EFFECT OF WORK MOTIVATION ON JOB PERFORMANCE

AMONG HEALTHCARE PROVIDERS

(A CASE STUDY OF UNIVERSITY OF MEDICAL SCIENCES TEACHING

HOSPITAL, ONDO STATE)

BY
OWOLABI OPEYEOLUWA IMOLEAYO
CHTA/HIM/2020/415

A PROJECT SUBMITTED TO THE DEPARTMENT OF HEALTH

INFORMATION MANAGEMENT, ONDO STATE COLLEGE OF

HEALTH TECHNOLOGY AKURE, ONDO STATE, NIGERIA.

May, 2023.

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 CHAPTER ONE
INTRODUCTION
1.1 Background to the Study

The performance of workers depends on ability, tools or equipment and motivation

(Griffin & Moorhead, 2017). While motivation is seen as the most important, it is also the most

difficult to manage (Kinicki et al., 2017). The reason is that if a worker lacks ability or

knowledge to perform, a training programme can help to acquire more skills as well as tools can

be provided if there is none. However, if motivation is the problem, there will be difficulty in

determining what could be done to motivate the employee to work harder and well (Griffin &

Moorhead 2017). Bulkus and Green (2019), explain that motivation is derived from the word

“motivate”, which means more push or influence to proceed to fulfilling want. Performance on

the other hand, is a combination of staff being available, competent, productive and responsive

(WHO, 2016).

Health workers are part of a country’s health system and they are very important in

improving health outcomes. Therefore, adequately trained, skilled and motivated health workers

in appreciable numbers at facilities where they are needed, is essential in the delivery of quality

health care (WHO, 2010). Motivation is present in almost every life function, but a common

place we find the need to apply it is in the work place (Charadraseker, 2013). Thus, motivation is

the effort a person is willing to put in his or her work to achieve goals and objectives. Motivation

is individual (Kinick & Williams, 2018), meaning that what motivates one person might not

necessarily motivate another. Ghazanfar et al. (2011), observed that employees spend most of

their time at workplace, as a result, it is important that they have a positive mindset for the wok

they do.

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 Health care is highly labor intensive, and thus, service quality, efficiency, and equity are

all directly mediated by workers‟ willingness to apply themselves to their task. While worker

performance is dependent on, or limited by, resource availability and worker competencies, the

presence of these factors is not sufficient in themselves to ensure desired worker performance.

Worker performance is also contingent on workers‟ willingness to come to work regularly, work

diligently, be flexible, and carry out the necessary tasks (Hornby and Sidney, 2018). Increased

motivation combined with effective management practices and supervision creates these

conditions for a more effective workforce performance. Health sector policy makers and health

facility managers must recognize the importance of work motivation in reaching sector and

organization goals, and they must understand the links between their current policies and worker

motivation (Van Lerberghe et al., 2012). In order for an organization to meet its obligations to

shareholders, employees and society, its top management must develop a relationship between

the organization and employees that will fulfill the continually changing needs of both parties. At

a minimum the organization expects employees to perform reliably the tasks assigned to them

and at the standards set for them, and to follow the rules that have been established to govern the

workplace. Management often expects more: that employees take initiative, supervise

themselves, continue to learn new skills, and be responsive to business needs. At a minimum,

employees expect their organization to provide fair pay, safe working conditions, and fair

treatment (Beer et al, 2014).

Alhassan et al. (2019), studied the association between health worker motivation and

health care quality efforts in Ghana. These researchers identified that most of the health facilities

did not document the evidence of processes for continuous quality improvement safety. On the

whole staff motivation was seen as low, although workers in the private facilities perceived

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improved conditions than workers in the public facilities supporting the fact that more

comprehensive staff motivation was needed to improve quality strategies.

Obviously, the compelling and competing demands facing the hospital are affecting the

best delivery of healthcare to Nigerian. The poor condition of service of health workers,

particularly, the poor infrastructure of the hospital and the low level of salaries, insufficient

specialist services in the hospital, inadequate sub-specialist services, long waiting time, poor

staff attitudes, indiscipline, and intermittent shortage of material resources unquestionably reflect

the negative levels of commitment and lack of professionalism. These serve as a powerful

disincentive to workers efficiency. It has become imperative in the face of the challenges for

serious minded corporate entities to take strategic steps based on very elaborate strategic plans

(short-term, medium-term and long-term) to normalize the situation and find ways to motivate

their workers in the face of these challenges to optimize their performance.

1.2 Statement of the Problem

According to WHO (2006), the African continent is currently facing severe human

resource crisis in the health sector. These human resource shortages appear to have affected the

delivery of quality and efficient health services. Sub-Saharan Africa has the lowest health worker

to population ratio in the whole world (Friederike, 2019). Employee’s and health workers

performance mostly depend on employee motivation. Motivated employees are royal,

committed, and productive and provide good services to the organization. Employer should

exercise employee motivation through the series of rewards for job well done and better

organizational performance (Sevanson, 2011)

Low motivation affects employees and organization performance. According to Dieleman

et al (2013), the issue of low motivation in the work place is one major contributor to the brain

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drain of health workers from Africa to other countries and from rural to urban areas within the

same country. More so, for decades, researchers have been studying factors influencing

performance in health organizations with emphasis on worker factors and work environment

factors. Therefore, this study looks at the effects of motivation on health workers performance at

University of Medical Sciences Teaching Hospital (UNIMEDTH) Ondo, Ondo State.

