By Cindy Lorah
The opening keynote address of the American Medical Group Association (AMGA) meeting in Orlando, March 15, featured Daniel Pink, author of A Whole New Mind and Drive, who shared his insight on the science of motivation and some of its implications for health care.
First, he looks at our “intrinsic” knowledge of motivation – what people generally believe and act on regularly. Namely, that rewarding a behavior gives you more of it and punishment for a behavior gives you less. Social scientists have basically been testing this “hypothesis” for years, and the result is that “sometimes” this holds true, but not nearly as often as we generally think…and this can lead to big mistakes.
This type of “IF – THEN” motivation (IF this action happens, THEN you will get this reward/punishment) has been shown to be great for simple and short-term tasks. However, it is not great for complex, long-term situations. One key study showed that as long as a task involves only mechanical skills, bonuses work as expected. However, once the task calls for “even rudimentary cognitive skills,” a larger reward led to poorer performance. Although this may seem wrong on a profound level, it is not surprising to social scientists. People love rewards and tend to focus intently on achieving them. However, if people need to think creatively and multi-dimensionally, you do not want to motivate single-minded focus.
An example pertaining to health care are studies looking at pay-for-performance initiatives. One study showed there “is not evidence that financial incentives can improve patient outcomes,” and a second showed that there is no evidence that pay-for-performance in hospitals led to a decrease in 30 day mortality.
To be clear, it is a fact that money is a motivator. It matters a lot, but its effects are nuanced. People are exquisitely tuned to norms of fairness. People need to be paid enough to “take money off the table” and to be perceived as being paid fairly.
Assuming “fair” compensation exists, there are 3 motivators for enduring performance: Autonomy, Mastery, and Purpose.
“Management” is a brilliant “technology” that has enabled a lot of growth, but it has a single focus – compliance. Increasingly, organizations are looking for engagement, not compliance. People don’t get engaged by being managed – they need to “get there by their own steam.” Great bosses are characterized by those who have high standards and provide a high level of autonomy. When people are given an amount of sovereignty over 4 T’s – Time, Technique, Team & Tasks – they will perform at a higher level.
A good example is Facebook’s hiring practices. The organization hires talent, but follows this by internal interviews that allow the teams to decide which group is the best fit for each new hire.
Other examples include the creation of “islands of autonomy” in which employees are encouraged to carve out regularly scheduled times (an hour or two per week, for example) to specifically focus on innovation, ways to better serve clients, or (in the case of Mayo Clinic) to do whatever they WANT. These initiatives have been shown to increase engagement, increase the number breakthrough ideas, and decrease burn-out.
People like to do things they can get better at. This is a widely ignored phenomenon, but explains our interest in sports, playing musical instruments, etc. A Harvard study did an extensive study of daily work motivation and found that the biggest motivator is “…making progress in meaningful work.” This involves feedback, which most organizations are not set-up to provide well! Younger workers, especially, have grown up in a technological world that provides rich, regular, robust feedback. Compare this to the annual review process that provides irregular, untimely, usually unhelpful feedback. We need to work on increasing the “metabolism of feedback” in organizations and can start with encouraging people to “own” their own performance reviews by keeping track of their daily accomplishments and goals. He recommends the free version of iDoneThis, which will send you an email at the end of each day asking you what you accomplished and chronicling it for future reference.
People have a strong desire to feel a sense of purpose. Many hospitals, for example, have struggled with how to get clinicians to wash/sanitize their hands. In a study that compared the effectiveness of different messages encouraging hand hygiene, only the one that emphasized the benefits to the patient was effective. Managers typically spend a lot of time on how things should be done and give short-shrift to why they should be done. Bringing the why to the surface (especially in health care, where the why is so critical) is a powerful motivator.
Pink encourages checking out the resources and “autonomy audit” at his website: www.danpink.com