Health worker motivation reflects the interactions between workers and their work environment. Because of the interactive nature of motivation, local organizational and broader sector policies have the potential to affect motivation of health workers, either positively or negatively, and as such to influence health system performance. Yet little is known about the key determinants and outcomes of motivation in developing and transition countries. This exploratory research, unique in its broader study of a whole range of motivational determinants and outcomes, was conducted in two hospitals in Jordan and two in Georgia. Three complementary approaches to data collection were used: (1) a contextual analysis; (2) a qualitative 360-degree assessment; and (3) a quantitative in-depth analysis focused on the individual determinants and outcomes of the worker's motivational process. A wide range of psychometric scales was used to assess personality differences, perceived contextual factors and motivational outcomes (feelings, thoughts and behaviors) on close to 500 employees in each country. Although Jordan and Georgia have very different cultural and socio-economic environments, the results from these two countries exhibited many similarities among key determinants: self-efficacy, pride, management openness, job properties, and values had significant effects on motivational outcomes in both countries. Where results were divergent, differences between the two countries highlight the importance of local culture on motivational issues, and the need to tailor motivational interventions to the specific issues related to particular professional or other groupings in the workforce. While workers themselves state that financial reward is critical for their work satisfaction, the data suggest a number of non-financial interventions that may be more effective means to improve worker motivation. This research highlights the complexity of worker motivation, and the need for a more comprehensive approach to increasing motivation, satisfaction and performance, and for interventions at both organizational and policy levels. (C) 2003 Elsevier Science Ltd. All rights reserved.
