Theoretical aspects of work motivation in medicine. Fundamental research What is the application of theories of personnel motivation in health care facilities

Tatarnikov M.A. Research Institute of Public Health and Healthcare Management of the Moscow Medical Academy named after. I.M Sechenova

Increasing the work motivation of medical workers is the most important problem in healthcare management. Without solving it, it is hardly possible to really improve the quality and culture of medical care to the population, as well as increase the efficiency of the activities of medical institutions (HCIs) and the industry as a whole based on the rational use of financial, material and human resources. It has now been proven that money does not always motivate a person to work harder (although no one belittles the role of material interest!). The problems of increasing work motivation are systemic in nature and require an integrated approach to solving them. The article presented to your attention discusses the main theories of work motivation. The analyzed theories are universal in nature and applicable in healthcare management.

Classification of theories of work motivation

Modern methods of work motivation are based on the results of sociological and socio-psychological research. It is believed that in order to effectively motivate employees, it is necessary to determine their needs in order of importance and ensure the possibility of satisfying them in the process of work. However, it should be taken into account that the true motives of human behavior are quite complex and are not always accessible to understanding, incl. and by the individual himself. From the point of view of cognitive psychology, work motivation is the process of influencing the attitudinal system or its individual components in order to stimulate a person to activities aimed at achieving the goals of the organization.

Currently, there are two main groups of theories of motivation:

2. Process theories of motivation, which are based primarily on the study of cognitive characteristics of the perception and interpretation of information and cognition of people.

The substantive theories of motivation are based on the works of A. Maslow, F. Herzberg and D. McClelland.

A. Maslow developed the most important theoretical principles about the types of needs, self-actualization and mechanisms of personality development. According to his theory, needs can be divided into five main categories:

1) physiological needs - food, water, sleep, etc.;

2) needs for security and confidence in the future;

3) social needs (the need for love, affection, support, belonging to something or someone);

4) the need for respect, self-esteem, recognition;

5) the need for self-actualization (a person’s need for the development of his personality, self-expression, development of abilities, realization of his potential).

According to A. Maslow, needs form a hierarchical structure, which, as a dominant, determines human behavior. At any given moment in time, a person will strive to satisfy the need that is most important or strong for him. The needs of higher levels do not motivate a person until the needs of the lower level are satisfied, at least partially. However, this hierarchical structure is not absolutely rigid and strict. Therefore, A. Maslow subsequently combined all existing needs into two classes - the needs of need (deficit) and the needs of development (self-actualization).

There is no universal method of work motivation that is effective in all situations and for all employees. What leads to success today may not be successful tomorrow. What works for some people may not work for others. What works in one situation may have the opposite effect in another. That is why for effective motivation it is necessary to use a situational approach. It should be taken into account that a person’s needs and ways of satisfying them are determined by his attitudinal system, place in the social structure and previously acquired life experience.

Thus, there are many needs that determine people's motivation and their subsequent behavior, which, in their opinion, can lead to the satisfaction of these needs. Since needs may change over time, it is necessary to periodically adjust the motivation process. The manager’s task is to determine the dominant needs of his subordinates and, in accordance with the goals of the organization, to contribute to their full or partial satisfaction.

D. McClelland's theory of motivation focuses on the needs of higher levels. According to it, people have three basic needs: power, success and belonging. In Maslow's hierarchy of needs, the desire for power is located between the needs for esteem and self-actualization and manifests itself as the desire to influence other people.

People with a need for power often present themselves as energetic people who are not afraid of confrontation. These are not necessarily power-hungry careerists in the negative sense of the word. According to McClelland himself, those people whose highest need for power and no inclination towards adventurism or tyranny, and whose main need is to exercise their influence, must be prepared in advance to occupy leadership positions. Personal influence can be the basis of leadership only in very small groups. If a person wants to become the leader of a large team, he must use much more subtle and socialized forms to manifest his influence. The positive qualities of a leader are manifested in his interest in achieving the goals of the organization, in taking the initiative to provide members of the led team with ways and means of solving assigned tasks, in developing in subordinates self-confidence and competence, which will allow them to work effectively.

The need for success in Maslow's hierarchy of needs is also located between the needs for esteem and self-actualization and is satisfied by the process of bringing work to successful completion.

To motivate people with the need for success it is necessary:

Give them tasks with little risk of failure;

Delegate them sufficient authority to unleash their initiative;

Regularly and specifically reward them in accordance with the results achieved.

People with a need for belonging are interested in social relationships, the company of acquaintances, building friendships, and helping others. To motivate them you can:

Be attracted to work that provides opportunities for social communication;

Create a work atmosphere that does not limit interpersonal relationships and contacts.

F. Herzberg's theory of motivation is of practical interest. As a result of the research, it was revealed that motivational factors for increasing labor productivity and factors that make work more attractive are different in nature and do not always coincide with each other.

The first (they are called motivations) include:

Good chances of promotion;

Recognition and approval of work well done;

Payment related to performance;

Opportunities for creative and business growth;

High degree of responsibility.

The second (they are called hygiene factors) include:

Working conditions (convenient work schedule, sanitary and hygienic conditions, comfort and location of the workplace, work without great strain and stress);

Amount of earnings and availability of additional material benefits;

Interpersonal relationships with superiors, colleagues and subordinates.

Thus, motivations are associated with the nature and essence of the work activity itself, and hygiene factors are associated with working conditions and the work environment.

Considering that job satisfaction and work motivation are influenced by different factors (or the same ones, but to varying degrees), their analysis taking into account local conditions is of utmost importance in the work motivation of medical workers.

The absence or insufficiency of hygiene factors causes job dissatisfaction. However, they do not in themselves motivate a person to work. You can increase wages, introduce additional benefits, improve working conditions, thereby increasing the degree of job satisfaction, and not receive the corresponding labor return. However, we must not forget that job satisfaction itself, to one degree or another, is a motivating factor for effective work activity.

The connection between job satisfaction and job performance is not always present. For example, some employees are highly satisfied with their jobs because they have ample opportunities for social interaction with colleagues. At the same time, they may not be interested in improving the quality and productivity of labor.

The manager’s task is to identify and satisfy, first of all, those needs of subordinates that contribute to the achievement of the organization’s goals.

Despite the fact that the substantive theories of A. Maslow, D. McClelland and F. Herzberg do not take into account numerous behavioral aspects and features of a person’s perception of the environment, their importance for understanding the motivational mechanism is still great. The main provisions of substantive theories are presented in Table. 1.

Table 1

The main provisions of the substantive theories of A. Maslow, D. McClelland and F. Herzberg

A. Maslow's theory

1. Needs are divided into primary and secondary and represent a five-level hierarchical structure in which they are arranged according to priority.

2. Human behavior is determined by the lowest unsatisfied need in the hierarchical structure.

3. Once the need is satisfied, its motivating influence ceases.

D. McClelland's theory

1. The three needs that motivate a person are the need for power, success and belonging (social need).

2. Today, these above-mentioned higher-order needs are especially important, since the needs of lower levels, as a rule, have already been satisfied.

Theory of F. Herzberg

1. Needs are divided into hygiene factors and motivations.

2. The presence of hygiene factors only prevents job dissatisfaction from developing.

3. Motivations that roughly correspond to the needs of higher levels according to Maslow and McClelland actively influence human behavior

4. In order to effectively motivate subordinates, the manager must himself understand the essence of the work

Source: Meskon M., Albert M., Khedouri F. Fundamentals of Management: Trans. from English - M.: Delo, 1997. - P. 375.

Process theories of motivation

Process theories consider not only the existing needs of a person, but also the process of choosing possible behavior based on the characteristics of his perception of the environment, expectations and assessment of the possible results of the chosen behavior. There are three main process theories of motivation:

Expectancy theory;

Theory of justice;

Porter-Lawler model.

According to expectancy theory, a person expects that the type of behavior he chooses will lead to the satisfaction of his needs. If, in the subjective opinion of the individual, the probability of achieving the desired result is small, the motivation to act decreases.

Expectancy theory considers the following relationships:

● labor costs - labor results;

● labor results - remuneration;

● reward - satisfaction with reward, its subjective value for the individual.

People hope that their efforts will lead to the planned result, the achieved result will lead to a reward, and that the reward will be valuable and desirable for them. Otherwise, employee motivation begins to wane.

Work motivation is often associated with money or other material benefits. In modern theories of motivation, the concept of reward is interpreted more broadly. It refers to everything that a person can get as a result of a certain behavior and considers valuable to himself. Since each person's value system is unique, the assessment of the value of a reward will depend on many external (situational) and internal (dispositional) factors. What is valuable to one person may not be of much value to another. What is meaningful in one situation may be less valuable in another. Therefore, employee motivation must be differentiated. There are 2 types of reward:

1. Internal reward (a feeling of achieving results, meaningfulness and significance of the work performed, self-esteem). Internal rewards come from the work itself.

2. External reward (salary, promotion, symbols of official status, prestige, social recognition). External rewards are provided by the organization in which the person works.

The optimal ratio of internal and external rewards is determined by the needs of people. Despite the low salaries of medical workers, their work motivation should not be reduced only to material rewards.

According to expectancy theory, work motivation will weaken if people feel that:

● there is no direct connection between the efforts expended and the results achieved;

● there is no connection between the achieved results and the desired reward;

● the results achieved will be rewarded, but with a reasonable amount of effort these results will not be achieved;

● the subjective value of the proposed remuneration is not too great and does not satisfy the actual needs of the employee.

To increase productivity, managers must set high but realistic expectations of their subordinates' performance and convey to them that they can achieve them if they put in the effort.

Management practices confirm the strong influence that one person's expectations have on the behavior of another. Employees' assessment of their capabilities largely depends on what management expects from them. If management's requirements are high enough, but justified and understandable to subordinates, productivity and quality of work tend to increase.

The theory of equity is based on the proposition that people evaluate (extremely subjectively!) the ratio of the reward they receive to their own effort expended, and compare it with the reward of other workers for similar work. If it turns out that his colleague received more, then a psychological (and often physiological!) feeling of discomfort and violated justice arises. To restore the balance, it is necessary either to increase the level of remuneration received, which is not always possible, or to reduce the efforts made, which is easier. People who believe they are underpaid tend to work less intensively. However, if they believe they are overpaid, their work behavior generally does not change.

It should be emphasized once again that assessments of labor contribution and remuneration are extremely subjective. Typically, comparisons are made with employees of one's own organization or with employees of other organizations performing similar work. Medical professionals must clearly understand why another person is paid more for similar work, and accept these reasons as fair, otherwise internal discomfort will persist.

The theory of justice is of extremely important practical importance in motivating employees of healthcare institutions. To reduce socio-psychological tension in work collectives, not only reasonable explanations regarding material support are required, but also a fair (in the opinion of the workers themselves) distribution of material benefits in the compared social groups. It is not for nothing that the level and procedure for remuneration of medical workers throughout the country are approximately the same and are comparable with the salaries of other public sector employees on the basis of a single tariff schedule. A medical worker is much more influenced by the size of wages in a neighboring health care facility than by the income of other social groups.

The Porter-Lawler model includes elements of expectancy theory and equity theory. In accordance with it, labor results depend on three variables:

Effort expended;

Human abilities;

His assessment of his role in the labor process.

The amount of effort expended depends on the employee's assessment of the value of the reward and confidence that it will be received. According to the Porter-Lawler model, productive work and a sense of accomplishment lead to a sense of satisfaction. Previously, it was believed that job satisfaction determined high performance. However, practice has shown that high performance is the cause of satisfaction, and not its consequence. Satisfied employees do not always work better.

During work, money is the most common remuneration. Although the analysis of remuneration schemes for medical workers is not included in the scope of this publication, it should be noted that when developing them, the use of not only economic approaches, but also socio-psychological methods. Many people attribute material rewards to hygiene factors. A simple salary increase may not have a motivating effect. However, money allows you to satisfy not only physiological, but also social needs of a person (the desire for security, confidence in the future, the need for respect, self-esteem, recognition). Material rewards should only follow effective work. Wages that are not related to the results of work lose their motivating value. However, the implementation of the principle of payment based on final results in healthcare is hardly possible due to the difficult to formalize criteria for assessing the performance of medical workers and health care facilities.

The reward received influences a person's future work behavior. People tend to repeat the behavior that they associate with satisfying their needs and avoid behavior that in their minds is associated with their lack of satisfaction. In psychology, this process, based on the mechanism of reward and punishment, is called social learning. If certain actions receive positive reinforcement, they are repeated and reinforced. Conversely, people stop doing things that do not provide any value to them (there is no positive reinforcement) or have negative consequences.

With work motivation, normative social influence is extremely important, aimed at the acceptance of prevailing norms, beliefs, ideas and rules of behavior in society or a separate social group. Rejection of generally accepted norms by an individual, including rules of labor behavior, as a rule, leads to his social disapproval and coldness from others. And social approval refers to basic human needs. Therefore, the formation of positive values and work culture in the team is the most important task of managers of healthcare institutions. In addition, people feel the need to compare their own assessments with others and receive confirmation from others that they are correct.

Medical workers’ assessment of their financial situation and working conditions

The results of sociological studies of the financial situation and working conditions of medical workers, the degree of their satisfaction with their work and profession are extremely important for the study of their work motivation. Unfortunately, the industry does not have a system of medical and sociological monitoring, which does not allow obtaining sociological data over time in different regions and promptly presenting the obtained data to the heads of health authorities and institutions.

According to a survey conducted by the author of 1919 medical workers in the Moscow region in 2002, only 0.9% of respondents were completely satisfied with their financial situation, 22.8% were partially satisfied, and the vast majority (73.1%) were not satisfied. Medical workers have no doubts about this - the number of those who found it difficult to answer was only 3.2%. The majority (84.1%) believe that their salary is too low and does not correspond to their labor contribution.

There is an extremely low level of respondents’ assessment of the material security of their families. Only 2 people (0.1%) rated it as high and 15 (0.8%) as above average. The rest rated it as average (27.6%), below average (42.7%) and low (25.8%). Only 3.0% found it difficult to answer or did not answer this question.

27.8% of respondents were completely satisfied with their work, 59.9% were partially satisfied, 6.1% were dissatisfied, and 6.2% found it difficult to answer this question.

About half of the respondents (45.1%) are completely satisfied with interpersonal relationships in their team, 47.3% are partially satisfied, and only 2.7% are dissatisfied. The rest (4.9%) found it difficult to answer.

Things are somewhat worse with the assessment of working conditions. Only 14% of medical workers are completely satisfied with them, 58.8% are partially satisfied, 21.8% are dissatisfied and 5.4% found it difficult to answer.

Despite low pay and not always satisfactory working conditions, only 4.6% of respondents would like to move to another job. 40.6% are ready to do this if there is a good offer. However, the majority (41.4%) do not want to change their place of work under any circumstances. The share of those who found it difficult to answer this question was 13.4%.

The increase in wages for primary outpatient clinic workers has not yet received a proper sociological and socio-psychological assessment. Based on numerous statements by representatives of the medical community and publications in the media, it can be assumed that the increase in wages for certain groups of healthcare workers has led to a certain social tension in a number of work teams of health care facilities, which cannot have a beneficial effect on work motivation, the quality and culture of providing medical care to the population.

