Most leadership training treats communication as a transmission problem. You have information. The other person needs it. The task is to package the information clearly enough that it lands.
This works fine for transmitting facts. It fails predictably and consistently when the goal is to change behavior. Mark Valenti's session is about why it fails, what's actually happening in those conversations, and what a different approach looks like in practice.
Valenti's background is in healthcare — specifically in the discipline of motivational interviewing, a framework developed by Bill Miller and Stephen Rollnick starting in the early 1980s for working with people struggling to change behavior around substance use, medication adherence, chronic disease management, and similar high-stakes behavioral change. The framework has since been adopted across healthcare and is now being applied to leadership contexts where the underlying problem is structurally similar: someone needs to change a behavior, and telling them to change it isn't working.
What makes the session worth watching for CI and operational excellence leaders isn't the healthcare origin. It's the recognition that the conversations Valenti describes — patient says they want to manage their diabetes but isn't taking their medication, doctor responds by explaining one more time why the medication matters — map directly onto conversations CI leaders have every week. Frontline employee says Lean is another flavor of the month. CI leader explains why this initiative is different from the last one. Employee says they understand and goes back to doing things the way they were done before.
The structure of the failure is the same. The mechanism is the same. And the alternative Valenti walks through is the same — built around listening for what's actually being said, evoking the other person's own reasons to change rather than supplying yours, and recognizing that people change because of their motivations, not because of yours.
Mark Valenti has a background in health systems management, human behavior, and patient activation. He has worked with partners including the National Board of Medical Examiners on their China Health Coach program and Australia's Flinders University on an innovative approach to patient chronic condition self-management. He helps others uncover their intrinsic motivation to reach their goals. His teaching framework, "Activate Your Audience," helps speakers better express their messages.
Valenti opened by clearing away the misconceptions, because the term "motivational interviewing" carries baggage that makes the actual practice harder to see.
It is not motivational speaking. It is not Tony Robbins working up a crowd. It is not the charismatic doctor or charismatic boss generating enthusiasm through force of personality.
It is not Matt Foley from Saturday Night Live scaring people into change with the threat of ending up like him, living in a van down by the river. It is not showing patients images of diseased lungs or amputated limbs to scare them into compliance. Scare tactics, Valenti said, produce short-term attention and almost never produce sustained behavior change.
It is not manipulation. It is not a set of clever techniques for getting people to do what you want them to do while convincing them it was their idea.
It is not therapy. It has roots in client-centered therapy, but the goal is more specific — directive toward a particular behavioral outcome rather than open-ended exploration of feelings.
It is not job interviewing. The questioning techniques overlap, but the purpose is different.
What it is, in Valenti's working definition, is a guiding style that invites people to examine their own values and behaviors and come up with their own reasons to change. It draws out the other person's ideas rather than supplying yours. It addresses ambivalence — the universal human experience of wanting two things that are partially incompatible — by helping the person work through the ambivalence themselves, rather than trying to overpower one side of it from outside.
Valenti credited a former colleague, Dr. Bruce Block, with the framing that 99.9 percent of the time, healthcare doesn't happen in the doctor's office. It happens in the patient's life — in their community, with their family, in the supermarket, in the moments between visits. The doctor's visit is a tiny percentage of the time that matters. The rest is the patient making decisions about food, exercise, medication, and self-monitoring on their own.
The same is true of work. The huddle is a small percentage of the operating week. The training session is a few hours among hundreds. The performance review happens twice a year. What matters operationally is what the person does in the spaces between those events, when no one is watching and no one is reminding them.
Activation is Valenti's word for that state — people doing what they need to do without someone looking over their shoulder, because they have internalized why it matters and how to do it. Activation is the operational goal of any behavior change effort, in healthcare or anywhere else. Compliance can be enforced. Activation has to be evoked.
This distinction matters because most organizational change efforts target compliance and call it activation. Training delivered, attendance logged, audit performed. The behavior happens when measured and stops happening when measurement stops. The activation never developed because the conversations along the way addressed the wrong problem.
Valenti walked through a framework — credited to his colleague Brittany Wilson — that breaks change into three components: knowledge, importance, and confidence. All three have to be present for behavior change to happen.
