WEBVTT 00:00:00.000 --> 00:00:03.080 Welcome to the deep dive. Today we're looking 00:00:03.080 --> 00:00:06.139 into something absolutely fundamental. what drives 00:00:06.139 --> 00:00:08.619 us, especially within the demand and world of 00:00:08.619 --> 00:00:11.140 medicine. We all see that incredible dedication, 00:00:11.199 --> 00:00:14.539 don't we? That real push to heal and innovate. 00:00:14.720 --> 00:00:17.699 We do, and it raises a big question. What's really 00:00:17.699 --> 00:00:20.440 underneath all that? What fuels that excellence 00:00:20.440 --> 00:00:23.460 and wellbeing when the pressure is immense? Exactly, 00:00:23.620 --> 00:00:25.579 and our mission today really is to challenge 00:00:25.579 --> 00:00:28.039 some of those, well, ingrained ideas about motivation. 00:00:28.320 --> 00:00:30.620 Yes, moving past the simple carrot and stick. 00:00:30.820 --> 00:00:33.570 We want to explore how understanding our you 00:00:33.570 --> 00:00:35.950 know, fundamental drives can genuinely impact 00:00:35.950 --> 00:00:38.750 job satisfaction, performance, and even innovation 00:00:38.750 --> 00:00:40.450 in healthcare. It's quite profound, actually. 00:00:40.829 --> 00:00:42.329 Let's kick off with a little thought experiment. 00:00:42.789 --> 00:00:45.609 Imagine it's, say, 1995. You're telling an economist 00:00:45.609 --> 00:00:47.969 you've got a crystal ball showing two new encyclopedias 00:00:47.969 --> 00:00:50.570 about to launch. Which one will succeed by 2010? 00:00:50.710 --> 00:00:53.850 Okay. So the first is from Microsoft. Huge company, 00:00:53.929 --> 00:00:55.829 well -funded. They'll pay professionals, have 00:00:55.829 --> 00:00:58.990 managers sell it. The works. Basically, in Carta. 00:00:59.250 --> 00:01:01.710 Built on all the usual business rules. Incentives, 00:01:01.929 --> 00:01:04.540 management, planning. Right. Standard stuff. 00:01:05.500 --> 00:01:07.939 Then there's the second one. Not from a company 00:01:07.939 --> 00:01:11.540 at all. Built by volunteers. Thousands of them. 00:01:11.879 --> 00:01:14.180 Working for free, just for the fun of it. No 00:01:14.180 --> 00:01:17.739 pay. And the encyclopedia itself. Online only. 00:01:18.060 --> 00:01:20.680 Totally free. Well, back in 95, any sensible 00:01:20.680 --> 00:01:22.420 economist would have probably laughed, wouldn't 00:01:22.420 --> 00:01:25.900 they? The second model sounds frankly ridiculous 00:01:25.900 --> 00:01:28.319 by conventional standards. Microsoft has all 00:01:28.319 --> 00:01:30.849 the resources. pays people properly. It seems 00:01:30.849 --> 00:01:33.969 like a no -brainer, and Carta must win. Exactly. 00:01:34.090 --> 00:01:36.489 The volunteers. They're getting nothing, even 00:01:36.489 --> 00:01:39.170 losing potential earnings. It defies economic 00:01:39.170 --> 00:01:41.170 logic as we knew it. But as you probably know, 00:01:41.370 --> 00:01:44.290 that's not what happened. October 2009, Microsoft 00:01:44.290 --> 00:01:47.189 shut down Encarta. And the other one? Wikipedia. 00:01:47.510 --> 00:01:49.510 Became the biggest encyclopedia in the world. 00:01:49.849 --> 00:01:51.409 Millions of articles, hundreds of languages. 00:01:51.849 --> 00:01:54.109 It didn't just survive, it thrived. It completely 00:01:54.109 --> 00:01:56.189 overturned expectations, didn't it? It really 00:01:56.189 --> 00:01:58.719 did. shattered that conventional wisdom. It suggests 00:01:58.719 --> 00:02:00.319 there's something else going on, a duping kind 00:02:00.319 --> 00:02:03.019 of driver we often overlook. And that's precisely 00:02:03.019 --> 00:02:06.200 why this matters so much for medicine. If this 00:02:06.200 --> 00:02:09.099 applies to encyclopedias, what does it mean for 00:02:09.099 --> 00:02:12.800 a field like ours? High skill, high stakes, lives 00:02:12.800 --> 00:02:15.900 on the line. You have to ask, don't you? Is our 00:02:15.900 --> 00:02:17.960 basic understanding of motivation actually fit 00:02:17.960 --> 00:02:20.340 for purpose in today's complex medical world? 00:02:20.840 --> 00:02:23.419 A world demanding constant learning, empathy, 00:02:23.719 --> 00:02:26.699 innovation? Perhaps it's outdated. So let's dig 00:02:26.699 --> 00:02:28.819 into where this alternative understanding came 00:02:28.819 --> 00:02:31.500 from. It started, perhaps surprisingly, quite 00:02:31.500 --> 00:02:33.800 a while ago. Middle of the last century. That's 00:02:33.800 --> 00:02:35.939 right. With two scientists whose initial work 00:02:35.939 --> 00:02:37.840 didn't quite get the traction it deserved at 00:02:37.840 --> 00:02:41.039 the time, we begin in 1949 with Harry Harlow 00:02:41.039 --> 00:02:43.360 at the University of Wisconsin. The primate lab 00:02:43.360 --> 00:02:45.800 guy. The very same. He sat at this lab and gave 00:02:45.800 --> 00:02:48.580 rhesus monkeys a simple mechanical puzzle. Pull 00:02:48.580 --> 00:02:51.979 a pin, undo a hook, lift a lid. Simple for us, 00:02:52.099 --> 00:02:53.939 but... Tricky for a monkey. And he just put these 00:02:53.939 --> 00:02:56.560 in their cages. No training, no reward planned 00:02:56.560 --> 00:02:58.580 initially. Exactly. Just to see how they'd react. 00:02:58.699 --> 00:03:01.000 Sort of baseline observation before proper tests. 00:03:01.099 --> 00:03:03.460 Yeah. But something quite remarkable happened 00:03:03.460 --> 00:03:06.280 straight away. What was that? The monkeys, completely 00:03:06.280 --> 00:03:08.400 unprompted, just started playing with the puzzles. 00:03:08.780 --> 00:03:11.379 They were focused, determined. Harlow even said 00:03:11.379 --> 00:03:13.400 they looked like they were, well, enjoying it. 00:03:13.500 --> 00:03:15.879 And they got good at it. Fast. Swallowing it 00:03:15.879 --> 00:03:18.460 in under a minute sometimes. Wow. Without any 00:03:18.460 --> 00:03:20.240 reward, that goes against the grain, doesn't 00:03:20.240 --> 00:03:22.979 it? Completely. Back then, the thinking was all 00:03:22.979 --> 00:03:26.400 about two main drives. Biological needs, hunger, 00:03:26.840 --> 00:03:30.060 thirst, sex, and external rewards or punishments. 00:03:30.479 --> 00:03:33.479 Skinner and all that. The behaviorist view. Precisely. 00:03:34.039 --> 00:03:35.680 But these monkeys weren't hungry or thirsty. 