Human Resources for Health最新文献

Background: There have been a globally paucity of comprehensive quantitative studies on the physician turnover trends. This study aimed to investigate the trajectory and magnitude of Chinese physician turnover, as well as its influencing factors.

Methods: We established a retrospective cohort by combining annual physician surveillance data and annual medical institution report data between 2011 and 2021. Turnover was defined as physicians who changed their practice institution at least once between 2011 and 2021. We reported the national annual turnover rate, net turnover rate of different regions and types of healthcare institutions. The direction of turnover across provinces and institutions was exhibited using Sankey diagrams. A time-dependent Cox regression analysis was used to examine the factors that influence physician turnover.

Results: This study included 3.7 million physicians, with 19.4% changing practice institutions between 2011 and 2021. The national annual turnover rate has risen from 1.6% to 4.4%. The majority of turnover occurred within provinces and the same type of healthcare institutions. Eastern regions and urban areas experienced net turnover inflow. Factors that increased the likelihood of physician turnover include: being younger, male, more educated, having senior professional titles, having non-permanent employment contracts, working in rural, non-hospital, or private institutions, and working in institutions with relatively low revenue or high workload.

Conclusions: This study suggests that the physician turnover rate is rising in China. Polices should pay more attention to physician retention in less-developed regions. The underlying causes of physician turnover should be thoroughly investigated. Continuous monitoring of physician turnover is critical to leverage its potential positive impact on revitalizing the healthcare system and to avoid its possible negative impact on equal geographic distribution of physicians.

Background: Contributing to the high hospital-based maternal, neonatal, and child mortalities in low resource countries and conflict zones is a shortage of health workers, especially physicians. Training programs, conducted over 12 years, have enhanced the skills of midwives, and nurses, to provide high quality, hospital-based, care to pregnant women, newborn infants, children, and adolescents.

Methods: A task-shifting partnership between the Ministry of Health, World Health Organisation, United Nations Population Fund, United Nations Children's Emergency Fund and the charity Maternal and Childhealth Advocacy International was established in 2012. Rural county health teams selected 37 midwives, 20 nurses, 1 nurse/midwife and 2 physician assistants, for advanced training. They were appointed following a written examination and interview. Obstetric clinician trainees underwent a 3-year programme, which included operative procedures. The training programs for neonatal and paediatric clinician trainees were 2 years and 2.3 years, respectively. Training consisted of apprenticeship-based training and distance learning. It was delivered by Liberian and international specialists. Trainee competence was established by continuous clinical assessment, oral, and written clinical examinations. The programme also upgraded hospital buildings and provided essential equipment and drugs.

Results: 59 trainees completed training, 2 failed and 57 qualified in final examinations. 27 are working as obstetric clinicians, 15 are working as neonatal clinicians, and 11 are working as paediatric clinicians. Therefore, 53 are working in 18 hospitals and 4 Comprehensive Emergency Obstetric and Newborn Care (CEmONC) facilities. Obstetric clinicians manage major obstetric emergencies. They perform abdominal surgery, including the management of ruptured ectopic pregnancy and basic and complicated caesarean sections. Neonatal clinicians resuscitate and care for sick and premature babies to WHO Special Care Level 2. Paediatric clinicians manage the main paediatric emergencies that contribute to high mortality. Before the arrival of the international trainer, paediatric mortality in the training hospital was 9.5% and was 4.1% in the final year of training.

Conclusions: This task shifting programme in Liberia has shown that midwives and nurses can be trained to provide safe and effective hospital care for pregnant women, newborn infants and children. This approach is one solution to the health workforce problem in low resource and conflict settings.

Background: The global prevalence of multiple long-term conditions (MLTCs) is increasing, challenging healthcare providers worldwide. In low- and middle-income countries (LMICs), healthcare professionals face additional obstacles in managing MLTCs due to the presence of disease-specific guidelines. This issue is exacerbated by the limited emphasis on both pre-service and in-service training of healthcare professionals on MLTCs within LMICs. Therefore, we conducted a systematic review to synthesize the scientific evidence on training and educational initiatives on MLTCs for health professionals in LMICs.

