Introduction

Why do we need motivated employees? The key answer is survival (Smith, 1994, cited in Chan, 2004). It is a fact that low employee motivation is one of the commonly occurring blockages and problems in managing people at work as well as getting high productivity in many organizations (Robbins, 1998; Francis and Woodcock, 1975). Besides, in our changing workplace and competitive market environments, motivated service employees and their contributions are the vital currency for an organization's survival and success (Chan, 2004; Low Kim Cheng, 2000). Hence, the primary aim of the paper is to uncover the key sources of motivation among employees in hospitals in Singapore.

“Formally, “motivation” may be defined as “the extent to which persistent effort is directed toward a goal” (Campbell et al., 1970).

Motivation is so critical; it energises the employees. “Just a little and it goes a long way” (Interviewees' inputs, mentioned 25 times). The study of motivation is the study of “all those pushes and prods...that... move us, either eagerly or reluctantly, to action” (Miller, 1962; also cited by Gross, 1996: 96).

However, “money-vator” is only one of the motivational sources. “Cash incentives are not the only way to motivate employees” (interviewees' input; Goh, 2005; Low Kim Cheng, 2001a). Although it is true that employees are normally motivated by pay increments, bonuses, commissions and incentive trips or gifts, “it has become a common happening during good times for employers to start receiving resignation letters after paying bonuses, especially from younger employees with potential” (interviewee's input). Indeed, a resourceful manager should be able to motivate his people without having to rely simply on cash incentives.

The resourceful manager should, in fact, bear this in mind: motivation could mean completely different things to different people. “People are individuals. One's man's meat is another's poison” (one interviewee's input). People are different, and different people have different needs and ways to stay motivated. Indeed, they also have different values and convictions.

Literature Review

Psychologists agree that motivation is “a decision-making process through which an individual chooses desired outcomes and sets in motion behaviour appropriate to acquiring them” (Huczynsk, 1996: 100). At work, money motivates and it is the vehicle by which employees can buy the numerous need-satisfying things they desire (Robbins, 1998; Doyle, 1992). “Money or cash incentives motivate if (employees) perceived a strong linkage between performance and rewards” (three interviewees” input; this is also echoed by Mitra et al., 1995; also cited in Robbins, 1998: 197).

However, several non-monetary ways to motivate employees do exist. These non-monetary ways, “higher-order need” methods and McGregor's Theory Y can also be applied to motivate employees (Robbins, 1998: 170; 197). Non-monetary techniques are normally intrinsically motivating to the employees (Herzberg, cited in Robbins, 1998: 171; Lim and Daft, 2004: 303–304). Being achievement-oriented can be seen as self-actualisation. Achieving and the drive to become what one is capable of becoming or to surpass others can be very motivating (McClelland, 1985; Robbins, 1998).

Among these non-monetary ways, work challenges also provide job satisfaction (Herzberg's motivation-hygiene theory, cited in Robbins, 1998: 171). People tend to do what they like or enjoy (Lim, 2000: 3; Robbins, 1998). Employees also want to be respected and appreciated or praised (“positive reinforcement”: a pleasant or rewarding consequence following a behaviour, Lim and Daft, 2004: 295): and, they also value recognition and positive stroking (Low Kim Cheng, 2003, 2001a; Huczynsk, 1996; James and Jongeward, 1992). They avoid “negative reinforcement,” the withdrawal of an unpleasant consequence once a behaviour is improved (Lim and Daft, 2004: 296). An example is that of a supervisor who stops reprimanding a nursing officer for tardiness once the nurse starts getting to her shift work on time.

It is also a good managerial practice to keep employees informed and build a culture of ownership (Case, 1996, 1992). One needs to be a people-person (Yong, 2005; Low Kim Cheng, 2001a): Apply the five I’s; be Informal, communicate well and allow them to apply their own Initiative. If they are Informed, Invited for suggestions and Involved, they have a sense of ownership. If they are not informed, they get alienated. Low Kim Cheng (2001a: 111) calls this “the mushroom principle.” To be alienated or being in “separation” (Schacht, 1970, cited in Watson, 1997: 115) can be de-motivating. Ordinarily, employees want to be involved; employees need to be informed. They also want to get feedback and to know where they stand on their jobs.

