STUDY'S AUTHOR:
Alexander Temnitsky, Leading Research Fellow of the HSE Centre for Health Policy
Temnitsky studied Russian doctors’ personal motives driving their performance between 2007 and 2014 and found values such as commitment to one’s profession and altruism — empathy and desire to help patients — as well as expectations of a good income, to top the list of incentives for some 70% of respondents surveyed at different times. Following far behind the top trio were motives such as being able to help family, friends and oneself in maintaining health, chosen by one-quarter to one-third of all respondents over time.
Table 1. The hierarchy of health worker motives between 2007 and 2014
|
Key motives: |
Survey year | |||
|
2007 |
2009 |
2011 |
2014 | |
|
Opportunity to earn a living |
1 |
1 |
3 |
3 |
|
Professional interest |
2 |
2 |
1 |
1 |
|
Compassion and care for patients |
3 |
3 |
2 |
2 |
|
Opportunity to help family, friends, self to maintain good health |
4 |
4 |
4 |
4 |
|
Security of employment |
5 |
5 |
6 |
5 |
|
Professional development |
6 |
6 |
5 |
6 |
|
Inability to find another job nearby that fits one's training |
9 |
7 |
9 |
8 |
|
Respect and support from family and friends |
7 |
8 |
7 |
7 |
|
Career opportunity |
8 |
9 |
10 |
9 |
|
Opportunity to win the respect of peers |
10 |
10 |
8 |
10 |
|
More opportunities for socializing |
11 |
11 |
11 |
11 |
|
Number of respondents |
621 |
791 |
2399 |
945 |
Source: Temnitsky's paper.
Motives such as socializing with colleagues and earning their respect were found to be secondary and only part of contributing to a favourable atmosphere in the workplace.
The study is based on the findings from a survey of 951 doctors in five Russian regions, conducted in 2014 as part of the HSE Programme for Basic Research, and from two other surveys of 2450 doctors in 20 regions and 1611 doctors in 14 regions, conducted in 2011 and 2013, respectively.
Temnitsky presented his findings in the paper 'The Structure and Dynamic of Russian Doctors' Work Motivation' at the HSE's XVII April Conference.
According to Temnitsky, doctors' interest in their work is linked to their dominant values, which he has grouped into four broad categories.
The first category, focused on networking, is associated with motives such as being respected by peers, enjoying the support of family and friends and being able to help them maintain their health, as well as opportunities for more social interactions.
The second category, focused on professional and humanistic values, is associated with interest in the content of one's work and compassion for patients.
The third and fourth groups of values are focused, respectively, on career opportunities, income, and secure employment.
The respondents were asked to assess the importance of different motives on a scale of 1 to 11 (one being very important and eleven unimportant). By indicating their key motives, doctors effectively expressed their attitudes towards the socioeconomic context of their practice, its professional aspects and the role of their immediate environment.
Professional interest (ranking first in 2014 and 2011; Tab.1), compassion (ranking second in the same years), and money (ranking third) were the top motives chosen by doctors consistently over the years. It is noteworthy that compassion, essential for the medical profession, has always played a key role.
According to Temnitsky, a little over 50% of respondents in all surveys consistently chose the three motives indicated above; the next most important motive was the opportunity to help the family and oneself in maintaining good health; this pragmatic consideration gained a maximum of one third of responses over the years.
Understanding medical doctors' value attitudes and resulting motivations has important implications for healthcare reform — like that ongoing in Russia today, where healthcare facilities have adopted a new type of employment contract (termed ‘effective contract’) with doctors, which provides for performance indicators and productivity incentives.
Temnitsky examined the relative power of different motivations and found that a combination of professional interest, remuneration and the desire to help patients — i.e. a comprehensive set of motives driven by both monetary and non-monetary incentives — were indicated as key performance drivers by the largest group of doctors ranging from 61% to 71% of the sample over the years (Table 2).
Among the remainder of the respondents, those who sought to maximize their social capital by helping family and friends varied from one-quarter to one-third over the years. These two clusters of motivations, according to Temnitsky, play a key role and should be considered in designing incentivisation policies for healthcare workers.
Table 2. Key motivational clusters (%).
|
Clusters: determining motives |
Survey year | ||
|
2009 |
2011 |
2014 | |
|
1. Opportunity to help family, friends, self to maintain good health: 'social capital' motives |
35 |
26 |
27 |
|
2, Professional interest, helping patients, earning a good income: ‘comprehensive’ motives. |
62 |
64 |
71 |
|
3. Respect and support from family and friends: ‘helping one’s close circle’ motives |
- |
7 |
- |
|
4. More opportunities for social interaction: ‘socializing’ motives |
3 |
3 |
2 |
|
Total |
100 |
100 |
100 |
|
Number of respondents |
791 |
2450 |
950 |
Source: Temnitsky's paper.
Temnitsky studied the potential impact of the 'effective contract' policy for the two biggest clusters of doctors in terms of their motivations. He found that 'social capitalists' tend to claim — and earn — higher incomes and are more likely than their colleagues driven by ‘comprehensive’ motives to accept out-of-pocket pay from patients and to practice privately on the side in addition to being employed by a clinic (5% vs. 1% in the 'comprehensive' group in 2014).
Thus, the new performance incentives policy can effectively stimulate 'social capitalists' while taking into account their focus on networking and willing acceptance of informal payments. As for medics driven by ‘comprehensive’ motives, according to Temnitsky, they are likely to respond well to the new monetary incentives, but may show a limited increase in productivity due to inertia and sticking to habitual work practices.
In their responses, 'social capitalists', more often than the 'comprehensive' group (90% vs. 81%), emphasize patients' growing demands as to health care quality and the role of good workplace conditions in the performance of medics. In answering questions about the key features of new employment policies, the cluster of 'social capitalists' are more likely to mention that the new type of contract includes performance indicators as the basis for incentive payments (42% vs. 30%), clear job descriptions and terms of pay (47% vs. 39 %), and availability of computers and other modern equipment in the workplace (35% vs. 24%).
Compared to their 'comprehensive' colleagues, 'social capitalists’ are less likely to have been awarded a qualification grade (29% vs. 38% of medics without a qualification grade). According to Temnitsky, the 'social capital' cluster mainly consists of lower-status doctors who have not yet attained the desired position in their institution or are generally dissatisfied with their employment situation and seek to achieve their pragmatic goals elsewhere.