Motivation

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  • Motivation

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

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