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This case study seeks to investigate work-based decision-making practices of long-term employees at Carolina Hospital. Through researching company documents and performing interviews, participating employees' decisions and motivations were analyzed and deconstructed in relation to the Expectancy Theory.  The Expectancy Theory is based on the basic idea that people will be motivated when they believe that their efforts will lead to performance they want, as well as rewards they desire (Redmond, 2010). We proposed that individual perceptions of ability, value, and priorities, as well as company policies and benefits, influence employee motivation and decision-making.  It was hypothesized that, by applying the Expectancy Theory and learning what will produce a high motivational force score for employees, companies will have a higher success rate of internal promotions and employee success.  Motivational force score, according to Expectancy Theory, is pressure within the person to be motivated (Redmond, 2010) and can be calculated using the following formula: Motivation = Valence * Expectancy * Instrumentality.  For each situation, there may be one or more rewards or outcomes for a behavior (or, in this case, a decision).  Expectancy Theory assumes that, for every possible outcome, valence, instrumentality, and expectancy must be high for an employee to have a high motivational force score. Thus, if an employee must choose between receiving a promotion or staying in the position they are currently in, we hypothesize that the employee will choose the outcome with the highest perceived reward/value. 

In order for companies to stay profitable, they need to retain their trained employees.  Hiring and training is time consuming as well as expensive. However, in 2012, employee loyalty is at a 7-year low ("Declining Employee Loyalty", para. 2).  According to Andrew Cobb (2012), "When you are talking about loyalty in the workplace, you have to think about it as a reciprocal exchange.  My loyalty to the firm is contingent on my firm's loyalty to me. But there is one party in that exchange which has tremendously more power, and that is the firm" ("Declining Employee Loyalty", para. 4).  Though a successful business, Carolina Hospital has been struggling with high turnover rates and long-term employees turning down promotions. We examine how workplace factors, such as social relationships, politics, rewards, policies, and equality or independence, as well as how outside factors, such as family and social relationships (outside of work), outside activities or obligations, etc. for the 5 long-term employees affect motivation.  Long-term employee is defined as any employee who has remained within the company (though not necessarily remained in same position) for 15 or more years.  

Carolina Hospital has recently undergone major political and financial changes, beginning in the 1980s.  Once a small community hospital, Carolina Hospital has since boomed into a thriving, expanding business with multiple locations.  Due to this expansion, the hospital has now been split into many departments delegated by supervisors who have little contact with the employees, save for each department's manager and, together, they determine who receives raises, promotions, or layoffs.  The CEO of the hospital makes executive decisions regarding allocation of financial resources by department and in the number of employees in those departments.  Many view this new way of running the hospital as 'too corporate' and detached from the individuals.  Of the 5 employees examined, some witnessed the company's transition from small business values to the bigger business practices. Others began in one department and have since either risen in rank or transferred to another area.  This study seeks to dissect the factors that contributed to each employee's career-based decisions, as well as what has made them remain with the same company for more than 15 years. 

Case Information

Carolina Hospital is the city's largest for-profit hospital system, with three charter hospital facilities in their system.  The main, and original, facility, is where the study was performed (though some employees interviewed also worked at the other locations).  For over 20 years, Carolina Hospital has had a set system of rewards, based on length of employment.  There is an annual 1% raise for all employees, as well as an increase in vacation time for the first 4 years, followed by increases every 2 years after that.  Carolina Hospital also encourages education and reimburses employees for a certain percentage of educational costs.  However, in efforts to increase profits and minimize expenses, the hospital has continually implemented restrictive policies that have led many employees to either transfer to another hospital or refuse promotion.  Below, we will give a small biography for each of the 5 employees which will help us examine their decisions within the company, as it relates to the Expectancy Theory.

