HMGT 320 WEEK 5 DISC DOCX

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L e a r n i n g O b j e c t i v e s

C H A P T E R 1 0

L E A D I N G : M O T I VAT I N G A N D I N F L U E N C I N G

Pleasure in the job puts perfection in the work.

Aristotle

Studying this chapter will help you to

➤ define motivation,

➤ describe theories of and methods for motivation,

➤ explain how managers motivate employees in organizations,

➤ define and describe power in organizations,

➤ identify types of power managers use in organizations, and

➤ explain how managers use politics to influence people in organizations.

C o p y r i g h t 2 0 1 9 . H e a l t h A d m i n i s t r a t i o n P r e s s .

A l l r i g h t s r e s e r v e d . M a y n o t b e r e p r o d u c e d i n a n y f o r m w i t h o u t p e r m i s s i o n f r o m t h e p u b l i s h e r , e x c e p t f a i r u s e s p e r m i t t e d u n d e r U . S . o r a p p l i c a b l e c o p y r i g h t l a w .

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Here’s WHat HaPPeneD In Boston (and the entire nation), external forces were changing the way healthcare would be organized, delivered, and paid for in the future. Stakeholders were demand- ing patient-centered care, fewer hospital readmissions, and payment based on the value (rather than volume) of services. Managers at Partners HealthCare planned how to adapt to—and fit with—these external changes. They planned new strategic initiatives and goals that, if achieved, would enable Partners to survive and thrive in its changing external environment. Then managers had to lead thousands of employ- ees to carry out these plans, which included creating the cardiac telehealth program. Leading required influencing and motivating people. Managers throughout Partners had to motivate employees to accept new goals and, in some cases, change how they worked. Employees were unlikely to be motivated by the same methods, so managers had to figure out which motivational approaches to use with which employees. They understood that some employees might be motivated by feelings of achievement whereas others would be motivated by financial rewards or opportunities for profes- sional growth. Managers also considered the various sources and kinds of power they had. They used appropriate power to influence and motivate employees to implement the cardiac telehealth program.

A s evident in the opening Here’s What Happened, managers must lead others to accomplish the mission and goals of a healthcare organization (HCO). They can do this by influencing and motivating people. Managers at all levels of an HCO

influence and motivate others, usually beginning at the top and flowing down through the organization. Top executives motivate their management team and the organization as a whole. Middle managers motivate staff in their departments. Lower-level supervisors motivate staff in their work units.

This chapter describes how managers influence and motivate others to accomplish an HCO’s goals and desired outcomes. It builds on ideas discussed in chapter 9 and adds to our managerial toolbox of tools, methods, theories, and techniques for managing HCOs. Chapter 9 explained that leading is a process by which a person tries to influence someone. Well, how do managers influence someone? Chapter 10 answers that question.

Perhaps you already have some answers. You probably have influenced people—a sibling, a roommate, or a coworker—to do things. How did you try to influence them? Did you try the same approach with everyone or try different methods with different people? Which methods worked best?

This chapter explains what motivation is and then presents eight motivation theo- ries. Each has strengths and weaknesses, and each is used in HCOs. The best motivation approach depends on the situation and the people involved. Managers must understand their employees well enough to judge which motivation approach to use for which employees

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in which situations. Motivation and influence involve the use of power and politics, which are also discussed in this chapter. We learn the kinds of power that leaders use and when power and political tactics are likely to be used (and sometimes abused).

mo t I vat I o n tH e o ry a n D mo D e L s Motivation is the “set of forces that leads people to behave in particular ways” (Griffin, Phillips, and Gully 2017, 170). Reading this definition carefully, we realize that motivation is not the act of doing something; it is the forces that lead people to do something. When managers motivate employees, they apply forces to create workers’ desire and willingness to behave a certain way. However, managers must realize that motivation is not enough to ensure a worker actually behaves as desired. For example, Matt may be motivated to shampoo the waiting room carpet at a medical group practice in Albany. But if the carpet- cleaning equipment is broken, Matt will be unable to do that task despite his motivation. The same would happen if his boss reassigned him to some other task that was more urgent.

This chapter examines motivation theories (sometimes referred to as motivation approaches or motivation perspectives). Some might not technically fulfill all the requirements of a true theory, so that word is used loosely. First we consider four theories based on human needs, after which we consider four theories that are based on other factors:

1. Maslow’s hierarchy of needs theory (based on physiological survival, safety and security, belongingness, esteem, self-actualization)

2. Alderfer’s ERG theory (based on existence, relatedness, growth)

3. Herzberg’s two-factor theory (based on hygiene factors and motivators)

4. McClelland’s acquired (learned) needs theory (based on achievement, affiliation, power)

5. Adams’s equity theory (based on fairness of outcomes relative to inputs)

6. Vroom’s expectancy theory (based on effort, performance, outcome)

7. Locke’s goal-setting theory (based on goals)

8. Skinner’s reinforcement theory (based on rewards and punishments)

Use of human needs theories is challenging because workers belong to four or even five generations that have different values, motivators, interests, and feelings about work. So which of these theories or approaches should a leader use? Like many other aspects of management, it depends. We know that in HCOs today, workers are very diverse regarding their generations, ethnicities, and other characteristics. These differences cause differences

motivation

The set of forces that

leads people to behave

in particular ways.

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in values, preferences about work, and motivators. For example, the American culture val- ues achievement, and Eastern cultures value harmony. Further, a person’s motivators may change over time. When Adrianna graduates from college with loans to repay, she will be motivated by money. After she repays her loans, she may be more motivated by opportuni- ties for professional growth. When it comes to motivation, one size does not fit all.

So as a manager, what should you do? First, assess the situation and people. Second, choose appropriate motivation methods to fit the situation and people. Think about the quote at the beginning of the chapter. Figure out what brings pleasure to each of your employees. If you can provide that through their work, it may help motivate them to work. If an employee gains pleasure from being with other people and forming friendships, then be sure the job provides opportunities for social interaction. Think about this advice as you study each motivation theory.

