It's all about the money? A qualitative study of healthcare worker motivation in urban China

doi:10.1186/s12939-017-0616-9

. 2017 Jul 7;16(1):120.

doi: 10.1186/s12939-017-0616-9.

It's all about the money? A qualitative study of healthcare worker motivation in urban China

Ross Millar¹, Yaru Chen², Meng Wang³, Liang Fang³, Jun Liu⁴, Zhidong Xuan⁵, Guohong Li^{6

7}

Affiliations

¹ Health Services Management Centre, University of Birmingham, Birmingham, UK.
² Warwick Business School, University of Warwick, Coventry, UK.
³ School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Shihezi City People's Hospital, Urumqi, China.
⁵ Institute of Social Medicine and Health Management, Henan University, Kaifeng, China.
⁶ School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China. guohongli@sjtu.edu.cn.
⁷ Center for HTA, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China. guohongli@sjtu.edu.cn.

PMID: 28687089
PMCID: PMC5501304
DOI: 10.1186/s12939-017-0616-9

It's all about the money? A qualitative study of healthcare worker motivation in urban China

Ross Millar et al. Int J Equity Health. 2017.

. 2017 Jul 7;16(1):120.

doi: 10.1186/s12939-017-0616-9.

Authors

Ross Millar¹, Yaru Chen², Meng Wang³, Liang Fang³, Jun Liu⁴, Zhidong Xuan⁵, Guohong Li^{6

7}

Affiliations

¹ Health Services Management Centre, University of Birmingham, Birmingham, UK.
² Warwick Business School, University of Warwick, Coventry, UK.
³ School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁴ Shihezi City People's Hospital, Urumqi, China.
⁵ Institute of Social Medicine and Health Management, Henan University, Kaifeng, China.
⁶ School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China. guohongli@sjtu.edu.cn.
⁷ Center for HTA, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, China. guohongli@sjtu.edu.cn.

PMID: 28687089
PMCID: PMC5501304
DOI: 10.1186/s12939-017-0616-9

Abstract

Background: China's healthcare reform programme continues to receive much attention. Central to these discussions has been how the various financial incentives underpinning reform efforts are negatively impacting on the healthcare workforce. Research continues to document these trends, however, qualitative analysis of how these incentives impact on the motivation of healthcare workers remains underdeveloped. Furthermore, the application of motivational theories to make sense of healthcare worker experiences has yet to be undertaken.

Methods: The purpose of our paper is to present a comparative case study account of healthcare worker motivation across urban China. It draws on semi structured interviews (n = 89) with a range of staff and organisations across three provinces. In doing so, the paper analyses how healthcare worker motivation is influenced by a variety of financial incentives; how motivation is influenced by the opportunities for career development; and how motivation is influenced by the day to day pressures of meeting patient expectations.

Results: The experience of healthcare workers in China highlights how a reliance on financial incentives has challenged their ability to maintain the values and ethos of public service. Our findings suggest greater attention needs to be paid to the motivating factors of improved income and career development. Further work is also needed to nurture and develop the motivation of healthcare workers through the building of trust between fellow workers, patients, and the public.

Conclusions: Through the analysis of healthcare worker motivation, our paper presents a number of ways China can improve its current healthcare reform efforts. It draws on the experience of other countries in calling for policy makers to support alternative approaches to healthcare reform that build on multiple channels of motivation to support healthcare workers.

Keywords: Governance; Health workers; Human resource management; Motivation; Renumeration; Trust relationships.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Shanghai Jiaotong University School of Medicine Ethical Review Board.

Consent for publication

Informed consent was obtained by all those who contributed to the research.

Competing interests

The authors declare no competing interests.

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References

1. Blumenthal D, Hsiao W. Lessons from the east — China’s rapidly evolving health care system. N Engl J Med. 2015;372 doi:10.1056/NEJMp1410425. - PubMed
1. Yip W, Hsiao W. What drove the cycles of Chinese health system reforms? Health Syst Reform. 2015;1:52–61. doi: 10.4161/23288604.2014.995005. - DOI - PubMed
1. He AJ, Meng Q. An interim interdisciplinary evaluation of China’s national health care reform: emerging evidence and new perspectives. J Asian Public Policy. 2015;8:1–18. doi: 10.1080/17516234.2015.1014299. - DOI
1. Zhang M, Yang R, Wang W, Gillespie J, Clarke S, Yan F. Job satisfaction of urban community health workers after the 2009 healthcare reform in China: a systematic review. Int J Qual Health Care. 2016;28:14–21. doi: 10.1093/intqhc/mzv111. - DOI - PubMed
1. Yip W, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China’s huge and complex health-care reforms. Lancet. 2012;379:833–842. doi: 10.1016/S0140-6736(11)61880-1. - DOI - PubMed

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[1] Blumenthal D, Hsiao W. Lessons from the east — China’s rapidly evolving health care system. N Engl J Med. 2015;372 doi:10.1056/NEJMp1410425. - PubMed

[2] Blumenthal D, Hsiao W. Lessons from the east — China’s rapidly evolving health care system. N Engl J Med. 2015;372 doi:10.1056/NEJMp1410425. - PubMed

[3] Yip W, Hsiao W. What drove the cycles of Chinese health system reforms? Health Syst Reform. 2015;1:52–61. doi: 10.4161/23288604.2014.995005. - DOI - PubMed

[4] Yip W, Hsiao W. What drove the cycles of Chinese health system reforms? Health Syst Reform. 2015;1:52–61. doi: 10.4161/23288604.2014.995005. - DOI - PubMed

[5] He AJ, Meng Q. An interim interdisciplinary evaluation of China’s national health care reform: emerging evidence and new perspectives. J Asian Public Policy. 2015;8:1–18. doi: 10.1080/17516234.2015.1014299. - DOI

[6] He AJ, Meng Q. An interim interdisciplinary evaluation of China’s national health care reform: emerging evidence and new perspectives. J Asian Public Policy. 2015;8:1–18. doi: 10.1080/17516234.2015.1014299. - DOI

[7] Zhang M, Yang R, Wang W, Gillespie J, Clarke S, Yan F. Job satisfaction of urban community health workers after the 2009 healthcare reform in China: a systematic review. Int J Qual Health Care. 2016;28:14–21. doi: 10.1093/intqhc/mzv111. - DOI - PubMed

[8] Zhang M, Yang R, Wang W, Gillespie J, Clarke S, Yan F. Job satisfaction of urban community health workers after the 2009 healthcare reform in China: a systematic review. Int J Qual Health Care. 2016;28:14–21. doi: 10.1093/intqhc/mzv111. - DOI - PubMed

[9] Yip W, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China’s huge and complex health-care reforms. Lancet. 2012;379:833–842. doi: 10.1016/S0140-6736(11)61880-1. - DOI - PubMed

[10] Yip W, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. Early appraisal of China’s huge and complex health-care reforms. Lancet. 2012;379:833–842. doi: 10.1016/S0140-6736(11)61880-1. - DOI - PubMed

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It's all about the money? A qualitative study of healthcare worker motivation in urban China

Affiliations

It's all about the money? A qualitative study of healthcare worker motivation in urban China

Authors

Affiliations

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

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Cited by

References

MeSH terms

LinkOut - more resources

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