Human Resources for Health最新文献

Background: Critical workforce shortages in primary care (PC) and academic medicine (AM) persist in many low- and middle-income countries (LMICs). China hosts approximately 68,000 international medical students (IMSs), primarily from LMICs, constituting a potential workforce solution. However, little is known about factors shaping their intentions towards PC and AM. This study investigates these influences using established career-choice frameworks in the Chinese context.

Methods: An exploratory sequential mixed-methods study was conducted following the instrument development model. Qualitative interviews (n = 20) identified influencing factors, which informed a quantitative survey distributed to IMSs at 17 Chinese institutions. Responses from LMIC-origin IMSs were analysed. Principal component analysis (PCA) extracted viewpoint components, and hierarchical logistic regression examined the effects of individual, institutional, and viewpoint factors on students' intentions toward PC and AM.

Results: Qualitative findings revealed IMSs' career intentions were shaped by multiple interacting factors across home- and host-country contexts. Among the 961 surveyed IMSs, 15.6% (n = 150) chose PC specialties, and 36.3% (n = 349) preferred AM. PCA identified three components from viewpoint factors: "personal needs to satisfy", "perceptions of work characteristics", and "social needs to satisfy" (Kaiser-Meyer-Olkin index 0.946, p < 0.001, 60.5% of variance explained). Regression models showed PC preference was positively associated with older age and rural/regional origin, and negatively associated with personal needs to satisfy. AM preference was positively associated with older age, lower study year, originating from the African region compared to other nationalities, and higher-ranked institutions.

Conclusion: IMSs' intentions towards PC and AM are shaped by student characteristics, personal needs, and institutional environments, offering valuable insights for LMIC workforce planning. Chinese institutions can strengthen this potential by embedding targeted PC and AM modules, expanding research and mentorship opportunities, refining admissions to prioritise likely candidates, and supporting cross-cultural training. These strategies align international medical education with LMIC health priorities and inform career guidance and tailored support for globally trained physicians.

Task shifting and task sharing involve the deliberate redistribution of healthcare responsibilities to non-specialist workers to maximise resources, expand access, and enhance health. Structured training, regulatory measures, and monitoring can transform non-specialist workers into nascent professionals. While this is often assumed to be beneficial, it can create new scarcities and resource pressures. We call this the "Professionalisation paradox": task shifting and sharing initiatives are often successful because they bring non-professional workers and approaches into healthcare delivery, but the very success of those programmes frequently prompts the professionalisation of the workers and roles involved. We explore paramedicine as a case study, where emergency responders started as part of a task shifting-based approach from military medicine to fill gaps in civilian emergency care, but have now become a professional group bound by rules that can restrict their flexibility. Professionalisation offers advantages such as improving care standards, safety, and worker employment security. However, this also means that paramedics are less able to act freely and compassionately, as they might feel limited by regulations or fearful of making mistakes. We propose ways to balance the benefits of professionalisation while keeping task shifting and task sharing adaptable and community-focused. Future approaches to creating task shifting and task sharing-based models of service delivery might include combining structured training with more flexible methods. This will allow providers to use their skills without feeling overly restricted. Creating supportive policy frameworks around these roles could help maintain accountability and give them more room to respond to patient needs. Striking this balance will help ensure that task shifting and task sharing retain their core purpose of providing accessible, responsive care.

Background: Conflict is a recurring feature of healthcare delivery, especially in hospitals that operate with limited staff, inadequate supplies, and heavy workloads. Although conflict among healthcare workers in Ghana has been documented, little research has explored how it emerges within the everyday routines of resource-constrained hospitals or how staff interpret and respond to it. This study examined the causes, effects, and management of institutional conflict in two public hospitals in the Effutu Municipality, using Organizational Information Theory and the Institutional Logics Perspective to guide interpretation.

Methods: A qualitative phenomenological approach was used to explore staff experiences of workplace conflict. Thirty healthcare workers from clinical, administrative, and support units were purposively selected based on their direct exposure to work-related conflict. Data were gathered through semi-structured interviews and four focus group discussions, audio-recorded with consent, transcribed verbatim, and analyzed thematically following Braun and Clarke's framework. Trustworthiness was ensured through triangulation, member checking, reflexive journaling, and a clear audit trail.

Results: Conflict stemmed from three overlapping sources, namely communication breakdowns, competing professional priorities, and interpersonal or behavioral tensions. Staff described rushed or incomplete handovers, unclear directives, and documentation gaps as frequent triggers. Disagreements between clinicians and administrators over resource use and decision-making authority intensified these tensions, particularly in moments of scarcity. Personal attitudes, tone of communication, and strained relationships further complicated teamwork. The effects were substantial, including threats to patient safety, reduced productivity, emotional exhaustion, and concerns about the hospitals' public reputation. Conflict was managed through management-led mediation, appeals to professional codes of conduct, and informal grouping of staff with shared backgrounds, though these strategies often addressed surface issues rather than underlying structural pressures.

Conclusion: Addressing healthcare conflicts requires more than interpersonal mediation. Strengthening communication processes, supporting collaborative decision-making, investing in staff capacity, and improving organizational systems are essential for reducing conflict and improving patient care.

