I have been a big fan of the author Daniel Pink (@danielpink on twitter) since I heard about his most recent book Drive: The Surprising Truth About What Motivates Us and I saw him speak near Harvard back in January.
I loved the book, as it was reminiscent of Dr. W. Edwards Deming’s ideas on employee motivation — how the best path to success comes through tapping into peoples’ intrinsic motivation instead of trying to bribe them with rewards or financial incentives (“bribe” was the word that Dr. Deming often used). Not a flattering word, is it?
There is a video online of Dan Pink talking at the TED Conference (18 minutes) about his book and the important ideas within. I’m linking since I can’t embed the video on my site, running on WordPress.org. I’ll share my thoughts below.
If you want people to perform better, you reward them – that’s the American Way, Pink says. Let’s step back and look at healthcare – If incentives worked, then punishment would prevent medical mistakes and rewards could guarantee perfect patient care. Sounds too simplistic, right?
Pink, in the video, makes the “evidence-based case for rethinking how we run our businesses.” Citing various psychology research studies, Pink shares evidence that suggests that financial incentives actual HARM performance for anything requiring the least bit of cognitive skill. “Incentives dull thinking and block creativity.”
I think of conferences I’ve been to recently, whether I presented or not. I don’t remember any of them having a prize or an extrinsic reward for “best presentation.” Why did we all volunteer our efforts and make attempts to do a good job? Things like pride, wanting to share with others — all good intrinsic motivations. I wonder if a prize would have led to lower-quality presentations?
These “contingent” (or “if-then” as in “if you do this, then I will pay you that”) incentives cause harm – it’s the “most robust” social science finding and “one of the most ignored.” As Pink says:
What’s alarming to Pink is that the prevailing “business operating system” is built on the wrong assumptions – the assumption that extrinsic motivation and rewards lead to BETTER performance in knowledge work settings. These incentives are harmful. As Pink says, “This is not a feeling” that they don’t work – there’s proof.
Pink and the research show that “if-then” rewards work great for purely mechanical tasks. But even most factory jobs aren’t purely mechanical roles for people. Even factories are environments where thinking occurs (or should occur) by front-line employees.
If your task has “a clear set of rules and a single solution,” then if-then rewards might work. But again, that’s not many tasks or jobs in this modern age. Rewards hurt performance — even with relatively HUGE rewards. It’s not the size of the reward that matters…
It’s a compelling video. “It this a socialist conspiracy?”, Pink asks jokingly. No, it’s backed by research from economists from MIT, the University of Chicago, and the London School of Economics.
This idea that rewards can be harmful should all be familiar to people who are familiar with Dr. Deming or his protege Alfie Kohn, author of books like Punished By Rewards: The Trouble with Gold Stars, Incentive Plans, A’s, Praise, and Other Bribes — you can listen to my podcast with Kohn here.
What are the implications for Lean? Well, for one, we can’t expect to entice people to implement Lean faster or more effectively with extrinsic and financial rewards. We have to tap into intrinsic motivation. In healthcare, we have the natural intrinsic motivation that it’s a helping profession. If we can orient people around making improvements to the system that lead to better patient care and quality outcomes, we have a fighting chance of making Lean work.
Secondly, can we expect to improve quality or safety through extrinsic rewards? Probably not! Remember Dr. Deming’s story about the factory that offered a prize for zero injuries? What happened? People stopped reporting injuries! Another case where extrinsic incentives caused more dysfunction than true system improvement.
Pink says the three building blocks for intrinsic motivation are:
In the video, he focuses on Autonomy (in the longer hour-long talk I saw, he talked about all three). Purpose is also a building block of the LEI approach to lean (“Purpose, Process, People.“). Purpose is critically important, especially in healthcare. Mastery comes from dedication to ones work – human development and continuous improvement.
Pink defines “autonomy” as “the urge to direct our own lives.” It might seem, on the surface, that autonomy runs counter to Lean concepts of “standardized work.”
The Lean concept is that standardized work should be defined and written by the people doing the work, not dictated by engineers, managers, or consultants. That sounds like autonomy to me. Standardized doesn’t mean turning people into unthinking robots. Having standardized work forced on people violates the autonomy principle and leads to disengagement.
Autonomy, to me, means that you have direction over improvement in the workplace. As Toyota says, you have two jobs: 1) do the work (as you helped define it) and 2) improve the work. This sounds like autonomy to me (as opposed to being an automaton).
Pink suggests giving people a fair paycheck (taking money off the table) and then giving them autonomy (rather than paying a low wage with high incentives that are supposed to be “motivating.”) Sounds similar to what Dr. Deming preached.
One example of autonomy cited – the companies that give “20% time” for working on cool stuff – like Google. That doesn’t mean Google employees have complete freedom 100% of the time. Autonomy leads to higher engagement, lower turnover, and better results.
How many nurses even get TWO PERCENT time to work on process improvement, yet alone anything close to 20%? How would healthcare be better if employees weren’t viewed as direct labor to be motivated through incentives?
What are your thoughts about how this fits with Lean?
Again, I highly recommend the book: Drive: The Surprising Truth About What Motivates Us.
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the VP of Customer Success for the technology company KaiNexus.