To strengthen your understanding of each theory, consider how leaders at Partners HealthCare could apply each theory. Think, too, about how these theories could be used to motivate you—in your college studies, a volunteer service role, a part-time job, or a club or sport activity.

m a s L o W ’ s H I e r a r c H y o f n e e D s t H e o r y

Abraham Maslow theorized in the 1950s that human motivation comes from five basic human needs that have a hierarchical order—from the lowest, most basic need for physi- ological survival to the highest need for self-fulfillment (Griffin, Phillips, and Gully 2017). He thought people had to fulfill their lowest unsatisfied need before they would be motivated by higher needs. Thus, they would have to fulfill their physiological survival need before the safety need would motivate them. The needs are shown in exhibits 10.1 and 10.2.

exHIbIt 10.1 Maslow’s Hierarchy

of Needs Self- actualization

Esteem

Belongingness

Safety and security

Physiological survival

Sources: Information from Griffin, Phillips, and Gully (2017); Johnson and Rossow (2019); Walston (2017).

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How do HCOs satisfy employees’ five needs as theorized by Maslow? Take a few minutes to jot down your ideas, and then confer with a classmate. Maslow’s approach to motivating employees is used in many organizations, including HCOs. However, managers should consider several current views about this hierarchy of needs (Griffin, Phillips, and Gully 2017; Johnson and Rossow 2019):

1. The five types of needs can overlap; a single need can fit in more than one category.

2. The hierarchy is culturally biased because it is based on American values.

3. People do not always fully satisfy the lowest unmet need before seeking to satisfy higher needs.

4. A manager can motivate employees by enabling them in their jobs to meet their most urgent needs.

a L D e r f e r ’ s erg t H e o r y

To overcome criticism of Maslow’s theory, Clayton Alderfer later theorized that people could be motivated to seek three needs in varying order and while seeking more than one need at the same time (Griffin, Phillips, and Gully 2017; Johnson and Rossow 2019; Walston

Maslow’s Need Examples from Daily Life Examples for HCO Worker

Self-actualization Accomplishing personal goals, fulfilling one’s potential

Accomplishing profes- sional goals, fulfilling one’s career

Esteem Self-respect, respect from others, status, competence

Recognition, respect from boss, performance awards

Belongingness Friendship, love, affection Friendly coworkers, infor- mal work group

Safety and security Warm housing, protection from crime, no worries

Job security, health insurance, protection from harassment, safe workplace

Physiological survival Food, water, air Clean indoor air, income to buy food

Sources: Information from Griffin, Phillips, and Gully (2017); Johnson and Rossow (2019); Walston (2017).

exHIbIt 10.2 Examples of Maslow’s Five Needs

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2017). His approach seems more realistic than Maslow’s. Sometimes we are simultaneously motivated by more than one need or by a need that does not follow a set sequence.

Alderfer’s needs are shown in exhibit 10.3. These needs are similar to Maslow’s, but they are more distinct, overlap less, and are not rigidly hierarchical:

1. Existence (similar to Maslow’s physiological and safety needs)

2. Relatedness (similar to Maslow’s belongingness and esteem needs)

3. Growth (similar to Maslow’s self-actualization needs)

Managers can use Alderfer’s needs to motivate employees. Consider a medical clinic in Oshawa where managers are trying to motivate workers to improve patient care. For workers with basic existence needs, managers could explain that if the workers help imple- ment the patient care goal, the clinic will attract patients and earn revenue. As a result, the workers will keep their jobs and have money to buy things to satisfy their basic existence needs. Without enough patients and revenue, the clinic might have to lay off workers, which would threaten the workers’ existence needs.

H e r z b e r g ’ s t W o -f a c t o r t H e o r y

In the late 1950s and early 1960s, Frederick Herzberg studied workers and concluded that they are motivated by things that increase feelings of satisfaction. Herzberg’s research led him to conclude that satisfaction and dissatisfaction are caused by different factors (Griffin,

Alderfer’s Need Examples from Daily Life Examples for HCO Worker

Existence Food, water, air, housing, protection from crime

Job security, protection from harassment, clean indoor air, income to buy food

Relatedness Self-respect, respect from others, status, compe- tence, affection, friend- ship, love

Recognition, respect from boss, performance awards, friendly coworkers, infor- mal group

Growth Accomplishing personal goals, fulfilling one’s potential

Accomplishing profes- sional goals, fulfilling one’s career

Sources: Information from Griffin, Phillips, and Gully (2017); Johnson and Rossow (2019).

exHIbIt 10.3 Examples of

Alderfer’s Three Needs

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Phillips, and Gully 2017; Walston 2017). One group of factors, which he labeled hygiene, is associated with dissatisfaction. Hygiene (maintenance) factors are extrinsic—external to the work itself—and would generally fit with Maslow’s three lower needs (Johnson and Rossow 2019). Hygiene factors include company policies, pay, supervision, coworkers, and other work conditions. If these are adequate, they prevent workers from feeling dissatis- fied. If workers are dissatisfied, improving the hygiene factors reduces their dissatisfaction. Herzberg argued that better hygiene factors would make workers feel less dissatisfied but would not make them feel more satisfied.

So what would satisfy workers? A second group of factors, which Herzberg labeled motivators, come from the work itself and include achievement, growth, recognition, challenge, autonomy, and responsibility. Herzberg believed motivators are intrinsic— internal to the work—and arise from the content of the work itself and how it makes a worker feel. Motivators could be viewed as equivalent to Maslow’s two higher needs (Johnson and Rossow 2019). For example, feeling achievement and fulfillment after completing a new, challenging project comes from the work itself. Herzberg argued that workers are motivated to do work that includes more motivators, which would enable the workers to realize more satisfaction. These motivators would not reduce or affect dissatisfaction, however.