Knowledge is whether the person understands what to do. The technical content. The mechanics. The procedure.
Importance is whether the person believes the change matters. The value judgment about whether this thing is worth doing.
Confidence is whether the person believes they can do it. The self-efficacy assessment about whether they're capable of carrying it out.
Most organizational change efforts focus almost entirely on knowledge. Training materials are produced. PowerPoints are presented. Standard operating procedures are documented. The implicit assumption is that if people know what to do, they will do it. This assumption is wrong, and it's wrong in a way that makes every other downstream intervention less effective than it should be.
A patient may understand exactly how to take their blood pressure medication and still not take it — because they don't think it's that important, or because they aren't confident they can remember it as part of their daily routine. An employee may understand exactly how to follow the new documentation standard and still not follow it — because they don't think it's important enough to justify the time it takes, or because they aren't confident they can fit it into their workflow without falling behind on other things.
The diagnostic move for any leader trying to drive change is to figure out which of the three is missing for the specific person they're working with. Knowledge gaps get filled with information. Importance gaps get addressed by helping the person connect the change to something they already value. Confidence gaps get addressed by reducing the scale of the first step until success is achievable, then building from there. The interventions are different for each gap, and applying the wrong one — usually more information — wastes effort and reinforces the perception that the leader isn't listening.
Valenti drew on Daniel Pink's "Drive" to give a structure to how motivation actually works. The framework distinguishes three levels.
Motivation 1.0 is biological. Survival needs. Food, shelter, safety. When these aren't met, nothing else matters. The brain isn't capable of considering higher-order motivations when the basic conditions for being alive feel uncertain.
In the workplace, this translates more subtly than in clinical settings. People aren't usually worried about physical survival at work. They're worried about job security — which is, in evolutionary terms, the modern analog of survival. If someone is afraid they're about to be laid off, they're not innovating. They're not contributing creative ideas in meetings. They're operating in Motivation 1.0, conserving energy for the threat. Two of the Gallup engagement questions — having the materials and equipment needed to do the work, and knowing what's expected — map directly to Motivation 1.0 conditions. Without those baseline conditions, nothing else lands.
Motivation 2.0 is extrinsic. Rewards and punishment. Carrots and sticks. The pizza party for filling out the lean board. The gift card for completing the wellness visit. The competition for hitting the productivity target. These work in the short term and produce reliable behavior as long as the reward or punishment is present.
The problem with Motivation 2.0 is that it actively interferes with Motivation 3.0. When extrinsic rewards become the reason for a behavior, intrinsic motivation gets crowded out. Pink's research, and decades of behavioral research before his, has documented this consistently. Pay people to do something they used to do because they enjoyed it, and they will stop doing it when the pay stops. The reward replaced the meaning.
This has direct implications for how leaders communicate. Valenti noted that even something as innocuous as "thank you for staying late, I really appreciate it" is operating in Motivation 2.0 — focusing on the relationship and the leader's approval. The alternative, "you really are dedicated to our patients," operates in Motivation 3.0 — naming the intrinsic motivation that drove the behavior in the first place. The leader is reflecting back something the employee already believed about themselves, rather than providing approval the employee needs to chase.
Motivation 3.0 is intrinsic and has three components: autonomy, mastery, and purpose. People who feel they have genuine choice in their work, who feel they're developing real capability, and who feel they're contributing to something larger than themselves operate in this register. The behavior sustains itself because the meaning sustains itself.
Valenti's example for autonomy was direct: when a leader says "this meeting is mandatory," they remove the perception of choice and push the employee back toward Motivation 2.0. When a leader says "this meeting is optional, and you should decide based on whether you find it valuable," they preserve autonomy — and they put the burden on themselves to make the meeting actually valuable. If no one shows up to an optional meeting, that's information about the meeting, not about the employees.
The single most useful concept in the session for anyone leading change is what Miller and Rollnick call the righting reflex.
The righting reflex is the immediate instinct, when someone says something we disagree with, to correct them. To explain why they're wrong. To supply the information that will fix their thinking. To right what we perceive as wrong.
The reflex is universal. It's strongest in people who care most about the issue. It's especially strong in clinical and CI roles, where the leader genuinely knows things the other person doesn't and is responsible for outcomes the other person is part of producing.