00:03:36.020 --> 00:03:38.060 Solving the puzzle didn't get them food or water. 00:03:38.439 --> 00:03:40.680 And there were absolutely no external rewards. 00:03:40.879 --> 00:03:43.780 No raisins, no applause, nothing. So Harlow was 00:03:43.780 --> 00:03:46.659 puzzled himself. He was. He wrote about it posing 00:03:46.659 --> 00:03:49.099 interesting questions for motivation theory. 00:03:49.280 --> 00:03:51.599 How could they learn and perform so well without 00:03:51.599 --> 00:03:54.400 any extrinsic incentives? He was genuinely scratching 00:03:54.400 --> 00:03:56.719 his head. So what did he propose? He suggested 00:03:56.719 --> 00:03:59.680 a third drive He argued the performance of the 00:03:59.680 --> 00:04:02.639 task provided intrinsic reward. They did it because 00:04:02.639 --> 00:04:05.759 doing it felt good The enjoyment was the reward 00:04:05.759 --> 00:04:09.500 itself. He called it intrinsic motivation a groundbreaking 00:04:09.500 --> 00:04:12.919 idea for the time Absolutely, but then came the 00:04:12.919 --> 00:04:16.079 really baffling part. He thought okay if I do 00:04:16.079 --> 00:04:19.180 give them a reward like a raisin, surely they'll 00:04:19.180 --> 00:04:22.579 do even better. Makes sense. But no, the complete 00:04:22.579 --> 00:04:25.459 opposite happened. When he introduced food rewards, 00:04:25.899 --> 00:04:28.240 the monkeys made more errors and solved the puzzles 00:04:28.240 --> 00:04:31.240 less often. That's astonishing. A reward made 00:04:31.240 --> 00:04:34.000 performance worse. He was stunned. He wrote it 00:04:34.000 --> 00:04:36.139 was a phenomenon not reported in the literature. 00:04:36.639 --> 00:04:39.139 It suggested our whole understanding was, well, 00:04:39.300 --> 00:04:42.209 flawed. He urged scientists to close down large 00:04:42.209 --> 00:04:44.649 sections of our theoretical junkyard, saying 00:04:44.649 --> 00:04:47.209 our explanations were actively misleading. A 00:04:47.209 --> 00:04:49.870 pretty strong statement, but then he didn't pursue 00:04:49.870 --> 00:04:52.949 it. Largely, no. He moved on to other research. 00:04:53.209 --> 00:04:55.490 It was controversial, challenging the core beliefs 00:04:55.490 --> 00:04:57.829 of the time, and maybe the pushback was too strong. 00:04:58.170 --> 00:05:00.529 So these crucial insights just sat there, on 00:05:00.529 --> 00:05:02.629 the periphery for about two decades. Incredible, 00:05:02.790 --> 00:05:04.790 until someone else picked it up. Yes, fast forward 00:05:04.790 --> 00:05:08.850 to 1969. Edward Deesing. a psychology graduate 00:05:08.850 --> 00:05:11.949 student at Carnegie Mellon. He had an MBA, actually, 00:05:12.310 --> 00:05:14.569 and suspected that both academics and businesses 00:05:14.569 --> 00:05:17.110 had motivation fundamentally wrong. So he wanted 00:05:17.110 --> 00:05:20.310 to test Harlow's idea, but with people this time. 00:05:20.610 --> 00:05:24.170 Spot on. He used the Soma Puzzle Cube. Quite 00:05:24.170 --> 00:05:27.269 a popular, tricky puzzle back then. He got university 00:05:27.269 --> 00:05:30.029 students, split them into two groups, A and B. 00:05:30.889 --> 00:05:33.990 Three one -hour sessions over three days. A very 00:05:33.990 --> 00:05:35.850 careful setup. Okay, so what was the structure? 00:05:36.889 --> 00:05:38.810 Session one, both groups just worked on puzzles 00:05:38.810 --> 00:05:41.389 from drawings. Then Dissy left the room for eight 00:05:41.389 --> 00:05:43.290 minutes saying they could do whatever they liked, 00:05:43.850 --> 00:05:47.069 carry on puzzling, read magazines, just sit there. 00:05:47.810 --> 00:05:50.649 He secretly watched them. And what happened in 00:05:50.649 --> 00:05:53.310 that first session? Both groups spent a similar 00:05:53.310 --> 00:05:55.470 amount of free time on the puzzle, about three 00:05:55.470 --> 00:05:58.089 or four minutes. He showed a basic level of intrinsic 00:05:58.089 --> 00:05:59.910 interest, you know? Right, makes sense. Then 00:05:59.910 --> 00:06:02.189 session two. This is where it changed. Group 00:06:02.189 --> 00:06:04.709 A was told they'd get paid one dollar for each 00:06:04.709 --> 00:06:07.800 puzzle solved. Group B, the control, got nothing. 00:06:08.199 --> 00:06:10.120 Now, during the eight -minute free time in this 00:06:10.120 --> 00:06:12.620 session, Group A, the paid group, suddenly spent 00:06:12.620 --> 00:06:14.699 much more time on the puzzle, over five minutes. 00:06:14.800 --> 00:06:17.100 Ah, so the money worked, exactly what you'd expect. 00:06:17.139 --> 00:06:19.319 On the surface, yes. It looked like proof that 00:06:19.319 --> 00:06:21.920 rewards boost engagement. But then came Day 3, 00:06:22.399 --> 00:06:25.540 the crucial test. What happened on Day 3? Day 00:06:25.540 --> 00:06:27.699 C told Group A the money had run out for that 00:06:27.699 --> 00:06:29.959 session, so no pay today, just like the first 00:06:29.959 --> 00:06:32.319 day. Now watch what happens in the free choice 00:06:32.319 --> 00:06:35.980 period. Group B, who were never paid, actually 00:06:35.980 --> 00:06:38.060 played with the puzzle a bit longer than before. 00:06:38.399 --> 00:06:41.139 Still interested. Okay. And Group A, the ones 00:06:41.139 --> 00:06:44.339 who had been paid? They spent significantly less 00:06:44.339 --> 00:06:47.240 time on the puzzle. Not just less than when they 00:06:47.240 --> 00:06:50.000 were paid, but even less than their initial unpaid 00:06:50.000 --> 00:06:52.660 session. Their original motivation seemed to 00:06:52.660 --> 00:06:55.560 have vanished. Wow. So the reward actually killed 00:06:55.560 --> 00:06:57.740 their interest long -term, just like Harlow's 00:06:57.740 --> 00:07:00.839 monkeys. Precisely. Dizzy's conclusion was stark. 00:07:01.120 --> 00:07:03.899 When money is used as an external reward for 00:07:03.899 --> 00:07:06.740 some activity, the subjects lose intrinsic interest 00:07:06.740 --> 00:07:09.480 for the activity. That short -term boost from 00:07:09.480 --> 00:07:12.120 the cash seemed to undermine the deeper inherent 00:07:12.120 --> 00:07:14.839 motivation. Like a sugar rush followed by a crash. 00:07:15.000 --> 00:07:17.379 A good analogy. Dizzy argued humans have this 00:07:17.379 --> 00:07:19.800 inherent tendency to seek out novelty and challenges, 00:07:20.240 --> 00:07:23.600 to explore and to learn. Our third drive. But 00:07:23.600 --> 00:07:26.139 he warned it's fragile. It needs the right conditions. 