1.3 Objectives of the Study

The broad objective of the study is to examine the effect of motivation on health workers

performance with a case study of University of Medical Sciences Teaching Hospital, Ondo,

Ondo State.

The specific objectives of this study are:

1. To identify motivational strategies adopted by University of Medical Sciences Teaching

Hospital for their health workers Ondo, Ondo State.

2. To evaluate the effectiveness of these motivational packages on health worker’s

performance in University of Medical Sciences Teaching Hospital Ondo, Ondo State.

3. To assess the level of satisfaction with the motivational packages in University of

Medical Science Teaching Hospital Ondo, Ondo State.

1.4 Research Question

1. What are the motivational strategies adopted by UNIMEDTH for their health workers?

2. How effective is the existing motivation packages on clinical staff performance in

University of Medical Science Teaching Hospital Ondo, Ondo State.?

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 3. What is the level of satisfaction with motivational packages in University of Medical

Science Teaching Hospital Ondo, Ondo State?

1.5 Scope of the Study

The study was conducted within the framework of evaluating motivational practices and

its effect on health worker’s performance at University of Medical Sciences Teaching Hospital.

The study focused only on the health worker at University of Medical Sciences Teaching

Hospital, Ondo State.

1.6 Significance of the Study

The study is expected to enable the researcher gain deeper insight into the motivational

practices and its effect on health workers performance at University of Medical Sciences

Teaching Hospital (UNIMEDTH) so as to contribute effectively in participatory decision making

with respect to staff motivation and performance. This research sought to provide the needed

information that would guide the Management of UNIMEDTH to better align their strategies on

motivation with their staff performance measurement systems for optimum staff performance.

The findings are expected to help inform decision making in the area of strategic planning with

regard to staff motivation and performance. The study will be very useful to other researchers

interested in the area of motivation, that is, the outcome of this study will serve as a base for

academicians who want to conduct further studies on the impact of motivation practices on staff

performance especially in the health sector for the betterment of the health service in Nigeria.

1.7 Definition of Terms

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Health is defined as a complete state of physical, mental and social wellbeing of an individual,

not mere the absence of diseases or infirmity.

Health workers are people whose job it is to protect and improve the health of their

communities

Motivation is the word derived from the word ’motive’ which means needs, desires, wants or

drives within the individuals. It is the process of stimulating people to actions to accomplish the

goals.

Job performance means good ranking with the hypothesized conception of requirements of a

role. There are two types of job performances: contextual and task. Task performance is related

to cognitive ability while contextual performance is dependent upon personality

Employee motivation: is “the willingness to exert high levels of effort toward organizational

goals, conditioned by the effort’s ability to satisfy some individual need

Incentives: are reward and/or punishment that healthcare providers face from the organisation in

which they work and specific intervention they provide (WHO Report 2008).

Intrinsic motivation: is an inducement derived from within the person or from the activity itself

and, positively affects behavior, performance, and well-being.

Extrinsic motivation: is said to exist when behavior is performed for its own sake rather than to

obtain material or social re-enforcers

Performance: is the combination of healthcare providers being available (retained and present)

competent, productive and responsive.

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 CHAPTER TWO
LITERATURE REVIEW
2.0 INTRODUCTION

This chapter reviews the earlier studies related to the stated questions of the study.

Among the Issues to be discussed include the concept and theories of motivation, motivational

strategies in the health sector, and performance and performance management. The following

topics were reviewed under the following sub-heading:

 Motivation

 Intrinsic and Extrinsic Motivation

 Classification of Motivation

 Theories on Motivation

 Motivational Strategies in the Health Sector

 Performance and Performance Measurement

 Relationship between Motivation and Performance

 Factors Enhancing Employees Performance

2.1 Motivation

Motivation has been defined as: the psychological process that gives behaviour purpose

and direction (Kreitner et al, 2012); a tendency to behave in a purposive manner to achieve

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specific, unmet desires; an inner force to gratify an unsatisfied need; and the will to accomplish

(Mullins, 2005). In simple terms motivation could operationally be defined as the inner force that

drives individuals to achieve personal and organizational goals. Motivation can therefore be said

to be at the heart of how innovative and productive things get done within an organization (Bloisi

et.al, 2013). Understanding what motivates employees is one of the key challenges for managers.

Although it is not possible directly to motivate others, it is nonetheless important to know how to

influence what others are motivated to do, with the overall aim of having employees identify

their own welfare with that of the organization (Bloisi et.al, 2003). It has been established that

motivation is concerned with the factors that influence people to behave in certain ways. Arnold

et al (2016) established three components of motivation namely; Direction i.e. what the person is

trying to do, Effort i.e. how hard a person is trying and Persistence i.e. how long a person keeps

on trying (Armstrong, 2006).

2.1.1 Motivation Concept

The underlying concept of motivation is some driving force within individuals by which

they attempt to achieve some goal in order to fulfill some need or expectation. This gives rise to

the basic motivational model shown in Figure 1 below. In this model, people’s behaviour is

determined by what motivates them (Mullins, 2015). The ideas of Taylor (1856- 1915), his

rational economic concept of motivation and subsequent approaches to motivation at work has

fuelled the continuing debate about financial rewards as a motivator and their influence on

productivity. In a job where there is little pleasure in the work itself or it offers little opportunity

for advancement in career, personal challenge or growth, many people may be motivated

primarily if not exclusively, by money (Mullins, 2015).

