Module Title ORGANIZATIONAL BEHAVIOR

Module Leader Mr. Papaconstantinou

Assignment Title Motivation in Public Health Sector

Student Name Aleksandar Atanasov

Word count:
3273

Contents

Module Title............................................................................................................ 1 ORGANIZATIONAL BEHAVIOR..................................................................................1 Module Leader........................................................................................................1 Mr. Papaconstantinou.............................................................................................1 Assignment Title.....................................................................................................1 Motivation in Public Health Sector..........................................................................1 Student Name ....................................................................................................... 1 Aleksandar Atanasov..............................................................................................1 Word count:............................................................................................................ 1 Contents................................................................................................................. 2 Abstract.................................................................................................................. 3 Introduction............................................................................................................ 4 Literature review ................................................................................................... 5 Motivation in Health Organizations.........................................................................9 ...................................................................................................................11 Identifying a problem ..........................................................................................11 Reference List......................................................................................................14

Abstract As in the all areas in the public sector, the employees of the public health sector face difficulties with the old paradigm of working, especially the employees in the emergency health care service and the biochemical laboratory. There is an attempt to implement some new strategies and methods of work but without much success, because of the lack of motivation of the fully employed workers especially those who are at the maturity of their work age. The given literature provides various examples and solutions of different approaches in order to achieve motivation among employees in the public health sector, focusing on intrinsic and extrinsic factors which are important motivation incentives. The security of the regular pay-check of the fully employed workers and the knowledge that they are not obligated to put their best effort in order to provide best service makes them not willing to try, learn and provide effective and efficient service to their patients.

As opposite to the fully employed workers, the volunteers drive for learning and spending extra working hours in the laboratory is based on their motivation to acquire the knowledge and the practice needed, which would lead to acquiring the preferred job position.

Introduction JZU Zdravstven Dom Gevgelija is a public Health Organization for Preventive health care situated in the south east of Macedonia. Its run and owned 100 % by the state. The mission of the company is to give preventive Health care to the population of the south east part of the country, namely for 40.000 people. It operates and it is responsible for three neighboring municipalities, with a main building and leading units along with administration office located in Gevgelija, a town placed at the Macedonian border with Greece. There are several separated units for preventive health care, namely for children operated by the organization. Apart from the preventive health care departments for children, the organization also poses the emergency health care service and a biochemical Laboratory. The organization employs 75 people which are fully employed and fully paid, and 25 workers as a volunteers who work shoulder to shoulder with the others but are less paid, and they receive only 20% of the average national salary. 70 % of the fully employed are medical workers and the other 30 % are administration and maintainer staff. In the recent years Macedonian Health system has faced continuous undergoing changes, which were driven from the simple reason to improve health care quality across the state and to change the inherited feeling of dissatisfaction among the citizens towards more satisfied and more secured ones. Mainly the changes have been focused on the public providers to deliver more and improved health services through the existing human resource. The installment in of new and sophisticated equipment practically affected the previous organizational structure. In the course of structuring,
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large health organizations have been transforming into a few smaller and supposedly better organized and more efficient ones. Many small and new health organizations have raised out of the large entities. The complexities of the system have become even higher with the appearance of so many health entities, which on one hand are competing for patients but on the other hand in particular situations are avoiding patients and avoiding the responsibilities with the claim that they refer to another entity in the system. Even though many reforms have been introduced so far, not much has been done on the employees training, recruitment and retention which are one of the primary parts of the chain, because without proper settings on them no reforms will succeed or will produce the preferred outcome. Health care service is highly labor intensive, it is based primarily on doctors approach and examination. The quality of service they provide can be measured through their willingness and efficiency of delivering the aid. Not motivated doctors lead to insufficient delivery of aid, week utilization of available resources and above all week health system performance. So when changes happened, health workers faced emerging pressure from their internal and external environment, since there is an increase demand for their services as well as a bigger expectation from them. They had to meet all these demands with fewer resources. All of these go to the emerging question which I will try to answer using literature in the following text. What factors can really motivate employees in the face of increased external and internal demands, on the whole when they are being asked to meet these demands with fewer resources? Motivation issue and the improvement of performance was always a difficult task to be achieved in public sector especially in the health care sector. Literature review Work motivation is one of the most explored topics in the field of management and psychology over recent decades. The biggest challenge
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that concerns improving organizational effectiveness and productivity for any type of organization (private or public) is the work motivation, described as a and meeting point between and corporate objectives for for effectiveness productivity employees needs reward,

