Autonomy and Motivation for the Healthcare Workforce

Autonomy and Motivation for the Healthcare Workforce Posted By:
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I recently discovered the New England Journal of Medicine podcast Not Otherwise Specified. In full transparency, I have not been one to spend much time listening to podcasts; however, this one instantly captured my attention. In particular, I found the Why We Work episode engaging as it explores the role of work in fulfilling our basic needs as humans.

In this episode, host Dr Lisa Rosenbaum converses with psychologist Dr David Blustein, and they reflect upon Self-Determination Theory (SDT). From a high level, the SDT framework posits human motivation as being driven by 3 main psychological needs: competence, relatedness, and autonomy. When humans are in environments that meet these needs, they are more engaged and motivated. 

It is the psychological need for autonomy that I would like to shine light upon.  

Perhaps by kismet, my copy of Daniel Pink’s Drive, a thoughtful exploration of human motivation, was a victim of the feline zoomies last week. As I picked it up to return it to the shelf, I thought to look up autonomy. Sure enough, the author writes about his experience meeting Edward Deci and Richard Ryan, the architects of SDT. The book emphasizes that the “secret” to motivation and satisfaction is cultivating environments where the psychological needs of autonomy, competence, and relatedness are met, thus providing optimal opportunity for humans to thrive.

However, the word autonomy can mean different things to different people, so context is important. In the podcast, Dr Blustein notes that healthcare professionals today are experiencing a decline of autonomy in medicine, in the context of increasing pressures around patient volumes or throughput, and medical decision-making.  

Numerous papers have been published, particularly in recent years, noting that the perception or actual loss of autonomy is a negative contributor to clinicians’ well-being. A simple PubMed search for this topic is revealing. It is not a new issue, though it likely was amplified in many care environments over the past couple of years. At the same time, the past few years also brought opportunities to increase autonomy amid the pandemic. In point of fact, Russell Mannion et al thoughtfully note, “...there is a risk that positive innovations associated with autonomy will be lost as healthcare systems revert to traditional top-down ‘command and control’ ways of working.”

Although it can be challenging to meet organizational and operational needs while conferring more autonomy, the potential challenges are not a reason we cannot or should not try.   

In January 2017, Drs Tait Shanafelt and John Noseworthy published a chart of factors (Figure 3 of their article) that can contribute to burnout and engagement in physicians, and are likely to at least partially extend to members of the healthcare team in general. The control and flexibility component best maps to the concept of autonomy, and Figure 3 can serve as an inspiration for areas of opportunity to promote greater autonomy. 

Opportunities to cultivate environments that bolster engagement abound. A thoughtful approach to identifying and solutioning for them requires input from all members of the team, and where more autonomy can be conferred to both individuals and teams, a net positive impact is an attainable result.  

References: 

  1. nejm.org/doi/full/10.1056/NEJMp2400689.
  2. Selfdeterminationtheory.org. Theory. selfdeterminationtheory.org/theory/https://selfdeterminationtheory.org/theory/.
  3. Pink D. Autonomy. In: Drive. Riverhead Books; 2011.
  4. Mannion R, Exworthy M, Wiig S, et al. The power of autonomy and resilience in healthcare delivery. BMJ. 2023;382:e073331.
  5. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc. 2017;92:129-146.

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Filed under: Health Policy and Trends , Miscellaneous , Practice Management/Career , NPs & PAs

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