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 Organizational success is dependent upon members being motivated to use their full

talents and abilities, and directed to perform well in the right areas. According to Mullins (2005),

a major

international study by Proudfoot Consulting revealed that, the most important reason for

productivity loss was poor working morale. This includes absence of positive team spirit, low

motivation, poor sense of belonging, people feeling undervalued and poorly rewarded. It is in

view of these that Allen and Helms (2015) suggested that different types of reward practice may

more closely complement different generic strategies and are significantly related to higher

levels of perceived organisational performance (Mullins, 2015). With a positive motivation

philosophy and practice in place, productivity, quality and service should improve because

motivation helps people towards achieving goals, gaining positive perspective, creating the

power for change, building self-esteem and capability, and managing their development and

helping others. Mullins cited Kreitner et al (2014) suggestion which states that, although

motivation is a necessary contributor for job performance, it is not the only one. Along with

ability is also a combination of level of skill; knowledge about how to complete the task; feelings

and emotions; facilitating and inhibiting conditions not under the individual’s control. Most

businesses use pay, promotion, bonuses or other types of rewards to encourage high levels of

performance. At a minimum, employees expect the organization to provide fair pay, safe

working conditions, and fair treatment. Like management, employees often expect more,

depending on the strength of their needs for security, status, Involvement, challenge, power, and

responsibility.

For organizations to address these expectations an understanding of employee

motivation is required (Beer et al., 2014). Carnegie (2015) emphasizes the human aspects of

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management. They postulate that as it is people who make a business succeed or fail it is the

organization’s chief responsibility to motivate their people so that they will assure success (Cole,

2013). Every human being has the potential for creativity and for achieving goals. The infinite

question is how organizations reach this potential and how they stimulate creativity and foster in

their people the desire to succeed and to achieve self-fulfillment through their work. The

common theme is the belief that people need to be respected and treated as precious human

capital, more essential to an organization’s effectiveness than its financial capital. People are

now seen as the primary source of a company’s competitive advantage. Therefore, the way

people are treated increasingly determines whether an organization will prosper or even survive

(Lawler, 2013). Organizations are under constant pressure to enhance and improve their

performance and are realizing that an interdependent relationship exists between organizational

performance and employee performance.

Motivation is also described as the activation or the establishment of goal-oriented

behavior; and it is of two major forms, namely intrinsic or extrinsic. Several theories had

specified that motivation is deeply rooted in the basic needs to minimize physical pain and

maximize pleasure, or it may include specific needs such as eating and resting, or a desired

object, hobby, goal, state of being, ideal, or it may be attributed to less-apparent reasons such as

altruism, selfishness, morality, or avoiding mortality. Conceptually, motivation should not be

confused with either volition or optimism (Seligman, 2014).

2.2 Intrinsic and Extrinsic Motivation

2.2.1 Intrinsic Motivation

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 Intrinsic motivation comes from rewards inherent a task or activity itself - the enjoyment

of a puzzle or the love of playing (Deci, 2012). Reputable researchers have found that it is

usually associated with high educational achievement and enjoyment by students. Bandura's

(2017) Self-Efficacy and Ryan and Deci's (2015) Cognitive Evaluation Theories threw more

light on the subject. In most cases, students have been found to be intrinsically motivated if they

attribute their educational results to internal factors that they can control (for example the amount

of effort they put in), believe they can be effective agents in reaching desired goals, and

interested in mastering a topic, rather than just rote-learning to achieve good grades. Reiss (2000

and 2004) indicated that there are 16 basic desires that motivate the actions of people and further

define their personalities. People differ in these basic desires which represent intrinsic desires

that directly motivate a person's behaviour, and not aimed at indirectly satisfying other desires.

People may also be motivated by non-basic desires, but in this case, this does not relate to actual

motivation, or only as a means to achieve other basic desires.

2.2.2 Extrinsic Motivation

Extrinsic motivation comes from outside of the performer. It is related to tangible rewards such

as salary and fringe benefits, security, promotion, contract of service, the work environment and

conditions of service. Money is the most obvious example, but coercion and threat of punishment

are also common extrinsic motivations. While competing, the crowd may cheer on the performer,

which may motivate him or her to do well. Trophies are also extrinsic incentives. Competition is

in general extrinsic because it encourages the performer to win and beat others, not to enjoy the

intrinsic rewards of the activity (Mullins, 2015; Armstrong, 2016). Lepper et al. (2013) indicated

that extrinsic rewards can lead to over justification and a subsequent reduction in intrinsic

motivation. They were illustrated that when children who were expected to be (and were)

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rewarded with a ribbon and a gold star for drawing pictures spent less time playing with the

drawing materials in subsequent observations than children who were assigned to an unexpected

reward condition and to children who received no extrinsic reward (Lepper et al, 1973).

2.3 Classification of Motivation

The complex and variable nature of needs and expectations at work give rise to the

following simplistic but useful, broad three-fold classification of motivation to work namely:

• Economic reward- It is an instrumental orientation to work and includes items such as pay,

fringe benefits, pension right, material goods and security.

• Intrinsic satisfaction- This is a personal orientation to work and concern with „oneself‟. It is

dependent on the individual attitude and varies from person and circumstances. It also varies

from jobs and different parts within the same the job. It is derived from the nature of the job

itself, interest in the job, and personal growth and development.

