【作者】 杨冰一；

【导师】 孟庆跃；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2013， 硕士

【摘要】 背景：乡镇卫生院在我国农村基本医疗服务体系中具有关键作用。卫生服务人员作为提供医疗服务的主体,其数量与全民的健康水平密切相关。然而,我国过去一直面临农村地区卫生服务人员短缺的问题。在短期内无法缓解卫生人员短缺问题的情况下,研究如何留住并改善现有乡镇卫生院人员的工作绩效,最大限度地发挥卫生服务人员的主观能动性是非常有必要的。研究目标：本研究的目标是以2012年山东省莒南、平阴和梁山三县乡镇卫生院的实证研究为例,描述分析新医改后乡镇卫生院人员对激励因素的偏好、满意度及对工作的态度和离职意愿的现状及其影响因素,并探讨激励因素满意度对工作的态度和离职意愿的影响。资料来源和方法：本研究数据来源于欧洲联盟资助的“亚洲健康公平和疾病风险研究”项目在中国的子课题,选取了其中于2012年7月在山东省莒南、平阴和梁山三县乡镇卫生院中收集的数据进行分析。调查问卷采用Microsoft Access2007软件进行双录入,用SPSS16.0软件进行统计分析。对乡镇卫生院人员的激励因素偏好、激励因素满意度、工作态度和离职意愿进行描述性统计分析,对不同人口学特征的调查对象之间的差异进行统计推断；采用因子分析的方法探索激励因素满意度的内在结构；运用有序多分类logistic回归方法分析工作态度和离职意愿的影响因素。主要结果：总体上,山东省乡镇卫生院人员较为偏好经济激励和物质环境方面的激励,对社交和尊重层次的需求偏好相对较小。然而,经济激励恰好也是调查对象最不满意的激励因素,人际关系的满意度最高。经因子分析在乡镇卫生院人员对激励因素的满意度中提取出5个公因子,即“管理制度”、“物质环境”、“尊重与自我认同”、“职业发展”和“人际关系”。不同人口学特征的调查对象对激励因素的偏好和满意度均存在差异。绝大多数调查对象认为自己目前工作努力,且离职意愿不高。多因素分析发现：有行政职务、对“尊重与自我认同”和“人际关系”满意的调查对象更容易认为自己工作努力；乡镇卫生院人员对激励因素的满意度是维持卫生人员队伍稳定的保护因素,学历和行政职务则是危险因素。结论与政策建议：新医改后,经济激励依旧是对乡镇卫生院人员作用最明显的激励因素,然而乡镇卫生院人员对经济激励因素的满意度却最低。较高的满意度有利于乡镇卫生院人员产生积极的工作态度,也有助于减少离职的意愿。据此提出以下几点政策建议：继续加大政府对乡镇卫生院的财政投入；完善相关制度,提高乡镇卫生院人员满意度；加强管理者与员工的沟通,提高员工对组织的认同感；针对不同特征乡镇卫生院人员采取有针对性的激励措施。更多还原

【Abstract】 BackgroundTownship Health Centres (THCs) play key roles in primary health system in rural China. The amount of health service providers, who are generally regarded as principal part in providing health services, has been proved to have a close relationship with people’s health status. China, however, has been facing the shortage of health service provider in rural areas in the past decades. Since it seems impossible to solve the shortage within a short term, how to retain health workers and improve their performance and therefore to enable their initiative with the greatest degree became very necessary and significant.Aims and objectivesThe study aims to describe current situations of THCs workers’preference and satisfaction for incentive factors as well as their work attitudes and turnover intentions using the sample from THCs in Junan, Pingying and Liangshan, Shandong Province in2012. Effects of THCs workers’satisfaction for incentive factors on their work attitudes and turnover intentions will also be explored in this study.Data source and methodThe data of THCs workers collected in Junan, Pingyin and Liangshan in July2012come from Health Equity and Financial Protection in Asia,funded by EU. Microsoft Access2007was used for data entry and SPSS16.0was used for statistical analysis. For current situations of THC workers’preference and satisfaction for incentive factors and their work attitudes and turnover intentions, descriptive statistical analysis was used; for differences among objectives with different demographic characteristics in THC workers’preference and satisfaction for incentive factors and their work attitudes and turnover intentions, statistical inference was used; factor analysis was used to explore inner structure of THC workers’ satisfaction for incentives; and Ordinal regression was used to find out factors affecting work attitudes and turnover intentions of THC workers.Main resultsIn general, economic incentive and material incentive are preferred by THC workers in Shandong province, and preference for social and respective requirements, in contrast, are relative lower. However, economic incentive is the lowest satisfaction among THC workers while the satisfaction of interpersonal relationship is the highest.5independent factors were extracted through factor analysis, and they are: management system, material environment, respect and self-esteem, career development and interpersonal relationship. Preferences and satisfactions for incentive factors differed among objectives with different demographic characters.The fact was found by the Ordinal analysis that people with administrative duty, higher satisfaction for respect and self-esteem, or higher satisfaction for interpersonal relationship are more likely to consider themselves work hard. Satisfaction for incentive factors is a protective factor for health work staff remaining stable while education background and administrative duty are risk factors.Conclusion and policy implicationsEconomic incentives are still the most effective factors to THC workers after health system reform, however, THC workers’ satisfaction for them is not very high. Higher satisfaction is helpful for THC workers having positive attitudes to work as well as can reduce the possibilities of them having turnover intentions. Accordingly, the following suggestions for policy-making are therefore offered:Continue increasing the financial input by the government to THC; improve relevant systems and thereby improving satisfaction of THC workers; improve communication between THC managers and staff and consequently enhance staff’s identify to organizations; and take specific incentive measures to THC workers with different characters.更多还原