The problem is that the righting reflex doesn't produce the behavior change it's trying to produce. It produces the opposite. When someone is told they're wrong — especially when they're told this with data and authority — their hidden brain registers the conversation as a threat. Their press secretary, to borrow the framing from Dr. Mark Jaben's webinar on the same topic, gets to work defending their original position. The leader's correction becomes more evidence that the leader doesn't understand the situation, doesn't respect the employee, or doesn't see the constraints the employee is operating under.
Valenti showed a brief video from a sketch about a couple talking. The woman is describing a feeling — pressure, anxiety, something hard to articulate. The man, off-screen but visible in profile, has a literal nail sticking out of his forehead. He keeps pointing out that the nail is the obvious problem. The woman keeps saying she doesn't want him to fix it. She wants him to listen. He keeps trying to fix it.
The sketch is funny because everyone recognizes the dynamic. Most of us are the guy with the nail. We see the obvious problem. We want to fix it. We don't understand why our willingness to fix the obvious problem isn't being received as helpful. And the moment the guy finally says "that sounds really hard," the woman softens. The conversation becomes possible. The fix that wasn't possible while he was trying to install it becomes available the moment he stops.
The righting reflex is the version of this dynamic that plays out in every change conversation. The leader sees the problem. The employee resists. The leader explains. The employee resists harder. Eventually the conversation either ends in surface agreement that produces no real change, or it escalates into something neither party wanted.
The alternative isn't passivity. It isn't agreeing with everything the employee says. It's recognizing that the conversation has to move through empathy and listening before the leader's perspective has any chance of being heard at all. The fix has to wait until the person on the other side feels heard. Until that point, the fix is the problem, not the solution.
The technical heart of motivational interviewing is the distinction between sustain talk and change talk, and the discipline of evoking more of the latter.
Sustain talk is the language people use to defend their current behavior. The positives of the status quo. The negatives of changing. "I've been smoking for thirty years and I feel fine." "I don't have time to test my blood sugar four times a day." "Lean is just another flavor of the month."
Change talk is the language people use when they're considering or moving toward change. The negatives of the status quo. The positives of changing. "I get winded going up the stairs now in a way I didn't five years ago." "When I do test my blood sugar, I feel better the rest of the day." "I get that we have to fix our office problems."
Most people in ambivalence — which is most people, on most issues, most of the time — produce both kinds of talk in the same conversation. They want to change and they don't. They see the case for action and they see the case for inaction. The mix shifts based on how the conversation is going.
The leader's job, in this framing, is to listen for the change talk and reflect it back, evoking more of it. Not to argue with the sustain talk. Not to overpower it with data. To recognize when the person has said something that suggests movement, and to invite them to say more about it.
Valenti's example: "I get that we have to fix our office problems, but this lean thing is just another flavor of the month." The sustain talk is in the second half — frustration with previous initiatives, skepticism about this one. The change talk is in the first half — agreement that there are office problems that need fixing. The leader operating on the righting reflex hears the sustain talk and pushes back on it. The leader operating in motivational interviewing hears the change talk and invites elaboration. "Tell me more about the office problems you see. What would be different if those got fixed?"
The conversation that follows is entirely different from the one that follows a defense of Lean. The employee is now talking about problems they care about, in their own words, in a context where their concerns are being taken seriously. The change talk they produce is theirs. It will hold up over time in a way that a leader's argument about Lean will not.
A question came in during the session about the word "compliance" itself — whether it's the right framing for what we're trying to produce in patients or employees. Valenti's answer was direct.
The word compliance carries a deficit framing. The patient who isn't taking their medication is "non-compliant." The employee who isn't following the new protocol is "non-compliant." The framing locates the problem in the person and implies they're failing to do what they're supposed to do.
The alternative framing — which motivational interviewing prefers — is that the person is struggling with following their care plan, or struggling with adopting the new protocol. The shift is more than semantic. It moves the locus from the person to the situation. It opens up curiosity about what's making the behavior hard. It treats the person as someone working through a real challenge rather than someone failing to comply with an instruction.