Dissatisfaction and satisfaction are not opposite ends of one scale, as shown here:

Dissatisfaction Satisfaction

Instead, dissatisfaction and satisfaction are separate concepts. Each may be present in varying degrees, such as on a scale of 0 to 10:

Dissatisfaction 0 10 Satisfaction 0 10

Herzberg advised managers to first use hygiene factors to reduce workers’ dissatisfac- tion (Griffin, Phillips, and Gully 2017). Managers should ensure adequate pay, supervision, policies, and coworker relationships and provide safe, secure jobs and working condi- tions. When workers do not feel dissatisfied, managers should then design jobs and work to enable workers to experience motivators and satisfaction. Managers should organize their employees’ work for achievement, recognition, autonomy, responsibility, fulfillment, growth, and respect.

This two-factor theory became popular, but it has weaknesses (Griffin, Phillips, and Gully 2017; Walston 2017). For example, some hygiene factors can affect both dis- satisfaction and satisfaction. Sometimes both hygiene and motivator factors can motivate workers to higher levels of performance. Workers may perform better because a hygiene factor (e.g., a big pay raise) also provides a form of recognition and thus is a motivator.

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Limitations arise when culturally diverse workers grow up with different feelings about hygiene factors (e.g., following rules, interacting with supervisors, accepting a job’s work- ing conditions) and about motivators (e.g., desire for achievement, challenge, autonomy). Research findings are mixed and seem to depend on other factors, such as an employee’s organization level and age.

Despite its limitations, managers often use the two-factor theory. As a manager, pay attention to both dissatisfaction and satisfaction and realize that different factors might be needed to reduce dissatisfaction and to increase satisfaction. When applying the two-factor motivation theory, you might first have to improve hygiene factors such as working condi- tions and rules so that workers do not feel dissatisfied. Then, you can increase motivators to increase job satisfaction—and work motivation. This step may require redesigning jobs to give workers more opportunities for achievement, recognition, growth, responsibility, and self-accountability. To do so, you can follow Hackman and Oldham’s job characteristics model (Griffin, Phillips, and Gully 2017, 213; Walston 2017, 65):

1. Increase workers’ work variety with different activities and skills.

2. Increase workers’ work identity with responsibility to complete a whole piece of work.

3. Increase workers’ work significance with awareness of how work affects other people.

4. Increase workers’ work autonomy with freedom and choice regarding work decisions.

5. Increase workers’ work feedback with clear information about job performance.

Think about how job redesign connects to organizing work and staffing, discussed in earlier chapters. Repetitive data-entry keyboard jobs could be redesigned to include more task variety with different equipment. Clinical career ladders could be developed for nurses (as discussed in chapter 8) to motivate them with potential job-growth opportuni- ties. A maintenance worker could be given more responsibility for scheduling preventive maintenance or selecting supplies. However, managers must ensure that workers have the ability to perform the increased job duties; training might be necessary. Further, extrinsic dissatisfiers must be minimized so they do not interfere with intrinsic satisfiers (motivators).

Managers should periodically survey employees as a group and also ask them indi- vidually about their job satisfaction and dissatisfaction. The responses will help managers plan what to do. Leaders need to understand their employees well enough to know how to satisfy them. Otherwise, at Employee Karaoke Night, someone might sing the Rolling Stones song “(I Can’t Get No) Satisfaction.”

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m c c L e L L a n D ’ s a c Q u I r e D n e e D s t H e o r y

In the late 1980s, David McClelland developed an approach to motivation based on learned human needs. McClelland’s theory argues that people grow up learning and acquiring (from family and society) three culturally rooted needs (Griffin, Phil- lips, and Gully 2017; Hellriegel and Slocum 2011; Walston 2017):

1. Achievement. The need to effectively accomplish tasks, responsibilities, meaningful work, high standards, competitive goals, and challenges

2. Affiliation. The need for social interaction, approval, participation, friendships, and other supportive relationships with people

3. Power. The need for control and influence over people, resources, and one’s environment

An important component of the acquired needs theory is that needs are learned and can be learned throughout one’s life. People differ in how much they desire to fulfill each need because of differences in their life experiences (especially while growing up). In their work lives, people tend to pursue jobs that enable them to fulfill their desired amount of these three needs. For example, many allied health jobs (e.g., therapist, nurse, pharmacist) involve much individual work, personal responsibility, and self-sufficiency— all of which enable workers to experience individual achievement. People with a high need for achievement often are found in these jobs, and managers can motivate them by appealing to their need for achievement. Millennial workers tend to have a high need for affiliation. Managers may motivate them by creating opportunities to work in teams and interact with others.

To apply McClelland’s theory, you as a manager can do two things. First, for each job, consider how much the job would enable someone to experience achievement, affiliation, and power—and then hire someone who has similar needs for achievement, affiliation, and power. As mentioned, jobs vary in how much they enable someone to fulfill each of these three needs. It would not make sense to hire someone with high affiliation needs to fill an isolated job located in a basement cubicle. (As a manager, you can use what you learned about staffing in chapter 7 to hire people with motivational needs that fit the job.) Second, while someone is working in a job, pay attention to the worker’s needs (which may change

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over time), and adjust the job, if possible, so that it enables the worker to fulfill unmet needs. For example, to motivate Henrik, his manager might be guided by the acquired needs theory and adjust Henrik’s job to include more challenging goals, more opportunity for affiliation, or more autonomy and control.

