| Objective To evaluate the present situation of incentive measures and to develop optimization strategy of rural doctors in Shandong Province with the background of new medical reform,by using quantitative and qualitative methods.To summarize incentive measures about rural doctor.To analyze the satisfaction of rural doctors to the existing incentive measures,and to comprehensively evaluate the rural doctors' satisfaction of incentive measures in different regions in Shandong Province.To discover the influencing factors about rural doctors' satisfaction of incentive measures and to study its mechanism.To study the incentive preference of rural doctors in Shandong Province.To comprehensive analyze the incentive problems of rural doctors with the satisfaction analysis results.And then to discover the problems of incentive about rural doctors,and put forwards specific proposals about rural doctors' incentive measures.Method The self-designed date collection directory was used to collect date.Multi-stage stratified random sampling method is used to determine the research objects,and the self-designed questionnaires are used to make a cross-sectional survey.The qualitative research methods such as Delphi method,focus-group-discussion were used to collect qualitative data by organizing experts and scholars,relevant department heads,staff and residents.Relevant motivation theories likes Maslow's Hierarchy of Needs and Motivation-Hygiene Theory of Frederick Herzberg were used to analyze rural doctors' satisfaction of incentive measures.Methods of rank sum ratio and TOPSIS were used to evaluate the rural doctors' satisfaction of incentive mechanism in different regions of Shandong province.Quantitative and qualitative methods were used,involving Grounded Theory and SEM,to explore the influencing factors.The Important Quadrant Model which combined with incentive preference and satisfaction of incentive mechanism was used to analysis them.Meanwhile,Porter-Lawler integrated incentive model was combined to find the questions and to put forward the policy suggestions.Results(1)From the related documents about existing incentives for rural doctors in Shandong province,it is found that,in Shandong,for rural doctors performance appraisal is more concentrated in the basic public health services and basic medical examination is weak;Old-age security,risk guarantee,honor rewards and punishment measures are involved but weak.(2)The analysis of rural doctors satisfaction about the present situation of incentives is that the proportion of dissatisfaction is 81.4%.It is found that through Maslow's demand analysis,in the survival demand level for the rural doctors,the identity of pay salary is not good.The dissatisfaction proportion of basic drug subsidy level,level of public health subsidy and general practice income level is 82.6%,79.9% and 89.2%.In the security demand level,most of the rural doctors think long working time(70.2%),heavy workload(97.1%),big difficulties(92.6%),high pressure(95.3%)and not reasonable content settings(77.7%),high risk(96.4%),poor old-age security(84.2%),their identity of working conditions is not good.In the social demand level,most of them have good interpersonal relationship.In the level of respect and demand,the attitude for most of rural doctors about leadership decision-making and feedback tended to general.Most of them think poor social evaluation(58.5%),poor social status(87.6%),no reasonable status localization(85.2%),poor professional reputation(68.4%).In the level of self-actualization needs,most of them think training opportunities is less and promotion way is lack.(3)The results of satisfaction of incentives situation of different types of rural doctors is that: different regions,different gender and marital status are different,and the difference is statistically significant(P<0.05);In addition,Whether they are in provincial planning clinic is different(P<0.05).(4)The comprehensive evaluation results of rural doctors' satisfaction rate of incentive measures showed that the majority of the counties'(Districts)score of incentive measures satisfaction was “medium”,and the one in first-class(districts)was less;The result of RSR showed that four districts were in the upper level,and TOPSIS only three.(5)The analysis on influencing factors of rural doctors incentive measures satisfaction: Grounded theory was used to construct hypothetical model after sorting out the interview data,through structural equation model to verify,and then found that security factors,factors of survival,self realization factor and respect factors had a direct impact on rural doctors' incentive measures satisfaction and the influence coefficient were 0.120,0.440,0.150 and 0.110.Factors of survival,social factors and respect factors had indirect effect on satisfaction through other factors,and in addition,there were some other factors that influence each other.(6)The highest layer of preference score was income incentive,and the preference score ranked in top three were reducing the risk in practice(1010.48),improving welfare(875.23)and solving the problem of identity(730.71);In combination with satisfaction analysis,we found that the matching degree of the two was low,and in specific 7 incentive measures of the rural doctors' preference score were higher but had lower satisfaction,which needed to be improved.(7)Using Potter loale model to comprehensively analyze the predicament of rural doctors' encouragement motivation,which showed that the current incentive predicament mainly included four aspects,that is the impeded link between effort and work performance,the blocked link between work performance and reward,lower levels of satisfaction and the low valence and expected value.Conclusions(1)While all regions of Shandong Province have different incentives for village doctors,but satisfaction of them are poor with the existing incentives or incentives at different levels to meet the needs of its case.It showed that a series of measures did not achieve an effective incentive.(2)In the analysis of influencing factors,survival factors have the maximum influence on the incentives satisfaction for rural doctors,and coincide with Maslow hierarchy of needs theory.(3)Rural doctors are more preferred with health factors,and aspects of their survival needs are the most valued.Furthermore,reducing the risk of occupational of rural doctors is currently the most urgent measures to give incentives.(4)By analyzing data,the current status of incentive of rural doctors in Shandong Province are not optimistic.Therefore,from multiple angles such as institutional level,managers,rural doctors themselves,villagers and the like,are required to improve the encourage status of rural doctors.Institutional measures should be taken to increase government investment,identity rural doctor,dredge their promotion channels,ensure practice environment,improve oversight mechanism of primary health care sector policy implementation and the like.Managers should take measures to arrange the rational distribution of village clinics,strengthen management,establish a scientific and effective performance appraisal system,improve the effectiveness of training and other measures as well.Rural doctors should clarify the role they played and improve their learning ability and quality initiatively.The villagers should show respect to rural doctors and cooperate with the work of doctors actively.Through a full range of incentives for rural doctors,enhancing professional identity,thereby enhancing their motivation and stability on work,in order to be better on serving the rural health service. |
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