The desire of industry management to staff the primary level by significantly increasing wages is understandable and understandable, but the desire of an employee to take a position with a higher salary and the desire to work in it productively and efficiently are far from the same thing. As noted above, an increase in material remuneration does not always lead to an increase in work motivation and the desire to work better. In addition, according to the theory of justice, overworked specialists, especially those working in central district hospitals, who perform a large volume of work, often have considerable work experience and a fairly high level of professional training and who have not received what they believe are due remuneration, may experience a decrease in work motivation. . To develop an effective system of motivation for medical workers, sociological and socio-psychological research is required, including the study of the phenomenon of cognitive dissonance in the process of work.

Socio-psychological foundations of work motivation of medical workers

New approaches in the field of social and cognitive psychology make it possible to more effectively solve the problems of increasing the work motivation of medical workers, therefore healthcare managers must know the basic principles and methods of socio-psychological influence on their subordinates, which, along with improving the material reward system, are becoming increasingly important.

It is now generally accepted that a person’s behavior, thoughts, emotions and intentions (intentions) do not depend on objective reality, but on its subjective interpretation based on the individual’s attitudes. Therefore, it is necessary to understand how people perceive the world around them and how this affects their motivation. Labor behavior is determined by the forecast of the future, and the forecast of the future is determined by the interpretation of the information available to the employee on the basis of existing attitudes. Considering that the latter are purely individual for each person and are formed on the basis of previous life experiences, values and beliefs, the difficulties of the practical application of the theory of justice and the Porter-Lawler model, which contains elements of subjective forecasting, are understandable.

According to A. Maslow's theory, the basis of motivation is human needs - from lower physiological to higher needs for respect, self-esteem, recognition and self-actualization. Employees expect their needs to be met through certain work behaviors. Moreover, motivation will be stronger if the needs are subjectively perceived as extremely valuable and relevant.

Traditional methods of influencing subordinates are coercion and reward. A special place is occupied by material incentives, which are not only economic, but also socio-psychological in nature. However, nowadays it is increasingly difficult to effectively use coercion and even material rewards in labor relations. Under these conditions, the importance of socio-psychological methods of motivation increases. The ultimate goal of their use is to change existing or form new human attitudes and change the labor behavior of workers.

As is known, people’s work behavior is determined by the complex interaction of internal (dispositional) and external (situational) factors. Moreover, the effect of the latter is often underestimated. The reasons for a person’s behavior are usually sought in his personal traits, neglecting the influence of the social situation. However, it is the situation and its subjective interpretation that are often the most important factors determining a person’s behavior and emotional state. Therefore, the formation of an optimal working environment and an appropriate moral and psychological climate is the most important task for managers of healthcare institutions.

Elements of a person’s attitudinal system (behavior, cognitions, emotions and intentions) constantly influence each other. For example, new knowledge can lead to a change in a person's behavior or emotional state. At the same time, installations are, as a rule, a fairly harmonious and orderly system. Their inconsistency with each other can lead to cognitive dissonance, which manifests itself in psychological discomfort and is the most important motivating factor in an individual’s thinking and behavior. Thus, work motivation can be changed as a result of cognitive dissonance as a result of a discrepancy between individual attitudes or their components, which causes emotional distress, and sometimes even vegetative-vascular and other physiological disorders. Such manifestations motivate the individual to eliminate cognitive dissonance by changing behavior and (or) other components of the attitudinal system. Remember the previously discussed theory of justice, when not only a person’s emotional state changes, but also his work behavior, and you will understand the importance of socio-psychological analysis in the process of work motivation.

If a person cannot find an external reasoned justification for his actions, to eliminate cognitive dissonance he will try to find the internal reason for his behavior by changing existing attitudes. For example, with low material remuneration, a medical worker may begin to think of himself as an altruist, selflessly helping people, or increase the subjective importance of communication with colleagues, or come up with another reason (and sincerely believe in it!), often without an objective basis, but corresponding existing installations.

Psychology experts say that if you want to change people's work behavior, the more you force or reward them, the more likely you are to get the desired result. However, if your ultimate goal is to change people's attitudes towards work, then the fewer incentives you need to motivate the employee, the better. The weaker the external motivating factors, the more the personal attitude will change towards compliance with the behavior to which the person agreed under the influence of these factors. The person begins to think that he made the decision himself. Therefore, the incentive must be strong enough to influence behavior, but weak enough so that employees feel that they are free to choose their behavior.

Thus, to effectively motivate employees, it is necessary to determine their attitudes and needs in order of importance and ensure the possibility of satisfying them in the process of work. It should be taken into account that the true motives of human behavior are quite complex and are not always accessible to understanding, incl. and for the individual himself.

A need is expressed in a physiological or psychological feeling of lack of something. And although there is still no universally accepted classification of needs, most scientists agree that needs, in principle, can be divided into primary (innate physiological needs for air, food, water, sleep, sex) and secondary (needs for success, respect, affection, power, belonging, etc.). Primary needs are genetically determined, while secondary needs arise and change throughout a person’s life depending on the environment. As a result, people's secondary needs are more individualized than their primary needs.

Self-actualization is understood as a person’s need to develop his personality, self-expression, and realize his potential.

Cognitive dissonance arises as a result of a discrepancy between individual attitudes or their components and manifests itself in psychological discomfort. Elimination of the phenomena of cognitive dissonance is an important motivating factor in human behavior and mental activity.

An attitude is a stable predisposition to a certain assessment, pattern of thinking and behavior, based on cognitions, emotions, intentions (intentions) and previous behavior, which can, in turn, influence cognitive processes, emotions, the formation of intentions and future behavior.

Cognitions are knowledge formed as a result of cognitive processes. They include beliefs, ideas, knowledge about an object and how to behave in relation to it.

Intentions are intentions that precede the actions themselves. Behavioral intentions can be realized in actions or remain in the form of intentions.

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Introduction

Motivation is one of the main functions of any manager, and it is with its help that the company’s personnel are influenced.

The function of motivation is that it influences the workforce of an enterprise in the form of incentives for effective work, social influence, collective and individual incentive measures. These forms of influence activate the work of management subjects and increase the efficiency of the entire management system of an enterprise or organization.

The essence of motivation is that the company’s personnel perform work in accordance with the rights and responsibilities delegated to them, in accordance with the management decisions made.

When planning and organizing work, the manager determines what exactly the organization he leads must accomplish, who, how and when, in his opinion, should do it. If the choice of these decisions is made effectively, then the manager has the opportunity to coordinate the efforts of many people and jointly realize the potential capabilities of a group of workers.

The main task from the point of view of the motivational process of workers is to make them not so much owners of the means of production, but rather owners of their own labor force.

Leaders translate their decisions into action by putting into practice the basic principles of motivation. People working in modern organizations are usually much more educated and wealthy than in the past, so the motives for their work are more complex and difficult to influence. The effectiveness of motivation, like other problems in management activities, is always associated with a specific situation.

The topic of the course work is “Motivation of work activity among medical workers.”

primary goal- conduct a theoretical analysis of the main approaches to motivating work activity and carry out an empirical study of the socio-psychological attitudes of medical workers in the motivational and need-based sphere.

Tasks:

1. Consider the concept of motivation

2. Show the essence of work motivation

3. Analyze the motivation of the activities of medical workers of the Vyshnevolotsk Central District Hospital.

4. Identify the social and need-based attitudes of medical workers in the motivational and need-based sphere.

5. Summarize the results of the study.

Object of study- a group of medical workers aged 20 to 50 years, numbering 20 people.

Subject of study- social and psychological attitudes of medical workers in the motivational and need sphere.

Hypothesis- the leading social and psychological attitudes of medical workers in the motivational and need sphere are altruism and freedom. Method of O. F. Potemkina.

Based on the objectives, the structure of the course work consists of an introduction, 2 chapters, a conclusion, and appendices. In Chapter 1, “The Concept of Motivation,” I consider the modern concept of motivation, the motive of work. In Chapter 2, “Motivation for Work,” I show the essence of motivation for work and analyze the motivation of the activities of medical workers of the Vyshnevolotsk Central District Hospital.

Chapter 1. Motivation concept

1.1 The concept of work motivation

motivation medical worker

Let us return once again to the definitions of motivation already discussed in the introduction.

In classical foreign and domestic literature on management, motivation has different definitions:

Motivation is the process of motivating oneself and others to act to achieve personal or organizational goals.

Motivation is the process of a person’s conscious choice of one type of behavior or another, determined by the complex influence of external (incentives) and internal (motives) factors. In the process of production activities, motivation allows employees to satisfy their basic needs by performing their work duties.

Labor motivation is the employee’s desire to satisfy needs (obtain certain benefits) through work.

Let's consider the basic concepts that explain the essence of motivation and stimulation of work.

1.2 Labor motive

A motive is a conscious impulse to achieve a specific goal, understood by an individual as a personal necessity.

The motive for work is formed only in the case when labor activity is, if not the only, then the main condition for obtaining benefits. Assessing the likelihood of achieving goals is of great importance for the formation of work motives. If obtaining a benefit does not require much effort or is very difficult to obtain, then the motive for work most often does not form.

The formation of a labor motive occurs if the subject of management has at his disposal the necessary set of goods that corresponds to the socially determined needs of a person. To obtain benefits, the personal labor efforts of the employee are required. Labor activity allows the employee to obtain these benefits with lower material and moral costs than any other type of activity.

The group of leading motives that determine employee behavior is called the motivational core (complex), which has its own structure, which varies depending on the specific work situation.

The strength of the motive is determined by the degree of relevance of a particular need for the employee. The more urgent the need for a particular benefit, the stronger the desire to obtain it, the more active the worker will be.

The motives for work are varied. They differ in the needs that a person seeks to satisfy through work, in the benefits that a person will need to satisfy his needs, and in the price that a worker is willing to pay to obtain the benefits he seeks. What they have in common is that the satisfaction of needs is always associated with work.

The benefit becomes a stimulus for labor if it forms the motive for labor. The practical essence of the concepts “motive of labor” and “stimulus of labor” is identical. In the first case, we are talking about an employee striving to obtain a benefit through work (motive). In the second - about the subject of management, which has a set of benefits necessary for the employee, and provides them to him under the condition of effective work activity (incentive).

1. 3 Modern theories of motivation

Traditionally, in the works of researchers of employee motivation, various motivational theories are divided into two categories: substantive and procedural.

More recent process theories of motivation are based primarily on how people behave based on their perceptions and cognitions. The most well-known process theories of motivation are: expectancy theory, equity theory and Porter and Lawler's model of motivation, others.

Abraham Maslow's theory of motivation. When Maslow created his theory of motivation in the 1940s, he recognized that people have many different needs, but also believed that these needs could be divided into five main categories.

1. Physiological needs are essential for survival. They contain the primary needs listed earlier.

2. Needs for security and confidence in the future include the need for protection from physical and psychological dangers from the outside world and confidence that physiological needs will be satisfied in the future. A manifestation of the need for certainty in the future is the purchase of an insurance policy or the search for a secure job with good prospects for retirement.

3. Social needs, sometimes called affiliation needs, are a concept that includes a feeling of belonging to something or someone, a feeling of being accepted by others, a feeling of social interaction, affection or support.

4. Esteem needs include the needs for self-esteem, personal achievement, competence, respect from others, and recognition.

5. The need for self-expression is the need to realize one’s potential and grow as an individual.

According to the theory under consideration, all these needs can be arranged in the form of a strict hierarchical structure (pyramid), at the base of which there are primary, physiological, safety and security needs, and closer to the top - secondary needs, and at the very top of this pyramid - the needs for self-expression and respect. With this hierarchical structure, Maslow wanted to show that the needs of lower levels require satisfaction and, therefore, influence human behavior before the needs of higher levels begin to affect motivation. At any given moment in time, a person will strive to satisfy the need that is more important or stronger for him. In his opinion, in order for a higher level need to become a determinant of human behavior, a lower level need must be satisfied. As for the highest need for self-expression, Maslow believes that since as a person develops as an individual, his potential capabilities expand, the need for self-expression can never be fully satisfied. Therefore, the process of motivating human behavior through needs is endless. That is, a person experiencing hunger will first strive to find food and only then satisfy other needs. Living in comfort and security, a person will first be motivated to activity by the need for social contacts, and then will begin to actively strive for respect from others. Only after a person feels inner satisfaction and respect from others will his most important needs begin to grow in accordance with his potential.

Subsequently, a number of provisions of Abraham Maslow's theory were criticized by motivation researchers. In particular, it was established, firstly, that in general there is no clear five-stage structure of needs according to Maslow; in order for the next, higher level of the hierarchy to begin to influence human behavior, it is not necessary to satisfy the need of the lower level completely, for an individual or group of people, higher-level needs at a certain point in time may be more significant than primary needs; secondly, the concept of the most important needs has not received clear confirmation; thirdly, the satisfaction of certain needs does not automatically lead to the involvement of higher-level needs; fourthly, the concept does not take into account individual differences of people, for example, one person may be more interested in self-expression, while the behavior of another will be primarily determined by the need for recognition, social needs and the need for security.

Thus, managers must know what an employee prefers in the reward system and what makes some of his subordinates refuse to work with others. If a manager wants to effectively motivate his subordinates, he must be sensitive to their individual needs.

Despite the above criticisms of this theory, it has made an extremely important contribution to the understanding of what underlies people's desire to work. Managers of various ranks began to understand that people's motivation is determined by a wide range of their needs. To motivate a person, a leader must enable him to satisfy his most important needs through activities that contribute to the achievement of the organization's goals. Therefore, in the table we have presented a list of some actions with which managers can satisfy the needs of subordinates at higher levels during the work process. (Appendix Table 1)

McClelland's theory of needs. McClelland believed that people have three needs: power, success and belonging. The need for power is expressed in the desire to influence other people. Within Maslow's hierarchical structure, the need for power falls somewhere between the needs for esteem and self-expression. People with a need for power are more likely to be outspoken and energetic people, not afraid of confrontation and eager to defend their original positions. Management very often attracts people with a need for power, as it provides many opportunities to manifest and realize it.

The need for success also lies somewhere in between the need for esteem and the need for self-expression. This need is satisfied not by proclaiming the success of this person, which only confirms his status, but by the process of bringing the work to a successful conclusion. People with a high need for success take moderate risks, like situations in which they can take personal responsibility for finding a solution to a problem, and want specific rewards for the results they achieve. Thus, to motivate people with a need for success, you must assign them tasks with a moderate degree of risk or possibility of failure, delegate them sufficient authority to unleash initiative in solving the tasks, and regularly and specifically reward them in accordance with the set results.

Motivation based on the need for affiliation according to McClelland is similar to motivation according to Maslow. Such people are interested in the company of acquaintances, establishing friendships, and helping others. People with a strong need for affiliation will be attracted to jobs that provide them with extensive social interaction.

Herzberg's two-factor theory. In the second half of the 50s of the XX century. Frederick Herzberg and his colleagues developed another needs-based motivation model. As a result of a study of employees of a large paint and varnish company, he divided the entire set of factors influencing staff satisfaction with work and motivation to work into two groups: “hygiene factors” and “motivation”.

Hygiene factors are related to the environment in which work is carried out, and motivation is related to the very nature and essence of the work.

According to Herzberg, in the absence or insufficient degree of presence of hygiene factors, a person develops job dissatisfaction. However, if they are sufficient, then in themselves they do not cause job satisfaction and cannot motivate a person to do anything.

