Background
Human resource management in health system: Bangladesh scenario
Methods
Study design, population and settings
Conceptual model
Data collection tools and techniques
Domains | Cronbach’s α | Items |
---|---|---|
Variables | ||
Organizational characteristics | .77 | 18 |
Organizational supports | .83 | 8 |
Physical working condition | .82 | 5 |
Workloads | .79 | 2 |
Health-professional politics | .81 | 3 |
Social characteristics | .72 | 4 |
Internal social supports | .68 | 2 |
External social supports | .65 | 2 |
Job Characteristics | .72 | 9 |
Autonomy | .68 | 2 |
Task variety | .66 | 4 |
Task significance | - | 1 |
Feedback from job | - | 1 |
Skill variety | - | 1 |
Outcomes | ||
Satisfaction | .73 | 3 |
Turnover intention | - | 1 |
Burnout | .70 | 3 |
Statistical analysis
Results
Background information of the respondents
Variables Categories | Public PHC (n = 121) Number (%) | Public SHC (n = 117) Number (%) | Public total (n = 238) Number (%) | Private (n = 116) Number (%) |
---|---|---|---|---|
Job position | ||||
Medical Officer | 87 (72) | 73 (62) | 160 (67) | 94 (81) |
Junior Consultant | 29 (24) | 27 (23) | 55 (23) | 15 (13) |
Senior Consultant | 0 (0) | 10 (8) | 10 (4) | 5 (4) |
RMO | 5 (4) | 5 (4) | 9 (4) | 2 (2) |
EMO | 0 (0) | 4 (3) | 4 (2) | 0 (0) |
Qualification/specialization | ||||
Graduate- MBBS/GP | 82 (68) | 58 (49) | 140 (59) | 80 (69) |
Postgraduate/Specialist | 39 (32) | 57 (49) | 96 (40) | 34 (29) |
Dentists | - | 2 (2) | 2 (1) | 2 (2) |
Dual practice | ||||
Yes | 96 (79) | 89 (76) | 185 (78) | 69 (59) |
No | 25 (21) | 28 (24) | 53 (22) | 47 (41) |
Geographic distribution by division (No. of districts) | ||||
Dhaka (5) | 18 (15) | 11 (9.5) | 29 (12) | 24 (21) |
Chittagong (6) | 12 (10) | 25 (21) | 37 (16) | 19 (16) |
Rajshahi (6) | 26 (22) | 25 (21) | 51 (21) | 23 (20) |
Khulna (2) | 19 (16) | 10 (9) | 29 (12) | 19 (16) |
Sylhet (2) | 9 (7) | 11 (9.5) | 20 (8) | 7 (6) |
Barisal (2) | 16 (13) | 5 (4) | 21 (9) | 7 (6) |
Rangpur (6) | 21 (17) | 30 (26) | 51 (21) | 17 (15) |
Descriptive statistics with multivariate analysis of variance
Domains | Public (n = 238) | Private (n = 116) |
p-values |
---|---|---|---|
Variables | Mean (SD) | Mean (SD) | |
Organizational characteristics | |||
*Organizational supports | 2.47 (± 0.65) | 3.24 (± 0.77) | <.001 |
*Physical working condition | 2.70 (± 0.79) | 3.58 (± 0.78) | <.001 |
Workloads | 3.60 (± 0.95) | 3.50 (± 0.89) | .396 |
*Health-professional politics | 3.74 (± 0.88) | 3.05 (± 1.12) | <.001 |
*Grand mean OC | 3.13 (± 0.43) | 3.34 (± 0.53) | <.001 |
Social characteristics | |||
*Internal social supports | 3.53 (± 0.87) | 3.99 (± 0.79) | <.001 |
*External social supports | 3.73 (± 0.75) | 4.17 (± 0.66) | <.001 |
*Grand mean SC | 3.63 (± 0.67) | 4.08 (± 0.62) | <.001 |
Job Characteristics | |||
*Autonomy | 3.34 (± 0.85) | 3.76 (± 0.90) | <.001 |
*Task variety | 3.29 (± 0.65) | 3.66 (± 0.67) | <.001 |
Task significance | 4.34 (± 0.81) | 4.42 (± 0.63) | .350 |
*Feedback from job | 3.78 (± 0.95) | 4.15 (± 0.74) | <.001 |
Skill variety | 4.13 (± 0.92) | 4.12 (± 0.84) | .992 |
*Grand mean JC | 3.57 (± 0.52) | 3.87 (± 0.48) | <.001 |
Outcomes | |||
*Job satisfaction | 2.95 (± 0.81) | 3.24 (± 0.78) | .002 |
Turnover intention | 3.06 (± 1.14) | 3.19 (± 1.24) | .189 |
*Burnout | 2.89 (± 1.24) | 2.09 (± 1.03) | <.001 |
Correlation statistics
Work characteristics | Provider | Outcome variables | ||
---|---|---|---|---|
Satisfaction | Turnover intention | Burnout | ||
