Autonomy 2

“Today, Jaded Julie, we’re going to continue our discussion of the assertion in Daniel Pink’s book, Drive, that autonomy is the principal workplace motivator. To an arm-chair psychologist, that sounds as if autonomy is the major component of self-actualization, the pinnacle of Maslow’s well-known pyramid.” (1)

“Whoa there, Abraham. You lost me with self-actualization.”

“It’s not hard, Julie. Self-actualization is just another way of describing the life force that will ultimately lead to maximizing one’s abilities. Like the old Army slogan, ‘Be all you can be.’”

“Now I see; you and I talked about that years ago. Now the slogan is ‘An Army of One.’ Pink would like that, but I don’t. An army must be a team—not a bunch of autonomous warriors.”

“You are getting at the problem, Julie. Autonomy leads to self-actualization only in certain instances. In Europe I’ve seen Grieg’s and Mahler’s composer’s cabins—actually one-room buildings with a big piano overlooking a lake—where they wrote beautiful music in solitude. Autonomy certainly worked for those guys.”

“But it won’t work in a hospital, Curmudge. A surgeon is likely to be the most autonomous person in the building, but he would never have gained his skill without the collaboration of an anesthesiologist and the rest of the OR team.”

“Great insight! Now let’s look at the broader problem. If autonomy won’t lead to one’s maximizing their potential in a hospital, what will give one the freedom to be the best they can be in any endeavor that requires teamwork?”

“I know the answer you’re waiting for, Curmudge. It’s ‘Lean.’ But you’re going to have to explain it, beginning with this question. If autonomy and standard work are opposites and people seem to like autonomy so much, why will they accept the standard work aspect of Lean?”

“Imai provides a short answer. ‘Where there is no standard, there can be no improvement’. (2) Thus improving and reaching your full potential require a starting point—the standard.”

“That seems reasonable. How about some examples?”

“Most everything done in a hospital or clinic is part of a system or process. Consider a housekeeper who cleans inpatient rooms. She is right in the middle of the patient discharge-new patient admission process. Because she works alone, she has a degree of autonomy. She might modify the way she cleans a room so as to lessen the pain in her back.”

“That would be autonomy all right, but it doesn’t sound like self-actualization. Of course, anyone with back pain would do almost anything to obtain relief.”

“Because of her dedication to the hospital, the housekeeper doesn’t dare to vary from the standard cleaning protocol for fear of leaving a room inadequately cleaned and sanitized. So she proposes her modification to her supervisor and team. They test it, approve it, and adopt it, and she receives the appreciation of her teammates who might also have had back pain. To a housekeeper, using Lean to make her standard work easier may constitute self-actualization.”

“It seems that in a team environment, a bit of autonomy can be the first step in improving a standardized process. Thus autonomy and standard work are not always opposites.”

“That’s the idea, Julie. Now let’s consider an example at the other end of the health care food chain. Improvements in accepted medical procedures or medications often begin with an ‘a-ha’ moment in the mind of an individual physician or medicinal chemist. That’s autonomy. But before it becomes an evidence-based procedure or an FDA-approved medication, a lot of teamwork and trials are required to make it a new standard. So once again, autonomy and standard work are complementary.”

“Back to our original concern, Curmudge. How can one achieve self-actualization—being all you can be—through teamwork?”

“Although their tangible rewards range from promotions to reduced back pain, the people in our examples, from the highly-educated professionals to housekeepers, are rewarded most of all by feelings of personal accomplishment and contributions to something with a purpose—be it knowledge, the welfare of their patients, or an organization—that is bigger than they are.”

“Hey, Curmudge, for once you are writing about something that you know.”

“I had almost forgotten, Julie. Several years ago I had a compression fracture in my back.”

Affinity’s Kaizen Curmudgeon

(1) http://en.wikipedia.org/wiki/Self-actualization
(2) Imai, Masaaki. Gemba Kaizen

Note: An observation on the practice of emergency medicine in a primitive location may be accessed via this link.

Autonomy

“Jaded Julie, a few weeks ago I was reading a book by Daniel Pink. The title is Drive: The Surprising Truth About What Motivates Us.”

“Okay, Retired Guy, I know you are going to tell us what’s in the book. I also know that you’re too cheap to buy a book unless it is a true classic. So why don’t you confess as to the circumstances of your reading Pink’s book?”

“I saw the book on the shelf in Barnes and Noble, picked it up and read part of it. Then I found an extensive review in Amazon.com. That may sound like education on the cheap, but remember, I received my last paycheck in 2004.”

“So what, O Thrifty Scot, did you learn?”

“Pink said that ‘people would prefer activities (at work) where they can pursue (1) Autonomy: People want to have control over their work. (2) Mastery: People want to get better at what they do. (3) Purpose: People want to be part of something that is bigger than they are.’”

“Those sound reasonable. They remind me of Quint Studer’s ‘Purpose, Worthwhile Work, and Making a Difference.’ But there are instances where one can’t have all three of Pink’s preferred activities. For example, it’s hard to have complete autonomy—each individual doing what he wants to do—in an organization with a unified purpose like a symphony orchestra, a drill team on parade, or more appropriate to our concern, a hospital.”

“A very astute observation, Jaded Julie. And it’s unfortunate that of Pink’s three ingredients of drive, the one he emphasizes is autonomy. An individual in most organizations can’t be truly autonomous, although that might be possible for a hermit in a cave…”

“…or a curmudgeon in a cubicle.”

“Let’s go back to our hospital example, Julie. Can people be motivated in an organization that precludes complete autonomy?”

“Curmudge, the best answers for that are in a combination of Studer’s Hardwiring Excellence and Lean. There’s no question that a well-run hospital has the right purpose, and that as a nurse, my job is worthwhile and can make a difference in a patient’s outcome.”

“It sounds as if you like what you do. You, hopefully like all nurses and others who have chosen a career in health care, are motivated when you walk in the door. In that case, an important task for the hospital or clinic is to prevent your becoming de-motivated.”

“You know it, Curmudge. Without the right culture, i.e. Lean, a hospital can become a hotbed of de-motivation and frustration. In a place like that, nurses are always on a treasure hunt for supplies, buried in paperwork, harried and overworked, and forced to spend their shift on devising workarounds rather than caring for patients. That would squelch anyone’s motivation.”

“For the moment let’s return to Daniel Pink’s book. Recall his three components of drive: autonomy, mastery, and purpose. In my opinion, the principal driver for people in health care is not autonomy or the freedom to do whatever they want. That’s not going to overcome a hospital’s potential de-motivators. Our biggest motivator is purpose or being part of something bigger than you are. We’re going to talk more about Lean, autonomy, purpose, and motivation later, Julie. So until we study the subject further we can’t condemn Pink. He appears to have a valid list of motivators, but he prioritizes them in an order that doesn’t fit health care.”

“One might say that he is in the right church but the wrong pew.”

“If you say so, Julie.”

Affinity’s Kaizen Curmudgeon