Motivation in the Healthcare Environment

HCA 310 Health Care Strategic Management

Introduction “Many business managers today are not aware of the effects that motivation can (and does) have on their business, and it is therefore important they learn and understand the factors that determine positive motivation in the workplace.” (ROK connect unlimited 2006) Why is this important? Motivated employees are needed in our rapidly changing workplaces to help organizations survive. Motivated employees are more productive which can help maintain efficiency. It takes hard work and insight to motivate employees to join the company, perform well and stay with the company. To be effective, managers need to understand what motivates employees within the context of the roles they perform. Of all the functions a manager performs, motivating employees is arguably the most complex and important. (Dunham 2004) This is due, in part, to the fact that what motivates employees changes constantly. For example, research suggests that as employees' income increases, money becomes less of a motivator and as employees get older, interesting work becomes more of a motivator. (Dunham 2004) This paper attempts to look at theories of motivation, determine what implications they have on the healthcare industry and demonstrate why it is such an important consideration for managers.

Why is motivation important? “Employee motivation has a direct impact on a health services organization’s performance; therefore, managers need to understand what motivates employees.” (Borkowski 2005, 114)

What is Motivation? According to Borkowski, “motivation is described as the conscious or unconscious stimulus, incentive, or motives for action toward a goal resulting from psychological or social factors, the factors giving the purpose or direction to behavior. Motivation is one of the biggest challenges a manager can face. In the health care environment, it is important to keep employees motivated for several reasons. Most importantly, low productivity equals low profits.” Most people can relate to making choices about how much effort to put forth at their jobs. “They never check these reports anyway, so I can probably get away with not doing them this week,” or “I’ll get done what I can, and what I can’t do, will just have to wait; after all I’m just one person and I only make ten dollars an hour! What do they expect?!” Employees can also have bad perceptions of the company and blame re-structuring and inter-office politics for their poor performances.

Defining management To ascertain why motivation is important to managers, you must first look at what the definition of management is. Management is, getting work done through others. In working through others, managers must think about efficiency and effectiveness. This allows you as a manager to accomplish organizational objectives with a minimum of effort, expense, or waste. The classical functions of management include: • Planning- determining organizational goals and a means for achieving them; • Controlling- monitoring progress toward goal achievement and taking corrective action when progress isn’t being made; • Organizing- deciding where decisions will be made, who will do what jobs and tasks, and who will work for whom in the company; and • Leading- inspiring and motivating workers to work hard to achieve organizational goals. (Williams 2006, 5)

Theory X and Theory Y managers In the mid 1900’s Douglas McGregor proposed Theories X and Y by which managers motivated their employees. “McGregor, in his book “The Human side of Enterprise” states that people inside the organization can be managed in two ways. The first is basically negative, which falls under the category X and the other is basically positive, which falls under the category Y. After viewing the way in which the manager dealt with employees, McGregor concluded that a manager’s view of the nature of human beings is based on a certain grouping of assumptions and that he or she tends to mold his or her behavior towards subordinates according to these assumptions.” (Shah 2000) Theory X managers are autocratic and believe that employees are unintelligent and lazy. They promote a closely controlled work environment. Theory Y managers believe that employees can be creative and competent; they want meaningful work; they want to contribute; and they want to participate in decision making and leadership functions. McGregor found that theory X managers were no longer effective in todays’ workplace. (Borkowski 2005, 9)

The big challenge for managers Typical problems that managers face in motivation include: low performance, turnover, conflict, and stress. The biggest impact on all of these problems is attitude. Attitudes are a complex combination of personality, beliefs, values, behaviors and experiences. (Borkowski 2005, 44) This is important because one person with a consistently bad attitude can lower the morale of an entire workgroup in an otherwise healthy organization. “When it comes to Human Resource Management and recruiting, in recent years hire for attitude became a well known mantra. Several commercial tests such as the LAB Profile, iWAM and PAPI were developed to measure work Attitude and motivation, e.g. for pre-employment testing.” (Wikipedia, 2006) “Unlike personality, attitudes are expected to change as a function of experience.” (Wikipedia, 2006) Motivation techniques and detailed managerial attention can help to alleviate these problems. Listening, coaching, and providing feedback as well as promoting a collaborative team environment can also be considered important.(Borkowski 2005, 50) A study was done to explore the experiences of health workers working in the primary health care facilities in Kilimanjaro Region, Tanzania, in terms of their motivation to work, satisfaction and frustration, and to identify areas for sustainable improvement to the services they provide. Results from the study showed the following problems: understaffing, insufficient training and managerial feedback, and promotion. The study indicated that although financial incentives are important, they are not sufficient to motivate health workers. Supportive supervision, performance appraisal, career development and transparent promotion have since been prioritized by PHCF workers for improving the services they deliver in Tanzania. (Manongi 2006)