The four theories discussed so far focus on human needs as a way to motivate workers. Managers who use these theories should understand which workers have which unmet needs. These needs are likely to vary among the four to five generations in the workplace. Baby boomers may be motivated by achievement, whereas millennials prefer work–life balance. We now turn to motivation theories that use approaches other than human needs.

a D a m s ’ s e Q u I t y t H e o r y

John Stacey Adams developed equity theory in the 1960s. It is based on people’s desire to be treated fairly (equitably). The theory has two main elements: inputs and outcomes (Griffin, Phillips, and Gully 2017; Walston 2017). A worker’s inputs are the education, experience, skills, knowledge, time, efforts, and so forth given to the job. Outcomes are the pay, benefits, recognition, and other rewards received for performing the job. A worker compares her outcomes received to her inputs given to the job and then judges whether it seems fair. She also compares her inputs and outcomes to those of other workers and judges whether everything seems fair. Have you ever gone through this mental process? Here is an example:

1. Sean, a health insurance sales representative, considers his education, years of experience, sales ability, knowledge of the healthcare market, and effort that he brings to his job. He considers his pay, benefits package, and other rewards received for doing the job.

2. Sean knows the background of some other sales reps at his company. From conversations and other sources, he has a pretty good idea what Megan, Brandon, and Danielle are earning. He mentally sizes up the outcomes-to- inputs ratio of each sales rep:

Sean’s outcomes Megan’s outcomes Brandon’s outcomes Danielle’s outcomes Sean’s inputs Megan’s inputs Brandon’s inputs Danielle’s inputs

3. Sean figures he compares fairly (equitably) with Megan and Brandon. Sure, Brandon makes more money, but he has much more experience than the others, so it seems fair. But Sean is annoyed to think that Danielle’s ratio is higher than his and everyone else’s. In his opinion, she is getting about the

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same pay despite having a lot less education, experience, and sales ability. He feels it is unfair, and he becomes dissatisfied. Of course, this feeling is based on Sean’s perceptions and judgments, which might not be accurate. The secondhand information might be incorrect. He might not know the full story about his coworkers. Nonetheless, he makes his judgments. This manner of judging fairness is not ideal, but workers often do it.

Inequity causes a worker to feel tension and become motivated to resolve the inequity. If Sean feels underpaid, he becomes motivated to seek increased rewards (e.g., pay, time off, work schedule) or reduces his work effort to match (in his mind) his rewards. He might slack off and take long breaks. Some workers will leave the organization if they cannot achieve equity with their current employer. Some employees deviously increase their rewards by stealing supplies from their company. Inequity can also work in the other direction. If Danielle becomes aware of this information, she may feel overpaid. Perhaps she will feel tension (guilt) about the inequity and work extra hard to feel she really does deserve her pay.

Inequitable situations arise in HCOs, especially when workers compare themselves to similar workers in other organizations. Labor markets for some jobs are unstable, and pay scales are moving targets. (Recall chapters 7 and 8 on staffing, recruitment, and compensation.) A nurse or pharmacist might know a peer who is getting much higher pay somewhere else because that employer was frantic and paid a high starting salary for an essential position. Paying a higher salary upsets the outcomes-to-inputs ratio for the position.

Managers should pay attention to equity theory and realize that workers compare themselves with others. A challenge for managers is to get workers to consider all of their rewards rather than just pay. Sometimes, a worker feels her lower pay is unfair when com- pared with someone else’s pay, not realizing that she gets better health insurance than the other person. Managers should remind employees about their total compensation. Managers must also realize that workers compare their work effort with other workers’ efforts. Good workers quickly become frustrated and feel tension from inequity if they have to work with slackers. If HCO leaders do not motivate (or replace) low performers, high performers may leave the organization to relieve their tension. Then the HCO loses good workers and is left with lousy ones. Hmmm, what’s wrong with this picture?

v r o o m ’ s e x P e c ta n c y t H e o r y

The expectancy theory of motivation was developed by Victor Vroom and others, also in the 1960s. Work effort, performance, and outcomes are the main components of this theory. It “suggests that people are motivated by how much they want something and the likelihood they perceive of getting it” (Griffin, Phillips, and Gully 2017, 187). Let’s imagine

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Latasha is an associate in a healthcare consulting company in St. Louis. She could improve her work to earn a year-end pay bonus.

1. Latasha considers whether her improved work effort would be likely to produce good enough job performance. Does she expect that her better effort will be enough to create the necessary level of performance? Or will other factors (e.g., lazy coworkers, broken equipment) interfere with her improved work effort and prevent achieving sufficiently improved performance?

2. Latasha considers to what extent improved work performance would obtain the desired outcome. Is the outcome tightly connected to her job performance? If she improves her work and produces better job performance, will she really get that pay bonus? Or will the bonus depend on other factors, such as the company’s overall financial situation?

3. Latasha considers how strongly she wants the outcome. How much does she really want the bonus pay? The extra money would be great, but how about the added stress and having to work late some days? Would it all really be worth it?

Taken together, this approach argues that Latasha will wonder if her effort will pro- duce the performance needed to obtain a valued outcome. The more she really wants the pay bonus—and expects that her improved work effort will produce the performance needed to obtain that bonus—then the more motivated she will be to improve her work effort.

Research generally supports this theory, although it has weaknesses (Griffin, Phillips, and Gully 2017). Expectancy theory assumes that workers (e.g., Latasha) rationally and logically do the mental calculations, yet in reality they might not. Also, even if workers try to rationally calculate the value of rewards, they might easily misjudge the connection between effort and performance or between performance and outcome. Finally, some work- ers feel outcomes are not within their control and instead are mostly influenced by other forces and events, so why bother? If workers perceive favoritism or a biased boss, applying expectancy theory will be less effective. Expectancy theory, like others, is culturally biased and thus works better in some countries and cultures (e.g., the United States) than in others (e.g., Brazil, China) depending on the extent to which workers feel they can control their work, performance, and outcomes.

As a manager, you can use this approach to motivate workers as long as you real- ize its limitations. Workers may put forth the effort you want if they expect their work will lead to the performance level that will earn them the rewards they desire. Realize that the value of rewards (outcomes) varies according to people’s unique needs. Suppose two workers—Ricardo and Ahmad—work in a hospital’s information systems department in Northridge. Ricardo wants personal growth and new experiences, whereas Ahmad prefers

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more vacation days. As an incentive to improve job performance, the hospital offers to send one worker to the Healthcare Information and Management Systems Society conference. Ricardo would value (and be motivated by) that reward more than Ahmad would.

