The specificity of the motivation of medical personnel in the healthcare system. Thesis: Management of medical personnel. - How can this be achieved?
The key advantage of non-economic incentives is the ability to influence intrinsic motivation. To study the level of significance of non-economic motivation (NEM) for medical workers public clinics and hospitals, an empirical study was conducted among 407 doctors and nurses. 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 occupy managerial positions - good, friendly relationships with colleagues at work and the ability 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 secondary medical staff is the most important element that determines the productivity of their work 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 underdeveloped. 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, in conditions of low wages and poor working conditions in most regions, altruistic motives and a sense of responsibility for the patient are often key drivers of health 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 high level responsibility and social significance of work in the industry. The focus on public medical organizations is 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 are used (“if not ... then ...”) and economic incentives (since the actions of an individual are conditioned by the desire to receive a reward). 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, the regular expression of gratitude from the management, the availability of feedback, the 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, but integration is defined as external motivation, since a person is guided by external factors and is 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 to internal occurs throughout the entire time the specialist works in the 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 the importance of non-economic incentives by medical workers in state medical institutions depending on their earnings, age and position, and 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. 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 providing outpatient and inpatient medical care to adults and children, as well as those holding managerial and non-managerial positions.
As a result of the literature review, 10 key factors of non-economic motivation were identified that are most relevant for Russian healthcare workers, which 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. Facilitate leadership vocational training worker.
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.
The 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 out 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 already use non-economic incentives. In medical organizations, such factors as the use of their various skills and knowledge in their work (77%), 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 by the formula:
where z = b1 ×X1 + b2 ×X2 + ... + bn ×Xn + a, Xn are the values of the independent variables, bn are the binary logistic regression coefficients, and is a constant.
Table 6. Correlation between factor value and significance level
According to logistic regression analysis indicators, with increasing age and income, health professionals tend to value aspects of their work more, such as content. professional activity(the opportunity to develop and apply a variety of skills), as well as the significance of the 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. decisions.
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 when employees know what 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, an 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 patient recovery.
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) should 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 highest 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.
Yugay 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
"HR officer. Personnel management", 2007, N 3
The predominantly retrospective methods of payment for medical care that exist in Russian healthcare contribute to a decrease in the efficiency of the use of labor and material resources. Understanding the process of labor motivation and how citizens make choices in the process of organizing their behavior allows us to develop a more effective system of influence on them by the leader.
In this regard, it is advisable to dwell in more detail on the distinctive features of the motivational attitudes of employees, methods of influencing and regulating the behavior of individuals in accordance with the goals of the Samara Clinical Ophthalmological Hospital (hereinafter SKOB) named after. T.I. Eroshevsky, which is a municipal enterprise belonging to the Health Department of the Samara Region, the Ministry of Health of the Russian Federation. Particular attention should be paid to the relationship between the satisfaction of the staff of SKOB them. T.I. Eroshevsky with work and productivity of their labor, taking into account the criteria for the effectiveness of the organization's activities, as well as to study the role and place of motivation in the personnel management system, the structure of incentives, the role of the medical care payment system in the formation of the motivation system.
In SKOB them. T.I. Eroshevsky, mainly economic methods of managing the motivation of labor activity are used:
1) the salary of an employee, determined by budget financing at the level of UTS rates;
2) the practice of rewarding employees for the volume and quality of work performed;
3) allowances, additional payments for work experience (in accordance with current regulations), the use of scientific achievements and advanced labor methods, servicing especially dangerous categories of patients.
Unfortunately, budget financing at the level of the rates of the Unified Tariff Scale (UTS) does not provide the proper motivation for the work of physicians. The UTS rates do not even exceed the subsistence minimum in Samara, the value of which in the fourth quarter of 2005 was 3,433 rubles per capita of the able-bodied population. Therefore, in order to attract and retain highly qualified specialists, it is necessary to find ways to increase wages at least to the level of the average for the region. Bringing economic incentives to the division of the medical organization and a specific medical worker in the SKOB them. T.I. Eroshevsky is provided by saving the funds received by the organization as part of the payment for medical care on the principle of fund holding (on-farm mutual settlements).
At this stage of the introduction of on-farm settlements, due to the complexity of accounting, settlements are carried out only on the payroll fund based on internal tariffs, which conditionally include only wage costs.
