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This essay is a reflective piece on an observation made in a clinical setting. The author has chosen to focus on the motivation aspect of the scenario. Motivation is also used to describe the process of activating human behaviour. Motivation implies a sense of movement, excitement and expectancy. The phenomenon of motivation encompasses a concern with what energises behaviour, directs or channels behaviour, and mountains or sustains behaviour (Steer & Porter in Huber, D. 2000).
Thus motivation is a method to move individual towards goals. The basic unit of human's behaviour is an activity or a discrete action. People vary in both their ability to do an activity and their motivation to do it. Motivation is the willingness aspect (Huber, D 2000).
Motives or needs are defined as wants, drives, or impulses within the individual. They are the drives to action and the reasons for behaviour. Motives are directed towards goals and are the energising forces that become a reason to strive for the hoped for rewards outside the individual. The need with greatest strength at any one time is what leads to activity (Hersey, P. cited in Huber, D. 2000).
There are energising forces within individuals that steer them to behave and environmental forces that turns on the drives. The idea of goal orientation means that human behaviour is directed towards something. To analyse motivation from a systems orientation means to look at both forces within individuals and those in the environment that feedback to either reinforce the intensity of a drive or to discourage a course of action and redirect efforts. Thus motivation is concerned with those factors that energise, direct, and sustain human behaviour (Steer & Porter cited in Huber, D. 2000), eg motivation can appear as a result of the persuasive communication that occurs between leader and follower (Hersey &Duldt cited in Huber, D. 2000)
Motivation has been described as the ability to get individuals to do what the other person wants them to do, when and how they want it done. Motivated people have a sense of forward drive as identifying characteristics. They have a sense of energy, enthusiasm, and goal directedness. The most powerful source of motivation is thought to be internal (intrinsic) drives. To motivate effectively, leaders need to discover in their followers, something that arouses a desire, energises the will, and serves as a basis for action or thought (Schweiger 1980).
Therefore motivation in interprofessional situation is a must to ensure that the patients are receiving the right and effective care and treatment and the work is carried out effectively. Using three models the author will critically analyse the scenario (in appendix) with possible solutions to any issues that may have arose.
Maslow's (1954) Hierarchy of Needs Theory
(Maslow's hierarchy Pyramid www.wikipedia.org)
According to Maslow the first needs that a person must satisfy are physiological needs, which include food, sleep, clothing, and shelter. In a workplace these needs are satisfied by sufficient wages to live and physically acceptable conditions (Shortell, S.M. 2000). In the scenario a vital physiological need was compromised; a human needs to rest and sleep. With reduced staff, many radiographers were required to endure more frequent shifts and longer working hours. If this basic human need is not met, radiographers are less likely to perform to their best ability and to further advance to the next level within the hierarchy of needs. Ensuring staff are fully rested is the responsibility of the staff management. Careful planning of staff rosters and policies that ensure radiographers are regulated to a set number of hours and shifts per week need to be implemented to ensure staff are working to their optimal capacity. Not only is it important to ensure staff are fully rested for motivational reasons, it is also an important safety issue for both staff and patients.
Safety and Security
Once the first level has been fulfilled, Maslow's next level of need emerges. Individuals become anxious with the need of safety and security. In a workplace, security often refers to job security in terms of continuity of employment and safety usually refers to being free of the fear of physical harm (Huber, D. 2000). As mentioned in the scenario violence from patients under the influence of certain drugs and the condition of some patients is becoming more prevalent within the CT department. Another concern is the rising incidence of treating patients with blood borne disease and communicable diseases. Obviously managers need to ensure all occupational health and safety policies and all hospital safety procedures are implemented and enforced. In addition to physical safety, job security also needs to be addressed to ensure employees can move to the next level of needs within Maslow's hierarchy (Shortell, S.M. 2000). With the constant threat of downsizing the number of staff due to the budget cuts, radiographers are inadvertently put under a lot of stress to maintain their position within the department. Radiographers may be sacrificing rest by accepting more hours just to ensure that at the end of the day they have a job, thus reducing motivation to perform to their best and affecting the quality of their work.
