Work force motivation, a novel application of expectancy theory in emergency medicine

Abstract

Study objectives: Expectancy theory has been used in the business community to motivate employees and identify those with leadership potential. Motivation is scored as a product of expectancy, instrumentality, and valence. Expectancy is the belief that one's efforts will result in obtaining a performance goal. Instrumentality is the belief that if one meets the performance goal, a greater reward will be forthcoming. Valence refers to the value the individual places on each reward. This theory has never been applied in the health care environment. The purpose of the study is to identify variances in motivation scores among physicians (attending and residents) who practice in either an urban or suburban emergency medicine residency program. Methods: A survey using standardized and previously validated questions was conducted in 2 emergency medicine residency training programs, one in a suburban community-based emergency department and the other in an urban setting. Descriptive statistics were reported with mean±SD. Statistical analysis performed included independent t tests and analysis of variance, where applicable. Statistical significance was considered at P value equal to .05. Results: Total surveys completed were 104, with a response rate of 79% (suburban 65%, urban 89%). Across both sites, a significant difference was seen between attending physicians (1,075±467, n=44) and residents (1,446±522, n=60, P<.001). This difference was also in evidence within each site. Among residents, no significant differences were noticed, with a trend toward higher scores in each advancing program year. The motivation scores are as follows: postgraduate year (PGY)-1, 1,359±500 (n=19); PGY-2, 1,470±586 (n= 22); and PGY-3 to 5, 1,504±479 (n= 19). Among attending physicians, years of experience were as follows: less than 2, 1,302±373 (n= 7); 2 to 5, 1,031±410 (n= 11); 6 to 10, 947±334 (n= 4); and greater than 10, 1,048±538 (n= 22). There was a trend toward lower scores among part-time physicians (n=5, 878±483) compared with full-time physicians (n=39, 1,100±466) but it failed to show statistical significance. There was no difference in scores between physicians with administrative responsibilities or protected time. Between the urban and suburban environment, there was no difference in scores according to level of training or among attending physicians (Table). Table, abstract 415 Suburban, Mean±SD (No.) Urban, Mean±SD (No.) Attending 1,096±401 (21) 1,056±529 (23) PGY-3 to 5 1,289±474 (3) 1,544±484 (16) PGY-2 1,661±644 (5) 1,414±577 (17) PGY-1 1,306±538 (8) 1,398±494 (11) Open table in a new tab Study objectives: Expectancy theory has been used in the business community to motivate employees and identify those with leadership potential. Motivation is scored as a product of expectancy, instrumentality, and valence. Expectancy is the belief that one's efforts will result in obtaining a performance goal. Instrumentality is the belief that if one meets the performance goal, a greater reward will be forthcoming. Valence refers to the value the individual places on each reward. This theory has never been applied in the health care environment. The purpose of the study is to identify variances in motivation scores among physicians (attending and residents) who practice in either an urban or suburban emergency medicine residency program. Methods: A survey using standardized and previously validated questions was conducted in 2 emergency medicine residency training programs, one in a suburban community-based emergency department and the other in an urban setting. Descriptive statistics were reported with mean±SD. Statistical analysis performed included independent t tests and analysis of variance, where applicable. Statistical significance was considered at P value equal to .05. Results: Total surveys completed were 104, with a response rate of 79% (suburban 65%, urban 89%). Across both sites, a significant difference was seen between attending physicians (1,075±467, n=44) and residents (1,446±522, n=60, P<.001). This difference was also in evidence within each site. Among residents, no significant differences were noticed, with a trend toward higher scores in each advancing program year. The motivation scores are as follows: postgraduate year (PGY)-1, 1,359±500 (n=19); PGY-2, 1,470±586 (n= 22); and PGY-3 to 5, 1,504±479 (n= 19). Among attending physicians, years of experience were as follows: less than 2, 1,302±373 (n= 7); 2 to 5, 1,031±410 (n= 11); 6 to 10, 947±334 (n= 4); and greater than 10, 1,048±538 (n= 22). There was a trend toward lower scores among part-time physicians (n=5, 878±483) compared with full-time physicians (n=39, 1,100±466) but it failed to show statistical significance. There was no difference in scores between physicians with administrative responsibilities or protected time. Between the urban and suburban environment, there was no difference in scores according to level of training or among attending physicians (Table).