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PERFORMANCE EVALUATION OF EMPLOYEES IN
HOSPITAL SERVICE

Prof.Assoc. Dr. Gazmend NURE

ABSTRACT

Employee performance assessment is one of the most important functions of human resource
management. It starts immediately after the employees get hired and goes on throughout the
employment process. The constant and fair evaluation of employees is linked to their
motivation and further performance at the workplace. Only when they feel valued and
motivated employees can work more effectively and will not be inclined to leave the company
in which they are employed. Employee appraisal is a process that happens constantly. In each
organization, superiors evaluate employees, employees evaluate superiors, employees
evaluate each other. For organizations, the problem of performance appraisal is often dealt
with in a formal or not procedure through which performance assessments of its employees
should be made. Albania of recent years, which is already operating in global markets, has
faced new human resource management practices and modern concepts of performance
appraisal. How are the medical and non-medical staffs adapted to these practices and are they
applied by its managers? These are the initial questions which led to the beginning of this
paper which aims to clarify through the observation and study of how the performance
evaluation is realized and based on and stating in more detail in the case of personnel at Fier
Regional Hospital. performance is a process that contributes to the effective management of
individuals and teams in order to achieve high levels of organizational performance. As such,
it places an equal understanding of what needs to be achieved and an approach to leading and
developing people who will ensure its achievement. The purpose of this study is to reflect the
way human resource management functions in the administration public focusing and
reflecting the performance evaluation case at the Fier Regional Hospital and the motivational
strategies undertaken by this hospital. Throughout the study, we will see how the assessment
is conducted and how the employee perceives performance appraisal based on the analysis of
a study .The study summarizes the analysis of 150 questionnaires, supplemented by different
employees who change their age, gender and job position. The study aims to emphasize
whether performance evaluation at the hospital is performed, or the employee views the
assessment as important and motivational or frightening as well as the differences between the
public hospital and the private hospital in terms of performance assessment.
 Content content

Abstract ................................................................................................ .
Acknowledgments ............................................................................................. ..
Content of the topic ....................................................................................
List of tables ............................................... .................................................. .....................
Chapter I - Entry .............................................. ........................................
1.1 Purpose of the study .............................................. .................................................. ............
1.2 Objectives of the study .............................................. .................................................. .....
1.3 Hypotheses of the study .............................................. .................................................. .......
1.4 Subject Structure .............................................. .................................................. ...........
Chapter II - Study Methodology ............................................ ..........
2.1 Method used .............................................. .................................................. ......
2.2 Sampling ................................................ .................................................. ....................
2.3 Study Limitations .............................................. .................................................. ...
Chapter III- Literature Review ............................................. ...............
3.1-What do we mean by the term performance ........................................... ........................
3.1 / 1 Performance Evaluation ............................................ ...............................
3.1 / 2 Importance of Performance Assessment .......................................... ........
3.1 / 3 Criteria for Performance Evaluation .......................................... .........
3.1 / 4 Time and frequency of performance estimates ............................
3.1 / 5 Evaluation Goals ............................................ .............................................
3.1 / 6 Performance Evaluation Methods .......................................... ..................
3.1 / 7 Performance of Public Activities and its Implications ........................
3.1 / 8 Managing Sub-Standards Performance ........................................ ......
3.2 Motivation ............................................... .................................................. ..........................
3.2 / 1 What is motivation? ........................................... .........................................
3.2 / 2 Theories explaining motivation ........................................... .........................
3.2 / 3 Employee Motivation Concepts .......................................... ...................
 3.2 / 4 Stimulation of staff encourages motivation .......................................... ...........
3.3- Performance-related salary ........................................... ............................................
3.3 / 1 Relationships with performance bonuses .......................................... ............
3.4- Selected Evaluation for Evaluation of Performance Results in Albania ...........
Chapter IV - Human Resources Management at Fier Regional Hospital ................
4.1 Fier regional hospital of the health service in Fier ........................................ ...
4.2-Analytical Structure of Fier Regional Hospital .......................................... ................
4.3- Performance Evaluation at Fier Regional Hospital ......................................... ...
Chapter V - Performance evaluation of employees in other institutions providing health
services .................................. ..............................................
5.1- American Hospital .............................................. .................................................. ...
5.1 / 1 Performance Evaluation of US Hospital Workers .......................................
Chapter VI - Analysis of Data ........................................... ............................
6.1 Analysis of completed questionnaires by Fier Regional Hospital staff .....
6.2 Analysis of questionnaires completed by US hospital staff .....................
Chapter VII - Conclusions and Recommendations ............................................ ..
Bibliography ................................................. .................................................. .....
List of tables
Table 1: Personnel Movements and Causes .......................................... ................................
Table 2: Movements within the institution in recent years ......................................... ................
Table 3: Employee Ages .......................................... ..........................................
Table 4: Characteristics of performance evaluation and motivational strategies ....
Chapter I - Entering
Employee performance assessment is very important in achieving each institution's objectives
as a good performance will bring a more positive image to the institution. In terms of
performance, different definitions are given by different authors, one of whom I will note:
Performance is a result of the work done because it provides a strong link between the
organization's strategic goals, customer satisfaction and economic contribution.Employee
appraisal is a process that happens constantly.In each organization, superiors evaluate
employees, employees evaluate superiors, employees appreciate each other.Performance
Evaluation is the process of identifying, evaluating, and developing the performance of an
individual's work within an organization so that the organization's objectives and goals are
effectively achieved while at the same time benefiting employees in terms of gratitude,
confidence, and delivery career guidance.The performance evaluation of public administration
employees is a matter that has much to be discussed as many public institutions do not
properly carry out this assessment or are merely a formal assessment by a form that reflects
some of the performance indicators and assessment that every indicator for each employee is
done, which is carried out differently in private institutions.With regard to this assessment
there are employees who do not know whether or not there are employees who fearfully look
at such an assessment and are still unaware that such an assessment is important to them even
though they think this assessment will be very effective if done properly.

Purpose of the study

Taking into account the differences between the public and private sector in human resources
management and performance evaluation, this study will attempt an analysis of the perception
that public administration employees and more specifically Fier Regional Hospital employees
have work to assess their performance.
Objectives of the study
This paper is based on the fulfillment of several objectives among which we can mention:
1. Review the literature with regard to some of the key concepts of performance, its
assessment, methods, measurement criteria used by public administration, and motivational
strategies and their role in improving performance.
2. Conduct a questionnaire at the Fier Regional Hospital to identify and understand whether
performance evaluation is done and how it is done and whether motivation affects or does not
affect employee performance.
3. Completing the questionnaire at the US hospital to highlight the differences between a
private and public hospital.
4. Perform a data analysis based on the information being stored.
5. Submitting a series of work conclusions and giving recommendations for a better
performance of public administration employees in relation to the private sector.
Research Questions (Hypotheses)
Hypothesis 1
Performance evaluation in the public administration is done through a combined formal and
informal system in accordance with established standards.
Hypothesis 2
There are huge differences in employee performance appraisal between a public hospital with
a private hospital.
Hypothesis 3
The role of performance-motivation linkage.

