{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T06:07:53Z","timestamp":1788847673432,"version":"build-2803163510"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study developed a context-specific framework of perceived conditions related to lower turnover intention among high-level medical professionals in county-level hospitals and examined the configurational pattern associated with a high retention-oriented score.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A multicenter cross-sectional study combined three Delphi rounds, psychometric evaluation, and fuzzy-set qualitative comparative analysis (fsQCA). The Delphi process progressed from 33 items in round 1\u201337 in round 2 and 34 assessed in round 3, with 33 retained for the survey. From July 2024 to February 2025, online and paper questionnaires were distributed in 10 county-level public hospitals in Jiangsu Province. Of 635 questionnaires distributed, 611 were returned and 579 were valid. The sample was randomly split for exploratory factor analysis (EFA;\n                      <jats:italic>n<\/jats:italic>\n                      = 289) and confirmatory factor analysis (CFA;\n                      <jats:italic>n<\/jats:italic>\n                      = 290). fsQCA used the full sample, a frequency threshold of 10, consistency of 0.85, and proportional reduction in inconsistency (PRI) of 0.70.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty experts participated in Delphi round 1 and 29 in rounds 2 and 3 after one expert retired. The final 31 condition items showed high internal consistency (alpha = 0.971), suggesting both reliability and possible redundancy. Parallel analysis in the EFA half-sample suggested two factors, whereas a theory-constrained five-factor solution remained interpretable. In the CFA half-sample, the correlated five-factor model fit was marginal (Satorra-Bentler chi-square = 1350.48, df = 424, CFI = 0.903, TLI = 0.893, RMSEA = 0.087, 90% CI 0.082\u20130.092, SRMR = 0.042) and was similar to the second-order and bifactor models. No condition met the 0.90 necessity threshold. The corrected truth-table analysis identified one high-score configuration, PD\n                      <jats:sup>*<\/jats:sup>\n                      IES\n                      <jats:sup>*<\/jats:sup>\n                      CIS\n                      <jats:sup>*<\/jats:sup>\n                      OIE (consistency = 0.953; PRI = 0.917; coverage = 0.631). PD and CIS were core present conditions; IES and OIE were peripheral present conditions; IEPS was not included.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A single sufficient configuration combined favorable perceptions of personal development, institutional\/environmental support, compensation\/incentive support, and organizational\/interpersonal empowerment. The result does not support multiple substitutable pathways. Because the outcome was a retention-oriented score derived from a turnover-intention measure, the findings concern lower turnover intention rather than directly observed retention. The cross-sectional, individual-level results indicate associations and should not be interpreted causally or at the hospital level.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1917115","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T05:35:47Z","timestamp":1788845747000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Factors and a configurational pathway associated with lower turnover intention among high-level medical professionals in county-level hospitals in China: a multicenter cross-sectional study"],"prefix":"10.3389","volume":"14","author":[{"given":"Shuxin","family":"Dong","sequence":"first","affiliation":[{"name":"School of Health Economics and Management, Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuyuan","family":"Tai","sequence":"additional","affiliation":[{"name":"Personnel Section, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiming","family":"Yao","sequence":"additional","affiliation":[{"name":"School of Health Economics and Management, Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junlong","family":"Shen","sequence":"additional","affiliation":[{"name":"School of Health Economics and Management, Nanjing University of Chinese Medicine","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuemei","family":"Huang","sequence":"additional","affiliation":[{"name":"Personnel Section, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Southeast University","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2584","DOI":"10.1016\/S0140-6736(17)33109-4","article-title":"The primary healthcare system in China","volume":"390","author":"Li","year":"2017","journal-title":"Lancet."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1802","DOI":"10.1016\/S0140-6736(20)30122-7","article-title":"Quality of primary healthcare in China: challenges and recommendations","volume":"395","author":"Li","year":"2020","journal-title":"Lancet."},{"key":"B3","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1017\/S1744133123000257","article-title":"Strengthening primary healthcare in China: governance and policy challenges","volume":"19","author":"Qian","year":"2024","journal-title":"Health Econ Policy Law."},{"key":"B4","doi-asserted-by":"publisher","first-page":"l2349","DOI":"10.1136\/bmj.l2349","article-title":"What can we learn from China's health system reform?","volume":"365","author":"Meng","year":"2019","journal-title":"BMJ."},{"key":"B5","doi-asserted-by":"publisher","first-page":"449","DOI":"10.1186\/s12913-021-06472-7","article-title":"The hospital management practices in Chinese county hospitals and its association with quality of care, efficiency and finance","volume":"21","author":"Zhu","year":"2021","journal-title":"BMC Health Serv Res."},{"key":"B6","doi-asserted-by":"publisher","first-page":"474","DOI":"10.18502\/ijph.v48i3.891","article-title":"Have the pilot county hospitals' service capability been improved since the healthcare reform? 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