Factors Influencing Retention, Job Satisfaction, and Motivation among Jordanian Health Workers

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Program/Project Purpose: Recent epidemics in Africa and
natural disasters across the world have shown the challenging aspects
of handling additional burdens on health care facilities in a resource-
constrained environment. There is a need for technology innovation
to address global health infrastructure limitations. The implementa-
tion of a mobile facility engineered with a smart monitoring system
allows for rapid augmentation of medical resources to meet
increased medical needs in these settings.
Structure/Method/Design: In conjunction with custom-devel-
oped patient tracking software and a video interfacing system, we
conducted a proof of concept study validating a smart monitoring
system in the emergency smart pod in Houston, Texas. The system
also incorporated wireless, multiparametric patient sensors that
allowed continuous vital sign monitoring and transmission con-
nected to the wireless patient monitoring system. The patient cohort
participated in three different scenarios (emergency response, critical
care, and triage) and were monitored for different time spans
according to their needs. Incremental data analytic assessment was
used to provide onsite staff with enhanced clinical educational
support and ensure efficient use of the wireless smart pod system.
Outcome & Evaluation: During the 3-week study period, all
eligible subjects (n¼20) admitted to the emergency smart pod were
enrolled in the study, generating a total of 21.7 hours (1.08 hours/
patient) of periodic vital sign data (including heart rate, blood pres-
sure, and respiratory rate), heart rate variability monitoring, and heart
waveform analysis. Remote communication with off-site physicians
allowed for expanded care and real-time feedback. All patients toler-
ated the sensor monitoring without problems, with manually deter-
mined and automated vital signs well correlated with one another.
This study showed that a smart monitoring system in a mobile facility
is instrumental in addressing patient needs in a range of emergency
crisis and disaster situations. Feedback was provided to collaborators
to support smart monitoring system improvement.
Going Forward: Additional validation phases will incorporate
modeling of interactions of multiple mobile facility units and field
testing in a health care resource-constrained location to be determined.
Source of Funding: Paul G. Allen Family Foundation USAID
Ebola Grand Challenge.
Abstract #: 1.075_HHR
An Assessment Toolkit for Measuring Outcomes in Nursing
Study Abroad Programs
S. Kirby; University of Utah, Salt Lake City, UT, USA
Background: International experiences and study abroad have
become a common type of experiental learning in higher education,
including nursing.However, a lack of outcomes measures in nursing
study abroad programs, particularly from validated and reliable tools,
has been identified in the literature. This poster is the result of
a Doctor of Nursing Practice project to develop a toolkit that may
be used to measure outcomes in nursing study abroad.
Methods: Outcomes from nursing study abroad programs were
identified in the literature. Validated, reliable tools to measure these
outcomes were identified through further search, and through an
online survey sent to study abroad directors at randomly selected
colleges of nursing that have membership in CUGH.
Findings: Tools were identified for many of the identified
outcomes. Those that are available for use along with cost, means
of obtaining permission, and psychometric data were incorporated
into a toolkit for use by nursing study abroad directors.
Interpretation: Validated and reliable tools are available for many
of the identified outcomes in nursing study abroad. These may be
utilized to meet the identified need for outcomes measures in
nursing study abroad programs.
Source of Funding: None.
Abstract #: 1.076_HHR
Factors Influencing Retention, Job Satisfaction, and
Motivation among Jordanian Health Workers
M. Dieleman
1
,E. Kleinau
2
;
1
HRH2030/KIT, Washington, District of
Columbia, USA,
2
HRH2030, Washington, USA
Program/Project Purpose: In Jordan, about 3.78 million people,
including refugees and marginalized populations, living in remote
areas rely on Ministry of Health (MoH) services. The MoH’s
2013-2017 strategic plan lists retention of staff and attracting new
talent into the public health system as two of its biggest challenges.
USAID’s HRH2030 program performed a national level research
study to identify factors influencing retention, job satisfaction, and
motivation among doctors, nurses, and midwives within MoH
health facilities and to provide evidenced-based recommendations
to support the MoH in formulating policies to improve staff reten-
tion and recruitment.
Structure/Method/Design: HRH2030 used an exploratory,
mixed methods design combining both quantitative (questionnaires
and a validated tool) and qualitative (semi-structured interviews and
focus group discussions) data collection techniques. The study
approached 1,565 health workers in 67 primary health centers, 31
comprehensive health centers, and five hospitals across the four
governorates of Irbid, Ma’an, Zarqa, and Amman.
Quantitative data analysis: Responses to individual questions
were described and analyzed using frequency distributions, mean,
and median scores. Multivariate regression analysis was performed
to test the association and contribution of different factors to moti-
vation and satisfaction. Data were disaggregated by cadre, facility
type, governorate, and gender.
Qualitative data analysis: Responses were analyzed per group of
respondents and by research question, using a framework approach
based on the research questions and leading issues in the topic
guides. We added new items emerging from the interviews and
focus group discussions. Answers between and within groups were
compared and contrasted, paying particular attention to differences
between cadres and genders.
Outcome & Evaluation: The study found that the top satisfaction
factors were patient appreciation, interpersonal relations with
colleagues and manager, and working arrangements. The most
frequently dissatisfying element was insufficient financial incentives,
Annals of Global Health, VOL. 83, NO. 1, 2017 Health Systems and Human Resources
JanuaryeFebruary 2017: 18–58
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followed by lack of adequate supplies, infrastructure, and continuing
educational/professional development opportunities, excessive work-
load, disjointed human resource management practices, and aggres-
sion in the workplace.
Going Forward: HRH2030 will disseminate the results of the
research with key stakeholders and provide technical assistance to
the MoH in developing evidenced-based policies and procedures
for improving worker motivation and retention.