00:07:26.639 --> 00:07:29.019 External controls like money can crush it. So 00:07:29.019 --> 00:07:32.220 focusing only on external rewards can backfire 00:07:32.220 --> 00:07:35.720 spectacularly. It can. Deci admitted it was controversial. 00:07:36.279 --> 00:07:38.319 Nobody was expecting rewards would have a negative 00:07:38.319 --> 00:07:41.740 effect. But it launched his lifelong work challenging 00:07:41.740 --> 00:07:44.259 our core assumptions about motivation. And you 00:07:44.259 --> 00:07:46.160 can immediately see the relevance for medicine, 00:07:46.379 --> 00:07:48.259 can't you, if someone goes into medicine driven 00:07:48.259 --> 00:07:50.660 by that passion for care or the intellectual 00:07:50.660 --> 00:07:53.420 challenge? Exactly. What happens if we overlay 00:07:53.420 --> 00:07:57.000 that with purely external incentives, bonuses 00:07:57.000 --> 00:07:59.800 tied strictly to patient numbers or adherence 00:07:59.800 --> 00:08:02.800 to protocols without room for judgment? Could 00:08:02.800 --> 00:08:06.160 that unintentionally diminish that core intrinsic 00:08:06.160 --> 00:08:08.399 drive. It's a really concerning thought. Think 00:08:08.399 --> 00:08:10.699 about a medical student, maybe full of enthusiasm, 00:08:10.899 --> 00:08:13.060 loving the science, maybe even volunteering extra 00:08:13.060 --> 00:08:15.360 hours. Right. And then perhaps the system starts 00:08:15.360 --> 00:08:18.019 rewarding them, mainly for ticking boxes, completing 00:08:18.019 --> 00:08:20.720 specific tasks, remarks, hitting certain metrics. 00:08:21.339 --> 00:08:24.040 They might do the tasks, sure, short -term compliance. 00:08:24.319 --> 00:08:26.379 But that initial spark, that love of learning 00:08:26.379 --> 00:08:28.779 for its own sake. It could get dampened down, 00:08:28.899 --> 00:08:32.100 couldn't it? focus shifts from the fascination 00:08:32.100 --> 00:08:34.100 of understanding disease or connecting with a 00:08:34.100 --> 00:08:36.320 patient to just earning the grade or hitting 00:08:36.320 --> 00:08:39.279 the target. The why changes and that changes 00:08:39.279 --> 00:08:41.460 everything. Okay, so this leads us into what's 00:08:41.460 --> 00:08:44.379 often called motivation 2 .0, this sort of default 00:08:44.379 --> 00:08:46.379 operating system for much of the last century. 00:08:46.799 --> 00:08:48.820 That's a good way to put it. It's built on two 00:08:48.820 --> 00:08:51.740 very simple ideas really. Reward what you want 00:08:51.740 --> 00:08:54.440 more of, punish what you want less of, the carrot 00:08:54.440 --> 00:08:57.039 and the stick. And to be fair, It did work for 00:08:57.039 --> 00:08:59.139 certain kinds of tasks, didn't it? Oh, absolutely. 00:08:59.320 --> 00:09:02.240 For routine, algorithmic work, assembly lines, 00:09:02.639 --> 00:09:05.200 basic admin, anything where the steps are clear 00:09:05.200 --> 00:09:07.840 and repetitive, it was pretty effective. If you 00:09:07.840 --> 00:09:10.840 pay per piece, you often get more pieces. Simple 00:09:10.840 --> 00:09:13.240 cause and effect. But there's a massive caveat 00:09:13.240 --> 00:09:15.480 here, isn't there, before any of this even applies? 00:09:15.759 --> 00:09:18.500 Crucially, yes. You must have adequate baseline 00:09:18.500 --> 00:09:22.330 rewards. Fair salary, decent benefits. equitable 00:09:22.330 --> 00:09:25.330 compensation. If people feel fundamentally undervalued 00:09:25.330 --> 00:09:28.450 or insecure, forget motivation. Their focus is 00:09:28.450 --> 00:09:31.299 entirely on that unfairness, that anxiety. Which 00:09:31.299 --> 00:09:33.460 feels particularly relevant in healthcare right 00:09:33.460 --> 00:09:35.919 now, with workforce pressures and retention issues. 00:09:36.480 --> 00:09:39.700 That baseline fairness is non -negotiable. Absolutely 00:09:39.700 --> 00:09:43.220 vital. You can't motivate someone who feels unfairly 00:09:43.220 --> 00:09:45.860 treated or constantly worried about making ends 00:09:45.860 --> 00:09:49.100 meet. But once that baseline is met, that's when 00:09:49.100 --> 00:09:52.320 Motivation 2 .0 starts to show its cracks. Especially 00:09:52.320 --> 00:09:54.980 for complex work. Right. And you've identified 00:09:54.980 --> 00:09:57.940 seven key areas where it can actually backfire. 00:09:58.279 --> 00:10:00.919 Seven deadly flaws, as it were. That's right. 00:10:01.240 --> 00:10:04.059 Seven ways this traditional approach can be counterproductive, 00:10:04.340 --> 00:10:06.899 even harmful, particularly in fields like medicine. 00:10:07.210 --> 00:10:09.009 Let's start with the first one, which is quite 00:10:09.009 --> 00:10:11.850 striking. It can actually extinguish intrinsic 00:10:11.850 --> 00:10:15.169 motivation, the Sawyer Effect. Exactly. Named 00:10:15.169 --> 00:10:17.529 after Tom Sawyer tricking his friends into enjoying 00:10:17.529 --> 00:10:20.409 whitewashing a fence. Rewards can do the opposite, 00:10:20.529 --> 00:10:22.470 turn play into work. There was that study with 00:10:22.470 --> 00:10:24.590 preschoolers and drawing. Yes, leper and green. 00:10:25.389 --> 00:10:27.549 Kids who naturally liked drawing were split into 00:10:27.549 --> 00:10:29.929 groups. One group was told they'd get a certificate 00:10:29.929 --> 00:10:32.409 if they drew an expected reward. Another got 00:10:32.409 --> 00:10:34.450 a surprise certificate afterwards. A third got 00:10:34.450 --> 00:10:37.309 nothing. And the result? Weeks later. The kids 00:10:37.309 --> 00:10:39.789 who expected the award showed much less interest 00:10:39.789 --> 00:10:42.250 in drawing during free play than the other two 00:10:42.250 --> 00:10:44.970 groups. The expected reward had somehow killed 00:10:44.970 --> 00:10:47.509 their natural enjoyment. So it's the expectation 00:10:47.509 --> 00:10:49.690 of the reward that does the damage. It reframes 00:10:49.690 --> 00:10:52.889 the activity. Precisely. It's just the why. Imagine 00:10:52.889 --> 00:10:55.570 that young doctor passionate about their specialism. 00:10:56.090 --> 00:10:58.990 If suddenly every little thing is tied to a metric. 