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Yes, it is possible for you and your employees to be happy on the job. The key is in how you handle two factors: motivation and ‘hygiene.’

Fam Pract Manag. 1999;6(9):26-30

Employee satisfaction and retention have always been important issues for physicians. After all, high levels of absenteeism and staff turnover can affect your bottom line, as temps, recruitment and retraining take their toll. But few practices (in fact, few organizations) have made job satisfaction a top priority, perhaps because they have failed to understand the significant opportunity that lies in front of them. Satisfied employees tend to be more productive, creative and committed to their employers, and recent studies have shown a direct correlation between staff satisfaction and patient satisfaction.1 Family physicians who can create work environments that attract, motivate and retain hard-working individuals will be better positioned to succeed in a competitive health care environment that demands quality and cost-efficiency. What's more, physicians may even discover that by creating a positive workplace for their employees, they've increased their own job satisfaction as well.


  • Employee satisfaction affects every aspect of a medical practice, from patient satisfaction to overall productivity.

  • Frederick Herzberg theorized that employee satisfaction has two dimensions: “hygiene” and motivation.

  • Hygiene issues, such as salary and supervision, decrease employees' dissatisfaction with the work environment.

  • Motivators, such as recognition and achievement, make workers more productive, creative and committed.

Herzberg's theory

In the late 1950s, Frederick Herzberg, considered by many to be a pioneer in motivation theory, interviewed a group of employees to find out what made them satisfied and dissatisfied on the job. He asked the employees essentially two sets of questions:

  1. Think of a time when you felt especially good about your job. Why did you feel that way?

  2. Think of a time when you felt especially bad about your job. Why did you feel that way?

From these interviews Herzberg went on to develop his theory that there are two dimensions to job satisfaction: motivation and “hygiene” (see “Two dimensions of employee satisfaction”). Hygiene issues, according to Herzberg, cannot motivate employees but can minimize dissatisfaction, if handled properly. In other words, they can only dissatisfy if they are absent or mishandled. Hygiene topics include company policies, supervision, salary, interpersonal relations and working conditions. They are issues related to the employee's environment. Motivators, on the other hand, create satisfaction by fulfilling individuals' needs for meaning and personal growth. They are issues such as achievement, recognition, the work itself, responsibility and advancement. Once the hygiene areas are addressed, said Herzberg, the motivators will promote job satisfaction and encourage production.

Two dimensions of employee satisfaction

Frederick Herzberg theorized that employee satisfaction depends on two sets of issues: “hygiene” issues and motivators. Once the hygiene issues have been addressed, he said, the motivators create satisfaction among employees.

Hygiene issues (dissatisfiers)Motivators (satisfiers)
Company and administrative policiesWork itself
Interpersonal relationsResponsibility
Working conditionsAdvancement

Applying the theory

To apply Herzberg's theory to real-world practice, let's begin with the hygiene issues. Although hygiene issues are not the source of satisfaction, these issues must be dealt with first to create an environment in which employee satisfaction and motivation are even possible.

Company and administrative policies. An organization's policies can be a great source of frustration for employees if the policies are unclear or unnecessary or if not everyone is required to follow them. Although employees will never feel a great sense of motivation or satisfaction due to your policies, you can decrease dissatisfaction in this area by making sure your policies are fair and apply equally to all. Also, make printed copies of your policies-and-procedures manual easily accessible to all members of your staff. If you do not have a written manual, create one, soliciting staff input along the way. If you already have a manual, consider updating it (again, with staff input). You might also compare your policies to those of similar practices and ask yourself whether particular policies are unreasonably strict or whether some penalties are too harsh.

Supervision. To decrease dissatisfaction in this area, you must begin by making wise decisions when you appoint someone to the role of supervisor. Be aware that good employees do not always make good supervisors. The role of supervisor is extremely difficult. It requires leadership skills and the ability to treat all employees fairly. You should teach your supervisors to use positive feedback whenever possible and should establish a set means of employee evaluation and feedback so that no one feels singled out.

Salary. The old adage “you get what you pay for” tends to be true when it comes to staff members. Salary is not a motivator for employees, but they do want to be paid fairly. If individuals believe they are not compensated well, they will be unhappy working for you. Consult salary surveys or even your local help-wanted ads to see whether the salaries and benefits you're offering are comparable to those of other offices in your area. In addition, make sure you have clear policies related to salaries, raises and bonuses.

Interpersonal relations. Remember that part of the satisfaction of being employed is the social contact it brings, so allow employees a reasonable amount of time for socialization (e.g., over lunch, during breaks, between patients). This will help them develop a sense of camaraderie and teamwork. At the same time, you should crack down on rudeness, inappropriate behavior and offensive comments. If an individual continues to be disruptive, take charge of the situation, perhaps by dismissing him or her from the practice.

Working conditions. The environment in which people work has a tremendous effect on their level of pride for themselves and for the work they are doing. Do everything you can to keep your equipment and facilities up to date. Even a nice chair can make a world of difference to an individual's psyche. Also, if possible, avoid overcrowding and allow each employee his or her own personal space, whether it be a desk, a locker, or even just a drawer. If you've placed your employees in close quarters with little or no personal space, don't be surprised that there is tension among them.