In contrast, the absence or inadequacy of motivation does not lead to job dissatisfaction. But their presence fully causes satisfaction and motivates workers to improve their work efficiency. According to Herzberg, the factors that cause job satisfaction are not opposites on the same dimension. Each of them is, as it were, on its own measurement scale, where one operates in the range from minus to zero, and the second from zero to plus. If contextual factors create a bad situation, then employees experience dissatisfaction, but even at best these factors do not lead to great job satisfaction, but rather a neutral attitude. Job satisfaction is caused only by motivational factors, the positive development of which can increase motivation and satisfaction from a neutral state to a “plus”. Herzberg's theory of motivation has much in common with Maslow's theory. Herzberg's hygiene factors correspond to physiological needs, needs for safety and confidence in the future. His motivations are comparable to the needs of Maslow's higher levels. Herzberg believes that the employee will pay attention to hygiene factors if their implementation is inadequate. According to Maslow, if an employee satisfies primary needs, he begins to work better. But in order to achieve motivation, the employee must ensure the presence of not only hygiene, but also motivating factors. Many organizations have attempted to implement these theoretical insights through job enrichment programs. During the implementation of the labor “enrichment” program, work is restructured and expanded so as to bring more satisfaction and rewards to its immediate performer. “Enrichment” of work is aimed at structuring work activity in such a way as to make the performer feel the complexity and significance of the task entrusted to him, independence in choosing decisions, the absence of monotony and routine operations, responsibility for the given task, the feeling that the person is performing separate and completely independent work .

Subsequently, motivation researchers refuted some of the provisions of Herzberg’s theory. In particular, research methods were criticized: as a rule, people instinctively associate favorable situations at work with the role of their personality and objects that they control, and unfavorable ones with the role of other people and things that objectively depend on the respondents.

Thus, the insights Herzberg obtained were partly a result of the way he asked questions.

At the same time, Herzberg’s study did not take into account the subjectivity of different people’s perceptions of the same factors, which can cause job satisfaction in one person and dissatisfaction in another and vice versa. In general, critics of his theory subsequently concluded that since different people have different needs, different factors will motivate different people. In addition, Herzberg suggested a strong correlation between job satisfaction and job performance. Research has shown that such a correlation does not always exist; for example, despite a high degree of job satisfaction, productivity may be low if a person, through work, satisfies his social and communicative needs to the detriment of work responsibilities. Thus, although Herzberg made important contributions to the understanding of motivation, his theory does not take into account many of the variables that determine the situations associated with it.

Victor Vroom's expectancy theory. The presence of an active need is not the only active condition for motivating a person to have a specific goal. A person must hope that the type of behavior he chooses will actually lead to satisfaction or getting what he wants.

Expectations can be considered as a given person's assessment of a certain event. We are based on the relationships: labor costs, results - remuneration, valence (satisfaction with remuneration). Expectations for effort are the relationship between the effort expended and the result obtained. If people feel that there is no direct relationship between the effort expended and the results achieved, then, according to this theory, motivation will weaken. Lack of relationship may occur due to the employee's incorrect self-esteem, due to his poor training and improper training, due to the fact that the employee does not have enough authority to perform a certain job.

Performance-reward expectations are the expectation of a specific reward or reward in response to the level of performance achieved. If there is no perceived relationship between the achieved result and the expected reward, motivation will weaken. If a person is confident that the results achieved will be rewarded, but with a reasonable amount of effort he cannot achieve them, motivation will be weak. Because individuals have different needs and desires for rewards, the specific reward offered in return for performance may not be of any value to them. If the value of any of the above factors is small, motivation will be weak and labor results will be low. Valence is the perceived degree of relative satisfaction or dissatisfaction resulting from receiving a particular reward. In order for a person to be motivated for a certain activity, his achievements in this activity must be rewarded with something that he values, and the reward must be associated with achieving the goal so that the person notices it.

Theory of justice. Equity theory posits that people subjectively determine the ratio of reward received to effort received and then relate it to the rewards of other people doing similar work. If comparisons show imbalance and injustice, that is, a colleague received more compensation for similar work, then psychological stress arises. As a result, it is necessary to motivate this employee, relieve tension to restore justice, and correct the imbalance. People can restore the imbalance or sense of fairness by either changing the level of effort expended or by attempting to change the level of reward received.

The main conclusion of equity theory is that until people begin to believe that they are receiving fair compensation, they will tend to reduce the intensity of work. At the same time, the perception and assessment of justice are relative. Some organizations are trying to solve the problem of employees feeling that their work is being assessed unfairly by keeping payment amounts secret. However, this is not only difficult to do technically and organizationally, but also makes people suspect management of injustice even where there is none.

Porter and Lawler model. The results achieved depend on the efforts made by employees, their abilities and characteristics, and their awareness of their role. The level of effort exerted will be determined by the value of the reward and the degree of confidence that a given level of effort will actually entail a very specific level of reward. The Porter-Lawler theory establishes a relationship between reward and results.

One of the most important conclusions of Porter and Lawler is that productive work leads to satisfaction. According to human relations theory, satisfaction leads to better performance at work, or, in other words, more satisfied workers perform better. Porter and Lawler believe that a sense of accomplishment leads to satisfaction, and it is not satisfaction that leads to high job performance and increased productivity. Research conducted by economists, psychologists and sociologists has confirmed the conclusions of Porter and Lawler that high performance is a cause of overall satisfaction, and not a consequence of it. Ultimately, Porter and Lawler's model made a major contribution to the understanding of motivation. She showed, in particular, that motivation is not a simple element in the chain of cause-and-effect relationships of the management process. This model also shows how important it is to integrate concepts such as effort, ability, results, rewards, satisfaction and perception within a single interconnected system. The most important theories in the science of human resource management are presented in the table in the Appendix.

Later, in the late 70s and early 80s of the last century, much attention was paid to the analysis of the system of human relations based on the experience of the American company IBM and Japanese quality circles.

As an example of modern European research on this issue, one can cite a study of work motivation in Finland, carried out by Tapani Alkula. Since the organization is the place where most people spend their lives, the most important external factor influencing their motivation is the environment in which people would like to work, their expectations about work. The following aspects of this problem have been identified:

Work time. It has been established that there is a direct correlation between working hours and the place of work in life;

Family status. The more important family is, the less attention is paid to work;

Sexual aspect. Interest in work is influenced by traditional male and female roles as an indicator of male and female identity. Socio-gender differences influence the role and place of women in organizations and social and labor relations. These differences exist, and it is necessary to take this factor into account when developing and implementing management strategies. According to the results of studies conducted in Sweden and Finland, the importance of work in these countries in people's lives tends to decrease, in Sweden there is an increase in the role of leisure, and in Finland - family.

Chapter 2.Work motivation

2 .1 The essence of work motivation

The essence of motivation is to, focusing on the system of needs of employees, to ensure the full and effective use of their labor potential to quickly achieve the goals of the organization.

The function of motivation is that it influences the organization’s workforce in the form of incentives for effective work, social influence, collective and individual incentive measures. These forms of influence activate the work of management subjects and increase the efficiency of the entire management system of the organization.

It is impossible to change people's attitudes towards work by law, since this is a long evolutionary process, but it can be accelerated if you soberly assess a specific situation and take into account the reasons that gave rise to it.

Managers are always aware that it is necessary to encourage people to work for the organization, but at the same time they believe that simple material rewards are enough for this. In some cases, such a policy is successful, although in essence it is not correct.

People working in modern organizations are usually much more educated and wealthy than in the past, so the motives for their work are more complex and difficult to influence. There is no single recipe for developing a mechanism for effectively motivating workers to work. The effectiveness of motivation, like other problems in management activities, is always associated with a specific situation.

Motivation can be defined in different ways.

On the one hand, motivation is the process of motivating oneself and other people to action, suggesting the possibility of satisfying personal needs while achieving organizational goals.

On the other hand, motivation is the process of a person’s conscious choice of one type of behavior or another, determined by the complex influence of external (incentives) and internal (motives) factors. In the process of production activities, motivation allows employees to satisfy their basic needs by performing work duties.

Since our goal is to review the processes and methodology of the influence of the management of the personnel management service on individuals to increase their work interest, the first definition proposed by M.Kh. is simple and accurately reflects the essence of the motivation process. Meskon, M. Albert, F. Khedouri.

That is, we consider the motivation of work activity as a process of employees satisfying their needs and expectations in the course of performing their chosen work, carried out as a result of the implementation of their goals, consistent with the goals and objectives of the organization, and at the same time as a set of measures applied by the subject of management, to improve the efficiency of workers.

The generally accepted point of view is that need is a feeling of psychological or physiological lack of something. Researchers of this problem have established that primary needs are a feeling of the need for food, water, sleep, and intimacy. Secondary needs, of a higher level, imply the need for success, respect, power, affection, and belonging to someone. It has long been proven that primary needs are genetically laid down, while secondary needs are recognized by a person with experience.

Motivation is the feeling of a lack of something and the individual’s awareness of what actions need to be taken to make up for this lack. The degree of satisfaction obtained from achieving a goal influences a person's behavior in similar circumstances in the future. People strive to repeat the behavior that leads to the satisfaction of the need, and to avoid the behavior that is associated with insufficient satisfaction of the need. Because needs drive people to seek their satisfaction, managers must create situations in which people feel that they can satisfy their needs through the type of behavior that leads to the achievement of organizational goals.

A motive is a conscious impulse to achieve a specific goal, understood by an individual as a personal necessity. The work motive is the need (reason) to satisfy which the employee carries out highly productive work activities. The motive for work is formed only in the case when labor activity is, if not the only, then the main condition for obtaining benefits. Assessing the likelihood of achieving goals is of great importance for the formation of work motives. If obtaining a benefit does not require special efforts, or if the benefit is very difficult to obtain, then the motive for work most often does not form. The formation of a labor motive occurs if the subject of management has at his disposal the necessary set of goods that corresponds to the socially determined needs of a person. To obtain benefits, the personal labor efforts of the employee are required. Labor activity allows the employee to obtain these benefits with less material and moral costs than any other type of activity, and brings him greater satisfaction.

The structure of the labor motive includes: the need that the employee wants to satisfy; a good that can satisfy this need; labor action necessary to obtain a benefit; price - costs of a material and moral nature associated with the implementation of a labor action. For the formation of work motivation, the greatest significance is the nature of the labor norms and values acquired by the individual, which give meaning to all further work activity and determine the way of life. A person enters into professional work with an already formed value consciousness. He knows what interests he would like to realize through work.

This is how the second, practical, layer of labor consciousness is formed, conditioned, on the one hand, by the value orientations of the individual, and on the other, by the specific circumstances of professional working life. Practical requirements for work determine specific motivation, which, in contrast to the value consciousness that determines the meaning and long-term goals of work activity, mainly predetermines the choice of ways and means of their implementation.

Labor motivation is the most important factor in work performance, and as such it forms the basis of an employee’s labor potential, that is, the entire set of properties that influence production activities. In general, labor potential consists of psychophysiological potential (a person’s abilities and inclinations, his health, performance, endurance, type of nervous system) and personal (motivational) potential.

Motivational potential plays the role of a trigger that determines what abilities and to what extent an employee will develop and use them in the process of work. It is obvious that, although the connection between motivation and labor results is mediated by natural abilities and acquired work skills, it has already been proven that motivation is the main source of an individual’s effective work activity.

Rewards serve to motivate people to perform effectively. Together with the concept of “motivation,” the term “reward” takes on a broader meaning than just “money or pleasure,” with which this word is most often associated. Reward is everything that an employee considers valuable to himself. But each person’s understanding of value is specific, and therefore, assessments of reward and its relative value differ.

Internal rewards come from the work itself. This may be a feeling of achieving a result, the content and significance of the work performed, and self-esteem. Friendship between members of the work team and simply communicating with colleagues during work are also considered as internal rewards. The simplest way to ensure internal reward is to create appropriate working conditions that generate satisfaction from the work process itself.

External reward is provided not by the work itself, but by the subject of management, who has the opportunity to reward for work. From a motivational point of view, external reward can be defined as stimulation of work.

The group of leading motives that determine employee behavior is called the motivational core (complex), which has its own structure and depends on the specific work situation.

The motives for work are varied. They differ in the needs that a person seeks to satisfy through work, in the benefits that a person requires to satisfy his needs, and in the price that a worker is willing to pay to obtain the benefits he seeks. What they have in common is that the satisfaction of needs is always associated with work.

Several groups of labor motives can be distinguished, which together form a single system. These are motives for the meaningfulness of labor, its social usefulness, status motives associated with public recognition of the fruitfulness of work, motives for obtaining material benefits, as well as motives focused on a certain intensity of work.

It is advisable to include among social motives: collectivism (the need to be in a team), personal self-affirmation, the motive of independence, the motive of reliability (stability), the opposite motive to the previous one for acquiring new things (knowledge, things), the motive of justice, the motive of competition, which is genetically inherent in every person. Let's look at some of the motives of this group in more detail.

1. The need to be in a team. This motive is especially characteristic of the Eastern (Japanese) style of personnel management, where the dominant concepts are: group morality, lack of individual competition, corporate culture and others. For workers of the former USSR, this motive is still a significant factor in choosing a place of work and value orientations. The need to work in a good team, according to many sociologists, is still included in the leading group of employee labor orientations.

2. The motive of self-affirmation is typical for many workers, mainly young and middle-aged; it is the actual motivating factor for highly qualified employees.

3. The motive of independence is inherent in employees with the “owner” motivation, who are ready to sacrifice stability and sometimes higher earnings in return for the attitude of “being the owner and running your own business.”

4. The motive of reliability (stability) is essentially a motive of independence with the opposite sign. If in the first case workers prefer risk and an active search for new types of activity, then in the second case preference is given to stability of life and activity. As sociological studies show, the basis of nostalgia for the past among the majority of respondents is precisely stability, the existence of which was characteristic of the past system.

5. The motive for acquiring new things (knowledge, things) underlies many elements of a market economy. The system for creating the material world in economically developed countries is built on it. It is this that is used by producers of new goods and services, and other motives are sometimes just the outer shell or filling.

6. The motive of justice permeates the entire history of the development of human civilization. For as long as humanity has existed, there has been debate about what is fair and what is unfair in this society for so many years. Each society establishes its own understanding of justice, non-compliance with which leads to demotivation of workers and sometimes to cataclysms.

7. The motive of competition is one of the strongest motives operating at all times. A certain degree of expression of competitiveness is genetically inherent in every person. It is most often used in the USA and Canada and is formulated as follows: “We work in the gym.” When this motive is implemented in the company's personnel management strategy, the "labor standard - remuneration" system is replaced by the "labor standard - competition - remuneration" system, which significantly motivates employees.

At the same time, in the specialized literature on personnel management and work motivation, the concepts of motivation and stimulation are separated. We believe that motivation is aimed at changing the employee’s attitude towards work, and stimulation is aimed at maintaining a given level of labor productivity, that is, the result of motivation will be a change in the work environment or the location of the individual, and the result of stimulation will be consolidating the position of the individual, strengthening his position, ensuring compliance with labor standards or increasing labor productivity and quality of work without significantly changing his working conditions. Stimulation is an orientation towards the actual structure of the employee’s value aspirations and interests, towards a more complete realization of the existing labor potential. And although motivation and stimulation complement each other, they, as already mentioned, are opposite in direction: the first is focused on changing the existing situation; the second is to consolidate it.

Labor stimulation is part of the process of motivating workers, the importance of which for Russian enterprises and organizations is currently very great.

Stimulation performs economic, social and moral functions.

The economic function is that labor stimulation helps to increase production efficiency, which is expressed in increased labor productivity and product quality.

Social function is provided by the formation of the social structure of society through different levels of income, which largely depend on how incentives affect different people.

