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This article was originally published on February 2, 2010.
Dear Al,
With the recent H1N1 scare, I would appreciate any advice on approaching colleagues in a healthcare institution—usually managers and MDs—to stay home when they are sick rather than feel obligated to come to work. I would also appreciate any advice on motivating them to get immunized against the flu without having to force them. Fighting the Flu
Dear Fighting,
The recent H1N1 situation illustrated the importance of motivating someone to do something they don’t want to do.
What can we learn about motivation from looking at the situation where people are sick but feel obligated to come to work? As we discuss in Crucial Accountability, there are a few key concepts that provide the foundation for this discussion.
Consequences Motivate. There are consequences that occur naturally, and there are consequences that are imposed or enforced by others. People make decisions to act based on the consequences they anticipate. As a result, motivation is personal because people see and anticipate different consequences. Almost subconsciously, people assess the positive and negative consequences that are most likely to occur and then they act based on those assumptions.
Help Others See Consequences. We can motivate others by helping them see both the obvious and the more obscure consequences. In your situation, this includes consequences to self, to coworkers, to patients, to coworkers’ and patients’ families, to finances, to reputation, and to the quality of work. When we help others see and feel the consequences, people can change their desire to act in certain ways.
So let’s separate some of the issues in this case. For example, the manager is aching and coughing and trying to decide if she should go to work. What are the consequences of staying home? Positive consequences are that she will feel better physically. Sipping hot chocolate and lounging around the fireplace sounds pretty good. Also, she won’t get anyone else sick. However, she’s not sure she’s that sick and she assumes the probability of getting someone else sick is fairly low.
Negative consequences include not getting paid because she has exceeded her paid time off. This is particularly glaring because she has several bills that are due. She will also miss two meetings because delaying them is impossible. Catching up when she returns will be next to impossible. And while some people might have bad thoughts about her coming to work sick, she can probably avoid these people. Even if she doesn’t avoid them, they probably won’t speak up any way.
The combined value of the anticipated consequences makes the decision easy. If she goes to work, she will get paid, get important work done, and it is highly unlikely she will get anyone sick. More importantly, no one will say anything to discourage her decision. Take note that for a doctor, the financial and productivity consequences might be even more costly and the likelihood that anyone would speak up to the doctor is almost nil.
So as someone who cares about the consequences of spreading germs, what do you do? Here is some advice.
First: Manage expectations as a group around not coming in when sick.
Excellent performance begins with clear expectations. When we make agreements, we often agree on the who, the what, and the how; but we would improve motivation if we focused on the why. Have a discussion about the reasons you are making this agreement and clarify the possible positive and negative consequences. Why should people not come to work when they are sick? Why should they get immunized? Look at it from the perspective of the sick person. What will they lose? What will they gain? What will happen to colleagues and patients?
In addition to sharing the facts, share real stories of what happened in your hospital. Share the story of the nurse who picked up a virus at work and passed it on to her mother who was now in the intensive care unit. Where did the problem start? Usually with colleagues who came to work when they were sick.
Also, talk about the financial consequences or about the trust that might be lost if a colleague makes a commitment. Helping people understand and feel the weight of both clear and obvious consequences helps them make more balanced decisions.
Second: Agree to hold one another accountable.
As a part of your discussion, agree to hold each other accountable and speak up to individuals who come to work sick. Part of that agreement should be that everyone will talk in a way that is safe and professional; they will try to understand and help. Speaking up and holding others accountable is not just the boss’s job; it is everyone’s job.
When we make agreements, clarify expectations, outline natural consequences, and feel able and motivated to speak up, we reap the benefits of having a crucial confrontation. The difference between good teams and organizations and the best teams and organizations is how rapidly and respectfully problems get resolved. Individuals in these teams don’t let issues fester and they don’t let issues destroy relationships. They quickly and respectfully put them on the table and reach a resolution.
Best wishes,
Al
