TYUMEN STATE UNIVERSITY
International Institute of Finance, Management and Business
Department of "Quality Management"
Staff motivation as a process of the quality management system of a medical institution
(Graduate work)
Scientific adviser:
M.A. Katkova
Tyumen, 2011
List of abbreviations
Introduction
Chapter 1 Literature Review
1 Theoretical - methodological foundations of motivation
3 Studies of the peculiarities of the motivation of the labor activity of the personnel of the GLPU TO "OIKB"
Chapter 2. Materials and methods of research
1 Research materials
2 Research methods
Chapter 3. Personnel motivation as a quality management system process medical staff
1 Recruitment process
2 Analysis of the recruitment process
4 Guidelines for the recruitment process
Chapter 4 discussion of results
1 Brief description of work
Bibliography
List of abbreviations
MP - staff motivation
KMP - the quality of staff motivation
DG - CEO
NUP - Head of Human Resources
RPP - head of the profile division
MPP - Recruitment Manager
MDTO - document manager labor relations
MPU - medical and preventive institution
Ministry of Health of the Russian Federation - Ministry of Health Russian Federation
CHI - compulsory health insurance
UZ - health care institution
The study of the process of motivation of medical personnel through various means and methods. Detailing and analysis of the process made it possible to identify bottlenecks, develop guidelines and recommendations for its improvement.
Keywords: motivation of medical personnel.
of the examination process of quality nursing care through various means and methods. Detailed analysis of the process and allowed to identify bottlenecks and develop recommendations for improving the process. Development guidelines. : expert quality nursing care, nursing staff.
Introduction
Health care is a special area of activity but ensuring the right of citizens to health care, which is the property of the nation, and therefore remains a priority in the political, economic and social life of the state and society.
The existing system in Russian healthcare financial incentives labor activity turned out to be ineffective and became one of the causes of the crisis medical work. The low-paid but high-skilled work of doctors and other categories of health workers is inefficient, reproduces an undeveloped worker who is immune to the opportunity to earn more by improving quality and increasing efficiency. professional activity, suppresses the initiative and thus prevents the introduction of new technologies for the provision of medical care, preserves the low level of organization and working conditions.
Under the conditions of radical changes, the old mechanisms of labor become ineffective, and the new ones must go through the path of formation. The activity of each employee in matters of increasing the efficiency of professional activity can be ensured by a fundamentally new quality of labor management, based on mastering the motivational mechanism for managing human behavior, developing an effective system within organizational work with personnel, shaping, developing and enriching the needs, abilities and opportunities for realizing personal potential.
Building an effective motivational structure of professional activity in a medical institution requires conceptual approaches to the development of management strategies in the field of work with personnel. Professional activity is associated with a whole group of motives, forming the motivational sphere of an employee, in which motives are located in a hierarchy subordinate to each other.
The components of the motivational structure in the management system of a particular institution are very diverse, but. from our point of view, on the psychological state of the employee and his attitude to the fulfillment of his own professional duties the strongest impact is: cash reward, assessment and recognition of professional achievements and the possibility of professional growth.
The foregoing justifies the need for a comprehensive study of the state and development of the personnel motivation procedure as an essential component of the quality management system, the development of evidence-based approaches to the organization and examination of the quality of personnel selection.
The object of the study is the medical staff of the Regional Infectious Diseases Clinical Hospital.
The subject of the study is the motivation of medical personnel.
The aim of this study is to develop practical advice and guidelines for improving the recruitment process.
Research objectives:
To study the theoretical and methodological foundations of personnel motivation, as well as the personnel motivation management system in Russia today;
To investigate the quality of motivation of the medical staff of the GLPU TO "Regional Infectious Diseases Clinical Hospital";
To study existing approaches to the problem of staff motivation;
To analyze the results of the study and form approaches to building a personnel recruitment management system in a medical institution.
The research material is GLPU TO "Regional Infectious Diseases Clinical Hospital". There were proposals for research regulations organization, characteristics of the institution, passport, as well as Required documents medical personnel.
The recruitment process was described by the method using a flowchart, a context diagram, and the process was also identified.
Scientific novelty thesis consists in a comprehensive study of existing approaches to assessing the motivation of medical personnel.
The scientific and practical significance of the work is determined by the results of the study, which make it possible to provide objective information about the state of the PC system in the institution to this problem. A process model for the management of PP in a medical institution has been developed, the use of which will make it possible to objectively assess the level of staff motivation and find bottlenecks in this process.
Chapter 1 Literature Review
1 Theoretical and methodological foundations of motivation
The main feature of personnel management in the transition to the market is the increasing role of the employee's personality. The current situation in our country is great opportunities, and great threats to each individual in terms of the sustainability of its existence.
That is, now there is an extremely high degree of uncertainty in the life of every person. Therefore, it is necessary to develop new approach to personnel management. This approach is as follows:
) creation of a philosophy of personnel management.
) creation of perfect personnel management services.
) application of new technologies in personnel management.
) creation and development of shared values, social norms, a set of behavior that regulates the behavior of an individual.
The philosophy of personnel management is the formation of the behavior of individual employees in relation to the development goals of the enterprise. In such conditions, the motivation of the work activity of the company's employees becomes especially important. In order for a person to perform the work entrusted to him conscientiously and efficiently, he must be interested in this or, in other words, motivated.
In personnel management, motivation is seen as a process of activating the motives of employees (internal motivation) and creating incentives (external motivation) to encourage them to work effectively. In this regard, the terms stimulation and motivation are also used as synonymous with the term motivation. The purpose of motivation is the formation of a set of conditions that encourage a person to take actions aimed at achieving the goal with maximum effect.
Ideas about the possibilities of motivating the work of workers have undergone major changes in management practice. For a long time, it was believed that the only and sufficient incentive to induce an employee to work effectively is material reward. Taylor, the founder of the school of scientific management, developed his system of organizing the work of workers, convincingly proving the relationship between labor productivity and its payment. However, Mayo's experiments at Hawthorne found a significant influence on labor productivity of other factors - psychological ones. Over time, various psychological theories of motivation have appeared, trying to consider the determining factors and structure of the motivational process from different positions. As a result, the so-called "carrot and stick" policy was replaced by the development of more complex systems for stimulating the motivation of workers to work, based on the results of its theoretical study.
Modern theoretical approaches to motivation are based on ideas formulated by psychological science that studies the causes and mechanisms of purposeful human behavior. From these positions, motivation is defined as the driving force of human behavior, which is based on the relationship of needs, motives and goals of a person.
General characteristics the process of motivation can be represented if we define the concepts used to explain it: needs, motives, goals.
Needs are the state of a person who needs an object necessary for his existence. Needs are the source of human activity, the cause of his purposeful actions.
Motives are the motivations of a person to act, aimed at the result (goal).
Goals are the desired object or its state, which a person strives to possess.
The general scheme of the motivational process, reflecting its cyclicity and multi-stage, as well as the relationship of needs, motives and goals, is shown in (Fig. 1.1).
Rice. 1.1 Scheme of the motivational process
The presented scheme is rather conditional and gives only the most general idea of the relationship between needs and motives. The actual motivational process can be much more complex. The motives driving a person are extremely complex, subject to frequent changes and are formed under the influence of a whole complex of external and internal factors- abilities, education, social position, material well-being, public opinion etc. Therefore, predicting the behavior of team members in response to different systems of motivation is very difficult.
Motivation as a control function is implemented through a system of incentives, i.e. any actions of the subordinate must have positive or negative consequences for him in terms of meeting his needs or achieving his goals. The study of the team can allow the leader to create a motivational structure with which he will carry out the education of the team in the right direction.
At present, the organization of an effective personnel incentive system is one of the most difficult practical problems management. Typical problems in organizations associated with low staff motivation are:
High staff turnover
High conflict
Low level of executive discipline
Poor quality work (marriage)
The irrationality of the motives of the performers' behavior
Weak connection the results of the work of performers and encouragement
Negligent attitude towards work
Lack of conditions for self-realization of the potential of employees
Problems public cooperation in the company's activities
Low effectiveness of the influence of managers on subordinates
Low level of interpersonal communications
Crashes in manufacturing process
Problems in creating a consistent team
Weak career prospects, reflecting on the working tone of employees
Contradictions in the relationship between the entrepreneur and the employee
Low efficiency of methods of normative description of labor
Employee job dissatisfaction
Low professional level of staff
Lack of initiative of employees
The activities of the management are negatively evaluated by the staff
Unsatisfactory moral and psychological climate
Insufficient equipment of workplaces
Organizational confusion
Insufficient attention to studies and internships of the reserve
Underdevelopment of social and cultural life of the enterprise
Unwillingness of employees to improve their skills
Inadequate work incentive system
The discrepancy between the actual behavior of the performer and the expectations of him from the boss
Low morale in the team
Problems in personnel management, prone to ambition, career growth and many others.
Building an effective motivation system requires study theoretical foundations motivation and currently used incentive systems.
There are three main approaches to choosing a motivational strategy:
Incentive and punishment: people work for a reward: those who work well and a lot are paid well, and those who work even more are paid
pay more too. Those who do not work well are punished.
Motivation through the work itself: give a person an interesting and satisfying job, and the quality of performance will be high.
Systematic communication with the manager: define goals with the subordinate and give him positive feedback when he is doing the right thing and negative feedback when he is wrong. Chosen motivational
The strategy is based on an analysis of the situation and the leader's preferred style of interaction with other people.
The following motivational methods are used:
Using money as a reward and incentive.
Imposition of penalties.
The development of belonging.
Motivation through work itself.
Reward and recognition of achievements.
An exercise in leadership.
)Encouragement and reward of group work.
)Training and development of employees.
)Restriction, limitation of negative factors.
The interpretation of the concept of "quality" is found in all philosophical currents. The most famous theories of motivation are: 1) the theory of the hierarchy of needs, developed by Maslow; 2) the ERG theory developed by Alderfer; 3) McClelland's theory of acquired needs; and 4) Herzberg's theory of two factors.
Abraham Maslow is one of the most famous representatives of the behavioral direction in a number of teachings about management. The well-known and widely accepted concept of the hierarchy of needs developed by Maslow includes the following main ideas and premises:
People are constantly feeling some kind of need.
People experience a certain set of strongly expressed needs that can be combined into separate groups.
Need groups are in a hierarchical arrangement in relation to each other.
Maslow's concept had a great influence on the development of the theory and practice of modern management. However, life has shown that the concept has a number of very vulnerable points.
First, needs manifest themselves differently depending on many situational factors (job content, position in the organization, age, gender, etc.).
Secondly, there is not necessarily a strict following of one group of needs after another, as it is presented in Maslow's "pyramid".
Thirdly, the satisfaction of the upper group of needs does not necessarily lead to a weakening of their impact on motivation. Based on the systematization and integration into a certain set of needs, the forms of their manifestation in human behavior and possible means of satisfying needs, a table can be drawn up showing the relationship between individual means of motivation and Maslow's pyramid of needs (Table 1.1).
Table 1.1
An example of the relationship of needs, their manifestations and means of satisfaction
Need groups Form of manifestation of needs Means of satisfying needs Self-expression Striving for results Providing creative work Recognition and self-affirmation Desire to occupy a certain position in the team Assigning ranks or titles Affiliation and belonging Striving to establish friendships Encouraging the formation of informal groups Safety Striving to prevent dangerous changes Building an insurance system Physiological needs
From Simon's point of view, organizational goals affect the behavior of employees only when they inform them about what this behavior should be. Goals are determined on the basis of the value assumptions of the organization's decisions. Value assumptions are assumptions about which organizational goals are most desirable at a given time. The more precisely the value prerequisites are indicated, the more rational the decisions made by the organization. Properly set goals make it possible to distinguish between acceptable and unacceptable options for organizational decisions. Thus, organizational goals are the main connecting element between the rational behavior of employees and the choice of rational organizational decisions.
Strategic Goals organizations can serve as a starting point for constructing a hierarchy of goals. First, a general goal is set to be achieved, then a set of means is determined to achieve this goal, after which subordinate goals are set for the implementation of previously defined means, then more detailed means are searched for to achieve the above-mentioned subordinate goals, etc. The division of general goals into specific subordinate tasks and their subsequent distribution according to structural divisions organizations or individual performers enhances rational behavior workers. This simplifies decision making at every organizational level. It is no coincidence that Simon introduces organizational structure as a "set of action plans".
Organizations support rational decision-making not only by separating responsibilities between employees using a goal-setting mechanism, but also by providing them with the necessary means for their implementation - resources, information, equipment. Model rational organization Simon emphasizes the importance of unobtrusive control of employees: training and distribution of information play a more significant role in the development of rational employee behavior than orders or sanctions.
