THE MOTIVATION OF HEALTH WORKERS AND WORKPLACE RELATIONSHIP IN A HOSPITAL ENVIRONMENT (A CASE STUDY OF SOME SELECTED HEALTH WORKERS IN LAGOS STATE).

CHAPTER ONE

INTRODUCTION

Background to the Study

The poor quality of health services continues to impede progress toward improving both access to and the use of essential public health services in low- and middle-income countries (LMICs). This is aggravated by the inefficient use of scarce resources, such as manpower, medical equipment, and supplies. Motivated and well-trained health workers are essential for high-quality service delivery. Poor job motivation affects health workers’ performance, service delivery, and health system performance; improved job motivation is needed to overcome these problems (Rashad, Mensah, Barker, Leatherman, Kelley and Agins, 2012).

The job motivation of health workers has many drivers. Motivation can be defined as ‘an individual’s degree of willingness to exert and maintain an effort towards organizational goals’ and can be influenced at many levels; the individual, organization, health sector, and the community. Workers’ individual goals, self-concepts, expectations, and experiences are important individual level determinants of motivation. Health workers may be motivated by several factors. They may, for example, be motivated because they have been trained for the job and feel they have the ability to perform well, and/or they expect a return either monetary, such as financial incentives or income, or non-pecuniary, such as trust or reputation (Franco, Bennett and Kanfer, 2002).

At the organizational level, structures, processes, resources, relationships with peers, and institutional rules may affect motivation and the ability to deliver a service. This includes the sense of belonging and justice within the organization, which may be affected by the way benefits are distributed among workers. A positive sense of justice requires transparent management and communication. Health workers’ motivations are also influenced by community expectations of the services delivered, and their interactions with and feedback from clients (Khim, 2016).

Job motivation consists of two broad categories: intrinsic and extrinsic motivation. Both represent a return from a job. A doctor, for example, may be motivated in doing his or her job because of the opportunities to meet and assist patients, which is intrinsic motivation, and/or because he or she is paid to do the job, which is extrinsic motivation. Extrinsic motivation may also be non-financial, such as recognition, commendation, or opportunities for continuing education or training (Prytherch, Kagone, Aninanya, Williams, Kakoko and Leshabari, 2013).

Motivation varies by gender, the type of health worker, training, and job tenure. The factors driving motivation change according to the local context. There are numerous factors that drive job motivation and performance, which are country-specific. They include financial incentives, career development, and opportunities for training and continuing education. Factors within the working environment, such as resources, facility quality, management and leadership, working relationships, performance appraisal, and communications, also contribute to worker motivation (Irimu, Greene, Gathara, Kihara ,Maina  and Mbori-Ngacha , 2014).

Working conditions greatly influence staff motivation and practices regarding quality improvement and patient safety. Health sector reforms in any of these areas can affect motivation through changes in organizational culture, resource provision, reporting structures, human resource management, channels of accountability, and interactions with clients and communities (Prytherch, Kagone, Aninanya, Williams, Kakoko and Leshabari, 2013).

The health care sector is important, and the quality and efficiency of service depend to a large extent on human labour. Poor worker motivation can greatly affect health outcomes and patient safety. Poor worker motivation is common and can manifest as lack of courtesy to patients; tardiness and absenteeism; poor process quality, such as failure to conduct proper patient examinations; and failure to treat patients in a timely manner. In the workforce, it can manifest in high staff turnover rates, high vacancy rates and indifferent performance ( Gilson and Heggenhougen ,1994).

 Motivation is, therefore, tied to job performance. High job motivation is much more likely to lead to high job performance, which is the target of employers ( Biri and Iwu, 2014).Performance of employees in any organization is vital, not only for the growth of the organization, but also for the growth of individual employees (Meyer and Peng 2006). Also, performance on the job can be assessed at all levels of employment such as: Personnel decision relating to promotion, job rotation, job enrichments etc (Aidis, 2005; Meyer and Peng 2006).

Performance of members of any organization depends on the ability to effectively interact with their superiors, subordinates and co-workers within the organization and consumers, suppliers and general public outside. Workplace relationship therefore is a very important issue involving any organization. Most organizations have people problems rather than business problems. People problems are due to faulty interpersonal relations, which hinder the attainment of organizational goal. Efforts should be made therefore to enhance the interpersonal skills of the people at work (Obakpolo, 2015).

Workplace relationships have an advantageous impact on both organizational and individual variables. Research has demonstrated that friendships at work can improve individual employee attitudes such as job satisfaction, job commitment, engagement and perceived organizational support (Morrison, 2009). In addition, employee’s negative work attitudes can be mitigated when peers act as confidantes to discuss bad and unpleasant work experiences (Song and Olshfski, 2008).

In today’s corporate world, there is a need for work to be done as quick as possible, and for this purpose, working professionals need to have good relationship between each of her. Healthy professional relations can be maintained by effective workplace communication and team work. Workplace relationships gradually develop with good team participation with other members. On the other hand, these relationships may deteriorate when a person leaves the group and stops being in touch (Stephen, 2010). It is against this background that the study examines the motivation of health workers and workplace relationship in a hospital environment with reference to some selected health workers in Lagos State.

