Based on the results of below given research study, please explain following points;

Bansal, R. N., & Malhotra, M. (2016). A case study of motivational levels among personnel working in a government teaching hospital of Punjab. Biomedical and Pharmacology Journal, 9(2), 585-591.

· Explain diversity among hospital employees.

· Identify groups of hospital employees which have low motivation level.

· Explain reasons of low motivation among employees by applying motivation theories.

Explain the leadership traits and approaches hospital managers can use to obtain desired behavior from low motivation level employees.   

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A Case Study of Motivational Levels among Personnel Working in A

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DOI: 10.13005/bpj/976

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Biomedical & Pharmacology Journal Vol. 9(2), 585-591 (2016)

A Case Study of Motivational Levels among Personnel
Working in a Government Teaching Hospital of Punjab

RAVINDER NATH BANSAL and MEEENAKSHI MALHOTRA

1Deputy Medical Superintendent, GGS Medical College Hospital,
Baba Farid Univerity of Helath Sciences, Faridkot, Punjab, India.

2Professor and Head,University Business Schools, Punjab University, Chandigarh, India.

http://dx.doi.org/10.13005/bpj/976

(Received: April 20, 2016; accepted: July 01, 2016)

ABSTRACT

Motivation of helathcare workers is as improtant as is in other organisations, to be able to
provide quality care to patients and ensuring better productivity of staff especially in public sector
institutions. The aim of the study was to assess the motivation levels of personnel working at a
public sector teaching hospital and to identify differences in various categories of personnel.
Study was conducted on all the personnel working at the medical college including all doctors,
nurses, paramedics and non-medicos except for class IV staff who could have not understood
the questionnaire adequately. Respondents were ensured of the confidentially of response and
621 personnel responded and filled the questionnaire. Statistical analysis was done using SPSS
v20. Combination of non-parametric and parametric tests was used like mean, percentages, t-test
and ANOVA analysis dividing the study groups into demographic profiles and various categories
of personnel like Doctors, Nurses, Paramedics and Non-Medics. Showed significant differences
in motivations levels between genders, job type between various motivational factors. Factors
studied in this project are essential for ensuring quality in services and for higher productivity
levels especially in healthcare setups. Introjected motivation factors is one such factor in addition
to work environment which can be used as an opportunity by the management of healthcare
organisations

Key words: Management in Public Sector healthcare institutions with limited
options to exercise external motivation must actively look for other options like

increasing their focus on introjected motivation and creating healthy work environments.

INTRODUCTION

Quality of services provided by an
organization, are a product of skill, motivational
levels and satisfaction levels of its staff members.
Management of a hospital, its respective leaders in
the organization act as an important factor and their
style translates into motivational levels and
effectiveness of their staff1. Motivation is defined as
the key for achieving personal and/or organizational
goals through the processes that account for an
individual’s intensity, direction and persistence of
effort toward attaining a goal2. Hospitals being
manpower intensive industries; performance of their

system depends on the motivational levels of its
personnel, translating into productivity and quality
of output. Thus understanding the needs and
motivational opportunities are important for service
oriented organizations like hospital3. Large Hospital
with a matrix of skilled professionals like doctors,
nurses, paramedics and other supporting
ministerial staff form a complex situation to maintain
motivational levels of its employees. Further it
becomes complex due to economic relationship
with its customers coming from a wide variety of
social background4. This becomes further complex
in teaching hospitals with multiple hierarchy levels
among different categories of staff members.

586 BANSAL & MALHOTRA, Biomed. & Pharmacol. J., Vol. 9(2), 585-591 (2016)

Various theories have been formulated by
researchers including Maslow’s Hierarchy of
Needs, Herzberg’s two factor theory, Alderfer’s
theor y, Skinner’s Reinforcement theor y and
McClelland’s theory about what motivates people.
Motivational state of an employee relates to ‘content
(what motivates a person), process (how a person
is motivated) and the reinforcement theory (person’s
current behaviour is influenced by past actions)’5.
Motivation is not just an external award or an
incentive, it is a product of relationship between
work culture, chain of command, accountability and
opportunities that exist within that organisation3

.

Herzberg theory based on ‘factors for
dissatisfaction’ identifies two types of motivation.
One is to attain a particular post and to retain the
same which satisfies the needs of job security, salary,
working conditions and its luxuries. Second is
performance improvement leading an emotional
satisfaction for achievement and recognition3,6.
Luthans (1998) asserts that ‘motivation is the
process that arouses, energizes, directs, and
sustains behaviour and performance’. Motivation
levels of a worker depend on the complex
relationship between work allotted, work
environment, relationship with super visor,
availability of resources required to perform, social
environment7, work values of the organisation,
human resources practices, expectations of the
worker societal values and may more factors. Lower
levels of motivation as a result of above factors may
manifest as; absenteeism, inefficiency, poor
performance, lack of courtesy towards patients and
their relatives and poor efficacy thus hampering
the overall performance of the organisation8

.

