Job characteristics model-based study of the intrinsic motivations for primary care practitioners

Abstract

BackgroundIncentives for primary care workforce are close related to the “strengthening basic healthcare” strategy of the new health reform of China and help achieve the goals of establishing a tiered system for rational diagnosis and treatment. Previous studies primarily focused on extrinsic incentives and their influence on performance, with limitation of exploring intrinsic motivations directly from the job. ObjectiveThis study aimed to analyze the job characteristics of primary care practitioners within the framework of Job Characteristics Model, evaluate their effect of intrinsic motivations on various job performance, compare the impact of five job characteristic dimensions with extrinsic motivators such as salary on these performance, and offer policy suggestions to enhance the motivations for bettering performance of primary care practitioners. MethodsA questionnaire survey was conducted between February and June 2021. The questionnaire was developed by the authors and delivered to primary care practitioners of 18 community health centers and 20 township health centers of three cities in Shandong Province China. The health centers were selected through a multi-stage sampling method. Within participants who completed the questionnaires, 167 participants were selected through a convenience sampling process, for semi-structured interviews. These interviews explored their opinions on job characteristics in their roles. Pearson correlation analysis was used to examine the association between the five job characteristics and extrinsic motivators, with self-motivation, performance, professional burnout, and intent to leave. Multiple linear regression was employed to assess the impact of these factors on job performance. The interview data were analyzed through thematic analysis. ResultsA total of 870 questionnaires were included in the study. Participants gave the highest rating to skill variety (4.09 ± 0.71) and the lowest to task integrity (3.18 ± 1.04) in the job characteristics. Scores for task significance, feedback, and autonomy were 3.91 ± 0.76, 3.46 ± 0.83, and 3.43 ± 0.79, respectively. Pearson correlation indicated positive associations of each job characteristic dimension with self-motivation and performance (P<0.05), and negative associations with burnout and intent to leave (P<0.05). Multiple linear regression results revealed that job characteristics dimensions significantly affected job performance, with notable impacts on self-motivation (R²=18.8 %), performance (R²=11.3 %), professional burnout (R²=16.5 %), and intent to leave (R²=21.9 %). These characteristics showed greater explanatory power compared to extrinsic motivators (1.7 %, 3.4 %, 5.8 %, and 11.8 % contributions to the four performances, respectively). Interviews highlighted challenges such as fragmented task assignment, limited autonomy, and inadequate feedback. ConclusionThe influence of intrinsic motivations stemming from of job characteristics is more significant in explaining job performance among primary care practitioners than extrinsic motivational factors. A noticeable discrepancy exists between theoretical job characteristics and their practical application. Focus should be shifted towards the intrinsic motivations of job. Recommended measures include enhancing training opportunities and their quality of service, reducing work-related stress, empowering medical professionals, increasing resource investments, relaxing policy constraints, and improving the performance management system. These measures aim to impact job perceptions, thereby enhancing the motivations and performance of primary care practitioners.