Motivating the Willing but not Able

Last week’s posts on improving data display and usage got me thinking about the broader topic of how to motivate people and how to evaluate why people don’t just do what you want them to do.  There are several ways to dissect this issue, but I see people falling into one of two large camps: willing-but-not-able and able-but-not-willing.

In simplest terms, the willing-but-not-able (WnA) are people who want to do the right thing, but simply don’t know what that is, or how to execute it.  They are generally average performers, so they do what their job entails, but somehow cannot link that work to the broader service principles.  Perhaps they lack the ability to identify opportunities to use these principles consistently.  Perhaps they are intimidated because they see high performers act seemingly without effort and just don’t see how they can match that level of mastery.  They love singing karaoke, but they know they can’t be Michael Bublé on the stage.

The able-but-not-willing (AnW) can often be identified as those who get many service complaints.  These folks know at some basic level that they are not delivering on service, but don’t care.  They focus on doing the letter of their job and not the spirit of their job.  They think service is superfluous and they “aren’t paid for that.”  Sometimes they even wear their gruff demeanor as a badge of honor.  They may have had the service spark, but it has long since been extinguished. 

The challenge is that you need to know which person you are dealing with before you can remedy the situation.  The solution for these types of people is decidedly different and if you execute the wrong solution, you won’t fix the problem, and you might actually make it worse.  I will talk about AnW on Wednesday.  Today I will focus on the WnA.

Some of you reading this will assume that the WnA are the easy ones to fix.  Heck, if they are willing but not able, just make them able!  Give them some training!  Like so many things, this seems simple in statement, but deceptively complex in execution.  So let us break this apart. 

Perhaps it is simply a skills gap and a training need.  But how do we fix that?  What is the training protocol for new hires in your organization?  Are service standards part of the portfolio of skills training?  What is your organization’s philosophy on on-boarding?  If your organization is like, um, EVERY organization, you have a battle over the nature of what on-boarding should be.

• On one side, you have those that say that everything is important.  New hires need to be able to navigate the clinical must-haves, how to use the time-card software, deliver on service, understand the total compensation package, appreciate the financial considerations regarding overtime, etc.  All of this IS important.  The problem is that if you try to cover EVERYTHING in the day-one training, the new staff will be drinking from the firehose and retaining nothing.  In fact, even those who stress that it all must be covered on day-one will acknowledge that very little is being retained.
• On the other side, there are those who embrace the need to triage the new hire training.  They will promote a 30/60/90 approach, where some things are trained in the first 30 days, some in the next 30 days and still others in the following 30 days.  These people will cite the firehose as a reason to break things up.  The problem here is that once those new hires leave orientation and scatter like quail to their departments, you have lost that captive audience.  It takes a very attentive leader or training department to make sure that the “later” stuff gets done.  The reason some training never happens is that the elements most important to the local leaders are those things front-loaded into the first 30 days.  When a new pharmacist hits the floor, their leader is primarily focused on how to accurately document in the electronic health record, how to use the automated medication dispensing machine and how to document wastage.  Maybe, in the following 30 days, they will receive training on what the telltale signs of diversion are, or what opportunities the organization offers for continuing education.  The rest won’t get done, unless that individual wants to self-direct any learning or that leader is especially passionate about that learning.

What that training looks like is also causes issues.  The direct approach of pulling people off the floor to sit in the conference room for training sixty or ninety days later may be the easiest way to check that box, but that doesn’t mean it leaves a lasting impression.¹ Additionally, executing training while patients still need care can be a scheduling nightmare.  Do you run short during those training windows?  Do you over-staff, so you can function adequately while staff shuffle to and from a training session?  This in turn may mean having staff not mentally present at the training session, as they are thinking about everything they will have to do when they get back to work.  Or, it may mean throwing a wrench in your efficiency or finance numbers, as you add staff that are not warranted by the patient volume.

So many organizations try to cascade the training, adopting a “Train the Trainer” model.  By training the manager and giving them the tools to take this message back to their team, it is believed that this will provide a more meaningful and less expensive option.  Of course, now you have put this training into the hands of folks who we acknowledged two paragraphs ago did not see this as important enough to address in their original 30/60/90 plans. 

