In a particular organizational culture, what brings about positive attitudes to create efficiency in productivity? These variables of positive attitudes in a working environment are attributed by the factors of Motivation. These variables tend to act internally or externally to direct behavior. Marquis and Huston, 2009 stated that "Motivation is the force within an individual that influences or directs behavior". Motivation comes from within the individual, the managers should recognize the need and wants of individual workers and use the strategies of motivation to bring out the best in their performance. Motivation could be either Intrinsic or extrinsic. Intrinsic motivation comes from within the individual worker, elevating his ambitions towards job performance and productivity, it includes responsibility, autonomy, opportunities for advancement and challenges and developing new skills. Extrinsic motivation is driven by the work environment, and it occurs after the task has been accomplished(Marquis and Huston,2009), it includes rewards such as a raise in salary, promotions, punishments, disciplinary action, withholding pay.
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Focus of this Research Investigation: My focus of this research investigation is to create an impact in the primary health sector, affecting both perceived contextual factors (workers' perception of the organizational culture) and individual worker differences in the process to increase work output, hence achieving organizational goals.
My case study: An operational research conducted in Mali to identify the match between motivation and the range and use of performance management activities in a health sector.
Objectives: to describe the factors motivating and demotivating health workers, and match the motivators with the implementation of performance management.
Case study A:
My experiences in working with a primary Health care provider in Nigeria have shown the development of a poor organizational culture in management due to the of lack of motivation and leadership strategies. This poor culture has resulted in patients not receiving appropriate care leading to a corresponding decrease in the annual profit of the institution. This analysis and solution will aim to provide an overview of the present knowledge about initiatives to changing medical practice. Changing behaviour is possible, but it requires comprehensive approaches at different levels tailored to specific settings and target groups(Grol and Grishaw,2003, p. 1225).
Objectives: identification of factors of motivation in health workers leading to an optimum performance.
Findings: This case study suggests that the low performance in the hospital is caused by significant cultural divergence. The key points of divergence are caused by leadership and management orientation, accountability and information system, human resource policies and relationship within the local health economy. The leadership and management system is typically an autocratic style of management. The management staff has no regards to the welfare or state of mind of their subordinates, using the carrot and stick approach as a strategy for high performance- reward and punishment to induce behavior. The accountability and information system serves to improve health system reforms and job clarification. This is compromised by lapses in working policies and withdrawal of employee incentives. The intrinsic factors of motivation are lost, they are propelled to achieve goals through extrinsic rewards, which are compromised. The quality care given that was often enjoyed by the patients has drastically reduced leading to strict change in policies regarding, reducing salaries.
The strategy employed is to re-ignite the motivational workforce and improving the retention of these health workers which is a critical factor for health system performance.
Discussion: Nigeria's public sector is the greatest health service provider and employer of numerous health workers. The health sector suffers shortages in staff resources particularly for nurses and possess inadequate skills due to lack of resource availability and management capabilities. In this study, motivation of the health workers can be induced by applying both the Herzberg's 2-factor theory and Adam's Equity theory of a "fair day's work for a fair day's pay"(Noyle, 1999, p. 545). Their motivation and performance can be achieved by introducing non-financial incentives while also improving structural conditions. The strategy involves satisfying the motivating factors in the health workers like greater job responsibilities and recognition. The other factors necessary are career development, financial satisfaction and a good hospital management. There should also be fairness in the distribution of reward to performance. These tools can raise the motivation of accomplishment, creating a zeal for achievement.
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The strategy for the inducing motivation in the staffs in by implementing a performance management system. Having an interview or a deep group discussion with the staffs, finding out what really motivates them to accomplish organizational goals. The information gotten will be matched with the performance management tools like leave allowances, thirteen months' salary, over-time allowance and other rewards that is appropriate according to the respective staff performance level. Performance is a function of ability and motivation.
Thus, Job Performance: f(Ability)(Motivation)
Ability depends mostly on education, experience and training. There are some strategies that can increase the motivation of the health workers quickly: positive reinforcement or high expectations of the job, appropriate discipline and punishment to defaulters, being fair to your staffs, satisfying the needs of the staffs, streamlining jobs to fit employee abilities, implementation of a reward scheme and it should be based on performance(AccelTeam,2012), Employee motivation: theory and practice). These strategies depend on the organizational culture of the work place. There is normally a gap between the employee present state of mind and what he desires for himself which could propel him to an increased output. The manager tries to bridge that gap, this bridge is the outcome of Motivation. The motivational system being implemented must conform to the corporate policy of the Hospital or health center.
