BACKGROUND The motivation of health workers is a key concern of policy makers, practitioners and researchers. Public Service Motivation (PSM), defined as the altruistic desire to serve the common interest, to serve others and to help patients and their families regardless of financial or external rewards, has been shown to be key to the performance of public servants. Yet, limited attention has been paid to this kind of motivation in health care settings in low- and middle-income countries. Little is known about PSM and its contextual specificity in the Moroccan health system. We set out to qualitatively explore the meaning of PSM and its expression among health workers in four public hospitals. METHODS We adopted a multiple embedded case study design to explore PSM in two well-performing and two poor-performing hospitals. We carried out 68 individual interviews, eight focus group discussions and 11 group discussions with different cadres (doctors, administrators and nurses). We carried out thematic analysis using NVivo 10. RESULTS Our analysis shows that public service motivation is a notion that seems natural to the health workers we interviewed. Daily interactions with patients catalysed health providers' affective motives (compassion and self- sacrifice), a central element of PSM. It also provided them with job satisfaction aligned with their intrinsic motivation. Managers and administrative personnel express other PSM components: attraction to public policy making and commitment to public values. A striking result is that health workers expressed strong religious beliefs about expected rewards from God when properly serving patients. CONCLUSION This study highlights the presence of PSM as a driver of motivation among health workers in four Moroccon hospitals, and the prominence of intrinsic motivation and compassion in the motivation of frontline health workers. Religious beliefs were found to shape the expression of PSM in Morocco.

中文翻译：

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公共服务动机在摩洛哥公立医院重要吗？多重嵌入式案例研究。


背景 卫生工作者的积极性是政策制定者、从业者和研究人员关注的一个主要问题。公共服务动机（PSM）被定义为服务共同利益、服务他人以及帮助患者及其家人的利他愿望，无论经济或外部奖励如何，已被证明是公务员绩效的关键。然而，对低收入和中等收入国家医疗保健机构中的这种动机的关注有限。人们对 PSM 及其在摩洛哥卫生系统中的具体情况知之甚少。我们着手定性探讨 PSM 的含义及其在四家公立医院卫生工作者中的表达。方法 我们采用多嵌入案例研究设计，在两家绩效良好和两家绩效较差的医院中探索 PSM。我们与不同干部（医生、管理人员和护士）进行了 68 次个人访谈、8 次焦点小组讨论和 11 次小组讨论。我们使用 NVivo 10 进行了主题分析。 结果 我们的分析表明，公共服务动机对于我们采访的卫生工作者来说似乎是一个很自然的概念。与患者的日常互动促进了医疗服务提供者的情感动机（同情心和自我牺牲），这是 PSM 的核心要素。它还为他们提供了与其内在动机相一致的工作满意度。经理和行政人员表达了 PSM 的其他组成部分：对公共政策制定的吸引力和对公共价值观的承诺。一个引人注目的结果是，卫生工作者表达了强烈的宗教信仰，认为在为患者提供适当的服务时，上帝会给予他们期望的回报。 结论 本研究强调了 PSM 作为摩洛哥四家医院卫生工作者积极性驱动因素的存在，以及内在动机和同情心在一线卫生工作者的激励中的突出作用。人们发现，宗教信仰塑造了摩洛哥 PSM 的表达方式。