Well good morning. Welcome to Plenary Session 2. We had an outstanding day yesterday and today promises to be just as good, if not even better. So it's my pleasure today to introduce the Roten Family Lecturer. Daniel H. Pink, or Dan Pink, as he's popularly known, is one of the best-selling non-fiction authors of the last decade. He's published half a dozen books on work, business, and behavior. Before venturing out on his own nearly 20 years ago, Dan worked in several positions in politics and in government, including serving from 1995 to 1997 as Chief Speechwriter to Vice President Al Gore. Dan was host and co-executive producer of Crowd Control, a National Geographic television series on behavioral science. He also appears frequently on NPR's Hidden Brain, the PBS NewsHour, and other TV and radio networks in the U.S. and abroad. In 2015, the London-based group Thinkers 50 named him as one of the top 10 business thinkers in the world. His TED Talk on the Science of Motivation is one of the 10 most-watched TED Talks of all time, with more than 19 million views. His books have won multiple awards and have been translated into 37 languages. He received a BA from Northwestern University, where he was a Truman Scholar and was elected to Phi Beta Kappa, and a JD from Yale Law School. He assures me that although he's an Ivy League lawyer, he's never practiced law, especially not as a plaintiff's attorney. He's also received honorary doctorates from Georgetown University, the Pratt Institute, the Ringling College of Art and Design, and Westfield State University. He lives in Washington, D.C. with his wife and their three children. On a personal note, when I relocated to Richmond a few years ago, I gave a copy of his book Drive to each of the faculty members in my department, as well as to our university president. So it's my pleasure to welcome Dan Pink. Thank you, Alex. Good morning, everybody. It's a pleasure to be here. It's a privilege to pay tribute to Al Roten, whose remarkable life story really exemplifies the spirit of service that is the theme of this conference. So this morning, what I want to do is talk about motivation. I want to talk about motivation. Now, already, good, I see some people rolling their eyes, which is exactly the reaction I expected. Because you've seen this movie before, right? You come to a conference like this, there's one dude standing up, a bunch of people sitting down, and the topic is motivation, and certain conventions seem to follow from that. So maybe you expect me to talk about some great athletic triumph I had earlier in my career. I've had none. Maybe you instead, you've seen these before, too, you might want me to talk about, maybe you expect me to talk about some great physically heroic thing that I've done. So let me tell you about the time I climbed Mount Everest in 80 degree below zero weather with my two-year-old child and our family cat who became gravely ill along the way. I've never done anything like that either. I've actually never done anything like that. I want to talk about motivation from a far, far nerdier perspective, much more characteristic of who I am as a human being, more characteristic of who many of you are as human beings, and that's the perspective of science. What does science tell us about what motivates people? What does science tell us about what motivates people to do really, really, really great things at work? It turns out that over the last 50 years, a group of social scientists all over the world have taken a very hard-headed, very empirical look at that question. What motivates us? In field studies, laboratory experiments, increasingly now big data, they've tried to crack the code of what motivates us. So I want to tell you about what they found and what implications it might have for your work, but before I even begin that, I want to acknowledge that it's a strange question to ask. What motivates us, right? Because every single person in this room has a deep and sophisticated knowledge of the laws of motivation, not simply because most of you are physicians, most of you are surgeons, but because all of you are human beings. Every human being has a deep and sophisticated knowledge of motivation, but it's a kind of knowledge that's a little bit peculiar, right? So give me 30 seconds to walk out on epistemology here for a second. There's different kinds of knowledge that human beings have. There is implicit knowledge and explicit knowledge. Explicit knowledge and implicit knowledge. Let me give you an example of explicit knowledge. Can someone tell me who the Vice President of the United States is? Tell me your first name, right there, that gentleman right there. Steven. Steven says it's Mike Pence. Steven, that is correct. That is explicit knowledge. Steven knows something and he knows that he knows it. But there's another kind of knowledge that's more peculiar. That's implicit knowledge. It's when we know something, but we're scarcely aware that we know it. Let me give you an example of this. I'm going to give you a problem here in a moment, but I need to eliminate some people who have expertise. So how many of you majored in physics in college? How many physics majors do we have here in the house? Okay, it looks like less than half of you majored in physics. But