Within your organization, upper management has decided that your department must be downsized, and it is up to each manager to begin preparing his or her team for the changes. One of the changes to be

Sources on: Explain what theoretical concepts from your reading support the points you are making.

The literature provides an array of strategies for managers to use in seeking to help motivate and engage individuals. Some of these seem very obvious, while others represent the “tried-and-true” approaches to management. Still others represent innovations. No matter, they are worth enumerating here.

Expect the best. People live up to the expectations they and others have of them. As stated best by Henry Ford: “Whether you think you can or you think you can’t, you’re right!” (Manion, 2005).

Communicate and address the big picture. Employees are more engaged when their bosses communicate regularly, keep them apprised of what is happening, and what the collective purpose is of the organization. They also need to understand how what they are tasked with fits into the larger picture of the organization (Baldoni, 2008, 2013), as well as society as a whole (Kanter, 2013). The latter is particularly true in health care, whereas Herzer and Pronovost (2013) suggest “inspiring a collective purpose and vision” is an important motivator for physicians. This is also the case for other health care professions in both direct care and non-direct care settings.

Reward the desired behavior. Make sure that rewards are not given for undesirable behaviors and be sure to use many different types of rewards to achieve the desired outcomes (Manion, 2005). Do something special to recognize desired behavior; examples suggested by Studer (2003, 2014) include sending a written thank you note to an employee’s home or using a “WOW card.” The latter is a simple card that can be filled out and sent to an employee, explaining that “Today you ‘WOWed’ me when you _____________________.” Fill in the blank with an explanation of what that special something was.

Create a “FUN (Focused, Unpredictable, and Novel) approach.” Atchison (2003, p. 21) suggests using money for a variety of creative employee rewards, such as giving $50 gift certificates to a shopping center in recognition of employees’ exceeding expected patient outcomes.

Celebration. Baldoni (2008) suggests using celebration to communicate the importance of completed projects or progress made.

Reward employees in ways that enhance performance and motivate them. Don’t waste money on traditional types of recognition. Though these are viewed as being nice, they don’t motivate (Atchison, 2003). Money is better spent on true rewards for specific types of performance and outcomes.

Tailor rewards. As mentioned earlier, Atchison (2003) steers managers away from standard types of rewards, such as giving the obligatory Thanksgiving turkey—unless the employees look forward to those turkeys. Instead, he recommends finding more creative ways to spend the organization’s money and reward employees.

Focus on revitalizing employees. Research shows that, when employees are working on overloaded circuits, motivation is diminished and productivity declines. This is particularly true in health care organizations. Hallowell (2005) suggests managers can help to motivate employees by encouraging them to eat right, exercise regularly, take “real” vacations, get organized, and slow down.

Find creative ways to obtain information and recognize excellence in employees. Studer (2003) suggests asking for feedback on service excellence when doing patient satisfaction surveys and hospital discharge phone calls. With data and information from these sources, recognition can be provided to individual employees, thereby motivating them to continue providing excellent customer service. This also communicates to the entire organization the importance of and commitment to a patient-centered and service-oriented culture.

Get subordinates to take responsibility for their own motivation. This can be achieved by managers taking steps to deal with problem employees, to understand employees’ needs, to determine what motivates their employees, to engage employees in the problem-solving process, and to really work hard at resolving, rather than ignoring, difficult employee problems (Nicholson, 2003).

“Do unto others as you would have done unto you.” It goes without saying that everyone wants to be treated well at work, making it important for managers to respect the employees they work with (Lipman, 2013).

Focus on collaboration instead of competition. Health care is a team sport, where patient care is frequently provided by an array of employees. This is true of physicians collaborating with others to be patient-centered and work to enhance the quality of care (Herzer & Pronovost, 2013).

Play to employees’ strengths, promote high performance, and focus on how they learn. This requires managers to know what their employees’ strengths and weaknesses are, to find out what will be required to get specific employees to perform, and to understand how to capitalize on the ways those employees learn as an alternative method of encouraging and motivating them (Buckingham, 2005).

Give employees “three compliments for every criticism.” Studer states: “I thought I heard that compliments and criticism were supposed to be balanced. But the truth is, if you give a staff member one compliment and one criticism, it equals a negative relationship. If you give a staff member two compliments to one criticism, it will equal a neutral relationship. If you give a staff three compliments to one criticism, it will equal a positive relationship” (2003, p. 232).

Acknowledge the importance of work-life balance and employee well-being. Several studies, particularly those pertaining to younger generations, point out the importance of promoting well-being (Caver, Davenport, & Nyce, 2015; Gallup, 2014). A recent study of health care employees by Shuck and Reio (2014) states “high engagement group employees demonstrated higher psychological well-being and personal accomplishment, whereas low engagement group employees exhibited higher emotional exhaustion and depersonalization” (p. 43). Several other studies focus on balancing life at work with leisure activities (Kultalahti & Viitala, 2014; O’Boyle & Harter, 2013; Zwilling, 2012). As managers, it is important to recognize this for all employees and respect their needs regarding leisure and other activities outside of work (Lipman, 2013).

