The Impact of Organizational Justice on Turnover Intention Among Primary Healthcare Workers: The Mediating Role of Work Motivation

Abstract

Background: Adequate staffing of primary healthcare workers (PHCWs) is essential for strengthening healthcare systems, yet high turnover intention among these workers presents a significant challenge. While existing strategies primarily target economic incentives and career progression, this study proposes that enhancing organizational justice could offer a novel and impactful approach to retention. Drawing on equity theory and self-determination theory, the study examines how organizational justice influences turnover intention and the mediating roles of both the intensity and type of work motivation. Methods: This is a cross-sectional study design. A multi-stage cluster sampling method was utilized to administer a questionnaire survey to 1,200 PHCWs from 36 primary health institutions in Shandong Province, China. Results: Multivariate linear regression analysis revealed that organizational justice significantly reduces turnover intention among PHCWs (β = −0.435, p < 0.001). Among its three dimensions, distributive justice (β = −0.203, p < 0.001) and procedural justice (β = −0.177, p < 0.01) had significant impacts on turnover intention, whereas interactional justice did not. The study also confirmed the mediating role of work motivation, with work motivation type accounting for 18.2% of the total effect, exerting a greater influence than work motivation intensity, which accounted for 13.8% of the total effect. Conclusion: This study finds that organizational justice, especially distributive and procedural justice, reduces turnover intention among PHCWs in China. Work motivation mediates this effect, with motivation type having a stronger influence than motivation intensity. Enhancing organizational justice through transparent systems for compensation, promotion, and inclusive decision-making can foster the internalization of work motivation, providing a sustainable approach to improving retention and supporting the stability of the primary healthcare workforce.