every single person in this room has a deep and sophisticated knowledge of the laws of physics. Again, not because many of you are physicians, but because you're human beings. So let me give you a problem here. I weigh about 84 kilos. This stage is about a meter off the ground. I want you to make a prediction based on your laws of physics. What will happen when I take one step this direction and another step this direction? Who has an answer to that question? I'll fall on my face. Tell me your first name. Bob. Bob says I will fall on my face. That is correct. All right? Bob, how long did it take you to figure that out? Not too long. Give it to me and quantify it for me. A second. Think about that for a second. That's incredible processing power on Bob's part. I didn't see him take out a piece of paper. I didn't see him pull out a calculator or anything like that. He didn't write down, okay, 84 kilos, a meter off the ground. He just knew it. He didn't say, oh, wow, wait a second, this guy is 84 kilos. The stage is about a meter off the ground. The law of gravity is one of the few laws actually enforced in New Orleans. He didn't say anything like that. He said he just knew it, right? He just knew it. That's what implicit knowledge allows us to do. It allows us to make quick decisions, take quick actions without always trying to access that information. Here's the reason for that tortured explanation. Most of our knowledge of motivation that guides us in our jobs, again, whether we're surgeons, whether we're doing other kinds of work in a hospital, whether we are working in a medical device company, most of our knowledge of motivation is implicit knowledge. So we know about motivation, but we never announce the laws out loud. And our implicit knowledge of motivation goes like this. It's very simple, very mechanical. When you reward behavior, you typically get more of it. And when you punish behavior, you typically get less of it. Rewarding behavior gets you more, punishing it gets us less. And all of us, I would imagine, in this room, myself included, in the last 24 hours, have made a decision or taken an action based on those implicit laws of motivation. Again, we've never, they're implicit. We've never surfaced them. We never say them out loud any more than we say the law of gravity out loud. But all of us have taken action based on those implicit laws. Rewarding behavior gets you more, punishing it gets you less. Well, here's the great thing about science, as all of you know. Scientists are skeptical. So scientists take those kinds of propositions, and they say, just humor me here for a second. Let's consider that a hypothesis rather than set a law. And over the last 50 years, scientists have tested that hypothesis. And here's what they found. I'm going to give you a super duper big level view of it, and then another level, and then we'll talk about what to do about it. But the super duper big level view of this, what 50 years of science tells us about motivation is this. Here's a summary, all right? 50 years of science of motivation. When you reward behavior, you do get more of it. Sometimes. When you punish behavior, you do get less of it. Sometimes. But not all the time. And here's the kicker, not nearly as much as we think. And so if you go into your encounters, and those implicit laws are off, you're going to make mistakes. And even worse than that, you're not going to know why you made the mistake, so you're going to compound it. So what I want to do here is give you, just recalibrate those understanding of motivation on the job, and then we'll talk about how to navigate things a little bit differently. I want to show you some of the ways that this research touches on medical practice. So I'm going to give you one study here. So let's talk about, I'm going to give you one study here that captures the big idea. There's one core idea here that I want to make clear to you, all right? And I can do it with a single study. It's actually a set of nine studies. I'm going to telescope them. It's a set of nine studies. This is done by four economists. Two behavioral economists, including Dan Ariely, who was here yesterday, and two neoclassical economists. All of them, first rate in their field, all of them from top universities across North America. And here's what they did. They divided their participants into three groups. And they treated everybody the same, except for the amount of reward that was promised to them for high performance on a particular task. So they had people do a series of challenges, physical challenges, throw a ball through a hoop, cognitive challenges, alphabetize cards quickly, memorize strings of digits, still more complicated cognitive challenges, solve a math problem, ideation exercises. And as I said, they divided up people into three groups. Everybody's treated exactly the same way, except for the amount of reward that's promised for high performance. So this group over here, if you're one of the top performers, you get a little bit of money. Second group, if you're one of the top performers, you get more money. You get ten times what this group is getting. This group over here, if you're one of the top performers, you get a lot more money. You get ten times what this group is getting. X, 10x, 