00:10:59.200 --> 00:11:02.080 or a bonus patient interactions, research output, 00:11:02.519 --> 00:11:05.399 even attending meetings, the focus can subtly 00:11:05.399 --> 00:11:08.519 shift. From the joy of the task itself to simply 00:11:08.519 --> 00:11:11.559 earning the reward, the satisfaction of helping 00:11:11.559 --> 00:11:14.139 someone, the intellectual buzz of a diagnosis 00:11:14.139 --> 00:11:16.779 that can get overshadowed by hitting the target. 00:11:17.279 --> 00:11:19.460 It fundamentally changes the experience. OK, 00:11:19.600 --> 00:11:22.330 flaw number two. Diminishing performance, especially 00:11:22.330 --> 00:11:25.029 for complex tasks. Yes. There was a study in 00:11:25.029 --> 00:11:28.269 India by Dan R. Reilly. People were offered low, 00:11:28.309 --> 00:11:31.190 medium, or high cash rewards for tasks needing 00:11:31.190 --> 00:11:33.730 cognitive skill, memory, games, anagrams, that 00:11:33.730 --> 00:11:35.309 sort of thing. And you'd think higher rewards 00:11:35.309 --> 00:11:38.230 equal better performance. You would. But for 00:11:38.230 --> 00:11:40.970 the cognitive tasks, the group offered the highest 00:11:40.970 --> 00:11:44.009 rewards performed the worst. They seemed to choke 00:11:44.009 --> 00:11:47.200 under the pressure. And it's not isolated. A 00:11:47.200 --> 00:11:49.960 big LSE meta -analysis found financial incentives 00:11:49.960 --> 00:11:52.840 often negatively impact performance on thinking 00:11:52.840 --> 00:11:55.179 tasks. That's deeply concerning for healthcare, 00:11:55.320 --> 00:11:58.299 isn't it? complex diagnosis, intricate surgery, 00:11:58.879 --> 00:12:01.120 research breakthroughs. These aren't routine. 00:12:01.340 --> 00:12:03.840 Not at all. They're heuristic, needing creativity, 00:12:04.480 --> 00:12:07.539 judgment, adaptability. If you put intense pressure 00:12:07.539 --> 00:12:11.259 on, say, the volume of patients seen or the number 00:12:11.259 --> 00:12:13.860 of procedures done through high stakes bonuses. 00:12:14.159 --> 00:12:16.139 It could narrow the focus, make people rush, 00:12:16.279 --> 00:12:19.370 maybe miss things. Potentially, yes. It might 00:12:19.370 --> 00:12:21.710 impair that careful, comprehensive thinking needed 00:12:21.710 --> 00:12:24.190 for the best outcomes, especially in tricky cases. 00:12:24.409 --> 00:12:26.789 Or hinder the collaboration needed for discovery. 00:12:27.129 --> 00:12:29.110 The pressure to hit the number could inadvertently 00:12:29.110 --> 00:12:32.169 compromise the quality. Flaw three. Crushing 00:12:32.169 --> 00:12:34.870 creativity. The candle problem. Glücksberg's 00:12:34.870 --> 00:12:36.769 classic experiment. Fix a candle to the wall 00:12:36.769 --> 00:12:39.149 with tacks and matches. Don't let wax drip. You 00:12:39.149 --> 00:12:41.149 need to realize the box holding the tacks can 00:12:41.149 --> 00:12:43.409 be used as a shelf. Ah, the out -of -the -box 00:12:43.409 --> 00:12:46.580 thinking. Literally. And when people were offered 00:12:46.580 --> 00:12:49.039 money for solving it quickly, they took longer. 00:12:49.659 --> 00:12:52.259 The reward narrowed their focus, made them less 00:12:52.259 --> 00:12:54.340 likely to see the creative solution. And Theresa 00:12:54.340 --> 00:12:56.519 Emma Beale found similar things with artists. 00:12:56.820 --> 00:12:59.320 Yes, her work is fascinating. Commissioned art, 00:12:59.639 --> 00:13:02.840 driven by external demands and rewards, was consistently 00:13:02.840 --> 00:13:06.139 rated less creative than the artist's non -commissioned 00:13:06.139 --> 00:13:09.759 passion projects, even if technically good. The 00:13:09.759 --> 00:13:12.590 artists felt more constrained. So the intrinsically 00:13:12.590 --> 00:13:15.090 motivated artists ultimately did better creatively? 00:13:15.450 --> 00:13:17.809 In the long run, yes, which has huge implications 00:13:17.809 --> 00:13:20.730 for medical innovation. If research or developing 00:13:20.730 --> 00:13:23.809 new treatments is driven mainly by if -then rewards 00:13:23.809 --> 00:13:26.990 hit this target, get this bonus, it could stifle 00:13:26.990 --> 00:13:29.870 the very creativity needed for real breakthroughs. 00:13:30.210 --> 00:13:32.649 It encourages safe bets over bold ideas. OK, 00:13:32.730 --> 00:13:35.230 number four, crowding out good behavior. This 00:13:35.230 --> 00:13:37.690 one feels quite fundamental. It does. Think about 00:13:37.690 --> 00:13:40.250 the Swedish blood donation study. Offering a 00:13:40.250 --> 00:13:42.690 small payment actually halved the number of donors 00:13:42.690 --> 00:13:45.529 compared to the purely voluntary group. It seemed 00:13:45.529 --> 00:13:49.049 to taint the altruistic act, turn something noble 00:13:49.049 --> 00:13:51.429 into a transaction, and that somehow lessened 00:13:51.429 --> 00:13:53.610 the appeal for many. And the Israeli daycare 00:13:53.610 --> 00:13:56.990 fines. Another classic. Fines for late pickups 00:13:56.990 --> 00:13:59.789 were meant to reduce lateness. Instead, late 00:13:59.789 --> 00:14:02.529 arrivals increased. The fine changed it from 00:14:02.529 --> 00:14:05.370 a moral obligation, don't inconvenience the staff, 00:14:05.870 --> 00:14:08.220 to a price you could pay for being late. That's 00:14:08.220 --> 00:14:10.399 directly relevant to medical ethics, isn't it? 00:14:10.679 --> 00:14:13.200 Altruism is so core to the profession. Absolutely. 00:14:13.700 --> 00:14:15.659 If you start incentivizing things like shorter 00:14:15.659 --> 00:14:18.240 consult times or hitting procedure quotas too 00:14:18.240 --> 00:14:20.460 heavily, does that subtly undermine the doctor's 00:14:20.460 --> 00:14:23.120 intrinsic drive to provide comprehensive, compassionate 00:14:23.120 --> 00:14:25.620 care? Does the focus shift from the patient's 00:14:25.620 --> 00:14:28.340 holistic needs to just efficiency or volume? 00:14:28.679 --> 00:14:31.580 It's a real risk. Flaw five. encouraging cheating, 00:14:31.980 --> 00:14:34.419 shortcuts, and unethical behavior. Yes. When 00:14:34.419 --> 00:14:37.039 you have narrow, high -stakes, short -term goals, 00:14:37.480 --> 00:14:39.600 the pressure to hit the number can become immense. 