A supportive work environment with good relationships is also very motivating. When there's chemistry, and when managers relate well with their employees, employees feel happy and are indeed motivated (Low Kim Cheng, 2003, 2001a; Reeves, 1994).

Methodology

The methodology deployed in this research is the interview method, and the researchers adopted a semi-structured form of interview.

The interviewees are all employees from the hospitals in the National HealthCare Group (NHG) in Singapore (see Fig. 1). The period of study was from 1 July to 28 July 2005. The size of the sampling is 43 people, and they were people whom the researcher knew and/or were referred to him by his contacts.

Fig. 1
figure 1

Hospitals in Singapore National Health Group

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Individual interviewees included ranks of Nursing officers and Senior Nursing officers. In terms of the interviewees 13 of 30% were male, 30 of 70% were females. In terms of age 40% of the sample were between the age 20 to 29; 49% were between 30 to 39%; and 11% were from 40 to 49. Most of the interviewees (28 of 65%) had been on the job more than 5 years.

The average interview lasted 40 minutes. Interview survey responses were recorded and reviewed by content analysis to ascertain common trends or themes.

At the beginning of these interviews, the researcher began with some small talk to put the interviewees at ease. As in Low Kim Cheng (2005a, 2002a,b), the session began by asking the employees about their personal likes and interests, often detected in previous interactions, previous telephone calls or in the informal conversations occurring before the actual interview. The personal likes and dislikes then serve as a springboard for further discussions on the motivational sources of the interviewees.

During the interviews, the main questions asked were:

  • What are their key sources of motivation?

  • What needs or motives primarily motivate them?

  • What are their strongest (weakest) forces of motivation?

Findings

While 17 interviewees or 39.53% stated that “monetary rewards are critical, these help to motivate us,” 26 interviewees or 60.46% expressed their emphasis on the non-monetary aspects or rewards of motivation.

Figure 2 shows some key thinking or feelings verbalised by several interviewees; they have expressed their motivational concerns. Figure 2 shows the responses made by the interviewees on both their monetary and non-monetary needs.

Fig. 2
figure 2

Interviewee responses on both monetary and non-monetary needs/rewards

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Nonetheless, it is safe to say that most people will feel motivated when they know they are contributing, doing something useful, being heard; receiving praise and acknowledgement, learning and/or having their skills developed.

The key findings indicate five powerful motivational carrots that the Singaporean manager can apply, and they are:

  • Catch Them Right And Praise Them

  • Give Positive Stroking And Show Genuine Care And Concern

  • Inform, Involve, Mentor And Coach Your People

  • Let Your People Grow And Allow Them to Achieve

  • Match Personal Values And Ensure Person/Environment-Fit

Each of the five key techniques will be discussed in the Analysis and Discussion Section.

Analysis and Discussion

Catch Them Right and Praise Them

Interviewee responses included: “Singaporeans as a whole tend to be critical.” “They are more of the thinking sort.” “Normally, they give few praises.” “My managers oriented themselves to just the tasks, get the job done” (some interviewees' input; these words were mentioned 27 times). These re-affirm Tan and Tan's (1999) study that indicates that Singapore managers are the thinking types. It is said that the thinking personality type generally prefers activities that respond to logical analysis and to situations where human factors don't have to be a primary concern (Lawrence, 1993; Hirsh and Kummerow, 1989). This study also confirms Low Kim Cheng's (2002a) study that shows rationalism as one of the Singaporean values and as an important value of the Singaporean managers when running their companies.

Thirty five respondents or 81.39% of the interviewees cited that they “want(ed) praise,” “appreciation” and “recognition” as the most important motivational source for them. “Managers need to show respect, and recognise the people's efforts and work” (interviewees' input). Here, in the hospital setting, those who make a point of being helpful to others value “the gratitude currency” (Huczynsk, 1996: 105). Managers need to see the good side of their people, praise them and give them compliments. Any employer or manager can use these cost-free carrots.

