Motivating Pharmaceutical Employees in Kuwait

Motivating Pharmaceutical Employees in Kuwait The pharmaceutical sector in Kuwait has never been considered by the Government to be as important as the other healthcare or even many other professional sectors, like engineering for example. It has always been viewed as a less important profession with a very small number of professionals relatively to other jobs in the country. However, Pharmacy is a necessity in Kuwait and in every country, in addition to the obvious increment of the number of pharmacists who join the field every year, especially since the beginning of the last decade after Kuwait University launched its first pharmaceutical department in 1997. Therefore, these pharmacists must be heard and understood like every other profession in Kuwait, they have potential and needs which must be considered and met whenever possible by the Government. One of these needs or even necessities is motivation. The practice of motivation is critical for every successful organization, just like other important measures to increase pe rformance; it is a tool that must be present in every healthy working environment. Being a previous pharmacist working in the public sector in Kuwait, the Author has come across this subject numerous times with different pharmacists, who had negative views of the matter in most times. However, there was no clear study which shows the true level of motivation that is being experienced in the sector, which is the reason for conducting this research. 1.2 Problem Definition The experience of motivation for pharmacists who work in the public sector is poor, compare with other healthcare professionals such as doctors, and compare to the pharmacists who work in the private sector in Kuwait. Therefore, the Author chose to examine the level of that motivation in a deeper manner to have clearer and more reliable view of the concept within the public sector of pharmacy, in addition to finding new methods which could improve the implementation of such practice. 1.3 Research Objective The main objective of this thesis is to define the level of motivation that is experienced within pharmacists working in the public sector in Kuwait. The sub-objectives can be classified into the following three measures: The first one is to determine the level of motivation that is experienced in the public pharmaceutical sector in Kuwait. The second objective is to determine whether there is an effect of motivation on the overall performance of pharmacists. The third and final measure is to explore new techniques and motivational methods that can be used in order to satisfy public pharmacists and fulfill their needs. 1.4 Research Questions The research shall consist of one major question and three minor ones. The major research question is: What is the experience of motivation for pharmacists who work in the public sector in Kuwait? The minor questions are as follows: What is the level of motivation that is experienced in the public pharmaceutical sector in Kuwait? What are the effects of motivation on the overall performance of pharmacists? What can be used as new techniques or new methods of motivation in order to satisfy public pharmacists and fulfill their needs? 1.5 Research Methodology For the research method, we will conduct personal interviews, which shall be done face to face to get the most reliable responses from pharmacists. The proposed methodological framework for this study, will be based largely on several motivational models that would be described later in chapter two, they are Maslow Hierarchy of needs, achievement motivational model, the two factor theory, the expectancy theory and the equity model. From those five models, a guiding criterion will be extracted and compared with the responses of the research questions. In addition to that, the role of management and supervision and its effects on motivation will be examined and compared to the characteristics of a motivational management which will be addressed in chapter 2. And finally, the interviewees will be asked for their recommendations and suggestions for newer and better motivational techniques and methods, to be implemented by the Ministry of Health. 1.6 Data Analysis Method After collecting the qualitative data, they will be analyzed using different criteria. The analysis will basically list the answers of the participants and find the relationships between them with the assistance of weighing frequencies of repentant responses to reach a better conclusion. The conceptual framework will be based on five motivational theories (Maslows hierarchy, achievement model, two-factor theory, the expectancy theory, and the equity theory), which is the base for analyzing the findings. The impact of positive motivation implementations will also be discussed with the selected pharmacists, in addition to an interpretation of their recommendations on improving the motivational process within the Ministry of Health. 1.7 Thesis Structure The structure of the thesis will be based on five main chapters, they are listed below: Chapter one: Introduction. Chapter two: Literature Review. Chapter three: Research Design and Methodology. Chapter four: Data Analysis, Findings and Discussion. Chapter five: Conclusion, Recommendations and Further Research. The next chapter will present our literature review. CHAPTER 2: LITERATURE REVIEW 2.1 Introduction Motivation is a global concept, recognized worldwide today; it is a necessary tool for all different kinds of organizations to survive and grow, and most importantly to succeed. Below is a literature review for the term motivation. It includes different definitions of the term in addition to other terms related to motivation. Different theories on motivation will be mentioned and reviewed briefly to better understand the meaning and limitations of the term motivation. Successful tools to achieve the desired motivation will also be addressed and explained, as well as a review on the different mechanisms used by organizations to motivate their employees. And finally, there will be a review on employee motivation techniques used including a few examples from the best motivational companies in Kuwait. 2.2 Motivation So, who are the motivated workers? According to Myers (1964), when Texas Instruments Incorporated conducted a six year of research and study on the subject of motivation during the 1950s, they came up with the following conclusion1: Employees are motivated to work more effectively when they have a job that is challenging, because it might give them some interest in the job, more enjoyable work, a possibility of recognition, and a since of achievement when they accomplish the task. They become dissatisfied when those noted factors are missing from their jobs. They may also become dissatisfied by some negative factors related to the job itself including astringent rules, no breaks, low status, and low levels of salary or fringe benefits. This study was conducted by a company which experienced a tremendous growth in the 1950s, their annual sales rose from $2 million to over $200 million, along with their employee force which had risen from 1,700 to 17,000 in that decade. This success was accomplished because of their brilliant management philosophy, which provided employees with opportunities that allowed them to explore their works and efforts, and even set their own goals. In addition, the culture was a very friendly and informal one, as employees had very close relationships and strong communication links. Despite that success, the growth was not for long after those years, and employees were no longer highly motivated as before, because there were poor managerial skills in understanding the concept of motivation and how each employee can be motivated. This was in the 1950s; today the main idea or the concept of motivation still have the same old parameters, but with some improvements and modifications after many long studies by many of scientists and philosophers. To best understand the term motivation, one must start with the definition. 