THE ESSENCE AND PROBLEMS OF THE MOTIVATION SYSTEM AT THE STAGE OF FORMATION OF MODERN SPECIALISTS OF HUMANE PROFESSIONS

UDC: 356.33:316.628 THE ESSENCE AND PROBLEMS OF THE MOTIVATION SYSTEM AT THE STAGE OF FORMATION OF MODERN SPECIALISTS OF HUMANE PROFESSIONS Chorna V. V.1, Khliestova S. S.1, Korolova N. D.1, Gumeniuk N. І.1, Vyhivska O.V.2, Khliestova І. V.1 1National Pirogov Memorial Medical University, Vinnytsia (str. Pirogov, 56, Vinnytsia, Ukraine, 21018) 2Zhytomyr Military Institute (Myr Av., 22, Zhytomyr, Ukraine, 10023)


Introduction
Medical staff is the most complex and specific type of resource used by a medical institution in its activities. The effectiveness of professional activities of medical institutions largely depends on the efficiency of medical staff. It is because of the interest of the medical worker in the results of his work in the creation of appropriate working conditions that can increase productivity. Therefore, a medical institution can realize its potential for professional and qualification growth only under the conditions of the adequate motivation of medical staff.
Today the fundamental issue of preservation and progressive development of the health care potential of modern Ukraine is to ensure the quality of the medical sector this is related to the general aspects of the process of improving the management of medical staff, in particular at the state regional and local levels [4,9].
The current legislation of Ukraine regulates and conceptually substantiates the activities of medical institutions. The Law of Ukraine "On Health Care" emphasizes that medical care is a mandatory primary part of the life of Ukrainians [15]. The field of domestic medicine has been aiming at ensuring the development of medical infrastructure and its staff by their abilities, individual, mental and physical characteristics, cultural needs. Therefore, any medical institution must provide an appropriate level of motivation of medical staff concerning the requirements of modern society.
The effectiveness and efficiency of the system of motivation of medical staff largely depend on complete and reliable information about the needs, interests, and motives of the labor resources of medical institutions. To obtain such data requires so-called "motivational monitoring". It is a system of constant monitoring and control of the state of the motivation of medical staff for its operative research and assessment in dynamics, acceptance of qualified administrative decisions in the interests of increase of efficiency of work [2].
The experience of modern management in the field of medicine shows that traditional methods of assessing the motivational orientation of medical staff no longer meet the needs of the management staff. There is a need for a system of motivational monitoring, which would create a new information base for management decisions in the field of the motivation of professional activities of medical staff. The development of a quality system of the interest of medical staff in medical institutions should help to identify currently adequate tools and incentives to influence the behavior of medical workers to achieve their own goals and the goals of the medical institution.
The aim -investigate the essence of the catalyst of the medical staff of health care institutions of Ukraine, identify problems of management of the system of motivation of medical staff, generalize and systematize the stages of designing the interest of medical staff of medical institutions.

Materials and methods
Analysis of domestic and foreign scientific sources, logical-theoretical method (to study the essence of the interest of medical staff); method of system analysis and synthesis, generalization (consideration the quality of work of medical staff and identify problematic aspects of increasing work motivation). An anonymous survey on the catalyst of the professional activity of medical staff according to the method of K. Zamfir in the modification of A. Rean and a survey on the approach of A. Leonov, S. Velichkovska on the differential assessment of the reduced working capacity of medical workers.

Results. Discussion
Primary theories of interest have been forming based on the historical experience of human behavior and the use of simple incentives for coercion, material, and moral encouragement. Methods, techniques, and methods of motivation have come a long way in evolutionary development. For many years, the model of physical coercion to work was dominant, and only then -the model of economic necessity and stimulation of labor following its productivity [6].
Interest in the problems of motivation and stimulation of work arose long before the emergence of management theory as a science and the very term "motivation" Since the emergence of the organization and the need to subordinate the actions of its employees.
The basis in the original systems of motivation was the instinct of self-preservation. The man has been perceiving as a biological being, which primarily aimed to obtain food, protect themselves, build housing. The scientific study of the causes of human activity has been initiating by great thinkers -Aristotle, Democritus, Heraclitus, Plato, Socrates. Democritus considered need as the main driving force and believed that in the absence of demands, man could not get out of the wild [1].
