Assessment of satisfaction of medical workers of obstetric services of rural areas with working conditions (on example of Ryazan region)

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Abstract


The Russian Federation is undergoing serious socio-economic changes, including those in the Russian healthcare system. High morbidity and mortality rates increase the population's need for medical care. It also increases the requirements of the society to doctors. Doctors have to solve not only medical, but also complicated legal, psychological, ethical problems.

Aim. To analyze satisfaction of medical workers of obstetric and gynecological service in rural areas with working conditions (on an example of the Ryazan region) on the basis of the results of questioning.

Materials and Methods. Acquisition of statistical material was carried out by the method of questioning of the obstetric and gynecological service workers (n=18) using the questionnaire developed by the authors. The questionnaire included questions concerning the working conditions, satisfaction with salary, organization of work, and also relationship with administration, colleagues and patients. Statistical data processing was carried out using Statistica 10.0 program. The method of descriptive statistics with determination of the arithmetic mean, variance and calculation of 95% confidence interval was used.

Results. It was found that 83.3% of employees of the obstetric and gynecological service of the Ryazan region, including 80.0% of doctors and 84.6% of midwives, were in general satisfied with the work. Here, 61.1% of respondents noted filling in of a large volume of reporting forms and medical documentation. Only 22.2% of the surveyed employees of the obstetric and gynecological service saw the absolute possibility of their professional growth in the medical organization. Relationships with patients were evaluated as full trust and mutual understanding by 72.2% of respondents.

Conclusion. The conducted pilot study clearly demonstrated that satisfaction of healthcare workers with working conditions implies many factors concerning the content and conditions of their professional activities. Improvement of the efficiency of the activity and job satisfaction of medical workers can be achieved by a number of measures based on the principles of quality management system: continuous improvement, leadership, staff involvement, relationship management. Increase in satisfaction of healthcare workers with working conditions is the basis for elimination of shortage of personnel in the healthcare sector, for provision of primary healthcare units including those in remote areas of the country and rural areas, with personnel, and assurance of the quality of medical care. The study showed that workers of the obstetric and gynecological service of the Ryazan region are generally satisfied with the working conditions, are provided with tools enabling them to take clinical decisions, highly appreciate the moral and psychological climate in the team. At the same time, a high percentage of respondents noted filling in a large volume of reporting forms and medical documentation, lack of opportunities for professional growth and low salaries.


Full Text

The priority tendency in the personnel policy in the healthcare sphere of RF is development of the system of management of human resources based on planning of training and employment of personnel in accordance with the demands of the sphere, strengthening of intellectual potential with use of innovative educational technologies and effective motivational mechanisms that permit to provide medical organizations with personnel capable of improving the quality of medical care and its availability to the population at a high professional level [1-3]. The problem of insufficient provision of healthcare with medical personnel performing primary medical care, still remains actual. Especially dramatic is the situation in the rural regions [4-6].

Satisfaction with labor is the basic element of the personnel policy of a medical organization where the work with personnel is the priority direction and the established aims and tasks are directed at preservation, strengthening and development of the potential of personnel, at creation of a skilled and consolidated team capable of timely response to permanently changing market demands [7,8].

A study of satisfaction of medical personnel with working conditions is a part of the quality management system in a medical organization, and its results may be an effective tool for increase in the effectiveness of the work of the organization in whole [9-11].

The aim of work – to analyze satisfaction of the workers of obstetric-gynecological service (OGS) of a rural region with the working conditions (on an example of the Ryazan region) on the basis of the results of questionnaire.

Materials and Methods

The object of study was obstetrics and gynecology doctors and midwifes of Ryazan Municipal Regional Hospital (RMRH) who participated in social research. In the course of study 5 obstetrics and gynecology doctors and 13 midwifes were questioned – all medical personnel of OGS of the Ryazan region. The overwhelming majority of medical personnel were women – 94% (80% of doctors and 100% of midwifes). 33% of respondents were above 60 years of age (40% of doctors and 30% of midwifes); 16% of respondents were workers of medical and obstetric stations (MOS), 39% – personnel of outpatient clinics and 45% – workers of ambulance rooms. 44% of respondents had the highest qualification category (40% of doctors, 50% of midwifes). 50% of respondents (80% of doctors, 40% of midwifes) had more than 25-year period of work in healthcare sphere, 33% of respondents (40% of doctors and 30% of midwifes) had been working in RMRH for more than 25 years.

