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Health services management

Health Services Management

Motivation Theories and Practice

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The art of management involves creating the conditions that are most conducive to motivating individuals. People ultimately react in a motivated way based on their own internal needs, aspirations, and self-images. Effective managers are able to tap into those internal processes through the relationships they build with employees and the way they shape the work environment (Kreitner, 1995).

Work motivation is one of the most studied issues in the management literature. The fact that motivation has been addressed so often suggests that it is a key element to the success of an organization. It also reveals the lack of consensus on what truly motivates people (Kreitner, 1995).

There are several theories on motivation, which include both content and process theories. Content theories focus largely on needs and need deficiencies that are motivated by an internal drive, they include Maslow's Needs Hierarchy, Clayton Alderfer's ERG Theory, Herzberg's Two Factor Theory and McClelland's Learned Need Theory. Process theories of motivation look at what people are thinking about when they decide whether or not to put effort into a particular activity, theses theories include Expectancy Theory, Equity Theory, Reinforcement Theory and Goal Setting Theory (Shortell S.M.& Kaluzny A.D. 2000). cal1966, please do not redistribute this work. We work very hard to create this website, and we trust our visitors to respect it for the good of other students. Please, do not circulate this work elsewhere on the internet. Anybody found doing so will be permanently banned.

A number of issues can effect the motivation of employees as illustrated by an ICU nurse's account in the article "A Cry for Help" from Shortell and Kalunzny's book Health Care Management Organisation and Behavior. Lack of recognition, unpredictable job security, exhaustion and depleting team sprit coupled with insufficient rewards all contributed to the ICU nurses' diminishing job satisfaction and motivation.

During the course of this paper I will focus on both content and process theories of motivation and how they relate to the issues raised in the article "A Cry for Help". Furthermore, I will make recommendations for management intervention based on the issues raised and theories explored.

The Issues, Theories and Recommendations. This work from coursework.info

Motivation can be defined as a concept used to describe the factors within an individual that arouse, maintain and channel behaviour towards a goal (McSweeny F.K. & Swindell S. 1999). Since it is part of a manager's job to get their work done through others, managers need to understand why people do things and what motivates them in order to convince their employees to work towards the goals of the organisation (Kreitner, 1995).

Maslow's theory states that individuals are motivated to satisfy a number of different kinds of needs, some of which are more powerful than others. Maslow argues that until these most pressing needs are satisfied, other needs have little effect on an individual's behaviour. As one need becomes satisfied, and therefore less important to us, other needs emerge up and become motivators of our behaviour (Shortell S.M.& Kaluzny A.D. 2000). Many of the issues raised in the article "A Cry for Help" related to Maslow's need of hierarchy and it's relation to motivation.

According to Maslow the first needs that anyone must satisfy are physiological which include hunger, thirst, sex and sleep. In the workplace setting such needs are satisfied by sufficient wages to live and physically acceptable working conditions (Shortell S.M.& Kaluzny A.D. 2000). In the case of "A Cry For Help" a vital physiological need was compromised; the innate human need to rest and sleep. With reduced staff, many nurses were required to endure more frequent shifts and longer working hours. If this basic human requirement is not met, nurses are less likely to preform to their best ability and to further advance to the next level within the hierarchy of needs. Ensuring staff are fully rested is the responsibility of the staff management. Careful planning of staff rosters and policies that ensure nurses are regulated to a set number of hours and shifts per week need to be implemented to ensure staff are working to their optimal capacity. Not only is it important to ensure staffs are fully rested for motivational reasons, it is also an important safety issue for both staff and patients. from coursewrok work info

Once the first level of needs are largely satisfied, Maslow maintains, the next level of needs emerges. Individuals become concerned with the need for safety and security. In the workplace, security often refers to job security such as continuity of employment and safety usually refers to physical safety (Shortell S.M.& Kaluzny A.D. 2000). As illustrated in the article "A Cry for Help", violence from patients under the influence of alcohol and drugs is becoming more prevalent within the ICU wards. Another concern is the rising incidence of treating patients with HIV, hepatis and other blood borne and communicable diseases. Obviously managers' need to ensure all occupational health and safety policies, and all hospital safety procedures are implemented and enforced. Similarly to Royal Perth Hospital, management could implement a zero tolerance on violence against their staff. Environmental changes such as security screens, doors, alarms and guards in addition to public campaigns could be implemented within the hospital. Not only does this serve as a purpose to keep staff and patients safe it also demonstrates to hospital staff that management are concerned with their health and welfare.

