Status of healthcare workers after comprehensive reform of urban public hospitals in Beijing, China: sustainable supply, psychological perception, and work outcomes.

BACKGROUND: Healthcare reform in China has attracted worldwide interest and reached a new juncture. In an attempt to improve healthcare quality and patient satisfaction, the government of Beijing introduced comprehensive reform of urban public hospitals in 2016 and implemented new policies on personnel, compensation, management, and diagnosis and treatment. As the agents of healthcare service, and a target of reform measures, healthcare workers were greatly affected by these reforms but have not been carefully studied. METHODS: This study used mean value analysis, variance analysis, and qualitative content analysis to investigate the status of healthcare workers after comprehensive reform of urban public hospitals in Beijing. RESULTS: We found a gradual but constant increase in the number of healthcare workers in poor health in Beijing public hospitals. After the reforms, this population reported high challenge stress, public service motivation, job satisfaction, job performance and quality of healthcare, moderate presenteeism, and low hindrance stress and turnover intention. The status of healthcare workers differed by subgroup and changed during the reform process. CONCLUSIONS: Our study provides data useful for policy recommendations regarding the implementation and extension of future reforms and offers important lessons for developing and developed countries that are reforming public hospitals to improve efficiency and reduce costs.

Perceived social support and presenteeism among healthcare workers in China: the mediating role of organizational commitment.

OBJECTIVES: We assessed the role of social support in presenteeism by examining organizational commitment among Chinese healthcare workers. METHODS: One thousand four hundred thirty-four healthcare workers from 6 hospitals in 4 Chinese cities completed a questionnaire measuring presenteeism, social support, and organizational commitment. With organizational commitment as the mediator, regression analyses and structural equation modeling were used to test the model. RESULTS: Organizational commitment was directly inversely associated with presenteeism (ß = - 0.42, p < 0.001). Coworker support was moderately but significantly inversely associated with presenteeism (ß = - 0.15, p < 0.001), but the path from supervisor support to presenteeism was not significant (ß = 0.05, p > 0.05). The correlation between supervisor support and coworker support was significant (ß = 0.71, p <0.001). Supervisor support and coworker support were significantly positively associated with organizational commitment (ß = 0.41, p < 0.001, and ß = 0.14, p < 0.001, respectively). CONCLUSIONS: Supervisor support was more important in promoting organizational commitment, while coworker support was more effective in reducing presenteeism. The mediating effect of organizational commitment was significant.

How job stress influences job performance among Chinese healthcare workers: a cross-sectional study.

OBJECTIVES: Public service motivation refers to the idea of commitment to the public service, pursuit of the public interest, and the desire to perform work that is worthwhile to society. This study investigates how challenge stress and hindrance stress influence job performance among healthcare workers in Chinese public hospitals. It has also examined the mediating effect of public service motivation. METHODS: Data of 1594 healthcare workers were obtained from typical public hospitals in eastern, central, and western China. To test our hypotheses, we used descriptive statistical analysis, correlation analysis, structural equation modeling, and subgroup analysis to investigate the sample. RESULTS: Challenge stress and hindrance stress were strongly correlated among healthcare workers in Chinese public hospitals (ß = 0.59; p < 0.001). Challenge stress was significantly positively associated with public service motivation (ß = 0.14; p < 0.001) and job performance (ß = 0.13; p < 0.001). Hindrance stress was significantly negatively associated with public service motivation (ß = - 0.27; p < 0.001) and job performance (ß = - 0.08; p < 0.05). Public service motivation was directly positively associated with job performance (ß = 0.58; p < 0.001), and it indirectly mediated the association between job stress and job performance. CONCLUSIONS: This study provides important empirical evidence on the effects of job stress and public service motivation on job performance among healthcare workers in Chinese public hospitals. Job performance may be raised by limiting hindrance stress, which provides moderate challenge stress and increases public service motivation.

Do Challenge Stress and Hindrance Stress Affect Quality of Health Care? Empirical Evidence from China.

Severe job stress has adverse effects on the health of Chinese healthcare workers. We investigated associations between job stress, health, and quality of health care among Chinese healthcare workers. To analyze associations between stress, health, and quality of health care among healthcare workers in 74 Chinese hospitals, we surveyed 2426 healthcare workers of primary, secondary, and tertiary hospitals in Western, Central, and Eastern China in 2017. Structural equation modelling was used to examine relationships between job stress, health, and quality of health care. The mediating effect of health on the association between job stress and quality of health care was examined with the Sobel test. In the final model, health had a moderate direct positive effect on the quality of health care (ß = 0.24; p < 0.001). Challenge stress had a direct inverse effect on health (ß = -0.05; p < 0.05) and a significant direct positive effect on the quality of health care (ß = 0.26; p < 0.001). Hindrance stress had a significant inverse effect on health (ß = -0.37; p < 0.001) and a moderate inverse effect on the quality of health care (ß = -0.19; p < 0.001). The correlation between challenge stress and hindrance stress was significant and positive (ß = 0.59; p < 0.001). A partial mediation effect was in the final model. The health status of healthcare workers is an important concern at all levels of Chinese hospitals. To improve quality of healthcare, appropriate challenge stress is recommended among young staff, and interventions targeting hindrance stress should be developed and implemented in all hospital departments.

A retrospective and prospective assessment of the zero-markup drug reform in China from the perspective of policy diffusion.

The zero-markup drug policy is an important component of the new round of Chinese health care reform that began in 2009 to promote the separation between medical and pharmaceutical services, reduce patients' medical burden, and improve the medical supply security system. Over the past 8 years, the zero-markup drug reform policy has been carried out in 4 pilot rounds (a policy diffusion model with Chinese characteristics) and has been promoted throughout the mainland China. At this critical point, it is necessary to review this policy systematically. Therefore, based on the literature, government documents, and interview records, this study analyzed the characteristics, progress, achievements, challenges, and recommendations of zero-markup drug reform by using the policy diffusion theory. The study found that zero-markup drug reform has completed its initial diffusion by use of the "policy experiment" method and has reduced drug prices and patients' burden to a certain extent. However, in the next phase of policy diffusion, the reform still requires adjustment and innovative measures to respond to future challenges. Generally speaking, as China's unique health care reform practice, the experience of zero-markup drug reform could be used as a reference for other countries to control drug prices, separate medical and pharmaceutical services, and establish a modern system of hospital operation.