Monday, May 10, 2010

Motivation 3.0 for Physicians

Just finished reading "Drive" by Daniel H. Pink and was left pondering the ramifications in healthcare of the Motivation 3.0 operating system that the author proposes is more relevant for success and fulfillment in the 21st century. As opposed to the "carrot vs. stick" theories of behavior modification defined by Motivation 2.0, the "upgraded operating system" is built upon the intrinsic motivators of autonomy, mastery, and purpose.

For physicians, we have created numerous financial rewards and penalties, which essentially take the intrinsic enjoyment out of the work of medicine, and convert it into a system to be gamed. Therefore, we should not be surprised that the system is indeed played, and that the numerous incentives and penalties have in great part contributed to the overall dysfunctionality of the system, not to mention the relative dis-satisfaction that many practitioners now feel in their vocation.

Building a new model upon the Motivation 3.0 framework, healthcare leaders, policymakers, and administrators should attempt to cultivate true internal motivation by creating environments wherein practitioners can find autonomy, seek mastery, and develop a re-connection to the purpose that brought them to medicine in the first place.

Autonomy requires that the physician have some control over their task, time, technique, and team. External pressures from the changing healthcare landscape have impinged upon nearly all of these elements. In order to provide/ return autonomy to physicians, administrators need to observe and faciliate, not censure and command.

Physicians have generally been trained for thousands of hours in order to be "masters" in their practice. However, true "mastery" requires unlocking a deep passion for what they do combined with a desire for steady improvement in their skills. The work of healthcare institutions -efficiency and improvement - is potentially interconnected with the individual's needs for mastery. However, management needs to do a better job of ensuring that the institution's objectives are better interlaced with the professional's and that the need to achieve simplistic outcomes doesn't subvert the practitioners drive for true mastery.

Purpose may be the most ephemeral of these elements, however, this is the one that most likely drew practitioners to undertake a long road of education, training, and practice so that - in addition to making a decent living - they could also serve the common good. Many practitioners are still captivated by that drive, but are unable to connect with this purpose on a day-to-day basis, which may be overshadowed at times by financial and time pressures, difficult patients, and complex cases. Management should endeavor to help make this connection, which can in turn invoke a deeper sense of achievement, and thereby help to drive overall greater performance.

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