Statement of the Problem

Most countries especially less developed ones have been found to have less than 50% of the required staff available to provide health care in most health institutions, and in most, health care services are provided by non-qualified staff (WHO, 2006,Hongoro and Normand, 2006).

Health Workers are leaving their workplaces because of difficult working conditions. This portents grave danger to the poor who want to access health care, this scenario is no different in Nigeria as many health workers are leaving for greener pastures. The series of industrial unrest seen in the Nigerian health sector is indeed alarming. The frequency and intensity of the strikes have created a serious lacuna in health care services provision and the trust patients have in our health system has been eroded.

Organisations around the world consist of people with similar aim, objective, goals and insights, who cooperatively join hands to achieve what an individual cannot achieve in isolation. If therefore, the people that make the place will not relate positively with one another then, the goals of the organisation can hardly be achieved. There are organisations where there are no cordial relationships among staff members, and subordinates and superiors; for example, when strife, jealousy, hatred, bias, backbiting, witch-hunting, all of these and many more co-existing with the people, there is bound to be conflict which may not be healthy for the organisation. Hence, for a healthy atmosphere in any organisation, the people must understand their differences; there must be the “give and take” which is the basis of a true and genuine relationship. Therefore the gap of the study is to investigate the influence of motivation and workplace relationship among health workers in a healthcare setting.

Purpose of the Study

This study is to investigate health workers motivation and the effect on workers relationship using selected hospitals in Lagos State. The following objectives are to achieve the purpose of the study.

1.      To examine types of motivation and its influence among health workers in Lagos State.

2.      To examine the influence of workplace relationship among health workers in Lagos State.

3.      To determine the effect of socio-economic characteristics (Sex, age, marital status, educational qualification and income) on motivation of health workers in Lagos State.

Research Questions

1. Will team work motivate health workers in private and public sector in Lagos State?

2. Will interpersonal relationship motivate health workers in Lagos State?

3.Will income motivate health workers in Lagos State?

Research Hypothesis

Hypothesis 1

H₀₁: Team work will not significantly motivate health workers in private and public sector in Lagos State

Hypothesis 2

H₀₂: Interpersonal relationship will not significantly motivate health workers in Lagos State

Hypothesis 3

H₀₃: Income will not significantly motivate health workers in Lagos State

Significance of the Study

The findings from this study would be of great value to government, practitioners and health care owners. In this sense, it will help government, practitioners and health care owners to know the required working conditions that would enhance health workers performance and facilitate higher productivity. It will also help sensitize the government on areas in which they need to focus more attention to health workers so as to boost their morale and hence elicit better efforts towards achieving their goals and organizational goals.

Finally, the study will also act as a source of reference for further studies to be done on human resource in higher institutions in Nigeria. Future researchers will also benefit from this study because it will provide them with relevant information on the topic.

Delimitation of the Study

The study will consist of health workers in public and private hospitals in Lagos State. The sample for the study will be selected through random sampling techniques. The sample for this study will comprise of 50 health workers in Ikeja and Gbagada area of Lagos State. The study will employed the use of a structured research instrument titled “Motivation of Health workers and Workplace Relationship (MHWWR) designed by the researcher. The questionnaire will be administered personally by the researcher having taking permission from the appropriate quarters.

Finally, the data will be analyzed using descriptive and inferential statistics of T-test and Chi-Square at 0.05 level of significance in analyzing the data collected.

The scope of this study is to examine health workers motivation and the effect on workers relationship using selected hospitals in Lagos State.

The study will be restricted to the following selected hospitals such as Gbagada General Hospital Ifako, Apapa General Hospital, Solid Rock Hospital, R- Jolad Hospital and Aniyun Hospital.

Definition of Terms

Motivation: Motivation can be defined as a person’s degree of willingness toward achieving an individual goal that is consistent with that of the organization and the reasons underlying behavior which can be either intrinsic or extrinsic

Interpersonal Relations: Interpersonal relationship at work constitutes the day to day interaction between co-workers, or managers and employees. These relations are a natural part of the work environment and are usually pleasant and creative, but sometimes the source of tension and frustration.

Workplace: A workplace is a location or building where people perform physical or mental work in order to earn a living.

Job Satisfaction: Job satisfaction is a personal feeling of contentment which a health workers has and exhibits towards his or her work situation.

Rewards: Something given in return for or get from job completed, superior performance.

Payment: “A pre-set regular recompense, normally compensated on a monthly basis”.

Promotion: The progress of an employee from one employment level to a new employment level that having a high salary package, high level designation and frequently, more employment responsibilities.

Recognitions: “One-time cash or non-cash award for significant outstanding performance”.

Employee Performance: Employee performance is defined as whether a person executes their job duties and responsibilities well. Many companies asses their employee's performance on an annual or quarterly basis in order to define certain areas that need improvement. Performance is a critical factor in organizational success.