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1. Intrinsic: The Key to
Sustainable Change
Health Promotion LIVE July 15, 2010
Rosie Ward, Ph.D., MPH, CHES
Certified Intrinsic Coach®
Health Management Services Manager
RJF Agencies, Inc.
How People Make Behavior
Changes
Changing the Change Paradigm

2. “Insanity: doing the same
thing over and over again and
expecting different results.”
~Albert Einstein
Traits of Human Nature
• To be curious
• To be active
• To initiate thought and behavior
• To make meaning from experience
• To be effective at what we value
Sources: Brandt (1999) & Chance (1992)

3. What Comes To Mind???
Intentional Change Theory
• Idea of smooth, continuous change not a
reality for most people.
• Change process is often non-linear and
discontinuous.
• Change process stems from a set of discoveries
or epiphanies.
• Adults learn what they want to learn!
Source: Boyatzis (2006). Journal of Management Development, 25(7)

4. Intentional Change Process
• Must begin with a person wanting to change.
– Desire does not have to be conscious or within
scope of awareness.
• Discovery of who one wants to be (ideal self)
– Not to be confused with the ought self
• Accurate assessment of the real self.
Source: Boyatzis (2006). Journal of Management Development, 25(7)
Theory U
• New model for understanding & conducting profound
change and deep learning.
• What & how we pay attention are key to what we
create.
• Blind Spot – inner “operating center”
– Becoming aware of blind spot critical to change
(individually and systemically)
• Shift in awareness to connect to our essential self via
presencing and learning from future as it emerges
Source: Theory U, Otto Scharmer (2009)

5. Paradigms of Change
• Helping
• Fixing
Both paradigms assume the client / employee has
something wrong and needs external assistance to
get somewhere.
• Serving
The Role of Motivation
What Works for Long-Term
Change?

6. Types of Motivation
• Intrinsic Motivation:
– “People doing an activity because they find it
interesting and derive spontaneous satisfaction
from the activity itself.” (Gagne & Deci, 2005)
• Extrinsic Motivation:
– People are driven to do something due to pressure
or tangible rewards rather than for the fun or
interest of it.” (Petri, 1991)

7. Extrinsic Motivation
Do Extrinsic Rewards
Undermine Intrinsic
Motivation?
We can’t motivate others;
we can get compliance, but
the desire has to come from
within.
Businesses Ignore the Evidence
• Carrot & Stick (especially
$$$) not only ineffective but
HARMFUL
• True Motivation =
Autonomy; Mastery;
Purpose.
Results in higher EE satisfaction
and stronger results

8. Baseline Rewards
• Baseline Rewards must be adequate & equitable.
– Salary, contract payments, benefits, a few perks, etc.
• Without - focus will be on the unfairness of the
situation and anxiety over the circumstance.
– No motivation at all.
• Removing barriers increases actions.
Source: Drive, Daniel Pink (2009)
When Incentives Work
• Algorithmic Tasks - follow a set of established set of
instructions down a single pathway to one conclusion
(i.e., there’s an algorithm for solving it).
• Heuristic Tasks - no algorithm exists; have to
experiment and find a novel solution.
• External rewards and punishments (both carrots
and sticks) work nicely for algorithmic tasks only.
Source: Amabile, T. (1996), Harvard Business School

9. What About the Stick?
• Do negative consequences
reduce undesired
actions?
• Shift from moral obligation
to purely transactional.
– People start weighing the
consequences of sticks to
determine if the punishment
is worth it.
Source: Gneezy & Rustichini (2000)

10. Principal-Agent Theory
• Principal – the motivator
(i.e., employer, teacher,
parent)
• Agent – the motivatee (i.e.,
employee, student, child)
• Once reward in place, need
contingent rewards in order
for behavior to continue.
Escalating Zero Point
2002 HA Participation: 2006 HA Participation:
• $50 = 50-60% • $100 = 50-60%
• $100 = 60-70% • $200 = 60-70%
• $200 = 80% • $400 = 80%
Heavy Use of Extrinsic Incentives → It
costs more over time to get the same result.
Source: StayWell Health Management (2002, 2006)

11. Negative Motivation
• Heart Patients (double or quadruple bypass
operations)
– 2 years post operation, how many actually stick to new
habits?
– Only 10%!
• Dr. Dean Ornish program
– Patients taught to appreciate life rather than fear death.
– 2 years post operation, how many actually stuck to new
habits?
– 70%!

12. Typical Conversations
• Notice who is doing the work.
• Notice the energy and commitment from the
person being “coached”.
• What do you think the likelihood of success
will be?
The “Try Harder” Approach
• Putting the employee in a passive role requires us
to work harder.
“If I could only find a different way to say this…”
“Maybe if I had them try x…”
• This leads to:
Frustration
Being stuck in a viscous cycle
BURNOUT!

