The Influence Of Doctor’s Psychological Contracts On Turnover Tendency In Tertiary Public Hospital: The Mediating Role Of Job Burnout

BackgroundAs an important human resources of public hospitals,doctors’ professional technology and team stability are conducive to the formation of the brand effect of hospitals,can attract patients to come to medical treatment,and enhance the core competitiveness of high-level social medical institutions,which is the premise and pillar for the long-term development of public hospitals.At present,however,there are still unreasonable public medical institutions allocation of resources,doctors long-term high load work,occupational pressure,easy to produce burnout,quit will increase,at the same time the rise of high level social medical institutions,doctors’ multi-point practice policy gradually promoted to a certain extent also exacerbated the public hospital brain drain.How should public hospitals protect the reasonable rights and interests of doctors,and what kind of practice environment should they provide for doctors?In order to better attract,retain and motivate doctors,it is the issue that hospital managers should focus on.This requires doctors to understand the expectations and requirements of doctors for the hospital and themselves,so as to put forward targeted management policies conducive to the development of hospitals and doctors.Previous studies have pointed out that the performance of psychological contract is conducive to promoting the positive work of employees.On the contrary,if the performance is not good,it is easy to cause negative emotions,job burnout,or even resignation.Therefore,it is of great significance to analyze the psychological contract status of doctors’ psychological contract and their influence on the resignation tendency,find the factors and foothold affecting the resignation tendency from the perspective of psychological contract,and help hospital managers take corresponding measures to stabilize the professional team of doctors,and realize the sustainable development of public hospitals.ObjectivesThis paper analyzes the basic conditions of psychological contract,job burnout and turnover tendency of doctors in tertiary public hospitals,and discusses the influence of psychological contract on turnover tendency with job burnout as the intermediary.From the perspective of improving the level of psychological contract,it provides suggestions for public hospitals to strengthen human resource management and reduce brain drain.MethodsIn this study,two tertiary public hospitals in Jinan were used as sample hospitals,and an online questionnaire survey was conducted on the doctors of these two hospitals.The questionnaire consists of four parts,including basic personal information,the Psychological Contract Evaluation Scale of Public Hospital Doctors,the MBI-GS Burnout Scale,and the Turnover Tendency Scale,which are used to investigate the basic personal situation of doctors in public hospitals,the level of psychological contract performance perception,the current situation of burnout and the turnover tendency.Using the analysis framework constructed by the institute,descriptive analysis,univariate analysis,multiple linear regression and intermediary effect analysis were conducted to explore the current situation and mutual relationship of each variable,so as to put forward relevant suggestions.Results(1)The average score of doctors’ psychological contract hospital responsibility in tertiary public hospitals was 4.73±1.00,while the average score of psychological contract doctors was 5.42±0.63.Compared with the hospital performance evaluated by doctors,their own performance score was generally higher.different genders,departments,working years,professional titles,average daily working hours,health status,medical reasons,and whether there is any administrative position in the psychological contract hospital responsibility and doctor responsibility scores were significantly different(P<0.05).The average burnout score was 1.90±0.99,which was mainly manifested by emotional exhaustion.Physician burnout levels showed different gender,age,educational background,department,personnel relations,professional title,average daily working hours,health status,and employment reasons(P<0.05).The average turnover tendency score was 1.94±0.78 points,The resignation tendency of doctors was significantly different in terms of different gender,age,department,personnel relationship,average daily working hours,health status,and employment reasons(P<0.05).(2)There was a significant negative correlation between hospital responsibility(R=-0.493,P<0.001)and doctor responsibility(R=-0.375,P<0.001)and resignation tendency;There was a significant negative correlation between hospital responsibility(R=-0.435,P<0.001)and physician responsibility(R=-0.434,P<0.001)and burnout;Significant positive relationship between burnout and turnover tendency(R=0.654,P<0.001).(3)The responsibility of the hospital and doctors can significantly affect the turnover tendency.From the dimensions of the psychological contract,in the hospital responsibility the development responsibility(β=-0.177,P<0.05)and concept responsibility(β=-0.210,P<0.01)had significant effects on turnover tendency;Doctor concept responsibility(β=-0.170,P<0.01)and development responsibility(β=-0.151,P<0.01)had significant effects on turnover tendency.(4)Job burnout had a partial mediation effect in the effects of hospital responsibility and physician responsibility on turnover tendency,with intermediary effect values of-0.201(95%CI=[-0.256,-0.151])and-0.320(95%CI=[-0.405,-0.241]),accounted for 52.0%and 69.1%of the total effect,respectively.Conclusions and recommendationsThe degree of psychological contract in public hospitals is high,the degree of responsibility perceived by doctors is higher than that of the hospital.Generally speaking,job burnout and resignation willingness are at a low level,and their burnout is mainly manifested as emotional exhaustion;Psychological contract hospital responsibility and doctor responsibility can significantly affect the tendency to leave,specific to each dimensions,hospital development responsibility and concept responsibility,doctor development responsibility and concept responsibility on leaving tendency,in addition,the doctor’s health and love the profession is also the important factors;Burnout has a significant mediation effect in the effect of psychological contract on turnover tendency.Based on the above conclusions,in order to reduce the burnout of doctors in public hospitals,reduce the incidence of resignation tendencies,and thus reduce the brain drain,this study proposes the following recommendations:1.Improve the responsibility realization mechanism from the hospital level(1)Establish a reasonable career development path for doctors and broaden the promotion channels;(2)Improve the two-way communication mechanism and improve the assessment and incentive system;(3)Strengthen talent training and establish a reasonable talent echelon;2.Reduce doctor burnout from the individual level(1)Pay attention to doctors’ health problems and establish a reasonable scheduling system to reduce the work pressure of doctors;(2)Pay attention to the construction of hospital culture and concept,and enhance the doctors’ sense of responsibility and mission.