The main motivational provisions of the system
on-farm settlements
The system of on-farm settlements includes the following provisions:
A clear definition of the quantitative and qualitative indicators of the final results of the work of the unit's team used for planning, accounting, encouraging;
Effective planning of the work of departments, timely bringing to it the planned performance indicators;
Strict accounting of the results of activities of departments;
Direct connection between the amount of funds for the remuneration of the team and the final results of its work, the guarantee to the team of the unit of payment of the total amount of wages for the amount of work performed with the required quality within the specified time frame, regardless of how many employees the specified volume is completed;
Providing the team with independence in choosing specific forms of organizing their work, using the equipment and other resources assigned to them, in distributing collective earnings;
Distribution of collective earnings among employees, taking into account the quantity, quality and final results of each work in accordance with the coefficient of labor participation;
Mutual responsibility of the administration of a medical organization and a structural subdivision, as well as subdivisions among themselves for non-performance (poor-quality, untimely performance) of work or contractual obligations.
A medical organization, forming a payroll fund within the income included in the production and financial plan, makes deductions:
To the reserve fund to provide assistance in case of seasonal fluctuations in the volume of work and other unforeseen circumstances;
The remaining wage fund is used to pay employees, depending on the volume and quality of work performed by them. For poor-quality performance of work, penalties are applied in the manner and amount approved by the head of the medical organization.
On-farm mutual settlements are based on the principles of end-to-end team contracting. At the same time, one or another structural unit of a medical organization (children's ophthalmological department) acts as a team. The wage fund of the brigade is determined not by the staffing table, but by the volume of work performed, taking into account its quality. Internal tariffs for medical services are a measure of the cost of labor and material resources, i.e. in the case of a team contract, with the help of tariffs, the labor expended is measured and the money actually earned is paid.
It is often believed that with brigade forms of labor organization, the task of accounting for the labor contribution becomes irrelevant. However, it is not. Brigade forms are expedient not at all because collective payment stimulates work better, but because it is far from always possible to accurately assess the work of each individual worker. Only the features of the modern division of labor, when the result, formalized in terms of quantitative and qualitative parameters, can often be distinguished only by a group of workers (where each of them performs partial operations or work that only in total leads to the final result, for example, during a surgical operation), create the need to pay for overall result. In addition, the brigade uniforms themselves do not at all deny individual payment. On the contrary, brigade forms are most effective precisely when there is a brigade form of remuneration for each member of the brigade through the coefficient of labor participation (KTU), points, etc. The funds earned in the current month by the subdivisions are used to reimburse costs, including for remuneration of employees, taking into account the KTU of mutual settlements, the payment of penalties, and the creation of a reserve.
Study of the system of motivation for labor activity
The study of the system of motivation of labor activity of workers using a modified questionnaire developed by the Research Institute of Labor was carried out in the children's department of the hospital. The conditions for sampling respondents in the questionnaire "Motivation of activity" are reflected in Table 1.
Table 1
Sampling conditions for the questionnaire "Motivation of activity"
Mathematical analysis of the results of the questionnaire data makes it possible to determine the level of satisfaction of employees with the existing system of motivation (Table 2).
table 2
Satisfaction of employees of the children's department of SCOB
them. T.I. Eroshevsky system of motivation
The survey data show that the level of employee satisfaction with material incentives, although it leaves much to be desired, is nevertheless significantly higher than the same indicator for non-material incentives and amounts to 0.66 points.
One of the most important elements that characterize the system of motivation of employees of the SKOB them. T.I. Eroshevsky, is wages. The performance of not only a particular employee, but also the organization as a whole depends on how much the amount of wages encourages employees to work effectively (Table 3).
Table 3
Distribution of respondents' answers to the question "Does it encourage
wages you work effectively?"
The remuneration system used stimulates only 17% of respondents for effective work, this figure is very low, 39% of employees reduce labor intensity, 9% are looking for "left earnings", 35% generally find it difficult to answer the question about wages. Thus, loss of working time, reduced labor intensity, additional vacations, absenteeism, downtime - all this can be explained by low wages.
A large number of factors influence wages. Their impact can be seen from both the employer's and employee's perspectives. Within the framework of this study, the analysis of respondents' opinions on this issue is of particular interest (Table 4).
Table 4
Distribution of respondents' answers (in %) to questions
on the degree of influence of factors on wages
According to the results of the questionnaire survey, the following factors have the greatest influence on the size of wages: education and experience, initiative, enterprise, energy and efforts of the employee himself. Such a factor as the interest of the administration in the employee does not affect the amount of wages. This can be explained by the use in SKOB them. T.I. Eroshevsky tariff system of remuneration and insufficient efficiency of the administration in the field of improving the system of labor motivation. The above data indicates that such an element of the motivation system as wages is an inhibitory factor, which indicates its extremely unfavorable impact on the climate of the team. Measures are needed to increase employee satisfaction with this factor.
