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Contents
INTRODUCTION ...................................................................................................................................... 2 Motivation .......................................................................................................................................... 2 Motivation Theories ........................................................................................................................... 2 Leadership .......................................................................................................................................... 7 Groups and teams .............................................................................................................................. 9 RECOMMENDATIONS ....................................................................................................................... 10 CONCLUSION .................................................................................................................................... 10 REFERENCES ...................................................................................................................................... 11

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INTRODUCTION
Today we are witnessing the era of globalization, in which the movement of capital, people and knowledge are constant, amplify the patterns of demand and competitiveness, and financial pressures are increasing. An only company with competitive advantages is that it can survive and overcome the competition, increasing the life cycle of their products and/or services and its profits. This reality affects all businesses and industries in general, but in particular the hospital industry, because it is inserted in a highly competitive business, where quality of service is a critical success factor. The performance of the employees of a hospital is associated with the quality of services because the customer will interact with the employee. That is, the performance of employees has a significant impact on hospitals, because their level of motivation and commitment will make all the difference between a mediocre service and high quality service. Similarly, but in a different light, we have the leadership that today is a hotly debated topic, increasingly being assigned to lead a vital role in the performance of an organization. In this context this study aimed to contribute to the improvement of knowledge level of the hospital industry in Rossett NHS Trust, particularly in terms of human resources and leadership. On this report we will look a case study, it will talk an attempt to introduce multiskilled, wardbased teams of support workers in a Rossett NHS Trust hospital, a medium-sized hospital in the UK, which in this particular site operate with 250 people.

Motivation
Robbins (1996: 212-213) explains that the motivation correspond to the wish of exercise high levels of effort in view of the organization's goals, conditioned by the ability of effort to satisfy some individual need. Rosenfeld and Wilson (1999: 74-75) argue that motivation is the level of willingness on the part of an individual to increase the effort, to the extent that this additional meeting some needs. The motivation is then, no doubt, responsible for stimulating and channeling human behavior in order to achieve a particular goal and that in this context stimuli serve as drivers of human action. So the motivation will be significant in the manner and intensity that will be used by an individual to perform a given task.

Motivation Theories
The motivation has captivated over time the attention of many scholars, who try to understand the behaviours and attitudes of employees in organizations, so that it can predict and control employees performance. Thus, there were a number of ideas, giving rise to different theories and perspectives of looking at motivation at work. On the basis of most theories of motivation is the interaction between the situation, needs and driving forces of individuals (Wilson & Rosenfeld, 1999: 75). According Lashey and Lee-Ross (2003: 93) these "theories can be separated into two groups depending on whether the focus on meeting the needs of individuals or the cognitive processes involved when establishing priorities with their motivational needs". HRM Director at NHS Trust, felt it would improve worker motivation as porters would feel part of a team and be included if chocolates were give out or nights out were planned. They would take a pride in their work and be recognised at ward level.

Needs Theories
The group of theories of individual needs, as an explanation of the process motivation of individuals, highlights the internal needs of people and behaviour resulting from the effort they made to reduce or satisfy these needs. The needs theory more relevance are: the BUS723 - Multiskilling at Rossett NHS Trust INTRODUCTION 2

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Needs Theory of Maslow's, the Needs Theory of Frederick Herzberg, the Theory of Needs Alderfer (ERG) and the Theory of Needs McClelland.

Maslow's needs theory

The Maslow Theory of Needs comes in 1954 with a representation of human needs pyramid, stating that individuals construct their priority needs in accordance with a distinct internal hierarchy. Maslow (1943: 22-23) argues that people are motivated by the desire to attain or maintain the various conditions under which is the basic satisfaction and by certain more intellectual desires. Maslow's theory is based on three major assumptions: Principle of Dominance, which corresponds to the fact that human behavior is influenced by the unmet needs; the principle of hierarchy, which corresponds to the fact that needs can be assembled according to a hierarchy; Principle of Emergency, in which one level of needs emerges as a source of motivation and consequently will determine the individual's behaviour, only when the requirements of level or lower hierarchical levels are met. Through Figure 1 it can verifies that the needs of individuals are ranked from the bottom to the top of the pyramid and the importance of these moves in that direction. The pyramid is divided into five levels, each with a specific set of needs: the first level (base) are physiological needs, which relate to food, rest, shelter and sex on the second level are the needs of safety, which relate to security and protection against danger, disease, uncertainty, unemployment and theft, on the third level are the social needs that include the relationship, acceptance, friendship, understanding and consideration for others, the fourth level are the esteem needs, which relate to pride, self-love, progress, trust, recognition, appreciation and admiration for others, in the fifth and final level are the need for selfrealization, which refer to the realization full of every individual, personal development and improvement of their talents. Figure 1: Maslows theory on the hierarchy of human needs

