Employee Motivation In A Non-Profit Hospital In The Federal State Of Baden-Württemberg

Employee motivation in nonprofit healthcare institutions has become an increasingly relevant topic due to the sector’s limited financial resources and inability to offer conventional material incentives. Unlike for-profit organizations with greater access to financial means, nonprofit institutions often rely on intrinsic motivational factors such as a sense of purpose, professional fulfillment, and organizational culture.

The motivation process illustrates how individuals act based on their needs, which serve as internal drivers of behavior. These needs generate a force composed of physical and mental impulses to achieve satisfaction.

• ^*Corresponding author: jelena.a.rajevic@gmail.com

  (сс) ©    © 2025 by the authors. This article is an open access article distributed under the terms and conditions of

the Creative Commons Attribution (CC BY) license .

According to Turabik and Baskan (2014), once an individual is stimulated, they act to fulfill their needs and reach a state of satisfaction.

Theoretical approaches to motivation can be categorized into three major groups:

Early views on motivation were based on the belief that humans are inherently lazy and selfish, requiring external pressure to be productive. Motivation here is induced systematically, avoiding overt coercion.

Content theories of motivation argue that internal needs drive individuals to action. These include Maslow’s hierarchy of needs, Alderfer’s ERG theory, Herzberg’s two-factor theory, and McClelland’s need theory (Stosić, 2014). These models classify needs into specific groups—from physiological needs and safety to achievement and personal growth.

Motivation process theories focus on how individuals evaluate the effort needed to achieve goals and select specific behaviors accordingly. Motivation depends on expectations about the likelihood of reward, the value of outcomes, and perceived task complexity (Leković, 2011). These theories emphasize how motivation evolves during goal pursuit and is shaped by situational factors and individual expectations.

Each framework is rooted in real-world behavior and valuable for managers who wish to influence change. Thus, motivational knowledge becomes a fundamental tool for managers to design work environments supporting individual and organizational success.

A key theme across all major theories—especially content and process theories—is that both existential and socio-developmental needs drive people. Therefore, effective motivational strategies should include material compensation and non-material incentives to address employee needs (Stosić, 2014).

While employees may share similar needs, the degree of importance they assign to each need often varies. For this reason, managers must approach employees as individuals and identify their specific motivational priorities.

Although these motivational theories have been criticized, they still offer useful frameworks for designing motivational systems, especially when tailored to the characteristics of a given organization.

Considering motivation, it is important to account for employment conditions and job market limitations. In some countries, especially during economic crises, motivation is influenced by internal drivers and the perceived scarcity of job opportunities.

Whereas traditional motivation theories emphasize internal factors as the primary drivers of behavior, behavioral control theories argue that motivation can be shaped entirely through external factors. The core idea is that employee behavior can be directed and shaped through rewards and reinforcement (Stosić, 2014).

Modern motivation theories—such as Maslow’s (1943) hierarchy of needs, Herzberg’s two-factor theory (Herzberg et al., 1959), and Deci and Ryan’s (1985) self-determination theory—emphasize the importance of non-material incentives in promoting job satisfaction and engagement. Herzberg distinguishes between hygiene factors (e.g., salary, job security) that prevent dissatisfaction and motivators (e.g., achievement, recognition, responsibility) that drive satisfaction. Deci and Ryan highlight autonomy, competence, and relatedness as key components of intrinsic motivation.

This study examines the motivational factors influencing employees in a nonprofit hospital in the German state of Baden-Württemberg, explicitly focusing on personal motivators and dominant forms of motivation in the organization. It analyzes both material and non-material motivators, as well as intrinsic and extrinsic factors, while considering the specific characteristics of the nonprofit healthcare sector. Special attention is given to whether employees in such organizations are more motivated by non-material factors and whether demographic differences (e.g., gender, tenure, job position) influence motivational preferences.

Materials and methods

This study aimed to identify the key motivational factors that influence employees in a nonprofit hospital, with a particular focus on the distinction between material and non-material incentives. It also examined whether there are statistically significant differences in the perception of motivation based on gender, years of work experience, and job position.

The following hypotheses were formulated:

• H1: Non-material forms of motivation have a greater impact on employees than material factors.

• H2: There are significant differences in the perception of motivation between men and women.

• H3: There are significant differences in motivational factors depending on job position.

• H4: There is a correlation between years of work experience and the dominant type of motivation.