The degree of employee satisfaction is directly affected not only by economic incentives, but also by such components of production life as: the content of work, conditions and organization of work, workplace, distribution of work. Judging by the results of the survey, the satisfaction of the department's specialists with the above elements is quite high.
Let us turn to the data in Table 5. Analyzing the data in Table 5, we can conclude that all factors of the social and production environment, with the exception of satisfaction with growth prospects, are of a stimulating nature. On average, about 70% of employees are quite satisfied with their work. Slightly more than 20% expressed incomplete satisfaction with various elements of the social and industrial environment. About 7% found it difficult to answer, and only 3% are generally not satisfied with their work.
Table 5
Employee satisfaction with certain elements
social and industrial environment of the children's department
SKOB them. T.I. Eroshevsky
|
Elements |
Total |
Level |
||||||||
|
Satisfied |
Partially |
Not |
||||||||
|
conditions |
||||||||||
|
organization |
||||||||||
|
workplace |
||||||||||
|
His |
||||||||||
|
prospects |
||||||||||
|
distribution |
Judging by the survey data, the employees are most satisfied with the current level of workplace organization and working conditions. The level of satisfaction for these elements is 0.83 and 0.76 points, respectively. And here it is important to note that the administration of the department made a lot of efforts to obtain such a high rating. Each workplace is provided with everything necessary both directly for the work itself (computer equipment, telephone communication, etc.), and for creating favorable working conditions (modern comfortable furniture, air conditioners, etc.).
Few are satisfied with the prospects for their professional growth in the department. According to the majority of respondents, professional growth is associated only with career advancement. This is difficult to achieve in the department, since all vacant positions have long been filled, and the situation is unlikely to change in the near future. Although for some members of the team, growth prospects are primarily an opportunity to improve their professional level, gain work experience, etc.
The state of motivation is also influenced by non-material incentives, such as the distribution of vacations. At first glance, it may seem that the influence of this factor is insignificant in comparison with such factors as: working conditions and wages, organization of work, growth prospects, etc. Nevertheless, the emergence of frequent disagreements on this basis can subsequently lead to destructive conflicts, which will ultimately have a negative impact on the psychological climate of the team.
This does not threaten the staff of the children's department. Most employees are quite satisfied with the distribution of vacations (Table 6).
Table 6
Satisfaction of employees with the distribution of holidays
children's department of SKOB them. T.I. Eroshevsky
The percentage of satisfaction of employees of the children's ophthalmology department with the distribution of vacations is shown in Diagram 1.
Diagram 1. Percentage of the degree
employee satisfaction
them. T.I. Eroshevsky distribution of holidays
│ ┌───┐
│ │ │ ┌───┐
│ │ │ │ │ 13%
│ │ │ │ │ ┌───┐ 7%
│ │ │ │ │ │ │ ┌───┐
│ │ │ │ │ │ │ │ │
┼─┴───┴─┴───┴─┴───┴─┴───┴─
60% - Completely satisfied
20% - Not completely satisfied
13% - Don't know
7% - Not satisfied
It is important to note that there are no dissatisfied with the distribution of holidays in the team. About 20%, or 3 people, expressed their incomplete satisfaction with this factor. And this is quite understandable: the team is female, and such a personal issue as vacation time is far from being indifferent to any woman. As a rule, most people who want to relax always fall in the summer. It is impossible to let all employees go on vacation in the summer. Hence some dissatisfaction, but the administration of the department is always trying to reduce it. If possible, everyone is given a full vacation in the summer months. In the absence of such an opportunity, the vacation is divided into parts, and one of which necessarily falls in the summer.
After analyzing the data obtained as a result of the survey, we can draw conclusions about the insufficient development of the motivation system for employees of the Samara Clinical Ophthalmological Hospital. T.I. Eroshevsky and the need for its further improvement.
The Russian CHI system is dominated by retrospective methods of payment for medical care. Having fulfilled its main task of ensuring payment for the real result of the activities of medical institutions, including the SKOB them. T.I. Eroshevsky, these methods today need serious modification, since the prevailing principle of additional payment upon the provision of services does not correspond to the new tasks of Russian healthcare. Any health policy, no matter how reasonable, needs constant monitoring and adjustment.
Let's consider the technology of evaluation and selection of new payment methods in the Samara Clinical Ophthalmological Hospital. T.I. Eroshevsky, the use of which will facilitate this process, as well as forms of modification of the old method.