Source: Adapted from http://steves.seasidelife.com Thus, the motivation is stimulated by the level which is still not satisfied. This means that individuals are motivated to satisfy needs that are unsatisfied. At the time that the level of BUS723 - Multiskilling at Rossett NHS Trust INTRODUCTION 3

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needs is satisfied, the next level of needs becomes more important, causing individuals to expend a set of efforts to meet them, and this evolution, i.e., rising from one level to another, made from the bottom to the top of the pyramid of needs. According to Maslow's no need is fully satisfied, but need can only have a highhanded action, when there is a high degree (but not complete) satisfaction. "The main consequence of the satisfaction of every need is a need that is submerged and a high level of new need arises" (Maslow, 1987: 33). Although Maslow's Needs Theory is based on an intuitive logic, the reality is that empirical tests of this theory have been limited and recent studies show that its predictive power may be ambiguous (Lashey & Lee-Ross, 2003: 94-95) has also been criticized for being static, descriptive and overly devoted to the ideological side (Wilson & Rosenfeld, 1999: 75-76). However still the best known theory of motivation in the world due to its approach, which appeals to common sense and be easy to use. In trust scenario Many of the porters, almost exclusively male, quite openly expressed their unwillingness to undertake cleaning duties, which some thought were womens work. This gender issue raised its head in many consultations between porters and managers and was a frequent topic of conversation between porters. In other words, porters are not motivated to perform certain tasks. In the case of Rossett NHS Trust directors only concern about successful implementing the generic work it benefits which would help to provide good value for money and make cost savings. Therefore, it seems that NHS Trust dont really care about the need of its employees.

Equity theory
According to equity theory, each person would tend to compare what is offered as a reward for their performance with what was offered to people like him. In this comparison, implies the pursuit of fair treatment, or, as stated by the theorists, the pursuit of equity (Bergamini, 1997). In the interpretation of Robbins (2002), employees make comparisons between their work - inputs (effort, experience, education, competence) and results (pay, raises, recognition) - and the inputs and results of others. When they realize that relationships are unequal, they experience a tension of equity. This state of negative tension provides a motivation for broker action (Adams quoted in Robbins, 2002). As proposed by Adams (cited Bergamini, 1997), those who contribute most to an organization also expect to receive more in terms of reward. In this sense, the theory provides useful guidelines for equity so that we can understand the different types of social relationships in the workplace. It is essentially based on the comparison necessarily imply the existence of a reference point for this comparison to performed. Robbins (2002) states that, according to the theory of equity, when the worker perceives an injustice, he is expected to make one of these six choices: 1. "Change their inputs (make less effort) 2. Change their results (for example, employees can receive part produced by increasing their incomes by producing more parts with less quality) 3. Distort their self-image (for example: "I thought I worked at a moderate pace, but I realize now that I work much more than others ") 4. Distort the image of others (for example: "Mike's work is not as interesting as I thought it was "). 5. Search another point of reference (for example: "I may not be earning as well as my brother-in-law, but certainly more than my father made when he was my age"). 6. Leave the ground (for example, leaving the position)" It is important to note that employees seem to seek equity in the distribution of other organizational rewards. For example, the positions of status and luxurious offices in the equation results serve as equity for some employees (KING, MILES DAY cited and ROBBINS, 2002). BUS723 - Multiskilling at Rossett NHS Trust INTRODUCTION 4

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In organizational terms, the Equity Theory is strongly related to the remuneration and distribution of benefits and recognition among their employees. These processes, if not well managed can undermine the social climate of the organization, contributing to creating a work environment where there is perceived injustice and consequently without stimuli for motivation to work. All existing formal status and pay differentials between members of Hotel Services, with the exception of management, would be removed. As a consequence of generic working, many staff were to be upgraded and all would receive a basic pay rise representing 2 per cent for porters and 8 per cent for domestic staff. Performance pay was to be based on attendance. Overtime and weekend working would be carefully monitored in an attempt to reduce costs. In this situation it would be unfair because if they were to perform same duties by rotating roles if the implementation succeeds staff members should receive equal amount.