13. Intrinsic Motivation
• Occurs when learning activity & learning
environment elicit motivation in a person.
• Key to organizational effectiveness = empowered &
intrinsically motivated employees.
• Self-leadership (Neck & Manz, 1992)
– Recognizes intrinsic rewards
– Increased self-efficacy and performance
Sources: Brandt (1999); Chance (1992); Lahiry (1994); Neck & Manz (1992)
Creating Intrinsic Motivation
• Having goals and rewards that are meaningful to
people.
• Having learning/activity that is important to people.
• When learning/activity helps people obtain valued
accomplishments.
• When learning/activity helps people integrate
themselves with the world, with others, and promotes
self-awareness.
Sources: Brandt (1999) & Chance (1992)

14. On Second Thought…
Understanding the Power of the
Thinking Behind the Actions
Who Am I?
Person #1 Person #2
• Lazy • Overwhelmed
• Unmotivated • Grieving
• Disengaged • Strong
• Stressed • Loving
• Alcohol/Drug Problem • Saintly
SAME Person → Perspective / Judgment
changes based on information apparent to us.

15. How Thinking Gets In Our Way
• “I know I should…”
• “I really need to…”
• “I just can’t seem to get motivated…”
• “If only ______ (person) would do …..”
Behavior Change – who does the work?
Being told what to do – does it work?
Thought Self-Leadership
• Individual thoughts central to intrinsic
motivation & self-leadership.
• Use of specific cognitive strategies to control
own thoughts.
• Organizations need to create an environment
that fosters developing and maintaining
constructive thinking.
Sources: Manz & Neck (1991)

16. Values Thinking
• Hartman’s hierarchy of values:
Intrinsic (I) – value for individual uniqueness
Extrinsic (E) – strategy / expertise
Systemic (S) – it ought/should be this way
• I > E > S – people are more valued than things;
things are more valued than mere ideas of things
or people.
Sources: Hartman (1967) & Pomeroy (2005)
Values Thinking in Life
World / Work View: Self-View:
• (I) – people have value • (I) – I value my uniqueness;
independent of roles, clarity of self independent
accomplishments; people > of roles, etc.
tasks
• (E) – I view myself in terms
• (E) – task-focused; people = of my roles
means to get things done.
• (S) – idea-focused; people • (S) – I view myself as a
viewed in terms of our ideas “cog in the wheel”
of how they & they world
SHOULD be.
Sources: Hartman (1967) & Pomeroy (2005)
Proprietary & Confidential.
© 2010, Rosalind Ward, Ph.D.
All rights reserved.

17. I,E,S in Organizations
• Judgment Index™ (C. Stephen Byrum, Ph.D.)
– Uses HVP to measure strength of judgment, stress indicators,
burnout indicators, hiring, morale/engagement, etc.
Outcomes Outcomes
Part 1 – Vs. Part 1 –
Work Side Work Side
Part 2 – Part 2
Self Side Self Side www.judgmentindex.com
I, E, S
Systemic
Extrinsic
I Want to Have ↑ Insurance
Limitless Energy Premiums for
Incentives
Smokers
Behavior Change I Want to Be
There for My Healthy Snacks in
Programs
Kids Vending Machines
Intrinsic

18. The Danger of Assessment Labels
What Happens When the
Intrinsic is Missing?
• Jumping to conclusions
• Judgment
• Impatience
• Frustration
Without the intrinsic, you can never be
anything other than my ideas about you…

19. “I wish my parents would see
me for all that I AM instead of
all the things that I haven’t
become!”
Behavior Change
• Behavior change results from a shift in
thinking.
• Behavior change is not DOING differently.
– Doing differently is the outward observable of the
internal change.

20. Why People Relapse
• Old behaviors met some greater need.
• When old behaviors are eliminated, the need still
exists.
• New behavior has not been substituted or does not
fully meet the need.
• Too much focus on fixing rather than building on
strengths???
• Reduced intrinsic thinking???
Moving Upstream
Thinking
Skills
Emotional
State
Behavior
Wellness

21. Brain: Friend or Foe?
Prefrontal
Cortex Basal
Ganglia
Cognitive Challenges with Change
• Change itself amplifies stress & discomfort.
• Carrot & Stick don’t succeed in the long run.
• Brains = pattern-making organs with innate desire to
create meaningful connections.
• People can detect the difference between authentic
inquiry and persuasion efforts.
• Change requires changing mental maps through
creating moments of insight.
Source: Rock & Schwartz, “The Neuroscience of
Leadership”, Strategy + Business (2009)

22. Changing When Change is Hard
• Successful change =
– Change situation
– Clarity of direction
• Rational & Emotional
Systems must align with
surrounding environment
When Engagement Occurs
• Emotionally connected to others
• Cognitively stimulated
• Know what is expected of them
• Have what they need to do their work
• Perceive they are part of something significant with
co-workers they trust
• Have chances to improve and develop
Source: Harter, Schmidt & Hayes, Journal of Applied Psychology (2002)