00:14:40.100 --> 00:14:42.159 We've seen it in sales with mis -selling, in 00:14:42.159 --> 00:14:44.799 finance with cooking the books. The goal restricts 00:14:44.799 --> 00:14:46.879 the view, as some researchers put it. And the 00:14:46.879 --> 00:14:49.559 potential for that in medicine is, well, worrying. 00:14:50.460 --> 00:14:52.950 Pressure on financial targets. waiting lists 00:14:52.950 --> 00:14:55.750 without enough resources, procedure quotas. It 00:14:55.750 --> 00:14:58.210 creates a temptation, doesn't it, to maybe cut 00:14:58.210 --> 00:15:01.190 corners on care quality, perhaps fudge the data 00:15:01.190 --> 00:15:03.909 slightly, or even, in the worst cases, engage 00:15:03.909 --> 00:15:07.110 in unethical billing or unnecessary procedures 00:15:07.110 --> 00:15:10.090 just to meet the target. The low road becomes 00:15:10.090 --> 00:15:12.129 appealing. Whereas intrinsic motivation, wanting 00:15:12.129 --> 00:15:14.509 to learn, help patients do your best, doesn't 00:15:14.509 --> 00:15:16.769 offer shortcuts. Exactly. The goal is the high 00:15:16.769 --> 00:15:20.250 road. Number six, creating addiction. Rewards 00:15:20.250 --> 00:15:23.570 can be addictive. In a sense, yes. Once you offer 00:15:23.570 --> 00:15:25.669 a reward for something, people expect it. And 00:15:25.669 --> 00:15:27.929 often you need bigger rewards over time to get 00:15:27.929 --> 00:15:30.870 the same effect. Brian Knudsen's fMRI studies 00:15:30.870 --> 00:15:33.789 showed anticipating money lights up the nucleus 00:15:33.789 --> 00:15:36.629 accumbens. The brain's reward center. Same area 00:15:36.629 --> 00:15:38.730 involved in drug addiction. The very same. That 00:15:38.730 --> 00:15:41.409 dopamine hit. It suggests a potentially compulsive 00:15:41.409 --> 00:15:44.330 loop can be created. So for professionals, constantly 00:15:44.330 --> 00:15:46.750 chasing bonuses or recognition could become a 00:15:46.750 --> 00:15:50.139 treadmill. It could. Satisfaction becomes fleeting, 00:15:50.539 --> 00:15:53.419 always needing the next external hit, which can 00:15:53.419 --> 00:15:56.700 lead straight to burnout or deep dissatisfaction 00:15:56.700 --> 00:15:59.259 if those rewards aren't there or aren't enough. 00:16:00.080 --> 00:16:02.320 It makes fulfillment dependent on something external. 00:16:02.940 --> 00:16:05.259 And finally, number seven, fostering short -term 00:16:05.259 --> 00:16:08.299 thinking. Yes, rewards tend to narrow focus onto 00:16:08.299 --> 00:16:11.100 the immediate game, like companies obsessed with 00:16:11.100 --> 00:16:13.740 quarterly earnings, sacrificing long -term R 00:16:13.740 --> 00:16:16.230 &D. And in healthcare. It could mean focusing 00:16:16.230 --> 00:16:19.070 on immediate metrics, discharge rates, short 00:16:19.070 --> 00:16:21.389 -term cost savings while neglecting long -term 00:16:21.389 --> 00:16:23.929 patient health, preventive care, or building 00:16:23.929 --> 00:16:26.669 sustainable systems. So incentivizing quick discharges 00:16:26.669 --> 00:16:28.929 might mean less time for patient education that 00:16:28.929 --> 00:16:31.289 prevents future problems. Or focusing only on 00:16:31.289 --> 00:16:33.450 acute treatment rather than investing in community 00:16:33.450 --> 00:16:35.409 health that prevents illness in the first place. 00:16:36.009 --> 00:16:38.509 It shifts focus from the patient's lifelong well 00:16:38.509 --> 00:16:42.029 -being to just the next measurable event, a very 00:16:42.029 --> 00:16:44.419 short -term view. Right, so we've painted a fairly 00:16:44.419 --> 00:16:46.659 bleak picture of traditional rewards in many 00:16:46.659 --> 00:16:48.679 contexts, but it's not all bad, is it? You're 00:16:48.679 --> 00:16:50.720 not saying get rid of all extrinsic motivators. 00:16:50.960 --> 00:16:52.820 Oh, absolutely not. That would be throwing the 00:16:52.820 --> 00:16:55.559 baby out with the bathwater. The science is more 00:16:55.559 --> 00:16:58.580 nuanced. There are specific situations where 00:16:58.580 --> 00:17:00.659 carrots and sticks do work, and understanding 00:17:00.659 --> 00:17:03.820 that is crucial for health care settings. Okay, 00:17:03.840 --> 00:17:07.000 so when do they work? The big exception is for 00:17:07.000 --> 00:17:09.759 routine tasks. Remember, Gluckberg's Campbell 00:17:09.759 --> 00:17:12.859 problem. When he made it easy, took the tax out 00:17:12.859 --> 00:17:15.420 of the box, making the solution obvious, the 00:17:15.420 --> 00:17:17.700 rewarded group solved it faster. Because it wasn't 00:17:17.700 --> 00:17:19.680 a creative challenge anymore, just execution. 00:17:20.079 --> 00:17:23.200 Exactly. It became an algorithmic routine. And 00:17:23.200 --> 00:17:26.819 the core principle here is rewards don't undermine 00:17:26.819 --> 00:17:29.420 intrinsic motivation for dull tasks, because 00:17:29.789 --> 00:17:32.069 Well, there's usually very little intrinsic motivation 00:17:32.069 --> 00:17:34.269 there to undermine in the first place. Ah, right. 00:17:34.369 --> 00:17:36.650 So for things like straightforward data entry, 00:17:36.990 --> 00:17:39.829 basic admin, repetitive lab procedures. Precisely. 00:17:40.069 --> 00:17:42.369 Tasks that don't require much creativity or passion, 00:17:42.630 --> 00:17:45.529 just accuracy and efficiency. For those, if -then 00:17:45.529 --> 00:17:48.170 incentives or higher pay can genuinely lead to 00:17:48.170 --> 00:17:50.130 better performance without those negative side 00:17:50.130 --> 00:17:52.039 effects we talked about. Okay, that's a really 00:17:52.039 --> 00:17:54.960 important distinction. And even when using rewards 00:17:54.960 --> 00:17:57.240 for these routine tasks, are there ways to do 00:17:57.240 --> 00:18:00.380 it better? Yes, definitely. Three key practices 00:18:00.380 --> 00:18:04.720 help. First, offer a clear rationale. Explain 00:18:04.720 --> 00:18:08.079 why the task matters, even if it's dull. Like 00:18:08.079 --> 00:18:10.859 this accurate data entry is vital for patient 00:18:10.859 --> 00:18:13.980 safety and care quality. Exactly. Give it context, 00:18:14.220 --> 00:18:16.480 link it to the bigger purpose. It makes even 00:18:16.480 --> 00:18:20.000 mundane work feel more significant. Second, acknowledge 00:18:20.000 --> 00:18:22.680 the task might be boring. Just be honest about 00:18:22.680 --> 00:18:24.880 it. Yes. Say something like, look, we know this 00:18:24.880 --> 00:18:27.079 paperwork isn't exciting, but it's necessary. 