2.2.1 Definition of Motivation For the purpose of this thesis, we will keep the definition of (The Collins business Dictionary, 2002) regarding the concept of motivation. In that perspective, motivation is defined as the force or process which impels people to behave in the way that they do. In a work setting, motivation can be viewed as that which determines whether workers expand the degree of efforts necessary to achieve required task objectives2. Furthermore, here is another explanation of the term: motivation represents the forces acting on or within a person that causes the person to behave in a specific, goal-directed manner3. In addition, the online business dictionary (business dictionary , 2009) defines it as the Internal and external factors that stimulate desire and energy in people to be continually interested in and committed to a job, role, or subject, and to exert persistent effort in attaining a goal. Motivation is the energizer of behavior and mother of all action. It results from the interactions among conscious and unconscious factors such as the (1) intensity of desire or need, (2) incentive or reward value of the goal, and (3) expectations of the individual and of his or her significant others4. Since the term motivation is being defined, one must address some terms which are highly related to motivation, including: job satisfaction, job commitment, and job loyalty. Job satisfaction is the satisfaction that an individual gains (or does not gain) from his or her job. It is generally believed that satisfied employees will be more highly motivated and will work more productively than dissatisfied employees. Job dissatisfaction may lead to absenteeism, job turnover, industrial actions, and etc2. Commitment is the state of being bound emotionally or intellectually to a course of action or to another person or persons2. It is a well known fact that job satisfaction strongly leads to job commitment, which later leads to loyalty. Furthermore, job loyalty is another state led to by motivation, and it is a measure of commitment based on obligation or, in consumer preferences, degree of satisfaction2. 2.3 Theories of Motivation Over the years, many researchers have looked into the human psychology and studied the human nature to understand the process of motivation. They have come up with many theories which are being thought now to millions of students around the globe. Below this paragraph there is an overview of some of the most recognized theories of motivation worldwide, starting with the need theories: Maslows hierarchy of needs, and David C McClellands achievement motivation model. 2.3.1 Motivating Employees through Satisfying Human Needs 2.3.1.1 The Needs Hierarchy Theory The hierarchy of needs theory is one of the most recognized theories in the subject. It was found by Abraham Maslow, who published an article in 1943 under the title A theory of human motivation, which was developed later into the hierarchy of needs theory in Maslows Motivation and Personality book in 19545. The hierarchy model is shown in figure 2.1, as presented in the following website (making it clear.com, 2007)6: (Figure 2.1) Maslows Needs Pyramid or Maslows Needs Triangle Taken from (making it clear website, 2007) Maslow has based his theory on the fact that people are motivated by certain types of needs, he classified them into five levels based on their importance to people, and they are in ascending order: physiological, security, affiliation, esteem and self-actualization. He then arranged them in a hierarchy showing the order in which these needs are fulfilled from bottom to top5. According to Maslow, these human needs can be classified into lower and higher levels of needs, the lower levels or factors of needs has to be satisfied and fulfilled before the higher ones, which means they must be satisfied in order, so that a person can be motivated, and reach a high level of achievement in life5. The model indicates that when one need is satisfied, another one becomes important, which means that the lowest level of needs  (physiological)  must be  fulfilled  in  order to  move to the higher one (security), and so on, until one reaches  self-fulfillment 3. In other words, each level of needs is a motivator, which when satisfied, does not motivate anymore, and the higher level is now the motivator5. Firstly, Physiological needs. They are the first and lowest level of the hierarchy, they are the most basic needs which are necessary for the continuation of life, and they include: the desire for food, water, air, and sleep3. It can safely be said that no human being can live without the physiological needs, which is why they are sometimes called survival needs. They must be satisfied in order for a person to move up the hierarchy, and be motivated by the next level of needs5. Secondly, security needs. They occupy the second level of the pyramid, and are sometimes called safety needs, as they include the need for safety, stability and absence of pain, threat or illness3. When it comes to work, these needs may cause the preference for a safe and secure job, with a health insurance benefit for example. They include financial security, as they may cause people to open savings accounts for the security of their future, or to take different types of insurances for example, the insurance against accidents4. When this level is satisfied, a person may move to the next level5. Thirdly, Social needs, which can be explained as the needs someone wants from society, such as friendship and the feeling of belonging3. This level of needs deals with the emotions of the human being, every person needs to feel accepted and loved by others, and as most people do, a human may belong to a group, which can be a small one like family and friends, or a large one such as clubs, religious parties, or even gangsters. In the case that this emotional need was not fulfilled, a person may be lonely and experience some mental disorders such as anxiety or depression3. Esteem is the next level in the pyramid, and it is the desire to feel respected and self worthy, and thereby boost the self-esteem. People need to be valued by other people, they need to be accepted by what they are and recognized for their activities and contributions in order to feel self-valued. The imbalances of this need can lead to low self-esteem, which can cause psychological conditions such as depression3. The highest and last need is Self-actualization, which only appears when all the levels have been satisfied, and involves people recognizing their full potential, and be the best as they can be at what they do3,which can be best seen with self-employed people3. 2.3.1.2 The Achievement Motivation Model This model of motivation has been identified by David C McClellands in 1961. He proposed the idea that there are three important types of needs; they are achievement, authority/power, and affiliation needs. These needs were found to be present in every worker especially within managers, and the degree of which need is dominant can be seen in the workers attitude and behavior at work, which is based on their motivational status7. The ones, who are motivated by achievement, can be seen competing against a high standard, having difficult and challenging goals, and always seeking achievements and advancements in their jobs3. The authority/power motivated ones always strive for authority and leadership. They need to be leaders and have their ideas prevail. In addition, they want to be influential, make an impact in work and on other workers, and reach high personal status3. The affiliation motivated persons are team players; they are motivated by friendly relationships with others, as they need to be liked and always have close friendships7.   