In addition to physical safety, job security also needs to be addressed to ensure employees can move to the next level of needs with in Maslow's hierarchy (Shortell S.M.& Kaluzny A.D. 2000). With the constant threat loss of jobs due to company mergers and downsizing, ICU nurses are inadvertently put under further stress to maintain their position within the company. Nurses may be sacrificing rest by accepting more hours just to ensure they have a job, thus reducing motivation to preform to their best and affecting the quality of their work. Visit coursework bf in bf fo bf for bf more writing bf Do bf not bf redistribute

Similarly, once safety and safety needs have become largely satisfied, individuals become concerned with belonging - a sense of membership in some group or groups, a need for affiliation and a feeling of acceptance by others (Shortell S.M.& Kaluzny A.D. 2000). With the temporary staff being employed on a regular basis, team cohesion and connectedness may suffer reducing teamwork and an overall feeling of belonging. Organising team and social events with staff, such as a hospital netball team or after work drinks once a month can help to enhance a sense of belonging which inturn will motivate staff to work as a team, building stronger 'team work' attitudes among the nurses.

When there is a feeling that the individual belongs somewhere, he or she is next motivated by a desire to be held in esteem. People need to be thought of as worthwhile by others, to be recognised as people with some value (McSweeny F.K. & Swindell S. 1999). This is probably one of the most vital components in motivating staff. The lack of recognition for the hard work and long hours ICU nurses put in to their jobs may be the most damaging of all the issues previously mentioned. As one nurse says, "ICU nursing is becoming frustrating. It is frustrating to always be there, to work so closely with patients, to do so much to keep them going and then to have someone else get all the credit". Whilst nurses are frustrated they will feel less motivated to increase productivity and patient services, especially if they are not getting the credit or recognition they deserve. Managers can combat feelings of frustration by encouraging nurses with positive feedback and continual praise for their efforts and hard work. Even small gestures such as organising an impromptu 'pizza night' or 'muffin morning' to celebrate times when nurses have been working particularly hard go along way to making staff feel appreciated and valued ( McConnell, C. 1997). Public awareness campaigns such as the "Nurses...can't live with out them" advertisements helps increase publics' perception about the value of our nurses. Whilst changing public perceptions maybe beyond the scope and financially capabilities of some mangers, ensuring that all staff members are given equal praise for their efforts in staff 'pep' talks may help to change the value other staff members, including physicians, place on the ICU nurses.codf dfr sedfdfw ordf dfk indf fodf df.

Finally, Maslow says, when all these needs have been satisfied at least to some extent, people are motivated by a desire to self-actualise, to achieve whatever they define as their maximum potential, to do their job to the best of their ability. This is the most difficult level for management to define and identify as different individuals have different ideas and goals (Shortell S.M.& Kaluzny A.D. 2000). It is within the interest of the hospital and it's staff that management ensure all other needs within the hierarchy are addressed to motivate staff to do their job to the best of their ability.

Several points must be made concerning Maslow's model of motivation. First, it should be made clear that the theory does not mean that individuals experience only one type of need at a time. In fact, we probably experience all levels of needs all the time, only to varying degrees (McSweeny F.K. & Swindell S. 1999). As the ICU nurse presented in the article "A Cry For Help", nurses juggle their physiological needs (lack of sleep due to long working hours) with the need for job security. We do not progress simply from one level in the hierarchy to another in a straightforward, orderly manner as there is a constant, but ever-changing pull from all levels and types of needs (McSweeny F.K. & Swindell S. 1999).

A second point that must be made about Maslow's hierarchy is that the order in which the theory has set up the needs does not necessarily reflect their significance for every individual. Some people may have such a high need for esteem that they are able to subordinate their needs for safety, or their physiological or belonging needs to these (McSweeny F.K. & Swindell S. 1999). A nurse may be will to jeopardise their safety to work in an intensive care unit (ICU) for the increased pay and prestige.

A third, and very important point to be made about Maslow's hierarchical model is the claim that once a need is satisfied it is no longer a motivator - until it re-emerges. Food is a poor motivator after a meal (McSweeny F.K. & Swindell S. 1999). The point in this is clear for management. Unfortunately, many organisations and individuals still fail to get the message. As clearly stated in 'A Cry For Help' the ICU nurse felt nursing staff were being underpaid and over-work. As expressed by the ICU nurse, " Administration is trying to focus on less financial rewards and more on non-tangible rewards...but believe me money still talks". If management placed emphasis on needs that have not been satisfied, such as better pay and financial rewards, employees would be more likely to be motivated to fulfil that need and work towards achieving the goals of the organisation (McSweeny F.K. & Swindell S. 1999).

