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July 10, 2018
January 9, 2018

The Tricky, but Crucial Game of Motivation

Mark Opperman

During a recent practice management consultation, we met a frustrated practice owner. This practice owner had just given all his employees a raise, as he did every year. These annual raises were not associated with performance or longevity. If an employee had been employed during the month – they got a raise. The problem? Even after the raise, employees did not seem any happier or more motivated. The practice owner still saw employees coming in late, making repeated mistakes and not seeming to care. He had been sure that after he gave his employees a raise they would be happy and their performance would improve. At the very least, he had expected that the morale of the employees would improve, yet it had not.  

Whenever we perform a practice management consultation, team members are asked to complete a confidential survey providing their opinions and feedback regarding the practice. The surveys asks team members some very specific questions along with some general ones. The responses from team members are always interesting and informative but can you guess what is the most common statement made by employees? It is, “the practice owner or manager is quick to find fault and slow to praise.” It is the most common complaint we hear--employees do not feel valued or appreciated.

Positive reinforcement is relatively easy. Just a pat on the back, a simple “thank you” or “you did a great job” goes a long way to make your employees feel appreciated. So if it is so easy, why do we fail to do it? The answer is often that we are simply too busy. Caught up in our own lives and responsibilities, we just don’t think about it. Even when we know how important it is and really want to give that positive reinforcement to employees, sometimes we just forget. For other people, this lack of positive reinforcement might be intentional. Perhaps they feel that their team is truly not doing a good job and they may even be little angry with them. So they take this feeling out on the team by not reinforcing them or correcting their work or behavior. Either way, the results are the same—de-motivated employees and a poor working environment. A raise will not fix this problem.

Can you motivate your employees to change their behavior? No. The truth is that you cannot motivate anyone to do anything they don’t want to do. What you can do is create an environment in which employees want to excel at their job and actually exceed your expectations. Consider this: at what point in an employee’s term of employment are they most motivated? The answer is when they are first hired. At that time employees are usually enthusiastic, happy and excited. They want to do everything and anything. And then what happens? We chip away at their motivation until they are unhappy or just plain give up and do not care anymore. They have become de-motivated. 

There are three requirements for positive reinforcement to be effective. The positive reinforcement must be immediate, it must be appropriate and it must be sincere and honest. Let’s look at each of these key elements individually.

It must be immediate – I know of a practice manager who would keep track of all the good things an employee did all year and then, at their annual review, would “dump” these on the employee. The manager was surprised that employees did not seem to appreciate this. In fact, many employees didn’t remember the situation or action and wondered why the manager had waited until their evaluation to share this information with them. The sooner an employee receives positive reinforcement the better. The positive reinforcement can be in the form of a small reward such as a gift card, a little present, time off, or it can just be the words “you did a great job.”  

During a consultation at a practice a few years ago, I arrived at the practice early one morning before the hospital opened. As I waited in my car in the parking lot, I saw a car pull in and an individual get out and start walking to the front door of the hospital. On the way into the practice, this person picked up some litter in the parking lot and even got a poop bag and removed some feces. While this was happening, the practice manager arrived at the practice and followed the first individual into the hospital. I then walked in and introduced myself. The manager asked if she could be excused and went into her office. She soon came back out and approached the other employee (we’ll call her “Julie”). The manager said, “Julie, I noticed you coming into the building this morning and picking up some trash and feces in the parking lot. Thank you so much for caring about our practice and doing that. I have a little gift for you, just to show how much I appreciate your consideration.” The manager then gave Julie a Starbucks gift card. By this time all of the other receptionists were present and they applauded Julie and they also gave her a pat on the back. Wow! That was an excellent demonstration of what positive reinforcement is all about. For positive reinforcement to be effective is should be as immediate as possible.

It must be appropriate – At a major conference one year, I presented a seminar on motivation and delegation and I discussed positive reinforcement in great detail. One individual in attendance at the meeting had been listening intently and, upon returning to his practice, found that his hospital had been given a minor facelift. The floors had been cleaned and waxed, the outside landscaping worked on, and the walls in a few of the exam rooms had even been painted. Well, remembering what he just learned about positive reinforcement, he called everyone into the treatment area, expressed his joy and appreciation to everyone and gave each employee one hundred dollars. Feeling very proud of himself, he went into his office. When he emerged later he was surprised to find some very disgruntled and angry employees. Any idea what had happened? Of the twelve or so employees employed by the practice, only six of them had participated in the work. So by giving a bonus to everyone, it was a slap in the face to those who had actually done the work and a negative reinforcement to those who did not. I found out about this when this practice owner called me on the phone to yell at me that I did not know what I was talking about! It is very important that, when you give positive reinforcement, it is appropriate. Make sure you know that the person did the work and was the one deserving of your praise or reinforcement.

