“I feel comfortable working here… In most instances I can rely on my experience. But if I am not sure then I do not worry but ask my colleagues for their help.”

This is a quote from an auxiliary midwife in Burkina Faso, in a review of 23 studies from low- and middle-income countries. Below is the citation and abstract.

Many health workers worldwide do not feel so comfortable in the workplace, often because of hierarchical power dynamics, and this is a serious threat to patient safety and quality iof care. I am reminded of a personal experience where I interviewed a pharmacist in a primary care centre in Tamil Nadu. He told me that he would never question what the doctor wrote on the prescription, even if the dose was dangerously incorrect. He did that when he was young, he said, and the doctors reprimanded him. Now he just does exactly as he is told.

CITATION: Exploring the influence of trust relationships on motivation in the health sector: a systematic review

Dickson R O Okello and Lucy Gilson

Human Resources for Health 2015, 13:16  doi:10.1186/s12960-015-0007-5

ABSTRACT

Background: Dedicated and motivated health workers (HWs) play a major role in delivering efficient and effective health services that improve patients’ experience of health care. Growing interest in HW motivation has led to a global focus on pay for performance strategies, but less attention has been paid to nurturing intrinsic motivation. Workplace trust relationships involve fair treatment and respectful interactions between individuals. Such relationships enable cooperation among HWs and their colleagues, supervisors, managers and patients and may act as a source of intrinsic motivation. This paper presents findings from a qualitative systematic review of empirical studies providing evidence on HW motivation, to consider what these studies suggest about the possible influence of workplace trust relationships over motivation.

Methods: Five electronic databases were searched for articles reporting research findings about HW motivation for various cadres published in the 10-year period 2003 to 2013 and with available full free text in the English language. Data extraction involved consideration of the links between trust relationships and motivation, by identifying how studies directly or indirectly mention and discuss relevant factors.

Results: Twenty-three articles from low- and middle-income countries and eight from high-income countries that met predetermined quality and inclusion criteria were appraised and subjected to thematic synthesis. Workplace trust relationships with colleagues, supervisors and managers, employing organisation and patients directly and indirectly influence HW motivation. Motivational factors identified as linked to trust include respect; recognition, appreciation and rewards; supervision; teamwork; management support; autonomy; communication, feedback and openness; and staff shortages and resource inadequacy.

Conclusion: To the authors’ knowledge, this is the first systematic review on trust and motivation in the health sector. Evidence indicates that workplace trust relationships encourage social interactions and cooperation among HWs, have impact on the intrinsic motivation of HWs and have consequences for retention, performance and quality of care. Human resource management and organisational practices are critical in sustaining workplace trust and HW motivation. Research and assessment of the levels of motivation and factors that encourage workplace trust relationships should include how trust and motivation interact and operate for retention, performance and quality of care.

—

Let’s build a future where people are no longer dying for lack of healthcare knowledge – Join HIFA: www.hifa2015.org