The current methods of payment for medical care have undeniable advantages, that they are familiar, computer technologies have been created for them, and do not require much effort on the part of the organization. The change in these methods is associated with serious transformations in the activities of both SKOB them. T.I. Eroshevsky, and insurers.
Methodology for assessing and choosing payment methods
medical care
As a methodology for assessing and choosing methods of payment for medical care, a formalized decision-making technology is proposed. The use of this technology makes it possible to reduce or eliminate psychological obstacles to changing the payment method and choose the best option, taking into account the required organizational measures and financial costs.
The main steps of decision making technology include:
1) analysis of the situation and formation of goals for changes;
2) selection of criteria by which the options for change will be evaluated;
3) establishment of ranking values of criteria;
4) development of alternative options for changes;
5) comparison of alternative options for changes according to the selected criteria;
6) selection of the optimal variant of changes;
7) analysis of the consequences of implementation.
Operating in SKOB them. T.I. Eroshevsky, the payment system provides for the financing of polyclinics according to the cost estimates and payment for inpatient care for the actual number of completed cases of treatment at tariffs in the context of medical and economic standards (MES).
Conducting a SWOT analysis allows us to present both the strengths and weaknesses of the current payment system in the Samara Clinical Ophthalmological Hospital named after N.N. T.I. Eroshevsky, as well as to outline the directions of its change in the conditions of the current restrictions. The results of the SWOT analysis of the current payment system are presented in Table 7.
Table 7
SWOT analysis of the current payment system
in SKOB named after T.I. Eroshevsky
|
Strengths |
Weak sides |
|
Provided predictability |
Is absent |
|
Opportunities |
Restrictions |
|
Go to preliminary |
imperfection |
The analysis showed that the current payment system does not contribute to the solution of the main tasks of the payment system - to promote the restructuring of medical care and ensure the predictability of costs.
Eliminating the weaknesses of the current system involves solving the following tasks:
to ensure the interest of polyclinics and hospitals in resource saving;
create incentives for the development of hospital-replacing technologies;
ensure predictability of hospital care costs;
create incentives for polyclinics to reduce the level of hospitalization of the attached population;
motivate employees of the organization;
create incentives for medical prevention.
The problem of optimizing the economic mechanisms of personnel management in SKOB im. T.I. Eroshevsky will be solved by improving the system of payment for medical care. Currently, only the top management of the organization is involved in determining the size of quotas for all categories of personnel working in the organization. The provisions on material incentives do not clearly describe the criteria and set of performance indicators for the categories of personnel for which the incentive is carried out. Quite often, the criteria and the system of indicators do not have a clear rationale and are not brought to the attention of the working staff. There is no feedback on the results of the distribution of the material incentive fund (FMP).
The purpose of the proposed methodological approaches is to eliminate some of the listed shortcomings of the mechanism for managing the distribution of the material incentive fund. First of all, we are talking about the democratization of the mechanism for determining the share of remuneration for each category of the organization's personnel and the formalization of the feedback mechanism in the scheme for managing the distribution of the FMP.
The proposed model of management of FMP in SKOB them. T.I. Eroshevsky will look like this (Scheme 1).
Scheme 1. The proposed model for managing the FMP
in SKOB them. T.I. Eroshevsky
┌──────────────────────────────────┐
├──────────────────────────────────┤
│Regulations on financial incentives│
└────────────────┬─────────────────┘
┌───────────────────────────────┴────────────────────────────────┐
│ Elements of the system of material incentives in medical │
│ organizations │
│ Top management, head. departments of the medical organization│
└────┬───────────────────────────────────────────────────────────┘
┌────┴───────────────────────────────────────────────────────────┐
│ List of types of labor activity for material incentives │
└────┬───────────────────────────────────────────────────────────┘
┌────┴───────────────────────────────────────────────────────────┐
│ List of activities against material incentives │
└────┬───────────────────────────────────────────────────────────┘
┌────┴───────────────────────────────────────────────────────────┐
│ The amount of material incentives determined by the highest │
│ leadership, head. divisions, other formal and │
│ informal leaders of professional medical groups │
│ organizations │
└────┬───────────────────────────────────────────────────────────┘
┌────┴───────────────────────────────────────────────────────────┐
│ Issuance of remuneration to staff │
└────┬───────────────────────────────────────────────────────────┘
┌────┴───────────────────────────────────────────────────────────┐
│ Creation of a tool and behavior of sociological surveys by │
│ FMP distribution results │
└────────────────────────────────────────────────────────────────┘
As can be seen from the presented two management models of the FMP of a medical organization, at least two essential features come to the fore, in our opinion, optimizing the management system in the second model:
1. Involvement in the mechanism of differentiation of remuneration of formal and informal leaders of all levels of management of a medical organization. The managerial tool in this case is the so-called preference matrix (paired comparisons) for the leaders of each professional group of a medical organization.
