A Qualitative Study into the Experiences and Motivation of Filipino Healthcare Professionals in Pre- and Post-COVID-19 Pandemic

A Qualitative Study into the Experiences and Motivation of Filipino Healthcare Professionals in Pre- and Post-COVID-19 Pandemic

*Alfred Anthony Bueno, Angel May M. Buhisan, Kayle Erika Shayne P. Nayal, and Jason O. Manaois

Department of Psychology, Xavier University – Ateneo de Cagayan, Cagayan de Oro City, Philippines

*Corresponding Author

DOI: https://doi.org/10.51244/IJRSI.2023.1012042
Received: 09 December 2023; Revised: 15 December 2023; Accepted: 20 December 2023; Published: 14 January 2024

 ABSTRACT

Motivation is among the core components of work performance among individuals and organizations, particularly for workers facing challenging and complex work environments. The Self-Determination Theory analyzes the key elements of one’s motivation, focusing on intrinsic and extrinsic motivational patterns. Healthcare workers face specialized tasks (e.g., providing patient care) and daily challenges (e.g., weighty workloads) that test their motivation to pursue their chosen profession. In this article, the self-determination theory is applied to clarify both (a) experiences and (b) challenges of these healthcare workers employed in Cagayan de Oro City. The current study utilized an online qualitative survey to obtain responses from the target sample. The data were coded and thematically analyzed. Results indicate that participants experience both ends of the motivational continuum; some experience a personal inherent desire for continued learning and professional development, while others are motivated in their profession for increased financial compensation and benefits. These workers’ challenges include workload challenges, conflicts with colleagues, changes in the workplace environment, and difficulties encountered through patient interaction. Policymakers should focus on providing a balance between boosting healthcare workers’ monetary compensation, providing further growth and development in their field, and enhancing workplace conditions; improvements in their motivation level can be anticipated to increase.

Keywords: self-determination theory, healthcare workers, challenges, intrinsic motivation, extrinsic motivation

INTRODUCTION

Filipino healthcare workers (HCWs) are highly appreciated. HCWs provide direct medical care as doctors and nurses or indirect care as aides, assistants, laboratory technicians, or medical waste handlers. Oversaturation and shortages of frontline healthcare staff imperil global healthcare systems. Even before COVID-19, there needed to be more long-term labor planning, low staff retention, and mobility for relocation and retirement due to old age [1].

In 2014, the WHO recommended 4.45 competent health professionals per 1000 persons. The report demonstrates a need for more health personnel in the Philippines. Shortages include 60,000 doctors, 121,000 nurses, and 109,000 midwives. This emphasizes the urgency of addressing healthcare shortages. Though crucial to patient care, healthcare workers often endure workplace stress, anxiety, and tension, especially during crises [2]. Studies suggest that these issues lower their morale, impacting patient happiness and the quality of healthcare services.

In addition, the Coronavirus disease (COVID-19) has disrupted people’s daily lives since its rapid global pandemic spread in 2019. It also made it more difficult for healthcare providers in hospital and community settings, as most of their staff has been sent to help control and contain the disease. The sudden global spread of the virus, along with its high death toll in the Philippines, emerged with far-reaching consequences on people’s health, social lives, and economic well-being [3].

Existing literature indicates that healthcare professionals have reported experiencing various mental health challenges, such as depression, anxiety, stress, burnout, and work-related bullying, while actively combating the COVID-19 pandemic [3]. These dedicated individuals find themselves in a precarious position, as they not only encounter harassment, violence, and discrimination within their healthcare settings but also within the communities they serve [3]. This worldwide health crisis has resulted in a noticeable escalation in the scarcity of healthcare professionals.

However, healthcare workers have encountered various intrinsic and extrinsic challenges and motivations within and outside the workplace, notwithstanding their well-known and valiant efforts to combat this worldwide crisis [3]. Motivation has several motivational components, including financial factors, job progression, continued education, health facility infrastructure, resources, relationships with administration, and personal acknowledgment.

In light of the difficulties Filipino healthcare workers from Cagayan de Oro face on the job, this article investigates the intrinsic and extrinsic factors that motivate them to continue providing quality healthcare. The study intends to clarify (a) the experiences and (b) workplace problems for these healthcare workers.

LITERATURE REVIEW

A. Motivation among Healthcare Workers

One of the driving forces among healthcare workers is motivation. As verified during the 2018 Global Conference on Primary Health Care (PHC), motivation is a valuable investment for delivering PHC and improving the health workforce. Many things could motivate someone to work in the medical field. Healthcare is labor-intensive [4]. Therefore, “personal calling,” exhortation, experiences, chance, a desire for social status, high esteem for health professionals, and economic variables are essential to a strong workforce. In addition, staffing, work schedules, promotions, performance, open communication, and enough resources can motivate workers [5].

In times of public health crisis, natural disasters, and other calamities, healthcare personnel are essential for society. According to research, not all professionals are ready to take the chance to work in such circumstances [6]. The “sense of duty” or duties alone will not be enough to keep healthcare staff on the job in the face of these difficulties.

It was also suggested that health professionals are inspired to do their best according to their field’s progress. This, in turn, helps them feel better about themselves. Healthcare personnel are encouraged to do their best by receiving public acknowledgment of their efforts. Public recognition encourages healthcare workers to achieve their best. They may be promoted because they deserve it and progress [7]. Alderfer, Herzberg, and Maslow believe this is crucial to self-worth and becoming one’s best [8]. Success and responsibility may boost a healthcare worker’s confidence.

However, in Malawi, it has been discovered that effective HRM practices boost HCW motivation and performance and that continual education and career promotion are insufficient to retain health workers [9]. Human resource management strategies should include giving and receiving constructive criticism, creating clear job descriptions, and providing proper supervision.

Several studies have demonstrated that healthcare employees’ motivation and job satisfaction are directly related. Determining these elements can facilitate creating motivated responses to these challenges [10]. This can be done using knowledge about motivation and the forces that improve or suppress it. According to a multi-method study, healthcare professionals’ demotivation is reinforced by their fears of infecting their friends and family members while on the job during a pandemic [11].

The workforce environment is another factor that might affect the healthcare system. Health organizations face external pressures that cannot be effectively managed without proper modifications to the workforce, suggesting that workforce development appears to be an intrinsic aspect of the health policy formulation process [12]. Lack of preventative and protection information, increasing job load, social isolation, and lack of childcare can also add to an already stressful situation. This demonstrates the critical role of organizational support in shaping organizational interventions and coping methods for employees [13]. Moreover, understanding why healthcare worker demotivation can lead to successful solutions. Reducing factors that worsen healthcare workers’ unwillingness to work might reduce the detrimental impacts of disenchantment on performance in high-risk environments [14].

B. Challenges Encountered by Healthcare Workers

One of the biggest problems worldwide is the shortage of medical personnel [15]. The World Health Organization recognizes that the decline of healthcare workers over the past decades has significantly impacted public health [16]. A study discovered seven critical challenges for healthcare personnel in Bangladesh. These involve increased workload, psychological suffering, lack of quality personal protective equipment (PPE), social exclusion or stigmatization, and lack of incentives, coordination, and management throughout service [17].