The study was conducted during January and February 2025 using an online survey. The sample consisted of 20 respondents employed in a nonprofit hospital in Baden-Württemberg. Most participants were women (80%), and most had higher education qualifications (85%). Work experience ranged from entry-level to more than 30 years, and participants included both operational staff and those in lower and middle management positions. The survey included questions on the importance of various motivators (e.g., salary, job security, autonomy, recognition) and their presence in the workplace. Data were analyzed using SPSS, applying descriptive statistics and significance tests (Mann–Whitney, ANOVA, and Chisquare).

Results

Non-material factors such as good relationships with colleagues, job security, and opportunities for professional development motivate employees more strongly. While material factors are also considered important, they are not the dominant motivators (see Table 1).

Table 1. Employee Ratings of Personal Motivators

Item	Mean	Standard Deviation
Performance-based pay	3.60	1.314
Salary level	3.85	1.040
Good communication and relationships with peers	4.35	1.137
Pension and health insurance	3.60	1.188
Good working conditions	3.85	1.137
Job security	3.95	0.826
Good relationship with supervisors	3.85	0.933
Interesting and creative work	3.95	0.887
Recognition for a job well done	3.75	1.118
Opportunities for advancement	2.95	1.191
Autonomy and independent decision-making	4.00	0.795
Opportunities for development and improvement	3.95	0.887

The arithmetic mean of the rated personal motivators ranges from 2.95 to 4.35, indicating moderately positive assessments across the variables. This suggests that employees are generally motivated to work. The standard deviations reflect some response variability, though most values fall within a moderate range.

These findings confirm that non-material motivators received higher average scores than material ones, supporting Hypothesis H1 .

The extent to which the organization responds to these motivational needs is shown in the following table.

Table 2. Presence of Motivational Factors in the Organization

Item	Min	Max	Mean	Standard Deviation
Performance-based pay	1	5	3.00	1.298
Salary level	2	5	3.25	0.851
Good communication and relationships with peers	1	5	3.70
Pension and health insurance	1	5	3.55	1.234
Good working conditions	1	5	3.45	1.099
Job security	2	5	3.90	0.852
Good relationship with supervisors	1	5	3.65	1.040
Interesting and creative work	2	5	3.35	1.089
Recognition for a job well done	1	5	3.10	1.210
Opportunities for advancement	1	4	2.45	0.826
Autonomy and independent decision-making	1	5	3.45	1.234
Opportunities for development and improvement	2	5	3.70	0.865

In Table 2, which presents various organizational motivational factors, the arithmetic means range from 2.45 to 3.90, again reflecting moderately positive assessments. The standard deviations are generally moderate, with values below 1, indicating relative response consistency.

Employees perceive job security and good interpersonal relationships as the most prevalent aspects of their working environment. In contrast, recognition and opportunities for advancement received the lowest scores, highlighting areas where organizational practices could be improved.

There are statistically significant differences between male and female respondents regarding the motivators that are important to them at work

A t-test will be used to determine whether there is a statistically significant difference between male and female respondents regarding the motivators that are important to them at work. If it is determined that the data do not follow a normal distribution—specifically, if the data on advancement opportunities for men and women are generally not distributed—the Mann-Whitney U test will be applied instead. In the first case, the goal is to test differences in arithmetic means and the mean values by gender. (Table 3) Table 3: Descriptive Statistics – t-test assumption

	Gender			Statistic	Std. Error
Advancement Opportunity	Female	Mean		3,00	,274
		95% Confidence Interval for Mean	Lower Bound	2,42
			Upper Bound	3,58
		5% Trimmed Mean		3,00
		Median		3,00
		Variance		1,200
		Std. Deviation		1,095
		Minimum		1
		Maximum		5
		Range		4
		Interquartile Range		2
		Skewness		-,348	,564
		Kurtosis		,027	1,091
	Male	Mean		2,75	,854
		95% Confidence Interval for Mean	Lower Bound	,03
			Upper Bound	5,47
		5% Trimmed Mean		2,72
		Median		2,50
		Variance		2,917
		Std. Deviation		1,708
		Minimum		1
		Maximum		5

		Range	4
		Interquartile Range	3
		Skewness	,753	1,014
		Kurtosis	,343	2,619

The data do not follow a normal distribution. The Shapiro-Wilk test indicates that p > 0.05, so a t-test cannot be conducted. Instead, the non-parametric Mann-Whitney U test will be used to determine whether the groups have statistically significant differences .