Words like compliance, adherence, denial, and resistance all carry this deficit framing. They make the person the problem. The motivational interviewing alternative reframes each of them as descriptions of a struggle that has reasons worth understanding. Resistance becomes sustain talk plus possible discord in the relationship. Denial becomes a person who hasn't yet been heard. Compliance becomes activation toward a shared goal.
The third edition of Miller and Rollnick's textbook actually removed the word "resistance" from the framework entirely, replacing it with two more precise concepts: sustain talk (the person is communicating they want to maintain their current behavior) and discord (something is wrong in the relationship between the helper and the person). These two things require different responses. Lumping them together as "resistance" obscures what's actually happening and pushes the leader toward the wrong intervention.
The structured practice Valenti highlighted for sharing information without falling into the righting reflex is called elicit, provide, elicit.
First, elicit. Before sharing what you know, ask what the other person already knows or thinks about the topic. What's their current understanding? What have they tried? What concerns do they have? The question opens the conversation and surfaces the actual starting point, which is rarely what the leader assumed.
Then, provide. Share the relevant information — but only the information that addresses what the elicitation surfaced. Not a comprehensive overview. Not everything you know. The specific thing that fits what the person said they needed to hear.
Then, elicit again. Ask what they think about what you just shared. How does it fit with what they already knew? What questions does it raise? What would they do with it?
The structure prevents the most common failure mode in change conversations, which is dumping information that the other person didn't ask for and doesn't have the context to absorb. It treats the conversation as collaborative rather than transactional. And it produces information that's actually been processed rather than information that's been received and forgotten.
Research Valenti cited suggests that patients forget 40 to 80 percent of what they're told in a medical encounter, and that of the information they do remember, roughly half is remembered incorrectly. The same dynamics operate in workplace conversations. Elicit, provide, elicit is structural friction against that decay. It slows the conversation down enough that the information actually has a chance to be absorbed.
The argument running through this session is that change happens in conversations between two people, and the quality of those conversations determines whether the change happens at all. The methodology is human work. The listening is human work. The willingness to wait for change talk before responding is human work. None of that is what infrastructure does.
What infrastructure does is reduce the structural reasons that good conversations fail to translate into sustained behavior change. A conversation that produces genuine change talk and a real commitment to try something different needs a place where the commitment becomes visible and trackable. Otherwise, the conversation lives in the moment it happened, the commitment fades, and the next conversation has to restart from scratch.
The diagnostic work of figuring out whether a person's barrier is knowledge, importance, or confidence depends on having enough touchpoints over time to actually see the pattern. A single conversation reveals a snapshot. A series of conversations, supported by visible commitments and observable follow-through, reveals where the person is actually getting stuck. Without that visibility, every conversation tends to default back to providing more knowledge, because knowledge gaps are the easiest to address even when they aren't the real barrier.
The intrinsic motivation work that Valenti drew from Pink's framework — autonomy, mastery, purpose — only operates at scale if the organization has structures that support it. People can't experience autonomy if every meaningful decision goes through hierarchy. They can't experience mastery if their development isn't tracked and recognized. They can't experience purpose if they can't see how their daily work connects to outcomes that matter. The infrastructure doesn't create these conditions. It makes them sustainable when the leadership behavior is in place.
The shift from extrinsic to intrinsic motivation in workplace culture is a multi-year project that depends on the cumulative effect of thousands of small interactions. The conversations that compose those interactions are where the work actually happens. What infrastructure does is keep the work from disappearing into the gaps between conversations — keep the commitments visible, keep the patterns observable, and keep the daily improvement work connected to the purposes that make it worth doing.
What is motivational interviewing? A guiding style of communication, developed by Bill Miller and Stephen Rollnick starting in the early 1980s, that helps people work through their ambivalence about behavior change. Rather than persuading, arguing, or scaring people into change, motivational interviewing draws out the person's own reasons for change through listening, empathy, and structured questioning. It originated in substance use treatment and has since been adopted across healthcare and increasingly in leadership contexts.
How is motivational interviewing different from motivational speaking? Motivational speaking is the speaker generating enthusiasm or urgency in the audience. Motivational interviewing is the helper drawing out the person's own motivation. The direction is opposite. Motivational speaking pushes; motivational interviewing pulls. The two approaches use almost none of the same techniques and produce very different durability of change.
