INFLUENCE OF EXTRINSIC MOTIVATION ON EMPLOYEE’S PERFORMANCE IN MOI
TEACHING AND REFERRAL HOSPITAL ELDORET, KENYA
Background of the Study
Researchers and managers have believed that organizational objectives and goals are
unachievable without enduring commitment of members and employees of the organization. The
worlds are going through an enormous change. Globalization of businesses is increasing and
information technologies are advancing (Dockel, 2003). These major changes reshaping our
significantly, for better and for worse (Keritner, 2004). They lead to changes in the way business
is done, the way employees behave and the way managers manager their employees. For
companies to remain successful, they are required to adapt to these changes (Vercueil, 2001). The
changes that are reshaping the world have altered the way organizations operate and have also led
to changes in employee characteristics (Robbins, 2000). When employees have high autonomy,
receive feedback about their performance, and have an important, identifiable piece of work to do
which requires skill variety, they may experience feelings of happiness and therefore intrinsic
motivation to keep performing well (Hackmam & Oldham, 1980).
Frederick Herzberg, distinguished professor of Management at the University of Utah and
Behavioral theorist conducted studies on worker motivation in the 1950's. He developed the
Motivation-Hygiene theory of worker satisfaction and dissatisfaction. This incredible researcher
concluded that hygiene factors such as salary, fringe benefits, and working conditions can prevent
dissatisfaction, but they do not motivate the worker. He found that motivators such as
achievement, recognition, responsibility, and advancement increase satisfaction from work and
motivate people toward a greater effort and performance. Herzberg and other behavioral theorists
were influenced by the writings of Abraham Maslow, a theoretical psychologist who analyzed
what human beings seek in their lives and developed the Needs-Hierarchy concept.
Of the many theories of work motivation, Herzberg's (1966) motivator-hygiene theory has been
one of the most influential in recent decades. Basically, the theory divides motivating factors
into two categories: Motivator factors, which have something to do with the work itself, and
Hygiene factors, which have something to do with the surrounding context.
Motivator factors include such things as responsible work, independence in doing the work, and
satisfaction arising from the completion of challenging tasks. Hygiene factors include pay,
security, and general working conditions. According to Frederick Herzberg, hygiene factor
operate primarily as de-motivators if they are not sufficient. He suggests that workers are most
satisfied and most productive when their jobs are rich in the motivator factor. When the work is
interesting, he suggests can be accomplished by the job enrichment
According to Greenberg (2003) and Baron (2000) definition of motivation could be divided into
three main parts. The first part looks at arousal that deals with the drive, or energy behind
individual (s) action. People turn to be guided by their interest in making a good impression on
others, doing interesting work and being successful in what they do. The second part referring to
the choice people make and the direction their behaviour takes. The last part deals with
maintaining behaviour clearly defining how long people have to persist at attempting to meet their
goals. Motivation can be intrinsic and extrinsic. Extrinsic motivation concerns behavior
influenced by obtaining external rewards (Hitt, et al, 1992). Praise or positive feedback, money,
and the absence of punishment are examples of extrinsic or external rewards (Deci, 1980).
On the global scale, extrinsic employee motivation is of great importance in the health sector so as
to ensure staff retention as well as enhance the provision of quality services in that sector. The
employee retention rate can indicate how well an organization or institution maintains employee
satisfaction. A key constraint to achieving the MDGs is the absence of a properly trained and
motivated workforce (Griffin, 2012). Loss of clinical staff from low and middle-income countries
is crippling already fragile health care systems. Health worker extrinsic motivation is critical for
health system performance and a key problem is how best to motivate and retain health workers.
While motivational factors are undoubtedly country specific, financial incentives, career
development and management issues are core factors. Nevertheless, financial incentives alone are
not enough to motivate health workers (Schermerhorn , 2010). It is clear that recognition is highly
influential in health worker motivation and that adequate resources and appropriate infrastructure
can improve morale significantly. While medical migration may be dire for some countries,
others intentionally export health workers in exchange for financial remittances. For example,
Filipino nurses are actively exported for which the Philippines receives over USD800 million
annually (Hongoro, 2006). There is, however, no mechanism to ensure that repatriated income
will find its way into health care. Furthermore the loss of experienced personnel has a serious
impact on health system progression (Fargus, 2000).