It must be sincere and honest – Employees know when you are sincere and when they are deserving of your praise. The owner or manager who constantly gives praise even when it is not warranted will lose the respect of his or her employees. Positive reinforcement should be for an act that goes above and beyond, not just for “converting oxygen to carbon dioxide.” An employee who goes to a client’s house to pick up a pet or deliver medication would be deserving of positive reinforcement. Employees who might volunteer to participate in a career day or State Fair booth, go out of their way to help another employee or client, or take a special interest in a patient would all be deserving of positive reinforcement. You should reinforce your employees for a “stretch goal,” something that is beyond the expected. In doing so, you set the bar for other employees and they will strive to exceed your expectations and be reinforced. An effective manager looks for opportunities to reinforce their team members. In fact, I think this is one of the most enjoyable aspects of personnel management. Suppose that your son, Johnny, comes home from school one day with his report card and shows you that he got four A’s and one D. What would most parents say? “Johnny, what is wrong with you? You got four A’s and a D! Why didn’t you work harder and get five A’s?” Instead, I think that we should say, “Wow, Johnny you got four A’s! That is awesome! I bet if you keep that hard work up, you will get five A’s next semester. You did great and I am really proud of you.” Reinforce the positive and ignore the negative – unless the negative is so bad that you must deal with it. Your team should be so used to getting honest and positive reinforcement from you that, when they don’t hear it, they know they have failed to meet your expectations.

Making It Happen

There are lots of little tricks you can use to help you remember to use positive reinforcement. One of my favorites is to place five quarters or tokens in your left pocket and, every time you reinforce an employee, take a token out of your left pocket and place it in your right pocket. At the end of the day, you should have all five tokens in your right pocket. Another favorite idea is one I call “good job bucks.” To initiate this idea, you will need to design and print some good job bucks. This would be clinic money (something like Monopoly money) and might have a picture of your practice on it. Blank good job bucks are given to employees, maybe every other week in their paycheck. The good job buck states on it “I am giving you a good job buck because _________” and the employee writes the reason why they are giving the good job buck to a team mate. The good job bucks are then given by employees to other employees; they cannot give them to themselves. In this way, employees are rewarding other employees. Once you set this up, you also need to come up with a redemption program. You can make up a list of rewards, such as employees can turn in 10 good job bucks for a $20 gift card, 40 good job bucks can be redeemed for an $80 hospital credit, or 50 good job bucks can be turned in for a day off. Be creative and involve your employees in this process – you will find out what is important to them. Then let the magic happen. Employees will reinforce other employees and morale will soar!

Incentive Program

Employees say that one of the best things management could do to improve an employee’s performance and longevity within any business is evaluations. Employees want to know how well they are doing and what they can do to further improve themselves and their performance within your practice. I believe that performance evaluations should be done at least once a year. But we have been using an incentive program that combines performance evaluations with the practice’s increase of gross and have found this program to be amazingly effective in motivating team members.

There are basically two components to the incentive program-- a financial component and a performance component. On the financial side, you need to establish a bonus fund. Normally, the amount of the fund would be 10% of the increase of gross from one quarter compared to the same quarter of the previous year. For example, we would compare the gross income for October, November and December of this year to the gross for October, November and December of last year. Let’s say that, between those two corresponding periods, the practice’s gross increased by $10,000.  Then we would take 10% of that increase, or $1,000, and set it aside in an employee incentive fund. And employees should be made aware of this by posting a graph each month that shows the month’s income compared to the same month of the previous year.

On the performance side, each employee is evaluated on a quarterly basis. You should have specific evaluations for each position within your practice. Each employee is asked to fill out the evaluation form on themselves and then you, the manager or owner, fill out the same evaluation on that employee. You sit down with each employee and review these evaluations. This is a great opportunity to discuss employees’ performance and let them provide you with feedback, as well. You can also talk about new responsibilities or goals you would like to see the employee achieve.

At the end of this process, evaluation forms are scored. Typically, an employee can score between 0 and 100 on their evaluation. The next step is a little tricky, but the score must be adjusted based on the number of hours the employee has worked during that quarter. As an example, if one of your employees only worked 20 hours a week and scored an 80 on their evaluation, that 80 would be converted into a 40 because the employee only worked 50% of full-time hours. Once this calculation has been made, all the adjusted scores are added up and each score divided by the total to see what percentage of the incentive fund each employee will receive. Here is a very simple example: Suppose you had two employees sharing in a bonus fund of $1,000. One employee scored 60 on their evaluation and the other scored a 40 (after adjusting for hours). This means that one employee would receive a bonus of $600 and the other would receive $400. Again, the entire fund is divided based on the evaluation score each employee received and that score adjusted by the number of hours the employee worked during that quarter.  If this seems complicated to you, contact our office ( or call 303-674-8169).  We have an entire write up that should help to explain how to implement the program.  

With this incentive program, all your employees are now working for the success of your practice and are rewarded when that is achieved. There is no discrimination, so the kennel assistant can make just as much as the technician or manager. The program says, “If you do well in your area and you contribute to the success of the practice, then you have just as much right to a bonus as anyone else.” We have used this program in hundreds of practices and it has been highly successful. You do need to follow the program to the letter to make it work.

These are just a few of the many ways to create an environment in which your employees will be motivated. As a practice manager or practice owner, it is your responsibility to reinforce your employees and tell them how well they are doing. Remember to reinforce the positive and ignore the negative, unless the negative is so bad it has to be dealt with. Money in the form of salary is not a motivator, so don’t think that by giving a raise or paying your employees well, they will be motivated. However, if you don’t pay employees well, you may not be able to motivate them. So, pay your employees fairly, incorporate some motivational techniques and consider incorporating an employee incentive program within your practice. You will be impressed with the results!

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