Multiple variables have affected these healthcare professionals’ jobs directly and indirectly during the pandemic. Many healthcare personnel experience burnout and stress [15]. Burnout and stress cause psychological harm as well as an increased risk of infections like COVID-19 [18]. However, even before the pandemic, multiple studies showed that these healthcare workers’ physical health had declined significantly [19],[20] which may still exist and increase even after the pandemic.

Additionally, studies found that being aware of stress had a depressing effect on motivation [21]. Moderate stress levels maintain worker productivity and efficiency, whereas excessive stress levels decrease them. Workplace motivation might suffer when employees are under much stress. The research proposes that hospital management reduces workplace stress to enhance healthcare workers’ creativity [21].

On the other hand, health professionals are vulnerable to both “pull” and “push” variables, such as job satisfaction, financial opportunities, salary, and working conditions [22]. It is crucial to keep employees by compensating them fairly for their efforts. However, monetary compensation is not the only factor to consider. A lack of resources and work opportunities causes this deficit. Other factors that lead to unstable work environments include inadequate pay, hazardous work environments, and restricted career growth and progress opportunities [23].

In a study,  poor management and a lack of teamwork and support are major demotivating elements in management and leadership [4]. However, managerial openness has a beneficial influence on motivation [7]. Salaries are seen as a key motivator in developing nations because of poverty, but in developed countries, they are viewed as an incentive rather than a motivation.

Therefore, finding answers to how to keep the healthcare sector motivated in the face of these challenges can be done by looking back at similar crises in the past and applying the lessons learned wherever they apply to the current predicament [6].

C. Self-Determination Theory

This study is grounded on the Self-Determination Theory (SDT) authored by Ryan and Deci [24]. The Self-Determination Theory examines two areas of motivation: intrinsic (engaging in activities one finds essential to oneself) and extrinsic (engaging in activities that reward pleasure and extinguish pain or punishment). It examines motivation in learning, personal experience, performance, and well-being [25].

The basic elements of the Self-Determination Theory are found within three psychological needs that must be met for an individual to attain psychological well-being: autonomy, competence, and relatedness [25]. Autonomy is defined as one’s sense of volition and willingness to produce one’s behavior. Competence is defined as one’s self-efficacy and mastery of one’s activity. Relatedness is the desire to have a sense of belonging and connection to others. All these three components are vital in integrating intrinsic and extrinsic motivation [24].

The Organismic Integration Theory (OIT), a sub-theory within the SDT [25], introduces a taxonomy of human motivation that categorizes one’s motivation based on the extent it emanates from one’s self. Amotivation is found at the far left of the continuum, a clear lack of intentionality in one’s action. A person who may be amotivated, does not see any value in the activity nor feels competent to accomplish such action. Next is external regulation is a type of motivation rooted in taking action to achieve desirable rewards or avoiding punishment. Individuals with this type of motivation have an external perceived locus of causality.

Following the continuum, introjection or introjected regulation is an internal regulation that still possesses an external orientation towards motivation. Actions performed by individuals with this type of motivation are driven to enhance their ego or avoid anxiety. Maintaining their self-esteem is placed at a higher order, and behaviors experienced are not fully part of their inner self. Moving towards a more autonomous extrinsic motivation, identification and integration are among the motivation types that lean closer to intrinsic motivation. In identification, motivation is somewhat internal, and one sees the relevance of a task. Individuals under this motivational stage may reflect on the personal values of the outcome of their own behavior. Meanwhile, in integrated regulation, one engages in behaviors congruent with one’s goals and values. Finally, in intrinsic motivation lies an inherent enjoyment derived from doing the work at hand.

Extrinsic and intrinsic motivation differ in an individual’s intention to accomplish various activities. For instance, a healthcare worker who enjoys his job and wants to learn more is intrinsically motivated. However, a worker motivated by monetary compensation may have high extrinsic motivation. Thus, intrinsic motivation occurs when a person pursues personal interests. Extrinsic motivation involves taking action to achieve a desirable outcome [26].

D. Significance of the study and research question

Although studies on motivation among healthcare workers have been extensively studied, learning the status of these essential workers remains a significant topic, as their line of work directly impacts the lives of the community. Previous literature has focused on specific healthcare workers’ professions, especially nurses and doctors.

In this study, we wish to expand the terminology of a healthcare worker further to qualify other professions as categorized by the World Health Organization [16]. By investigating motivation amidst challenges through a qualitative lens, the present study seeks to offer a meaningful analysis of the experiences among healthcare professionals that contribute to their motivational drives to pursue their practice. This research provides a timely resource for policymakers from our public and private institutions to focus on developing post-COVID-19 pandemic strategies to sustain or enhance healthcare workers’ support and motivation.

Furthermore, this study is a piece for the current professionals to take part in self-reflection of their ambitions and goals that drive them to this career path. This study may also offer insight for future professionals to reflect on their motivations before pursuing further work in the field.

Given these, the study seeks to explore the following question: From the perspective of Filipino healthcare workers, (1) what are the challenges these healthcare workers are facing in their line of work, and (2) what are the intrinsic and extrinsic factors that motivate healthcare workers to continue working in their chosen practice amidst challenges?

RESEARCH METHOD

A. Participants

The following inclusion criteria were used in recruiting participants: 25 years old and above and at least five (5) years of experience in their field to ensure that the participants have acquired years of work experience to investigate the phenomenon of motivation reliably. All participants were employed in Mindanao, specifically in Cagayan de Oro City, from October 15 to November 9, 2023, at the time of the survey. During the COVID-19 pandemic, Cagayan de Oro City was among the cities in Northern Mindanao that were badly affected by the virus outbreak. The city enforced lockdown policies to keep the virus from spreading, and designated facilities were constructed for patients who have transmitted the disease. At this time, healthcare workers were among the most essential workers in the field as the number of patients multiplied daily.

There were 40 respondents to the qualitative open-ended survey questionnaire. The average length of service for participants in their current employment varied, with reporting service between 5-7 years at (82.5%), 10 years and above of experience at (12.5%), and 8-10 years at (5%). 98% of the sample were female, and only 2% were male. The age ranged from 25 to 51 years old and above, with most participants falling between 25 and 30 years old (80%). A variety of professions were represented, comprising medical technologists (35%), nurses (28%), pharmacists (13%), psychometricians (8%), dentists (5%), social workers (5%), dieticians (3%), phlebotomists (3%), and dental assistants (3%). Healthcare professionals worked in different facilities, with 75% private and 25% public facilities.