MOTIVATING ACROSS GENERATIONS

The U.S. has experienced a health professions labor force shortage over the last decade. By the year 2020, a nationwide shortage is projected of approximately 100,000 physicians, one million nurses, and 250,000 public health professionals (Health Resources and Services Administration, n.d.). This shortage, along with the aging Baby Boomer population, means an intense focus is vital in order for health care organizations to successfully function over the next few decades. Total employment is estimated by the U.S. Bureau of Labor Statistics (BLS) to increase by 15.6 million, or 10.8%, during the period of 2012–2022. These projections include a changing labor force, specifically one that is older, more racially and ethnically diverse, as well as more demanding. More than 50% of new jobs are projected to be in professional and service-providing occupations. Of the four fastest growing occupations, three are in the health field, i.e., health care, health care support, personal care services—the fourth being the construction field. These four occupational fields are expected to comprise over 5.3 million new jobs, or one-third of total employment growth, by the year 2022 (BLS, 2009, 2013).

Health care managers need to embrace the challenges, opportunities, and new strategies when managing such a diverse labor force (American Hospital Association, 2010). This will require managers to evaluate their current management styles, especially when considering actively engaging and motivating a labor force across multiple generations. According to the American Hospital Association’s (AHA) 2010 study, Workforce 2015: Strategy Trumps Shortage, social trends over the last several decades have been dominated by the values, preferences, and experiences of the Baby Boomer generation, which includes those born between 1946 and 1964. However, the Baby Boomers are only one of four generations that comprise today’s labor force. A generation is a “group of individuals born and living contemporaneously who have common knowledge and experiences that affect their thoughts, attitudes, values, beliefs and behaviors” (Johnson & Johnson, 2010, p. 6). Members of the four main generations include the traditionalists, the Baby Boomers, Generation X, and the Millennials (Generation Y). One consideration not previously addressed is that our workforce is experiencing history in the making as it is on the cusp of accommodating the newest generation, Generation Z, making five generations working alongside each other in the workplace. As pointed out by the AHA (2014) and Johnson and Johnson (2010), the intergenerational workforce reflects a continuum, with each generation moving along it and eventually leaving the workforce.

Each generation has unique characteristics and expectations and is motivated in different ways. Literature might vary slightly regarding the nicknames, birth date ranges, and cohort sizes, especially when considering the newest generations entering the workforce. The key points provided in Table 3-1 illustrate an overview of generational differences among workplace characteristics and motivational preferences.

What appeals to one generation more than likely will not appeal to another generation. Motivational techniques, such as rewards and incentives, vary widely across generations. One generation might prefer recognition based on proof of their time-tested work ethic, while another generation might expect instant gratification stemming from what they consider a job well done. Schullery (2013) found “Millennials are significantly more interested in extrinsic rewards than are Boomers, although Millennials are less interested than GenX” and that “each generation is increasingly less likely to value intrinsic rewards as highly as the previous generation” (p. 260). A caveat to this is that these results may change over time.

Different standards of motivation are required for each generation. In order for health care organizations to be successful in the future, the workplace needs to be one of coexistence of all generations, even when their workplace characteristics and motivational preferences are drastically different. Managers play a key role in how the generations will work together and what it takes to engage employees to be motivated workers.

Reading on: Describe 3 motivational methods you would apply as a manager.

Psychologists have studied human motivation extensively and have derived a variety of theories about what motivates people. This section briefly highlights the motivational theories that are widely known in the field of management. These include theories that focus on motivation being a function of (1) employee needs of various types, (2) extrinsic factors, and (3) intrinsic factors. Each set of theories follows.

Needs-Based Theories of Motivation

Maslow’s Hierarchy of Needs

Maslow (1954) postulated a hierarchy of needs that progresses from the lowest, subsistence-level needs to the highest level of self-awareness and actualization. Once each level has been met, the theory is that an individual will be motivated by and strive to progress to satisfy the next higher level of need. The five levels in Maslow’s hierarchy are:

Physiological needs—including food, water, sexual drive, and other subsistence-related needs;

Safety needs—including shelter, a safe home environment, employment, a healthy and safe work environment, access to health care, money, and other basic necessities;

Belonging needs—including the desire for social contact and interaction, friendship, affection, and various types of support;

Esteem needs—including status, recognition, and positive regard; and

Self-actualization needs—including the desire for achievement, personal growth and development, and autonomy.

The movement from one level to the next was termed satisfaction progression by Maslow, and it was assumed that over time individuals were motivated to continually progress upward through these levels. While useful from a theoretical perspective, most individuals do not view their needs in this way, making this approach to motivation a bit unrealistic.

Alderfer’s ERG Theory

The three components identified by Alderfer (1972) in his ERG theory drew upon Maslow’s theory, but also suggested individuals were motivated to move forward and backward through the levels in terms of motivators. He reduced Maslow’s levels from five to the following three:

Existence—which related to Maslow’s first two needs, thus combining the physiological and safety needs into one level;

Relatedness—which addressed the belonging needs; and

Growth—which pertained to the last two needs, thereby combining esteem and self-actualization.

Alderfer also added his frustration–regression principle, which postulated that individuals would move in and out of the various levels, depending upon the extent to which their needs were being met. This approach is deemed by students of management to be more logical and similar to many individuals’ worldviews.

