Since management is defined as getting work done through others, hospital pharmacy managers must not only train individuals to do the necessary tasks but also provide an environment in which individuals are motivated to work. Motivation is the state of being stimulated to take action to achieve a goal or to satisfy a need. Motivation comes from within an individual, not from a supervisor. But, supervisors can help employees become motivated by structuring the work for that employees are challenged.
Simple techniques, such as introducing variety in technicians’ responsibilities by having them rotate duties every few hours, can help staff motivation. Motivation techniques can be learned by anyone, even though some individuals seem to have personalities that make them especially good in working with others. These motivation techniques can be learned from experience and through advanced education.
This article will discuss some applicable theories of motivation and illustrate how hospital pharmacists can improve the motivational environment in their departments. The discussion of these theories is also relevant to staff pharmacists, who supervise the work of technicians. It must be remembered, however, that there is only so much that can be dome to promote a motivational environment; the rest is left to the employees. For this reason, it is important in job interviews to assess the motivation of prospective job candidates and to match what they like about jobs with the department environments.
Assumptions about People
Manager’s assumptions about people influence their leadership styles.
According to McGregor, managers who generally believe that people are lazy,
lack motivation, are not very bright, dislike responsibility, and are resistant
to change hold theory X assumptions about people.
Managers, who enjoy some type of work, work for reasons besides money, seek and accept responsibility, can control their own work, and want supportive management hold theory Y assumptions about people. McGregor postulates that theory X and theory Y assumptions are on opposite ends of continuum. An individual’s assumptions will vary depending on the situation, but generally, each manager will lean toward either the X or Y end of the continuum.
If managers lean toward theory X assumptions about people, they will use an autocratic leadership style that relies on external controls, such as fear or punishment, to manage employees. Theory X managers will make all decisions independently of the employees and will make work simple and unchallenging, such as on an assembly line. Pharmacists and technicians working under this kind of manager will probably not have opportunities to rotate work areas or shifts, and overtime, they will tend to become lazy, lack of initiative, and avoid responsibility.
Moving to the other end of the continuum, theory Y managers generally use a participative leadership style and encourage employees to participate in decision-making. These managers allow employees to maximize productivity. These opportunities might be in specialized areas, such as oncology clinics, sterilize products, parental nutrition programs, drug administration programs, and decentralized filling of unit dose carts. Given these opportunities, pharmacists and technicians may be happier, find their jobs more challenging, and take more responsibility.
Managers’ expectations of their employees- theory X and theory Y – become a self -filling prophecy. Research on new employees in many different work settings indicated that the expectations held by an employee’s immediate supervisor definitely influenced that employee’s immediate supervisor definitely influenced that employee’s success or failure. It is easy to see how this could happen. For example, a pharmacist working with a newly hired technician could easily become frustrated if the technician could easily become frustrated if the technician is slow in performing tasks; the pharmacist, however, must maintain positive expectations for the technician, recognizing that everyone is slow in the beginning. Labeling this employee as lazy or slow projects this expectation onto him and is unfair.
Hierarchy of Needs
Maslow’s theory of the hierarchy of needs postulates that motivation
comes from employees’ unmet needs and that satisfied needs are not motivators.
Maslow‘s arranges these needs in a hierarchy in a pyramid divided by
equally spaced horizontal lines.
At the bottom of the pyramid are physiologic needs. These are needs for air, water, food, and shelter. If a person does not have these needs satisfied, none of these needs are important. Generally, pharmacy employees have these needs met with inflation, unemployment, and staff cuts, satisfaction of physiologic needs may not be as secure as in the past.
Moving up the hierarchy, the next level of needs is safety from both physical and emotional harm. Employees often satisfy these needs by preferring the familiar or status quo. When managers rotate work areas or shifts, employees may object because their satisfied safety needs are being disturbed. Similarly, personnel preparing; i.v. admixtures are not being obnoxious when they ask for biological safety cabinet in which to prepare cytotoxic drug products; rather they have unmet personal safety needs.
