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The system of personnel motivation in healthcare institutions. Peculiarities of staff motivation in healthcare

How to increase motivation medical staff
Why Use the Attention Test for Healthcare Managers
How to use the vanity of employees to improve the quality of services provided
What are the three KPI indicator can significantly improve the quality of work of doctors

Method 1. Create a sense of peace and prosperity in the team

One medical clinic, as an additional motivation, provides medical staff with subsidies for gasoline, cellular communication, treatment and beauty treatments. Regularly offers assistance in paying off consumer loans or studying at the expense of the company in Russia and abroad. Clinic staff receive Good work gifts (watches and Jewelry), and at the end of the year, the best employee is rewarded with a trip abroad. Other employees of the clinic (mostly paramedical staff) receive gifts and flowers on their birthdays, tickets to the theater.

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The company organizes corporate celebrations, trips for mushrooms, trips to a bowling club or a joint dinner in a restaurant. The purpose of the leadership is to unite everyone into a family that lives in peace and prosperity. It is important to organize the life of employees so that they can work comfortably: the clinic pays for work clothes and shoes, there is an Italian coffee machine in the staff room, you can also drink tea; drinks and sweets - also at the expense of the clinic. Of course, this alone is not enough for nurses to work conscientiously. Therefore, they have a good salary, and after four years of work, the company increases their salary by 10%.

Method 2. Focus on the vanity of some employees

Network owner and manager veterinary clinics and pet stores employees to name a new clinic (pet store) after the one who offers the brightest and most interesting idea, as well as give him 3% of the profits of this new company. And although most of the staff reacted rather coolly to the proposal of the head, it inspired two employees. One of them sends a colleague 15 ideas a day, even while on vacation. So that the communication would not take too much time, it was decided to send a list of ideas in the morning - if the director is interested in something, he will call back and ask for more details. Sometimes such activity tires the owner of the company, but he cannot help but recognize that thanks to innovations, the company is developing dynamically.

Method 3: Use the Monetary Mindfulness Test for Healthcare Executives

Eat good way evaluate the professionalism of the managers of medical institutions.

In one company, the manager saves graphs of profit indicators for last year. And if in any month of the current year in the division (which has existed for more than three years) the profit exceeds the figures for the same month of the previous one and the manager reports this to the director, then he will receive a bonus. The fact itself is important, whether the manager will pay attention to the performance of the unit or not, whether he will call to brag that he has exceeded last year's revenue. If he doesn’t, it means that he doesn’t have any plan, he doesn’t compare today’s indicators with those that were before, and he has no goal. It would seem surprising: if the company has such an order, is it possible to miss an opportunity that concerns you personally and entitles you to receive an award? But it's happening. Perhaps the point is laziness, inattention and indifference of local leaders. For this, on the contrary, it is worth punishing: the bonus due to the manager personally can be given to the development of a competing unit.

Method 4. Become a personal example for employees when introducing and maintaining service standards

For service rules to become a natural model of behavior for staff, they need to be constantly promoted.

First of all, the standards for medical staff should be formulated in detail and unambiguously, for example: “Addressing the patient by name and patronymic, the administrator offers to put on shoe covers, indicating their location: “Please put on shoe covers.” Or: “The administrator shows the wardrobe, offers to leave outerwear (but not “undress”) and sit on the sofa: “I will come to you and we will issue a card.”

However, one should not hope that it is enough to give an employee a folder with instructions and, having studied everything on his own, he will follow them without your reminders. Therefore, regularly remind about the standards at meetings. Set a personal example. It is important because the standards cannot describe all possible situations - sometimes employees are forced to use common sense. To correct mistakes, clearly demonstrate how ridiculous this situation looks from the outside.

Make it so that the implementation of service standards affects the bonus part of the reward. If, for example, the indicator "level of quality of work" reaches 100%, then the bonus is paid in full. If any of the standards is violated (the patient left in shoe covers or did not receive a gift due to him), then this figure is reduced to 95% and the payment is reduced accordingly. Even if this is a small deduction, it is still unpleasant for employees to lose part of their income. Conversely, if the client wrote good review, then the indicator will increase to 105% for everyone who worked with him that day.

Method 5. Determine the correct and understandable criteria for evaluating the work of personnel

Change the wage system. Keep the calculation based on the labor productivity indicator (KPI). So, for doctors, labor productivity is measured by three indicators.

KPI 1 - quality medical care. Conduct quality assessment quarterly.

KPI 3 - doctor loading. The indicator captures how much time he has open in his appointment schedule and how many patients he eventually saw. It is measured in a medical program (for example, "Medialog"), where the name of the doctor and all the data are entered.

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Peculiarities of personnel motivation in the field of health care have long been the subject of numerous studies, in which questions about the importance of non-economic and economic motives were most often studied. In addition, special attention was paid to the analysis of the effectiveness of changes in the organization wages to increase the quality of medical care provided to the population. However, it should be noted that the influence of economic and non-economic motives on the effectiveness of medical personnel has been little studied.

Economic motives should be considered everything that is associated with additional benefits that can be acquired as a result of the implementation of necessary requirements. The benefits, as a rule, can be direct, in the form of money, or indirect, which manifest themselves in the opportunity to earn extra money in another place, while having more free time.

