1. 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)

2. 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

5. 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 ?

6. 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)

7. 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)

8. 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

10. 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

11. 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)

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

13. 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

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

15. 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

16. 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)

17. 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

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

19. 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

20. 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)

21. 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)

22. References:
Antunes AV, Sant Anna LR 1996, ‘Satisfaction and motivating in nursing’,Revista Brasileira de Enfermagem, vol. 49, no.3, pp
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
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
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
Gust D ‘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, <
Mischa Willis-Shattuck, Posy Bidwell, Steve Thomas, Laura Wyness, Duane Blaauw, Prudence Ditlopo, Motivation and retention of health workers in developing countries: a systematic review
MSG 2015, Importance of Motivation. Viewed 25 April 2016, <
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.

23. Thank you