Also the organizational culture has a huge impact on work conditions. By improving the organizational culture it will produce a working environment that can aspire individual determinant in motivation and recognizing the essence of cultural values which will undoubtedly lead to job satisfaction and an overall increase in performance.
The following techniques can be applied to quality management to improve the organizational culture and values. Aspiring for excellence in the task at hand, involving the entire employees in quality improvement efforts. Emphasis should be made on the quality of the outcome and the procedures involved. A strong emphasis should be made on the importance of self-evaluating of individuals and the organization. Health workers should have a higher degree of responsibility and liberty in their respective duties. Team building and empowerment should be practiced among these staffs providing a sense of self-realization and participation in achieving organizational goals.
These tools of management have been applied to ignite motivation among employee producing satisfaction at the work environment. Many organizations have adapted these tools or techniques to increase job performance. The European Foundation of Quality Management (EFQM) applied the techniques of management and came up with certain criterion used affecting motivation.Supervision schemes, techniques for Recognition, performance management, training and professional development, leadership, participation mechanisms and intra-organizational communication process(Human resource for health, 2006).
These tools have been applied in some countries health service sector and gained positive results. In Zambia, there have introduced training for medical staffs to improve their skills in delivering quality service and care. This act as led to a higher retaining rate of staffs. Also in Ethiopia, continued education is encouraged for their staffs, a clear career structure and a defined organizational culture which recognizes the cultural values present has led to an improved staff satisfaction and retention.
Approaches to motivation are linked to the motivational theories. These theories are, the process theory, content theory and instrumentality theory. The instrumentality theory uses rewards and punishment (carrot and stick approach) to achieve performance. The content theory emphasizes about satisfying individual needs, identifying the main needs that influence behavior. This approach was deduced using Abraham Maslow model(1954) and Frederick Herzberg's two-factor theory. The process theory focuses on the psychological process that affects motivation, applying Victor H. Vrooms expectancy model and John Adam goals equity model (Armstrong,2003).
The content theory focuses on what exactly brings about motivation, looking into their inner needs, strengths and the way these factors are expressed in the goals that individual follow. This model follows the thought that if managers can understand these needs, they can design a reward system that can bring about individual satisfaction which will lead to accomplishing organizational goals.
Abraham Maslow's hierarchy of needs gives us an in-depth to the individual needs and satisfaction.
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According to Abraham Maslow, an individual is motivated after passing through this five hierarchical stages of needs(Naylor, 1999). They cannot proceed to the next stage unless they have satisfied their needs of the previous stage. This model has been widely criticized by scholars, indicating that the hierarchy of needs doesn't exist, that at all levels, needs are present at a given time and that the managers don't have that time to know where employees stand on Maslow's hierarchy scale. Despite all of this criticism, the model is useful for managers to reward the diverse needs of individuals at work(Aswathappa, 2005).
The Herzbeg two-factor theory of motivation states that two different factors can affect motivation in the work environment, Hygiene factors and Motivators. The hygiene factors prevent dissatisfaction in the work environment like pay, job security, good working conditions, these factors cannot bring about satisfaction, even if in abundance. Motivators are the forces or factors that propel the individual or produces the zeal for a greater performance, these factors include, sense of achievement, responsibility within the job, recognition by others(Naylor, 1999).
Sense of achievement
Recognition by others
Responsibility within the job
Advancement and personal growth
Company policy and administration
Level and quality of supervision
NEITHER DISSATISFIED OF SATISFIED
To achieve motivation in the work environment, the managers have to manage both hygiene factor and motivators, with the motive to improve the hygiene factors, setting a positive frame of mind for motivation(Aswathappa, 2005).
This method has been criticized by scholars relating its application to job satisfaction and not to motivate individuals in achieving effective performance or productivity. Also there was no emphasis on the overall measure of satisfaction. This theory had a huge impact stimulating thought, research and experimentation on motivation in a working environment (Aswathappa, 2005).
The process theory examines different variables that make up motivation. The Equity theory in this category refers to the individuals subjective judgement about the fairness of the reward received to the input made in comparison to the reward of others(Koontz and Weihrich, 2006). According to this theory, the expectations of the employees see the ratio of their outcomes to inputs as equitable (Fiore, 2004).
There are several responses an employee may take when going through the phase of inequity, they can change their outcome, change inputs, distort perceptions of the importance of the job or the reward, or quit.
