December 06, 2011
A 2012 goal at Health Enhancement Systems is to beat back the momentum around cash and cash-equivalent rewards for wellness participation. We believe it’s one of the biggest threats to workplace wellness viability today (see Making Wellness Rewarding… Without Rewards).
It’s an uphill struggle. Everyone we’ve talked to who’s given cash, gift cards, or even discounts on healthcare premiums say the same thing: it works. Extrinsic rewards (external enticements to do something to get something) always produce compliance in whatever wellness activity — completing an assessment, enrolling in health coaching, registering for a campaign, participating in a screening — the first time.
To date, however, we’ve not found a single wellness program that offered the incentive in year 3 and got the same or better results as in year 1. Every program has either had to increase the reward or, more often, implement a disincentive to get compliance.
The carrot has, in effect, turned into a stick. And a stick might be okay if it actually produced the desired long-term effect… if it engaged people in the healthy behavior and they internalized and kept doing it, regardless of the carrot or stick. But we don’t see that.
In fact, we’ve not found anyone to say they’ve been able to withdraw the cash-based incentive/disincentive and see the health behavior continue (we would love to hear from you if you have been able to do this; we’ll share your story with our readers). So the only logical conclusion is the carrot/stick stakes will only get higher until either:
We’ve talked with several health promoters since our last article on this topic who are rolling back financial incentives because they’re looking down the road and seeing how this can only end in one of the ways described above.
Why Intrinsic Motivation Wins
To reinforce our position that financial incentives are a bad idea, we’re extensively reviewing what’s been published by noted researchers like Edward Deci, Teresa Amabile, Alfie Kohn, and others. Among the compelling arguments in support of intrinsic motivation (doing something for the reward inherent in the activity itself) is an individual’s desire for autonomy and control described by Deci:
To be autonomous means to act in accord with one’s self — it means feeling free and volitional in one’s actions. When autonomous, people are fully willing to do what they are doing, and they embrace the activity with a sense of interest and commitment. Their actions emanate from their true sense of self, so they are being authentic. In contrast, to be controlled means to act because one is being pressured. When controlled, people act without a sense of personal endorsement. Their behavior is not an expression of the self, for the self has been subjugated to the controls. In this condition, people can reasonably be described as alienated.
To sum up, long term, carrots can only turn into sticks and sticks can only produce alienation.
Think Baby Carrots
The key to an effective incentive, motivation, or reward strategy is to limit the monetary value, not increase it. In other words, the “thing” someone receives (if they receive anything at all) in recognition of adopting the desired behavior should have little to no monetary value. Like baby carrots, you can snack on them, but they can never be mistaken for a meal.
To reinforce autonomy and control — thereby creating an environment where intrinsic motivation can flourish — consider a shift for 2012. Think about changing your focus to a simple recognition that’s personal — not the kind where the participant’s name is emblazoned on a trophy, but where you look them in the eye, shake their hand, and say “Congratulations. You must feel good about your accomplishment.”
And if you want to toss in a T-shirt, that’s okay too — we have some on sale.