The founder of motivational concepts was A. Smith, who argued that a person should have been forcing to work and his work should have been monitoring. In 1776, the scientist in his work "Studies on the Nature and Causes of the Wealth of Nations" developed the concept of "economic man". Smith believed that the dominant motive for the activity is selfish interest, which is satisfied only in the process of exchange between people [11].
The definition of "motivation" by different authors has been interpreting ambiguously. Given the above motivation can be defined as a system of internal and external factors that motivate employees to work, to achieve both personal and organizational goals.
The following types of motivation can have been identifying, which have been using by modern organizations in Ukraine and abroad (Fig. 1).
The leading method of quality management of medical staff of medical institutions in modern conditions is money motivation. The aforementioned is because the minimum wage of a doctor in Ukraine is small, the economically active population is less than those who have been employing. The load on the creative component of the professional activity of the work team and daily training can have been marking by certain bonuses and bonuses.
Status motivation is ambiguous. Career growth and prospects for improving professional competence, depending on the field of activity of the organization and the position of the employee may not be understandable.
Work motivation can be quite flexible. If a healthcare professional needs to change their work schedule, working conditions, or take time off, they always have the opportunity to make this request to their supervisor. However, most domestic enterprises do not keep wages.
One of the popular measures of the management system today is social motivation, the purpose of which is to provide a social package. The social package in the EU countries has the following components: health, work motivation, education, training, social support, recreation, entertainment. Abroad, the main cost of the social package up to 50% falls on various types of insurance, but the main one is health insurance [2].
In Ukraine, the spread of the social package is typical only for employees of large domestic companies that are developing rapidly and want to enter the international markets of European countries, where they adhere to the civilized principles of social responsibility for their employees. The labor legislation of Ukraine does not provide for a social package, but there are mandatory insurance premiums for wages in the social fund (table 1).
It should have been noting that the condition of competitive social policy was that the management of the organization not only seeks to maximize profits from its activities but also to put in the first place the social security of its staff, create decent working conditions, preserve and enrich human capital [8].
Motivation management involves the creation of such a management system of medical staff, which forms the necessary level of motivation of employees to quality performance, which ensures the success of the medical institution. Managers have to round the clock look for new opportunities to activate health professionals, primarily through the internal resources of their medical institution, and build a dynamic, flexible system of work motivation based on the study of the features of the motivational sphere [12].
Motivation management has been focusing on the conscious and purposeful use of motivation. For motivation to bring the expected results, the system of motivation in the medical institution should have been basing on the principles: • systematic (systematic monitoring of its effectiveness); • complexity (the combination of tangible and intangible methods of stimulation, positive and negative motivation); • flexibility, transparency, and dynamism.
Thus, the management of motivation is to create favorable conditions that cause health professionals to strive for active professional activity.
The success of each medical institution depends on many factors, but primarily it is ensured through the work of responsible, proactive health professionals. The desire to work efficiently and productively is one of the main factors for the success of the medical institution.
This problem was also reflecting in several regulations of the Ministry of Education and Science of Ukraine, which has been a confirmation of the relevance and importance of research on the quality of incentives for subordinates to governing bodies [14].
The modern market of medical services in the segment of health care facilities has been characterizing by increasing competition between institutions located in one region, one city, one neighborhood. The desire of medical institutions to compete only based on a large number of medical staff is not entirely justified. Not all patients focus only on the outcome of treatment. Most mainly pay attention to the comfort of the medical institution and the timely desire of medical staff to "help when needed". In addition, medical reforms pose new challenges to the current head of the medical institution, related to the effective and efficient management of the competitiveness of their institution, in particular improving the quality of motivation of medical staff given the current trends in the labor market [13].
Therefore, one of the requirements for the effective operation of a medical institution is the professional training of medical staff, the chief task of which is the formation of their competence. Competence is a professional and personal characteristic, which has been determining in the process of activity, in which the system of knowledge, skills, abilities, and professionally important qualities of medical staff has been realizing in practice. All this necessitates the use of appropriate organizations of work incentives, which would contribute to the formation of competence of medical staff [16].