100x, small, medium, large. Now, our implicit laws, let's go back to those for a moment. Our implicit laws tell us that this group will outperform this group, and the second group will outperform the first group. And ladies and gentlemen, that's what happened. As long as the task involved only mechanical skill, bonuses worked as they'd be expected. The higher the pay, the better the performance. This group crushed it, this group finished in second, this group finished in third. Not that interesting. Not that surprising. But here's where it gets a little bit more interesting and a little bit more surprising. Here's what they say. But, once the task called for even rudimentary cognitive skill, that's their phrase, not mine, rudimentary cognitive skill, a larger reward led to poorer performance. Okay, I heard a few murmurs out there. That's murmur-worthy, right? A larger reward led to poorer performance? That seems peculiar. That seems weird. That seems un-American, doesn't it? That's not how it's supposed to work. That might be true in France, but that can't be true in the United States, right? A larger reward led to poorer performance? What? This group with the biggest reward did the worst? This group with the second biggest reward did the second worst? This group over here with the smallest reward did the best? This is peculiar. Here's what's going on. Scientists, economists, social psychologists, cognitive scientists have been finding out the same thing over and over and over and over and over and over again for 50 years. Here's the key idea. This is the one idea I want to leave you with here. There's one conceptual idea here. There's a certain kind of reward that we use in organizations. Social psychologists, economists call it a controlling contingent reward. That's too many syllables for me. Controlling contingent reward. I like to call it an if-then reward. As in, if you do this, then you get that. If you do this, then you get that. If you do this, then you get that. Here's what 50 years of social science tells us about if-then rewards. Not about all rewards, all right? We have a whole set of rewards that we use in organizations, but this is the mainstay reward. If you do this, then you get that. Here's what 50 years of social science tells us about if-then rewards. If-then rewards are great for simple and short-term tasks. They work extremely well. They are extraordinarily effective. Why would that be? The explanation is actually quite simple. We want to try to devise all these complicated explanations for these phenomena, but most of them reduce to something relatively simple and straightforward. Let me ask you a question. If-then rewards are great for simple and short-term tasks. The explanation here is rather straightforward. Let me ask you a question. Do we like rewards? I don't mean middle-aged white guys, although there are plenty of them here. Human beings. Do we, human beings, like rewards? This would be the interactive part of the presentation. Do we like rewards? Yes. A little or a lot? A lot. We love rewards. We're going to talk in a moment about intrinsic motivators. They're very important. I think they are the pathway to high performance. It doesn't mean that human beings don't like rewards. On the contrary, we love rewards. We love them. We love them. We love them. We love them. We love them. They get our attention, but they get our attention in a particular way. They get our attention like this. Locked in. Focus like that. That is a very effective frame if you know exactly what you need to do. If the task is algorithmic. If you're following a recipe. Following a set of rules. Marching down a set of steps to a finish line that you can see. If-then rewards are extremely effective for simple and short-term tasks because they get us to focus. And if the task is algorithmic, we block away distractions. We can see the finish line. It enhances our performance. But the same body of research tells us that if-then rewards are not so great for complex and long-term tasks. Why? It's the same reason. It's the same reason. We love rewards. Rewards get us to focus. That's a very good frame of mind if the task is purely algorithmic and the finish line is near. But let's say the task is more complicated. You're not sure precisely everything that you need to do. Let's say you're dealing with a mercury problem. You don't want to look at a creative conceptual task purely like this. You want to look at it like this. And if-then rewards, by their nature, by our response to rewards, get us to look like this. So for complex creative tasks, you want to have a broader frame and you need more to get that motivational energy to get to a finish line that's further away. So here's what 50 years, this is, it's pretty straightforward, I think. 