Theme structure
- In the first chapter there is a presentation of the topic that I will study and in this case is the
evaluation of the performance at Fier Regional Hospital, the purpose of the study, the
objectives and the hypotheses on which such a study has been established.
- The second chapter presents the methodology used in collecting data that are primary and
secondary data. To provide primary data, standard questionnaires have been compiled, which
are filled by all respondents. A considerable part of the secondary data is provided through the
use of different texts by different Albanian and foreign authors to see theories and models of
performance evaluation on the one hand and how it is implemented in the Albanian public
administration.
- In the third chapter, which is a literature review, there are contradictions for the definition of
performance, its evaluation, methods and criteria for evaluation, timing and frequency of
evaluation, reasons for evaluation, motivation definition, theories explaining motivation,
incentives financial and non-financial.
- The fourth chapter presents Fier Regional Hospital as a provider of hospital health services,
its features, services it provides, its analytical structure, human resources status, and
performance evaluation and motivational strategies undertaken or not.
- The fifth chapter reflects how performance assessment is performed in a private hospital
such as the US hospital to highlight major differences between private and how and how does
this assessment take place in another public institution providing health services such as
Health Centers.
- The sixth chapter assesses the performance of employees based on questionnaires conducted
with hospital staff employees as well as US hospital staff.
- Chapter Seven outlines some of the conclusions and the relevant recommendations to reflect
the important role that performance assessment has.
Chapter II-Methodology
For the realization of this study a methodology is used that consists of a combination of
primary and secondary data. A considerable part of the secondary data is provided through the
use of different texts by different Albanian and foreign authors to see theories and models of
performance evaluation on one hand and how it is implemented in the Albanian public
administration then these data are also used to make comparisons between private and public.
To provide primary data, standard questionnaires have been compiled, which are filled by all
respondents. The questionnaire is made up of 20 questions. In the first 2 questions, the
descriptive data of the respondents are given while the other questions are related to
performance appraisal, motivation and reward systems, how they affect and how they affect
performance.
The purpose of the questionnaires is to get information from employees about how they
perceive performance appraisal, whether this assessment is realized and how it is
implemented, what are the differences between the evaluation in a public hospital and the
private one, and how performance is related to the remuneration systems. Questionnaires tend
to establish a link between what employees think about their work and how they are assessed,
how motivated, and whether this motivation influences their performance.
Champion
The sample includes employees of Fier Regional Hospital and employees of the American
Hospital. For this purpose, 150 questionnaires have been drafted, of which 100 are for
employees of Fier Regional Hospital and 50 for employees of the American hospital.
Study Limitations
During the study I encountered difficulties in completing the questionnaires because the
interviewees were reluctant to complete some that they did not really know how this
assessment was made and some others did not want, so out of 100 questionnaires were
completed only 80 while 50 questionnaires at the American hospital were completed only 30.
Along with it, it was difficult to get information at the American Hospital but only after
submitting an application to the Human Resources Department I managed to accomplish what
I wanted to achieve, therefore, to note the differences in the performance appraisal of the
employee.

Chapter III - Literature Review

3.1-What do we mean by the term performance?
Definition of term performance by some researchers: Bates and Halton (1995) have
mentioned that performance has a multi-dimensional construct, the measurement of which
depends on many factors. They also point out that measuring targets is important to measure
the performance accomplished.Kane (1996) points out that performance is something that the
person leaves behind the actions he does and it exists regardless of purpose Bernardin (1995)
emphasizes that performance is the result of work done because they provide a strong link
between the organization's strategic goals, consumer satisfaction and economic input.In
Oxford, the term performance is explained as achieving, executing, executing something
ordered or assumed by a person.Performance should also be seen as a behavior, the way in
which individuals, groups or companies should work.Brumbrach (1988) Performance implies
both behavior and results at the same time. Behavior is the source of action that turns
performance from something abstract to something concrete, so it turns to the result.
3.1 / 1 Performance Evaluation
Employee performance assessment is one of the most important functions of human resources
management.It starts immediately after the employees get hired and goes further throughout
the employment process.The constant and fair evaluation of employees is linked to their
motivation and further performance at the workplace.Only when they feel valued and
motivated employees can work effectively and will not be inclined to leave the company in
which they are employed. Employee appraisal is a process that happens constantly.In each
organization, superiors evaluate employees, employees evaluate superiors, employees
appreciate each other. Performance Evaluation is the process of identifying, evaluating and
developing the performance of an individual's work in an organization so that the
organization's objectives and goals are effectively achieved while at the same time employees
benefit in terms of gratitude, confidence, and delivery career management.Performance
evaluation today is the placement and assessment of an employee's performance at work.Such
a process has two main purposes: first performance evaluation serves for administrative
purposes.Provides information on salaries, bonuses, promotion and secondly, performance
appraisal serves the purposes of development. Information that brings such a process can be
used to develop training needs plans, career planning, etc.Performance evaluation in this
context is defined as the actual or past performance rating based on its quality standards.Thus,
the evaluation process includes: setting standards, evaluating the employee's current
performance with these standards, communicating the assessment results to the respective
employees in order to motivate employees to correct performance deficiencies or invite and
encourage them to continue the same.Performance assessment is a very important link to
human resource practices because the information that this practice entails itself impacts
many other practices,starting from recruitment and selection to management and management
of talents.When evaluating the performance, always assuming that this process is done
properly, truths are revealed on other human resource practices.For example, if a given
criterion is overlooked or not considered necessary to be taken into account during
recruitment and selection, now during the performance appraisal process turns out to be
necessary or vice versa, a criterion that was heavily given to recruitment and selection results
that it is not so well achieved when the performance appraisal process is done.
The performance appraisal process is a very important and delicate process because it faces
the individual as well as the high levels of management with reality and as such it has to be
directed more closely by the human resources department as well as by the line managers .
Finally, the importance of performance appraisal in the public sector is ever increasing as
more and more public administrators are part of performance-based pay schemes, but the
node of these schemes lies in the performance appraisal process.2
3.1 / 2 The Importance of Performance Evaluation

The purpose of the performance assessment is to:

See how employees have accomplished their tasks compared to performance standards for a
given period of time.
Identifying the needs of the employees for formation and development and setting new
objectives.
Encourages managers to think carefully and objectively about the performance of their
employees and the factors that influence them.
It provides the employees with information on its performance, information that serves as a
basis for improvement and development.
Performance Evaluation (VP) means the process through which a company's employees can
reflect, discuss and change their work method. At the individual level, the process makes
changes in learning and behavior possible. At company level, the process enables systematic
data collection on individual performance. These data, on the other hand, serve to identify the
training needs, to raise the right individuals in the right positions and to set the path of
organizational development of the company.
Performance Evaluation is a management tool that serves employees, managers, and Human
Resource Management. If done correctly, Performance Evaluation creates a culture of justice,
continuous improvement, and support of set standards. Benefits from setting performance
appraisals in each given company are as follows:

Performance Evaluation.
a. Enables executives to develop a fair and well-defined assessment, a plan that applies to all
employees.
b. Enables employees to be recognized in advance on what basis they are evaluated.
3.1 / 3 Criteria for performance evaluation as a rule are determined based on the objectives of
the special pay scheme with performance.
Criteria can be based on performance: individual, group, or in the organization.
The criteria based on the individual's performance require the setting of individual objectives
and
an appropriate performance appraisal system. Individual training is also required to increase
the knowledge and skills at work and opportunities available to the employee. An individual
should be given the opportunity to control his performance.
When the objective is to promote overall performance through: teamwork, collaboration,
sharing information and knowledge, and when individual performance can not be measured,
individual performance criteria are not appropriate. Group-based criteria are appropriate
where there is a need for common culture to support group values and co-operation.
Enterprise performance is easier to measure, because there are direct indicators that express
the quality of its activity. While individuals and groups find it harder to identify the
relationship between their performance and that of the company.

The problem of performance appraisal often arises in the formal or non-formal procedure
through which performance assessments of its employees must be made. Albania of recent
years, which already operates in global markets, has faced new human resource management
practices and modern performance appraisals. How are the formal practices of employee
appraisal in the public administration applied and how well are the employees feeling from
these practices?
Formal assessment systems are defined as planned, organized and controlled activities,
conducted in order to monitor, measure, judge and improve the employee's contribution to the
organization's objectives. Also, the formalization of the assessment activity requires
determining who will evaluate and what role the employee will have in evaluating. The
formal system can be used to improve the assessment therefore it should support and
encourage the manager in the staff's ongoing assessment. Apart from the formal assessments,
the informal forms of assessment are also referred to as the unofficial assessment made by
superiors without a defined structure and can be realized in unwritten form daily.
3.1 / 4 Time and frequency of performance estimates.
Regular assessments should be made at specified intervals. Organizations
you can set it up employ the employees on the basis of the probation period. This period is
three, six months to one year to see if the employee is qualified to perform the job. Whether
there is such a system, the evaluation should be done between the evaluation period and then
back to the end of it. After that all employees must get at least one rating by their supervisor.It
must be borne in mind that the probation period serves to enable the leader to remove an
employee from work if he does not do it well. However the end evaluation of this period must
contain a statement from the supervisor, where he or she recommends not permanent
employee retention. Regular assessments should be made by Personnel Department or Head
of Administration Each supervisor should be notified in advance of the date.

3.1 / 5 Evaluation Goals

Evaluating the performance of the job is a way to clarify what is expected of the job. it
helps develop standards for satisfactory work, qualifying the quantity and the quality of work
acceptable and suitable for a particular job. This is done for the benefit of the employee,
supervisor and organization.
Why do we need performance appraisal?
The success of an institution depends largely on how employees perform their duties. The
purpose of performance appraisal is for employees to recognize their strengths and
weaknesses while performing certain tasks.
Knowing them creates the opportunity to work to make the necessary upgrades. Employee
performance appraisal should be periodically carried out using the appropriate method.
Today, some useful, innovative methods are used to evaluate performance.
3.1 / 6 Performance Evaluation Methods
The "HIGH-POSITIVE" method
According to this method, the employee's superior is the one who prepares the performance
appraisal. Direct superior is the most suitable person to perform performance appraisal, as the
direct relationship with the employee allows him to closely follow the performance of his
subordinate's duties during a working year. If the employee has questions about how it is
assessed and how it can be improved, all responses can be given from the direct supervisor,
who has regularly followed his job. During the assessment of performance through this
method, together with the supervisor may also be present a specialist of the human resources
unit.