Table 4: Group Differences

	Gender	Mean Rank	Sum of Ranks
Advancement Opportunity	Female	10,81	173,00
	Male	9,25	37,00

Table 5: Mann-Whitney U Test

Test Statisticsa
	Advancement Opportunity
Mann-Whitney U	27,000
Wilcoxon W	37,000
Z	-,492
Asymp. Sig. (2-tailed)	,623
a. Grouping Variable: gender

The p-value is 0.623, greater than the significance level of 0.05 (p > 0.05), indicating no statistically significant difference between the groups. In other words, there is no statistically significant difference between the median values for males and females regarding the motivator "opportunity for advancement." This result leads to the rejection of the second research hypothesis:

There are statistically significant differences between male and female respondents regarding the motivators important to them at work.

Determining the Statistical Significance of Differences Based on the Position of Respondents about the Types of Motivation Present in a Non-Profit Hospital in the Federal State of Baden-Württemberg

The independent variable "opportunity for development and professional advancement" as a form of motivation in the organization will be observed, with regard to the factor "job position." Table 6: Descriptive Statistics

Descriptives
	Position of Respondents			Statistic	Std. Error
opportunity          for development      and professional advancement	Lower and middlelevel management	Mean		4,00	,236
		95% Confidence Interval for Mean	Lower Bound	3,46
			Upper Bound	4,54
		5% Trimmed Mean		4,00

		Median		4,00
		Variance		,500
		Std. Deviation		,707
		Minimum		3
		Maximum		5
		Range		2
		Interquartile Range		1
		Skewness		,000	,717
		Kurtosis		-,286	1,400
	Non-managerial position	Mean		3,45	,282
		95% Confidence Interval for Mean	Lower Bound	2,83
			Upper Bound	4,08
		5% Trimmed Mean		3,45
		Median		4,00
		Variance		,873
		Std. Deviation		,934
		Minimum		2
		Maximum		5
		Range		3
		Interquartile Range		1
		Skewness		-,290	,661
		Kurtosis		-,501	1,279

Based on the responses to the questions, most respondents hold non-managerial positions and are at the middle or lower levels of management. Descriptive statistics show that skewness and kurtosis values are below 0.5, which confirms the normality of the data distribution.

Table 7: Test of Normality

ПозицијаГдеРадите Kolmogorov-Smirnova Shapiro-Wilk Statistic df Sig. Statistic df Sig. opportunity for development and professional advancement Lower and middle-level management ,278 9 ,044 ,833 9 ,049 Non-managerial position ,266 11 ,029 ,887 11 ,127 a. Lilliefors Significance Correction

The assumption of normality is met (Shapiro-Wilk test) because p = 0.049 , which is < 0.05. Table 8: Homogeneity of Variances

Test of Homogeneity of Variances
opportunity for development and professional advancement
Levene Statistic	df1	df2	Sig.
2,284	1	18	,148

Homogeneity is verified using Levene's test. The significance level is Sig = 0.148 , which is greater than 0.05, indicating no difference between the variances of the subgroups.

Table 9: ANOVA

opportunity for development and professional advancement
	Sum of Squares	df	Mean Square	F	Sig.
Between Groups	1,473	1	1,473	2,083	,166
Within Groups	12,727	18	,707
Total	14,200	19

The significance level is Sig = 0.166 , which means that the groups do not differ, i.e., there is no statistically significant difference between the respondents' job positions about the form of motivation "opportunity for development and professional advancement" present in the non-profit hospital in the federal state of Baden-Württemberg.

This result leads to the rejection of the third research hypothesis:

There are statistically significant differences between the positions of respondents in relation to the types of motivation present in the non-profit hospital in the federal state of Baden-Württemberg.