Decades ago, medical professionals for a long time used a definite set of knowledge, skills, and abilities. But the rapid and rapid development of science, technology, and medicine requires the formation of medical staff, not only unquestionable knowledge, skills, and capacity that are the basis of the specialty. But also the genesis of professionally essential qualities and abilities of the individual for quality and productive work.
In the conditions of accelerated innovative development of modern medicine, medical institutions of health care of Ukraine cannot have been lifting aside, and therefore require providing conditions for professional development and self-realization of medical staff. Innovations and technologies, in turn, require not only high education, skills, activity but also a high level of responsibility, independence, confidence, ability to adapt and work in new conditions, to be socially oriented. Successful treatment of patients, response to challenges, rehabilitation care, etc. depends on the formation of professional qualities, level of training, and motivation of medical staff. Management of the system of motivation of medical staff of a medical institution is a significant element of personnel management and has been aiming at increasing "commitment to medical work", positive development, and quality performance of professional activities. The problem of motivation management also Providing social benefits and guarantees provided by the collective agreement, the agreement Recreation and entertainment Table 1. The structure of the social package.
The essence and problems of the motivation system at the stage of formation of modern specialists of ...

"Вісник Вінницького національного медичного університету", 2021, Т. 25, №3
ІSSN 1817-7883 eІSSN 2522-9354 determines the increase of personal capabilities of medical staff, which allow them to independently and effectively implement the goals of the treatment process. To do this, you need to have theoretical knowledge in the field, seek to improve them, be able to apply them in practice. Therefore, the main task of modern medical institutions of health care in Ukraine is to encourage medical staff to increase productive work and creative potential the presence of specific qualities, attitudes, training should be the most far-reaching characteristic of their work. The formation of the motivation system of the medical staff of the medical institution is closely related to the formation of his personality, which is a continuous and holistic process of development and has been determining by its socialization, education, and self-education.
A well-motivated health care worker must have an interest in medicine and value human life, be passionate about working in their health care facility, be observant, tactful and educated, purposeful, demanding, fair, balanced, able to work, have professional orientations and goals, humanistically oriented and sustained in the treatment of patients.
To ensure the effective management of the system of motivation of medical staff, the head of the medical institution of health care must conduct training, which consists in the formation of appropriate professional responsibility to patients and the medical institution itself. The problem of motivation management can have been solving by using active methods of improving work efficiency or involving medical staff in activities that require the mandatory application of not only professional but also personal knowledge, skills, and communication and management skills [17].
Therefore, to effectively determine the motivation of medical staff of medical institutions of Ukraine, we used the method of "Motivation of professional activity" K. Zamfir in the modification of A. Rean. This technique makes it possible to determine the relevance of types of motivations as: 1 -material reward; 2 -the desire for career growth; 3 -the desire not to be criticized by management and colleagues; 4 -the desire to avoid possible punishment or trouble; 5 -focus on prestige and respect from others; 6 -satisfaction from a job well done; 7 -social utility of labor. This technique allows determining three types of motivation and motivational complex of a medical worker of any qualification, specialty, work experience: internal motivation -understanding the usefulness of work, desire to engage and improve their professionalism and be satisfied with the results of their work; external positive motivation -achieving career growth, the constant need for material incentives, rewards, awards; external negative motivation -unpleasant to receive criticism, reprimand, fines from management [2].
Analyzing the survey data, it has been finding that the external negative motivation exceeds the external positive in male medical staff -3.2±0.8 and female medical staff -3.0±1.2 points, respectively, so these medical workers have a decrease in interest in work, lack of desire for career growth, lack of self-perception, indifference to work, to patients, which can negatively affect the quality of medical care, interpersonal relationships in the team and at home. The results of the questionnaire on the differential assessment of the state of the reduced working capacity of medical workers of health care institutions of Ukraine are analyzed. From the obtained results, a high degree of oversaturation index has been finding in male medical workers -3.2% and female medical workers -1.6% and a high degree of fatigue -4.8% and 3.9%, respectively, which can have been assessing as a condition before diseases in medical professionals.
If the process of stimulating the work of medical staff in medical institutions will increase their professional competence, it will positively affect the whole set of motives, interests, and needs of the institution, and as a result -the quality of its work. Therefore, the chief purpose of managing the motivation system of medical staff is its training in terms of training qualified professionals, scientists, and managers, competitive in the market of medical services, competent and responsible, able to work at international standards, ready for professional growth, social and professional mobility.
