Job satisfaction and its modeling among township health center employees: a quantitative study in poor rural China

Jun A Liu 0 Qi Wang 1 Zu X Lu 0 0 Department of Social Medicine, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , No.13, Hangkong Road, Wuhan, Hubei Province , PR China 1 Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology , No.13, Hangkong Road, Wuhan, Hubei Province , PR China Background: Job satisfaction is important to staff management of township health centers (THCs), as it is associated with organizational performance, quality of care and employee retention. The purpose of this study was to measure job satisfaction level of THC employees in poor rural China and to identify relevant features in order to provide policy advice on human resource development of health service institutions in poor regions. Methods: A self-completion questionnaire was used to assess the job satisfaction and relevant features (response rate: 90.5%) among 172 employees (i.e., clinic doctors, medico-technical workers and public health workers) of 17 THCs in Anhui and Xinjiang provinces of China. The study covered a time period of two months in 2007. Results: The mean staff job satisfaction scored 83.3, which was in the category of "somewhat satisfied" on a scale ranging from 0 (extremely dissatisfied) to 100 (extremely satisfied) by employing Likert's transformation formula. Exploratory factor analysis (EFA) revealed eight domains involved in modeling of job satisfaction, among which, the caregivers were more satisfied with job significance (88.2), job competency (87.9) and teamwork (87.7), as compared with work reward (72.9) and working conditions (79.7). Mean job satisfaction in Xinjiang (89.7) was higher than that in Anhui (75.5). Conclusions: Employees of THCs have moderate job satisfactions in poor areas, which need to be raised further by improving their working conditions and reward. - Background Job satisfaction is defined as the positive personal perception towards work or work experiences [1]. In fact, job satisfaction has been identified as an important determinant of employee retention, turnover and work performance [2]. In health service sectors, job satisfaction is highly associated with staff 's intention to quit, quality and efficiency of services, and patient satisfaction [3]. It has been reported that doctors with higher job satisfaction are more likely to provide more satisfactory services and produce better therapeutic effect than those with the lower one [4]. Therefore, higher job satisfaction tends to result in much higher patient satisfaction and reduce medical costs, thereby making a hospital more competitive [5]. Recently, doctor dissatisfaction has become a subject of keen investigation [6]. In 2001, Richard Smith posed a question "Why are doctors so unhappy?" in BMJ, believing that the reasons varied, some of which were deep and complicated [7]. So far, health service institutions in most countries introduced a patient-centered management, which, to some extent, hurt the interest of doctors [8]. Moreover, in 2000, WHO designed a measure of responsiveness to assess the respect of consumers' rights [9]. These moves, unknowingly, erode the rights of doctors, and impair their motivation to better serve patients. In China, township health centers (THCs) are primary health care organizations, owned by the state or collectives, and provide public health services and primary medical services to above 800 million populations in rural China, which play important roles in the three-tier rural health-care network and the "New Rural Corporative Medical System" [10]. However, job satisfaction and retention of THC employees are lower than those of employees working in urban community health centers (CHCs) in China. The Guangdong province is among the richest regions of China, but investigations have shown that job satisfaction of the THC staff in the province was not high, in that caregivers there were not satisfied with their work reward and professional development [11]. Short of long-term governmental investment, some THCs are struggling to survive, especially those in poverty-hit rural areas, which hardly meet the healthcare needs of the local population [12]. To help THCs provide better health services in poor rural China, Chinese Ministry of Health and Hong Kong Kadoorie Foundation elected to launch a Rural Community Health Promotion Project in 2004. One major purpose of the project was to improve overall conditions of THCs, including site construction, provision of basic medical equipment and skill training. In 2005, the project was started in 17 THCs in poor regions of Xinjiang and Anhui. This article was to assess staff job satisfaction of THCs in the poor regions covered by the project and identify critical determinants to job satisfaction, with an attempt to work out strategies to improve the job satisfaction and retention in these institutions. Methods Overview The framework of our research is shown in Figure 1. In preparation phase, reports on job satisfaction [13-16] were reviewed and a questionnaire on job satisfaction of THC employees was developed on the basis of both organizational and individual features. The self-completed questionnaire was employed to estimate the job satisfaction of the employees of THCs covered by Kadoorie Project. Quantitative analyses were applied to describe the staff job satisfaction status and identify critical influencing factors and to establish a model of job satisfaction. In this study, all subjects worked in the fields of clinical, medico-technical, and public health services of 17 THCs, 7 in Anhui and 10 in Xinjiang. Administrators were not included. All the THCs were low-level non-profit medical institutions located in poor rural areas. Seven THCs in Anhui Province were financially independent, and the other 10 institutions in Xinjiang were fully supported by local governments. All the subjects were asked to complete the questionnaire anonymously. Investigators, if necessary, would provide assistance in filling out the questionnaire. Questionnaires took, on average, two hours to fill out in each THC. In the survey, some subjects were too busy with their work to fill out the questionnaires. In the end, a total of 172 employees completed the questionnaires: a response rate of 90.5%. In order to collect relevant information from respondents, a study design based on epidemiological investigations and face-to-face interviews was conducted by using self-maid questionnaires without any experimental procedures on humans or animals. We promised keeping secret of personal information of all subjects. And all questionnaires were filled anonymously. Therefore this study did not harm the ethics of subjects. All subjects gave their informed consent prior to the study. Questionnaire Various instruments are used to evaluate job satisfaction [17], among which the job description index (JDI) [16,18 (...truncated)