Franco Lynne Miller, Bennett Sara, Kanfer Ruth
University Research Co., LLC, Partnerships for Health Reform Project, Bethesda, MD 20814, USA.
Soc Sci Med. 2002 Apr;54(8):1255-66. doi: 10.1016/s0277-9536(01)00094-6.
Motivation in the work context can be defined as an individual's degree of willingness to exert and maintain an effort towards organizational goals. Health sector performance is critically dependent on worker motivation, with service quality, efficiency, and equity, all directly mediated by workers' willingness to apply themselves to their tasks. Resource availability and worker competence are essential but not sufficient to ensure desired worker performance. While financial incentives may be important determinants of worker motivation, they alone cannot and have not resolved all worker motivation problems. Worker motivation is a complex process and crosses many disciplinary boundaries, including economics, psychology, organizational development, human resource management, and sociology. This paper discusses the many layers of influences upon health worker motivation: the internal individual-level determinants, determinants that operate at organizational (work context) level, and determinants stemming from interactions with the broader societal culture. Worker motivation will be affected by health sector reforms which potentially affect organizational culture, reporting structures, human resource management, channels of accountability, types of interactions with clients and communities, etc. The conceptual model described in this paper clarifies ways in which worker motivation is influenced and how health sector reform can positively affect worker motivation. Among others, health sector policy makers can better facilitate goal congruence (between workers and the organizations they work for) and improved worker motivation by considering the following in their design and implementation of health sector reforms: addressing multiple channels for worker motivation, recognizing the importance of communication and leadership for reforms, identifying organizational and cultural values that might facilitate or impede implementation of reforms, and understanding that reforms may have differential impacts on various cadres of health workers.
工作情境中的动机可定义为个人为实现组织目标而付出并维持努力的意愿程度。卫生部门的绩效严重依赖于工作人员的积极性，服务质量、效率和公平性都直接受到工作人员投入工作意愿的影响。资源可用性和工作人员能力固然重要，但不足以确保实现理想的工作绩效。虽然经济激励可能是工作人员积极性的重要决定因素，但仅凭它们无法也未能解决所有工作人员的积极性问题。工作人员的积极性是一个复杂的过程，跨越许多学科领域，包括经济学、心理学、组织发展、人力资源管理和社会学。本文讨论了对卫生工作者积极性的多层次影响：内部个人层面的决定因素、在组织（工作情境）层面起作用的决定因素，以及与更广泛社会文化互动产生的决定因素。卫生部门改革会影响组织文化、报告结构、人力资源管理、问责渠道、与客户和社区的互动类型等，进而影响工作人员的积极性。本文所述的概念模型阐明了影响工作人员积极性的方式，以及卫生部门改革如何能对工作人员积极性产生积极影响。卫生部门政策制定者在设计和实施卫生部门改革时，可通过考虑以下方面，更好地促进目标一致性（工作人员与其工作的组织之间）并提高工作人员的积极性：解决影响工作人员积极性的多种渠道问题，认识到沟通和领导对改革的重要性，确定可能促进或阻碍改革实施的组织和文化价值观，以及理解改革可能对不同类别的卫生工作者产生不同影响。