• Social relationship- It is the relational orientation to work and concerned with the other

people. It is an important feature in all set ups. It improves the supportive working relationships

and teamwork (Mullins, 2015).

2.4 Theories on Motivation

The various strategies of motivations are dictated by established theories of motivation.

Motivation is said to vary over time and according to circumstances.

The two basic theories of motivation are:

 Content Theories and

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  Process Theories

2.4.1 Content Theories

These theories attempt to explain the specific things which actually motivate the

individual at work. These theories are concerned with identifying people‟s needs and their

relative strengths and the goal they pursue in order to satisfy these needs. These theories place

emphasis on the nature of the needs and what motivates individuals. The basis of these theories

is the belief that the content of motivation consists of needs (Mullin, 2005). The various

postulated content theories are:

 Maslow‟s hierarchy of need theory

 Clayton Alderfer‟s ERG theory (Alderfer‟s needs modified theory)

 Herzberg‟s two-factor (motivation-hygiene) theory

 McClelland‟s achievement motivation theory

Abraham Maslow’s Hierarchy of Need Theory

One of the most widely mentioned theories of motivation is the hierarchy of needs theory put

forth by psychologist Abraham Maslow. Maslow saw human needs in the form of a hierarchy,

ascending from the lowest to the highest, and he concluded that when one set of needs is

satisfied, this kind of need ceases to be a motivator (Mullins, 2015; Armstrong, 2016). Below is

the Abraham Maslow’s Hierarchy of Need Theory

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(i) Physiological Needs: These are important needs for sustaining the human life. Food, water,

warmth, shelter, sleep, medicine and education are the basic physiological needs which fall in the

primary list of need satisfaction. Maslow was of an opinion that until these needs were satisfied

to a degree to maintain life, no other motivating factors can work.

(ii) Security or Safety Needs: These are the physical danger and the fear of losing a job,

property, food or shelter. It also includes protection against any emotional harm. Once

physiological needs are met, one's attention turns to safety and security in order to be free from

the threat of physical and emotional harm. Such needs might be fulfilled by, living in a safe area,

medical insurance, job security and financial reserves (Locke and Latham, 2012).

(iii) Social Needs: Since people are social beings, they need to belong and be accepted by others.

People try to satisfy their need for affection, acceptance and friendship. Once a person has met

the lower level physiological and safety needs, higher level motivators awaken. The first levels

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of higher-level needs are social needs. Social needs are those related to interaction with others

and may include friendship, belonging to a group, giving and receiving love (Mullins, 2005).

(iv) Esteem Needs: According to Maslow, once people satisfy the social need, they tend to want

to be held in both by themselves and by others. This kind of need produces such satisfaction as

power, prestige, status and self-confidence. It includes both internal esteem factors like self-

respect, autonomy and achievements and external esteem factors such as status, recognition and

attention. After a person feels that they "belong" to a group, the urge to attain a degree of

importance emerges. Esteem needs can be categorized as external motivators and internal

motivators. Internally motivating esteem needs are those such as self-esteem, accomplishment,

and self-respect. External esteem needs are those such as reputation and recognition (Locke and

Latham, 2002). Some examples of esteem needs are recognition (external motivator), attention

(external motivator), social status (external motivator), accomplishment (internal motivator) and

self-respect (internal motivator).

(v) Need for Self-Actualization: Maslow regards this as the highest need in his hierarchy. It is

the drive to become what one is capable of becoming; it includes growth, achieving one’s

potential and self-fulfillment. It is to maximize one’s potential and to accomplish something.

Self-actualized people tend to have motivators such as truth, justice, wisdom and meaning. Self-

actualized persons have frequent occurrences of peak experiences, which are energized moments

of profound happiness and harmony. According to Maslow, only a small percentage

(10%) of the population reaches the level of self-actualization (Mullins, 2015).

Clayton Alderfer’s ERG Theory

Alderfer (1969) has tried to rebuild the hierarchy of needs of Maslow into another model

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named ERG that is, Existence – Relatedness – Growth. According to him there are 3 groups of

core needs. The existence group is concerned mainly with providing basic material existence.

The second group is the individuals need to maintain interpersonal relationship with other

members in the group. The final group is the intrinsic desire to grow and develop personally

(Mullins,2015). Below is the Clayton Alderfer’s ERG Theory diagram

The major conclusions of this theory are:

1. For an individual, more than one need may be operative at the same time.

2. If a higher need goes unsatisfied, then the desire to satisfy a lower need intensifies.

Frederick Herzberg’s Two- Factor (Motivation-Hygiene) Theory

Frederick Herzberg (1959) had tried to modify Maslow‟s need Hierarchy theory. His

theory is also known as Two-factor theory or Hygiene theory. He stated that there are certain

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satisfiers and dissatisfiers for employees at work. Intrinsic factors are related to job satisfaction,

while extrinsic factors are associated with dissatisfaction. He devised his theory on the question:

“What do people want from their jobs?” He asked people to describe in detail, such situations

when they felt exceptionally good or exceptionally bad. From the responses that he received, he

concluded that opposite of satisfaction is not dissatisfaction. Removing dissatisfying

characteristics from a job does not necessarily make the job satisfying. He states that presence of

certain factors in the organization is natural and the presence of the same does not lead to

motivation. However, their non-presence leads to de-motivation. In similar manner there are

certain factors, the absence of which causes no dissatisfaction, but their presence has

motivational impact (Cole 2003). Below is Frederick Herzberg’s Two- Factor (Motivation-

