卫生工作者的动机是政策制定者的主要关注点,从业者和研究人员。公共服务动机(PSM)定义为为共同利益服务的利他主义愿望,为他人服务并帮助患者及其家人,无论其经济或外部回报如何,已被证明是公务员表现的关键。然而,在低收入和中等收入国家的卫生保健机构中,对这种动机的关注有限。关于PSM及其在摩洛哥卫生系统中的背景特异性知之甚少。我们着手定性探讨PSM的含义及其在四家公立医院卫生工作者中的表达。
我们采用了多个嵌入式案例研究设计,在两家表现良好和两家表现不佳的医院中探索PSM。我们进行了68次个人访谈,与不同干部进行了8次焦点小组讨论和11次小组讨论(医生,管理员和护士)。我们使用NVivo10进行了主题分析。
我们的分析表明,对于我们采访的卫生工作者来说,公共服务动机是一个很自然的概念。与患者的日常互动催化健康提供者的情感动机(同情和自我牺牲),PSM的核心元素。它还为他们提供了与内在动机一致的工作满意度。经理和行政人员表达了其他PSM组成部分:对公共政策制定的吸引力和对公共价值观的承诺。一个引人注目的结果是,卫生工作者表达了强烈的宗教信仰,即在为患者提供适当服务时,上帝的预期奖励。
这项研究强调了在摩洛哥四家医院的卫生工作者中,PSM是动机的驱动力。以及内在动机和同情心在一线卫生工作者动机中的突出地位。在摩洛哥,人们发现宗教信仰塑造了PSM的表达。
The motivation of health workers is a key concern of policy makers, practitioners and researchers. Public Service Motivation (PSM), defined as the altruistic desire to serve the common interest, to serve others and to help patients and their families regardless of financial or external rewards, has been shown to be key to the performance of public servants. Yet, limited attention has been paid to this kind of motivation in health care settings in low- and middle-income countries. Little is known about PSM and its contextual specificity in the Moroccan health system. We set out to qualitatively explore the meaning of PSM and its expression among health workers in four public hospitals.
We adopted a multiple embedded
case study design to explore PSM in two well-performing and two poor-performing hospitals. We carried out 68 individual interviews, eight focus group discussions and 11 group discussions with different cadres (doctors, administrators and nurses). We carried out thematic analysis using NVivo 10.
Our analysis shows that public service motivation is a notion that seems natural to the health workers we interviewed. Daily interactions with patients catalysed health providers\' affective motives (compassion and self- sacrifice), a central element of PSM. It also provided them with job satisfaction aligned with their intrinsic motivation. Managers and administrative personnel express other PSM components: attraction to public policy making and commitment to public values. A striking result is that health workers expressed strong religious beliefs about expected rewards from God when properly serving patients.
This study highlights the presence of PSM as a driver of motivation among health workers in four Moroccon hospitals, and the prominence of intrinsic motivation and compassion in the motivation of frontline health workers. Religious beliefs were found to shape the expression of PSM in Morocco.