Once safety needs are satisfied, employees move to the next level of needs for motivation, social needs. Social needs relate to the desire to belong to a group, to be loved, and to be accepted. Hospital pharmacy managers can help their employees satisfy these needs by holding department or hospital social events such as Christmas parties, by recognizing birthdays, and by making sure that new employees are taken to lunch. By simply acknowledging employees are taken to lunch. By simply acknowledging employees by name or by saying “good morning,” managers can convey the importance of the employees to the department. Also, immediate supervisors should show a personal interest in the people they work with and in their families.
When employees talk about what they did over the weekend or the previous evening, they are trying to satisfy their needs to belong to the work group. Managers’ attempts to eliminate all of this visiting will leave these needs unsatisfied and possibly result in conflict.
The next rung in the hierarchy is esteem (ego) needs. These needs reflect the desire for power, achievement, status, esteem from others, and self-esteem. These needs are particularly satisfied by receiving recognition for doing a good job. Another powerful way these needs might be satisfied is for the employee to be seen as an expert and consulted by others on the staff. Managers who involve employees in determining procedures and the organization of work flow provide employees with opportunities to feel like an integral part of the department.
The pinnacle of Maslow’s hierarchy is self-actualization, which is satisfaction with one’s own accomplishments and attainment of lifelong goals.
Maslow believes that satisfaction of this level of needs is not attained by
everyone, and, when it is, it is reached late in life.
When applying Maslow’s hierarchy of needs theory to employees, managers
must remember that individuals will react differently depending upon which
needs are unmet at any point in time. Unexpected reactions from employees should
make managers step back and see if a satisfied need is being threatened. An
example might be if employees get upset when their lunch schedules are changed.
The change may result in unsatisfied social needs that were preciously satisfied
by their lunch group. Even though managers recognize why these employees are
upset, the changes in lunch hours should be made if deeded; with time, new
lunch groups will form and these needs will again be met. The important thing
is for managers to understand why their employees may be reacting as they are.
Another situation that might threaten satisfied needs may occur when a pharmacist who is recognized as the department’ expert in parenteral nutrition I asked to train a back-up pharmacist. The expert pharmacist may resist training a backup because the expert pharmacist may resist training a back-up because then the expert’s status would have to be shared. A manager needs to help the expert pharmacist understand that a competent back-up is needed to cover vacations, schedule days off and sick days.
Motivators for pharmacists generally are going to be esteem needs. Pharmacists working in the central inpatient pharmacy get their esteem challenged every time a nurse calls regarding a missing dose. Rarely do nurses acknowledge the number of correct doses received, but rather the one missing dose. For these pharmacists to meet their esteem needs, managers must change the processing pf work. For example, perhaps pharmacists could dispense first doses or fill unit dose carts on the nursing unit so that pharmacists and nurses get to know each other as individuals rather than as nurse and pharmacists. Rotating pharmacists through the central and inpatient areas and inpatient areas or having nurses check the carts with pharmacists are other possible ways of getting pharmacists into roles that will help them meet their needs rather than threaten them.
Managers can assist pharmacists responsible for purchasing and repacking feel good about their jobs by establishing procedures that allow adequate lead time for these functions to occur. An example would be to establish a procedure for checking the inventory of repackaged items so that items can be repackaged before the inventory is depleted – a crisis situation that reflects poorly on the repackaging pharmacist.
Likewise, a method must be used to indicate shortages of drug products to the purchaser so outages do not occur. These procedures will require cooperation from the rest of the staff, and the manager should make sure the procedures are followed.
Managers should spend as much time with pharmacists involved in drug distribution as they do with clinical pharmacists, and they could continually discuss how each person’s job is essential to the department. When new services are being developed, managers must guard against getting so involved in the new projects that the rest of the staff feels left out.
Based on our experience, supportive personnel are probably motivated by unmet social needs; however, esteem needs may strong motivators for some of them. Messengers may have a difficult time feeling wanted if nurses constantly complain about the pharmacy’s turnaround time; staff pharmacists also tend to take them for granted. How many pharmacy managers have spent hours trying to organize a daily schedule for messengers, only to realize that the messengers could develop a better schedule? Asking for their input could result in not only a better schedule but also could help the messengers feel like worthwhile pharmacy employees. Similarly, pharmacists generally organize unit does filling bays while technicians spend most of their time in these bays. Letting the technician organize their work area indicates that the pharmacists respect their opinions and are willing to let them have some control over their jobs.