Students sometimes are motivated to study based on expectancy theory. Consider a student who attended college on a scholarship and had to maintain a B average (perfor- mance level) to keep her scholarship (valued outcome). She wondered how much she had to study for a final exam. After thinking about it, she expected that if she studied five hours (effort), that would be enough to earn at least a B on the exam (performance), which would be enough to maintain her scholarship (valued outcome).

L o c k e ’ s g o a L -s e t t I n g t H e o r y

Edwin Locke in the 1960s theorized that goals would motivate people. Research has con- firmed his theory—under certain conditions (Griffin, Phillips, and Gully 2017; Hellriegel and Slocum 2011). Motivation from a goal increases under the following conditions:

◆ The goal is specific, not general.

◆ The goal is challenging yet attainable; it is of manageable size and complexity.

◆ People know the goal.

◆ People accept and are committed to the goal.

◆ People have the knowledge, ability, and resources to attain the goal.

◆ People receive enough feedback on progress toward the goal.

Goal-setting theory can be effective if managers apply it based on careful thought and planning. A leader must take three steps to set this theory into action (Borkowski 2011):

1. Set the goal. The goal may be set by the manager, by the worker, or by both (cooperatively). The goal’s specificity and degree of difficulty require careful judgment. If the goal is too easy to achieve, it will not motivate the worker. If it is too hard to achieve, it will demotivate the worker and create negative feelings toward the manager. Each employee is unique, and managers must know their employees well. Highly confident workers respond better to a harder goal than do workers with low self-confidence. Internal and external factors—such as laws, accreditation standards, consumers’ demands, and community standards—may have to be considered in setting a goal.

2. Obtain the employee’s acceptance of the goal and commitment to accomplish it. If the employee helped set the goal or provided input for it, acceptance and

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commitment are more likely. Employees’ prior success in achieving goals also contributes to acceptance of new goals.

3. Provide ongoing support and resources to enable achievement of the goal. This support could include training; help with breaking a goal into smaller steps and activities; and providing supplies, equipment, time, information, and so forth. The manager must support the employee by giving regular feedback regarding goal progress.

This approach to motivation is used in many organizations, including HCOs. Some use it as part of a management-by-objectives approach to goal setting throughout the organization.

Let’s consider a government-funded behavioral health clinic. As a result of changes in policy and priorities, the state government reduced funding for the clinic by 10 percent. Meanwhile, more people are experiencing stress, depression, and behavioral health problems. Lori, the clinic supervisor, meets with her three counselors to set goals for the number of clients each counselor will see per week. After discussion, they set a goal of increasing client visits per counselor by four visits per week for the next six months (after which the goal will be reevaluated). All counselors accept and commit to this goal, although Lori senses hesitation by one of them.

The counselors brainstorm ideas that could help achieve this goal, and Lori ensures resources are available. She arranges for the clinic’s scheduling coordinator to provide a weekly report to each counselor so they can monitor progress. Later that week and then monthly, she meets individually with each counselor to give feedback (and seek feedback) on progress toward the goal.

s k I n n e r ’ s r e I n f o r c e m e n t t H e o r y

The final motivation theory discussed here comes from B. F. Skinner’s work in the mid- 1900s. Skinner thought that people learn from and become motivated by the consequences of their behavior (Griffin, Phillips, and Gully 2017). (More recently, social learning theory has shown that people also learn from and become motivated by observing other people’s behavior and consequences.) Let’s examine reinforcement theory and how a leader can use it:

1. The theory begins with a stimulus—a leader’s policy, instruction, or goal that informs a worker what should be done. This stimulates the employee to behave (or not behave) a certain way. The leader can also state which consequences will occur if the employee does (or does not) behave the desired way.

2. The stimulus is followed by a response, which is the worker’s behavior or action.

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3. That response is followed by a consequence, which is one of four kinds of reinforcement by the leader (described later). Depending on what the consequence (reinforcement) is, it might increase or decrease the frequency of that response (behavior) in the future. The consequence motivates the employee to respond a certain way.

Sports coaches often use this method with players and teams. Duke University men’s basketball coach Mike Krzyzewski has won five National Collegiate Athletic Association championships and more than one thousand games. Coach K (as he is known) is a master motivator who uses reinforcement theory with players. Parents also use this method with children and teenagers. Can you recall examples from your life? Managers use reinforce- ment theory with employees in HCOs. Managers can increase or decrease the frequency of a specific work behavior by using positive or negative consequences.

1. A leader gives something positive (e.g., verbal praise) as a consequence of behavior. This action reinforces desired behavior and makes it more likely to reoccur.

2. A leader removes something negative (e.g., having to work every third weekend) as a consequence of behavior. This action reinforces desired behavior and makes it more likely to reoccur.

3. A leader gives something negative (e.g., a verbal warning) as a consequence of behavior. This action makes unwanted behavior less likely to reoccur.

4. A leader removes something positive (e.g., catered lunch each Friday) as a consequence of behavior. This action makes unwanted behavior less likely to reoccur.

Leaders must think carefully about which behaviors are reinforced or not reinforced, intentionally or unintentionally. Sometimes a leader unintentionally gives something posi- tive to a worker and thereby reinforces unwanted behavior. For example, in a meeting the leader gives time and attention to a disruptive person, which reinforces disruptive behav- ior. The leader should avoid the positive reinforcement—time and attention—so that the undesired behavior decreases and stops. Further, in the meeting the leader might forget to commend a helpful person who contributes good ideas. Because he does not positively reinforce that desired behavior, that person might not contribute as much in the future. During the meeting, the leader should thank someone who contributes good ideas—then that behavior will more likely be repeated.

