Human resource management interventions to improve health workers' performance in low and middle income countries: a realist review.
Human resource management interventions to improve health workers' performance in low and middle income countries: a realist review.
复制标题
DOI：
10.1186/1478-4505-7-7
复制
发表时间：
2009-04-17
影响因子：
4
通讯作者：
van der Wilt, Gert Jan
中科院分区：
文献类型：
--
作者：
Dieleman, Marjolein;Gerretsen, Barend;van der Wilt, Gert Jan
背景：提高卫生工作者的业绩对于实现千年发展目标至关重要。在文献中的人力资源管理（HRM）干预措施，以提高卫生工作者的业绩在低收入和中等收入国家（LMIC），几乎没有任何关注的问题，人力资源管理干预措施可能会带来的结果，在何种情况下。然而，这种信息对于评估成果的可转移性至关重要。我们的目的是探讨如果现实主义的审查出版的主要研究提供了更好的洞察力，人力资源管理干预措施的功能在LMIC.METHODOLOGY：一个现实主义的审查，不仅询问是否干预已被证明是有效的，但也通过哪些机制的干预产生的结果和上下文因素似乎是至关重要的影响。结果：结果表明，人力资源管理干预措施可以提高卫生工作者的绩效，但不同的背景下产生不同的结果。关键的执行方面是地方当局、社区和管理部门的参与;适应当地情况;以及当地工作人员积极参与确定和执行解决问题的办法。引发变革的机制是知识和技能的增加、感到有必要变革以及卫生工作者的积极性。促进激励的机制是保健工作者对当地问题的认识和增强工作人员的能力，使他们接受新的信息，并产生归属感和尊重感。此外，护理质量和工资补贴的明显改善也激励了工作人员。在低收入国家的卫生部门，只对有限的人力资源管理干预措施进行了评价。假设基本的人力资源管理干预措施通常不明确，阻碍我们的理解人力资源管理干预工作如何work.CONCLUSION：应用现实主义的观点，可以确定哪些人力资源管理干预措施可能会提高性能，在何种情况下，以及哪些群体的卫生工作者。为了能够更好地帮助了解人力资源管理干预措施如何能够改善卫生工作者的业绩，需要将定性和定量研究方法结合起来，并需要使用共同的评价指标和共同的报告格式。
BACKGROUND: Improving health workers' performance is vital for achieving the Millennium Development Goals. In the literature on human resource management (HRM) interventions to improve health workers' performance in Low and Middle Income Countries (LMIC), hardly any attention has been paid to the question how HRM interventions might bring about outcomes and in which contexts. Such information is, however, critical to assess the transferability of results. Our aim was to explore if realist review of published primary research provides better insight into the functioning of HRM interventions in LMIC.METHODOLOGY: A realist review not only asks whether an intervention has shown to be effective, but also through which mechanisms an intervention produces outcomes and which contextual factors appear to be of critical influence. Forty-eight published studies were reviewed.RESULTS: The results show that HRM interventions can improve health workers' performance, but that different contexts produce different outcomes. Critical implementation aspects were involvement of local authorities, communities and management; adaptation to the local situation; and active involvement of local staff to identify and implement solutions to problems. Mechanisms that triggered change were increased knowledge and skills, feeling obliged to change and health workers' motivation. Mechanisms to contribute to motivation were health workers' awareness of local problems and staff empowerment, gaining acceptance of new information and creating a sense of belonging and respect. In addition, staff was motivated by visible improvements in quality of care and salary supplements. Only a limited variety of HRM interventions have been evaluated in the health sector in LMIC. Assumptions underlying HRM interventions are usually not made explicit, hampering our understanding of how HRM interventions work.CONCLUSION: Application of a realist perspective allows identifying which HRM interventions might improve performance, under which circumstances, and for which groups of health workers. To be better able to contribute to an understanding of how HRM interventions could improve health workers' performance, a combination of qualitative and quantitative research methods would be needed and the use of common indicators for evaluation and a common reporting format would be required.