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10 MOTIVATING OTHERS Encouraging Great Results and Outstanding Contributions
Starting Point
Go to www.wiley.com/college/Lombardi to assess your knowledge of the basics of motivating to meet needs. Determine where you need to concentrate your effort.
What You’ll Learn in This Chapter ▲ Three theories of needs-based motivation ▲ Maslow’s five levels of need ▲ Three theories of process-based motivation ▲ Strategies for successful goal setting ▲ Fours ways to reinforce behaviors ▲ Nontraditional work arrangements for today’s workplace
After Studying This Chapter, You’ll Be Able To ▲ Differentiate between internal and external motivators ▲ Interpret Maslow’s hierarchy of needs ▲ Apply tools and techniques for motivating others ▲ Use common behavior-reinforcement techniques ▲ Examine the role of job design in motivation ▲ Compare various job design alternatives in today’s workplace
Goals and Outcomes ▲ Master the terminology and tools related to motivation ▲ Describe motivational techniques that involve needs, processes, and goal ▲ Compare motivational theories and approaches ▲ Choose appropriate alternative job designs and work arrangements ▲ Use needs, processes, and goals to motivate others ▲ Choose appropriate methods of behavior reinforcement ▲ Propose motivation strategies for a team or department ▲ Formulate alternative job designs ▲ Evaluate motivation techniques and strategies
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10.1.1 HIERARCHY OF NEEDS 279
INTRODUCTION Managers know that “productivity through people” is an important ingredient for long-term success in today’s demanding, people-intensive health care work- place. Managers have a variety of techniques and tools to motivate others. Unful- filled needs can motivate workers to avoid poor conditions and strive for better work experiences. The various process theories of motivation all suggest ways to get employees to choose to work harder for more positive outcomes. Managers can utilize external factors—especially positive reinforcement and punishment— to influence how staff works. By designing appropriate, compelling jobs, man- agers can encourage employees to motivate themselves. In today’s rapidly chang- ing health care workplace, job design and alternative work arrangements are major methods of encouraging outstanding worker performance.
10.1 Motivation Based on Human Needs
The term motivation is used in management theory to describe forces within indi- viduals 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 unmoti- vated person does not.
Health care managers who lead teams and staff through motivation create conditions under which other people feel continually inspired to work hard and perform to the best of their abilities.
By understanding what motivates people, health care managers can appreci- ate where team members are coming from; they can also better direct the ener- gies of team members to achieve truly great things for their organizations. The following sections explore a variety of ways that people find motivation in the modern workplace.
Needs are unfulfilled physiological or psychological desires of an individual. Some theories of motivation use individual needs to explain the behaviors and attitudes of people at work. Although each of the theories in this section focuses on a slightly different set of needs, all the theories agree that needs cause ten- sions that influence attitudes and behavior.
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.
10.1.1 Hierarchy of Needs
Abraham Maslow’s theory of human needs provides an important foundation for management thinking. Maslow views people as seeking the satisfaction of the five levels of needs, as Figure 10-1 shows. Lower-level needs include physiolog- ical, safety, and social concerns, while higher-level needs include esteem and self- actualization concerns.1
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280 MOTIVATING OTHERS
Two principles are central to Maslow’s theory:
▲ The deficit principle holds that a satisfied need is not a motivator of behavior. People are expected to act in ways that satisfy deprived needs—that is, needs for which a “deficit” exists.
▲ The progression principle holds that a need at one level does not become activated until the next lower level need is already satisfied. Peo- ple are expected to advance step by step up the hierarchy in their search for need satisfactions. At the level of self-actualization, the more these needs are satisfied, the stronger they are supposed to grow. According to Maslow, a person should continue to be motivated by opportunities for self-fulfillment as long as the other needs remain satisfied.
Maslow’s theory advises managers to recognize that blocked or deprived needs may negatively influence work attitudes and behaviors. By the same token, pro- viding opportunities for need satisfaction may have positive motivational conse- quences. Figure 10-1 gives some examples of how managers can use Maslow’s ideas to better meet the needs of people at work.
What satisfies higher order needs?
Self-actualization needs • Creative and challenging work • Participation in decision making • Job flexibility and autonomy
What satisfies lower order needs?
Social needs • Friendly co-workers • Interaction with customers • Pleasant supervisor
Safety needs • Safe working conditions • Job security • Base compensation and benefits
Physiological needs • Rest and refreshment breaks • Physical comfort on the job • Reasonable work hours
Esteem needs • Responsibility of an important job • Promotion to higher status job • Praise and recognition from boss
Figure 10-1
Work motivation and Maslow’s hierarchy of needs.
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10.1.2 TWO-FACTOR THEORY 281
10.1.2 Two-Factor Theory
Frederick Herzberg’s two-factor theory offers another framework for under- standing motivation in the workplace.2
The theory was developed from a pattern identified in the responses of almost 4,000 people to questions about work. When questioned about what “turned them on,” respondents tended to identify things relating to the nature of the job itself. Herzberg calls these satisfier factors. When questioned about what “turned them off,” they tended to identify things relating more to the work setting. Herzberg calls these hygiene factors.
As shown in Figure 10-2, the two-factor theory associates hygiene factors, or sources of job dissatisfaction, with aspects of job context. That is, “dissatis- fiers” are considered more likely to be a part of the work setting than of the nature of the work itself. The hygiene factors include such things as
▲ working conditions; ▲ interpersonal relations; ▲ organizational policies and administration; ▲ technical quality of supervision; ▲ base wage or salary.
Herzberg’s two-factor theory argues that improving the hygiene factors, such as by adding piped-in music or implementing a no-smoking policy, can make peo- ple less dissatisfied with these aspects of their work. But these changes do not in themselves contribute to increases in satisfaction.
To really improve motivation, Herzberg advises managers to give proper attention to the satisfier factors. As part of job content, the satisfier factors deal
Job Dissatisfaction
Influenced by job context, or hygiene factors
• Working conditions • Interpersonal relations • Organizational policies • Quality of supervision • Base wage or salary
Job Satisfaction
Influenced by job content, or motivator factors
• Sense of achievement • Feelings of recognition • Sense of responsibility • Opportunity for advancement • Feelings of personal growth
Rule Poor job context increases dissatisfaction.
