Motivation and performance issues in the NHS


The National Health Service (NHS) in United Kingdom is a remarkable institution of a public service. It represents an experiment in social engineering, an attempt to provide free healthcare to the population of the UK across a comprehensive range of service. (Greener I, 2008) Because of being public service, there are a lot of problems arise from the customers (patients) towards services which the customers got from NHS. Effective workforce is a significant factor as it is organization primary players which drive the organization achieve the goals and delivery services. Human resources, therefore, plays the central role in the health sectors in improving the workforce performance and accessibility to services and quality of care. Motivation is a key obstacle to health sector development in term of staff performance. It is a challenge for Human Resource. In order to achieve health services targets, a Motivated and capable workforce is a key which help the health sectors increase the productivity and quality of health services. Motivation is defined as "an individual's degree of willingness to exert and maintain an effort towards organizational goals" (Franco LM. et al., 2002, 1255-56) In terms of theory, there are many different theories in motivation. (Franco LM. et al., 2002, 1255-56) Generally, people always get confused between two areas of motivation which are motivation to be in a job and motivation to perform, but both areas are very important for managers. They need to understand that all activities in the workplace can be impacted by both areas of motivation. Herzberg's two-factor theory of motivation at the workplace [Herzberg, 2003] is the theory which is used for this issue. It describes the differentiation between these two areas of motivation. In order to understand these differenced, the theory distinguishes satisfiers which are the main causes towards whether high or low performance in the workplace. From dissatisfies, if these are absented or perceived as inadequate, these will be the main causes for job dissatisfaction and de-motivate the workers to remain in a job. Empowerment, recognition, rewarding, responsibility and the work itself are examples of motivating factors. Dissatisfies are all about working conditions, salary, relationship with colleagues, administrative supervision, etc. [Herzberg, 2003]. Therefore, organization need to concentrate on performance management- using a vary of human resources management (HRM) tools such as: performance appraisals, rewarding, continuous education, and career development etc…[Martinez J. 2001) because performance management is an approach which can influence satisfies. However, in the public health sectors, performance management such as resource-poor settings is often underdeveloped because these sectors usually focusing only on supervision or other certain aspect of performance management. (Martinez J, Martineau T. 2001; Fort AL, Voltero L.2004; Trap B, et al., 2001)

2.Research objectives

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This objective of this research is to describe the important factors which lead to motivation and demotivation of the health service's nurses of Abingdon Mental Health Centre in Oxford and also investigate factors leading to motivation. Furthermore, it will demonstrate relationship between motivations with the performance management activities in terms of why the activities can motivate employees and what are those activities. Apparently, a survey for this research to be conducted to health service's nurses of Abingdon Mental Health Centre in Oxford aimed to determine their perception in terms of motivation towards the performance management activities. Furthermore, an interview will be also conducted to know what are the motivations and demotivations of the workers regarding to performance management activities. Finally this research comes up with relevant findings and provides understanding recommendations on performance management activities in relation to the motivation of the nurses in order to help them to perform better.

2.3Research Hypothesis

Research hypothesis is a tentative explanation or postulate by the researcher of what the researcher predicts for the outcomes of an investigation will be. (McBurney D.H. and White T.L , 2009) It, basically, states the researcher's expectation concerning the relationship between independent and dependent variables in the study. The research hypothesis of this study is as follows.

Hypothesis: There is significant relationship between motivation and performance management.

Hypothesis: The performance management activities can highly motivate or demotivate the nurses of Abingdon Mental Health Centre

2.4 Research questions

Generally, the purpose of this study is to conduct the study on the relationship between performance management activities and the motivation of health service's nurses. This study tries to answer the following queries :

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1. What extent the motivates and demotivates for health sector nurses?