The secondary motives primarily include wages, various bonuses, bonuses, payments, allowances and benefits. Their tasks are to attract employees to the quality performance of their duties, increase staff loyalty and, most importantly, maximize work efficiency.

Non-economic motives, in turn, include socio-psychological And organizational methods motivation.

Organizational methods are methods that contribute to the involvement of employees in solving company-wide problems, as well as the manifestation of initiative. In addition, such methods are aimed at improving working conditions.

Socio-psychological methods are focused on enhancing a favorable environment in the team.

Having studied the economic and economic methods motivation should talk a little about the statistics of wages in the Irkutsk region. According to which the total number of employees is significantly reduced due to unstable and low wages. This increases the interdependence between employees, manager and systems. The work of employees in a single team significantly increases the level of productivity of the organization as a whole, this happens due to the interaction of people with different views and work experience. In addition, when a company has such formal and informal groups requires much less control. And to this day, the salaries of medical personnel remain at a low level, which forces employees to take cash while breaking the law, but it should be said that doctors who work only for wages and to preserve the health and lives of patients still exist.

According to the reports of all districts of the Irkutsk region, the average salary of doctors is about 28 (twenty eight) thousand rubles a month, but still in some medical institutions this figure is significantly lower.

In order to increase the efficiency of labor productivity, as well as the level of staff qualification, the manager should know and be able to apply not only economic and non-economic motives, but it is also necessary to use material and non-economic motives. material incentives to work.

It is also necessary to familiarize yourself with the statistics of other countries, such as the United States. In the United States, according to 2014 data, the profession of a doctor is one of the highest paid, the salary of senior medical staff is a little more than 260 (two hundred and sixty) thousand rubles. The control over their activities is carried out mainly by the patients themselves, and in case of poor-quality service, they can sue and get the removal of doctors from their duties. Undoubtedly, the occurrence of such moments is another important incentive to do your job efficiently and accurately.

Therefore, we came to the conclusion that each person, to one degree or another, needs high-quality and timely medical care.

And in order for medical institutions to be able to provide the population with the necessary assistance, it is necessary to motivate the staff as efficiently as possible. And one of the most important roles in the process of motivating personnel in the healthcare sector is played by surplus wages in the form of allowances, bonuses and rewards of an individual nature, as well as favorable relations between the manager and his subordinates. In addition, changes in the organization of wages are the most effective way to motivate to improve the quality and effectiveness of the work of medical personnel.

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Introduction

Motivation is one of the main functions of the activity of any manager, and it is with its help that the impact on the personnel of the enterprise is exerted.

The function of motivation lies in the fact that it has an impact on the workforce of the enterprise in the form of incentives for efficient work, social impact, collective and individual incentive measures. These forms of influence activate the work of management subjects, increase the efficiency of the entire enterprise and organization management system.

The essence of motivation lies in the fact that the staff of the company performs work in accordance with the rights and duties delegated to it, in accordance with the adopted management decisions.

When planning and organizing work, the manager determines what exactly the organization he leads should do, who, how and when, in his opinion, should do it. If the choice of these decisions is made effectively, then the manager gets the opportunity to coordinate the efforts of many people and jointly realize the potential of a group of employees.

The main task from the point of view of the motivational process of workers is to make them not so much the owners of the means of production, but the owners of their own labor force.

Leaders put their decisions into action by putting into practice the basic principles of motivation. People working in modern organizations, are usually much more educated and wealthy than in the past, so their motives labor activity more complex and difficult to influence. The effectiveness of motivation, like other problems in management activities always associated with a particular situation.

Subject term paper"Motivation of work activity in medical workers».

primary goal- to carry out a theoretical analysis of the main approaches to the motivation of labor activity and to carry out an empirical study of the socio-psychological attitudes of medical workers in the motivational-demand sphere.

Tasks:

1. Consider the concept of motivation

2. Show the essence of work motivation

3. To analyze the motivation of the activities of medical workers of the Vyshnevolotsk Central District Hospital.

4. To identify the social needs of medical workers in the motivational and need sphere.

5. Summarize the results of the study.

Object of study- a group of medical workers aged 20 to 50 years in the amount of 20 people.

Subject of study- socio-psychological attitudes of medical workers in the motivational-demand sphere.

Hypothesis- the leading socio-psychological attitudes of medical workers in the motivational-demand sphere are altruism and freedom. Method of O. F. Potemkina.

Based on the tasks set, the structure of the course work consists of an introduction, 2 chapters, a conclusion, and applications. In chapter 1 "The concept of motivation" I consider the modern concept of motivation, the motive of work. In chapter 2 "Motivation of labor activity" I show the essence of motivation for labor activity and analyze the motivation of the activities of medical workers of the Vyshnevolotsk Central District Hospital.

Chapter 1. The concept of motivation

1.1 The concept of labor motivation

medical worker motivation

Let's go back to the definitions of motivation already mentioned in the introduction.

In classical foreign and domestic literature on management, motivation has various definitions:

Motivation is the process of encouraging oneself and others to act in order to achieve personal or organizational goals.

