The recently released APA 2023 Workforce Census report showed that around three in 10 physiotherapy businesses are affected by staff supply and retention issues. 

While job satisfaction across the industry is relatively high, there is an evident gap between what we are providing as practice owners and what our staff are looking for. 

Successfully bridging this gap will increase job satisfaction and motivation, leading to a more effective workforce and longer-term retention of your team. 

It will also improve your attractiveness as a practice to potential prospects. 

There are many options available for doing this including remuneration structures, quality mentoring programs and career development opportunities. 

However, which one is most effective? The answer is that it depends.

Choosing the appropriate option to increase your team’s level of job satisfaction relies on understanding the factors that underpin motivation and then tailoring your approach to the individual.

Motivation, as described by Frederick Herzberg’s two-factor theory, comprises two distinct components: hygiene factors and motivators. 

Hygiene factors are the extrinsic, basic elements of the job such as a competitive salary, job security and good working conditions.

Motivators are the intrinsic elements such as recognition, responsibility and achievement. 

Both components are necessary ingredients for cultivating a high level of job satisfaction and engagement for an individual and
their presence or absence in a workplace will significantly affect an employee’s level of motivation. 

There are four combinations of these factors that you will typically see in your practice.

High hygiene and high motivation—these employees are highly motivated and engaged with their work. While they may or may not be your highest biller, their energy and enthusiasm are key motivators within the team.

High hygiene and low motivation—these employees view their work as just a pay cheque and will do the minimum requirements to keep their job. They will be highly resistant to doing tasks or activities that are outside of their ‘job description’.

Low hygiene and high motivation—these employees may actually be one of your highest billers but they also have the most complaints. They are highly engaged in the work but can be an energy drain within the practice.

Low hygiene and low motivation—these employees are not engaged or motivated. You should try to move them on as soon as possible.

Gregory Goh.

Clearly, we should be cultivating a practice environment that moves our employees towards the high hygiene and high motivation zone while protecting the team from both the low-hygiene and low-motivation individuals. 

This is why choosing the most effective option to bridge the gap between what we offer our team and what they actually want should be tailored to the individual. 

While we should ensure that we are providing an adequate baseline of hygiene and motivation factors, the art of motivating a team lies in our ability to be adaptable.

Some team members will be more motivated by increased hygiene factors, such as a generous remuneration and bonus structure, while others will be motivated by greater responsibilities within a practice. 

Herzberg’s motivation theory operates on an assumption of equity in which team members are given opportunities based on their individuality and what will bring out their highest contribution to the practice. 

There are two main steps to take in applying motivation theory to your practice: elimination and enhancement.

Step 1: elimination

The first step is to identify and remove any potentially negative hygiene factors within your practice. 

This can be completed through a formal process such as employee engagement surveys or informally through mentoring sessions. 

The aim is to open a conversation with your team about what they are experiencing as job stressors within the practice. 

Once these have been identified, you can address them—either by fixing the hygiene factors or by providing a clear explanation as to why a particular factor is present. 

This step provides a strong foundation on which to build an engaging work environment.

Step 2: enhancement

The second step is focused on enhancing the motivating factors for your team. 

Herzberg suggests three ways to improve the engagement levels of your team: job enrichment, job enlargement and employee empowerment.

Job enrichment

Enrichment is about analysing the current level of challenge that your team member has within their role and adjusting it to decrease their boredom or disengagement. 

For example, if a clinician has begun to outgrow their current role, you can encourage them to widen their current skill set by upskilling in more niche treatment areas or to deepen their current skills by attending external courses. 

Guiding your team member towards more job complexity increases the level of intrigue in their job and reduces boredom and disengagement.

Job enlargement

Enlargement expands on the previous step and is intended to grow and diversify your team member’s current skill set to encompass non-clinical areas such as mentoring or business development.

This serves to keep your team member engaged—expanding their skills and knowledge in a way that is aligned to their interests and goals—while also strengthening the capacity of your practice by leveraging these new skills to improve business processes.

Employee empowerment

This final aspect is focused on creating an environment of autonomy and contribution within the practice, providing team members with a high level of empowerment in their jobs. 

It involves establishing a culture of psychological safety where team members can offer suggestions and improvements within the practice and appropriately delegating responsibilities and tasks. 

This strengthens the previous steps of job enrichment and enlargement, deepening your team’s sense of empowerment and contribution to the practice.

To retain and attract high-quality employees, it is vital for private practice owners to be able to effectively engage and inspire their team. 

Understanding and applying Herzberg’s motivation theory can assist in cultivating an environment of high hygiene and motivating factors where team members can achieve a strong sense of job satisfaction and motivation. 

This will lead to a high-performing team, increased employee retention and a truly great place to work.

In the words of Frederick Herzberg, ‘It’s the job of the manager not to light the fire of motivation, but to create an environment to let each person’s personal spark of motivation blaze.’

>> Greg Goh APAM is a physiotherapist, practice owner, leadership and business consultant, and author of Words Matter: How to win patients and influence behaviour change. He is passionate about developing the next generation of leaders within the healthcare industry.