1. 2 nd Policy Dialogue in the Baltic Countries on Human Resources Vilnius, Lithuania 26 – 27 September 2005 WHO Europe - European Observatory Ministry of Health of the Republic of Lithuania Strategies to improve motivation and productivity Sigrún Gunnarsdóttir

2. Overview: 1.Motivation 2.Productivity in the context of pressure 3.The importance of supportive relationships 4.Policy challenges

3. Frame of analysis Motivation Productivity Influential factors within the work environment - in the context of high workload

4. Motivation in health care 1.Patient needs 2.Professional standards 3.Organisational goals Quality patient care Efficiency Public welfare An environmentally facilitated active approach toward learning new behaviour patterns or solving new problems Karasek & Theorell, 1990, p. 170 In Health Care this means to meet:

5. Basic needs at work : Karasek & Theorell, 2000; Williams et al, 2001; Harter, Schmidt, Keyes, 2003; Models on Magnet Hospital; Model on Organisational Empowermenr Clarity of expectations Sense of belonging To learn continuously Satisfied workers are: –Cooperative –Committed –Productive Feeling of contribution Sense of control Safety

6. High workload in health care Reports from European countries & US: Swedish doctors (n=447, Arnetz et al, 2002) 67% too much workload Nurses in 5 countries (US & Europe) (n=10.319) (Aiken et al, 2002) 32,9% - 54,2% with burnout scores above norms Icelandic nurses & doctors (n=695 & n=341, Gunnarsdóttir, 2005 & Tómasson et al, 2003) 35,9% & 65,0% exhausted from work US doctors (n=1.735, Williams et al, 2001) 40,3% likely to decrease work hours

7. Increasing pressure: Pace Productivity Decreasing opportunities: Communication Control Negative balance between demands and control of work impacts motivation and productivity Karasek & Theorell, 2000; Firth-Cozens & Greenhalgh, 1997; Brown, Arnetz, Petersson, 2003; IOM, 2004:Keeping Patient Safe; Aiken et al, 2002; Laschinger et al, 2005 Productivity in the context of high demands

8. Control Demands Kanter, 2004; Aiken et al, 2002; Laschinger et al, 2005; Arnetz et al 2001; Freeborn, 2001 Supportive relationships Access to information Access to recources To balance high demands Demand – Control – Support Model Improved performance Karasek and Theorell

9. Studies about motivation and productivity at The University Hospital Reykjavík 1.Workers in kitchen & laundry, 2000 2.Nurses and midwives, 2002-05 Follow-up participation study with managers 2005 In the context of increasing work demands Merger - Cut down in resources Focus: Well-being Job satisfaction Leadership Work performance Sigrún Gunnarsdóttir

10. The studies in Reykjavík Workers in kitchen & laundry (n=200) Support from staff and managers Overview and control over work Nurses and midwives (n=695) Support from unit managers Teamwork Staffing Follow-up study: Action research with nurse managers (n=20) To improve leadership behaviour To prevent burnout among managers Influential factors: Sigrún Gunnarsdóttir

11. Background to the Nurse study Reykjavík Organisational traits: Supportive leadership Participation management Teamwork Professional autonomy Positive outcomes: Recruitment Job satisfaction Retention Staffing The quality of patient care Characteristics of Magnet Hospitals: A link between the Models on Magnet Hospitals & Organisational Empowerment Laschinger et al, 2003

12. Impact analysis of work environment factors on nurse and patient outcomes Supportive leadership Adequate staffing Good nurse-doctor teamwork Job satisfaction Burnout High quality care Sigrún Gunnarsdóttir Sign relationships OR=+4,87 B=-1,91 OR=+1,91 Findings in line with models on Magnet Hospitals & Organisational Empowerment Aiken et al, Laschinger et al OR=+1,94

13. From the landscape of Icelandic health care...

14. Frame of analysis Motivation Productivity Influential factors within the work environment - in the context of high workload

15. Forsberg, Axelsson & Arnetz, 2000; 2001,Harter, Schmidt, Keyes, 2003 Extrinsic rewards: Pay Benefits Payment by results Intrinsic motivators: Meaningful work Recognition Responsibility Personal growth Tangible (extrinsic) rewards not necessarly motivating Not always linked to productivity Two aspects of motivation Herzberg, 1959

16. Influential factors within the work environment to improve motivation & productivity: Supportive relationships Shared values Participatory mangement Professional autonomy Access to information Access to recources Motivation – (intrinsic) Control over work Commitment Productivity Characateristics of transformational leadership; Supportive leadership Aiken et al, Kanter, 2003; Berwick, 2003; Firth-Cozens, 2004; Laschinger et al, 2005; Arnetz et al; Gilson, 2005; Bass, 1998 Social capital Organisational trust

17. Expertise and resources are foundational Meaningful work Dynamic social networks A minimum of control Opportunities to grow Aiken et al; Kanter, 2004; Arnetz et al, 2002; Williams et al, 2001; Peter Drucker, 1999; Motivated and productive workforce Health care professionals are motivated via:

18. Scientific management: Mechanism of control Detailed job descriptions Clear procedures Supportive leadership Teamwork Trust Human Resource Management: Beyond Taylorism Frederick W Taylor was born in 1856 Intrinsic factors Extrinsic factors

19. Conclusion 1.Motivation is reinforced by supportive relationships and sense of control 2.Supportive leaders unlock the best in staff through vision, shared values and trust 3.The link between high trust in health care and high performance is worth exploring further

20. Policy challenges 1.Foster visionary and supportive leaders 2.Promote teamwork at all levels 3.Support professional autonomy

21. 2 nd Policy Dialogue in the Baltic Countries on Human Resources Vilnius, Lithuania 26 – 27 September 2005 WHO Europe - European Observatory Ministry of Health of the Republic of Lithuania Strategies to improve motivation and productivity Sigrún Gunnarsdóttir