Herzberg goes further than Maslow, cutting the hierarchy off near the top and maintaining that motivation results only from some elements of esteem needs and self-actualisation. Herzberg's theory states that there are two types of motivators, one type which results in satisfaction with the job, and the other that merely prevents dissatisfaction (Shortell S.M.& Kaluzny A.D. 2000).

Herzberg's theory suggests that we should focus our attention on the individuals in jobs, not on the things that we surround them with. He maintains that we tend to think that growth and development will occur if we provide good working conditions, status and security, whereas in fact what stimulates growth and motivation are opportunities for achievement, recognition, responsibility and advancement (Shortell S.M.& Kaluzny A.D. 2000). The nurses at the ICU ward will feel more motivated if they felt their efforts were being rewarded and recognised as equally as the other members of staff, particularly the physicians. In reference to Herberg's theory, management could offer recognition such as praise; job titles, public recognition and more challenging job assignments to ICU nurses to increase overall staff motivation and therefore increase quality of patient care and productivity (Shortell S.M.& Kaluzny A.D. 2000).

McClelland's Learned need theory, takes Maslow's Needs of Hierarchy even further and divides motivation into needs for power, affiliation, and achievement. The one single motivating factor that has received the most attention in terms of research is the need for achievement (McSweeny F.K. & Swindell S. 1999). Individuals with a high need to achieve have a number of distinctive characteristics which separate them from their peers. As ICU nurses are specialty nurses working in a competitive environment, one could assume that due to the high level of speciality training and advanced technology, most ICU nurses would fall in to the category of high achievers. If this is so, then ICU management need to reward nurses with increased responsibility when a task has been completed well, this inturn will motivate staff to maintain a high level of performance on all future tasks.

High achievers also like to set moderately high goals for themselves. Management can encourage this behaviour by setting a list of realistic goals (McSweeny F.K. & Swindell S. 1999). For instance, in the 'A Cry for Help' article the nurse said, "administration has recently been demanding more customer-friendly staff from the ICU nurses", objectives could be put in place by management for ICU nurses to achieve better customer service. Once again, the achievement of this type of objective results in greater personal satisfaction and increased motivation.

Lastly, people who are high achievers also want concrete feedback on their performance; this can be easily achieved by creating performance portfolios that are detailed regularly (McSweeny F.K. & Swindell S. 1999). However the point must be made that it would be inappropriate to treat all ICU nurses as high achievers and attempt to motivate them all by offering them challenging jobs, rapid and objective feedback on performance and personal responsibility for success or failure.

The equity theory argues that people are motivated by "inequity". That means that a person looks at others who are doing the same or similar jobs to them and compare how much effort that they put into the job and how much they are rewarded for their work (Shortell S.M.& Kaluzny A.D. 2000). For example the permeant ICU nurses who are working overtime, see the temporary pool nurses who does not put in much effort but receive more pay and better hours. While the equity theory was originally concerned with differences in pay, it may be applied to other forms of tangible and intangible rewards in the workplace (McSweeny F.K. & Swindell S. 1999). The nurses also feel that they are working just as hard to keep patients alive but doctors get all the praises and prestige. This would probably be a negative motivator, discouraging that person from working so hard. There are, on the other hand, positive motivators where a person feels that they receive more than others in the same job and so feel that they are being rewarded for their efforts (McSweeny F.K. & Swindell S. 1999). A manager may implement strategies such as pay for overtime, and recognition and praise for hard work to those that are most deserving. The single most important thing to remember about equity theory is that if rewards are to motivate employees, they must be perceived as being equitable and fair (McSweeny F.K. & Swindell S. 1999).

Vroom's Expectancy Model suggests that people choose among alternative behaviours because they anticipate that particular behaviours will lead to one or more desired outcomes and that other behaviours will lead to undesirable outcomes. Behaviour that results in rewarding consequences is likely to be repeated (Shortell S.M.& Kaluzny A.D. 2000). Expectancy theory and reinforcement theory are similar in that both consider the processes by which an individual chooses behaviours in a particular situation. However, expectancy theory focuses more on behaviour choices, and reinforcement theory focuses more on the consequences of those choices. If organisations do not link outcomes to performance then people have less reason to care about performance (McSweeny F.K. & Swindell S. 1999). In the case of the ICU nurses they felt both underpaid and overlooked compared to their performance. Again appropriate praise and pay will ensure nurses maintain motivation to deliver an expected level of service. Employees who do an exceptionally good job on a particular project should be rewarded for that performance. It will motivate them to try to do an exceptional job on their next project. The reward can be almost anything, but it must be something desired by the employee. Some of the most powerful rewards are symbolic; things that cost very little but mean a lot to the people who get them. If hospital managers cannot financially reward their nursing staff they could uses other rewards such as plaques or certificates (McSweeny F.K. & Swindell S. 1999). Not only does this reinforce the behaviour it also gives nurses the recognition they crave.