Rule Good job content increases satisfaction.
Figure 10-2
Two-factor theory in the workplace.
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282 MOTIVATING OTHERS
with what people actually do in their work. By making improvements in what people are asked to do in their jobs, Herzberg suggests that job satisfaction and performance can be raised. Important satisfier factors include
▲ a sense of achievement; ▲ feelings of recognition; ▲ a sense of responsibility; ▲ opportunity for advancement; ▲ feelings of personal growth.
Scholars have criticized Herzberg’s theory as being methodbound and difficult to replicate.3 Yet, the two-factor theory remains a useful reminder that there are two important aspects of all jobs:
▲ Job content: What people do in terms of job tasks. ▲ Job context: The work setting in which they do it.
Furthermore, Herzberg’s advice to managers is still timely: (1) Always correct poor context to eliminate actual or potential sources of job dissatisfaction; and (2) be sure to build satisfier factors into job content to maximize opportunities for job satisfaction.
10.1.3 Acquired Needs Theory
David McClelland offers another motivation theory based on individual needs.4
▲ Need for achievement is the desire to do something better or more effi- ciently, 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.
According to McClelland, people acquire or develop these needs over time as a result of individual life experiences. In addition, each need carries a distinct set of work preferences. 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.
People high in the need for achievement, for example, like to put their com- petencies to work, they take moderate risks in competitive situations, and they are willing to work alone. As a result, the work preferences of high-need achiev- ers include individual responsibility for results, achievable but challenging goals, and feedback on performance.
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10.2 MOTIVATION BASED ON PROCESS 283
10.2 Motivation Based on Process
Although the details vary, each of the need theories described in section 10.1 can help managers understand individual differences and deal positively with workforce diversity.
The following process theories can add further to this understanding. The equity, expectancy, and goal-setting theories each offer advice and insight on how people actually make choices to work hard or not, based on their individual pref- erences, the available rewards, and possible work outcomes.
F O R E X A M P L E
Complex Needs in Today’s Health Care Organization Researcher Milton Hammerly sees needs driving not only health care employees and managers, but also patients, insurance agents, and independent providers. In reports he’s written for American Journal Medical Quality, Ham- merly focuses on the complexity theory of needs, in which Maslow’s hier- archy of needs drives the behavior of everyone involved in providing health care. Hammerly recommends that health care organizations must of course satisfy lower-order needs (survival), but that they must also provide oppor- tunities for everyone to satisfy higher-order needs (actualization). Employ- ers aware of actualization needs can maintain a stronger workforce for longer periods of time. Patients who work toward actualization needs (per- haps through more active collaboration with their caregivers) can experi- ence more than mere survival—they can experience truly improved health and wellness.
• Identify and define motivation, needs, two-factor theory, and acquired needs theory.
• Compare the three main theories of motivation based on need.
• Describe Maslow’s hierarchy of needs, including the deficit principle and progression principle.
• Contrast elements of the two-factor theory: satisfier factors and hygiene factors.
• Compare the three types of needs that make up acquired needs theory.
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284 MOTIVATING OTHERS
10.2.1 Equity Theory
The equity theory of motivation is known best through the work of J. Stacy Adams.5 The essence of the 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.
Equity comparison typically occurs whenever managers allocate extrinsic rewards, especially monetary incentives or pay increases. Inequities occur when- ever people feel that the rewards received for their work are unfair given the rewards other people appear to be getting. A worker may compare his or her situation to other co-workers in the group, to workers elsewhere in the organi- zation, and even to people employed by other organizations.
Adams predicts that people will deal with perceived inequity by changing
▲ their work inputs by putting less effort into their jobs; ▲ the rewards received by asking for better treatment; ▲ the comparison points by finding ways to make things seem better; ▲ the situation by transferring or quitting the job.
Much of Adams’s research has been laboratory based and focuses on per- ceived negative inequity, a condition that most managers would want to avoid. 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.
People who feel overpaid and perceive positive inequity, by contrast, have been found to increase the quantity or quality of their work. However, many questions involving this particular issue remain to be answered.
Informed managers anticipate perceived negative inequities whenever espe- cially visible rewards—such as pay or promotions—are allocated. Instead of let- ting equity concerns get out of hand, they carefully communicate the intended value of rewards being given, clarify the performance appraisals upon which they are based, and suggest appropriate comparison points.
10.2.2 Expectancy Theory
Victor Vroom’s expectancy theory of motivation asks a central question: What determines the willingness of an individual to work hard at tasks important to the organization?6
Expectancy theory suggests that “people will do what they can do when they want to do it.” More specifically, 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.
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10.2.3 GOAL-SETTING THEORY 285
▲ 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 � I � V
In other words, motivation is determined by expectancy times instrumentality times valence. The multiplier effect has important managerial implications. Math- ematically speaking, a zero at any location on the right side of the equation (for E, I, or V) results in zero motivation.
For example, a typical assumption is that people will be motivated to work hard to earn a promotion. But is this necessarily true? If expectancy is low, moti- vation will suffer. The person may feel that he or she cannot achieve the per- formance level necessary to get promoted. So why try? If instrumentality is low, motivation will suffer. The person may lack confidence that a high level of task performance will result in being promoted. So why try? If valence is low, moti- vation will suffer. The person may place little value on receiving a promotion. It simply isn’t much of a reward. So, once again, why try?
As Figure 10-3 shows, the management implications of expectancy theory include being willing to work with each individual and try to maximize his or her expectancies, instrumentalities, and valences in ways that support organiza- tional objectives. Stated a bit differently, a manager can apply expectancy theory by clearly linking effort and performance, linking performance to work out- comes, and choosing work outcomes valued by the individual.
10.2.3 Goal-Setting Theory
Task goals, in the form of clear and desirable performance targets, are the basis of Edwin Locke’s goal-setting theory.7 The theory’s basic premise is that task goals can be highly motivating—if they are properly set and if they are well man- aged. Specifically, goals
▲ give direction to people in their work; ▲ clarify the performance expectations between a supervisor and subordi-
nate, between co-workers, and across subunits in an organization; ▲ establish a frame of reference for task feedback; ▲ provide a foundation for behavioral self-management.