Reinforcement theory works best when there is a clear relationship between some- one’s response to a stimulus and the consequence of that response (Griffin, Phillips, and

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Gully 2017). Although big consequences are more noticeable than small consequences, even small, symbolic consequences may be effective. Prompt consequences to behavior are more effective than delayed consequences. However, the consequence does not have to occur for every response. The relationship may vary, such as an immediate reward for every response initially and then, after some improvement, a reward for every third or fourth response. What really matters is that employees know how consequences relate to their behaviors.

Managers should be cautious about removing a positive consequence that employees have become used to because, after a while, employees assume it is permanent. Managers should also be cautious about punishments as consequences and clearly explain the reason for them. If employees perceive those consequences as unfair or undeserved, they will feel resentment, anger, and hostility that can jeopardize future working relationships or make the worker try to secretly “get back at” the boss. Managers should strive to reinforce good behavior, ensure they do not reinforce bad behavior, and avoid punishing bad behavior too often. Finally, managers must know their employees as individuals to properly apply motivational theory.

Reinforcement theory is common in HCOs. Let’s consider a radiologic technology school in Detroit. The instructor teaches students to “get it right the first time” to avoid repeat scans that require more time and discomfort for patients. The students must ensure the patient is properly positioned so scans and images fully capture the area of interest and do not have to be repeated. The instructor’s statement is a stimulus. It stimulates a response from student Sofia, who has been careless and had to repeat scans. After receiving the stimu- lus, she works more accurately. In the next week, Sofia has fewer repeats than usual and only has to redo one procedure. Her teacher rewards her with verbal praise for this specific

TRY IT, APPLY IT

Suppose you are a summer intern in a company that does website design and social

media work for HCOs. More than a hundred employees work there in different jobs,

teams, and departments. The company president wants to reduce energy use by 12

percent during the next two years. Employees submit suggestions for how they could

reduce their energy use. But these ideas would require people to change behaviors

and be inconvenienced. Who wants that? Using this chapter, explain how managers

could apply three different theories of motivation to influence workers, teams, and

departments to reduce their energy use. What are the pros and cons of your motivation

approaches? Discuss your ideas with classmates.

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improvement. The praise is a consequence of fewer repeat scans, and it feels good to Sofia. It motivates her to keep improving to continue getting the praise. Meanwhile, Jason, another radiologic technology student, has had to repeat many scans and has not improved. The teacher talks privately with Jason, emphasizes why his careless work is not acceptable, and advises him that he might not pass the course. To avoid this negative consequence, Jason improves his work. The next week, he “gets it right the first time” for all but one of his patients—a big improvement! The instructor praises Jason, and that positive consequence further motivates him to behave as desired.

Po W e r a n D Po L I t I c s The use of power is important for leading, influencing, directing, and motivating. For example, although not stated explicitly, reinforcement theory involves the use of power to create consequences (e.g., rewards and punishments). In management, we can think of power as “the ability of one person or department in an organization to influence other people to bring about desired outcomes” (Daft 2016, 523). To be more concise, power is the ability to influence others to achieve outcomes. Some people think power and authority are the same, but authority is just one type of power. What are other types of power? Read on.

s o u r c e s a n D t y P e s o f P o W e r

People and managers use multiple sources and types of power. Some are tied to a specific person, and others are tied to a specific position in an organization. A person in an HCO can have certain personal powers based on her character, behavior, abilities, values, and so forth. A person can develop a range of personal powers, and these can change over time. A position in an HCO—such as quality manager in a hospice—can have certain positional powers based on the position itself: its responsibilities, authority, place in the organization structure, and so forth. Whoever is appointed to the position is granted and may use the position’s powers. When that person leaves the position, she no longer can use that position’s powers. In an organization’s vertical hierarchy, higher-level managers establish and may change positional powers of lower-level positions, such as by decentralizing more authority to a lower position.

The early work of John French and Bertram Raven in the mid-1900s identified five types of power: legitimate, reward, coercive, expert, and referent. Further study of power in organizations has identified others (Daft 2016). Exhibit 10.4 defines various personal powers and positional powers and gives examples of each. Note that types of power may overlap and are not entirely independent of each other. Returning to the Here’s What Hap- pened at the beginning of this chapter, which types of power do you think people used at Partners HealthCare?

In their jobs, managers use personal power and positional power to motivate and influence others to achieve goals. Of course, other HCO workers also have power to

power

The ability to influence

others to achieve

outcomes.

personal power

Power based on a

person.

positional power

Power based on

a position in an

organization.

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Personal Power

Type Definition Examples

Reward Give something that is valued Give praise, money, friend- ship, a ride to work

Coercive Punish, penalize, reprimand Ignore, insult, withdraw friendship

Expertise Provide needed knowledge, skill, ability

Set up a new tech device, explain history of the community

Referent Inspire through charisma, trust, respect, emotion, admiration

Give an emotionally compel- ling speech about children

Positional Power

Type Definition Examples

Legitimate Authorize decisions, take actions, direct subordinates and expect obedience from them

Assign a subordinate to work Saturday, sign an e-health contract, hire a new chaplain

Reward Give something that is valued Give praise, promotion, pay raise, bigger office, reserved parking

Coercive Punish, penalize, reprimand Scold, reduce pay, deny requested time off

Resource control Give, remove, use, or assign valued resources that others need or want

Give equipment, approve funds, restrict use of space

Information control

Give (or not give) selected infor- mation to others to affect their perceptions and knowledge

Serve as information gate- keeper; decide who gets which information about a possible merger

Network centrality

Be in the flow of information (“in the loop”) and connected to key people to know what is going on

Serve on key commit- tees, network with others, exchange information with a friend in the mayor’s office

Sources: Information from Daft (2016); Griffin, Phillips, and Gully (2017); Johnson and Rossow (2019);

Walston (2017).

exHIbIt 10.4 Types of Power

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motivate and infl uence others. Many healthcare workers, especially physicians, have power based on their expertise in a specifi c type of healthcare work. Th e Using Chapter 10 in the Real World sidebar describes a CEO who used referent power while leading his health system to become nationally known for innovation.

o r g a n I z at I o n P o L I t I c s

Managers and others who have power may use it by engaging in politics to infl uence decisions and resolve confl icts. Politics enables their organization to move forward to achieve its goals. Politics is “the use of power to infl uence decisions” to achieve desired outcomes (Daft 2016, 536). Politics involves using force other than one’s job performance

politics

The use of power to

infl uence decisions.