2. Strengthening the feedback of the object of management (employees) with the subjects of management of all levels of management of the medical organization.
Based on the study, the following conclusions were drawn:
1. The strength of the mechanism for motivating the labor activity of employees at the enterprise determines the completeness of the use of human resources, and also ensures a high level of services provided, which is especially important for enterprises providing medical services.
2. In Russian healthcare, there is a particularly great need to revise existing payment methods. There is a need to move from a predominantly retrospective payment principle to an advance payment principle.
3. The use of promising methods of payment for medical care will ensure proper funding of healthcare organizations and create an effective system of motivation for medical workers.
N. Prokhorenko
Deputy General Director
CJSC "Insurance company"
"Samara-Med"
G.Gagarinskaya
Professor,
head of department
Samara State
technical university
O. Kalmykova
Associate Professor of the Department
"Economics and management of the organization"
Samara State
technical university
A. Shavdina
Postgraduate student of the department
"Economics and management of the organization"
Samara State
technical university
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Ministry of Health and Social Development of the Russian Federation
State budgetary educational institution of higher professional education
"Chita State Medical Academy
Ministry of Health and Social Development"
Department of Public Health and Health
Internship in the specialty "Management of nursing activities"
Topic: "Motivation in the work of nursing staff"
Completed by: Podorozhnaya N.V.
Chita, 2013
Introduction
Chapter 2
Conclusion
Bibliography
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 non-material motivation nurses. Considering the limited material resources of health care, the effective and adequate value orientation of the staff 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 purpose of the study is to consider the essence of motivation in the work of nursing staff, while analyzing the factors that motivate their work.
1. Consider and systematize the theoretical foundations for studying the motivational orientation in work.
2. Summarize information about the motivational orientation of medical workers.
3. Carry out a practical study of job satisfaction and increasing the work motivation of nurses using the example of 321 OECS.
The object of the study is the nurses of health facilities.
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 the received data);
Sociological (questioning);
Statistical (data from reporting documents).
Course work consists of an introduction, two chapters - theoretical and practical, conclusion and list of references.
Chapter 1. Theoretical aspects work motivation in medicine
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 2012, 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 continue to be some trends that negatively affect the state of labor motivation of nurses.
One of the main reasons affecting the labor motivation of 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 of greater importance, 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 implanted 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 informal 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 insufficiency of the 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.
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 a 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. During production activities motivation enables employees to satisfy their basic needs by fulfilling job 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 completely differently 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 - 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;
The labor action necessary to obtain the benefit;
The price is the costs of a material and moral nature associated with the implementation of a labor action.
Fig.1. The relationship between the need for work and job satisfaction, attitude to work
motivation medical staff sister
Labor motivation - the most important factor performance, 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.
Table 1
Labor motivation system
The main objectives 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 of 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, apply various methods motivation.
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 staff 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), coercive (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 instructions, 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:
1. 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.
2. 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.
3. Financial incentives. All types of bonuses, bonuses and, in fact, salary are components of this factor.
It is impossible to change the attitude of people towards work by law, since this is a long evolutionary process, but it can be accelerated if a specific situation is soberly assessed and the reasons that gave rise to it are taken into account.
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 Factors of motivation for the work of nurses in health care facilities and the main directions for its increase
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 arouse a 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, then 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.
Five levels in the system of labor motivation of nursing staff of medical institutions can be represented in the form of 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. 2).
Fig.2. 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 in 2012, studies were carried out on the distribution of values according to the priorities of nurses (researchers A.I. Kochetov and E.I. Loginova) . 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, the same researchers (A.I. Kochetov and E.I. Loginova) conducted a survey of nurses in one of the clinical diagnostic centers in Novosibirsk. 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 a 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.