The McClelland theory proposed that all people have a combination of these needs, however not in the same level. The level of which particular need is dominant can be seen in someones attitude and behavior at work. He thinks that the managers, who are strongly affected by affiliation motivation, always need to be liked, which in turn affects their decision-making criteria. While authority motivated workers will posses a high level of commitment and work ethics, and in most cases are managers or leaders, unless they do not have the required skills or flexibility for the job. In addition, McClelland thinks that the best leaders are the ones with strong achievement motivation, however they may have some difficulties in leading their staff into believing and having as much dedication to what they want to achieve7. In his theory, McClelland proposed that achievement-motivated people are characterized by the following attitudes3: They set their own goals, because of their high selectivity of matters; they cannot accept other people to draw goals for them. They take full responsibility in their decisions and results, if they succeed they want the credit, and if they do not, they do not mind the blame. To them, Achievement is valued more than financial reward. They prefer achieving their goals to receiving praise or getting recognition. They do not consider a financial reward as a goal; to them it is just a measure of success. They are not highly concerned about Security, or about their status. They like nothing more than a reliable feedback for their work, not to get an appraisal or something of that matter, but to measure their work and see how successful they have been. They always seek better ways to do things, and improve their methods. they are highly selective for jobs which have higher satisfaction for their needs, which means they choose jobs which have greater responsibilities and opportunities for them to set their own goals and achieve them, for example they can work as managers, or in the sales department, in addition to many of them work as entrepreneurs. Next, there is a description of another category of motivation models, which is based on job designs. 2.3.2 Motivating Employees through Job Design 2.3.2.1 The Two-Factor Theory In 1959, Frederick Herzberg and his associates developed a famous theory of motivation known as the two-factor theory, or the motivator- hygiene model of motivation. He studied people to know what the factors that causes them to be satisfied at work, and the ones that causes dissatisfaction to them. He then came up with a list of factors and classified them in two categories: motivators and hygiene factors8. Motivators are the factors that satisfy people at work, in addition to generating positive feeling; they include recognition, achievement, advancement, responsibility, and challenging work. They are called intrinsic factors, because they are related to the job itself 3. Hygiene factors on the other hand, are factors which usually gives negative feelings to individuals, and may affect job dissatisfaction if they were absence, hence the term hygiene, because in the absence of hygiene, health can deteriorate. They include: job security, working conditions, salary, relationship with co-workers and supervisors, company policy and fringe benefits. They are called extrinsic factors because they are external to the job, not directly related to the job itself 8,3. 2.3.2.2 The Job Characteristic Model This is one of the most famous models of motivation, proposed by Hackman Oldham (1976), and it is highly used in designing jobs in many organizations5. It is related to Herzbergs model to a great degree, as it proposes the use of motivation factors at a workplace, and limiting the hygiene factors to minimum9. The model includes five main characteristics of any job, they are: skill variety, task identity, task significance, autonomy and job feedback. It proposes that the levels of all these characteristics should be increased in order to create a motivational environment at the workplace3. The first characteristic is skill variety, which is the amount and the types of skills and competencies required by a certain job. Some jobs are a daily routine activity and require too little from an employee to get them done, while other jobs require certain competencies and skills from individuals which can make them more interesting. Next is task identity, and it is the identification of the complete work needed to complete a task by an employee, from beginning to end, with an identifiable outcome3. Task significance is another characteristic, and it is described as the amount of importance and necessity of a given task, and whether it is worth doing and would have an impact on other people and society, or if it would not make a big difference when it gets done. The fourth characteristic is autonomy, and it is the amount of empowerment and control provided in certain jobs, which increases their importance in peoples minds. The last one is job feedback, which gives indications on an employee performance and effectiveness; therefore a job should be formulated in ways which allow superiors to measure the performer as simply and accurately as possible3,9. The model proposes that the levels of these five characteristics should be increased, because they have strong effects on three psychological aspects in humans, they are3: Experienced meaningfulness of the tasks performed. Experienced personal responsibility for task outcomes. Knowledge of the results of task performance. In the end, the model states that if these three status were raised in a human being, that individual will be highly satisfied at the job and strongly motivated to work. Next, there is another category of motivation models, which is based on performance expectations. 2.3.3 Motivating Employee through Performance Expectation 2.3.3.1 The Expectancy Theory The link between motivation and the expectancy theory was defined by Condrey as: Motivation is a product of the individuals expectancy that a certain effort will lead to the intended performance, the instrumentality of this performance to achieving a certain result, and the desirability of this result for the individual, known as valence10. The theory was found by Victor Vroom in 1964, a business professor at Yale School of Management , it proposes the idea that people become motivated to do a certain job when they believe they will get a certain reward that they want and expect. They make an estimation of the desired results, and based on that they act and behave in a way which will help them get to those results. It predicts that individuals within an organization can be motivated when they believe that10: More effort exerted will yield better performance at a job. Better performance will result in desirable organizational rewards, such as salary increment. These rewards are valued by the performer and satisfy the needs Satisfying the need is worthwhile doing better and giving the required effort to the proposed job. However, Victor Vroom together with his associates Edward Lawler and Lyman Porter thought that the link between peoples behavior at work and their goals was not exactly as simple as previous scientists had proposed. He believed that the performance of an employee is based on three major psychological factors, which can create a strong motivational force to that employee, they are9: Valence: refers to how people feel about and the level of satisfaction they get from the outcomes and rewards of completing their jobs, such as money, promotion, and satisfaction. On the one hand, an outcome is said to be a positive valent if an employee prefers having it. On the other hand, an outcome which an employee does not want to have is known as a negative valent. An outcome which an employee is indifferent about are said to have zero valence. Expectancy: it is the belief of employees that their actions will lead to certain outcomes, and their confidence in what they can do. Instrumentality: This is the belief of employees that they will get what has been promised to them after completing the task successfully. Vroom proposed that the belief of an employee in these three factors helps psychologically in building a motivational force which makes that employee happy and avoiding negativity. Hence, the theory describes the mental procedure of motivation, as people make choices based on their understanding and behavior 3. 