Rational organization theory is based on the concept of cognitive constraints on individual decision making, or bounded rationality. Simon says that an isolated individual cannot achieve a high degree of rationality because the number of options he has to consider is very large. An individual choice occurs on the basis of the premises accepted by the subject as the basis for the choice. The individual's behavior will be determined by the limits set by these premises. With this in mind, organizations define a complete set of tasks, stable expectations, necessary information and tools, a current work program, and a set of constraints within which the required decisions can be made by the individual.
Thus, this theory emphasizes the importance of rules and established practices in maintaining rational behavior within an organization. Organizational rational behavior of employees, and especially their decision-making, requires, first of all, strict adherence to the rules established by the organization.
Obviously, a person's behavior depends on what needs make him act, what he aspires to, what he wants to get and what opportunities he has for this. However, even if we assume that all this is well known (although this is clearly a utopian assumption), there is still no guarantee that it will be possible to completely understand the motivation of a person. And, obviously, this is all the more difficult to do in a situation where it is impossible to find out everything about the needs and aspirations of a person. Nevertheless, it does not follow from this that the motivational process cannot be recognized and controlled. There are a number of theories that talk about how the motivation process is built and how people can be motivated to achieve the desired results. Theories of this type constitute a group of theories of the process of motivation. The most general concept of motivation comes down to the following provisions. A person, having realized the tasks and the possible reward for their solution, correlates this information with his needs, motivational structure and capabilities, adjusts himself to certain behavior, develops a certain arrangement and carries out actions leading to a specific result, characterized by certain qualitative and quantitative characteristics. On (fig. 1.1.) this process is schematically shown.
Expectation Theory
Human behavior is constantly associated with the choice of two or more alternatives. From what a person gives this or that preference depends on what and how he does, how he behaves and what results he achieves. Expectancy theory is designed to answer the question of why a person makes a particular choice, faced with several alternatives, and how motivated he is to achieve an outcome in accordance with the choice made.
Rice. 1.1. General theory of the motivational process
In its most generalized form, expectancy theory can be formulated as a doctrine that describes the dependence of motivation on two points: how much a person would like to receive and how much it is possible for him to get what he would like to receive, in particular, how much effort he is willing to spend for this. Goal setting theory
The theory of goal setting comes from the fact that a person's behavior is determined by the goals that he sets for himself, since it is in order to achieve his goals that he carries out certain actions. It is assumed that setting goals is a conscious process, and conscious goals and intentions are what underlies the definition of human behavior. The roots of this theory, in a certain sense, go back to the developments of F. Taylor, but the leading developer of this theory is Edwin Locke. It is believed that the directed dissemination of this theory began after his completion in 1966. dissertation work. The article “On the Theory of Motivation and Stimulation by Goals” published in 1968 by Edwin Locke is considered the first fundamental work on the theory of goal setting. A significant contribution to the development of this theory was made by T. Ryan, as well as by Locke's colleague G. Latham. Speaking about the history of the formation of the theory of goal setting, it should be noted that before Locke in the 50s. a number of positions of management with the help of goals were put forward in the works of Drucker and McGregor in the framework of the theory of management with the help of goals.
AT general view the basic model describing the goal setting process is as follows. A person, taking into account the emotional reaction, realizes and evaluates the events taking place in the environment. Based on this, he determines for himself the goals to which he intends to strive, and, based on the goals set, carries out certain actions, performs certain work.
Equality Theory:
One of the constant aspirations of people is the desire to receive a fair assessment of their actions. People, although not to the same extent, desire to be treated fairly. At the same time, justice is associated with equality, in comparison with the attitude towards others and the assessment of their actions. If a person believes that they approach him in the same way as others, without discrimination, evaluate his actions from the same positions as the actions of others, then he feels the fairness of the attitude towards himself and feels satisfied. If equality is violated, if individual members of the organization receive undeservedly high marks and rewards, then the person feels offended, and this leads to frustration and dissatisfaction. At the same time, dissatisfaction can occur even when a person receives a high reward in relation to the expenditure of his labor. The influence of this moment on the relationship of a person with an organization is the basis of one of the theories of the motivational process - the theory of equality.
The founder of the theory of equality is Stacey Adams, who, on the basis of his research at General Electric, formulated the provisions of this theory. The main idea of the theory of equality is that in the course of work a person compares how his actions were evaluated with how the actions of others were evaluated. And on the basis of this comparison, depending on whether he is satisfied with his comparative assessment or not, a person modifies his behavior.
The theory of equality proceeds from the fact that in the process of comparison, although objective information is used, for example, the value wages, the comparison is carried out by a person on the basis of his personal perception and his actions, and the actions of the people with whom he compares. The theory of equality operates in the following main categories. An individual is a person who considers the organization's assessment of his actions from the standpoint of justice and injustice. Compared persons - individual people and groups of people in relation to which the individual compares the assessment of his actions. An individual's perceived reward is the combined amount of reward received by an individual for individual performance. This value is subjective, is the result of the individual's perception of rewards for their actions, and may include such individual "rewards" that the organization has no idea about.
The perceived reward of others is the sum of all the rewards that, in the individual's view, the compared persons received. This assessment is also subjective, as it is based on information from individual data, and sometimes rumors that the individual has received.
Thus, the structure of a motive as the basis of an action or deed is multicomponent; it most often reflects several causes and goals.
2 Medical personnel motivation management system
In quality management, personnel motivation is the motivation of employees to be active in ensuring the required product quality.
Motivation is based on the principle of providing employees with opportunities to achieve personal goals through a conscientious attitude to work. Without this, one cannot speak of any serious interest of the staff in high quality products, and without commitment, any plans to improve quality are likely to remain on paper.
A variety of personal goals and aspirations of employees, their level of education and culture determine different needs and require the use of different methods of motivation. Indeed, approaches to motivation in a research institute and a corrective labor colony must obviously be different.
Reforms that are long overdue in public sector sectors, and in particular in healthcare, are stalling for a number of reasons, including direct resistance or misunderstanding of their meaning by representatives of professional communities. This means that the proposed reform options do not adequately take into account the specifics of work motivation honey workers. The desire of the industry management to staff the primary link by a significant increase in wages is understandable and understandable, however, the desire of an employee to occupy a position with a higher salary and the desire to work productively and efficiently in it are far from the same thing. Therefore, it is extremely important to understand the specifics of motivations, the institutional conditions for their implementation, and the motives and institutions resulting from this.
Considering the problem of motivating the work of health workers, they note a high level of neuropsychiatric disorders among students (exceeding that among the population), as well as leading place such disorders in the structure of their morbidity. According to researchers, one of the reasons for the emotional tension of students of medical universities and colleges is their loss of the meaning of study and, as a result, a decrease in satisfaction with their educational work.
Studies also show that about 30% of medical students are not going to work in their specialty after graduation; 37% of doctors with less than 5 years of experience would like to change their profession; 46% of the nurses surveyed do not see prospects for themselves in their professional activities, since it does not provide a decent standard of living.
Today it is recognized that approximately 60-80% of all diseases are due to mental causes, or at least mediated by them, and yet are considered in the context of experiences, intrapsychic and psychosocial conflicts. The patient is beginning to be seen as more than just a carrier of symptoms and case histories; more and more relevant are the questions: who is sick, "what kind of person is sick, and not just what kind of disease the person is sick with."
Each person understands success in his own way, but the very possibility of achieving it in the profession contributes to a person's experience of social well-being, satisfaction with his professional activities and, as a result, mental well-being and thus has a positive impact on his health.
Individual features of the perception of the social situation in which the health worker is located depend on the mental makeup of his personality. With the same professional situation, one will be satisfied, and the other will be annoyed, since each of them may have their own, different professional expectations and ideas about professional success. The same event can cause severe stress in one person, and not affect another at all. In the first case, the mental state of a person should cause concern, and in the second case, psychosomatic balance is observed.
If a health worker is in a state of well-being, balance, then he projects the same feelings onto the world around him, including colleagues and patients. Against the background of general satisfaction with one's life (in particular, professional life), individual adversities will be less painful. But if his thoughts are filled with doubts and fears, dissatisfaction and aggression, then all this is also projected onto the outside world and others, exerting a negative influence on them.
If a person in the process of labor activity has the opportunity to satisfy needs that are significant for himself (physiological, psychological and social), then he experiences job satisfaction, if not, he feels depressed, anxious.
The health worker experiences general satisfaction from his work, if in its process his need for professional achievements, career, recognition, self-improvement, if he sees the results of his work, and above all, the recovery of patients. Dissatisfaction with work depends mainly on external factors: low wages, safety violations at the workplace, poor working conditions, difficulties in relations with management, colleagues, subordinates, patients. Interestingly, eliminating job dissatisfaction factors does not necessarily lead to increased job satisfaction. Of course, a lot depends on the individual characteristics of the employee, on his expectations, priorities. For some, for example, the size of wages is more significant for job satisfaction, for others - irregular working hours, etc.
One of the constant aspirations of people is the desire to receive a fair assessment of their actions. If a health worker believes that he is treated in the same way as others, without discrimination, his actions are evaluated from the same positions as the actions of others, then he feels the fairness of the attitude towards himself and feels satisfied. Such a comparison, although it uses objective information (for example, the amount of wages), is carried out by a person on the basis of his personal perception of his actions and the actions of the people with whom he makes comparisons.
If he believes that he is not sufficiently rewarded, he has a feeling of dissatisfaction. People are guided by a comprehensive assessment of remuneration. In this integrated assessment wages play an important, but far from the only role. Considering the unfair and unequal assessment of his work, the physician loses motivation for active, creative actions in terms of the goals of the medical institution. In this case, the following reactions are possible:
a decrease in the intensity and quality of labor (“I do not intend to give all the best for such pay”);
an attempt to increase their remuneration (criminal reactions are possible).
For Russia, it is typical to combine work in several organizations or at several workplaces at once, which leads to employee overload, a decrease in the quality of his work;
reassessment of one's capabilities (depression, a sense of hopelessness, an inferiority complex, etc.);
an increase in social activity, which often gives rise to interpersonal conflicts in the organization;
change for oneself the object of comparison (“Other respected people now have even more difficult time”);
transfer to another unit, another organization (in our country, it is not uncommon for the best medical workers to move from state medical institutions to commercial ones), leaving for work abroad, changing professions.
If a doctor or other physician takes part in various intraorganizational activities, participates in decision-making about the work he performs (he is involved in setting goals that he has to achieve, determining the tasks that he has to solve), has the right to control the quality and quantity of his work. labor and, accordingly, is responsible for the final result, can make proposals for improving the organization of his work, then he receives satisfaction from this, works more efficiently and productively.
Medical work in Russian conditions increasingly motivated by internal factors, many external factors, with the exception of social significance his professional activities are not working enough. In fact, there is an exploitation of such personal qualities of physicians as responsibility, a sense of duty, fidelity to the medical oath, love for one's work, the country, while external stimulation from the state is insufficient. If the older generation of healthcare workers has this internal motivation formed and is quite stable, then the younger generation needs external support for the determination to engage in the difficult profession of a physician, and this support must be accompanied by a fair material assessment of their work (if all prices in the country are being brought up to world prices, then the assessment work of the physician should also become such).
One of the concepts that is used in the analysis of motivation medical workers, is the concept of authorship of D. March and G. Simon, coming from the limited rationality of a person. In this model, two types of employee motivation are distinguished. These are the motivations associated with belonging to this organization, as well as the motivations associated with working in this organization.
Thus, the main motives in labor behavior are the needs, attitudes, value orientations of the individual, its functional states, as well as external motives - incentives, which are divided into material and moral. Important motivators of active labor behavior, in addition to the above factors, are the expectations of achieving a significant goal in the labor process and job satisfaction. The most effective labor motivation is carried out when people expect (and are even better sure) that their efforts will allow them to achieve the goal, lead to the desired reward, lead not only to satisfaction of needs (physiological - in food, water, rest; social - connections, personal identification, self-respect), but will also bring satisfaction with the labor process itself and its results.
3 Study of the peculiarities of the motivation of the labor activity of health workers
Today, one can often hear the words that managing people is both a science and an art. However, it is impossible to effectively influence a person's motivation if you cannot assess its current state. It is difficult to choose an effective means of influencing the motivation of subordinates, relying only on assumptions and guesses about what they need, what makes them give all the best at work.