Theory of Dual factors

According to Herzberg (1997, 61), creator of the theory of dual factors: "The factors involved in producing the satisfaction (and motivation) in the work are separate and distinct from factors that lead to job dissatisfaction. Since it is necessary to consider separate factors, depending on whether we are examining the satisfaction or dissatisfaction at work, it follows that these two feelings are not antagonistic. The opposite of job satisfaction is not job dissatisfaction, but the absence of satisfaction, and, similarly, the opposite of job dissatisfaction is not job satisfaction, but no satisfaction". This theory divides motivation into hygiene and motivators factors, and the hygienic cover all the benefits offered by the company, such as working environment, relationship with superiors, job security, wages and social benefits, which are seen as that can generate dissatisfaction and, when these factors are appropriate, people will not be dissatisfied. Since the motivating factors that are related to the position held by the employee and covers: recognition and opportunity for advancement, responsibility and achievement and lead officials from states of non-fulfilment to the state of satisfaction (PONTES, 2002). Figure 2, shown below shows the model of Herzberg.

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Source: Adapted from Robbins (2002, p.56) Herzberg was a staunch defender of intrinsic motivation, emphasizing the limitations of rewards and extrinsic punishments. Its proposition is the motivation for their work, to be achieved through job enrichment (Vroom, 1997). For Herzberg (1997), the enrichment of the job is how to increase employee satisfaction, as this offers the opportunity to enrich psychological growth of the employee. It is a proposition that should not be deployed at once, but continuously. The initial changes should last a fairly long period and should boost the position up to the level of the skill challenge hired. Those with greater ability can best demonstrate this ability and achieve promotions to higher positions. The major contributions of the two factors theory to understand the motivation for the study were: the possibility that the employee has greater autonomy for planning and carrying out their work, the appreciation of the enrichment processes of positions and a different approach on the role of remuneration on the motivation to work. Denise Lipton, the manager responsible for establishing the pilot scheme which ran on one large ward, argued that The domestics think its a great idea, Women will go for it to see men cleaning and they really enjoy the varied workload. Others attempted to explain why staff were positive about change with comments like, Now they dont know what other duties theyre going to be doing and they really enjoy that, so their job satisfaction has gone up. Thats doesnt seems good practice in term of leadership roles, because it doesnt go accordingly with Herzberg theories practices. Among these factors, security and relationship status with colleagues is not seen present at NHS Trust. With change implementation in NHS Trust, employees wont get a good salary which may not be satisfactory. Apart from basic salary, employees would get bonus BUS723 - Multiskilling at Rossett NHS Trust INTRODUCTION 6

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according to their performance which could be inexistent because of lacking in motivation from staff member which would lead to a poor performance. At NHS Trust there are not suggestions and feedbacks from employees which could be at first stance always welcomed and it seems there is no relationship between staffs and directors. Staff is discontent or dissatisfied with management at NHS Trust. The team might fail to move on to the next stages in their reactions to change, and commitment to the change process wont develop.

Leadership
Leadership has been studied, and there are several concepts formulated by different authors: "It's the ability to mobilize free individuals, employees, to raise their voluntary participation in the achievement of objectives" (DULUC, 2000: pag.79). "Leadership its about courage and capacity to lead a company forward and progress, despite all the difficulties that might sow in the way" (Adair, 1993: p.12).

Leadership Theories
Traces theory
According to Robbins (2007), this theory divides the traits of a leader in social, physical, intellectual or personality. The difference between leaders and non-leaders can be observed through seven basic traits: ambition and energy, desire to lead, honesty and integrity, confidence, intelligence, high self-monitoring and knowledge relevant to the job. Extraversion appears to be the most important aspect of effective leader (Robbins, 2007).

Behavioural theories
The difference between the approaches of the traits and behavioural traits is that they assume that the leadership skills are innate. The behaviour, in contrast, it believes that these skills can be taught.

