During a busy day in one of our clinics, I would often take a break from my schedule to watch how things were working.  It is amazing what you can learn when you take yourself out of the busy-ness of the space to simply observe.  Over the years I made a habit of doing this often.  By doing so I was able to gauge how we were functioning as a team.  Not unlike watching a sports team, people were moving in synchrony, with purpose and most of the time, with energy.  To extend the metaphor, the team members were making plays, caring for clients and each other to create a healing experience for everyone involved.  The concept of flow is the topic of a future blog. 

At staff/team meetings I often talked about this synergistic action and how, as a team, our success depended upon each player showing up ready “to play”.  Although it was always emphasized that no one player is more important than the other, each player's contribution matters.  The degree to which each person on the team was “on their game” made a difference. Each person either contributes or detracts from the flow of providing a meaningful experience for their colleagues and the patient.  Our success as a business, as professionals, and the success of our patients depended upon this team performance.

The sports team metaphor fits to illustrate some important concepts.  Successful sports teams have clear goals.  They know what “winning” looks like.  They have players who have different roles but share a common purpose.  Great teams celebrate the wins and reflect on the losses, knowing that learning happens in both cases.  Elite level sports teams spend big money hiring great coaches and developing their players.  Each player's success depends not only on the skills of each player, but also the motivation to succeed, improve and contribute. I saw these traits not only in the college teams I worked with, but also in the clinical teams that served our communities.  While running the daily operations provided a brilliant training ground to hone clinical and administrative skills, I needed to better understand why our business, and many like it, did so well.  

To better understand how teams and individuals can improve performance, we can turn to the science of performance psychology. Performance psychology is the study of individuals and groups who engage in goal oriented behaviors.  With this definition, one can make the case  that “everyone performs” at some level.  Patients are striving to improve, therapists are striving to succeed as professionals, and the entire clinical team operates in ways that help the team achieve their goals. While sports teams are fun to watch, I would say that so is a well-run clinic, especially if you are a leader in the organization.  It’s a brilliant study of human behavior and motivation.  

Performance psychology provides individual therapists, healthcare organizations and patients research based methods for successfully achieving goals.  While my specific area of research is in the trait characteristics that may influence the connectability of physical therapists and patients, there are many theoretical constructs that provide individual therapists and business owners an edge toward improving outcomes as we all contend with factors that contribute to burnout and poor performance 

Motivational climate is a concept that stems from achievement goal theory (AGT). The motivational climate is how team members understand the conditions of success and falls into two categories, performance or mastery.   

• Performance climate is one that emphasizes results achieved through comparison between employees and competition.  Coaches and players (in sports and business) who focus on performance use most of their cognitive-emotional resources to focus on comparing their results to others. This creates anxiety and requires high energy expenditure. Although it seems clear that some people thrive on competition, too many healthcare providers are struggling under the inherent stressors of providing quality and engaging care and hitting productivity targets. For many, it is exhausting and contributing to burnout.
• Mastery climate elevates the value of self-development, employee effort and cooperation.  It spotlights the process around which an individual and team operate rather than the goal.  Coaches and leaders lead team members to focus on learning the game, playing well, openly communicating the process and honing their skills through a series of successes and failures. Mastery climate allows employees to reallocate valuable cognitive-emotional resources toward optimizing performance, such as successfully engaging with patients and colleagues. 

While there is some debate about the role of productivity goals in physical therapy, organizations of all sizes must consider the importance of staying productive and efficient. As the saying goes, “no margin... no mission”. However, the motivational climate that we set to achieve this margin can make a difference in the health and longevity of your organization.  When players are stressed about hitting a goal, they are not likely to perform well, which leads to a spiral of poor performance.  Consider the type of motivational climate you want to create in your organization and consider the following:

1. Contextualize Organizational Goals.  Don’t just post goals for your team to achieve, provide an ongoing process of teaching team members about “why” the goals are important.  Ensure that the goals are aligned to your organization's mission and values.  Explicitly connect the dots to ensure that everyone is on the same page and fosters the basic psychological need of relatedness.
2. Create a culture of learning. When an organization’s top value is learning, it sets the stage for a mindset of development.  Break down the overall organization’s goals into the skills necessary to achieve the goals and create resources to build these skills.  As an example, I worked with a client who wanted to decrease their cancellation rate. We created a series of small steps that allowed the therapist to focus on the steps rather than reaching the goal. This significantly dropped their anxiety, increased confidence and led to achieving the stated goals.
3. Emphasize the development process as a team. Leaders who actively engage employees to explore their challenges and successes help them develop a sense of mastery and autonomy.  Downplay competition and create an atmosphere where people feel safe to learn from each other.  To do this requires leaders to create opportunities for individuals in a group to share how they do what they do knowing that they are supported in their development.  

Motivational climate is only one concept in the evolving role of performance psychology in healthcare.  Although the business of providing healthcare has always been complex, the recent pandemic and changes in reimbursement models are placing additional pressure on leaders searching for ways to improve performance.  By recognizing that the team’s success depends upon each of your players being at the top of their game and working together, leaders can implement strategies to achieve better results.