Nigerian authors Gbadamosi and Adebakin, (1996) state that motivation is an aspect of the
behavioural sciences that attempts to answer the question of why human beings behave the way
they do. Ott, (1989) had concluded from his studies that achievement; recognition, the work itself,
responsibility, advancement and growth are major satisfiers because of their positive influence.
More recent studies have advanced on Herzberg„s position. While there are studies to support
Herzberg‟s list of satisfiers in his sequence, there are questions as to the position or order of these
satisfiers.
Generally, an employee who is motivated will try harder to do a good job than one who is not
motivated. The level of performance attained is determined by three interdependent factors;
ability, motivation and resources. Ability and motivation are driving forces of behaviour to create
the level of performance.
There is a growing need to strengthen health systems in East African countries to help meet the
Millennium Development Goals (MDGs). It is widely accepted that a key constraint to achieving
the MDGs is the absence of a properly trained and motivated workforce and improving the
retention of health workers is critical for health system performance. East African countries such
as Tanzania need at least half a million additional workers in order to offer basic services
consistent with the MDGs (WHO, 2006). Instead, these countries are affected by health worker
loss crippling already fragile health care systems. Nurse migration has been shown to be
motivated by the need for professional development, better quality of life and personal safety. An
estimated $500 million is spent annually on medical education of workers from Africa who will
eventually emigrate (WHO, 2006).Targeted recruitment drives for health workers from resource-
poor countries have become a common solution to filling vacancies in richer countries. A medical
carousel whereby health workers move to countries offering attractions such as better salaries and
training opportunities typically leaves the poorest countries with all drain and no gain (Stilwell et
al, 2003). Health worker loss can compromise health system capacity to deliver adequate care as
the more experienced workers migrate because their skills are highly desired. Staff shortages
increase workloads and stress levels, further de-motivating remaining staff. To cope with
increased workload, staffs sometimes lower their standard of care (Mays, 2005). Health worker
migration is not confined to external movement. In-country migration, from rural to urban and
from public to private sector, is also creating problems with the rural areas worst affected leaving
these both understaffed and the staff who are there are often under qualified (Greenhalgh et al,
2005).
The Kenya health sector has made remarkable strides in the provision of health services. There is
however a wide gap in the health services between the private and the health sector. There is a
huge preference of the services from the private institutions. It is estimated that 47% of the health
services in Kenya is provided by the private sector whereas the public sector owns 33% and the
rest by charity and non-governmental organizations (Kirigia, 2006). These statistics are however a
point of concern when compared to the number of health professionals leaving the private
institutions that provides health services. In Kenya alone, US$65,997 is spent educating a single
medical doctor from primary school to university and for every doctor who emigrates;
US$517,931 returns in investment are lost (WHO, 2006). There is a lot of brain drain as a result
of healthcare professionals migrating to seek greener pastures (Drischel, 2005).
Moi Teaching and Referral Hospital (MTRH) is the second National Referral Hospital in Kenya.
It is located in Eldoret, in the Rift Valley Province of Kenya. It was opened in 1917 as a
cottage hospital and it was not until the establishment of Moi University in 1984 and the
subsequent establishment of the Faculty of Health Sciences at the University that the hospital
elevated from a district hospital to a teaching and referral institution.The hospital has an 800 bed
capacity and received patients from western Kenya, parts of Eastern Uganda, and the southern
Sudan. The hospitals employees a large number of employees who have to be motivated to
perform better and stay with the organization.
Statement of the Problem
Employees are extrinsically motivated if they are able to satisfy their needs indirectly, especially
through monetary compensation. Money is a “goal which provides satisfaction independent of the
actual activity itself” (phalomano, 2003). Extrinsically motivated coordination in firms is
achieved by linking employees‟ monetary motives to the goals of the firm. The ideal incentive
system is strict pay-for-performance. Although many economists admit the existence of intrinsic
motivation, they leave it aside because it is difficult to analyze and control (Williamson, 1985).
Even if the assumption of opportunism is an “extreme caricature” (Fox, 2007) opportunism as a
“worst-case scenario” is a prudent consideration when designing institutional structures
(Williamson 1996). Transactions cost theory goes a step farther by assuming that individuals are
opportunistic and seek self-interest with guile. Opportunism is a strong form of extrinsic
motivation when individuals are not constrained by any rules.