Patty- Patty is 52 years old. She began working at Carolina Hospital when she was 22 years old. She started at $3.75 an hour as a low-level employee in the financial department. At that time, she had an Associates degree in Accounting.  Growing up, Patty's parents were very materialistic and pressured her to be successful to earn their approval. Thus, when she got the opportunity from the hospital for a promotion and paid schooling, she took it.  By the time she married, she was already making a great deal more than she had been just 5 years prior.  Although it meant placing her son in daycare when only 3 weeks old, Patty chose to remain in the higher-stress position after starting a family.  She continued on to get her Master's degree and rise in the financial department until she reached the 3rd-highest position, making roughly $100,000 annually.  At this point, she had two sons and barely spent time at home.   She claims her decision to dedicate herself to work and do whatever they asked of her (social expectations, over time, out of town trips, more responsibility, etc.) was for her and her son's good--the financial aspect and the job security would give her the ability to get out of an abusive marriage.  However, when, at 50, she was offered the second-highest position in her department, she took it.  She no longer had children to raise and was divorced. In fact, she had remarried and now had a grandson.  Though the position offered 'status,' recognition, more power, and great pay, it also meant working constantly, being on call regularly, and stress that is now nearly crippling her.  Patty consistently shows great effort, going above and beyond what is asked of her.  In the interview, Patty states that she finds her identity and worth in work and cannot imagine quitting.  She feels too many need her and she likes being needed.  When asked about family sacrifices, Patty is vague and says 'it is not about quantity, it's about quality,' though she does admit the stress has led her to feelings of depression, exhaustion and insomnia. 

Maria- Maria is 44 and has been working at Carolina Hospital as a CNA for 17 years.  She is bilingual, which is a great asset for the company; however, she has consistently refused offers for promotions or paid schooling.  Maria admits a fear of not being able to succeed if given that challenge, but also adamantly insists her decisions are based on her family.  The reward of being able to be a part of her children and grand-children's lives far outweighs any financial reward.  When the hospital built different facilities around the city, Maria requested that she not be transferred or floated, due to transportation issues.  Recently, the hospital has been offering Maria a significant pay raise if she signs on to be a 'floater.' The hospital has assured her that she will only go to the other facilities as needed, and that the main campus will remain her primary workplace.  The first time she was asked, she refused.  When the supervisor of the department approached her and told her that they valued her commitment, skills, and connection with patients, Maria accepted.  In the interview, Maria said talking to her Supervisor made her feel motivated by giving her confidence she could do the tasks asked of her. In addition, she says that the higher pay will help her to get her own vehicle, and provide for her family better. 

Wanda- Wanda is 44.  She has been working as an OB/GYN at the hospital since 1996.  Carolina Hospital is the first and only hospital Wanda has worked at since graduating from NYU.  Wanda is single and lives 50 minutes from the hospital with her mother, who is 72 and very ill.  Wanda knows she is very good at her job and has received plenty of praise for it.  In 2010, Wanda was approached by the Board of Directors about opening up a clinic closer to her home.  Wanda accepted the position and the clinic is set to open in 2013.  Records indicate, however, that Wanda passed up an opportunity to be promoted within her department a few years before. When asked why she passed up the first offer, but accepted the second, Wanda says it is because she did not feel she could perform the tasks with the first promotion as well as she can by staying at the same position in a different location. Wanda admits that she bumps heads with authorities a lot and expects a lot of freedom from them by going to the clinic.  Wanda also notes that the first promotion would have required, she believes, more stress and less time at home.  Wanda is motivated by the possibility of having a smaller number of patients with whom she can get to know better. She is also motivated by the fact that it is closer to home should her mom have an emergency.  Finally, Wanda confides that she hopes she can earn and save up enough to 'buy out' the hospital at some point and set up this clinic as her own private practice, as her own boss. 

Roger-  Roger is 65. He has been a maintenance man at Carolina Hospital for 47 years.  He was here before the hospital expanded and witnessed all the changes that came with new bosses and business practices.  Roger dropped out of high school at 16 and left home. He is a hard working man, but claims to be a simple man. He does not see himself as smart and looks forward to spending time with his family and working on cars on the weekend.  He has refused opportunities for better positions and better pay.  He says it is because he does not want to have to worry about anyone but himself. He is dedicated to the hospital, but just wants to do his job and come home. He is not interested in the politics and knows that a higher position would put him right in the middle of that. Roger is known to drink and does not have ambition to 'do better' in life.  When asked why he has stayed with Carolina Hospital, he answered, "they treat me good." When pressed further, he says that the hospital gave him a job at 18 when other places wouldn't and he feels a sense of loyalty to them. They also helped his family with medical care when they needed it and gave him a company truck a few years ago. He also says he has a retirement set up and is just biding his time "'til he can bow out."

