2 nd Policy Dialogue in the Baltic Countries on Human Resources Vilnius, Lithuania

1. Strategies to improve motivation and productivity 2nd Policy Dialogue in the Baltic Countries on Human Resources Vilnius, Lithuania 26 – 27 September 2005 WHO Europe - European Observatory Ministry of Health of the Republic of Lithuania Sigrún Gunnarsdóttir

2. Overview: • Motivation • Productivity in the context of pressure • The importance of supportive relationships • Policy challenges

3. Frame of analysis Motivation Influential factors within the work environment - in the context of high workload Productivity

4. Motivation in health care An environmentally facilitated active approach toward learning new behaviour patterns or solving new problems Karasek & Theorell, 1990, p. 170 • Patient needs • Professional standards • Organisational goals In Health Care this means to meet: • Quality patient care • Efficiency • Public welfare

5. Basic needs at work : • Clarity of expectations • Sense of belonging • To learn continuously • Feeling of contribution • Sense of control • Safety Satisfied workers are: • Cooperative • Committed • Productive Karasek & Theorell, 2000; Williams et al, 2001; Harter, Schmidt, Keyes, 2003; Models on Magnet Hospital; Model on Organisational Empowermenr

6. High workload in health care Reports from European countries & US: Swedish doctors (n=447, Arnetz et al, 2002) 67% too much workload Nurses in 5 countries (US & Europe) (n=10.319) (Aiken et al, 2002) 32,9% - 54,2% with burnout scores above norms Icelandic nurses & doctors (n=695 & n=341, Gunnarsdóttir, 2005 & Tómasson et al, 2003) 35,9% & 65,0% exhausted from work US doctors (n=1.735, Williams et al, 2001) 40,3% likely to decrease work hours

7. Productivity in the context of high demands Negative balance between demands and control of work impacts motivation and productivity Increasing pressure: Pace Productivity Decreasing opportunities: Communication Control Karasek & Theorell, 2000; Firth-Cozens & Greenhalgh, 1997; Brown, Arnetz, Petersson, 2003; IOM, 2004:Keeping Patient Safe; Aiken et al, 2002; Laschinger et al, 2005

8. To balance high demands Demand – Control – Support Model Karasek and Theorell Supportive relationships Access to information Access to recources Improved performance Control Demands Kanter, 2004; Aiken et al, 2002; Laschinger et al, 2005; Arnetz et al 2001; Freeborn, 2001

9. Workers in kitchen & laundry, 2000 Nurses and midwives, 2002-05 Follow-up participation study with managers 2005 Studies about motivation and productivity at The University Hospital Reykjavík Focus: Well-being Job satisfaction Leadership Work performance In the context of increasing work demands Merger - Cut down in resources Sigrún Gunnarsdóttir

10. Workers in kitchen & laundry (n=200) Support from staff and managers Overview and control over work Nurses and midwives (n=695) Support from unit managers Teamwork Staffing The studies in Reykjavík Influential factors: Follow-up study: Action research with nurse managers (n=20) To improve leadership behaviour To prevent burnout among managers Sigrún Gunnarsdóttir

11. Organisational traits: Supportive leadership Participation management Teamwork Professional autonomy Positive outcomes: Recruitment Job satisfaction Retention Staffing The quality of patient care Background to the Nurse study Reykjavík Characteristics of Magnet Hospitals: A link between the Models on Magnet Hospitals & Organisational Empowerment Laschinger et al, 2003

12. Impact analysis of work environmentfactors on nurse and patient outcomes Sign relationships Supportive leadership OR=+4,87 Job satisfaction B=-1,91 OR=+1,91 Adequate staffing Burnout OR=+1,94 Good nurse-doctor teamwork High quality care Findings in line with models on Magnet Hospitals & Organisational Empowerment Aiken et al, Laschinger et al Sigrún Gunnarsdóttir

13. From the landscape of Icelandic health care ...

14. Frame of analysis Motivation Influential factors within the work environment - in the context of high workload Productivity

15. Two aspects of motivation Herzberg, 1959 Intrinsic motivators: Meaningful work Recognition Responsibility Personal growth Extrinsic rewards: Pay Benefits Payment by results Tangible (extrinsic) rewards not necessarly motivating Not always linked to productivity Forsberg, Axelsson & Arnetz, 2000; 2001,Harter, Schmidt, Keyes, 2003

16. Influential factors within the work environment to improve motivation & productivity: Supportive relationships Shared values Participatory mangement Professional autonomy Access to information Access to recources Motivation – (intrinsic) Control over work Commitment Productivity Organisational trust Characateristics of transformational leadership; Supportive leadership Social capital Aiken et al, Kanter, 2003; Berwick, 2003; Firth-Cozens, 2004; Laschinger et al, 2005; Arnetz et al; Gilson, 2005; Bass, 1998

17. Motivated and productive workforce • Expertise and resources are foundational • Health care professionals are motivated via: Meaningful work Dynamic social networks A minimum of control Opportunities to grow Aiken et al; Kanter, 2004; Arnetz et al, 2002; Williams et al, 2001; Peter Drucker, 1999;

18. Mechanism of control Detailed job descriptions Clear procedures Supportive leadership Teamwork Trust Scientific management: Beyond Taylorism Human Resource Management: Intrinsic factors Extrinsic factors Frederick W Taylor was born in 1856

19. Conclusion • Motivation is reinforced by supportive relationships and sense of control • Supportive leaders unlock the best in staff through vision, shared values and trust • The link between high trust in health care and high performance is worth exploring further

20. Policy challenges • Foster visionary and supportive leaders • Promote teamwork at all levels • Support professional autonomy

21. Strategies to improve motivation and productivity 2nd Policy Dialogue in the Baltic Countries on Human Resources Vilnius, Lithuania 26 – 27 September 2005 WHO Europe - European Observatory Ministry of Health of the Republic of Lithuania Sigrún Gunnarsdóttir