motivation
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TRANSCRIPT
Staff motivation: Staff motivation:
The impact of non-financial The impact of non-financial
incentives and Quality Management toolsincentives and Quality Management tools
M.L.PANDIA
Contents:
• GTZ‘s stake in HRH
• The link between (low) motivation and migration
• Some study findings
• Conclusions and need for further action
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
Low job satisfaction / low motivation
Push factor of migration
Poor performance
Low job satisfaction / low motivation
Push factor of migration
Poor performance
Performance improvement
Staff retention
Challenge
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
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
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
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
Multicountry study on motivation and incentives
Research aspects• Motivating factors• Career / migration plans• Quality management tools• Project experiences: what works, what doesn‘t?
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
Country study KenyaViews 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)
Country study KenyaViews 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)
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!
Non- / financial incentives applied
0
10
20
30
40
50
60
70
80
Survey findings
in %
N = 18 countries
Study
leaveTraining Awards Performance
related payBonus
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
Quality Management tools
0
10
20
30
40
50
60
70
80
MD
Nursesin %
Survey findings
N = 18 countries
Regular meetings
Regular supervision
Feedback Performance assessments
0
10
20
30
40
50
60
70
80
Staff satisfaction surveys
Leadership & management training
Disciplinary action enforced
Clear formulation of expectations and organizational goals
Survey findings
Quality Management tools
N = 18 countries
in %
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
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
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
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
Conclusions• There is no blueprint
Each region/facility needs its specific mix of incentives
• Working hypothesis seems to be confirmedMotivation 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
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
Thank you very much
for your attention!
Comments!
Feedback!Questions?
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?
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
Ways to increase motivation
Individual
Organizational factors
Cultural factors
Financial incentives
Ways to increase motivation
Individual
Organizational factors
Cultural factors
Financial incentives Non-financial incentives
Ways to increase motivation
Individual
Organisational factors
Cultural factors
HR related
Quality management
tools Financial incentives Non-financial incentives
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
• “Religion matters a lot. It makes you feel for the other” (nurse)
• 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).
Non- / financial incentives applied
0
10
20
30
40
50
60
70
80
90
Stu
dy
leave
Tra
inin
g
Aw
ard
s
Perf
orm
ance
rela
ted p
ay
Bonus
Survey findings
in %
N = 29 countries
Management and QM tools: Staff supervision and recognition
01020304050607080
Reg
ula
rm
eeti
ng
s
Reg
ula
rsu
per
visi
on
Fee
db
ack
Per
form
ance
asse
ssm
ents
MD
Nurses
in %
Survey findings
N = 18 countries
Management and QM tools:Staff surveys, leadership, disciplinary
action
0
10
20
30
40
50
60
70
80
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
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?
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
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
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.
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.