ISSN 0798 1015

Vol. 38 (Nº 33) Año 2017. Pág. 12

Factors of motivation in the professional activity of medical staff

Factores de motivación en la actividad profesional del personal médico

Ludmila Stanislavovna LEONTIEVA 1; Tatiana Viktorovna KHALILOVA 2; Mayya Viktorovna GALOCHKINA 3; Elvira Evaldovna SYMANIUK 4; Elena Nikolaevna SPIRCHAGOVA 5

Received: 20/05/2017 • Approved: 01/06/2017

Content

1. Introduction

2. Bibliography review

3. Research method

4. Result and discussion

5. Conclusion

References

1. Introduction

The working conditions and motivation of medical staff are the essential characteristics of the condition of the healthcare system and determine its efficacy. These factors are especially significant under institutional reorganization, which includes creation of united university clinic as a scientific-educational medical basis of Kazan Federal University.

2. Bibliography review

When analyzing the topic, the authors based on the theoretical research by Robbins SP., Buchbinder S, Shanks N, Griffeth RW, Hom PW, Gaertner S (Robbins SP, 2003; Buchbinder S, Shanks N, 2006; Griffeth RW, Hom PW, Gaertner S, 2000), the scientific-methodological works by the researchers from National Research University Higher School of Economics, who had monitored the economic processes in the Russian healthcare system (Kolosnitsyna M.G., Potapchik E.G., 2011), the researches on motivation of the medical staff in different countries (Blank, Robert H., 2004; Persefoni Lambrou, Nick Kontodimopoulos, and Dimitris Niakas, 2010; Rafat Mohebbifar, Mohammad Zakaria Kiaei, Omid Khosravizadeh, 2014; Krogstad U, Hofoss D, Veenstra M, Hjortdahl P., 2006; Laubach W, Fischbeck S., 2007; Benson SG, Dundis SP, 2003; Dieleman M, Toonen J, Touré H, Martineau T., 2006; Kamasheva A.V., Valeev E.R., Yagudin R.Kh., Maksimova K.R., 2015), and the comparative analysis of the features and social consequences of healthcare system reforming under various systems of public administration (I.S. Glebova, L.S. Leontieva, T.V. Khalilova, 2016; Osotkina M.V., Gorn A.P. 2014; Nigomatullina, R.M. and E.M. Nikolayeva, 2013; Golna C, Pashardes P, Allin S, 2004; Franco LM, Bennett S, Kanfer R., 2002; Byrne M., 2006).

3. Research method

Sociological research with the polling technique was carried out in February-March 2016 in the medical-sanitary department of Kazan (Volga region) Federal University – “University Clinic”, sample size – 142 medical workers. The polls were processed with SPSS software. The research objective is to determine the degree of professional-labor satisfaction of medical staff and elaborate recommendations to increase the efficiency of rendering medical services to the population. The following research tasks were set: 1. To define the overall level of medical staff satisfaction with particular aspects of their labor activity, and organizational-psychological, material-financial working conditions demanded by the staff; 2. To reveal the attitude to organization of remuneration of labor; 3. To measure the potential “employee turnover”, the level of conflicts among the employees and motivation of personnel for scientific-educational activity; 4. To determine the attitude towards institutional reorganizations of medical establishment.

4. Result and discussion

The polled medical workers are staff members with the average employment history in the present medical establishment of 12.1 years. The majority are women (86.62%). All age groups are equally represented. The professional – qualification level is rather high –71.1% respondents have categories in their profession. The poll was carried out among the personnel in ten medical professions. The maximally represented profiles of medical activity are the diagnostic (30.3%) and the therapeutic (28.3%) ones.

The summarized index of the employees’ demands balance is their estimation of overall satisfaction with work in the particular establishment. The share of positive estimations (fully satisfied and rather satisfied) was 55.8%, the share of negative estimations was less – 40.7%. However, this index leaves much space for organizational improvement. The degree of overall satisfaction with work in the particular establishment is closely connected with the desire to resign or to stay in the establishment (Krogstad U, Hofoss D, Veenstra M, Hjortdahl P, 2006). The higher the satisfaction level, the lower the potential turnover level: 72.42% of the employees do not want to change their working place or profession. Of those who want to change the kind of work, 10.35% are aimed at private medicine sector or complete change of the profession. With all other favorable conditions, this group forms the programmed percentage of the “normal” employee turnover. Thus, the priority of the HR activity should be aimed at those 12.41% of employees who want to change their medical establishment for another public medical establishment.

The relatively high overall level of medical staff satisfaction with their labor activity is determined not so much by the material as by moral factors. “This is an interesting job” and “We have got a good team of employees” - say 73.94% and 57.04% of respondents respectively (Tab.1). Working in the particular medical establishment from the point of view of “stability” and “convenient working schedule” is valuable for 39.44% and 34.51% of respondents respectively (Tab.1).

