A Research On Turnover Intention Of Primary Medical Staff In Anhui Province Based On Two-factor Theory

Background: Primary medical personnel play a fundamental role in providing primary medical services and residents’ health management.As the outbreak of COVID-19,the strength of normalized epidemic prevention and control has continued to sink to the grassroots level,which increasingly highlights the status of grass-roots medical personnel as "gatekeepers of residents’ health".However,due to the comprehensive effect of internal and external environment and its own status quo,the incidence of their resignation has increased,and has been increasingly concerned by the society;It has been found that both economic and non-economic incentives may affect the stability of the medical staff.At present,the relevant research on the turnover intention and incentive preference of grassroots medical personnel in Anhui Province is still insufficient and not in-depth.Therefore,further exploring the relationship between the two is of great significance for stabilizing and expanding the grass-roots medical team and strengthening the grass-roots health service system.Objective: Under the background of the steady implementation of the "Healthy China2030" strategy and the continuous promotion of the "Fourteenth Five-Year Plan" health standardization work plan in Anhui Province,A baseline survey was conducted on the turnover intention,incentive level and preference of grass-roots medical staff in Anhui Province,and to build a structural equation model to deeply explore the relationship between the two and the role of relevant intermediary variables,in order to promote the comprehensive development of grass-roots medical staff It will provide scientific basis for reducing the level of turnover intention,and then provide reference for improving the quality of primary medical service and formulating the management strategy of primary medical staff.Methods: literature review and expert discussion were used,this study developed and integrated a number of scales and questionnaires,including the current situation of the incentive level of grass-roots medical staff in Anhui Province.According to the geographical characteristics of Anhui Province,a multi-stage stratified random sampling method was used to select some cities and counties(districts)in northern,central and southern Anhui as the survey site.The data entry uses the questionnaire star platform to distribute and summarize the survey data online.The SPSS26 was used for T test,variance analysis,correlation analysis and multiple linear regression analysis in the data analysis.Mplus8.0 is used to construct the structural equation model between variables for path analysis and exploration.Result:(1)Basic information of the respondents: a total of 1003 people were sampled,of which 68.6% were women,52.6% were 36-50 years old,47.4% and 42.2% were total working years and 11-25 years at the grass-roots level,37.4% and 26.1% were practicing doctors and registered nurses,44.3% have bachelor degree or above,44.6% were monthly income of 3000-5000,55.0% were community health service centers,and 23.4% were township health centers,The staff in the establishment account for 46.5%,the contract employment accounts for 39.6%,the staff from northern Anhui accounts for 25.7%,the staff from southern Anhui accounts for 27.3%,and the staff from central Anhui accounts for 47.0%.(2)The level of incentive factors,job burnout,social support and turnover intention: the total scores of health care factors and motivation factors of the respondents were 51.61 ±8.916 and 51.54 ± 7.392,respectively.Among them,the dimension with the score of health care factors was interpersonal relationship(7.81 ± 1.422),the dimension with the highest score of motivation factors was sense of responsibility(7.89 ± 1.205),the emotional exhaustion,personality disintegration in job burnout The dimension scores of reduced sense of achievement were 18.80 ± 5.872,11.56 ± 5.323 and 25.44 ± 4.690 respectively,the total scores of perceived social support were 63.37 ± 10.320,and the total scores of turnover intention were 12.23 ± 4.275.(3)The Influencing factors of turnover intention: The results of multiple linear regression analysis showed that there was a regression relationship between different length of service and different length of service,health factor score,motivational factor score,job burnout score,type of practicing qualification,educational background,marital status,monthly income,the type of work unit,the region and the score of turnover intention was statistically significant(P<0.05),and the number of years of service(B=-0.072)of the respondents was inversely proportional to the score of turnover intention,The scores of health care factors(B=-0.095)and incentive factors(B=-0.063)are inversely proportional to the scores of turnover intention,and the scores of job burnout(B=0.112)are directly proportional to the scores of turnover intention,while the scores of perceived social support have no statistical significance with the scores of turnover intention.The turnover intention of licensed physicians is 1.209 higher than that of those without qualification,and that of pharmacists is 2.460 higher than that of those without qualification;The willingness to leave of college graduates is 0.971 higher than that of technical secondary school graduates and below,and the willingness to leave of college graduates and above is 2.240 higher than that of technical secondary school graduates and below;Unmarried people are 1.664 more willing to leave than married people;The turnover intention of the staff of the community health service station is 1.24 lower than that of the staff of the community health service center,and that of the village health room is 1.825 lower than the community health service center;The turnover intention of central Anhui was 1.161 higher than that of northern Anhui.(4)Intermediary effect analysis: Job burnout was positively correlated with turnover intention,while the scores of health care factor,incentive factor and perceived social support were negatively correlated with turnover intention.The partial path coefficient of the variables involved is significant(P<0.05),and the model has partial intermediary effect.In the path relationship between health care factors and turnover intention,the indirect effect of job burnout on turnover intention is 0.414,The indirect influence of perceived social support on turnover intention is 0.450,the total indirect effect of health care factors on turnover intention is 0.401,the direct effect is 0.183,the intermediary effect of job burnout and perceived social support is 80.27%,65.66%,respectively,and the intermediary effect of job burnout is more obvious;In the path relationship between incentive factors and turnover intention,the indirect effect of job burnout on turnover intention is 0.214,the indirect effect of perceived social support on turnover intention is0.104,the total indirect effect of motivational factors on turnover intention is 0.335,the direct effect is 0.085,the intermediary effect of job burnout and perceived social support is 34.60% and 61.66% respectively,and the intermediary effect of perceived social support is relatively obvious(P<0.05),The mediating effect of job burnout was not significant(P>0.05).Conclusion:(1)The scores of health care factors and incentive factors of grass-roots medical personnel in Anhui Province are at the middle level.The score of incentive factors is higher than that of health care factors,reflecting their low satisfaction with health care factors.The job burnout score is in the middle level,the perceived social support score is in the high support state,and the turnover intention is in the low.The job satisfaction of grass-roots medical staff in Anhui Province is not high,the work enthusiasm is low,and the work pressure and burnout are obvious,which may have a negative impact on the stability of the entire grass-roots medical team.(2)Years of service,Practicing qualification type,educational background,marital status,monthly income,type of work unit,and region are the influencing factors of turnover intention: the longer the years of work,the more likely the turnover will occur,which may be due to their knowledge level and professional ability to promote them to seek a better platform to achieve further progress in their career;Practitioners are more likely to leave their jobs than those without qualification.It may be because their post-practice development plans are more ambitious and clear,and they want to seek better development,although the number of licensed pharmacists in primary medical institutions is small,,so they should have a higher willingness to leave their jobs than practicing physicians;Married people may less likely to leave,possibly because they are in a stable period of family life;People whose monthly income is lower than the middle level are more likely to leave their jobs,which may be due to the fact that the remuneration of primary medical institutions still does not meet expectations;The staff of community service stations and village clinics are less likely to leave,which may be due to their educational background,professional ability and other reasons,and have not considered leaving or seeking other jobs.(3)From the fitting results of structural equation model,the indirect effect of health care factors on job burnout in the path of turnover intention is more obvious,while the effect of social support is weaker.Under the current situation of epidemic prevention and control combined with peacetime and wartime,it is suggested that managers should pay more attention to the work pressure of grass-roots medical staff;The effect values of incentive factors and health care factors are not significantly different,indicating that the two factors play a similar role.Therefore,it is suggested that managers should reasonably use the two-factor incentive means to stabilize and expand the grass-roots medical staff.