What it takes to motivate for QI

As we have discussed in many previous blogs, all quality improvement (QI) relies on change (although not every change will lead to improvement) – and this almost always means involves on influencing and motivating other to change their behaviours.  Whether this is someone taking a one-off action or changing the way they do things on a daily basis, motivating people to change their behaviours is hard to do.

We talk a lot about the human side of change and about the human factors that make us naturally resistant to change – you can read more about it here – we also need to understand what motivates people to change, in order to be able to improve our chances of success.

We have also found in the last year that, in trying to encourage as many of our teams and individuals as possible to learn about and get involved in QI, motivation is a really import job for leaders.  Right now, in organisations like ours, getting involved in QI is still a discretionary effort, and therefore we need to tap into people’s intrinsic motivation.

motivation-003Intrinsic motivation is highly personal and it is not something that can be simply ‘turned-on’ in people, but there are some tools that everyone can use to start.  Before we describe these, it is worth taking some time to explore why traditional methods of motivation are not effective for QI.

Traditional methods of motivation

Frederick Winslow Taylor was an American mechanical engineer who sought to improve industrial efficiency in the early 20th century.  He was one of the first management consultants and (along with Henry Ford) was one of the early proponents of the mass production lines.

Winslow-Taylor famously wrote “Hardly a competent workman can be found who does not devote a considerable amount of time to studying just how slowly he can work and still convince his employer that he is going at a good pace.”  Obviously not a philosophy we agree with here, but an insight into employee relationships of the time.

The invention of the production lines meant no improvement or mastery was required on the part of individuals, simply the assembly of parts.  In Winslow-Taylor’s world, workers who think would mess up the production line and in this kind of working environment (‘Don’t think…just do’) we don’t need motivation. Instead we have carrots and sticks.


Carrots and sticks do not work for QI (if they work at all).  This is because traditional management says performance will only improve if the reward or the consequences are great enough, but we know this is only true of the most mechanical of tasks.  We also know that this leads to a breakdown of relationships between leaders and their teams, and often leads to cultures of fear.  All of this is toxic to QI.

Intrinsic motivation

Intrinsic motivation is required for QI because it is the key to motivating for creativity, collaboration and supporting sustainable change.  It is not easy to spark the intrinsic motivation in teams who are really busy and feeling under pressure.  But when encouraging people to join you in participating in QI, there are some tips we have found useful:

1 – Purpose

If we want to motivate someone to do something differently, we need to take time to describe not only the what, or the how, but to really focus on the “why”.  We are much more likely to change our behaviour if it fits with something we really believe in.   People are more likely to commit discretionary effort and be resilient in the face of adversity, if they are changing for a purpose they believe in.

2 – Autonomy

Autonomy is a significant factor in motivation. Part of being an individual is about being able to control our own lives and make our own choices.  Trusting people to work autonomously is also a great way to build a culture of trust and mutual respect.

 3 – Mastery

Our self-esteem relies on knowing that we are competent or becoming competent and regular feedback is critical to letting people know that they are competent or making progress.

In the short video below, Dan Pink describes these three ideas in a little more detail.

Some points to take away:

– Remember the basics of QI and by using the Model for Improvement we can help people make changes in a simple and effective way.

– However, for QI to be successful, we also often need people around us to change their behaviours.  We are all naturally resistant to change and we know that traditional methods of motivation do no work for QI.

– Instead we need to tap-into the intrinsic motivation of individuals.

– When asking people to change, take time to explain the purpose (‘Why?’).  Try to give autonomy and give regular feedback.  And make it easy to people to get started and to get involved.

Finally, consider the points made by Prof. Don Berwick in the video below.  We were fortunate to see Prof. Berwick’s presentation in Gothenburg last year, and we found this short section on motivation to be… pretty motivating.

Let us know what you think in the comments section below.


Mark – @MarkH_Work

One thought on “What it takes to motivate for QI

  1. Fantastic blog and most poignant was the realisation that in industries which rely on mass production thinking’ made workers less productive. Herein lies the danger of applying industry principles to healthcare. We need to connect to give care compassionately, which requires thinking. Therefore effective healthcare professionals need to think and as leaders we need to intrinsically motivate them, explaining the purpose, fostering autonomy and building mastery.

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