Bill- Bill is 45. Bill is the Supervisor of maintenance. He has been working with Carolina Hospital for 15 years.  His cousin is on the Board of Directors and got him this job.  Bill is known to be rude, lazy, and unmotivated. He is well paid and has many benefits, yet consistently does not show up to work or complains about the job. Bill believes he cannot be fired because of his 'connection.' He does not enjoy maintenance work and knows very little about it.  As a result, he asks Roger for help.  His supervisor maintains all the campuses and has little time to check on Bill.  The other employees file complaints, but Bill uses his 'connections' to silence them before they get to anyone who could punish him.  Bill does not feel you should enjoy your job and sees nothing wrong with his behaviors. 


Expectancy is based upon the notion that effort leads to better performance; that the harder one works, the better the perceived result. Expectancy can also be defined as the relationship between effort and performance, which is known as the E-P linkage (Isaac, 2001). One must believe that the effort that is put in will actually yield the expected performance (Redmond, 2010).  It is important to note that there are internal and external factors that affect an employee's expectancy.  For example, if an employee is required to use an outdated computer program, it is likely his/her expectation will be low that their effort will lead to a better performance due to the limitations forced on him/her by such external factors.  On the other hand, if an employee is not confident he/she can learn a new program, his/her motivation to exert more effort in this area will be low because of their internal expectation of failure.  Expectancy can be measured on a scale of 0-1, with a score of 0 indicating that the employee is certain he/she cannot perform successfully and 1 indicating certainty that he/she can perform successfully.  If an employee has a score of 0.5, it indicates he/she believes they have a 50/50 chance of success (Redmond, L.4, p.3).  


Instrumentality is the relationship between performance and outcome, otherwise known as the P-O linkage (Redmond, 2010).  If an employee believes that improving their performance at work will get a desired reward (raise, promotion, time off), then they are willing to work harder.  If a weak relationship between performance and the outcome is perceived (not likely to get the pay raise, etc.), the individual is not likely to change their behavior.  In other words, instrumentality is based on the employee's belief that if they attain a certain level of performance, they will receive the desired outcome--an employee may believe that volunteering to work overtime, for example, may be instrumental in getting them noticed by their boss, which may be instrumental in ensuring a performance-based raise (or better yet, a promotion), which would then be instrumental in allowing her to go on her dream vacation to Italy.  Like expectancy, instrumentality is based more on the employee's beliefs about contingencies than the contingencies that actually exist (Redmond, 2010).  Even if there is strong link between performance and outcomes in reality, if the employee does not believe this link exists, Expectancy Theorists believe the employee will not be motivated to perform. 

Instrumentality may range from a probability of 1.0 (meaning that the attainment of the second outcome (i.e., pay raise) is certain if the first outcome (improved job performance) is attained) through zero (meaning there is no likely relationship between the first outcome and the second). An example of zero instrumentality would be exam grades that were distributed randomly (as opposed to be awarded on the basis of excellent exam performance) (HR Tutorials, 2011).  A score of .5 indicates that the employee perceives there is a 50/50 chance that the performance will produce the desired outcome. 


Valence can be posed as the question, "How strong is the relationship between what I do and what I get" (Redmond, L.4, pg. 5). From the Latin, valentia, valence means value and represents the importance people put on possible outcomes. This is to say that an employee holds a belief about how desirable an outcome of his or her actions will be. However, unlike instrumentality, valence is measured on a -1 to +1 scale. More simply, a negative score for valence represents an undesirable outcome, a score of zero represents a neutral outcome, and a positive valence score represents a desirable outcome.

An interesting point about valence is that a person may change their opinion about an outcome after it has happened. For example, if a company is undergoing a major change in management, an employee may worry about new rules and regulations; this would make the change in management a negative valence for the employee. However, after the change, they find that the work environment is now better-suited to their work style and prefer the new management to the old. While valence is best examined prior to the outcome occurring, it may still change for the employee personally.

Motivational Force

Motivational force is the product of the combined results of Expectancy, Instrumentality and Valence. It can be formulated as: MF=Expectancy x Instrumentality x Valence.  Motivational force is characterized as "the pressure within the person to be motivated.  The larger the force, the more a person will be motivated to obtain the outcomes of the job" (Redmond, L.4, p. 6).  In order for an individual's motivational force to be high, expectancy, instrumentality and valence must all be high.

  (, 2011). 


Case Details





of MF




Within-Subject Results



Sr. Management -



Patty has always believed that if she put in the extra effort that she would achieve the outcomes that she wanted. This is evident in the amount of work she was willing to do, the sacrifices that she was willing to make regarding time with her family, her commitment to education, achieving a Masters in finance and rising to the second position in her department. In addition to having the desire and belief  in herself, she also had the support of her parents, who pushed her to be successful, and the support of the hospital, which funded her advanced degree. This validates the statement that with proper training and a high interest level, people will have an increased
level of expectancy" (Redmond, 2010).