Hygiene) Theory diagram

McClelland’s Theory of Needs

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 David McClelland in 1988 developed a theory on three types of motivating needs. These

are need for power, need for affiliation and need for achievement. Basically, people for high

need for power are inclined towards influence and control. They like to be at the center and are

good orators. They are demanding in nature, forceful in manners and ambitious in life. They can

be motivated to perform if they are given key positions or power positions (Cole 2003). In the

second category are the people who are social in nature. They try to affiliate themselves

with individuals and groups. They are driven by love and faith. They like to build a friendly

environment around themselves. Social recognition and affiliation with others provide them

motivation. People in the third category are driven by the challenge of success and the fear of

failure. Their need for achievement is moderate and they set for themselves moderately difficult

tasks. They are analytical in nature and take calculated risks. Such people are motivated to

perform when they see at least some chances of success. McClelland observed that with the

advancement in hierarchy the need for power and achievement increased rather than Affiliation.

He also observed that people who were at the top, later ceased to be motivated by these drives

(Cole, 2003).

Goal Setting Theory of Edwin Locke

It was postulated by Edwin Locke in 1979 and it states that motivation and performance

are higher when individuals set specific goals, when accepted goals are difficult, and when there

is feedback on performance (Mullins, 2015). Instead of giving vague tasks to people, specific

and pronounced objectives help in achieving them faster. As the clarity is high, a goal orientation

also avoids any misunderstandings in the work of the employees. The goal setting theory states

that when the goals to be achieved are set at a higher standard, then in that case employees are

motivated to perform better and put in maximum effort. It revolves around the concept of “self-

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efficacy” that is individual’s belief that he or she is capable of performing a hard task (Reiss,

2004). Goal-setting theory is based on the notion that individuals sometimes have a drive to

reach a clearly defined end state. Often, this end state is a reward in itself. A goal's efficiency is

affected by three features: proximity, difficulty and specificity. An ideal goal should present a

situation where the time between the initiation of behavior and the end state is close. This

explains why some children are more motivated to learn how to ride a bike than mastering

algebra. A goal should be moderate, not too hard or too easy to complete. In both cases, most

people are not optimally motivated, as many want a challenge (which assumes some kind of

insecurity of success). At the same time people want to feel that there is a substantial probability

that they will succeed. Specificity concerns the description of the goal in their class. The goal

should be objectively defined and intelligible for the individual. A classic example of a poorly

specified goal is to get the highest possible grade. Most children have no idea how much effort

they need to reach that goal (Locke and Latham, 2002).

Theory X and Theory Y” of Douglas McGregor

Douglas McGregor in his 1960 book “The Human side of Enterprise”, states that people inside

the organization can be managed in two ways. The first is basically negative, which falls under

the category X and the other is basically positive, which falls under the category Y. After

viewing the way in which the manager dealt with employees, McGregor concluded that a

manager‟s view of the nature of human beings is based on a certain grouping of assumptions and

that he or she tends to mould his or her behaviour towards subordinates according to these

assumptions (Bloisi et al, 2003). Below is the Theory X and Theory Y” of Douglas McGregor

diagram

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Reinforcement Theory

B.F. Skinner (2013), who propounded the reinforcement theory, holds that by designing the

environment properly, individuals can be motivated. Instead of considering internal factors like

impressions, feelings, attitudes and other cognitive behaviour, individuals are directed by what

happens in the environment external to them. Skinner states that work environment should be

made suitable to the individuals and that punishment actually leads to frustration and

demotivation. Hence, the only way to motivate is to keep on making positive changes in the

external environment of the organization (Reiss, 2014)

Self-Determination Theory

Self-determination (SDT) theory, developed by Edward Deci and Richard Ryan (2013),

focuses on the importance of intrinsic motivation in driving human behaviour. Like Maslow's

hierarchical theory and others that built on it, SDT posits a natural tendency toward growth and

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development. Unlike the other theories, however, SDT does not include any sort of "autopilot"

for achievement, but instead requires active encouragement from the environment. The primary

factors that encourage motivation and development are autonomy, competence feedback, and

relatedness (Deci, and Ryan, 2013).

Models of Behaviour Change

Social-cognitive models of behaviour change include the constructs of motivation and volition

(Locke and Latham, 2002). Motivation is seen as a process that leads to the forming of 29

behavioural intentions. Volition is seen as a process that leads from intention to actual behaviour.

In other words, motivation and volition refer to goal setting and goal pursuit respectively. Both

processes require self-regulatory efforts. Several self-regulatory constructs are needed to operate

in orchestration to attain goals. An example of such a motivational and volitional construct is

perceived self-efficacy. Self-efficacy is supposed to facilitate the forming of behavioral

intentions, the development of action plans, and the initiation of action. It can support the

translation of intentions into action (Locke and Latham, 2002)

2.5 Motivational Strategies in the Health Sector

Motivation of the health worker depends on a number of factors. Determinants of health

worker motivation originates at the individual level, the immediate organizational level and the

environmental level (Bennett and Franco, 2009). Thus, motivational strategies in health can be

looked at from any of these levels after careful assessment of where the greatest impact can be

attained.

