Health Services Management - Motivation Theories and Practice.

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Health Services Management

Motivation Theories and Practice

Introduction

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).

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.

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.

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.
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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.

Similarly, once safety and safety ...

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