Ideally, the Public health sector is supposed to provide thriving work environment that will
enable the employees to perform at their best and give maximum output. The public health sector
is also allied with staff trainings to maximize the productivity of the employees and ensure
maximum returns for the organization (Latham, 2007). The public health sector should provide
the employees with good compensation packages and provide opportunities for career growth.
The public health sector should provide adequate opportunities for their staff to realize expand
and exploit their talents and capabilities to their fullest potentials. The health sector has plenty of
opportunities to promote the overall growth of the employees as well as the organization itself
(philps, 2012).
The current situation in the Kenya‟shealth sector is worrying with the most complaints emanating
from this sector. There are numerous complaints of staff exploitation and neglect (Numerof,
2003). Most often, the cases of lack of compensation for work done by the workers have become
a norm. There are issues of high employee turnover among other employee related issues. Despite
these numerous problems with employees in Kenya‟s public sector no study has been done on
employee motivation in this sector.
According to workers compensation and employment Act (2006), organizations are legally
required to provide the above benefits to their employees and worker compensation
ACT (CAP: 225), which emphasizes social security and provision of financial assistance to those
who lose jobs through no fault of their own. Despite of the above ways of motivating employees,
performance in organization is still poor in form absence at work, late coming, and insufficient
construction of responsible employees among others in Moi Teaching and Referral. The staff
appraisal exercise has also shown that duties and responsibilities are not being adequately carried
out, with low scores observed in many cases. This is revealed through the appraisal files that are
filled annually and kept in the Human resource office. Some line managers have shown great
weakness in the supervision of their subordinates, with the appraisal assessment not carried out.
This is shown by the missing appraisal files of some workers, who are not appraised as demanded.
In relation to management a lot of directives are given to the employees to produce tangible
results and yet little attention is given to adequately motivate their efforts. This can be observed
by the directives of meeting deadlines to produce documents, keeping punctuality, warning letters
in cases of indiscipline with few inadequate incentives to encourage good performance. The study
therefore seeks to find the effects of motivation on staff performance in the Health Services of
Kenya, in MTRH. Significance of the Study
The findings of this study will help human resource management in Moi Teaching and Referral
Hospital (MTRH) Eldoret on realizing the influence of extrinsic motivation on work performance
in the organization and development plan on improving or sustaining the employees effort.
The study will be very useful to other researchers interested in the area of extrinsic motivation.
That is, the outcome of this study will serve as a base for academicians who want to conduct
further studies on the Influence of extrinsic motivation practices on staff performance especially
in the health sector for the betterment of the Health service in Kenya.
Scope of the study
The study was carried out at MTRH Eldoret. The organization was selected because of its
accessibility of the researcher and being one the organization that has employees of different
categories. The organization also has a lot of challenges on work performance due to the kind of
services they provide to the clients based on experience in the centre.
Basic Assumption
This study makes an assumption with an expectation that all respondents were expected to be
honest, accurate and detailed in providing information.
Limitations of the Study
In the process of conducting this study, the following limitations were anticipated:
The management of MTRH may deny the researcher access to the facility since the respondents
may not understand the real intention of the study or may be too busy doing their work. They may
also fear giving out information for fear of victimization. The researcher overcome all this by
assuring the respondents that the study was for academic purpose only and the information given
had to be treated with utmost confidentiality. The researcher used a letter from his college to
ascertain to the respondent that the data to be collected is to be used for academic purposes only.
The institution’s administrators may also object to the research being carried out in their facility
due to the altering of the various routine programs and schedules. The researcher thus sought to
make appointments with the management so that they can amicably arrange for a convenient time
to conduct the research. This ensured that the researcher was able to collect the data required for
the study within the scheduled time without interfering with the company’s normal functioning in
Kenya, the study will only analyze data from MTRH. This because this is a national hospital with
many employees and the findings from it can easily be applied to other hospitals. This study laid
more weight in on motivation factors in MTRH in the last five years (2009-2013). Although
MTRH has been in place for a much longer period, this study is more interested in relation the
prevailing conditions in the recent past. The content scope of this study was limited to the
following determinants of extrinsic motivation; salary, employee promotion, employee training
and the working environment. This is because these are the major factors identified by other
studies as the major determinants of employee motivation.
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