Theory of contingencies
The theory of contingencies, finally, emphasized that one should also focus on the influence of the situation. Some approaches to the identification of basic situational variables were more successful than others and thus received wide recognition, namely: Fiedler's model, situational theory of Hersey and Blanchard; theory of exchange between leader and led, goal and path models, and models of participation and leadership (Robbins, 2007, p. 263). In the model of Fiedler effective group performance depends on the fit between leader style and the degree of control that the state gives (ROBBINS, 2007, p. 263). If leader wants to increase organizational and group effectiveness, they must not only train more effectively the leaders, but also to build an organizational environment where he can do well (Bergamini, 1994, p. 55). For Fiedler's contingency theory, the supervisor must establish interpersonal interactions between group members and between the leader and each member of the group, so that they expand the tuning ability of the individual. It should also work in favour of the individual motivation of each member and dismiss an individualized training for each lead (Bergamini, 1994, p. 55). NHS Trust sounds that is lacking of relationship between leader and its employees. Employees are not being involved in group discussions and they are not participating in key meetings with directors. It makes them feel as a part of the organization. The Absenteeism in NHS Trust among ancillary staff, those largely affected by the change (generic or multiskilled working), is about double the hospital average. It is because lack of task structure to which they didnt react accordingly. Such a blow was due to improper BUS723 - Multiskilling at Rossett NHS Trust INTRODUCTION 7

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groups without any goal to achieve. At NHS Trust, there is no proper orientation of groups and that too without any goals to achieve and due to which they might lose their market position. At NHS Trust sounds, position power has been seen as rewards are being given out to its employees and promotions are being made, some of the porters are assigned to specific departments or directorates, such as X-ray, but most are located in a central pool and respond to demand for their services. There are three porter-managers. According to Fiedler`s contingency model, two factors, leader member relation and position power is well oriented at NHS Trust sounds that they are lacking in task structure as no goals are defined and no situational actions are made. One of reason the change implementation is failing its because of lacking of task structure and consequently they are suffering dissatisfaction among staff.

Leadership Styles
In the practice of art is to lead individuals to carry out a job, every leader has his particular way, his own style of relationship with employees. However, they can within a certain extent, change their perspectives, with the acquisition of new knowledge, attitudes and skills (Silva, Matos, 1992: pag.117). Several authors who have addressed the types of leadership but Rowe (2001), there are essentially three types of Leadership: Autocratic, Democratic and Liberal.

Autocratic style
The emphasis is focused on leading leader who sets the guidelines, without any group participation, determines measures and techniques for implementing tasks. At NHS Trust, a small domestic team comprising the Director of Site Services, her deputy and the managers of domestic and portering staff fine-tuned, customised and planned the implementation of this initiative. The managing team change of NHS Trust did not gather the whole workforce together to discuss the changes. All the decision has been made through managers and directors without consultancy of the majority of staff. The small management team was enthusiastic and dedicated. They articulated the benefits of the scheme with conviction. According to Hogg and Vaughan (2002), in the case of NHS Trust the directors and team leader's autocratic leadership style did not fit the requirements of the task and thus sowed the seeds of resistance to change. The poorly managed change process became costly to the NHS Trust due to the loss of human resources, reduced staff morale and lowered the credibility of the management. The changes might left the team members feeling betrayed, and individual team members traumatised.

Democratic style
The emphasis is focused on the leader and subordinates. The guidelines are discussed and decided by the group, encouraged and assisted by the leader. The group itself outlines steps and techniques to achieve the target.

Liberal style
Emphasis on subordinates. There is complete freedom for group decisions or individual, with minimal participation of the leader; (Rowe 2001). The NHS Leadership Qualities Framework (DOH, 2002, p34) suggests leading change through people with effective and strategic influencing is essential in a Rossett NHS Trust environment. This is supported by Rowe (2001) who suggests that strategic, transformational leadership is a key element within an organisation staffed by professionals and that a collaborative style is required to achieve transformational, lasting change. BUS723 - Multiskilling at Rossett NHS Trust INTRODUCTION 8

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However, the team leader's leadership style in NHS Trust is autocratic and the team members were no longer consulted about matters concerning it, which was inappropriate in team work approach. Rowe (2001) suggests that a democratic leadership style works best with a mature experienced team with shared responsibility and accountability. The change in leadership style meant that the team felt disempowered and uninvolved in decision making which did not allow ownership of the change process to emerge. Furthermore, the flow of information to the team slowed down and the team's concerns about the change did not reach top management implying that communication channels in the new organisational structure were not functioning efficiently.