‘Deci and Ryan’ had proposed that
motivation depends on self-determination of an
individual9. External motivation on one side forms
the most controlled form of motivation and intrinsic
motivation on the other extreme is least controlled
form of motivation. In between two extremes is
introjected regulation being closer to extrinsic and
identified regulation being closer to intrinsic
motivation.

On review of literature it was found that
many studies have been done assessing the
motivation levels in non healthcare organisations.

However, very few studies have been done in
healthcare and that too mostly in non-teaching
hospital. Objective of this study is to find the overall
motivation levels of different types of employees in a
non-profit making teaching hospital and additionally
identifying and comparing the possible variation in
motivations levels within the various groups.

Hypothesis
a) H

0
1: That is there is no significant difference

between motivational levels in male and
female employee under study

b) H
0
2: That is there is no significant difference

between motivational levels in regular and
contractual employee under study

c) H
0
3: That is there is no significant difference

between motivational levels based on the
duration of service of employees under study

d) H
0
4: That is there is no significant difference

between motivational levels based on the
age of the employees under study

e) H
0
5: That there is no significant difference

between motivation levels between Doctors,
Nurses, Paramedics and Non-medicos
employees under study

MATERIALS AND METHODS

For the purpose of this study one of the
Government Medical Colleges in Punjab was
selected. This institute was established more than
30 years ago. Hospital today has an average OPD
of more than 1800 patients per days with more than
36000 admissions per year supported by 700 plus
beds and being manned by 1000 plus personnel
including 275 doctors, 282 nurses, 143 paramedics,
96 non-medicos and 250 plus class IV staff

Study Instrument
It consisted of two parts namely: personal

profile of the respondent and component of the
motivation. Motivation questionnaire proposed by
‘Motivation at Work Scale’ (Gagne, 2010) was used.
Motivation was measured for factors namely
intrinsic Motivation, Identified regulation, Introjected
regulation and extrinsic motivation (Table.1). Internal
consistency of the scale was checked and found to
be adequate with Cronbachs’s alpha found to be
0.910, which testified the strong reliability of the
scale.

587BANSAL & MALHOTRA, Biomed. & Pharmacol. J., Vol. 9(2), 585-591 (2016)

Sample Size and Sampling
For the purpose of this study all doctors,

nurses, paramedics and non-medical employees
(Class III) were selected. Questionnaire was
distributed to 796 eligible personnel as per the
above criterions. Employees were met either in
small groups or individually. Study instrument was
pretested on 5 subjects for clarity, comprehension
and flow of questions.

Statistical analysis
Each of the motivational factor was tested

using 3 questions for each factor on a 7 point likert
based scale ranging from non-agreement at score
1 to exact agreement with score 7. Further
assessment of motivation levels was done as
comparative levels using t-test and ANOVA. Data
management was done using Excel sheet and
Statistical package (SPSS, Ver.20). The items were
scored on a seven-point Likert scale according to
the following response categories. 1 = not at all, 2 =
very little, 3 = a little, 4 = moderately, 5 = strongly, 6
= very strongly, 7 = exactly. Higher scores indicated
higher levels of motivation. With respect to the data,
imputation of missing values was applied for missing
values among the items pertaining to items in that
scale.

RESULTS

Distribution of respondents: 621
respondents completed their questionnaire. The sex
ratio of respondents was in favour of females (66:34).
71% of the respondents were regular employees
and the rest were contractual staff members. Study
group respondents included 33% doctors, 39%
Nurses, 16% paramedics and 12% Non-medicos.

Among the 621 respondents, Introjected
Regulation had highest mean value of 16.22 (±6.34)
followed by Identified Regulation 15.58 (±6.27),
Intrinsic Motivation 13.73 (±5.6) and least mean
value was for Extrinsic Regulation 11.99 (±5.60).
Lower Extrinsic Motivation is in line with the
assumption that external rewards are not possible
in public sector organisations (table 2).