50 years of social science tells us this. If-then rewards, not all rewards, if-then rewards are great for simple and short-term tasks and not so great for complex and long-term tasks. Great for simple and short-term tasks, not so great for complex and long-term tasks. Great for simple and short-term, not so great for complex and long-term. All right? So, here's a few things about this. Number one, in the science, this is not a close call. If we were to take a social scientist from any universities, randomly go to the Tulane University directory, pluck a social scientist, bring her here to this stage and say, you're not going to believe it. If-then rewards are great for simple and short-term tasks and less great for complex and long-term tasks, she would say, yeah, we've known this for years. Nobody's working on this anymore. And yet, it hasn't made its way into organizations. And the trouble with that is that if you think about what any organization does, if you think about your own work, think about any set of, any work as a series of tasks. Some of them are simple and short-term, some of them are complex and long-term. And so, what happens is, is that we tend to use these if-then rewards for, when these if-then rewards work for simple and short-term tasks and they're effective, we pat ourselves on the back for being, you know, savvy, strategic, charismatic leaders. And then, when they fail over here for this other set of tasks, complex and long-term tasks, we're puzzled. We say, what? Those carrot and sticks didn't work there. That's so weird. I got it. I know what we need. We need more carrots. We need crunchier carrots. Or the sticks aren't working. Oh, we should poke people in the eye three times rather than just twice. And it's leading us down the wrong road. And you're beginning to see some evidence of this in medicine. As you know, one of the most prominent trends in medicine is this idea of bringing, essentially, if-then rewards into medicine. And there are now several studies showing their efficacy. So, this is one famous paper from the New England Journal of Medicine about the long-term effects of premium pay-for-performance on patient outcomes. Here's what they found. We found no evidence that the largest hospital-based pay-for-performance program led to decreases in 30-day mortality. That's what they were measuring. No evidence. Didn't necessarily do any harm, but it didn't do any good. And remember, any kind of if-then regime requires a massive administrative operation to administer it. So, there's a cost to it and no benefit. The results, here's what they say, suggest that the way we currently can see pay-for-performance is unlikely to have any meaningful impact on patient outcomes. So let's fix up the program a little bit and study it again. Fast forward a couple years later. Now we've got this. Does paper performance improve surgical outcomes? An evaluation of phase two of the premium hospital quality incentive demonstration. Phase two, we fix the flaws. How does this do? Despite recent enhancements, do not improve surgical outcomes at participating hospitals. As significantly redesigned, paper performance may not be a successful strategy to improve outcomes in surgery. And I think we know why. Is surgery simple in short term? Is neurosurgery simple in short term? No. It's a little bit more complicated. It has a longer time horizon. And what we know from 50 years of research is that if-then rewards aren't very good for those kinds of tasks. And yet here we are, going with this implicit knowledge, saying that, oh, if-then rewards are good for everything. If-then rewards get us to perform at a higher level. And when the vast majority of evidence says, uh-uh, it doesn't work very well. And you look at that story of Dr. Klein, gee, I bet his performance and his team's performance would have been really enhanced if there was a paper performance scheme there, right? I mean, give me a break. That's not, that had nothing to do with what they were doing there. And they performed at an exceptional heroic level. So what does work? What does work? Well, let's turn the corner and talk about what works a little bit more effectively. And here, all of us have to start piecing together a motivational regime that is scientifically based. All right? All of us, listen. You guys believe in evidence-based medicine, right? Evidence-based medicine. We should have evidence-based hospital administration, evidence-based management, evidence-based leadership. And the evidence, and the evidence is telling us that these if-then rewards, here's the thing. These if-then rewards are good for some things, but they're not good for everything. And for the other stuff, we need a different regime. So what does that set of, what does that recipe look like? Here's what it looks like. Let's start here. Okay? And I want, again, there's nuance here, all right? So fact. Money is a motivator. Fact. Money is a motivator. And all of you, you're well-trained physicians. You know that's a fact because I wrote fact in capital letters right at the top. All right? But this is something, I'm a Washingtonian. This is something that we in Washington refer to as a true fact, okay? This is actually really the case. In Washington, we have facts and we have true facts. And this is a true fact. This is really the case. It's not as if compensation doesn't matter to people's motivation. Compensation matters a lot. Money matters a lot. But it matters in a slightly more sophisticated way. What we want, money is generally a proxy for fairness. Not always, but it's generally a proxy for fairness. So if you have two people doing similar work inside the same operation and one is getting paid more than the other for the same level of contribution, this person is demotivated because it's not