How can I motivate you to do it my way?

Motivation is a goal-directed behavior. To be motivated, a person must have a perceived goal. Before discussing goals, we must look at the difference between motivation and motion. Motion is movement. It is the act of changing position, regardless of what caused that change. Motivation, on the other hand, is motion that is associated with a personal incentive. There is an internal drive to employ certain behaviors to reach a given, self-defined goal. Motivation is self-directional movement.

Our primitive brain regions in the hypothalamus and limbic system are set up to give us the ability to recognize pain and pleasure. We tend to move away from pain and toward pleasure. But this is motion, not motivation. It only becomes motivation when it is a planned process that takes us from our current position toward a new, better position. The planning and awareness used to reach our goal is the function of the higher centers in the cortex.

As described by Herzberg, older systems of "motivation" (actually "motion") used the carrot-and-stick approach.[1] If I offer you a reward to do something, you move toward the "carrot," but that does not guarantee motivation toward the goal related to the "carrot." In general, carrots are seduction, not motivators. This is the pleasure response, causing motion toward a primitive need. The problem here is that seductions must be supplied repeatedly in order to cause continuous motion. There is no personal drive to move except when the carrot is held out, and bosses can waste a lot of time waving carrots if this is the way things are done.

The "stick" end of the system is a "kick in the ass" (KITA) approach. I kick, and you move. This is also not motivation, except in the sense that your motivation is to avoid my foot next time, which is not the intended goal. Assuming the goal is to achieve a certain positive outcome in the future, KITA must be applied again and again to create motion, hoping that the "kick" results in the other person traveling in the desired direction.

Neither seduction nor KITA is a motivator, unless you are a rare breed of pleasure-puppeteer masochist. Both cause motion, but neither causes self-directed direction toward the intended goal. The only self-motivated event that occurs is the boss's motivation to continually seduce or kick.

The best modern description of motivation I have found is derived from the work of Hackman and Oldham, supported by extensive theory testing.[2] This work showed that there are five components to motivation:

* Skill variety - you get to use different skills.

* Task identity - you identify personally with what you do.

* Task significance - you feel that what you do is significant or important.

* Autonomy - you have some self-control and responsibility.

* Feedback - the knowledge of the actual results of what you do.

The first three of these components contribute "meaningfulness" to the work, the fourth contributes to ownership of results, and the last gives feedback about the results of what is done. I think most physicians will view meaningfulness as a "given" for themselves. This does not mean, however, that meaningfulness of health care will necessarily be a "given" for nonphysicians. Sometimes, nonphysicians must be shown the meaningfulness of activities.

These five components of motivation take one in a self-directed manner toward a desired goal. But what is the goal? Goals are personally meaningful events. I emphasize "personal," because no one can think for us. We have to personally feel the value of an event or outcome for it to be "our" goal. Otherwise, it's just someone else's goal - a "you want," not an "I need."

Goals, if they are to be a business norm, cannot just be meaningful to the person who gives out the tasks, they must also be meaningful to the persons doing the tasks. Thus, a goal is a personally owned event that is meaningful to the self. The boss may give us the goal, but we have to see the value to us of aiming for it, if it is to be a real goal that is answered by self-motivation (and not mere motion).

Motivation toward a goal requires a set of behaviors. Our behaviors are what dictate how well we aim toward a goal, and how quickly we get there. According to Dwyer,[3] when we "give" someone a goal, there are four states that must be met in order to allow a person to develop the self-motivation desired:

* They must have the capability to do what is requested. This means having the knowledge, skills, abilities, and tools to do it.

* They must have, a perception that there is a value to them in doing it.

* They must believe the potential value will actually be received by doing it.

* Their perceived risk or cost of doing it must be outweighed by the value they believe they will receive.

Influence is the ability to affect these four states for people, and to be believed in the process. Note that the majority of influence comes through dealing with people's perceptions. Thus, influencing someone toward self-motivation is mostly a perception game. By dealing with perceptions others have, assuming we have provided them with capability, we end up with Dwyer's critical point about influence. "Never expect anyone to engage in a behavior that serves your values unless you give that person adequate reason to do so."[3]

Put another way, we should never expect others to do something to meet our needs or demands until they see the value, to them, of doing it. Thus, to motivate others to do what we want them to do, we have to meet their needs in return. It is not that we see a value in what we ask them to do; we must show them the value to them of doing it. Once they perceive a personal value in the action, they are self-motivated. This does not typically require either seduction or KITA, but it requires knowing what their needs are, resulting in a sort of "negotiated trade."

Some might accept the above ideas, yet say that the value to them is not getting fired or reprimanded. The trouble with this negative approach is that it leads to a common chain of events[4]:

* Attrition, physically or mentally - people "leave," physically if possible, mentally if they can't physically escape.

* Defense mechanisms - e.g., rationalization, scapegoating, or denial.

* Motion, not motivation.

These events occur in sequence; each stage occurs before the next can occur. Thus, negative approaches usually fail to cause motivation. This points out the importance of staying in a positive frame of communication. One must always look for, and use, a positive way to meet the other person's personal needs. To do less may cause motion, but it won't create motivation. This does not mean I should give others everything they could possibly want. Just as others have a risk of giving me too much, there is also a risk to me to give them too much. Each of us has an opportunity cost - the cost to us of losing opportunities by giving to others. Thus, what I must work on is finding the "in-between" ground where I am reasonably satisfied and the person I am motivating is reasonably satisfied. I can get almost anyone to do something for me if I offer the person enough money or "value," but I must not destroy myself in the process by being overly generous. We're looking for the win-win situation, where both of our needs are being met. I just happen to be concentrating on his or her needs a little harder than the "controlling" individual might.

Job motivation requires that we design jobs in a way that supplies employees with the resources (training and tools) to do what is requested. We will show them the meaningfulness of the task and lead them to adopt it as their own meaningfulness system. We will supply them with an environment that offers an appropriate level of autonomy and personal responsibility for outcomes. And we will give them feedback about the results of their activities. These events win cause others at work to be motivated.

Failures in motivation occur when seduction or KITA are used instead of the above methods. Furthermore, failures, or less than optimal results, can occur if any components of the above formula are neglected.

In certain organizations, the values of many tasks may be fairly self-evident. Additionally, people who have been productive and "in the system" for a while often know what needs to be done and don't require frequent reminders. Too much input when others already "get it" may actually annoy and slow them. But if the values aren't apparent to them, the manager's role is to provide direction and vision and to explain why the goal is important to all involved. Merely satisfying your own needs, without having others share a perceived value of those needs, won't work.

Motivating people will require some sacrifices. We must face our own risks and the costs of meeting others' needs. But, after all, they're sacrificing, too. If we can show them the value to them of their sacrifices, and also what we are doing to meet their needs, the relationship becomes negotiated. When they see we are negotiating on their behalf, we're both on the same side.

References

[1.] Herzberg, F. "One More Time: How Do You Motivate Employees." Harvard Business Review 65(5):109-20, Sept.-Oct. 1987. [2.] Hackman, J., and Oldham, G. "Motivation Through the Design of Work: Test of a Theory." Organizational Behavior and Human Performance 16:250-79, 1976. [3.] Dwyer, C. The Shifting Sources of Power and Influence. Tampa, Fla.: American College of Physician Executives, 1991. [4.] Kay, E., and others. "A Study of the Performance Appraisal Interview." Technical Report by General Electric Management, 1965.

Richard M. Burton, MD, FACPE, is Medical Director, QualMed/HealthNet, Pueblo, Colo. He is Cochair of the College's Vantage Council.

COPYRIGHT 1994 American College of Physician Executives
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