger influence than motivation intensity. Enhancing organizational justice through transparent systems for compensation, promotion, and inclusive decision-making can foster the internalization of work motivation, providing a sustainable approach to improving retention and supporting the stability of the primary healthcare workforce.