Performansa Göre Ücretlendirme’nin Doktorlar Tarafından Algılanan Negatif Yönleri

Gelişen teknoloji, sosyal ve politik yapı, yasalar ve bireylerin beklentileri kısaca kamu kurumlarının içerisinde bulunduğu ve ilişkide olduğu tüm çevre her geçen gün hızlıbir biçimde değişmektedir. Kamu kurumlarının hizmet kalitesini arttırmak, çalışan memnuniyetini yükseltmek ve bireylerin beklentilerini karşılayabilmek amacıyla farklıyöntemler uygulanmaktadır. Bu yöntemlerden birisi olan performansa göre ücretlendirme diğer yöntemlere göre daha fazla önem kazanmaktadır. Kamu kesiminde de son zamanlarda yoğun ilgi duyulan performansa göre ücretleme, Türkiye’de özellikle sağlık sektöründe yaygın olarak kullanılmaya başlanılmıştır. Bu sebeple etkin bir rekabet ortamıoluşturup, kaliteli hizmet sunumu ile müşteri memnuniyetini gerçekleştirmede büyük bir payıolan bu sistemin olumlu yönlerini görüp, üzerinde ayrıntılıbir biçimde durulmasıgerekmektedir. Performansa göre ücret uygulamasında birçok sorunla karşılaşılmaktadır. Sağlık politikasıbelirlemede PGÜ’nün öncelik kazanması, hasta aleyhine gelişmelere yol açabilmektedir. Bu sorunlar karşısında sisteme yöneltilen eleştiriler de artmaktadır. Bu eleştirilerden birisi, özellikle de bireysel performansa göre ücret sistemi başta olmak üzere, PGÜ sistemlerinin dayandığıteorik temellerin tümden geçersiz olduğu yönündedir. Dolayısıyla, bu görüşe göre, bu sistemlerin başarılıolmasımümkün görülmemektedir. Diğer yandan literatürde, sistemin kendisi değil, uygulama hatalarının olumsuzluklara yol açtığıgörüşü ağır basmaktadır. Buna göre uygulama sırasında yapılan hataların giderilmesi sistemin başarısıaçısından belirleyici olmaktadır. Bu araştırma KAHRAMANMARAŞDevlet Hastanesi, Kadın Doğum ve Çocuk Hastanesi’nde çalışan doktorların, performansa göre ücretlendirme uygulamalarının negatif yönlerini tespit etmek amacıyla yapılmıştır. Araştırmada veri toplama aracıolarak anket kullanılmıştır. Anketle toplanan sayısal verilerin çözümlenmesinde yüzde analizi, Oluşturulan hipotezleri test etmek amacıyla ANOVA analizi kullanılmıştır. Doktorların PGÜ sistemine ilişkin ankette yer alan önermelere verdikleri yanıtlara bağlıolarak oluşturulan katılımcıgruplarıarasında anlamlıfarklılıklar olup olmadığına ilişkin dört tane araştırma hipotezi kurgulanmışve araştırma için elde edilen veriler ile analiz edilmişlerdir. Araştırma hipotezlerinin tümünün yapılan incelemeler sonucunda doğrulandığıgörülmüştür. Doktorlar işyüklerine, PGÜ sistemini güvenilir bulmalarına, PGÜ sisteminden memnuniyet düzeylerine ve PGÜ sisteminin performans ve motivasyonlarınıne düzeyde etkilediğine ilişkin algılamalarına göre, PGÜ sistemini farklıölçülerde değerlendirmektedirler.

