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The organization of the health workers survey on satisfaction with social status and level of wages

Priority areas of development: sociology
2013
Department: Laboratory of Economic Problems in Health Care
The project has been carried out as part of the HSE Program of Fundamental Studies.

Object of research: doctors, middle and junior medical staff, other staff of medical facilities.

Goal of research: To identify the impact of the transition to an effective contract with health workers on their motivation, work practices and social status.

Empirical base of research: a survey of health workers conducted by the HSE with the organizational support of the Ministry of Health of Russia in 12 regions of the Russian Federation in September-October 2013. The total number of respondents was 4874 people, including 283 chief physicians, 1425 doctors, 1705 nurses, 717 nursing staff people, 744 other personnel of medical facilities.

Results of Research:

Nearly two-thirds of physicians (63%), the majority of nurses (53%) and other staff (53%) consider their profession prestigious. The estimates of prestige explicitly depend on the size of the salary paid and do not depend on the level of the professional category and type of medical facility. The most preferable factors raising the status of health worker are the decent wage (81% of respondents) and a decent pension (55%). But the second important factor for doctors is the legal protection of professional activity (54%).

The assessment of satisfaction of health workers by different aspects of activity shows that they are more satisfied with relationships with colleagues, managers, patients, as well as working hours than with the amount of wages, the volume of work, and the work organization.

The working time hours at the main place of work is 46 hours per week on average. As many as 20% of health workers have employment outside the main place of work, and the duration of the corresponding working time is more than 20 hours per week on average.

Medical professionals spent a great deal of their working time on the paperwork. This can take up to  55% of doctors' working time and 54% of the nursing time. Implementing electronic technologies for processing and documentation in health facilities did not radically changed the situation: doctors and nurses spent 29% of their time completing documents in an electronic format.

In general, 24% of doctors surveyed have said that they have used foreign languages in their work, but in the central hospitals, polyclinics and ambulance stations the share of such doctors is 2.5 times less. This is a worrying indicator of the level of qualification of doctors providing primary and secondary care, and of the extent to which the care provided lacks modern medical knowledge.

This survey data confirms that the Government's decision to raise significantly the wage of health workers by 2018 is timely as a noticeable improvement in the quality of their work is impossible without strengthening their motivation, and without decent pay for their labor. The inconsistency of the earnings in relation to the volume of the work (this was noted 62 % of respondents), the big difference in the wages of different categories of employees of medical facilities (35%) and under-estimation of the level of qualifications ( 32%) are currently the main factors of dissatisfaction with the organization of labor remuneration.

The modal group of medical personnel believe that the planned increase of wage is sufficient (39%). However, attention is drawn to a large proportion of those who believe that the planned increase is inadequate (28%), and to a large proportion of respondents who found it difficult to answer ( (34%). Apparently, this indicates that the majority of health workers have unrealistic expectations as to the real scale of wages in 2018, or are not sure that the declared increase will actually happen.

In the respondents' answers to the question of what part of the wages should grow faster, the modal response was the desire to see the base of the advancing growth compared with the challenging part of the wage . 56 % of health workers metioned this . A second common response was the same emphasis on the pace of both parts ( 27%). According to all categories of workers, the share of the base part of wage should reach an average of 62 %, i.e. 10% more in comparison to the existing situation. And the chief physicians are more vociferous in increasing the share of the basic wage (median 70%).

Most of the chief physicians (58%) supported the rationale of allocating a number of occupational groups of workers for whom the wage increase in the coming years should be faster; these are health care workers who provide emergency medical care, neurology, cardiology, pediatricians, general practitioners and surgeons.

Most of the respondents of all categories of health workers consider it possible to determine the parameters of volume and quality of their work (57% and 66 %, respectively ), and the doctors were convinced of these opportunities even more - 64 % and 70 %.

Level of implementation, recommendations on implementation or outcomes of the implementation of Results:

The results of the survey can be used to identify the strategy of transition to effective contracts and for the improvement of organization work and remuneration of health workers.

Field of application: organization of work and remuneration in health facilities.