Working Paper 7 Determinants of Health Worker Motivation in Jordan : A 360 Degree Assessment in Two Hospitals

Abstract

This paper represents one of three components of a larger study examining health worker motivation in two hospitals in the Hashemite Kingdom of Jordan. The overall objective of the 360 degree assessment was to begin to identify the major organizational, situational, and individual factors associated with health worker motivation, and to better understand how major constituencies (i.e., managers, supervisors, workers, and patients) perceive the hospital/work environment. Specific objectives of this study component were to: > Assess congruence between managers, supervisors, and workers on perceptions of hospital goals; > Compare perceptions of hospital and worker characteristics among types of workers (physician, nurse, other) and levels of respondents (managers, supervisors, workers, patients); > Identify possible factors for stimulating good performance and possible interventions for enhancing motivation. The study used a semi-structured interview tool, which was applied to a sample of 125 workers and 85 patients in two hospitals in Jordan, one a large central teaching hospital and the other a small rural community hospital. An additional 54 hospital directors, governorate health directors and central Ministry of Health staff were also interviewed. The instrument adapted items used to investigate work motivation in the U.S. context to the Jordanian context. Respondents answered questions relating to (1) their perceptions of hospital goals, (2) their attitudes towards the hospital environment and culture, (3) their perception of the characteristics of their fellow workers, (4) the possible benefits of different work conditions, and (5) the efficacy of specific interventions to improve motivation. While most questions took a Likert format, qualitative responses were also encouraged, recorded, and analyzed. Neither of the hospitals had clearly stated organizational goals and consequently respondents were unclear about how their work could contribute to the achievement of hospital goals. In terms of hospital and worker characteristics, respondents were quite positive about co-worker behaviors (respect, reliability), and positive (if a little less so) about co-worker intrinsic motivation and pride/reputation of the hospital. Questions about management openness and availability of modern equipment elicited more neutral reactions, while those about job/career opportunities and satisfaction with pay drew negative responses. Perceptions held by nursing staff tended to be significantly more negative than those held by physicians or other workers. Management openness was viewed more positively by managers and supervisors than by workers, and there was a non- significant tendency for managers and supervisors to view hospital characteristics more positively than workers, while viewing worker characteristics more negatively. Patients’ perceptions were generally similar to those of workers, and managers from other hospitals and governorates were also similar to those found at the two study hospitals.The most critical group of factors in stimulating motivation were those related to opportunities for increased salary, increased opportunities of personal achievement (promotion, training, new skills, etc.), and improved working environment. Effective interventions for improving motivation included: better equipment, medical records, and physical environment; fairer policies on pay, promotion, and attendance; and better job definition, more teamwork, and resolution of staff transportation and child care issues.