Background: Nurses are crucial for high-quality healthcare, but there's a growing shortage. Wage inequality is a significant problem among nurses, affecting both nurses and patient care. This study investigates the wage gap among nurses in Iran.

Methods: This study examined wage inequality among 595 nurses using wage quartiles, Lorenz curves, and a Gini coefficient (GC) decomposition. The decomposition method was used to analyze the contributions of within, between, and overlap subgroups to the overall wage inequality, along with the population share, wage share, and GC for each subgroup of nurses.

Results: The findings revealed that nurses in the top quartile earn 2.03 times more than nurses in the bottom quartile, with respective wage rates of $9.31 and $4.58. The total GC for nurses' wages was 0.16, indicating a moderate wage gap. Among nurses, those in specialized roles had the highest wage at $9.10 based on Purchasing Power Parity (PPP). This was followed by nurses aged over 40 years ($8.30), nurses with over 15 years of work experience ($8.15), and those working in psychiatric centers ($8.08). Conversely, the lowest wage rates among nurses were observed in those working in non-provincial hospitals ($5.51), followed by nurses in the private sector ($5.73), and nurses working in general hospitals ($5.76). The GC analysis revealed that the highest wage inequality was among nurses working in hospitals specializing in Ophthalmology and ENT (GC = 0.23), the private sector (GC = 0.18), and emergency departments (GC = 0.18). Conversely, the lowest wage inequality was observed in nurses working at the surgery department (GC = 0.10) and cardiology hospitals (GC = 0.11).

Conclusions: The wage gap among Iranian nursing staff was moderate. Work experience, employment type, age, number of children, hospital specialty, workplace sector, and department significantly affected wage inequality among nurses, while gender and academic qualifications had no significant impact on the wage gap. Considering the importance of the wage gap for nurses' motivation and function, policymakers should consider these key determinants and develop targeted strategies to mitigate the wage gap among nurses.

Background: Hospital pharmacists play a pivotal role in ensuring the safe and effective use of medications, thereby supporting the quality of care and the resilience of health systems. Identifying the factors influencing turnover intention among hospital pharmacists and implementing strategies to maintain an appropriate talent pool can contribute to strengthening public health and improving patient outcomes. This study aimed to identify the factors influencing turnover intention among hospital pharmacists in South Korea and provide implications for strategies to support pharmacist retention.

Methods: A cross-sectional survey was conducted in July 2024 with 592 full-time pharmacists employed in tertiary and general hospitals using proportional stratified sampling by hospital type and region, representing 16.0% of the pharmacists working in these hospitals. The questionnaire incorporated items from Mitchell's Job Embeddedness theory, the Korean Occupational Stress Scale, and Singh's turnover intention scale, and underwent expert content validation and exploratory factor analysis. Multivariable linear and logistic regression analyses were performed to determine the factors associated with turnover intention after adjusting for key demographic and institutional characteristics.

Results: Among the 592 respondents, 255 (43.1%) had high turnover intention, with shorter employment durations associated with higher turnover intention scores. Within job embeddedness, factors significantly reducing turnover intention included fit to organization_task, organization-related sacrifice_direct, link to organization_task, and link to community_transverse. Within job stress, the factors that significantly increased turnover intention were lack of rewards, job demand_density, and organizational system_fairness. The identified associations were consistent across both linear and logistic regression models, supporting the robustness of the findings.

Conclusions: To retain skilled professionals, hospitals should improve their reward structures, foster a culture of fairness, and provide targeted support to junior pharmacists. Improving role fit in task assignments may help reduce turnover risk and enhance workforce stability.

Background: In Ethiopia, non-physician surgeons, such as Integrated Emergency Surgical Officers (IESOs) and MSc Clinical Midwives, provide critical comprehensive emergency obstetric and surgical care in areas, where physician shortages persist. Although task shifting has improved access to maternal healthcare services in many low-resource settings, maternal and newborn mortality remain high, particularly in the conflict-affected Tigray region. This study aimed to assess the impact of a comprehensive training program on safe cesarean delivery, essential newborn care, and obstetric anesthesia on IESOs' knowledge.

Methods: An embedded mixed-methods design was employed. Quantitative data included a pre-post-test on safe cesarean delivery, early neonatal care, and obstetric anesthesia, as well as a before-and-after training assessment of seven core domains (historical background of cesarean delivery, indications for and safe prevention of cesarean delivery, preoperative preparation, surgical technique, difficult cesarean delivery, early neonatal care, and obstetric anesthesia). Fifty-nine IESOs in Tigray were enrolled. Qualitative data were obtained from two focus group discussions and five in-depth interviews that explored training adequacy and professional competency. Quantitative data were analyzed using R (version 4.6.2), and qualitative data were thematically analyzed using ATLAS.ti (version 7).