Knowledge of methods for assessing motivation and their competent use will not only increase the return on subordinates, but will also provide an opportunity to better understand those people.
empirical base psychological research are the data received from the junior and middle medical staff of the Regional Infectious Diseases Clinical Hospital. During the study, two groups of medical personnel were identified, consisting of 281 people.
The first group includes paramedical workers and doctors. Compound:
head nurse
elder nurses
procedural nurses
guard nurses
Average age surveyed group 37.3 years. Gender - 19 women, 4 men. Education: secondary special 16 people, 7 people - higher medical education. The work experience of this group in the GLPU TO "Regional Infectious Diseases Clinical Hospital" averages 7 years.
The second group is junior medical personnel. Composition: nurses - 10, food distributors - 4. The average age of this group is 33.5 years, female workers 12 people. Education: 20% of the surveyed have incomplete secondary education, 30% have specialized secondary education in various professions, 50% have complete secondary education. The work experience of a group of junior medical workers in this institution is 2.6 years.
To collect primary psychological information, I used such a method as a questionnaire. Questioning is one of the main technical means specific social research; used in sociological, socio-psychological, economic, demographic and other studies. During the survey, each group selected for the survey is asked to answer in writing the questions posed in the form of a questionnaire.
The purpose of the survey: to study satisfaction with various aspects of the work of employees of the GLPU TO "Regional Infectious Diseases Clinical Hospital".
The more choices of this or that statement and the points scored on it, the greater the importance for the respondent of this or that reason when choosing medical specialty.
The medical staff of the two groups was offered a questionnaire. This questionnaire was compiled by me to study the structure of the motive. The questions in the questionnaire are designed in such a way as to reveal the satisfaction of medical personnel with various aspects of their labor activity. The respondents were offered closed questions, - the answer to which is to choose from several statements proposed in the questionnaire.
The respondent must give answers to 11 questions, choosing one answer from five options and ticking it.
Questionnaire text:
How would you rate the working conditions in your institution?
Does the job meet your expectations?
Of the factors listed below, check those that influenced your decision to choose this particular profession.
Are you sure of the social significance of your work?
How do you rate existing system pay for your work?
Do you see prospects for further career growth and personal and professional development?
Do you think that your job status is an important motivational factor for you?
What do you dislike about your job?
What do you think needs to change in your workplace?
Survey results.
When summarizing the results, it was revealed that 49% of respondents chose a profession by vocation, 26% - on the advice of relatives and friends; for 17.5% - this is a random choice, 7.5% of respondents had no other choice. Thus, for almost half of the respondents, the choice of a profession was due to internal motives, and for the other half - external ones. To the question: “Do you like your profession now?” 160 people answered: “Yes”, 40 people would like to change it now.
When assessing the attitude of staff to work in general, it was found that for 148 people the main factor determining job satisfaction is relations with their closest colleagues; for 65 people - satisfaction with the organization of labor and for 48 people - satisfactory relations with the administration.
When asked about the main negative factors affecting the work, the answers were distributed as follows:
Low wages (97.5%)
Risk of HIV infection, viral hepatitis (42.5%)
High psycho-emotional stress (36.5%);
Low social status of the profession (29%);
Dissatisfied with the job in general (2.5%)
Comparing the answers, it can be noted that wages do not satisfy almost all respondents, regardless of their age. This problem is the main reason for the acute shortage of paramedical workers.
When answering the question about the moral and psychological climate in the department, 61.5% of respondents noted good, friendly relations between employees, however, 37.5% indicated the presence of individual conflict persons in the team, 6.5% - an unsatisfactory moral and psychological climate in departments, 2.5% - on the conflicts of the team with the official leader. Comparing the assessment of the moral and psychological situation of the staff and the manager, one can note a more optimistic assessment of this parameter among the manager (82.8%).
Motivating influences must be built taking into account the life priorities of employees. Nursing staff were asked to rate priorities. The majority of respondents noted health promotion (77%), material needs(65%), housekeeping (49%), interesting work(29.7%), spiritual needs (27.4%), social recognition (19.4%), leisure (17.8%), career (14.7%).
Respondents were asked to choose one of the most preferred types of incentives: material, non-monetary material and non-material. Material incentives were preferred by 77.7% of respondents; non-monetary material - 15; non-material - 7.5%. Thus, the main incentive for medical personnel, regardless of age, is financial incentives (92.5%).
When choosing non-reliable financial incentives, respondents preferred the following:
Provision of preferential vouchers for rest and treatment (71.5%);
Improving working conditions, workplace ergonomics, design, equipping with comfortable furniture (66.5%);
Introduction of flexible working hours (62.5%);
Provision of subsidies for payment of departmental housing and utilities (59%);
Provision of overalls (54%);
Voluntary medical insurance for personnel (44%);
Shortening the duration working week (37,5%);
Rewarding with a valuable gift (31.5%);
Provision of a separate office (25%);
The results of the study show that moral encouragement attracts only a small minority of respondents. However, when conditions change, when the use of material incentives is impossible for various reasons, the respondents identified the following preferred forms of moral encouragement in the questionnaires;
Attentive attitude to individual proposals aimed at improving the common cause (69%);
Conducting confidential conversations (41.5%);
Declaration of gratitude (59%);
Personal informal praise, verbal encouragement (39.5%);
Promotion to the reserve for a higher position (25%);
Involvement of employees in management (10%);
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The key advantage of non-economic incentives is the ability to influence intrinsic motivation. An empirical study was conducted among 407 doctors and nurses to examine the level of significance of non-economic motivation (NEM) for medical workers in public clinics and hospitals. The results showed that most of the heads of state medical organizations already use non-economic incentives. For each respondent, the NEM significance index was calculated. More than half of the respondents (68.3%) indicated a high importance of non-economic incentives (i value NEM ≥ 8.0) as factors that might increase their willingness to work harder in the current situation There is a statistically significant difference between managerial and non-management positions in determining the significance of the factors.
For leaders, the most important thing is to know that the work they do is very significant for society. For specialists who do not hold managerial positions - good, friendly relationships with colleagues at work and the opportunity to apply professional knowledge and skills at work.
Leaders today use a variety of tools to improve the performance of organizations. The set of tools used depends on the stage of development, leadership style and overall strategy. One of the key tools is employee motivation, which can be implemented through the use of various approaches and methods.
Given the dynamic external environment organization, it is important for the manager to build a flexible system of incentives that will be able to quickly adapt to changes and meet internal needs. In the healthcare system, the motivation of doctors and paramedical personnel is the most important element that determines their productivity and affects the success of the industry as a whole. It should be noted that the motivation system in most medical organizations in developing countries, which includes Russia, is not sufficiently developed. In Russia, there is a problem staffing medical organizations, which is expressed in the disproportion in providing the population with doctors in the regions, in the imbalance vocational training frames. The right motivation system will help solve these problems and improve the performance of doctors and nursing staff.
There are various incentives that form the motivation system in a medical organization. In management theory, they are divided into 2 key groups - economic and non-economic. Economic incentives are based on material incentives for an employee when he performs a set of tasks in accordance with established requirements. These include salaries, bonuses, bonuses. Non-economic incentives include psychological, organizational, moral incentives. They influence the desire of the employee to put more effort into work, but do not imply direct financial payments. A number of authors note a significant advantage of non-economic incentives, since it is they that can affect the internal motivation of an employee, cause the maximum desire to work better and more.
Figure 1. Levels of human motivation. Internalization process
According to one study, with economic motivation, workers can achieve 50 to 80% of their potential. When non-economic incentives are included in the motivation system, this indicator can reach 100%. The authors of health motivation studies argue that non-economic incentives play an important role in shaping the positive attitude of doctors and nurses to their profession, many of them help to unlock the potential and increase the level of responsibility. In Russia, with low wages and poor working conditions in most regions, altruistic motives and a sense of responsibility for the patient are often key drivers of healthcare development.The relevance of studying the role of non-economic incentives in the system of motivation of medical workers of state medical organizations lies in the fact that this particular group of incentives can affect the necessary internal motivation, given the high level of responsibility and social significance of work in the industry. Focus on government medical organizations due to the fact that in conditions of limited resources, their management needs to look for less costly and more effective ways staff motivation.
Methodology
The study was based on the theory of internal self-determination, within which an approach was proposed that allows changing the level of motivation from the lowest (amotivation, unwillingness to perform an action) to a higher one (passive consent, active desire to act). This process is called internalization. As the level of internalization increases, so does the level of engagement and diligence. Let us consider in detail each stage of the process and the types of incentives that correspond to it. The process begins with amotivation, when a person has no desire to perform a particular action. Amotivation implies that any work is of no value to him, or he considers himself incompetent, or that his actions will not lead to the desired result.
In other words, at this stage there are no external or internal reasons that could prompt him to act. The next level is external regulation, when actions are taken to comply with the set requirements and / or to receive remuneration. At this stage, non-economic organizational incentives of a sanctions nature (“if not ..., then ...”) and economic incentives (since the actions of an individual are conditioned by the desire to receive a reward) are used. The second type of extrinsic motivation is introject motivation. Introjection is understood as a kind of internal regulation, when a person acts to avoid feelings of guilt, anxiety, or to enhance self-esteem, be proud of himself. The intensity of activity is regulated by his desire to increase his self-esteem.
To activate the motivation of this level, it is necessary to resort only to non-economic and non-material incentives, i.e. to such tools that can affect the emotions and inner self-esteem of the individual. These include, for example, a regular expression of gratitude from management, the presence feedback, support of colleagues. A more autonomous form of extrinsic motivation is identification. At this stage, a person independently tries to realize the significance of his actions for the organization. This can be facilitated by giving him the opportunity to take part in solving issues significant for the organization, publicly express his opinion, interest from the management in his position. Finally, the most autonomous form of extrinsic motivation is integration. Integration occurs when certain external rules become the internal rules of a person. This happens through introspection, the correlation of external rules with internal values and needs.
The higher the level of understanding of the reasons for their actions, the higher the level of motivation to perform them. This stage of external motivation has much in common with internal motivation, however, integration is defined as external motivation, since a person is guided by external factors and focused on achieving results. To move to this stage of motivation, it is necessary to conduct regular conversations with subordinates about what goals the organization follows, what is the role of each of them in achieving them. At the same time, it is important for the manager to distribute official duties in such a way that they correspond as closely as possible to their values and needs.
The highest stage of motivation is intrinsic motivation, when a person independently shows a desire to act, is interested in the activity itself, and not in obtaining benefits. At this stage, extrinsic motivation is transformed into intrinsic, and the process of internalization is completed. AT modern society the more common view is that work needs to be done because of external regulators (rewards). However, in the process of performing an activity and in the absence of enhanced control, each employee has the opportunity to see the properties of this task that are interesting to him, thus, there will be a change in the reason for which he performs it, and, consequently, the type of motivation. The above process of transition of external motivation into internal one occurs throughout the entire period of work of a specialist in a company, and it can begin and end at different stages. It all depends on the employee and his manager. Moreover, both of them are interested in this process, because, as noted above, a higher level of an employee increases his efficiency for the company and ensures his mental well-being, which is undoubtedly important for him.
From the point of view of management, the manager should take into account the fact that he himself still plays a key role in changing the personal paradigm of the employee, determining the powers of the subordinate, the degree of control, entrusting the execution of tasks and providing the necessary assistance. According to the theory, to the highest stage of motivation ( intrinsic motivation) it is impossible to come without the use of non-economic incentives. As mentioned above, it is their use together with economic incentives that allows you to use 100% of the employee's potential.
In order to study in more detail the perception of health workers of public medical institutions the importance of non-economic incentives depending on their earnings, age and position, to assess the prevalence of motivation factors, an empirical study was conducted in 3 state polyclinics, one state clinical hospital and in a children's federal center. The state polyclinics whose respondents took part in the study are located in 3 different districts of Moscow (North-Western, South-Western and Southern administrative districts). All institutions provide outpatient medical care of various profiles, and patients also have the opportunity to receive paid medical care. Adult patients are treated in 2 polyclinics, and children are treated in the third one. It should be noted that in all polyclinics, the questionnaires were filled in by medical workers of the head institution and branches. The study was also conducted among employees of the state clinical hospital in Moscow and the largest children's federal center.
Thus, the sample of the study included doctors and nurses who provide outpatient and inpatient medical care to adults and children, as well as those who hold managerial and non-managerial positions.
