绩效管理对基层卫生人员工作绩效的影响机制研究——工作动机的中介作用

Research on influence mechanism of performance management on the work performance of primary health workers:the mediation role of work motivation

目的:分析基层医疗卫生机构绩效管理制度运行现状,探究绩效管理对基层卫生人员工作绩效的影响及其作用机制。方法:采用多阶段整群抽样,对山东省青岛、东营与枣庄三市18家社区卫生服务中心和20家乡镇卫生院的基层卫生人员进行问卷调查和个人深入访谈,共计回收有效问卷870份,访谈175人。结果:绩效管理各维度(考核规范性、考核意义感、反馈及时性、分配公平性)中,有三个维度给予正面评价的人员比例未过半数,对四个维度给予负面评价的人员比例均在10%~20%之间,其中分配公平性的得分相对最低。绩效管理对任务绩效无显著影响,对关系绩效与学习绩效有显著弱影响。卫生人员工作动机的主导类型为控制性动机,工作动机在绩效管理要素和工作绩效之间起完全中介作用,且自主性动机对关系绩效和学习绩效的影响强于控制性动机。结论:当前基层医疗卫生机构绩效管理存在指标设置不合理、考核过程形式化、考核结果反馈不及时等问题,激励作用有限,对基层卫生人员工作绩效影响较弱。为此,应通过制定合理的考核指标、加强针对考核结果的沟通与反馈、发挥绩效工资的激励作用、培育发展性的绩效管理文化等举措完善基层医疗卫生机构绩效管理,提高基层卫生人员工作动机与绩效。

Objective:Analyze the current situation of performance management system in primary health institutions,and investigate the impact and influence mechanism of performance management on the performance of primary health workers.Methods:Multi-stage cluster sampling was used to conduct questionnaires and in-depth interviews with the primary health workers in 18 community health service centers and 20 township hospitals in Qingdao,Dongying and Zaozhuang of Shandong Province,with a total of 870 valid questionnaires and 175 interviews.Results:In the four dimensions of performance management including formalization,significance,feedback and justice,three dimensions does not get more than half positive evaluation,and the negative evaluation in all four dimensions are between 10%and 20%,and the score of justice is relatively lowest.The performance management has non-significant effect on task performance and significant weak effect on contextual performance and learning performance.The dominant type of primary health work’s motivation is controlled motivation.Work motivation plays a fully mediation role between performance management and work performance,and the effect of autonomous motivation on contextual performance and learning performance is stronger than that of controlled motivation.Conclusions:The current performance management of primary health institutions has many problems such as unreasonable indicator settings,informal assessment process and slow feedback of evaluation results,which leads to limited incentive effect on health workers’work performance.Therefore,some measures should be taken to improve primary performance management and promote work motivation and performance of primary health workers by setting reasonable appraisal index,strengthening communication and feedback of evaluation results,promoting the incentive effect of performance pay and cultivating the growth performance management culture.