Development of competency model for family physicians against the background of 'internet plus healthcare' in China: a mixed methods study.

BACKGROUND: Identification of the service competences of family physicians is central to ensuring high-quality primary care and improving patient outcomes. However, little is known about how to assess the family physicians' service competences in primary care settings. It is necessary to develop and validate a general model of core competences of the family physician under the stage of construction of family doctor system and implementation of 'Internet Plus Healthcare' service model in China. METHODS: The literature review, behavioural event interviews, expert consultation and questionnaire survey were performed. The scale's 35 questions were measured by response rate, highest score, lowest score, and average score for each. Delphi method was used to assess content validity, Cronbach's α to estimate reliability, and factor analysis to test structural validity. Respondents were randomly divided into two groups; data for one group were used for exploratory factor analysis (EFA) to explore possible model structure. Confirmatory factor analysis (CFA) was then performed. RESULTS: Effective response rate was 93.56%. Cronbach's α coefficient of the scale was 0.977. Factor analysis showed KMO of 0.988. Bartlett's test showed χ2 of 22 917.515 (df = 630), p < .001. Overall authority grade of expert consultation was 0.80, and Kendall's coefficient of concordance W was 0.194. By EFA, the five-factor model was retained after thorough consideration, and four items with factor loading less than 0.4 were proposed to obtain a five-dimension, 32-item scale. CFA was performed on the new structure, showing high goodness-of-fit test (NFI = 0.98, TLI = 0.91, SRMSR = 0.05, RMSEA = 0.04). Overall Cronbach's α coefficients of the scale and each sub-item were greater than 0.9. CONCLUSIONS: The scale has good reliability, validity, and credibility and can therefore serve as an effective tool for assessment of Chinese family physicians' service competences.

Career Calling as the Mediator and Moderator of Job Demands and Job Resources for Job Satisfaction in Health Workers: A Cross-Sectional Study.

Job satisfaction of health professionals is a key determinant of the quality of health services and even affects the development of the healthcare system. In this study, we sought to explore the mechanism by which job demands, job resources, and career calling affect the job satisfaction of health professionals. Our findings may provide insights for increasing their job satisfaction and improving the quality of health services. We conducted a questionnaire survey of 1,117 health workers in Hangzhou; t-test, Chi-squared analysis, hierarchical linear regression was used to analyze the state of job satisfaction of health personnel and the associated factors; path analysis with the Structural Equation Model was used to explore and verify the effects of job resources, demands, and career calling on job satisfaction, as well as their mechanism. Social support, performance feedback, working conditions, and career calling had significant positive effects on job satisfaction of health professionals, whereas work-family conflict and emotional requirements for work had significant negative effects. Path analysis indicated that job resources, demands, and career calling directly affected job satisfaction; job resources and demands showed indirect effects on job satisfaction with career calling as a mediator. Career calling had a positive moderating effect in the path of "job resources-job satisfaction," and a negative moderating effect in the path of "job demands-job satisfaction." In conclusion, hospital administrators should provide more job resources for health workers and formulate reasonable job demands while paying close attention to work-related pressure. Hospital administrators and health departments need to improve hospital policies and inculcate a sense of belonging and career calling among health professionals. Education and evaluation of career calling need to be accorded more attention so that healthcare workers can perceive a stronger sense of calling and achievement, and hence a higher degree of job satisfaction.

Impact of a Chaxu Atmosphere on Nurses' Organizational Responsibility behavior-The Mediating Roles of Envy and Silence.

