American Association for Physician Leadership

Operations and Policy

Are They Interested in Improving?

David F. Smith, PhD

August 8, 2020


Abstract:

Employee improvement efforts can enhance a medical practice’s top and bottom line numbers. These efforts can have a positive impact on office culture, resulting in a more satisfying place to work. The challenge with implementing an improvement program is ensuring participants are enthusiastic about the changes involved. Team members will be in one of two modes regarding the improvement program: fixed interest or growth orientation. It is better if they have a growth orientation.




Supporting team members’ improvement is an important quality of managers and leaders. For managers, improvement leads to better results. For leaders, assisting team members to improve develops a trusting relationship, which is important to employee motivation and morale. However, team members have to want to improve. Psychological theories of interest are the underpinnings of successful improvement programs.

The theories of interest are how psychologists describe what people pay attention to and how they pay attention. (Note that economists also have a theory of interest, so when doing research into this subject, it is important to make sure the approach is regarding people and not money theories.) Understanding how team members perceive their opportunity to improve provides leaders the basis for creating an interest in improvement. The more motivated employees are, the more likely they are to participate and, eventually, succeed. Of course, managers can get employees interested in change by telling them they will be fired if they don’t do what is ordered, but leadership is about positive motivation, the carrot rather than the stick.

The Science

What does science say about how leaders can develop interest in improvement? First, research shows there are two basic states of mind a team member could have: (1) a fixed set of interests; or (2) a growth orientation that supports the development of other interests. Growth orientation is open-minded and has a great chance of success. Secondly, experimental results show that this dichotomy between fixed interest and growth orientation can be manipulated. It is possible to create conditions that change how a person perceives an opportunity. This matters because people approaching an opportunity with a fixed mindset are more likely to quit developing that opportunity if presented with obstacles. With a growth orientation, even when obstacles are met, people continue to work toward the goal, resulting in a successful conclusion.

The third element that research finds is that these mindsets differ in still another aspect. Someone with a fixed interest mindset usually does not get interested in areas outside of his or her current interests. For example, a techie with a fixed mindset is much less likely to get interested in learning the guitar than is a techie with a growth mindset. If a leader is presenting an opportunity for change, therefore, it is better if the team member is in a growth mode about the change. That is the leader’s job: creating the environment for growth orientation rather than a fixed mindset, and it is part of the successful implementation of an improvement plan.

Consider the organizational challenge of motivating a lab manager to learn public speaking skills. Perhaps he or she is not interested in jobs that require presenting to a group. However, the organization needs these back-office experts to be on the frontline at patient seminars, for example, because they are the ones with the technical answers. Having skilled speakers who do the analytical work would benefit the practice. The question is, “How does the leader get that employee interested in presenting at the seminars?” If the team member is examining this opportunity from a fixed interest point of view, he or she will follow their existing tendency to avoid the opportunity, because it doesn’t fit with how they perceive their interest. If that person, instead, had a growth orientation, he or she would see this opportunity as different from their current way of working and would accept the challenge nonetheless. The key is for leaders to create a growth environment, something that can be done effectively.

An Example

In a medical practice, there might be a team of lab specialists, each with somewhat different roles or expertise. A good manager would implement a cross-training program, for many organizational reasons. A good leader would know that cross-training can appeal to the career-minded team member by supporting improved skill development, broader organizational involvement, and simply enjoying the attention of their leader. Proper implementation of improvement plans starts with an open-minded conversation discussing the opportunities for improvement with each team member one-on-one.

Readying the Practice

The practice’s employee environment must be conducive to improvement. Two conditions must be met before embarking on an improvement campaign:

  • There must be a shared belief at the practice that employee improvement is important. This is more than job-related task improvement; it includes support for non-direct task improvement opportunities such as attending industry conferences to broaden knowledge and outlook. This condition is necessary for the team member to be attuned to having improvement opportunities.

  • There must be some relationship between the improvement activity and the goals of the team member. These most often are career enhancement possibilities. Career enhancement usually is seen as promotions or increased income, but it also can come as intrinsic rewards, such as status and greater independence. What is offered requires the leader to know what goals are important to each team member. Leaders must develop an understanding of each team member to match individual goals with team objectives. This matching may require leadership coaching of the member; this is where the work begins for the leader.