2.3.4 Motivating People through Equity 2.3.4.1 The Equity Model The Equity Theory was developed by J. Stacy Adams in 1962; it describes how an employee perceives that the outcome reward of a certain job is being fair, after completing one which is expected to be satisfying9. The theory can be measured against other employees in a work place, or even employees from different organizations. Normally this measurement results in three different perceptions: they will feel they are fairly rewarded, under rewarded, or over rewarded. Unless they feel fairly rewarded, they will act in a way as to reduce inequity. Because they always try to measure what they put in a job (input) and what they get from it (output). Examples of employees inputs and outputs can be found in table 2.1 3: Table 2.1 Examples of employee inputs and outputs in a job: Inputs Outputs Attendance Recognition Personal skills Fringe benefits Commitment and effort Responsibility Level of education Sense of achievements Past experiences Job perquisites (parking space or office location) Performance Job security Personal appearance Promotion and growth Social status Salary Technical skills Seniority benefits Training Status symbols Support of collogues Working conditions (Taken from J Slocum, Jr. (2007) Fundamentals of organizational behavior) The Equity Theory is built on the belief that, employees who think their rewards are fair and equal to their contributions, are the most motivated ones, The same goes for the ones who belief they are being rewarded in a similar manner as their peers. On the other hand, employees may become demotivated when they belief that their input is greater than the output. They may become depressed and not satisfied with their status, and show many negative reactions9. Therefore, managers must be fair and give their employees their fair share of rewards, based on their actions and inputs. They should understand how to balance inputs and outputs fairly, so that they give each employee fair and deserved rewards, which in turn improves employee motivation and thereby gives them more job satisfaction9. As mentioned before, managers must understand the balance of inputs and outputs of their employees; because employees measure their inputs differently, in addition to the fact that they may prefer different types of rewards. For example, a working mother may prefer more flexible working hours to an incentive9. At the end, managers should make sure their employees do not feel under rewarded, because then they will be demotivated, which should be avoided in any organization that wants to be successful. They should reward them fairly and equally based on their efforts, contributions, expectations, and peers 11. 2.3.4.2 The Procedural Justice Theory This theory was proposed by Rawls (1971), and it is based on fairness just like the previous equity model; however it is not based on the outcomes or the outputs, but on the fairness of the process of making decisions5. The theory measures the procedure of making decisions in an organization, which can be fair or unfair, and affects employee motivation and job satisfaction9. Procedural justice can be very important and essential to every company or organization, because it has a great effect on employees. When they perceive a procedure as fair, they become highly motivated to work and improve their inputs at their jobs. On the other hand, if they think the procedure is unfair they may be dissatisfied and demotivated to work9. A good example can be seen in most companies is pay raise determination, if employees perceive fairness of the decision, they will be satisfied, and visa versa. Sometimes, the fairness of such decision can be more satisfying than the raise itself, because the human being highly values equity and fairness. Employees may also judge the process of layoffs within a company, as the survivors would judge the fairness of the decision and become highly affected by it, and if it was a fair decision, they would become highly satisfied and more committed to their job. However if the decision was unfair, they may become demotivated and even have fear about their job status, which usually leads to seeking jobs elsewhere 3. Another examples is students, especially hard workers who put so much efforts in their studies, they expect to get good grades for their hard work, but sometimes they are misjudged or marked unfairly, which can be seen when they compare their results or marks with each other, and when they think the marking procedure was unfair, they become hugely dissatisfied9. 2.3.5 Other Theories of Motivation There are many theories and models of motivation, which are not widely recognized as the ones explained before; here is a review of some of them: 2.3.5.1 The Incentive Theory of Motivation According to Kerr (1995), a reward can be very effective in boosting employee motivation. Whether it was tangible or intangible, when a reward is presented to an employee after a certain behavior or performance, it is more likely that the same desired performance will occur again. In addition, the sooner the reward is given the better, as its effect would be larger in employees minds, and later on, this performance becomes a habit by that employee12. However, as the author has noted, there might be some difficulties applying the technique efficiently by managers, because they should make sure that the reward is not just a simple reward, it should be some kind of a reinforcer, which is like a reminder to employees of the incentive they get for what they did, and later on this becomes embedded in their behavior, and a continuous source for motivation, and job satisfaction. 2.3.5.2 The Drive-Reduction Theory The theory was proposed by C. Hull (1940), who suggested that when a person experiences some kind of a biological drive or arousal to do something, that person will experience a driving force to do that thing. And whenever that person does the action, then the action would be reinforced. For example: when a person is hungry and wants to eat, there would be a drive to do so, but as soon as that person eats, the forced drive becomes reduced. However, the theory was not considered very successful because it did not explain clearly the motivation process9. 2.3.5.3 The ERG (Existence, Relatedness and Growth) Theory Suggested by Clayton Alderfer in 1969, who followed up on Maslows needs theory. He reestablished the order of needs into three categories: the existence category including Physiological and safety needs, the relatedness category including affiliation and esteem needs, and the growth category including self-actualization and needs 13, 9. 