Given that they create what it sells, employees are the Irish Health service's most valuable asset. They are increasingly being asked to embrace change on many different levels. In order to facilitate this process, it behooves management to actively promote employee motivation. Herzberg et al's "motivation-hygiene" theory of motivation proposes that certain "motivator" and "hygiene" factors can respectively affect job satisfaction and dissatisfaction. Considering "motivators," better on-the-job performance may increase motivation. However, work overload can become a dissatisfier. Devolving equal levels of authority and responsibility and providing appropriate recognition may also serve to motivate. Likewise, providing opportunities for promotion and personal growth may maintain motivation, as might re-engineering of jobs so that work remains meaningful. Over time both salary and incentives may come to be viewed as entitlements and lose their ability to motivate. Other "hygiene" factors such as organizational policy and administrative structure, relations with others, job insecurity, physical working conditions, and quality of supervision can lead to job dissatisfaction. Hence, the theory of Herzberg et al usefully highlights many factors that may serve to motivate or demotivate employees. However, this theory does not reflect some of the realities of the modern health care work environment.