What the Fortune 500 Can Teach Healthcare About Employee Retention: Q&A With Bill Sims Jr. on Employee Engagement

Bill Sims Jr. has spent his career helping top companies — including Coca-Cola, Disney and DuPont — create behavior-based employee recognition programs to engage and retain top-performing employees.

His new book, "Green Beans & Ice Cream: The Remarkable Power of Positive Reinforcement," Mr. Sims shares best practices for employee engagement, and why the best organizations don't use money — but managers — to retain the best and brightest.

He recently answered a few questions for me about the book, employee engagement in healthcare and why external positive reinforcement (e.g., giving a child an ice cream treat) can be just as powerful in achieving desired outcomes (e.g. getting a child to eat green beans), despite popular discourse in the vein of Daniel Pink arguing external motivators are useless. That's simply not the case, he argues, and his book helps explain why.  

Q: Your book promotes the power of positive reinforcement, through positive feedback and recognition. You argue that positive feedback is more powerful in developing high-performing employees than money. This has been supported by studies, and if followed, companies could potentially have more effective, and less costly, retention programs. Why do you think this is the case?  

Bill Sims Jr.: In my book, I reference an interesting study where researchers strap an MRI machine to people and compare their normal brain state to their brain state when they are given money. Money produced a "thrill" response in the straitum, which is the same part of the brain that is stimulated by risk-taking activities like skydiving and gambling. But, what's most impressive to me is that the researchers found when people were given feedback on what they did right, it stimulated the same brain area as money. When your boss, friend, or spouse tells you what they appreciate about you, your straitum lights up like a Christmas tree. So we can get the same impact on the human brain using positive reinforcement that we get with money. The cool part is that positive reinforcement can often be free. Does it cost you any money to tell your kids, employees, co-workers or spouse that they did a good job? No. So why don't we do it more often?

Q: And why don't more employers seem to recognize this?

BS: In hundreds of studies, employees indicate that money ranks about No. 5 as a driver of employee engagement, while positive reinforcement (which takes many forms: autonomy, feedback, personal growth, verbal praise) ranks No. 1. Sadly, more than 70 percent of workers never get a simple "thank you" from their boss. Why? Because when managers are asked what they think drives worker performance, their first pick is money. Positive reinforcement and feedback are completely overlooked as engagement drivers by most managers.

Q: You have also said performance reviews — a long-held practice for employee growth and development — are "a total waste of time and money." Why? Don't employees need to be made aware of how they're doing and have an opportunity to receive constructive criticism and identify areas for growth?

BS: Almost everyone hates performance evaluations. In short, these systems require you to identify and separate your top, average and below average performers.

For top performers, your reward will often be increased responsibilities, making it difficult to maintain the same level of performance for the next year. If you are an average performer, you take heart that you weren't in the bottom category, and feel fine where you are. And if you're a below average performer, you know your days are numbered. Why should you even bother to try harder? So the system can actually reward and create average and below average performance.

I'm reminded of Jane Elliott's experiment with school kids. The kids with blue eyes were told they were smarter and better than those with brown eyes. Before long, the blue eyed kids scored higher on tests than brown eyed kids. Then, Elliott reversed the experiment and found the brown eyed kids outperformed blue eyed kids once they were told they were the smartest.
In short, folks, you get what you reinforce. Not only are performance evaluations flawed in their approach, they are flawed in their timing. Reinforcement has to be immediate, and quarterly or yearly bonus plans just aren't frequent enough to truly get people to do their best.

Q: But without performance reviews, what do managers do if employees don't perform to the level required of their role?

BS: I cover this in my book, but essentially, you need a different style of management than the one most folks use. I call it PR+ Coaching Leadership. In this method, you focus on a few critical things that each person needs to do to be better today than yesterday. You reinforce those improvements daily if possible in order to change that employee's behavior.

Q: In the book, you caution against one-size-fits all employee recognition events, such as an employee appreciation day or company picnic. You even argue against using employee of the month programs to recognize high performers. How can these be bad things?

BS: Each of these are bad but for different reasons. Let's take the employee of the month program first. When we make one person the winner, we make all the other people losers. That creates internal competition and silos, which stifles mentoring and coaching. Employee appreciation days and picnics aren't bad by themselves. There's nothing wrong with having a meal with your team, as long as you understand it is completely useless when it comes to changing their behavior. Giving everybody the same thing, whether it's a pizza party, t-shirt, 5 percent pay raise, or a steak dinner actually erodes commitment and encourages poor performers. Suppose you and I work together in the same branch or department. You are the hardest worker in the bunch. Putting forth extra effort, you are committed to doing whatever it takes to take care of our customers and co-workers. Me? I'm what you call a C.A.V.E. person (Citizen Against Virtually Everything). I break rules, goof off, text my girlfriend when the boss isn't looking. And then we both get invited to an "Employee Appreciation" dinner. How does that make you FEEL?" Answer: Pretty bad. We have destroyed your commitment and soon you might just drop down to being an average performance. What's the use? Nobody here notices anyway.
And me? Why I'm loving every minute of being a CAVE person. They must like it, cause I just got rewarded for it. One size fits all punishes your high performers and rewards your low performers. It's not fair.

Q: Daniel Pink has made a name for himself by arguing against external motivators, such as positive reinforcement. Instead, he argues that the goal of the manager is to help his or her employees tap their internal motivation. You say that external motivators do work. How do you support your theories against those of Pink and his supporters?

BS: I agree with a little of what Dan Pink says. The science has shown for years that autonomy, mastery and purpose are powerful forms of internal positive reinforcement that the work itself delivers. Leaders should create a system where the obstacles and barriers to autonomy, mastery and purpose are removed. But I cannot agree with his assertion that external positive motivators are wrong. In a nutshell, he states that rewarding you with a bonus or a commission because you worked hard and brought in profits to your company is wrong. Pink believes that it will somehow rob you of your internal satisfaction for doing the job. If we applied his logic across the board, students should never be awarded college scholarships (because that will rob them of their desire to study). Brain surgeons should make no more than dental technicians, since they are robbed of their internal joy by being compensated for performance. The Pink logic doesn't really hold up here. The studies he quotes, many of them the work of Edward Deci, have been examined by other psychologists who have found that external positive reinforcement does increase performance, and it does so without any degradation of internal drive or motivation. My book has a chapter called "Don't drink the Pink Kool Aid" which covers these studies in depth.

Q: If you had to boil your 30 years of work on positive reinforcement into a single piece of advice to healthcare leaders, what would it be?

BS: What makes great leaders truly great? It's their ability to get their team to deliver a higher level of performance than they would without the leader, especially in moments when you're not there watching. It is all about behavior change. Changing behavior can improve patient satisfaction, employee retention, quality of care, safety and more. You won't get the best out of your people until you learn how to master the remarkable power of positive reinforcement. My book is dedicated to this pursuit.

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