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Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
Motivation
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Motivation

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  • Transcript

    • 1.
      • Staff motivation:
      • The impact of non-financial
      • incentives and Quality Management tools
              • M.L.PANDIA
    • 2.
      • Contents:
      • GTZ‘s stake in HRH
      • The link between (low) motivation and migration
      • Some study findings
      • Conclusions and need for further action
    • 3. stake in HRH
      • Technical cooperation
      • Support for process and change management
      • Capacity building and HRM/HRD
      • Substantial experience in Quality Management
      • => Improvement of staff skills and working
      • conditions for staff
    • 4.
      Low job satisfaction / low motivation Push factor of migration Poor performance
    • 5.
      Low job satisfaction / low motivation Push factor of migration Poor performance Performance improvement Staff retention Challenge
    • 6.
      Low job satisfaction / low motivation Push factor of migration Poor performance Performance improvement Staff retention What is the role of non-financial incentives & Quality Management tools? Challenge
    • 7. Motivation and the role of non-financial incentives
      • Even with an adequate salary, health workers (HWs) may not be motivated.
      • Even without an adequate salary and under poor working conditions, there are motivated and performing HWs.
      Empirical evidence
    • 8. Motivation and the role of non-financial incentives
      • Even with an adequate salary, health workers (HWs) may not be motivated.
      • Even without an adequate salary and under poor working conditions, there are motivated and performing HWs.
      Common agreement on: Non-financial incentives are an essential component to increase motivation. Empirical evidence
    • 9. Multicountry study on motivation and incentives
      • in process:
      • 4 country studies
      • (El Salvador, Nicaragua, Benin, Kenya, possibly Tanzania)
      • Semi-structured, qualitative interviews
          • with 40-50 medical doctors and nurses from the public, private and NGO sector in each country
      • Focus group discussions
      • completed:
      • Self-administered survey
      • among MoH officials (counterparts) & GTZ-Health staff
      • 29 Responses; 18 from Africa
    • 10. Multicountry study on motivation and incentives
      • Research aspects
      • Motivating factors
      • Career / migration plans
      • Quality management tools
      • Project experiences: what works, what doesn‘t?
    • 11. Multicountry study on motivation and incentives
      • Research aspects
      • Motivating factors
      • Career / migration plans
      • Quality management tools
      • Project experiences: what works, what doesn‘t?
      • Objectives
      • => Assessment of the role and effects of non-financial
      • incentives and QM tools on motivation
      • => Identification of potential approaches to improve
      • motivation and to retain staff in rural areas
    • 12. Country study Kenya Views of health workers on migration
      • “ If everyone had a chance to go, everyone would go” (nurse, 40 years, government clinic)
      • “ Not all here have gone. So you can say we are motivated” (laughs) (MD, 55 years, Mission hospital)
      • “ Most of my colleagues think about leaving the country” (nurse, 31 years, government clinic)
      • “ Migration has never been a serious thought for me. I don’t have the connections you need in order to go” (nurse, 46 years, government clinic)
      • “ It is too hectic in the city. I prefer to stay in the rural area” (MD, 42 years, Mission hospital)
    • 13. Country study Kenya Views of health workers on their work
      • “ We have no motivation here, but we work” (nurse, 51 years, Mission hospital)
      • “ With the given workload due to understaffing, even easy tasks get difficult” (nurse, 32 years, government clinic)
      • “ Supervision gives you moral support” (nurse, 30 years, government clinic)
      • “ The lack of equipment and lack of drugs is very frustrating and depressing. You cannot do quality work.
      • “ I have not yet lived up to my own ideal. It is hard under given external conditions to achieve one’s goal” (MD, 28 years, government hospital)
    • 14. Country study Kenya: Some observations
      • Before joining the health profession, most health workers did not seem to have been aware of the working conditions and salary grades.
      • The main reason for moving to the capital is further career development and training.
      • Once established, many health workers prefer to stay in rural areas given the conditions in cities.
      • Many health workers have thought about or tried to migrate, but felt unable to go abroad.
      • BUT: Despite the frustrations, there is lots of commitment and professional ethos!
    • 15. Non- / financial incentives applied Survey findings in % N = 18 countries Study leave Training Awards Performance related pay Bonus
    • 16. Incentives to stay in remote areas
      • Exists in most countries:
        • Financial incentives
        • In-kind benefits (housing, transport)
        • Improvement of career opportunities (further training, better promotion scores)
        • „ Release paper“ after agreed period in rural areas
      • Other measures to reduce shortages in rural areas:
        • Decentralised training institutions
        • Recruitment of retired staff
        • Contracted personnel
      Survey findings
    • 17. Quality Management tools in % Survey findings N = 18 countries Regular meetings Regular supervision Feedback Performance assessments
    • 18. Survey findings Staff satisfaction surveys Leadership & management training Disciplinary action enforced Clear formulation of expectations and organizational goals Quality Management tools N = 18 countries in %
    • 19. Some examples of good practice
      • Refresher training:
      • very high retention rate in the project area (Zambia)
      • Housing for clinicians, clear career structure, CME, agreed number of years of services in hospitals:
      • improved staff satisfaction and retained staff (Ethiopia)
      • Awards, closer supervision, team building:
      • increased service output (higher EPI and antenatal coverage) and less applications for transfers (Ghana)
      Survey findings
    • 20. Suggestions for effective incentive schemes
      • Mix of financial and non-financial incentives
      • Performance based, or rather efforts related pay/ incentives
      • Individual/ group performance targets
      • Career development plan