Groups and teams

According to Drucker (2001), a group can be defined as the combination of two or more individuals which work together for a specific goal or task to achieve in a standard way. Every individual in a group is given specific role to play. Groups need to be well managed to achieve a specific goal. Groups which are not well managed doesnt achieve their goals easily. Specific goals and standards to achieve that goal within a particular period of time is given to a group to perform better in an organization. According to Cameron and Green (2003) Skills are the distinctive capabilities of key people. The nature of the team membership implied a range of key skills interdependent on the other for effective performance. At NHS Trust sounds that different teams/group did not receive appropriate training on the information system or to do portering or cantering or even performing x-ray roles with generic worker implementation it would became a source of frustration and confusion. The fact on rotating jobs and with significant and unfair payment distribution it may contribute to staff's frustration and negative attitudes with the change process. With changing implementation at NHS Trust, it sounds that there are groups of individuals which are not that well organized and without any goal to achieve. This is one of the main reasons for its downfall. At NHS Trust show that groups are not well maintained. NHS Trust should maintain their groups very well with specific task to achieve in a particular period of time its goals. It should declare a better rewards and performance bonus to the one who achieve the particular goal within time with better performance. NHS Trust should manage groups in effective way to attain a certain goal. There are 4 stages with which groups can be made and progress in a certain way for particular task. According to Robbins & Finley (1997) and Boyett & Boyett (1999) these are:

Forming
This stage, members are learning to deal with each other, little work is done and there is great insecurity and anxiety. First impressions are formed and the leader or coordinator must provide directives to the group;

Storming
This is the negotiation of working conditions, where hostility, tension and conflict prevail. The leadership at this stage is crucial to explain limits, offer suggestions and maintain order;

Norming
Members come into alignment and acceptance of their roles in the team, which began to gain focus and unanimity. The information is freely shared, and the focus is now on maintaining relationships, which help cooperation among members. The team is still not fully focused on tangible results; BUS723 - Multiskilling at Rossett NHS Trust INTRODUCTION 9

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Performing
Its the phase of conquest, where optimal levels of income are finally achieved - productivity, quality, decision making and interpersonal relationship. There is a healthy competition, which predominate the help and mutual respect and the atmosphere is one of enthusiasm. The different team at NHS Trust might consider the change as a natural part of organisational development. However, the team became increasingly resistant to change when it felt that the organisation did not really care about its employees, their concerns, and the ultimate reason for the organisation's purpose, being the patient. The team members felt that their concerns about the lack of resources had not been taken seriously, and this inevitably led to a feeling that the Trust did not care about its employees or their views. Strong emotions such as anger and frustration were expressed by the team members. The lack of formal communication channels meant that the team members took them out on each other. Johnson, Scholes and Whittington, (2005) argues that at times of change, rumours, gossip and storytelling increases in importance and that team members engage in counter communication, thus unconsciously spreading distrust, suspicion and negativity which leads to lowered staff morale and job satisfaction. The key resisting force in the change process was a lack of communication and poor leadership at NHS Trust. However, due to poor project planning, Trust management failed to consider the internal factors that had a major impact on the change.

RECOMMENDATIONS
Given the improved performance of employees in the NHS Trust hospital, as well as the effectiveness of their leaders, we can draw attention to some key points: Draw up periodically, at least once a year, satisfaction surveys of employees, in order to gauge their opinion about the conditions in their workplace, bearing in mind that these are the motivating factors to which employees make more importance. Based on their opinions, it should be created working conditions that encourage the commitment and dedication of employees, increasing their satisfaction in same time their productivity; Develop opinion surveys to determine the degree of satisfaction given the existing leadership by analyzing the characteristics and behaviours of the leader towards employees, trying to adopt the leadership style most appropriate taking into account the prevailing circumstances; Make a continuation bet on the qualification of employees, in order to improve their performance and quality of service; Take into account the inter-personal relationships with employees, encouraging their participation in decision making.

