Assessment of health professionals’ working preferences using Discrete Choice Experiments (DCEs): A pilot study in Cluj County, Romania (ASCEND)


Context and rationale of the study

Romania is currently facing multiple challenges in managing its health workforce, which is directly impacting the quality and effectiveness of the care provided for patients suffering from both communicable and non-communicable diseases. According to official Governmental documents, significant disparities exist between health professionals’ distribution among different specialties, between acute and chronic conditions, as well as with regards to their geographic distribution (differences between urban and rural areas, and across different regions in the country).

Especially since 2007, the main challenge has been health professionals’ mobility. Although there are no exact figures about the number of health professionals leaving the country, almost all the stakeholders in the system are concerned with the decrease in number of health professionals needed to stay and practice in the country. Moreover, no data is available regarding the factors which influence physicians’ and nurses’ decisions to work abroad.

The rationale behind this project is that a better understanding of the factors responsible for

health professionals’ working preferences will contribute significantly to the design of effective recruitment, training and retention strategies for the health workforce in Romania. By effectively recruiting, training and retaining health professionals in the country, conditions are created for the delivery of quality healthcare for Romanian patients with non-communicable diseases.

Aims of the study

Health professionals’ (nurses’ and physicians’) working preferences are influenced by a complex array of factors, both pecuniary and non-pecuniary. The hypothesis we are testing is that these factors differ according to each professional’s category (nurse, physician), as well as to their specialty and seniority level.

The long-term goal of this project is to help inform policies in Romania dealing with the planning of health workforce treating patients with chronic diseases.

The objectives of the present study are as follows:

O1. To assess Romanian physicians’ and nurses’ preferences for different working conditions.

O2. To identify the factors underlying Romanian physicians’ and nurses’ decision to work in a specific environment.

Study design and population

The study has a cross-sectional design, with mixed-method approach, involving Discrete Choice Experiments (DCEs) as a quantitative method and in-depth interviews for the qualitative component. The DCEs have been designed based on several attributes which have been identified as relevant in health professionals’ working preferences. Given the particularities of the Romanian healthcare system, in-depth interviews have been used to identify the attributes to be included in the DCE scenarios. This qualitative research phase was important in informing the design of the DCEs, as highlighted in the literature reviewed.

Nurses and physicians from two hospitals in Cluj county (Turda Hospital and Huedin Hospital) were included in our study. The participants were requested to choose from different options of possible workplaces, which share the same attributes, but have different attribute levels.

Expected results and potential impact

The results of our study will help to better inform policy makers when drafting the actions to be taken in order to manage the Romanian health workforce. Specifically, we aim to provide valuable insight into what motivates health professionals, what they value about their present or desired workplace and what would be attractive for them in the Romanian healthcare system.

On the long run, we envisage that our results will be used by those stakeholders responsible with health workforce planning and forecasting (such as local, regional and national policymakers). Eventually, it will be reflected in the timeliness and quality of healthcare provided to Romanian patients.

Dissemination of the project and its results at European level

The methodology of the study, as well as its preliminary results have been presented during the Joint Action Health Workforce Planning and Forecasting Conference on improving planning methodologies & data across Europe in Rome, 4th and 5th of December 2014. The presentation is available at this link.

Research team

Marius Ionut Ungureanu MD PhD(c) 
Research interests: Healthcare management, leadership in healthcare, hospital administration, health services delivery, health services organization, health services financing, informal payments, dental care delivery, quality management in healthcare, health workforce management, health workforce mobility, discrete choice experiments in health workforce management. 
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Mara Paula Timofe PhD(c)
Research interests:research on injury and violence prevention, health policies and different health management aspects, both at a national and international level
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rmc2 Razvan M. Chereches MD PhD
Executive Director
Interests: guerrilla public health, global health capacity building, health systems assessment & reform


Elena Bozdog PhD(c)
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alexandra Alexandra Bocoș
Research interests: Hospital administration, healthcare management and economics, health workforce management, health informatics, quality management in dental care delivery.
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The partners who contributed to this project are the Municipal Hospital Turda and the City Hospital Huedin.

Funding Unit

Research reported by this project was supported by the National Institute of Environmental Health Sciences (NIEHS) and the Fogarty International Center of the National Institutes of Health under Award Number D43TW008308. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Total budget: $7,950

Period of time: 2013-2014