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Good wages and pleasant working conditions are important, but true motivation stems from something deeper.

Fam Pract Manag. 2004;11(10):54-55

I used to think that staff motivation was as simple as offering a special parking space for Employee of the Month or sponsoring an employee night at the minor league ballpark. It turns out that motivating employees is a lot more complicated than that, and many employers (including physicians) have been going about it all wrong.

In a study conducted by Kenneth Kovach of George Mason University, 1,000 employees and 100 of their bosses were asked to list the things that they believe motivate employees.1 There was no overlap at the top of the two lists. Bosses thought employees would be motivated by good wages and job security, while employees listed factors such as participating in interesting work, feeling appreciated at work and “being in on things.” They ranked job security and good wages as important but lower on the list.

Kovach’s findings are consistent with other well-regarded motivational theories, such as Abraham Maslow’s hierarchy of needs.2 At the bottom of Maslow’s pyramid are food, shelter and clothing, the most basic human needs, which motivate us to get out of bed in the morning and go to work. Once those basic needs are met, according to Maslow, we are motivated by higher factors, such as autonomy and selfesteem, although not everyone is motivated by the same thing.

Another researcher that expanded on this idea was Frederick Herzberg. The late professor of management and psychology helped distinguish between “hygiene” factors and true “motivators.”3,4 Hygiene factors are the external elements that impact staff, including the following:

  • Supervision,

  • Company policy and administration,

  • Working conditions,

  • Salary,

  • Interpersonal relationships,

  • Job status,

  • Job security.

Motivators are the internal elements that impact staff, such as the following:

  • Achievement,

  • Recognition for achievement,

  • Growth or advancement,

  • Responsibility,

  • The work itself.

Herzberg found that while the hygiene issues do not actually motivate staff, they are necessary to prevent dissatisfaction and are an essential foundation to motivation. Therefore, employers cannot afford to ignore hygiene factors but should not mistake them for true motivators. At the same time, employers cannot neglect the motivators. Without them, physicians might be able to create a decent work environment, but their staff will never be inspired to improve their level of performance. A physician who aspires to a well-run, high-performing practice must be mindful of both.


  • Factors such as good wages, positive working conditions and strong interpersonal relationships do not motivate staff, but their absence leads to dissatisfaction.

  • True motivation comes from having a sense of achievement, recognition and responsibility.

  • Employers should reflect on whether they are providing a truly motivational climate and what they can do to improve.

Making progress

To provide a truly motivational climate for your employees, begin with the hygiene issues and take steps to secure them. For example, you may need to rethink a contentious company policy, institute supervisor training or assess whether your wages and benefits are competitive.

Once the hygiene issues are in order, begin developing the motivators. Start by asking yourself the following questions, suggested by Kovach. Better yet, ask for your staff’s input on these issues:

  • Do you thank staff for a job well done?

  • Is feedback timely and specific?

  • Do you make time to meet with and listen to staff on a regular basis?

  • Is your workplace open, trusting and fun?

  • Do you encourage and reward initiative and new ideas?

  • Do you share information about your organization with staff on a regular basis?

  • Do you involve staff in decisions, especially those that will affect them?

  • Do you provide staff with a sense of ownership of their jobs and the unit as a whole?

  • Do you give your employees a chance to succeed?

  • Do you reward staff based on their performance?

Next, meet with staff members individually, perhaps at their yearly performance evaluations, to identify opportunities and obstacles. Find out what they like about their jobs and what they wish they could change. Based on what you learn, don’t be afraid to throw out old processes, send your nurse for training or redesign job functions to promote achievement and responsibility. Herzberg offers these ideas:4

  • Remove some controls involved in an employee’s job but retain accountability;

  • Increase individuals’ accountability for their own work;

  • Delegate to employees not just a portion of a task but the complete natural unit of work (e.g., an entire division or area);

  • Circulate monthly financial or status reports to all staff, not just supervisors;

  • Assign specific or specialized tasks to individuals, enabling them to become experts.

These efforts aren’t simple, but they will make your office a more rewarding place to work – for everyone.

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