Thoughts on Motivating Health Workers

Maurice MiddlebergThis post was originally published on the IntraHealth International blog.

At the recent Global Health Council Conference, I had the great pleasure of moderating an IntraHealth/CapacityPlus-sponsored event on health worker motivation featuring two extraordinary people: Daniel Pink, the author of the best-selling Drive: The Surprising Truth About What Motivates Us, and Dr. Barbara Stilwell, director of technical leadership at IntraHealth.

Health leaders and managers wrestle constantly with the challenge of motivating health workers. Health workers must be retained, productive, and caring if the huge deficits in access to health workers are to be addressed. Pink and Stilwell brought to bear their very considerable expertise on this question.

The common theme from both experts is that people aren’t pigeons. Pigeons may respond to simple stimuli in their environment, but the motivations of people reflect the depth and complexity of our humanity. Health workers are people, too, and their motivations are equally complex. This common sense understanding is, unfortunately, not much reflected in the way health workers are managed. Rather, simplistic notions involving salary increments and differentials tend to rule.

Both Pink and Stilwell acknowledge that money matters, but only up to a point. People must be paid enough to live decently by whatever local standard applies. They are also exquisitely tuned to fairness—perceptions of unequal pay for equal work can devastate morale. Straightforward monetary incentives work well for simple, mechanistic tasks but can be useless or counter-productive when conceptualization and creativity are needed. Beyond a certain threshold, motivations quickly become more complex than simply striving for another dollar.

Health care certainly has its share of algorithms, but caring for patients and populations—especially in resource-poor settings—isn’t mechanistic; it requires initiative, thought, and creativity. Effective health workers at every level are internally driven to bring ever better care to those they serve.

Based on his review of fifty years of research, Pink postulates three principal motivators: autonomy, mastery, and purpose. Autonomy refers to the need people have for choice in the workplace. This includes choice as to how, where, when, and with whom work is accomplished. Mastery refers to the drive for increasing competence. From childhood on, we can observe the intense desire that people have to be good at something—and to continue to grow in skills and accomplishment. Purpose captures what Victor Frankl called “man’s search for meaning.” In and out of the workplace, people want to serve some purpose larger than themselves. Health care exemplifies settings where the drives for autonomy, mastery, and purpose are intrinsic to the profession—if leaders and managers are wise enough to create environments that are conducive to these motivators.

Barbara Stilwell focused on three elements of the relationship between the health worker and the client as the key elements of motivation: touch, partnership, and expertise. Importantly, the power of these motivators lies in the right side of the brain, where our emotions and creativity reside. It is a widespread observation—and there is some good empirical evidence—that there is a healing power in touch. Health workers are taught and encouraged to touch their patients. The power of touch is equally important to the health worker. It creates the human bond and emotional reward that resides in the healing arts. Touch is linked to partnership. The old medical model presumes that health care is something that the expert provider gives to the passive client. But we now know that the best health care is a partnership—between the provider and the patient, the family, and the community. These powerful bonds make for better health care and more motivated and more effective health workers. Partnership helps increase expertise. Stilwell refers here not to the learning that comes from books and classes, but rather the implicit expertise that derives from experience and intimate knowledge of clients and their context.

Autonomy, mastery, and purpose. Touch, partnership, and expertise. These provide great guideposts for creating environments where health workers can thrive.

The mastery of the subject demonstrated by Pink and Stilwell was more than matched by their styles. In different ways, each brought panache, humor, and passion to the discussion. Even late on a Friday at the end of a long conference, the packed auditorium was enthralled and engaged. A very lively round of discussion followed the formal presentations.

One e-mail I received captures the spirit of the day; it said, “Thank you to you and your colleagues at IntraHealth for a great event. I want to pass along my gratitude for an interesting and inspiring event.”

I leave you with Dan Pink’s closing words. He said, “The creature that is least conscious of water is the fish, because it is surrounded by water every day—the presence of water is banal. I come from outside the community in which you live. Mostly, I am called upon by places like banks, retail stores, and factories. They ask me to help them motivate their workers. But sometimes it is hard to find the transcendent purpose in these enterprises. I hope you can see yourselves as I see you. You people swim in a sea of transcendent purpose every day. You may not always be aware of this because you live with it all the time. But from the perspective of an outsider, nothing could be more motivating than what you do.”

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