1. NICHOLAS H. APOSTOLERIS, PHD MBA HEALTH CENTER DIRECTOR ACTION HEALTH SERVICES VP OF BEHAVIORAL HEALTH SERVICES COMMUNITY HEALTH CONNECTIONS, INC. ASSISTANT PROFESSOR DEPARTMENT OF FAMILY MEDICINE AND COMMUNITY HEALTH UMASS MEDICAL SCHOOL Work Environments and Morale: Setting Up Your Program For Success

2. Work Environments and Morale: Goals Participants will: Share experiences from their programs regarding morale challenges Share experiences regarding successful approaches to improving morale Learn the principles of Self Determination Theory as they apply to the work place environment Learn how to change workplace environments to improve employee satisfaction

3. Work Environments and Morale Is morale an important issue for your program? What does high morale look like? When have you had times of high morale? What brings down morale?

4. Morale Challenges Mission-related When personnel feel they are not adhering to the mission Personnel-related In all positions Personality Non-work stressors Others? Resource-related On mission, but insufficient resources to do the job right

5. Morale improvement successes Any common themes from your experiences? Could they work without additional resources? Where did the good ideas come from? Who was listening for these ideas?

6. Self Determination Theory Developed at the University of Rochester in the past 30 years Focuses on better understanding why we do what we do and on how to improve social environments When people are self-determined, they experience the satisfaction of doing something that is important to them To feel self-determined, fundamental psychological needs must be met

7. Motivation and Morale Self Determination Theory poses that people have three fundamental psychological needs Autonomy Competence Relatedness Environments can be supportive or unsupportive of the fulfillment of these needs Environments supportive of the person fulfilling these needs will result in more intrinsically motivated action

8. Fundamental Psychological Needs Autonomy The perception that we have choices and can act on those choices Competence The perception that we can function in the world, doing what we need to do to survive and succeed Relatedness The perception that we are related to others and ourselves in a positive way

9. Motivation Orientation External Act to avoid punishment Act to get an external reward Internal/Extrinsic Act to avoid negative self-evaluation Act to obtain a positive self-evaluation Intrinsic Act for the love of the act Immersed in the act – sense of time can be lost

10. Enhancing Intrinsic Motivation Potential negative effects from tangible rewards Intrinsically motivated behaviors become extrinsically motivated A lowering of intrinsic motivation for the activity How to avoid the negative effects of rewards Detach from a specific task request Make the tangible reward unexpected Verbal recognition rather than tangible rewards

11. Controlling Environments Work environments, especially when stressed, tend to adopt a bottom-line approach Workplace well-being issues can be framed exclusively in dollar terms, which can make for poor work environments Recruitment, retention, productivity all are related to work environment Tendency is to just push harder and to value compliance and obedience of employees Vertical hierarchies can be efficient – but at a cost

12. Controlling Environments Control in this context is not good Attempting to control the actions of others rather than setting up the situation so that the actions are self-determined Feeling controlled versus feeling self-determined or autonomous Negative consequences of controlling environments When people feel controlled, they act in a more oppositional, even anti-social way

13. Environments that Support Basic Needs Fulfillment of each of the basic needs can be supported or damaged by the nature of the environment Autonomy-supportive environments Competence-supportive environments Relatedness-supportive environments

14. Autonomy-Supportive Environments When a person perceives that they have meaningful choices, that is autonomy-supportive When a persons point of view is valued and brought into consideration in decision-making, that is autonomy-supportive Autonomy-supportive environments tend to produce more proactive and engaged people

15. Competence-Supportive Environments Determine areas where people perceive their own competence to be high Be careful about moving people into areas where they will have a sharp drop off in perceived competence Provide trainings with adequate time to assimilate information Trainings that overload with too much information too fast are not helpful

16. Relatedness-Supportive Environments Relatedness is to ones self and to others Relatedness to self Realistic expectations Limiting negative self-talk Valuing self-care Relatedness to others Positive, appropriate connections to others Respect for personal boundaries Warmth and good will

17. Where does personality fit in? Causality Orientations Autonomy Orientation Some people will perceive environments as being more autonomy- supportive than will other people Organize life around personally meaningful goals Control Orientation Some people will perceive environments as being more controlling than will other people Lots of shoulds Seek/need deadlines Impersonal Orientation Things happen for reasons out of our control Do what has been done – no ability to do things differently Depressed about present, anxious about future

18. What can we do to improve our workplace? Suggestions for increasing Autonomy Supportiveness and reducing how controlling our workplace can feel? Suggestions for increasing Competence Supportiveness? Suggestions for increasing Relatedness- supportiveness?

19. Valuing our Colleagues Well-being of the person as an end value Not solely as a means to an end Higher productivity Lower recruitment costs Colleagues are not machines and are not disposable They stay or go back to the community Improved or harmed by their work experiences Strengthening communities by strengthening and elevating our workforce

20. References Self Determination Theory http://www.psych.rochester.edu/SDT/ Interpersonal control, dehumanization, and violence. Moller & Deci. Group Processes and Intergroup Relations, 13, 41-53. http://www.psych.rochester.edu/SDT/documents/2010_MollerDeci_GPIR.pdf Intrinsic Need Satisfaction. Baard, Deci & Ryan Journal of Applied Social Psychology, 34, 2045-2068 http://www.psych.rochester.edu/SDT/documents/2004_BaardDeciRyan.pdf Self determination theory and work motivation. Gagne & Deci. Journal of Organizational Behavior, 26, 331-362 http://www.psych.rochester.edu/SDT/documents/2005_GagneDeci_JOB_SDTt heory.pdf http://www.psych.rochester.edu/SDT/documents/2005_GagneDeci_JOB_SDTt heory.pdf

21. Contact Information Nicholas H. Apostoleris, Ph.D. ACTION Health Services Community Health Connections, Inc. Fitchburg Family Medicine Residency Program UMass Medical School 275 Nichols Road, Fitchburg, MA 01420 nhaphd@gmail.com