B. Data instrument and collection

Google Forms, a survey administration software allowing users to customize questionnaires, was used to gather data through purposive sampling. Due to the schedules of varying work shifts among the healthcare professionals, the online survey was gathered through the online form and answered at the participants’ availability. Demographic data such as age, sex, profession, and years of service were collected. For this study, the qualitative answers to the questions ‘What is the reason you decided to be in the healthcare profession?’, ‘What were the challenges or obstacles you have encountered in your profession?’, ‘Can you tell us how was your experience as a healthcare professional before the COVID-19 pandemic?’, ‘Can you tell us how was your experience as a healthcare professional after the COVID-19 pandemic?’, ‘What continues to inspire you or holds your interest being in the healthcare profession?’, ‘Describe an experience where you felt extremely engaged and happy in your work as a healthcare professional’ and ‘How do you envision your chosen profession benefiting your future career or personal goals?’

C. Data Analysis

This study seeks to analyze the data gathered through thematic analysis to identify themes and patterns along the qualitative data. Utilizing the six-phase guided outline by Braun and Clarke with each step designed to follow the phases of a qualitative research design [27]. The present study uses a deductive and inductive approach to analyzing the data. In particular, the analysis of motivation in the present sample follows a deductive approach, utilizing the Self-Determination Theory [23]  as a guideline to identify and classify the themes. Meanwhile, the analysis of the challenges faced by healthcare workers takes an inductive approach, allowing more flexibility in the analysis. The study follows the criteria by Guba and Lincoln [28] to establish reliability and validity. Two independent researchers first analyzed the data before inter-coding. After the themes and codes were consolidated, a third researcher reviewed the codes for further validity. A thematic map analysis is created at the final step to supplement the themes generated. From the data collected, an average of two to three (2-3) line answers per participant were observed from each question before inspecting the themes.

D. Quality and Validity

This section describes the study’s validity and quality standards. The study utilized Yardley’s four principles, context sensitivity, commitment and rigor, reflexivity, and self-reflexivity, to identify the quality issues and ensure accuracy.

Sensitivity to context. This study demonstrates the researchers’ focus on context sensitivity by presenting an in-depth account of participants’ experiences and the surrounding environment. This is facilitated through comprehensive reading, demonstrating adaptability, and implementing member checking.

Commitment and Rigor. To guarantee the caliber, legitimacy, and dependability of study findings, Yardley contends that dedication is important [29]. The present investigation exemplified a solid dedication to rigor by employing a systematic approach to data collection, demonstrating reflexivity in the research process, ensuring transparency, and conducting a comprehensive analysis of the gathered information.

Reflexivity. In this study, the process of critical reflection on one’s beliefs, values, and biases is shown through transparent reporting and the discussion of researcher-participant dynamics.

RESULTS

The results of the thematic analysis revealed nineteen themes. Nine sub-themes can be categorized within the challenges in the healthcare field: three under workload challenges, two under conflicts with colleagues, two under changes in workplace environment, and two under experiences with patient interaction (see Table 1). Ten sub-themes could be classified within the Self Determination Model Continuum, which is the four types of extrinsic motivation: two under external regulation, one under introjected regulation, two under identification, and two under integrated regulation (see Table 2), and three under intrinsic motivation (refer to Table 3). In the following sections, we will expound on each topic using actual quotations from the dataset.

A. Challenges in the Healthcare field

Healthcare workers’ challenges are crucial for studying motivation. As mentioned, healthcare workers are among the Philippines’ top professions that face specific occupational hazards. Several of these problems have caused low retention and employee shortages. These experiences contribute significantly to their perseverance in the workforce. The themes gathered in the current study present challenges in the healthcare field relating to limited resources in the hospital facilities, imbalances in workload and compensation rates, and understaffed healthcare departments; conflicts with colleagues, individual differences, and miscommunication with colleagues; changes in the workplace environment, adjustments in protocols due to COVID-19;  experience with patient interaction, dealing with different attitudes and providing quality medical services.

Table I. Thematic analysis of the challenges encountered by healthcare workers

Theme	Sub-theme	Description	Exemplars
Workload challenges	Limited resources in hospital facilities	This refers to situations in which healthcare institutions are confronted with limitations in essential elements such as financial assistance, supplies, and equipment.	‘There weren’t enough medicines, and patients were anxious and unsure, which made things difficult.’ (P36)
	Excessive workloads and inadequate compensation	This is where healthcare workers experience the burden of excessive job demands combined with inadequate financial compensation.	‘Because my colleagues are quitting because we are so underpaid and hospitals, especially private ones, refuse to give us more benefits.’ (P16)
	Understaffed healthcare facilities	This indicates insufficient doctors, nurses, or other healthcare workers to provide patient services.	‘The population status of health care professional are declining.’ (P24)
Conflicts with colleagues	Individual Differences	This refers to employees’ personalities that causes misinterpretations or insufficient information sharing between colleagues in the workplace that create misunderstandings and conflicts.	“To be honest, it’s always been dealing with my coworkers, especially since I work at a public hospital and we’re of different ages, which makes “micromanaging” common.” (P38)
Changes in the workplace environment	Distance from workplace	This means that commute time, level of job satisfaction, and ability to strike a work-life balance are significantly impacted by how close or far away one lives from their workplace.	‘It was easier when the public transportation was back. But later on the traffic in city went bad, probably because a lot of people bought cars due to scarcity of public vehicles during the pandemic and everything are back to face to face settings.’ (P34)
	Adjustments in protocols due to COVID-19	This implies that the facilities and healthcare workers have had to adapt their procedures in order to prevent the COVID-19 pandemic.	‘The pandemic presented unexpected problems, such as adjusting to new practices, increasing workload, and dealing with the emotional toll of watching the virus’s extensive impact on patients and communities.’ (P4)
Experiences with patient interaction	Dealing with different attitudes	This entails that healthcare workers may encounter different attitudes from patients considering their different situations.	‘Emotional and Mental challenges, especially the negative actions and comments from patients, and heavy workload and low salary.’ (P28)
	Providing quality medical services	This means giving people thorough and effective health care with a focus on their well-being and best health results. This includes several facets, including precise diagnoses, treatments based on research, caring for patients with attention, and effective communication.	‘Having patience. It is very difficult especially when your patience is tested everyday. As a nurse, you are bombarded everyday with different challenges.’ (P2)

Limited resources in hospital facilities

Healthcare workers frequently encounter challenges in delivering high-quality healthcare services due to the constraints posed by limited resources within hospital facilities. Even before the outbreak of COVID-19, healthcare professionals frequently encountered challenges in spite of their aforementioned unwavering dedication to providing optimal support and aid to patients. These limitations can significantly affect the overall effectiveness and efficiency of healthcare services, which is evident in the following exemplars:

‘Dealing with patients’ needs with limited resources’ (P37)

‘The demand for healthcare services frequently outstrips available resources, resulting in lengthy work hours and elevated stress levels.’ (P4)

The consequences of particular circumstances can vary, encompassing a broad spectrum of outcomes. These outcomes may include increased workloads and heightened stress levels among individuals involved. Things became considerably more challenging after the COVID-19 outbreak. Added pressure was placed on healthcare staff, and traditional methods of operation underwent changes. The work became much more difficult as they had to cope with increased stress, new safety protocols, and a move towards new methods of treating patients. Additionally, there is a possibility of compromise in the quality of patient care.