The moral function is determined by the fact that incentives to work form an active life position and a highly moral climate in society. At the same time, it is important to ensure a correct and justified system of incentives, taking into account traditions and historical experience.

The figure shows some types of incentives to ensure effective work activity (Appendix. Fig. 1).

Researchers of these issues, based on a generalization of practical experience, have identified a number of requirements for the organization of labor incentives.

Complexity implies the unity of moral and material collective and individual incentives, the meaning of which depends on the system of approaches to personnel management, the experience and traditions of organizations.

Differentiation means an individual approach to stimulating different layers and groups of workers.

Flexibility and efficiency are manifested in the constant revision of incentives depending on changes occurring in society and the team.

Incentives should be based on certain principles.

Accessibility implies that every incentive should be available to all workers.

Sensibility, that is, the presence of a threshold for the effectiveness of a stimulus, which varies significantly in different groups.

Graduality implies that material incentives are constantly being adjusted upward, which must be taken into account.

Minimizing the gap between the result of labor and its payment (for example, weekly wages, the introduction of an advance system).

The modern content of the motivation mechanism in its present form was formed gradually; researchers of this problem gradually increased knowledge in this area of influence on individuals to increase the efficiency of their work activities.

2.2 Motivation for work activity among medical workers

The predominantly retrospective methods of payment for medical care existing in Russian healthcare contribute to a decrease in the efficiency of use of labor and material resources. Understanding the process of labor motivation and how citizens make choices in the process of organizing their behavior allows us to develop a more effective system of influence on them by the leader.

In this regard, it is advisable to dwell in more detail on the distinctive features of the motivational attitudes of employees, methods of influencing and regulating the behavior of individuals in accordance with the goals of the Vyshnevolotsk Central District Hospital (hereinafter referred to as the Central District Hospital), which is a municipal enterprise related to the Health Administration of the Tver Region, the Ministry of Health of the Russian Federation. Particular attention should be paid to the relationship between the job satisfaction of CRH staff and their labor productivity, taking into account the criteria for the organization’s performance, as well as to study the role and place of motivation in the personnel management system, the incentive structure, and the role of the medical care payment system in the formation of the motivation system.

The Central District Hospital mainly uses economic methods for managing work motivation:

1) the employee’s salary, determined by budget financing at the level of UTS rates;

2) the practice of rewarding employees for the volume and quality of work performed;

3) allowances, additional payments for length of service (in accordance with current regulations), the use of scientific achievements and advanced labor methods, and servicing especially dangerous categories of patients.

Unfortunately, budget financing at the level of the Unified Tariff Schedule (UTS) does not provide adequate motivation for the work of doctors. ETS rates do not even exceed the subsistence level in Tver. Therefore, in order to attract and retain high-quality specialists, it is necessary to find ways to increase wages at least to the level of the regional average. The delivery of economic incentives to a unit of a medical organization and a specific medical worker in a central district hospital is ensured by saving funds received by the organization as part of payment for medical care on the principle of fund holding (intra-economic mutual settlements).

At this stage of the implementation of intra-farm mutual settlements, due to the complexity of accounting, mutual settlements are carried out only for the wage fund on the basis of internal tariffs, which conditionally include only wage costs.

The main motivational provisions of the system of intra-economic settlements

The system of on-farm mutual settlements includes the following provisions:

A clear definition of the quantitative and qualitative indicators of the final results of the work of the department’s team used for planning, accounting, and promotion;

Effective planning of the work of departments, timely delivery of planned performance indicators;

Strict accounting of the performance of departments;

A direct connection between the amount of funds for remuneration of the team and the final results of its work, a guarantee to the department’s team of payment of the total amount of wages for the volume of work completed with the required quality within a given time frame, regardless of how many employees the specified volume was completed;

Providing the team with independence in choosing specific forms of organizing their work, using the equipment and other resources assigned to them, and distributing collective earnings;

Distribution of collective earnings between workers, taking into account the quantity, quality and final results of each person’s work in accordance with the labor participation rate;

Mutual responsibility of the administration of a medical organization and a structural unit, as well as departments among themselves, for non-fulfillment (low-quality, untimely performance) of work or contractual obligations.

A medical organization, forming a wage fund within the limits of the income included in the production and financial plan, makes deductions:

To a reserve fund to provide assistance in case of seasonal fluctuations in the volume of work and other unforeseen circumstances;

The remaining wage fund is used to pay employees depending on the volume and quality of work they perform. For poor quality work, penalties are applied in the manner and amount approved by the head of the medical organization.

On-farm mutual settlements are based on the principles of end-to-end team contracting. In this case, one or another structural unit of a medical organization (children's ophthalmology department) acts as a team. The team's wage fund is determined not by the staffing table, but by the volume of work performed, taking into account its quality. Domestic tariffs for medical services are a measure of labor costs and material resources, i.e. In case of team contracting, tariffs are used to measure the labor expended and pay out the money actually earned.

It is often believed that with brigade forms of labor organization, the task of accounting for labor contribution becomes irrelevant. However, it is not. Team forms are advisable not because collective pay better stimulates work, but because it is not always possible to accurately assess the work of each individual employee. Only the features of the modern division of labor, when the result, formalized according to quantitative and qualitative parameters, can often be distinguished only by a group of workers (where each of them performs partial operations or work that only collectively leads to the final result, for example, during a surgical operation), create the need to pay for labor for overall result. In addition, the brigade forms themselves do not at all deny individual payment. On the contrary, brigade forms are most effective precisely when there is a brigade form of remuneration for the labor of each team member through the labor participation coefficient (LCU), points, etc. The funds earned by departments in the current month are used to reimburse costs, including remuneration of employees, taking into account the CTU of mutual settlements, payment of penalties, and creation of a reserve.

Study of the work motivation system

The Russian compulsory medical insurance system is dominated by retrospective methods of payment for medical care. Having fulfilled their main task of ensuring payment for the real results of the activities of medical institutions, including the Central District Hospital, these methods today require serious modification, since the prevailing principle of additional payment upon the provision of services does not correspond to the new tasks of Russian healthcare. Any health policy, no matter how reasonable, needs constant monitoring and adjustment.

Let's consider the technology for assessing and selecting new payment methods in the Vyshnevolotsk Central District Hospital, the use of which will facilitate this process, as well as forms of modification of the old method.

The current methods of payment for medical care have undeniable advantages: they are familiar, computer technologies have been created for them, and do not require special efforts on the part of the organization. Changing these methods is associated with serious changes in the activities of both the central district hospitals and insurers.

Methodology for assessing and selecting payment methods for medical care

A formalized decision-making technology is proposed as a methodology for assessing and selecting payment methods for medical care. The use of this technology makes it possible to reduce or eliminate psychological obstacles to changing the payment method and select the best option, taking into account the required organizational measures and financial costs.

The main steps of the decision technology include:

1) analysis of the situation and formation of goals for change;

2) selection of criteria by which change options will be assessed;

3) establishment of rank values of criteria;

4) development of alternative options for changes;

5) comparison of alternative options for changes according to selected criteria;

6) choosing the optimal option for changes;

7) analysis of the consequences of implementation.

The current payment system in the Vyshnevolotsk Central District Hospital provides for the financing of clinics based on cost estimates and payment for inpatient care for the actual number of completed cases of treatment at tariffs in the context of medical and economic standards (MES).

Conducting a SWOT analysis allows us to present in an easy-to-read format both the strengths and weaknesses of the current payment system in the Vyshnevolotsk Central District Hospital, as well as to outline directions for its change under the current restrictions. The results of the SWOT analysis of the current payment system are presented in Table 8 (Appendix Table 2).

The analysis showed that the current payment system does not contribute to solving the main objectives of the payment system - to promote the restructuring of medical care and ensure predictability of costs.

Eliminating the weaknesses of the current system involves solving the following problems:

ensure the interest of clinics and hospitals in resource conservation;

create incentives for the development of hospital-replacing technologies;

ensure predictability of hospital care costs;

create incentives for clinics to reduce the level of hospitalization of the attached population;

motivate the organization's employees;

create incentives for medical prevention.

The problem of optimizing the economic mechanisms of personnel management in the Central District Hospital will be solved by improving the payment system for medical care. Currently, only the top management of the organization takes part in determining the size of quotas for all categories of personnel working in the organization. The provisions on material incentives do not clearly describe the criteria and set of performance indicators for the categories of personnel for which incentives are provided. Often the criteria and system of indicators do not have a clear logical basis and are not brought to the attention of working personnel. There is no feedback on the results of the distribution of the material incentive fund (IFF).

1.1. The essence of social and labor relations in medical institutions

In the last decade, throughout the world and in Russia in particular, interest in problems of organization and management in healthcare has grown significantly. One of the reasons for this attention of researchers and practitioners in the field of public health is the natural integration processes occurring in healthcare systems, a certain consolidation of structures that, to one degree or another, ensure the preservation and improvement of public health: hospitals, clinics, insurance and pharmaceutical companies, government bodies, social protection institutions, etc. The observed processes are characteristic both at the level of national healthcare systems and in the international sphere.

In the context of the priority of the economic components of the development of states, the unique nature of healthcare, as part of the social structure of society, is also manifested in the fact that institutions and subjects of the healthcare system, being the largest employers, ensure the economic stability of the population, and, as medical structures, bear no less important share of responsibility for labor productivity, the health of the nation, and the defense capability of the state.

Modern healthcare systems, functioning and developing in a liberal society, in the conditions of the existence of civilized markets and specific marketing relations, inevitably feel the influence of the processes that characterize such relations. However, these processes of mutual influence are, of course, two-way: healthcare systems around the world are increasingly influenced by market fluctuations and the integration of marketing and political structures.

Today, not a single country in the world, including Russia, can manage the healthcare system without taking into account the impact that the organization and activities of this government system can have on both domestic and global markets, both domestic and international markets. on the global health status of the population.

It should be recognized that in Russia, the rapid political and economic changes of the past fifteen years have had an extremely strong impact on the social infrastructure of society, including the healthcare system. In practice, such failure of industry management manifested itself in personnel and structural unwillingness to adapt to naturally occurring socio-economic changes, which immediately affected the general health of the population. In particular, in a country that amazed the whole world in the 70-80s of the twentieth century with the invention of the Ilizarov apparatus, the use of radial kerototomy for myopia, as well as the unimaginable effectiveness of reducing child mortality in the period from the 50s to the end of the 80s, - in the 90s years, infant mortality increased to 18.6 cases per thousand births (higher than in Ghana), overall mortality increased by 50% compared to the 1980 level, and life expectancy for men decreased by 13 years: from 69 to 56 years.

Some of the reasons for the poor state of healthcare in Russia are the following:

Weakness of political will in the country for desirable and effective reform of the public health system;

Lack of modern personnel potential of managers capable of evolutionarily modifying the conservative forms of the outdated system of providing medical care, first forming structures and relationships in healthcare based on economic, market laws, and then ensuring management and regulation of medical services markets.

Imperfection, and sometimes elementary ignorance in practical healthcare of modern forms and methods of management; insignificant use of scientifically based management methods based on artificial intelligence systems in industry management.

The effectiveness of organizational influence and, consequently, the effectiveness of the organization’s work depends on the clarity of the drafting of formal (official) regulations, the correctness of established norms and standards (Fig. 1).

Rice. 1. Characteristics of organizational impact

Formal job regulations are developed in accordance with the provisions of the Labor Code of the Russian Federation and other regulations governing labor relations in the Russian Federation. For heads of government organizations, formal regulations are developed by higher-level organizations. For personnel, formal regulations are usually developed within the organization.

Formal job descriptions (regulations) contain characteristics of the composition and content of the work of an individual employee, his rights and responsibilities. Each employee of the organization in his work must be guided by the provisions of the regulations, which allow him to outline the range of his responsibilities.

Regulation in management is manifested in two aspects: statics and dynamics.

Regulation in statics determines:

The status of the control system links or the system itself;

Goals and objectives of each link;

Place in the management system;

Relationships with other links.

Regulation in dynamics determines:

Performing individual functions;

Daily routine of the manager and staff;

The work of departments of the management apparatus;

Regulations of meetings and meetings.

Formal regulations play a big role in both the management and functioning of an organization.

Currently, much attention is paid to the efficiency of medical institutions in performing their work. Efficiency is determined by how well the administrative and support work is organized, which affects the final result.

Communications within the organization also have a great influence on the quality of care provided. In its most general form, an information system is a set of interconnected components that collects, processes, stores and distributes information to support the activities of an organization. The level of information systems is influenced by two factors:

1. level of scientific and technological development in the organization, that is, how modern the technologies used are;

2. people and existing culture in the organization.

The totality of information circulating in health care facilities for the purpose of understanding them can be conditionally grouped into the following areas:

1. Commercial information system (information about the state of the economic system, factors that positively or negatively influence that area of economics);

2. Legal information system (information about current legislation);

3. Special operational information system (information about the methods, forces and means of ensuring the security of information from access by third parties).

4. Professional medical information system (information about treatment, prevention and rehabilitation of patients).

Social and labor relations are part of the diverse social connections between work groups and departments of the organization, as well as between individual workers within them, which directly relates to work activity. Social and labor relations are of paramount importance for solving problems of productive employment and social services. protection of people involved in the production of goods and services needed by society, remuneration and income generation, technologization of labor processes, humanization of work and its conditions, increasing independence, creative initiative and responsibility of workers, development of self-government, functional and social partnership.

1.2. Motivational mechanisms of social and labor relations

The market economy, through the mechanism of competition, harmonizes the motives “for oneself” and “for others.” A planned economy in a command-administrative system leads to a mismatch of these motives, since in it the worker gives to society significantly more than he receives for his work. The reaction to this is a decrease in the quality of labor and a deterioration in the consumer properties of manufactured products.

Incentives are usually understood as any external benefits that satisfy significant human needs and push a person to more productive work.

Stimulating labor involves creating the conditions of an economic mechanism under which active labor activity, which produces certain, pre-fixed results, becomes a necessary and sufficient condition for satisfying the significant and socially determined needs of the employee and for the formation of his motives for work.

Motivation is the process of motivating oneself and others to act to achieve personal or organizational goals.

Urge, or the feeling of lack of something, is the manifestation of a need through the formation of interest, which is considered as a conscious need. Motive as an incentive, a reason for activity, is directly associated with human behavior to achieve a goal. Thus, the reasons that determine a person’s participation in work are not only his desire, capabilities and qualifications, but also motivation (motivation). You can induce activity by enriching with ideas, mobilizing will, knowledge, determining the amount of remuneration and linking it with the results of activity, as well as finding out the system of his values for a person, satisfying the need for power depending on a person’s ability to influence other people. The process of motivation also involves the beliefs and views of the person to whom it is directed.

Most often in management there is simultaneous motivation and stimulation.

Theories of motivation use concepts of need. The most general classification of needs is their division into primary and secondary.

Primary ones are physiological in nature, secondary ones are psychological (for example, the need for success, respect, power, etc.).

All theories of motivation attempt to explain human behavior in an organization using various psychological, sociological and physiological concepts. Each of them has its own strengths and weaknesses - a universal theory of motivation has not yet been created. Managers, regardless of adherence to a particular theory, should remember that motivation is a complex phenomenon that is largely determined by the individual characteristics of the employee. Effective personnel management requires managers to constantly analyze and take into account these features in their activities.

Modern theories of motivation fall into two categories:

Procedural.