Methods: We conducted a search across PubMed, Embase, and CINAHL within the domains of 'multiple long-term conditions' and capacity-building and systematically reviewed the articles retrieved. The data were synthesized using a healthcare training framework that encompasses objectives, target audience, content and curriculum, training methodology, trainers and facilitators, logistics and implementation, participant engagement and satisfaction, and outcomes. Our findings were reported according to PRISMA guidelines. This systematic review was prospectively registered with the International Prospective Register of Systematic Reviews (CRD42022348483).

Results: Out of 15,981 initial records, 3614 duplicates were removed, leaving 12,367 for title and abstract screening. After full-text review of 204 articles, only four met the inclusion criteria-two from India, one from Ukraine, and one covering multiple African countries (South Africa, Uganda, Ethiopia, and Kenya) demonstrating a scarcity of literature in the field. These studies focused on increasing healthcare providers' capacity to manage multiple chronic conditions through knowledge, skills, and competency-based training. A 'train-the-trainer' approach was emphasized for broader impact in low-income settings. Training methods varied, incorporating interactive sessions and interdisciplinary modular programs. Key recommendations included integrating updated curricula into medical education and addressing logistical barriers. While participants reported improved skills, challenges included sustaining support and adapting programs to local contexts.

Conclusions: MLTC-focused training in LMICs remains limited, with existing programs emphasizing competency-based learning and a 'train-the-trainer' approach. Key challenges include sustainability, logistical barriers, and local adaptation. Integrating structured, interdisciplinary training into medical education and professional development, alongside policy support and stakeholder collaboration, is important for future implementation.

Background: Adverse working conditions in Romanian out-of-hours primary care (OOH-PC) are a growing concern due to the shortage of healthcare professionals, outmigration, and inadequate measures to address the retirement of family doctors. This has led to significant fluctuations in the number of OOH-PC centres across the country. To address the existing knowledge gaps regarding the OOH-PC services, this study aimed to explore the challenges faced by healthcare workers in after-hours care.

Methods: A qualitative approach was used to gather insights from 14 healthcare professionals, including family doctors, nurses, representatives of professional associations, emergency doctors, and paediatricians. Through thematically analyzed in-depth semi-structured interviews, the researchers examined the working conditions in OOH-PC in Romania from the perspective of healthcare workers.

Results: Data analysis yielded five key themes related to adverse working conditions in OOH-PC: working hours and shift length, increasing workload and patient influx, obstacles to achieving work-life balance, inconveniences related to OOH center premises (rest space, security), and insufficient financial compensation for after-hours health service provision.

Conclusions: In the context of systemic changes in the Romanian health system, this article provides valuable information on the current working conditions of primary care health workers in OOH care. It highlights the importance of improving working conditions to attract and retain healthcare professionals in OOH-PC.

Background: The turnover rate of newly graduated nurses is very high, and their turnover intention is affected not only by individual-level factors, but also by organizational-level factors. However, the multilevel factors reflecting the characteristics of newly graduated nurses in Generation Z and their turnover intention have not been identified previously.

Objective: To identify the individual- and organizational-level factors that affect the turnover intention of newly graduated nurses in Generation Z.

Methods: This study was a cross-sectional questionnaire survey. Online survey was performed from August to November 2022. Participants were a total of 283 newly graduated nurses and 45 nurse managers to respond to each individual and organization-level questionnaire. The collected data were analyzed for frequency, descriptive statistics, and multilevel analysis.

Results: The multilevel analysis indicated that the individual-level factors that affected the lower turnover intention of newly graduated nurses in Generation Z were higher work-life balance (β = - 0.320, p < 0.001), higher organizational commitment (β = - 0. 384, p < - 0.001), and desired nursing unit placement (β = - 0.209, p < 0.001). The organization-level factors associated with lower turnover intention were lower average number of night shifts per month (β = 0.303, p < 0.05), higher salary (β = - 0.263, p < 0.05), longer orientation period (β = - 0.612, p < .01), preceptor-preceptee ratio of 1:1 (β = - 0.409, p < 0.05), and existence of a mentoring program (β = - 0.318, p < 0.05). Furthermore, the nursing work environment was the most influential factor, and a supportive environment for nursing work (β = - 0.630, p < 0.01), efficient computer-related environment (β = - 0.251, p < 0.05), and recognition and respect (β = - 0.564, p < 0.05) were associated with lower turnover intention.