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. In the process of production activity, motivation allows employees to satisfy their basic needs by fulfilling their job duties.

Labor motivation is the desire of an employee to satisfy needs (to receive certain benefits) through labor activity.

Consider the basic concepts that explain the essence of motivation and stimulation of labor.

1.2 Labor motive

A motive is a conscious impulse to achieve a specific goal, understood by an individual as a personal necessity.

The motive of labor is formed only in the case when labor activity is, if not the only, then the main condition for obtaining the benefit. Great importance for the formation of labor motives has an assessment of the probability of achieving goals. If obtaining a benefit does not require special efforts or it is very difficult to obtain, then the motive for labor is most often not formed.

The formation of the motive of labor occurs if the subject of management has the necessary set of benefits at its disposal, corresponding to the socially determined needs of a person. To obtain benefits, the personal labor efforts of the worker are required. Labor activity allows the employee to receive these benefits with less material and moral costs than any other type of activity.

The group of leading motives that determine the behavior of an employee is called the motivational core (complex), which has its own structure, which differs depending on the specific working situation.

The strength of the motive is determined by the degree of relevance of a particular need for the employee. The more urgent the need for this or that good, the stronger the desire to receive it, the more actively the worker will act.

Motives for work are varied. They differ in the needs that a person seeks to satisfy through labor activity, in the benefits that a person needs to satisfy his needs, in the price that the worker is willing to pay for obtaining the desired benefits. What they have in common is that the satisfaction of needs is always associated with labor activity.

Good becomes a stimulus for labor if it forms the motive of labor. Practical Essence the concepts of "labor motive" and "labor incentive" is identical. In the first case we are talking about an employee seeking to benefit through labor activity (motive). In the second - about the subject of management, which has a set of benefits necessary for the employee, and provides them to him under the condition of effective labor activity (incentive).

1. 3 Modern theories of motivation

Traditionally, in the works of researchers of employee motivation, various motivational theories are divided into two categories: substantive and procedural.

More modern process theories of motivation are based primarily on how people behave in relation to their perception and cognition. The most famous procedural theories of motivation are: the expectation theory, the theory of justice and the model of motivation by Porter and Lawler, others.

Abraham Maslow's Theory of Motivation. Creating his theory of motivation in the 1940s, Maslow recognized that people have many different needs, but also believed that these needs can be divided into five main categories.

1. Physiological needs are essential for survival. They contain the primary needs listed earlier.

2. Needs for security and confidence in the future include the need for protection from physical and psychological dangers from the outside world and the confidence that physiological needs will be met in the future. A manifestation of the need for confidence in the future is the purchase of an insurance policy or the search for a reliable job with good views on retire.

3. Social needs, sometimes called belonging needs, is a concept that includes a sense of belonging to something or someone, a feeling of being accepted by others, a feeling of social interaction, affection or support.

4. Esteem needs include the need for self-respect, personal achievement, competence, respect from others, recognition.

5. The need for self-expression is the need to realize one's potential and grow as a person.

According to the theory under consideration, all these needs can be arranged in the form of a strict hierarchical structure (pyramid), at the base of which there are primary needs, physiological, safety and security needs, and closer to the top - secondary needs, and at the very top of this pyramid - the needs for self-expression and respect. With this hierarchical structure, Maslow wanted to show that the needs of the lower levels require satisfaction and, therefore, affect human behavior before the needs of higher levels begin to affect motivation. At each particular moment in time, a person will strive to satisfy the need that is more important or stronger for him. In his opinion, in order for a higher-level need to become a determinant of human behavior, a lower-level need must be satisfied. As for the highest need for self-expression, Maslow believes that since with the development of a person as a person his potentialities expand, the need for self-expression can never be completely satisfied. Therefore, the process of motivating human behavior through needs is endless. That is, a person experiencing hunger will first seek to find food and only then satisfy other needs. Living in comfort and security, a person will first be motivated to activity by the need for social contacts, and then will begin to actively seek respect from others. Only after a person feels inner satisfaction and respect from others, his most important needs will begin to grow in accordance with his potential.

Subsequently, a number of provisions of the theory of Abraham Maslow were criticized by researchers of motivation. In particular, it was found that, firstly, in general, there is no clear five-step structure of needs according to Maslow, in order for the next, more high level hierarchies began to influence human behavior, it is not necessary to satisfy the need of a lower level completely; for an individual or a group of people, the needs of a higher level at a certain point in time can be more significant than primary needs; secondly, the concept of the most important needs has not received a clear confirmation; thirdly, the satisfaction of some needs does not automatically lead to the activation of needs of a higher level; fourthly, the concept does not take into account the individual differences of people, for example, one person may be more interested in self-expression, while the behavior of another will be primarily determined by the need for recognition, social needs and the need for security.

Thus, managers must know what this or that employee prefers in the reward system and what makes one of the subordinates refuse to work with others. If a manager wants to effectively motivate his subordinates, he must feel their individual needs.

