Six Elements for Creating a Framework for Employee Motivation and Performance

by Dan Strakal, Ed.D.^*

There is a growing body of evidence that states that many workers, including those employed in medical practices and healthcare in general, are not working at peak performance. In fact, the work effort they are expending may be on a trend line down. An alarming number of workers say they are giving considerably less effort to their jobs than they are capable of. Many recent studies of the American workplace support these findings:

• A two-year examination of worker behavior indicated that just slightly over half (51%) of the worker’s time was considered productive time.¹ 
• “Poor communication” and “lack of appreciation” rank highest in causing dissatisfaction at work, and 70% of respondents to a survey indicated they could improve productivity by 30% to 60% if asked for their suggestions by management.² 
• Healthcare workers are satisfied with their work and co-workers, but are less satisfied with promotional opportunities, superiors, and compensation.³ 
• Many employees within the healthcare sector perceived more negative than positive changes in healthcare including less job security; less time available to spend with individual patients; and increases in workload, paperwork, and control of healthcare by insurance companies.⁴ 

CREATING A FRAMEWORK FOR PERFORMANCE IN A MEDICAL PRACTICE SETTING

There are six key questions that practice managers can answer to ensure employees remain at high levels of performance. These questions revolve around the employees’ purpose within the practice, managers’ expectations, assurance that managers will build the employees’ competence to perform on the job, consistent and constructive feedback, adequate support, and a system of fair and equitable rewards and recognition (Table 1). If managers are willing to invest the time and brainpower required to answer these questions consistently, they will see dramatic increases in employee performance and motivation.

Following is a condensed framework that contains each of these elements, the employees’ questions, and the manager’s tasks related to answering these questions. In addition, several suggestions are provided to help practice managers respond to these questions.

FRAMEWORK FOR PERFORMANCE

1. Aligning Purpose: Why am I here?

Management influence in the area of aligning purpose is the task of helping employees understand how they fit into the organization and relate to its mission or vision. Elements of the practice manager’s task are to:

• Communicate the mission and purpose of the organization.
• Facilitate individual goal setting.
• Emphasize common values.

Alignment of organizational and individual purpose instills a sense of belonging or ownership. High levels of commitment are common when an individual understands and accepts how he or she fits within the organization. Individual initiative and “self-starter” behavior emerge as the result of the alignment of purpose.

Following are suggestions on how you as a manager positively influence this aspect of performance:

• Where and when possible, involve staff in the development of the organizational, office, or work group mission and/or vision statements.
• Communicate the mission consistently through words and actions throughout the organization or work group.
• Discuss the mission in meetings. Remind others of key elements such as who are the practice’s patients and/or clients, what are their needs, what does the practice do to meet those needs, and what makes the practice unique in how it serves its patients and/or clients. (Don’t forget internal clients.)
• Push to measure individual and team performance against the accomplishment of the mission.
• Find opportunities to recognize individual behavior that clearly contributes to the mission.
• Encourage others to set personal and professional goals that are aligned with the organization.
• Emphasize organizational values in all aspects of patient/client service and internal, team, project, and office management.

2. Clarifying Expectations: What am I to do?

Management influence in the area of creating clear expectations is the task of helping others understand what is expected of them on a task level. This requires the practice manager to:

• Communicate exactly what tasks are expected.
• Identify when the tasks are to begin and end.
• Establish how well the tasks are to be done.

Knowing exactly what is expected has a powerful motivating effect on most individuals. A clear understanding of what is expected is critical for an individual to be able to perform at consistently high levels. Clear expectations promote longer periods of sustained effort to achieving desired outcomes.

Following are suggestions on how you as a manager positively influence this aspect of performance:

• Carefully describe what the desired end result will look like.
• Provide as much flexibility as possible by giving an individual specific direction but allowing him or her to determine how to accomplish the task.
• Start with the “what”; add the “how” if necessary.
• Discipline yourself to be specific about the desired outcome and time frames.
• Be sensitive to individual differences and the need for specificity about assignments.
• Be a disciplined, goal-oriented role model.
• Confirm an individual’s understanding of the task expectations.
• Make task assignments clear by establishing exactly what is desired, when it is desired, and how it will be measured.

3. Building Competence: How do I do it?

Management influence in the area of building competence is the task of helping others acquire the knowledge, skills, and capacity to do the job. Specifically, building competence requires the practice manager to:

• Assess knowledge, skills, and capacities required by the job.
• Assess the knowledge, skills, and capacities of the individual.
• Facilitate development of needed knowledge, skills, and capacity.

Competent individuals have the capacity to be peak performers. In fact, peak performance is not possible if the task requires more than the individual can deliver. Effective leaders create opportunities for others to be challenged, grow, and develop. They stretch others without causing them to be overly frustrated.

Following are suggestions on how you as manager positively influence this aspect of performance:

• Analyze a task to determine exactly what is required for successful performance.
• Evaluate individual performance to assess current levels of skill, knowledge, and capacity.
• Create opportunities for others to grow and develop through task assignments.
• Delegate interesting/challenging assignments to others.
• Pay attention to the approach or strategies employed by successful performers.
• Coach individuals on the use of appropriate strategies.
• Use a variety of one-on-one training approaches to develop skill in different people.
• Foster an environment where questions and learning are encouraged.

