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The transformation of the structure of the health workforce and motivation of medical personnel under the influence of economic, technological factors and state human resources policy

Priority areas of development: state and public administration
2016

The aim of the project: determination of conditions for effective policy in development of human resource capacity and strengthening of the work motivation of the health workforce

Methods:

For a comparative analysis of human resources policy in Russia and other countries:

  • analytical review of foreign literature,
  • statistical analysis,
  • countries’ clusters formation according to the selected directions and results of human resources policy.

For the analysis of changes in the motivation of the health workforce:

  • qualitative interviews and questionnaire survey of the health workforce;
  • cross-tables, variance, regression, factorial, discriminant, cluster analysises of the surveys’ data conducted in 2017–2016.

Empirical background of the research:

  • questionnaire surveys data of the health workforce carried out by Levada-Center in order of Independent Institute for Social Policy in 2007, by HRU HSE and Levada-Center in 2009 and 2014, by NRU HSE and Russian Public Opinion Research Center in 2011, by NRU HSE supported by Ministry of Health of the Russian Federation in 2013, by NRU HSE and C-Media in 2016;
  • the records of qualitative interviews with physicians and heads of health facilities which were conducted in Moscow in 2015 and 2016 and in one of the subject of the Russian Federation in 2016;

Research outcome:

Comparative analysis of the human resources policy of Western countries shows that the extensive build-up of number of physicians and nurses is gradually giving way to intensive development strategy, which aims to change the structural parameters of staffing. The importance of long-term planning is rising, a new institutional structure of workforce planning is forming and the planning process becomes more transparent, expanding the circle of its participants.

In Russia, there is the planned numbers only for two categories of health workforces such as physicians and nursing staff. The planning is conducted only for the current demands and takes into consideration more narrow range of tasks and factors.

In Western countries, there are common principles for the planning of number of places in higher medical education, planning is conducted regardless of the source of funding for training. In Russia, the state does not regulate the structure of budgetary places in residency.

Comparative analysis of the regulatory mechanisms in specialization of medical practice, forms of professional development of medical personnel, medical certification mechanisms shown a wide variety of these mechanisms by country and generality of core principles in staff training, supporting of access of graduates to subspecialities, professional development of physicians and nurses (longer duration of postgraduate education, high requirements to quality of education, which is verified by external evaluation in form of accreditation system). Russia is far behind in the level of training and the professional development of physicians.

The study of motivation of physicians confirmed the stability of polymotivation-effect. The three most important work motives are 1) an opportunity to make money, 2) a professional interest in the work, and 3) the compassion and care to the patient (altruism).

The findings of the survey conducted in 2016 quite clearly indicate that the conclusion of an effective contract with health and making connection between effective contract and wage rate contribute to: obtaining higher wages, increasing satisfaction (the amount of wages, the conditions for the training, the rules of remuneration for high results of work), a change in the evaluations of situation in the health sector in favor of more positive. This is the first evidence of effective of such type of contract.

The  implementation of effective contract led to increasing of the motivation to work primarily in young physicians. At the same time the more experienced physicians react to innovations less strongly.

Ongoing health restructuring measures have an impact on work motivation of health workforce. The most acute problem was the correlation between the earnings and volume of work. At the same time the problem of effectiveness of the work and the quality of practice were put on the back burner. In the Moscow hospitals there is fixed the negative correlation between the evaluations of changes of personal attitude to work and evaluation of process of staff reductions. At the same time the reorganizations (merger, association) of medical facilities have an impact on work motivation of medical measures in other way.

There were found out some changes in the relations between doctors and patients. The vast majority of health workforce say that patients have become more demanding in the question of the quality of medical care. The traditional paternalistic model of interaction between doctors and patients is already not the dominant model for physicians. Preference for the partnership model between doctor and patient is recognized for about half of the doctors.

The stage of implementation, recommendations for the implementation or outcomes of implementation of research results

The proposals for the use of international experience in human resources policy of the state were defined.

The results of the research can be used for correction of the policy of implementation an effective contract and strengthening of motivation of health workers.

Publications:


Базаров Т. Ю., Корчагина В. В. Значение соответствия детских врачей-стоматологов профессиональным компетенциям для успешной реализации в повседневной практике // Стоматология детского возраста и профилактика. 2016. Т. 15. № 2(57). C. 40-44. 
Vlassov V., Vishnevsky A. G. Privatisation and mortality in Russia // The Lancet Public Health. 2017. Vol. 2. No. 5. P. e207-e208. doi
Shishkin S. Health Care, in: Russia: Strategy, Policy and Administration. London : Palgrave Macmillan, 2018. С. 229-239. 
Sheiman I., Gerry C. The Health Workforce of the Russian Federation in the Context of the International Trends / Высшая школа экономики. Series WP BRP "Economics/EC". "WP BRP 01/PSP/2016". 2016. 
Danishevsky K. Why and how the Russian health workforce is different? // Медицина. 2016. No. 2. P. 73-108. 
Тарасенко Е. А. ПОЛИТИКА И УПРАВЛЕНИЕ В СФЕРЕ ЗДРАВООХРАНЕНИЯ В ГЛОБАЛЬНОЙ ПЕРСПЕКТИВE // Журнал исследований социальной политики. 2016. Т. 14. № 3. C. 444-451. 
Шейман И. М. Проблемы перехода на подушевой принцип оплаты первичной медико-санитарной помощи // Вопросы государственного и муниципального управления. 2016. № 4. C. 143-164. 
Власов В. В. Почему в России нет реформы здравоохранения?, in: XVI Апрельская международная научная конференция по проблемам развития экономики и общества: в 4 кн.. Москва : Издательский дом НИУ ВШЭ, 2016. С. 378-384. 
Темницкий А. Л. Мотивационный потенциал структуры заработной платы врачей, in: XVI Апрельская международная научная конференция по проблемам развития экономики и общества: в 4 кн.. Москва : Издательский дом НИУ ВШЭ, 2016. С. 394-402. 
Sheiman I., Gerry C. Too many and too few: The paradoxical case of physicians in the Russian Federation // International Journal of Health Planning and Management. 2018. Vol. 33. No. 1. P. 391-402. doi