Table 1. What do you value most in your work?

Source: Table compiled by the authors

Such factors as the prospects of career growth, creative self-actualization and possibility of high salary are poorly expressed (2-3%) (Tab.1), thus, requiring additional attention and development from the leadership. This is confirmed by ranking of weighted average value of medical staff satisfaction with particular aspects of their labor activity. Among the outsiders are the possibility of professional (2.91) and career growth – 2.75 (out of 4), amount of payment (2.19) and the pattern of reckoning salaries and bonuses (2.36) (Tab.1). The first two factors launch changes in financial indicators of the labor activity. Thus, as researchers note [Ivanenko N., Khairova I., Fajzrakhmanova A., 2015], the need for competitive system of professional education increases, as well as for systematic retraining of the medical staff.

The leading position in the estimation ranking of professional activity is occupied by “satisfactory relations with the immediate supervisor” (3.43) (Tab.2), followed by closely related factors of favorable psychological climate at work (3.33), stability (3.29) and working schedule (3.25) (Tab.2). 

Table 2. Ranking by the degree of satisfaction with various aspects of work

Source: Table compiled by the authors

In general, the efficiency of organization of work at medical institution is estimated as 3.04 points (Tab.2), which can be viewed as a favorable indicator, though leaving a vast field for action, for example, in the sphere of improving working conditions (3.00), technical equipment (3.18), organization of treatment in general (3.14) and especially - availability of medications (2.84) (Tab.2).

The level of salaries is estimated by the majority of respondents as inadequate: 61.12% consider it to be low and very low, 36.11% - average (Tab.3). Only 2.78% of medical staff estimated their salary as high or above average (Tab.3).

Table 3. How do you estimate the level of your salary at your present working place?

Source: Table compiled by the authors

The respondents see the cause of such financial inadequacy in the misbalance between the salary and the working contribution; this is the opinion of 62.07% of respondents, which absolutely correlates with the number of respondents who estimated their salary as “low” or “very low” – 61.12% (Tab.3) and with the number of respondents who estimated their workload as “high” (59%) and “very high” (20%). Among the specific drawbacks in the organization of payment at medical institution, the respondents highlighted two, to the equal extent – non-transparency in determining the size of payments and the large difference between the salaries of ordinary doctors and the management (20% each). The low level of differentiation in salaries of doctors with different length of working life was marked as a drawback by 22.76% of medical workers; while 17.93% highlighted the lack of possibilities for additional payments. It is notable that the size of bonuses does not disappoint the respondents, as only 0.69% marked them as low.

Thus, the topical problem zones, from the viewpoint of the staff satisfaction, are, first of all, material provision (level and order of salary calculation, pensions) and prospects of development, both personal-creative and career.

As the respondents highlighted the high importance of psychological climate and estimated it as positive, we can state the favorable overall interpersonal situation among the staff. However, any social interaction is fraught with the possibility of clashes between interests, objectives and ways of achieving them. The analysis of conflict level showed that the summarizing factor “working conditions” was highlighted by 27.59% workers; the problem specification is presented in the estimation ranking of the conditions for professional activity (Tab.2). Almost the same number of respondents (26.9%) quite justly see the cause of conflict in situation when a worker does not fulfill his or her functional duties. At that, the cause of irresponsible behavior is in moral-labor attitude, not in professional level of colleagues, as the latter was characterized as low by 4.14% respondents only. A significant number of respondents highlight such conflict-generating factors as individual-personal characteristics of their colleagues (22.07%) and management – 12.41% (authoritarian style).

Thus, as interpersonal relations are of deeply subjective character, and the management style is viewed as authoritarian by one eighth of the respondents only, the efforts should be focused on reducing such conflict-generating factors as:

 1) “working conditions” (according to the estimation ranking in Tab.2)

 2) “functional duties”, the responsible fulfillment of which determines social value of the profession, as well as the efficiency and reputation of a particular medical institution.

The relation towards organizational changes, i.e. integration of several municipal clinics, is neutral in a half of the respondents (50.36%) and rather positive in almost a quarter of the respondents (24.09%). The completely positive (13.87%) and negative (11.68%) opinions to these changes are at the opposite extremes. Thus, the positive attitude of various degrees was expressed by 37.96% (fully and partially positive) to 88.92% (including “neutral”) respondents. Constructive expectations from the changes are felt by 61.48% of the respondents: enthusiasm (4.1%), hope (34.43%), positive feeling (1.64%), involvement (21.31%). The feelings of depression and anxiety are characteristic for 15.58% medical workers, while 22.95% of them do not understand the purpose of the carried out changes. It is possible, that the negative attitude of some respondents towards reorganization is connected with the increase (36.81%) and significant increase (17.36%) of the workload after integrating with other medical institutions. However, 20.83% believe that the workload has increased but insignificantly, and 22.92% of the respondents have not noticed the changes in the workload.