In process theories of motivation, individual behavior is determined not only by needs, but by environmental factors.

Process theories include the Porter-Lawler model of motivation, V. Vroom's theory of expectations and the theory of justice.

In 1943, psychologist Abraham Maslow proposed a theory of motivation in which people's behavior was determined by a wide range of needs. According to Maslow, “man is an eternally willing being.” His needs can be arranged in a strict hierarchical structure. Maslow's theory is based on the hierarchy of needs. The hierarchy system he developed is sometimes called “Maslow’s ladder” or “Maslow’s pyramid.”

The lowest layer in the pyramid is occupied by physiological needs - human needs for food, water, air, warmth, etc. They are necessary to maintain the functioning of the body.

The next level is security needs. They are associated with a stable living situation, confidence in the future, protection from illness and fear.

The need for recognition and self-affirmation is characteristic of fewer people. They are characterized by a desire to be capable, competent and confident. This requires a person to educate himself.

The top of the pyramid is occupied by the needs for self-expression. These needs are of the most individual nature and are associated with a person’s desire for the fullest application of his knowledge, skills and abilities in creative work.

In his theory, K. Alderfer identifies 3 groups of needs:

Existence needs;

Communication needs;

Growth needs.

These groups are similar to Maslow's groups, but the theories have one important difference. If Maslow believed that the satisfaction of needs can occur only in one direction - from lower to higher, then Alderfer put forward the idea that needs can be satisfied in both directions: upward, if the need of the lower level is not satisfied, and downward, if the need of the higher level is not satisfied. high level.

D. McClelland put forward the theory of acquired needs. Unlike Maslow, he presented the need without hierarchy as a group: success, power and belonging. The need for power is expressed by a person’s desire to achieve his goals more effectively than before. The need for power manifests itself in the desire to influence people's behavior and take responsibility for it. The need for involvement is achieved by searching for opportunities to establish good relationships with the team, obtaining their approval and support.

F. Herzberg's two-level theory is that factors that cause an increase in dissatisfaction, when eliminated, do not necessarily lead to an increase in satisfaction, and vice versa.

Two groups of factors in Herzberg's theory:

1. motivating factors (needs for growth) - recognition, promotion, opportunity for growth;

2. health factors (needs to eliminate difficulties) - wages, workplace conditions, routine and regime, relationships with employees and management.

Herzberg proved that the absence of the first group of factors will not lead to great dissatisfaction, and their presence will improve the quality of the work performed. The absence of the second group of factors leads to employee dissatisfaction, but the presence is not a fact of his satisfaction.

All the theories considered are fundamentally different from each other, but at the same time they all reflect a certain commonality in human motivation to act.

A person's behavior depends on what needs force him to act. There are 4 theories that reveal the process of motivation.

1. Expectancy theory is based on the saying: “Everything is known by comparison.” Human behavior is always associated with the choice of a more attractive alternative from several options. Two groups of expectations:

Expectations linking effort and rest from work;

Expectations linking job performance and results obtained.

According to expectancy theory, a person behaves in accordance with what he believes will happen in the future if he makes a certain expenditure of effort.

2. The theory of goal setting is based on the fact that people's behavior is determined by the goals that they themselves set for themselves or someone sets for them; In order to achieve these goals, a person carries out certain actions and receives a result, which is the motive. If the result is good, he experiences satisfaction, and if the result is negative, he experiences frustration. The quality of performance depends on two groups of factors:

Organizational factors;

Employee abilities.

These factors also influence goal setting, and therefore motivation itself.

3. The theory of equality is based on a person’s desire to be treated fairly. Moreover, justice is associated with equality. If a person feels discrimination towards himself and evaluation of his results in comparison with others, then he experiences dissatisfaction. For effective personnel management, a manager must be fair in assessing personnel. A prerequisite is that the employee is aware of the existing atmosphere of equality.

4. The concept of participative management is based on the fact that a person always strives to participate in organizational processes. If he is given this opportunity, he begins to work with greater efficiency. The manager must provide staff with the opportunity to make decisions. This will make it possible to achieve responsibility from employees, their awareness and more full use of the potential of the organization's human resources. These theories give managers the key to building an effective system for motivating people.

Each theory has its advantages and disadvantages.

Various theories of motivation contribute to significant improvements in specific management approaches.

Speaking about motivation, it must be stated that there is no one “best” way. People have many different needs and goals. People behave differently to achieve their goals. What is acceptable for one person may not be suitable for another. This once again confirms that in practice it is very difficult to carry out this important management function.

From the point of view of the nature of actions applied to an employee of an organization, motivation can be:

Positive;

Negative.

The main methods of positive motivation include:

Material incentives in the form of personal salary increases and bonuses;

Assignment of particularly important work, etc.

Negative motivation involves, first of all:

Material penalties (penalties);

Decrease in social status in the team;

Psychological isolation of the employee;

Creating an atmosphere of intolerance;

Based on the method of satisfying needs, motivation is divided into:

On the material side - aimed at satisfying needs through payment of labor. Its methods will be increasing the official salary, establishing a personal allowance, etc.;

Labor - satisfies the needs of the employee through achieving the results of his work. It involves encouraging creative initiative, the possibility of employee participation in the management process, i.e. those methods that will provide the employee with satisfaction from the work he performs;

Status - aimed at satisfying needs by obtaining a higher level status (promotion, leadership recognition).

By the nature of the focus of management methods, we can distinguish:

Economic;

Social;

Psychological;

Organizational motivation.

Economic motivation is a motivation that establishes a direct dependence of a person’s material security on the results of his work. It is formed by various components.

Salary is the main type of remuneration for an employee, including:

Basic salary

Piece work;

Time-based;

Additional:

Allowances for qualifications (experience, academic degree, etc.);

Additional payments for difficult working conditions, part-time work, for night work, for teenagers, nursing mothers, for work on holidays and Sundays, for overtime work, for leading a team;

Vacation pay or vacation compensation, etc.

Bonuses are one-time payments from the organization’s profits (for some labor achievement, etc.).

Participation in share capital:

Purchasing shares of an organization and receiving dividends;

Purchasing shares at preferential prices;

Free receipt of shares.

Profit sharing - the share of profits from which the incentive fund is formed is established. Profit sharing payments are not a one-time bonus. Applies to categories of personnel that can actually influence profits. Most often, these are managerial personnel, and the share of this part of the profit corresponds to the rank of the manager in the service hierarchy and is determined as a percentage of the profit brought by the division he manages.

Stimulation with free time;

Health care programs;

Programs related to the upbringing and education of children;

Payment of transportation costs or servicing with your own transport;

Organization of catering;

Discounts on the purchase of company goods (allocation of funds for a discount on the sale of these goods);

Housing construction programs (allocation of funds for own housing construction or on share terms);

Flexible social payments (organizations set a certain amount for the purchase of necessary benefits and services);

Life insurance at the expense of the organization;

Temporary disability payment programs (usually at the expense of the organization);

Medical insurance (both for employees and their family members);

Contributions to the Pension Fund.

Psychological motivation is based on a deep knowledge of the laws of human behavior, based on the structure of his personality, hidden from direct observation. The most common incentives that regulate employee behavior based on the expression of social recognition of work:

Presentation of certificates, badges, pennants;

Posting a photo on the Honor Board.

Organizational motivation is based on relationships of power and subordination and regulates employee behavior based on changes in his sense of job satisfaction. It includes:

Transformation of the team structure, rationalization and coordination of this structure;

The inclusion of creative elements in the organizing process and the very nature of work.

G.K. White identifies the main approaches to increasing work motivation:

Freedom of his actions;

Place (conditions) of work;

The concept of “optimality” in the formation of labor motives, taking into account that:

Payment must meet the expectations of employees: expectations must be researched and specifically formed.

1.3. The influence of social communications on the formation of motivation of medical personnel

The activities of the hospital are closely interconnected with the receipt, accumulation, storage, processing and use of various information flows. When determining the value of the information received, it is necessary to be guided by such criteria (properties) as usefulness, timeliness and reliability of the information received.

The usefulness of information lies in the fact that it creates favorable conditions for the subject to make a prompt decision and obtain an effective result. In turn, the usefulness of information depends on its timely delivery to the subject.

Employees of the Kolyvan Central District Hospital receive job descriptions from a higher organization or from their immediate superiors, a mandatory clause of which is about confidentiality and non-disclosure of information received. The Civil Code of the Russian Federation has an article that deals specifically with this:

1. Information constitutes an official or commercial secret in the case when the information has actual or potential commercial value due to its unknownness to third parties, there is no free access to it on a legal basis, and the owner of the information takes measures to protect its confidentiality. Information that cannot constitute an official or commercial secret is determined by law and other legal acts.

2. Information constituting an official or commercial secret is protected by the methods provided for by this Code and other laws.

All incoming information from higher-level organizations is first received by the head physician of the hospital, and then, depending on the purpose, the information is transferred to deputies and communicated to the rest of the staff (if necessary).

Basic regulatory documents that come from a higher organization:

Territorial compulsory medical insurance program.

List of medical services provided at the expense of the state or municipal healthcare system.

A list of expensive operations and equivalent interventions that are financed from the state budget.

Regulations on the procedure for conducting an examination of the quality of medical care.

Medical-economic and medical-technological standards.

The effectiveness of any organization depends on how correctly and effectively the communication systems work. The reliability of information transmission is determined by the reliability of the connection of elements in the communication system.

There are several definitions of the term “communication”, but in this work we will adhere to the following: communication is a connection during which information is exchanged between systems in living and inanimate nature.

Main goals of communications:

Depending on the method of information exchange, there are:

Interpersonal, or organizational, communications based on oral communication;

Communications based on written exchange of information.

Communication (information) flows are an integral part of any functioning organization. Classification of communication flows can be carried out on a number of grounds (Table 1).

Table 1.

Classification of communication flows in an organization

As you can see from the table, there are a lot of communication flows. In this case, we are only interested in formal communications, so we will dwell on them in more detail.

Formal communications are determined by the rules, job descriptions of the organization, and are carried out through formal channels. The basis of formal communications is regulations; they fix the rules and norms of formal communications.

Formal communications can be grouped in several areas:

Incoming – outgoing;

Constant – variable;

Internal - external.

In the information support of formal regulations, two functions can be distinguished: primary and secondary, which in turn are subdivided:

primary functions:

Organization of information arrays;

Organization of information flows;

Organization of processes and means of collecting, storing, processing and transporting information.

There are also certain requirements for the quality of information, these are:

Complexity of the information system;

Timeliness and reliability;

Sufficiency and reliability;

Targeting and legal correctness;

Reusability and coding capability;

High speed of selection, processing, transmission and relevance.

Formal regulation of the management process ensures:

A clear definition of the relationships, rights and responsibilities of management bodies in various fields of activity;

Establishment of duties, rights and responsibilities of structural units and individual employees of the management apparatus;

Formation on a regulatory and legal basis of the contour of management systems;

Streamlining techniques and methods for solving individual management problems;

Establishment of quantitative characteristics of management processes at various levels;

Determining the conditions for economic incentives for organizations and individual workers.

Formal regulation as an integral part of communication makes it possible to streamline and balance (regulate) the work of both the entire organization and its individual components.

To improve communications in health care facilities, first of all, it is worth paying attention to the disagreements that arise between different departments. Improved interpersonal relationships can lead to a clearer structure of communication flows.

In this case, formal regulations play an important role. A clear understanding by each employee of his field of activity leads to structuring of work. The need for regulations arises to resolve issues of division of labor obligations among employees of health care facilities.

Formal regulation is intended to outline the responsibilities of each employee, but in health care facilities, so-called “borderline” issues often arise that slow down the work of staff due to the inability to cope with such situations. Figure 2 shows the regulations for substitutes and “borderline” situations.

Figure 2. Regulations and border issues

Resolving “borderline” issues is one of the main problems in health care facilities, since it is the inability of deputies and other personnel to cope with their resolution that greatly affects communication flows.

The information flow diagram aims to assess the rationality of its organization and develop recommendations for its improvement. It is the scheme of communication flows that establishes rational connections between all components participating in the path of flow circulation.

Therefore, at this period of time, the management of health care facilities faces a certain task: to establish methods for the formation, processing and transmission of information flows so that they not only do not interfere, but also contribute to improving the work of the organization through a clear separation and understanding of the actions of personnel in various communicative situations. It is necessary to consider the manager as an integral part of the system in which he works. In turn, it is the behavior of the manager that influences the behavior of the staff as a whole.

In addition to the analysis of information resources and technical factors, purely human factors play an important role in decision making. These factors express not only the requirements of the feasibility of implementing or achieving an alternative, but also the requirements of human ethics and morality. Making the right decision requires not only technical competence in assessing information resources, but also taking into account purely human factors.

Do not forget that there are certain official connections between health care facility staff, as one of the elements of formal communications. These connections can be divided into three main types:

Organizational – subject;

Organizational - functional;

Organizational and administrative.

After certain observations, we can conclude that these connections are not only not always respected, but are sometimes grossly violated. An example is that in relation to their superiors, almost half of the staff does not respect subordination. Thus, the structure of communications is disrupted. Again, in this case, we can say that the management of health care facilities is obliged to monitor these violations and suppress them, since this affects not only the circulation of information flows, but, ultimately, the quality of the work itself.

A well-functioning document flow indicates that formal communications are, after all, well developed, but this also has its drawbacks. Operational information does not always reach the addressee on time, which is associated with disruptions in communication flows.

To solve emerging problems, it is necessary to regulate communication flows, which has several methods:

Collection of operational information (for health care facilities is of the greatest importance, since there are many shortcomings in this area);

Building a system of interactions to solve current problems (flaws in solving “borderline issues”);

Regulation of communication flows;

Combating distortions in transmitted information, overcoming communication barriers (the main problem arising in this area is barriers between different departments associated with mismatched areas of competence);

Regulation of horizontal formal communications.

The problem considered allows us to say that formal communications of health care facilities have their own shortcomings, but there are not as many of them as it might seem at first glance.

The main task facing management, with the help of formal regulations or other formal introductions, is to organize the uninterrupted circulation of communication flows within the organization to improve the quality of both the communications themselves and the work of the hospital as a whole. Solving this problem can make the work of both management and staff easier.

The individual characteristics of the motivation of each employee influence the work motivation of both formal and informal groups. Each employee belonging to a particular group, consciously or intuitively, ultimately seeks his own benefit. If a group meets a person’s expectations, then its unifying forces increase. If a worker believes that he can get on his own what he can get in a group, then his sense of belonging to the group and labor productivity weaken. If the personal motives that the employee experienced when joining the group remain unsatisfied, then the initial motivation may turn out to be negative.

Determining the structure of group motivation in the practice of personnel management can be done on the basis of identifying the specifics of the group’s work activity, focus on teamwork, established moral standards, differences in views that can damage the group’s goals, etc. To strengthen group motivation, it is recommended to use the following approaches :

Help a group (formal or informal) experience shared work success;

Create conditions for strengthening the trust of the group in the manager (leader) and of group members in each other;

Actively involve group members in group-wide activities in order to cultivate a positive sense of belonging to the group;

To fully support faith in the reality of solving the work tasks facing the group.

The deeper the gap between what a worker gives to society and what he receives in return, the less such motives for work as duty to people, society as a whole, and the desire to benefit people with his work mean to him. At the same time, the motives of material reward for work hypertrophy in his mind. These processes develop most strongly when the level of employee remuneration turns out to be significantly lower than the cost of the necessary product.