Conclusions: The findings indicate that improvements to the nursing work environment and human resources of the organization should be prioritized to prevent the turnover of newly graduated nurses in Generation Z.

Background: Civil service and contractual recruitment are common recruitment pathways with significant differences in terms of security and benefits for rural doctors and their career trajectories. However, there are tensions between doctors' expectations of the systems and the systems' imaginings of what it offers in terms of recruitment. In this paper, we explore these tensions from the perspective of frontline public sector doctors.

Methods: This qualitative multiple-case study research was carried out in two Indian states. We used semi-structured interviews with 33 doctors and 28 key informants from the two states. Thematic analysis, using the framework approach, was used to arrange and synthesize qualitative data. In addition, job histories were constructed from the doctors' interviews to examine their experiences with recruitment and analyzed using simple numbers.

Results: The findings suggest that in one study State, the doctors and the administration perceive civil service and contractual recruitment differently with tensions between personal and systemic perspectives. Findings from this State suggest that contractual doctors conceive the progression from contractual to civil service recruitment as sequential. Contrary to doctors, health administration regards these two forms of recruitment as distinct-potentially complementary, but certainly strategic, but not necessarily sequential. However, there are several obstacles faced by doctors that negatively affect their expectations of progressing to civil service recruitment and their career trajectories. The critical obstacles are: prolonged contractual employment, irregular PSC evaluations, and decreasing opportunities to become civil servants. All these factors lead to discontent among contractual employees, with critical consequences for their career trajectories and job satisfaction. However, findings from the other State indicate the use of alternative approaches in recruitment, leading to frequent civil service recruitment and positive perceptions among doctors.

Conclusions: The idea that civil service recruitment forms a continuum with contractual recruitment is a misconception held by rural doctors, while the administration sees important distinctions between them. This disjunction in perspectives is problematic, leading to negative perceptions and breach of doctors' assumptions, with broader implications. From a health systems and workforce perspective, the need for the administration to acknowledge and address disjunctions through effective human resource approaches is critical.

Background: Organizational culture significantly influences the quality of healthcare services and healthcare professional education. Although various scales exist to measure organizational culture at the undergraduate level, validated instruments specifically tailored for healthcare professional education remain scarce. The study aims to validate the adapted scale and provide empirical insights into organizational culture in healthcare professional education.

Methods: The adaptation process involved expert consultations to ensure content and face validity, followed by a mixed-methods approach. Quantitative data were collected from 402 students enrolled in the Faculties of Medicine, Dentistry, and Health Sciences during the 2023-2024 academic year. Exploratory and confirmatory factor analyses were performed to examine the scale's structure. Reliability was assessed using Cronbach's alpha and McDonald's omega coefficients.

Results: Expert review led to the removal of redundant and unclear items, refining the scale to 30 items across five subscales: Structural Order and Formality, Belonging and Collective Responsibility, Achievement and Performance Orientation, Authority and Hierarchy, and Competition Orientation. The Kaiser-Meyer-Olkin measure (0.846) and Bartlett's test confirmed sample adequacy. Exploratory factor analysis explained 40% of the total variance. Confirmatory factor analysis showed acceptable model fit indices (χ²/df = 3.37, RMSEA = 0.091, CFI = 0.95, TLI = 0.94). The scale demonstrated strong internal consistency (overall McDonald's ω = 0.878; Cronbach's α = 0.874), although lower reliability was noted for Authority and Hierarchy and Competition Orientation subscales.

Conclusions: The adapted organizational culture scale is a valid and reliable tool for assessing organizational culture in healthcare professional education. Its use is recommended for tracking cultural changes and supporting strategic educational improvements. Further validation across different institutions and cultural contexts is encouraged to reinforce its generalizability.