00:18:27.279 --> 00:18:29.500 And we really appreciate you doing it diligently. 00:18:30.240 --> 00:18:32.500 It shows respect, validates their experience. 00:18:32.599 --> 00:18:35.220 And third? Allow autonomy over technique where 00:18:35.220 --> 00:18:37.400 possible. Even for routine stuff. Don't dictate 00:18:37.400 --> 00:18:40.000 every single step if you don't have to. So these 00:18:40.000 --> 00:18:42.539 reports need finishing by 5 p .m. You figure 00:18:42.539 --> 00:18:44.980 out the best workflow. That sort of thing. Giving 00:18:44.980 --> 00:18:48.619 even a small amount of control over the How can 00:18:48.619 --> 00:18:50.980 boost engagement and satisfaction significantly? 00:18:51.400 --> 00:18:54.140 Okay, so that's routine tasks. What about the 00:18:54.140 --> 00:18:57.359 non -routine creative conceptual work? Developing 00:18:57.359 --> 00:18:59.680 new techniques, complex research, innovative 00:18:59.680 --> 00:19:03.299 patient programs. If then rewards are still risky 00:19:03.299 --> 00:19:05.779 there? Extremely risky. That's where they narrow 00:19:05.779 --> 00:19:08.400 focus and stifle creativity. For that kind of 00:19:08.400 --> 00:19:10.259 work, if you want to use rewards, the approach 00:19:10.259 --> 00:19:13.000 needs to be different. We call it now that rewards. 00:19:13.200 --> 00:19:15.519 Now that? How does that work? These are rewards 00:19:15.519 --> 00:19:18.140 given after the task is complete. unexpectedly, 00:19:18.480 --> 00:19:20.980 and not contingent on hitting a specific pre 00:19:20.980 --> 00:19:23.200 -agreed target. More like a bonus or a thank 00:19:23.200 --> 00:19:25.220 you after great work has already been done. So 00:19:25.220 --> 00:19:27.839 not, if you do this, then you'll get that. But 00:19:27.839 --> 00:19:29.960 now that you've done such great work, here's 00:19:29.960 --> 00:19:33.000 a token of appreciation. Precisely. For example, 00:19:33.319 --> 00:19:35.480 now that your team has navigated that incredibly 00:19:35.480 --> 00:19:37.960 complex case so brilliantly, let's celebrate 00:19:37.960 --> 00:19:41.940 with a team lunch. It's recognition, not an incentive 00:19:41.940 --> 00:19:45.059 that drove the behavior. So it's much less likely 00:19:45.059 --> 00:19:47.660 to undermine intrinsic motivation. And within 00:19:47.660 --> 00:19:50.640 those, now that rewards, non -tangible ones are 00:19:50.640 --> 00:19:54.680 powerful. Hugely powerful. First, specific, sincere 00:19:54.680 --> 00:19:57.720 praise and positive feedback. Offered privately, 00:19:58.259 --> 00:20:00.980 ideally, not just good job, but detailed comments 00:20:00.980 --> 00:20:03.940 on what was good. The insights shown, the empathy 00:20:03.940 --> 00:20:06.339 demonstrated, the skill applied. That really 00:20:06.339 --> 00:20:09.220 lands and boosts intrinsic drive. It affirms 00:20:09.220 --> 00:20:12.779 their competence. Exactly. And second, Useful 00:20:12.779 --> 00:20:15.339 informational feedback, not just hitting targets, 00:20:15.799 --> 00:20:17.779 but feedback that helps them learn and grow. 00:20:18.359 --> 00:20:20.480 For a researcher, detailed comments on methodology 00:20:20.480 --> 00:20:22.740 or the potential impact of the work is far more 00:20:22.740 --> 00:20:25.059 motivating long term than just a check mark for 00:20:25.059 --> 00:20:27.400 publishing. It feeds into mastery. So it's about 00:20:27.400 --> 00:20:30.859 using rewards thoughtfully, strategically, and 00:20:30.859 --> 00:20:34.200 often shifting from if -then to now -that, especially 00:20:34.200 --> 00:20:36.779 for complex work. That's the key takeaway. Nuance 00:20:36.779 --> 00:20:38.940 is everything. Right. We've explored the pitfalls 00:20:38.940 --> 00:20:41.619 of Motivation 2 .0 and the nuances of rewards. 00:20:42.160 --> 00:20:45.099 Now let's pivot to Motivation 3 .0. This is the 00:20:45.099 --> 00:20:47.619 row, the upgraded operating system. You could 00:20:47.619 --> 00:20:50.579 say that. It's built on a much deeper, more scientifically 00:20:50.579 --> 00:20:52.880 sound understanding of what truly drives us. 00:20:53.180 --> 00:20:55.559 It fosters what we call type I behavior. Type 00:20:55.559 --> 00:20:59.059 I behavior. Yes. Behavior that's fueled by intrinsic 00:20:59.059 --> 00:21:02.359 desires. The inherent satisfaction of the activity 00:21:02.359 --> 00:21:05.319 itself. It leads to better performance. better 00:21:05.319 --> 00:21:08.640 health, greater well -being overall. It's the 00:21:08.640 --> 00:21:11.460 opposite of type X, which is all about the external 00:21:11.460 --> 00:21:14.299 rewards. And crucially, type I isn't something 00:21:14.299 --> 00:21:18.039 you're born with. No, it's made, not born. The 00:21:18.039 --> 00:21:20.839 environment, the organizational culture is absolutely 00:21:20.839 --> 00:21:24.240 key. Organizations can choose to create conditions 00:21:24.240 --> 00:21:26.799 where type I behavior flourishes, or they can 00:21:26.799 --> 00:21:29.529 stifle it. And the science points to three core 00:21:29.529 --> 00:21:31.710 elements, three essential nutrients for this. 00:21:31.769 --> 00:21:34.190 That's right. The pillars of motivation 3 .0 00:21:34.190 --> 00:21:37.329 are autonomy, mastery, and purpose. When these 00:21:37.329 --> 00:21:39.349 three are present, people thrive. Let's break 00:21:39.349 --> 00:21:41.529 those down, starting with autonomy. Autonomy 00:21:41.529 --> 00:21:43.650 is fundamentally the desire to direct our own 00:21:43.650 --> 00:21:47.329 lives, to feel we have choice, volition. Self 00:21:47.329 --> 00:21:49.329 -determination theory highlights it as perhaps 00:21:49.329 --> 00:21:51.809 the most crucial of our basic psychological needs, 00:21:52.309 --> 00:21:54.049 feeling like you're in the driving seat, not 00:21:54.049 --> 00:21:56.470 just a pawn. And the evidence supports its impact. 