Excessive workloads and inadequate compensation

The typical workweek of an 8 to 5 employee is incomparable to the amount of effort demanded by a healthcare professional. Before the COVID-19 pandemic, it was apparent that healthcare workers had several duties and responsibilities expected of them. However, as the pandemic has heightened awareness of the importance of stringent safety measures for protecting healthcare providers and patients, the workload has also increased. This includes patient care, admin, and helping colleagues deal with medical issues. The following exemplars illustrate healthcare workers’ complaints about working under a heavy workload.

‘The increasing workload and time limits in my healthcare career have been big challenges for me. ’ (P4)

‘Before pandemic, DOH have less requirements for infirmary hospitals but now we are facing a lot of paperworks ,reportings online and seminars.’ (P21)

Moreover, it is essential to acknowledge a notable discrepancy between the substantial expectations placed on healthcare professionals and the insufficient compensation they receive. This discrepancy presents a critical concern that has far-reaching implications, impacting not only the financial well-being of individuals but also the overall quality of care provided to patients. Although they are dedicated to their work, the compensation rates do not adequately reflect the scope of their obligations, as seen in the following examples:

‘Though our pay increased during and after the pandemic, we were still underpaid and extremely overworked.’ (P1)

‘But still, it doesn’t change the fact that the healthcare workers are understaffed, overworked and underpaid.’ (P19)

Understaffed healthcare facilities

Healthcare workers also find that understaffing has been quite common in their work. In addition, it has been found that understaffing within medical facilities significantly impacts the occurrence of burnout among healthcare professionals. Some mention that the healthcare staff and patient ratio is imbalanced, especially before the COVID-19 pandemic.

‘Facilities being extremely understaffed and we are extremely overworked and underpaid.’ (P16)

 ‘Workforce shortage is one of the major challenges that the healthcare industry is facing right now which causes severe BURNOUT and EXHAUSTION to the healthcare workers like me. Not to mention the “overworked, underpaid” situation the health workers are experiencing, despite the risk we are getting into this job.’ (P19)

Furthermore, healthcare workers have experienced burnout due to workload challenges after the pandemic. The aftermath of the pandemic has undoubtedly placed an extraordinary burden with increased workloads, prolonged periods of high stress, and often inadequate resources. The following examples highlight healthcare personnel’s post-pandemic challenges.

‘After the pandemic, we have to do 16 to 24-hour shifts just to make up for the unfair division of labor because my colleagues are quitting because we are so underpaid and hospitals, especially private ones, refuse to give us more benefits.’ (P16)

‘Very exhausting. Because of the restrictions and the need to protect your patients, yourself and your family from getting  sick.’ (P20)

This phenomenon has been linked to various adverse outcomes, including job dissatisfaction and an increased likelihood of healthcare professionals leaving their positions. This makes it harder to stop the vicious loop and worsens the existing shortage of healthcare workers.

Individual Differences

In an environment that seeks efficiency in performing one’s duties and responsibilities, conflicts among colleagues may arise. Among healthcare workers, many of the challenges faced include dealing with the attitude of their patients and fellow colleagues. Healthcare workers describe the differences between one’s level of seniority in the work environment seems to be an important factor in the challenges faced among these healthcare workers. Here are some exemplars

‘Insecurity of the seniors to me’ (P23)

‘Some challenges are the attitudes of my co-workers towards me.’ (P7)

Working with toxic workmates and watchers.’ (P40)

In addition, working in the healthcare field demands clear lines of communication among healthcare workers to provide  comprehensive patient-centered care. Such collaboration among workers is done to ensure all staff members clearly understand the procedures and protocols to be followed. As a result, challenges in relaying important information can lead to miscommunication. The following exemplars describe the challenges of miscommunication among their colleagues.
‘We don’t have good communication with co-workers’ (P11)

‘I think it would be miscommunication. From your fellow workmates to the staff nurses and other employees in the hospital. It affects everyone and compromises your workflow.’ (P20)

Distance from the Workplace

The location of one’s area of assignment is one obstacle healthcare workers face in their line of work. In particular, farther distances from one’s area of residence can have an impact on punctuality and one’s overall disposition for the day. Moreover, the challenges of commuting to one’s workplace are also critical challenges among these healthcare workers both pre- and post-pandemic. The exemplars below show such obstacles:

‘The hospital is far from the city’ (P5)

 ‘And the public transportation was hard to find.’ (P34)

Adjustments in protocols due to COVID-19

The COVID-19 pandemic has brought a new wave of practices individuals follow to avoid transmitting the virus. In healthcare facilities, strict protocols have been maintained to make sure of the safety of both workers and patients. Among the preventive measures most healthcare workers take is wearing personal protective equipment (PPE).

‘Carefree. We don’t use much of PPE’s back then’ (P13)

‘Everything changed especially wearing PPE’s’ (P10)

In addition, the pandemic has impacted how medical consultations have taken place.

‘The healthcare system after the pandemic has changed in a way that a lot of people are sometimes hesitant to seek medical attention because of the fear or the risk of contracting the virus at the hospital or health facility. Some doctors also prefer to do check-ups through online platforms which somehow affect the quality of patient care.’ (P19)

Overall, healthcare workers took the necessary steps to ensure the safety of patients is met up to standard.

‘during and after pandemic infection control is being strictly practiced and we are not allowing patients to enter the clinic if they are having symptoms such as feve, flu and colds.’ (P30)

‘We are very thorough in medical history taking to make sure the safety of both parties.’ (P31)

‘Massive changes have been implemented to our practice since the height of the pandemic, which may have been overwhelming for us to manage as we were required to make adjustments immediately. I can say that protocols have been more tedious because numerous factors must be taken into account to ensure not only patient safety, but also our own.’ (P37)

Dealing with different patient attitudes

As healthcare workers are faced with a variety of medical cases on a daily basis, they are also met with multiple personalities at work – specifically those coming from their patients. Many of the workers express their challenges in communicating with patients. Among these statements include:

‘Dealing with close minded patients’ (P10)

 ‘Hot tempered clients’ (P22)

 ‘and sometimes dealing with toxic and chronic patients’ (P30)

Additionally, an added task in the healthcare profession not only includes dealing with the patient’s immediate care but as well as in consoling with the family members.

‘It was already a very challenging task to be a nurse as we deal not only with patients but with their families as well’ (P6)

Providing quality medical services

As professionals in the field, providing precise diagnoses, and treatments based on research is among the most salient practices healthcare workers should provide for their patients. Educating others, whether providing further awareness on procedures conducted or sharing one’s knowledge is a standard for many healthcare workers. However, providing such a service can be challenging at times.

One of the challenges that I experienced was when I have to explain to the mothers why their children did not pass the 1st step of the process. (P34)

 We need to convince everyone to get vaccinated. (P26)

In other instances, specialized medical procedures are also among the medical services healthcare workers are expected to provide for their patients.