Despite the above criticisms of this theory, it has made an extremely important contribution to understanding what underlies the desire of people to work. Managers of various ranks began to understand that the motivation of people is determined by a wide range of their needs. To motivate a person, the leader must enable him to satisfy his most important needs through such activities that contribute to the achievement of the goals of the organization. Therefore, in the table, we have presented a list of some of the actions by which managers can satisfy the needs of higher-level subordinates during the labor process. (Appendix. Table 1)

McClelland's theory of needs. McClelland believed that people have three needs: power, success, and belonging. The need for power is expressed in the desire to influence other people. Within Maslow's hierarchical structure, the need for power falls somewhere between the needs for respect and self-expression. People with a need for power more often manifest themselves as frank and energetic people who are not afraid of confrontation and strive to defend their original positions. Management very often attracts people with a need for power, as it provides many opportunities to manifest and implement it.

The need for success also lies somewhere in between the need for respect and the need for self-expression. This need is satisfied not by proclaiming the success of this person, which only confirms his status, but by the process of bringing the work to a successful conclusion. People with a highly developed need for success take moderate risks, like situations in which they can take personal responsibility for finding a solution to a problem, and want specific rewards for their results. Thus, in order to motivate people with a need for success, you must set them tasks with a moderate degree of risk or the possibility of failure, delegate them enough authority to unleash the initiative in solving the tasks set, regularly and specifically reward them in accordance with the set results.

Motivation based on the need for belonging according to McClelland is similar to motivation according to Maslow. Such people are interested in the company of acquaintances, establishing friendships, helping others. People with a developed need for belonging will be attracted to a job that will give them extensive opportunities for social interaction.

Herzberg's two-factor theory. In the second half of the 1950s Frederik Herzberg and his collaborators developed another need-based motivation model. As a result of a study of employees of a large paint and varnish company, he divided the entire set of factors that affect staff satisfaction with work and motivation for work into two groups: hygiene factors and "motivation".

Hygiene factors are associated with environment in which the work is carried out, and motivation - with the very nature and essence of the work.

According to Herzberg, in the absence or insufficient degree of presence of hygienic factors, a person develops job dissatisfaction. However, if they are sufficient, then by themselves they do not cause job satisfaction, they cannot motivate a person to do anything.

In contrast, the absence or inadequacy of motivation does not lead to job dissatisfaction. But their presence fully causes satisfaction and motivates employees to improve the efficiency of labor activity. According to Herzberg, the factors that cause job satisfaction are not opposites in the same dimension. Each of them is, as it were, in its own scale of measurements, where one operates in the range from "minus" to zero, and the second - from zero to "plus". If contextual factors create a bad situation, then employees experience dissatisfaction, but at best these factors do not lead to great job satisfaction, but rather a neutral attitude. Satisfaction with work is caused only by motivational factors, the positive development of which can increase motivation and satisfaction from a neutral state to a "plus". Herzberg's theory of motivation has much in common with Maslow's theory. Herzberg hygiene factors correspond to physiological needs, the need for safety and confidence in the future. His motivations are comparable to the needs of the highest levels of Maslow. Herzberg believes that an employee will pay attention to hygiene factors if their implementation is inadequate. According to Maslow, if an employee satisfies primary needs, then he begins to work better. But in order to achieve motivation, the employee must ensure the presence of not only hygienic, but also motivating factors. Many organizations have attempted to implement these theoretical insights through work enrichment programs. During the implementation of the program of "enrichment" of work, work is restructured and expanded in such a way as to bring more satisfaction and rewards to its direct executor. "Enrichment" of labor is aimed at structuring labor activity in such a way as to make the performer feel the complexity and significance of the task entrusted to him, independence in the choice of decisions, the absence of monotony and routine operations, responsibility for this task, the feeling that a person is performing a separate and completely independent work. .

Subsequently, researchers of motivation disproved some of the provisions of Herzberg's theory. In particular, research methods have been criticized: as a rule, people instinctively associate favorable situations at work with the role of their personality and objects that they control, and unfavorable ones with the role of other people and things that objectively depend on the respondents.

Thus, the conclusions that Herzberg drew were partly the result of the way he asked questions.

At the same time, Herzberg in the study did not take into account the subjectivity of perception by different people of the same factors that can cause job satisfaction in one person and dissatisfaction in another, and vice versa. In general, later critics of his theory concluded that since different people have different needs, then different people will be motivated by different factors. In addition, Herzberg assumed a strong correlation between job satisfaction and work performance. Studies have shown that such a correlation does not always exist, for example, despite a high degree of job satisfaction, productivity may turn out to be low if a person satisfies his social and communication needs through work to the detriment of job responsibilities. Thus, although Herzberg made an important contribution to understanding motivation, his theory does not take into account many of the variables that determine the situations associated with it.

Victor Vroom's Expectancy Theory. The presence of an active need is not the only active condition for motivating a person to have a specific goal. A person must hope that the type of behavior he has chosen will actually lead to satisfaction or getting what he wants.

Expectations can be considered as an assessment of a certain event by a given person. We are based on the relationships: labor costs, results - remuneration, valence (satisfaction with remuneration). Expectations for labor costs are the ratio between the effort expended and the result obtained. If people feel that there is no direct relationship between the effort expended and the results achieved, then according to this theory, motivation will weaken. The lack of relationship can occur due to the employee's incorrect self-esteem, due to his poor preparation and incorrect training, due to the fact that the employee does not have enough authority to perform a certain job.