CONCLUSION
The team leader's task-oriented leadership style did not suit the context of the change process, and partly contributed to its failing. Cameron and Green (2003) suggest that leadership will be most effective when the leader's leadership style, the subordinates' preferred leadership style and the requirements of the task fit together. A directive leadership style therefore is ineffective if the subordinates' preferred leadership style is democratic, even though the task is well defined within tight parameters. In addition, Hogg and Vaughan (2002) argued that the most effective leaders are those who are able to combine task and socio-emotional leadership styles, and organise team members to work towards achieving goals at the same time promoting harmonious relationships. The new team leader paid no

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attention to the team culture and failed to communicate to management about the impending issue. This report has as main objective to bring to discussion the issue of leadership and motivation in the NHS Trust hospital. Also aims to contribute to a better understanding of the behaviour of employees in this particular case and determine the true importance of leadership in the success of the hospital. In terms of leadership allows a more complete picture of the existing style of the leader of NHS Trust hospitals, contributing to the changes at the institutional level in the hospital is done most effectively and efficiently. In short, it is now evident that the leaders of the NHS Trust hospital are not participatory and not worried about people having a great influence on the motivation of their employees, with serious consequences affecting the performance and commitment of workers, highlighting the leadership in business as one of the critical success factors more important.

REFERENCES
ADAIR, John. (1993). The dynamic leadership. Lyon Francisco de Castro. Portugal. BERGAMINI, C. W. (1997). Motivation in organizations. 4. ed. New York: Atlas. BERGAMINI, Ceclia W. (1994). Leadership, Management Direction. New York: Atlas. BOYETT, J.; BOYETT, J. (1999) The Guide Gurus: the best concepts and business practices. New York: Campus. Cameron, E. and Green, M. (2004) Making Sense of Change Management. Kogan Page. DOH. (2002) Star Ratings System for Hospital Performance Has Improved Services For Patients. NHS Modernisation Agency. www.dh.gov.uk. Accessed 16 Jan 2012. DRUCKER, P.F. (2001). Managing in times of great change. New York: Thomson Learning Publisher Pioneer. DULUC, Alain. (2000). Leadership and confidence. Piaget Institute. Lisbon. Herzberg, F. Again, how do you motivate employees? In: In: Bergamini, C., Coda, R. (1997). Psychodynamics of organizational life and leadership motivation. 2. ed. New York: Atlas. Hogg, M. and Vaughan, G. (2002) Social Psychology. Prentice Hall. Johnson, G., Scholes, K. and Whittington, R. (2005) Exploring Corporate Strategy. Text and Cases. Seventh Edition. Prentice Hall. Lashley, Conrad & Lee-Ross, Darren (2003). Organizational behavior for leisure services. Oxford: Elsevier Butterworth-Heinemann. Luthans, Fred (1998). Organizational Behavior (8 ed.). New York: McGraw-Hill International Edition. Maslow, Abraham H. (1987). Motivation and Personality (3 ed.). New York: Harper Collins Publisher. Maslow, A.H. (1943). A theory of human motivation, Psychological Review, Vol. 50, pp. 370-396. PONTES, B. R. (2002) Job & Salary Administration. 9. ed. New York: LTR. ROBBINS, Stephen. (2004) Fundamentals of Organizational Behavior, New York: Editor. ROBBINS, S. P. (2002) Management: challenges and prospects. New York: Saraiva. BUS723 - Multiskilling at Rossett NHS Trust INTRODUCTION 11

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ROBBINS, H; FINLEY, M. (1997) Why teams do not work - What went wrong and how to make them creative and efficient. New York: Campus. Robbins, Stephen P. (1996). Organizational Behavior: concepts, controversies, applications (7 ed). London: Prentice-Hall International. Rosenfeld, Robert H. & Wilson, David C. (1999). Managing Organizations: Text, Readings & Cases (2 ed). London: McGraw-Hill. Rowe, W.G., (2001) Creating wealth in organizations: The role of strategic leadership, Academy of Management Executive. VROOM, V. H. (1997). Management of people, not personnel. 11. ed. New Yourk: Elsevier.

Websites
http://steves.seasidelife.com/2006/03/16/maslow%E2%80%99s-theory-on-the-hierarchy-ofhuman-%E2%80%9Cneeds%E2%80%9D/ - Accessed 16/01/2012

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