As a result of the literature review, 10 key factors non-economic motivation, the most relevant for employees Russian healthcare that were assessed in the questionnaire:
1. Opportunity to engage in activities at work that bring pleasure and are best achieved.
2. Opportunity to develop professionally at work.
3. Ability to apply professional knowledge and skills at work.
4. Assistance of the management to the professional training of the employee.
5. Respectful attitude from management.
6. Knowing that the work being done is valued by management.
7. Knowing that the work being done is important to society.
8. Good, friendly relationships with work colleagues.
9. Reputation of the organization.
10. Equipment of the workplace, including the availability of the necessary materials and equipment for work. These stimuli formed the basis of a questionnaire that was designed to conduct an empirical study. The purpose of the questionnaire is to assess the prevalence of non-economic incentives in public medical organizations in Moscow, to study their relationship with each other, as well as their significance for respondents with different socio-demographic characteristics.
Questionnaire data were recoded into numerical values and analyzed in SPSS Statistics 22.0; the following methods of statistical analysis were used in the study: descriptive statistics, contingency tables, correlation coefficients, factorial and logistic regression analysis.
results
To collect primary data, 600 questionnaires were distributed, 480 were received, respectively, the return rate was 84.7%. Out of 480 questionnaires, 407 were filled in correctly. Thus, the study sample included 407 doctors and nurses from 5 different state medical organizations (Table 1). The results of the study showed that most of the heads of state medical organizations are already using non-economic incentives. In medical organizations, factors such as the use of their various skills and knowledge in their work (77%), the friendly and respectful attitude of the head towards his subordinates ( 74%), work by vocation (59%) and a friendly atmosphere in the team (58%).
Table 1. Socio-demographic characteristics of the sample
For each respondent, an index of the significance of non-economic motivation was calculated based on an assessment on a 10-point scale of the level of significance of each of the 10 factors according to the following formula: 
where Xi is the respondent's assessment of the non-economic motivation factor, n is the number of factors. Then, the level of significance of non-economic motivation was determined in accordance with the interval in which the index fell (Table 2).
According to the results of calculations, for more than half of the respondents (68.3%), the index of significance of non-economic incentives was high (i value NEM ≥8.0). Correlation analysis showed that with the growth of the well-being of medical workers, the importance of non-economic incentives grows (Corr.=0.021; p<0,05) (табл. 3). Это объясняется тем, что при достижении уровня заработной платы, позволяющей покрыть базовые потребности работника, его деятельность перестает быть направленной на ее увеличение. На этой стадии его можно мотивировать только за счет неэкономических стимулов. Также в рамках исследования респонденты выбирали факторы, которыми они готовы по- жертвовать ради повышения заработной платы.
Table 2. Significance levels of the index of non-economic motivation
Table 3. Dependence of the level of significance of non-economic motivation on the income level of respondents
Table 4. Significance of non-economic motivation factors for managerial and non-management positions
It is worth noting that, in general, respondents were not ready to sacrifice a large number of non-economic benefits of their work. Thus, the maximum value was at the level of 17% for the first statement “The opportunity to engage in activities that bring pleasure and are best obtained at work”, 14% of respondents are ready not to receive management assistance for their professional development and not to perform socially important work. All other factors were chosen by less than 10% of respondents.
The results of the data analysis also showed that there is a statistically significant difference between managerial and non-management positions in determining the significance of factors. All respondents were divided into 2 groups: managers, which included heads and senior nurses, and non-managers, which included doctors and nurses.
In each group, for a set of factors, the proportion (in%) of respondents who rated "8", "9", "10" was determined. Then, for each factor, the statistical significance of the difference between the number of those who chose these assessments was determined using Student's t-test. For leaders, the most important thing is knowing that the work they do is meaningful to society. For specialists who do not occupy leadership positions, there are good, friendly relationships with colleagues at work and the opportunity to apply professional knowledge and skills at work (see Table 4). To group 10 non-economic incentives depending on their significance for the respondents, a factor analysis with an orthogonal rotation Varimax was applied. As a result, they were also divided into 3 groups (3 factors) (Table 5).
Table 5. Factor Analysis: Matrix of Components
For each factor, the average score was calculated using the following formulas: 
where X1, X2, X3 is the average value of the factor, X1–X10 is the number of the element under study in question No. 14 “Assess the significance of factors that could increase your desire to put more effort into work” (Table 2), n is the number of respondents. Then for the values of these 3 factors (X1, X2, X3) in accordance with the table. 6, the level of significance was determined.
Logistic regression analysis
Logistic regression analysis allowed us to determine how gender, age, family, position, education, time in the organization, wealth level, workload affect whether factor 1, factor 2 or factor 3 is significant (will affect the desire to put in more effort) for a medical worker. The probability of an event occurring, i.e. The probability that a medical worker will consider factor 1, factor 2 or factor 3 as a significant non-economic incentive that will encourage him to put in more effort was calculated using the formula:
where z = b1 ×X1 + b2 ×X2 + ... + bn ×Xn + a, Xn are values of independent variables, bn are binary logistic regression coefficients, and is a constant.
Table 6. Correlation between factor value and significance level
According to the indicators of logistic regression analysis, with increasing age and income, medical workers tend to appreciate such aspects of their work as the content of their professional activity (the opportunity to develop and apply a variety of skills), as well as the significance of work for themselves, for management and society (Table 7) . Respondents who work more than 40 hours a week, who have a family, rated such motivators as respectful attitude from the management and a friendly atmosphere in the team higher than those who do not have a family and who are not overloaded with work (see Table 1). Table 7).
Table 7. Results of logistic regression analysis
As a result of factor analysis, the elements of non-economic motivation were combined into groups. The first factor is "Recognition, feedback from colleagues and managers." The relationship of factors in the 1st group can be explained by the fact that, with a friendly and respectful attitude on the part of the management in a medical organization, employees regularly express gratitude, actively use public expressions of gratitude, hold meetings where they can voice their point of view, which will be taken into account in the future. solutions.
The second major factor of non-economic motivation includes elements of non-economic motivation that relate to the content of professional activity. If for an employee work is an opportunity for self-realization, it is also his vocation, corresponds to life goals and attitudes. At the same time, most likely, he is periodically given tasks with increased complexity, and he has sufficient autonomy in completing them. He applies a variety of skills, knowledge, and leadership contributes to his professional development.
The relationship of elements in the third factor “Organization of work” can be explained as follows: when the organization has clearly built processes, distributed powers and responsibilities among employees, and also when employees know what kind of work awaits them (since the tasks are simple and repetitive), they are less stressed. This suggests that they are less prone to conflicts, they lack uncertainty, which leads to the creation of a friendly atmosphere in the team. The results of the regression analysis showed that with the growth of income for medical workers, such factors of non-economic motivation as professional development and the significance of work for the employee, management and society become important.
This can be explained by the fact that with the growth of income, the employee is fully provided with his basic needs and he strives for intangible values. So, in accordance with Maslow's theory of motivation, the employee moves to a level where he is motivated by respect, veneration from colleagues and management, and self-realization.
Thus, we can draw the following conclusion: if the manager wants to ensure that the employee is interested in his professional development and the level of his competence increases, he needs to increase wages. Otherwise, the worker's activity will be aimed only at making money, since he needs to satisfy his basic needs. In practice, most often the situation is the opposite: the manager waits until the level of professionalism of the employee rises so that he has something to increase his remuneration for. However, the present study showed a reverse causation. The significance of age can be explained by the fact that with age, employees usually occupy a higher position and receive a higher income. This may also be due to the fact that with age, a person's values change - they become less focused on material goods, and therefore, they are motivated by work that is significant for society, as well as developing oneself as a specialist.
The statistically significant influence of a variable such as family on the likelihood that a health worker will be motivated by relationships with management and colleagues is explained by the fact that having a family indicates that relationships are important to him and he knows how to support and develop. The statistical significance of factors such as education and work overload may be explained by the fact that people with higher levels of education tend to perform more complex work and therefore take on more responsibility. In carrying out such work, both support and assistance, as well as recognition from management, are important. The results of the study are aimed at making it clear to the heads of medical organizations how to use non-economic motivation.
In this regard, it should be noted that when developing a human resource management policy, it is worth considering the specifics of the state and its healthcare system, culture and traditions. A study of job satisfaction and motivation of doctors in US and German clinics showed that the significance of the same factors for them may differ. The general trend in both countries is that it is important for healthcare professionals to participate in decision-making that affects the operation of clinics. However, for German doctors, the possibility of advanced training, employment stability, relationships with the team and the opportunity to use modern technologies and equipment are more significant. For American colleagues, wages are most important, relationships with colleagues are in second place, and access to new technologies turned out to be completely insignificant. For physicians in the USA and Germany, the possibility of teaching and research activities, participation in international exchange are not significant.
This suggests that motivation systems cannot be universal, they need to be adapted. Moreover, even within the same country, one should not rely on the same principles and factors for building a motivation system, including in the healthcare sector. A study of the motivation of physicians with families in Switzerland showed that this group of workers is not so much interested in career growth, but the balance between work and personal life is important for them. The factors of job satisfaction for this group are the possibility of part-time employment, flexible work schedule. Therefore, a separate motivation system should be developed for them.
Conclusion
Non-economic incentives are an integral part of the motivation system for medical workers in state medical institutions. Limited funding, an unstable economic situation are forcing their managers to look for new ways to motivate staff, in addition to raising wages and using different pay systems. The key advantage of non-economic incentives is the ability to influence intrinsic motivation. In medical practice, it is especially important that the doctor has an internal interest in providing quality medical services and in the recovery of the patient.
1. With an increase in the employee's salary, non-economic incentives should be more actively used to increase his motivation. The set of incentives may differ depending on age and position.
2. Medical workers in leadership positions (heads of departments and senior nurses) must first of all develop an understanding that their work is important for society. Since this factor is related to intrinsic motivation, it can be one of the indicators when making a decision by the top official of the organization whether to transfer an employee to a managerial position or not.
3. In the structure of non-economic incentives for non-management positions, the main emphasis should be placed on creating a friendly atmosphere in the team. To do this, the manager needs to evenly distribute responsibilities between subordinates, build internal processes, and carry out activities that develop the internal culture of the institution.
4. In order for the activities of medical workers not to be aimed only at making money, bring them pleasure and stimulate them to self-development, it is necessary to increase their wages to a level that covers basic needs.
5. When creating a motivation system, managers should take into account the peculiarity of medical workers who have a family and whose workload exceeds 40 hours per week (overworked). First of all, it is necessary to provide them with the most friendly and comfortable atmosphere and show respect.
Managers should also take into account that the introduction of new management tools, including motivational ones, can affect the usual work of medical workers, and in some cases cause resistance. Therefore, special attention should be paid to communication and change management to facilitate the transition process. In this case, a strong leader plays a special role, who is able to convey the vision and the need for transformations, ensuring the involvement of employees.
Yugai Mikhail Torichellievich – Candidate of Medical Sciences, Associate Professor, Department of Health Management and Economics, National Research University Higher School of Economics, General Director of the International Medical Cluster Foundation
Pankevich Victoria Igorevna - Master of Healthcare Management and Economics of the National Research University Higher School of Economics, Chief Specialist of the Communications Department of the International Medical Cluster Foundation
And the current health problem - the lack of nursing staff - poses an important task for nursing managers to staff the staff of nurses and maintain the existing staffing potential of the department. In many ways, its solution depends on the level and content of labor motivation of nursing staff.
Consider some practical approaches to motivating nurses.
General approaches to staff motivation
Staff motivation can be external and internal.
EXTERNAL MOTIVATION
The external motivation of a nurse to work consists of material rewards and non-material (moral) encouragement of her work. It should be noted that the capabilities of the nursing manager are limited, as a rule, in the direction of material incentives for department employees, i.e., determining their salary level, the size and regularity of bonuses, awarding valuable gifts (vacation tickets, a set of cosmetics, jewelry, watches, etc. .). While non-material incentives are often used by such leaders inefficiently, although they have great motivating potential.
When talking about non-material incentives, they mean, first of all, the allocation of one employee or group of employees against the background of the rest of the team for a job well done or a significant contribution to the development of nursing.
Nursing performance can be assessed in a number of ways:
- presentation of a letter of thanks, but always from a higher management;
- adding gratitude to the work book (at present, this type of moral encouragement is practically not used);
- posting a photo on the board of honor of the department or clinic.
All this in the long run is a positive portfolio of the employee.
It is important to pay attention to the fact that when evaluating the achievements of nursing staff, it is better to adhere to the following rules:
- It is necessary to celebrate distinguished nurses with a certain regularity and in a solemn atmosphere. With this act, the nursing manager emphasizes the value of employees. The solemnity of the situation allows you to go beyond the ordinary.