Specifically what do hospital managers need to do to motivate employees? Once in a while or periodically, walk around, and apply what Ken Blanchard and Spencer Johnson once said, catch your people when they are doing the right things (Blanchard and Johnson, 1985: 39). Then, praise them! “People who feel good about themselves produce good results” (Blanchard and Johnson, 1985: 19; Reeves, 1994). Your people will know that they'll get your special attention for their good work, and your people's energy level will be higher. Indeed, everyone likes to be praised. They also get infected with “your contagious positive mood” (Rinke, 2004: 18).

However, praise—different from “flattery which has connotations of insincerity and expediency”—should not be manipulative, but essentially authentic and then, such motivation can be sustaining (Farson, 1991: 39). “They need to be sincere and must come from the heart” These were opined by some interviewees, and they have, in fact, been highlighted by others (Low Kim Cheng, 2001a). Show that the employees matter—though this appears to be like a motherhood statement; managers indeed need to spend time with their people. Talk to them one-to-one or in groups, and show one's interest of their concerns (Yong, 2005; Low Kim Cheng and Theyagu, 2003; Low Kim Cheng, 2003, 2001a).

Give Positive Stroking and Show Genuine Care and Concern

Thirty one respondents or 72.09% of the interviewees stated that they “want genuine care and concern” as the next vital motivational source for them.

“People want positive strokes,” it is “an expression of affectionate or appreciative feelings.” “Even a boss's pat on the back, and compliments, handshakes or thank-you cards from in-patients can be motivating.” (interviewees' input; mentioned 34 times; James and Jongeward, 1992: 47). Here, “in the service line, there is a strong need to relate with people” (interviewee's input), and apply the power of relationships (Low Kim Cheng, 2001a). Listening is one of the finest strokes one person can give to another (Low Kim Cheng, 2001a; James and Jongeward, 1992; Farson, 1991). These are grouped as currencies that strengthen the relationships with others rather than focus on the achievement of the tasks (Huczynsk, 1996).

“When the manager notices his people appear down, he needs to show concern... he needs to listen to them. When the leader is showing genuine concern, it helps a lot though the problem he's facing has nothing to do with work.” “The key word is genuine and sincerity” (interviewee's input).

Note that one should not treat one's staff as if they are a problem, one is there to help one's people. “Besides, in helping, one turn deserves another! People reciprocate” (Low Kim Cheng, 2002b: 15, 2001a). “You can get everything in life you want, if you will just help enough other people get what they want” (Zig Ziglar, cited in Low Kim Cheng, 2002b). Normally, there is a need to offer help within one's limits, and the staff would be grateful to the manager. “The staff will be able to focus better at work once his personal issues are resolved” (interviewee's input). Indeed, one turn deserves another—his people will most likely step forward to give support the next time round when the manager faces a tough situation. This is amplified in Low Kim Cheng (2001a: 113) when he highlights that “people want to follow a people person. The movers and shakers are the people-persons, those who enchant others through their relationships power.”

Inform, Involve, Mentor and Coach Your People

Thirty respondents or 69.76% of the interviewees expressed their “need to learn, be informed, advised and mentored by their superiors.” “Get suggestions from us.” “Give the people feedback, that is very motivating” (interviewees' input). These inputs coincide with Bacal's (1999) and Case's (1996, 1992) views: inform, explicitly and up front, and invite involvement. When being advised and coached, the employee knows where he really stands and whether he is making any progress. Building their confidence and helping them to be the best that they can be, your people also look up to you. As their guide, set the example. Such motivational advice also coincides with Rinke's (2004: 127) exhortations: “lead like a coach, not a cop.”

“Create a learning environment and encourage the hospital employees to learn” (Interviewees' inputs, these statements were mentioned 16 times). A newspaper report (Tong, 2005: C20) confirms this. Here, an engineer-turned-nurse, has opined that, “the best part of being a nurse is that she can continuously upgrade her skills, that too for free, as ‘all the courses are sponsored by the hospital’ ” (Tan, quoted in Tong, 2005: C20). “Besides, at times, (our) leaders feel they have to ‘rally the troops’ through pep talk.” “(Besides,) it's good to have mentors, coaches, outside speakers, professors and training consultants or attend self-growth training or talks to hear different perspectives and refreshing views” (Interviewees' inputs).