Thus, it is possible to determine the main activities of health care managers at various levels of management aimed at maintaining and increasing the labor motivation of nurses (Table 2).
table 2
The main directions of increasing the labor motivation of nurses
|
at the level of public administration |
at the local government level |
at the management level of the organization |
|
|
1. Increasing the prestige and widespread promotion of the social significance of the nursing profession. Providing recognition to workers and veterans of the profession. |
|||
|
2. Establishing a decent level of remuneration for nurses. |
2. Organization of seminars, conferences, competitions at city, district, regional levels, exchange of experience between various medical institutions. |
2. Development of a system of additional financial incentives for employees, creation of opportunities for preferential medical care for employees and their families. |
|
|
3. Equipping medical institutions with modern equipment and introducing modern technologies. |
3. Allocation of additional funds for the technical and technological equipment of medical institutions. |
3. Development of organizational culture: popularization of the mission, formation of loyalty and commitment of employees of the organization and other specific aspects. |
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4. Popularization of an increased level of secondary and higher nursing education. |
4. Organization of targeted recruitment to higher educational institutions of graduates of medical schools and colleges who have shown themselves excellently during their studies. |
4. Attention to personnel work: the creation of programs for the adaptation of young professionals, the study of labor motivation of personnel and the creation of motivational programs, etc. |
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5. Expansion of the hierarchical structure of health care institutions, creating opportunities for career growth and more differentiated remuneration for nurses. |
5. Attracting schoolchildren and students of medical schools and colleges to research work and popularization of medical knowledge, establishing nominal scholarships. |
5. Prevention of professional stress and professional burnout syndrome: introduction of a position of a psychologist, training of personnel in anti-stress behavior skills, conducting socio-psychological trainings. |
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6. Development of load standards and standards for the provision of medical care. Introduction to the staff of health care facilities of the position of HR manager and psychologist. |
6. Creation of comfortable conditions at work. Monitoring compliance with safety regulations. Implementation health-saving technologies. |
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7. Introduction to advanced training programs for paramedical workers of mandatory social and psychological training (at least 24 hours). |
7. Wide involvement of highly qualified medical personnel in teaching activities at the advanced training departments of paramedical workers. |
7. Development of the nursing process as the main model for the provision of nursing care. |
Some of the measures listed in the table are being successfully implemented in the field of domestic healthcare at the present time, while the other part requires its detailed consideration and application.
1.4 Measuring and indicators of job satisfaction of nurses
In recent years, increased attention has been paid to the evaluation of customer satisfaction. Interest in this problem is associated with the formation of a client-oriented approach and the creation of a quality management system, which is an indispensable attribute of increasing the competitiveness of a medical institution.
At the same time, insufficient attention is paid to the assessment of staff satisfaction. Meanwhile, the relevance and importance of solving this problem is due to a number of factors. Here are some of them .
Taking into account, within the framework of personnel management, the needs and expectations of its employees in recognizing their activities, job satisfaction, as well as in their development, helps to ensure that they are most motivated, and, consequently, retain qualified employees and attract new ones. High staff satisfaction allows the organization not only to reduce staff turnover, but also to counter the problem of labor shortage, which today is especially acute in relation to highly qualified specialists who provide key areas of activity of medical facilities. The satisfaction of the organization's employees largely determines the degree of satisfaction of its customers.
Thus, in order to improve the organization's policy in the field of personnel management, the existing quality standards recommend conducting an assessment of staff satisfaction, which will help form a feedback system with employees.
What is employee job satisfaction? Staff satisfaction with work should be understood as the fact that employees perceive the degree of compliance of the conditions provided by the organization, content, remuneration (and other factors) with the needs and requests of employees, that is, what they consider important.
Table 1
Various forms of job satisfaction
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Progressive Job Satisfaction: |
The person feels job satisfaction in general. By increasing the level of aspiration, a person tries to reach an even higher level of satisfaction. Therefore, "creative dissatisfaction" regarding certain aspects of the work situation may be an integral part of this form. |
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Stable job satisfaction: |
The person feels satisfied with a particular job, but is motivated to maintain a level of aspiration and a pleasant state of contentment. The increase in the level of aspiration is concentrated in other areas of life due to insufficient work incentives. |
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Satisfaction with work in humility (satisfaction with the work of a resigned person): |
The person feels vague dissatisfaction with work and lowers the level of aspiration in order to adjust to the negative aspects of the work situation at a lower level. By reducing the level of aspiration, he is able to achieve a positive state of contentment again. |
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Constructive job dissatisfaction: |
The person feels dissatisfied with the job. While maintaining a level of aspiration, he tries to cope with the situation by trying to solve problems on the basis of developing enough tolerance for frustration, annoyance. In addition, meaningful actions are available to him within the framework of target orientation and motivation, aimed at changing the working situation. |
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Fixed job dissatisfaction: |
The person feels dissatisfied with the job. While maintaining the level of aspiration at a constant level, he does not try to cope with the situation by trying to solve problems. Frustration tolerance makes the defense mechanisms needed to make an effort to solve a problem seem beyond any possibility. Therefore, the individual gets stuck on his problems, and a pathological development of events is not excluded. |
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Pseudo-satisfaction with work: |
The person feels dissatisfied with the job. When confronted with intractable problems or annoying conditions at work and while maintaining the same level of aspiration, for example, due to motivation for a certain kind of achievement or due to rigid social standards, a distorted perception or denial of a negative work situation can result in pseudo job satisfaction. |
According to this model, the development of job satisfaction is a three-stage process. Depending on the combination between expectations, needs and motives, on the one hand, and the work situation, on the other, a person forms a certain degree of satisfaction or dissatisfaction with her / his work. In addition, depending on subsequent changes in levels of aspiration and on subsequent problem-oriented behavior (aimed at solving the problem), six forms of job satisfaction or dissatisfaction can develop.
