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'If feedback is to motivate others, it is only right we also respond to it'

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Nursing Times blogger Becky Cridford on motivation and morale in Sierra Leone’s hospital wards

Last week, the monthly ward bonus winners were finalised and announced. To give you some background, the ward bonus scheme aims to improve care by monitoring wards against set criteria. Staff on winning wards then receive a small financial bonus.

Research suggests that feedback (rather than incentives alone) is important for motivating behaviour change in healthcare workers, so I duly went to each ward to give written and verbal information on where marks had been won and lost. I was met, as you might expect, with a mixed response. The wards that won the bonus were happy enough. But on wards that didn’t win, reactions ranged from resigned dismissal (‘We never win, Welbodi doesn’t love us’) to eloquent high-volume annoyance (‘I sweat every day, but the work is too much! I must give you small shake-shake!’).

What I am concerned about now is that the scheme may start to have a demoralising effect on those wards that ‘never win’.

The experience has made me reflect on sources of motivation and frustration. What is it that makes people want to do this job? Where does job satisfaction (or lack thereof) come from? How can you stimulate improvement?

I’ve not been here long, and I won’t speak for Sierra Leonean nurses, but I can (tentatively) see similarities with what I understand from UK nursing. I recognise the pleasure of seeing patients improving, or when the worst happens and a child dies, how the knowledge that we did all we could makes this easier to accept. I can empathise with the frustration and disappointment when colleagues do not always manage to work as a team, when we know, deep down, that we have not given the care we would want for ourselves, when we feel out of control, or when “the system” seems to work against us and our voices are not heard.

One of the main concerns the nurses voiced about the bonus scheme was that some of them are working exceptionally hard, but since their ward has a heavy workload, it is harder for them to meet the criteria. By the same token other nurses are not working as hard, but since their workload is less, they receive the bonus anyway. They argue that the bonus should be for individual nurses.

Quite apart from the difficulties of monitoring the performance of each member of staff, the bonus aims to promote team-work by evaluating and rewarding wards, rather than individuals. But it is also true that the staff workload ratio does vary enormously and this is something the hospital management team are trying to address.  

I’ve discussed the problems with the deputy matron and my colleagues and I hope we will be able to make some improvements. The scheme may still be contentious, but I do hope that the changes will demonstrate to the nurses that their feedback is heard, is valued and can effect change. Moreover, if we employ the concept that feedback will motivate improvement in others, then it seems only right that we also respond to the mechanism: we too are healthcare workers.

Or perhaps, for me at least, it’s the threat of punishment that is more effective - I’d certainly like to avoid that “small shake-shake”.

About the author

Becky Cridford is a nurse who is spending the next year working with The Welbodi Partnership in Sierra Leone, a charity that supports the delivery of vital paediatric care.

The 2010 Vodafone World of Difference UK programme, delivered by the Vodafone Foundation, offers 500 winners the chance to work with their chosen charities for two months and get paid for their time.

Find out more on both programmes and the application form at

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