23. Brains Are Like RW CDs
“Scientists estimate that the average person has
50,000 to 60,000 thoughts a day. 90% of
those are repetitive. 85% of the repetitive
thoughts are negative. If leaders have
approximately 45,900 negative thoughts a
day, and, their followers are doing the same,
the most important skill that leaders can
develop is training the mind to lead.”
~Suzanne Kryder, Ph.D.
(www.themindtolead.com)
Stop DOING, Start BEING
• People know if being
manipulated, coped with,
etc….it’s not about skills but
how leaders regard others.
• Our thinking about others
influences how they perceive our
behaviors.
• People respond not to what
we’re doing but how we’re
being.

24. Increasing the Intrinsic:
The Role of Coaching
Sustained Behavior Change
Cognitive Coaching Research (Stanford)
New New Skill New Behavior
Knowledge Developed at Work
Instruction Only 90% 25% 5%
Add
90% 50% 5%
Demonstration
90% 90-95% 5%
Add Practice
90% 90-95% 5%
Add Feedback
90-100% 95%
Add Coaching 90-100%

25. Strengthened Intrinsic = Working
Beyond What is Merely Apparent
• Disabling the dominance of E and S thinking.
• Listening with a Spirit of Service
– vs. Listening to Assess
– vs. Listening for Solutions
How To Elicit the Intrinsic
• Really listening to people without judgment.
• Asking forward-moving questions that get to the core
of what is most important to that person.
“What do you want?”
“What do you want that’s important to you right now?”
• What? > How? > Why?

26. Intrinsic Capacity and Intrinsic
Coaching®
What Research Tells Us
Intrinsic Coaching®
“A paradigm changing approach to better
results for, with, and through people” by
“increasing people’s capacity to think better
about choices, especially by increasing
intrinsic thinking” (Totally Coached, Inc.)

27. 2 Studies…So Far
Lifestyle Makeover Program: Doctoral Research:
• Increased intrinsic capacity • Increased intrinsic capacity;
• Improved life balance strengthened internal
• Improved blood lipids & systemic
glucose • Improved life balance &
• SUSTAINABLE results! resiliency
• Better outcomes at work and
in life as a result of shift in
thinking (I>E>S).
Being>Doing>Becoming
Outcomes Outcomes
Vs.
Part 1 – Part 1 –
Work Side Work Side
Part 2 – Part 2
Self Side Self Side
Self Side is critical to have I>E>S (Robert Hartman)
Source: Byrum, Ph.D. / Judgment Index™

28. ress &
rs: Work-side st
4 Stress Indicato stress & ability
to
ability to cope; Self-side
IENCY)
cope (i.e., RESIL
Value of Increased Intrinsic Capacity
• Builds RESILIENCY
– Stress / lack of coping and resiliency = #1 cause of
poor judgment
• Self-side coping / resiliency significantly related to
job satisfaction and affective commitment.
• Also strengthens internal systemic (clarity of life
direction).
Sources: Byrum, Ph.D. (2009) & Ward, Ph.D. (2008)

29. I>E>S in Action – City of Ames, IA
• Population of Ames 52,000 (with college)
• City municipality – 14 departments
• Multiple sites - 16 locations
• 560 employees, 1350 total insured members
• 75% M: 25% F
• Average age = 44
• 5 unions environment
I>E>S in Action – City of Ames, IA
Program design is very intrinsic – “seeing” people in
their lives vs. trying to change them.
Systemic Components: I>E>S:
• Required to complete annual • Focus on improving
blood profile and HA. intrinsic thinking and clarity
of goals – people & culture.
• Other Required Criteria:
– Preventive exams • Program linked to reduced
– Consumerism modules health insurance premium,
– Metabolic Measures but found it was about the
– Participation in 4 programs message, not the money
– 7 IC® coaching sessions/year

30. City of Ames - Results
• After 3 years:
– 70% participation rate amongst EEs; 100% retention rate (3
participants left organization)
– 53% reduction in risk factors
– 92% of participants satisfied
– 84% of participants felt coaching making a difference
– 97% of participants reported coaching was a positive
experience
• What’s Next? Leaders complete IC® training; weave
into culture beyond EE wellness program.
Summary of Key Points
• Behavior change is complex; When using tools and
resources, make the information second to the
person.
• Missing link is Intrinsic, but extrinsic and systemic
are needed for support.
• Sustained change results from eliciting new
thinking, not being told what to do or given more
information.

31. What new thinking have you
had today that you want to
apply at your organization?
Health Management Services Manager, RJF Agencies, Inc.
www.rjfagencies.com; wardr@rjfagencies.com
Dr. Rosie Ward
www.DrRosieWard.com; rosie@drrosieward.com