Motivation Hygiene Theory
Herzberg’s research has demonstrated that there are motivators and hygiene
factors in the work setting. Hygiene factors are policies, pay, and supervision,
working condition, benefits, and working relationships. When present at an
adequate level, hygiene factors are not motivators; but, if hygiene factors
are inadequate or absent, they are dissatisfies. Motivators are achievement,
recognition, the work itself, responsibility, and advancement. Herzberg’s
hygiene factors correspond to Maslow’s primary physiologic and safety
needs, while the motivators correspond to Maslow’s social and esteem
needs.
Applying this theory to hospital pharmacy involves designing jobs that allow
for actual achievement or specialization. Employees should be recognized for
doing good jobs. Pharmacists could be given more responsibility by appointing
first-line supervisors or by assigning them to hospital committees. Advancement
programs for practitioners separate form the management route will also be
a motivator.
Value System Theory
In the People Puzzle, Massey described his values developed by the age of 10
guide people’s behavior. These values are gut level rather than intellectual
and are subjective reactions to the world. Values filter the way individuals
view the world, such as the definition of right and wrong. When there are
clashes of values conflicts between people develop.Employees between the
ages of 25-35 were value programmed from 1959 to 1969 and experienced an
abundance of consumer goods. Sputnik, men landing on the moon, the Vietnam
War, and a presidential assassination. Television allowed all these people
to experience these events as if they personally had been involved.
The implications of Massey’s theory for managers is that managers must
recognize that they are not going to drastically change their employees’ values
and that they must learn to work with individuals who have different values.
For example, persons about 60 years old may tend to be traditionalists who
are team oriented, respect authority, and work for work’s sake. Younger
employees may tend to be challengers who are very individualistic, want to
participate in decision making, and expect to work for self-fulfillment.
Unless the individuals in these two groups compromise, conflict is unavoidable.
An understanding of why employees react the way they do may assist managers
in relating to them.
Quality Circles
By studying Japanese businesses, Ouchie and others developed the concept of
quality circles. Quality circles are small groups of employees who identify
and suggest solutions to problems in the work environment. The goals of quality
circle in a hospital pharmacy department are as follows:
• Increase productivity,
• Decrease errors and enhance quality,
• Increase job satisfaction,
• Build a problem-prevention attitude
• Inspire worker teamwork and participation, and
• Enhance leadership and personal development of employees
In describing the operation of a quality circle in a hospital pharmacy department Parness noted that the circle identified many problems by voted to focus on three specific ones: too few prepackaged medications, too much time spent by pharmacists at the front window, and unfamiliarity of nurses with pharmacy procedures. After collection and analyzing data the circle presented four specific recommendations to department managers. By implementing the circle’s recommendations Parness conclude that the work flow in the pharmacy department and job satisfaction of pharmacy employees improved.
While there are substantial differences between Japanese and American organizations, such as lifetime employment slow evaluation and promotion and nonspecific career paths, other Japanese management concepts have implications for hospital pharmacists in the United States. For example, non-specialized career paths of first-line supervisors and assistant directors could be accomplished by periodically rotating them through all areas of the department. These middle managers would also benefit from exposure to operations of their hospital departments and participation on hospital committees.
Leadership Styles
Personnel managers apply motivational theories through their leadership styles.
While managers may use predominately one style, the other styles are useful
depending upon the situation. The three leadership styles are autocratic, participative
and laissez faire.
In the autocratic style, managers make all of the decisions without consulting employees. Managers tell employees what to do and how to do it. Generally, only time hospital pharmacy managers should use the autocratic style is when tasks must be done quickly, such as during and emergency, or when there is no leeway, such as for narcotic control procedures. The autocratic style is also appropriate un enforcing hospital policies such as dress code, use of sick time, and documentation of vacation time.