2. How do the motivating factors relate to performance management activities?

3. Literature Review

3.1 Introduction to motivation

In the past, when the human resource management was not a big factor of an organization, employee was considered as just an input for the production of goods and services. Nevertheless, when the time has passed, the way of thinking about the employee was changed by researching, referred to the work of Elton Mayo from 1924 to 1932 which was the Hawthorne Studies (Dickson, 1973). These studies found that there was not only money which can motivate the employees and their attitudes are linked to their behavior (Dickson, 1973). The Hawthorne Studies showed the approach of the human relations to management, in which the motivation and needs of employees are important issues which become the primary focus of management team (Bedeian, 1993).

3.2 Motivation Defined

The concept of motivation was defined by many contemporary authors. Motivation has been defined as a willingness to behave in an appropriate manner in order to achieve specific, unmet needs (Buford, Bedeian, & Lindner, 1995) and "what causes people to behave as they do" (Denhardt et al., 2008, p. 146).

3.3 Motivation Theories

According to the Hawthorne Study results, understanding factors which motivated employees and how those employees were motivated was the interesting focus of many researchers. (Terprtra,1979) There are four major approaches that help us to understand the motivation are Maslow's need-hierarchy theory, Herzberg's two- factor theory, Vroom's expectancy theory and Skinner's reinforcement theory..

Maslow indicated that employees have five levels of needs (Maslow,1943): physiological, safety, social, ego, and self- actualizing. Maslow argued that before reaching the highest level need, the lower level needs had to be satisfied first. The motivation was categorized into two factors according to Herzberg's work, which are motivators and hygienes (Herzberg, Mausner, & Snyderman, 1959). Achievement and recognition are examples of the motivators or intrinsic factors which can produce job satisfaction. Whereas, pay and job security are the Hygiene or extrinsic factors which produce job dissatisfaction. Vroom's theory is basically about employees' effort. Vroom believed that employees' effort will lead to an effective performance and this performance will connect to rewards. (Vroom, 1964) Rewards can be either positive or negative which both will affect the employees' motivation. The employees will be highly motivated when they have got the more positive the rewards. In other hand, the employees will be less motivated when they have got the more negative the rewards. Skinner's theory is basically about the employees' behaviors. He states that for those employees' behaviors which lead to the effective performance, they will be repeated and in contrast, for any behaviors which lead to the poor performance, they will not be repeated. (Skinner, 1953) Therefore, managers should positively reinforce those employee behaviors which help the employees perform effectively and should negatively reinforce employee behavior that leads to the poor performance.

3.4 The Role of Motivation

There was a question which always arise about why an organization needs to motivate it employees. The answer to this question is survival. (Smith, 1994) In the workplace which is changing rapidly, motivated employees are needed in order to help the organization to survive because they are more productive. To get effective performance, understanding about what motivates employee is an important role for managers because motivating employees is arguably the most complex. This is due to constantly changes of what motivates employees. (Bowen & Radhakrishna, 1991). Therefore, effective management is amazing because it can inspire and enthuse employees reduce absence, create followers and produce effective results. (Mohammed A. 2007)

3.5 Performance Management

3.5.1 Performance management defined

Although, there are many definition of performance management, however for the more specific definition define performance management as a process which contributes to the effective management of individuals and teams and it is targeted at individual employees in order to improve and enhance the employees' performance and achieve high levels of organizational performance. (Armstrong M. and Baron A. 2004 ; Brown A.2005)

3.5.2 Theoretical framework

The concept of performance management is basically linked to the theory of motivation because it is theoretically under-pinned on the theory of motivation. In the concept of performance management includes (1) strategic such as long term goal, (2) integrated such as people management either individual or team, (3) performance improvement , (4) continuous development and (4) managing behaviors. Cannell M. (2010)

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Armstrong and Baron (2005) stress that when the best performance is set, it will be a tool which helps managers manage effectively such as if the managers know and understand an expectation of their employees and deliver on these expectations, it will motivate their employees produce high level of performance . This tool also ensures that the managers are aware that their behavior on subordinates can be impact to the performance.

Performance management is basically managed when a job is defined and it will be ended when an employee leaves the job. To be effectiveness of managing employees' performance the following must be considered for a working performance management system. (Heathfield S. 2009 ; Rao T.V, 2004)

Job description - This should be clear in order to help employees understand the expectations for the position because job descriptions provide a framework of the positions.