‘Patient that has complex case that we have to have 2 sittings for serial extractions.’ (P31)

 ‘difficult cases encountered during tooth extraction procedures’ (P30)

Table II. Thematic analysis of healthcare workers’ Extrinsic Motivation

Type of Extrinsic Motivation	Theme	Description	Exemplars
External Regulation	Societal expectations on career choices	This term describes people’s expectations influenced by cultural, familial, and societal values, which influence decisions in what is viewed as financially secure or renowned careers.	‘Due to undecided if what course or path to take/ parents suggestion.’ (P18)
	Increased benefits and monetary compensation	This shows an understanding of the importance of financial incentives and improved benefits in the attraction and retention of a motivated workforce.	‘I need a job to sustain my needs and wants, especially bills.’ (P28)
Introjected Regulation	Societal recognition	This represents the acknowledgment that emphasizes the importance of one’s influence on the larger community and is a critical component in maintaining a sense of worth and belonging.	‘Whenever my patients thank me. It brings a big smile on my face even after 5 years of working.’ (P2)
Identification	Relatedness to workplace culture	This pertains to how a person’s values, conduct, and vocational objectives correspond with the dominant standards observed in a workplace setting. It concerns the extent to which workers experience a sense of belonging, comprehension, and involvement in the common principles and customs that characterize the company’s culture.	‘Every time I bond with my coworkers who are extremely professional and nice.’ (P36)
	Sense of responsibility towards patient care	This depicts medical staff members’ dedication and responsibility to provide safe, compassionate, and high-quality care. It displays a commitment to ensuring patients’ health, putting their needs first, and maintaining moral standards in healthcare practices.	‘It was difficult, but everyone on the healthcare team worked together, and helping patients stay healthy makes it all worthwhile.’ (P4)
Integrated Regulation	Sharing one’s expertise with others	The act of sharing information, skills, and insights in order to improve everyone’s understanding. It shows a dedication to developing innovation, growth, and a culture of lifelong learning.	‘Visiting barangays to educate health to people and provide services to some people who were less fortunate.’ (P25)
	Internalization of impact on the community	This means being deeply connected to and aware of how one’s actions, choices, and contributions affect and help others. This makes people more aware of how their actions affect the group, which builds a sense of responsibility and a dedication to making things better for everyone.	‘I can offer holistic support to my patients; the fact that I am capable of assisting people is something I initially underestimated, and it’s what most fascinates me about my job because it constantly surprises me with just how much I am able to do every time I encounter different situations.’ (P37)

B. Extrinsic motivation

Extrinsic motivation describes the state of mind when an action is taken solely to gain an external reward. As the literature mentions, health professionals are susceptible to factors that can either attract or repel them from their chosen profession. These factors include but are not limited to job satisfaction, financial opportunities, compensation, and working conditions. Thus, bonuses and pay raises are linked to certain accomplishments that motivate healthcare workers to perform at a high level. It is crucial to keep employees by compensating them fairly for their efforts. The subthemes shed light on how healthcare workers express extrinsic motivation. This includes societal expectations on career choices, increased benefits and monetary compensation, societal recognition, relatedness to workplace culture, a sense of responsibility towards patient care, sharing one’s expertise with others, and internalizing impact towards the community.

Societal Expectations on Career Choices

Healthcare workers often face the challenge of meeting societal expectations for stable and respected professions while navigating their calling to serve and heal. Family and societal standards can greatly affect people who work where specific jobs are often culturally praised and seen as necessary. Meeting social or familial expectations might motivate people to pursue specific healthcare careers even if their inner motivation does not match, as seen in this example:

‘[It’s] actually not my choice but my mom’s choice.’ (P7)

‘Parent’s decision to take this course.’ (P13)

Increased benefits and monetary compensation

Some healthcare personnel favor some specializations over others, as seen by the previous subtheme. Before the COVID-19 pandemic, job security was already a very important factor in choosing where to live because of the growing competition for skilled medical workers around the world. Healthcare workers looked for stability and security in their jobs, comparing different job possibilities based on how likely they were to have a stable job that would last. This emphasizes the desire for job stability, high demand overseas, and the anticipation of improved benefits and a fulfilling wage to underline the developing landscape of motives and expectations of healthcare professionals, as evidenced in this quote:

‘Job security and in demand abroad’ (P27)

‘Hopefully, when I go abroad I would have better benefits and a satisfying salary.’ (P18)

Moreover, there was a huge need for healthcare workers after the pandemic, which created both problems and chances. The demand made healthcare jobs more important, but it also brought about new uncertainties, such as the need to quickly adapt to changing healthcare practices and the strain on resources. Because of this, job security became an even more important factor for medical workers, affecting their choices about where to work after the pandemic. The following quotes give us an idea that financial compensation and improved benefits are evident:

‘Through several ways, such as job stability, continous learning, and financial security,’ (P17)

‘It also provides me with better financial opportunities.’ (P38)

‘It benefited me because this is my bread and butter. I was able to send my children to school and able to sustain our needs and wants…’ (P7)

This can encourage healthcare workers to pursue opportunities that match their skills and passions while meeting their financial and personal goals. This also reflects the increasing value placed on the healthcare workforce’s challenging and important professional tasks. Thus, healthcare workers are aware of the value of their work and demand compensation commensurate with the difficulty of their jobs. As the healthcare industry faces tough economic times, this change highlights the need for societies to properly value and support those who work to improve other people’s health.

Societal recognition

Reputation in one’s community has a powerful influence on extrinsic motivation in many areas of life. The following quotation demonstrates how external variables like status, respect, and community recognition may have a significant impact on people’s motives in healthcare workers:

‘The reason I chose a healthcare profession is that my course is in high demand, and I’ve always wanted of obtaining a professional license and a well-paying job.’ (P17)

‘To follow my mother’s footsteps’ (P36)

Recognizing the demand for a job, the status of getting a professional license, and the practice of following family members into the same field are all examples of outside factors that affect career choices.  This shows how family traditions can affect job choices, highlighting the drive to feel accepted and valued in one’s social and family groups.

In some situations, healthcare workers are naturally highly respected by society because of the importance of their work. Although there were some changes after COVID-19, similar dynamics were still there. The pandemic has further highlighted healthcare workers’ significance and vital societal responsibilities. The higher need for healthcare workers made their jobs even more important, which made people respect them even more. Consequently, respect for family and society impacted healthcare personnel’s job choices even in the post-pandemic environment. This acknowledgment may motivate persons seeking financial security, a sense of validation, and respect from their communities. The following quotations demonstrate the claim:

‘The government are focusing our health care facilities and they appreciated now the health care professional.’  (P24)

‘After the pandemic, a lot of learning opportunities opened.’ (P25)

In addition, the appreciation of their patients and other outside sources of validation and recognition, such as awards for their talents and efforts, are key to shaping their motivation. The following quotation illustrates this point of view:

‘I genuinely like what I do because it makes me good about myself to know that my knowledge and abilities can benefit other people.’ (P37)

‘I feel really happy when a patient comes back to me and says that they have been healed because of the advice I gave them that last time they went in the pharmacy.’ (P9)

‘I had a critical pediatric patient, we really monitored him during my night shift. Few days later, the mother came to me and happily express her gratitude for taking care of his son and that his son feels better.’ (P29)

The sense of accomplishment that comes from knowing that others value their work adds an extra layer of meaning to the already important work of healthcare. It emphasizes the significance of external acknowledgment and recognition as key variables leading to overall motivation and work satisfaction in their profession.

