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ORIGINAL ARTICLE
Year : 2010  |  Volume : 19  |  Issue : 1  |  Page : 20-29  Table of Contents     

In depth analysis of motivational factors at work in the health industry


1 Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College, Ram Nagar, Banur, Punjab, India
2 Department of Management Studies, Punjabi University, Patiala, India
3 Department of Obstetrics and Gynaecology, Gian Sagar Medical College, Ram Nagar, Banur, Punjab, India
4 Department of Community Medicine, Gian Sagar Medical College, Ram Nagar, Banur, Punjab, India
5 Department of Biochemistry, Gian Sagar Medical College, Ram Nagar, Banur, Punjab, India
6 Director, Gian Sagar Nursing College, Ram Nagar, Banur, Punjab, India

Date of Web Publication16-Mar-2011

Correspondence Address:
Sukhminder Jit Singh Bajwa
House no 27-A, Ratan Nagar, Patiala, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-6748.77631

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   Abstract 

Background: Motivation of health workers is necessary to generate the organizational commitment towards the patients and the hospital and therefore the knowledge about what motivates and satisfies them is very essential.The aim of the project was to investigate and analyze the various factors that help in motivation of the health workers while performing their clinical duties in the hospital. Materials and Methods: A simple random study was conducted among 100 employees of our institute, which included doctors, staff nurses and paramedical staff. One hundred employees from Gian Sagar Institute were chosen randomly for the purpose of our study. All the employees were enquired by the questionnaire method as well as by individual interviews regarding the various motivating and demotivating factors at the work place. Detailed enquiries were performed regarding the various aspects concerning the job factors and work satisfaction. All the answers and findings were observed and recorded. Results: Statistical Analysis Used: Simple non-parametric tests like mean, percentages and chi square tests were employed to analyze the data.The demographic profile of all the employees showed only minor differences which were statistically non-significant. Skills, task identity, task significance, autonomy, feedback, environment, job security and compensation were observed to be the important factors for the motivation of employees. The depth and the extent to which these factors were studied at work in the hospital showed remarkable differences. Conclusion: All the factors studied in this project are essential basis for organizational commitment, but feedback represents the factor with the highest motivation potential especially among the younger population.

Keywords: Job satisfaction, motivation, organizational commitment


How to cite this article:
Bajwa S, Virdi SS, Bajwa SK, Ghai GK, Singh K, Rana CS, Singh J P, Raj S, Puri A. In depth analysis of motivational factors at work in the health industry. Ind Psychiatry J 2010;19:20-9

How to cite this URL:
Bajwa S, Virdi SS, Bajwa SK, Ghai GK, Singh K, Rana CS, Singh J P, Raj S, Puri A. In depth analysis of motivational factors at work in the health industry. Ind Psychiatry J [serial online] 2010 [cited 2018 Dec 10];19:20-9. Available from: http://www.industrialpsychiatry.org/text.asp?2010/19/1/20/77631


   Introduction Top


The clinician provides outpatient/inpatient and emergency services, which represent not only the basis for a hospital's success but are also an important and highly central aspect in the lives of health workers due to several reasons. First, the salary is the biggest incentive and reward for taking care of their day to day needs. Secondly, the satisfaction achieved while serving a patient or saving his life is a great performance enhancer. Thirdly, the hospital provides a platform for day to day social interaction as well as formation of various formal and informal groups. Fourthly, the tag of a health provider is often a source of rank, or status, in the society in general, especially for the medical fraternity who all are looked upon as noble humans.

Work can lead to a feeling of great satisfaction for many workers, but some still remain dissatisfied. Regarding the fact that health professionals spend a large part of their life, almost 40-45 years, in delivering medical services, it is important that these professionals experience positive feelings toward their tasks so that they can continuously remain motivated to provide quality health services. The pessimistic and negative thoughts and feeling arising from the work place disturb the social and family structure of a person who caries all these problems home. The doctors' and staff's feelings toward their work have a significant influence on their personal lives as well as on the quality of life for the patients and the image of the workplace.

The doctors, staff and paramedical staff are valuable resources that may contribute in several different ways to health care activities, provided that the workplace gives them an appropriate chance. [1] For the image of the hospital to acquire a good standing, a hospital needs employees who act toward the goals of the organization and have a strong desire to work dedicatedly in the organization. [2] These attributes are basically generated by a sense of concrete motivation. The quality of work is improved and a higher percentage of job satisfaction results from these motivating forces. [3] The effect the motivation has on work performance has been widely studied in recent times. [4] The best results in the work atmosphere are produced by individuals who are highly motivated.

