Research On Optimization Strategies Of Practice Environment For Medical Staff In Tertiary Public Hospitals

Objective The study aimed to gain an in-depth understanding of the incentive preferences of medical staff in tertiary public hospitals under the pandemic of COVID-19,and to provide more targeted recommendations for the design of policies to optimize the practice environment of medical staff in tertiary public hospitals in the post-pandemic era.Methods The practice environment and incentive factors of medical staff were collected through literature review and an online questionnaire survey was conducted in tertiary public hospitals in Hefei from July to August 2020 to obtain the practice environment experience of medical staff under pandemic.Based on the discrete choice experiment,the attributes and their corresponding levels of this study were determined through literature review and expert consultation.In addition,the D-efficiency research design was carried out through Ngene1.2software,and data collection was also through online questionnaires.Stata 16.0 was used for statistical analysis,and we use econometric analysis to elicit the job choice preference of medical stuff.Results(1)Medical stuff in tertiary public hospitals had a low level of satisfaction with workloads,career development,monetary income and respect from the society.Under the pandemic,the pressure on medical stuff increased,and their sleep quality was negatively affected.(2)Four attributes were considered: career development,workload,respect from society,and monthly income.(3)A total of 789 valid questionnaires were included in the analysis,with an effective response rate of73.33%.Doctors and nurses accounted for 33.71% and 66.29% respectively.(4)The results of the conditional logit model,mixed logit model(MLM)and latent class model(LCM)all show that the four attributes included in this study are all statistically significant,that is,career development,workload,respect from society,and monthly income all have a significant impact on the motivation of medical staff.Both the MLM and the LCM identified the heterogeneity of incentive preferences,and the latter had a better fitting effect.(5)Based on the results of the LCM,the results of the three subgroups are the best.On the whole,medical staff hope to obtain better respect from society and monthly income,rather than a heavier workload;In terms of relative importance,respect from society rank first,followed by workload,monthly income,and career development.The analysis of willingness to pay reveals that medical staff were willing to sacrifice three times the average national salary to obtain sufficient career development.When the workload increased from light to maximum,they expect to be paid an additional three times the average national salary based on their existing level.In terms of poor respect from society,medical staff were willing to sacrifice 4-5 times the average national salary to obtain normal,good,and excellent respect from society,respectively.(6)Among the different subgroups,the prospect minded class and the workload unconcerned class valued respect from society the most,while the income dependent class valued monthly income the most.The prospect minded class included more doctors,and staff with higher levels of education,deputy senior titles or above and longer working years,compared with other classes.The income dependent class had the highest number of nurses,but also included more member with lower levels of education and fewer working years.(7)Overall,compared with monetary incentives,the effect of non-monetary incentives is more significant,especially when social respect is raised to a good level or above,that is,more than50% of the public give positive comments,and its incentive effect exceeds 60.0%.Conclusions and Recommendations(1)The practice environment experience and overall compensation incentives for medical staff in tertiary public hospitals still need to be improved.(2)Non-monetary incentives are more effective than monetary incentives,and a good social atmosphere of Zun Yi Zhong Wei should be actively created.(3)There is heterogeneity in the incentive preferences of medical staff.Sufficient career development has a better incentive effect on senior medical staff,and a reasonable adjustment of the income structure of medical staff has a more significant incentive effect on junior staff.Releasing the pressure of non-medical work and reducing workload can significantly improve the enthusiasm of medical staff.