In the participative leadership style, managers consult with employees, allow employees to decide how to complete tasks, and delegate responsibility. I it is appropriate to use the participative style only the employees are actively involved in performing the task and when the employees are knowledgeable about the subject being discussed. Situations that should be handled using a participative style would be changes in work flow procedures, changes in work schedules, and the selection of equipment and supplies. The participative style uses the motivators of esteem needs from Maslow’s theory and motivators of actual achievement, responsibility, and recognition from Herzberg’s theory. Involving employees in the decision – making process creates opportunities for employees to meet some of their unmet needs and this facilities motivation.
The Laissez Faire leadership style lets employees’ manager themselves; the manager’s role is to supply information and resources to the employees. I the hospital pharmacy milieu, this leadership style am best used in managing clinical pharmacists and drug information pharmacists. These individuals need freedom to adjust their schedules to fit the needs of the patients and clients for whom they are responsible. They need guidance from managers, but this should be in the form of alternatives for problem solving rather than clear-cut instructions. Since clinical pharmacists represent the pharmacy department to physicians, nurses, and patients they need to understand the department’s philosophy, policies and procedures (especially for the pharmacy and therapeutics committee); and the rationale behind the policies and procedures. Managers should have frequent contact with clinical pharmacists to ensure that their questions about these matters can be answered.
Application of Theories to Practice
Given this discussion of motivational theories, these theories will be applied
to three hospital pharmacy employee groups: pharmacists as practitioners,
pharmacists as first-line supervisors, and supportive personnel.
Motivating pharmacists as practitioners revolves around using Herzberg’s motivators and Maslow’s esteem needs. Helping pharmacists maintain their professional competence through staff development meetings or assisting them in attending national and state meetings provides the opportunity to learn new information and to compare their present level of practice to other practitioners. Many pharmacists do not realize the value of the practice they have develop special expertise in areas such as pharmacokinetics, computers sterile products, or paternal nutrient therapy, managers can help these practitioners gain satisfaction from being recognized as “experts” by their peers. Expanded patient-care roles for pharmacists may provide more job satisfaction. Another strategy managers can use to create an environment in which pharmacists are motivated would be to involve pharmacists in setting the department’s short-term and long-term goals. Still another way is to encourage practitioners to make contributions to the literature and then to reward those individuals when they are successful in publishing their work.
Good practitioners need dome form of advancement without having to move into management positions. This advancement should include additional responsibility, recognition, and financial rewards. A practitioner advancement program that incorporates these elements has been described by Schneider et al. Points are accumulated for activities such as making in-service education presentations, improving a pharmaceutical service and developing a specialty area of practice.
To create a motivational environment, managers must communicate regularly with all employees who report them. Having access to managers provides employees with the opportunity to discuss the positive impact they have had on the department, as well as problems they are encountering. Managers can acknowledge good performance and provide alternative for solving problems. Regularly scheduled meetings will ensure that managers do not sacrifice time with employees because of constant paperwork.
While a promotion to first-line supervisor can be motivating to an individual, managers must ensure that this pharmacist succeeds in management experiences achievement, and gets recognition. Mangers should play the role of a coach training this supervisor in personnel management philosophy, decision-making skills, employee discipline procedures, and training skills. Managers must be sure there is a clear understanding of responsibility and authority,. Newly promoted first line supervisors should be delegated responsibilities as they are able to handle them. Managers should go out of their way to tell supervisors that they are doing a good job because supervisors are constantly presented with problems by their subordinates, and they can easily lose perspective. For example employees rarely – if ever – tell their supervisors that they like working for them; rather, employees want to know why the schedule is not comp0leted, why another employee is not working as hard as they are, why the work areas is a mess, or why they have had to work more evening shifts in the last six month then someone else.
While pharmacy supportive personnel may be most concerned with meeting their social needs they are also motivated when given more responsibility, asked for input, and recognized for doing a good job. As the individuals who work most closely with supportive personnel when they do a good job and inform the supervisors in writing so that these employees get appropriate recognition. To recognize their contributions outside of the pharmacy department exemplary supportive personnel can be nominated for hospital employee of the month, written up in the “This Is My Job” section of the hospital newsletter, or appointed to the hospital suggestion committee.
Conclusion
Hospital pharmacy managers must understand what motivates people and then create
an environment within the pharmacy department that allows or promotes these motivators.
There will always be some minor problems among employees, but most employees
will channel their energy into positive productive activities if the motivators
are present.