The policy makers, management and the administrators must have deeper insights into the needs, desires and expectations of the employees so as to bring forth the changes essential to motivate the employees. Only then can one become an able manager and administrator. Moreover, the structure of the work and the employees' degree of satisfaction with the job are important in order to increase the actual motivation and satisfaction with their work. The strongest motivator is something that people value, but lack. [5]

The health industry is a very vast branch, and to study the motivational factors at work prevalent in this industry is just like finding the pearls from the sea bed. Still, we have made an attempt to study motivational factors present in our hospital. In a hospital setting, where, everyday, hundreds of patients are being treated, a multitude of challenges are posed in precise data collection as there will be a lot of variations in the different departments in lieu of dealing with the patients. Some doctors will be attending the patients in the outpatient department (OPD) while others will be attending to them in the wards. Still others will be treating them in the emergency and operation theatres as well as in intensive care units, which always pose a very challenging situation not just for the doctors but also for other supporting staff as well, like the nurses and the paramedical staff. The essential factors for motivation, present quite a variable degree of their existence among the employees of different strata.

Doctors are supposed to be dealing with the human life with the utmost care and in the most perfect manner, and the same is expected from the supporting staff as well to some extent. Unless and until these health care workers are fully motivated, how you one expect good results. The human life is invaluable and one has to be very motivated to deal with such delicate aspects while taking care of the disease process. Lack of motivation at any level of this health profession hierarchy can affect the life of the patient to any extent, thereby increasing the mortality as well as morbidity. Motivation has to be present in its fullest form if one wants 100% results in patient care.

There are hardly any studies about motivational factors at work in any hospital attached to a medical college. The one big reason is that a human resource student is not well versed with the medical terms and the importance of various procedures being carried out on the patients if he or she is not a medico at the same time. Secondly, to have an access to the mentality of the doctors and to understand their point of view is not an easy job as far as a non-medico student is concerned. Thirdly, it is a much unexplored territory and, therefore, framing of questions and their pattern also pose a challenge for the student. Being a specialist doctor in clinical sciences as well as an MBA degree holder in human resource management, the author has tried his level best at least to start a pioneer study in his hospital with an underlying aim for the betterment of patients and health workers in particular and the society as a whole.

In our institute (Gian Sagar Medical College and Hospital), we carried out a study to analyze the various motivational factors at work with an aim to:

  • know the various motivational and demotivating factors in the health industry,
  • find out the most critical factors for motivation and job satisfaction among doctors and medical personals,
  • find out the extent and degree to which these factors are present in our hospital and
  • find out the importance of these factors for the employees.



   Materials and Methods Top


The identification of the objective is the basic step in the research process. It is well said that, "A objective well defined is half solved." The objective in our study was "to analyze the various motivational factors for employees and the importance and the extent to which they are present at Gian Sagar Medical College and Hospital."

The consent for the study was obtained from the ethical committee of the institution. The research design for this project was descriptive research design, as descriptive studies attempt to obtain a complete and accurate description of the situation. The sampling design used in this project was quota sampling, as the sample of the employees for the survey was selected from the organization from different quotas. For the present research, we randomly chose doctors, staff nurses and paramedical staff of various units like the Emergency Ward, Intensive Care Unit (ICU), Operation Theatre personnel, General Ward, Out Patient Department, etc. Among the doctors, we randomly involved 10 Associate Professors, 10 Assistant Professors, 10 Senior Residents and 10 Junior Residents of different departments. Among 40 nurses, all senior and junior staff were involved and, similarly, 20 paramedical staff personnel were included in this research study [Table 1].
Table 1: Demographic profile of the subjects

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An exploratory qualitative research was carried out among health workers (doctors/staff nurses/paramedical staff) in Gian Sagar Medical College and Hospital so as to identify the entry points for developing strategies that improve their performance in the hospital. The study aimed to determine the major motivating factors, and it is the first in Gian Sagar that looks at health workers' job perception and motivation.