The consequence of the decline in the importance of labor motives “for others” is the deprofessionalization of workers. Concern about improving professional qualifications ceases to be relevant, since the consumer properties of manufactured products have no personal meaning and are not related to meeting one’s own needs.

Motives for work are formed if:

Society (or the subject of management) has at its disposal the necessary set of goods that corresponds to socially determined human needs;

To obtain these benefits, the labor efforts of the employee are necessary;

Labor activity allows the employee to obtain these benefits with lower material and moral costs than any other type of activity.

Motivation is the process of nurturing in an individual internal motivations to achieve the goals set for him. In management, the term “motivation” is also used, which has a broader meaning - it is both motivation (as a process of influence) and a set of formed motives.

Motivation differs from stimulation in that incentives emphasize rewards, while motivation focuses on creating internal belief.

Motivation is the process of motivating oneself and others to act in order to achieve personal or organizational goals.

The concept of needs is closely related to the concept of motivation. Need is an objective state of need for something, the need for something.

Needs, as a first approximation, are lower and higher. Based on emerging needs, under the influence of personal characteristics of the social environment, current situations are formed into certain motives, these motives cause corresponding activity.

2.1. Basic approaches to assessing the performance of medical personnel

The health of the population is the most valuable achievement of society, therefore preserving and strengthening it is a national task in which everyone without exception must take part. Not the least role in fulfilling this task is assigned to our numerous, hardworking and main health care team - paramedical workers. The number of paramedical workers in Russia is about 1.5 million, including about 900 thousand nurses, more than 239 thousand paramedics, 95 thousand midwives, etc.

Recognizing that the prestige of the nurse and her social status have been declining for many years, active, targeted work is currently being carried out in Russia to revive the nursing profession and its significance.

An analysis of nursing showed that it lags behind in Russia compared to developed countries. The reasons for this situation are manifold: the traditional idea in our country of a sister as a doctor’s assistant, performing only auxiliary medical functions; neglect of foreign experience, underestimation of scientific principles and income for the management and organization of the work of nursing personnel, their professional training.

Nursing did not represent a special social institution, but remained a secondary part of health care, a technical activity devoid of independence. Perhaps this was facilitated by the system of training specialists, both in duration from one to two years, and in methodological support. Radical socio-political and economic transformations in Russia at the turn of the 20th and 21st centuries brought forward a number of complex organizational, legal and economic problems in reforming the healthcare system.

Changes in the operating conditions of government structures, the severity of the economic situation in the country, the ongoing transition to market relations, and the emerging diversity of medical practice put forward new approaches to the organization and methodological support of training, retraining and advanced training of industry specialists, and their practical use.

Enormous responsibility, an overwhelming flow of information from abroad, strict recommendations from foreign partners indicating “how to do” and “the only way to do it,” honesty, conservatism in relation to a “minor problem” did not give any room for error in determining the strategic line in resolving the issue of ways of developing domestic vocational education.

In the process of heated discussions, a new system of personnel training was born, based on the achievements of Russian medical science, practice and education.

Classic theories in the field of personnel management, including the principle of unity of command, are based on the following provisions:

Work for most individuals does not bring satisfaction; reward for them is much more important than the process of work;

There are very few employees who want or can do work that requires initiative, creativity, independence, and self-control;

The main task of a manager is strict control and supervision of subordinates; he must also break down tasks into simple, easily digestible operations and monitor employees' completion of them.

In this case, it is worth paying attention to the fact that the manager himself decides who will do what work. Therefore, issues related to this or that work, which is determined by the manager without the participation of personnel services, can be considered the implementation of the principles of unity of command.

The main problems associated with this can be divided into two groups:

Misunderstanding among workers due to lack of information;

Manager misunderstanding.

Modern management incorporates the achievements of various approaches and continues to be replenished with new knowledge. In the 1980s, organizational culture issues became the focus of attention. The importance of organizational culture as a strong management tool has increased. Research has proven that the main potential for progressive change lies in the person himself, in his consciousness and culture. And cultural stereotypes of human behavior in an organization have a direct impact on the final results of production activities.

In the 1990s, leadership developments came to the fore. International management poses a number of questions to the theory and practice of management, in connection with which the issues of determining general (universal) and specific forms and methods of management, adaptation to the national local environment and a number of others are considered.

The main points of the modern system of views on management, in contrast to the classical management model, are as follows:

An organization is an open system;

Success depends on how well the company “fits” into the external environment and adapts to its changes;

The organization must be characterized by constant renewal and adaptation to external factors;

The bet is on a self-actualizing person. Hence the need for attention to such factors as organizational culture, various forms of democratization of management;

Recognition of the social responsibility of management both to society as a whole and to individuals working in the organization;

Orientation towards a new social group - cognitariat, the power of which is based on knowledge and use of intelligence, rather than muscular strength.

The new system of views on management is known as the “quiet management revolution”, because it does not destroy existing management systems and methods, but, complementing them, gradually adapts them to new conditions.

One of the global problems of modern economic development in Russia, as well as in most countries of the world, is the problem in the field of working with personnel. Approaches to this problem are varied. Undoubtedly, great attention is paid to the structuring of methods and systems of personnel selection, placement, staffing, optimization, training and promotion of the personnel component of the organization. When establishing a market economy in domestic practice, all of the above aspects must be taken into account.

One of the most important tasks of the personnel management service is the analysis and regulation of group and personal relationships. The importance of this issue cannot be underestimated, because the effectiveness of the organization ultimately depends on the quality of work of individual groups.

Defining the concepts of the categories “indicator” and “criterion” is important for assessing the functioning of both professional groups and the personnel service as a whole. According to L.I. Abalkin, in the process of labor activity a person receives a certain result, which can be expressed both quantitatively and qualitatively. The criterion of efficiency is understood as the main distinguishing feature of an economic phenomenon, which most fully expresses its essence, states and properties inherent in this phenomenon. Indicators are quantities that reflect the size and quantitative relationships of the characteristics of economic phenomena. The criterion is in unity with indicators, since through indicators it is discovered, exists and acts.

For the effectiveness of personnel management, as well as to identify performance assessment, V.S. Lipatov suggests establishing the following criteria. The first are those related to the control object, general and specific criteria. The second ones are related to the efficiency of personnel.

The purpose of the research is to, based on the facts obtained:

Identify measures to improve the work of professional groups, the implementation of which will improve the communication system in the group;

Change the requirements for the professional qualification level of the composition of the professional group;

Identify the main factors influencing the successful functioning of professional groups;

Develop an optimal group selection system, taking into account all possible factors of external and internal influence on the professional group.

To develop organizational measures, it is important to analyze the content of the work of employees of a professional group. It should be taken into account that working in a group requires mental work from each member.

Differences between group members are expressed in the level of education, the method of entry into service, career development and the place that the employee occupies in the service hierarchy.

At the stage of forming the methodology, it is necessary to reconcile the conflicting demands placed on the plan from different directions. Therefore, it is necessary to take into account the impact on the professional group of numerous economic, motivational, psychological and social factors.

The processes taking place in professional groups reflect the dynamics of the organizational system. Therefore they must be manageable. Communication as an organizational process is a key process. Construction and optimization of communication networks allows you to organize them in the most effective way in accordance with the current situation. Taking into account psychological and social factors in personnel management is one of the most important aspects of the functioning of an organization. Psychology is a science that deals with human problems and the specific features of management. The objects of study here are the relationships between people in a team. E. A. Utkin defines the main psychological problems as structural-functional analysis of management activities; psychological analysis of the construction and use of workplaces, socio-psychological analysis of production and management teams, the interaction of people in them, factors in the formation of a favorable moral and psychological climate; study of the psychology of management and leadership, personality and activity, relationships between the manager and subordinates, psychological aspects of personnel selection and placement, psychological aspects of personnel management, factors influencing the processes of decision-making and implementation.

2.2. Methods for assessing the motivation of medical personnel

Theories of human relations have been applied since the early 1930s. They are based on the following provisions:

Individuals strive to be useful and significant, experiencing a desire to be involved in a common cause and recognized as individuals;

The fulfillment of these needs is no less important for them than a high level of wages;

The main task of a manager is to make every worker feel useful and needed; the manager must inform subordinates and take into account their suggestions for improving the organization’s performance; subordinates are given a certain independence, implying self-control over the execution of current work.

As they develop, theories of personnel management become more and more humane. The School of Human Relations and the School of Behavioral Sciences involves:

Using techniques for managing interpersonal relationships.

Application of the Sciences of Human Behavior.

The use of labor psychology in the school of human relations allows us to develop a theory of motivation based on the fact that the individual comes first in this school and it is his needs that are taken into account in the first place.

Work motivation is the process of stimulating an individual performer or a group of people to perform activities aimed at achieving the goals of the organization, to productively carry out decisions made or planned work.

This definition shows the close relationship between the managerial and individual psychological content of motivation, based on the fact that the management of a social system and a person, in contrast to the management of technical systems, contains, as a necessary element, the coordination of the chains of the object and subject of management. Its result will be the labor behavior of the object of management and, ultimately, a certain result of labor activity.

Motivational aspects of labor management are widely used in countries with developed market economies. In our country, the concept of labor motivation in the economic sense appeared relatively recently in connection with the democratization of production. Previously, it was used mainly in industrial economic sociology, pedagogy, and psychology. This was due to a number of reasons. Firstly, the economic sciences did not seek to analyze the relationship of their subjects with the named sciences, and, secondly, in a purely economic sense, until recently, the concept of “motivation” was replaced by the concept of “stimulation”. This “truncated” understanding of the motivational process led to an orientation toward short-term economic goals and the achievement of short-term profits. This had a destructive effect on the employee’s need-motivational personality and did not arouse interest in his own development and self-improvement, but it is precisely this system that today is the most important reserve for increasing production efficiency.

Information support is one of the most important supporting functions, the quality of which is a determining factor in the validity of any management decision and the effectiveness of the management system. In dynamics, information support as a process is included in the concept of “communication”.

The quality of information has a great influence on the communication processes circulating in the organization. Today, information is viewed as a global process associated with fundamental changes in the structure and nature of economic and social development, decisively changing the nature of work and human living conditions.

The need for a general theory of communications is caused by the large number of communication processes with which the life of each person individually and the organization as a whole is saturated.

A communication network is a connection of individuals participating in the communication process in a certain way using information flows.

The process of information exchange in organizations can be divided into two categories: planned, or formal, information transfer and unplanned, or informal, information transfer. Every organization has some kind of official structure through which information is transmitted for its intended purpose.

The purpose of a formal organizational structure is to channel communication flows in the right direction. The size of departments in an organization limits the ability to develop a communication network. Depending on how communication networks are built, the group's activities may be more or less effective.

The enterprise's communications system must ensure an active influence on the internal environment. The enterprise information system, as part of its main activity of collecting information coming from the external environment, must especially carefully process and systematize those signals that are initiated by the enterprise’s impact on the external environment.

Many sociometric methods allow you to observe relationships between people. The sources of past, present or future conflicts manifest themselves in an environment in which they can be diagnosed and discussed, predicted and prevented, as a result of which their impact is minimized. If conflicts in interpersonal relationships can be prevented, this means that these relationships have good prospects.

Undoubtedly, in a sociometric experiment, the factor of spontaneity in the methods of action and training is important, since they demonstrate the development of initiative and the positive consequences of human activity in society.

The problems solved by sociometric research are varied, including:

Training, development of specific skills;

Creative development of personality;

Training in spontaneity and other communication skills;

Diagnostic tools;

Creativity training;

Group recruitment, selection and forecasting of candidate adaptation, situational standardization of selection quality, introduction of new members, etc.

There are certain principles of group “therapy” that are the same for sociometry, no matter who these principles are applied to - one person or a group. Sociometry allows not only to draw boundaries between situations and spheres, but also allows you to establish a mutually acceptable distance between people and groups, which in a business organization is implemented as a delimitation of competence and spheres of influence between departments and employees.

When conducting a sociometric study, it is necessary to take into account contact with the group and remain independent in your assessments. It is important to consider that each group member has a concept of a human self and a professional self, which are closely intertwined.

When developing methods for collecting sociological data, the theoretical level of the problem under study is transferred to the level of empirical description and analysis. This provides a basis for testing working hypotheses and generating new theoretical knowledge.

Carrying out sociological research requires a flexible combination of scientific-theoretical, methodological and organizational activities.

Methods of social measurement were formed and improved with the transition from one level of social research to another. Therefore, each of them is one-sided in nature and in a specific sociological study is used in conjunction with others.

When monitoring mass processes, it is necessary to be at a certain distance from the object being studied, recording the elements and main features of “open behavior.” To understand the essence of events in a particular group or organization, the researcher must participate in their activities for a long time. It is the duration of this study that is its main drawback.

Informal relationships in healthcare organizations, as well as in other organizations, can be studied using sociometric methods, since various studies provide almost all the necessary characteristics of individuals.

Communication represents two interrelated aspects: the informational and the interaction aspect, therefore it can only be considered in this unity.

The main goals of communications in the organization:

Ensuring the effectiveness of information exchange between the object and the subject of management;

Improving interpersonal relationships in the process of information exchange;

Creation of information channels for the exchange of information between individual employees and groups to coordinate their tasks and actions;

Regulation and rationalization of information flows.

During the transition to the information society, it is necessary to prepare a person for the rapid perception and processing of large volumes of information, mastering modern means, methods and technology of work. In addition, new working conditions create a dependence of one person's awareness on the information acquired by other people. Therefore, it is no longer enough to be able to independently master and accumulate information, but one must learn a technology for working with information in which decisions are prepared and made on the basis of collective knowledge. This suggests that a person must have a certain level of culture in handling information. To reflect this fact, the term information culture was introduced.

Information culture is the ability to purposefully work with information and use computer information technology, modern technical means and methods to receive, process and transmit it.

Information culture is:

A new type of communication that allows the individual to freely enter information existence;

Freedom of access and access to information existence at all levels from global to local, since the intranational, intrastate type of information existence is as untenable as national science;

A new type of thinking, formed as a result of the liberation of a person from routine information and intellectual work, among the features that define it, the latter’s orientation towards self-development and self-learning is already clearly manifested today.

Information culture absorbs knowledge from those sciences that contribute to its development and adaptation to a specific type of activity. An integral part of information culture is knowledge of new information technology and the ability to use it both to automate routine operations and in extraordinary situations that require an unconventional creative approach.

At the stage of psychological assessment of the group’s personnel, it is typical to use complex psychological tools to determine the accentuation of individuals’ character, psychological potential, level of conflict, etc.

The role of communication in the formation of personality and the main structural components is emphasized by famous psychologists B. G. Ananyev and B. F. Lomov. Thus, B.F. Lomov notes that it is the process of communication that plays a particularly important role in the exchange of ideas, interests, the transfer of character traits, the formation of attitudes and positions of the individual. It is necessary to pay more attention to the individual as a reflection of social relations. This allows us to develop methods and forms of collective communication, study the socio-psychological nature of the work collective, its structure, socio-psychological processes accompanying the development of the work group into a team

3.1. Characteristics of the main medical and economic indicators of the activities of the outpatient department of the Central District Hospital

The healthcare of our country has gone through a complex historical path of development, which in the 20-60s made it possible to solve the problems of social and hygienic well-being in the country in conditions of predominantly infectious pathology. For several decades, the development of healthcare has been extensive, which has been largely justified. However, in the 70-80s, due to the beginning of the epidemiological transition and new conditions of the country’s socio-economic development, it was necessary to transfer healthcare to a new mode of operation, but for a number of reasons this was not done. Moreover, in the last decade, those negative trends that were associated with the residual principle of financing, the dominance of administrative-command management methods, and the equalizing cost-based nature of the entire national economy have intensified.