fair. If you have two people doing comparable work in the same labor market for the same kind of operation and one is getting paid over here more than this, she's getting paid over here, she's demotivated because it's not fair. So we have this sort of very American muscle memory that says that there's very American belief that if we raise the salience of money, we will improve performance. That raising the salience of money improves performance. And here's the thing, that's true for some things, all right? You want people to stuff envelopes, pay them per envelope. I can guarantee you, you will get more envelopes stuffed if you pay people per envelope, guaranteed. But for more sophisticated kinds of work, for more sophisticated kinds of work, do you want people thinking about the money? No. You want people thinking about the work, all right? Listen, I got a mother-in-law who two weeks ago had to have a heart procedure at Stanford Medical Center, okay? I don't want those cardiologists, when they're working on her, thinking about money. I want them thinking about her. I want them thinking about the work. So how do you get people to think about the work? You take the issue of money off the table, all right? You don't raise the salience of money. You eliminate the salience of money by paying people enough so they're treated fairly and paid well, and they don't have to focus on the money, they can instead focus on the work. So it's a little bit more complicated than we think. Again, we always want to raise the salience of money to improve performance, and that's true for some things, but for many things, what you want to do is reduce the salience of money, take the issue of money off the table. Once you do that, it turns out there are three core motivators for enduring performance on these more sophisticated tasks. Autonomy, mastery, and purpose. As you can tell, I'm a firm believer in the rhetorical power of repetition. No, I am. I'm a firm believer in the rhetorical power of repetition. So let's talk about autonomy. Basically the problem with, let's talk about this very, very briefly on autonomy. The problem with if-then rewards, the problem with if-then rewards is not the rewards. This is another area where it's a head fake. The problem with if-then rewards is the contingency, because a contingency is a form of control. If I offer you an if-then reward, I'm trying to control your behavior. And human beings have only two responses to control. They comply or they defy. And for the most sophisticated tasks, we don't want compliant people. There's some things for which we absolutely want compliance, but we don't want purely compliant people, and we don't want purely defiant people. We want people who are engaged. The way that human beings engage is through self-direction. And so what you want to look for are ways to give people some amount of sovereignty over what they do, the core aspects of their work, over what they do, when they do it, who they do it with, and how they do it. When people have a little bit more autonomy over these aspects of their work, they do better. Now, this is challenging in medicine, right? Because you don't want massive amounts of autonomy over technique when we know that the checklist environment can actually be very, very effective. You often don't have that kind of freedom for autonomy over time. So you have to look for small wins in medicine. And one of the small wins, there's a great example of a small win that I think you can get, and there's some research showing its benefit for physicians. Let me tell you about these guys right here. These guys are physicists. These guys are physicists. All right? They, Andre Geim and Konstantin Davosoloff. They have a laboratory at the University of Manchester in the UK. They have research that they apply for grants and have to carry out the research from the grants. They have papers due in academic journals. But these guys, these physicists, they won the Nobel Prize in Physics for isolating graphene, which is a substance that is one atom thick and something like 70 times the strength of steel. Now, the way that they configure their lab is like this. Again, they have all this work that they have to do, but they take a couple of hours every week, a couple of hours every week for what they call Friday evening experiments, Friday evening experiments. And the rules of Friday evening experiments are relatively straightforward. It can't be anything where you have a, you can work on whatever you want, but it can't be anything where you have a paper due, it can't be anything you have funding for, and it can't be anything boring. Just a couple of hours every week just to do purely autonomous work. And I guess they do them on Friday nights because they're physicists. They made their breakthrough on graphene, not in their regular work, but in their Friday evening experiments. They made, they won the Nobel Prize in Physics, right? That's pretty good, right? If I told my mother that I won the Nobel Prize in Physics, she would be pleased, right? Not as pleased as if I had gone and become a doctor, but still, she would be pleased. That's what this tiny little island of autonomous work does. And there's some interesting research out of the Mayo Clinic showing that this is an antidote to