USING CHAPTER 10 IN THE REAL WORLD

In 2017, Philip Newbold retired after a total of 30 years as the CEO of Memorial Hospital

of South Bend, Indiana, and later as the CEO of its parent Beacon Health System. He is

widely known for—and has received national awards for—innovation in healthcare. As

a manager and leader, he used referent power to motivate and infl uence.

Newbold’s deep commitment to improving his community and its health inspired

him and many others. He initiated “community plunges” by hospital and community

leaders to visit and directly witness local populations with diffi cult health problems.

Newbold took employees from all levels of his HCO on dozens of “inno-visits” to non-

HCOs, including Whirlpool, John Deere, The Hershey Company, and Nike Inc., to discover

new ideas to improve work. “Good Try” awards were given to employees for good ideas

that were tried, did not work, and were examined for lessons to guide the next try. During

his career, Newbold mentored younger employees, taking a personal interest in them

to help them grow.

His inspirational vision of what Memorial Hospital and Beacon Health System could

(and did) become inspired the board, medical staff, employees, volunteers, and other

stakeholders. They respected and trusted Newbold, were excited by him and his vision,

and followed both. Newbold’s example as a role model for innovation, service, and suc-

cess inspired others. His actions exemplifi ed the use of referent power to motivate and

infl uence the thousands of people he worked with. His infl uence continues as Beacon

innovates with virtual healthcare to fi t millennials’ extensive use of smartphones and

social media (Bailey 2017; Radick 2016).

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and professional competence to increase one’s stature, gain advantage, and influence oth- ers (McConnell 2018). Politics is a normal part of organization life and can be helpful or harmful to an organization.

Politics and political behavior arise from conflicts and disagreement about goals, scarce resources, task interdependence, and other aspects of organizations. However, the intensity and manner of politics may vary depending on each organization’s culture and the behavior it considers acceptable. Managers may use politics as an appropriate positive force to resolve disagreements and reach decisions so the organization can proceed with a course of action. Sometimes stubborn conflict paralyzes an organization for months or longer until someone uses power and politics to influence enough stakeholders to reach a decision.

When managers use power in self-serving ways that are contrary to the organiza- tion’s goals, policies, values, and rules, then politics is negative. A manager who wants the big office that became available may engage in politics by spreading false rumors to discredit someone else vying for the office. In these situations, people feel “playing politics” is bad—or nasty, dishonest, manipulative, unfair, deceptive, unethical, and self-serving. This is a common view of organization politics, and it hurts employee morale, satisfaction, and job performance.

The following list contains political tactics managers, groups, and other people use to influence others and gain their support (Griffin, Phillips, and Gully 2017, 472):

◆ Appeal—ask for a favor or support “because we are friends”

◆ Coalition—build a group of supporters and loyal followers

◆ Consultation—consult others for advice or about decisions and goals

◆ Exchange—give others something they want in return for a favor

◆ Ingratiation—flatter and praise others

◆ Inspiration—appeal to others’ ideals, hopes, values, and aspirations

◆ Legitimacy—refer to authority, official documents, formal rules, and precedents

◆ Pressure—coerce, harass, or persistently remind

◆ Reason—persuade using facts, logic, and rational thinking

Other methods involve controlling who has access to which information, which conflicts and decisions get attention, who provides input on decisions, and how one looks in the organization. Unprofessional tactics include starting deceptive rumors and sabotaging a rival’s work (McConnell 2018).

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A person engages in politics to influence other people. Those people may respond to political tactics by actively supporting the person and her requests, actively opposing the person and her requests, or offering passive support or passive resistance. Multiple political tactics might be used over an extended period of time to try to influence people—perhaps succeeding and perhaps not. The effectiveness of politics varies depending on the people and situation. Daft (2016) asserts that effective managers use “soft power” (personal traits and relationships) more often than “hard power” (based on job authority).

Unfortunately, managers and others who have power sometimes abuse it. Power is more likely to be abused in the following situations. Managers should try to prevent abuse of power by minimizing these situations in their HCOs (McConnell 2018; Walston 2017):

◆ Scarcity of resources (e.g., budgets, staff, promotions, space, opportunities)

◆ Unclear or unknown organization goals

◆ Many layers of management in the vertical hierarchy

◆ No information or fuzzy, unclear information; rumors and gossip rather than clear, hard data

◆ Power consolidated in one person or only a few people

◆ Unequal dependencies among people

◆ Complacent organization culture that does not care

Note that new managers often focus on the technical parts of their job while over- looking the political aspects. They focus on tasks to complete a project without realizing the politics of the project. New managers can benefit by understanding organization politics in their HCO. As a manager, you should watch how people practice politics and develop your ability to use it appropriately.

Management involves leading, and leading involves motivating (influencing). Motivation must happen at all levels of an HCO, beginning at the top and flowing down through the organization. People are different and do not respond equally to the same motivators. Thus, a manager should first assess the situation and people. Then, a manager should choose appropriate motivation methods to fit the situation and people. Leaders can apply theories of motivation that focus on the human needs that people have. These approaches include Maslow’s hierarchy of needs theory, Alderfer’s ERG theory, Herzberg’s two-factor theory,

o n e m o r e t I m e

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and McClelland’s acquired needs theory. Leaders can also apply Adams’s equity theory, Vroom’s expectancy theory, Locke’s goal-setting theory, and Skinner’s reinforcement theory.