Performance expectations - rewards - is the expectation of a certain reward or reward in response to the level of performance achieved. If there is no relationship between the result achieved and the expected reward, motivation will weaken. If a person is confident that the results achieved will be rewarded, but with a reasonable effort he cannot achieve them, the motivation will be weak. Since individual people have different needs and desires for rewards, the specific reward offered in return for the results achieved may not be of any value to them. If the value of any of the above factors is small, there will be weak motivation, low results of work. Valence is the perceived degree of relative satisfaction or dissatisfaction that results from receiving a particular reward. In order for a person to be motivated for a certain activity, his achievements in this activity must be rewarded with what he values, and the reward must be associated with the achievement of the goal so that the person notices it.

The theory of justice. The theory of justice postulates that people subjectively determine the ratio of the reward received to the effort received and then relate it to the reward of other people doing similar work. If comparisons show imbalance and injustice, that is, a colleague received a greater reward for similar work, then psychological stress arises. As a result, it is necessary to motivate this employee, relieve tension in order to restore justice, and correct the imbalance. People can restore imbalances or a sense of justice either by changing the level of effort they put in or by trying to change the level of reward they receive.

The main conclusion of the theory of justice is that until people begin to believe that they receive a fair remuneration, they will tend to reduce the intensity of work. At the same time, the perception and evaluation of justice are relative. Some organizations are trying to solve the problem of employees' feeling of unfair evaluation of their work by keeping the amounts of payments secret. However, this is not only difficult to do technically and organizationally, but also makes people suspect that the leadership is injustice even where there is none.

The Porter and Lawler model. The results achieved depend on the efforts made by employees, their abilities and characteristic features from their awareness of their role. The level of effort expended will be determined by the value of the reward and the degree of confidence that a given level of effort will in fact entail a well-defined level of reward. The Porter-Lawler theory establishes a relationship between rewards and results.

One of the most important findings of Porter and Lawler is that performance leads to satisfaction. According to the theory of human relations, satisfaction leads to the achievement of high performance in work, or, in other words, happier workers work better. Porter and Lawler believe that a sense of accomplishment leads to satisfaction, rather than satisfaction leads to high performance and productivity growth. Studies conducted by economists, psychologists, and sociologists have confirmed the findings of Porter and Lawler that high performance is the cause of overall satisfaction, and not a consequence of it. As a result, the Porter and Lawler model has made a major contribution to the understanding of motivation. She showed, in particular, that motivation is not a simple element in the chain of causal relationships in the management process. This model also shows how important it is to combine such concepts as efforts, abilities, results, rewards, satisfaction and perception within a single interconnected system. The most important theories of the science of personnel management are presented in the table in the Appendix.

Later, in the late 70s and early 80s of the last century, much attention was paid to the analysis of the system of human relations through experience. American company IBM and Japanese quality circles.

As an example of modern European research on this issue, we can cite a study of labor motivation in Finland, carried out by Tapani Alkula. Since the organization is the place where most of people's lives are spent, the most important external factor influencing their motivation is the environment in which people would like to work, their expectations about work. The following aspects of this problem have been identified:

Work time. It has been established that there is a direct correlation between working time and place of work in life;

Family status. The more important the family is, the less attention is paid to work;

Sexual aspect. Interest in work is influenced by traditional male and female roles as an indicator of male and female identity. Socio-gender differences affect the role and place of women in organizations and social and labor relations. These differences exist, and it is necessary to take this factor into account when developing and implementing management strategies. According to the results of studies conducted in Sweden and Finland, the importance of work in people's lives in these countries tends to decrease, in Sweden there is an increase in the role of leisure, and in Finland - the family.

Chapter 2Motivation of labor activity

2 .1 Essence of work motivation

The essence of motivation lies in the fact that, focusing on the system of needs of employees, to ensure complete and effective use their labor potential to achieve the goals of the organization as soon as possible.

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.

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 effective motivation workers to work. The effectiveness of motivation, like other problems in management, is always associated with a specific situation.

Motivation can be defined in different ways.

On the one hand, motivation is the process of stimulating oneself and other people to action, suggesting the possibility of satisfying personal needs while achieving the goals of the organization.

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. In the process of production activity, motivation allows employees to satisfy their basic needs by performing work duties.

Since our goal is to review the processes and methodology of the impact of the management of the personnel management service on individuals to increase their labor interest, the first definition proposed by M.Kh. is simple and accurately reflects the essence of the motivation process. Mescon, M. Albert, F. Hedouri.

That is, we consider the motivation of labor activity as a process of satisfaction by employees of their needs and expectations in the course of performing their chosen work, carried out as a result of the realization of their goals, consistent with the goals and objectives of the organization, and at the same time as a set of measures applied by the subject of management, to improve the efficiency of workers.

The generally accepted point of view is that a need is a feeling psychologically or physiologically of a lack of something. The researchers of this problem found that the primary needs are the feeling of the need for food, water, sleep, intimacy. Secondary needs, higher level, imply the need for success, respect, power, affection, belonging to someone. It has long been proven that primary needs are laid down genetically, while secondary ones are realized by a person with experience.

