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