Management of health care delivery

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Chapter 10

Motivating Others

[These slides are intended to be used in conjunction with Health Care Management by Donald J. Lombardi and John R. Schermerhorn, Jr. with Brian Kramer (the Text). Please refer to the Text for a more complete explanation of the materials covered herein and for all source material references.]

The term motivation is used in management theory to describe forces within individuals that account for the level, direction, and persistence of effort they expend at work. Simply put, a highly motivated person works hard at a job; an unmotivated person does not.
Needs are unfulfilled physiological or psychological desires of an individual.
Good managers and leaders establish conditions in which people can satisfy important needs through their work.
They also take action to eliminate things that can block the satisfaction of important needs.
There are three main theories of motivation based on needs.

Motivation Based on Human Needs

Hierarchy of Needs

Abraham Maslow’s theory of human needs views people as seeking the satisfaction of the five levels of needs.

Two principles are central to Maslow’s theory:
deficit principle
progression principle

Two-Factor Theory

Frederick Herzberg’s two-factor theory offers another framework for understanding motivation in the workplace.

Acquired Needs Theory

David McClelland offers another motivation theory based on individual needs.
Need for achievement is the desire to do something better or more efficiently, to solve problems, or to master complex tasks.
Need for power is the desire to control other people, to influence their behavior, or to be responsible for them.
Need for affiliation is the desire to establish and maintain friendly and warm relations with other people.
Managers are encouraged to recognize the strength of each need in themselves and in other people. Attempts can then be made to create work environments responsive to them.

Motivation Based on Process

Process theories are motivational theories that focus on how people actually make choices to work hard or not, based on their individual preferences, the available rewards, and possible work outcomes.

Equity Theory. The essence of this theory is that perceived inequity is a motivating state – that is, when people believe that they have been inequitably treated in comparison to others, they will try to eliminate the discomfort and restore a sense of equity to the situation.
For example, people who feel underpaid and perceive negative inequity, for example, tend to reduce their work efforts to compensate for missing rewards. These workers are less motivated to work hard in the future.

Motivation Based on Process (con’t)

Expectancy theory. Victor Vroom’s motivation theory based on an individual’s willingness to work hard at tasks important to the organization.
Vroom suggests that the motivation to work depends on the relationships among the following three factors:
expectancy: A person’s belief that working hard will result in a desired level of task performance being achieved
instrumentality: A person’s belief that successful performance will be followed by rewards and other potential outcomes
valence: The value a person assigns to the possible rewards and other work-related outcomes
Expectancy theory suggests that motivation (M), expectancy (E), instrumentality (I), and valence (V) are related to one another in a multiplication-based equation:

M = E x I x V

Motivation Based on Process (con’t)

Goal-setting theory. Edwin Locke’s theory that clear, desirable performance targets (goals) can motivate.
Specifically, goals
give direction to people in their work
clarify the performance expectations between a supervisor and subordinate, between co-workers, and across subunits in an organization
establish a frame of reference for task feedback
provide a foundation for behavioral self-management

The degree to which people are involved in setting performance goals can influence their satisfaction and performance. Research indicates that a positive impact is most likely to occur when the participation:
allows for increased understanding of specific and difficult goals and
provides for greater acceptance and commitment to them

Some additional tips for successful goal-setting include the following:
set specific goals
set challenging goals
build goal acceptance and commitment
clarify goal priorities
reward goal accomplishment

Motivating through External Forces

Reinforcement theory. Motivational theory that explains human behavior as a result of one’s external environment.
The basic premises reinforcement theory is based on what E. L. Thorndike called the law of effect: Behavior that results in a pleasant outcome is likely to be repeated; behavior that results in an unpleasant outcome is not likely to be repeated.

Reinforcing Behaviors

Operant conditioning. B. F. Skinner’s concept of learning by reinforcement.
Four strategies of reinforcement are used in operant conditioning:
positive reinforcement
negative reinforcement
punishment
extinction

Utilizing Positive Reinforcement

Positive reinforcement can be a valuable motivational tool.
When using positive reinforcement in the workplace, managers need to always be mindful of two important laws:
law of contingent reinforcement
law of immediate reinforcement
The timing of positive reinforcement can also make a difference in its impact:
continuous reinforcement
intermittent reinforcement

As a reinforcement strategy, punishment attempts to eliminate undesirable behavior by making an unpleasant consequence contingent with its occurrence.
To effectively use punishment:
tell the person what specifically he or she is doing wrong
tell the person what specifically he or she is doing right
make sure the punishment matches the behavior
administer any punishment in private
follow the laws of immediate and contingent reinforcement
combine punishment with positive reinforcement for maximum effectiveness

Using Punishment

Job design is the process of creating or defining jobs by assigning specific work tasks to individuals and groups.
Job performance is the quantity and quality of tasks accomplished by an individual or group at work.
More and more health care organizations now consider a value-added aspect when evaluating the worthwhileness of jobs and/or jobholders.
An important goal in job design is to always create jobs rich with potential satisfaction.

Motivating through Job Design

A good job provides a fit between the needs and capabilities of workers and tasks so that both job performance and satisfaction are high.
Common job design alternatives, include:
job simplification
job rotation
job enlargement
job enrichment

Exploring Job Design Alternatives

The core characteristics model offers a way for health care managers to create jobs, enriched or otherwise, that best fit the needs of people and organizations.

Relying on the Core
Job Characteristics

When job enrichment is a good job design choice, you have four main ways of improving the core characteristics:

form natural units of work
combine tasks
open feedback channels
practice vertical loading

Relying on the Core
Job Characteristics (con’t)

Some of the most popular and effective new developments in the way jobs are structured include:

Compressed workweek: any work schedule that allows a full-time job to be completed in less than the standard 5 days of 8-hour shifts.
Flexible working hours: also called flexitime or flextime, describes any work schedule that gives employees some choice in the pattern of their daily work hours.
Job sharing: one full-time job is split between two or more people.
Telecommuting: also called flexiplace or cyber-commuting, is a work arrangement that allows at least a portion of scheduled work hours to be completed outside of the office, facilitated by various forms of electronic communication and computer-mediated linkages to clients, patients, and a central office.
Independent contracting: specific tasks or projects are assigned to outsiders rather than full-time workers.

Exploring Alternative
Work Arrangements

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