2.3.5.4 The Goal Setting Theory This is based on the idea that when an employee sets a goal for oneself, he/she will have to increase performance to achieve t Motivating Pharmaceutical Employees in Kuwait Motivating Pharmaceutical Employees in Kuwait The pharmaceutical sector in Kuwait has never been considered by the Government to be as important as the other healthcare or even many other professional sectors, like engineering for example. It has always been viewed as a less important profession with a very small number of professionals relatively to other jobs in the country. However, Pharmacy is a necessity in Kuwait and in every country, in addition to the obvious increment of the number of pharmacists who join the field every year, especially since the beginning of the last decade after Kuwait University launched its first pharmaceutical department in 1997. Therefore, these pharmacists must be heard and understood like every other profession in Kuwait, they have potential and needs which must be considered and met whenever possible by the Government. One of these needs or even necessities is motivation. The practice of motivation is critical for every successful organization, just like other important measures to increase pe rformance; it is a tool that must be present in every healthy working environment. Being a previous pharmacist working in the public sector in Kuwait, the Author has come across this subject numerous times with different pharmacists, who had negative views of the matter in most times. However, there was no clear study which shows the true level of motivation that is being experienced in the sector, which is the reason for conducting this research. 1.2 Problem Definition The experience of motivation for pharmacists who work in the public sector is poor, compare with other healthcare professionals such as doctors, and compare to the pharmacists who work in the private sector in Kuwait. Therefore, the Author chose to examine the level of that motivation in a deeper manner to have clearer and more reliable view of the concept within the public sector of pharmacy, in addition to finding new methods which could improve the implementation of such practice. 1.3 Research Objective The main objective of this thesis is to define the level of motivation that is experienced within pharmacists working in the public sector in Kuwait. The sub-objectives can be classified into the following three measures: The first one is to determine the level of motivation that is experienced in the public pharmaceutical sector in Kuwait. The second objective is to determine whether there is an effect of motivation on the overall performance of pharmacists. The third and final measure is to explore new techniques and motivational methods that can be used in order to satisfy public pharmacists and fulfill their needs. 1.4 Research Questions The research shall consist of one major question and three minor ones. The major research question is: What is the experience of motivation for pharmacists who work in the public sector in Kuwait? The minor questions are as follows: What is the level of motivation that is experienced in the public pharmaceutical sector in Kuwait? What are the effects of motivation on the overall performance of pharmacists? What can be used as new techniques or new methods of motivation in order to satisfy public pharmacists and fulfill their needs? 1.5 Research Methodology For the research method, we will conduct personal interviews, which shall be done face to face to get the most reliable responses from pharmacists. The proposed methodological framework for this study, will be based largely on several motivational models that would be described later in chapter two, they are Maslow Hierarchy of needs, achievement motivational model, the two factor theory, the expectancy theory and the equity model. From those five models, a guiding criterion will be extracted and compared with the responses of the research questions. In addition to that, the role of management and supervision and its effects on motivation will be examined and compared to the characteristics of a motivational management which will be addressed in chapter 2. And finally, the interviewees will be asked for their recommendations and suggestions for newer and better motivational techniques and methods, to be implemented by the Ministry of Health. 1.6 Data Analysis Method After collecting the qualitative data, they will be analyzed using different criteria. The analysis will basically list the answers of the participants and find the relationships between them with the assistance of weighing frequencies of repentant responses to reach a better conclusion. The conceptual framework will be based on five motivational theories (Maslows hierarchy, achievement model, two-factor theory, the expectancy theory, and the equity theory), which is the base for analyzing the findings. The impact of positive motivation implementations will also be discussed with the selected pharmacists, in addition to an interpretation of their recommendations on improving the motivational process within the Ministry of Health. 1.7 Thesis Structure The structure of the thesis will be based on five main chapters, they are listed below: Chapter one: Introduction. Chapter two: Literature Review. Chapter three: Research Design and Methodology. Chapter four: Data Analysis, Findings and Discussion. Chapter five: Conclusion, Recommendations and Further Research. The next chapter will present our literature review. CHAPTER 2: LITERATURE REVIEW 2.1 Introduction Motivation is a global concept, recognized worldwide today; it is a necessary tool for all different kinds of organizations to survive and grow, and most importantly to succeed. Below is a literature review for the term motivation. It includes different definitions of the term in addition to other terms related to motivation. Different theories on motivation will be mentioned and reviewed briefly to better understand the meaning and limitations of the term motivation. Successful tools to achieve the desired motivation will also be addressed and explained, as well as a review on the different mechanisms used by organizations to motivate their employees. And finally, there will be a review on employee motivation techniques used including a few examples from the best motivational companies in Kuwait. 2.2 Motivation So, who are the motivated workers? According to Myers (1964), when Texas Instruments Incorporated conducted a six year of research and study on the subject of motivation during the 1950s, they came up with the following conclusion1: Employees are motivated to work more effectively when they have a job that is challenging, because it might give them some interest in the job, more enjoyable work, a possibility of recognition, and a since of achievement when they accomplish the task. They become dissatisfied when those noted factors are missing from their jobs. They may also become dissatisfied by some negative factors related to the job itself including astringent rules, no breaks, low status, and low levels of salary or fringe benefits. This study was conducted by a company which experienced a tremendous growth in the 1950s, their annual sales rose from $2 million to over $200 million, along with their employee force which had risen from 1,700 to 17,000 in that decade. This success was accomplished because of their brilliant management philosophy, which provided employees with opportunities that allowed them to explore their works and efforts, and even set their own goals. In addition, the culture was a very friendly and informal one, as employees had very close relationships and strong communication links. Despite that success, the growth was not for long after those years, and employees were no longer highly motivated as before, because there were poor managerial skills in understanding the concept of motivation and how each employee can be motivated. This was in the 1950s; today the main idea or the concept of motivation still have the same old parameters, but with some improvements and modifications after many long studies by many of scientists and philosophers. To best understand the term motivation, one must start with the definition. 