Managers and leaders should use power and organization politics to help their HCO achieve its goals. They may use different sources of power in organizations, and these sources may change as circumstances change. Individual people have power, and indi- vidual positions (jobs) in organizations have power. Managers should understand and use their personal power and the power of their positions to influence, motivate, and lead oth- ers. They can become more effective by paying attention to which workers have which types of power and how they use those powers. People and groups in organizations engage in politics to increase power and influence for their preferred goals, which might or might not support organization goals.

1. Which of the motivation theories do you like best? Why?

2. What are some difficulties managers may face when applying motivation theories in an HCO?

3. Compare and contrast the sources of power discussed in this chapter.

4. Which types of power do you prefer? Which would you feel least comfortable using?

5. How do you feel about people using politics and political tactics in HCOs? How can this be helpful? Harmful?

FOR YOUR TOOLBOX

• Maslow’s hierarchy of needs theory

• Alderfer’s ERG theory

• Herzberg’s two-factor theory

• McClelland’s acquired needs theory

• Adams’s equity theory

• Vroom’s expectancy theory

• Locke’s goal-setting theory

• Skinner’s reinforcement theory

• Personal power

• Positional power

• Politics and political tactics

f o r D I s c u s s I o n

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C h a p t e r 1 0 : L e a d i n g : M o t i v a t i n g a n d I n f l u e n c i n g 2 6 1

These questions refer to the Integrative Case Studies at the back of this book.

1. Hospice Goes Hollywood case: Using at least two of the motivation theories discussed in this chapter, explain how Ms. Thurmond could motivate the medical director and nurse to support implementation of new policies and procedures for accreditation.

2. How Can an ACO Improve the Health of Its Population? case: Using at least two of the motivation theories discussed in this chapter, explain how Ms. Dillow could motivate the patients, consumers, and community members to care about and improve their health.

3. “I Can’t Do It All!” case: Using at least two of the motivation theories discussed in this chapter, explain how Mr. Brice could motivate his vice presidents to make decisions in their areas of responsibility.

4. “I Can’t Do It All!” case: Referring to the types of power in exhibit 10.4, describe which types of power you think Mr. Brice could use to achieve his desired outcomes.

5. Increasing the Focus on Patient Safety at First Medical Center case: Based on what you learned in this chapter, do you think Dr. Frame should use politics and political tactics to achieve her desired outcomes? If so, explain how she could use specifi c tactics.

6. Managing the Patient Experience case: Based on what you learned in this chapter, do you think Mr. Jackson should use politics and political tactics to achieve his desired outcomes? If so, explain how he could use specifi c tactics.

c a s e s t u D y Q u e s t I o n s

RIVERBEND ORTHOPEDICS MINI CASE STUDY

Riverbend Orthopedics is a busy group practice with expanded services for orthopedic

care. It has seven physicians and a podiatrist, plus about 70 other employees. At its

big, new clinic building, Riverbend provides extensive orthopedic care. Several tech-

nicians provide diagnostic medical imaging, from basic X-rays to magnetic resonance

images. The physicians perform surgery in their own outpatient surgery center with Riv-

erbend’s own operating nurses and technicians. Therapy is provided by three physical

(continued)

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M a n a g e m e n t o f H e a l t h c a r e O r g a n i z a t i o n s2 6 2

Bailey, L. 2017. “Phil Newbold: Innovator, Leader and Trusted Mentor.” The Beam. Pub-

lished September 19. https://beam.beaconhealthsystem.org/phil-newbold-innovator

-leader-trusted-mentor/.

Borkowski, N. 2011. Organizational Behavior in Health Care, 2nd ed. Sudbury, MA: Jones

& Bartlett.

Daft, R. L. 2016. Organization Theory and Design, 12th ed. Mason, OH: South-Western

Cengage.

Griffi n, R. W., J. M. Phillips, and S. M. Gully. 2017. Organizational Behavior: Managing Peo-

ple and Organizations, 12th ed. Boston: Cengage Learning.

RIVERBEND ORTHOPEDICS MINI CASE STUDY (continued)

therapists and one part-time contracted occupational therapist. In addition to staff pro-

viding actual patient care, the clinic has staff for fi nancial management, medical records,

human resources, information systems/technology, building maintenance, and other

administrative matters. Occasional marketing work is done by an advertising company.

Legal work is outsourced to a law fi rm. Riverbend is managed by a new president, Ms.

Garcia. She and Riverbend have set a goal of achieving “Excellent” ratings for patient

experience from at least 90 percent of Riverbend’s patients this year.

Ms. Garcia knows that to lead staff, she must motivate staff. To do this, she usually

has relied on reinforcement theory and legitimate, reward, and coercive powers.

mInI case stuDy QuestIons

1. Using information from this case and the chapter, suggest to Ms. Garcia how she

could use other motivation theories to motivate the employees to achieve the quality

goal. Then do the same for physicians.

2. Using information from this case and the chapter, describe how Ms. Garcia could use

other types of power to achieve the quality goal.

r e f e r e n c e s

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C h a p t e r 1 0 : L e a d i n g : M o t i v a t i n g a n d I n f l u e n c i n g 2 6 3

Hellriegel, D., and J. W. Slocum. 2011. Organizational Behavior, 13th ed. Mason, OH: South-

Western Cengage Learning.

Johnson, J. A., and C. C. Rossow. 2019. Health Organizations: Theory, Behavior, and Devel-

opment, 2nd ed. Sudbury, MA: Jones & Bartlett.

McConnell, C. R. 2018. Umiker’s Management Skills for the New Health Care Supervisor,

7th ed. Burlington, MA: Jones & Bartlett Learning.

Radick, L. E. 2016. “The Virtual Delivery of Care.” Healthcare Executive 31 (5): 21–30.

Walston, S. L. 2017. Organizational Behavior and Leadership in Healthcare: Leadership Per-

spectives and Management Applications. Chicago: Health Administration Press.

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L e a r n i n g O b j e c t i v e s

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