According to Zurn (2003), there are several incentives or motivational factors. A study in

South Africa on the effects of a newly introduced, so-called "rural allowance" showed the limited

impact on retention and motivation (Reid, 2004). Aligning health worker and system objectives

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is difficult. The aim is to have satisfied health workers who are motivated to work harder (Hicks

and Adams, 2001). Evidence is limited, but financial and non-financial incentives are mutually

reinforcing, and changing the culture of the health system to make goals more readily understood

and shared can incentives be made more powerful.

2.6 Performance and Performance Measurement

Performance can be defined as the way in which someone does a job, judged by its

effectiveness (Encarta, 2009). Performance is a product of ability multiplied by motivation.

Ability is the product of aptitude multiplied by training and resources. Motivation is the product

of desire(effort) and commitment (Van der Waldt, 2004). Performance management involves

having in place systems and methods which translate the goals of strategic management into

individual performance terms through human resource. This includes appraisal of individuals as

well as planning and influencing their future performance through targets and development (Van

der Waldt, 2004).

The widest used method of evaluating employee performance is the employee

performance appraisal. This is based on what the organization considers as acceptable standard

of

performance and assesses worker’s performance based on these standards. Most of the standards

do not take into view the view of clients. For service organizations, the output of the service is

an objective measure of its outcome. Thus, for a hospital, the number of patients that visit the

hospital can also be used as an objective measure of its output.

However, Gomes and Miranda Gomes (2011), in their work Performance Measurement

and Stakeholder Perceptions: Assessing Performance through the Dimensions of Stakeholder

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Expectations developed a criterion for assessing health worker performance in terms of

complaints and problems. Thus, this will also serve as basis for measuring health worker

performance in this study. Performance of Health workers are measured based on its correlation

with national indicators on health system performance indicators like maternal mortality, live

births, trend in OPD utilization, trend in emergency services etc. Since there are no adequate

statistics on performance appraisal such as percentage achieving their own set objectives and

customer satisfaction survey, for the purpose of this study, complaints on staff performance,

views of patients and management as well as number of patients that visit the hospital will be

used as indicators of staff performance.

2.7 Relationship between Motivation and Performance

The link between motivation and performance seem to be an obvious one. If individuals

are highly motivated, they will perform better. In turn, better performance may well lead to a

sense of achievement and result in greater motivation. Most people have an intuitive sense that

motivation is linked with performance. Although some may disagree on how much impact

motivation has on performance, most would agree that high levels of performance are difficult

to achieve when little or no motivation to perform is present (Frederick- Recascino and Hall,

2003). Thus, the relationship between motivation and performance can be a mutually reinforcing

one. This, however, begs a number of questions to do with perception, ability and stress. Yes,

motivated individuals may do more work, but this will need to be carefully managed if they

aren‟t going to spend most of their energy on aspects of work they find stimulating, which may

be of little or no benefit to the company. Motivated employees may be more productive,

provided they have the requisite skills to do the job and the perception to realize whether they

24
have or not. It is just as important to take steps to improve ability by means of good selection

and training as it is to pay attention to motivation (Karan, 2009).

Motivation implies pressure – to move forward, to do more- but too much pressure, in

other

words too much stress, can be harmful in both the short and the long term. Of course, the answer

is balance. In the short-term, we need sufficient pressure to concentrate well and do the job

quickly and efficiently, but not so much that panic starts to intrude a concentration becomes

difficult. In the medium to long term, we must avoid working to exhaustion. A motivated and

qualified workforce is crucial to increase the productivity and quality of health services in order

to contribute to achieving health services targets. Priority programmes have a stake in a skilled

and motivated workforce, as they are implemented primarily by a health facility's existing health

staff (Franco et al, 2002).

Aiyetan and Oltuah (2006) conducted a research on the relationship between motivation and

performance of workers in the Nigerian construction industry. The purpose was to identify a

number of motivational schemes that enhance the performance of two types of workers:

construction workers and office workers. The study used two sets of questionnaires: one set was

administered on management staff and the other on non-management staff (operatives). The

study revealed that salaries paid to operatives in the study were below the stipulations of the

Nigerian National Joint Industry Council. It further showed that operatives are rarely promoted,

and operatives prefer financial incentives to non-financial incentives. The study recommended

that increases in salary via promotion, overtime allowances and holidays with pay should be used

as motivators (financial incentives) for increase in performance of construction workers

(operatives).

25
 A study on motivation was undertaken in Sweden by Edlund and Nilsson (2007) and

focused on the factor’s managers use to motivate employees and differences regarding gender

and age in medium-sized Swedish enterprises. A qualitative case study methodology was used to

interview managers in two companies in Northern Sweden. The findings showed that motivation

was an individual thing and managers have a hard task motivating their employees. It also found

that employees of today are more motivated by intrinsic factors rather than extrinsic factors

which were dominant in the past. However, none of the two sets of factors should be overlooked

by managers when motivating employees. The most unusual finding in that study concerning

gender and age was that managers do not motivate their employees differently with reference to

gender and age.

Calista (2009) examined motivation through incentive programs in Singapore on 380

white collar workers, using questionnaire administered online. The results of the study showed

that incentives had a very strong motivational potential influence on employees’ willingness to

work harder. The three motivating factors were interpersonal relationship, workplace

environment and interesting work, all of which have the potential to motivate employees at

higher levels. For long-term motivation, job related factors such as meaningful work, flexible

working hours, and friendly social gestures were found to be effective motivators, while

monetary, social gathering, tangible items such as awards, certificates and gifts were most

effective motivators for short-term.