physician burnout, which I know is a huge, huge issue. I see it with my friends who are physicians. And what this Mayo research told us is that when physicians have that small little island of autonomy, one day every two weeks or a few hours every week to, and you can look at that, if you want to look at that site, when physicians have this small little island of autonomy to do what's most meaningful to them, whether it's research, whether it's working in a clinic for low-income people, whatever, that is one of the best antidotes to physician burnout that we have, right? Because human beings are, by their nature, autonomous and self-directed. Let's talk about mastery. This is easy. Mastery is our desire to get better at stuff. We like to get better at stuff because we like to get better at stuff. It's inherently satisfying. And there's research out there from Harvard Business School showing that the single biggest day-to-day motivator on the job is making progress in meaningful work. When we make progress, we're motivated. When we're motivated, we can continue to make progress. I don't want to spend a lot of time on that because I want to end with purpose. Because there is some remarkable research out here on purpose, and it's something that is baked into what all of you do. I'm going to give you three quick studies, then we'll pay it off. So this study comes from the University of Michigan. We've got to have some Michigan grads out there. Any Michigan grads out there? Okay. Just be cool, because I grew up in Columbus, Ohio, so we don't want to go crazy here, alright? So if you've ever gotten a call from undergraduates asking for money, not your kids, but people raising money from the University of Michigan, this was done at this call center, and here's what they did. It's a call center at the University of Michigan raising money. And so they treated all the callers the same, they have the same script, the same call list. The only thing different is what these callers do for the five minutes before they get on the phone. So this group, for five minutes before you get on the phone, you read a newspaper article. This group over here, for the five minutes before you get on the phone, you read a letter from someone who used to work in the call center testifying to the personal benefit of having worked there. My name is Joe Schmatz, I worked at this call center for a year and a half as an undergraduate, and I learned communication skills and sales skills, and I'm now an account executive at an ad agency in Chicago. These people over here, they read letters, but they read letters from people who are on the receiving end of the money that was raised. My name is Maria Lopez, my parents couldn't afford to send me to college, but I got a scholarship to Michigan, funded by the money raised here, and I'm now a pediatrician in Detroit. Okay? Five minutes of control group reading a newspaper article, five minutes of reading about the personal benefit, five minutes of reading about the purpose. Not surprising that these groups and this group outperformed that group, but take a look at that third group over there. Earned more than twice the number of weekly pledges and more than twice the amount of weekly donation money. So think about that. Think about a five-minute cost-free intervention that can double production. And it wasn't, and this is a sales-y kind of environment, and it wasn't a pay-per-performance if-then reward. It was bringing to surface the purpose of things. And you see a lot of interesting evidence of this in medicine. Let's take radiology. This is a famous study, you might know of it. It's a study of radiologists done out of Israel, and here's what they did. They got a group of radiologists, let's say that you guys were radiologists, divided in groups. You guys, this group over here, we give you scans to read. This group over here, we give you scans, the same scans, but in each scan, accompanying it on the computer is an image of the individual, the person whose body part you're scanning. So let's, I don't, what is this, the, what bone is this, radius? You guys have no idea either. All right. Arm bone, arm bone. I guess, all right, you don't do anything south of the neck here, so. So let's say that, what is this? Ulna. Radius is this one. Ulna is on the back. Okay, there you go, so. Very good. All right. So I guess that puts me halfway to an MD now. So I go in there, so we go in, so you look at somebody's, you know, radius, and then, but when you're looking at the radius, you have a photograph of Fred or Maria or whoever. All right. So how does that make a difference when you put the picture of the patient next to the scan? And the answer was, heck yeah. Here's what they found. When a digital photograph was attached to a patient's files, radiologists provided longer, more meticulous reports. So they took their job more seriously when you put a face on it. But here's where it gets super interesting. For this group over here, we took the scans and then represented them to you again six months later. All right. You don't know this is going on. This is the same exact scans that you saw six months ago because, you know, you don't know because a radius is a radius, is an ulna, is an ulna, is an ulna, right? And six months later, the exact