“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.
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About Me
Kaizen is a Japanese word meaning change for the better. A curmudgeon is a crusty, irascible, cantankerous old person. The Kaizen Curmudgeon blog consists principally of conversations between the Curmudgeon and Jaded Julie. Their topic is Lean (the Toyota Production System) and its applications in health care. We attempt to depict Curmudgeon as the resident Old Guy who possesses some degree of perspicacity and is not nearly as grouchy as the formal definition of curmudgeon suggests. As her name implies, Jaded Julie is a nurse who has “had it up to here” with waste and inefficiency. She is unsophisticated, somewhat feisty, and does not appreciate having to learn the Japanese terminology of Lean. Of course, both the Kaizen Curmudgeon and Jaded Julie are fictional. The author of Kaizen Curmudgeon is a retired Associate Professor of Chemistry who has been a volunteer in health care since 2004.
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