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 for advanced clinical dentistry. The most essential 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 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

Many employers believe that a person will work harder if paid more. Many also believe that pay is the only reason that people work. However, modern management proposes that people work for reasons other than pay. (After all, many people put in many hours of volunteer work for organizations that pay nothing!) Although people must meet their financial needs, they also work because of the friendships they form on the job and the sense of personal accomplishment and value they can gain from a job. It follows, then, that if people work for these other reasons, a business owner can motivate them to work harder or do better by arranging the job so that they can accomplish these needs.

Modern management experts believe that people work for three reasons; compensation (pay and benefits), psychological reasons (personal growth and fulfillment), and social reasons (friendships and relationships in the workplace). As the practice manager, the owner must control these motivation factors to develop and encourage excellent employees. That is a difficult task in itself. To make the problem even more complicated, different employees want different amounts and types of fulfillment in each area. Motivating employees to work at their peak level can be a complex problem.²

In the 1950s, corporate America learned that 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. Adapting 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 primarily controlled by external environmental factors. On the other hand, psychoanalytic psychologists follow the teachings of Freud, who proposed that human behavior is primarily controlled mainly through internal unconscious variables. Maslow’s motivational theories state that human behavior is controlled by external and internal factors and the need for healthy humans to be their best.

In 1943, Maslow formulated his “hierarchy of needs theory”.⁴ He proposed that people have complex and nuanced needs that must be satisfied, and these needs will motivate them 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 wants 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 that 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 that 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 that 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.

With dental school enrollment now at a 50-50 gender split, the percentage of women dentists in the workforce has grown from 24.1% to 34.5% between 2010 and 2020. It is anticipated that the dentist workforce will reach gender parity by 2040.⁶

Motivational theories generally apply to individuals regardless of gender, as similar psychological processes drive human motivation. However, specific theories and perspectives concerning women's motivation have been explored, considering societal factors and gender-specific experiences. Here are a few motivational theories that have been discussed in the context of women:

Self-Determination Theory (SDT) suggests that individuals are motivated when their basic psychological needs for autonomy, competence, and relatedness are fulfilled. Research has shown that women's motivation can be influenced by their need for connection and supportive relationships, making relatedness an essential factor.

Transformational Leadership Theory focuses on leadership styles and their impact on motivation. Some research suggests that transformational leadership, which involves inspiring and empowering followers, may be particularly effective in motivating women. Transformational leaders tend to create a supportive and inclusive work environment, enhancing women's motivation and engagement.

Social identity theory explores how their membership influences individuals' self-concept and motivation in social groups. Women's motivation can be influenced by their gender identity and the degree to which they identify with other women. When women perceive a solid and positive social identity, it can enhance their motivation and empowerment.

The impact of gender on motivation is complex and multifaceted, influenced by individual differences, cultural factors, and societal expectations. Therefore, it is crucial to consider the diversity of experiences and motivations within any gender group.⁶

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

Some characteristics of self-actualizers are:

• They perceive reality efficiently and tolerate uncertainty;

• 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 essential 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 total absorption and concentration;

• Trying new things instead of sticking to safe paths;

• Listening to one’s 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. Instead, self-actualization is a process of achieving one’s potential.^4,5

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

Instead of five hierarchically organized needs, Clayton Alderfer proposed that basic human needs may be grouped under three categories—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.⁷

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.⁸

David McClelland's Acquired Needs Theory proposes that individuals acquire three types of needs due to 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 allows them to achieve goals. They tend to do things themselves and cannot delegate to others; if they do, they micromanage.

Those needing 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 needing power are motivated when their job allows them to influence others and control their environment. Individuals with this need are most effective in managerial and leadership positions.⁹

Another influential theory of motivation is Adam's Equity Theory.¹⁰  Equity theory views motivation from team members' perceptions of a fair balance when comparing their efforts (skills, hard work) and results (outcomes, salary/benefits, and recognition). Motivation may also grow or diminish if team members perceive imbalance when comparing their efforts and results against other team members. Team members who see equitable levels of effort and results among team members will be motivated. However, motivation will decline if team members believe they are contributing more effort than others and/or not realizing comparable results (recognition, pay, etc.).

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 dental practice. Its institution by the employer will contribute to more harmonious and productive team members.