The above input also coincides with what Low Kim Cheng (2001b: 17) has highlighted, “All of us need mentors to advise and guide us. Through mentoring relationships, we learn and advance in our chosen fields. Learn a new skill together (Whitmore, 1994) or agree on a project or assignment (Rinke, 2004). Promote discovery, trigger learning, and allow the employees to think it through. Let them learn, explore and choose the options and solutions available. The leader's supportiveness can be clearly seen by his being solution-centred rather than being blame- or problem-focused. In time, a partnership is also being built between the coach/mentor and the coachee/mentee (Low Kim Cheng, 2003, 2001a; Low Kim Cheng and Theyagu, 2003). These relationships supplement the formal or substantive training that professionals go through. Such mentoring relationships make the professionals feel ‘at home’ in the organisation.” Here, one more point to note, the setting up of a new association of former and retired nurses in Singapore, The Nursing Alumni, (Lee, 2005: H5) should be seen as a motivating, and professional-enhancing move. The Nursing Alumni can help to foster camaraderie among former nurses, and supply an avenue through which experienced nurses serve as mentors to their younger counterparts.

Overall, it is vital to improve learning, and unlock a person's potential to maximise his performance. It is better to help one's employees to learn rather than telling or teaching them (Rinke, 2004; Whitmore, 1994). This helps to build a supportive company climate, one that is not only motivating, but also, morale building.

Let Your People Grow and Allow Them to Achieve Much

Twenty eight respondents or 65.11% of the interviewees stated that they “want to achieve much” and “grow professionally.” This point reinforces the previous point mentioned in Section 5.3. Besides, as highlighted by Foster (2003), and Rubin and McNeil (1983), most people usually want to be in control of their own destiny, and not at the mercy of outside forces. “Self-growth and achieving helps in creating our own destiny,” “climbing, moving on—using ever continuous effort” and “the power to prevail” is a vital motivational source (interviewees' input; Foster, 2003; Lim, 1999).

“Akin to the saying, “nothing succeeds like success, we want to achieve.” “We want to better ourselves, we take up nursing courses and degree programmes” (interviewees' input; mentioned 21 times). This re-affirms Myers (1991) study that indicates that, “achievement itself is a motivator.” The healthcare employees seem to be achievement-oriented; they appear to be achievers. In this researcher's view, the national culture of hard work and goal-orientation may have influenced these hospital employees.

This confirms Low Kim Cheng's (2002a) study that reveals that Singaporeans are achievement-oriented, and achievement is one of the 12 values uncovered in the study. In addition, among other elements, Singaporeans' value-orientation includes an “achievement-orientation” (Ong, 2002; Chiew, 2002: 14). This need to achieve has become ingrained in the Singaporeans' psyche. The basic desire to achieve is said to characterise Singapore and many Singaporeans derives their motivation from the political, social, environmental and other challenges that Singapore has had to face. Singapore has made an art of creating virtues out of limited circumstances (Low Kim Cheng, 2002a).

Additionally, several of the interviewees' used words such as:

  • I resolve to prevail... I prevail in times of difficulties such as during the time fighting against the Severe Acute Respiratory Syndrome (SARS) in 2003... we turned the pain into gain. After the event, we came out stronger.

  • We must be “uruthi” (Tamil for being determined).

  • Nowadays, we must move on ... Climbing, we must continue... persisting in spite of cost-cutting, outsourcing, and others.

These statements reflect the fact that the people are very motivated, being capable of driving, formulating appropriate protocols to deal with future outbreaks of SARS and other infectious disease (Tay et al., 2004). The interviewees' responses also coincide with what Lee (2005: H5) has indicated. A top nurse has expressed these; accordingly, when she was new, a few weeks on the job, a task was thrust into her:

The doctor was screaming and shouting at me, and I was so frightened, I cried and apologised profusely... (Lina Ma, quoted in Lee, 2005: H5)

She did not quit, but determined, “she went on to specialise in nursing the elderly” (Lee, 2005: H5).