What makes a great manager? “What great leaders do is to find what is common to all and take advantage of that quality. Great managers treat employees as chess pieces knowing that each moves differently and they fine-tunes roles to take advantage of their distinctiveness. They must also learn workers strengths (self-assurance), their triggers (recognition) and determine how they learn (analyzing, doing, or watchers). Finally they must hire well, set expectations, and interact effectively with their own boss.”(Wilkinson 2006) One of the most popular business minds of the 20th century, Charles Schwab, said, “I consider my ability to arouse enthusiasm among my people, the greatest asset I possess, and the way to develop the best that is in a person is by appreciation and encouragement.” Regarding employees, he also said, “There is nothing else that so kills the ambitions of a person as criticisms from superiors. I never criticize anyone. I believe in giving a person incentive to work. So I am anxious to praise but loath to find fault. If I like anything, I am hearty in my approbation and lavish in my praise.” It is natural for most of us to do the opposite. We are quick to criticize wrongs and slow to appreciate correctness. As the old saying goes, “Once I did bad and that I heard ever, twice I did good and that I heard never.” (Carnegie 1936, 25)

Theories of Motivation “Understanding individuals and what motivates them is a conundrum for healthcare mangers, especially since there is a need to manage such diverse groups. On a daily basis, managers need to manage not only secretarial staff with minimal education requirements, but also highly skilled individuals such as nurses, physicians, and other licensed healthcare professionals. Process theories assist in predicting employees’ behavior so that it may be influenced if necessary.” (Borkowski 2005, 139)

Maslow’s Hierarchy of Needs Considered to be the father of humanistic psychology, Abraham Maslows’ hierarchy of needs is the most popular and widely cited of the human motivation theorists. People have five levels of needs that they are driven to fulfill. “Maslow saw human needs in the form of a hierarchy, ascending from the lowest to the highest, and he concluded that when one set of needs is satisfied, this kind of need ceases to be a motivator.” (Shah 2000) “The most basic needs are physiological, such as the need for air, water, and food. After the basic physiological needs are achieved, an individual moves toward satisfying safety and security needs. At this lower level of the hierarchy, individuals are interested in having a home in a safe neighborhood, job security, a retirement plan, and medical insurance.” (Borkowski 2005, 115) The next level addresses affiliation needs. Humans have a drive to feel needed and loved and in the workplace, they seek a sense of community and belonging. At this level interaction between coworkers and managers becomes important. The fourth level involves self esteem needs. These include the need for recognition, promotions and participation in decision making. The very top tier is about self actualization. The needs fulfilled at this level are autonomy, fulfillment from the job, the ability to demonstrate creativity and innovation for challenging tasks. Although only a limited number of studies support Maslow’s theory, it possesses potent ideas both tangible and psychological, that can help a manager gain insight into how complex human needs are. (Borkowski 2005)

Equity Theory The equity theory suggests that employees are motivated when they perceive that they are being treated fairly. The basic components of the equity theory are inputs, outcomes, and referents. Inputs include all of the contributions that an employee makes to an organization, such as experience, hours worked, education, etc. Outcomes are the rewards that an employee receives in exchange for their contributions to the organization. These include pay, job titles and fringe benefits. Referents refer to employees comparing themselves to each other to determine if the treatment is fair and equitable. Comparisons are usually drawn between employees of like characteristics such as job level, age, race, gender, or tenure. (Williams 2006, 393) Employees compare what they “input” into the organization versus the received “outcome” or rewards. This is called the outcome/input (O/I) ratio. When inequity exists, it is either called underreward or overreward. Underreward happens when a referents perceived O/I ratio is greater than your own or when their outcomes outweigh their inputs in comparison with your own. Overreward is just the opposite, however due to peoples unsurprisingly high tolerance for overreward, there is little expectation for impact on the overrewarded. (Williams 2006, 395)

Applying Equity Theory The main way that managers can utilize this theory is to focus on correcting major inequities. (Williams 2006) Minor inequities are usually considered to be subjective. It would be next to impossible to have every employee feel that they are being treated with 100% equality across the board. Each employee has a different perception of what they think equal is. “Although these different perceptions make it difficult for managers to create conditions that satisfy all employees, it is critical that they do their best to take care of major inequities that can energize employees to take disruptive, costly, or harmful actions, such as decreasing inputs or leaving.” (Williams 2006, 395)