A Ghanaian study was conducted on motivation by Kwasi (2010). The purpose of the

study was to examine factors of motivation that will lead to employees being highly motivated

for increased performance at the workplace with particular reference to the Building and Road

Research Institute (BRRI). It surveyed a sample of workers using a questionnaire and data was

26
analyzed using SPPS package. The results of the study indicated that elements such as

empowering employees and involving workers in decision making played an important role in

motivating employees.

Malekia (2009) conducted a cross-sectional research using a structured interview guide

among 326 healthcare workers in three municipalities of Dar es Salaam, Tanzania. The purpose

was to assess motivation to perform among healthcare workers in primary healthcare facilities.

The study found that 71.8 percent of the health workers were motivated to perform their tasks

well, while 28.2 percent were not motivated. Both financial and non-financial incentives were

seen to influence motivation. However, the study found the main motivating factors were

community recognition/appreciation, fairness in performance assessment, reward system and

education.

Akah (2010) conducted study of motivation in Ultimate Companion Limited, Douala,

Cameroon. Its purpose was to examine factors that motivate employees in order to have

increased performance within the company. It surveyed a sample of 74 employees in the

company and data analysed using descriptive statistics. The study found that employees at

Ultimate companion limited had an overall fair job satisfaction. The employees are not satisfied

with their current salary situation at the company which illustrate that financial motivation was

important within a company.

The findings equally showed that majority of the employees are motivated most to

perform when they receive non-financial rewards. Also, majority of the employees showed a

great intrinsic value for higher performance. Finally, the study recommended that the

management at Ultimate companion limited should use multiple motivational strategy in order to

achieve greater performance from the employees. Nadim et al. (2012), conducted a research on

27
Effects of Motivational Factors on Teachers’ Job Satisfaction in public sector degree colleges of

Punjab, Pakistan the objective of this study is to analyze the effects of intrinsic and extrinsic

motivational factors on teacher job satisfaction in public sector degree colleges of Punjab,

Pakistan. Data was collected from 406 respondents from public sector colleges in the Punjab.

SEM was used to test the hypotheses using AMOS package

2.8 Factors Enhancing Employees Performance

Motivation Employees want to earn reasonable salaries, as money represents the most

important incentive, when speaking of its influential value (Sara et al, 2004). Financial rewards

have the capacity to maintain and motivate individuals towards higher performance, especially

workers from production companies, as individual may use the money to satisfy their needs.

Therefore, pay has a significant impact in establishing employees’ diligence and commitment,

being a key motivator for employees. Nevertheless, studies have shown that pay does not boost

productivity on the long term and money does not improve performance significantly (Whitley,

2002).

Moreover, focusing only on this aspect might deteriorate employees’ attitude, as they

might pursue only financial gains. Fortunately, there are other non-financial factors that have a

positive influence on motivation, such as rewards, social recognition and performance feedbacks.

Numerous researches have also pointed out that rewards lead to job satisfaction, which in turn

influence directive and positively the performance of the employees. Moreover, rewards are one

of the most efficient tools of management when trying to influence individual or group behavior,

as to improve organization’s effectiveness. The vast majority of companies use pay, promotion,

bonuses and other types of rewards to motivate employees and to increase their performance. In

order to use salary as a motivator, managers have to develop salary structures, according to the

importance of each job, individual performance and special allowances.

28
 Employees can also be motivated through proper leadership, as leadership is all about

getting thing done the right way. In order to achieve these goals, the leader should gain the

employees’ trust and make them follow him. Nevertheless, in order to make them trust him and

complete their tasks properly for the organization, the employees should be motivated (Baldoni,

2005).

The leaders and the employees help one another to attain high levels of morality and

motivation. Trust represents the perception of one individual about others and his willingness to

act based on a speech or to comply with a decision. Therefore, trust is an important factor for an

organization that wants to be successful, as it has the ability to enhance employees’ motivation

and foster interpersonal communication. Irrespective of the degree of technical automation,

attaining high levels of productivity is influenced by the level of motivation and effectiveness of

the staff. Therefore, developing and implementing employee training programs is a necessary

strategy to motivate workers. In addition, a good communication between the managers and the

workforce can instigate motivation, as the degree of ambiguity decrease.

CHAPTER THREE
RESEACH METHODOLOGY

3.1 Introduction

29
 This chapter focus on the research methodology adopted in the conduct of the study. This

chapter will explain the following subheadings:

 Research Design

 Population of the Study

 Sample Size and Sample Techniques

 Data Collection Instrument

 Validity and Reliability of the Instrument

 Data Collection Procedure

 Method of Data Analysis.

3.2 Research Design

Research design refers to the overall strategy or plan that a researcher uses to answer

their research question(s). It involves making decisions about various aspects of the research

process, such as the research method(s) to be used, the population/sample to be studied, the data

collection instruments and procedures, and the data analysis techniques to be employed. The

research design that was employed in this research is descriptive design, it was designed to

examine the effect of motivation on health workers performance with a case study of University

of Medical Sciences Teaching Hospital, Ondo, Ondo State.

3.3 Population of the study

The population of a study refers to the entire group of individuals, objects, or phenomena

that the researcher is interested in studying. It is the group from which a sample is drawn, and the

30
findings of the study are intended to be applicable to this larger population. The research work

was conducted at University of Medical Sciences Teaching Hospital, Akure, Ondo State. The

study population consists 1,477 Health workers working in University of Medical Sciences

Teaching Hospital, Ondo, Ondo State. The table below shows the population of health workers

in the study area.