Overall motivation levels were higher in
male employees 59.25 (±21.38) as compared to
that of female employees 53.76(±26.79), this was
statistically significant using t-test at 0.05 levels of
significance with p=0.005. Further male employees
had higher means for all the four motivational factors
as compared to female employees. However using
t-test this difference was statistically significant only

Table 1: Various Motivational Factors under Study

S.No Motivational factor Statement numbers Type

1 Intrinsic Motivation 1-3 Autonomous Motivation
2 Identified Regulation 4-6
3 Introjected Regulation 7-9 Controlled Motivation
4 Extrinsic Regulation 10-12

Table 2: Mean Values for Different Motivation Factors

N Minimum Maximum Mean Std. Deviation

Introjected Regulation 620 0.0 21.0 16.216 6.3317
Identified Regulation 621 0.0 21.0 15.580 6.2724
Intrinsic Motivation 621 0.0 21.0 13.734 5.6014
Extrinsic Regulation 621 0.0 21.0 11.995 5.6034
Total Motivation 621 0.0 84.0 55.641 24.8886
Valid N (listwise) 620

588 BANSAL & MALHOTRA, Biomed. & Pharmacol. J., Vol. 9(2), 585-591 (2016)

for motivational factors Intrinsic Motivation,
Introjected Regulation and External Motivation with
p value of 0.002, 0.006 and 0.041 respectively.
Using t-test no statistical difference was found in
motivational factor indentified regulation among
male and female employees with p=0.146.

Overall motivational levels were higher in
regular employees 56.70 (±24.28) as compared to
that of contractual employees 53.61 (±25.95),
however this difference was statistically
insignificant at 0.05 levels of significance with
p=0.142. Similarly there was no statistical difference
in motivation levels of employees for all the four
motivational factors tested individually.

Using t-test it was found that there was no
statistical difference in motivational levels based
on the duration of service and age of the employees.

Employees were further divided into 4
broad categories based on their profession into

Doctors, Nurses, Non-Medicos and Paramedics.
Overall motivation levels (Table 3, Graph 1) were
higher in paramedics 64.02(±19.66), followed by
non-medicos 60.85(±17.56), doctors 57.87(±20.18)
and least was for nurses 48.78 (±30.08). ANOVA
analysis was done and this difference was
statistically significant (p=0.000) at 0.05 level of
significance.

Mean Intrinsic Motivational levels were
highest for doctors 15.04(±5.24), followed by
paramedics 14.93(±4.74), non-medicos 14.67
(±4.7) and least was for nurses 11.86(±5.96). This
difference was statistically significant (p=0.000)
based on ANOVA analysis at 0.05 levels of
significance.

Mean Identified Regulation level was
highest for paramedics 17.48(±5.20), followed by
doctors 16.35(±5.26), non-medicos 15.30(±5.45)
and least was for nurses 14.23(±7.32). This
difference was statistically significant (p=0.000).

Table 3: Mean Values for Different Motivation Factors for Different Categories of Personnel

Intrinsic Identified Introjected Extrinsic Total
Motivation Regulation Regulation Regulation Motivation

Mean Rank Mean Rank Mean Rank Mean Rank Mean Rank

Para Medic 14.93 2 17.49 1 18.48 1 13.82 1 64.03 1
Non Medico 14.67 3 15.31 3 18.33 2 13.17 2 60.85 2
Doctor 15.04 1 16.35 2 16.16 3 11.48 3 57.88 3
Nurse 11.86 4 14.23 4 14.72 4 11.34 4 48.78 4
Total 13.73 15.58 16.22 12 55.64

Fig. 1: Graphical representation of
mean values of motivational levels

among various categories of employees

Mean Introjected Regulation level was
highest for paramedics 18.47(±5.09), followed by
non-medicos 18.33(±4.60), doctors 16.16(±5.38)
and least was for nurses 14.71(±7.45). This
difference was statistically significant (p=0.000).

Mean Extrinsic Motivational level was
highest for paramedics 13.82(±5.37), followed by
non-medicos 13.17(±4.85), doctors 11.48(±4.81)
and least was for nurses 11.34(±5.37). This
difference was statistically significant (p=0.000).

Further multiple comparison was done for
professionals (doctors, nurses, non-medicos and

589BANSAL & MALHOTRA, Biomed. & Pharmacol. J., Vol. 9(2), 585-591 (2016)

paramedics) for each of the motivational factors
separately. On analysis for Intrinsic Motivation it was
found that mean motivational levels were similar
among doctors, paramedics and non-medicos.
However Intrinsic Motivation levels were
significantly lower for nurses compared to other 3
groups.

On analysis for Identified Regulation it was
found that mean motivational levels were similar
among doctors, paramedics and non-medicos.
However Identified Regulation levels were
significantly lower for nurses compared to other that
of doctors and non-medicos.

For Introjected Regulation using multiple
comparison it was found that there was significant
difference in the motivation levels for non-medicos
vs nurses, paramedics vs nurses and paramedics
vs doctors with the later one in the pair having lower
motivational values.