Dissatisfaction reduced output departure from organization
Balance or imbalance of reward
Continuation at the same level of output
Harder work Discounted reward
More than equitable rewards
(Koontz and Weihrich, 2006, p. 296)
The expectancy theory is a unique tool of management used for analyzing motivational problems. It follows the perception of expected outcome affecting individual behavior. Victor Vroom in 1964 deduced that the major factors in expectancy in this context involves the link between personal effort and outcome, and valence involves the anticipated satisfaction from the outcome. This theory has two major factors, expectancy(the belief that a particular action will lead to a particular outcome) and valence(affective orientation towards a particular outcome)(Hollyforde and Whiddett, 2002). Motivation is achieved by matching the employee's competence to demand of the job so that the effort-performance expectancy is high. Also an incentive scheme that links performance to reward should be developed and this reward should be appreciated by the employee (Naylor, 1999).
Anticipated satisfaction from outcomes
Profitability that performance will lead to outcomes
Profitability that effort will lead to performance
All these motivational theories and concepts are very unique in its application and varies from one organization to another. One of the strategies implemented to induce motivation is identifying who has sufficient power to assist this change or alternatively to work against it, also the second phase is to compare those individuals capable of hindering change with a desire or motivation to do so.
One of these theories was used to develop a motivational strategy in a health Institution in Mali. Its researched findings and results can be matched with the discussions from Case A.
CASE STUDY B: Research has proved that employees and employers often perceive motivation differently. The principles and application of motivation are unknown to health workers, this knowledge could favour production efficiency.
BACKGROUND ON MALI
"According to the Ministry of Health, in 2001 Mali had 5173 health workers, of whom the majority (77%) work in the public sector at district, regional and national level. They are managed and paid by the Ministry of Health and are civil servants. Community health center staff (18% of the workforce) is managed and paid by local health committees, though technical supervision and training is provided by the district teams. Only 5% of the health workforce is employed full-time in private clinics, though dual working is common" (Human resources for Health 2006,4:2)
In Mali the Human resources for health (HRH) conducted an operational research to identify the match between motivation and the range and use of performance management among health workers.
OBJECTIVES: To describe the factors motivating and demotivating health workers in Mali and match the motivators with the implementation of performance management.
The main study questions of this operational research conducted by the Human resources for Health are:
1. What motivates and what demotivates health workers?
2. What kind of performance management activities are used and how are they perceived by health workers and their managers?
3. How do these performance management activities match with motivating factors? (Human resources for health, 2006. P 2)
METHODS: An exploratory qualitative study was conducted, involving 28 interviews and discussions involving eight groups of health workers. This was followed by a cross-sectional survey, during which 370 health workers were interviewed followed by in-depth discussions. The following issues were investigated: motivating and demotivating factors, experiences with performance management, including job descriptions, continuous education, supervision, performance appraisal and career development.
FINDINGS: The study revealed that the core motivators of health workers was a sense of responsibility, training and recognition, next to salary. The other factors that supplements these core motivators are influenced by performance management (job descriptions, supervisions, continuous education and performance appraisal) attributes (Human resources for health, 2006. P 2). From the results of the research, it showed that the physicians were mostly concerned about their responsibilities and duties rather than salaries or wages, though the registered nurses too were in the range as the physicians but lower in points. The midwives and auxiliary nurses were indeed motivated by salaries and benefits.
Most of the health workers complained about the lack of tools/equipment like bandages, delivery kits and blood -pressure machines to enable them to complete their task. General staff at the community level had issues with poor management involving in no leave periods and unclear rules and regulations. At all levels the managers also complained of lack of equipments and demotivating factors inhibiting effective work performance(Human resources for health, 2006. P 3).
Performance management is not optimally implemented in Mali, as job descriptions were not present or were inappropriate; only 13% of interviewees received 4Ã- per year supervision, and training needs were not analysed. Some 48% of the interviewees knew their performance had been appraised in the last two years; the appraisals were perceived as subjective. No other methods were in place to show recognition.
The results enabled the research team to propose adaptations or improvements upon existing performance management.
The research showed that the main factors motivating the eight professional health workers were related to recognition or appreciation, responsibility and training. Also the realization of various performance management activities (job description, promotion, career development and performance appraisal) by staffs to inspire motivation. It is imperative for managers distinguish between motivating factors and demotivation factors or performance management techniques that cause or induce increased output or performance in the work place.