It can be argued that in the 80s, a kind of health crisis developed in our country. The “Regulations on a new economic mechanism in healthcare” adopted in 1989 was aimed at overcoming all these negative aspects. The level of professional training of medical workers, the availability of medicines, and the low level of material and technical base of healthcare have become the most acute problem of the healthcare crisis observed in our country. The state monopoly that has prevailed in these areas for many years, the insignificant amount of funds allocated from the state budget, and the predominance of extensive development methods are the main reasons for the difficulties that have arisen.

The changes taking place in the country could not but affect healthcare. In the context of the transition to a market, it was not possible to maintain healthcare as a purely state island with 100% government financing of the services provided. The solution to the problem of maintaining healthcare at the proper level was its combined financing, since both the state and enterprises, regardless of their form of ownership, and the citizens themselves are interested in preserving and maintaining health.

The form of management in healthcare reflected its fundamental features under the conditions of a command-administrative system, which led to the following consequences: first of all, a chronic lack of financial resources, ineffective use of available resources, insufficient material incentives, the inability of healthcare to influence demographic, environmental, social economic factors that determine people's living conditions and their health.

The solution to all these problems seems possible in the conditions of new economic relations. The 90s were a turning point in the healthcare sector. It was at this time that the medical services market developed.

Table 2 shows the financing of the Iskitim Central District Hospital for 12 months of 2005

Table 1

ICRH financing

Table 3 shows the implementation of budget expenditure estimates for 12 months of 2005.

Table 3

Execution of cost estimates according to the budget

	Name of expense items (item code)	Amount (thousand rubles)
	Completed (funding received)	% execution	Actual expenses	Cash expenses

Including by article:
	Salary (211)
	Payroll accruals (213)
	Increase in the cost of inventories (340 in terms of medicines and dressings, reagents)
	Increase in the cost of fixed assets (310 in terms of acquisition of soft equipment)
	Increase in the cost of inventories (340 in terms of food)
	Increase in the cost of inventories (340 in terms of fuel and lubricants)
	Increase in the cost of inventories (340 in terms of spare parts, household and construction materials, office supplies)
	Other payments (212 daily allowance)
	Transport services (222)
	Communication services (221)
	Utilities (223)

	Property maintenance services (225 current repairs of buildings)
	Other expenses (226)
	Social assistance benefits to the population (262)
	Other payments (212 methodological literature)
	Increase in the cost of fixed assets (310 in terms of acquisition of equipment, vehicles)
	Other services (290)

Table 4 shows data on the cost of a unit of medical care.

Table 4

Cost of a unit of medical care (rub.) (per day, visit - according to compulsory medical insurance, call - according to the budget)

	Name of aid unit	Cost per unit of assistance (RUB)
		Hospital				Clinic
		Total (RUB)	By article:			Total (RUB)	By article
			medicines		soft inventory		medicines	soft inventory
1.	Bed day	102,32	64,02	31,82	6,48
2.	Visit	15,57	15,39	0,18
3.	Call	0,42	0,42

Table 5 shows data on the amount of compulsory health insurance funds received for 12 months of 2005.

Table 5

Compulsory health insurance

Table 6 presents the average salary of personnel for 2004-2005.

Table 6

average salary

From the table presented we can see that the salaries of medical personnel in 2005 increased compared to 2004.

Table 7 shows medical services for 12 months of 2005.

Table 7

Paid medical services

The formation of supply and demand for medical services, as well as pricing, depend to a certain extent on many factors. At the same time, protecting public health depends not only on the effective functioning of the medical services market, but also on a number of other markets that are closely interconnected. If we consider only the functioning of medical institutions, then they primarily act in two main markets: the resource market and the medical services market.

The resource market includes the labor market and the material resource market. This market supplies medical institutions with medical equipment, medicines, and instruments. Operating in this market, medical institutions buy the necessary resources and make payments, which act as wages and income to the owners of the resources. In the resource market, medical institutions act as buyers, in the medical services market - as sellers.

In conditions of widespread use of health insurance, the service market can be represented by the following types: the insurance market, the market for medical services under the insurance system and the free market for medical services. As for the resource market, it can also be classified in a certain way. This is the medical equipment market, the drug market, and the labor market.

The market for medical services and the market for resources are closely interconnected. On the one hand, the demand in the resource market is derived from the demand for medical services, and on the other hand, the price level and, in general, the situation in the resource market determine the potential opportunities and boundaries for the development of medical institutions. Therefore, it is no coincidence that the level of professional training of medical workers, the availability of medicines, and the low level of material and technical base of healthcare have become the most acute problem of the healthcare crisis observed in our country. The state monopoly that has prevailed in these areas for many years, the insignificant amount of funds allocated from the state budget, and the predominance of extensive development methods are the main reasons for the difficulties that have arisen.

The first medical cooperatives and small enterprises that appeared in these conditions were largely successful due to access to modern equipment, scarce medicines, and the attraction of the most qualified specialists. This led to even greater differentiation in the quality of medical care and increased social tension in society. Therefore, the state was forced to strengthen state control in the production of medicines and medical equipment. In particular, this was expressed in the reorganization of the Ministry of Health of Russia, which turned into the Ministry of Health and Medical Industry of the Russian Federation, as well as in the publication in the summer of 1994 of the Decree of the Government of the Russian Federation “On state support for the development of the medical industry and improving the provision of the population and health care institutions with medicines and medical products."

In any case, most of these problems can be successfully solved only by expanding the financial base of the entire health care system in the country. The development of market relations today makes this opportunity real. Along with the traditional source of financial resources, which is the state budget, new ones are emerging. As defined in the law “On Medical Insurance of Citizens in the Russian Federation,” they can be funds from state and public organizations, enterprises, income from securities, loans from banks and other creditors.

In order for these listed sources to actually function, conditions are necessary that make financial investments in protecting public health a fairly attractive direction. To this end, in our opinion, it is necessary to differentiate financial market instruments and provide them with appropriate government support. And although public and private insurance organizations will play the main role in these processes, medical institutions and relevant health care authorities can attract additional free funds. This can be achieved in various ways:

1. Issue of own debt obligations;

2. Participation in the capital and profits of a medical institution by issuing shares;

3. Obtaining loans from a commercial bank.

At present, when there is a process of formation of a multi-structure in healthcare and there is an acute shortage of financial resources, the creation of leasing companies, in our opinion, could significantly improve the material and technical base of medical institutions. At the first stage, these could be state-owned leasing firms, which could serve as a sort of distributor for the scarce volumes of modern medical equipment, ensuring that it ends up in good hands. In addition, as world experience shows, it is preferable to use leasing where there is particularly complex and rare equipment that is serviced by lessors better than the medical institution using it can do.

In the economic literature there are proposals to use such a specific form as factoring in the service sector. Factoring is the purchase of requirements for commodity supplies by a factoring company, usually carried out on a contractual basis. As a result of such an operation, the entrepreneur selling claims receives 70-90% of the amount of claims in the form of an advance within 2-3 days. The remaining 10-30% is a kind of guarantee amount for the factoring company. The factoring firm charges the entrepreneur a certain percentage for the immediate provision of the equivalent of debt claims, a risk premium and reimbursement of administrative and management expenses. Factoring is effective primarily at manufacturing enterprises and wholesale companies that respectively produce and sell consumer goods. However, it seems possible to us in the conditions of compulsory health insurance, when many enterprises do not make payments to the territorial compulsory health insurance funds on time, and many of them are on the verge of bankruptcy, the debt obligations of enterprises to funds and insurance organizations could be sold to factoring companies. This would ensure greater uniformity in the financing of health care institutions.

3.2. Model for managing the motivation of medical personnel in an organization

There are three groups of career management principles: general, specific and individual.

The general principles of career management include four fundamental management principles:

The principle of the unity of economics and politics with the priority of politics;

The principle of unity of centralism and independence;

The principle of scientific validity and effectiveness of management decisions;

The principle of combining general and local interests with priority to interests of a higher rank.

Single principles define the requirements unique to career management. Among them are the principles of workforce marketing, career development risk, career management tools, competitive advantage, and workforce competitiveness.

Career management methods are a set of actions and ways to achieve a goal, a certain ordered activity to increase the value of human capital in an organization.

Personnel development management as an element of the system of market relations in an organization creates conditions for adapting the structure of the total employee to the structure of production and to the structure of market demand for goods and services, coordinates the activities of management subjects to increase the competitiveness of personnel.

Special principles of career management characterize the requirements inherent in managing socio-economic systems in general. These are the principles of systematicity, complexity, progressiveness, perspective, normativity, integrity, process, functionality, economy, measurability, administration, equal partnership, optimality, etc.

In the system of methods, it is necessary to distinguish between methods of the science of career management, which should be understood as a set of purposeful actions and ways of obtaining new knowledge about managerial relations and the career management system and methods of direct career management.

Methods of career management science are combined into two groups: the first is general scientific methods of cognition, which are used in almost all theoretical studies. This group includes the method of materialistic dialectics, scientific abstraction, logical and historical methods of reflecting reality in thinking, analysis and synthesis, induction and deduction, etc.

The second group of methods in the science of career management consists of special methods of cognition - special and individual. Special methods of career management science combine:

Methods for collecting primary information and methods for primary processing of specific management data;

Methods of studying, evaluating and summarizing the information received in order to develop and make management decisions;

Methods of strategic analysis and forecast.

Methods of direct career management are based on knowledge of the laws of social development, the interests of labor market subjects, and legal norms regulating the basic principles of behavior of these subjects in the sphere of using growing human capital. Among these methods, a distinction is made between direct and flexible methods.

Let's consider those career management methods that are used by the management of the Kolyvan Central District Hospital.

Consideration of a career as a process determined by the influence of people and events on it is carried out within the framework of two fundamentally different approaches. The first is a personal approach, which puts the personal inclinations, preferences and abilities of the individual at the forefront, and the second approach, which emphasizes the processes of communication and socialization as factors in the formation of a specialist.

The personality approach focuses on how the decision to choose a career is formed as a result of various incentives, motivation and contacts with other people, the extent to which this decision reflects the types of activities that brought satisfaction in early life, and what the expectations associated with this choice. With the second approach, the social status of a given profession, the expected social rewards and incentives awaiting the individual along this path are very important. During the process of socialization, initial goals and expectations are constantly adjusted in the light of new experiences, knowledge, and changing conditions.

The Kolyvan Central District Hospital employs a stable, highly professional team, whose members are constantly improving their professional skills. Management creates favorable conditions for staff career growth. First of all, it is naturally mandatory to take advanced training courses, attend seminars and other events that promote professional and personal growth.

Society places increased moral demands on certain types of professional activities. Basically, these are professional areas in which the labor process itself requires coordination of the actions of all its participants. Particular attention is paid to the moral qualities of workers in that field that are associated with the right to manage people’s lives; here we are talking not only about the level of morality, but also, first of all, about the proper performance of their professional duties.

The labor activity of people in these professions, more than any other, does not lend itself to preliminary regulation and does not fit within the framework of official instructions. The peculiarities of the work of these professional groups complicate moral relations, and a new element is added to them: interaction with people - the objects of activity. This is where moral responsibility becomes crucial. Society considers the moral qualities of an employee as one of the leading elements of his professional suitability. General moral norms must be specified in a person’s work activity, taking into account the specifics of his profession. Thus, professional morality must be considered in unity with the generally accepted system of morality. Violation of work ethics is accompanied by the destruction of general moral principles, and vice versa. An employee’s irresponsible attitude towards professional duties poses a danger to others, harms society, and can ultimately lead to the degradation of the individual himself. In modern society, an individual’s personal qualities begin with his business characteristics, attitude to work, and level of professional suitability. All this determines the exceptional relevance of the issues that make up the content of professional ethics. True professionalism is based on such moral standards as duty, honesty, demanding of oneself and one's colleagues, and responsibility for the results of one's work. Each type of human activity (scientific, pedagogical, artistic, etc.) corresponds to certain types of professional ethics.

Professional types of ethics are those specific features of professional activity that are aimed directly at a person in certain conditions of his life and activity in society. The study of types of professional ethics shows the diversity and versatility of moral relations. For each profession, certain professional moral standards acquire some special significance.

Psychological analysis of work activity is a mandatory initial stage of work in the field of work psychology. It plays the role of the foundation on which any specific study is built. Depending on the task at hand, the angle from which the profession is analyzed may change. But the psychological study of professions can also have a more independent theoretical aspect.

The variety of types of work activity has raised and is raising before labor psychology the problem of psychological classification of professions, identifying common characteristics of the psychological traits of various types of work, finding what unites and, conversely, separates professions from a psychological point of view.

The psychological study of specific types of work activity is called professiography, or professiography (description of a profession), and the result of the study is called a professiogram.

The professional profile includes a whole set of characteristics:

About this type of work;

Technical and economic characteristics;

Social,

Social-psychological,

Sanitary and hygienic characteristics of working conditions.

Soviet psychotechnicians called the characteristics highlighted in the professiogram a professionally important sign and considered them as a set of psychotechnics, called them professionally important signs and considered them as a set of mental processes and personality traits that are actualized by this type of work and influence its result.

The use of professiograms by mid-level managers of the Kolyvan Central District Hospital is a necessary condition for managing the career of staff.

Service and professional advancement is the process of progressive movement of an employee through various positions and levels of management, contributing to the full realization of the individual’s potential and increasing work efficiency.

Considering the development of an employee from the very beginning of his career in the Kolyvan Central District Hospital, we can highlight the following main stages of vertical career and professional advancement of employees:

Internship at an enterprise as a senior student;

Work as a young specialist accepted into the organization;

Appointment to the position of a lower management manager;

Appointment to the position of middle management manager;

Appointment to a senior management position.

Let's look at each stage of promotion in more detail. The following features of student internship at the Kolyvan Central District Hospital can be highlighted:

During the internship, HR specialists and heads of relevant departments select the most capable and talented students;

Selected candidates undergo training and practical training to work in a specific department of the organization;

Students who successfully complete the internship process are included in the permanent staff of the organization.

Working as a young specialist in the Kolyvan Central District Hospital also has its own characteristics:

Over the course of 1 to 2 years, the young specialist becomes familiar with the activities of the organization in detail;

Sometimes management provides for the opportunity for a young specialist to undergo internships in various departments of the organization in order to identify the area where his talent and capabilities will be fully revealed;

Based on data on the performance of a young specialist, a decision is made to promote him (if there is a corresponding vacancy) or to enroll him in the reserve for promotion to leadership positions.

Working as a lower-level manager is characterized by the following features:

During the first 2-3 years of work at this stage, targeted preparation for further promotion is carried out: employees are sent to advanced training courses, they replace absent managers, and independently perform some of their functions;

After this preparation, testing and other selection procedures are carried out;

If the selection is successful, the employee is promoted to the position of mid-level manager or enrolled in the reserve to fill the corresponding position.

The work of a mid-level manager in the Kolyvan Central District Hospital has the following features:

For each manager, an individual plan of work at this stage and preparation for further promotion is developed;

Each middle manager works under the supervision of a senior manager;

Testing of middle managers is carried out annually in order to identify professional knowledge, skills and abilities sufficient to independently manage the organization and solve problems of strategic importance;

Based on the results of work and testing, a decision is made on the further promotion of the employee.