2.2.1 Definition of Motivation For the purpose of this thesis, we will keep the definition of (The Collins business Dictionary, 2002) regarding the concept of motivation. In that perspective, motivation is defined as the force or process which impels people to behave in the way that they do. In a work setting, motivation can be viewed as that which determines whether workers expand the degree of efforts necessary to achieve required task objectives2. Furthermore, here is another explanation of the term: motivation represents the forces acting on or within a person that causes the person to behave in a specific, goal-directed manner3. In addition, the online business dictionary (business dictionary , 2009) defines it as the Internal and external factors that stimulate desire and energy in people to be continually interested in and committed to a job, role, or subject, and to exert persistent effort in attaining a goal. Motivation is the energizer of behavior and mother of all action. It results from the interactions among conscious and unconscious factors such as the (1) intensity of desire or need, (2) incentive or reward value of the goal, and (3) expectations of the individual and of his or her significant others4. Since the term motivation is being defined, one must address some terms which are highly related to motivation, including: job satisfaction, job commitment, and job loyalty. Job satisfaction is the satisfaction that an individual gains (or does not gain) from his or her job. It is generally believed that satisfied employees will be more highly motivated and will work more productively than dissatisfied employees. Job dissatisfaction may lead to absenteeism, job turnover, industrial actions, and etc2. Commitment is the state of being bound emotionally or intellectually to a course of action or to another person or persons2. It is a well known fact that job satisfaction strongly leads to job commitment, which later leads to loyalty. Furthermore, job loyalty is another state led to by motivation, and it is a measure of commitment based on obligation or, in consumer preferences, degree of satisfaction2. 2.3 Theories of Motivation Over the years, many researchers have looked into the human psychology and studied the human nature to understand the process of motivation. They have come up with many theories which are being thought now to millions of students around the globe. Below this paragraph there is an overview of some of the most recognized theories of motivation worldwide, starting with the need theories: Maslows hierarchy of needs, and David C McClellands achievement motivation model. 2.3.1 Motivating Employees through Satisfying Human Needs 2.3.1.1 The Needs Hierarchy Theory The hierarchy of needs theory is one of the most recognized theories in the subject. It was found by Abraham Maslow, who published an article in 1943 under the title A theory of human motivation, which was developed later into the hierarchy of needs theory in Maslows Motivation and Personality book in 19545. The hierarchy model is shown in figure 2.1, as presented in the following website (making it clear.com, 2007)6: (Figure 2.1) Maslows Needs Pyramid or Maslows Needs Triangle Taken from (making it clear website, 2007) Maslow has based his theory on the fact that people are motivated by certain types of needs, he classified them into five levels based on their importance to people, and they are in ascending order: physiological, security, affiliation, esteem and self-actualization. He then arranged them in a hierarchy showing the order in which these needs are fulfilled from bottom to top5. According to Maslow, these human needs can be classified into lower and higher levels of needs, the lower levels or factors of needs has to be satisfied and fulfilled before the higher ones, which means they must be satisfied in order, so that a person can be motivated, and reach a high level of achievement in life5. The model indicates that when one need is satisfied, another one becomes important, which means that the lowest level of needs  (physiological)  must be  fulfilled  in  order to  move to the higher one (security), and so on, until one reaches  self-fulfillment 3. In other words, each level of needs is a motivator, which when satisfied, does not motivate anymore, and the higher level is now the motivator5. Firstly, Physiological needs. They are the first and lowest level of the hierarchy, they are the most basic needs which are necessary for the continuation of life, and they include: the desire for food, water, air, and sleep3. It can safely be said that no human being can live without the physiological needs, which is why they are sometimes called survival needs. They must be satisfied in order for a person to move up the hierarchy, and be motivated by the next level of needs5. Secondly, security needs. They occupy the second level of the pyramid, and are sometimes called safety needs, as they include the need for safety, stability and absence of pain, threat or illness3. When it comes to work, these needs may cause the preference for a safe and secure job, with a health insurance benefit for example. They include financial security, as they may cause people to open savings accounts for the security of their future, or to take different types of insurances for example, the insurance against accidents4. When this level is satisfied, a person may move to the next level5. Thirdly, Social needs, which can be explained as the needs someone wants from society, such as friendship and the feeling of belonging3. This level of needs deals with the emotions of the human being, every person needs to feel accepted and loved by others, and as most people do, a human may belong to a group, which can be a small one like family and friends, or a large one such as clubs, religious parties, or even gangsters. In the case that this emotional need was not fulfilled, a person may be lonely and experience some mental disorders such as anxiety or depression3. Esteem is the next level in the pyramid, and it is the desire to feel respected and self worthy, and thereby boost the self-esteem. People need to be valued by other people, they need to be accepted by what they are and recognized for their activities and contributions in order to feel self-valued. The imbalances of this need can lead to low self-esteem, which can cause psychological conditions such as depression3. The highest and last need is Self-actualization, which only appears when all the levels have been satisfied, and involves people recognizing their full potential, and be the best as they can be at what they do3,which can be best seen with self-employed people3. 2.3.1.2 The Achievement Motivation Model This model of motivation has been identified by David C McClellands in 1961. He proposed the idea that there are three important types of needs; they are achievement, authority/power, and affiliation needs. These needs were found to be present in every worker especially within managers, and the degree of which need is dominant can be seen in the workers attitude and behavior at work, which is based on their motivational status7. The ones, who are motivated by achievement, can be seen competing against a high standard, having difficult and challenging goals, and always seeking achievements and advancements in their jobs3. The authority/power motivated ones always strive for authority and leadership. They need to be leaders and have their ideas prevail. In addition, they want to be influential, make an impact in work and on other workers, and reach high personal status3. The affiliation motivated persons are team players; they are motivated by friendly relationships with others, as they need to be liked and always have close friendships7.   