Contextual influences on health worker motivation in district hospitals in Kenya
Contextual influences on health worker motivation in district hospitals in Kenya
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DOI：
10.1186/1748-5908-4-43
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发表时间：
2009-07-23
影响因子：
7.2
通讯作者：
English, Mike
中科院分区：
文献类型：
--
作者：
Mbindyo, Patrick;Gilson, Lucy;English, Mike
背景：组织因素被认为对卫生工作者采取改善其实践的干预措施具有重要影响。这些还受到个人和更广泛的卫生系统层面运作因素的影响。我们试图探索对工作人员动机的背景影响，这一因素可能会改变旨在改变肯尼亚医院临床实践的干预措施的效果。方法：Franco LM 等人（卫生部门改革和公共部门卫生工作者动机：概念框架。Soc Sci Med. 2002, 54: 1255-66）动机影响模型用于构建研究框架，定性方法包括个人深入研究 185 名卫生工作者在对 8 个地区医院进行为期一周的访问期间，采用访谈、小组访谈和焦点小组讨论的方式收集了数据。在计划干预之前收集数据，旨在实施新的实践指南并提高护理质量。此外，还利用对研究地点卫生工作者日常行为的现场观察来为分析提供信息。结果：研究环境可能对工作者的积极性产生重要影响。医院层面的有效管理可以创造一个有利的工作环境，从而改变资源短缺的影响。支持性领导可以促进干部之间良好的工作关系，通过提供当地激励措施提高积极性，并适当处理工人在晋升、绩效评估过程和良好沟通方面的期望。这种组织属性可能会抵消国家层面的消极因素，例如糟糕的服务计划，并增强个人激励因素，例如维持专业标准的愿望。结论：动机可能会强烈影响任何改变或改善卫生工作者和医院实践的尝试。一些影响动机的因素本身可能会受到选择实施变革的流程的影响。
Background: Organizational factors are considered to be an important influence on health workers' uptake of interventions that improve their practices. These are additionally influenced by factors operating at individual and broader health system levels. We sought to explore contextual influences on worker motivation, a factor that may modify the effect of an intervention aimed at changing clinical practices in Kenyan hospitals.Methods: Franco LM, et al's (Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002, 54: 1255-66) model of motivational influences was used to frame the study Qualitative methods including individual in-depth interviews, small-group interviews and focus group discussions were used to gather data from 185 health workers during one-week visits to each of eight district hospitals. Data were collected prior to a planned intervention aiming to implement new practice guidelines and improve quality of care. Additionally, on-site observations of routine health worker behaviour in the study sites were used to inform analyses.Results: Study settings are likely to have important influences on worker motivation. Effective management at hospital level may create an enabling working environment modifying the impact of resource shortfalls. Supportive leadership may foster good working relationships between cadres, improve motivation through provision of local incentives and appropriately handle workers' expectations in terms of promotions, performance appraisal processes, and good communication. Such organisational attributes may counteract de-motivating factors at a national level, such as poor schemes of service, and enhance personally motivating factors such as the desire to maintain professional standards.Conclusion: Motivation is likely to influence powerfully any attempts to change or improve health worker and hospital practices. Some factors influencing motivation may themselves be influenced by the processes chosen to implement change.