A special assessment of the achievements of nursing staff in the form of a letter of thanks, an entry in a work book, etc., significantly enhances the professional image of nurses, gives them a competitive advantage in the labor market. The leader should not be afraid of the latter, since a person is inclined to remain in the team where he is valued.
- A positive assessment of the contribution of a nurse to the work of the department should be made in the presence of the entire team, for example, during a meeting, which indirectly increases the motivation of other employees.
Everything that was discussed above refers to the significant achievements of nurses. But even in the daily bustle of the nursing manager, it is important to be able to notice the merits of the nursing staff and express gratitude to him. In this case, a simple word "thank you" and the phrase "you did well" would be appropriate. Such a simple reaction of the leader has a beneficial effect on the psychological atmosphere in the department, since the subordinate sees attention to himself.
In professional and social life, we often encounter such a psychological phenomenon: everything that causes positive emotions in us (a person, place, event, behavior), we easily accept. Everything that is unpleasant to us, we avoid.
In relation to the topic of discussion - employee motivation - this means that the perception of the image of the head nurse / head nurse by nurses should be positive.
To understand how a particular subordinate perceives his leader, it is not necessary to resort to questionnaires, it is enough to pay attention to his reaction when meeting with his boss.
If the nurse makes eye contact, her facial expressions are friendly, joyful - she has a positive attitude towards her leader.
If a nurse averts her eyes, lowers her head, frowns, purses her lips, turns away, moves away - she most likely perceives her leader intensely.
In the first case, the senior / chief nurse understands: everything that she broadcasts to this subordinate, she will accept and execute; discussion of difficult working moments will be constructive.
In the second case, the nursing manager must be prepared to be skeptical about his instructions, delays in execution and demagogic reasoning of the subordinate.
Thus, the manager's concern for his own positive image does not just become a tribute to fashion, but is dictated by the need to increase the motivation of employees.
INTERNAL MOTIVATION
We talked about the fact that along with external motivation, there is internal motivation, which is based on personal goals and employees' own interest in work.
The goal is defined as the image of the desired result. To correctly formulate a personal goal means to correlate it with six criteria: reality, concreteness, measurability, balance, independence, self-sufficiency.
The goal is realistic if it takes into account the personal and professional capabilities of the employee and production realities.
The goal must be specific. The wording of the nurse “I want to do a good job” is incorrect with respect to this criterion. The goal “I want no patient complaints about me for a month” is specific and can be measured. If at the end of the month there were no complaints about the nurse, it means that she has achieved her goal.
The balance of the goal means that goals should be formulated not only “for others”, but also “for oneself”. The goal above is an example of a “for others” goal. “Others” can be not only patients, but also colleagues, a manager, etc. An example of a goal “for myself” is the wording of a nurse: “I want to feel cheerful on 3-5 points during the work shift.” The state of cheerfulness is a subjective indicator, but it can be controlled by periodic measurements of one’s state during the shift on a scale of 0–5 points, where “0” means complete fatigue, and “5” - full activity. The balance of goals is important because goals "for oneself" serve as a resource and potential for goals "for others". Not vice versa!
The independence of the goal means its personal nature for the nurse. That is, the goal is “own”, or it is set by the manager and accepted by the employee as “own”. It is known that in order to achieve other people's goals, the motivation of an employee is lower or completely absent.
The independence of the goal indicates the importance of achieving it independently or together with colleagues. The significance of the goal for the employee is determined by his contribution to the implementation of this goal. The greater the contribution, the greater the personal significance!
Thus, in order to manage motivation, it is important for a nursing manager to understand the goals of the work of each nurse in the department. They can be found out through questionnaires or informal conversations with each of them. The chief nurse/chief nurse needs to contribute to the realization of these goals.
When giving tasks to subordinates, it can be useful for a manager to check his wording for compliance with the six goal setting criteria described and try to give them personal meaning for employees.
As already noted, interest is a resource for intrinsic motivation. Our sociological survey of 56 nurses working at the Scientific Center for Children's Health allowed us to identify the internal motives of the nursing staff. This is career growth, the possibility of publications, participation in the scientific work of departments and scientific and practical conferences.
The data obtained opened the prospect for introducing an innovative approach to motivating nurses.
An innovative approach to motivation
An innovative approach to motivation is to create a new system of labor motivation for nursing staff.
Traditionally, career advancement involves raising the status of a nurse and becoming a senior nurse in a leadership position. A successful chief nurse rises through the ranks to the position of chief nurse. Since jobs for nursing managers are limited, many nurses may not have such aspirations.
A new approach is now becoming a horizontal professional development of a nurse, when she expands her competencies by moving to work in another department. The same applies to the senior nurse, who is able to organize nursing care in a non-core department for her. The scientific justification for such personnel movements is the proven expediency of changing professional duties by an employee with a frequency of 1 time in 5 years. This approach allows the nursing staff to be in constant professional and personal development, and the management - to mobile solve the problems that have arisen due to the interchangeability of nurses.
The formation of internal labor motivation is facilitated by the involvement of nursing staff in research and teaching activities. This opportunity is based on the desire of nurses to influence the work of the department and develop nursing. The experience of the Scientific Center for Children's Health shows that a high interest in participating in scientific research, understanding and transferring their knowledge and skills encourages nurses to publish abstracts, make poster presentations, and conduct master classes at pediatric nurses' forums, which since 2011 have been regularly are held within the framework of the Congress of Pediatricians of Russia.
The study of new experience convinces that the participation of nurses in activities that are atypical for them has a positive effect on the development of their professional and personal qualities: it forms a scientific style of thinking, improves public speaking and emotion regulation skills, reduces anxiety, increases mental activity, stress resistance and confidence. in itself . Ultimately, all this keeps the motivation to work with nurses at a high level.
General and innovative approaches to motivating nursing staff are, in a sense, universal in the direction of increasing the labor motivation of department employees. At the same time, it is important for a nursing manager to see in each nurse an individuality, a personality, which will ultimately help him to competently and effectively interact with her.
Individual-personal approach to motivation
If we consider the staff of the department as a whole, within it we can easily distinguish subgroups of employees that differ in the degree of activity in the labor process.
We distinguish four such subgroups:
- "supporting";
- "contemplative";
- "opposing";
- "avoiders".
Let us characterize these subgroups and define strategies for increasing labor motivation in each of them.
The first subgroup - "supporters" - are proactive nurses who take an active part in the life of the department. They are sociable, perform their duties quickly enough. "Supporters" have a positive attitude towards the leader, they are his support, both in current and in emergency cases. Since such employees do not always control their activity, they can implicitly compete with the manager.
The second subgroup - "contemplators" includes employees who prefer to observe the processes as if from the outside. They do not show their own initiative and are active only when directly addressed to them. They have a measured pace of activity. They also perceive the leader positively, are able to provide assistance, but without enthusiasm.
"Opponents" make up the third subgroup of those nurses who have their own point of view on the issues under discussion and actively (sometimes aggressively) demonstrate it. Since they are critical of the manager, it is usually difficult for him to interact with this subgroup of employees. At the same time, “opponents” often have a new perspective on the situation and can provide constructive feedback to the nursing manager. Such nurses can be proactive. In response to the assignment, they often demonstrate a skeptical attitude.
The fourth subgroup includes nurses who, as it were, “serve out” working time and are defined by us as “avoiders”. They are hardly noticeable in the labor process. Their work is done slowly or carelessly. Such behavior is often aimed specifically at getting relief from part of their duties. These nurses love to take sick leave.
An assessment of the ratio of subgroups within the team of the department shows that the subgroups of "participating" and "contemplating" make up the majority of nurses. They account for approximately 30 and 50%, respectively. "Opponents" make up about 5-10%, "avoiders" - 10-15% of employees. This ratio is relative, depends on the size of the team and its specifics.
To maintain a high level of motivation in the “supporters” subgroup, means of moral encouragement are well suited: attention to initiatives, interest in the opinion of nurses, regular and reasonable gratitude for work. "Supporting" nursing staff, due to their high productivity, can be included in the first place by the head in research activities.
"Contemplative" nurses, as noted above, respond well to personal attention. They expect the manager to have more frequent and longer discussions of production issues. "Contemplators" show their professional qualities brighter and freer in the group.
Nurses - "opponents", as a rule, individualists. In addition, if the “contemplators” wait in silence to get the attention of the leader, then the “opponents” demand this attention. At the behavioral level, their exactingness is expressed in the form of criticism of the leader's decisions, opposition to his point of view, and active demonstration of his opinion. It is important for the nursing manager to understand that behind this behavior of some nurses there is usually a lack of attention to their individuality. To control the situation in the team and maintain creative activity, it is enough to give the “opponents” the opportunity to make public their position and / or offer to implement their ideas with the delegation of responsibility for the result (of course, before assessing the consequences). Also, it may be useful for the leader to discuss some issues with “opposing” nurses in principle, despite the discomfort of such communication. Nursing managers should not be misled by the critical reactions of "opponents" to moral incentives, they work for this subgroup of nurses as well.
The "shunners" make up the most unmotivated part of the department's nursing staff. Repressive measures in relation to them cause only reciprocal negative emotions, rejection of the leader and his activities. In addition, this subgroup of nurses may be completely absent only in organizationally mature teams, which in practice is extremely rare even in small departments. In our opinion, the manager's wait-and-see position seems to be reasonable in relation to the "avoiders". However, it should not be passive waiting. It is important for the nursing manager to offer “avoiders” options for feasible activities in which they can be successful.
An interesting typology of nursing staff is offered by R.I. Hardy. Let us turn to his description of the most common nurse personality types in medical practice:
- The nurse is a "routiner".
This is a nurse who carefully, scrupulously, deftly and skillfully carries out the instructions of the head. However, its distinguishing feature is the mechanistic performance of its duties. That is, it is aimed at manipulation, and not at the patient. Describing this type of nurse, Hardy notes: she "is able to wake a sleeping patient just to give him a sleeping pill prescribed by a doctor." - A nurse "playing a learned role."
Such a nurse in her work is guided, first of all, by her ideas about the ideal nurse. More often she plays the role of a benefactor, which is why her behavior looks, as a rule, artificial and ostentatious, and care and care become insincere. It is from such a nurse, the author points out, that one can often hear: “... in vain I inspired him ...”, “I brought him up for hours ...”, etc. - Nervous Nurse.
This, as a rule, is a nurse with an emotionally labile, sensitive-anxious personality type, prone to neurotic reactions. Her emotional tension often leads to manifestations of rudeness, irritability, irascibility, which she directs at the patient. Often such nurses complain about their health, which gives them reason to refuse to carry out assignments and even not go to work. - "Strong" nurse ("Grenadier").
Type of nurse with pronounced masculine personality traits. At the behavioral level, such an employee is distinguished by a confident, firm gait (“A grenadier is coming!”), decisiveness, perseverance, peremptory exactingness. A "strong" nurse can be a good organizer and mentor, about whom they say: "Strict, but fair." Within the type, there are also rigid nurses (rigid, inflexible), with an insufficient level of culture - rude and even aggressive towards patients. - The nurse is the mother.
Maternal nurses perform their work with great care, attention and empathy for patients. Hardy gives this image of the “mother” nurse: “Often these are cute fat ones, silently“ rolling ”through the wards. They have time everywhere and, despite their gray hair, often in liveliness and mobility are not inferior to twenty-year-olds. - nurse is a "specialist".
The type of nurse who can do complex work, but within very narrow limits. This is a nurse - a fanatic of her special activity, except for her, she is not interested in anything else.
Motivation, taking into account the typological characteristics of nurses, is a difficult task for the leader, it requires him, without exaggeration, to work daily to transform the characteristics of their personality. This work should be directed, first of all, to changing the structure of motivation, the formation of new motives.
So, for a “routine” nurse, the motives of care and help must be filled with sensual content.
For a nurse who “plays a learned role”, it is important for the leader to maintain self-respect and at the same time cultivate a respectful and partner attitude towards patients.
It is useful to turn the attention of a “nervous” nurse to her own needs and goals “for herself”. This will give her a resource to stabilize her emotional state.
Involving a "grenadier" nurse in scientific activities will allow her to show her "masculine" qualities. The "strong" features of this type of nurse can be compensated by emphasizing her feminine nature (mother, wife).
The “mother” nurse's style of care should be encouraged by the manager. It is important to disseminate the behaviors characteristic of this style as an experience among the employees of the department.
Nurse-"specialist" should be encouraged to improve skills in related fields.