satisfaction. Motivation theories for employees arrived from the field of Human resource Management and Organizational Behavior, where they utilize individuals needs and its satisfaction for different areas as foundation for work motivation theory. Those individuals needs are often described as being Intrinsic or extrinsic in nature. Also motivation can be distinct as the processes that depend on an individuals intensity, direction and persistence of effort toward reaching a goal. In most cases motivation comes out from a need which must be fulfilled, and this in turn leads to a certain behavior. Fulfillment of needs outcomes in some type of reward, which turns out to be either intrinsic or extrinsic. Lambrou et al. (2010) On the same filed but underlining more the public sector. Expressed through to findings done by Giauque and Ritz (2010) on Swiss public employees, employed in the large municipals. They found out that, Public Service Motivation is strongly connected with positive intrinsic factors such as supportive work environment through good recognition from the colleagues and superiors as well as good relations with them, which are good predictors for work motivation. But at the same time they stress that material incentives or extrinsic work factors are poor predictors of work motivation. This study provided data for Swiss Public Sector that high payment or other extrinsic factors play little or no role for motivating the work force to perform better under these motivational factors. Also these authors suggest public sector organizations to be more concentrated and focused to the intrinsic motivational factors rather to the other factors. Organizations should provide favorable atmosphere to the

employees through better relationship between employees and good recognition from the colleagues and superiors. According to me, this findings and theory has big limitation and cannot guide the organizations to use as a practice to motivate its work force. Since Organizations are living organism which are structured from people with different characters. It is very hard or same times impossible to achieve favorable work environment in context of good personal relationship between employees. People are born individuals and they interact in many different ways. So concentrating only on intrinsic motivational factors is wrong and same times cannot be achieved. There is a trend and tendency in many European Countries where reforms are undertaken in the public sector. The Government or the public sector organization imposed many extrinsic incentives such as pay for performance which were found to be more effective and countable. There is also general opinion that many people are attracted to Public Sector only because they can gain stability payment and good working conditions for less working and lower responsibility than in private sector. They expect to work little but to be secured by the unions for equal or higher payment than in the private sector. On the other hand workers who contribute more on the work place are hardly recognized and in many occupations they cannot be compensated fairly for their extra contribution. This problem is identified by Carrigan (2011) where he underlines the need of imposing clear fair and streak roles in the working place, the ones installed should posse stick sanctions for under performers and reward for those who make it above. They have to work enough to keep what they currently have, and one must work harder in order to gain more. This is the way it should be in the workplace. (p.58) Georgellis et al (2010) From many motivational factors that can be identified in the public sector, starting from self-interest to ethics and roles, we can find broad definition
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that tries to incorporate all these elements through the description from Heckhausen (1991) who stressed out that public service motivation is defined as the belief, values and attitudes that go beyond self-interest and organizational interest, that concern the interest of a large political entity and that motivate individuals to act accordingly whenever appropriate. Addressing the same issues research conducted by the Vandenabeele (2007), found out that public service motivation originates from within an institution, since public servicemen has absorbed certain public services values in his own. A research done on exploring goal and social cognitive theories in the public sector found out ,that importance of public sector organizational goals have a positive effect on work motivation through its influence on the importance of job goals. When the employees recognize its work contribution as a very important towards achieving organizational goals, they more likely perceived their work as meaningful, Whright (2001) which can be a very significant motivation factor for individuals to attain or to retain in the public sector. Also other authors findings suggest that salaries, job security and working hours are not significant enough to attract the individuals to attain to the public sector or they exert a negative effect. On the other side satisfaction with intrinsic rewards increases the probability for shifting individuals to the sector. Their finding suggested that public sector employees are motivated and attracted to public sector jobs primarily of a higher satisfaction with the nature of the work itself, because public sector offers higher opportunities for pro-social or altruistic behaviors. Georgelis et al (2010) But these theories refer to the broad view on the public sector in the developed countries were the public organizational reforms are in their maturity phase. In the less developed countries, and also recently in some developed countries, public organization tend to be seen through the extrinsic side, because they provide stable and fair salary compared to the
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private sector economical crises.