Expectancy Theory Imagine that you work for a company that offers telecommuting to eligible employees, sponsored daycare or four day work weeks. This is the essence of the expectancy theory. “Expectancy theory says that an employee can be motivated to perform better when there is a belief that the better performance will lead to good performance appraisal and that this shall result into realization of personal goal in form of some reward.” (Shah 2000) You might not have children, so the daycare service is not going to be of much use to you. Maybe telecommuting isn’t very important to you because you live really close by or you function better in a team environment. The big consideration is that different things motivate different people and designing a corporate reward system could prove to be a challenge. “Expectancy theory says that people will be motivated to the extent to which they believe that their efforts will lead to good performance, that good performance will be rewarded, and that they will be offered attractive rewards.” (Williams 2006, 396) The basic components of the expectancy theory include: valence- the attractiveness or desirability of a reward or outcome; expectancy- the perceived relationship between effort and performance; and instrumentality- the perceived relationship between performance and rewards. According to this theory, if any one of these variables declines, overall motivation will decline as well. (Williams 2006, 394)

Applying Expectancy Theory In applying the expectancy theory, managers need to frequently and systematically gather information about what employees want from their jobs. Surveys can be useful in this endeavor, and it is important to determine these wants on a regular basis. (Williams 2006) Marc Albin, CEO of Albin Engineering says, “My experience in managing is, they’re all different. Some people want to be recognized for their cheerful attitude and their ability to spread their cheerful attitude. Some want to be recognized for the quality of their work, some for the quantity of their work. Some like to be recognized individually; others want to be recognized in groups.” (Williams 2006, 395)

Reinforcement Theory Reinforcement theory uses psychology to effect change in a corporate environment. “B.F. Skinner, who propounded the reinforcement theory, holds that by designing the environment properly, individuals can be motivated. Instead of considering internal factors like impressions, feelings, attitudes and other cognitive behavior, individuals are directed by what happens in the environment external to them. Skinner states that work environment should be made suitable to the individuals and that punishments actually leads to frustration and de-motivation. Hence, the only way to motivate is to keep on making positive changes in the external environment of the organization.” (Shah 2000) Behavior is based on consequences. Reinforce positively if you want to increase the frequency of a behavior and reinforce negatively if you want to decrease the frequency of a behavior. (Williams 2006, 399)

Applying Reinforcement Theory Five steps are important to remember in applying this theory. First, identify critical, observable performance related behaviors. Then measure how frequent the behavior is. The next step is to analyze the causes and consequences of those behaviors. After that, intervene by using positive of negative reinforcement to increase the desired behavior. Finally, evaluate whether steps were successful in changing the behavior. Additionally, managers should choose the simplest and most effective schedule of reinforcement, administer punishment at appropriate times, and make sure not to reinforce the wrong behaviors. (Williams 2006, 400)

Goal Setting Theory of Edwin Locke According to Williams, people will be motivated to the extent to which they accept specific, challenging goals and receive feedback that indicates their progress toward goal achievement. Things to look out for are: goal specificity- making sure that goals are specific and detailed; goal difficulty- extent to which a goal is difficult or challenging; goal acceptance- the extent to which a goal is consciously understood and agreed upon; and performance feedback- indicates progress being made by giving information about past performance.

Applying Goal Setting Theory It is important for managers to give employees specific challenging goals. “Instead of giving vague tasks to people, specific and pronounced objectives, help in achieving them faster.” (Shah 2000) This simple tool is often overlooked by managers. Also, making sure that workers truly understand, accept, and embrace the given goals can mean the difference between a well oiled organization and a situation of constant frustration. Trust is the key here, and allowing employees to play a part in decision making will help in this regard. Most importantly, give specific and detailed feedback to the employee. When employees reach goals, giving them positive feedback can give them the motivation they need to attain higher and more difficult goals. (Williams 2006, 406)

Conclusion “To support good performance, health care workers need motivation. Indeed, highly motivated individuals can often overcome obstacles such as poor working conditions, personal safety concerns and inadequate equipment. Given the current challenges related to human resources for health in most developing countries, helping workers to be as productive as possible in the face of such obstacles can be an important outcome of increased motivation.” (Intrahealth 2006) With the growing elderly population, new treatments, and advances in medical technology, there is no doubt that health care is one of the largest industries in America and the world and motivation in the healthcare environment is more important than ever. Denise Holland, the Corporate Director for Human Resources, Incorporated, a substance abuse treatment center, says that motivation is probably the biggest challenge of her job.(Holland 2006) Overall morale is pretty good, and the pay is fair; the counselors are usually pretty satisfied and they take steps to maintain that satisfaction. “Monetary rewards don’t last long, so we use other incentives, like luncheons and time off,” she says. Motivation is a constant adjustment that managers must make and it requires knowledge, understanding, perseverance and effort to accomplish this task on an ongoing basis. It is important for organizations to set attainable goals for their employees as well. Understanding that you motivate your employees whether you are actively participating or not is the first step in becoming a better manager. Applying the different theories of motivation can give a manager a decided advantage in obtaining optimum productivity from their employees.

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