Relatedness to workplace culture

This subtheme emphasizes the value of relatedness as a fundamental component of workplace culture and extrinsic motivation, and it does so by highlighting the significance of connecting with coworkers, which is emphasized in these statements. Prior to COVID-19, healthcare workers had a strong sense of belonging and worked well together. Face-to-face interactions and teamwork were key to the close-knit atmosphere that helped provide high-quality patient care. As seen by the following statements, having a sense of connection with one’s coworkers, mainly when those coworkers are characterized as both pleasant and professional, substantially contributes to overall job satisfaction.

‘Being with amazing colleagues’ (P12)

‘Bonding with my coworkers and share jokes with each other.’ (P14)

Identifying ways to strike a balance between the need for safety and the importance of personal relationships in healthcare settings is a significant challenge in the post-pandemic period. Not only can these contacts help maintain a pleasant mood, but the bonds of friendship and camaraderie they create are powerful extrinsic motivators. It will be essential to adapt to and cultivate a supportive environment to ensure the health and well-being of healthcare personnel and the quality of treatment provided to patients. In this way, friendships among coworkers serve as an external reinforcement that impacts job satisfaction and motivation.

Sense of responsibility towards patient care

This subtheme sheds light on the complex dynamics of providing patient care as a sense of professional responsibility. Despite the external challenges, the commitment to patient care remains steadfast, demonstrating how external motivators can contribute to a sense of professional responsibility that is illustrated in the following quotes:

‘I used to believe that my job wouldn’t be very stressful, but I’ve come to realize that working as a community pharmacist in a private company demands a significant amount of my time. I’ve been struggling to find time for my family, friends, and even for myself. It also requires a great deal of patience when dealing with various types of patients and customers.’ (P17)

‘It was horrible. I would go to work exhausted and I would also go home exhausted. From the PPE’s that were basically smothering me alive to the fear of death on your shoulder when no vaccines were available. As a senior nurse, I lived through it and I can say it was the worse time being a frontliner. But someone had to do it.’ (P2)

‘After COVID-19, the work is challenging but satisfying because it requires responding to changing patient requirements, especially mental health needs, and sensing community resilience.’ (P36)

Moreover, the joy and improvement experienced in patients’ lives become outward signs of success. The praise and thanks from patients or colleagues are external validations, adding to a sense of inspiration and drive in the healthcare profession. This realization becomes a driving force, coinciding with the exterior component of professional duty. The following examples include how external incentives, admiration, and the tangible influence on individuals or communities contribute considerably to the extrinsic motivation that feeds healthcare workers’ feeling of professional obligation in providing patient care.

‘The smiles on the patients and their everyday progress gives me the drive to continue to work despite having a lot of roadblocks in my profession’ (P6)

‘I believe that being appreciated and able to help others by giving my best at work is what keeps me inspired and motivated in the healthcare profession.’ (P17)

‘Helping those individuals especially in the remote area since I am working in a community hospital.’ (P21)

Sharing one’s expertise with others

Knowledge sharing in the healthcare industry enables workers in the healthcare sector to get external acknowledgment, confirming the value of their expertise and helping the progress of their careers. The positive influence their education will have on the health of their community is an external motivation that will encourage them to constantly update their knowledge and become aware of the latest health news. This can be shown in the following examples:

‘…as well as the sharing my own knowledge for our patient’s diagnosis to their tests results.’ (P20)

‘To apply my knowledge I’ve learned to my family’ (P36)

‘It is fulfilling to think that I have helped someone in the community by educating them.‘ (P9)

“And I am now capable to serve, and educate the individuals how important is oral health.” (P31)

‘I envision my chosen profession able to help other people and continuously educating them about the importance of having themselves checked by a health care professional.’ (P25)

All external motives are Making a difference in people’s lives, encouraging innovative approaches to healthcare, and visualizing a field that consistently trains and helps its members grow professionally. This means that motivation from the outside comes from the desire to see one’s chosen profession as a never-ending source of enlightenment and support for others; this immense social influence serves as an external incentive for healthcare personnel.

Internalization of impact towards the community

Internalizing one’s professional impact on the community reflects incorporating external variables into one’s personal ideals and professional identity. A strong congruence between personal beliefs and the larger aims of public well-being is made possible when healthcare workers understand their beneficial effect on the community. This internalization keeps them dedicated to making a difference and points out the significance of external validation in forging a professional identity closely linked to community service.

‘Supporting people as a mental health practitioner is fulfilling for me. It gives me satisfaction to help people comprehend and cope with their difficulties, letting them know they are not alone in their struggle. Witnessing them acknowledge the validity of their feelings is particularly rewarding.’ (P32)

‘it was fulfilling and hectic before the COVID-19 but it gave me pleasure to know that my job had an impact on how patients were cared for and how their treatment plans were made.‘ (P11)

‘still needs to be cautious but the thought that my work makes a direct contribution to the health and happiness of the community made me feel happy and fulfilled’ (P17)

The acknowledgment and societal implications of their work are internalized by healthcare professionals, which cultivates a profound sense of purpose that is intricately linked to their contribution to community health. The process of internalization not only drives individuals to contribute to the community’s welfare consistently but establishes a firm commitment that integrates external motivators into their intrinsic sense of professional identity and fulfillment.

C. Intrinsic motivation

Intrinsic Motivation refers to doing an activity out of one’s own inherent interest. In a workforce that remains one of the most valuable careers in today’s time, intrinsic motivation is pictured to be of great value among healthcare professionals in the field. Despite a hurdle of difficulties and challenges, one’s intrinsic motivation can be defined as a key factor that ties an individual to remain devoted to seeking out activities they thoroughly enjoy doing. The subthemes gathered from the present study’s analyses enumerate how healthcare workers manifest intrinsic motivation in their line of work. This includes fulfilling one’s inherent desire, genuine compassion towards the community, and career growth and personal development.

