I was meeting with my team trying to generate new ideas to solve an old problem. It was one of those days when the stars aligned and everyone was participating, ideas were generated and refined, and a positive atmosphere was created. Suddenly, one of my most senior nurse managers turned to me and said, “You really get excited when people think!” True, but why is it so rare?
Early in my leadership career, I heard a talk by Peter Senge about what he called “the learning organization.” I read his book and found his basic idea attractive—that successful organizations were able to learn from their work and change how they did things. As a physician, I saw myself as a learned professional who had to constantly add to my store of knowledge and learn from my experience (tacit knowledge,) so to me it was obvious that medical organizations should be learning organizations, using the methods of continuous quality improvement as the starting point. I soon learned it might be obvious to me, but not to most other people to whom I presented the idea. When I talked to friends, they would often reply it did not seem “practical,” and certainly not something they would spend money and time on. I eventually quit talking about learning organizations.
Recently, I read a book about why some ideas stick and others don’t. In a discussion about Abraham Maslow’s list of needs, the authors note:
“When people talk about “self-interest,” they’re typically invoking the physical, security, and esteem layers. Sometimes belonging gets acknowledged if the speaker is touchy-feely. Not many marketers or managers venture beyond these categories…”
The authors then present a hypothetical case—the firm plans to offer a $1,000 bonus and wants to test how to present it to the chosen employees. One way emphasizes making a down-payment on a new car or the house, the second emphasizes putting it in the bank, and the third emphasizes that money shows how much the company values your contribution, since it doesn’t throw money away.
“When people are asked which positioning would appeal to them personally, most of them say #3. It’s good for the self-esteem—and, as for #1 and #2, isn’t it kind of obvious that $1,000 can be spent or saved? …
Here’s the twist, though: when people asked which is best positioning for other people, not them, they rank #1 most fulfilling, followed by #2. That is, we are motivated by self-esteem, but others are motivated by down payments. This single insight explains almost everything about the way incentives are structured in most large organizations.”
In another example they assert the chasm between ourselves and others opens again. Most people say an appeal to learning would be most motivating, but predict other people would respond better to appeals to security and esteem. I suspect this is what people meant when they said creating a “learning organization” was not practical.
Just to get a current flavor for this issue, I did a Google search on “what do employees want from their employers 2021” and was flooded with articles. One example, from the Harvard Business Review, lists “flexible options for work,” “new productivity measures,” and team diversity. The author’s take home message for leaders?
“Organizations will need to prioritize reskilling and upskilling to attract and retain the talent they need to make their business grow. Those that do will not only boost the motivation of their existing workers, but will gain the attention of the brightest new recruits and position themselves to emerge from the pandemic not just where they were, but in a stronger, better position than they were.”
Implicit is the notion that learning and thinking are necessary parts of any successful organization. What used to be a strange idea has now become conventional wisdom, at least for the commentariat. But is it true in practice? I wonder if the sheer volume of articles doesn’t mean that most organizations still think in terms of “practical” measures such as pay and benefits only?
Certainly, wise leaders have known for centuries you can’t pay people enough to do dangerous, hard work—they have to be motivated by something else. The pandemic has made even ordinary work like customer service in a restaurant, potentially dangerous, so imagine the impact on health care organizations, where exposure to pathogens is an occupational hazard? If ever there is a time to reach beyond the basic motivations, it is now. A cartoon I saw a few years ago said it best. “CFO to CEO: What happens if we invest in these people and they leave? CEO to CFO: What happens if we don’t invest in these people and they stay?”
Why is thinking rare? Presently I believe the primary issues is dealing with variation. If variation is bad, following policy is imperative, but individualizing care means variation. To do it well requires creating an organization where people who have knowledge and experience are expected to think as a routine part of the job. It takes time, effort and practice, but when it happens, it is exciting. And nothing is more practical when the goal is excellent patient care. Try it, you might like it, too.
10 June 2021
 Senge PM. The Fifth Discipline: The Art and Practice of the Learning Organization. (New York: Doubleday, 2006.)
 Heath C and Heath D. Made to Stick: Why Some Ideas Survive and Others Die. (New York: Random House, 2008.
 Minahan T. What Your Future Employees Want Most. Harvard Business Review, 31 May 2021. Accessed 7 June 2021 at https://hbr.org/2021/05/what-your-future-employees-want-most
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