Results: A total of 59 participants took part in the quantitative component, 94.9% of whom were male. The mean pre-training knowledge test score on safe cesarean delivery, early neonatal care, and obstetric anesthesia was 60.1 (± 8.7). This increased to 75.7 (± 10.58) on post-training test (mean difference 15.6, 95% CI 13.31-17.9, p < 0.001). The self-reported understanding of the seven domains improved from 17.1 (± 4.2) to 21.5 (± 4.3) (p < 0.001). Qualitative findings confirmed high appreciation of the training's relevance and possible practical application but also highlighted concerns about long-term support, career and skills advancement, and resource constraints in the post-conflict environment.

Conclusions: Comprehensive and context-specific training significantly enhanced the knowledge of non-physician surgeons in safe cesarean delivery, early neonatal care, and obstetric anestehsia in Tigray. Ongoing mentorship, career development opportunities, and system-level support are crucial for sustaining these gains and rebuilding maternal and newborn health services in conflict-affected and other resource-limited settings.

Background: The health workforce (HW) plays an important role in patient care, and in rural Australia its distribution varies substantially. This paper explores trends in Australia's HW full-time equivalent (HW-FTE) rates and estimates the risk of HW attrition phenomena using data from local government areas (LGAs) during 2013-2021.

Methods: Trends and spatial analyses were used to understand HW-FTE rates for allied health professionals, medical practitioners, and nurses and midwives in four major types of Australian Statistical Geography Standard (ASGS) remoteness areas. The time-to-event modelling was used to identify HW retention times and probability of HW attrition, by remoteness areas and major states in Australia.

Results: On average the HW-FTE rate at the granular geo-spatial LGA level exhibits variation in trends between States, rurality, LGA and health professional groups over the study period. The increase in the HW-FTE rate over time for medical practitioners and allied health professionals is lower for outer regional, remote, and very remote Australia compared to inner regional Australia. The HW-FTE rate is also consistently lower for rural Australia compared to major cities irrespective of HW professions. The average HW retention time estimated for allied health was highest in major cities (5 years), and lowest in outer regional areas (3 years). States such as NSW and QLD had more than 4 years of HW retention time for medical practitioners. For nurses and midwives, the average retention time was less than 3 years for all states in Australia. There is variation in trends in HW-FTE rate between LGAs within and between States, including markedly contrasting trends between geographically adjacent LGAs.

Conclusions: Our results provide new insight into variation in HW availability, and trends in availability, between major health professional groupings between States, degrees of rurality and local government areas across Australia. This presents new opportunities for understanding and addressing factors that underly the variation in trends for the purpose of refining policy and programs that aim to address the persistent maldistribution and shortages in health worker availability between major cities and regional and remote parts of Australia.

Background: A sense of calling-defined as viewing work as a meaningful contribution to society-has been linked to job satisfaction and overall well-being. In medicine, this intrinsic motivation may interact with systemic challenges and influence physicians' career trajectories, including their desire to work abroad.

Aim: To examine the relationship between medical students' sense of calling and their willingness to work abroad, comparing first- and final-year students.

Methods: This cross-sectional study was conducted at a Turkish medical school in 2024. A total of 278 students (140 first-year, 138 final-year) completed a structured online questionnaire. The survey included socio-demographic characteristics, perceptions of the medical profession, intention to work abroad, and the Turkish version of the Calling and Vocation Questionnaire (CVQ). Descriptive and comparative statistical analyses were conducted, with statistical significance set at p < 0.05.

Results: More than half (56.8%) of students expressed a desire to work abroad, primarily citing a higher quality of life and income. First-year students reported significantly higher interest in working abroad and marginally higher "presence of calling" scores than final-year students. Dissatisfaction with the healthcare system and anticipated income were significantly associated with the intention to migrate. The presence of calling was slightly, though not significantly, higher among students intending to relocate.

Conclusion: Medical students' vocational ideals decline over time, influenced by systemic dissatisfaction and perceived limitations within the national healthcare system. Addressing structural barriers in medical education and professional practice is essential to preserving professional motivation and mitigating physician migration.

Background: Job satisfaction is closely related to health service quality and patients' outcomes, including safety and continuity of care. With the transformation of Saudi Arabia's healthcare system driven by Vision 2030, determining the factors influencing job satisfaction among healthcare workers has become critical.

Objective: To identify the sociodemographic determinants and their association with healthcare workers' job satisfaction in public hospitals in Jeddah, Saudi Arabia.

Methods: Through a cross-sectional design, healthcare workers from 13 public hospitals were invited to respond to a self-administered questionnaire based on Spector's Job Satisfaction Survey. Data were collected via an electronic online survey (Google Form). Chi-square, ANOVA, independent t-tests, and multiple linear regression analysis were used.

Results: Nine hundred and thirty-two healthcare workers responded. There were significantly more females than males among nurses, midwives, and those with bachelor's qualifications. Conversely, there were significantly more males than females in administrative jobs. Males reported significantly higher income, were more likely to be married, and perform non-clinical work. Higher satisfaction scores were reported among males, non-Saudis, those 50 years or above, holding a diploma education, married, working in a tertiary hospital, and working the day shift. The regression model showed that being female, working in a night or rotating shift were negatively associated with job satisfaction. Being non-Saudi and working part-time were positively associated with job satisfaction.

Conclusions: Job satisfaction was higher among non-Saudis and those working part-time. It was lower among females and those working at night or rotating shift.