In conclusion, it should be noted that consideration of modern approaches to motivating nursing staff, on the one hand, reminds nursing managers of the general rules of motivation, the unfulfilled potential of moral encouragement, the need for proper goal setting and caring for one's own positive image. On the other hand, familiarity with innovative approaches gives the manager the opportunity to include nurses in new and significant activities for them, thereby overcoming the routine of work and developing personal and professional qualities.
General and innovative approaches that increase the motivation of employees should be complemented by an individual approach of the nursing manager to each nurse, taking into account her personal and behavioral characteristics. In the implementation of the individual-personal approach, the educational function of the leader is fully revealed, which should play an increasingly large role in motivating employees.
List of used literature
1. Biryukova E.G., VarfolomeevaE. Yu. Innovative technologies for training nursing staff on the example of a day hospital at a high-tech clinic / Biryukova E.G., Spivak I.M. Education of nursing staff in health-saving behavior. Digest of articles. Moscow: LAP LAMBERT Academic Publishing, 2014, pp. 20–28.
2.Spivak I.M., BiryukovaE. G. The role of research activities in the development of the personality of a nurse // Bulletin of the Association of Nurses of Russia. 2015. No. 2/21. pp. 7–9.
3. HardyR.I. Doctor, sister, patient. Psychology of work with patients. Budapest: Academy, 1974. 286 p.
Federal Agency for Health and Social Development
Extramural
Specialty 060108-Nursing
Department of Nursing
COURSEWORK IN MANAGEMENT
MOTIVATION OF WORK OF NURSING STAFF
IN THE MEDICAL INSTITUTION
Candidate of Medical Sciences, Associate Professor of the Department of Nursing
| INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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| 1. THE CONCEPT OF SATISFACTION WITH WORK AND INCREASING THE INDUSTRIAL MOTIVATION OF NURSES. . . |
7 |
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| 1.1 |
Problems of labor motivation in medicine. . . . . . . . . . . . . . . . . . . |
7 |
| 1.2 |
The concept and essence of staff motivation. . . . . . . . . . . . . . . . . . . . . . . |
11 |
| 1.3 |
Basic theories of motivation ………………………………………………………………………………………………. |
17 |
| 1.4 |
Factors of motivation of work of nurses in health care facilities and the main directions of its increase ………………………………. . . . . . . . . . . . . |
26 |
| 1.5 |
Methods of measuring and indicators of satisfaction with the work of nurses ………………………………………………………… |
32 |
| 2. CHARACTERISTICS OF THE HEALTHCARE POINT
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37 |
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| 2.1 |
Health center management structure
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37 |
| 2.2 |
Analysis of performance indicators of the health center. . . . . . . . . . . . . . . . . . . . . …………… |
40 |
| 2.3 |
Analysis of the personnel potential of the health center. . . . . . . . . |
41 |
| 3. WAYS OF STUDYING JOB SATISFACTION AND INCREASING THE INDUSTRIAL MOTIVATION OF NURSES. . . …………………………………………………………………………... |
42 |
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| CONCLUSION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . |
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| LIST OF USED LITERATURE. . . . . . . . . . . . . . . . . . . . . . . . |
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| APPS |
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DEFINITIONS AND ABBREVIATIONS
| Motivation |
- motivation of a person to activity, which is determined by the presence of needs and the creation of conditions for their implementation and obtaining results. |
| motives |
- motivating causes of human behavior and actions that arise under the influence of his needs and interests and represent the image of the good desired by the person, which satisfies the needs, provided that certain labor actions are performed. |
| Labor motivation (labor motivation) |
- this is the desire of the employee to satisfy needs (to receive certain benefits) through labor activity |
| health care facility |
- medical and preventive institution |
| JSC |
Public corporation |
INTRODUCTION
The stability of the staff is one of the conditions for the effective operation of any company, and the struggle for low staff turnover is a problem that is especially relevant for areas such as healthcare and pedagogy. To solve it, one must be able to predict the situation, learn to manage the process of staff turnover. And one of the first steps here can be a study showing how satisfied employees are with their jobs. Often, satisfaction is understood as the retention of an employee in the enterprise.
The problems of increasing the labor motivation of medical workers are the most important function of healthcare management. Without their solution, it is hardly possible to really improve the quality and culture of providing medical care to the population, as well as increase the efficiency of the activities of medical institutions (HCIs) and the industry as a whole based on the rational use of financial, material and human resources. It has now been proven that money does not always induce a person to work harder (although no one downplays the role of material interest!). The problems of increasing labor motivation are systemic in nature and require an integrated approach to their solution.
The relevance of the study lies in the fact that by studying satisfaction, one can obtain information about the strength of staff attachment to the enterprise. Here it is appropriate to talk about material and moral incentives for employees. Job satisfaction data is information about personnel risks. It is important for any leader who does not want to be a hostage to the current situation. The problems of motivation and stimulation of personnel are widely considered today in the scientific and journalistic literature. However, attempts to adapt the classical theories of motivation to the present are largely not systematized, which makes it difficult to use the technologies and methods of motivation in practice. The complexity of the practical organization of the personnel motivation system is also determined by the poor study of the characteristics of the motivation of workers employed in certain sectors of the economy and types of production. It is quite obvious that in different fields of activity there is a professional specificity of motivation. The urgency of the problem is also due to the rigidity of the management system in health care, which has largely retained the features of management that are characteristic of the socialist planned system and do not fit into modern market conditions. In most health care institutions, the possibilities of material stimulation of labor are limited by the lack of funds, so special attention should be paid to the means of non-material motivation of nurses. Given the limited material resources of health care, the effective and adequate value orientation of the personnel of a particular medical institution, non-material form of motivation, is of particular relevance. As the material and technical base of health care is strengthened, the issues of personnel management in its not material, but socio-psychological aspect will increasingly arise before the heads of medical institutions. Increasing the work motivation of nurses is an urgent problem, the significance of which is especially high in connection with the healthcare reform and the implementation of the National Health Project. Managers should clearly understand the importance of motivation as one of the management functions and use every opportunity to reduce the factors that demotivate nurses
The hypothesis of the study is that among managers at various levels, as well as among ordinary employees, it is widely believed that the efficiency and quality of work, all other things being equal, are proportional to the amount of remuneration. However, it is obvious that high salaries are not a guarantee of protection against corruption and simply negligent attitude to work at all levels. As it turned out, motivation (i.e., the process of inducing activity to meet personal needs and achieve the goals of the organization) is the result of the influence of a complex set of factors. The priority factors of motivation include wages, working conditions, stability, professional growth, the social significance of work, interest in work, etc.
The imperfection of the existing system of motivation for the work of medical workers, in particular nurses, the paucity of publications on motivation in healthcare institutions, served as a reason for the study.
The purpose of the study is to analyze the factors of motivation of the work of the nursing staff of the health center. Research objectives:
- Consider and systematize the theoretical foundations for studying the motivational orientation in work.
Summarize information about the motivational orientation of medical workers.
To characterize and evaluate the staff potential of the health center Prepare a questionnaire for the study of job satisfaction
The subject of the study is the features of the motivational orientation of nurses.
When conducting this study, the following research methods were used:
-Analytical (analysis of received data)
- Sociological (questionnaire)
- Statistical (data from reporting documents)
CHAPTER 1. THE CONCEPT OF SATISFACTION WITH WORK AND INCREASING THE INDUSTRIAL MOTIVATION OF NURSES.
1.1. Problems of labor motivation in medicine.
Increasing the labor motivation of personnel is one of the priority tasks of management in any field of activity. Of particular importance is the solution of this problem in the field of healthcare in connection with the tasks set in the "Concept for the development of the healthcare system in the Russian Federation until 2020" .
Nursing is an integral part of the health care system, aimed at solving the problems of individual and public health of the population in a changing environment. Nursing includes health promotion, disease prevention, psychosocial care and care for people with physical and/or mental illnesses and disabled persons of all age groups. According to the Central Research Institute of Organization and Informatization of Healthcare in 2010, the number of nurses in the Russian Federation was 1327.8 thousand people. Nursing is part of the health care system, which has significant human resources and real potential to meet the needs of the population for quality and affordable medical care.
Despite the tasks set for healthcare, at the present time in the development of nursing there are still some trends that negatively affect the state of labor motivation of nurses.
One of the main reasons affecting the labor motivation of the staff is the level of material remuneration for work and the feeling of fairness of this remuneration. For employees with external motivation, this factor can be of decisive importance not only as a factor supporting and regulating the motivational state, but often play a decisive role in deciding whether to continue working in a particular organization and in medicine in general. For internally motivated workers, of course, other factors are more important, but the low level of wages makes them also experience significant dissatisfaction.
The vast majority of both patients and doctors underestimate the contribution of a nurse to the diagnostic and treatment process; doctors do not know how and are not focused on building equal partnerships with nurses, they do not recognize higher nursing education, and even more so, an increased level of secondary professional education of nurses. Historically, there was an idea of a nurse as an assistant to a doctor, his "right hand", an appendage. “[The nurse] must begin her work with the thought firmly planted in her head, the thought that she is only the instrument by which the doctor carries out his instructions; it does not occupy an independent position in the process of treating a sick person" (McGregor-Robertson, 1904).
Despite a whole century separating us from this statement, at the present time, little has changed in this mentality. Many doctors directly or indirectly express their superiority, allow incorrectness in relation to nursing staff, all this acts as a factor that significantly reduces the desire to work.
A high degree of physical and psychological stress on nurses, underdevelopment of coping strategies, as well as a number of organizational factors contribute to the rapid development of professional burnout syndrome, which, according to various authors, affects from 40 to 95% of paramedical workers. The burnout of medical workers significantly deforms the system of value orientations of the individual, emphasizing material values to the detriment of spiritual ones, and shifts labor motivation from internal to external.
The low level of wages provokes unofficial sources of income, with the help of which workers try to satisfy not only the need for fair material remuneration for work, but also the need for recognition and respect. It is she who is one of the leading internally motivated workers in the structure of labor motivation, which are often doctors. The lack of recognition is compensated by replacing it with a monetary equivalent and material symbols, with a clear lack of opportunity to do this with the help of wages, there is a shift in emphasis to unofficial sources. Although it should be noted that we are talking more about doctors; paramedical workers are much less able to use informal means of remuneration. Moreover, it is smaller opportunities, but no less desire. In this situation, nurses experience a growing sense of injustice, which leads to the disunity of the “doctor-nurse” tandem, affecting the quality of treatment and reducing the labor motivation of the latter. But the problem of deformation of the value-motivational system of medical workers is of particular importance in this situation. Behind the visible side of this problem, there is another one: informal payments are beginning to be recognized as a significant incentive that encourages nurses to work better, and students to choose a medical profession, i.e. included in the system of labor motivation. The collection of unofficial payments, in addition to the legal aspect of the problem, is fundamentally contrary to the principles of biomedical ethics, discredits the public health system, and negatively affects the quality of medical care and the prestige of the medical profession.
The opportunities for self-improvement and training of nurses remain very limited: mandatory advanced training is carried out once every 5 years, the opportunities for the exchange of experience between the average staff of various medical institutions are not used enough, the methods of intra-organizational training are little used: horizontal rotation of personnel, "young nurse school" and other forms of education. Meanwhile, the realization of the need for training and development, on the one hand, and the participation of nurses themselves in pedagogical activities, on the other hand, have a powerful motivational potential for a significant part of workers.
One of the main health problems is the lagging of the material and technical base of medical institutions from modern requirements. In addition to the surface problem of the quality of medical care, this leads to a decrease in the prestige of the nursing profession, to insufficient use of the motivational potential of the need for self-improvement. In the "Concept for the development of the healthcare system in the Russian Federation until 2020" one of the priority tasks is the development of "infrastructure and resource support for healthcare, including financial, material, technical and technological equipment of medical institutions based on innovative approaches and the principle of standardization", which is designed not only to improve the quality of medical care, but also to promote the development labor motivation of personnel.
The personnel management system needs to be improved. Currently, there is practically no hierarchy in the system of organization of nursing. Career opportunities are very limited: Nurse, Head Nurse, Head Nurse. Only in some health facilities there are such positions as a specialist in training nursing staff, a specialist in quality control of nursing activities. For example, positions such as foreman or shift supervisor, nurse-mentor are not provided. The introduction of a number of such positions could serve the career aspirations of some nurses and a more differentiated approach to the issue of remuneration.