Table III. Thematic Analysis of healthcare workers’ Intrinsic Motivation

Theme	Description	Exemplars
One’s inherent desire	One’s inherent desire drives personal decisions, goals, and pursuits. It includes the inherent elements that dictate behavior and choices, mirroring an inner compass that shapes the path to satisfaction and purpose.	‘I decided on nursing as my field choice because it is the only profession in which I can envision myself working.’ (P37)
Genuine compassion towards the community	This is genuine and authentic care for the health and happiness of others. It means wanting to understand, help, and make a big difference in the community’s needs and problems without expecting anything in return.	‘Being able to help my patients especially the less fortunate and hearing them saying thank you is very fulfilling…because in one way or another I am able to help them without expecting anything in return.’ (P7)
Career growth and personal development	This includes how a person’s working and personal skills are always changing and getting better. The pursuit of career-related and personal goals necessitates expanding one’s knowledge base, honing one’s skills, and taking advantage of opportunities for progress.	‘My experiences shaped me and improved my skills, preparing me to become a psychologist. These experiences will be useful in my future endeavor to open my own mental health center.’ (P37)

One’s inherent desire

Choosing one’s lifelong vocation is no easy task, but rather, making such a decision entails thorough moments of self-reflection and practice of discernment. For many healthcare professionals, fulfilling one’s childhood dreams to work in the helping profession has led them to where they are now in their current job positions. Many of these healthcare workers emphasized their own inherent interests in pursuing this field, labeling such work as their ‘passion’, ‘childhood dream’, and ‘calling. In the following exemplars, workers resonate a strong desire to be in this industry:

‘I chose to work in healthcare because I have a strong desire to serve people and make a difference in their lives.’ (P4)

‘I believe it’s my calling. And I can’t imagine myself not to be in this industry, because this is my childhood dream.’ (P19)

‘When I was young, this was really my dream – being a dentist.’ (P31)

In addition, a number of healthcare workers describe their passion and interest in this career as the only one they envision themselves working for. These are displayed in the following quotations below:

‘I decided on nursing as my field choice because it is the only profession in which I can envision myself working.’ (P37)

‘I don’t see myself being in any other field rather than being in healthcare.’ (P16)

Genuine compassion towards the community

As the previous subtheme revealed how healthcare workers emphasize their intrinsic motivations aligned to their personal desires and dreams, the following subtheme focuses on how such workers also exemplify a heart for compassion and service to their community. Many of the workers share similar statements in providing their service most especially in areas that are at a disadvantage. The exemplars that follow showcase this inward empathy for service:

‘I want to provide healthcare services to far flung areas’ (P26)

‘… to be able to serve the vulnerable’ (P14)

‘This profession benefits my personal goals by seeing myself serve a lot of community who are struggling in dental problems.’ (P31)

Alongside the desire to provide service in underprivileged areas, some of the healthcare workers also share their love for the profession itself, which includes the package of providing quality patient care:

‘I love my profession and to give my services to my patients to the best of my ability’ (P30)

‘I love the thought of giving care to patients’ (P8)

Compassion is a cornerstone of healthcare personnel’ inherent conduct in both the pre and post-COVID-19 circumstances. Nevertheless, the epidemic has increased their focus on the broader effects of their work on the community, highlighting their ongoing dedication to providing medical knowledge and assistance that goes beyond the health of individual patients to the welfare of whole communities. Additionally, the compassion to provide one’s medical expertise to change the lives of people in the community is a core category for such intrinsic behavior.

‘The way people appreciate your work and how much you can change people’s lives for the better.’ (P1)

‘When you can help the patients or watchers to make their heavy feeling to become slightly bearable, or to give them smile on how you communicate with them. Proper communication and having compassion towards them.’ (P28)

‘This profession benefits my personal goals by seeing myself serve a lot of community who are struggling in dental problems.’ (P31)

Career growth and personal development

Interestingly, among the themes obtained in the analyses of the study, the pursuit of continued learning in one’s career growth and personal development has garnered the most number of responses from the healthcare workers. Constant skill and knowledge acquisition was essential for healthcare workers’ employment even before COVID-19. Competence in their duties was a source of motivation in a world where new illnesses were often found; it went beyond simply being good at their occupations. Many healthcare personnel demonstrated a strong commitment to lifelong learning by actively seeking new information. A couple of quotations include:

‘Hoping to learn more and be able to expand my learnings to different kind of diseases. Learning, exploring and enjoying it at the same time.’ (P21)

‘I will still continue working as a nurse and will continue to look for more opportunities to learn and broaden my knowledge base to improve my skills in patient care’ (P6)

‘I will personally and professionally grow in this profession in my personal life, I will have contentment of what I have now.’ (P3)

Being skilled became even more crucial due to the rapid shift of workload after the COVID-19 outbreak. The healthcare workforce has to adapt swiftly to changing circumstances and overcome novel obstacles. Adapting to the unexpected was equally as important as what they already knew. Furthermore, this perspective towards continuous professional development also extends to healthcare workers’ goals in reaching greater heights in their field of expertise. Additionally, some of the workers also envision their careers to take them to new places.

‘I aspire to be the best that I can be in this profession, which can help me to be efficient in my career. (P19)

‘I envision myself to be more confident and capable in providing my service to others’

‘It will help me reach places I always dreamt of going/living’ (P39)

‘I envision my career taking me to new places and sharing my knowledge via health education to the public.’ (P1)

Finally, migration and pursuing their careers abroad have been among the central themes gathered in the lived experiences of these healthcare workers. The desire of many Filipino healthcare professionals to practice abroad has made migration a significant factor in the issues facing the healthcare industry. Many people aspired to work overseas because they wanted to broaden their horizons, advance their careers, and generally live better lives. Some of the exemplars of this theme include:

‘I can envision myself to work abroad.’ (P35)

‘I envision my future career to take place abroad’ (P23)

‘Because I enjoy working as a medtech and I wanted to pursue my career abroad’ (P18)

 Healthcare professionals, both in the Philippines and around the world, played a pivotal part in the spotlight of the global health crisis. Individuals’ aspirations frequently drive this desire to pursue employment in foreign countries for enhanced prospects, professional development, and an elevated standard of living.

DISCUSSION

The COVID-19 pandemic has had a significant and transformative effect on the global healthcare landscape, causing disruptions to the previously established trajectory of progress.  Even before  the COVID-19 pandemic, healthcare providers were dealing with a dynamic  environment of new medical discoveries, better patient care, and different health problems. The crisis has placed healthcare workers in an unprecedented situation, where they are confronted with various challenges, such as shortages, increased risks, and a significant surge in demand, which is still evident after the COVID-19 pandemic.

The study’s findings indicate that hospital facilities face limited resources, such as equipment and supplies. Additionally, healthcare professionals often experience excessive workloads and inadequate compensation, impacting their job satisfaction and overall well-being. Moreover, understaffed healthcare facilities pose challenges in delivering efficient and timely medical services.

Individual differences among healthcare professionals, including their skills and expertise, can also influence the quality of care provided. According to a study, bad management and a lack of teamwork and support demotivate managers and leaders [4]. On the other hand, disclosure from managers benefits employee motivation [7]. In some countries, salaries are seen as an important way to motivate people, but in rich countries, they are seen more as a reward than a way to motivate people.

