Suchergebnisse

Objective:This study investigated Pakistani physicians' decision-making concerning their decisions to stay in Pakistan, migrate abroad, or resettle back into their country after working abroad. Methods:This qualitative study employed a phenomenological research design. Thirteen Pakistani physicians characterised as 'stayers', 'leavers' and 'resettlers' were interviewed via telephone to explore their lived experience in 2008-2009. Results:Results show a dynamic nature of the physicians' career decision-making depending on their constant weighing of complex personal, family, professional and societal factors. Stayers, leavers and resettlers are not mutually exclusive groups but rather individual physicians' can move between these groups at different stages of career and life. Physicians vary in their decision making. Stayers and resettlers place more emphasis on personal and family reasons and societal factors providing there is a permanent job for them. Leavers focus on health system problems and recent societal problems of personal and societal insecurity. Conclusions:The findings of this study indicates that physician migration, retention and resettlement is a complex issue and there are multiple personal, social, political and economic factors that affect their decisions to stay, move abroad or resettle back into their countries. Therefore, it is recommended that future research focusing on health workers retention, migration and resettlement issues look at it from a holistic perspective rather than focusing only on the economic and professional imperatives. The findings of this study have international implications for health care managers dealing with a highly mobile international medical workforce. Strategies considering different stages of the physician career/ life cycle need to highlight the importance of identity, belonging and place as doctors weigh this with career goals.

Kinley Dorji,1,2 Phudit Tejativaddhana,1,3 Taweesak Siripornpibul,1,4 Mary Cruickshank,1,5 David Briggs1,6 1College of Health Systems Management, Naresuan University, Phitsanulok, Thailand; 2Ministry of Health, Royal Government of Bhutan, Thimphu, Bhutan; 3ASEAN Institute for Health Development, Mahidol University, Nakhon Pathom, Thailand; 4Faculty of Science, Department of Mathematics, Naresuan University, Phitsanulok, Thailand; 5School of Nursing and Healthcare Professions, Federation University, Mpunt Helen, VIC, Australia; 6University of New England, Armidale, NSW, Australia Objective: This study aims to identify the required management competencies, current competency levels, and strategies for improving the management competencies of Bhutanese primary health care (PHC) managers.Methods: A quantitative method with a cross-sectional survey using self-administered questionnaires. This study recruited 339 PHC managers across Bhutan. The data were analyzed using statistical software.Results: This study identified three competency domains and seven key sub-domain competencies. People domain was perceived to be the highest required competency with a mean score of 4.2376, followed by execution (4.1851), and the transformation (4.0501) domains. For the seven key sub-domains, the communication sub-domain (4.3220) was perceived as the highest required competency, followed by professionalism (4.2967), managing change (4.1776), relationship building (4.1686), analytical thinking (4.1091), leadership (4.0980), and innovative thinking (3.9794). The current competency levels of PHC managers in domains and sub-domain competencies were the people domain (3.7322), execution (3.6471), and the transformation (3.5554). For the sub-domains, communication (3.8092), professionalism (3.7939), relationship building (3.6603), analytical thinking (3.6396), leadership (3.5805), managing change (3.5723), and innovative thinking (3.4543).Conclusion: Findings of Bhutan health managers' competencies are consistent with the findings of other international contexts. This study suggests that agencies responsible for health system need to focus more on the competencies defined by the study to positively influence health leadership and management development interventions. Keywords: Bhutanese primary health care managers, district health system, health reform, leadership and management competency

Objective: This study investigated Pakistani physicians' decision-making concerning their decisions to stay in Pakistan, migrate abroad, or resettle back into their country after working abroad. Methods: This qualitative study employed a phenomenological research design. Thirteen Pakistani physicians characterised as 'stayers', 'leavers' and 'resettlers' were interviewed via telephone to explore their lived experience in 2008-2009. Results: Results show a dynamic nature of the physicians' career decision-making depending on their constant weighing of complex personal, family, professional and societal factors. Stayers, leavers and resettlers are not mutually exclusive groups but rather individual physicians' can move between these groups at different stages of career and life. Physicians vary in their decision making. Stayers and resettlers place more emphasis on personal and family reasons and societal factors providing there is a permanent job for them. Leavers focus on health system problems and recent societal problems of personal and societal insecurity. Conclusions: The findings of this study indicates that physician migration, retention and resettlement is a complex issue and there are multiple personal, social, political and economic factors that affect their decisions to stay, move abroad or resettle back into their countries. Therefore, it is recommended that future research focusing on health workers retention, migration and resettlement issues look at it from a holistic perspective rather than focusing only on the economic and professional imperatives. The findings of this study have international implications for health care managers dealing with a highly mobile international medical workforce. Strategies considering different stages of the physician career/ life cycle need to highlight the importance of identity, belonging and place as doctors weigh this with career goals.