Aligning public health workforce motivation and health system governance

Abstract The sustainability of public health systems relies not only on technical and financial resources but also on the motivated commitment of healthcare professionals. In contexts marked by demographic pressures, burnout, and workforce shortages, it is paramount to understand if and how institutional policies acknowledge and address healthcare professionals’ motivation. In this study, we explore how the motivation, and underpinning personality traits, and values held by public healthcare professionals are perceived, recognised, or overlooked within institutional governance and health policy frameworks in Portugal. We adopt a qualitative research design combining semi-structured interviews with key decision-makers from two hospital centres and national policy influencers, with a discourse analysis of six strategic policy documents published between 2019 and 2024, including government programmes and national health plans. The findings reveal that while institutional discourse increasingly emphasises efficiency, innovation, and human resources planning, it consistently neglects the ethical and relational dimensions of healthcare work. Policy documents rarely reference values such as compassion, empathy, or public duty, portraying professionals primarily as instruments of system performance. In contrast, interviewees emphasise the need for a strong intrinsic motivation, ethical commitment, and frustration over the lack of symbolic and institutional recognition. Attuning political discourse and professional ethos of healthcare workers is essential for strengthening commitment, retention, and the quality of care within the National Health Service (SNS). These findings offer critical insights for the future development of more human-centred and ethically grounded health workforce policies and underscore the importance of aligning health system governance with intrinsic motivational drivers to enhance staff engagement, support sustainable human resource models, and promote integrated, high-performing health services.