Motivation is the feeling of a lack of something and the individual's awareness of what actions need to be taken to fill this lack. The degree of satisfaction received when achieving the goal affects the behavior of a person in similar circumstances in the future. People tend to repeat the behavior that leads to satisfaction of the need, to avoid that which is associated with insufficient satisfaction of the need. Since needs cause a person to desire to satisfy them, managers must create situations in which people feel that they can satisfy their needs through a type of behavior that leads to the achievement of the organization's goals.

A motive is a conscious impulse to achieve a specific goal, understood by an individual as a personal necessity. The labor motive is the need (reason) for the satisfaction of which the employee carries out highly productive labor activity. The motive of labor is formed only in the case when labor activity is, if not the only, then the main condition for obtaining the benefit. Of great importance for the formation of labor motives is the assessment of the probability of achieving goals. If obtaining a benefit does not require special efforts, or if the benefit is very difficult to obtain, then the motive for labor is most often not formed. The formation of the motive of labor occurs if the subject of management has the necessary set of benefits at its disposal, corresponding to the socially determined needs of a person. To obtain benefits, the personal labor efforts of the worker are required. Labor activity allows the employee to receive these benefits with less material and moral costs than any other types of activity, and brings him greater satisfaction.

The structure of the labor motive includes: the need that the employee wants to satisfy; a good that can satisfy this need; labor action necessary to obtain a benefit; price - costs of a material and moral nature associated with the implementation labor action. For the formation of labor motivation, the nature of the labor norms and values learned by the individual, which give meaning to all further labor activity and determine the way of life, is of the greatest importance. A person enters professional labor activity with an already formed value consciousness. He knows what interests he would like to realize through work.

This is how the second, practical, layer of labor consciousness is formed, conditioned, on the one hand, by the value orientations of the individual, and, on the other hand, by the specific circumstances of professional working life. Practical requirements for work determine a specific motivation, which, in contrast to the value consciousness that determines the meaning and long-term goals of labor activity, mainly predetermines the choice of ways and means of their implementation.

Labor motivation is the most important factor in the performance of work, and as such it forms the basis of the employee's labor potential, that is, the entire set of properties that affect production activities. In general, labor potential consists of psychophysiological potential (human abilities and inclinations, his health, performance, endurance, type of nervous system) and personal (motivational) potential.

The motivational potential plays the role of a trigger mechanism that determines what abilities and to what extent the employee will develop and use in the process of work. Obviously, although the connection between motivation and labor results is mediated by natural abilities and acquired labor skills, it has already been proven that it is motivation that is the main source of productive labor activity of an individual.

Rewards serve to motivate people to efficient operation. Together with the concept of "motivation", the term "reward" takes on a broader meaning than just "money or pleasure", with which this word is most often associated. Remuneration is everything that an employee considers valuable to himself. But the understanding of the value of each of the people is specific, and therefore, the assessments of the reward and its relative value differ.

The internal reward comes from the work itself. This may be a sense of achievement of results, meaningfulness and significance of the work performed, self-respect. Friendship between members labor collective and simply interacting with colleagues in the course of work are also seen as intrinsic rewards. The easiest way to ensure internal rewards is to create appropriate working conditions that cause satisfaction from the labor process itself.

External remuneration is given not by the work itself, but by the subject of management, which has the ability to reward labor. From a motivational point of view, external rewards can be defined as labor stimulation.

The group of leading motives that determine the behavior of an employee is called the motivational core (complex), which has its own structure and depends on the specific working situation.

Several groups of labor motives can be distinguished, which together form a single system. These are the motives of the meaningfulness of labor, its social utility, status motives associated with the public recognition of the fruitfulness of labor activity, motives for obtaining material benefits, as well as motives focused on a certain intensity of work.

It is advisable to include social motives: collectivism (the need to be in a team), personal self-affirmation, the motive of independence, the motive of reliability (stability), the opposite of the previous motive for acquiring something new (knowledge, things), the motive of justice, the motive of competitiveness, genetically inherent in every person. Let us consider some of the motives of this group in more detail.

1. The need to be in a team. This motif is especially characteristic of the Eastern (Japanese) style of personnel management, where concepts dominate: group morality, lack of individual competition, corporate culture, and others. For employees former USSR this motive is still a significant factor in choosing a place of work and value orientations. The need to work in a good team, according to many sociologists, is still included in the leading group of worker orientations.

2. The motive of self-affirmation is typical for many workers, mostly young and middle-aged, it is actually a motivating factor for highly qualified employees.

3. The motive of independence is inherent in employees with the motivation of the "owner", who are willing to sacrifice stability, and sometimes higher wages, in exchange for the attitude "to be the owner and run your own business."

4. The motive of reliability (stability) is essentially the motive of independence with the opposite sign. If in the first case employees prefer risk, active search new types of activity, then in the second - preference is given to the stability of being and activity. as show sociological research, the basis of nostalgia for the past among the majority of respondents is precisely stability, the existence of which is characteristic of the past system.

5. The motive for acquiring something new (knowledge, things) underlies many elements market economy. It is based on the system of creation of the material world in the economically developed countries. It is he who is used by manufacturers of new goods and services, and other motives are sometimes only an outer shell or filling.