What is the righting reflex? The immediate instinct, when someone says something we disagree with, to correct them — to supply the information that will fix their thinking. The reflex is universal and especially strong in people who care about the issue and have relevant knowledge. The problem is that it doesn't produce behavior change. It produces defense. The person being corrected hears the correction as a threat, and their hidden brain shifts into protecting their current position rather than considering alternatives.
What's the difference between change talk and sustain talk? Sustain talk is the language people use to defend their current behavior — the positives of the status quo and the negatives of changing. Change talk is the language people use when they're considering change — the negatives of the status quo and the positives of changing. Most people produce both in the same conversation. The leader's job in motivational interviewing is to listen for the change talk and reflect it back, evoking more of it, rather than arguing with the sustain talk.
Why does the framework focus on autonomy so heavily? Because the perception of choice is what activates intrinsic motivation. The moment a person feels they don't have a choice, they regress to extrinsic motivation at best and Motivation 1.0 (survival mode) at worst. When a leader uses language that removes the perception of choice — "this is mandatory," "you have to do this," "I really recommend you attend" — they're moving the conversation backward, even if they're trying to be helpful. Autonomy is the first ingredient of intrinsic motivation, and without it, the other two (mastery and purpose) can't operate.
What are the three conditions required for behavior change? Knowledge (the person understands what to do), importance (the person believes it matters), and confidence (the person believes they can do it). All three have to be present. Most organizational change efforts focus heavily on knowledge while neglecting importance and confidence — which is why so many well-trained employees still don't do what the training taught them.
Why is "compliance" considered the wrong framing? Because the word locates the problem in the person and implies they're failing to do what they're supposed to do. The motivational interviewing alternative — that the person is struggling with their care plan or struggling with a new protocol — locates the problem in the situation and opens up curiosity about what's making the behavior hard. The third edition of the Miller and Rollnick textbook actually removed the word "resistance" from the framework, replacing it with two more precise concepts: sustain talk and discord in the relationship.
What is the elicit-provide-elicit framework? A structure for sharing information without falling into the righting reflex. First, elicit — ask what the person already knows or thinks about the topic. Then, provide — share the specific information that addresses what the elicitation surfaced. Then, elicit again — ask what they think about what you just shared. The structure prevents the most common failure mode in change conversations, which is dumping information that the other person didn't ask for and doesn't have the context to absorb.
How does motivational interviewing apply to a workplace context? The mechanics are essentially the same as in healthcare. A frontline employee skeptical about Lean is in the same structural position as a patient ambivalent about taking a medication — they have reasons for their current behavior, they have some recognition that change might be worth considering, and they're not going to be moved by being told they're wrong. The same disciplines — listening, expressing empathy, evoking change talk, respecting autonomy, addressing the right one of knowledge/importance/confidence — apply directly to leading change in any organization.
Can you do motivational interviewing in short conversations, or does it require formal coaching sessions? Valenti was direct that the framework applies to ordinary conversations, not only formal coaching encounters. The mindset — treating resistance as information, listening before responding, asking before telling, respecting the other person's autonomy — can be brought into any conversation. The formal skill set (the OARS techniques — open questions, affirmations, reflections, summaries) takes substantial practice to master, but the underlying disposition is available immediately.
Why does Valenti say extrinsic motivation can backfire? Because extrinsic rewards crowd out intrinsic motivation. Pay people to do something they used to do because they enjoyed it, and they will stop doing it when the pay stops — because the reward replaced the meaning. The same applies to gratitude, approval, and other relationship-based rewards. "Thank you for staying late, I really appreciate it" is Motivation 2.0 — relationship-focused. "You really are dedicated to our patients" is Motivation 3.0 — naming the intrinsic motivation the person already had.
How much practice does it take to become competent in motivational interviewing? Valenti cited an estimate of roughly 300 hours of competent practice to become genuinely skilled. The framework looks simple on paper and is hard to execute well in real conversations, because the righting reflex is automatic and persistent. The skills get faster and more natural with practice, but the underlying discipline — staying with the person's perspective long enough to actually understand it — never becomes effortless.
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