Abstract
BackgroundOrganizational factors are considered to be an important influence on health workers' uptake of interventions that improve their practices. These are additionally influenced by factors operating at individual and broader health system levels. We sought to explore contextual influences on worker motivation, a factor that may modify the effect of an intervention aimed at changing clinical practices in Kenyan hospitals.MethodsFranco LM, et al's (Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002, 54: 1255–66) model of motivational influences was used to frame the study Qualitative methods including individual in-depth interviews, small-group interviews and focus group discussions were used to gather data from 185 health workers during one-week visits to each of eight district hospitals. Data were collected prior to a planned intervention aiming to implement new practice guidelines and improve quality of care. Additionally, on-site observations of routine health worker behaviour in the study sites were used to inform analyses.ResultsStudy settings are likely to have important influences on worker motivation. Effective management at hospital level may create an enabling working environment modifying the impact of resource shortfalls. Supportive leadership may foster good working relationships between cadres, improve motivation through provision of local incentives and appropriately handle workers' expectations in terms of promotions, performance appraisal processes, and good communication. Such organisational attributes may counteract de-motivating factors at a national level, such as poor schemes of service, and enhance personally motivating factors such as the desire to maintain professional standards.ConclusionMotivation is likely to influence powerfully any attempts to change or improve health worker and hospital practices. Some factors influencing motivation may themselves be influenced by the processes chosen to implement change.
Highlights
Organizational factors are considered to be an important influence on health workers' uptake of interventions that improve their practices
We describe the hospitals as contexts from a more traditional quality of care perspective [19], the process of intervention [20] and reported barriers to use of clinical practice guidelines [21]
Tool development Based on these theoretical considerations, Key Informant Interview (KII) and Focus Group Discussion (FGD) tools were developed
Summary
Organizational factors are considered to be an important influence on health workers' uptake of interventions that improve their practices. A number of factors ranging from the individual to national level operate together to influence how health workers take up interventions to improve their work practices [1,2,3,4,5] Often this influence works through the local personal, educational, professional, community, or institutional environment in which work takes place, or the social, cultural, economic, and political environments more generally [1,2]. Worker motivation and its influence on changing clinical practices of health workers in low-income settings [2,6,7] is rarely explored as a major factor that may mediate or modify the effects of interventions [2,7,8,9]. Studies of health worker's motivation explore determinants of motivation by examining the subjective perceptions of health workers [8,10,11,12,13,14,15] either to understand effects of health sector reforms on worker performance [10,11,14], or influences of performance management on worker motivation [8,11,13]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