The statistical material was collected by a method of anonymous questioning on paper medium using the questionnaire designed by the authors. The questionnaire included questions reflecting the opinion of medical workers about peculiarities of the working conditions, satisfaction with the salary, organization of work, relationship with the administration, colleagues and patients. The results were presented using descriptive statistics methods.

Results and Discussion

83.3% of respondents (workers of OGS of the Ryazan region) were satisfied with their work (80.0% of doctors, 84.6% of midwifes).

In the section concerning satisfaction with the content of work the respondents noted the following peculiarities of their work: management of a high volume  of reporting documents, journals and medical documents – 61.1% of respondents (10% of doctors and 46% of midwifes). Here, 55.5% of respondents (80.0% of doctors and 46.1% of midwifes) were sure that exclusion of filling in a large volume  of documents from the duties of medical workers will permit them to give more attention to a patient; 33.3% of respondents (60.0% of doctors and 23.0% of midwifes) think that to make the labor activity easier it would be reasonable to improve provision with information  and to introduce a unified information system in a medical organization including electronic medical cards. At the moment of survey about 60.0% of doctors and 7.6% of midwifes were provided with computers. With this, 38.8% of respondents do not possess computer skills, and 33.3% of respondents do not think it necessary to introduce electronic medical cards, but would prefer to preserve management of medical documentation (journals, etc.) on paper carriers.

100.0% of respondents were provided with procedures of rendering medical care, with clinical recommendations and medical care standards, 100% of doctors and 84.6% of midwifes note availability of reference literature. According to the data of questionnaires,  all the surveyed doctors rest on Clinical recommendations for taking decisions in their professional activity.

Only 22.2% of respondents see an absolute possibility for their professional advancement in a medical organization, with this, 61.2% refrained from answering. 77.7% of respondents use a possibility for acquiring new knowledge and skills from programs of postgraduate education including distance education. 72.2% of medical workers (92.3% of midwifes, 20.0% of doctors) read specialized medical literature only from time to time.

The results of study also showed that 83.3% of respondents including 60.0% of doctors and 92.3% of midwifes are not satisfied with their salaries. 16.6% of respondents consider the system of payment unfair, and 55.5% refrained from answering.

17.8% of medical workers (20.0% of doctors, 15.3% of midwifes) feel fatigue already in 4 hours after the beginning of the working day because of unfavorable working conditions that affect effectiveness of work: 50.0% of respondents noted muscle tension associated with the working position, 27.7% noted a high nervous-psychological tension.

A study of moral and psychological climate in the team gave the following results: 88.8% of respondents evaluated the management style of the chief doctor as democratic; 95.0% of medical workers considered the manager as giving sufficient attention to their work and to organization of AGS; 83.3% think that administration do not impose inflated requirements and set well-defined and clear tasks; 75.0% respondents regularly obtain feedback from the manager.

Study of communications in the team showed that 61.1% of respondents are sure in sympathy to the majority of colleagues; 55.5% support the statement ‘my team is my family’, 77.7% of respondents note rare occurrence of conflict situations in the team. The main cause of conflicts in the team is considered to be incorrect distribution of functional duties (33.3% of respondents).

Examination of interactions of medical workers with patients showed that 61.1% of respondents feel compassion to patients, 27.7% feel sympathy, however, 11.2% feel irritation. 72.2% of respondents evaluated interrelations with patients as absolute trust and mutual understanding. In communication with patents 55.5% of respondents try to fully participate in their problems, while 44.4% limit the communication by only taking the necessary information. It is important to note that 44.4% of respondents consider patients to be more protected in their rights than themselves. Nevertheless, 88.8% of respondents did not have any cases of infringement of their rights as of medical workers.

On the whole, 61.1% of respondents noted that the thing they value most in their work is recognition by their colleagues and patients, 22.2% value increase in the material well-being, 27.7% – psychological comfort.

We think that the results obtained within the frames of even a small pilot study are of a practical interest, since study of satisfaction of personnel with the working conditions is the basis of quality assurance and is directed at realization of the main ISO (International Organization for Standardization) 9001-2015 principles – constant improvement. Although 83.3% of the OGS workers were satisfied with their job, 61.1% of respondents noted a high volume of medical documents requiring filling, and 17.8% feel fatigue as early as in 4 hours after start of the working day, which could be regarded as an unfavorable fact. We believe that to  make the working activity easier and to increase the effectiveness of the work of doctors and midwifes, it is necessary to use a coordinated approach to constant improvement in the whole organization: creation of comfortable conditions for the working activity, transition to the optimal electronic management of documents, provision of the personnel with modern technical means.