Herzberg’s Two-Factor Theory

Herzberg (2003) further modified Maslow’s needs theory and consolidated it down to two areas of needs that motivated employees. These were termed:

Hygienes—lower-level motivators which included, for example, “company policy and administration, supervision, interpersonal relationships, working conditions, salary, status, and security” (p. 5).

Motivators—higher-level factors which focused on aspects of work, such as “achievement, recognition for achievement, the work itself, responsibility, and growth or advancement” (p. 5).

Herzberg’s is an easily understood approach that suggests that individuals have desires beyond the hygienes and that motivators are very important to them.

McClelland’s Acquired Needs Theory

The idea here is that needs are acquired throughout life. That is, needs are not innate but are learned or developed as a result of one’s life experiences (McClelland, 1985). This theory focuses on three types of needs:

Need for achievement—which emphasizes the desires for success, for mastering tasks, and for attaining goals;

Need for affiliation—which focuses on the desire for relationships and associations with others; and

Need for power—which relates to the desires for responsibility for, control of, and authority over others.

All four of these theories approach needs from a somewhat different perspective and are helpful in understanding employee motivation on the basis of needs. However, other theories of motivation also have been posited and require consideration.

Extrinsic Factor Theories of Motivation

Another approach to understanding motivation focuses on external factors and their role in understanding employee motivation. The best known of these follow.

Reinforcement Theory

B. F. Skinner (1953) studied human behavior and proposed that individuals are motivated when their behaviors are reinforced. His theory is comprised of four types of reinforcement. The first two are associated with achieving desirable behaviors, while the last two address undesirable behaviors:

Positive reinforcement—relates to taking action that rewards positive behaviors;

Avoidance learning—occurs when actions are taken to reward behaviors that avoid undesirable or negative behaviors. This is sometimes referred to as negative reinforcement;

Punishment—includes actions designed to reduce undesirable behaviors by creating negative consequences for the individual; and

Extinction—represents the removal of positive rewards for undesirable behaviors. Likewise, if the rewards for desirable behaviors cease, those actions can be impacted as well.

The primary criticism of the reinforcement approach is that it fails to account for employees’ abilities to think critically and reason, both of which are important aspects of human motivation. While reinforcement theory may be applicable in animals, it doesn’t account for the higher level of cognition that occurs in humans.

Intrinsic Factor Theories of Motivation

Theories that are based on intrinsic or endogenous factors focus on internal thought processes and perceptions about motivation. Several of these are highlighted:

Adams’ Equity Theory—proposes individuals are motivated when they perceive they are treated equitably in comparison to others within the organization (Adams, 1963);

Vroom’s Expectancy Theory—addresses the expectations of individuals and hypothesizes they are motivated by performance and the expected outcomes of their own behaviors (Vroom, 1964); and

Locke’s Goal-Setting Theory—hypothesizes establishing goals motivates individuals to take action to achieve those goals (Locke & Latham, 1990).

While each of these theories deals with a particular aspect of motivation, it seems unrealistic to address them in isolation, since these factors often do come into play in and are important to employee motivation at one time or another.

Management Theories of Motivation

Other approaches to motivation are driven by aspects of management, such as productivity, human resources, and other considerations. Most notable in this regard are the following:

Scientific Management Theory—Frederick Taylor’s ideas, put into practice by the Gilbreths in the film Cheaper by the Dozen, focused on studying job processes, determining the most efficient means of performing them, and in turn rewarding employees for their productivity and hard work. This theory assumes people are motivated and able to continually work harder and more efficiently and that employee pay should be based on the amount and quality of the work performed. Over time, this approach is limited by the capacity of employees to continue to increase the quantity of work produced without sacrificing the quality.

McGregor’s Theory X and Theory Y—draws upon the work of Herzberg and develops a human resources management approach to motivation. This theory first classifies managers into one of two groups. Theory X managers view employees as unmotivated and disliking work. Under the Theory X approach, the manager’s role is to focus on the hygienes and to control and direct employees; it assumes employees are mainly concerned about safety. In contrast, Theory Y managers focus on Herzberg’s motivators and work to assist employees in achieving these higher levels. In assessing this theory, researchers have found approaching motivation from this either/or perspective is short-sighted.

Ouchi’s Theory Z—is rooted in the idea that employees who are involved in and committed to an organization will be motivated to increase productivity. Based on the Japanese approach to management and motivation, Theory Z managers provide rewards, such as long-term employment, promotion from within, participatory management, and other techniques to engage and motivate employees (Ouchi, 1981). In fact, Theory Z can be considered an early form of engagement theory.

While all of these theories are helpful in understanding management and motivation from a conceptual perspective, it is important to recognize that most managers draw upon a combination of needs, extrinsic factors, and intrinsic factors in an effort to help motivate employees, to help employees meet their own personal needs and goals, and ultimately to engage employees in and to achieve effectiveness and balance within the organization. Managers typically take into account most of the aspects upon which these theories focus. That is, expectations, goal setting, performance, feedback, equity, satisfaction, commitment, and other characteristics are considered in the process of motivating employees.