Ineffective service levels at hospitals due to motivational issues Course: MBA - MN7121 Assessment 01 ESOFT Kandy Fundamentals of Management and leadership Kapila Hettiarachchi (MBBS, MD)

Introduction Ministry of health in Sri lanka is a non profit organization and provide health service to public free of charge Ministry of health of has more than 60,000 skilled workers including doctors, nurses, other allied health workers

introduction Each hospital is managed by a director with or without deputy director The consultants (managers) in the hospital are the clinical department heads Government spend millions to uplift and maintain health of the country Is there anything else to do ?

justification Skilled work force, specialist doctors, experienced doctors, experienced nurses and allied health personals leave the country annually Poor communication skills among workers Team effort, unity & integration of the unit is under achieved Absenteeism at work is high (Specially minor staff)

Literature review Motivation Work place motivation defined as “the willingness to exert different level of efforts towards achieving organisational goals and satisfying existing needs” (Franco, 2002)

Importance of Motivation (MSG, 2015) Puts human resources into action Improves level of efficiency of employees Leeds to achievement of organizational goals Builds friendly relationships Leeds to stability of work place

Hertzberg Two Factors Theory Hygiene Factors Motivators Company Policy & administration Achievement Supervision Recognition Interpersonal relations Growth Possibilities Salary Career advancement Job security Level of responsibilities Personal Life The job itself Working Conditions

Intrinsic & Extrinsic Motivation Intrinsic Motivation A persons internal desire to do something e.g. interest, challenge and personal satisfaction Extrinsic motivation Motivation that comes from outside the person e.g. pay, bonuses, and other tangible rewards (Gust, 1996)

Process theories This explain how workers select behaviours with which to meet their needs Expectancy theory Equity theory Goal- setting theory

Expectancy theory Focus on three relationships (Vroom, 1964; Lawler and Porter, 1967) Focus on three relationships Expectancy (effort - performance relationship) Instrumentality (performance – reward relationship) Valance (reward - personal goal relationship) Effort Performance Rewards Personal goal

Equity theory ( Adams, 1965 ) Concerns with the Issues of justice Rewards that those work effort produce Believe in they are treated inequitably

Goal- setting theory (Locke and Latham, 1990) Motivation as the intent of an employee to meet certain goals Goal setting may be used as an effective method for motivating employee

analysis Application to health workers Need for esteem (less trust of management, no suggestions listened to, poor complaint system, poor management relations, not a part of team, less contact with managers) Need for love belongings (less good relations with coworkers, less friendly atmosphere, management style is authoritative,) Will discuss comparison with our hospitals. We have a high job security but low pay. No bonus but has pension. Unions are stronger and demanding. Management style is authoritative and less good relationship with coworkers. Has a pride in service. Less trust in management. Poor complaint system. Need for institutional safety (Union membership, union representation) Need for safety (Low rate of pay, no bonus schemes)

analysis Demotivating factors Motivating factors Low income and allowance Difficult transportation No updated information Lack of knowledge Heavy workload without plan Inadequate acknowledgement Problems with management Poor /inadequate communication Inadequate support Increase workload Poor physical environment Poor self motivation Poor working condition Poor interpersonal relationships Poor supervision Opportunities for carrier progress Appreciation and support by the managers and colleagues Respect and appreciation for own work Opportunity for training

analysis Mainly intrinsic motivation plays a big role in developing countries. Specially for doctors and nurses e.g. interest, challenge and personal satisfaction

analysis 1. Application of expectancy theory Skilled health workers ( doctors, nurses) think their work is important for the outcome of the organisation So motivation of those workers should be done selectively 2. Application of equity theory Trade union actions are mostly demanding their share of equal rewards for the effort 3. Application of goal setting theory Doctors are motivated when they are given challenging goal

analysis Most of these theories comes from develop world and from industry and business Are they really applicable to developing countries ? Even without full filling the basic needs from their salaries workers are motivated to do a good job Why ? 1. Organisatinal, cultural and societal factors 2. Developed and developing countries are markedly different. External environment (economic, legal and socio-economic environment) Internal environment (culture of work, assumption about people behaviour at work)

recommendations Work itself (Autonomy at work, meaningful and challenging work) - Job design, job enrichment Relationship at work (recognition, appreciation by colleagues and supervisors) - Team work; self managing team Workplace conditions (availability of resources; working hours; workload) - Total quality management; quality circles Opportunities for personal development (opportunities for training, communication skill training) - Employee empowerment, career ladder Pay/ rewards (Level and mode of remuneration, pay differentials; non financial incentives)

References: Antunes AV, Sant Anna LR 1996, ‘Satisfaction and motivating in nursing’,Revista Brasileira de Enfermagem, vol. 49, no.3, pp. 425-34. Carmen D, Orvill A 2005, ‘Motivation of health care workers – review of theories and empirical evidence’, Cahiers de Sociologie et Demographie Medicale, vol. 45, no.1, pp.135-61. Dielman M, Cuong PV, Anh LV, Martineau T 2003, ‘Identifying factors for job motivation of rural health workers in North Viet Nam’, Human Resources for Health, vol.1, no.10 Fischer A, Muller M 2000, ‘perceptions of nursing service managers in the south African Military Health service on their level of motivation’, Curationis, vol.23, no.4, pp. 63-71. Franco LM, Bennett S, Kanfer R, Stubblebine P 2004, ‘Determinents and consequences of health worker motivation in hospitals in Jordan and Georgia’, Social science medicine, vol. 58, no. 2, pp. 343-355. Gust D. 1996. ‘Motivation and performance at work’, subject guide. Department of Organisational Psychology, Brikbeck Collage, University of London, 1st edition, 53p Health 2016, Government health manpower, viewed 14 April 2011, <http://www.health.gov.lk/en/notice/HRH%202015.pdf> Mischa Willis-Shattuck, Posy Bidwell, Steve Thomas, Laura Wyness, Duane Blaauw, Prudence Ditlopo, 2008. Motivation and retention of health workers in developing countries: a systematic review MSG 2015, Importance of Motivation. Viewed 25 April 2016, <http://managementstudyguide.com/importanceofmotivation.htm> smith LJ. ‘Evaluation of applicability of Maslow’s model of motivation in ancillary staff’. Working paper series, Facilities Management Graduate Centre, Shefield Hallam University, Sheffield, England, 2003.

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