The McClelland theory proposed that all people have a combination of these needs, however not in the same level. The level of which particular need is dominant can be seen in someones attitude and behavior at work. He thinks that the managers, who are strongly affected by affiliation motivation, always need to be liked, which in turn affects their decision-making criteria. While authority motivated workers will posses a high level of commitment and work ethics, and in most cases are managers or leaders, unless they do not have the required skills or flexibility for the job. In addition, McClelland thinks that the best leaders are the ones with strong achievement motivation, however they may have some difficulties in leading their staff into believing and having as much dedication to what they want to achieve7. In his theory, McClelland proposed that achievement-motivated people are characterized by the following attitudes3: They set their own goals, because of their high selectivity of matters; they cannot accept other people to draw goals for them. They take full responsibility in their decisions and results, if they succeed they want the credit, and if they do not, they do not mind the blame. To them, Achievement is valued more than financial reward. They prefer achieving their goals to receiving praise or getting recognition. They do not consider a financial reward as a goal; to them it is just a measure of success. They are not highly concerned about Security, or about their status. They like nothing more than a reliable feedback for their work, not to get an appraisal or something of that matter, but to measure their work and see how successful they have been. They always seek better ways to do things, and improve their methods. they are highly selective for jobs which have higher satisfaction for their needs, which means they choose jobs which have greater responsibilities and opportunities for them to set their own goals and achieve them, for example they can work as managers, or in the sales department, in addition to many of them work as entrepreneurs. Next, there is a description of another category of motivation models, which is based on job designs. 2.3.2 Motivating Employees through Job Design 2.3.2.1 The Two-Factor Theory In 1959, Frederick Herzberg and his associates developed a famous theory of motivation known as the two-factor theory, or the motivator- hygiene model of motivation. He studied people to know what the factors that causes them to be satisfied at work, and the ones that causes dissatisfaction to them. He then came up with a list of factors and classified them in two categories: motivators and hygiene factors8. Motivators are the factors that satisfy people at work, in addition to generating positive feeling; they include recognition, achievement, advancement, responsibility, and challenging work. They are called intrinsic factors, because they are related to the job itself 3. Hygiene factors on the other hand, are factors which usually gives negative feelings to individuals, and may affect job dissatisfaction if they were absence, hence the term hygiene, because in the absence of hygiene, health can deteriorate. They include: job security, working conditions, salary, relationship with co-workers and supervisors, company policy and fringe benefits. They are called extrinsic factors because they are external to the job, not directly related to the job itself 8,3. 2.3.2.2 The Job Characteristic Model This is one of the most famous models of motivation, proposed by Hackman Oldham (1976), and it is highly used in designing jobs in many organizations5. It is related to Herzbergs model to a great degree, as it proposes the use of motivation factors at a workplace, and limiting the hygiene factors to minimum9. The model includes five main characteristics of any job, they are: skill variety, task identity, task significance, autonomy and job feedback. It proposes that the levels of all these characteristics should be increased in order to create a motivational environment at the workplace3. The first characteristic is skill variety, which is the amount and the types of skills and competencies required by a certain job. Some jobs are a daily routine activity and require too little from an employee to get them done, while other jobs require certain competencies and skills from individuals which can make them more interesting. Next is task identity, and it is the identification of the complete work needed to complete a task by an employee, from beginning to end, with an identifiable outcome3. Task significance is another characteristic, and it is described as the amount of importance and necessity of a given task, and whether it is worth doing and would have an impact on other people and society, or if it would not make a big difference when it gets done. The fourth characteristic is autonomy, and it is the amount of empowerment and control provided in certain jobs, which increases their importance in peoples minds. The last one is job feedback, which gives indications on an employee performance and effectiveness; therefore a job should be formulated in ways which allow superiors to measure the performer as simply and accurately as possible3,9. The model proposes that the levels of these five characteristics should be increased, because they have strong effects on three psychological aspects in humans, they are3: Experienced meaningfulness of the tasks performed. Experienced personal responsibility for task outcomes. Knowledge of the results of task performance. In the end, the model states that if these three status were raised in a human being, that individual will be highly satisfied at the job and strongly motivated to work. Next, there is another category of motivation models, which is based on performance expectations. 2.3.3 Motivating Employee through Performance Expectation 2.3.3.1 The Expectancy Theory The link between motivation and the expectancy theory was defined by Condrey as: Motivation is a product of the individuals expectancy that a certain effort will lead to the intended performance, the instrumentality of this performance to achieving a certain result, and the desirability of this result for the individual, known as valence10. The theory was found by Victor Vroom in 1964, a business professor at Yale School of Management , it proposes the idea that people become motivated to do a certain job when they believe they will get a certain reward that they want and expect. They make an estimation of the desired results, and based on that they act and behave in a way which will help them get to those results. It predicts that individuals within an organization can be motivated when they believe that10: More effort exerted will yield better performance at a job. Better performance will result in desirable organizational rewards, such as salary increment. These rewards are valued by the performer and satisfy the needs Satisfying the need is worthwhile doing better and giving the required effort to the proposed job. However, Victor Vroom together with his associates Edward Lawler and Lyman Porter thought that the link between peoples behavior at work and their goals was not exactly as simple as previous scientists had proposed. He believed that the performance of an employee is based on three major psychological factors, which can create a strong motivational force to that employee, they are9: Valence: refers to how people feel about and the level of satisfaction they get from the outcomes and rewards of completing their jobs, such as money, promotion, and satisfaction. On the one hand, an outcome is said to be a positive valent if an employee prefers having it. On the other hand, an outcome which an employee does not want to have is known as a negative valent. An outcome which an employee is indifferent about are said to have zero valence. Expectancy: it is the belief of employees that their actions will lead to certain outcomes, and their confidence in what they can do. Instrumentality: This is the belief of employees that they will get what has been promised to them after completing the task successfully. Vroom proposed that the belief of an employee in these three factors helps psychologically in building a motivational force which makes that employee happy and avoiding negativity. Hence, the theory describes the mental procedure of motivation, as people make choices based on their understanding and behavior 3. 