Healthcare system has three levels in urban area in China. The top level includes large-scale tertiary hospitals; the middle level includes medium-scale secondary hospitals; and the basic and primary level includes community health services (CHS) institutions providing primary healthcare services. CHS institutions are small-scale medical institutions located in urban communities in China, usually providing out-patient diagnosis and treatment, and in-patient care and treatment of common disease and chornic disease for community resident. For China and many other countries in the world, CHS system is an important part of healthcare system.
Many countries have developed an efficient CHS system, as evidenced by the involvement of stable and professional CHS workers and the provision of good healthcare services to community residents . The CHS, which is mainly concerned with general practice and community care , can help to optimize the allocation of health resources and offer convenient and humanistic medical services while helping control the high costs of medical treatment [3, 4]. Many countries provide satisfactory primary medical services to residents by producing well-trained community general practitioners and community nurses [5–7]. However, in China, the education and development mechanism of community general practitioners and nurses is not good enough .
Differences in local conditions create different structures and patterns of CHS system. Many countries have been prioritizing the developing CHS, and China is no exception. In 2006, the state council promulgated “Guidelines on the Development of City CHS [No. 10 (2006) of the State Council] and “Guidelines on Strengthening the Role of Urban Community Health Personnel” [No. 69 (2006) of the Ministry of Human Resources and Social Security]. The goals were to develop an improved urban CHS system for China, strengthen the role of community health human resources, and improve general practice and community care. In 2009, China began to implement another set of medical and health system reform that focused on developing CHS system as the foundation and center of health work in the future, presented applicable measures, and set the goal of cultivating, developing, and stabilizing CHS talent .
At present, urban CHS of China has attained much progress and development. As of April 2013, a total of 33,990 CHS institutions have been organized throughout the country . In the first quarter of 2013, CHS institutions have diagnosed a total of 194,470,000 people and achieved a hospital bed utilization rate of 58.8%, with an average length of stay of 9.7 days . However, the development of CHS human resources is limited, as well as the technical capability. The income and training opportunities of CHS workers are relatively less than those of medical workers in hospitals.
Chinese CHS provides basic diagnostic and treatment services for disease prevention, keeping fit, recuperating health, health education, family planning technical service, common diseases, frequently encountered diseases, and chronic diseases . However, according to the former studies on the residents, only less than 30% of the residents are willing to choose CHS as the preferred option for treatment. Many residents who had received services from CHS once are not very satisfied [12, 13], because they do not have enough confidence in CHS  and think that the technical capability of CHS is insufficient [15, 16].
According to the former studies, CHS workers have relatively low work passion, low work efficiency, low work satisfaction, high demission rate, are not well educated, and possess poor professional skills, among others [17, 18]. However, CHS workers are crucial for the excellent performance of the CHS . Their working situation is directly related to community medical care safety, service quality, worker-patient relationship, patient satisfaction, and management and operational aspects of CHS institutions .
For one’ s work, passion is “a psychological state with the characteristics of strong and positive encouraging emotion, internal driving force, and putting into meaningful work with whole attention ”, and is having freshness and initiatives in work, having enthusiasm for work and keeping in a good working condition. Work passion is playing an important role for medical workers. With work passion, CHS workers’ team will become more stable and more effective, ensuring the sustainable development of CHS system. While, if CHS workers are lack of work passion, they are more likely to develop several problems such as low work efficiency, more emotional exhaustion, more job burnout, and more turnover intention . All these problems will influence the quality of patients’ treatment and care. Thus, probing into the current factors that influence the work passion of CHS workers, promoting their work passion, and making them keep enthusiasm for work are significant.
The purpose of this study is to analyze and determine the main related factors that influence work passion of CHS workers by investigating CHS workers from five Chinese provinces. We aim to avoid work passion loss, arouse work passion, motivation and enthusiasm for work, promote work efficiency, and reduce job burnout and turnover intention, to provide high-quality medical services to community residents and meet the basic health service demands of community residents.