We investigated the following aspects of work motivation in the health sector:

  1. perceptions on what motivates and demotivates health workers,
  2. perceptions of health workers on Human Resource Management (HRM) tools. The perception on the following HRM tools and their use was explored during the interviews and questionnaire:
    • salaries, incentives and allowances
    • communication, cooperation and relationship among colleagues
    • performance and potential appraisal
    • continuing training, medical education and career development
    • promotion policy
    • working conditions and environment
    • other activities to retain staff (e.g., provision of homes at a subsidized cost).
  3. perceptions of the community (patients and their attendants) about health workers,
    • treatment and advice received
    • staff attitude during consultations
    • criteria for a "good health worker"
    • overall performance of health workers and ways for improvement
    • current methods used by the community to show appreciation
    • suggestions for community methods to influence staff performance and staff motivation


Thereafter, the answers of the respondents were analyzed by using the mean. Thereby, certain subgroups such as age, gender, marital status of the respondents, the work area (doctors/paramedical staff), the position (leading/non-leading position) and the years a person has been working in the hospital represented the basis for the analysis. The data was arranged systematically and analyzed using non-parametric tests. A P-value <0.05 was considered significant.


   Results Top


The demographic profile of the subject with respect to age and gender did not show much difference. The study sample constituted of 40 doctors, 40 staff nurses and 20 paramedical staff persons.

The questions asked in the questionnaire were clustered into eight factors, which are according to the literature research critical factors for the motivation and job satisfaction. These are clinical skills, clinical task identity, significance of clinical task, decision making, feedback, working environment, job security and compensation (salaries and allowances). The questions regarding the benefits provided by the Hospital and Medical College were divided into four groups - benefit, food, housing and work.

Age

As is evident from [Figure 1], in our study, older people seem to receive greater job satisfaction out of the intrinsic motivation factors than younger people who lack those internal motivators to a higher extent.
Figure 1: Work situation and satisfaction with the work regarding the age (mean)

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When the responses in terms of the work situation and satisfaction were analyzed according to three age groups (≤30, 31-45 and ≥46), weak differences were found, which were statistically insignificant (P=0.34). In terms of skills, task identity, task significance, autonomy, feedback and environment, a tendency of increasing satisfaction with the job with increasing age of the employees can be noticed. Thereby, the differences regarding skills, task significance and autonomy are weak (P=0.16).

As is clearly evident from [Figure 2], in terms of the importance attached to the job features examined in the questionnaire - skills, task identity, task significance, autonomy, feedback, environment, job security and compensation - no strong or weak differences among the age groups could be noticed in our study (P=0.41).
Figure 2: Importance of job factors regarding the age (mean)

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Gender

[Figure 3] clearly highlights the fact that, in our study, women evaluated the job factors higher than men, which was statistically significant (P=0.032), except for task identity and feedback, which are evaluated higher by men, but are statistically non-significant (P=0.26).
Figure 3: Work situation and satisfaction with the work regarding the gender (mean)

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As is shown in [Figure 4], women always attached greater importance to the respective job features than did men. However, differences were statistically non-significant (P=0.38).
Figure 4: Importance of job factors regarding the gender (mean)

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Marital status

As is evident from [Figure 5], the responses in terms of the situation at work and the satisfaction with work, analyzed regarding the marital status, showed that married people evaluated the job factors higher than unmarried, which was statistically insignificant (P = 0.18).
Figure 5: Work situation and satisfaction with the work regarding the marital status (mean)

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[Figure 6] shows the higher evaluation of the job factors by married persons, which, on statistical analysis, was found to be insignificant (P = 0.084).
Figure 6: Importance of job factors regarding the marital status (mean)

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Doctors/paramedical staff

[Figure 7] from our study shows a clear tendency that the paramedical staff was more satisfied and perceived all investigated job factors to a higher extent than did doctors, which was statistically significant (P = 0.026). In particular, weak differences were noticed in skills, task identity, task significance and autonomy.
Figure 7: Work situation and satisfaction with the work of doctors/other staff (mean)

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[Figure 8] data from our study shows that in terms of the importance attached to the job features examined in the questionnaire, no differences between doctors and paramedical staff could be noticed (P = 0.096).
Figure 8: Importance of job factors regarding doctors/other staff (mean)

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Leading/non-leading position

[Figure 9] clearly depicts the data of our study, showing that leading persons evaluated all factors of the job higher than did non-leading persons, which was statistically significant (P = 0.014).
Figure 9: Work situation and satisfaction with the work regarding leading/non-leading position (mean)

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The data in [Figure 10] imbibed from our study conveys that with respect to intrinsic job factors in the actual work situation, as far as position is concerned, leading persons always perceive skill variety, task identity and task significance (in short, all the factors influencing the experienced meaningfulness of work) to a higher extent than do non-leading persons, which, on statistical comparison, was found to be significant (P = 0.0225).
Figure 10: Importance of job factors regarding leading and non-leading position (mean)