6. The motive of justice permeates the entire history of the development of human civilization. How many years humanity has existed, how many years there has been a debate about what is fair and what is unfair in this society. Each society has its own understanding of justice, the non-observance of which leads to demotivation of workers, and sometimes to cataclysms.

7. The competitive motive is one of the strongest motives operating at all times. A certain degree of expression of competitiveness is genetically inherent in every person. It is most commonly used in the US and Canada and is phrased like this: "We work in the gym." When this motive is implemented in the company's personnel management strategy, the system "labor rate - wages" is replaced by the system "labor rate - competition - wages", which significantly motivates employees.

At the same time, in the special literature on personnel management and labor motivation, the concepts of motivation and incentives are separated. We believe that motivation is aimed at changing the employee’s attitude to work, and stimulation is aimed at maintaining a given level of labor productivity, that is, the result of motivation will be a change in the environment for the implementation of labor activity or the location of the individual himself, and the result of stimulation will be to consolidate the position of the individual, strengthen his position, ensure fulfillment by him of labor standards or an increase in labor productivity and quality of work without a significant change in his working conditions. Stimulation is an orientation to the actual structure of the value aspirations and interests of the employee, to a more complete realization of the existing labor potential. And although motivation and stimulation complement each other, they, as already mentioned, are opposite in direction: the first is focused on changing the existing situation; the second is to secure it.

Labor stimulation is part of the process of motivating employees, the significance of which for Russian enterprises and organizations are now very large.

Stimulation performs economic, social and moral functions.

The economic function lies in the fact that the stimulation of labor contributes to an increase in production efficiency, which is expressed in an increase in labor productivity and product quality.

The social function is provided by the formation social structure society through different levels of income, which largely depend on how incentives affect different people.

The moral function is determined by the fact that incentives to work form an active life position, a highly moral climate in society. At the same time, it is important to provide a correct and justified system of incentives, taking into account traditions and historical experience.

The figure shows some types of incentives for ensuring effective labor activity (Appendix. Fig. 1).

The researchers of these issues, based on the generalization of practical experience, have identified a number of requirements for the organization of labor incentives.

Complexity implies the unity of moral and material collective and individual incentives, the value of which depends on the system of approaches to personnel management, experience and traditions of organizations.

Differentiation means an individual approach to stimulating different strata and groups of workers.

Flexibility and efficiency are manifested in the constant revision of incentives depending on the changes taking place in society and the team.

Stimulation should be based on certain principles.

Accessibility implies that every incentive should be available to all employees.

Perceptibility, that is, the presence of a threshold for the effectiveness of the stimulus, which varies significantly in different groups.

Graduality implies that material incentives are constantly subject to upward correction, which must be taken into account.

Minimization of the gap between the result of labor and its payment (for example, weekly wages, the introduction of a system of advances).

The modern content of the motivation mechanism in its present form was formed gradually, the researchers of this problem gradually increased their knowledge in this area of influence on individuals in order to increase the efficiency of their labor activity.

2.2 Motivation of labor activity of medical workers

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 worth considering in more detail distinctive features motivational attitudes of employees, methods of influencing and regulating the behavior of individuals in accordance with the goals of the Vyshnevolotsk Central district hospital(hereinafter CRH), which is municipal enterprise related to the Health Department of the Tver Region, the Ministry of Health Russian Federation. Particular attention should be paid to the relationship between the satisfaction of the staff of the Central District Hospital with work and their productivity, 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 the Central District Hospital, 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. ETC rates do not even exceed living wage across Tver. 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 medical organization and a specific medical worker in the Central District Hospital 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).

On this stage introduction of on-farm mutual settlements due to the complexity of accounting, mutual settlements are carried out only for the payroll fund on the basis of internal tariffs, conditionally including only wage costs.

The main motivational provisions of the system of 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, a guarantee to the team of the unit of payment total amount wages for the volume of work performed with the required quality within the specified time, 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 between employees, taking into account the quantity, quality and final results of each work in accordance with the coefficient labor participation;

Mutual responsibility of the administration of a medical organization and a structural subdivision, as well as subdivisions among themselves for non-fulfillment (poor-quality, untimely fulfillment) of work or contractual obligations.

A medical organization, forming a payroll 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 payroll 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. In this case, one or another acts as a brigade. structural subdivision medical organization (children's ophthalmological department). The wage fund of the brigade is determined not staffing, and the volume of work performed, taking into account its quality. Domestic tariffs on 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 designed according to quantitative and quality parameters the result can often be distinguished only by a group of workers (where each of them performs partial operations or works that only summarily lead to end result, for example, during a surgical operation), create the need to pay for the 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

IN Russian system Compulsory medical insurance is dominated by retrospective methods of payment for medical care. Having fulfilled their main task of providing payment for the real result of the activities of medical institutions, including the CRH, these methods today need serious modification, since the prevailing principle of additional payment after the provision of services does not correspond to the new tasks. Russian healthcare. Any health policy, no matter how reasonable, needs constant monitoring and adjustment.

