基层卫生人员心理契约和离职倾向对工作绩效影响机制及作用路径研究  

Study on the Influencing Mechanism and Action Path of Psychological Contract and Turnover Intention on the Work Performance of Primary Health Staffs

作　　者：郑珏 徐安婷 曹欣 詹祥[1,5,6] 缪清清 陈家应 胡丹[1,5,6] 李富 唐卫卫[1,5,6] Zheng Jue(School of Health Policy and Management,Nanjing Medical University,Nanjing,P.R.China)

机构地区：[1]南京医科大学医政学院,江苏南京211166 [2]复旦大学公共卫生学院 [3]南通大学公共卫生学院 [4]南通大学卫生健康发展研究院 [5]江苏省健康研究院 [6]南京医科大学全球健康中心 [7]南京医学会

出　　处：《中国卫生事业管理》2023年第9期703-709,共7页Chinese Health Service Management

基　　金：国家自然科学基金面上项目“基于分级诊疗制度目标的家庭医生队伍建设研究”(71874087);江苏省高校哲学与社会科学研究一般项目“严重精神障碍患者社区康复协同管理服务机制研究”(2019SJA0297);江苏省教育厅哲学社会科学重点研究基地项目“基于协同治理理论的严重精神障碍患者社区管理患者家庭就医意愿与阻力研究”(2019B05);健康江苏浦口创新研究中心“浦口区基层医疗卫生人才队伍建设”项目;江苏高校哲社社会科学优秀创新团队“公共健康政策与管理创新研究团队”资助。

摘　　要：目的:研究基层卫生人员心理契约、离职倾向对其工作绩效的影响机制,探析离职倾向在其中的中介作用,明晰三者之间的作用路径,为基层卫生人力队伍建设提供依据。方法:对南京市浦口区基层卫生人员进行问卷调查,收集相关社会人口学信息,测量心理契约、离职倾向和工作绩效水平,拟合多重线性回归模型分析影响机制,采用结构方程模型明确三者间的作用路径。结果:基层卫生人员的心理契约对其工作绩效存在正向促进作用(β=0.537,P<0.001),纳入中介变量离职倾向后发现,心理契约仍对工作绩效存在正向促进作用(β=0.242、P均<0.001),其直接效应的标准化路径系数为0.362;离职倾向总分对工作绩效有负向影响,即离职倾向越高,工作绩效越低(标准化路径系数β=-0.388,P<0.001)。结论:重视基层卫生人员内在诉求,在绩效考核公平性等其内在诉求方面加强建设;提升基层卫生人员薪酬福利待遇、提供事业发展机会和塑造良好的人际关系等工作环境氛围是降低离职倾向的重要抓手;要从系统和整体的思维出发,多措并举、系统解决好基层卫生事业发展所面临的突出问题,实现基层卫生高质量发展。Objective To study the influence mechanism of psychological contract and turnover intention of primary health workers on their work performance,explore the intermediary role of turnover intention,clarify the action path,and provide a basis for the construction of primary health manpower team.Methods A questionnaire survey was conducted among the primary health staffs in Pukou District of Nanjing to collect the relevant social demographic information,measure the psychological contract,turn-over intention and work performance level,and fit the multiple linear regression model to analyze the influencing mechanism.And the structural equation model was used to define the action path.Results Psychological contract had a positively promoting effect on job performance of primary health workers(β=0.537,P<0.001).When the mediating variables of turnover intention was includ-ed,it was found that psychological contract still had a positively promoting effect on job performance(β=0.242,P<0.001),and the standardized path coefficient of its direct effect was 0.362.The total score of turnover intention had a negative impact on job performance(standardized path coefficientβ=-0.388,P<0.001).Conclusion It is suggested to value the inner demands of grass-roots health workers,strengthen the construction of their inner demands such as the fairness of performance appraisal,im-prove the salary and welfare benefits of grass-roots health workers,provide career development opportunities,and building good interpersonal relationships,which is important ways to reduce the turnover tendency and achieve the high-quality development of grass-roots health.

关 键 词：基层卫生人员 工作绩效 心理契约 离职倾向 

分 类 号：R192[医药卫生—卫生事业管理]