According to Locke, goal setting can enhance individual work performance and job satisfaction. To achieve these benefits, however, managers and team leaders must work together to set the right goals in the right ways. The degree to which
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286 MOTIVATING OTHERS
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 (1) allows for increased understanding of specific and difficult goals and (2) provides for greater acceptance and commitment to them.
Some additional tips for successful goal-setting include the following:
▲ Set specific goals: Specifically worded goals (“To complete three preop- erative consultations every hour,” for example) lead to higher performance than more generally stated ones (“Do your best”).
▲ Set challenging goals: As long as goals are viewed as realistic and attain- able, more difficult goals lead to higher performance than do easy goals.
▲ Build goal acceptance and commitment: People work harder for goals that they accept and believe in; they tend to resist goals forced on them.
▲ Clarify goal priorities: Make sure that expectations are clear as to which goals should be accomplished first and why.
▲ Reward goal accomplishment: Don’t let positive accomplishments pass unnoticed; reward people for doing what they set out to do.
To Maximize Expectancy
To Maximize Instrumentality
• Select workers with ability • Train workers to use ability • Support work efforts • Clarify performance goals
• Clarify psychological contracts • Communicate performance–outcome possibilities • Demonstrate what rewards are contingent on performance
Make the person feel competent and capable of achieving the desired
performance level
Make the person confident in understanding which rewards
and outcomes will follow performance accomplishments
To Maximize Valence
• Identify individual needs • Adjust rewards to match these needs
Make the person understand the value of various possible rewards
and work outcomes
Figure 10-3
Managerial implications of expectancy theory.
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10.3 MOTIVATING THROUGH EXTERNAL FORCES 287
The concept of management by objectives (see section 7.5.1) is a good illustra- tion of such a participative approach to goal setting.
F O R E X A M P L E
Setting Goals and Priorities Vision 2010, the aggressive 5-year growth plan for Harrison Hospital in Kit- sap County, Washington (www.harrisonhospital.org), relies heavily on Locke’s goal-setting theories of motivation. After extensive research and information gathering—including a survey of more than 2,500 employees and patients—Vision 2010’s 13-member team of hospital leaders presented a detailed plan with long- and short-term goals, complete with specific “milestone” checkpoints and public accountability measures (www.harrison- hospital.org/main/vision.html). Additionally, the plan sets employees’ prior- ities by focusing on nine areas for improvement: market position, expanded services, customer service, clinical excellence, physician and hospital align- ment, employee engagement, financial performance, information systems, and location and function of facilities.
10.3 Motivating through External Forces
The theories described in section 10.2 rely on cognitive explanations of behav- ior. They explain why people do things in terms of satisfying needs, resolving felt inequities, or pursuing positive expectancies and task goals.
By contrast, reinforcement theory explains human behavior as a result of one’s environment. Instead of looking within the individual to explain motivation
• Identify and define process theories, equity theory, perceived neg- ative inequity, expectancy theory, and goal-setting theory.
• Describe how inequity can motivate according to equity theory.
• Compare the effects of perceived negative inequity and perceived positive inequity.
• Discuss the relationship between the three expectancy theory factors of expectancy, instrumentality, and valence.
• Explain the importance of goals in the workplace.
• Suggest strategies setting effective goals.
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288 MOTIVATING OTHERS
and behavior, reinforcement theory focuses on the external environment and the consequences it holds for individuals.
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.8
10.3.1 Reinforcing Behaviors
Psychologist B. F. Skinner popularized the concept of operant conditioning, or learning by reinforcement. In management, reinforcement systematically rein- forces desirable work behavior and discourages undesirable work behavior.
Four strategies of reinforcement are used in operant conditioning:
▲ Positive reinforcement strengthens or increases the frequency of desir- able behavior by making a pleasant consequence contingent on its occur- rence. Example: A manager nods to express approval to someone who makes a useful comment during a staff meeting. Section 10.3.2 deals with positive reinforcement in greater detail.
▲ Negative reinforcement increases the frequency of or strengthens desir- able behavior by making the avoidance of an unpleasant consequence contingent upon its occurrence. Example: A manager who has been nag- ging a worker every day about tardiness does not nag when the worker comes to work on time one day.
▲ Punishment decreases the frequency of or eliminates an undesirable behavior by making an unpleasant consequence contingent on its occur- rence. Example: A manager issues a written reprimand to an employee who reports late for work one day.
▲ Extinction decreases the frequency of or eliminates an undesirable behavior by making the removal of a pleasant consequence contingent on its occurrence. Example: A manager observes that a disruptive employee is receiving social approval from co-workers; the manager counsels co- workers to stop giving this approval.
For example, Figure 10-4 shows how a manager can apply all four reinforce- ment strategies to influence continuous improvement among employees. Note, too, that the strategies of both positive and negative reinforcement strengthen desirable behavior when it occurs. The punishment and extinction strategies weaken or eliminate undesirable behaviors.
10.3.2 Utilizing Positive Reinforcement
Among the reinforcement strategies, positive reinforcement deserves special attention. Positive reinforcement can be a valuable motivational tool.
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10.3.2 UTILIZING POSITIVE REINFORCEMENT 289
When using positive reinforcement in the workplace, managers need to always be mindful of two important laws:
▲ The law of contingent reinforcement: For a reward to have maximum reinforcing value, it must be delivered only if the desirable behavior is exhibited. For example, an insurance call center manager should reward her staff for their prompt attention to calls only after the center fully meets its goal of answering every call within 60 seconds.
▲ The law of immediate reinforcement: The more immediate the delivery of a reward after the occurrence of a desirable behavior, the greater the reinforcing value of the reward. For example, a manager should comple- ment a perpetually late staffer for arriving on time to work as early in the day as possible.
The following are additional tips for effectively using positive reinforcement:
▲ Clearly identify desired work behaviors. ▲ Maintain a diverse inventory of rewards.
Figure 10-4
Applying reinforcement strategies.
Manager’s Objective
Individual Behavior
Reinforcement Strategy
Type of Reinforcement
Praise employee: recommend pay
increase
Stop complaints
Meets service standards with zero errors
Positive reinforcement
Negative reinforcement
Extinction
Punishment
High-quality medical services
Meets service standards but with higher percentage of errors
Withhold praise and rewards
Reprimand employee
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290 MOTIVATING OTHERS
▲ Inform everyone what must be done to get rewards. ▲ Recognize individual differences when allocating rewards.
