CHAPTER I – THE PROBLEM AND ITS BACKGROUND

Introduction

For a third world country like Philippines, in health care setting, one of the

major problems that our government faces is how to improve the productivity

and performance of health workers to ensure that health interventions are

appropriately and efficiently delivered to the patients. Human resources for

health, consisting of clinical and non-clinical, are the most important assets of

health systems. The performance of hospital depends on the knowledge and

skills of the individuals providing quality care. Therefore, the organization

should provide a positive working environment among employees to ensure

that their performance meet the standards of care.

Though our country have oversupply of nurses, government agencies such as

the Department of Labor and Employment (DOLE) and Professional

Regulations Commission (PRC) said that there are enough demand in the

global market to neutralize the surplus of Filipino nurses; recruitment agencies

said that the real problem lies in the fact that many nursing graduates are

unqualified.

According to Jackson Gan, the vice president of the Federated Association of

Manpower Exporters, most newly registered nurse in the Philippines are

unqualified because it is either that they do not have training or two years
work experience in big hospitals. This is because the Philippines does not

have enough government and private hospitals with 250-bed capacity.

Gan said, "The most modern private hospitals in Metro Manila have on

standby pools of nurses who want to work even as trainee nurses for free just

to get the experience required by foreign hospitals. Government hospitals like

the PGH [Philippine General Hospital], Jose Reyes, the Heart Center, and

others have on their waiting list hundreds of nurses who want to work on

those hospitals for the required training and experience."

This study is designed to identify and analyze factors that negatively and

positively affect the performance of professional nurses in Dr. Jose N.

Rodriguez Memorial Hospital and to explore factors that are strongly

associated with improved performance in order to suggest strategies for

improving their performance.

THEORETICAL FRAMEWORK

Bennett and Franco (1999:4) proposed a framework of factors that influence

work motivation. It shows a complex links and interaction between work

motivation, performance, and organizational factors within the health sector

environment:

• Workers’ individual factors such as goals, self-concepts, expectation,

workers’ capability and workers’ experience of outcomes are some of

the individual’s determinants of motivation.

 • The organizational factors and systems in which the worker is

operating the inputs such as drugs, supplies, support and feedback will

affect the outcomes of performance.

• The social and cultural factors which are outside the organizational

environment which includes issues such as the interaction between

health worker and the client, the expectations from the community on

how health care services should be delivered may affect motivation for

performance.

• The interaction between individual, organization, social and cultural

factors has been recognize as a dimension of performance. According

to Bennett and Franco (1999:4), the role of the organization is to

communicate its goals, as well as the process and resources for

achieving these goals, additional goals are put in place a system of

feedback and to develop staff knowledge and skills.

Bennett and Franco mentioned that problems of low motivation identified in

developing countries results in lack of courtesy to patients, high level of

absenteeism and poor quality of health care such as poor patient examination

and failure to provide timely treatment to patients.

Sharpley (2002:3) proposes a model that identifies individual perceptions (self

belief, anticipating success and critical thinking), experience of work (personal

impact, competency, meaningful work, feedback and discretion) and work

outcomes (job satisfaction, work stress, empowerment and motivation) as

differences in individuals that affect their experience at work.

In addition, organizational factors such as managerial support, colleague

support and organizational culture are associated with high performance.

According to him, interventions depend on all the above mentioned factors as

well as the overall attitude and communities by the organization which will

eventually lead to the achievement of organizational goals.

In this study, a combination of the conceptual framework of Bennett and

Franco (1999) and the model of Sharpley (2002) will be utilized as a

theoretical basis on which thid study is based and will be called the

Performance Model. This model consist of the following:

• Saocial factors that include expectations from the community, social

values, and cultural beliefs;

 • Individual factors that include issues of individual perception,

experience of work and individual work outcomes; and

• Organizational factors which include issues of performance

management style, strategic coherence, norms and standards,

communication, supervision and reward.

The performance model will guide the study as well as the development of a

framework for monitoring and improvement of performance of nurses.

According to this model, the variables and processes affecting performance of

nurses would include job satisfaction; goals and objectives; organizational

culture and support; management style, feedback and communication; and

the physical environment. Intrinsic factors such as motivation, self perception,

values and beliefs, incentives, rewards and employee benefits, knowledge

and skills are also important.

STATEMENT OF THE PROBLEM

Health care delivery is highly labour-intensive. The quality, efficiency and

equity of services are all dependent on the availability of skilled and

competent health professionals when and where they are needed. It is

essential that health workers are appropriately trained to deliver the required

services at a high standard.

Here in Philippines, the issues of performance and factors affecting

performance are not adequately addressed. In response to these concerns, a

study is proposed to answer these questions:

 Which factors affects the performance of newly registered nurses both

positively and negatively?

 Are nurse managers equipped to facilitate good performance of their

subordinates?

 Which strategies could be suggested to increase the performance of

professional nurses?
HYPOTHESIS

Working environments affect the performance of newly registered nurse in

relation with their nursing practice.

Working environment does not affect the performance of newly registered

nurse in relation with their nursing practice.

ASSUMPTIONS

The study aims to manage changes in nurses’ performance so as to improve

the performance of newly registered nurse in Dr. Jose N. Rodriguez Memorial

Hospital.

The objectives of this study are to:

1. Determine factors which positively and negatively affect the

performance of professional nurse;

2. Ascertain the skills and competencies of nurse managers in order to

facilitate good performance by their subordinates;

3. Propose strategies that could improve performance of professional

nurses.
SCOPE AND LIMITATION OF THE STUDY

The study will be conducted at Dr. Jose N. Rodriguez Memorial Hospital,

Tala, Caloocan City. The respondents will be 50-100 newly registered nurses

that are currently on the first month of their training and 10-20 nurse

supervisors. The study will be held from December 2010- March 2011.

SIGNIFICANCE OF THE STUDY

This study should support nurses in management positions and professional

nurse to identify factors that affect performance. It should also encourage and

motivate them to improve the overall performance of nursing personnel to

contribute to achievement of organizational goals.

DEFINITION OF TERMS

The following terms are relevant to this study:

Benchmarking: is the process of comparing one’s performance with the best

performance to become “the best of the best”.

Competency: skill, knowledge and attitude acquired through training,

education and experience, and performed to specific standards under specific

conditions.

Human Resources for Health: health workers, all persons working in Health

Care Delivery System. It includes private practices and health related

institutions, personnel working in units that supply medical aids, staff in

administration of a health sector, health information system, and supplies or

equipment for health care units.

Outcome Measurement: any measurement system use to identify the health

outcome of treatment of the patient.

Performance: means “to carry out, accomplish or fulfil an action or task”. It

also means “to work, function or to do something to specific standards”.

Performance Management: in the context staff management, it is about

helping people to work effectively by improving individual land team

performance, increasing the productivity of the organization.

Professional Nurse: a person who registered with the nurse regulatory and

registering authority of their country. Also called registered nurse working in

clinical area, nursing service and educational institutions.

Skill: the ability to perform task or group of task that often requires the use of

motor functions, specific knowledge and skills.

Standards of quality: the minimum level of acceptable performance, or the

range of acceptable performance result. Standards can be based on specific

knowledge and professional consensus.

Work environment: characteristics of the environment in which a person is

expected to work. It includes physical and social environment, employment

conditions and benefits.

Workforce: people who work in a various professions of health care, that is

doctors, nurse, midwives, pharmacist, dentist, allied health workers,

community health workers, paramedics, whose goal is to improve the health

of the population they serve.