"DESCRIPTION / ESE" METHOD

This assessment method takes time as the superior is required to provide complete
information on the subordinate's performance, describing briefly in essay form: his / her
strengths and weaknesses, field of expertise or aspects to be improved. The main advantage of
this method is that it creates the possibility for an open-to-aft communication.

Method "MANAGEMENT BY OBJECTIVES"

According to this method of assessment, the employee's work objectives are determined in
accordance with the work objectives of the entire institution. At each beginning of the year,
the supervisor and the employee together define the different criteria on the basis of which
performance evaluation will be carried out. The employee is periodically evaluated regarding
the way he or she is fulfilling the objectives of his or her work.

The "VET-ASSESSMENT" method

According to this method the employee is given a form where they evaluate their performance
on the basis of some criteria. Performance is evaluated at the same time by the superior.
During the final evaluation both the supervisor and the employee compare their assessments
with each other. Ideally, the employee's assessment with that of the superior would have to be
rough, assuming that the employee's assessment of himself was honest. If the ratings are
different, the employee should ask the superior what aspects he / she should try to improve
performance. Method 360 °This is the most popular method for assessing performance.
According to her, the Human Resources Directorate collects opinions about the employee's
performance at work from anyone who has been collaborating with him, starting with
associates, superiors, subordinates, and so on. Each of them evaluates the employee on the
basis of impressions created during work with him. All together offer the possibility of
realizing a fair assessment, as any of their impressions remains unknown to others. At the end
of the evaluation process, an employee from the Human Resources Department summarizes
all the estimates and discloses the final outcome of the performance appraisal.
Method "COLLECTION FOR COOLEGUN"
This method is not very popular, however it is applied by the institutions in certain areas.
According to her, colleagues appreciate each other's performance. The logic of this method is
that only peers who perform similar jobs can really understand and better understand the
problems that arise during the performance of the work and may give a fairer assessment. On
the other hand, if there is competition between colleagues, there is a risk that they give a
tougher assessment to each other. This method can be applied by a superior who is newcomer
to work and is not yet familiar with all the processes her.
The "GRAPHIC" method
This method is used in those institutions / organizations where measurable product is offered.
Each employee is assessed based on the amount of product offered by making a graphical
presentation of the work. This assessment method is very meticulous and objective.

Method "MATRIKS"
This type of assessment method works well in those institutions / organizations where there is
more than one senior / manager who interacts with a workgroup. Based on the matrix system,
an employee is evaluated by several superiors based on different criteria. Employees are given
specific points for different categories, from different managers. Based on these points one is
built average and is given a final score for each category. This method is very appropriate in
cases where employees report to some officers.

3.1 / 7 Performance of Public Activities and its Implications.

Performance Measurement is an instrument for evaluating program progress against goals and
objectives set by taking strategic objectives1
It consists of the following activities:
1- Documentation of a "production process" consisting of processes and activities that serve
to return inputs to outputs that are goods and services produced directly by the program.
2. Evaluating results by comparing them with program objectives. Generally speaking,
performance measurement can show the results of a particular policy or program but can not
analyze what changes can be made to the objectives of the activities or programs.
3-Efficiency, which is the relationship between the resources used and the maximum possible
amount of goods and services produced with this amount of resources.
4-Effectiveness that is the degree to which projects or programs achieve their expected
objectives or outcomes. Goods and services can be provided efficiently, but on
if they do not reach their predetermined objectives then it can be termed a waste of resources.
5-Compatibility, which means that institutions or agencies must act in accordance with the
budget or acts and other laws regarding expenditure management.
6. The quality of services, which has direct relevance to the relationship, is also related to the
availability, periodicity, reliability and continuity of the services.
So it refers more to the quality of service delivery than the result that brings the provision of
services.
Performance is a mix of these dimensions.
But it may happen that they are intertwined and can cause conflicts, for example, quality of
service can be improved, but this can lead to higher costs and efficiency gains.
There are many studies that measure public sector performance by assessing the quality of
public services such as education provision, infant mortality rate, student reading rate,
infrastructure quality, and so on.
Although some of these services are provided privately, governments in many countries have
played a key role in providing education, health and
infrastructure. According to theoretical considerations, the high level of expenditure is
justified if it serves to provide such high quality services.
One problematic but important aspect of performance measurement is the government's
spending on transfers and subsidies, government consumption and employment in the public
sector. High spending levels in these areas may reflect "citizens' preferences," but may also
reflect high levels of taxation that distort market signals and cause even higher costs for the
public. 3.1 / 8 Managing Sub-Standards Performance
Like the development and reward of performance management, it is also the issue of
managing an individual whose performance does not meet the required standards. Prior to the
management action, it is necessary to have specific performance standards, to assess the
current performance level of the employee, and to identify and communicate the performance
gap. Gillan (2002) states that there are three main reasons why staff does not perform well and
careful identification of reason will help with the management response.
First, the employee may not know what the manager thinks about him. This is a
communication problem and the manager needs to clarify the nature of the duty and
performance standards and co-ordinate the objectives.
Second, the employee knows what is required but does not know how to do it. This is a
learning problem and the manager should ensure that the staff is trained. If, after training, the
employee can not yet perform at the required standard then this is a matter related to his / her
skills.
Third, the employee knows what is required and may be in the expected standard but may
lack influence on resources and fall short of the lack of this influence. In this case, the
manager must ensure that efficient work systems are ready to support the employee in
achieving the standard.
3.2 Motivation
3.2 / 1 What is motivation?
Motivation at work is a group of energetic forces that originate both inside and outside the
individual to initiate work-related behaviors and to determine its shape, direction, intensity
and duration.1 Motivation is a very important process for organization and treatment of the
individual. This is a process as well as one of the human resource management practices that
engages a lot of human resource management and is well linked to performance.
From many authors, including those who study management or
organizational behavior, motivation is defined as a process that implies psychological
elements that promote a direct directed behavior from the objectives.
2.There are many definitions of motivation to work different from one another but some
consensus has been found for determining motivation at work with how a certain behavior
begins, energized, supported, directed, stopped, and the subjective reactions that are present in
organization as this happens.
Although the role of motivation and its impact on performance is limited by some authors,
however, they recognize the impact that motivation has on aspects of important work such as
direction, intensity and perpetuation of behavior associated with behavioral work desired by
the organization and its representatives.
While in the private sector, motivation at work is of particular importance, in the public sector
it is not given the proper attention. Public sector organizations are under constant pressure to
improve their productivity and reduce costs.
Since public sector employees are often labeled lazy, they serve only oneself and deviate, it is
necessary to have the best understanding of job motivation to describe, support, and improve
the efficiency and effectiveness of public organizations.
On the other hand, public sector motivation is thus seen as a highly altruistic concept, while
the above Perry and Wise definition is seen as a highly individualistic definition, but is
challenged by a much more institutionalized definition. Thus, public sector motivation is
defined as the belief that values and attitudes that go beyond self-interest belonging to a
political entity and motivate individuals to behave appropriately.
The result of a motivated behavior is performance. Motivation is a psychological state that
affects the individual's behavior. Performance is related to an external standard, which is more
formulated by others than by the individual.
The motivation process is influenced by two factors: the factors that are related to the work
and its conditions (physical conditions, work design, rewards, social norms, culture) as well as
individual conditions (skills, competences, personality, values). such a model divides the
theories into two main categories of theories related to internal motivation and theories related
to external motivation.
According to some other theories, the process of motivation is caused by how the individual
perceives himself in an ideal context, and himself in an actual context, he passes through the
needs and expectations of a particular job, thus causing a certain behavior , this system or
process is influenced by internal motivators such as job satisfaction, personal development,
recognition from managers, etc.Foreign motivators are out of control of the individual such as
payment, bonuses or material benefits.
Social motivators originate from the fact that an individual makes decisions that pertain to
him, but also influences or affects the group to which he belongs.
Another motivation definition is that given by Armstrong (2009), which defines strength-
related motivation as well as the direction of a behavior and the factors affecting people to
behave in a certain way. According to the same author the motivation is seen as the product of
the three main components: direction, effort and perseverance.
The term motivation can refer to the objectives individuals have, how individuals choose
these goals, and how others try to change their behavior.
In terms of its motivation and its approach to the public sector, it exists in two forms: first, as
the inner sense to serve the public, namely the public sector motivation (PSM) and secondly
as a studied practice and implemented human resource management.
In both of the above mentioned cases, motivation is, however, an internal incentive that has
psychological implications that directs the individual towards a desired behavior by the
organization. It is precisely this incentive to study and work on to achieve the proper behavior
of the individual toward what the organization wants.