The timing of positive reinforcement can also make a difference in its impact.
▲ A continuous reinforcement schedule administers a reward each time a desired behavior occurs.
▲ An intermittent reinforcement schedule rewards behavior only periodically.
In general, a continuous reinforcement elicits a desired behavior more quickly than an intermittent reinforcement. By contrast, behavior acquired under an intermittent schedule is often more permanent than behavior acquired under a continuous schedule.
Managers can mobilize the power of positive reinforcement through the process of shaping, which is the creation of a new behavior by the positive rein- forcement of successive approximations to it.
One way to succeed with a shaping strategy is to give reinforcement on a continuous basis until the desired behavior is achieved. Then use an intermit- tent schedule to maintain the behavior at the new level.
10.3.3 Using Punishment
As a reinforcement strategy, punishment attempts to eliminate undesirable behav- ior by making an unpleasant consequence contingent with its occurrence. To
F O R E X A M P L E
Employee Recognition Programs Over the last decade, many health care organizations have developed and enhanced employee recognition programs in an effort to encourage high lev- els of performance from all workers. Many recognition programs now salute contributions beyond (and in addition to) traditional “employee of the month” type recognition and anniversary of service awards. Overlake Hos- pital in Bellevue, Washington (www.overlakehospital.org), has five employee recognition programs to better identify and celebrate outstanding effort within the organization. For example, the hospital’s Bravo program enables employees to recognize co-workers for “going above and beyond the call of duty” on a single project or task. After completing a simple application form, Bravo awards can be issued at any time in any public forum (like a weekly team meeting). Bravo award items have included complementary movie tick- ets, small gift certificates, and celebratory “cookie cards.”
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10.4.1 DEFINING AND DESIGNING GOOD JOBS 291
punish an employee, for example, a manager may deny the individual a valued reward, such as verbal praise or merit pay, or the manager may administer an unpleasant outcome, such as a verbal reprimand or pay reduction. Like positive reinforcement, punishment can be done poorly or it can be done well.
Unfortunately, punishing is often done poorly. 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.
10.4 Motivating through Job Design
The process of job design is one of creating or defining jobs by assigning spe- cific work tasks to individuals and groups.
Done appropriately, job design can contribute to the accomplishment of two major goals—job performance and job satisfaction. One without the other is simply insufficient to meet the high standards expected of today’s health care workplace.
10.4.1 Defining and Designing Good Jobs
Job performance is the quantity and quality of tasks accomplished by an indi- vidual or group at work. Performance, as is commonly said, is the “bottom line”
• Identify and define reinforcement theory, operant conditioning, and shaping.
• Compare the four operant conditioning techniques: positive rein- forcement, negative reinforcement, punishment, and extinction.
• Explain how law of effect impacts all reinforcement theories.
• Describe strategies for effectively using positive reinforcement.
• Contrast characteristics and effectiveness of continuous and inter- mittent reinforcement schedules.
• List strategies for effectively utilizing punishing in the workplace.
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292 MOTIVATING OTHERS
for people at work. It is a cornerstone of productivity, and it should contribute to the accomplishment of organizational objectives.
Indeed, more and more health care organizations now consider a value- added aspect when evaluating the worthwhileness of jobs and/or jobholders. The performance of every job should add value to the organization’s production of useful goods and/or services.
In addition to its performance potential, any job should also provide oppor- tunities for job satisfaction. This indicator of quality of work life is defined as the degree to which a person feels positively or negatively about various aspects of a job.9
An important goal in job design is to always create jobs rich with potential satisfaction. This means managers must consider such things as pay, tasks, super- vision, co-workers, work setting, and advancement opportunities. Employers can address all these facets of job satisfaction in the attempt to improve attitudes and raise the quality of work life.
10.4.2 Exploring Job Design Alternatives
Job design in many ways is an exercise in “fit.” A good job provides a fit between the needs and capabilities of workers and tasks so that both job performance and satisfaction are high.
To tailor job design to better fit workers unique abilities and situations, man- agers can utilize several common job design alternatives, including job simplifi- cation, job enlargement and rotation, and job enrichment.
▲ Job simplification involves streamlining work procedures so that people work in well-defined and highly specialized tasks.
Simplified jobs are narrow in job scope, with a limited number and variety of different tasks a person performs. The logic is straightforward: Because some jobs don’t require complex skills, workers can be easier and quicker to train, less dif- ficult to supervise, and easy to replace if they leave. Furthermore, because tasks are precisely and narrowly defined, workers can become good at doing the same tasks over and over again.
However, there are some downsides to highly simplified jobs. Productivity can suffer as unhappy workers drive up costs through absenteeism and turnover and through poor performance caused by boredom and alienation. The most extreme form of job simplification is automation, or the total mechanization of a job.
The process of job simplification dates back to industrial assembly lines, in which each worker did a specific, simple task to help create a complex product, like an automobile. Today, however, job simplification is less common, particu- larly in complex health care workplaces. In fact, many health care jobs are becoming more complex (see section 10.5). Still, some entry-level positions (par- ticularly clerical and technical positions within large health care organizations) can still be focused and simplified.
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10.4.3 RELYING ON THE CORE JOB CHARACTERISTICS 293
One way to move beyond job simplification is to expand job scope by increasing the number and variety of tasks involved in a job.
▲ Job rotation increases task variety by periodically shifting workers between jobs involving different task assignments.
Job rotation in health care settings can include clinical, office, and laboratory set- tings with a series of functional job stations that workers are assigned to and shuffled on an hourly or daily basis.
▲ Job enlargement increases task variety by combining two or more tasks that were previously assigned to separate workers. The process often involves combining tasks done immediately before or after the work performed in the original job.
Frederick Herzberg (see section 10.1.2) questions the value of the job rotation and job enlargement. “Why,” he asks, “should a worker become motivated when one or more meaningless tasks are added to previously existing ones or when work assignments are rotated among equally meaningless tasks?” By contrast, he says, “If you want people to do a good job, give them a good job to do.”10
▲ Job enrichment that builds more opportunities for satisfaction into a job by expanding not just job scope but also job depth—that is, the extent to which task planning and evaluating duties are performed by the indi- vidual worker rather than the supervisor.
