What happens when it’s the end of the 3rd quarter and it becomes obvious to the team that they can’t reach the year end goal? For example, in a hospital critical care team, what happens if their patient satisfaction goals are just off enough so they know they can’t meet the year end goals? The results aren’t bad, but they can’t reach their year-end goal. So what does leadership do? What does the team do?
If there is a motivational financial reward that only occurs if they meet their year-end goal, a team in this bind is likely to reduce their striving to improve months before year-end. Not a good thing! Team members are at some level of “no” or discouragement and that leads to diminished creativity and engagement. The demons of de-motivation are likely to set in.
So what does a leader do? Follow the wisdom of intrinsic motivation, especially if you are working with smart, creative thinkers. Intrinsic motivation occurs when people are internally motivated to do something – perhaps because they feel it’s important, it matches their values or it gives them pleasure. Financial rewards are a form of extrinsic or external motivation. Daniel Pink’s books, A Whole New Mind and Drive, powerfully demonstrates the “what” and “how” of engaging knowledge workers with intrinsic motivation. He has a great youtube summary at http://www.youtube.com/watch?v=u6XAPnuFjJc. Pink emphasizes that motivational success requires that knowledge workers be given:
Depending on your workplace you are likely to be able to emphasize more of one or two of these components than all three, but remember that all three matter.
Pink shows that the traditional approach of extrinsic motivation, which is based in if – then scenarios, can result in motivational harm. The “if- then” framework is presented as “if you meet this result then you will get a reward such as money or time off.” The harm that can occur could be:
- Diminished intrinsic motivation
- Lower performance
- Less creativity
- Crowding out of good behavior
- Unethical behavior
- Short-term, narrowed, thinking (tunnel vision).
These are serious negative consequences but many organizations and leaders are deeply embedded in a system of extrinsic rewards. To change this leadership habitual approach requires: 1) knowledge that the habit doesn’t work, 2) commitment to learn a new way and 3) practice and experimentation to make it a fully owned new skill.
So to bring about change first the hospital management must be convinced that a different way is better and then the three steps of expanding intrinsic motivation need to be intentionally followed. The hospital in the beginning example needs the critical care team’s work to result in higher patient satisfaction as customer (patient) future care choices are increasingly based on patient evaluations and financial reimbursement by insurance companies and the Centers for Medicaid and Medicare are tied to patient satisfaction. Thus we have the certainty and knowledge that patient satisfaction is very important. Recognizing at the third quarter mark that success won’t happen, together with reviewing work such as Pink’s, should help support leadership change. The next organizational step is to offer and reinforce the three steps for building employee motivation. In the sample hospital team motivation can be built by guiding the team to recognize and build skills thus:
Purpose is so strongly available in healthcare that a good leader can hit a home run when the goal is presented well. The team can feel alignment with their core purpose and values in meeting the goal of expanding patient satisfaction, first of all because satisfied patients are likely to have better health outcomes and that’s a value match.
Mastery is readily supported by education, mentoring and encouragement.
Autonomy can be harder to provide as many procedures have very specific and highly measured steps that must be taken where variation isn’t available, yet autonomy means the staff has independence or freedom. Increased requirements for documentation and use of electronic health records reduce time available to serve patients as well as autonomy. The challenge is to find aspects of autonomy that are available and these can be a combination of special projects, such as a research study, as well as tapping into emotional intelligence. In Man’s Search for Meaning, Victor Frankl brilliantly demonstrated that one’s attitude is a foundational personal resource and strength. Teams schooled to be individually and collectively responsible for their attitudes and well as to cultivate relationship building and other emotional intelligence skills such as empathy, optimism and impulse control find numerous opportunities for exercising autonomy. In fact EI is a primary source of autonomy in a highly structured environment, such as staff in hospital units, experience.
Training and intentional leadership to build intrinsic motivation and emotional intelligence can make significant difference in meeting the positive outcomes required to support the massive reform underway in healthcare.