in this uncertain economical environment facing a

Also its worth to mention that technical people involved in the public sector such as IT technicians, electricians, maintenance staff and others are significantly motivated by the task and by the intrinsic factors as driving force towards better outcome. This is in a line with Amabile et al. (1996) who have established a positive relationship between challenging work and performance, Also Alpert (1992) has stressed the important role of work environment to enable opportunities for creativity for technical employees as intrinsic factor. However, in the research done by the Manolooulos (2008) for the extended Public sectors it appears that technical staff employed in public utilities is more dependable on extrinsic motivational factors such as many compositions to enhance their performance. Motivation in Health Organizations Motivated health work force is one of the several most important crucial elements for providing quality health care service through the public health system. We can have the best facilities in the world and newest equipment but without a motivated work force, the provided service is not going to be good enough. Let us start from the basics: motivated and satisfied health workers run and spend more energy actively towards their patients, which in the eye of patients is perceived as very pleasant and favorable, they fill secured and satisfied since there is someone who really cares for them, and that makes huge difference about the provided and perceived service. Since health service is executed through motivated workers, the patient mostly positions the service very high in terms of quality. On the top of that, health employees who just have simple smile on their face and feel motivated and satisfied with their work create patients experience in the health facility to be less painful and encouraging. For these reasons I place motivation issue right on the top of the Health care field, as a significant force that plays very important role in improving health care service.
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According to the recent study done by Lambrou, P. et al (2010) on motivation and job satisfaction among medical and nursing staff in a Cyprus public general hospital, with a decent sample of 300 respondents, motivation on health workers was influenced by both financial and nonfinancial incentives The intrinsic factors were presented, as leading and very significant, through the need of achievement expressed in the questionnaire distributed among male and female health workers. Right behind achievement health workers stress out that remuneration is the second most important motivational factor. Surprisingly they found out that only accident and emergency outpatient doctors were mostly affected by the remuneration motivational factors. This outcome refers to the possible explanation that this type of doctors category works under a rotational shift system, and the additional income may be a way of overcoming their potential frustration. But all above it refers to the fact that in general Health care professionals tend to be motivated more by intrinsic factors, meaning that this should be a target for effective employee motivation. In accordance to the above, survey done by Shattuck, M. et al (2008) pointed out that financial incentives alone are not enough to motivate health workers. They reveal that recognition can play a very influential role in health worker motivation as well as adequate resources and appropriate infrastructure which are also important. At the same context Peters, D. et al (2010) argue that managers in the public health organizations should pay more attention on the importance of locally assessing conditions and to run the incentives in a proper way which will lead to a better motivated work force in their health organization. Other issue that has to be managed by health managers and policy makers is the distribution of health service among population, in many countries they face with motivational issue of allocating the existing doctors to the rural and less populated areas. Since there are missing intrinsically motivated factors and the altruistic attitudes are not strong enough . Empowered extrinsic incentives may overcome the lack of doctors motivation towards serving patients in rural

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areas

with week working conditions and with no space for carrier

achievement. Bloom, D (2009)

Identifying a problem I found a serious motivational issue among fully employed employees and volunteers in the whole organization, but especially noticeable in the emergency health care service and in the biochemical laboratory. In the case of emergency health care service, the medical staff aside from their core services they execute, they used to perform additional activities in the past such as securing with medical cover football matches, tourist locations and other public events, mostly for getting additional money incentive. But with the recent changes in the public sector, the salary increased for 20 % and all the additional activities which were previously separately paid, now are included in the basic salary since they are executed during the regular eight working hours. On the other hand with the introduction of volunteers in this service unit, apart from the regular work, all the extra work was transformed directly to the voluntaries. Volunteers receive far less money than the fully employed employees, but they accept all responsibilities and tasks in order to seriously fulfill the job that is given to them. Demographically they are young and highly educated people with little experience who have just graduated from their school, and are looking for jobs and careers. The fact that they have just graduated and have no experience but they are allowed to work in a job which complement with their education, it comes out to be very motivating thing, from the point out that they can gain good experience through the job itself, which is fundamental for their future career and for the rising opportunity to be fully employed in public health Organization. Also the
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process for full recruitment in the public health sector especially for the medical staff requires fulfillment of legal obligations such as 2 years of medical practice for a license that enables them to apply for the free jobs in the private or in public sector. Since they have volunteered in the public sector they have far more chance to be selected for the job position than the other candidates. Al of these arguments draw the conclusion that volunteers compared to the fully employed workers tend to be more motivated in performing additional job activates, mainly to the opportunity to win one day to be fully employed. The same goes to the case of biochemical laboratory where volunteers are young, highly educated and very promising people compared to the fully employed employees who are in their maturity working stage. The second ones try to complete their work as quick as possible without desire of getting deeper in the work, they dont have the ambition for training and earning more additional knowledge, or more specifically to develop further their skills, to facilitate the work on the new sophisticated equipment, older age, as which requires Basic English and basic computer skills. Mainly due to their disadvantage of not knowing English and computers, their well as their lovely old working habit of performing repetitive, less responsible and simple tasks on the daily bases, which significantly contributes them being skeptical towards more complex tasks and to avoid changes as much as possible. On the other hand volunteers tend to perform highly opposite then the fully employed. They are trying to utilize every chance of gaining additional knowledge, they dont avoid and they are not scared of complex tasks and above all they put very little resistance to working additional hours on more demanding and complex biochemical analysis. Further more about money compensation fully employed workers receive regular salary which is standardized across the country and it refers to the employees educational degree, job position and working ages. All the completed biochemical analysis which are done during the daily eight
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working hours goes to the basic salary , the additional more demanding and more complex biochemical analysis where the work demands and sometimes exceeds the regular eight working hours, are tend to be laboratory can really