10.4.3 Relying on the Core Job Characteristics
Job rotation, enlargement, and enrichment may not be adequate tools for design- ing truly satisfying jobs in today’s demanding health care workplace.
The core characteristics model developed by Richard Hackman and his associates offers a way for health care managers to create jobs, enriched or oth- erwise, that best fit the needs of people and organizations.11
The model, shown in Figure 10-5, identifies five core job characteristics:
▲ Skill variety: The degree to which a job requires a variety of different activities to carry out the work and involves the use of a number of different skills and talents of the individual.
▲ Task identity: The degree to which the job requires completion of a “whole” and identifiable piece of work—that is, one that involves doing a job from beginning to end with a visible outcome.
▲ Task significance: The degree to which the job has a substantial impact on the lives or work of other people elsewhere in the organization or in the external environment.
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294 MOTIVATING OTHERS
▲ Autonomy: The degree to which the job gives the individual substantial freedom, independence, and discretion in scheduling the work and in determining the procedures to be used in carrying it out.
▲ Feedback from the job itself: The degree to which carrying out the work activities required by the job results in the individual obtaining direct and clear information on the results of his or her performance.
A job that is high in the core characteristics is considered enriched; the lower a job scores on the core characteristics, the less enriched it is. However, these core characteristics do not affect all people in the same way. Generally speaking, people who respond most favorably to enriched jobs have strong higher-order needs and appropriate job knowledge and skills. They are typically satisfied with their job context.
When job enrichment is a good job design choice, you have four main ways of improving the core characteristics:
▲ Form natural units of work. Make sure that the tasks people perform are logically related to one another and provide a clear and meaningful task identity.
▲ Combine tasks. Expand job responsibilities by pulling together into one larger job a number of smaller tasks previously done by others.
Core job characteristics
Critical psychological
states Job
outcomes
Skill variety
Task identity
Autonomy
Experienced meaningfulness of the work
Experienced responsibility for outcomes of the work
Knowledge of actual results of the work
Employee growth-need strength • Knowledge and skill • Context satisfactions
Feedback
Task significance
• High internal work motivation
• High growth satisfaction
• High general job satisfaction
• High work effectiveness
Figure 10-5
Core job characteristics and job design.
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10.5 EXPLORING ALTERNATIVE WORK ARRANGEMENTS 295
▲ Open feedback channels. Provide opportunities for people to receive performance feedback as they work and to learn how performance changes over time.
▲ Practice vertical loading. Give people more control over their work by increasing their authority to perform the planning and controlling previ- ously done by supervisors.
F O R E X A M P L E
Nursing: A Wealth of Alternative Designs Even though there are currently more than 2.5 million nurses in the United States, most regions of the country are experiencing a nursing crisis. (According to the U.S. Bureau of Labor Statistics, job options for registered nurses will grow faster than the average for all occupations through 2008.) To respond to shortages, hospitals and other health care providers are devel- oping a range of job designs to attract and retain quality nursing staffs. Established in 2001, CampusRN.com (www.campusrn.com) not only lists thousands of entry-level nursing opportunities around the country, the site reports on hiring and job-design trends—including flexible schedule, trav- eling nurses, independent contracting, and more—on its Nurse Corner area (www.campusrn.com/students/nurses_corner.asp).
10.5 Exploring Alternative Work Arrangements
Not only is the content of jobs changing for individuals and groups in today’s health care workplace, but the context is changing too. Work/life balance is increasingly at issue for a diverse workforce, and the increasing technology-based work environment is bringing new employment opportunities.12
• Identify and define job design, job performance, job simplification, job rotation, job enlargement, job enrichment, and core charac- teristics model.
• Explain how job design can affect employee motivation.
• Identify work situations where job simplification, rotation, enlarge- ment, and enrichment are each appropriate job designs.
• List the five job characteristics that make up core characteristics model.
S E L F - C H E C K
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296 MOTIVATING OTHERS
Among the more significant developments is the emergence of a number of alternative ways for people to schedule their time to balance work and per- sonal/family needs.13 The following sections cover some of the most popular and effective new developments in the way jobs are structured today.
10.5.1 Compressed Workweek
A compressed workweek is any work schedule that allows a full-time job to be completed in less than the standard 5 days of 8-hour shifts. In health care, a very common form is the “4/40” or the “3/12” that is, accomplishing 40 hours of work in four 10-hour days or three 12-hour days.
One advantage of these compressed schedules is that the employee receives 3 or 4 consecutive days off from work each week. This benefits the individual through more leisure time and lower commuting costs. The organization may also benefit through lower absenteeism and improved performance. Potential dis- advantages include increased fatigue and family adjustment problems for the individual, as well as increased scheduling problems, possible patient complaints, and possible union objections.
10.5.2 Flexible Working Hours
The term 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. Some employees may choose to come in earlier and leave earlier, while still completing an 8-hour day; others may choose to start later in the morning and leave later. In between these extremes are opportunities to attend to personal affairs, such as dental appointments, home emergencies, visits to chil- dren’s schools, and so on.
Flexible working hours are a challenging fit with the shift-driven schedules of clinical or medical positions at many health care facilities. However, for health care departments with less interaction with patients (accounting, administrative, laboratory), flexible working hours are becoming more common.
However, despite the challenges of incorporating flexible working hours in health care settings, the advantages are especially important to members of a diverse workforce. Flexibility is important to many dual-career couples who face the com- plications of managing careers and other responsibilities, including parenting. Sin- gle parents with young children and employees with elder-care responsibilities also find it very attractive to have the option of adjusting work schedules to allow for other obligations to be met. The added discretion flextime provides may also encourage workers to have more positive attitudes toward the organization.
10.5.3 Job Sharing
Another important development for today’s workforce is job sharing, whereby one full-time job is split between two or more people.