same scans, how do you perform on those? Approximately 80% of the radiological incidental findings originally reported when the photograph was, were not reported when the photograph was omitted from the file. So those incidental findings, when you remove the photograph, suddenly you're not seeing those anymore. This becomes a performance answer. One last one, and then we'll take some, then I'll wrap up. So let's talk about this within the hospital setting, all right? Hospital-acquired infections, not good, right? Pretty serious problem. Pretty easy antidote. Wash your hands, right? Healthcare professionals should wash their hands. How do we encourage healthcare professionals to wash their hands? How do we incentivize them, right? What we try to do is we try to control them. We try to incentivize them. We give them if-then rewards. These researchers looked at a large group of hospitals in North Carolina. And they said, well, maybe we can just persuade them with different kinds of messages. So in this hospital, they put up three different kinds of signs, and they actually measured the, they weighed the hand sanitizer dispensers before and after to see how much sanitizer was used. And then they went back and actually had Confederates monitoring the hand-washing behavior. So they put up three different kinds of signs. Two of them had no effect at all. One of them had as large of an effect as anything that they'd seen. One sign said, hand hygiene prevents you from catching disease. Another sign said, hand hygiene prevents patients from catching diseases. And a third sign said, gel in, wash out. Hand hygiene prevents you from catching diseases. Hand hygiene prevents patients from catching diseases. Gel in, wash out. Which one do you think was the most effective? How many people think this was the most effective? A lot of you. How many people think that this was the most effective? Fewer. How many people think that this was the most effective? All right. Well, I'll split opinion here. Here's what happened. I think we had a plurality for this one. Plurality for this one. The plurality of people here thought that gel in, wash out would be the most effective. You've heard of the wisdom of crowds. When you give a problem to a large group of people, together they will find the correct answer. This is not an example of that. This had no effect. This had no effect. What had an effect was this. Hand hygiene prevents patients from catching diseases. Take a look at this. Had as big an effect as anything that they tried. The hand hygiene of healthcare professionals increased significantly when they were reminded of the implications for patients, but not when they were reminded of the implications for themselves. Over and over and over again, we see this. One last takeaway for you, and then I'll be done. When we try to improve our own performance or other people's performance, we often focus on how. Here's how you do it. We give short shrift to why. Why are we doing it in the first place? Why does it even matter? Well, as touchy-feely as it sounds, this why, this purpose thing ends up being, there's a mountain of evidence showing this is by far the cheapest, this is by far the most cost-effective performance enhancer you have for yourself and for other people. Unfortunately, in the kind of profession that you're at, which outsiders, civilians like me look at it and say, holy smokes, these people are doing surgery on brains? That's incredible. These people are heroes. This is incredible. But when you're in the profession itself, you don't see that enough. It's like that old joke where these two fish swim by, and another fish comes in, and these two fish are swimming by, and this fish comes by and says, hey guys, how's the water? These guys over here say, what the hell is water? When you're in it, you don't see it enough. And so what's important is to raise the salience of that. And one way to do it, one tiny little technique is this. This week, have two fewer conversations about how to do something, and two more about why. You can, with yourself, with your team, with your colleagues, two fewer questions about how, two more about why, I think you'll see an uptick in performance. This is my final word. When we think about these qualities, autonomy, mastery, and purpose, this seems superficially a little bit soft-hearted. But it's not. I want you to think about this for a second, just one image to leave you with here. Think about a two-year-old. I defy you to find me a two-year-old anywhere on the planet who is not autonomous, and curious, and self-directed. I defy you to find me a four-year-old who is not autonomous, curious, and self-directed. I am convinced that that is our nature. And too often, institutions try to switch that nature. And for too long, we've had organizations that, in order to be efficient, had to go against the grain of human nature. I think what we're seeing now is that the people who achieve the most, the people who are most excellent, the organizations that perform at the highest level, are explicitly trying to go with the grain of human nature. I think that's easier. I think it's more interesting. And I think it's ultimately more effective. Thank you.

motivation

rewards

behavior

autonomy

mastery

purpose

enduring performance