00:21:56.680 --> 00:21:59.880 strongly. Studies show organizations offering 00:21:59.880 --> 00:22:02.619 more autonomy tend to grow faster, have lower 00:22:02.619 --> 00:22:05.319 turnover. There's a clear link between having 00:22:05.319 --> 00:22:08.390 decision latitude and job satisfaction. which 00:22:08.390 --> 00:22:10.390 is vital for retaining skilled professionals 00:22:10.390 --> 00:22:12.569 like those in medicine. So how does autonomy 00:22:12.569 --> 00:22:15.309 translate into practical terms in a healthcare 00:22:15.309 --> 00:22:18.470 setting? You mentioned four T's. Yes, a useful 00:22:18.470 --> 00:22:21.289 framework. First is task autonomy having some 00:22:21.289 --> 00:22:24.690 say over what you work on. Think of 3M's 15 % 00:22:24.690 --> 00:22:27.890 time for personal projects. For clinicians, maybe 00:22:27.890 --> 00:22:29.890 it's protected time for a research interest, 00:22:30.329 --> 00:22:32.049 a quality improvement project they initiate, 00:22:32.529 --> 00:22:34.630 or developing patient resources they see a need 00:22:34.630 --> 00:22:37.019 for. giving space for that self -directed work. 00:22:37.319 --> 00:22:40.680 Exactly. Second, time autonomy, having some control 00:22:40.680 --> 00:22:43.240 over when work happens, moving away from rigid 00:22:43.240 --> 00:22:45.180 clock watching towards more flexibility where 00:22:45.180 --> 00:22:47.740 possible. Flexible clinic hours, maybe more use 00:22:47.740 --> 00:22:49.940 of telemedicine scheduled thoughtfully, respecting 00:22:49.940 --> 00:22:52.299 people's peak working times rather than enforcing 00:22:52.299 --> 00:22:54.599 rigid shifts for everyone. Challenging in healthcare, 00:22:54.940 --> 00:22:57.819 but important. Third is technique. Autonomy over 00:22:57.819 --> 00:23:00.900 how the work is done. Like Zamos, empowering 00:23:00.900 --> 00:23:03.380 call center staff to use their judgment, not 00:23:03.380 --> 00:23:06.230 scripts. For clinicians, it means trusting their 00:23:06.230 --> 00:23:08.930 professional expertise, allowing individual style 00:23:08.930 --> 00:23:11.789 and empathy in patient care, not enforcing overly 00:23:11.789 --> 00:23:14.750 rigid protocols that stifle nuance and the art 00:23:14.750 --> 00:23:17.609 of medicine, respecting their judgment, and the 00:23:17.609 --> 00:23:20.730 fourth T. Team autonomy, having some agency over 00:23:20.730 --> 00:23:23.309 who you work with, like teams having input on 00:23:23.309 --> 00:23:25.809 new hires or encouraging self -warning groups 00:23:25.809 --> 00:23:28.490 for projects based on shared interest rather 00:23:28.490 --> 00:23:31.640 than purely top -down assignments. Imagine the 00:23:31.640 --> 00:23:34.000 synergy in a team that genuinely chose to work 00:23:34.000 --> 00:23:36.380 together. So for leaders, it's about actively 00:23:36.380 --> 00:23:38.660 looking for ways to increase autonomy across 00:23:38.660 --> 00:23:41.480 these four areas, maybe even asking staff directly. 00:23:41.799 --> 00:23:44.259 An autonomy audit could be very revealing, surveying 00:23:44.259 --> 00:23:47.119 the team. And crucially, leaders need to consciously 00:23:47.119 --> 00:23:49.720 relinquish control, where appropriate, involve 00:23:49.720 --> 00:23:52.200 people in setting goals, and use non -controlling 00:23:52.200 --> 00:23:54.680 language, shift from managing to people to creating 00:23:54.680 --> 00:23:56.480 conditions for them. Okay, that's autonomy. The 00:23:56.480 --> 00:23:59.170 second pillar is mastery. Yes, the urge to get 00:23:59.170 --> 00:24:00.849 better and better at something that matters. 00:24:01.450 --> 00:24:04.569 As we said, control leads to compliance. But 00:24:04.569 --> 00:24:08.309 autonomy unlocks engagement. And it's only engagement 00:24:08.309 --> 00:24:10.930 that fuels the drive for mastery. Which is essential 00:24:10.930 --> 00:24:13.690 in medicine, just complying isn't enough. Not 00:24:13.690 --> 00:24:16.529 nearly enough. Mastery is about striving for 00:24:16.529 --> 00:24:19.710 excellence. And a key part of this is experiencing 00:24:19.710 --> 00:24:22.759 flow. That concept from Millie Sikcentmihalyi. 00:24:22.880 --> 00:24:25.319 Those moments of complete absorption. Exactly. 00:24:25.539 --> 00:24:28.259 The surgeon focused on a tricky procedure. The 00:24:28.259 --> 00:24:31.000 diagnostician piecing together clues. The nurse 00:24:31.000 --> 00:24:33.599 managing a critical situation almost instinctively. 00:24:34.380 --> 00:24:36.839 Time disappears. The challenge matches the skill 00:24:36.839 --> 00:24:39.359 and the activity itself is deeply rewarding. 00:24:39.940 --> 00:24:43.099 Sikcentmihalyi found denying people flow actually 00:24:43.099 --> 00:24:45.599 caused psychological distress. It's that fundamental. 00:24:45.740 --> 00:24:48.839 So how do we foster mastery? You mentioned Goldilocks 00:24:48.839 --> 00:24:52.579 tasks. Right. Tasks that are not too easy, boring, 00:24:52.779 --> 00:24:55.240 not too hard, anxiety -provoking, but just right. 00:24:55.680 --> 00:24:58.039 Stretching capability slightly. In medicine, 00:24:58.059 --> 00:24:59.880 that means ensuring people get appropriately 00:24:59.880 --> 00:25:02.500 challenging cases, chances to learn new skills, 00:25:02.819 --> 00:25:04.299 development opportunities that push them gently. 00:25:04.359 --> 00:25:07.500 And deliberate practice. Crucial. Mastery takes 00:25:07.500 --> 00:25:10.819 hard work over time. Anders Ericsson's work showed 00:25:10.819 --> 00:25:14.180 this. Focused effort, seeking feedback, working 00:25:14.180 --> 00:25:17.829 on weaknesses, Think surgical simulations, refining 00:25:17.829 --> 00:25:20.730 clinical skills, case reviews. It's often the 00:25:20.730 --> 00:25:23.430 consistent effort on the mundane details that 00:25:23.430 --> 00:25:26.569 builds true excellence. And finally, the mastery 00:25:26.569 --> 00:25:29.210 asymptote. This is the idea that complete mastery 00:25:29.210 --> 00:25:31.430 is something you approach but never quite reach, 00:25:31.750 --> 00:25:34.349 like an asymptote in maths, especially in a field 00:25:34.349 --> 00:25:36.509 like medicine that's always evolving. So you 00:25:36.509 --> 00:25:40.009 never fully arrive. Not really. But understanding 00:25:40.009 --> 00:25:42.500 that can be liberating. The joy, the motivation 00:25:42.500 --> 00:25:44.740 comes from the pursuit itself, the continuous 00:25:44.740 --> 00:25:47.319 learning and improvement. It fuels lifelong learning 00:25:47.319 --> 00:25:49.339 and resilience, acknowledging that perfection 00:25:49.339 --> 00:25:52.200 isn't the goal, progress is. So organizations 00:25:52.200 --> 00:25:54.559 need to create opportunities for that flow, those 00:25:54.559 --> 00:25:57.180 Goldilocks tasks that deliberate practice. Yes, 00:25:57.380 --> 00:25:59.339 build a culture where striving for mastery is 00:25:59.339 --> 00:26:01.500 supported and celebrated. Protected time for 00:26:01.500 --> 00:26:03.819 learning, mentorship, challenging assignments. 