The prestige of the profession of a nurse, as noted earlier, plays one of the significant roles in the structure of the labor motivation of nurses. Most of the reasons listed above are directly or indirectly related to the position that this profession occupies in society. Raising the prestige of the profession is not so easy, and this is a common task not only for the healthcare system, but also for the cultural state of the whole society, the hierarchy of social values. Western-style labor motives and values introduced into the mass consciousness of Russians from the outside do not correspond to the model of attitude to work that has been formed over the centuries-old history of Russia on the basis of internal prerequisites and requirements for economic development. The decrease in the general cultural level of the population, of which nurses are a part, leads to the primitivization of needs, the underdevelopment of the motivational sphere. There is no widespread propaganda of the social significance of the nursing profession at all levels. Insufficient attention in health care institutions is paid to the development and maintenance of the culture of the organization, in particular, the popularization of the mission of the institution, the formation of loyalty and commitment to the organization of personnel, and other specific aspects of the formation of organizational culture. Increasing the work motivation of nurses is an urgent problem, the significance of which is especially high in connection with the healthcare reform and the implementation of the National Health Project.
1.2. The concept and essence of staff motivation.
Motivation is a complex psychological phenomenon that causes a lot of controversy among psychologists who adhere to various psychological concepts.
Motivation can be defined in different ways. On the one hand, motivation is the process of encouraging oneself and others to act in order to achieve personal or organizational goals. On the other hand, motivation is the process of a person's conscious choice of one or another type of behavior, determined by the complex influence of external (stimuli) and internal (motives) factors. In the process of production activity, motivation allows employees to satisfy their basic needs by performing work duties.
In the most approximate sense, such a definition reflects the internal state of a person, however, it should be noted that the forces that impel to action are outside and inside a person and force him to consciously or unconsciously perform certain actions. At the same time, the connection between individual forces and human actions is mediated by a very complex system of interactions, as a result of which different people can react in completely different ways to the same effects from the same forces.
Based on this, it can be assumed that the process of human motivation is subject to both internal and external determination. This is where the concept of motivation comes in. Motivation is an activity aimed at activating the workforce and everyone working in the organization and encouraging employees to work effectively to achieve the goals formulated in the plans.
The function of motivation lies in the fact that it has an impact on the workforce of the organization in the form of incentives for effective work, social impact, collective and individual incentive measures. These forms of influence activate the work of management subjects, increase the efficiency of the entire management system of the organization.
The essence of motivation lies in the fact that, focusing on the system of needs of employees, to ensure the full and effective use of their labor potential in order to achieve the goals of the organization as soon as possible.
Labor motivation is the desire of an employee to satisfy needs (to receive certain benefits) through labor activity.
The structure of labor motive includes:
- the need that the employee wants to satisfy;
- a good that can satisfy this need;
- labor action necessary to obtain a benefit;
- price - costs of a material and moral nature associated with the implementation of a labor action.
The relationship between the need for work and job satisfaction, attitude to work
Labor motivation is the most important factor in the performance of work, and in this capacity it forms the basis of the employee's labor potential, i.e. the whole set of properties that affect production activities. The labor potential consists of the psycho-physiological potential (a person's abilities and inclinations, his health, performance, endurance, type of nervous system) and personal (motivational) potential. Motivational potential plays the role of a trigger that determines what abilities and to what extent the employee will develop and use in the process of work. Motivation is also the process of creating such conditions that regulate labor relations, within which the employee has a need to work selflessly, since this is the only way for him to achieve his optimum in meeting needs. Motivation is the process of pairing the goals of the company and the goals of the employee in order to most fully meet the needs of both, the process of encouraging oneself and others to work to achieve common goals. Motivation is the creation of conditions for identifying the interests of an organization and an employee, under which what is beneficial and necessary for one becomes just as necessary and beneficial for another [22].
There are various ways of motivation, of which the following can be distinguished:
1. Normative motivation - inducing a person to a certain behavior through ideological and psychological influence: persuasion, suggestion, information, psychological infection, and the like;
2. Coercive motivation, based on the use of power and the threat of deterioration in the satisfaction of the needs of the employee if he fails to comply with the relevant requirements;
3. Stimulation - the impact is not directly on the individual, but on external circumstances with the help of benefits - incentives that encourage the employee to certain behavior.
The first two methods of motivation are direct, since they involve a direct impact on a person, stimulation is an indirect method, since it is based on the influence of external factors - incentives.
The motivation system can be presented in the form of a special table.
Labor motivation system
The main tasks of motivation are the following:
1) Formation in each employee of an understanding of the essence and significance of motivation in the labor process;
2) Training of personnel and management on the psychological foundations of intra-company communication;
3) Formation of democratic approaches to personnel management in each manager using modern methods of motivation.
To solve these problems, various methods of motivation are used.
Four main methods of motivation:
1. Coercion - is based on the fear of dismissal, punishment.
2. Remuneration - is carried out in the form of systems of material and non-material stimulation of labor.
3. Solidarity - is implemented through the formation of personnel values and goals that are close or coinciding with the values and goals of the organization, and is carried out with the help of persuasion, education, training and the creation of a favorable working climate.
4. Adaptation - implies influencing the goals and objectives of the organization by partially adapting them to the goals of top and middle managers. This type of motivation requires the transfer of authority to lower levels, and this becomes an internal motive that unites the goals of the management and personnel of the organization.
The essence of personnel motivation lies precisely in the fact that the personnel of the enterprise perform their work effectively, each guided by their rights and obligations, in accordance with the decisions of the management of the enterprise. The types of staff motivation vary slightly among different authors, but it is easy to single out a few basic ones.
Types of staff motivation according to the main groups of needs: material (the employee’s desire for prosperity), labor (the content and working conditions), status (the desire of the individual to take a higher position in the team, be responsible for more complex and qualified work).
Types of staff motivation according to the methods used: normative (influence through information, suggestion, persuasion), forced (use of the threat of dissatisfaction of needs, coercion, power), stimulation (indirect impact on the personality, benefits and incentives that encourage the employee to the desired behavior).
Types of motives according to the sources of occurrence: internal and external. External motives are external influences, with the help of certain rules of behavior in a team, through orders and orders, payment for work, etc. Internal motives are influence from within, when the person himself forms motives (for example, knowledge, fear, desire to achieve a certain goal or results, etc.). The latter type of incentive is much more effective than the former, because the work is done better and less effort is spent on it.
Types of personnel motivation in order to achieve the goals and objectives of the organization: positive and negative. Positive - these are personal bonuses and bonuses, assignment of the most important work and VIP clients, etc. Negative - these are various comments, reprimands and penalties, psychological isolation, transfer to a lower position, etc., and all types of penalties should be communicated and explained to the whole team, and not just to a specific individual.
Factors of staff motivation can be identified as follows:
- The need to work in a successful and well-known company. Here the main role is played by the prestige or "branding of the enterprise", when its employees are proud of the fact that they take an active part in the life of the organization.
Fascinating and interesting work. The best option when hobby and work are synonymous. If the work activity of an employee allows him to fulfill himself and brings pleasure, then the work of the individual will be successful and effective. The status of an employee, the possibility of his development and the acquisition of new knowledge, his participation in planning the tasks of the enterprise play an important role here.
Financial incentive. All types of bonuses, bonuses and, in fact, salary are components of this factor.
Managers are always aware that it is necessary to encourage people to work for the organization, but at the same time they believe that simple material rewards are enough for this. In some cases, such a policy is successful, although in essence it is not correct.
People who work in modern organizations are usually much more educated and well off than in the past, so their motivations for working are more complex and difficult to influence. There is no single recipe for developing a mechanism for effectively motivating employees to work. The effectiveness of motivation, like other problems in management, is always associated with a specific situation.
1.3 Basic theories of motivation.
Traditionally, in the works of researchers of employee motivation, various motivational theories are divided into two categories: substantive and procedural.
Content theories of motivation are based on the identification of those internal motives (needs) that make us act one way and not another. This group includes the concepts of Abraham Maslow, David McClelland, Frederick Herzberg and others.
More modern process theories of motivation are based primarily on how people behave in relation to their perception and cognition. The most famous procedural theories of motivation are: the expectation theory, the theory of justice and the Porter and Lawler model of motivation, others.
Abraham Maslow's Theory of Motivation.
Creating his theory of motivation in the 1940s, Maslow recognized that people have many different needs, but also believed that these needs can be divided into five main categories.
1. Physiological needs are essential for survival. These include the needs for food, water, shelter, rest, and sexual needs.
2. Needs for security and confidence in the future include the need for protection from physical and psychological dangers from the outside world and the confidence that physiological needs will be met in the future. A manifestation of the need for confidence in the future is the purchase of an insurance policy or the search for a secure job with good retirement prospects.
3. Social needs, sometimes called belonging needs, is a concept that includes a sense of belonging to something or someone, a feeling of being accepted by others, a feeling of social interaction, affection or support.
4. Esteem needs include the need for self-respect, personal achievement, competence, respect from others, recognition.
5. The need for self-expression is the need to realize one's potential and grow as a person.
According to the theory under consideration, all these needs can be arranged in the form of a strict hierarchical structure (pyramid), at the base of which there are primary needs, physiological, safety and security needs, and closer to the top - secondary needs, and at the very top of this pyramid - the needs for self-expression and respect. With this hierarchical structure, Maslow wanted to show that the needs of the lower levels require satisfaction and, therefore, affect human behavior before the needs of higher levels begin to affect motivation. At each particular moment in time, a person will strive to satisfy the need that is more important or stronger for him. In his opinion, in order for a higher-level need to become a determinant of human behavior, a lower-level need must be satisfied. As for the highest need for self-expression, Maslow believes that since with the development of a person as a person his potentialities expand, the need for self-expression can never be fully satisfied. Therefore, the process of motivating human behavior through needs is endless. That is, a person experiencing hunger will first seek to find food and only then satisfy other needs. Living in comfort and security, a person will first be motivated to activity by the need for social contacts, and then will begin to actively seek respect from others. Only after a person feels inner satisfaction and respect from others, his most important needs will begin to grow in accordance with his potential.
McClelland's theory of needs.
McClelland believed that people have three needs: power, success, and belonging. The need for power is expressed as a desire to influence other people. Within Maslow's hierarchical structure, the need for power falls somewhere between the needs for respect and self-expression. People with a need for power most often manifest themselves as frank and energetic people who are not afraid of confrontation and strive to defend their original positions. Often they are good speakers and require increased attention from others. Management very often attracts people with a need for power, since it provides many opportunities to manifest and exercise it.
Herzberg's two-factor theory.
In the second half of the 1950s Frederik Herzberg and his collaborators developed another need-based motivation model. As a result of a study of employees of a large paint and varnish company, he subdivided the entire set of factors that affect staff satisfaction with work and motivation for work into two groups: "hygienic factors" and "motivations".
Hygienic factors are related to the environment in which the work is carried out, and motivations are related to the very nature and essence of the work.
According to Herzberg, in the absence or insufficient degree of presence of hygienic factors, a person develops job dissatisfaction. However, if they are sufficient, then by themselves they do not cause job satisfaction, they cannot motivate a person to do anything.
In contrast, the absence or inadequacy of motivation does not lead to job dissatisfaction. But their presence fully causes satisfaction and motivates employees to improve the efficiency of labor activity. According to Herzberg, the factors that cause job satisfaction are not opposites in the same dimension. Each of them is, as it were, in its own scale of measurements, where one operates in the range from "minus" to zero, and the second - from zero to "plus". If contextual factors create a bad situation, then employees experience dissatisfaction, but at best these factors do not lead to great job satisfaction, but rather a neutral attitude. Satisfaction with work is caused only by motivational factors, the positive development of which can increase motivation and satisfaction from a neutral state to a "plus".
Despite the significant step forward in the development of the theory of motivation that meaningful concepts have made in this direction, they are not without certain shortcomings, which include:
1. ignoring the situational features of the motivational choice, reducing the whole variety of human motivating forces to a limited set of needs.
2. underestimation of the individuality of human activity. Trying to overcome the limitations of incentives on the principle of "carrot and stick", meaningful concepts of motivation fall into their own trap: they try to limit human behavior to a rigid hierarchy or set of internal values.
3. the inability to establish a clear correlation between the various needs of a person due to the lack of a universal theory of human activity.
These shortcomings, which inevitably included all substantive theories of motivation, tried to overcome other researchers in this field, who developed other motivational models, called process ones.
Victor Vroom's Expectancy Theory.
The theory of expectations is based on the position that the presence of an active need is not the only necessary condition for motivating a person to achieve a certain goal. A person must also hope that the type of behavior he has chosen leads to the satisfaction or acquisition of some good that he needs at the moment or has personal value for him. Human behavior is constantly associated with the choice of two or more alternatives. From what a person gives this or that preference depends on what and how he does, how he behaves and what results he achieves. Expectancy theory is designed to answer the question of why a person makes a particular choice, faced with several alternatives, and how motivated he is to achieve an outcome in accordance with the choice made.