Thus, 37.96% of the medical staff support the organizational changes to a different extent, 61.48% have positive expectations connected with them. However, half of the respondents are neutral, and 22.95% have not comprehended, and thus, have not accepted the reorganization objectives. The high percentage of neutrally-indifferent staff is a potential resource of support for organizational changes.

An analysis parameter especially important for the university clinic is the personnel motivation to broadening the sphere of professional involvement in scientific research and education. Despite rather high professional-qualification level, more than half of the respondents (57.24%) admitted that they are not ready (“rather not ready” - 13.1% and “not ready” - 44.14%) to carry out scientific research (Tab.4). Still higher is the number of the residents who are not ready to share their professional experience in scientific articles: 62.75% (“rather not ready” - 11.72% and “not ready” – 51.03%) (Tab.4).

Table 4. Are you ready to be involved in the following activities in the nearest future?

Source: Table compiled by the authors

40% of respondents are ready to be involved in educational activity in future, 30.34% - in the scientific-research activity (Tab.4). By age parameter, the most motivated for writing scientific articles are young people of 26-30 years of age and the 46-50-year-olds having a large professional experience. Among doctors of higher category, the percentage of the respondents, ready to be involved in scientific research is higher than among other qualification categories: 11.04% showed various degrees of readiness for writing scientific articles.

Thus, motivation to scientific-educational activity was expressed by approximately one third of the staff, mainly 26-30 and 46-50 year-olds. The latter, having no professional categories, are oriented towards the professional and creative growth. The former have both knowledge and professional experience, reflected in high qualification categories.

To determine the priority directions for reorganization, we made the ranking of the personnel demands in the sphere of organizational-psychological, material-financial conditions of professional activity.

In the sphere of comfortable working conditions, the most significant are the issues of material provision: decent pension (3.59), salary (3.58), comprehensibility of payment system (3.49) and material incentives (3.48). This group also includes the demand for improving the dwelling conditions (2.77). The respondents attach great importance to social-psychological climate in the team (weight average indicator 3.53 out of 4). This indicator is specified in particular psychological and professional needs: respectful attitude towards the staff (3.52), possibility to advance one’s qualification (3.43), recognition in the professional community (3.31), by the colleagues at work (3.30) and by the management of the medical institution (3.28). The need for the transparent payment system occupies the third position and is expressed in work quota setting (3.37), in the presence of the clear responsibility zone (3.33), in the dependence of incentive payments on the quality of work (3.20), in the availability of information on the work estimation criteria (2.95), in introducing the ranking index for each employee (2.77). The fourth position is occupied by the block of information-communicative needs of the staff: availability of information about the prospects of the medical institution development (3.34), possibility to discuss the problems openly (3.13) and regularly meet the management (2.95). The efficient implementation of the employees’ right for information and communication is considered by the researchers to be a backbone factor of social community development (Leontieva L.S, Gaynullina L.F, and Cherepanova E.S., 2014), able to reduce the degree of social-psychological tension and increase the level of satisfaction with the conditions and results of one’s work.

Thus, the priority tasks in compliance with the personnel needs are the following: 1) the level of material provision; 2) the psychological climate in the team; 3) the transparency of the payment system; 4) the availability of information and communication within the organization.

5. Conclusion

The analysis of the sociological poll of the medical staff allows to highlight the following problem situations and give recommendations to solve them.

1. The overall level of work satisfaction is maintained to a larger extent by the moral factors rather than the material ones. Thus, to increase the organizational-financial motivation, managerial decisions in problem zones are required: size of the work remuneration, possibilities for career growth, availability of medications.

 2. Lack of actual binding between the size of salary and the results of work. This problem requires introduction of transparent mechanisms and procedures to determine and differentiate the salaries of the medical staff.

3. The potential employee turnover. The staff dynamics can be defined as normal. However, the human resources departments should work individually with those who plan to shit for another public medical institution.

4. More than a half of the employees show neutral or negative attitude towards reorganization. That is why the information-communication work is required, like explanation of advantages of new organizational structure of medical institution.

Thus, social-economic efficiency of integration process of medical institutions largely depends on organizational-administrative attention towards value-motivation demands of medical staff.

References

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1. Kazan (Volga region) Federal University, Russian Federation, 420800, Kazan, Kremlevskaya Street, 18. Email: leontyeval@icloud.com

2. Kazan (Volga region) Federal University, Russian Federation, 420800, Kazan, Kremlevskaya Street, 18

3. Ural Federal University, Russian Federation, 620002 Ekaterinburg, Mira Street, 19

4. Ural Federal University, Russian Federation, 620002 Ekaterinburg, Mira Street, 19

5. Kazan National Research Technological University, Russian Federation, 420015, Kazan, Karl Marx street, 68