Pearson’s correlation coefficient - r; 95% BCa CI; p-value (p-values (two-tailed) of differences in transformed r-to-z between the two sectors) | ||||
Organizational supports | Public | .370; [0.25, 0.48]; <.001 | −.420; [−0.52, −0.31]; <.001 | −.214; [−0.34, −0.06]; .001 |
Private | .534; [0.35, 0.70]; <.001 (.07) | −.375; [−0.52, −0.21] < .001 (.64) | −.129; [−0.30, 0.04]; .17 (.44) | |
Physical working condition | Public | .335; [0.20, 0.45]; <.001 | −.181; [−0.31, −0.06]; .005 | −.083; [−0.21, −0.05]; .20 |
Private | .338; [0.16, 0.51]; <.001 (.97) | - .308; [−0.49, −0.10]; .001 (.24) | −.184; [−0.34, −0.02]; .05 (.37) | |
Workload | Public | −.018; [−0.18, 0.17]; .77 | .145; [−0.01, 0.27]; .03 | .179; [0.07, 0.28]; .006 |
Private | −.010; [−0.21, 0.20]; .92 (.97) | .014;. [−0.20, 0.21]; .88 (.25) | .060; [−0.15, 0.26]; .32 (.29) | |
Health- professional politics | Public | −.221; [−0.37, −0.06]; .001 | .270; [0.11, 0.41]; <.001 | .210; [0.10, 0.32]; .001 |
Private | .077; [−0.12, 0.27]; .42 (.008) | .082; [−0.29, 0.13]; .39 (.08) | .005; [−0.15, 0.16]; .96 (.06) | |
Internal social support | Public | .224; [0.08, 0.36]; .001 | −.085; [−0.22, 0.06]; .19 | −.050; [−0.17, 0.09]; .44 |
Private | .322; [0.12, 0.54]; .001 (.35) | −.250; [−0.40, −0.09]; .01 (.13) | −.222; [−0.36, −0.08]; .02 (.13) | |
External social support | Public | .295; [0.17, 0.40], <.001 | −.008; [−0.14, 0.14]; .90 | −.117; [−0.24, −0.002]; .07 |
Private | .162; [−0.07, 0.39]; .09 (.22) | −.093; [−0.27, 0.09]; .33 (.46) | −.291; [−0.45, −0.14]; .002 (.11) | |
Job characteristics | Public | .359; [0.20, 0.51]; <.001 | −.040; [−0.18, 0.09]; .538 | - .149; [−0.26, −0.03]; .02 |
Private | .196; [0.02, 0.36]; .04 (.12) | −.230; [−0.40, −0.06]; .016 (.08) | - .217; [−0.38, −0.06]; .02 (.54) | |
Satisfaction (a secondary outcome) | Public | - | −.427; [−0.55, 0.27]; <.001 | −.088; [−0.21, 0.04]; .17 |
Private | - - | −.358; [−0.52, −0.12]; <.001 (.47) | −.162; [−0.33, 0.01]; .09 (.51) |
Correlates of satisfaction
Correlates of turnover intention
Correlates of burnout
Multiple regression: Key predictors of work design outcomes
Model
Provider type
|
R
|
R
2
| Standardized β (p-value) | Change statistics | |||
---|---|---|---|---|---|---|---|
R
2
change |
F change | df 1 / 2 | Sig.
F change | ||||
A. Model: satisfaction | |||||||
Public doctors
| |||||||
1. Organizational supports | .371 | .137 | .19 (.006) | .137 | 36.32 | 1 / 228 | <.001 |
2. Job Characteristics | .439 | .193 | .23 (<.001) | .056 | 15.55 | 1 / 227 | <.001 |
3. Working condition | .469 | .220 | .17 (.009) | .027 | 7.90 | 1 / 226 | .005 |
4. Health-professional politics | .484 | .235 | - .13 (.040) | .015 | 4.28 | 1 / 225 | .040 |
Private doctors
| |||||||
1. Organizational supports | .539 | .290 | .539 (<.001) | .290 | 42.91 | 1 / 105 | <.001 |
B. Model: turnover intention | |||||||
Public doctors
| |||||||
1. Organizational supports | .416 | .173 | −.37 (<.001) | .173 | 47.85 | 1 / 228 | <.001 |
2. Health-professional politics | .443 | .196 | .16 (.012) | .023 | 6.36 | 1 / 227 | .012 |
Private doctors
| |||||||
1. Organizational supports | .351 | .123 | −.35(<.001) | .123 | 15.02 | 1 / 107 | <.001 |
C. Model: burnout | |||||||
Public doctors
| |||||||
1. Organizational supports | .209 | .044 | −.16 (.019) | .044 | 10.41 | 1 / 228 | .001 |
2. Health-professional politics | .255 | .065 | .15 (.023) | .021 | 5.23 | 1 / 227 | .023 |
Private doctors
| |||||||
1. External social supports | .291 | .085 | −.292 (.002) | .085 | 9.91 | 1 / 107 | .002 |