Beyond Carrots… and Sticks

NOTE:  This blog post talks extensively about the book Drive, by Danial Pink.  I purchased this book years ago, and I have never had any contact with Mr. Pink, his representation, or his publisher.  This is 100% my thoughts on the book and how it relates to living with diabetes.  Also, I encourage anyone reading this to go buy the book.

Not too long ago I saw a lot of attention given to the remarks of the incoming International Diabetes Federation President with respect to “fear arousal.”  Many (myself included) took this to mean health care providers should use to some degree fear in their interactions with people with diabetes.  To be certain, the pushback was pretty hard.  

I also chimed in with the following tweet:

This entire Twitter thread had me thinking very much about the motivation behind living with diabetes.  To be clear, there isn’t any “opt out” of diabetes, but to remain on the path, there are many days when just plain habit doesn’t do it, and I need to find some motivation.  

The most familiar motivation structure is the penalty/reward structure.  This is also known as the carrot-and-stick approach.  Meet a certain goal, get a reward (carrot), don’t meet the goal, receive a penalty (stick).  If I had to choose between a penalty and a reward, I would choose a reward structure.  It is just my personal preference. But the reality is that I don’t think carrots and sticks work for managing diabetes.  For the longest time, that is where I was on the carrot – stick continuum, mostly because that was the motivation structure that was familiar to me.

About five years ago, I came across the book “Drive,” by Daniel Pink.  For me, it was one of those fascinating non-fiction books that I could not put down once I started reading.  In Drive, Mr. Pink postulates that behavioral and economic studies have long shown that the typical carrot and stick reward structure only works well under a very narrow set of circumstances.  For pretty straight forward tasks, carrot and stick can be a very good motivator, but for complex tasks, it can actually demotivate people.  His book drive is all about how people working on complex tasks are motivated and stay motivated.  I’m going to expand on that a little bit and try to bend this theory to diabetes management, but first, I encourage everyone to view two short videos to get up to speed.  This first one is a Daniel Pink lecture with marker board animation to make it interesting.  Its about ten minutes, but I think it is time well spent.

The second video is a TED talk given by Mr. Pink.  It covers much of the same ground as the first video, but there are a few interesting additions that are well worth watching:

So now that we are all up to speed, there is one thing I want to address up front.  I believe Mr. Pink’s primary audiences are business managers and workers looking for a better motivational structure.  With this given audience, it is entirely appropriate to discuss pay (salary) and profits.  So a lot of his end conclusions tie back to a better motivated staff will result in better business.  Within the diabetes community, our larger goals are not aligned towards anyones profit or business.  Our goals are aligned with better and longer lasting health.  So keep that in mind.

As detailed in Drive, there are three factors that lead to better performance and satisfaction are; autonomy, mastery, and purpose.

Autonomy – First, a quick note:  autonomy is not correlated with “no rules.”  This is not “Let’s get a bottle of tequila and rummage through our spice rack to find the undiscovered magic bullet to solve diabetes.”  That is not what we are talking about. 

When I think of how autonomy is described in Drive and how it relates to diabetes, my first thought goes to “eat to your meter.”  Isn’t that what we are really saying?  Rather than burdening ourselves with lists of “good” food and ‘bad” food, or setting daily or meal-based numerical goals, have a talk with your health care professional, and eat healthy meals.  Check your BG before and after (y’all know the drill), adjust as needed based on feedback from your meter.  In this way, the autonomy to plan healthy meals and correct as necessary motivates us to find what works and what doesn’t.

Mastery – Mastery is a pretty universal motivational factor for people with diabetes.  The most immediate application I see is to cooking.  Since my diagnosis, I have been working pretty hard to find the right combination of spices and marinades to cook chicken breasts.  I have expanded from my basic knowledge of Italian seasoning and Mexican seasoning to include, jerk chicken, harissa, and I have been recently experimenting with Nando Peri-Peri sauce to make a Portuguese chicken.  I’m getting close.  Next year I will take on Peruvian chicken and hopefully, Puerto Rican chicken fricassee.  As you can see, by applying mastery, I have been motivated to find a variety of healthy chicken recipes.  I use them as part of my rotation of lunches (over mixed greens) and as an entree for dinner.  

Other examples of applying mastery might be to stretching exercises such as Tai Chi, or running your first 5k (or 10K!).  This factor is practically limitless, so long as you make the positive decision to get good at something, the motivation will also come along.

One last note on mastery, there is one other YouTube video on Drive that is worth watching.  This one is not narrated by Mr. Pink, but it does highlight a case of mastery, using the Swedish shipping firm Green Cargo as an example.   It appears about 4:15 into the video. In this example, the firm started doing performance reviews a little different.  Rather than yearly reviews, managers met with their employees monthly to determine if the employees were overwhelmed or underwhelmed in their current job.  The manger then worked with the employee to determine a “Goldilocks” work assignment for that employee.  These assignments are intended to be not too hard or easy, but designed to be a little above the employee’s ability.  As time went on, employees began to master the work of the business, and productivity increased.  Now, think about having a discussion with your HCP and collaboratively working out “Goldilocks” goals for exercise, diet, and wellness.  Wouldn’t that set the table to be more motivated between quarters?

Purpose – If there is one motivation factor that people with diabetes have that the folks in the business world might not, my bet would be on purpose.  Although diabetes may seem invisible to the uninitiated, we see constant reminders of the disease that lives within us everyday.  Our purpose is to meet the challenge of this disease every day, and to wake up the next morning and do it again.  Where I think we could do better is relating this purpose to the everyday.  It is so important to remember the purpose behind the foods we eat, the stairs we climb, and the medicines we take.  If we can take a moment to remind ourselves that we are doing these things for a purpose, they become more important – they become worth doing.

So there you have it.  Diabetes management is a complex task.  I believe (and I hope you might agree) that carrots and sticks don’t work as motivational tools.  We need a different set of rules, and I believe Autonomy, Mastery, and Purpose go a long way to stay motivated when dealing with diabetes.  So the next time you sit down with your health care team, talk about some of these concepts.  

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