Background: Primary health care plays an important role in providing populations with access to health care. However, it is currently facing unprecedented workforce shortages and high turnover worldwide.
Objective: This study examined the relationship between organizational culture and turnover intention among primary care providers in China.
Methods: A cross-sectional survey was administered in four large cities in China, Tianjin, Jinan, Shanghai, and Shenzhen, comprising 38 community health centers and 399 primary care providers. Organizational culture was measured using the Competing Value Framework model, which is divided into four culture types: group, development, hierarchy, and rational culture. Turnover intention was measured using one item assessing participants' intention to leave their current position in the following year. We compared the turnover intention among different organizational culture types using a Chi-square test, while the hierarchical logistic regression was used to examine the relationship between organizational culture and turnover intention.
Results: The study found that 32% of primary care providers indicated an intention to leave. Primary care providers working in a hierarchical culture reported higher turnover intention (43.18%) compared with those in other cultures (p < 0.05). Hierarchical culture was a predictor of turnover intention (OR = 3.453, p < 0.001), whereas rational culture had a negative effect on turnover intention (OR = 0.319, p < 0.05).
Conclusions: Our findings inform organizational management strategies to retain a healthy workforce in primary health care.
Keywords: Turnover intention; organizational culture; organizational management; primary care providers; primary health care.
Main findings: This study found that primary care physicians and nurses working in a hierarchical culture are more likely to report the intention to leave compared to other culture types, while those working in a rational culture are significantly less likely to report the intention to leave.Added knowledge: The dominant organizational culture identified in community health centers across eastern China is group culture, and organizational culture is a significant predictor of the turnover intention of primary care providers.Global health impact for policy and action: Future primary care reform should focus on managerial interventions in their efforts to retain health workers and, in particular, develop and implement strategies to cultivate and moderate rational culture.