The health industry is, on the whole, resilient. The study also re-affirms what Low Kim Cheng (2002a) has highlighted, that is, continuous effort or being resilient prevails among Singaporeans. Here, Low Kim Cheng (2002a) pointed out the Singaporean value of continuous effort and being resilient has been reinforced by the country's size, history and events, such as the British withdrawal in 1967, the small market and the setting of self-help groups along ethnic lines. One can also perhaps argue that again, the national culture has perhaps influenced these healthcare employees when giving their input.

Match Personal Values and Ensure Person/Environment-Fit

Twenty six respondents or 60.46% of the interviewees stated that they “prefer working in an environment that fits their values,” “I get what I want,” and “I want challenge and I get challenge.” Such input is also reflected in a recent newspaper report in which one respondent spoke of “the remuneration is not important” (Tong, 2005: C20). What is more critical is that one feels comfortable, enjoying “the comfort currency” (avoiding trouble or embarrassment) and being able to apply the “self-concept currency” (affirming one's values and identity; being true to yourself) (Huczynsk, 1996: 105; Reeves, 1994: 43). This is further echoed in Low Kim Cheng's (2005b: 36) study that “values themselves can be very motivating”; they supply “psychological bonding between the individual worker and the company.”

Employees “feel energised when (their) values match with the work environment” (interviewees' input). To some, the values are “working with people”; they are “extroverts.” To some, such values include “(when) you are working for the whole, you are acting for the future” and “as if they are seeking no reward, and are looking at the ‘spiritual dimension’ ” (interviewees' input). To them, there is this “value match” and is more “fitting” and “harmonising”; thus, echoing the feeling personality type as highlighted in Lawrence (1993) and Hirsh and Kummerow (1989).

Some respondents also spoke of “returning or contributing back to the community.” This, in a way, also re-affirms Low Kim Cheng's (2002a) and (2005a) studies that while there exists pockets of “cosmopolitans”—open to the world among Singaporeans, there are also the majority “heartlanders” who cling to tradition and those who feel the need to contribute back to the community.

Out of these 26 respondents who “prefer working in environment that fits their values,” however, three interviewees, 30 years old and above (6.9%) expressed that “they tended to be more jaded and were less idealistic.” These interviewees mentioned that they cared more for their values when younger then or when first entered the nursing profession,” but now, having families, they were a little less concerned with the latter. They “are getting sucked by bread and butter issues” and besides, “work is work, much paperwork is still there” (interviewees' input). Even then, on the flip side, these interviewees spoke of keeping themselves positive: “I keep my thoughts positive; I enjoy working with the patients.” These are similar to what have been amplified in Gilbert's (2001: 121) “I am the result of what I think,” and it becomes a self-fulfilling prophecy, and a very motivating experience. Thus, among such employees, positive thinking prevails, and they attempt to apply what Jensen (1995: 73) classifies as a check and resolution for internal conflicts of values and self-sabotage.

Nonetheless, “it's difficult to work in the hospital, there's much conflict if one does not have the service heart.” “I am happy to meet people of the same mind (and values)” “We have to believe in teamwork and work together; I like the all-in-the-family situation among the nursing staff” (Interviewees' input). Such input reflects the collaborative or relationships currency of motivation (Low Kim Cheng, 2001a; Huczynsk, 1996; Reeves, 1994). In fact, it also echoes the need profile and the avoidance of type conflicts as mentioned in Lawrence (1993); Hirsh and Kummerow (1989); and Hunt (1979). Here, “value congruence” exists; it “occurs when individuals express positive feelings upon encountering others who exhibit values similar to their own” (Schermerhorn et al., 1994: 138; Low Kim Cheng, 2001a).

Besides, “one must possess the service heart”; “values comes from the heart or our own feelings” (Interviewees' input; Freemantle, 2003; Low Kim Cheng, 2002b, 2000). “Feeling or service-oriented people work well in hospitals and other service-related outfits. They manage, deal and “relate sympathetic with others” (Hirsh and Kummerow, 1989: 47). The individual employee's values need to match with the company's values. Otherwise, mismatch, dissonance, or anomalies exist and the particular employee may feel dissatisfied, he may not work here for long or even leave” (Interviewee's input).