The stage of work as a senior manager is characterized by the following features:

The decision to appoint a senior manager to the post and the suitability of the position is made, as a rule, by a special commission consisting of representatives of senior management, as well as the founders of the organization (if the organization is commercial);

The knowledge and skills of a senior manager are less subject to formal testing (as is the case with trainees and lower-level managers), but the competence of a senior manager is judged by the results of the work of the entire organization.

Having examined each of the stages of career advancement, we can say that career management in the Kolyvan Central District Hospital is one of the mandatory methods of motivating staff.

If we ignore the presentation of the theory of motivation, which gives an idea of the mechanism of incentives for an employee’s labor behavior, then in a specific form, individual methods of influence can be reduced to the following groups:

Methods, the main result of which is material reward and other material incentives (wages, monetary rewards, bonuses, profit sharing, sale of shares to staff, benefits, solution to the housing problem, etc.);

Methods whose main result is psychological reward or incentives (job satisfaction, social recognition, greater responsibility, personal contact with management, recognition from senior managers, etc.);

Elimination of negative incentives (unequal opportunities for a business career, injustice, deception on the part of management, etc.);

Administrative (disciplinary) methods (reprimand, public warning, deprivation of privileges, reprimand, threat of dismissal, etc.);

Indirect influence (for example, through training, holding meetings, organizing competitions, etc.).

It is important to emphasize that if it is impossible in our country in modern economic conditions to provide fair and sufficiently high wages, methods of non-material incentives become of great importance. Experience shows that the main motivating benefits may be: in some cases -

Free work mode;

Trust towards the employee on the part of management, recognition of his value to the organization;

Reimbursement by the company of minor expenses of the employee for personal needs - payment for training courses, free meals, etc.; issuing a loan for the purchase of housing, etc.

Rates and salaries for employees of healthcare institutions are determined on the basis of the Unified Tariff Schedule (Table 8)

Table 8

Tariff coefficients

The salary systems used by healthcare institutions are determined taking into account the provisions of the Labor Code of the Russian Federation in accordance with the regulations governing the issues of remuneration of public sector employees. At the same time, within the allocated budgetary allocations, they independently determine the types and sizes of bonuses, additional payments and other incentive payments, bearing in mind that the qualifications of employees and the complexity of the work they perform are taken into account in the amounts of salaries (rates) determined on the basis of a unified tariff schedule (UTS). ).

Persons, other than medical and pharmaceutical workers, who do not have special training or work experience established in the qualification requirements for pay grades, but have sufficient practical experience and perform efficiently and in full the job duties assigned to them, on the recommendation of the tariff commission, in as an exception, may be appointed to appropriate positions. They can be assigned a pay grade within the prescribed range of grades for a given position in the same way as persons with special training and work experience.

The same tariff procedure may apply to junior medical and pharmaceutical personnel.

The amount of an employee’s salary is determined based on the official salary for the position held and other payment terms provided for by current regulations.

3.3. Recommendations for improving the employee motivation management system

Wages, in accordance with the basic law of a market economy, are formed under the influence of supply and demand in the labor market. When defining wages, it is necessary to keep in mind two concepts: nominal wages and real wages.

Nominal wage is the amount of money received by an employee per hour, day, week, year.

Real wages are the quantity of goods and services that can be purchased with a nominal wage, i.e. it is the purchasing power of a nominal wage. Real wages depend on nominal wages and the prices of purchased goods and services.

An increase in nominal wages, for example, by 8% with a price increase of 5% gives an increase in real wages by 3%. If prices for goods and services rise faster than nominal wages, then real wages may fall as nominal wages rise. Salary performs four main functions:

Reproductive;

Stimulating (motivational);

Social (contributing to the implementation of social justice);

Accounting and production, characterizing the degree of participation of living labor in the process of formation of the price of a product, its share in the total costs of production.

The salary level should be determined based on the principles:

Continuous improvement of the living standards of workers;

The growth of labor productivity should outpace the growth of average wages. This must be observed especially in the sphere of material production;

The importance of individual industries and productions in the national economic system must be taken into account;

The different qualifications of workers and their working conditions must be taken into account.

Allowances and bonuses are introduced to stimulate a conscientious attitude to work, improve product quality and production efficiency. The difference between allowances and bonuses is that allowances are paid in the same amount every month for a set period (for example, bonuses for above-standard performance), while bonuses can be irregular and their amount depends significantly on achieved results and changes quite often. Allowances and bonuses reflect the results of the employee’s own achievements.

The structure of labor compensation, as a set of remunerations to an employee for the performance of his job duties, includes salary, allowances, bonuses, bonuses and benefits.

Salary is a monthly remuneration provided for by the staffing table for the performance of certain functions of the position.

Allowances and surcharges – payments to personnel for the special nature of work, performance of work beyond normal duration, for work on weekends and holidays, for performance of work of various qualifications, for length of service in the company, traveling nature of work, etc. They may be mandatory (provided for by law) and corporate (provided for by the internal policy of the company) in nature.

Bonuses are periodic payments paid to an employee for actual results in achieving the goals of the position.

The practice of successful management shows that the efficiency of using human resources in an enterprise depends not so much on the amount of wages, but on the structure of labor compensation. Proper management of the labor compensation structure allows you to effectively manage personnel according to goals and results, influence personnel turnover, increase the level of their professional competence, and motivate them to solve individual and corporate problems.

For the purpose of bonuses, it is necessary to develop a bonus provision that should define:

Indicators and conditions of bonuses,

Prize amounts,

Circle of rewarded employees,

Frequency of bonuses,

Source of payment of bonuses.

Bonus indicators should depend on the labor efforts of the employees of a given team (product quality, delivery times, etc.). The number of indicators varies from 2 to 3. The circle of bonuses for certain indicators should include only those employees who can actually influence these indicators.

Additional payments for combining professions, positions, expanding service areas or increasing the volume of work performed are established by the enterprise at its own discretion. All wage fund savings resulting from the release of workers can be used for these purposes.

For managers of production departments and services, specialists and employees, certification must be carried out at least once every 3 years. Based on its results, decisions are made to increase or decrease salaries, introduce or cancel bonuses, and even dismiss employees from their positions.

The Labor Code of the Russian Federation provides for measures of employee liability for improper performance of his duties and a system of incentive measures for their successful and conscientious performance, as well as the procedure for applying them to employees. For exemplary performance of job duties, increased labor productivity, improved product quality, long-term and impeccable work, innovation in work and other achievements in work, the following incentives are applied: declaration of gratitude; issuing a cash bonus; rewarding with a valuable gift; awarding a certificate of honor; entry in the Book of Honor, on the Board of Honor, etc.

The Labor Code of the Russian Federation provides for the application of the following disciplinary sanctions for misconduct: reprimand, reprimand, severe reprimand, dismissal on appropriate grounds. For civil servants, an additional penalty is applied, such as a warning about incomplete official compliance.

The use of penalties not provided for by the Labor Code is not permitted. Penalties are not recorded in the work book.

Only one disciplinary sanction can be applied for a single offense. Before applying a penalty, the employer must require an explanation from the employee in writing. If you refuse to give an explanation, a corresponding act is drawn up. An employee’s refusal to give an explanation is not an obstacle to applying disciplinary action (Article 193 of the Labor Code of the Russian Federation).

A disciplinary sanction can be appealed by an employee to the State Labor Inspectorate or a labor dispute resolution body.

If within a year from the date of the disciplinary sanction the employee is not subjected to a new sanction, then he is considered not to have one.

The main method of assessing the performance of an employee at an enterprise or organization is certification. Certification - determining the degree of compliance of the employee’s skill level with the requirements of the work (function) performed by him.

Main objectives of certification:

Determining the employee’s professional suitability for the position held;

Identification of prospects for using the employee’s potential abilities and capabilities;

Stimulating the growth of employee professional competence;

Determining areas for advanced training, professional training or retraining of an employee;

Making proposals for the transfer of personnel, dismissal of an employee from a position, as well as transfer to a more (or less) qualified job

Let us highlight the main approaches to increasing work motivation:

1) design of external work motivation:

For assignments, the requirements must be meaningful, understandable, and provide feedback to the manager;

Regarding the organization of work - the organization must contribute to the achievement of the goal, provide appropriate support and contacts, create opportunities for training and obtaining the necessary information;

According to the characteristics of the working environment - fair pay, correct behavior of staff, aesthetic appeal of the environment;

2) designing an employee’s internal motivation involves:

Responsibility of the employee himself;

Freedom of his actions;

Employee participation in planning;

3) the concept of “equivalent exchange” - for monotonous industries, monotonous labor is “compensated”:

A variety of execution methods;

The pace of task completion (determined by the employee himself);

Place (conditions) of work;

4) the concept of “optimality” in the formation of labor motives, taking into account that:

Each person has an individual “threshold” of endurance, development, and perseverance;

Payment must meet the expectations of employees: expectations must be researched and specifically formed.

Social motivation is aimed at improving the working and rest conditions of members of labor and rest of members of the work collective, and increasing the social activity of workers. It includes:

1) stimulation with free time:

Providing the employee with additional days off and vacation for active and creative work;

Priority right to choose vacation time;

Organization of a flexible work schedule;

Reducing the working day due to high labor productivity;

2) medical care programs:

Organization of medical care;

Concluding agreements with medical institutions;

Allocation of funds for these purposes;

3) programs related to the upbringing and education of children:

Allocation of funds for the organization of preschool and school education for children of the organization’s employees;

Privileged scholarships;

4) payment of transportation costs or servicing with your own transport:

Fully serviced - permanent car with driver;

With partial service - a car with a driver for specific trips, reimbursement of travel expenses by own or public transport;

5) catering:

Creation of a place for food on the territory of the organization;

Payment of food subsidies;

6) housing construction programs (allocation of funds for own housing construction or on share terms);

7) flexible social payments (organizations set a certain amount for the purchase of necessary benefits and services);

8) life insurance at the expense of the organization:

Employee life insurance;

Payments from funds withheld from the employee’s income;

9) payment programs for temporary disability (usually at the expense of the organization);

10) medical insurance (both the employees themselves and their family members);

11) contributions to the Pension Fund.

Psychological motivation is based on a deep knowledge of the laws of human behavior, based on the structure of his personality, hidden from direct observation.

The most common incentives are those that regulate employee behavior based on the expression of public recognition of work: presentation of certificates and memorable gifts; posting a photo on the Honor Board.

The specific composition and structure of the motivational mechanism are determined by motivation methods: economic, social, psychological and organizational, the choice of which depends on the conditions created in the team and the desired results.

Many methods of motivation are difficult to attribute to just one type. As a rule, it is better to use complex motivation. For example, regularly applied economic methods (various remunerations, bonuses) will contribute to the employee’s feeling of satisfaction with the company’s policies towards its employees, his identification with the organization, and, consequently, there will be an impact on the psychological level. Also, the social methods used can partly be classified as economic, since, for example, the allocation of funds by an enterprise for food or for providing its own transport means a reduction in the employee’s personal expenses and contributes to the growth of his material well-being.

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The prestige of the company, customer appreciation and market position depend on the level of motivation of medical personnel. That is why it is important to maintain the level of motivation among clinic workers. A motivated employee means a successful clinic.

How to determine an applicant's interest

Each clinic employee must be motivated to work effectively, which is why, when selecting personnel, it is necessary to take into account not only the professional level of the specialist, but also the type of his motivation. This will help you find out whether the candidate’s expectations match the characteristics and specifics of the vacant position. There are a number of questions that will help determine the level of motivation of medical staff, for example: “Could the actions of the clinic manager make you give up?”, “What events in the clinic inspired you the most?”, “What would be the ideal job for a doctor?”

If the priority criteria when choosing a future job are a good salary and proximity to home, then this employee cannot be called motivated; most likely, he will not show personal interest in his work, will not take initiative, and will not improve the quality of the clinic’s service. The answers to questions like these will show you whether the applicant is used to working in a team, dealing with difficulties and is focused on results.

Types of staff motivation in a medical center

There are two main types of staff motivation in a medical center: material and intangible, each of them has its own pros and cons. Let’s figure out how to properly organize a motivational policy in a medical organization.

In most organizations, planning meetings are becoming commonplace and characterized by formalism. However, planning meetings are also a way to maintain staff motivation - discuss topical issues, comments and complaints from clients, and strive to ensure that staff are involved in solving the center’s problems. Teach them to openly express their own thoughts and give reasons.

An individual approach to communication with employees should become the main method of communication for the head of the clinic and a means of motivating staff in the medical center. Do not forget about evaluating the performance of subordinates - the praise of a manager or the recognition of colleagues is the best non-material reward and means of motivating a doctor. Communicate patient appreciation. Constructive criticism and individual praise will stimulate and increase the motivation of staff in the medical center.

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Professional deformation: indicators, problems, specifics, ways to minimize

A good way is to monitor the increase in the efficiency of the clinic by drawing up visual graphs; graphs can be published in internal newspapers or posted in the staff room.

Each clinic employee must be motivated to develop. This is a great way to avoid crisis stages in a doctor’s work or make them less noticeable. The opportunity for training and advanced training in the medical center contributes to a temporary change in activity and motivation of staff.

Another way of non-material motivation of staff is the leader’s brand; become an example and demonstrate your own achievements. Set goals equally with everyone, discuss progress or reasons for regression. Participate in the cultural activities of the organization; the staff should see that you are interested in the life of the clinic.

Organizational culture as the main component of physician motivation

What is the staff of a medical clinic? This is not just a group of people working together, these are like-minded people. The manager’s task is to make the staff a family, and the clinic a home.

Create the most comfortable working conditions: let the resident’s room always have cookies and sweets, a coffee machine and soft sofas, a beautiful clinic interior, cleanliness and order. Thanks to such important little things, the internal climate of the clinic is formed, and with it the indirect motivation of the doctor and other medical staff.

However, we should not forget that the psychological climate affects the motivation of the doctor no less than any other factors. And this is, first of all, a friendly team aimed at achieving common goals, a team of professionals ready to help and support each other. Such relationships are not formed immediately; you need to work on them. Perhaps among your colleagues there is a person who is ready to engage in joint leisure, organize holidays, and host company events. Entrust the work of staff cohesion to him or hire a knowledgeable person, for example, an event manager.

Material motivation of personnel: KPI system

Despite all the intangible benefits and ways to motivate a doctor, salary and incentive bonuses in the vast majority of cases are a fundamental tool for monitoring employee interest. Here we are talking about an accompanying component of motivation - the trust of an employee who not only knows what income is made of, but can also directly influence it.

One of the systems that a clinic can implement is KPI (Key Performance Indication) - it is suitable for assessing both the work of the entire clinic and each individual employee, and helps make the doctor’s financial motivation system as transparent and effective as possible. The system of indicators should be built taking into account the specifics of the clinic.

With the help of KPIs, planning targets are formed for employees, departments, and the clinic, and most importantly, it becomes clear what indicators should be focused on in order to achieve these plans. On the other hand, it becomes clear at what points this or that employee “sags”.

Motivational formula for calculating wages employee looks like:

Salary = Fixed part (salary) + Planned amount of variable part * (KPI1 coefficient * KPI2 coefficient * KPI3 coefficient).

KPI coefficients take values depending on the employee’s level of fulfillment of assigned tasks.

Indicators for the final work may be different. Let's consider several options, for example, Work quality indicator. The basis can be taken on disciplinary shortcomings in the employee’s work: absenteeism, tardiness,