Introduction

You can have the most beautifully designed and decorated office. You can have the most advanced business and technological systems to manage your financial, marketing and clinical needs. You can have the most ergonomic and efficient dental equipment to provide the most refined clinical dentistry. But by far the most important characteristic of your practice is the people in your team.

Dentistry is primarily a service business. Yes, you do produce a product – healthy and aesthetic smiles. However, the most successful businesses and practices are ones that realize their most important commodity is superior customer service. In his book “The Customer Comes Second,” Hal Rosenbluth astutely asserts "Providing great customer service is contingent on motivating employees (team members) to provide the great customer service."¹

Years ago employers motivated employees by behaving more like law enforcement officers. Solely, the boss established work-place rules and production standards. If employees failed to follow the rules or failed to meet production levels, they were punished through pay reductions or job termination. Over the years, motivational theories and practices advanced so the employer assumed the role of a coach rather than a cop. Coaches of a sport team provide the players with equipment, training and strategies to win games. Similarly, an employer provides employees (team members) with equipment, training and motivation necessary to provide exceptional service and products to customers.²

It wasn’t until the 1950s that corporate America learned the key to increased productivity and profit was through highly motivated employees. W. Edward Deming’s Total Quality Management programs successfully jumpstarted the new Japanese industrial revolution by instituting an employee motivational mindset by employers. During the 1940s Abraham Maslow established the groundwork for current motivational techniques. His adaptation of his Hierarchy of Needs Theory to employee management proved to American industry that the employer/employee relationship had to change if companies were to prosper.

Maslow is considered the founder of humanistic psychology. Humanistic psychology incorporates aspects of both behavioral psychology and psychoanalytic psychology. Behavioral psychologists follow the teachings of Skinner who believed human behavior is controlled largely by external environment factors. On the other hand, psychoanalytic psychologists follow the teachings of Freud who proposed the idea that human behavior is controlled mostly by internal unconscious variables. Maslow’s motivational theories states human behavior is controlled by both external and internal factors, and the need for healthy humans to be the best they can be.

In 1943, Maslow formulated his “hierarchy of needs theory.”³ He proposed people have complex and nuanced needs that must be satisfied, and these needs will motivate until they are essentially satisfied. The needs are arranged in a hierarchy from basic to higher needs with an individual needing to satisfy a lower need before a higher need can motivate. Once a need is satisfied, its power to motivate wanes. For example, a starving individual will do whatever is necessary to obtain food, i.e., eat food from a dumpster, but once fed, the promise of food no longer motivates.

The original five needs of the hierarchy are:

1. Biological and physiological needs (hunger, thirst, shelter, sex, sleep)

2. Safety needs (security, protection from physical and emotional harm, freedom from fear)

3. Love and belonging needs (affection and love, intimacy, belonging, acceptance, and friendship from family, work group, friends and romantic relationships)

4. Esteem needs (also called ego). The internal ones are self-respect, autonomy, and achievement; the external ones are status, recognition and attention

5. Self-actualization (realizing personal potential, self-fulfillment, seeking personal growth and peak experiences and being the best one can be at doing things)

Figure 1. Maslow’s Hierarchy of Needs.⁴

Figure 1. Maslow’s Hierarchy of Needs.⁴

In the 1960s and 1970s Maslow expanded the Hierarchy of Needs Pyramid to include:

6. Cognitive needs (knowledge meaning, etc.)

7. Aesthetic needs (appreciation and search for beauty, balance, form, etc.)

8. Transcendence needs (helping others to achieve self- actualization)

Maslow believed every person is capable and has the desire to move up the hierarchy toward a level of self-actualization. Unfortunately, progress is often disrupted by failure to meet lower level needs adequately. He noted only one in a hundred people become fully self-actualized because society rewards motivation primarily based on esteem, love and other social needs.

It is important to note that self-actualization is a continual lifetime process rather than an achieved state one eventually reaches.

Maslow proposed the “hierarchy of needs theory” not only worked in social situations but could be applied to the workplace. By arranging these needs in a pyramid, they could be used to motivate team members.