Source of Funding: USAID.
Abstract #: 1.077_HHR
Filling the Gap for Healthcare Professionals Leadership
Training in Africa: The Afya Bora Consortium Fellowship
D. Krakowiak
1
, Y. Mashalla
2
,G.O’Malley
3
, E. Seloilwe
2
, G. Ekane
4
,
S. Atanga
4
, O. Gachuno
5
, T.M. Odero
5
, D. Urassa
6
, E. Tarimo
6
,
D. Nakanjako
7
, N. Sewankambo
7
, Y. Manabe
8
, K. ousman
9
,
S. Chapman
10
, R. Dicker
10
, R. Polomano
11
, D. Wiebe
11
, J. Voss
12
,
K.N. Hosey
3
, J.N. Wasserheit
3
, C. Farquhar
3
;
1
University of Wash-
ington, Seattle, USA,
2
University of Botswana, Gaborone, Botswana,
3
University of Washington, Seattle, WA, USA,
4
University of Buea,
Buea, Cameroon,
5
University of Nairobi, Nairobi, Kenya,
6
Muhimbili
University of Health and Allied Sciences, Dar es Salaam, Tanzania,
7
Makerere University, Kampala, Uganda,
8
Johns Hopkins University,
Baltimore, USA,
9
African Health Resource Group, Baltimore, USA,
10
University of California, San Francisco, San Francisco, USA,
11
University of Pennsylvania, Philadelphia, USA,
12
Case Western
University, Cleveland, USA
Program/Project Purpose: The Afya Bora Consortium is a part-
nership of five African and four U.S. universities with the mission of
providing future global health leaders with advanced skills that are
beyond the traditional patient-centered training programs for
healthcare professionals. Each year, an interdisciplinary group of
twenty physicians, nurses and public health professionals participate
in a 12-month African-based intensive fellowship to improve skills
in leadership, resource management, program monitoring and eval-
uation, implementation, and applied research.
Structure/Method/Design: The Afya Bora Fellowship provides
leadership training in the form of eight in-person and four online
modules as well as two 4.5-month mentored attachments at govern-
mental and non-governmental organizations inBotswana, Cameroon,
Kenya, Tanzania, and Uganda. The fellows come together during three,
month-long highly interactive sessions held in different African coun-
tries during which interdisciplinary and multinational learning is
encouraged. Afya Bora Fellows complete evaluations of the modules
and program as well as self-assessments of learning throughout the
year. Data presented here are from all cohorts since 2011using qualita-
tive analysis of personal reflection reports.
Outcome & Evaluation: Fellows described multiple training gaps
the fellowship helped fill. Fellows reported that increased skills in
communication would help them to better motivate and align others
to address pressing problems in their healthcare systems. Improved
understanding of and capacity to use data for programmatic
purposes was also identified as essential to their ongoing leadership.
Fellows reported that their organizational and management abilities
had improved both from didactic learning and modeling of program
faculty and staff. Finally, fellows reported that the rich cohort expe-
rience provided them with an added appreciation of the advantages
of interdisciplinarity when solving problems.
Going Forward: Well-structured and targeted leadership training is
necessary to fill the gaps in traditional medical and nursing education
programs. Such training can catalyze healthcare professionals to
become more effective in leadership and improve the healthcare
systems in their countries while not contributing to “brain drain”
(all fellows thus far have remained in their respective countries).
The Afya Bora Fellowship can serve as a model for training and
research institutions as well as organizations in resource-limited
settings to sustainably strengthen human resource capacity to lead
and improve health systems.
Source of Funding: PEPFAR, Office of AIDS Research, HRSA
Grant #U91HA06801.
Abstract #: 1.078_HHR
Success and Challenges of Implementing a Tablet-Based
Trauma Registry in Tanzania
A. Lalande
1
, R. Boniface
2
, D. Bracco
3
, D.L. Deckelbaum
4
, T. Razek
4
;
1
McGill University, Montreal, Quebec, Canada,
2
Muhimbili Ortho-
paedic Institute, Dar es Salaam, Tanzania,
3
McGill University Health
Center, Montreal, Canada,
4
McGill University Health Centre, Mon-
treal, QC, Canada
Background: Trauma is one of the leading causes of morbidity and
mortality worldwide, even more so in low- and middle-income
countries. Access to epidemiological data through trauma registries
has been one of the keys to the success of improvement in trauma
care. A partnership between local leadership in Tanzania and the
Centre for Global Surgery, founded by McGill-based surgeons,
was formed about 10 years ago, and a minimal trauma registry
was implemented. It has since then been expanded to a 6 sites across
Tanzania and data collection is ongoing more steadily for the last 3
years using a tablet-based registry.
Methods: iTrauma
TM
is a minimal trauma registry that contains
a total of 26 questions about demographics, mechanism of injury,
type of injury and outcome. Data is gathered on site on paper by local
data collectors and is entered by an archivist on a tablet. Reports are
generated with minimal user involvement. Over the last year, a quality
assessment of the database was conducted using retrospective data.
The database, the collection process and the use of data were evalu-
ated to determine the robustness of the registry.
Findings: Over the course of the last 3 years, over 40 000 patients
have been entered in the database through the 6 sites. Each patient
file entered is on average 93.1% complete (number of questions
answered), which is significantly more than what was collected in
local hospital records (42.1%). The iTrauma
TM
catch rate compared
to local hospital logbooks was estimated on average to be 317% (range
111-797%). iTrauma
TM
data was overall concordant with hospital
records (not all data currently available, full analysis pending).
Interpretation: The implementation of a minimal trauma registry
in a low-income country in collaboration with local leadership is
feasible. A significantly larger amount of information about more
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