Patty believed that, by getting a higher education and sacrificing her family life, she would achieve the outcome and rewards desired--promotion, wealth, etc.

Patty has a high valence rating due to the fact that she sees her job, and progression through her work as the best way to achieve what she wants. She places a high value on her work and has felt that has offered her the best solutions through out her life.

Patty has been with the company before and after the changes were made--with leadership, finances, etc.  Patty has made consistent decisions and shown the same amount of effort throughout the period at Carolina Hospital.  Patty's motivation seems more internal than external (the desire to be wealthy, independent, powerful/successful, etc.); and, the rewards offered were in line with her expectations and desires



(Certified Nursing



Unlike Patty, Maria has not always displayed high expectancy, having not been convinced that the extra work effort was worth the outcome.  She has refused additional paid education and did not want to take advantage of the opportunities that new facilities might offer. However, when her supervisor assured her that she was valuable to the team and that they believed in her, she accepted, and even seemed enthusiastic, saying that her supervisor motivated her by giving her the confidence to take on more responsibility. This demonstrates how so often expectancy is based  upon perception; Maria's perception of herself and her abilities was low until she was given extra confidence and support by her supervisor. Unlike Patty, she did not have an inborn sense of confidence, but had confidence that needed to be nurtured and developed.

Maria's instrumentality is low, as seen through her refusal to pursue higher education, as offered by the hospital.  Maria has not believed that the opportunities offered would result in the outcomes and rewards she desired.  It was only after encouragement from the company that Maria began to see the rewards as valuable and the promotion as instrumental in achieving those desired results.

Maria places value on her work and the opportunities it offers her; however, she places more value on other things (such as time with her family). Maria's value on her job is positive and she appreciates her work, however it is not the most important thing to her.

Maria was not always sure that the effort that she expended would lead to the performance needed to ensure a positive outcome, but with additional support from management was able to change that perception.  Within-subject results show that Maria values encouragement as well as understanding from the company that her family needs come first.  






Wanda's expectancy is high; she believes in herself and her abilities and knows both her goals and limitations. She is more interested in fewer patients that she knows well,  and a job that is balanced well with home life, so not just any promotion will suit her. Her issue is not expectancy; she believes that the effort she puts in will yield the results she wants, she simply does not always want the outcome that is being offered to her.

Wanda chose to value her personal time and being closer to home. She also chose to have fewer patients and put in a solid caring effort for each of them, quality over quantity. She sees that accepting the position as main doctor at the clinic as instrumental in achieving these desired results. 

Wanda's valence has increased since she has been given the opportunity to work at a clinic closer to her home and sick mother. She felt before as though she was pushing what she felt was an acceptable time away from home. However, now she has more freedom and this has raised the value she places on her job.

Wanda passed up a promotion in the past because she did not think that it would justify the extra time away from home, and, in general  what she values above all is her autonomy, which the new role will give her. That appears to have tipped the scales in regard to the second role, although it is not so much that the hospital offered additional autonomy but rather that it is a consequence of the new situation, which Wanda values most. 






Roger puts in the exact amount of effort to achieve the outcome that he wants; he is not interested in moving up  but feels extremely supported by the hospital in his position and feels a sense of loyalty to them as a result. The hospital seems happy with his lack of ambition to move up, demonstrating support by looking after the healthcare needs of his family and supplying him with a truck. As with Wanda, expectancy is not Roger's issue; he is happy with the outcome of his efforts.

Roger does what is required and is just plugging away the days until his retirement.  Roger does not have an issue with effort or performance; however, he does not attribute this effort with any specific reward or outcome, other than being able to stay in this company and provide for his family. 

Roger does not have a positive or negative valence towards his his work. While he has loyalty to his company he is not looking to move further in his career. Roger is content where he is and does not feel the need to change anything. This gives him a neutral value to his job.

Roger has consistently passed up promotional opportunities, regardless of changes within the company. It is clear that he values his job; however, he does not expect his life would improve with a promotion.  Within-subject results show that Roger is motivated by the support and recognition he feels the company has given him over the years, values loyalty to work, and is content with where he is as long as it provides for his family. 