A study of satisfaction with remuneration of labor, evaluation of development and professional advancement may play a role in increase in the motivation for work and will permit to realize the principle of ISO 9001-2015 – involvement of personnel. Unfortunately, 83.3% of personnel working in the rural region, are not satisfied with their salaries, 16.6% regard the system of labor remuneration as unfair, 16.6% do not see any opportunity for professional advancement. We think that a solution to the question of satisfaction with the remuneration could be introduction of effective contract including criteria transparent and clear for medical workers that could reflect their contribution to the activity of a medical organization. To increase the motivation of medical workers to professional advancement, it is necessary to use additional methods of encouragement of workers, both material and non-material.

It was shown that almost ¾ of respondents read medical literature ‘from time to time’. Taking into account this low percent of medical workers who trace new tendencies in medicine, it is reasonable to introduce digests in a medical organization that could provide personnel with the necessary information and stimulate their interest in certain topics.

A study of interaction of the workers with the administration of the medical organization showed that the chief doctor possesses the leadership skills which promotes development of a medical organization and helps maintain the quality at the required level. The leadership principle is based on the process of social influence where interaction of the workers is oriented to achievement of the common goals, which increases satisfaction with the professional activity.

A study of interrelations in the team and with patients showed realization of ISO 09001-2015 principle in the medical organization – management of interrelations  and orientation to a customer: 61.1% of respondents consider colleagues to be their comrades, 77.7% note a low level of propensity for conflicts. Nevertheless, in case of conflict 33.3% of respondents consider its reason to be a non-optimal distribution of functional duties among the workers. To improve interrelations in the team and prevent conflicts, a uniform distribution of the load among the workers is required with reflection of these changes in the functional duties of the medical personnel.

A study of interrelations of medical personnel with patients showed that the most part of workers hold empathy for patients which results in establishment of ‘doctor-patient’ alliance that increases satisfaction both of a patient and of a medical worker thus providing realization of the principle of orientation to a customer

Conclusion

RF is undergoing serious social-economical transformations including those in the healthcare system. High parameters of morbidity and mortality rates increase the demand of the population for medical care, that is associated with increased requirements applied by the society to doctors. Doctors have to deal not only with medical, but also with complicated juridical, psychological and ethical problems.

Optimization of the conditions of the professional activity of doctors is one of the most effective solutions to these problems. A study of satisfaction of medical workers with the working conditions, scientific substantiation of the ways of optimization of medico-social conditions of professional activity of medical workers is an essential and socially significant task.

The conducted pilot study showed that workers of obstetric-gynecological service of the Ryazan region are on the whole satisfied with the working conditions and are provided with instruments permitting them to take clinical decisions, and highly appreciate the moral-psychological climate in the team. With this, a large percentage of respondents note a necessity to manage a large volume of reporting and medical documents, absence of a possibility for professional advancement and a low level of salaries. The effectiveness of the working process may be increased by realization of a complex of measures based on the principle of quality management: constant improvement, leadership, involvement of personnel, management of interrelations.

About the authors

Aleksandr Yu. Davydov

Ryazan State Medical University

Author for correspondence.
Email: d7711@mail.ru
ORCID iD: 0000-0001-6764-2487
SPIN-code: 6897-2440

Russian Federation, Ryazan

PhD-Student of the Department of Economics, Law and Health Management

Galina B. Artemieva

Ryazan State Medical University

Email: vestnik@rzgmu.ru
ORCID iD: 0000-0002-8946-7912
SPIN-code: 4053-4663

Russian Federation, Ryazan

MD, PhD, Associate Professor, Professor of the Department of Economics, Law and Health

Oleg A. Nagibin

Ryazan State Medical University

Email: vestnik@rzgmu.ru
ORCID iD: 0000-0002-2522-2369
SPIN-code: 2124-7580

Russian Federation, Ryazan

MD, PhD, Associate Professor of the Department of Public Health and Health with the Course of Health Organization of the Faculty of Professional Additional Education

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Copyright (c) 2019 Davydov A.Y., Artemieva G.B., Nagibin O.A.

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