00:26:04.000 --> 00:26:06.240 And the third pillar, purpose. The final leg 00:26:06.240 --> 00:26:10.259 of the tripod. Purpose is the yearning to contribute 00:26:10.259 --> 00:26:12.839 to something larger than ourselves. It gives 00:26:12.839 --> 00:26:15.200 context and meaning to autonomy and mastery. 00:26:15.880 --> 00:26:18.319 Why are we directing ourselves? Why are we striving 00:26:18.319 --> 00:26:21.920 to get better? Purpose provides the answer. And 00:26:21.920 --> 00:26:24.299 this feels particularly relevant now. Very much 00:26:24.299 --> 00:26:27.539 so. There's this sense, perhaps partly demographic 00:26:27.539 --> 00:26:29.740 with boomers reflecting, but maybe broader too, 00:26:30.059 --> 00:26:32.740 of people asking, what really matters? How can 00:26:32.740 --> 00:26:35.660 I make a difference? A real hunger for purpose. 00:26:35.930 --> 00:26:38.730 How does this contrast with older models? Well, 00:26:38.849 --> 00:26:41.950 Motivation 2 .0 often defaulted to profit maximization 00:26:41.950 --> 00:26:44.769 as the main goal. Motivation 3 .0 talks about 00:26:44.769 --> 00:26:47.230 purpose maximization, where profit is seen as 00:26:47.230 --> 00:26:49.630 a catalyst for achieving a larger purpose, not 00:26:49.630 --> 00:26:52.390 the end goal itself. Think of social enterprises, 00:26:52.650 --> 00:26:54.769 B Corp. And healthcare inherently has a purpose, 00:26:54.829 --> 00:26:58.089 doesn't it? Absolutely. Healing. Care. Discovery. 00:26:58.269 --> 00:27:00.950 It's profoundly purposeful. The challenge for 00:27:00.950 --> 00:27:03.049 organizations is to genuinely live that purpose, 00:27:03.329 --> 00:27:05.269 articulate it beyond just the financial numbers. 00:27:05.670 --> 00:27:08.369 Focus on community health, equity, patient outcomes 00:27:08.369 --> 00:27:11.210 as the real drivers. How can organizations ignite 00:27:11.210 --> 00:27:13.849 that sense of purpose? Through words and policies. 00:27:14.450 --> 00:27:18.170 Robert Reich's pronoun test is insightful. Do 00:27:18.170 --> 00:27:21.450 staff say we or they when talking about the organization? 00:27:22.069 --> 00:27:25.490 We suggest shared purpose. Leaders need to consistently 00:27:25.490 --> 00:27:27.869 use purpose -driven language. Talking about the 00:27:27.869 --> 00:27:30.609 mission, the commitment to patients. Exactly. 00:27:31.029 --> 00:27:33.869 And policy -wise. Things like pro -social spending, 00:27:34.150 --> 00:27:36.490 letting staff have input on charitable donations. 00:27:37.009 --> 00:27:39.190 Or that Mayo Clinic finding doctors spending 00:27:39.190 --> 00:27:41.049 just one day a week on their most meaningful 00:27:41.049 --> 00:27:43.890 work had half the burnout rate. That's incredible. 00:27:44.130 --> 00:27:48.079 Like 20 % time with a purpose. Precisely. directly 00:27:48.079 --> 00:27:50.539 linking well -being to purpose. And finally, 00:27:50.880 --> 00:27:53.119 it connects to the idea of the good life and 00:27:53.119 --> 00:27:55.119 having the right goals. The Rochester study. 00:27:55.400 --> 00:27:58.279 Yes, following graduates. Those pursuing intrinsic 00:27:58.279 --> 00:28:00.980 goals, personal growth, helping others, community 00:28:00.980 --> 00:28:03.279 reported much higher well -being than those who 00:28:03.279 --> 00:28:05.460 achieved extrinsic goals like wealth or fame, 00:28:05.940 --> 00:28:08.180 even if they were successful by external standards. 00:28:08.940 --> 00:28:10.920 The external stuff just didn't deliver the same 00:28:10.920 --> 00:28:13.460 deep satisfaction. So for medical professionals, 00:28:13.900 --> 00:28:16.960 while fair pay is essential, the real long -term 00:28:16.960 --> 00:28:19.319 drivers of well -being are that sense of purpose 00:28:19.319 --> 00:28:22.359 making an impact, continuous learning, and mastery. 00:28:22.579 --> 00:28:24.940 That's what the science strongly suggests. Those 00:28:24.940 --> 00:28:27.779 intrinsic factors are far more vital for a sustained, 00:28:28.079 --> 00:28:30.460 fulfilling career than just chasing external 00:28:30.460 --> 00:28:33.579 rewards. The meaning is in the work itself. So 00:28:33.579 --> 00:28:35.819 wrapping up our deep dive today, we've really 00:28:35.819 --> 00:28:38.099 journeyed from the limitations of the old carrot 00:28:38.099 --> 00:28:41.500 and stick model, Motivation 2 .0. To a much richer 00:28:41.500 --> 00:28:44.660 understanding, Motivation 3 .0. Built on our 00:28:44.660 --> 00:28:47.569 innate human needs for autonomy, mastery, and 00:28:47.569 --> 00:28:50.210 purpose. And embracing this isn't just theoretical. 00:28:50.609 --> 00:28:53.289 It's the key, isn't it, to unlocking higher performance, 00:28:53.529 --> 00:28:55.809 better well -being, and genuine fulfillment, 00:28:55.990 --> 00:28:58.390 especially in a field as vital as medicine. It 00:28:58.390 --> 00:29:00.170 really is. It's about creating an environment 00:29:00.170 --> 00:29:03.950 where people's inherent drive can flourish rather 00:29:03.950 --> 00:29:05.869 than just trying to control behavior with external 00:29:05.869 --> 00:29:08.450 levers. If you found this deep dive valuable, 00:29:08.750 --> 00:29:10.750 please do consider rating and sharing with colleagues 00:29:10.750 --> 00:29:13.069 who might also find these insights helpful. And 00:29:13.069 --> 00:29:15.089 perhaps a final thought to leave you with. In 00:29:15.089 --> 00:29:17.190 a healthcare landscape that desperately needs 00:29:17.190 --> 00:29:20.009 innovation, compassion, and resilience, how can 00:29:20.009 --> 00:29:22.990 we as practitioners, as leaders, actively ensure 00:29:22.990 --> 00:29:25.869 that our own drive and the drive of our teams 00:29:25.869 --> 00:29:28.509 is truly fueled by that deep sense of purpose 00:29:28.509 --> 00:29:31.250 and satisfaction, not just by external pressures 00:29:31.250 --> 00:29:33.470 to build the healthiest possible future?