The process of motivation according to the theory of expectation consists of the interaction of three blocks:
1. effort
2. execution
3. result
Expectancy theory studies and describes the interaction of these three blocks. At the same time, efforts are considered as a consequence and even the result of motivation. Performance is considered as a consequence of the interaction of efforts, personal capabilities and the state of the environment, and the result is considered as a function that depends on performance and on the degree of desire to obtain results of a certain type.
The main provisions of the expectancy theory are as follows.
First, since this theory is subject to the idea of finding an answer to the question of how motivation affects the performance of work, the initial postulate is that performance is determined by the product of the value of two factors: a person’s capabilities and his motivation.
Secondly, it is argued that motivation is given by the product of the value of expectation of the results of the first level by the value of the valence of the results of the first level.
Thirdly, the valence of the results of the first level is given by the product of the value of the valence of the results of the second level by the expectations of individual results of the second level. A person chooses the alternative where the motivation will be higher.
In practice, this means that the employee must have a firm understanding that the results of his work depend on his efforts, that certain consequences follow for him from the results of his work, and that the results he receives ultimately have for its value.
In the absence of one of these conditions, the process of motivation becomes extremely difficult or even impossible.
Drawing a general conclusion about the theory of expectation, it should be noted that it proceeds from the fact that people carry out their actions in accordance with what possible consequences these actions can lead to for them.
Based on the information available to them, people make a choice of one of the alternatives of action, based on what they will get as a result and what efforts they will have to expend in order to achieve this result. That is, according to the theory of expectation, a person behaves in accordance with what, in his opinion, will happen in the future if he makes a certain amount of effort.
The Theory of Justice.
The theory of justice is one of the most beautiful and therefore the most famous theory of motivation in Western management. Its main postulates:
1. people evaluate their relationships by comparison (what I put in and what I get).
2. Non-equivalence of contribution and return is a source of discomfort (guilt or resentment).
3. people who are not satisfied with their relationships seek to restore justice.
Simply put, the situation is probably familiar to everyone: the employer and employees evaluate their contribution in completely different ways. Employees feel the inadequacy of how they are evaluated, and begin to demand a different attitude towards themselves.
What happens next is illustrated by three ways to restore justice:
1. if a person receives less than he gives, he begins to reduce his contribution. Employees begin to be late for work, leave early, reduce the amount of work, increase break times, and so on.
2. Employees begin to demand higher wages, promotions, higher bonuses.
3. the cardinal way is a break in relations.
Why is there a violation of justice? There are four reasons:
1. Wrong psychological currency. In this case, either the contribution is not understood or it is not recognized. What do workers want?
? feelings of job satisfaction.
? adequate remuneration.
? flexible remuneration system (I do more - I get more)
? opportunities to realize all their abilities.
? variety of work (movements both vertical and horizontal).
Often, they receive only money as a return. Perhaps before you make a contribution to the relationship, you should think about what is of value to the other person, and offer him exactly that.
2. Another reason why it is difficult to maintain justice is the lack of trust. Sometimes an employee initially treats management with distrust and apprehension, assuming all sorts of troubles on their part. However, the opposite is also very common.
3. Hidden internal expectations. We quickly get used to the fact that one or another of our needs has always been met, and when this does not happen, we perceive this as a violation of justice.
4. Accumulation of grievances. We tend to give people some credit of trust and try to ignore people's negative actions. In addition, the process of sorting out the relationship is quite painful, and we do not want to deal with it.
The Porter and Lawler Model.
The results achieved depend on the efforts made by employees, their abilities and characteristics, on their awareness of their role. The level of effort expended will be determined by the value of the reward and the degree of confidence that a given level of effort will in fact entail a well-defined level of reward. The Porter-Lawler theory establishes a relationship between rewards and results.
One of the most important findings of Porter and Lawler is that performance leads to satisfaction. According to the theory of human relations, satisfaction leads to the achievement of high performance in work, or, in other words, happier workers work better. Porter and Lawler believe that a sense of accomplishment leads to satisfaction, rather than satisfaction leads to high performance and productivity growth. Studies conducted by economists, psychologists, and sociologists have confirmed the findings of Porter and Lawler that high performance is the cause of overall satisfaction, and not a consequence of it. As a result, the Porter and Lawler model has made a major contribution to the understanding of motivation. She showed, in particular, that motivation is not a simple element in the chain of causal relationships in the management process. This model also shows how important it is to combine such concepts as efforts, abilities, results, rewards, satisfaction and perception within a single interconnected system.
Later, in the late 70s and early 80s of the last century, much attention was paid to the analysis of the human relations system based on the experience of the American company IBM and Japanese quality circles.
As an example of modern European research on this issue, we can cite a study of labor motivation in Finland, carried out by Tapani Alkula. Since the organization is the place where most of people's lives are spent, the most important external factor influencing their motivation is the environment in which people would like to work, their expectations about work. The following aspects of this problem have been identified:
- working time. It has been established that there is a direct correlation between working time and place of work in life;
- family status. The more important the family is, the less attention is paid to work;
- sexual aspect. Interest in work is influenced by traditional male and female roles as an indicator of male and female identity. Socio-gender differences affect the role and place of women in organizations and social and labor relations. These differences exist, and it is necessary to take this factor into account when developing and implementing management strategies.
It is important to understand that while these theories differ on a number of issues, they are not mutually exclusive. The development of theories of motivation was clearly evolutionary, not revolutionary. These are not just theories like ivory towers. They are effectively used in solving everyday problems of encouraging people to work effectively.
1.4 Factors of labor motivation m / s in health care facilities and ways to improve it.
Motivation of personnel is a key direction of the personnel policy of any enterprise. But not all tools that allow highly effective management of the behavior of employees of commercial companies are also effective in managing medical personnel.
In the health care system, nursing staff is the most significant part of the workforce. The professional activities of nurses are particularly affected by such negative factors as insufficient prestige of the profession, relatively low wages, difficult working conditions, which complicates the management process. In this regard, it is extremely important to clearly motivate the activities of nurses in the changing management structure of medical institutions.
The concept of labor motivation in the economic sense appeared relatively recently. Previously, the concept of motivation was replaced by the concept of stimulation and was used mainly in pedagogy, sociology, and psychology. Such a limited understanding of the motivational process led to an orientation towards obtaining a momentary result. This did not cause significant interest of nursing staff in their own development, which is the most important reserve for increasing labor efficiency. Work has ceased to be the meaning of life for many people and has become a means of survival. And in such conditions it is impossible to talk about the formation of a strong labor motivation, about labor efficiency, advanced training of employees and the development of initiative.
In health care, a simple material reward is considered sufficient as the main motivational factor. Sometimes this policy is successful. And since a motive is a conscious impulse to achieve a specific goal, understood by a person as a personal necessity, a need, the structure of the motive includes, in addition to needs, actions to achieve them, and the costs associated with these actions.
Motivation is represented by motivation and stimulation. If motivation is a process of influencing a person in order to induce him to certain actions by awakening certain motives in him, then stimulation consists in using these motives.
With the development of health care, more and more attention is paid to the motivational function of management, when motivation is preferred over administrative and strict control. Moreover, the most common group of motivating factors is not "carrot and stick" and not fear and disciplinary responsibility, but a group of factors, including trust, authority, reward. Job security and working conditions are of great importance [17].
Five levels in the system of labor motivation of nursing staff of medical institutions can be represented as a kind of pyramid, at the base of which there is such a component of motivation as the principles of leadership, the remaining components of motivation can have the following arrangement according to the levels of the pyramid (see Fig. 1).
Fig. 1 The system of motivation for the work of nurses
The motivations of medical personnel and their actions to achieve certain goals are guided by values that are prioritized. At the same time, studies often refer to the scoring of values. On the example of one of the medical institutions in Novosibirsk, research was carried out on the distribution of values according to the priorities of nurses.
As a result of the survey, nurses put forward wages, medical care and job satisfaction in the first place. On the second and third place - respect for colleagues, good relations with them, as well as encouragement from the administration. Equally important for nursing staff is the possibility of self-realization, social package and recognition in the organization. The possibility of self-realization in the profession was indicated by 23% of respondents. This indicator is explained by the fact that the functions of nursing staff are more limited compared to doctors. Work is perceived as monotonous. Sisters often perform it mechanically, without delving into the essence of new tasks. Professionalism in a narrow specialization is growing and interest in self-education is decreasing. It should be emphasized that when asked about further cooperation with the organization, 7% of the nursing staff of the medical institution expressed dissatisfaction with the current state of affairs and 22% avoided answering this question. Thus, a survey of nurses showed that about 30% of the staff did not agree to continue working under the same conditions. This suggests that in order to retain staff, changes are needed both in the pay system and in the structure of nursing staff management.
In order to identify the preferred types of labor stimulation for nursing staff, a survey of nurses from one of the clinical diagnostic centers in Novosibirsk was conducted. The results of the study showed that 77.5% of respondents preferred financial incentives. Among non-monetary material incentives, nurses preferred the provision of preferential vouchers for rest and treatment (71.5%); improvement of working conditions, workplace ergonomics (66.5%); introduction of flexible working hours (62.5%); providing benefits for paying for departmental housing and utilities (59%); voluntary medical insurance for personnel (44%); organization of subsidized meals (44%). Among the preferred forms of moral encouragement, the majority of respondents noted: careful attention to individual proposals aimed at improving the common cause (69%); gratitude announcement (59%); one-time granting of authority in solving certain production issues (22%).
After analyzing the data on the preferred types of motivation, we can conclude that each individual employee has a motivational system peculiar only to him, which depends on the personal qualities of the person and the life circumstances in which he is currently located. It is necessary to strive to focus motivation on values that are of priority for a particular nurse.
The prestige of the profession of a nurse, as noted earlier, plays one of the significant roles in the structure of the labor motivation of nurses. Raising the prestige of the profession is not so easy, and this is a common task not only for the healthcare system, but also for the cultural state of the whole society, the hierarchy of social values. Western-style labor motives and values introduced into the mass consciousness of Russians from the outside do not correspond to the model of attitude to work that has been formed over the centuries-old history of Russia on the basis of internal prerequisites and requirements.
etc.................
Motivation of professional activity of nursing staff is one of the most urgent problems of modern health care. The prestige of the nursing profession in society is falling. For the most part, nursing staff is dissatisfied with their work, the payment system, so the quality of medical care is declining. Motivation, with its effective use by a nurse-leader, can become the main point in improving the quality of nursing care, obtaining satisfaction from one's work. To motivate the professional activities of nursing staff, various approaches are needed:
· Encouraging staff to be active with the help of external factors (material and moral incentives), payroll, bonuses, career advancement, recognition and approval of the results of work by the administration, additional leave, etc.;
Formation of internal (psychological) incentives for work among employees, interest in work, creativity, responsibility for the work done, self-respect by creating appropriate working conditions (workplace equipment - computerization, specially tailored work clothes, making individual business cards), providing freedom choice of actions in solving the problem and the exact formulation of this problem.
Each work done requires checking and comparing the actual results with the planned work, this process is called control. The head nurse should always be ready to check the quality of work of subordinates.
Thus, in order to ensure a clear, efficient, well-functioning work of nursing staff, and therefore the dynamic development of a medical institution, the manager needs to know well the four components of management - planning, organization, motivation and control.
Selection and placement of personnel
A low level of wages, far from adequate to the nature of work, its social significance, the degree of responsibility, and psychophysical stress; the decline in the prestige of the nursing profession - these and other reasons led to the fact that the best qualified nursing personnel began to leave medicine. In this regard, in medical institutions there was a "deficit" of middle and junior medical personnel. In such a situation, it often happens that anyone can get a job. Only after a certain period of time, the sister leader can evaluate the business and human qualities of a new employee and conclude how successfully or unsuccessfully this specialist was hired for this position. In this case, it is very difficult to avoid mistakes in the selection of personnel (Karaseva L.A., Dvoinikov S.I., 2002; Martirosyan E.R., 2002, etc.).
In order for the chief nurse to avoid mistakes to some extent and protect herself and her team from hiring unqualified and irresponsible employees, it is necessary to remember some practical advice that has been tested by the experience of many years of work of the heads of nursing services in a number of large medical institutions in Western Europe and Russia:
The practice of presenting characteristics or recommendations from the previous place of work has been accepted all over the world. Therefore, do not be shy to demand them from the applicant for work.
If there are doubts about the objectivity of the content of the characteristic or recommendation, this should be clarified during the interview.