Once the safety and security is dealt with and one is pleased, individuals become concerned with belonging - a need for affiliation and a feeling of recognition and love (Huber, D 2000). When there is a feeling that the individual belongs somewhere he/she is motivated by a desire to be held in esteem. People need to be thought as valuable by others, to be known as people with some value (McSweeny, F.K. 1999). This is probably one of the most important components in motivating staff. The lack of recognition for the hard work and long hours radiographers put into their jobs may be most damaging of all issues mentioned. As the radiographer says, "CT is becoming frustrating. Working here is no longer fun it is frustrating to always be there, to work so closely with patients, to do so much and then others take the credit". When radiographers are frustrated they will feel less motivated to increase productivity and patient services, especially when they are not getting the credit or the recognition that they deserve. This can be dealt with when managers combat feelings of frustration by encouraging radiographers with positive feedbacks and continual praises for their efforts and hard work (McConnell, C. 1997).
Finally, the highest level of the hierarchy of needs, at the apex, is self-actualisation needs. These relate to the need to maximise one's potential fulfilment, competence, and accomplishment (Huber, D. 2000). This is the most difficult level in the hierarchy in order for the management to define and identify as different individuals have different ideas and goals. It is within the interest of the hospital and their staffs that management ensures all other needs within the hierarchy is fulfilled to motivate staff to their job to the best of their ability (Shortell, S.M. 2000).
There are some considerations to be made concerning Maslow's model of motivation. First, it should be made obvious that the theory does not mean that individuals experience only one type of need at a time. In fact, we most likely experience all levels of needs all the time, at varying degrees (McSweeny, F.K. 1999). As the radiographer in the scenario juggles her physiological needs (lack of sleep, due to long working hours) with the need of job security. We do not progress just from one stage in the hierarchy to another in a simple, orderly manner as there is a steady, but ever changing force from all stages and types of needs (McSweeny, F.K. 1999).
Another point that must be made in regards to the Maslow's model is that the order in which the theory has set up, the needs does not necessarily reveal their significance for every individual. For example some people may have such a high need for esteem that they are able to lower their needs for safety, or their physiological or belonging needs to these (McSweeny, F.K. 1999).
A final and very important point to be made about Maslow's model is the claim that once a need is satisfied it is no longer a motivator i.e. until it re-emerges. A good example is food is a poor motivator after a meal (McSweeny, F.K. 1999). This point made by McSweeny 1999 clearly put his point across to the management. Unfortunately, many organisations and individuals still fail to get the message. Such as in the scenario if management placed emphasis on needs that were not satisfied, such as getting more rest, and financial rewards, employees would be more likely to be motivated to fulfil that need and work towards achieving the goals of the organisation (McSweeny, F.K. 1999).
Herzberg's (1959) Motivational Hygiene Theory
(Herzberg's Motivational Theory www.wikipedia.org)
Herzberg goes further than Maslow; Herzberg applied Maslow's general theory of motivation specifically to work motivation cutting the hierarchy off near the top and maintaining that motivation result only from some elements of esteem needs and self-actualisation (Huber, D. 2000).
Herzberg's theory states that there are two types of motivators, one that results in satisfaction with the job, and the other that simply prevents dissatisfaction (Clark, C. 2009). Herzberg's theory suggests that we should focus our thoughts on the individuals in jobs, not on the things that we surround them with. He maintains that we tend to think that growth and development will occur if we provide good working conditions, status and security, whereas in fact what arouses growth and motivation are opportunities for achievement recognition, responsibility and advancement (Shortell, S.M. 2000). The radiographer in CT will feel more motivated if she felt her efforts were being rewarded and recognised as equally as other members of staff, particularly the consultants.
In reference to Herzberg's theory, management could offer recognition such as praise; public recognition and more challenging job assignments to radiographers in order to increase overall staff motivation which will increase quality of patient care and productivity (Shortell, S.M. 2000).
McClelland's theory, takes Maslow's Needs of hierarchy even further and divides motivation into needs for Power, Achievement, and Affiliation. Each person tends to have one pre-dominant need. The need for power means the need to be in control and to get others to behave different to what they would normally do. The need for affiliation is the desire to work in a pleasant environment and have friendly, close relationships. The one single motivating factor that has received the most attention in terms of research is the need for achievement. The need for achievement means the strong craving to overcome challenges, to excel, to advance or succeed, and to grow (Huber, D. 2000).
The need for achievement can be identified and assessed. Individuals with high need to achieve have a number of distinctive characteristics which separate them from their peers. As the CT radiographer are specialised working in a competitive environment, one could assume that due to the high level of speciality training and advanced technology, most CT radiographers would fall into the category of high achievers. If this is so, then the CT management need to reward radiographers with increased responsibility when a task has been completed well, this in turn will motivate the staff and maintain a high level of performance on all future tasks.
