Title explains it all really. I love the master, and after catching up on all of Season 12 I love Sasha's master especially - only problem is that it feels like a Sept character every time they regenerate. The Doctor is always the same core person deep down, but it feels like the Master's ideology and motivations change all the time. I'd love some help knowing what he planned to do each time, and why he wanted to do what he did.

Work motivation and the relationship between job motivation and individual performance are one of the key issues investigated in studies on organizational behavior and human resources (HR) management [1].


Doctor Motivation


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In the light of the above findings, it appears desirable to investigate the level of motivation among medical doctors working in public hospitals, their expectations in professional life, their job satisfaction and how these factors relate to the organizational effectiveness of hospitals.

medical doctors make the greatest contribution to overall healthcare services, and they are therefore committed to autonomy and only reluctantly submit to effective organizational and executive supervision; and

A different mindset (mentality) of executives and medical staff, further amplified by the diverse nature of their work, is another source of conflicts in the management of healthcare professionals. The work of a medical doctor is based on science and rationality, whereas management is inherently less deterministic and more open to free interpretation. Hospital doctors are empowered to decide how to provide healthcare services as well as to choose whether and which resources to use. The executive director of a hospital may find it difficult to regulate, measure, and control the work of medical professionals who are free to make autonomous decisions [13]. The differences are evident in the preference of hospital performance indicators. The executives prefer structural indicators related to organization and its output, such as formal qualification and number of staff, which they can influence, while physicians opt for process-based indicators related to outcomes that they can control, such as proper diagnosis [2].

Many authors also argue that mismanagement or poor governance is the main obstacle to improve healthcare performance [6, 14]. With the absence of a clearly defined strategy of HR management, many countries are facing employment instability that threatens to paralyze the healthcare system [15]. A severe shortage of medical professionals, especially medical and nursing staff, has become a global problem [16]. A downward trend in physician employment figures is also seen in Poland [17]. The current number of physicians per 1000 population is only 2.3 and is the lowest in the European Union, with the average doctor-population ratio of 3.5.

Effective work motivation of the medical staff may be particularly relevant for improving the overall healthcare performance; here, the role and skills of hospital management can hardly be overestimated [18]. The rule is simple: if the executives endeavor to satisfy the essential workplace-related needs of medical staff, healthcare professionals will care more about reputation of their institution and will be more likely to recognize and satisfy patient needs [19].

The significance of work motivation is more evident among medical staff than among other public service employees. An aspect common for all medical doctors is that they work with patients who require special care and attention. This implies commitment and dedication as well as the ability to cope with the mental burden of having to deal with difficult patient experiences [20]. WHO suggests that the motivation of healthcare professionals should be considered as the main indicator of the quality of healthcare services [21]. Physicians who are more engaged in their work obtain better treatment outcomes as well as higher personal and patient satisfaction than those who are less motivated [5, 22].

Given the scarcity of literature on this subject, there is less information on the factors that influence the commitment of medical staff as opposed to nursing staff [23]. An important study found that achievements (meaning of work, respect, and interpersonal relations) constitute the main motivation factor for medical doctors, followed by remuneration, cooperation, and work attributes [24].

It should be highlighted here that individuals who choose to become medical doctors are very focused on their professional success and are more interested in motivation drivers. For example, they want to know how well they perform [25, 26].

To gain competitive advantage, hospitals should conduct more training and development programs for medical staff [27, 28]. Performance feedback is particularly important for medical doctors. Knowledge and skills underpinned by clinical experience are the fundamental drivers of this profession [29]. Performance feedback is the starting point in planning professional development. It also helps to use reasonably the capacity of medical staff and contributes to better overall organizational performance [29].

It is important to create formal assessment processes that are beneficial for personal development and recognize individual accomplishments of employees. In the UK, National Health Service uses Individual Performance Review (IPR) to evaluate the performance of medical staff. This method helps to meet professional requirements in terms of goal-setting or employee development review, even among high achievers. David Wigley argues that the IPR system should cover both individual motivation [31] and external motivation [32], and then combine it with organizational development programs to create an appropriate organizational culture [31]. IPR is a tool that enables achievement of high productivity, improved performance, and overall commitment [32] as well as improved behavior and professional autonomy of medical doctors and their involvement in the ongoing changes [33].

Researchers have highlighted the significance of evaluating performance (unless something can be measured, it cannot be improved) [39]. They have also indicated the lack of systems to monitor and improve the performance of medical doctors [40]. Hospitals need better performance metrics and more widespread implementation of research and remedial action plans.

To boost the motivation of medical staff and hence to safeguard proper performance at both individual and hospital levels, healthcare centers should implement organizational and management processes to align the needs of healthcare professionals with organizational goals [41].

This study was approved by the Ethics Committee of the Medical University of Warsaw (Approval No. AkBE/116/15). The researchers duly informed heads of hospital departments and medical doctors about the study. The contact details of the researchers and research information were included in the questionnaires. Participation in the study was voluntary, and the questionnaires were completed anonymously.

Next, we examined whether a statistically significant correlation existed between the work motivation factors of medical doctors and the organizational performance of public hospitals in which they worked (Fig. 5).

The evaluation of factors that medical doctors working in public healthcare consider to be the determinants of job satisfaction can provide valuable insights on whether any measures are necessary to improve the conditions that cause their dissatisfaction with work and consequently improve healthcare services in general [51, 52]. It is known that neither job satisfaction nor motivation can be easily captured; however, once they are measured, they can help to maintain and improve the performance of healthcare professionals [53, 54]. Experts in HR management increasingly recognize motivation as the key feature in predicting the behaviors or aspirations of individual employees.

The quality of supervision and performance feedback from the management are the motivating factors with a lasting effect on attitude to work. Not only do they enhance job satisfaction, but they also improve organizational and staff performance [25]. In the present study, 54% of the study population were relatively dissatisfied with their performance feedback. Medical doctors with a nonsurgical specialty formed a significant part of respondents who were relatively satisfied. Similar conclusions were drawn from a survey of surgical interns in Wales, 70% of whom were not subjected to regular review [82]. In a study of surgical residents in Germany, only 18% of the respondents believed that the hospital was interested in their progress [83]. The studies also indicate another important issue, which is mainly related to doctors in surgical training. It is alarming that despite the legal requirements, many junior physicians are not provided regular feedback either from the head of department or from the supervising physician. This appears to be a worldwide problem [73]. Likewise, a study of military doctors conducted by S. Chaudhury in 2002 revealed that HR policy was the key determinant of job dissatisfaction, including employee performance reviews and poor opportunities for promotion as well as suboptimal use of the capacity of medical staff [51].

Motivation is the driving force of success in any organization. This is especially true in the healthcare environment in which the performance of individual healthcare units largely depends on the commitment and dedication of healthcare staff [23, 84]. However, motivation in itself is not sufficient to provide high work efficiency. It must be accompanied by high standards of management which can ensure that the efforts of the staff are used as effectively as possible. The results of analyses confirm that the quality of supervision and work motivation of medical staff are interrelated. It is also worth highlighting that surgeons are significantly more likely to be more dissatisfied with most aspects of work and organization as compared to nonsurgeons. Hence, programs designed to improve motivation of surgeons should be modified accordingly. 006ab0faaa

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