Other things remain the same, it can also be argued that when the values match, the employees have a sense of partnership with the company and a higher level of commitment prevails. This researcher believes that such employees are normally imbued with purpose, and they are also passionate about the work projects and people. After all, one stands for one's values, and “if goals are vivid, specific... you believe that your life is worth living and you'll be right” (Waitley, quoted in Gilbert, 2001: 90). In such a milieu, Rinke (2004: 70) speaks of the employees as if they are working like volunteers, “don't have people work for you.”

In other words, organisations need to earnestly apply value-based living. Here, both the organisation, and the leaders and the employees have to agree on where they want to go and how to get there (du Plessis, 2005). The analogy here is that of the goose envisaging the winter frost and visualises the sunny beaches a continent away. It formulates a vision, mission, a value system, a strategy, and it then communicates this to the rest of the flock. And of course on the right day, all those in the flock who want to migrate to the same place rise up as one. All of them can read the winds, and they take turns to fly up front. They want to go to the same place and believe in getting there. To paraphrase du Plessis (2005), hospital managers need to communicate to their employees to do what they know has to be done to get where they want to go. The employees also need to know that they are going to the destination for the right core beliefs and reasons, and these are similar as the management's.

Such a theory assumes that employees find their work experiences in their company fulfilling and in harmony with their values; they share the same vision, mission and core beliefs or values (du Plessis, 2005; Rinke, 2004). If this is so, it also points to the ‘right’ way in the selection process. In a way, to ensure value congruence and person/environment-fit, hospitals may wish to ensure that people with service heart or who are service-oriented are hired. Nonetheless, studies have also shown that such work experiences are a result of effective management policies, and managers need to get such employees to perceive or credit good management for their positive experiences (Lahiry, 1994).

Overall, in most ways, this study of motivational sources also proves one thing, and this can be expressed by a motivation function [M] (adapted from Hunt, 1979: 44), that is:

$$ \matrix {{\text{Motivation}} = {{\text{Strength}}\,{\text{of}}\,{\text{needs}}} \mathord{\left/ {\vphantom {{{\text{Strength}}\,{\text{of}}\,{\text{needs}}} {{\text{motives}}\,{\text{and}}\,{\text{values}}\,{\left( {{\text{goals}}} \right)}}}} \right. \kern-\nulldelimiterspace} {{\text{motives}}\,{\text{and}}\,{\text{values}}\,{\left( {{\text{goals}}} \right)}}} \\ + \\ {{\text{Energy}}\,{\text{expended}}} \\ + \\ {{\text{Satisfactions}}} \ $$

Source: Hunt, 1979: 44(adapted).

Limitations and Benefits

The sample size of 43 persons limits the depth of analysis. In carrying out this study, this researcher believes that the main limitations are the time and cost constraints. The study is not sponsored or financed by any organizations. Hence, additional interviews or focus group studies have not been made.

This study started off initially to identify the motivational sources of employees, but an off-shoot and benefit of it is that the study examines the use of several non-monetary rewards that Singaporean managers can rely on to motivate their employees especially in hospitals and in the service industries. Another critical benefit of this study is that it uncovers the critical importance of value congruence and person/environment-fit when it comes to motivating one's employees.

Conclusions

Generally speaking, people in hospitals tend to be motivated more by intrinsic motivations; and value congruence and person-environment fit is a vital, if not, an integral component of employee motivation. Besides, “service comes with a heart,” service-oriented and motivated employees and their contributions are indeed the necessary currency for a hospital's success and owning customers in today's age of harried lifestyle and customer service excellence (some interviewees' input; Theyvendran et al., 2004; Low Kim Cheng, 2000).

On the other hand, while managers should show to their people that they matter, they need to apply different strokes or currencies for different folks. They should also attempt various ways to keep their staff feel motivated. Yet another critical point to note is that these carrots should not be overplayed or be given an over-dosage lest they will falsely perceive hypocrisy and lead to aversion.

Above all, as a manager, whatever one does, one should remember that staying and feeling motivated sets a good example. Walk the talk and supply the ethical correctness or inspirational currencies (Low Kim Cheng and Theyagu, 2003; Low Kim Cheng, 2003; Huczynsk, 1996). And that will, in most ways, also boost the staff's confidence, leading them to achieve even more.