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Job sharing often involves each person working one-half day, but it can also be done on weekly or monthly sharing arrangements. When it is feasible for jobs to be split and shared, organizations can benefit by employing talented people who would otherwise be unable to work. For example, a qualified specialist who is also a parent may be unable to stay away from home for a full workday but may be able to work a half day. Job sharing allows two such people to be employed as one. Although adjustment problems and benefit-costs concerns are challenging, a job-sharing arrangement can be good for all concerned.
10.5.4 Telecommuting
Telecommuting, sometimes called flexiplace or cyber-commuting, is a work arrangement that allows at least a portion of scheduled work hours to be com- pleted outside of the office, facilitated by various forms of electronic communi- cation and computer-mediated linkages to clients, patients, and a central office.
Telecommuting frees the jobholder from the normal constraints of commut- ing, fixed hours, and special work attire. The new vocabulary of telecommuting practices includes hoteling—where telecommuters come to the central office and use temporary office facilities, and virtual offices that include everything from an office at home to mobile workspace in automobiles.
Traditional health care workers who have little direct interaction with patients are the most appropriate candidates for telecommuting work arrange- ments. Additionally, as online and phone-based health care services—everything from Dial-a-Nurse to medical-claims consulting to phone-based psychological counseling—become increasingly common, health care workers can look for health care careers that are not bound to a specific geographic location.
Telecommuting options offer both advantages and disadvantages from a job design and management perspective. On the positive side are the freedom to be your own boss and the benefit of having more time for yourself. On the nega- tive side are the possibilities of working too much, difficulty separating work and personal life, feelings of isolation, and loss of visibility for promotion. Man- agers, in turn, may be required to change their routines and procedures to accommodate the challenges of supervising people from a distance.
10.5.5 Independent Contracting and Part-Time Work
Among the developments in more flexible work arrangements is a growing use of independent contracting, where specific health care-related tasks or projects are assigned to outsiders rather than full-time workers. Cleaning, case manage- ment, administrative work, specialized technical work, and dozens of other activ- ities make up the services health care organizations provide and are frequently completed by independent health care contractors.
When the project is completed, the contractor moves on to another assign- ment elsewhere. This benefits the organization by allowing for the hiring of
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298 MOTIVATING OTHERS
special talents and expertise “as needed” and without the need to engage in a long-term employment relationship. For the independent contractors, it can allow flexibility and variety in their jobs while providing opportunities for per- sonal choice in work-life balance.
Independent contractors are examples of the growing number of American workers who work on a part-time basis. In fact, employers are increasingly rely- ing on contingency workers, or permatemps, who supplement the full-time workforce, often on a long-term basis. Because part-time or contingency work- ers can be easily hired, contracted with, and/or terminated in response to chang- ing needs, many employers like the flexibility they offer in controlling labor costs and dealing with cyclical demand.14 On the other hand, some worry that tem- porary workers lack the commitment of permanent workers and may lower pro- ductivity.
Perhaps the most controversial issue of the part-time work trend relates to the different treatment part-timers may receive from employers. They may be paid less than their full-time counterparts, and they often fail to receive impor- tant benefits, such as health care, life insurance, pension plans, and paid vaca- tions. The social and economic implications of the growing role of part-time and contingent employment is an area that managers at all levels need to be mind- ful of and monitor carefully over the next decade as U.S. health care demands continue to grow and change.15
F O R E X A M P L E
Family-Friendly Health Care Organizations Working Mother magazine (www.workingmorther.com) annually evaluates thou- sands of U.S. workplaces—including hundreds of health care organizations— using a rigorous application with more than 500 questions that focus on job design and worker motivation. Although the target audience for Working Mother’s research is female workers with children, all health care profes- sionals looking for dynamic organizations with flexible hours, enriching work environments, and motivating advancement opportunities can benefit from reviewing the magazine’s 100 Best Places to Work list. For example, in 2004, the magazine identified Children’s Memorial Hospital (www.chil- drensmemorial.org) in Chicago, Illinois, as an outstanding health care organization. In addition to family-friendly scheduling options (job sharing, flextime, and so on), Children’s Memorial also offers a wide range of inno- vative childcare-specific services, including 80 hours of free in-home child- care, backup care, discounts at area centers, summer programs, and flexible spending accounts.
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KEY TERMS 299
SUMMARY Motivating others not only makes for a more pleasant workplace and happier workers, doing so also benefits an organization’s bottom line because of lower turnover rates and less need to dismiss workers. According the hierarchy of needs, the two-factor theory, and acquired needs theory, human needs can motivate people’s actions and attitudes. People’s choices to work hard are the basis of various process theories of motivation, which include equity theory, expectancy theory, and goal-setting theory. Managers can set up external forces—particularly positive reinforcement and punishment—to influence and motivate workers. Designing jobs that are appropriate for individual’s skills and career goals is a popular, relatively inexpensive way to motivate employees. Job design in today’s dynamic health care organizations requires managers to con- sider several alternative work arrangements such as telecommuting and job sharing.
KEY TERMS 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.
Continuous reinforcement Rewarding behavior each time a desired behavior schedule occurs.
Core characteristics model Richard Hackman’s motivation theory with five core job characteristics, skill variety, task identity, task, significance, autonomy, and feedback from the job itself.
• Identify and define compressed workweek, flexible working hours, job sharing, telecommuting, and independent contracting.
• Describe appropriate situations for various alternative work arrange- ments being used in today’s health care workplace.
• List advantages and disadvantages of various alternative work arrangements.
• Compare various forms of telecommuting.
• Discuss the pros and cons of today’s growing reliance on indepen- dent contractors and part-time employees.
S E L F - C H E C K
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Deficit principle In Maslow’s needs theories, only an unsatisfied need—one for which a deficit exists—can be a motivator of behavior.
Equity theory Motivation theory in which people who believe that they have been inequitably treated in com- parison to others will try to eliminate the discom- fort and restore a sense of equity to the situation.
Expectancy In expectancy theory, a person’s belief that work- ing hard will result in a desired level of task performance being achieved.
Expectancy theory Victor Vroom’s motivation theory based on an individual’s willingness to work hard at tasks im- portant to the organization.
Extinction In operant conditioning, anything that decreases the frequency of or eliminates an undesirable be- havior by making the removal of a pleasant con- sequence contingent on its occurrence.