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Years in the hospital

[Figure 11] shows that when the responses were analyzed with regard to the years people have been working in the hospital, some interesting findings were noted. After more than 5 years, a sharp increase in the satisfaction of employees can be recognized in terms of using a variety of skills, task identity and the meaningfulness and interest of the job, which turned out to be statistically significant (P = 0.016).
Figure 11: Work situation and satisfaction with the work regarding the years in the hospital (mean)

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From [Figure 12], it is evident that in terms of the importance attributed to the job factors that are examined in that study, no differences except for skills and the environment can be noticed, which was non-significant on statistical comparison (P = 0.112).
Figure 12: Importance of job factors regarding the years in the hospital (mean)

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   Discussion Top


The job characteristics model developed by Hackman and Oldham combines various features of different motivational theories. [ 6] The intrinsic motivation forms the basis of this model, which encourages an individual to perform the job well due to interests on the work and challenges in the job. We have adopted this model for the research carried out in our hospital.

The organizational environment is hugely responsible for influencing the motivation of its employees. [7],[8] Research into the subject of motivation throws light on the fact about the actions and thought process of the individuals. [9],[10],[11] A simple definition of motivation may state that "motivation is a process that triggers individuals to act as they do." [12] The intense drive within an individual that directs that person to perform his or her duties in a goal-directed behaviour signifies motivation. [13] The entire process of motivational behavior is a very complex phenomenon. [14] The motives do change over time and, sometimes, present a very conflicting situation to the individuals. [15],[16] In other words, an individual performs a task in order to achieve certain types of internal states, which he/she experiences as rewarding. [17],[18] Various theories and tasks have concluded that the intrinsic state and factors are responsible for motivating the employees in an organization. [19],[20],[21],[22]

There are different degrees of motivation present in the employees of our hospital depending on various attributes. The differences in age aspect may be due to the fact that older people had more experience and as a result got a promotion within the hospital. For instance, in the operation theatre, young people start in preparing the patient for surgery and get more advanced surgical procedure to do later on. "People get more responsibility and difficult tasks with the age" and it is sometimes very necessary when we are dealing with human life.

The strong differences as far as marital status is concerned arose because married persons have a high responsibility and commitment toward family. The increased security in job and opportunities for climbing the ladder of hierarchy is what makes them more satisfied. They are working with few facts in minds, like cessation of money flow once they lose the job and have to move their entire family to new places, with the additional burden of changing schools for their kids. In contrast, single persons have to think only about themselves as they are free to move and they do think that they can settle at any place.

The feedback about one's own performance does lead to an increase in the motivation level of health workers and instils in them a feeling of satisfaction toward their job. Moreover, regarding doctors, increases in the use of a variety of skills as well as in the task significance would contribute to a higher experienced meaningfulness of the work, which would consequently lead to higher satisfaction with the job, work effectiveness and to a higher internal motivation and ultimately leading to healthy working atmosphere.

The position a person holds in the hospital also enlightens some facts about the motivation, as individuals in leading positions have a broader work area and a higher responsibility, which in turn leads to the necessity to use a variety of skills and to perform a work from beginning to end. These features make the work more interesting and meaningful, and the people with a leading position enjoy a higher autonomy.

When a person is associated with the hospital for a longer time, his/her skills are used more frequently. This is true all over the hospitals, including the emergency and operation theater areas. With increasing years in the hospital, the persons get more tasks, are able to do more things by themselves and may perceive his/her job as more meaningful and interesting.

There was no significant difference on comparison of skills, task identity and task significance on the basis of years in hospital, especially up to 3-5 years. These people experienced the meaningfulness of the work, motivation and job satisfaction to the same extent. Persons who have been working in the hospital for more than 5 years experienced these three dimensions, to a weak extent, higher than that experienced by the other employees. In other words, they experienced their jobs as more meaningful. The facts that were related to skills indicated that persons who have been working a long time and will/maybe getting retired in a couple of years know their work very well and, may be, do not like to learn new things or to get more tasks to perform.

Job security was evaluated to be highest, with a mean of 4.5 compared with the other seven factors concerning the work situation and satisfaction. In other words, information about the patient figures and how the reputation and response goes are given to the employees during their monthly hospital meeting. The employees are apprised of how the management is concerned with the present facts.