In the case of indefinite dissatisfaction at the first step, i.e. in the case of differences between the actual values of the work situation and the nominal (own) values of the person, this model offers two different outcomes depending on the level of aspiration strength, which corresponds to the second step: a decrease in aspiration or maintaining the level of aspiration. A decrease in the level of aspiration should lead to what is called job satisfaction "in humility, humility." This form of job satisfaction is confirmed by the results of qualitative interviews, during which a lot of people are revealed who adapt to work situations either by reducing their level of motivation to work and aspirations, or by shifting their motivation and aspirations to non-work activity. It can be argued that the high proportion of satisfied workers who participate in this kind of research is due to a more or less large proportion of those who have passively shifted their aspirations far beyond the work situation. Therefore, according to this model, contentment in humility is only one of the three forms of job satisfaction, and must be distinguished from them.
Maintaining aspirations at the same level in the case of indefinite dissatisfaction with one's work can result in three forms, of which the most important is pseudo- (or false) satisfaction with work. Previously, it was ignored in studies because the authors doubted the ability to find justifications. This model suggests that the other two forms, fixed and constructive dissatisfaction with work, are closely related to the mastery of other options, to the mastery of resources, and to problem-oriented human behavior. All these models are relevant variables in this case, "working" at the third stage of development of various forms of job satisfaction. Both fixed and constructive job dissatisfaction seem to depend significantly on well-known features of the organization such as control or social support at work, in one connection, and on what is briefly called the ability to acquire resources - the ability to use this parameter - in another. Constructive dissatisfaction is obviously an adjunct to job satisfaction in humility.
The model of various forms of job satisfaction points to the lack of a simple quantitative representation, even if this representation is quite complex and includes several aspects, such as work colleagues, working conditions, content of work, promotion, and so on. Therefore, job satisfaction, which we usually think about and traditionally measure, must be differentiated. Presented in the form of stable, progressive and humble job satisfaction, on the one hand, and fixed and constructive dissatisfaction, on the other, job satisfaction (dissatisfaction) simply can no longer be regarded and used as a product; rather, it should be seen as a process-oriented outcome of the interaction between man and work, dependent to a large extent on the control mechanisms that govern this interaction.
To date, studies using the model of various forms of job satisfaction have led to three important results.
First, the forms of job satisfaction can be, according to this model, reasonably differentiated; while the proportions between forms in different samples may vary, several forms (eg satisfied in humility, constructively dissatisfied) recur in research (Bussing, 1992; Bussing et al, 1997).
Secondly, the forms of job satisfaction depend more on situational factors, for example, the degree of control by the employee of his workplace, than on the disposition of factors.
Thirdly, the forms of job satisfaction do not function like psychological types, that is, they are unstable over a long period of time. Although this model is considered progressive among other models, little is known about the background and consequences associated with various forms of job satisfaction. In addition, there is still a lack of in-depth research comparing this model with other common conceptions of job satisfaction.
The inability to meet the urgent needs of workers through labor activity leads to an increase in the importance of additional ways of “earning money”, including the search for other sources of employment, theft, corruption and other negative trends.
Job satisfaction depends on a number of factors, including wages, sanitary and hygienic conditions, the prestige of the profession, employment stability, etc. It should be noted that these factors are considered in the works of domestic and foreign scientists (theorists and practitioners) within the framework of the main theories of include the theory of two factors by F. Herzberg, the theory of human relations by E. Mayo and Roethlisberger, the Lawler-Porter model of motivation, and others. Such Soviet sociologists as V. A. Yadov, A. G. Zdravomyslov and others studied the problem of the attitude of workers to work. At the same time, some researchers note the presence of direct or indirect relationships between staff satisfaction and their loyalty (devotion) to the organization, as well as with the effectiveness of their work. The presence of these links makes it possible to identify the assessment of satisfaction.
