One of the subjects that have befuddled Long Term Care leaders over the years is worker motivation. One of the foremost researchers in this field is Frederick Herzberg, an industrial psychologist. It is Herzberg’s work on motivation and job enrichment that strikes at the heart of the success of self-direction concepts that are so foundational to The Green House model.
In the 1960’s, Herzberg proposed that a person’s needs break down into two categories: hygiene factors and motivational factors.
Hygiene factors relate to what makes us work and our biological needs, such as providing food, clothing, and shelter. Herzberg says we have a build-in drive to avoid pain relative to these needs, so we do what is necessary, such as work, to provide what we need.
Motivator factors, however, are very different. These factors include those specific items related to what makes us work well such as achievement, and through achievement, the ability to experience psychological growth.
Herzberg used the term job enrichment to describe how the motivator factors can be used to achieve higher levels of satisfaction with a job. The following list was taken from his Harvard Business Review article of 1968 (reprinted in 1987) entitled, One More Time…How Do You Motivate Employees? Take particular note of how closely these factors align with concepts embodied in radical workforce redesign with The Green House model.
Herzberg said that meaningful job enrichment involves the following:
1. Removing controls while retaining accountability.
2. Increasing the accountability of individuals for their work.
3. Giving a person a complete natural unit of work.
4. Granting additional authority to employees in their activity such as job freedom.
5. Making data and reports directly available to the workers themselves rather than just to supervisors.
6. Introducing education programs designed to enrich critical thinking skills.
7. Assigning individuals specific assignments or specialized tasks, enabling them to become experts.
It is surprising to think that Herzberg first discussed these concepts in the 1960’s, but that we are now just beginning to incorporate them through innovative models. In the elder care field, we have a mountain of research that supports the link between frontline caregivers involvement and improved clinical outcomes of care and quality of life. Organizational changes that support self-direction will continue to grow because it makes sense to leaders desperately searching for ways to increase responsibilities of frontline staff as well as the elders’ perception of feeling valued and respected. The Green House model’s systematic approach to workforce redesign and the creation of the Shahbazim, combined with radical environmental redesign, help ensure that the institutional, hierarchical model can’t slip back in.
The empowered Shahbazim that you find within the Green House homes nationwide helps to explain why 83% of Green House projects are ranked as either 4 or 5 Star homes on the CMS Nursing Home Compare website. The Green House model supports the relational coordination among the Shahbaz and the nurses and other staff. The theory of relational coordination states that the effectiveness of care and service is determined by the quality of communication among staff. The quality of staff’s communication depends on their relationships with each other. This theory is highly applicable in healthcare settings where tasks employees perform are closely interrelated. Their interdependence forces the staff to work with one another. But if their relationships and communication are weak, and institutional hierarchies minimize the voice of the elders and their caregivers, then elders’ needs tend to fall through the cracks.
The Green House model develops people’s communication and critical thinking skills so they know what to share and why it’s important. And the redesigned work environment supports good communication creating both a culture of safety and a meaningful life for the elders. Systems and redesigned roles that support relational coordination among staff are the key to the successful outcomes achieved by Green House projects.
Forty-five years ago, Herzberg was spot on. And he still is.