# The combined effect of perception of pay fairness and institutional transparency on physicians’ work enthusiasm: a mixed method study from China

## TL;DR

This study examines how pay fairness and institutional transparency affect Chinese physicians' work enthusiasm, finding that transparency enhances the positive impact of fair pay.

## Contribution

The study introduces a novel mixed-methods approach to analyze the combined effect of pay fairness and institutional transparency on physician motivation in China.

## Key findings

- Perception of pay fairness significantly and positively impacts work enthusiasm (β = 0.454, p < 0.001).
- Institutional transparency strengthens the relationship between pay fairness and work enthusiasm (β = 0.229, p = 0.003).
- Most physicians accept salary gaps with time allocation from 0.5 to 1.0 or less than ¥10,000.

## Abstract

Physician salary structures in Chinese public hospitals are crucial for motivating healthcare providers. Based on Expectancy Theory, this study aims to provide an evidence-based foundation for hospital managers in salary system design through investigating the combined effect of perceptions of pay fairness and institutional transparency on Chinese physicians’ work enthusiasm, with a focus on the moderating effect of institutional transparency.

A qualitative study was conducted from December 2023 to February 2024 to initially explore the relationships of perception of pay fairness, institutional transparency, and work enthusiasm. Subsequently, a quantitative study was conducted between April and May 2024 to examine the combined interaction of these factors. Physicians from Beijing, Haikou, Linyi, Nanjing, and Yinchuan were recruited to participate in the study.

The qualitative analyses showed that most physicians knew the determinants of salary but were not familiar with the details. The monthly salary gaps acceptable by most physicians featured time allocation ranging from 0.5 to 1.0, or less than ¥10,000 ($1,378). The structural results of the equation modeling showed that the perception of pay fairness had a significant and positive impact on work enthusiasm (β = 0.454, p < 0.001), and institutional transparency promoted the association between the perception of pay fairness and work enthusiasm (β = 0.229, p = 0.003).

Reasonable salary gaps and awareness of the scheme are required to improve physicians’ enthusiasm for their work.