Background: The global nursing shortage is a growing concern, particularly in regions experiencing rapid population growth and healthcare transformation. This study examines trends and regional inequalities in Saudi Arabia's nursing workforce distribution from 2019 to 2023 within the context of Saudi Vision 2030 and the Health Sector Transformation Program.

Methods: Data from the Ministry of Health's 2023 Statistical Yearbook were used for this study. Nurse-to-1 000 population ratios were calculated across 20 health regions. Inequality in the nursing distribution was assessed using Gini coefficients and Lorenz curves, disaggregated by sector (Ministry of Health vs. private health sector) and nationality (Saudi vs. non-Saudi).

Results: The national nursing workforce increased by 9% from 2019 to 2023, reaching 213 110 nurses. However, nurse-to-population ratios varied significantly across regions, ranging from 3.13 to 9.89 per 1 000 people. The overall Gini coefficient was 0.48, indicating a relatively unequal distribution of nurses across regions. Inequalities were more pronounced in the private health sector (Gini coefficient = 0.69) and among non-Saudi nurses (Gini coefficient = 0.59). While Saudization efforts led to a modest increase-Saudi nationals comprised 44.22% of the nursing workforce in 2023-localization remained uneven across regions and healthcare sectors.

Conclusion: Despite workforce growth and increased localization, Saudi Arabia continues to face considerable regional inequalities in nursing distribution. These disparities require targeted workforce policy interventions, including expanding nursing education opportunities, optimizing working conditions, and implementing strategic workforce plans to distribute nursing resources more equitably. Additionally, offering incentives for deployment in underserved regions will be critical.

Background: Physician shortages in underserved areas constitute a common challenge for governments and policymakers worldwide, including in European countries. The health sector in Portugal is characterized by geographical asymmetries in the distribution of physicians and the difficulty in retaining these professionals in certain areas of the country. In 2015, the Portuguese government created an incentive package to attract and retain physicians in underserved areas. In this case study, we describe the process that led to the creation of the incentives package, its main features, and the physicians that have benefited from it, and assess the effectiveness in terms of retention of physicians in the National Health Service (NHS) and the underserved areas.

Case presentation: Decree-Law no. 101/2015, published on 4 June, established the terms and conditions for awarding financial and non-financial incentives for physicians who work in underserved areas. It has been a fundamental instrument for attracting and retaining professionals to areas of geographical need, especially in the inner territories, seeking to fill needs and reduce asymmetries in the distribution of resources. In 2017 and 2021, the incentives package was reviewed to meet NHS demands and physicians' expectations.

Conclusions: The incentives package implemented in Portugal effectively deployed physicians to underserved areas. The several amendments to the package led to a 14-fold increase in physicians benefiting from the incentives and a 59% retention rate of these physicians in the same underserved health institution. However, the difference between the retention levels of physicians under the incentives package and those not covered is minimal. The financial and non-financial incentives need to be reviewed to better suit physicians' needs and expectations, as well as those of the NHS.

Health workforce migration is an important challenge for healthcare systems across Europe, with Romania facing one of the most significant impacts following its accession into the European Union. This article examines the trends, drivers, and consequences of health workforce migration in Romania, particularly physicians and nurses, explores policy interventions aimed at mitigating its effects and assesses their effectiveness. The analysis highlights the strategies employed to retain and attract healthcare workers, including financial incentives, regulatory reforms, and expanded educational opportunities. The study shows a two-thirds reduction in the annual migration of Romanian doctors to mainly countries of the WHO European Region, decreasing from 1532 in 2012 to just 461 in 2021, demonstrating the significant impact of policy interventions on workforce retention. While these interventions have successfully increased the overall number of health professionals in Romania and reduced overseas migration, challenges remain in ensuring equitable distribution and addressing workforce shortages in key specialties and occupations. Romania's experience offers valuable lessons for other European countries facing similar challenges and offers policy lessons for addressing one of Europe's most pressing healthcare priorities.