Examining the Existence of Statistically Significant Differences Between the Years of Work Experience of Respondents about the Types of Motivation Present in a Non-Profit Hospital in the Federal State of Baden-Württemberg

It was found that the variable “good communication” does not follow a normal distribution across the categories of the variable years of work experience . Therefore, the non-parametric Kruskal-Wallis test is applied, aimed at testing the significance of differences between the medians of five data groups. Table 10: Kruskal-Wallis Test for Performance-Based Pay

	Performance Based Pay
Chi-Square	4,370
df	3
Asymp. Sig.	,224
a. Kruskal-Wallis Test
b. Grouping Variable: ГодинеРС

Table 11: Kruskal-Wallis Test for Salary Level

	Salary Level
Chi-Square	5,110
df	3
Asymp. Sig.	,164
a. Kruskal-Wallis Test
b. Grouping Variable: ГодинеРС

Table 12: Kruskal-Wallis Test for Good Communication and Colleague Relationships

	Years of Experience	Mean Rank
Good  Communication  and Colleague Relationships	Up to 5 years	8,93
	from 6 to 10 years	8,90
	from 11 to 20 years	11,25
	over 31 years	14,50

Employees with the longest work experience (over 31 years) have the highest mean rank (14.50), indicating that they rated the importance of good communication the highest. Alongside this group, employees with 11–20 years of experience also highly value good communication and relationships, which is not the case among employees with shorter work experience. However, since p = 0.378 > 0.05 , this indicates that there is no statistically significant difference between the groups.

Table 47: Test for Good Communication

	Good Communication and Colleague Relationships
Chi-Square	3,089
df	3
Asymp. Sig.	,378
a. Kruskal-Wallis Test
b. Grouping Variable: ГодинеРС

Years of work experience do not significantly influence the perception of the importance of good communication and colleague relationships. The significance level Sig = 0.378 is greater than 0.05, meaning there is no statistically significant difference between years of work experience and the form of motivation in the non-profit hospital.

This leads to the rejection of the fourth research hypothesis:

There are statistically significant differences between respondents' years of work experience in relation to the types of motivation present in the non-profit hospital in the federal state of Baden-Württemberg.

Discussions and Conclusion

The study found that employees in the non-profit hospital are not primarily motivated by salary levels or pension and health insurance benefits, but rather by good interpersonal relationships, job security, autonomy, and recognition. In other words, motivation is not linked to material incentives but rather to strong interpersonal relations. These results align with contemporary motivation theories, emphasizing the importance of non-material factors in the work environment, particularly in the healthcare sector, where professional satisfaction and collegial support are key to successful work.

This confirms the research hypothesis:

"Employees in the non-profit hospital in the federal state of Baden-Württemberg are more motivated by non-material than material motivation."

Although material motivators—such as salary level, pension, and health insurance—are recognized as important, they are not the dominant factors of motivation among respondents. This suggests that employees in this hospital place greater importance on the intrinsic aspects of their work, ijmt.rs such as a sense of purpose and opportunities for professional development. Similar results have been recorded in other healthcare sector studies, where stability and interpersonal relationships have a greater impact on employee satisfaction and motivation than financial incentives.

The standard deviation analysis showed moderate variation in responses, indicating a certain level of agreement among respondents regarding the importance of different motivational factors. However, differences in the perception of individual motivators point to the need for further analysis of personal and organizational factors that may influence motivation.

The tested hypotheses in the study were partially accepted. Employees are motivated by intrinsic and extrinsic factors, confirming the first hypothesis . However, the study did not identify statistically significant differences in motivational factors based on gender, work experience, or job position within the non-profit hospital. Therefore, the other hypotheses were not confirmed , namely:

• •    "There are statistically significant differences between male and female respondents regarding the motivators important to them at work."

• •    "There are statistically significant differences between respondents' positions about the types of motivation present in the non-profit hospital in the federal state of Baden-Württemberg."

• •    "There are statistically significant differences between the years of work experience of respondents about the types of motivation present in the non-profit hospital in the federal state of Baden-Württemberg."

These results indicate a uniformity of employee motivational preferences, which may result from the organizational culture and specific nature of work in the non-profit healthcare system.

Based on the research results, the following recommendations can be made:

• •    Strengthen non-material forms of motivation , as employees perceive these as the most important.

• •    Since employees are primarily motivated by good communication and relationships with colleagues , investing in teamwork, internal communication channels, and mentorship programs is recommended.

• •    Priority should also be given to supporting professional development , ensuring continuous employee training, and career development programs .

• •    As respondents emphasized that job stability is an important motivator, the hospital should continue its stable employment policy and provide clear long-term cooperation prospects.

• •    Given that material factors were not highlighted as primary motivators (they are important, but not the most important), it is recommended to implement individualized incentive packages that may include non-financial benefits , such as flexible working hours and additional time off as a reward.

Conflict of interest

The authors declare no conflict of interest.