How to motivate staff for quality improvement

There are a wide range of methods available which will help motivate staff for quality improvement (QI). These include tried and tested tools that have worked well in other healthcare settings and that are proven to motivate colleagues to change. In this article we are going to look at various methods, such as: intrinsic motivation, purpose, autonomy and mastery, all of which will help motivate colleagues to improve.

Methods – how to improve staff motivation

Why is motivation so important in healthcare QI? The simple answer is: if you motivate staff for quality improvement and to embrace QI change, you are on the road to success! QI teams have tried many different ways of engaging staff in improvement, and methods to enhance staff motivation, so you can quite easily learn from others.

Staff engagement has been shown to be a very effective way of getting people involved and on board with QI and can be a great first step in motivating colleagues to embrace change.  The Institute for Healthcare Improvement (IHI) promotes the theory of Joy in Work, saying that: ‘The most joyful, productive, engaged staff feel both physically and psychologically safe, appreciate the meaning and purpose of their work, have some choice and control over their time, experience camaraderie with others at work, and perceive their work life to be fair and equitable.’

Recognition is another way to help improve staff motivation - employees feel valued if leaders publicly reward teams for their success, celebrate it and show appreciation.

In the article ‘What it takes to motivate for QI’, the authors gather together some hints and tips for improving motivation among healthcare workers, and promote three cornerstones: purpose, autonomy and mastery, as key tools in your toolbox for successful QI and transformational change. We’ll look at these in more detail later on in the article.

When you want to help teams make changes in a simple and effective way, it's worth going back to the basics of QI. This involves encouraging people to change their behaviours, which can, of course, be difficult as we can all be somewhat resistant to change!

One of the really important ways to motivate staff for quality improvement is to give teams autonomy and to give regular feedback, which really helps motivate staff for quality improvement.

Intrinsic motivation to motivate for creativity, collaboration and support sustainable change

‘How should we go about motivating staff to change?’ This is a question often asked in the world of QI.  Improvement is dependent on the willingness to change and - more specifically – the willingness to change behaviour and the way that people do things. We all recognise that this can be a difficult hurdle to overcome, as teams can be naturally resistant to change, so it's really important to understand what can lead to successful change and what motivates it.

To be successful in QI you would need to move away from being driven by fear and extrinsic motivation (which means doing something because it leads to a separate outcome like reward, recognition, or avoidance of punishment). The IHI have done a lot of work around intrinsic motivation. In their article ‘What Motivates Change?’ they look at intrinsic motivation, which is defined by clinical and social psychologists Richard Ryan and Edward Deci as ‘doing something for the inherent satisfaction that engaging in the activity provides'. This therefore means: ‘creating the conditions for many people to carry forward a shared cause on the basis of the inherent value that one experiences in the activity.’

Intrinsic motivation is one such method that is used in motivating colleagues to improve. To give an example shared by the IHI, staff engagement in the cardiovascular intensive care unit at University of Michigan Frankel Cardiovascular Center, (CICU) had not been going so well and team members agreed that their collaboration needed work. The Quality Data Manager started by asking team members why they chose to work in healthcare and what was important to them. When team members learned how much they had in common, including commitment to their patients, this led to more open conversations about challenges and a greater willingness to test changes. This is a really good example of people looking at their intrinsic motivations (or fundamental reasons) for wanting to continuously improve patient care, which helped the department to improve motivation among healthcare workers.

Intrinsic motivation is the key to motivating people for collaboration and creativity, while supporting sustainable change can help drive QI culture change. This is something that can be really difficult to achieve for busy teams under pressure, but as we have seen, not impossible. You really can improve motivation among healthcare workers by working on the basis of intrinsic motivation.

Motivating teams with purpose, autonomy and mastery

Why is motivation so important in healthcare and QI and how can you be better at motivating healthcare professionals?  You might want to take a look at some of the videos by experts in this area. Using charismatic motivators can really help to motivate staff to change.

Let’s dig a little deeper to find out how ‘purpose, autonomy and mastery’ can be key tools in your QI motivation toolbox. We watched a really helpful video by Dan Pink, which talks in detail about these motivators:

Purpose

This is an important element of the process. It means you need to explain not only how to do QI, but why! When people understand ‘why’ they are doing something they are more likely to do it better. Teams may start by asking: why does it matter? Why does my piece of the puzzle make a difference? One of the best – and most inexpensive - techniques for motivation you can use is to have fewer conversations about ‘how’ and more about ‘why?’ 

Autonomy

This is another really powerful motivator. Management can be seen as a ‘technology for compliance’. But for true success, you don’t want a compliant workforce, you want people to be engaged. Teams don’t engage by being managed per se, they become engaged under their own steam. Proper ‘technology’ for engagement is self-direction. If you can create an environment where teams have some control over what they do, this is great, as to learn to do something that we didn’t know how to do before is true progress.

Mastery

This is all about a sense of getting better and improving – about doing something now that you couldn’t do before. Mastery is inherently motivating! Some leaders may not be expert at making teams see the progress they are making, and this is absolutely vital. Progress depends on feedback, and receiving and giving the information on what you are doing. Talk less and listen more – ask questions. You’ll be helping yourself and others achieve ‘mastery’ and have a motivated workforce.

In the IHI blog: ‘Avoid the Scale-Up “Replica Trap”'  the authors say: ‘As improvers work together to adapt changes in new contexts, it leads to intrinsically motivational experiences of autonomy, growth, and community.’ This is because learning happens when QI teams make changes – both big and small – while pursuing the common aim. They finish by saying: ‘As people make choices about how to test and improve in action, they experience feelings of autonomy and growing mastery. Moreover, as they act with others, they experience a feeling that they are not alone. In other words, adapting in action can generate increased commitment to quality improvement.’

And to finish – we love this video on motivation by Don Berwick of the IHI – which is worth taking 10 mins to watch to get a real feeling of how you can motivate staff for quality improvement which can lead to great QI projects.