Assessment of staff satisfaction with work contributes to the adoption of balanced, informed decisions by management, for which it is necessary to have reliable, timely, complete information about the state of labor resources in the organization.
For evaluation, you can use a complex of medical and social research methods: sociological (questionnaire), social and hygienic (data from reporting documents), the method of expert assessments. The sources of information about the opinions of employees can be group (for example, a survey of a certain category of personnel) and individual interviews, questionnaires, etc.
You can also determine the structure of motivation and highlight the actual factors of satisfaction or dissatisfaction with work using the Herzberg test.
The causes of dissatisfaction identified through the assessment can be eliminated with the help of management actions available to the organization (for example, referral for training, bonuses, rotation, etc.).
Summing up, we note that in order to increase the level of staff satisfaction (and, thereby, achieve significant advantages for the company over competitors) through the introduction of an organization satisfaction assessment system, the following main steps must be taken.
Step 1. Assess the current level of staff satisfaction (in general, for key employees, etc.).
The personnel survey will allow to determine the level of its current job satisfaction and highlight the most problematic areas, as well as gaps (discrepancies) between the current and desired state.
The necessary components for organizing a survey are the development of a questionnaire, the choice of a method for processing and analyzing the information received, etc.
The assessment can be carried out both independently, with the involvement, for example, of the personnel service, and with the help of third-party organizations professionally engaged in such studies.
Both evaluation methods have their advantages and disadvantages. Assessment of staff satisfaction with work by the organization itself is certainly cheaper in cost. However, in this case, there is a risk of obtaining distorted, unreliable information due to the fact that the employees conducting the survey are deeply involved in industrial relations and are subject to interest in the results of the assessment.
A third party organization not interested in the results of the assessment will be able to conduct an independent survey. The implementation of this option will require certain financial costs, perhaps slightly more than the amount of funds for conducting the survey “in-house”. However, having experience in providing such a service, an external organization will be able to implement it more quickly and efficiently. Thus, at this stage, the involvement of an external organization to conduct the survey seems to be more preferable.
Step 2. Organization of a system for regular monitoring of staff satisfaction with work and the use of information to make informed management decisions in the field of personnel management.
Conducting staff satisfaction surveys at regular intervals will help to prevent possible problems at an early stage. Thus, it will allow the organization to retain key employees. The costs of conducting surveys pay off by significant savings in money and time for the selection, training and adaptation of new employees.
At this stage, it is advisable to shift the main focus of the work to the service of the personnel of the organization itself, outsourcing only some functions or business processes (for example, assistance in organizing the system, designing the distribution of functions between structural divisions, preparing drafts of the necessary regulations, methodological and information support ).
Step 3. Improving the system of regular monitoring (seizing opportunities to improve HR activities)
Taking into account the changes taking place in the external environment and in the organization itself, it is necessary to improve the assessment methodology (for example, change the survey questionnaire, sample, etc.), methods of analyzing information, etc. This will bring the tools used for assessing satisfaction in line with current requirements organizations for more accurate results.
It seems that the main activities of this stage should be entrusted to a third-party organization that will be able to professionally audit the existing system for assessing staff satisfaction and develop the necessary recommendations for its improvement.
Finishing the first theoretical chapter of the course work, we can draw the following conclusion.
Bibliography
1. Alekseeva O.D., Solovieva A.V. The role of the head of the nursing service in creating a "motivational" environment of the institution // Medical sister. - 2008. - No. 4
2. Antipova I.N., Shlykova I.N., Matveeva E.V. Management of motivation of labor activity of medical nurses of healthcare facilities // Chief Nurse. - 2010. - No. 6.
3. Bochkarev A.A. Labor motivation as a problem of social philosophy [Electronic resource]: Dis... candidate of philosophic sciences: 09.00.11. - M.: RSL, 2005
4. Butenko T.V. Mental burnout and work motivation of nursing staff [Text] // Young scientist. 2010. No. 11. - S. 157 - 161.
5. Butenko T.V. Work motivation of nurses: problems and prospects for solutions [Text] / T. V. Butenko // Psychological sciences: theory and practice: materials of the international. in absentia scientific conf. (Moscow, February 2012). - M.: Buki-Vedi, 2012. - S. 72-75
6. Vesenin V.R. Practical personnel management: a manual on personnel work / V. R. Vesnin. - M.: Yurist, 2007. - 495 p.
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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 2012, 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 continue to be some trends that negatively affect the state of labor motivation of nurses.
One of the main reasons affecting the labor motivation of 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 of greater importance, 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 implanted 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 informal 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 insufficiency of the 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.
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 a 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.