Education and training in order to produce effective performance, employees should get the necessary information such as job-related, position-related, and company-related information.

Compensation and recognition employees should be rewarded for their contributions. It is not only money. Compensation and recognition can be anything that proper for the employees' value, such as promotional or career development opportunities.

3.6 Employees' motivation in UK Health public service

In most public service, there are many issue arise according to services. Motivation is an important factor which help the employees deliver the best services to their patients. National Health Service (NHS) has tries to be the employer of choice for potential staff, (Moore A. 2009) therefore the performance management activities will be significant key point which helps employees perform better. "it is absolutely fine to ask if everything is ok inside and outside work" (Mohammed A. 2009 p.22) such as asking employees how they are and whether there is anything that mangers themselves can do for them in order to help them perform better because employee will appreciate if they are taken care well by their manager. There are some 60- 70 per cent of ex-employees cite their manager as the reason they left. (Mohammed A. 2007) As the motivation role, effective management is so crucial because it can produce effective result - in the case of health service, this means excellence patient care. (Mohammed A. 2007) Josie Irwin, head of employment relation at RCN state that employees usually expect more packages beyond pay and pension such as flexible working hour because it can balance employees' work and life. Moreover, other employees facilities are important, the facilities such as restaurants and car parking. These should be subsidized by the trust or provided free of change. (Moore A. 2009)

Sharon Scobell (2007), business manager at yell, states that keeping employees motivated must be high on the agenda because the commitment of the job and the quality of service can be impacted by the way employees are managed especially in the health service, the employee must be motivated to serve patients to the best of their ability because the health service is the place where the customers can be vulnerable and sensitive.

4. Research Methodology

In this part, the content includes the following topics : Methodological Approach, Population and sample, Research tools and Data collection .

4.1 Methodological Approach

1. Qualitative approach

A qualitative interpretive research approach will be adopted for this study. The qualitative approach is concerned with meaning, how it informs subjective understanding and it describes, either explicitly or implicitly (Hollway and Jefferson, 2000) The qualitative research does not have priority over other forms of researches, but it is a valuable way to gain access to social context such as traditional, culture or environment and it describes kinds of characteristic of people and events without comparing events in terms of measurements or amounts . (Holloway I. 1997; Thomas R.2003) Where quantitative focus on measurements and amounts of the characteristics displayed by people and event which is studied. (Thomas R. 2003)

This research required an organized data gathering in order to explain the research theories or philosophies that will be include in the research. Therefore, the exploratory qualitative will be conducted among managers and nurses. There will be conducted an in-depth interviews with the nurses and their managers. Interview will be recorded, taped and immediately transcribed and these will be highly considered with the confidentiality issue. The privacy, confidentiality of respondents will be protected throughout the processes

4.2 Population and sample

The research setting in this study is Oxford, United Kingdom. In oxford there is a wide variety of health service. Abingdon Mental Health Centre is one of the health services which specialize in mental health and it is found in National Health Service system

As this qualitative research is aiming to verify the workforce motivation and demotivation, and it is also aiming to verify the relationship between the motivation factors and performance management activities, a sample of thirty respondents in total has been randomly selected. The respondents are divided into two target groups which are twenty-five nurses and five managers.

4.3 Research Tools

As the researcher will use qualitative data, therefore questions will be provides for both group of respondents. Both groups will be asked two set of questions which one of them will be the same and one will be different regarding to their positional perspective. In-depth interviews will be used as the method of data collection for this study. For this research project the interviews will be conducted at respondents' residence and at the respondents' workplace which is Abingdon Mental Health Centre In every single interview, there might be a bias or false information of self-report data. Welman and Kruger (2001) recommend that the researcher should dress in more or less the same way as respondents and interviewers should be careful not to say any questions which may be construed as a desired response but should use open ended questions instead. Therefore, the researcher will be bear in mind about these recommendations.