As far as autonomy is concerned, it was found that some people want to be told what to do and/or do not like to tell other people to do something. For instance, some time ago, the hospital used to have one person responsible for the operation theaters, one for the ICU, one in charge of emergency and so on. That person was the coordinator, who had some overview about the work. It was intended to rotate that job in order that everybody has that job. However, it turned out to be quite difficult to get one of the persons to perform the job.

We found that rating of environment was very important, which is evident from the thinking of employees who wanted to have a good relationship with their coworkers, to be able to talk about something else other than the work sometimes, to have fun together and not just to work. In addition, it was argued that the employees depend mostly on their coworkers and spend more time with them at work than with their families, sometimes more than 48 h a week. Therefore, it is important to feel comfortable with work colleagues, no matter the type of work. Because people spend so many hours a day and so many days of their lives at work, the work conditions are important in order to feel comfortable.

In addition, the hospital is very secure, offers a lot of benefits and has quite a good reputation, particularly for the good environment in patient handling and advent of super specialities. It is a big and leading hospital - getting famous all over the northern part of the country, as stated by quite a few of the respondents.

Some other hospitals are in the same area where the same skills are needed. However, they are not a big threat. Today, some of them reduce employees due to the prevailing economic recession. In such times, people do not look for a new job because the last employed person is the first to go if there are reductions, according to the law. However, when that person has a special skill and demand is high, the hospital can keep him/her.

Furthermore, there are two bigger cities (Chandigarh and Patiala) in the near vicinity. Chandigarh is not a big threat as the city itself has a lesser number of hospitals, and is already overloaded. However, there are very good connections to Patiala but, even there, world class infrastructure and equipment to deal with complicated cases and that of superspeciality are not adequate.

Limitations

Motivation is a very broad subject, and the research is quite extensive if one has to go deeper into the subject. There is a wide range of theories on what motivates people (content theories) as well as theories that try to describe how behavior is initiated, directed and sustained (process theories). However, we basically restricted ourselves to the content theories, which identify the specific needs and are responsible for creating and directing the human behavior.

Age, gender, marital status, work area, position and the years a person has been working in the hospital were considered as individual characteristics and were examined in this study. In addition, in this project, no distinctions were drawn between doctors, nurses and paramedical staff in terms of the role-play in motivation. This means that the word "employee" includes doctors as well as all the other persons working in the hospital.

Other constraints prevalent during the conduction of research process and compiling of the results included:

  • Time constraint: As I had to perform my professional duties, teaching work and other miscellaneous work of the hospital, I hardly got time for extensive research to cover the wider aspects related to the topic of the study.
  • Cost constraint: Because the study was of a very personal nature, it could not be funded by the Hospital and College.
  • Private hospital: As Gian Sagar Medical College and Hospital is a private establishment, it cannot be considered as the true representative of the entire health sector because in the government set up, these research factors may acquire an altogether different proportion in terms of outcome of such study.

   Summary and Conclusions Top


As the strongest motivators seem to be things that people value but lack, the following motivators can be identified in order to increase the internal motivation and job satisfaction for the respective subgroups:

  • The strongest motivator regarding all subgroups is the feedback. This is an important factor for all the age groups and positions in the health industry.
  • The fulfilment, to a certain extent, of compensation and environment provides the basis for taking advantage of challenges in the job and to reduce job dissatisfaction.
  • All the factors studied in this project are essential basis for organizational commitment.
  • The intrinsic factors influence a person's willingness to expend considerable efforts toward the goals of the hospital and to remain in the hospital (attitudinal commitment) while the extrinsic factors, on the other hand, may contribute to the behavioral commitment.
  • Factors external to the work situation, such as the economic situation, mobility, family and other opportunities, may influence an individual's desire to stay in the hospital (behavioral commitment) as well.
Recommendations and future research

Motivation is a continual process and needs to be sustained and developed as individual and organizational factors change over time. It may be of interest to have a continuous view of what motivates the employees and provides them with satisfaction. Furthermore, it may be interesting to compare the received results with identical surveys performed in the other larger hospitals. Unfortunately, such data is not accessible and, therefore, it may be recommended to perform a new survey every second year in order to determine the degree of job satisfaction and to figure out the factors that are valued and lacked by the respective subgroups. A comparison of the surveys may provide the hospital with useful information about the success/failure of changes regarding the work and the development in the job satisfaction of the employees. The essentiality of such surveys is based on the one basic fact, which is the betterment of the health delivery system in the hospital industry.

 
   References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]
 
 
    Tables

  [Table 1]

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