Before you move on to the motivators, remember that you cannot neglect the hygiene factors discussed above. To do so would be asking for trouble in more than one way. First, your employees would be generally unhappy, and this would be apparent to your patients. Second, your hardworking employees, who can find jobs elsewhere, would leave, while your mediocre employees would stay and compromise your practice's success. So deal with hygiene issues first, then move on to the motivators:

Work itself. Perhaps most important to employee motivation is helping individuals believe that the work they are doing is important and that their tasks are meaningful. Emphasize that their contributions to the practice result in positive outcomes and good health care for your patients. Share stories of success about how an employee's actions made a real difference in the life of a patient, or in making a process better. Make a big deal out of meaningful tasks that may have become ordinary, such as new-baby visits. Of course employees may not find all their tasks interesting or rewarding, but you should show the employee how those tasks are essential to the overall processes that make the practice succeed. You may find certain tasks that are truly unnecessary and can be eliminated or streamlined, resulting in greater efficiency and satisfaction.

Achievement. One premise inherent in Herzberg's theory is that most individuals sincerely want to do a good job. To help them, make sure you've placed them in positions that use their talents and are not set up for failure. Set clear, achievable goals and standards for each position, and make sure employees know what those goals and standards are. Individuals should also receive regular, timely feedback on how they are doing and should feel they are being adequately challenged in their jobs. Be careful, however, not to overload individuals with challenges that are too difficult or impossible, as that can be paralyzing.

Recognition. Individuals at all levels of the organization want to be recognized for their achievements on the job. Their successes don't have to be monumental before they deserve recognition, but your praise should be sincere. If you notice employees doing something well, take the time to acknowledge their good work immediately. Publicly thank them for handling a situation particularly well. Write them a kind note of praise. Or give them a bonus, if appropriate. You may even want to establish a formal recognition program, such as “employee of the month.”

Responsibility. Employees will be more motivated to do their jobs well if they have ownership of their work. This requires giving employees enough freedom and power to carry out their tasks so that they feel they “own” the result. As individuals mature in their jobs, provide opportunities for added responsibility. Be careful, however, that you do not simply add more work. Instead, find ways to add challenging and meaningful work, perhaps giving the employee greater freedom and authority as well.

Advancement. Reward loyalty and performance with advancement. If you do not have an open position to which to promote a valuable employee, consider giving him or her a new title that reflects the level of work he or she has achieved. When feasible, support employees by allowing them to pursue further education, which will make them more valuable to your practice and more fulfilled professionally.

To assess your performance in each of the areas just discussed, see “How does your practice rate?

How does your practice rate?

To evaluate your practice's performance in the area of job satisfaction and to identify where you might focus your efforts, complete the following self-assessment, which is structured around Frederick Herzberg's motivation-“hygiene” theory. As you answer each question, keep in mind the needs and concerns of your employees and colleagues.

Company and administrative policies
Does the practice have a policy manual?
Are the policies easy to understand?
Do employees perceive the policies as fair?
Are all persons in the practice required to follow the policies?
Do employees have easy access to the policies?
Do employees have input into the policies?
Has the practice revisited or revised its policies recently?
Are your policies reasonable compared with those of similar practices?
Do the practice's supervisors possess leadership skills?
Do they treat individuals fairly?
Do employees feel that they can trust their supervisors?
Do the practice's supervisors use positive feedback with employees?
Does the practice have a consistent, timely and fair method for evaluating individual performance?
Are your practice's salaries comparable to what other offices in your area are paying?
Are your practice's benefits comparable to what other offices in your area are offering?
Do your employees perceive that they are being paid fairly?
Do your employees perceive that their benefits are sufficient?
Does the practice have clear policies related to salaries, raises and bonuses?
Interpersonal relations
Do individuals have opportunities to socialize with one another during the workday?
Do they have a sense of camaraderie and teamwork?
Does the practice deal with individuals who are disruptive?
Working conditions
Does your practice's equipment (everything from computers to scales) work properly?
Is the facility clean and up to date?
Are office conditions comfortable?
Do individuals have adequate personal space?
Work itself
Do employees perceive that their work is meaningful?
Do you communicate to individuals that their work is important?
Do you look for ways to streamline processes and make them more efficient?
Do individuals have clear, achievable goals and standards for their positions?
Do individuals receive regular, timely feedback on how they are doing?
Are individuals' talents being utilized?
Are individuals adequately challenged in their jobs?
Do you recognize individuals for their major accomplishments on the job?
Do you recognize individuals' small victories?
Do you give employees recognition in a timely, meaningful way?
Does the practice have a formal program (such as “employee of the month”) for recognizing staff members' achievements on the job?
Do individuals perceive that they have ownership of their work?
Do you give them sufficient freedom and authority?
Do you provide opportunities for added responsibility (not simply adding more tasks)?
Do you reward individuals for their loyalty?
Do you reward individuals for their performance?
Do you promote from within, when appropriate?
Do you support continuing education and personal growth?
If you answered “no” to any of the questions above, consider addressing those areas within your practice and seek input from your employees and colleagues.

The trickle-down effect

While there is no one right way to manage people, all of whom have different needs, backgrounds and expectations, Herzberg's theory offers a reasonable starting point. By creating an environment that promotes job satisfaction, you are developing employees who are motivated, productive and fulfilled. This, in turn, will contribute to higher quality patient care and patient satisfaction.

Suggested reading

Altruism in Practice Management: Caring for Your Staff.” J.M. Syptak. Family Practice Management. October 1998:58–60.

Health Professionals in Management. B.B. Longest. Stamford, Conn: Appleton & Lange; 1996.

Job Satisfaction: Application, Assessment, Causes and Consequences. P.E. Spector. Thousand Oaks, Calif: SAGE Publications; 1997.

Management of Organizational Behavior: Utilizing Human Resources, 7th ed. P. Hersey, K.H. Blanchard, D.E. Johnson. Upper Saddle River, NJ: Prentice-Hall; 1996.

The Motivation to Work. F. Herzberg, B. Mausner, B.B. Snyderman. Somerset, NJ: Transaction Publishers; 1993.

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