Health Workers Population

Doctors 125
Nurses 387
Health Records staffs 128
Pharmacist 47
Medical Lab Scientist 103
Other Health Workers 687
Total 568

3.4 Sample Size and Sampling Techniques

In determining the sample size of the study, Krejcie and Morgan (1970) sampling

determination was used, which says that out of 200,000 population 0.02% can be adequately

used as the sample size. Therefore, 8% was selected from among the total population of 1,477

Health Workers working in the targeted departments in the study area.

Health Workers Population Sample size (8% of the population)

Doctors 125 10
Nurses 387 31
Health Records staffs 128 10
Pharmacist 47 4
Medical Lab Scientist 103 8
Others 687 55
Total 1477 118

31
 Based on the total population of 1,477 Health workers in University of Medical Sciences

Teaching Hospital, Ondo, Ondo State, a sample size 118 health workers representing 8% was

selected for the study.

Non probability sampling method was employed with the use of convenience sampling

technique to select the sample. Convenience sampling is a non-probability sampling technique

where subjects are selected because of their convenient accessibility and proximity to the

researcher.

3.5 Data Collection Instrument

The instrument used for this study is questionnaire. The data were obtained through

questionnaire. The questionnaire was structured to consist mostly of closed ended type of

questions

3.6 Reliability and Validity of Instruments

The questionnaire prepared to explore information for the study was validated by the

supervisor after a critical assessment and correction which helped to greatly modify

questionnaire for the purpose of achieving the set objectives of the research. A trial test was also

conducted for the validation of the instrument.

3.7 Data Collection Procedure

A letter of introduction was given to the researcher for formal introduction to the target

population before administering the questionnaire using self-administered method. A verbal

introduction was done at the point of administering the questionnaire. An opening statement was

written at the beginning of the questionnaire; the subjects were briefed about the purpose of the

32
study and they were guided on how to fill the questionnaire correctly. The respondents were

assured about confidentiality of their information

3.8 Method of Data Analysis

The data analysis involved reducing the raw data into a manageable size, developing

summaries and applying statistical inferences. Consequently, the following steps were taken to

analyze the data for the study. The data from the questionnaire was edited to detect and correct

possible errors and omissions that were likely to occur and to ensure consistency across

respondents. Data was presented in frequency table and simple percentage.

33
 ONDO STATE COLLEGE OF HEALTH TECHNOLOGY AKURE

EFFECT OF WORK MOTIVATION ON JOB PERFORMANCE AMONG

HEALTHCARE PROVIDERS

(A CASE STUDY OF UNIVERSITY OF MEDICAL SCIENCES TEACHING

HOSPITAL, ONDO STATE)

Dear Respondents,

I am a final year student of the above-named institution. I am collecting information on the

above subject for my research project for the partial fulfilment of the requirement of the award of

Professional Diploma in Health Information Management.

The questionnaire is meant for academic purpose only. Hence, your response shall be treated

with uttermost confidentiality. Therefore, you are encouraged to answer the questions as honest

as you can.

Thank you

Section A: Demographic Data

Instruction: Please tick (√) the correct options as it applies.

1. Age: (a) 18 – 23 (b) 24 – 28 (c) 29 – 33 (d) 34 – 39 (e) 40 – 45 (f) 46 above

2. Sex: (a) Male (b) Female

3. Profession ______________

Section B: Motivational Strategies Adopted

6. Do you like your current time schedule of work? Yes [ ] No [ ]

7. Does your organization offer rewards or incentives to employees for meeting performance

goals? Yes [ ] No [ ]

34
8. Does your organization provide regular feedback and recognition to employees for their

accomplishments? Yes [ ] No [ ]

9. Does your organization provide training and development programs to help employees

improve their skills and knowledge? Yes [ ] No [ ]

10. Does your organization provide opportunities for career growth and advancement? Yes

[ ] No [ ]

Section C: Effectiveness of these Motivational Packages on Health Worker’s Performance

11. Are you well motivated when you work with little or no supervision? Yes [ ] No [ ]

12. Do you feel that the motivational packages provided by your hospital are sufficient? Yes [

] No [ ]

13. Do monetary rewards in terms of allowances and salary increment one the main factor of

motivation? Yes [ ] No [ ]

14. Has Recognition/Promotion been the major factor for motivating staff in your hospital?

Yes [ ] No [ ]

Section D: Level of Satisfaction with the Motivational Packages

15. Have you received any motivational packages from this hospital before? Yes [ ] No

[ ]

16. Were the motivational packages received helpful? Yes [ ] No [ ]

17. Do the motivational packages encourage you to work harder? Yes [ ] No [ ]

18. Does the motivational packages meet your expectations? Yes [ ] No [ ]

19. Would you like to receive more motivational packages in the future? Yes [ ] No [ ]

35
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39
HEALTHCARE PROFESSIONALS POPULATION
DOCTORS 125
NURSES 387
HIM 123
MLS 103
PHARMACIT 47
HEALTH ATTENDANT 553
PHYSIOTHERAPY 33
RADIOLOGY 39
DENTAL 44
SCIENTIFIC OFFICER 3
BIO-MEDICAL 10
ANAESTHESIA 2
PROSTHESIST 1
CLINICAL PSYCHOLOGY 5
PLASTER TECH 1
ORTHOMERTRIST 1
Total 1,477

40