The phenomenal growth in healthcare complexity – new expectations for outcomes, rapidly changing measures of success, and the need to actively partner with patients and community leaders – requires the engagement and top performance of all team members as they rapidly change what they do. This all requires those who act by choice not compliance. For example, healthcare professionals are learning to develop effective partnerships with patients leaving behind long-held beliefs of being in charge.
External motivators or carrot-and-stick incentives are overly relied on to achieve outcomes. The commonly held belief appears to be that if the right individual incentives (or penalties) are in place, leaders have done all that is required to achieve the desired outcomes. Some believe that physicians will not actively engage in quality, safety, or experience activities without financial incentives. What many are discovering is that comparative data as much as the potential monetary gains are both strong incentives. Rewards and incentives, particularly team based, can be part of a robust, holistic strategy committed to creating the environment to develop internal motivation.
How do leaders create the environment for people to thrive and to develop internal motivation? Three elements are noted in the literature to promote self-directed action.1-3
Choice: acting with choice leads to engagement. The opposite – lack of choice – leads to compliance (minimal effort) and contributes to burnout. Leaders who work in partnership with team members to create abundant opportunities for choice in daily work find that more engagement and better solution-finding result. People want to be able to have some ability to direct their lives and loss of that ability leads to lack of accountability and diminished commitment to the organization.
Mastery: making progress in one’s work, the chance to expand one’s abilities and accomplish something that matters in a supportive learning environment is the single greatest motivator.2 Clear goals grounded in Purpose enable individuals to understand what skills are needed.
The interaction of Purpose, Choice, and Mastery form a positively reinforcing cycle for self-motivation, engagement, and improved outcomes. Within the cycle, recognition (combined with rewards or incentives) can be successfully embedded as a means of emphasizing and aligning everyone around the Purpose.
Unfortunately, outmoded models of motivation that heavily rely on individual incentives and penalties are deeply embedded. In today’s pay-for-performance world with a growing number of carrot-and-stick measures, it would be natural to believe that is the only way people in complex settings are best motivated. Wrong! Over use of external motivators just means that the carrot or the stick has to get continually bigger. Years of organizational studies show the risks of this being the primary approach as summarized in Carrots and Sticks: The Seven Deadly Flaws2
1. They can extinguish intrinsic motivation
2. They can diminish performance
3. They can crush creativity
4. They can crowd out good behavior
5. They can encourage cheating, shortcuts, and unethical behavior
6. They can become addictive
7. They can foster short-term thinking
We only have to look to W. Edwards Deming to remind ourselves that the path to continuous improvement and ever improving outcomes is intrinsic not extrinsic motivators. Years ago he advised leaders to “eliminate work standards (quotas), substitute leadership; eliminate management by objective; eliminate management by numbers, numerical goals; substitute leadership.”3
Tomorrow every leader can begin a new cycle of Purpose – Choice – Mastery by beginning with why, engaging others to aid in how, and coach for mastery in a learning environment that encourages questioning, “how can we do this better?”
1. Bridges, Wm. (2009). Managing Transitions: Making the Most of Change. Cambridge, MA: Perseus.
2. Pink, D. (2009). Drive: The Surprising Truth about What Motivates Us. NYC: Riverhead Books
3. The W. Edwards Deming Institute.