Flexible working hours Any work schedule that gives employees some choice in the pattern of their daily work hours, also called flexitime or flextime.
Goal-setting theory Edwin Locke’s theory that clear, desirable perfor- mance targets (goals) can motivate.
Hygiene factors In two-factor theory, things relating more to the work setting.
Independent contracting Specific health care-related tasks or projects are as- signed to outsiders rather than full-time workers.
Instrumentality In expectancy theory, a person’s belief that suc- cessful performance will be followed by rewards and other potential outcomes.
Intermittent reinforcement Rewarding behavior only periodically. schedule
Job design The process of creating or defining jobs by as- signing specific work tasks to individuals and groups.
Job enlargement The process of increasing task variety by combin- ing two or more tasks that were previously as- signed to separate workers.
Job enrichment The process of building more opportunities for satisfaction into a job by expanding not just job scope but also job depth.
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KEY TERMS 301
Job performance The quantity and quality of tasks accomplished by an individual or group at work.
Job rotation The process of increasing task variety by periodi- cally shifting workers between jobs involving dif- ferent task assignments.
Job sharing One full-time job is split between two or more people.
Job simplification The process of streamlining work procedures so that people work in well-defined and highly spe- cialized tasks.
Law of contingent In operant conditioning, for a reward to have reinforcement maximum reinforcing value, it must be delivered
only if the desirable behavior is exhibited.
Law of effect In behavior reinforcement theory, behavior that results in a pleasant outcome is likely to be re- peated; behavior that results in an unpleasant outcome is not likely to be repeated.
Law of immediate In operant conditioning, the more immediate the reinforcement delivery of a reward after the occurrence of a de-
sirable behavior, the greater the reinforcing value of the reward.
Motivation Forces within individuals that account for the level, direction, and persistence of effort they ex- pend at work.
Need for achievement In acquired needs theory, the desire to do some- thing better or more efficiently, to solve problems, or to master complex tasks.
Need for affiliation In acquired needs theory, the desire to establish and maintain friendly and warm relations with other people.
Need for power In acquired needs theory, the desire to control other people, to influence their behavior, or to be responsible for them.
Needs Unfulfilled physiological or psychological desires of an individual.
Negative reinforcement In operant conditioning, anything that increases the frequency of or strengthens desirable behav- ior by making the avoidance of an unpleasant consequence contingent upon its occurrence.
Operant conditioning B. F. Skinner’s concept of learning by reinforcement.
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302 MOTIVATING OTHERS
Perceived negative inequity In equity theory, a condition people who perceive negative inequity tend to reduce their work ef- forts to compensate for missing rewards.
Permatemps Long-term temporary workers who supplement the full-time workforce.
Positive reinforcement In operant conditioning, anything that strength- ens or increases the frequency of desirable behav- ior by making a pleasant consequence contingent on its occurrence.
Process theory Motivational theory focuses on how people actu- ally make choices to work hard or not, based on their individual preferences, the available re- wards, and possible work outcomes.
Progression principle In Maslow’s hierarchy of needs, a need at one level does not become activated until the next lower level need is already satisfied.
Punishment In operant conditioning, anything that decreases the frequency of or eliminates an undesirable be- havior by making an unpleasant consequence contingent on its occurrence.
Reinforcement theory Motivational theory that explains human behav- ior as a result of one’s external environment.
Satisfier factors In two-factor theory, things relating to the nature of a job itself.
Shaping The process of creating a new behavior by the positive reinforcement of successive approxima- tions to it.
Telecommuting 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 elec- tronic communication and computer-mediated linkages to clients, patients, and a central office; sometimes called flexiplace or cyber-commuting.
Two-factor theory Frederick Herzberg’s motivation theory that fo- cuses on the nature of the job itself and the work setting.
Valence In expectancy theory, the value a person assigns to the possible rewards and other work-related outcomes.
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SUMMARY QUESTIONS 303
ASSESS YOUR UNDERSTANDING Go to www.wiley.com/college/Lombardi to evaluate your knowledge of the basics of motivating to meet needs. Measure your learning by comparing pretest and post-test results.
Summary Questions
1. Which of the following statements about motivation is true? (a) Managers who lead through motivation create conditions under
which others feel inspired to work hard. (b) Managers who understand what motivates people can appreciate
where staff are coming from. (c) Managers can better direct the energies of staff when they understand
motivation. (d) All of the above
2. All the needs-based theories on motivation contend that needs cause (a) perceptions that inspire attitudes and beliefs. (b) tensions that influence attitudes and behaviors. (c) desires that encourage action. (d) passions that inspire loyalty.
3. In Maslow’s hierarchy of needs, the deficit principle states that a need at one level does not become activated until the next lower need is already satisfied. True or false?
4. In two-factor theory of motivation, a satisfier factor would be (a) the sense of achievement you get from doing your job. (b) the salary and bonus you receive. (c) the relationship you have with your boss. (d) the length of your lunch break.
5. The process theories of motivation all focus on an employee’s choice to work hard (or not) based on (a) individual responsibilities, implied rewards, and desired job promotion. (b) individual rewards, available options, and potential job growth. (c) individual preferences, available rewards, and possible work
outcomes. (d) none of these.
6. In expectancy theory, the free motivating factors (expectancy, instrumen- tality, and valence) have a multiplier effect, which means a zero for any factor results in zero motivation. True or false?
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304 MOTIVATING OTHERS
7. Goals are useful in the workplace because they clarify hiring strategies and establish a frame of reference for worker retention. True or false?
8. Punishment can be an effective management tool. True or false? 9. In operant conditioning, anything that decreases the frequency of or
eliminates an undesirable behavior by making an unpleasant consequence contingent on its occurrence is (a) punishment. (b) extinction. (c) negative reinforcement. (d) positive reinforcement.
10. In order for positive reinforcement to be effective, rewards can be given when a desirable behavior is partially exhibited. True or false?
11. Job simplification allows work tasks to be narrowly defined and makes training easier. True or false?
12. Which of the following situations is an example of job rotation? (a) Workers moving among various job stations during the workday (b) Flexible scheduling that enables each work to set their workday (c) Two part-time workers sharing one full-time position (d) An interdepartmental team that meets weekly to discuss differing
work experiences 13. In the core characteristics model of job design, the degree to which a
job has substantial impact on the lives of others in the organization or the external environment is known as (a) task identity. (b) autonomy. (c) skill variety. (d) task significance.