      • QM tools: quality culture, quality circles , teambuilding, supportive supervision, feedback, participatory problem assessment
      • Awards and sanctions
      • Benchmarking , competition
      • Free time
      • “ Exposure” : Participation at international conferences
      Survey findings
    • 21. Difficulties in implementing incentives
      • Transparent criteria for performance related payment: Difficulties in definition and implementation (political interference, lack of good governance)
      • Sustainability of (financial) incentives -> become quickly part of the benefit package
      • High staff turnover -> sustainability of training?
      • Competition with other organisations that provide (higher) monetary incentives
      Survey findings
    • 22. Difficulties in implementing incentives (cont.)
      • Old habits, difficulty of changing long-term institutionalised norms and rules (e.g., age over merit, bureaucracy)
      • Cultural constraints: avoidance of being outstanding, reluctance of taking on responsibilities beyond one’s duties
      • Irrelevant in a context of extreme staff shortage?
      Survey findings
    • 23. Conclusions
      • There is no blueprint
      • Each region/facility needs its specific mix of incentives
      • Working hypothesis seems to be confirmed
      • Motivation can be considerably increased with non-financial incentives and QM tools.
      • But problems of sustainability and transparent application
      • Practical and simple methods are needed to monitor the impact of incentives on motivation.
      • Link HRH measures with good governance agenda
    • 24. Conclusions
      • Need for donor co-ordination and code of conduct
      • Medium term commitment (contract) with staff that is sponsored by donors for further studies/training
      • Allocation of study opportunities and study facilities at the decentralised level
      • Stronger focus on internal motivation
        • Ambition: career, further qualification
        • Professionalism and ethics
        • Altruism
    • 25.
      • Thank you very much
      • for your attention!
      • Comments!
      • Feedback! Questions?
    • 26. Open questions
      • Can motivation be improved “externally” (by financial or rather non-financial incentives), or is the willingness to perform and motivation ultimately an “intrinsic” predisposition?
      • Does the application of QM tools lead to personally internalised behavioural changes?
      • Are there other values and entry points within the local cultures on which to build upon?
    • 27. Motivational determinants Individual Organizational factors Cultural factors Cf. Franco et al. 2002 Goals, motives, values, self-efficacy, expectations HRM, structures, processes, communication, mission Cultural values, also regarding the patient-provider relation
    • 28. Ways to increase motivation Individual Organizational factors Cultural factors Financial incentives
    • 29. Ways to increase motivation Individual Organizational factors Cultural factors Financial incentives Non-financial incentives
    • 30. Ways to increase motivation Individual Organisational factors Cultural factors HR related Quality management tools Financial incentives Non-financial incentives
    • 31. Motivation and the role of non-financial incentives
      • Study objectives
      • Assessment of the role and effects of non-financial incentives and QM tools
      • Identification of potential approaches to improve motivation
    • 32.
      • “ Religion matters a lot. It makes you feel for the other” (nurse)
    • 33.
      • We have no motivation here, but we work (nurse, Mission hospital)
      • My motivation is on the higher side, after all, I do the work. Like most workers here. Not all here have gone. So you can say we are motivated (laughs) (doctor, Mission hospital)
      • High to very high. I still do my work, do what I have to do. After all I have signed my contract and I receive money for it. No-one has forced me to do that (doctor)
      • if everyone had a chance to go, everyone would go (nurse, 40 years, public)
      • Asked whether he wants to work in a city: No. The city life is too expensive for my salary. I want to establish myself in a rural area, open my own clinic (clinical officer, 33, public)
      • It has never been a serious thought for me. I don’t have the connections you need to go (nurse, 46 years, public) .
    • 34. Non- / financial incentives applied Survey findings in % N = 29 countries
    • 35. Management and QM tools: Staff supervision and recognition in % Survey findings N = 18 countries
    • 36. Management and QM tools: Staff surveys, leadership, disciplinary action Staff satisfaction surveys Some form of leadership & management training in % Disciplinary action enforced Survey findings N = 29 countries Clear formulation of expectations and org. goals
    • 37.
      • Low job satisfaction / low motivation
      • Push factor Poor
      • of migration performance
      • Staff retention Performance
      • improvement
      • What is the role of
      • non-financial incentives &
      • Quality Management tools?
    • 38. Multicountry study on motivation and incentives
      • Research aspects
      • Motivating factors, job satisfaction
      • Career / migration plans
      • Incentives and quality management tools
      • Project experiences
      • Objectives
      • => Assessment of the role and effects of non-financial
      • incentives and QM tools
      • => Identification of potential approaches to improve
      • motivation
    • 39. Reasons for ineffectiveness of incentive schemes
        • Insufficient package and thus low impact
        • Not performance-related, intransparent
        • Not effectively implemented, bureaucratic
        • Incentives have become an integral part of the benefit package
      Survey findings
    • 40. Motivation and the role of non-financial incentives
      • Empirical evidence:
      • Even with an adequate salary, health workers (HWs) may not be motivated.
      • Even without an adequate salary and under poor working conditions, there are motivated and performing HWs.
      • Common agreement on:
      • Non-financial incentives are an essential component to increase motivation.
    • 41. Motivation and the role of non-financial incentives
      • Empirical evidence:
      • Even with an adequate salary, health workers (HWs) may not be motivated.
      • Even without an adequate salary and under poor working conditions, there are motivated and performing HWs.
      • Common agreement on:
      • Non-financial incentives are an essential component to increase motivation.

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