A criticism of Maslow’s theory is that the lower needs must be essentially satisfied before a person can achieve his/her potential and self-actualize. By examining cultures in which large numbers of people live in poverty, it is clear people are still capable of achieving the higher levels of the hierarchy such as love and belonging and self-esteem, which according to Maslow should be very challenging and rare.

Another criticism is Maslow’s conclusions of self-actualization are based on the study of predominately highly educated white males such as Thomas Jefferson, Abraham Lincoln, Einstein, Mahatma Gandhi and Beethoven. His female subjects, Eleanor Roosevelt and Mother Theresa, comprised a small proportion of the study, eighteen subjects total.

Maslow (1970) estimated that only 2% of people reach the level of self-actualization.

Some characteristics of self-actualizers are:

• They perceive reality efficiently and tolerate uncertainyy;

• Accept themselves and others for what they are;

• Spontaneous in thought and action;

• Problem centered (not self-centered);

• Unusual sense of humor;

• Able to look at life objectively;

• Highly creative;

• Resistant to enculturation, but not purposely unconventional;

• Concerned for the welfare of humanity;

• Capable of deep appreciation of basic life-experience;

• Establish deep satisfying interpersonal relationships with a few people;

• Peak experiences;

• Need for privacy;

• Democratic attitudes;

• Strong moral/ethical standards.

Behaviors leading to self-actualization are:

• Experiencing life like a child, with full absorption and concentration;

• Trying new things instead of sticking to safe paths;

• Listening to one’s own feelings in evaluating experiences instead of the voice of tradition, authority or the majority;

• Taking responsibility and working hard;

• Trying to identify your defenses and having the courage to give them up.

Self-actualization is a matter of degree. It is not necessary to display all 15 characteristics to become self-actualized. Maslow states “There are no perfect human beings.” Self-actualization is not the same as perfection. Rather, self-actualization is a process of achieving one’s potential.^3,4

Other theories or models of motivation have emerged after Maslow formulated the Hierarchy of Needs Theory.

Instead of five needs that are hierarchically organized, Clayton Alderfer proposed that basic human needs may be grouped under three categories—namely, existence, relatedness, and growth. Existence corresponds to Maslow’s physiological and safety needs, relatedness correlates with Maslow’s social needs and growth encompasses Maslow’s esteem and self-actualization needs.⁵

Frederick Herzberg approached motivation by questioning what satisfies or dissatisfies individuals at work. Company policies such as supervision, working conditions, salary, safety and security may cause job dissatisfaction if lacking, however, if present are taken for granted. In contrast, factors such as achievement, recognition, interesting work, increased responsibilities, advancement and growth, motivate workers.⁶

David McClelland’s Acquired Needs Theory proposes individuals acquire three types of needs as a result of their life experiences. These needs are the need for achievement, the need for affiliation, and the need for power.

People with a high need for achievement are motivated best when their job provides them with the opportunity to achieve goals. They tend to do things themselves and cannot delegate to others and if they do, micromanage.

Those with a need for affiliation are motivated best when their job allows them to develop harmonious interpersonal relationships with others such as teachers and social workers. They would be ineffective in managerial and leadership positions.

Those with the need for power are motivated when their job provides them with the ability to have influence over others and control their environment. Individuals with this need are most effective in managerial and leadership positions.⁷

Another influential theory of motivation is Adams’ Equity Theory.⁸ Simply stated, equity theory views motivation from perceptions of team members who believe there should be a fair balance when comparing their individual efforts (skills, hard work) and results (outcomes, salary/benefits and recognition). Importantly, motivation may also grow or diminish if team members perceive imbalance when comparing their individual efforts and results against other team members. Team members who see equitable levels of effort and results among team members will be motivated. However, if team members believe they are contributing more effort than others and/or not realizing comparable results (recognition, pay, etc.), motivation will decline.

Since Maslow’s ideas inform other motivational theories, the ideas presented in this article are based on his Hierarchy of Needs Theory.

Maslow’s Hierarchy of Needs adapts well to the dental practice. Its institution by the employer will contribute to more harmonious and productive team members.