For External Motivation using multiple
comparison it was found that there was significant
difference in the motivation levels for paramedics
vs nurses and paramedics vs doctors with the later
one in the pair having lower motivational levels.

DISCUSSION

Healthcare organizations are manpower
intensive industries. Though driven by protocols,
human touch has more psychological and healing
impact than medications. Being manpower
intensive, motivation levels of the employees
significantly affect the satisfaction levels of the
patients and their relatives. Like for most of the
service sectors where human factor is crucial,
similarly, those working in a hospital play a crucial
role in medical care and treatment7, and authorities
should give particular attention to their motivational
needs and demands. Motivating is the
management process of influencing behaviour
based on the knowledge of what make people tick
(Luthans, 1998).

A study conducted by Masoud Asl and his
colleagues indicated that giving attention to 6 factors
‘good work environment’, ‘job security in the
organization’, ‘official rules and regulations’,

‘reasonable payment’, ‘having a sense ad
responsibility towards the job’, ‘interest in the work’
and ‘being successful in the job’ could have an effect
on workers’ performance12. Deci and Ryan, 1985
proposed that motivation differs in degree of self-
determination. The range is from the most controlled
form of motivation (External Regulation) which
represents behavior directed by external demands
to the least controlled form of motivation (Intrinsic
Motivation) where motivation is simply a result of
personal enjoyment of the activity. With respect to
non-profit organizations, the limited motivation
research that does exist, has mostly focused on the
impact that pay systems have on intrinsic motivation
(Calder & Staw, 1975; Cameron & Pierce, 1994;
Tang & Hall, 1995; Deckop & Cirka, 2000; Wright,
2007; and Perry, Hondeghem & Wise, 2010).

Government institution differ from other
institution in lacking the scope for providing
performance based pay and incentives. Of the four
types of motivational factors, External Motivation
was correlating with the fact that in Government
organization there is little scope for external
motivation and that any /all applicable incentives
like salary hike and promotion are time bound and
not bound to the performance of the individuals.
However in our research Introjected motivation had
a highest mean value (16.216), this provides an
opportunity to the administrators to be used as
effective tool for increasing the performance in
Government organization. In our study, finding of
lower Intrinsic Motivation level (13.7) is contrary to
opinion of Smith 1995, Salamon 2002.

In our study males had higher motivational
levels compared to females. No similar study could
be traced to compare the motivational level
difference between males and females in rural
segment, healthcare, public sector organisations.
Authors correlate this to the possible fact that male
members in the society need to perform better to
keep satisfying themselves; however the female
employees particularly in the rural segment of
population, seem to had more commitment towards
their families than work. However this was contrary
to findings of another study22.

The findings also suggest that there was
no statistical difference among motivational levels

590 BANSAL & MALHOTRA, Biomed. & Pharmacol. J., Vol. 9(2), 585-591 (2016)

among regular and contractual employees, this
supports the claim of the earlier studies that
organization work environment and polices are a
major factor affecting the motivational levels23,24. In
public sector organizations pay and incentives
being predefined for each category of employees
thus leaving little scope for difference in
motivational levels.

There was no statistically significant
difference in degrees of motivation present in the
employees of different age groups <=35yrs, 35- 45yrs, 45-55yrs, >55 yrs (P=0.44), this supports the
claim of earlier studies22,25.

There was no statistically significant
difference in degrees of motivation present in the
employees based on duration of service <=2yrs, 2- 4yrs, >4yrs (P=0.34) of the employees in our study
which correlates to the findings of Lambrou P.et
al22. While in another study showed that different
degrees of motivation is present in the employees
based on duration of service25. The differences could
be due the different setups, with our study being
done in a Government organisation and the others
done in a private setup.

Our study showed highest motivation
(mean score) for paramedics followed by non-

medicos, doctors and least in nurses. This is in
contrast to the finding of Jaiswal P. et al 2014. The
other explaining factors might be good salary
(proportionate to working hours) for paramedics and
non medicos in comparison to their colleagues
working in the private sector; favourable and safe
working condition; flexible assignments; flexible
duty hours; good collaboration between
occupational groups; leave provision and
compensatory leave, etc. The reasons for nurses
being the least satisfied in our study could be due
to improper recruitment policy, improper
deployment, few career growth opportunities, lesser
option for trainings, poorly defined job description
and priority towards family considering the rural
segment of population. Further studies are required
for investigation of lower level of motivation among
nurses in government teaching hospital of Punjab.

Due to the scope and limitations of the
study, author recommends that further research on
the factors affecting motivation is required be
undertaken to be able to better understand the
variation in motivational levels in the current study.
This will help government authorities to align their
strategies for better performance of staff; leading to
improvement in performance of employees and
thus the better services.

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