BACKGROUND: Chaxu atmosphere refers to the degree of differences, like the ripple effects in water, of the association between group members and the leader of the group resource. Unlike Western culture, China's nurses have been working in Chaxu atmosphere, which may boost their negative emotion and influence their workplace behavior. PURPOSE: This study aimed to clarify the chain-mediating role of envy and silence in the association between Chaxu atmosphere and organizational responsibility behavior. METHODS: A cross-sectional online survey was conducted, and a multistage stratified sampling method was employed to collect data. The study was conducted from September to October 2020 in China. Totally, 1740 nurses were recruited, and 1221 valid responses were collected. Socio-demographic factors, Chaxu atmosphere, employee envy, employee silence, and organizational responsibility behavior were assessed using questionnaires that included the Chaxu Atmosphere Scale, Employee Envy Scale, Employee Silence Scale, and Organizational Responsibility Behavior Scale. Hierarchical multiple regression was used to identify clusters of interrelationships among Chaxu atmosphere, envy, silence, and organizational responsibility behavior in nursing settings. RESULTS: Though the Chaxu atmosphere did not directly influence the organizational responsibility behavior of Chinese nurses, its effect is mediated by a chain of envy and silence. First, Chaxu atmosphere evoked envy in the nurses (ß=-0.040, P<0.001), thereby leading to decreased organizational responsibility behavior. Second, the Chaxu atmosphere promoted silence toward organizational issues (ß=-0.057, P<0.001), resulting in decreased organizational responsibility behavior. Third, the Chaxu atmosphere evoked envy in the nurses, which contributed to the formation of silence (ß=-0.025, P<0.001), resulting in a further decrease in organizational responsibility behavior. CONCLUSION: Nurses working in a high-level Chaxu atmosphere are prone to remaining silent on critical organizational issues due to increased envy, which subsequently reduces their organizational responsibility behavior. A better understanding of the association between the Chaxu atmosphere and workplace behavior will help nursing managers to foster harmonious relationships between nurses and their teams and to improve each individual's organizational responsibility behavior.

Contribution of Character Strengths to Psychology Stress, Sleep Quality, and Subjective Health Status in a Sample of Chinese Nurses.

Objectives: The main objectives of this study were to describe the current state of character strengths (CSs) of nurses; explain how they affect stress, sleep quality, and subjective health status; and reveal the mediating role of stress for the subject matter on the association between CSs, sleep quality, and subjective health status. Methods: A cross-sectional online survey was conducted from September to October 2020 in China. A multistage stratified sampling method was used, and 1,221 valid questionnaires across 100 cities in 31 provinces were collected. Results: For the participants in this survey, the three dimensions of CSs ranging from high to low were caring (4.20 ± 0.640), self-control (3.53 ± 0.763), and inquisitiveness (3.37 ± 0.787). There was difference in CSs scores across age (F = 8.171, P < 0.01), professional categories (F = 5.545, P < 0.01), and job tenure (F = 9.470, P < 0.01). The results showed that CSs significantly affected the psychological stress (ß = -0.365, P< 0.01), sleep quality (ß = 0.312, P< 0.01), and subjective health (ß = 0.398, P< 0.01) of nurses. Moreover, psychological stress partially mediated the association between CSs and both types of health outcomes. Conclusion: In China, the CSs of nurses are at high levels. We find that nurses with high-level CSs are likely to experience less psychological stress and exhibit healthy psycho-physiological responses, which contribute to positive health outcomes. Finally, our study argues that strength-based interventions of positive psychology in hospitals should be provided to minimize threats to the physical and psychological health of health professionals, which is a beneficial choice for future hospital reforms in the domain of occupational health management.

Provider payment to primary care physicians in China: background, challenges, and a reform framework.

Aim: To provide a framework for provider payment reform for primary care physicians in China. Background: Primary health care is central to health system reform and payment incentives have significant consequences for the equity and efficiency of it. Methods: This paper describes the special payments system for public primary health institutions and the subsequent internal salary remuneration to primary care physicians in China. Based on an analysis of the major challenges, we suggest a reform framework including the pattern of governance, and payments to primary health institutions and employed physicians. Findings: A mixed system of input-based and output-based payments to institutions would probably be appropriate under a long-term and relational contract with the government. It was also advised that internal remuneration is provided by a basic salary plus a bonus based on performance, and an extra-regional allowance. We hope that the results can be used to shift the passive budgeting of in-house staff within the public primary health institutions toward strategic purchasing.