3.2 / 2 Theories that explain motivation.

The motivation process starts with identifying the person's needs. Need is a perceived lack of
behavior that leads to the removal of this lack. Absences can be physiological, psychological
or social. In the field of motivation there are some consolidated classical theories, which have
been published around the '50s of the last century, theories which have inspired the most
modern theories that stand on the basis of the latter. One of the main theories is that compiled
by A. Maslow, known as the theory of needs hierarchy. Other theories are theories X and Y,
followed by theory Z, theory of dual factors (hygiene motivation), etc.
Theory of the hierarchy of needs
The best-known theory of motivation is that of the needs hierarchy formulated by Abraham
Maslow and was built using data from clinical author's studies on a group of neo-routine
patients. It assumes that within every human being extremely powerful needs, which can be
positioned against one another in a hierarchy.
This hierarchy is built on the basis of these assumptions:
• Once a need has been met, its importance as a motivator falls, is no longer stimulating to act.
• The needs group is very complex with several different needs affecting the individual's
actions at the same time. When one of them appears very powerful, for example, great thirst
dominates until it is completed.
• Before the higher level needs are sufficiently activated to promote behavior, the needs of the
lowest level should be met in general.

• There are many more ways to satisfy the needs of higher levels than those of lower levels.
According to Maslow, a person has five types of needs: physiological, security, union,
evaluation and self-actualization

1. Physiological needs: include hunger, thirst, the need for air, shelter, sexual intercourse and
other physiological needs of the body. These stand at the lowest level of the hierarchy
proposed by Maslo. People focus on meeting these needs before engaging in meeting other
needs. As long as employees are under the influence of physiological needs, their interests
and concerns are not focused on the work they are doing. They can accept any kind of work
you give, enough to meet those needs. Managers who try to motivate employees based on
physiological needs assume that people work first and foremost for money, and above all, are
concerned with comfort, avoiding physical pain and fatigue, and so on.

2. The need for security: includes the need to protect from physical and emotional dangers.
The need to be safe, stabilized, painless, without threats or illnesses, are all the need that may
be included in this category. People who are mainly motivated by the need for security
consider work largely as an element that creates a sense of stability and protection. Managers
who believe that their employees are mainly motivated by the need for security, do not
encourage innovation, nor do they reward risk taking.
For their part, they expect their employees to strictly follow the predetermined rules for them.

3. Need to be accompanied:
The need to associate with others, to be surrounded by loved ones and to be part of one's life
is part of this category. This need arises after physiological and safety needs are met. If
individuals are primarily motivated by the need to associate, they see work as an opportunity
to find and establish friendly and warm interpersonal relationships. Managers who believe
that their employees are driven largely by the need to have better and more friendly
relationships in the work environment is good to support this. Emphasizing social activities
outside the workplace, creating a climate of acceptance of support from colleagues and
building behavioral norms in the group are some of the concrete support that managers can
contribute.

4. Need to be assessed: includes inner feelings of self-esteem, achievement of goals in life, of

being of value and external factors such as: status, gratitude, and attention that others are
telling us. People with the high need to be evaluated want others to accept what they are and
to perceive as competent and capable. Managers who focus on the need to be evaluated try to
motivate their subordinates through public rewards and gratitude for the services performed.
The manager should be careful to motivate by showing gratitude if the individual is ruled by
the need to be valued.

5. Need to self-actualize: the urge to become the one you are capable of becoming. Includes
the need to grow, to achieve individual potential, to be realized. In essence, it means
extroverting, materializing, involve them in designing jobs, assign tasks individually, keeping
in mind the specific skills of employees, or give groups of employees a free hand in planning
and carrying out work.

According to Maslow, the five needs are listed in a hierarchical way, that is, they appear one
by one, ranging from the lowest to the highest. According to Maslow's Theory, though no
need can finally ever be satisfied, when it reaches a satisfying level of fulfillment, it (the
necessity) does not motivate anymore, but paves the way for another necessity which
according to Masloi immediately comes to a higher degree in the hierarchy of five needs. This
process continues as a degree until the need for self-actualization appears.

Theory X and Y
According to this theory formulated by Douglas McGregor, the views on the nature of
employees can be grouped into two basic categories. In one can be introduced the views
according to which managers evaluate their employees. This he calls Theory X and
summarizes these assumptions (McGregor, D., 1960):
Employees dislike work and whenever they can avoid it.Since employees do not want work,
they should be strengthened, controlled, threatened with punishment to achieve the desired
goals. Employees prefer formal direction. most employees place security on all other job
factors and are not ambitious.In contrast to these negative views on the nature of human
beings, McGregor makes 4 assumptions he calls Theory Y:
1. Workers may consider work as natural as resting or entertaining.
2. A person may exercise self-control if he is clear and accepts the objectives.
3. An ordinary person can be taught to accept or even seek responsibility.
4.Criteria in decision making is a feature that many people have, not just managers.
Theory X assumes that individuals are dominated by low-level needs.While theory Y suggests
that high-level needs are those that rule individuals. McGregor considering Y theory as more
realistic, proposing some ideas that are being implemented can increase employee job
diligence, such as participation in decision-making, creating challenging and responsible jobs,
and so on.However, assumptions of the X theory may also be appropriate for a given
situation. From theory X and Y, theory Z has been derived, which was first revealed by
Maslow in response to the theory x and y and then processed by William Ouchi. In principle
Z theory aims to stay in an intermediate situation between the theories x and y.According to
her, employees aim to create a joyful working environment and personal / intimate working
relationships with their superiors and colleagues. They need to be supported by the company
and highly appreciate a work environment in which facts such as family, culture, traditions
and social institutes are considered as equally important as work itself. These types of
employees have a sense of order, discipline, obligation to work hard and cohesion with
highly-developed associates. These employees can perform the tasks they charge when they
use all their knowledge while waiting for the company to support and take care of their well-
being.

Theory of dual factors, or motivation-hygiene

This theory was proposed by psychologist Frederik Herzberg. Given the belief that a man's
relationship to work and attitude to work can determine success or failure, Herzberg studied
the problem: What do people want from work?He asked many people to describe in detail the
situations in which they felt especially good or bad at work. Studying the answers, it was
noted that situations when people felt good at work were totally different from those when
they felt bad. Other factors relate to satisfaction, others with discontent at work. Internal
factors such as. achieving the goals, the gratitude that others tell us, work in itself,
responsibility and progress seem to be related to satisfaction at work. According to the study,
people who felt comfortable with work tended to attribute this to themselves. On the other
hand, dissatisfied people tended to attribute their dissatisfaction with external factors such as
company policy, administration, oversight, relationships between people, working conditions
etc. (Herzberg, F. 1968) Studying the data, Herzberg concluded that the opposite of pleasure
is not the dissatisfaction as believed. Removing negative features from a job does not
necessarily make it enjoyable. According to Herzberg 1968 (based on the results that he
derived from the study), the opposite of "pleasure" is "No pleasure" and the opposite of
"dissatisfaction" is "No dissatisfaction." The factors that lead to satisfaction at work are
divided and other than those that lead to dissatisfaction. Therefore, managers who try to
remove the factors that create discomfort at work can not but calm down, thus diverting
dissatisfaction, but not motivating. Characteristics such as company policy, administration,
oversight, human relations, working conditions and salary are termed by Herzberg as a
hygienic factor. When they are fit people are not dissatisfied, however, this does not mean
they are satisfied. If we want to motivate people to work, according to Herzberg, we need to
concentrate on achieving (how a job creates an opportunity for an individual to achieve his
goals in life), gratitude, work by himself, responsibility, and growth (moving forward). These
are features that people consider to be internal prizes. All of these theories have served to
form managerial thinking in human resource relations and staff management. It is good for
managers to have knowledge of these managerial theories and to use them in their daily work,
staff management and motivation, in order to achieve the highest results for their company
.
3.2 / 3 Employee Motivation Concepts:

Linear-Person Motivated by the Linear Concept, believes success is coming up the career
ladder in the company. Though very widespread as a concept, it seems a way to bring about
continuous success. The climbing movement in the organization's pyramid provides little
opportunity to advance further. Expert-Success for a person motivated by the concept of
expert is known the best concept. He is the best craftsman, the surgeon who is known in his
country for an innovative method or finance good "New positions are a natural extension of
previous work.One example may be the engineer who moves in project management, then in
budget preparation and ultimately in the company's financial functions.The spirals receive a
large amount of information, knowledge and experience. Many spiral people at a certain stage
of their careers have a great desire to share their knowledge with others. This desire pushes
some of them to break away from big companies and continue working as consultants or
teachers. Mobile-The success of "moving" is the ability to change jobs often. Movement is
more common than spirals, maybe every two to three years and the impending work is not
related to previous professional experiences. "Moving" can move from position as sketch
manager. These are people with extreme economic backgrounds who do not value security
much. Usually these people have grown into a family of high-income economies and assume
that money will always be there or have grown into a poor economic environment and know
they can live with little money. "Moving" can play an important role in companies that are
expanding geographically or in new markets. These people excel at first and value jobs
involving many people. Each of the career concepts has a variety of motives, which make
people happy and give them energy. The linears are motivated by power and achievements.
Experts seek expertise and security. Spirals appreciate growth and creativity. Movers are
passionate about variation and independence. Many people have a certain concept of career
success that they have integrated into their belief system, but have other strong motives
related to other concepts as well. Such a misunderstanding between the concept and
motivation can bring about despair, lack of motivation and concern. If an employee has some
motives that do not fit his concept of a successful career, he can easily change the concept of

success rather than motivation to achieve unification and end this dysfunction between
feelings and behavior.

3.2 / 4 Stimulation of staff promotes motivation

Performance-related incentives such as bonuses can encourage higher levels of staff

performance. Awards are usually related to the achievement of real or personal goals,
teamwork of the organization, or lobbying of all.Rewards are benefits given in addition to pay
as a means of increasing job satisfaction. Rewards and incentives can be an attractive element
of an employment package by:
Increased quality of work;
Abolish staff efforts;
Added value to the contramentct of employ

There are a number of incentive schemes, each with different costs. They include financial
and non-financial schemes, individual and group schemes, long-term and short-term schemes.
Financial incentives are useful for improving performance and may be:
Profit and stakeholder schemes
bonuses
percentage
Non-financial (and indirect) financial incentives are:
Official acknowledgment / rewards
Acknowledgment
Additional vacation. Gifts.

The incentive scheme can provide additional payroll officers based on individual or group
performance. Stimulations can also be provided on a short and long term basis, eg. based on
weekly goals or business objectives.There are a number of rewards, including:
Professional pensions;
Holiday longer than the minimum holiday defined by law;
Gifts, ie on the date of birth or at the end of the year;
Health benefits, ie health insurance / estimates;
The balance of benefits (family-society and work-life, ie Flexible Working Hours for Staff
Buffer Subsidy, Tea / Coffee Equipment and Goods / Services holidays, cinema tickets,
access to exercise gyms or sports facilities);
Lending (ie all-season tickets, social events, christmas agents, excursions or club
memberships);
Additional trainings (, which goes beyond the skills required for work

3.3- Performance-related salary

One of the greatest human resource practices that increases motivation is performance-
dependent payments. This practice has been used since the time of Taylorism and is used
successfully by organizations and nowadays. The task of modern human resources
management is to determine how much you will be the right salary for the respective
performance. This means that the reward is attractive to employees and not just a monetary
reward.Human resource practices that lead to the creation of an environment that guarantees
the opportunity of participation and performance performance are:

Keep Employees Always Informed

Employees should always be notified for opening up new jobs within the organization, for
rotation at work or for group work.
Enable group work
Human resource practices that promote teamwork or work between the departments, add to
their employees the sense of being part of the organization as a whole and also help them gain
full skills

3.3 / 1 Relationships with Performance Rewards

Achieving superior results compared to competitors requires among other things to be found
and the right focus: "The focus is on developing business strategies for achieving
long-term goals and the role played by human resources strategies in general and
remuneration strategies in particular in supporting these achievements "(Amstrong and
Brown, 2001). Within a management process the link between employee performance and
reward are self-substantiated and often necessary, but there is an argument to separate the
formal evaluation process from the informal one. The argument for the division is that the
payroll can affect the honesty of the self-assessment and interfere with the objectives of
developing the evaluation process by effectively transforming the manager from a trainer to
the court. The employee is less likely to be self-critical and expose the benefit and
development needs if it will have an impact on the placement of monetary compensation.
The remuneration in a broad sense has to do with employee salaries for the work done as well
and other benefits they receive from the organizations they are employed in. Currently, the
term "reward" reflects a more dynamic and more flexible treatment. In today's perspective, the
reward includes all those mentioned above, as well as non-financial aspects and motivation
applied in a contemporary human resource context. In a number of Western countries,
including America and Britain in particular, making this distinction in the concept of reward
compared to the past, the terms "old salary" and "new salary" are used. The old salary has
been characterized by bureaucratic wage management, hierarchical organization, strict labor
assessment and grading systems, as well as salary breakdowns from the strategic objectives of
the organization.
3.4- Selected Evaluation for Performance Evaluation in Albania.

The Albanian model, chosen for the evaluation of individual work outcomes, makes a
combination of "objective management", "top-down" or "superior" method and "descriptive"
method, the latter only for the related part with the assessment of basic skills.

Sub-legal bases
Guideline No. 2, dated 07/07/2000 "On the system of annual assessment of individual
achievements of civil servants", amended with the instruction no.5 dated 19/12 / 20073.3 The
Department of Public Administration to administer the process of assessing the individual
annual performance of civil servants and to provide the necessary training for its fruitful
implementation.
Decision No.231, dated 11.05.2000 "On admission to the Civil Service and Probation Period",
as amended; Point 26: At the end of the probationary period, based on the job description, the
results of
training and evaluation of individual job results, the direct supervisor decides:

a) Confirmation as civil servant

b) Departure from civil service
c) Postponing the probation period up to six more months once when it is considered that the
employee needs a longer period of time due to the complexity of the workplace.

All civil servants are subject to an annual assessment system for their work performance. Job
performance assessment is based on achieving the objectives for each job and the main skills
needed to accomplish the tasks.

The overall assessment is done on four levels of well-being at work that are "very good",
"good", "pleasing" and "unhelpful". The first three levels are positive estimates that relate
directly to the confirmation procedure at the end of the probation period, parallel movement
and promotion.
Also for these three levels, the civil servant is rewarded in monetary value at the end of the
year of assessment of individual outcomes, while level 4 is a negative estimate.
Normally, the assessment is performed by the direct superior, but in other special cases other
procedures may apply.

For special cases the procedure is decided by the cooperation of the unit responsible for
human resources management of the respective institution and the Department of Public
Administration.
In cases where the procedure provided for in this instruction is not followed correctly, DPA
in the role of the annual performance appraisal administrator officially advises the institution
responsible for compliance with the procedure by officially deciding on its normal
performance The assessment of annual achievements is a complex process which, if not
properly assessed, risks becoming a subjective process.
Managers of each institution should understand that annual performance appraisal impacts on
employee performance growth and is not used as a means of causing conflicts between the
superior and the subordinates.
Since managers are responsible for motivating their subordinates, to carry out a high-level
job, they must bear in mind that in a work environment where they exist
conflicting relationships, employee motivation is low, negatively affecting the overall
performance of the sector / directorate / institution.

The assessment is open to the employee and must be approved and signed by the direct
supervisor of the evaluating officer.
The concerned employee, although he may disagree with the level of assessment made by his
/ her superiors, must sign in Section E where to testify for receiving the assessment report of
the personal results.