4.4 Data Collection

In this study all primary data and secondary data will be used. Primary source of data will be collected through the in-depth interview, with audiotape recording if permission is granted. Furthermore, field-note will be taken also. Since, some data might be sensitive, the privacy, confidentiality of respondents will be protected throughout the processes of qualitative data collection. The location for the in-depth interview will be at the workplace of the respondents which is Abingdon Mental Health Centre or the respondents' residence if it is needed.

Secondary source of data will come from published articles from health service journals, government publications and also related studies on performance management. These secondary data will be useful secondary data because it might help researcher analyze and interpret more easily.

5. Reflections

5.1 Appraisal of resources

This study will be concentrated on Human Resource Management (HRM). Motivation is an aspect which is important for the performance of workforce. This study is aiming to verify the workforce motivation and demotivation, and it is also aiming to verify the relationship between the motivation factors and performance management activities. Therefore, people are a key aspect for this study. To be successful in this study, there are many resources which are needed. This study requires the information from interviewing thirty respondents which are divided into two groups which are workforce (twenty-five) and administrative staff (five). The detail or information which will be gathered from the in-depth interview will be help the researcher find out the answer for the research questions above. Nevertheless, there will be some errors if those respondents answer the questions with their biases or give some false information. Apart from respondents, an important person for this study is the researcher. Researcher is a MBA student who has done the Human Resource Management module. The Human resource management is the subject which includes many issues which the researcher interested in. Therefore, it will be easier for researcher to finish this study successfully. Additionally, there are other skills which the researcher thinks that they might be helpful for this study. Communication skills are very important skill for this study because in-depth interview need efficient communication between interviewer and interviewees. Due to the limitation of English ability of the researcher, the researcher need to be careful for preparing the questions for the interview in order to avoid some errors which might be occur because of misunderstanding. Apart from communication skills, planning skill and prioritizing skill are also needed to be focused. According to time limit, this study has to be finished in every single process on time. Therefore, research need to give priority to these skills also.

5.2 Ethical implications

Basically, qualities characteristic of the qualitative research has seen as an ability of an interviewer to listen attentively and empathically, whist self awareness need to be concerned too. (Smythe and Murray , 2000) There is a standard of ethical principle which needed to be give priority to such as free and informed consent, privacy and confidentiality (Berg,1995) Smythe and Murray (2000) emphasize that there may be ethically conflicted in the qualitative research because this research also involves some degree of personal involvement between researcher and respondents. This study need to be aware of factors which might lead to ethical issue. Due to some reveal information which might be the highly personal data, the research need to keep this information as confidentially in order to protect any harm to respondents. According to the idea of 'process consent' which is designed to protect the rights of respondents to withdraw their data at any time during the research, therefore, consent for respondents will be obtained through the research process, future uses of information for publication and data sharing need to be discussed. According to willingness of respondents to participate the interview, the questions for the in-depth interview need to be sure that the respondents will not feel that they are bothered with the repeated questions.

6. Time Scale and Resources

For this study, the researcher will carry as the table below

Method of procedure

Planed start

Planed finish

Resources and Skills needed

1. agree research strategy with supervisor

26thof July 2010

9thof August 2010

Research proposal

2. Meeting with supervisor

Once a week from 26thof July 2010

October 2010

- My work need to be updated every week

- Prioritizing and planning skill will be used

3. Complete literature review

1stof August 2010

30thof September 2010

- Health service journals, books about Motivation and performance management will be used

- Reading skill and critical skills is needed

4.Develop interview schedules

15thof August 2010

30thof September 2010

- Make a requirement to the manager in order to get permission.

5. Field research - conduct interviews

15thof August 2010

15thof September 2010

- Questions need to be approved by supervisor.

- Communication skills are needed

- Have to be aware about Ethic issue

6. Document Review -gather documents

15thof September 2010

22ndof September 2010

- Make sure that all the documents are valid

7. Data analysis

23rdof September 2010

30thof September 2010

- Analysis skill is needed

8. writing up final dissertation

1stof October 2010

25thof October 2010

- Harvard reference is needed