Individuals that are high achievers also want concrete feedback on their performances; this can be easily achieved by creating performance portfolios that are detailed regularly (McSweeny, F.K. 1999). However, the point to put across is that it would be inappropriate to treat all radiographers as high achievers and to attempt to motivate them all by offering them challenging jobs, rapid and objective feedback on performance and personal responsibility for success or failure.
There are other theories of work motivation such as the equity theory; developed in 1963 by Adams, this theory argues that people are motivated by "inequity". This means that a person looks at others who are doing the same or similar jobs to them and compare how much effort that they put into the job and how much they are rewarded for their work (Shortell, S.M 2000). A good example given in the scenario is when the permanent radiographer who is working overtime, sees the temporary bank radiographers who do not put in much effort but still receive more pay and better hours. While the equity theory was originally applied to difference in pay, it can be applied to other forms of tangible and intangible rewards in the workplace (McSweeny, F.K. 1999). The radiographers also feel that they are working as hard to provide adequate images for diagnosis but doctors get all the praises and prestige. This would probably be a negative motivator, discouraging that person form work hard. There are on the hand positive motivators where a person feels that they receive more than others in the same job and so feel that they are being rewarded for their efforts McSweeny F.K. 1999). A manager may implement stratergies such as pay for the overtime, and recognition and praise for hard work to those that are most deserving. The most important factor to remember about equity theory is that if rewards are to be rewarded to motivated employees, they must be perceived as being equitable and fair (McSweeny, F.K. 1999).
It is within the interest of the organisation and the individual to keep staff motivated. Motivated staffs are more likely to carry their tasks in a meaningful way and are a productive employee towards achieving their goals. (Kreitner 1995). A manager's role is to create a work environment that provides with the opportunity to attain their goals and experience what they value most in their professional lives.
Motivation theories provide a framework from which managers and senior members of staff can use to ascertain what motivates their employees. There were several issues raised in the scenario and were explored using theories of motivation.
In conclusion managers need to provide expressions of recognition, appreciation and acknowledgment to nourish their employees 'feelings of self-worth. When these expressions are applied the employees will perceive as being respected and valuable members of the team, and they are more cooperative, enthusiastic and committed to the organisational goals both in the present and in the future.
Outline of Scenario
(Names in the scenario will not be mentioned due to confidentiality)
It was a very busy Friday in the X-ray department, the outpatient's clinic, and the A&E request for x-rays were flowing in, there was a shortage of radiographers due to sickness and the hospital facing extreme budget cuts resulting in decreased number of staff. The Radiographers that were working were rushed off their feet trying to get patients in and out as quick as possible to cut down waiting time.
The manager in charge was running frantically around the department, as the CT department was also very short staffed, the manager was approaching radiographers who could possibly do overtime or rotate but was not having any luck as both the departments were very short staffed and most of the radiographers were on night shifts or had just completed a night shift. The manager was ever so stressed she had a lot of paper work to sort out and a pile of reporting to attend to.
One particular permanent radiographer who arrived in the department early decided to start work 1 hour early than her normal working time. This particular radiographer had been doing late shifts for the past 3 days in the CT department and was only rostered for half a day today. The radiographer walked up to the desk where the daily roster was kept to see where she was working today. As she walked up she noticed that the request card box was flowing with CT request and a couple of temporary radiographers were standing and chatting away and no one seemed to be bothered. When she checked the roster, she was rostered in CT she did not look happy. The manager came into the department and asked the permanent radiographer if she could work till late again today in the CT department.
The radiographer mentioned that she had been working till late for the past 3 days and was only working half day today. The manager replied ' I am aware of this but I have had no luck as most of the staff are off sick and there is no one to cover so your my only chance". Upon this the radiographer replied 'Can't the temps not volunteer'? 'Well they can't because they are set to do specific hours set by the agency". The radiographer decided not to argue and volunteered to work till late.
As the day went by the permanent radiographer was looking very tired due to lack of rest. She started to complain to her colleague who had been a radiographer for 30 years.
"CT is becoming frustrating. Working here is no longer fun it is frustrating to always be here, to work so closely with patients, to do so much and then others take the credit".
The senior colleague replied 'In my days things used to be different we used to be rewarded for the hard work we did but now things are changed they don't seem to care anymore we work hard or not'