Trust and motivation in the health sector : a systematic review

Supporting improved performance of health workers is vital in health system strengthening. There are several factors that have been identified as playing key roles in influencing health worker performance. Motivation of HWs is one of the areas for improving delivery of health care services, yet it is under investigated. Moreover, the mechanisms underlying the interactions between motivation and other variables such as workplace trust relations are largely unknown. This dissertation is organised into three parts. Part A is the review protocol which outlines the background and the review methodology. A qualitative systematic review approach is adopted and literature search of the five chosen databases is conducted using keywords and phrases derived from the review question. Defined inclusion and exclusion criteria are used to identify and select suitable articles. An appropriate tool is then used to appraise selected articles which are then subjected to thematic analysis. Part B is a literature review of existing empirical and theoretical work on health worker motivation. It provides the background to the systematic review in Part C. It defines the word motivation as used in the health sector, and then explores empirical work on health worker motivation using an appropriate conceptual framework. The literature review further summarises and concludes on the possible link between trust and motivation in the health sector

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

BACKGROUND: Dedicated and motivated health workers (HWs) play a major role in delivering efficient and effective health services that improve patients' experience of health care. Growing interest in HW motivation has led to a global focus on pay for performance strategies, but less attention has been paid to nurturing intrinsic motivation. Workplace trust relationships involve fair treatment and respectful interactions between individuals. Such relationships enable cooperation among HWs and their colleagues, supervisors, managers and patients and may act as a source of intrinsic motivation. This paper presents findings from a qualitative systematic review of empirical studies providing evidence on HW motivation, to consider what these studies suggest about the possible influence of workplace trust relationships over motivation. METHODS: Five electronic databases were searched for articles reporting research findings about HW motivation for various cadres published in the 10-year period 2003 to 2013 and with available full free text in the English language. Data extraction involved consideration of the links between trust relationships and motivation, by identifying how studies directly or indirectly mention and discuss relevant factors. RESULTS: Twenty-three articles from low- and middle-income countries and eight from high-income countries that met predetermined quality and inclusion criteria were appraised and subjected to thematic synthesis. Workplace trust relationships with colleagues, supervisors and managers, employing organisation and patients directly and indirectly influence HW motivation. Motivational factors identified as linked to trust include respect; recognition, appreciation and rewards; supervision; teamwork; management support; autonomy; communication, feedback and openness; and staff shortages and resource inadequacy. CONCLUSION: To the authors' knowledge, this is the first systematic review on trust and motivation in the health sector. Evidence indicates that workplace trust relationships encourage social interactions and cooperation among HWs, have impact on the intrinsic motivation of HWs and have consequences for retention, performance and quality of care. Human resource management and organisational practices are critical in sustaining workplace trust and HW motivation. Research and assessment of the levels of motivation and factors that encourage workplace trust relationships should include how trust and motivation interact and operate for retention, performance and quality of care