Motivating Employees to Top Performance and Service

What do employees want from me? The question looms over managers, physicians, and leaders, sometimes resulting in a feeling of utter defeat. We aspire to motivate and inspire employees to top performance, team work, and service orientation, but so often we feel that we don’t know what they want. Further, we make assumptions that our staff always want more money, a nicer office space, or promotion within the practice—but these are often out of our budgetary reach as managers and physicians. Sometimes we take it a bit further and think even if we gave them all of that, they would just want more. A 70-year-old study that says otherwise is worth revisiting.

The Study

There are distinct differences between what managers and doctors think employees want and what employees say will motivate and inspire them. Although this question has plagued physicians and practice managers forever, it is not unique to healthcare. Managers and leaders from all industries have been studying this question for a long time. A simple study, first performed in 1946, asked managers and supervisors to rank the items listed in Table 1 on a scale of 1 to 10, with 1 being what they think is most important to employees and 10 least important to employees, with similar results (see sidebar). Try it yourself using Table 1.

Focus on what you and the other managers thought would be the three items most important to employees and what you thought would be the three least important. Are your answers similar to how other managers have responded, or were they significantly different? Be brave, answer honestly—there is no wrong answer here, because this is a powerful lesson either way. Table 2 shows how other managers have answered over time.

The same list has been given to employees (non-managers) asking them to rank, on a scale of 1 to 10, what is most important to them (Table 3). As with the manager portion, the results of the employee portion have been consistent over time.

The Gap Between Manager and Employee Rankings

Table 4 presents the results from both groups and highlights the significant differences.

The top three most important things as ranked by employees, highlighted in boldface type, are ranked as 8, 9, and 10 by managers when asked what they think employees want. The three motivators that employees say are most important—full appreciation of work done, feeling of being in on things, and sympathetic help on problems—are exactly the three that managers estimate as being least important to employees. Within the parameters of this study, it is impossible for the managers to be further off in their estimation of what motivates employees.

There are many possible reasons for this vast gap. Maybe managers who answer this way have different recollections of their aspirations when they were non-manager employees. Perhaps there is something different in the make-up of employees who eventually become managers. The three motivators managers thought would be most important to employees are extrinsic and tangible. Employees may speak of these extrinsic motivators more because they can more easily name them, which may be the reason we, as managers, mistakenly think that’s what they want.

The categories ranked 1 through 4 by managers (highlighted in italics) are all extrinsic—that is, they come from outside the person. As a practice management consultant, I cannot count how many times a physician or manager has suggested that a percentage of collections paid as a bonus would really motivate their collectors. But extrinsic motivators have substantial limitations. The suggestion to pay collectors a percentage of what is collected will only lead to rifts among the employees. It places monetary value on collecting money, but none on service orientation for reception staff or clinical accuracy for medical assistants. Extrinsic motivators can be appropriate for some situations, of course. Special projects and targeted accomplishments might warrant an incentive bonus and or team celebration. But, in general, extrinsic motivations are expensive, frequently become entitlements, and create a culture of what’s-in-it-for-me rather than what-can-I-do-to-help. Where did your answers fall in the spectrum? Were they similar to other managers? Or were you closer to the employees’ answers?

Closing the Gap

This study tells us the top three factors that really motivate employees. They are within our control, they are in line with the intrinsic nature of healthcare, and they are achieved and maintained at no expense to the organization. However, these motivators will not overcome under- or unfair compensation. Each position in the practice should have a documented position description and a pay range that is competitive in the market.

Full appreciation of work done means observing and providing specific positive feedback.

Full appreciation of work done is more than the occasional thank you or “good job!” Full appreciation of work done means observing and providing specific, positive feedback. Rather than using the term “good,” specify why the actions were effective. Observe and describe, either orally or in writing, the details and behaviors of an accomplishment or instance of service orientation. The wonderful thing about positive feedback is that it can be done publicly, therefore providing both the feeling of being in on things and learning opportunities for others. Equally important, privately and directly addressing individual underperformance and actively managing those situations and staff, supports the message of full appreciation of work done to your top performers.

We can give employees the feeling of being in on things through team building, delegation, and gathering thoughts and soliciting opinions for process improvement, projects, and changes. Think about times when you have felt left out. Was it lack of communication on someone’s part? Communicating often is key to helping employees have the feeling of being in on things. Even if there is nothing or nothing new to communicate, communicate that to keep employees feeling that they are in the know.

Whereas instilling the feeling of being in on things is about manager communication, help on problems can be accomplished by listening—by making time for employees when they ask to talk and listening, not as a confessor, but as someone who will respond with discretion and compassion.

The ability to motivate employees without the incentive of organizational promotion is key.

Managers rank promotion/growth within the organization as number 3, but employees say it is relatively unimportant (number 7). As a physician or practice manager, this fact should provide relief, because often there really are not many opportunities for position promotion. Physician practices have flat and professionally based organizational charts. Nevertheless, excellence in service and performance, striving for improvement, and positive change are essential. The ability to motivate employees without the incentive of organizational promotion is key.

Just because the top three employee motivators can be described as “soft skills” does not mean we are softies. Addressing underperformance and problematic conduct with feedback and an improvement plan is essential. Failing to address work product and conduct brings the overall performance standards down for all employees and the practice as a whole. Creating and maintaining a work environment that motivates employees to top performance and service orientation while conveying compassion and support is the delicate balance that makes for managerial excellence.

As healthcare managers, we have the ultimate intrinsic motivator—helping patients and their families. Even roles that do not directly provide patient care can be tied to helping people, which can be a great inspiration to employees. There is no better feeling than knowing you have helped someone. Although appointment schedulers, billers, and cleaning staff may not see their roles as important to patient care, managers can tie every position to helping patients and their families—appointment schedulers facilitate access to the care patients need, and billers put patients’ minds at ease by explaining bills or even collecting at time of service, giving patients one less thing to worry about. Cleaning staff help the patients feel confident in the physician they have chosen by keeping the office space clean and neat. The best residency and fellowship training cannot undo the unsettled feeling someone gets when they see dust bunnies or old coffee cups in the reception area. Managing employees to see their importance and feel fully appreciated and in on things, and being accessible to employees for guidance and help costs you nothing and provides unlimited benefits to your practice.

The original study and some of the utilizations since

1946: Foreman Facts, Labor Relations Institute of NY

1949: Lawrence Lindahl, Personnel Magazine

1980: Kenneth A. Kovach1988: Valerie Wilson, Achievers International

1991: Bob Nelson, Blanchard Training & Development

1997–2001: Sheryl and Don Grimme, GHR Training Solutions