Consider the technology for evaluating and selecting new payment methods in the Vyshnevolotsk Central District Hospital, the use of which will facilitate this process, as well as forms for modifying 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. Changing these methods is associated with serious changes in the activities of both the Central District Hospital and insurers.

Methodology for assessing and choosing methods of payment for 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 allows you 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) choice the best option changes;

7) analysis of the consequences of implementation.

The current payment system in the Vyshnevolotsk Central District Hospital 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 you to present both strengths and weaknesses in a format that is easy to understand operating system payment in the Vyshnevolotsk Central District Hospital, as well as to outline the directions for its change in the conditions of current restrictions. The results of the SWOT analysis of the current payment system are presented in Table 8 (Appendix. Table 2).

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.

elimination weaknesses The existing system involves the solution of 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 the Central District Hospital 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. Absent Feedback according to the results of the distribution of the material incentive fund (FMP).

How to determine the interest of the applicant

Each clinic employee should be motivated to efficient work, that is why, when selecting personnel, it is necessary to take into account not only the professional level of a specialist, but also the type of his motivation. This will help to find out if the candidate's expectations correspond to the features and specifics. vacant position. There are a number of questions that will help determine the level of motivation of medical staff, for example: “Can the actions of the head of the clinic make you give up?”, “What events of the clinic inspired you the most?”, “What should be the ideal job for a doctor?”.

If the priority criteria when choosing future work are a good salary and proximity to home, then this employee cannot be called motivated, most likely, he will not show personal interest in his work, will not take the initiative, will not improve the quality of the clinic's service. Answers to questions like these will show you whether the applicant is used to working in a team, dealing with difficulties, and whether he is focused on results.

Types of staff motivation in a medical center

There are two main types of staff motivation in a medical center: material and non-material, each of them has its pros and cons. We will figure out how to properly organize a motivational policy in a medical organization.

In most organizations, planning meetings become commonplace and are distinguished by formalism. However, planning meetings are also a way to keep staff motivated - discuss topical issues, comments and complaints from clients, strive to ensure that staff should be involved in solving the problems of the center. Teach them to openly express their own thoughts and argue arguments.

An individual approach to communication with employees should become the main method of communication for the head of the clinic and a means of motivating staff in the medical center. Do not forget about the evaluation of the activities of subordinates - the praise of the manager or the recognition of colleagues is the best non-material reward and a means of motivating the doctor. Communicate thanks to patients. Constructive criticism and individual praise will stimulate and increase the motivation of the staff in the medical center.

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A good tool is to monitor the improvement of the efficiency of the clinic by compiling visual graphs, dagrams can be published in domestic newspapers or hung out in the staff room.

Each employee of the clinic should be motivated to develop. This is a great way to avoid crisis stages in the doctor's work or make them less noticeable. The possibility of training, advanced training in the medical center contributes to a temporary change in activities and motivation of staff.

Another way of non-material motivation of staff is the leader's brand, become an example, demonstrate your own achievements. Set goals on an equal footing with everyone, discuss progress or reasons for regression. Participate in the cultural activities of the organization, the staff must see that you are interested in the life of the clinic.

Organizational culture as the main component of doctor's motivation

What is a state medical clinic? This is not just a group of people working together, these are like-minded people. The task of the manager is to make a family out of the staff, and a house out of the clinic.

Create the most comfortable working conditions: let there always be cookies and sweets, a coffee machine and soft sofas, a beautiful interior of the clinic, cleanliness and order in the staff room. Thanks to such important details, the internal climate of the clinic is formed, and with it the indirect motivation of the doctor and other medical staff.

However, do not forget that the psychological climate affects the doctor's motivation no less than any other factors. And this is, first of all, a friendly team aimed at achieving common goals, a team of professionals who are ready to help and support each other. Such relationships are not formed immediately, they need to be worked on. Perhaps among your colleagues there is a person who is ready to engage in joint leisure activities, organize holidays, and hold company events. Entrust the work of staff cohesion to him or hire knowing person, for example, an event manager.

Material motivation of personnel: KPI system

Despite all the intangible benefits and ways to motivate a doctor, salary and incentive bonuses in the overwhelming majority of cases are a fundamental tool for controlling the interest of employees. Here we are talking about an accompanying component of motivation - the trust of an employee who not only knows what income is made up of, but can also directly influence it.

One of the systems that a clinic can implement is KPI ( key performance Indication) - it is suitable for evaluating both the work of the entire clinic and each individual employee, it helps to make the doctor's financial motivation system as transparent and efficient as possible. The system of indicators should be built taking into account the specifics of the clinic.

With the help of KPI, planned targets are formed for employees, departments, clinics, and most importantly, it becomes clear what indicators you need to focus on in order to achieve these plans. On the other hand, it becomes clear at what points this or that employee “sags”.

Motivational formula for payroll calculation employee looks like:

Salary = Fixed part (salary) + Planned amount of the variable part * (KPI1 ratio * KPI2 ratio * KPI3 ratio).

KPI coefficients take values depending on the level of performance of tasks by the employee.

The indicators for the final work may be different. Consider several options, for example, Work quality indicator. The basis can be taken disciplinary shortcomings in the work of the employee: absenteeism, lateness,