Measuring and managing the work environment of the mid-level provider - the neglected human resource
Measuring and managing the work environment of the mid-level provider - the neglected human resource
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DOI：
10.1186/1478-4491-7-13
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发表时间：
2009-02-19
影响因子：
4.5
通讯作者：
Chirwa, Maureen
中科院分区：
文献类型：
--
作者：
McAuliffe, Eilish;Bowie, Cameron;Chirwa, Maureen
背景资料：在过去十年中，有很多关于卫生人力危机的文章，这场危机正在削弱许多中等收入和低收入国家的卫生服务提供。由于移徙而失去大部分高素质保健专业人员的国家越来越多地依赖中级提供者作为提供保健服务的主体。中层提供者是卫生工作者，他们执行的任务通常与训练有素且国际移动的工作人员相关。他们的培训通常具有较低的入学要求，时间较短（通常为2至4年）。我们的研究旨在探讨非洲卫生人力资源的一个被忽视但至关重要的方面：提供一个工作环境，促进中层提供者的积极性和业绩。本文探讨了中等供应商在马拉维的工作环境，并有助于验证的工具来衡量中等供应商在低收入countries. Methods的工作环境：三个地区有目的地抽样从每个三个地理区域在马拉维。来自三个地区的34个卫生设施被纳入研究。每个设施的所有工作人员都包括在抽样范围内。共有153名工作人员同意接受访谈。参与者完成的工作环境，倦怠和工作satisfactions.Findings的看法措施：医疗服务提供者的工作指数，通过主成分分析和Rasch分析，我们修改现有的问卷，构成四个分量表，测量：（1）人员和资源的水平;（2）管理支持;（3）工作场所的关系;和（4）控制实践。多变量分析表明，工作指数的分数显着预测的动机和磨损，如情绪疲惫，工作满意度，对专业的满意度和计划在12个月内离开目前的职位的关键变量。此外，调查结果显示，中层医务人员（即临床主任和医疗助理）显着低于中层护士（即登记护士）与他们的工作环境，特别是他们的工作场所的关系满意度。他们也经历了显着更大的水平，他们的工作和他们的profession.Conclusion的不满：医疗服务提供者工作指数确定因素显着提高工作满意度和工作绩效中层干部在资源贫乏的环境。必须确定这些结果在多大程度上可以推广到目前的样本之外。与护士相比，临床官员和医疗助理工作的激励环境较差，令人关切，因为这些工作人员越来越多地被要求承担领导作用和更大的临床责任。需要对中级提供者进行更多的研究，因为他们是许多低收入国家提供保健服务的主体。本文有助于探索在低收入国家的中层供应商的工作环境的方法，并确定了需要进一步研究的几个领域。
Background: Much has been written in the past decade about the health workforce crisis that is crippling health service delivery in many middle-income and low-income countries. Countries having lost most of their highly qualified health care professionals to migration increasingly rely on mid-level providers as the mainstay for health services delivery. Mid-level providers are health workers who perform tasks conventionally associated with more highly trained and internationally mobile workers. Their training usually has lower entry requirements and is for shorter periods ( usually two to four years). Our study aimed to explore a neglected but crucial aspect of human resources for health in Africa: the provision of a work environment that will promote motivation and performance of mid-level providers. This paper explores the work environment of mid-level providers in Malawi, and contributes to the validation of an instrument to measure the work environment of mid-level providers in low-income countries.Methods: Three districts were purposively sampled from each of the three geographical regions in Malawi. A total of 34 health facilities from the three districts were included in the study. All staff in each of the facilities were included in the sampling frame. A total of 153 staff members consented to be interviewed. Participants completed measures of perceptions of work environment, burnout and job satisfaction.Findings: The Healthcare Provider Work Index, derived through Principal Components Analysis and Rasch Analysis of our modification of an existing questionnaire, constituted four subscales, measuring: ( 1) levels of staffing and resources; ( 2) management support; ( 3) workplace relationships; and ( 4) control over practice. Multivariate analysis indicated that scores on the Work Index significantly predicted key variables concerning motivation and attrition such as emotional exhaustion, job satisfaction, satisfaction with the profession and plans to leave the current post within 12 months. Additionally, the findings show that mid-level medical staff (i.e. clinical officers and medical assistants) are significantly less satisfied than mid-level nurses (i.e. enrolled nurses) with their work environments, particularly their workplace relationships. They also experience significantly greater levels of dissatisfaction with their jobs and with their profession.Conclusion: The Healthcare Provider Work Index identifies factors salient to improving job satisfaction and work performance among mid-level cadres in resource-poor settings. The extent to which these results can be generalized beyond the current sample must be established. The poor motivational environment in which clinical officers and medical assistants work in comparison to that of nurses is of concern, as these staff members are increasingly being asked to take on leadership roles and greater levels of clinical responsibility. More research on mid-level providers is needed, as they are the mainstay of health service delivery in many low-income countries. This paper contributes to a methodology for exploring the work environment of mid-level providers in low-income countries and identifies several areas needing further research.