separately paid from the basic salary as a additional reward, but this reward are only executed when the chief of the because sometimes justify the extra spent working hours in terms of quantity and complexity , they are spent due to the lack of efficient daily organization. Realizing that the complex biochemical analysis are not always paid, they are transferred directly to the volunteers who accept them easily and who dont mind leaving late from the laboratory, since they can gain access to learn more on the new sophisticated equipment which brings additional value to their current experience and at the same time increase their references list as a strong indicator for their future employment. 3. Conclusion Motivating public health workers is very challenging and demanding task, it requires broad and multy angular approach of satisfying heath workers needs, and dealing with constraints from organizational resources and the external demand . Motivation issue Is primarily addressed to the intrinsic and extrinsic factors of motivation, most of the mentioned readings in this essay point out that intrinsic factors are playing a dominate role over extrinsic factors. They found out that medical workers are more concern over recognition from the organization and the society, easy and fair carrier development path, empowerment for leading and making important decisions, than other factors of motivation such as job security, income and favorable work conditions. But other fraction of authors indicated that not only intrinsic factors really matters, that booth intrinsic and extrinsic factors and not one of them can be excluded, or placed oboe the other one. Regarding to the motivation issues identified above in the presented organization, using the argument and the findings from the listed authors, it appears that motivational differences that came out from the analyzed organizational units from the booth groups, can be explained through the
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demographics characteristics referring to the full employed health workers, where the age, play important role as well as with the intrinsic factors. The missing approach of the managers to apply recognition incentives and identify performers over underperformers is hidden problem that do not motivate and do not push the medical workers. Extrinsic motivational factors such as additional bonuses will also affect motivation positively, but due to legal framework little can be done by health managers to run with these incentives.

Reference List Alpert, M. (1992) The Care and Feeding of Engineers. Fortune,126 (6), pp. 87 95. Amabile, T. et al (1996) Assessing the Work Environment for Creativity. Academy of Management Journal, 39 (5), pp.11541184. Barnighausen , T. Bloom, D. (2008) Designing financial incentive programs for return of medical service in underserved areas : seven management functions .Human resources for health.[online] Available from : http://www.human-resources-health.com/content/7/1/52 /[Accessed 18th December 2011].
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Carrigan , M. (2011) Motivation In Public Sector Unionized Organizations .Journal of Business & Economics Research , 9 (1), pp.55-60. Georgellis, Y. et al (2010) Crowding Out Intrinsic Motivation in the Public Sector. Journal of Public Administration Research of Theory, 1 (21), pp.473493. Giauque , D. Ritz, A. (2010) Motivating employees of the public sector: does public service motivation matter. International Public Management Journal, 13(3), pp.213-246. Heckhausen, H. (1991) Motivation and Action, Berlin: Springer-Verlag. Citied in : Vandenabeele , W. (2007) Toward a public administration theory of public service motivation: an institutional approach. Public Management Institute Katholike Universiteit Leuven, 9 (4), pp.545-556. Manolopoulos , D. (2008) Work motivation in the Hellenic extended public sector : an empirical investigation. The International Journal of Human Resource Management, 19 (9), pp.1738-1762. Peters ,D. et al (2009) Job satisfaction and motivation of health workers in public and private sectors: cross-sectional analysis from two Indian states. Human resources for health.[online] Available from : http://www.humanresources-health.com/content/8/1/27 /[Accessed 18th December 2011]. Shattuck, M. et al (2008) Motivation and retention of health workers in developing countries : a systematic review. BioMed Central Ltd. [online] Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2612662/ / [Accessed 18th December 2011].

Stringhini , S. et al (2009) Understanding informal payments in health care : motivation of health workers in Tanzania .Human resources for health.[online] Available from : http://www.human-resourceshealth.com/content/7/1/53 /[Accessed 18th December 2011]. Vandenabeele , W. (2007) Toward a public administration theory of public service motivation: an institutional approach. Public Management Institute Katholike Universiteit Leuven, 9 (4), pp.545-556. Wright , B. (2001) Work motivation in the public sector : an application of goal and social cognitive theories. Department of Public Administration & Policy University at Albany (SUNY), 1 (1), pp.1-38.

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