4. Giving Feedback: How am I doing?

Management influence in the area of giving feedback is the task of providing an individual with information about his or her performance. To provide clear and consistent feedback, managers should:

• Be specific and timely about an individual’s performance.
• Make accurate assessments of performance.
• Keep feedback related to the task.

Clear and timely feedback helps an individual know how well he or she is doing. This feedback allows individuals to adjust their performance or implement corrective strategies. Effective feedback shapes performance, builds confidence, and encourages sustained effort.

Following are suggestions on how you as manager positively influence this aspect of performance:

• Provide timely feedback immediately after desired behavior is demonstrated.
• Develop an atmosphere that encourages the free flow of performance feedback.
• Take advantage of spontaneous situations and ad hoc meetings to provide feedback about an individual’s performance.
• Give feedback that is specific, accurate, objective, and focused on behavior.
• Keep personality separate from performance.
• Don’t try to “soften” a message by mixing positive feedback with reprimands.
• Use communication probes to help an individual “discover” an appropriate corrective strategy.
• Focus on the future and corrective behavior rather than the past and punishing behavior.
• If possible, deal with one issue at a time.

5. Providing Support: Will I succeed?

Management influence in the area of providing support is the task of helping others get the job done. Support takes various forms depending on the task, the individual, or the surrounding environment. It involves offering encouragement, giving advice, making introductions, providing protection, or making the needed resources available. Specifically, providing support requires the manager to:

• Build supportive relationships.
• Provide needed resources.
• Establish a flexible and supportive structure.

Every individual at some time in his or her work experience goes through periods of frustration, doubt, or uncertainty. At these moments, support is critical to sustaining peak performance.

Following are suggestions on how you as manager positively influence this aspect of performance:

• Invest time and energy getting to know others as individuals and to develop solid relationships.
• Foster a genuine caring attitude about the people with whom you work.
• Demonstrate an interest in the careers of others, not just in getting the work done.
• Develop sensitivity toward feelings and a willingness to discuss emotions.
• Reveal some of your own vulnerabilities and uncertainties by asking for and/or accepting help from others.
• Demonstrate confidence in the ability of others by trusting them with difficult assignments.
• Use verbal and nonverbal communication skills to encourage high performance.
• Help individuals see and avoid potential land mines in their career paths.

6. Rewards: What’s in it for me?

Management influence in the area of linking rewards is the task of assuring internal consistency between the extrinsic reward system and the other important messages communicated within the organization. More than almost any other form of communication, extrinsic rewards let people know what is important within the organization. Specifically, linking rewards requires the manager to:

• Find opportunities to recognize individual achievement.
• Link formal reward structure to desired behavior.
• Make use of ad hoc or informal rewards.

Recognition and extrinsic rewards that are clearly linked to key areas of desired performance can be powerful motivators. All other things being equal, performance that is rewarded will be repeated.

Following are suggestions on how you as manager positively influence this aspect of performance:

• Find ways to use public recognition to reinforce desired performance.
• Emphasize the use of rewards rather than the use of punishments to encourage desired behaviors.
• Review the formal and informal reward structure in the organization to determine which behaviors are actually being rewarded and which are being punished.
• Tie the formal reward system of the organization to the achievement of desired outcomes.
• Emphasize consistency in the formal and informal reward system of the organization, so that the message communicated is consistent.
• Look for opportunities to reward desired performance.

Applying the elements outlined in this framework can help to create a climate of motivation within your practice that allows employees to move toward the highest levels of performance.

Additional articles from The Journal of Medical Practice Management:

• 10 Ways to Give Your Office a Face-Lift
• Age to Age: Insight into Managing a Multigenerational Staff
• Better Off Alone? Why Physicians Don’t Merge
• Consumer-Driven Health Plans: Latest Challenge to Practices’ Cash Flow
• Educate Patients on Billing Policies to Improve Your Bottom Line
• How a Successful Litigator Decides Whether or Not to Sue You
• How to Perform Your Own Practice Operational Assessment
• Practice Management Secrets: Get Personal with Customer Service
• Self Assessment for Practices Considering Electronic Medical Record Systems
• Why Your Practice Must Do Background Checks
• Working with Patients with Physical Disabilities

1. Lockwood NR. Leveraging Employee Engagement for Competitive Advantage: HR’s Strategic Role. Society for Human Resource Management; March 2007; www.shrm.org.

2. Smith GP. Employee Retention and Job Satisfaction Survey. Chart Your Course International; www.ChartCourse.com.

3. Castle NG, Degenholtz H, Rosen J. Determinants of staff job satisfaction of caregivers in two nursing homes in Pennsylvania. BMC Health Serv Res. 2006;6: 60; published online May 24, 2006: doi: 10.1186/1472-6963-6-60.

4. Lyons KJ, Lapin J, Young B. A study of job satisfaction of nursing and allied health graduates from a mid-Atlantic university, J Allied Health. 2003;32:10-17.

Reprinted with permission from The Journal of Medical Practice Management, Copyright Greenbranch Publishing, (800) 933-3711, www.mpmnetwork.com.

*Capable Consulting, 4801 Lang Avenue NE, Suite 110, Albuquerque, NM 87109; phone: 505-798-2566; fax: 505-890-1749; e-mail: dan@capableconsulting.com; Web site: www.capableconsulting.com. Copyright © 2007 by Greenbranch Publishing LLC.