Once those conditions are met, three key dimensions are involved in a successful improvement discussion between a leader and team member:

  1. An agreement on what improvement is desired;

  2. Commitment of resources supporting the improvement; and

  3. Motivation of the team member to improve.

This discussion provides the leader with the keys to ensuring the team member is interested in the improvement program. The ways in which the initiation, agreement, and motivating occur affect the outcome. Leaders who do not handle these three dimensions may well not see improvement, and, worse, it might damage their relationship with that team member.

In this cross-training example, the first step is for the leader to have that general discussion about career improvement with each team member. Ask questions such as, “What are the next one or two goals for you in our practice, in your opinion?” This step, which prepares the team member’s mind for a growth opportunity, has been proven to be effective. Contrast this with the leader announcing to the group, “Cross-training will occur starting next week, and it will be good for you.” It’s not that the latter is bad— just worse, as measured by employee acceptance, motivation, and willingness to overcome obstacles. With the ground sufficiently prepared for open-mindedness through prior one-on-one discussions, the idea of cross-training will have much greater acceptance from the start, leading to greater success.

In the second step, the leader presents the idea of cross-training one-on-one and asks for feedback. This discussion enables the leader to gather two important types of information: (1) new ideas that might be incorporated; and (2) insight into possible resistance. If the cross-training plan is fully formed and ready for implementation before this step, management and the leaders have missed a tremendous opportunity to ensure success. This type of projected change in work for a team member should be presented to teams early in the planning process to create buy-in, get ideas, and identify roadblocks. This step motivates employees, because they feel trusted enough by their employer to be part of a planning process for possible changes in their work environment.

The third step is to capitalize on the important characteristic of growth orientation: optimism. By assuring the team member that rewards are there, resources will be available, the leader is supportive, and success is possible, the optimistic employee is encouraged to become an enthusiastic and interested participant, one who is in a growth mode. This is the foundation of success. This contrasts with a fixed orientation, which may support enthusiasm for an idea similar to the current interests, but not new ideas. Furthermore, if the individual with a fixed orientation initially does move forward, obstacles can lower his or her enthusiasm much more dramatically than with a growth-oriented individual.

The fourth step in leading this change program requires the leader to monitor not only the objective progress but also the level of optimism and excitement of the team members. Keep taking the temperature of the participants. Make it easy for cross-training to take place by providing the time needed, avoiding burdening the team members. Provide additional resources. Participate in the training effort. Team members will rise to the challenge, but only to a certain point. Keep up the intrinsic rewards by congratulating them at key steps. Ensure the entire practice knows what good work is being done. At the end of the project, celebrate.

Apply This Consistently

The technique described is subtle science and could be viewed as a bit sinister. Leadership is subtle, and good leaders aren’t sinister; good leaders are well-meaning. Team members will not see this as manipulation; rather, they will view this as what they want from their leader. They want to be included in decisions. They want their leader to understand their goals. They want to be rewarded. They seek improvement opportunities. Preparing a growth-oriented environment is good leadership. Take this example of cross-training and apply it to any improvement goal.

Prepare Your Practice for Growth Orientation

Prepare your medical practice by developing a culture of promoting improvement. The practice should have a strategic plan that outlines goals to meet. Good goals are measurable and describe how the goal will be met. Improvement is a tactic to meet strategic goals. A stated goal could be, “We will improve our bottom line by reducing the negative effects of an employee being absent (for good reasons) by cross-training to be able to fill those shoes as needed.” A practice needs to know where it wants to go and what it will take to get there. Usually “getting there” requires improvement is some human resource capacity. Another goal could be stated as, “We will improve our top line by being better social marketers by developing this marketing talent internally.” These goals must be communicated practice-wide so everyone understands where their employer is going and sees how it might affect them.

Understand Team Member Goals to Promote Growth Orientation

A strategic plan lays out how the practice sees its goals and provides the basis for achieving them. An individual has goals as well and also has a plan (perhaps not well-formed) for achieving those goals. It makes sense to match the employee’s personal goals with the strategic plan. The culture of improvement allows for frank discussions about personal goals, because a leader is trying to motivate a team member to move in the direction needed by the practice. Motivation is personal; according to research, motivation is not a group concept. Motivating is a one-on-one strategy that does contribute to the group effort, but the motivation is individual. Starting at the individual team member level makes it easier to have all employees working in the same direction.