The assessment is done on the basis of workload for a period of 12 months starting from 1
November to 31 October of the following year.
At the beginning of the assessment year, all employees, both those who will be evaluated and
those who will do the assessment, must recognize the objectives of the work on which the
assessment will be conducted.
Throughout the year, Senior Reporting Officer will monitor the employee's progress and
should highlight any particular issues or problems as they arise, under the responsibility they
have as reporting supervisors.
Rapporteur and Subsidiary under their dependence on the levels of overall performance
appraisal to be implemented in order to meet the overall assessment objectives.
The appraisal process ends by November 15, while the appeals process expires by the end of
November.
The calendar year of the assessment is organized in this way to link individual outcomes with
the pay component "Add-ons for work outcomes"
The annual performance evaluation is done by completing a standard form. The form consists
of five parts;
a. The employee's personalities
b. Job goal and objectives and performance evaluation based on achievement of objectives
c. Assessment of job performance based on core skills
d. General comments of the reporting officer and the counterfeiter officer
e. Employee signature

Characteristics of Fier Regional Hospital

In these years when we talk about Fier Regional Hospital we refer to one of the largest
hospitals in Albania offering high quality secondary and tertiary health services. Currently it
belongs to the city of Fier, ranked in the category of cities with large urban development,
which has an area of 730 m2.
Also whenever we refer to the Fier District we do not forget to include in the surroundings
such as: Lushnja Patosi. Ballsh.
The Durres Regional Hospital enjoys a status: semi autonomous. This is because it is funded
directly by the Health Insurance Institute (HII) but executives are determined by the Ministry
of Health, penalizing to some degree the decision-making autonomy.
Giving autonomy to regional hospitals management by allowing hospitals to personalize their
demands on real needs and not as a requirement centered on the Ministry of Health.
Hospitals budget funding from HII (apart from capital investments to be implemented as
projects approved by the Ministry of Health. Since 2009, hospitals were included in the health
care insurance scheme.
This enterprise came as a result of implementing a strategy that the government undertook
since 2005 to finance health services by a single funder.
Fieri Hospital has not yet provided full autonomy, no cost accounting system is used, full
balance can not be shown to indicate where they are, what they are doing and how to better
manage their funds in terms of improvement of patient service.
4.2-Analytical Structure of the Directorate of Fier Regional Hospital
Department
The Directorate consists of the director, the deputy technical director and the deputy director
of economics, from the chief nurse, the auditor's specialist. Hospitality and Secretarial and
Archivist Service Lawyer
Finance Sector
This sector consists of responsibilities, from 3 senior specialists and 3 archaeologists and 1
responsible for the cash.
Cost Sector
This sector consists of responsibilities, from 2 High Specialists 1 Senior Statistics Specialist
and 2 Operators.
Planning and Procurement Sector
The sector consists of sectoral responsibilities, 2 High Procurement Specialists and 1 High
Salary and 2 Evidence Expert.
Human Resource and Public Relations Sector
The human resources sector consists of a sectoral and 2 human resource specialist
Technology Management Sector
This sector consists of a responsible person, 1 Infromatics Specialist, 1 Biomedical Specialist
and 2 Operators.
Technical Sector
This sector is comprised of the Head of Sector. 1 Senior Specialist, 3 Technical. 5 Oxygen .25
drivers.
Hotel Sector
The Sector is comprised of the Head of Sector. 1 Senior Specialist 5 Engineer. 3 Dishwasher
and 6 Wardrobe.
The Environmental Services Sector
It is composed of Head of Sector. 2 Senior Specialist, and 64 Sanitary .
Medical Service at Fier Regional Hospital
General Medicine Service
It consists of 1 chief of service, 3 clinical staff, 11 staff, 1 chief nurse, 13 nurses.
Emergency-Emergency Service
Consists of the Chief of Service. Emergency Response Coordinator, 9 doctors, 1 head nurse,
and 13 nurses.
Infectious Diseases Clinic
It consists of1 Head of Clinic, 1Means of Infection. 1 head nurse and 8 nurses.
Consists of1 Head of Service. 1 Head of Clinical Surgery, 8Means Infection. 1 head nurse and
14 nurses.
ORL Clinic of Ophthalmology

It consists of the chief of the clinic, 1 ORL physician, 1 ophthalmologist, 1 chief nurse, 4
nurses, 2 instrumentist
Intensive Care Service
It consists of the chief of service, 4 anesthetist-reanimator physicians, 1 chief nurse, and 12
nurses
General Pediatric Service
It consists of the Chief of Service, 6 pediatric nurses from 4 doctors, 1 police nurse, 16 nurses.
Infectious Pediatric Clinic
It consists of 1 physician .1 head nurse, 8 nurses.
Intensive Pediatric Therapy Clinic.
It is Doctor 1. Chief Nurse 1. Nurse10
Obstetric-Gynecology Service
It consists of the chief of service,
Obstetric Clinic
It consists of 1 chief of clinic 5 doctors, of 1 nurse, of 18 nurses
Gynecology Clinic
There are 1 chief of the clinic 4 doctors, from 1 nurse, from 8 nurses
Neonatology Clinic
It consists of 1 chief of the clinic 3 doctors, of 1 nurse, of 16 nurses
Operating room
There are 1 nurse, 5 instruments.
Pharmaceutical Service
It consists of the chief of the service, from 2 pharmacists
Psycho-Social Service
3 Social Worker and Psychologist
Clinical-Biochemical Laboratory
It consists of the chief of the laboratory. 2 laburing surgeons, of 1 labyrinth, of 20 labs.
Imaging Service
It consists of the Chief of Service, imaging physician 2, 5 dyslexic laboratories, 1 nurse
Laboratory of Pathological Anatomy
It consists of 1 anatomist-pathologist, laburant 2, proctor1
Blood Bank
It consists of 1 physician, 2 nurses
Pneumophytes and Anti TB
It consists of1 chief of service, 1 physician, 2 nurses from 1 laborers
Polyclinic Service
It is comprised of 1 head of the polyclinic service, from the first nurse
Imaging Cabinet Physiotherapy Cabinet
1Laburant radiographs, 1 nurse 2 physiotherapist nurses
Cabinets of Cardiology Neurology Cabinet
2 cardiologists, 2 nurses, one doctor and one nurse
Cabinets and Neuropsychiatry Cabinets and Oncology.
1 cardiologist, 1 nurse, 1 physician and 2 nurses
Cabinet of Surgery Cabinet of ORL
1 doctor, 1 nurse 1 doctor and 1 nurse
The Cabinet of the Ophthalmology Cabinet of Endocrinology
2 doctors, 1 nurse 1 physician and 1 nurse

Orthopedic Cabinet Alchemy Cabinet

1 doctor, 1 nurse 1 doctor and 1 nurse
Cabinets of Nephrology Gastreology Cabinet
1 doctor, 1 nurse 1 doctor and 1 nurse
The Rheumatology Cabinet The Blood Punching Punch
2 doctors, 1 nurse 1 nurse
Professional Occupational Therapy Cabinet Urology Cabinet
1 doctor, 1 nurse 1 doctor and 1 nurse
The Cabinet of Dermatology The Cabinet of Hematology
1 doctor, 1 nurse 1 doctor and 1 nurse
Infectious Diseases Clinic and SST 1 doctor and 1 nurse

Total Fier 521 Regional Hospital Workers:

Administration 42
Supporting staff 50
Doctor 129
Nurse and Laboratories 234
Sanitary and Floriculture 66

Chapter IV - Human Resources Management at Fier Regional Hospita

4.1 Fier Regional Hospital as a provider of health services for patients

Hospitals suffer from various problems. So the financial system in the hospital systems before
2009 was top-down centralized.Decisions were made by the Ministry of Health which defined
hospitals' needs on a general average of the needs of each hospital, and therefore there was a
significant shift away from the real needs (equipment, medicines) of regional hospitals which
hindered the management of internal and consequently the provision of services in a proper
manner.The hospitals did not have financial independence as a result the staff was not
motivated to deliver the service effectively. Specifically, the Ministry of Health allowed up to
15% of secondary income for spending and 15% for investments, ie 70% passed to the state
budget and this did not motivate regional hospitals to increase secondary incomes also a
scheme of such did not include voice rewards for staff.It can be said that there are:
Lack of an information system regarding the registration and monitoring of internal technical
and financial activity .There is no possibility to calculate the cost of hospital services.
Lack of assessment descriptors of medical activity according to hospital services.
Increased level of informal payments, low collection of secondary incomes.
Lack of standard hospitality packages.Lack of approved treatment protocols according to
hospital services
The mission is to provide a better and quality service to patients.

The services provided by this hospital are:

Pathologjia
It includes forensics and cytological examination. It is guaranteed by anatomist-pathologist.

Surgery
General surgery, dealing with all urgent and planned cases including Urology, Orl-
Ophthalmology and Orthopedics. This service is provided by specialized medical surgeons
and nursing staff near this service.

The obstetric-gynecology service functions at the regional level and guarantees obstetrical
visit, gynecological visit, birth, operations of various obstetric and gynecological pathologies,
postnatal vaccination of the newborn child, continuous follow-up of pregnancy progression
for the pregnant woman, hospitalier treatment of gynecological and obstetrical pathologies.

