N I C H O L A S H . A P O S T O L E R I S , P H D M B A
H E A L T H C E N T E R D I R E C T O R
A C T I O N H E A L T H S E R V I C E S
V P O F B E H A V I O R A L H E A L T H S E R V I C E S
C O M M U N I T Y H E A L T H C O N N E C T I O N S , I N C .
A S S I S T A N T P R O F E S S O R
D E P A R T M E N T O F F A M I L Y M E D I C I N E A N D
C O M M U N I T Y H E A L T H
U M A S S M E D I C A L S C H O O L

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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

 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?

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

 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?

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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

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Self Determination Theory poses that people have three fundamental psychological needs
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Autonomy
Competence
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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

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

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

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

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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

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“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
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Feeling ‘controlled’ versus feeling ‘self-determined’ or
‘autonomous’
Negative consequences of controlling environments
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When people feel controlled, they act in a more oppositional, even anti-social way

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

 When a person perceives that they have meaningful choices, that is autonomy-supportive
 When a person’s 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

 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
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Trainings that overload with too much information too fast are not helpful

 Relatedness is to one’s self and to others
 Relatedness to self
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Realistic expectations
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Limiting negative self-talk
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Valuing self-care
 Relatedness to others
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Positive, appropriate connections to others
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Respect for personal boundaries
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Warmth and good will

 Causality Orientations
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Autonomy Orientation
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Some people will perceive environments as being more autonomysupportive than will other people
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Organize life around personally meaningful goals
Control Orientation
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Some people will perceive environments as being more controlling than will other people
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Lots of ‘shoulds’
Seek/need deadlines
Impersonal Orientation
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Things happen for reasons out of our control
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Do what has been done – no ability to do things differently
Depressed about present, anxious about future

 Suggestions for increasing Autonomy Supportiveness and reducing how controlling our workplace can feel?
 Suggestions for increasing Competence
Supportiveness?
 Suggestions for increasing Relatednesssupportiveness?

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

 Self Determination Theory
 http://www.psych.rochester.edu/SDT/
 Interpersonal control, dehumanization, and violence. Moller & Deci.
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Group Processes and Intergroup Relations, 13, 41-53.
 http://www.psych.rochester.edu/SDT/documents/2010_MollerDeci_GPIR.pdf
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Intrinsic Need Satisfaction. Baard, Deci & Ryan
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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.
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Journal of Organizational Behavior, 26, 331-362 http://www.psych.rochester.edu/SDT/documents/2005_GagneDeci_JOB_SDTt heory.pdf

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