Job morale of physicians and dentists in Kazakhstan: a qualitative study

Abstract

Background Job morale is thought to be particularly low in Kazakhstan, adversely affecting job motivation, job satisfaction and burnout rates. Previous research suggests that high job morale has a better effect on patient outcomes and care quality. We, therefore, conducted a qualitative study to explore experiences underpinning positive and negative job morale, and to generate potential strategies for improving job morale of physicians and dentists working in public healthcare settings in Kazakhstan prior to the COVID-19 pandemic. Methods Three focus groups containing 23 participants and 30 individual interviews were conducted, evidencing respondents' explanations of what affects job morale, and possible strategies to improve it. Data was synthesised using a thematic analysis. Results The themes about what influences job morale were: being unfairly rewarded for work; feeling vulnerable and undervalued; poor working styles and practices; and high internal value-based motivation. Various strategies were identified by participants to improve job morale, and these included: ensuring adequate and equitable financial income; improving the current malpractice system; eliminating poor working styles and practices; and creating a shared responsibility for health. Conclusions The current study has found that despite prevailing threats, job morale amongst physicians and dentists working in public healthcare settings in Astana have been prevented from becoming negative by their strong sense of calling to medicine and the satisfaction of helping patients recover. Emphasising this rather traditional understanding of the role of physicians and dentists may be a way to improve job morale throughout training and practice.

Job (dis-)satisfaction in pay-for-performance health care contexts: a meta-synthesis of qualitative literature

“…Since P4P alone is not sufficient to increase motivation, it is important to plan different types of incentives based on workers' attitudes and personalities in order to promote positive competition that limits pressure from peers and the organization. In this regard, institutions and organizations aim at ensuring fair and adequate pay based on commitment and performance, eliminating unfair, redundant, or time-consuming work practices and methodologies and creating shared responsibility for health (Sabitova et al, 2022). Indeed, worker satisfaction or dissatisfaction in a P4P system is also based on the empowerment of workers through discretionary space, autonomy, and a sense of control over their work, while ensuring distributive and procedural equity of treatment (Abhicharttibutra et al, 2022;Aghajani et al, 2021;Sabitova et al, 2022;Shams et al, 2023).…”

“…In this regard, institutions and organizations aim at ensuring fair and adequate pay based on commitment and performance, eliminating unfair, redundant, or time-consuming work practices and methodologies and creating shared responsibility for health (Sabitova et al, 2022). Indeed, worker satisfaction or dissatisfaction in a P4P system is also based on the empowerment of workers through discretionary space, autonomy, and a sense of control over their work, while ensuring distributive and procedural equity of treatment (Abhicharttibutra et al, 2022;Aghajani et al, 2021;Sabitova et al, 2022;Shams et al, 2023). An example of the importance of fair treatment at work in a P4P context is given below:…”

“…When the context, broadly understood, is supportive, the first finding is an increase in job satisfaction (e.g. Karimi et al, 2022;Maharani et al, 2022;Maisey et al, 2008;Sabitova et al, 2022). Job satisfaction is a significant indicator of the quality of health care (Maharani et al, 2022), and the excerpts from the reviewed literature suggest that workers in the health care sector experience greater job satisfaction when they work in a supportive environment.…”

“…I feel like I am making a difference, and it satisfies me. That is the most important thing (Sabitova et al, 2022(Sabitova et al, , p. 1513.…”

“…Closely related to job stress, respondents in the sample studies very often report feelings similar to burnout syndrome, as a condition of complete exhaustion of one's mental and physical energies that occurs especially in occupations that entail heavy emotional involvement, such as the health professions (Sabitova et al, 2022). Burnout is connected to work-related stress, which leads to the exhaustion of the individual's mental and physical resources and the manifestation of negative psychological symptoms (e.g.…”