gms | German Medical Science

Background: Many European countries experience workforce challenges due to demographic changes, increasing treatment complexity, multimorbidity and higher use of medical technology. The extent of health workforce skill-mix reforms varies across European countries, yet, there is limited cross-country research on the motivational factors, barriers and facilitators impacting on staff role changes in hospitals.

Question: The present study aims to analyse the following influencing factors impacting new roles:

1.

How motivated are physicians and nurses from different country groups to take up a new role?

2.

Which intrinsic and extrinsic motivators influences their decision undertaking a new role?

3.

What are the perceptions of physicians, nurses and healthcare managers on the barriers and facilitators to skill-mix and role change in hospitals?

4.

What are the major factors that lead to recruitment decisions among managers?

Methods: Cross sectional, observational study on staff role changes and contributing factors in nine European countries. Paper-based survey (in 2015 and 2016) among physicians, nurses and managers (N=1,781) in 112 hospitals treating patients with breast cancer or heart disease. Group differences across country groups (skill-mix reform vs. no or minor reform countries) and stratified by physicians, nurses and managers, were tested using Chi-squared, Mann-Whitney U and Kruskal Wallis tests.

Results: Nurses in England, Scotland and the Netherlands (countries with major skill-mix reforms) reported more frequently being motivated to undertake a new role (66.5%) and having the opportunity for a new role (52.4%), compared to nurses in countries with no or minor reforms (39.2%; 24.8%; p < .001 each) (Czech Republic, Italy, Norway, Poland and Turkey). Intrinsic motivating factors (personal satisfaction, use of qualifications) were considered more motivating than extrinsic factors (salary, career opportunities). Reported barriers were workforce shortages (min. 50% of physicians in countries with minor reforms, max. 74.4% of nurses in skill-mix reform countries), facilitators were professional and management support. The recruitment decisions of health care managers were led by skills and competences and experience of staff.

Discussion: Nurses from Germany reported less frequently being motivated for a new role and have less frequently the structural opportunities for undertaking a new role compared to countries in which major skill-mix reforms took place. Further research, preferably using RCT or pre-post designs, is necessary to analyse causal effects. Physicians and nurses from every country under study had in common that the use of their qualification was a strong motivator for undertaking a new role. Managers seek to employ staff with expertise and full use of qualifications. Prior studies have revealed that a skill-mismatch with over-skilling is inefficient and can lead to job dissatisfaction, therefore, the full use of qualification is required.

Practical implications: Managers need to know the motivational factors of their employees and in particular, the enabling versus hindering factors within their organisations to govern change effectively.