Management of health care delivery

Encouraging Great Results and Outstanding Contributions

Learning Objectives

After Studying This Chapter, Students Should Be Able To

· Define the concept of motivation

· Understand how to motivate personnel for positive outcomes

· Appreciate the concept of need as a psychological tool

· Explain the three theories of motivation

· Motivate through process, external forces, and job design

· Comprehend the use of alternative work arrangements as motivational tools

Chapter Summary

The term motivation is used in management theory to describe forces within individuals that account for the level, direction, and persistence of effort they expend at work. Managers as leaders of teams of people must know how to motivate workers to produce at a level of excellence. To accomplish this, they must also appreciate how individual needs are important in terms of individual attitudes and behavior. Three motivational theories are provided as tools for the manager.

Hierarchy of Needs

The Maslow hierarchy of needs theory is one of the more well-known concepts. It is based on two principles:

1. Deficit holds that a satisfied need is not a motivator of behavior.

2. Progressive holds that needs must be met as one moves from level to level.

Two-Factor Theory

The Hertzberg two-factor theory addresses workplace turn-on, turn-off factors as motivators. These include such workplace elements as:

· Working conditions.

· Interpersonal relations.

· Organizational policies and administration.

· Quality of technical supervision.

· Compensation.

These factors are tempered by additional elements such as recognition, achievement, opportunity for advancement, a sense of responsibility, and feelings of personal growth.

Acquired Needs Theory

Many managers will find the David McClelland theory of acquired needs more to the point of individual employee motivation because it addresses the factors that everyone wants from a job:

· Need for achievement of desire to do something better.

· Need for power or the desire to control.

· Need for affiliation or desire to maintain friendly relationships.

McClelland believes that successful managers will appreciate these factors within themselves and also within their staff.

Process Theories

Given that the American workplace is increasingly diverse, these theories are further aided by so-called process theories which seek to explain why people function as a team:

The equity theory presumes that people react to any situation that displays an inequity and thus are motivated to act until some form of equity is restored. Their reaction is to seek change in the workplace input, the rewards received, in comparison levels, and in the situation.

The expectancy theory assumes people will act when they want to and not before. Usually this is a direct function of these beliefs:

· Expectancy or hard work is its own reward.

· Instrumentality or good performance brings good rewards.

· Valence or the perceived value of doing something good is enough.

The goal-setting theory very simply sets goals and objectives by which a performance can be measured. The process involves:

· Giving clear direction to staff.

· Clarifying expected performance.

· Defining a frame of reference for getting the job done.

· Setting a foundation for self-behavior.

The concept of management by objectives (MBO) is a good example of this theory in practice.

The reinforcement theory is an extension of the belief that repetition sets up an “operant conditioning” (learning by reinforcement) state. Four forms of reinforcement apply:

· Positive reinforcement or reward for doing it right.

· Negative reinforcement or avoidance of unpleasant consequences.

· Punishment or an unpleasant consequence.

· Extinction or removal of a pleasant consequence.

Motivation through Job Design

The actual job function plays a major part in motivating an employee. Does the position have merit and play a significant role in the overall operation of the organization? Each job, each role must have a sense of satisfaction associated with its performance. In this regard, the practice of job rotation, enlargement, or enrichment can help keep the role of the position valuable and rewarding.

Richard Hackman describes five key job characteristics as essential in his core characteristics model which include:

1. Skill variation.

2. Task identification.

3. Task importance.

4. Autonomy for the employee.

5. Feedback from the job performance.

Recently, the workplace concept has responded to include a variety of new approaches to job satisfaction such that the worker achieves a balance of work life and personal life. These include:

· A compressed or shortened work week.

· Flexible work hours to accommodate personal life demands.

· Job sharing as a form of work expediency.

· Telecommuting or cyberspace work.

· Independent contracting.

· Part-time work.

Key Terms

Compressed workweek Any work schedule that allows a full-time job to be completed in less than the standard five days of eight-hour shifts.

Continuous reinforcement schedule Rewarding behavior each time a desired behavior 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.

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 comparison to others will try to eliminate the discomfort and restore a sense of equity to the situation.

Expectancy In expectancy theory, a person’s belief that working 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 important to the organization.

Extinction In operant conditioning, anything that decreases the frequency of or eliminates an undesirable behavior by making the removal of a pleasant consequence 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 performance 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 assigned to outsiders rather than full-time workers.

Instrumentality In expectancy theory, a person’s belief that successful performance will be followed by rewards and other potential outcomes.

Intermittent reinforcement schedule Rewarding behavior only periodically.

Job design The process of creating or defining jobs by assigning specific work tasks to individuals and groups.

Job enlargement The process of increasing task variety by combining two or more tasks that were previously assigned 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.

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 periodically shifting workers between jobs involving different 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 specialized tasks.

Law of contingent reinforcement In operant conditioning, for a reward to have 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 repeated; behavior that results in an unpleasant outcome is not likely to be repeated.

Law of immediate reinforcement In operant conditioning, the more immediate the delivery of a reward after the occurrence of a desirable behavior, the greater the reinforcing value of the reward.

Motivation Forces within individuals that account for the level, direction, and persistence of effort they expend at work.

Need for achievement In acquired needs theory, the desire to do something 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 behavior by making the avoidance of an unpleasant consequence contingent upon its occurrence.

Operant conditioning B. F. Skinner’s concept of learning by reinforcement.

Perceived negative inequity In equity theory, a condition people who perceive negative inequity tend to reduce their work efforts to compensate for missing rewards.

Permatemps Long-term temporary workers who supplement the full-time workforce.

Positive reinforcement In operant conditioning, anything that strengthens or increases the frequency of desirable behavior by making a pleasant consequence contingent on its occurrence.

Process theory Motivational theory focuses on how people actually make choices to work hard or not, based on their individual preferences, the available rewards, 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 behavior by making an unpleasant consequence contingent on its occurrence.

Reinforcement theory Motivational theory that explains human behavior 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 approximations 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 electronic communication and computer-mediated linkages to clients, patients, and a central office; sometimes called flexiplace or cyber-commuting.

Two-factor theory Frederick Hertzberg’s motivation theory that focuses 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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