To Incent or Not to Incent…What Really Works?

“Insanity: Doing the same things over and over and expecting a different result.” – Albert Einstein

No one disputes the genius of Einstein. Yet, we keep relying on doing what we’ve always done when it comes to trying to motivate others to bring about behavior change; truly insane. This thinking is outdated and faulty, and it is time to separate fact from fiction.

  • Extrinsic/Controlled Motivation is being driven to do something due to pressure or tangible rewards rather than for the fun or interest of it.1 Extrinsic or controlled motivation involves carrot and/or stick approaches in which people do something because someone else is trying to get them to do it.
  • Intrinsic/Autonomous Motivation is doing an activity because it is interesting, and the activity itself provides spontaneous satisfaction. 2 Intrinsic or autonomous motivation is when people do something because they want to do it.

Research consistently shows change efforts fail in the long run when based on carrot-and-stick extrinsic motivation2,3,4,5, yet this approach remains the dominant form of motivation in our culture today. In a 2012 TED Talk, Edward Deci, one of the world’s most respected authorities on motivation, put it best when he said:

“There are literally hundreds and hundreds and hundreds now of scientific investigations that have shown when you’re autonomously motivated your behavior will be more creative. You’ll be a better problem solver. When you encounter obstacles, you’ll be able to think outside the box and figure out what to do about them. Your performance will be better particularly at heuristic activities, and your emotions will be much more positive. And very importantly, autonomous motivation is associated with both physical and psychological health.”

Incentives can lead to compliance, but they don’t lead to commitment! When people are faced with “do ABC and you’ll get XYZ in return,” they start weighing the consequences to determine if the stick punishment or the carrot reward is really worth it; the focus shifts to being purely transactional. In fact, offering an incentive to try to “get” someone to change behaviors often has the opposite effect because it sends a message that “this must SUCK or you wouldn’t need to bribe me to do it.” Extrinsic motivators can actually give us more of what we don’t want.

Even a 2012 study published in the (biased towards the status quo use of incentives) “American Journal of Health Promotion”7 concluded that although financial incentives resulted in higher program completion rates (i.e., compliance), they did not result in improvements in health risks or health outcomes. Despite this, many health and business professionals choose to ignore the evidence and hang on to pre-existing beliefs. Case in point, in spite of decades of evidence decrying the use of extrinsic motivation, a March 3, 2014 American Journal of Health Promotion blog continues to advocate for incentives and how to make them work.

We know that, even in the face of consistently conflicting data, people often tend to hold on to outdated paradigms. Unfortunately, this is even more likely to happen when, as is the case with incentives, the entire industry has grown up around the use to control health behaviors. As the great American writer Upton Sinclair put it;

“It is difficult to get a man to understand something, when his salary depends upon his not understanding it!”

And make no mistake about it, the evidence is quite conclusive. Current approaches to behavior change are not working because:

  • The strategies have not changed in the last 30 years even though the evidence shows they are ineffective at best and harmful at worst.
  • Penalizing, prodding, coercing and preaching to people about what is wrong with them is not only ineffectual, it is unethical.
  • Using incentives and punishments to “get people to change” is completely unsupported by the literature — try it on your family and see how well it works.
  • Focusing on behaviors in the first place is the wrong approach; behaviors are the outward observable actions of what is happening internally in terms of emotions and thinking. Sustainable change results from developing more effective thinking.
  • Worksite efforts to pay people to be healthy often end up penalizing the people who can least afford it.
  • Hundreds and hundreds of studies clearly demonstrate that intrinsic motivation is the best and, for most people, the only way to promote positive, sustainable change.
  • Extrinsic motivation tends to diminish creativity, encourage cheating and lying, and reduce intrinsic motivation.

Because the carrot approach to incentives has not worked, many in health promotion/wellness are shifting to the stick approach – particularly in light of the wellness provisions in the Affordable Care Act. Why do people think that strong-arming people and fear of punishment will work? Again, a wealth of evidence shows that it does not.

Consider behavior change and the fear of death. Dr. Dean Ornish conducted research on heart patients who had double or quadruple bypass operations. These patients had a simple choice: make drastic lifestyle changes (i.e., eat healthy foods, stop smoking, reduce stress, exercise) or die. Even with the ultimate “motivator” of avoiding death, only 10 percent were able to make sustainable lifestyle changes two years post operation. As a result, Dr. Ornish designed his program to focus on teaching heart patients to appreciate life rather than fear death. The program included yoga, meditation, healthy diet, and stress counseling – all focused on having them enjoy life more fully. Two years post operation 70 percent of the patients had made sustainable lifestyle changes. The difference was in the approach. When people looked forward and built on what they had and what they wanted rather than simply trying to avoid a negative consequence, they had much better success with long-term change.7

Extrinsic, controlling motivation also backfires at an organizational level. Focusing on short-term fixes through the use of carrots and sticks may result in short-term behavioral compliance that could temporarily help the organization financially. However, in the long run, the literature is clear: The negative consequences greatly outweigh any potential short-term benefits. Because aside from failing to produce long-term behavior change, extrinsic motivation often:

  • Diminishes performance and creativity
  • Fosters short-term thinking
  • Encourages cheating and lying
  • Becomes habit forming
  • Reduces or extinguishes intrinsic motivation

Behavior change is not as simple as finding a magic trick to motivate someone or accessing the right pressure point to get them to behave differently. It requires a fundamental shift in how people think about their lives and their choices. It requires a shift to foster intrinsic motivation. More to come about intrinsic thinking in a future blog.

1 Petri, H. (1991). Motivation: Theory, research and application (3rd ed.). Belmont, CA: Wadsworth.

2 Gagne, M. & Deci, E. L. (2005). Self-determination theory and work motivation. Journal of Organizational Behavior, 26, 331-362.

3 Deci, E. L. & Flaste, R. (1995). Why we do what we do: Understanding self-motivation. London: Penguin Books.

4 Kohn, A. (1999). Punished by rewards. New York: Houghton Mifflin.

5 Pink, D. H. (2009). Drive: The surprising truth about what motivates us. New York: Berkley.

6 Gingerich, S. B., Anderson, D. R., Koland, H. (2012). Impact of financial incentives on behavior change program participation and risk reduction in worksite health promotion. American Journal of Health Promotion, 27(2), 119-122.

7 Ornish, D. (2005, March). Keynote presented at the 2005 Art and Science of Health Promotion Conference, San Francisco, CA.

8 Harter, J. K., Schmidt, F. L., & Keys, C. L. M. (2003). Well-being in the workplace and its relationship to business outcomes: A review of the Gallup studies. In C. L. M. Keys & H. Haidt (Eds.), Flourishing: the positive person and the good life (pp. 205-224). Washington, DC: American Psychological Asso

Rosie Ward, PhD, MPH, MCHES, BCC, CIC®, CVS-FR Rosie is an accomplished speaker, writer and consultant. She has spent more than 20 years in worksite health promotion and organizational development. In addition to her bachelor’s degrees in Kinesiology and Public Health, and a doctorate in Organization and Management, Rosie is also a Certified Intrinsic Coach® Mentor, Certified Judgment Index Consultant, a Certified Valuations Specialist, and a Board Certified Coach. Rosie uses this unique combination to work with executive and leadership teams to create comprehensive development strategies centered on shifting thinking patterns. She is a contributing author to the book, “Organization Development in Healthcare — High Impact Practices for a Complex and Changing Environment.” She leverages these principles to help organizations develop and implement strategies to create a thriving workplace culture that values and supports wellbeing and the unique, intrinsic needs of employees. Contact Rosie at or

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