Based on the result of the research, the health workers were influenced more by motiviers than hygiene factor. So by allocating greater responsibilities to the staff and by improving certain mechanisms for recognition can bring about intrinsic motivation towards job performance. Hygiene factors like salaries and incentives are important factors for health workers and should not be neglected. An improved management system can create motivated minds that would contribute to the improving quality services and care of the health system. For managerial application, Herzberg's model produces two types of motivational factors, hygiene factors and motivators. The Manager has to find the appropriate technique or strategy for applying them to induce motivation among its employees. The HR activities towards motivational problems will have to be thorough, identifying which factors in particular are necessary for causing motivation among their staff. The result gotten from this study was recommended to the Malian Ministry of Health to adapt the performance management strategies to the motivators gotten from the findings from the interview ( recognition, responsibility and training), by relating performance appraisal to the respective jobs of the health workers which are clearly defined. (Dieleman, M et al, 2006)
From this case study it can be deducted that the major factors regarding motivation are: financial satisfaction in terms of salary/allowances, career development involving the promotion or training, continuing education, improved working environment-physical condition of the institution, personal recognition/appreciation and finally a good hospital management system where there is a positive working relationship between the managers and the fellow health workers.
These motivational theories do not apply to every organization. It has limitations and flaws in its application. The Herzberg's theory has no measurement of job satisfaction against which employees could rate their satisfaction. This implies that the employees could dislike part of their job involvement and still still accept an overall satisfaction of the job. It becomes difficult to measure the presence or absence of motivation, hence evaluation of intrinsic motivating factors becomes difficult. The research data of Herzberg's theory were gotten from interviewees, so the responses could be assumed, hence this theory does not prove a valid relationship between job satisfaction and productivity/performance. The interviewees for this theory were mainly professionals in management positions in a variety of businesses, this shows that this is more of a management theory motivation and not for the general working employee (Hollyforde and Whiddett, 2002).
Victor Vroom's expectancy theory states that "effort depends on the valence placed on certain outcomes and expectancy that effort will lead to the attainment of those outcomes". Well this effort might not produce effective results or a higher performance in the workplace because it neglects the ability of the individual and the job clarification. This suggests that a highly motivated person may not produce effective results if they lack the ability or clearer understanding of the job description. Also it is argued that the job satisfaction is not related to the job performance because the job may be intrinsically satisfying but the performance output might not be acknowledged by the manager. This theory fails to consider the abilities, job roles or difficulties and different level of rewards that could compromise the link between job satisfaction and overall performance. It also neglects the influence of situational factors on employee motivation. Situational factors like work colleagues and family influences motivation, encouraging job satisfaction or performance.
Finally, Abraham Maslow's theory of hierarchy of needs had two major focus points, motivation influences behavior when unsatisfied needs have not yet been met, finally needs are arranged in order of hierarchy, once a need is satisfied, the next level of needs now acts as a motivator for achieving job satisfaction (Weisbord et al, 1995). This theory also fails to measure the degree of needs of the employee, this degree of satisfaction is only known by the employee and not the management. Also on the hierarchical scale of needs, why do some employees still need to satisfy needs that have already been satisfied? (O'Connor & Yballe, 2007) Alderfer's ERG theory clearly states" that all categories of needs can become more important as they are satisfied". Clayton P. Alderfer in 1969 stated "needs are met simultaneously and in no specific order", employees might place more emphasis on any level of needs in contrary to going to the next level when one is satisfied. This theory is difficult to apply in a working environment because these needs are not satisfied by only one source. For example the sense of belonging may be satisfied outside the work environment, getting this satisfaction from friends or frat groups that cannot be provided by employees in the work environment.
Managers must recognize the fact that what motivates an individual today may take a different turn the next day. The factors for motivating reduces as it goes up the hierarchical scale, because people need for satisfaction are so different.
Health workers are faced with different needs that has to be to be satisfied to increase their performance in achieving quality care and services. Their motivation for job satisfaction may be intrinsic or extrinsically influenced. Despite the criticism of the management theories, it models managers to inspire or motivate employees to be more productive, dealing with de-motivating issues that exist in the workplace. The Herzeberg's theory is a key theory in motivation. Most employees express attitudes that are dissatisfied with hygiene factors in the hospital like withdrawal of incentives, job clarification, reduced leave periods etc. Identifying and resolving these factors appropriately according to individual needs are very important in inspiring motivation. Also managers trying to apply the expectancy theory as a tool for motivation of employees should acknowledge the individual's perception of reward, recognizing the abilities of certain employees to their expected performances or outcomes.
A commitment-based approach to management should be practiced, allowing autonomy and self-discipline among employees. The employees take pride in their respective duties in the hospital, cooperating and trusting one another, overcoming communication barriers, building teamwork and coordinating their efforts effectively for both the hospital and the patients. The result of this approach produces a positive emotional energy, creating a form of synergy that could lead to a high performance in services in the workplace.
(Clayton P. Alderfer first presented the ERG Theory of Motivation in 1969 in his article, "An Empirical Test of a New Theory of Human Need.")