Thus, the creation and operation of a quality system of motivation of medical staff in a medical institution can be implemented in several stages, namely: • identifying the importance of motivation for medical staff; • research of the factors influencing the system of motivation of the medical staff of the medical institution; • determining the satisfaction of medical staff with the results of work.
The peculiarity of the implementation of these stages is the conduct of regular surveys of employees and analysis of available economic, sociological, psychological information. To assess the motivation of medical personnel it is also important to have a set of key indicators, which include the characteristics of medical staff and the quality of professional potential, assessment of the competitiveness of medical staff, professional qualification of medical staff, working conditions of medical staff (emotional burnout) in the hospital, the level of productivity of medical staff, the level of salaries of medical staff, personal safety, job satisfaction of medical staff [3,5,10]. For the motivation system developed in the medical institution to be manageable, it is necessary to create convinced prerequisites: the ability to obtain complete and reliable information about the state of satisfaction of the existing system of motivation of medical staff, and the ability to get an idea of the state and dynamics of motivation.
Ensuring the quality implementation of all stages of the system of motivation of medical staff, in general, should be based on the following principles: transparency and accessibility -incentives should be clear to every employer, as well as explanatory work among the heads of medical institutions; relevant decisions or draft decisions -should be published in the media and submitted for collective discussion; Ensuring the quality implementation of all stages of the system of motivation of medical staff, in general, should be based on the following principles: transparency and accessibility -incentives should be clear to every employer, as well as explanatory work among the heads of medical institutions; relevant decisions or draft decisions -should be published in the media and submitted for collective discussion; reality and efficiency -real implementation mechanisms that correspond to the current state of the labor market and are developed taking into account trends in economic development; gradual -providing material compensation to the employer for the employment of convinced categories of persons, promoting their further work in a particular workplace; mutual guarantees of the parties -guarantees of compensation fixed by the state provided that the conditions of quality work are met; complexity and system -recognizes the need to take into account all possible factors (organizational, moral, sociological, economic, legal, etc.); regulation -the use of incentives should be carried out using various instructions, arrangement, rules.
The main principle of designing a system of motivation for medical staff in a medical institution is the principle of rational selection and placement of employees concerning their personal and business quality characteristics: • providing opportunities for professional growth and career advancement of medical workers based on reasonable criteria for assessing their professional activities and personal qualities; • creating conditions for friendly relations and trust in the team, as well as confidence in management, while managers check the performance of medical professionals in their professional duties.
The responsibility for an effective motivation system rests mainly with professionally competent HR specialists. For such specialists to be able to achieve the goals set by the organization, they must not only have knowledge and experience in their specific field but also be informed about the staffing needs of heads of all departments, the needs of employees [7].
Therefore, managers of medical institutions must have a good understanding of the specifics of medical staff management and the specifics of forming a system of motivation to increase the level of staff productivity, and as a result -the height of development of their medical institution.

Conclusions and prospects for further development
1. Thus, summarizing the above material, it can have been stating that the essence of the motivation of medical staff of medical institutions of health care of Ukraine has been investigating, problems of management of system of motivation of medical staff are defined, stages of designing of the motivation of medical staff of medical institutions have been generalizing and systematizing.
2. To ensure quality management of the motivation of medical staff of the medical institution, the manager must identify and eliminate the causes that negatively affect the reduction of motivation for successful activities of medical staff and make timely and informed management decisions.
3. Motivation management involves the creation of such a personnel management system, which forms the necessary level of motivation of health professionals to quality performance, which ensures the success of the medical institution. The most important values are professional competencies and a confident psychological climate in the team. Therefore, the main task of modern medical institutions of Ukraine should be to encourage medical staff to increase productive work and creative potential the presence of specific qualities, life attitudes, training should be adequate characteristics. The experience of modern management in the field of medicine shows that traditional methods of assessing the motivational orientation of medical staff no longer meet the needs of the management staff. The current principle of designing a system of motivation for medical staff in a medical institution today is the principle of rational selection and placement of employees concerning their personal and business quality characteristics.