14. Job enrichment can be accomplished through vertical loading, which gives managers greater opportunity to assign a diversity of tasks to staff. True or false?
15. Flexible schedule is becoming a more common work choice in health care departments with (a) less interaction with patients. (b) more interaction with patients. (c) more union membership. (d) less union membership.
16. An alternative work arrangement in which a portion of scheduled work hours are completed outside the office is know as (a) job sharing. (b) flextime scheduling.
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REVIEW QUESTIONS 305
(c) independent contracting. (d) telecommuting.
17. Long-term temporary workers are sometimes paid less than their full- time counterparts, and they often do not receive health care benefits. True or false?
Review Questions
1. Based on two-factor theory, which type of factors must a manager address in order to improve motivation?
2. According to acquired needs theory, a shift nurse who has a strong desire to influence others and take responsibility for situations and projects has a high level of which type of need?
3. Place Maslow’s five levels of need in order, from low-level needs to high- level needs: esteem, safety, physiological, self-actualization, and social.
4. A medical billing center manager implements a policy in which employ- ees can come to work 2 hours early on Fridays and then leave 2 hours earlier at the end of the day. Based on Herzberg’s two-factor theory, which factor is the manager focusing on?
5. Which need in Maslow’s hierarchy of needs is a manager addressing when he makes an effort to celebrate each staff member’s birthday?
6. If a worker perceives an inequity in the workplace, he may become so uncomfortable with the situation that he will attempt to restore equal- ity. What are two examples of actions that can deal with perceived inequity?
7. Setting goals can be effective motivation. What should manager and employee do in order to make goal setting effective?
8. When a manager makes a special effort to provide positive feedback every day on appropriate patient charting, the manager is relying on which law or positive reinforcement?
9. What are the benefits of using a continuous reinforcement schedule or an intermittent reinforcement schedule?
10. Punishment can be done poorly or well. What are two strategies to effective deliver punishment?
11. The third-shift manager at a 24-hour convenience clinic decides to save her organization’s money by eliminating one front desk person during her shift and having nurses take on additional admission tasks. What job design alternative is the manager utilizing?
12. The core characteristics model of job design focuses on five key job char- acteristics. Which characteristic pays attention to an employee’s freedom and independence?
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13. Simplified jobs make training easier and allow for less managerial super- vision. However, these jobs also have some downsides. What is a down- side of a simplified job?
14. Compressed workweeks are becoming a popular scheduling choice in many health care organizations. What are some disadvantages of this type of work arrangement?
15. Telecommuting has advantages and disadvantages for today’s health care organizations. What are some pros and cons of this type of alternative work arrangement?
Applying This Chapter
1. Lisa, an LPN on your team, is an average worker, but you sense she has greater potential. Lisa has been on-staff for about 3 months and largely keeps to herself. She doesn’t seem particularly proud of the work she does, but she is satisfied with her salary and benefits. How might you use Maslow’s progression principle to identify ways to motivate Lisa to achieve a higher level of work?
2. Byron has worked in the intact desk at an emergency room for 5 years. He has never received a promotion, although he has received annual cost-of-living raises. Overall, his work attitude is “Why try? I get paid the same amount no matter how many patients I interact with.” Using Vroom’s expectancy theory (and the equation M � E � I � V), what might be affecting Byron’s performance?
3. How might the manager of the pediatric unit at a research hospital utilize shaping to positively reinforce the training and skill development of a new nursing intern?
4. The manager of a student health clinic is asked to work more job rotations into the job designs of his staff. What are some things the manager should consider?
5. To give your staff of eight full-time nurses greater flexibility and opportu- nity to spend more time at home with their young families, you decide to utilize job sharing. What are some possible job-sharing arrangements you might consider trying?
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YOU TRY IT
Your Acquired Needs Part of what makes McClelland’s acquired needs the- ory so powerful is that the work environments and job responsibilities can—and in fact, should—be tailored to meet workers’ specific needs. Consider the three types of needs described in section 10.1.3. Of achievement, power, or affiliation, which is the strongest need you have? What type of position would be most likely to satisfy your greatest need?
Do Your Job Goals Motivate You? According to the goal-setting theory of motivation, ap- propriately formulated and presented goals can lead workers to deliver outstanding performance on a daily basis. Evaluate the job-related goals of your current health care position based on the five-point criteria suggested by the goal-setting theory. Are your job- related goals specifically worded, challenging, built on employee acceptance and buy-in, prioritized in terms of relative importance, and linked to clear rewards? (If you don’t have job-related goals for a current position, review the goals of the Pharmacy Residency program at Mercy and Unity Hospitals of Minnesota at www.mercy-unity.com/ahs/mercyunity.nsf/page/ PharmGenMedRotation.)
Four Ways to Reinforce As the shift manager of the critical care nursing staff at a small community hospital, your greatest managerial challenge centers around two highly experienced nurses who have frequently been passed over for pro- motions due to lack of interpersonal skills. These senior
nurses frequently disregard new procedures you’ve been trying to implement; they also undermine your au- thority by engaging in overly critical conversations with newer staff members. How can you utilize the four types of behavior modification—positive reinforce- ment, negative reinforcement, punishment, and extinc- tion—to attempt to modify the nurses’ behaviors?
Alternative Designs As the leader of a group of four students assigned to create a group presentation about current health care employment trends, discuss the pros and cons of di- viding up work for the presentation based on the job design alternatives discussed in this chapter, specifi- cally, job simplification, job rotation, job enlargement, and job enrichment.
Which Alternatives Suit You? In today’s dynamic workplace, even entry-level health care workers are given opportunity to work under the alternative work arrangements described in section 10.5. Nine-to-five, Monday through Friday jobs are rare in health care, so before you assume that you’ll have a “regular” job, take time to consider each of the alternatives that section 10.5 discusses. Considering these alternative arrangements can open up a world of additional job opportunities. How would a com- pressed workweek fit with your lifestyle and commit- ments? How might you utilize flexible working hours or telecommuting, if either option were available to you? Does independent contracting have any appeal to you?
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