Pediatrics
Somatic pediatrician with a capacity of 65 beds, where the service is guaranteed by 6
pediatricians and divided into special wards (observation, neonatology, respiratory illnesses)
and pediatric RNM where heavy cases are treated.Infectious pediatrician with a capacity of 30
beds, the service is guaranteed by 1 doctor and 10 nurses.

Radiology
1. Abdominal echoes including (liver, spleen, pancreas, kidneys, urinary bladder, female and
male genital organs).
2. Echo mamo and thyroid glands.
3. Ro "Television Scope (lungs, stomach, abdomen).
4. Roofs of all kinds.
5. Mammograms.

Polyclinic
The Central Clinic of Specialties is subordinated to the Regional Directorate of the Fier
Hospital. In this clinic it conducts the medical visits of Fier district In 20 specialists
The 21 cabinets are covered by specialized and qualified personnel inside and outside the
country.
The main polyclinic is:
Diagnosing patients who come with a recommendation from the family doctor or directly,
Following chronic morbidity,
Patient education for health problems, etc.
Clinical-Biochemical Laboratory
Clinical- Biochemical Laboratory Provides the following services:
Complete blood analysis + Formula + Sediments
Total bilirubin + Direkte
SGPT (ALT)
The service of internal diseases where doctors offer this service and near the polyclinic offers:
1. Ecocardiography
2. Exercise
3. Electrocardiogram
4. Reanimation
Table 1. Personnel movements and causes

Immigration The newly Others in total

graduated

Get away 5 4 16 20

Come on 2 5 9 16

It is noted that the number of displaced persons from the institution is greater than that of the
newcomers, although the difference is very small only 4. Only 5 of the displaced have the
reason for emigration, while in the case of the newly graduated three have left and 9 have
come. But the majority of those who have been dismissed have been dismissed for other
reasons not declared by them. This indicates that external recruitment is the largest number
since it is comprised of newly graduated students.As for internal recruitment, we can say that
there has been enough movement. The most experienced employees have been given the
opportunity in higher positions, both managerial and higher hierarchical.
Table 2. Movements within the institution in recent years

The type of Deduction on

movement Rise on the job duty

Position ahead doctor nurse Head of service

Current position Head of service Doctors nurses

Supervice of nurse

deputy director

Nr. Of 5 5 5 5
employees

The degree of motivation for climbing career stairs within the institution exists but is not at all
high. It is noticed that the number of employees set up on duty with the number of employees
deducted on duty is the same and there are only 5 employees. So, in short, the employees who
were chief nurses returned to nurses while four nurses were positioned in the role of chief
nurse. The same goes for the doctors where those doctors who were in the position of the
chief of service went down in duty and in their place as chiefs of service were placed four
other doctors.

Career stages and motivation of the workforce at Fier Regional Hospital

According to the Table, the largest number of employees of Fier Regional Hospital consists of
those with a working age of 11-20 years (ie 200 employees) and 31 - ... years (120
employees). So the institution consists mainly of employees who are in the middle of the
career and in the downtrodden stage.
Table 3. Employee ages

Oldness at work / years Oldness at work / Nr. Of employees

years Oldness at work / years

0-10 100

11-- 12 180

21--30 148

31 93

Groups representing the share of employees in the exploration phase are relatively few in
number compared to others with only 100 employees while the total is 521 employees
(15.3%). Through this indicator we can assume that the number of newly graduates is low,
which indicates the few opportunities they have in the labor market.A positive indicator is
also that of the group representing the persons who are at the stage of career retention, mainly
those with a working age of 11 to 30 years, with a total of 328 employees (54.3%). show
stamina, experience experience, work ser- vice, professional capacity and have achieved an
acceptable work-life balance. While employees over 30 years of work are 93, they represent
about 30.4%. The above mentioned, despite the fact that career stages may vary considerably
between individuals according to their personality, profession, work environment or a
combination of them, and therefore these indicators will not be fully taken into account,
however, that the institution possesses the right capacity to guarantee professional
sustainability and experience transfer to young employees.
4.3- Performance Evaluation at Fier Regional Hospital

Assessing annual achievements is a complex process that, if not properly assessed, risks
turning into a subjective process. Persons responsible for performance appraisal make it clear
that the assessment of annual performance impacts on employee performance growth and is
not used as a means of causing conflicts between superiors and subordinates. The assessment
is open to the employee and approved and signed by the employee's direct supervisor, who
evaluates it. During the assessment, the reporting superior considers that most people can not
perform the task with the same standard in all aspects of the work. Most may have certain
skills and weaknesses that should be reflected in the assessment report that is being prepared.
A good superior considers that the annual results assessment is individual and relates to
concrete employees, so the performance of a sector as a whole should not be confused with
that of each employee. After individual assessment of each objective and skill is done and
after ensuring that these assessments match each other, the overall performance of the sector
is valued.At the Fier Regional Hospital performance evaluation is done once a year. One of
the methods of assessment is the top-down method where the employee's supervisor prepares
the performance appraisal. The direct superior is the most appropriate person to perform
performance appraisal, as the direct relationship with the employee allows him to closely
follow the performance of his subordinate duties during a working year. If the employee has
questions about how is evaluated and how it can be improved, all responses can be provided
by the direct supervisor, who has regularly followed his job. During performance assessment
through this method, together with the supervisor may also be present a specialist of the unit
For the assessment of the nurses is done by the chief nurse whose assessment is done by the
chief of the pavilion, which also evaluates the work of the other doctors of the pavilion while
its evaluation is done by the director. Therefore, evaluation based on the hierarchy. The
evaluation is individual ie for each employee, the following performance indicators are
evaluated such as:
1. His / her professional ethical behavior at work.
2. Apply the chart and type of work assigned by the head nurse.
3. Use of working time.
4. Relations with colleagues.
5. Discipline Measure.
6. Trainings (internally)
7. Trainings (abroad)
8. Absence with reason
9. Lacks without reason
10. Other (specify)
In addition to this form of assessment, there is also an informal assessment, ie an unofficial
assessment made by the head nurse or a pavilion doctor without a definite structure and which
can be done in an unwritten form daily. Applying such a rating system can serve to realize a
good healthcare delivery. Thus, the nurse can control the nurse in some direct or indirect
ways, thus controlling her work by supervising herself during her working hours at different
time periods or by considering peer reviews for each other. Though such a form of assessment
brings dissatisfaction and even violates the rights of the individuals involved.So far, such a
form of assessment has existed, but this year another assessment system will be applied as the
human resources specialist communicated. This method consists of evaluating employees
according to their labor objectives and basic skills such as:
direction
trial
Group work
Utilizing resources
self-stimulation
Creative spirit
self-organization
Communication Skills in Writing
Oral communication skills
Quality of service
Technical capability

The overall assessment is done on four levels of performance at work, which are: "Very
Good", "Good", "Satisfactory" and "Not Good".
But such an assessment has not yet been carried out at the Fier hospital three management
categories are responsible for the evaluation system. The performance of each employee is
evaluated by the head nurse, the chief of service and the director.At the Hospital Center there
are deficiencies in the performance appraisal process as this assessment is purely formal and
does not have any major impact on service delivery. Such a rating does not categorize staff,
does not motivate staff at all and is not accompanied by financial bonuses. We can even say
that such an assessment can be turned into a standard assessment for everyone and does not
reveal anything concrete about the skills of any employee.
As for the motivational strategies undertaken, there is nothing at all. There are many
disadvantages in this center regarding employee evaluation and motivation.

Chapter V - Evaluating the performance of employees in other institutions providing

health services.

5.1- American Hospital

The American hospital in the early days of 2007 opened its doors with an ambitious pledge
and great responsibility: to make it possible and bring what Albanians wanted outside the
borders of Albania:

Diagnosis and treatment of the highest standards of modern medicine.

In the first steps started the treatment of heart disease after another novelty was the
electrophysiological study that was carried out by professors and cardiologists.In 2007, the
hospital challenged another taboo of Albanian medicine by carrying out the transplant of a
kidney organ for the first time in the country.In 2008, the hospital united the undisputed
success of modern medicine with the US investment force under the name American Hospital.
Hospital staff are on the job in search of excellence in the services they provide. Staff
professionalism and contemporary technology make the difference at the American
hospital.This hospital provides opportunities for career development and a pleasant working
environment for employees. If staff is motivated, goals will be achieved which will help in
their individual progress and in the progress of the hospital.In the US hospital, weekly surveys
run on individuals,When did you last undergo a check-up ?.
In addition, conversation is made possible by questions and answers where people, citizens
ask the hospital representatives to answer.Alongside them there are a number of other sources
of information for citizens such as the submission of ongoing projects, ongoing information
on various health issues, various publications about diseases, diagnosis and treatment of the
services they offer.In addition, there is a vital sabbath where different topics are discussed.
5.1 / 1 Evaluation of the performance of US hospital staff.