Lastly the Goal approach suggests that managers and staff should set goals for the individual on a regular basis and that rewards should be tied to the accomplishment of goals. Goals are powerful because they direct people's attention and focus on tasks related to goal attainment (Shortell S.M.& Kaluzny A.D. 2000). Mangers need to work with the staff to set achievable goals that are seen to be both beneficial to the organisation and the individual. In the case of the ICU nurses, administration wants the nurses to be more customer friendly to patients and visitors visiting the ICU wards. Smaller more attainable strategies could be stet in place to achieve the final goal. For example, the overall goal may be - 'To be seen as a customer friendly environment by all who visit the hospital', however smaller, more achievable goals could be set to ensure the overall goal is achieved. Another example would be to have a 'to do' list that clearly outlines the goals that need to be achieved over the day, week or month. For staff to be motivated to achieve the goal, rewards and feedback must be promptly in order for staff to continue working towards achieving those goals (Shortell S.M.& Kaluzny A.D. 2000).

Based on the theories of motivation explored coupled with the issues raised in the article "A Cry for Help" these key recommendations could be made. Firstly the hospital management and administration need to better research the impact reducing staff would have on the remaining staff. As clearly illustrated in 'A Cry for Help', the retrenchment of ICU nurses had an enormous negative impact on the motivation and job satisfaction of the remaining ICU staff. As a result staff were expected to work harder and longer (sacrificing the need for sleep and rest) for the same amount of reward. Additionally when temporary pool nurses were hired the existing ICU nurses felt less valued as the pool nurses were doing less work for more pay and better hours. Strategies such as paid overtime, policies limiting working hours and constant positive reinforcement need to be implemented to ensure existing staff still remains focused and motivated.

Lack of recognition was another major factor affecting the motivation of ICU staff. As previously mentioned impromptu rewards such as muffins or pizza at the staff meetings for the extra effort put in over a certain period of time, increased responsibility ,certificates or plaques for outstanding achievement and increasing public and staff awareness about the value of ICU nurses through advertisements or 'pep' talks can help to increase nurses esteem thus increase motivation.

Lastly appropriate goals and rewards need to be clearly outlined by management. When goals are achieved management need to promptly give the staff member appropriate feedback in conjunction with positive reinforcement (Shortell S.M.& Kaluzny A.D. 2000). For example, once a nurse has achieved an assigned goal they may given an additional ten minutes in their lunch break or assigned another goal with more responsibility. If managers are unsure about what would motivate their staff the most a survey may help to identify what best motivates their staff.

Conclusion

It is within the interest of organization and the individual to keep staff motivated. Motivated staff are more productive and more likely to work towards achieving the goals of the organisation (Kreitner, 1995). The job of the manager is to create a work environment that provides employees with the opportunity to attain their goals and experience what they value most in their professional lives (Kreitner, 1995).

Theories of motivation provide a framework from which managers and supervisors can use to ascertain what motivates their employees. Several issues raised in the article "A Cry for Help" were explored using the theories of motivation. Issues relating to lack of staff recognition, lack of reward and set goals were all sited as problems ICU management need to address increased rewards though incentives for hard work along with increased recognition thru gestures such as muffin mornings, plaques and certificates could be used to increase the esteem of ICU nurses whist still providing the nurses with a safe and secure working environment.

In conclusion managers need to provide sincere expressions of recognition, appreciation, and acknowledgement to nourish their employees' feelings of self-worth. When employees feel that managers care about them and that they are perceived as respected and valuable members of the organization, they are more cooperative, enthusiastic, and committed to organizational goals, both in the present and in the future (Kreitner, 1995).

References

Kreitner, 1995. Management 6th Ed. Boston, Houghton Mifflin Company.

McConnell, C. 1997. Employee recognition: A little oil on the troubled waters of change. The Health Care Supervisor. vol.15, pp. 83-90.

McSweeny F.K, & Swindell S. 1999. general Process theories of motivation revisited. The role of habituation. Psychological Bulletin, vol.127, pp.437-457

Shortell S.M.& Kaluzny A.D. 2000. Health care management. Organisation design and behaviour. 4th Ed New York, Delmar

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