Supervisor of 



Bill already has what he wants, which is a good paying job where you do not have to expend much
effort, so he has no real motivation to expend any extra effort. Expectancy is defined as the relationship between effort and performance (Isaac, 2001), and in his case, he knows that neither has much to do with why he has the job or how he keeps it. He is also not punished for what is quite poor behavior, including missing work, complaining about the job, and making the job less pleasant for others around him.

Bill does just enough to not get fired. His performance is poor and the outcome is stagnant.

While Bill feels that he has everything he needs at the moment, he places little value on his work or his job in general. To Bill, the important factor of his job is money; however, he does not enjoy his work and therefore has places negative value to his job.

Within-subject results show that Bill expects the same outcome (reward) regardless of effort or performance. He stays with the company because he values the ability to do as he wishes without repercussions.  In order to improve motivation and performance, Bill may need accountability and discipline/punishment.

Limitations & Further Research:

The limitations on this research are that the study does not cover a broad range, as it is a cross-section of employees. In addition, this only covers employees in one organization, so it may not translate to another company that has a different organizational structure. Additionally, the motivational force of the employees could be very different if Carolina Hospital had a unionized workforce. 

To assess broader, generalizable findings across the organization, a survey could be taken amongst all employees. Due to the need for information about position and years with the company, such a survey would be limiting due to its lack of anonymity.  A longitudinal assessment would be able to access all employees across the entire organization, and value all of their opinions. The employees may also engage in some self-realization about their positions within the company, possibly generating more enthusiasm, but it could encourage complacency, or worse yet, alienation.

Another limitation is that Carolina Hospital's management may be unique in the ways in which they endeavor to retain and motivate long-term employees. In general, for-profit hospitals have been found to pay their workers less than their non-profit counterparts (Shalpoori & Smith, 2005), yet have a history of higher executive compensation and goals to drive profits (Rodack, 2012). In order to ensure that Carolina Hospital is representative of other for-profit institutions, a survey could be put in place to ensure that there is business and compensation-plan parity in order to determine whether the measures taken by Carolina Hospital would be effective in another institution.


As Victor Vroom (1964, 1995) proposed, motivational force is the result of the union of expectancy, instrumentality, and valence (VIE), hence the reason expectancy theory is also referred to as VIE theory.  This study sought to demonstrate, as Redmond (Redmond, L.4, pg. 6) suggested, that all three VIE factors must be high for motivational force to be high, and if any one is low, motivational force is low.  In an effort to explore the increasing problems at Carolina Hospital with both turnover and promotional stagnation, employees who managed to remain with the organization long-term were analyzed.  While the study's evaluation of motivational force necessitated consideration of all three levels of VIE theory, the particular emphasis was to determine how to increase valence, specifically, how to generalize information gleaned from the case study subjects into a more comprehensive understanding of assisting creation of the impression or belief in the desirability of long-term employment within the organization, as well as the desire to seek promotion within, rather than seek it elsewhere.

Interestingly, one factor which could normally be seen as a benefit proved occasionally a detriment: promotions.  While management might feel that an individual would be a perfect match for a new position, the perception of the employee as created by the employer might cause them to feel otherwise.  In fact, management decisions or expectations themselves may have a deleterious effect on whether employees stay in a given position, are willing to accept a new one, or leave the organization altogether for a new place of employment. Several long-term employees studied refused promotion either initially or repeatedly, for both personal and professional reasons, demonstrating that valence is not the same for all employees: some desire or almost demand promotion, while others are content to remain at their current levels indefinitely, and yet in both instances employee loyalty is not necessarily diminished.  The burden on management related to promotions is that they must determine which employees would want promotions, which are avoiding them for lack of appropriate encouragement, and lastly which are not actually interested.  Employee loyalty is therefore related to both their belief that they have the opportunity for promotions when they want one as well as not feeling pressured to change positions when they do not.

In summary, the study illustrated admirably how different employees are motivated by completely different interests, and what motivates one employee to remain with an organization long term varies dramatically with what motivates others.  A reasonable generalized conclusion would be that the best approach an organization could take with regards to increasing long-term retention of employees is to focus on regular evaluations of employees with the intent of determining precisely what motivates each one, as much as is possible given that some motivators are unconscious, and then having management demonstrate how the employer could assist the employees in reaching those goals, creating the perception that the quickest or best route to each employee's goal would be within the company.


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Knowledge@Wharton. (2012, 09 May).  Declining Employee Loyalty: A Casualty of the New Workplace. Retrieved from

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