All those individuals who are admitted to work at the American hospital should initially
undergo a 2-month trial period and accordingly decide whether to work more or less in this
hospital. Staff assessment is done every day they are evaluated by the headmistress for the
work they do, how they perform the tasks, how they behave with the patients, how they
communicate with each other. They are evaluated on the basis of their abilities, such as
judgment, intelligence, and sense of responsibility. In this hospital, different forms of
assessment are used as top-down methods where the assessment is performed on a
hierarchical level by the chief nurse, the pavilion doctor, the chief the service as well as the
director as well as peer evaluation. This assessment is applied in those cases where the
presentation of the studies by the staff is done and the colleagues give opinions, ideas and
suggestions to each other. Therefore, an evaluation is made each day every 6 months by the
steering board. Within this period of time, the staff should carry out the presentation of studies
dealing with various topics related to the morbidity of each pavilion. So if a pavilion has 14
nurses they divide into 2-th or 3-th groups where each group presents a topic. For the selected
topics, consultations are made every Friday, suggestions are given, remarks are made and then
the best accomplished studies are published and published in Monthly newsletters. Such a
form of assessment motivates many employees as it is accompanied by financial and non-
financial incentives since the best issue is being published and thus evaluated the staff that has
accomplished it. The best employees receive additional bonuses. Their salary is related to
performance. For the best employee of the pavilion is given a reward or other forms of non-
monetary reward such as traveling abroad, participation in trainings inside and outside the
country, gifts at the end of the year may be applied. These reward forms have been
implemented in this hospital since the moment of creation until the last year.
Characteristic for this hospital is that it enhances the motivation of employees not only with
performance-based payment, with monetary rewards, but the human resources department
always keeps employees well-informed about their performance, performance rotation, and
boosts group work among employees of various wards in this hospital.
Chapter VI - Data Analysis.
6.1 Analysis of completed questionnaires by employees of Fier Regional Hospital.
One of the research tools used in the study is the questionnaire addressed to employees of Fier
Regional Hospital and the employees of the American Hospital in Tirana. I have analyzed
their analysis to highlight the differences that exist between a public institution of private
performance assessment. From the analysis you will notice that these changes are great and
we will understand that a real and concrete performance evaluation is done at the American
hospital which reflects the problems of not performing the performance of public employees
as well should. The reasons for such a failure are numerous, but it is difficult to determine the
reasons in the concrete case. Reasons may be different, for example, no skilled people are
qualified to do the job properly, perhaps these people are in the wrong place and in the wrong
position. But it is not for me to determine it. Another reason may be that there are no tangible,
clear targets or there may be, but there are not the right ways to realize them. With regard to
Albanian medicine, with public hospitals many things are said, many strategies have been
undertaken but there are still many problems so when does not have a good job environment
when there are no conditions, medications how can a performance performance of employees
be?
1. Descriptive data
1. Gender
As we see from the chart, the largest percentage of women are women, which shows that the
number of female employees is greater or the willingness of women respondents to the
questionnaire has been greater.

2. Job position
As far as the highest work position is for nurses, this is related to the fact that they are the
most numerous in number.

Data related to performance evaluation

3. How do you see your work?

From the graph it is noticed that there is a distribution of almost % since the way they qualify
their work is different.

4.-Employment policy is right in your eyes?

The vast majority of them have given an intermediate response, therefore agree on average.
But if we compare the number of those who disagree with it is greater than those who are
completely in agreement.
5.- With regard to performance evaluation questions, whether or not there is, how often is
implemented, with what methods or criteria are given different opinions. Most of them nearly
48 of them know that there is such an assessment that is done once a year, is an individual
assessment that is made on the basis of some criteria of employees such as ethical
professional behavior, how they perform duties, trainings internally and internationally,
disciplinary measures, absenteeism, etc. There are also employees who said that this
assessment is done daily by the nursing nurse, by the chief of staff. No employees who think
such an assessment does not exist at all about 15 of them think so. Even those who have
replied that they exist are not clear about how it is implemented.

6- Is Assessment a Formal Procedure?

Employees interviewed have preferred to give a medium response while having % of = those
who think it is and those who think it is not a formal procedure. This is probably confirmed by
the fact that the evaluation does not bring any material or moral benefit.
7 -Delivery performance should be done or seen with fear?
About 89% of them think that an assessment should be made to help employees influence
their education and on-going education.

8..Wage reflects your performance?

According to them, the salary has nothing to do with performance but is determined based on
function, difficulty, seniority, guard watch, etc.

9. Does the institution support employees professionally?

Most of them have preferred to give a medium answer what supports them a bit but as we
notice there are those who are dissatisfied and think that they do not support them at all.
10. When the non-formal assessment affects your work
Even in this question the answers have been a bit contradictory as we have a% of those who
think it affects those who think not about 34% without excluding and% of those who think
that affects a little.

11. Do you impact performance appraisal on worker motivation?

About 58% of them think that the assessment made has not affected their promotion, as some
of them do not even know how this assessment is being conducted.
12. A good motivation brings high performance?

According to them, a good motivation is one that brings a higher performance because the
more motivated the employees are, the more monetary and non-monetary incentives to be
undertaken, the more they will affect performance.
In terms of testing, the majority of employees disagree with it. Some of their comments were:

More seminars and trainings should be held.

If testing is to be anonymous anode is done only to highlight the problems faced by medical
personnel
Testing is illegal.
The work that has been done will be in need of a good working environment, advanced
technology, high standards to provide the highest qualitative care.
Testing can be done I'm not afraid because I trust my knowledge pork y testing will not affect
us at all, in our formation or development. For us it is important to continue education

Chapter VII - Conclusions

Employee performance assessment is one of the most important functions of human resource
management. It starts immediately after the employees get hired and goes on throughout the
employment process.

The constant and fair evaluation of employees is linked to their motivation and further
performance at the workplace.

The purpose of performance appraisal is for employees to recognize their strengths and
weaknesses while performing certain tasks. Their understanding creates the opportunity to
work to make the necessary improvements.

The assessment is open to the employee and approved and signed by the employee's direct
supervisor, who evaluates it.

At the Fier Regional Hospital performance evaluation is done once a year. One of the
methods of assessment is the top-down method where the employee's supervisor prepares the
performance appraisal.

The assessment is individual, so for each employee, the following performance indicators are
evaluated: His / her ethical professional behavior at work. Implementation of the chart and
type of work assigned by the head nurse. Working hours use. Relations with colleagues.
Disciplinary Measure .Training (Internally) Trainings (Abroad), Fair Incompensation,
Absence without Reason.

Evaluation is a formal procedure that does not affect the work of any employee at all.
Among the 2 hospitals, respectively a public hospital and a private hospital, there were many
differences in both performance appraisal and remuneration systems. This is also related to
the second hypothesis of research which was verified by the results found by the
questionnaire analysis and of secondary data.

Of all respondents, respectively hospital hospital workers and those in the US hospital despite
the differences, see the performance assessment as a process to be made.

The degree of employee satisfaction varies depending on the degree of hirercy: we have the
nurses more satisfied with the direction of the general manager than with the direction of the
chief nurse or chief of the service this is also related to the lack of direct contact.

From Fier Regional Hospital staff there are different opinions about performance appraisal,
some think it is formal, but there are those who think the opposite. This is probably confirmed
by the fact that no matter how the assessment of the permitting can be very good, it does not
bring any material or moral benefit.

All respondents of the hospital center responded that the salary does not reflect their salary
and that there is no link between performance and remuneration systems.
The opposite is in the US hospital where the performance-motivation or reward relationship is
a mutual relationship.
So we confirmed the third hypothesis of research by analyzing the questionnaires.

Recommendations

Performance evaluation in a public hospital needs to be concrete and real, not just a formal
procedure that does not have any impact on the education and training of any employee.

Measures should be taken to increase the importance of performance measurement.

Measures should be taken and efforts made to have a performance evaluation system as
effective as evaluation in a private hospital.

Measures should be taken that performance appraisal is accompanied by material and

monetary benefits.
Public administration should improve current performance management practices by changing
the philosophy of the process, increasing the objectivity of outcome evaluation and creating
incentives for those who have good performance in the administration. Incentives, other than
cash, may include non-monetary interventions, eg. application of a wide range of delegation
of competencies

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