In studying these healthcare workers’ challenges, their role in the workplace played a vital role. Prior to the outbreak of COVID-19, the shortage of healthcare professionals had been a long-standing challenge in the field. Hospital facilities are often understaffed, resulting in the extension of work shift hours and reassignment of department duties. The daily working hours of a healthcare worker are incomparable to the compensation offered. As a consequence, a number of these healthcare workers have experienced burnout and stress [15], including declines in their physical health [19], [20]. However, most healthcare workers share a common sense of safety and security in the pre-pandemic times, as opposed to during and after the COVID-19 epidemic. A heightened risk of exposure to the virus has paved the way for many healthcare professionals working at on-site facilities [18]. Many healthcare professionals implemented standardized procedures and precautionary measures globally to mediate the risks of infection [17]. Nonetheless, the challenges faced by such workers remain the same. Their stress and motivation levels have been significantly affected by unequal labor division balances, which may put the value of their work at risk.

Existing literature on motivation has highlighted the importance of both inner and extrinsic motivation in one’s ability to pursue desired goals. As per the taxonomy of human motivation, this crucial psychological factor falls on a spectrum that extends from having less motivation to no at all to more independent and inward motivation processes [25]. The study found that family and societal expectations strongly impact healthcare workers’ behavior. External motivators include stability, significant demand overseas, and improved benefits and compensation. Money is not the only thing that can motivate people [5]. For example, hiring the right people, setting reasonable hours, promotions, performance reviews, clear communication, and having the right tools can all motivate and engage workers.

Even more, public recognition pushes healthcare workers to do their best. The findings suggest that status, respect, and group recognition motivate healthcare workers. People may want promotions because they feel they deserve them and actively pursue their goals [7]. Positive patient feedback, government recognition, and learning opportunities validate and appreciate healthcare workers. These elements make healthcare practitioners committed. Despite difficult workplace circumstances, praise and recognition are some of the strong extrinsic motivations of healthcare workers [30]. Additionally, the bonds between health workers and their colleagues, characterized by friendliness and professionalism, contribute to their job satisfaction and motivation. These connections serve as external reinforcers that improve the morale of healthcare workers. A supportive workplace culture is crucial because coworker connections affect job happiness and motivation.

The study also indicated that healthcare workers are driven by their positive impact on community health and their expertise validation. Family health care, pay, and terminal benefits greatly influence motivation and retention [31]. Healthcare workers were demotivated by fear of spreading infection to their families [11]. Thus, pursuing healthcare knowledge and excellence is motivated by the desire to enhance lives, create healthcare procedures, and envision a supportive and growing profession.

The research also shows that healthcare workers who recognize their work’s societal impacts have a strong sense of purpose. Alderfer, Herzberg, and Maslow’s ideas emphasize the importance of this factor in self-worth and potential [8]. As a result of their successes and the weight of their obligations, healthcare personnel may feel more confident in themselves. Internalization maintains a commitment that aligns external incentives with one’s professional identity and sense of fulfillment.

The process of finding one’s internal motivation is considered to be the most important aspect of autonomy. Healthcare is a labor-intensive field that requires a “personal calling” [4]. In the study’s themes, intrinsically driven professionals are passionate about their jobs. Healthcare practitioners in various literature have also valued their childhood ambitions as career goals [32]. This matches the experiences of Cagayan de Oro City healthcare professionals, who attribute their decision to work in the area to fulfilling their “childhood dream” and vocation to service.

Healthcare workers’ compassion is also shown by their intrinsic motivation to help others. This humanitarian act demonstrates that workers find fulfillment in their passions [33]. Career and personal development have also been studied as key intrinsic motivation indicators. Self-motivated workers learn and create more [32]. Most healthcare workers are interested in advancing their careers through education and training, which aligns with the study’s findings. However, these healthcare workers have expressed interest in pursuing their careers abroad. This suggests the Filipino healthcare workforce will be affected in the coming years [34].

A. Practical Implications

The current findings of this study have significant implications for healthcare policy, highlighting the undervaluation of healthcare professionals in the broader workforce. This research can serve as a catalyst for targeted policy and procedural adjustments to elevate the status of healthcare professionals. The findings indicate that it is critical to prioritize the provision of mental health and psychosocial support (MHPSS) for healthcare workers in light of the aforementioned difficulties and challenges. Integrating employee mental health programs in these high-risk organizations allows better methods to monitor and improve one’s overall psychological well-being [35], [36]. This helps in the development of policies and programs that support the professional growth of all healthcare workers while also fostering a safe environment that protects their mental health. It is essential for them to acknowledge that alternative employment opportunities within the country influence the salaries required to attract and retain staff members. They should also concentrate on developing critical skills for healthcare professionals by providing them with specialized training and developing a plan for their incentives and compensation. This study suggests upgrading employees’ skills during downtime to enhance employability and productivity and focusing training to prevent skill shortages when implementing stimulus programs.

B. Limitations of the study

The study presents data relative to the experiences and challenges among healthcare workers; however, there were several limitations in this study. It is suggested that more interviews will be conducted in future research to fully understand healthcare workers’ viewpoints. The number of participants (i.e., 40 healthcare workers) limits the present study. Furthermore, the study outlines typical problems healthcare professionals encounter, an important tool for future researchers to compare difficulties over various timeframes. With the sample only focused on one city (i.e., Cagayan de Oro City), data gathered could be further expanded should future researchers gather samples across other areas in the Philippines (e.g., Luzon and Visayas).  It is recommended that future researchers select their participants from a wider range of experiences in order to improve the depth of knowledge in this field. The data gathered in this qualitative research utilizes only an open-ended questionnaire survey. The target participants were asked to respond to pre-determined questions, allowing limited flexibility in asking follow-up questions and building rapport. The results of this study can be used as a starting point by future researchers who want to understand the complexities of healthcare professional experiences. The researchers strongly advise future researchers to explore other qualitative tools, such as an in-depth interview, to gauge further the experiences of these essential workers along with the challenges they have faced in their field. Expanding the study to include Filipino healthcare practitioners globally may benefit future researchers to improve the study’s generalizability and scope.

C. Conclusion

Filipino healthcare professionals demonstrate remarkable resilience and commitment despite challenging circumstances. This research paints a comprehensive picture of the multifaceted nature of motivation within the healthcare sector. It advocates for a balanced approach that acknowledges and nurtures intrinsic and extrinsic motivators to ensure healthcare professionals’ sustained engagement and satisfaction in their roles. The implications extend beyond the academic realm, urging the development of strategic policies recognizing and supporting the diverse motivational factors at play. Ultimately, these insights can inform initiatives to enhance workforce motivation and retention, thereby contributing to healthcare delivery and outcomes.

Additionally, policymakers must also take a holistic strategy to motivate healthcare staff. Enhancing monetary pay, providing opportunities for growth and development, and improving workplace circumstances must be balanced. Policymakers may boost healthcare personnel motivation, creating a more resilient and successful staff. This holistic approach recognizes the complexity of healthcare workers’ responsibilities and the interdependence of factors affecting their motivation and job satisfaction.

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