2.3.4 Motivating People through Equity 2.3.4.1 The Equity Model The Equity Theory was developed by J. Stacy Adams in 1962; it describes how an employee perceives that the outcome reward of a certain job is being fair, after completing one which is expected to be satisfying9. The theory can be measured against other employees in a work place, or even employees from different organizations. Normally this measurement results in three different perceptions: they will feel they are fairly rewarded, under rewarded, or over rewarded. Unless they feel fairly rewarded, they will act in a way as to reduce inequity. Because they always try to measure what they put in a job (input) and what they get from it (output). Examples of employees inputs and outputs can be found in table 2.1 3: Table 2.1 Examples of employee inputs and outputs in a job: Inputs Outputs Attendance Recognition Personal skills Fringe benefits Commitment and effort Responsibility Level of education Sense of achievements Past experiences Job perquisites (parking space or office location) Performance Job security Personal appearance Promotion and growth Social status Salary Technical skills Seniority benefits Training Status symbols Support of collogues Working conditions (Taken from J Slocum, Jr. (2007) Fundamentals of organizational behavior) The Equity Theory is built on the belief that, employees who think their rewards are fair and equal to their contributions, are the most motivated ones, The same goes for the ones who belief they are being rewarded in a similar manner as their peers. On the other hand, employees may become demotivated when they belief that their input is greater than the output. They may become depressed and not satisfied with their status, and show many negative reactions9. Therefore, managers must be fair and give their employees their fair share of rewards, based on their actions and inputs. They should understand how to balance inputs and outputs fairly, so that they give each employee fair and deserved rewards, which in turn improves employee motivation and thereby gives them more job satisfaction9. As mentioned before, managers must understand the balance of inputs and outputs of their employees; because employees measure their inputs differently, in addition to the fact that they may prefer different types of rewards. For example, a working mother may prefer more flexible working hours to an incentive9. At the end, managers should make sure their employees do not feel under rewarded, because then they will be demotivated, which should be avoided in any organization that wants to be successful. They should reward them fairly and equally based on their efforts, contributions, expectations, and peers 11. 2.3.4.2 The Procedural Justice Theory This theory was proposed by Rawls (1971), and it is based on fairness just like the previous equity model; however it is not based on the outcomes or the outputs, but on the fairness of the process of making decisions5. The theory measures the procedure of making decisions in an organization, which can be fair or unfair, and affects employee motivation and job satisfaction9. Procedural justice can be very important and essential to every company or organization, because it has a great effect on employees. When they perceive a procedure as fair, they become highly motivated to work and improve their inputs at their jobs. On the other hand, if they think the procedure is unfair they may be dissatisfied and demotivated to work9. A good example can be seen in most companies is pay raise determination, if employees perceive fairness of the decision, they will be satisfied, and visa versa. Sometimes, the fairness of such decision can be more satisfying than the raise itself, because the human being highly values equity and fairness. Employees may also judge the process of layoffs within a company, as the survivors would judge the fairness of the decision and become highly affected by it, and if it was a fair decision, they would become highly satisfied and more committed to their job. However if the decision was unfair, they may become demotivated and even have fear about their job status, which usually leads to seeking jobs elsewhere 3. Another examples is students, especially hard workers who put so much efforts in their studies, they expect to get good grades for their hard work, but sometimes they are misjudged or marked unfairly, which can be seen when they compare their results or marks with each other, and when they think the marking procedure was unfair, they become hugely dissatisfied9. 2.3.5 Other Theories of Motivation There are many theories and models of motivation, which are not widely recognized as the ones explained before; here is a review of some of them: 2.3.5.1 The Incentive Theory of Motivation According to Kerr (1995), a reward can be very effective in boosting employee motivation. Whether it was tangible or intangible, when a reward is presented to an employee after a certain behavior or performance, it is more likely that the same desired performance will occur again. In addition, the sooner the reward is given the better, as its effect would be larger in employees minds, and later on, this performance becomes a habit by that employee12. However, as the author has noted, there might be some difficulties applying the technique efficiently by managers, because they should make sure that the reward is not just a simple reward, it should be some kind of a reinforcer, which is like a reminder to employees of the incentive they get for what they did, and later on this becomes embedded in their behavior, and a continuous source for motivation, and job satisfaction. 2.3.5.2 The Drive-Reduction Theory The theory was proposed by C. Hull (1940), who suggested that when a person experiences some kind of a biological drive or arousal to do something, that person will experience a driving force to do that thing. And whenever that person does the action, then the action would be reinforced. For example: when a person is hungry and wants to eat, there would be a drive to do so, but as soon as that person eats, the forced drive becomes reduced. However, the theory was not considered very successful because it did not explain clearly the motivation process9. 2.3.5.3 The ERG (Existence, Relatedness and Growth) Theory Suggested by Clayton Alderfer in 1969, who followed up on Maslows needs theory. He reestablished the order of needs into three categories: the existence category including Physiological and safety needs, the relatedness category including affiliation and esteem needs, and the growth category including self-actualization and needs 13, 9. 2.3.5.4 The Goal Setting Theory This is based on the idea that when an employee sets a goal for oneself, he/she will have to increase performance to achieve t