Developing technology, social and political structure, laws, expectations of individuals; shortly, all the circles periphery which the public bodies are in or in relation with have been changing rapidly day by day. To increase the service quality of public bodies’ and employee satisfaction, and to meet the individual expectations different methods are applied. Performance related pay, which is one of these, methods is gaining importance more than others. Waging according to the performance is gaining interest in the public sector and it is particularly started to be used commonly in health sector. For this reason, this system that has a very crucial part in improving customer satisfaction together with quality service offering should be considered meticulously and positive aspects of this regime should be seen. A lot of problems are faced in waging according to the performance application. Gaining priority of PRP in determining the health policy can cause problems against the patients. Because of these problems criticism about the system is increasing. One of these criticism is; theoretical principles which the PRP systems dependent on are totally invalid, especially individual PRP primarily. That’s why according to this view success of these systems is seen as impossible. On the other hand, in literature the view that suggests application mistakes cause drawbacks is overbearing. According to this point of view elimination of mistakes during the implementation is determinative in the success of the system. This research has been done to determine the negative aspects of PRP applications on doctors who are working in Kahramanmaraş State Hospital and Women Birth and Child hospital. Because of the fact that PRP applications are widely used in health sector, it has been found to be appropriate to collect the research data from this sector. Research results were obtained by questionnaire method which was applied to doctors who work in Kahramanmaraş State Hospital and Women Birth and Child hospital. Questionnaire was sent to all 138 doctors but 114 of these were used in the research. In the analysis of numerical data obtained from the questionnaire percentage analysis was used, and to test the constructed hypothesis ANOVA analysis was used. Prepared questionnaire form consists of two parts. In the first section, questions about participants’ demographic features and in the second section, suggestions related to PRP system are included. Questions in the second section were prepared in fivefold Likert style. After the calculation of frequency distribution of answers given to the suggestions, groups were constructed according to the answers of doctors about the satisfaction about performance related pay, affect to the performance and motivation, work load and finally reliability of the used system. H1: There are meaningful differences between the doctors’ satisfaction levels from PRP system and their viewpoints about PRP system’s negative sides. H2: There are meaningful differences between the doctors’ viewpoints about PRP system’s negative sides and this system’s influence level on doctors’ performances and motivations. H3: There are meaningful differences between the doctors’ viewpoints about PRP system’s negative sides and their workload levels. H4: There are meaningful differences between the doctors’ viewpoints about PRP system’s negative sides and on what level they find this PRP system reliable. ANOVA test has been used to test the research hypothesis. Doctors who took part in questionnaire study to determine the PRP system’s negative sides stated that; 29.2% of them are satisfied in general and totally satisfied 36.3% are less satisfied, and 14.2% are totally dissatisfied from the system. The participant doctors who think that PRP system affects their performance positively has got a percentage of 52.7%, in contrast to this participants who think that it affects negatively has a percentage of 21.8%. Besides this, participants who think that it causes no performance or motivation change have a percentage of 25.5%. 69.3% of the respondent doctors stated that the system does not assess their performance fairly, 29.8 of the respondents find the system partly fair. According to the results of the questionnaire applied it is understood that doctors do not believe that PRP system evaluates the workers’ performances fairly but they believe that this system affects the performance and motivation of the employees positively. According to the results of the analysis, it is observed that when the satisfaction level from the system decreases the arithmetic averages of the answers for the postulates are increasing. For that reason it is understood that when the satisfaction level from the system decreases employees start to question the system more, utter the weak points more and they strongly agree on the postulates which can be a solution. Another result acquired from the research is that, the participants among the groups orientated for doctors performance and motivation who states the positive results of the system is significantly low compared with other groups. Explanation of the PRP system’s contribution to performance and motivation of the doctors via seminars or information meetings will be helpful for the system’s effective operation. In the analysis for the doctors’ workload interesting findings are also reached. The doctor group which says that they work intensely strongly agrees with the postulates which are about the system’s negative sides. The group’s, which is considered as high performance by working intensively, higher expectations from the PRP system is a natural consequence compared with the less working doctor group. Similarly, the participant group who do not think that PRP system evaluates their performance fairly agreed on the postulates more strongly compared with the other group the group who thinks that PRP evaluates their performance partly fair . Doctors reported that, on the one hand PRP system provides benefits primarily from the transactions which are lucrative, on the other hand it transforms some very important examinations and therapy processes into unreturned drudgery. They also reported that in PRP system the doctors’ specialization educations are either played down or neglected, and this causes injustice and inequality among different specialist groups. In general they express that thanks to this system, hospitals will turn into businesses which aim more profits than service, and patients will turn into customers