Key Learning Objectives

1. Motivation — Key Elements: Intensity, Direction, Persistence 
2. Maslow’s Hierarchy of Needs — The hierarchy, if it applies at all, aligns with U.S. culture. In Japan, Greece, and Mexico, where uncertainty-avoidance characteristics are strong, security needs would be on top of the hierarchy. Countries that score high on nurturing characteristics—Denmark, Sweden, Norway, the Netherlands, and Finland— would have social needs on top. There is no research – no validation on this theory at all. 
3. Theory X and Theory Y — Douglas McGregor assumptions for Theory X: managers believe employees inherently dislike work and must therefore be directed or even coerced into performing it; and for Theory Y: managers assume employees can view work as being as natural as rest or play, and therefore the average person can learn to accept, and even seek, responsibility.
   • The same concept applied to doctor-patient relationship can hence mean there may be doctors out there who think the only way to make patients actually do something is through strict supervision, precise prescriptions and control – no need to motivate them as they won’t like it anyways. And on another extreme there may be doctors who believe it’s the cultivation of motivation in patients that is enough to make sure they follow the specific regimen towards better health.
4. Hertzberg Two Factor Theory — According to Hertzberg, the factors that lead to satisfaction are separate and distinct from those that lead to dissatisfaction. Therefore, seeking to eliminate factors that can create dissatisfaction may bring about peace, but not necessarily motivation.
   • As we get used to things that were motivating us, the result is no longer motivation, but rather some sort of a neutral stance where the person doesn’t feel dissatisfied, but that neutral stance is far from being a motivation.
   • Remember the history’s golden rule: Yesterday’s luxuries are today’s commodities.
   • Still this theory evolved during the times of the influence of Industrial Revolution and most of the thought was towards making the employees at factories and assembly lines more motivated. As we progressed well beyond that context in the past few decades, obviously Hertzberg’s two factor theory should still be considered with caution and may seem too simplistic in its attempt to classify factors into basic vs. motivational. Still though it has something to really build on when trying to create factors for keep ourselves and/or our patients motivated.
5. McClelland’s theory of needs — 1) Need for achievement (nAch) is the drive to excel, to achieve in relationship to a set of standards. 2) Need for power (nPow) is the need to make others behave in a way they would not have otherwise. 3) Need for affiliation (nAff) is the desire for friendly and close interpersonal relationships.
   • Cultivate sense of achievement in patients via setting milestones to achieve on their path.
   • Give choice and freedom to ensure the patients feel engaged, motivated and in power
   • More praise and less emphasis on negative – affiliate with good not the bad.
6. Self Determination Theory —   proposes that people prefer to feel they have control over their actions, so anything that makes a previously enjoyed task feel more like an obligation than a freely chosen activity will undermine motivation. Deadlines and specific work standards do, too, if people believe they are in control of their behavior. Rewards and deadlines diminish motivation if people see them as coercive. 
   • EXAMPLE: If a senior sales representative really enjoys selling and making the deal, a commission indicates she’s been doing a good job and increases her sense of competence by providing feedback that could improve intrinsic motivation. On the other hand, if a computer programmer values writing code because she likes to solve problems, a reward for working to an externally imposed standard she does not accept, such as writing a certain number of lines of code every day, could feel coercive, and her intrinsic motivation would suffer. She would be less interested in the task and might reduce her effort.
7. Goal-Setting Theory — A theory that says that specific and difficult goals, with feedback, lead to higher performance. 
   • Individual believes she can achieve (better if Individual participates in setting a goal)
   • Individual accepts the hard task as achievable
   • Individual has internal locus of control
   • Individual goals are made public
   • Individual receives feedback on progress towards goal 
8. Management by Objectives (MBO) — A term used to describe a program that encompasses specific goals, participatively set, for an explicit time period, with feedback on goal progress.
9. Self-Concordance (derived from Self-Determination Theory) – The degree to which peoples’ reasons for pursuing goals are consistent with their interests and core values.
10. Job Engagement — The investment of an employee’s physical, cognitive, and emotional energies into job performance. 