Develop Improvement Plans to Support Growth Orientation

Develop plans with early inclusion only of team members who will be affected. The science of teamwork has shown that including each team member in discussions about their work, especially change, is responsible for a large part of the success of change and improvement efforts. This works because inclusion behavior by leaders shows interest and trust in the individual team member. The mutual understanding of what needs to be done and the trust that the two have built is an unwritten contract. Group discussions do not support this dimension of leader–member relationships. Individual discussions will lead naturally to bringing groups together to pave the way for group buy-in of plans that have been developed from the individual input. Growth orientation is supported by this because people are more excited about projects they helped design than by being told what to do.

Provide Rewards

Provide rewards for improvement that match the team member’s goals. These can vary by the dimensions for formal-informal, extrinsic-intrinsic, and public-private, as described:

  • Formal: a published set of rewards and requirements to achieve;

  • Informal: ad hoc “good job and thanks” throughout the improvement effort;

  • Extrinsic: something you can eat or spend, for example;

  • Intrinsic: something that makes a person feel good inside;

  • Public: let everyone know; and

  • Private: between the leader and team member.

So a formal, intrinsic, and public type of reward is a Leader Board announcement every week at a team meeting. An informal, extrinsic, private reward is a leader taking a team member to lunch (without announcing to the team) to say, “good job and thanks.” The leader behavior called “rewarding” is a complex subject on its own and is good for leaders to develop in themselves and their organizations.

Ensure Sufficient Resources to Support Growth Orientation

Ensure enough resources to complete the project. This is the time for a leader to be a great manager. The strategic goal must be supported by whatever is needed to accomplish it. Lack of resources will mean obstacles that will be blamed on management. Resources can be money, time, training, equipment, and many other elements of the improvement project. It is much better to have a growth orientation in team members than a task orientation if, indeed, resources become scarce or not available at all. One specific element of an improvement project is to provide the extra time needed by the participant in the change effort. Improvement requires the team member to work differently. When a team member does something different, it strains the relationship with the leader. A (usually) subtle negotiation takes place where the team member pushes back on the change unless there is enough time allotted to do what they are already doing while also doing the extra work required for the improvement, such as, for example, studying, learning new methods, and handling new equipment. These extra efforts are part of the improvement process and need to be accounted for when planning for improvement projects.

Monitor the Objective and Subjective to Maintain Growth Orientation

Monitor, coach, and cheer on each team member. Leadership is an important element in maintaining momentum in improvement projects. Keeping a team member in growth mode could be considered the most important element, because the effort will not come to a successful conclusion unless the momentum is maintained. A leader must constantly monitor what the team members are saying about the improvement project. They may not say it aloud unless asked. Have one-on-one discussions tying in the individual and practice strategic goals to the current state of affairs. Re-sell the ideas that were exciting at the initiation. Use this feedback to make necessary changes, especially in the total resources needed. Use informal rewards throughout to keep the total leader–member relationship strong and trusting. Be empathetic; change is not always easy.

Celebrate Success

Celebrate the fact that each team member improved. Celebration is another grand subject on its own. Be ready to celebrate and make sure it is a meaningful reward, as discussed earlier.

Summary

Improvement is critical to practice management. Doing those things that make improvement more likely is good management. Leaders are the tools used for that! Leaders recognize that individuals have their motivators and use their leadership skills to develop those motivators into efforts that attain the practice’s strategic goals. One leadership skill is knowing how to create growth orientation in individual team members through creating a practice-wide improvement culture and supporting individual efforts to improve. Improvement is a process that needs planning and nurturing. High-quality leadership is all about supporting the individual contribution to group success. The science of leadership describes “how and why” this works, with the essential element being the relationship between the leader and each team member.

David F. Smith, PhD

Director of Research, Five Star Leadership, Oahu Adventures Foundation, Inc., 6960 Feldspar Place, Carlsbad, CA 92009, and author of How Successful Teams Work: What Science Says About Leadership and High-Performance Teamwork (Lioncrest Publishing, 2018); phone: 619-876-6343; e-mail: davidsmith@​oafound.org.







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Topics

Communication Strategies

People Management

Motivate Others


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