If the WnA folks have the training needed, they may suffer from not seeing the opportunity or having the confidence to use those skills in real-world situations.  So, they may really need coaching in the moment along with validation of the process.  The challenge here is that coaching and validation, again, are straightforward in observation but not easy in implementation. 

One mistake a coach can make is to think that tough love is the only kind of love there is.  Great coaches know that simply yelling is not coaching.  Great coaches know there is a time for the negative and a time for the positive.  If a team is losing, they don’t need their coach to yell and tell them that they stink.  They already know that.  You telling them that just solidifies that negative image and doubt.  They (and their family) already hear that when they are out and about in public.  A good coach identifies the successes in any loss, talks about how to build on the good things, and says that a different outcome is only a few plays or good decisions away.  The team is GOOD, and they need to eliminate mistakes to become GREAT.  When a team is performing well and winning, you don’t need to tell them that they are awesome.  Again, they already know that.  Now is the time to focus on the things we could do better.  We are winning, but how much is effort and how much is luck?  Are we not making mistakes, or are we just good at not compounding them?  How do we work on our weaknesses?  The team is GREAT, but greatness requires constant attention.

This may seem logical, but it is hard for a manager to work against expectation.  Managers often heap praise on their high-performers (you all need to be like Denise) and heap derision on their low-performers (hey, Joe, why don’t you just focus on not breaking anything today and leave the hard stuff to the rest of us).   Doing this, the leader is driving a wedge into their staff; they are not breeding unity and collegiality.  Those in the middle tend to hate both the awesome and the dreadful and welcome the anonymity of being in the fat part of the bell curve, not showing off, not falling behind.  This is not to say that a leader needs to coddle failure and tamp down success.  It does mean, though, that if you have a WnA staff member who is failing, don’t beat them down, but coach them up. 

The same approach goes with validation.  Validating only really works if it is set in a safe environment where progress, not perfection, is the goal.  Otherwise, the staff will change their behavior and conform to standards when they know they are being observed (known as the Hawthorne Effect), or leaders will ascribe halos and horns to based upon previous perceptions instead of doing an honest assessment (known as Confirmation Bias.)

Finally, another big reason why WnA staff don’t act is that they see too many other things around that work against them.  There are too many patients, and not enough staff, and the care process is too cumbersome.  These staff know what they should be doing, and see opportunities to act, but feel too overwhelmed to act.  For these, it is less about training or coaching, it is instead about reframing the work, so they see the value.

Some things, like effective communication with patients and staff, feels burdensome because it is seen as a speed bump before they get to do their job.  But this is only if you see these elements as episodic—first I speak and then I do.  It is possible to chew gum and walk at the same time.

Here is an example from my life.  I was receiving care at the local emergency department, and a lab technician came in to draw blood.  She knocked and entered.  As she foamed-in, she said, “Hi, I am Kim, I am a lab tech here.  Can I get you to validate your name and birth date for me?”  Then as she approached, she said, “I am here to draw some blood because your doctor has requested some lab work to help determine next steps.  These tests are done in-house and should be back in about an hour.  Since they are important in helping understand why you are here, the care team cannot make any decisions until I get my work done.  Do you have any questions?  Great.  I am done here.”  Since she did her work while she was talking to me, it did two things.  First, it distracted me from the actual needle poke.  Second, it gave me a ton of information without making her job take any longer.  Too often folks think that service needs to be done first or separately, but it can be done during care.  I would often ask staff “How much of what you do is done in silence.  Why?”  You don’t have to extend an experience; you just must make better use of the time you have with the patient.

Now some things DO require additional time.  Hourly rounding on an impatient floor requires attention and effort.  Here the effort at reframing focuses on time savings and self-interest.  Hourly rounding reduces call-lights; helping patients on your timetable means less time helping patients on their timetable.  Hourly rounding reduces patient anxiety; every couple of minutes you spend answering a question and managing anxiety means saving twenty minutes winding down an anxious patient who is fed by their anxious family.

Working with the Willing-not-Able folks is not as simple as throwing more training at them, but it is a straightforward analysis of the nature of the gap and then meeting them where they need help.  Just because training standards are uniform, it doesn’t mean that the training needs to be.

¹This opens the door about what effective training looks like, which is a topic for another day.