    • EXAMPLE: When nurse Melissa Jones comes to work, it seems that everything else in her life goes away, and she becomes completely absorbed in what she is doing. Her emotions, her thoughts, and her behavior are all directed toward patient care. In fact, she can get so caught up in her work that she isn’t even aware of how long she’s been there.
11. Self-Efficacy Theory – An individual’s belief that he or she is capable of performing a task. How could an Individual have stronger belief in her capacities?
    • Inactive mastery – motivated as more and more relevant experiences with the task at hand
    • Vicarious modeling – motivated by benchmarking – when someone else is doing it successfully 
    • Verbal persuasion – someone tells her she’s capable of doing it and she will achieve goal
      • Pygmalion Effect – form of self-fulfilling prophecy in which believing something can make it true – in this case believing in doctor’s words , even if having doubts in oneself.
      • Galatea Effect – form of self-fulfilling prophecy in which believing something can make it true – in this case believing in himself/herself – so as it is internalized and it is not only manager’s words but our own belief.
    • Arousal – energized state, “psyched-up” state
12. Behaviorism, Operant Conditioning & Reinforcement Theory – Operant conditioning theory, probably the most relevant component of reinforcement theory, argues that people learn to behave to get something they want or to avoid something they don’t want. 
    • Skinner, one of the most prominent advocates of operant conditioning, argued that creating pleasing consequences to follow specific forms of behavior would increase the frequency of that behavior.
    • The concept of operant conditioning was part of Skinner’s broader concept of behaviorism , which argues that behavior follows stimuli in a relatively unthinking manner. Skinner’s form of radical behaviorism rejects feelings, thoughts, and other states of mind as causes of behavior.
13. Social Learning Theory – theory is an extension of operant conditioning— that is, it assumes behavior is a function of consequences—it also acknowledges the effects of observational learning and perception. Models are central to the social-learning viewpoint:
    • Attentional processes.  People learn from a model only when they recognize and pay attention to its critical features. We tend to be most influenced by models that are attractive, repeatedly available, important to us, or similar to us in our estimation.
    • Retention processes. A model’s influence depends on how well the individual remembers the model’s action after the model is no longer readily available.
    • Motor reproduction processes. After a person has seen a new behavior by observing the model, watching must be converted to doing. This process demonstrates that the individual can perform the modeled activities.
    • Reinforcement processes. Individuals are motivated to exhibit the modeled behavior if positive incentives or rewards are provided. Positively reinforced behaviors are given more attention, learned better, and performed more often.
14. Equity Theory – We all tend to compare ourselves with friends, neighbors, co-workers, or colleagues in other organizations or compare our current job/pay with past job/pays.
    • Remember the example of a nurse who happened to learn of the higher salary that a new colleague received despite having much less experience, then learning some clinics are paying even higher and finally ending her day in misery while being driven home by an Uber driver who was her long forgotten class-mate earning three times more than her and does so without having spent years in learning and developing like her, but rather by simply downloading an app. 
15. Expectancy Theory – A theory that says that the strength of a tendency to act in a certain way depends on the strength of an expectation that the act will be followed by a given outcome and on the attractiveness of that outcome to the individual. Or in other words the following three questions to be answered while checking if a specific incentive plan may or may not work.
    1. Does it depend on me? – Efforts to Performance Relationship
    2. Do I know what exactly I am getting? – Performance to Reward Relationship
    3. Is that still what I want? – Reward to Personal Goals Relationship

Task to Prepare

You are required to prepare a 2-minute speech on the topic of Motivation (no slides) which is to include the following:

• Your story about the time/moment you felt motivated describing what motivated you and how you felt
• Identify which of the above theories of motivation were in action in your story.
• What advice would you give to a novice doctor to help him/her build and maintain motivation in patients?

Please keep track of time as we will be timing the 2 minutes max precisely.

And looking forward to your stories and opinions analyzing the above topics.