However in reading an article on the BBC website: NHS: Crackdown on ‘hidden waiting’ ordered by ministers there was one paragraph that seemed to stand out from the crowd. The text was this:

Ministers believe there is not enough incentive for these patients to be treated, meaning some are left “languishing” unnecessarily.

Let’s let that sit there and percolate a little while we stand back and recall what the NHS is for.

The NHS was set up as a form of national health insurance. Collectively we pay tax and national insurance and if ever we need health care in our lives in the UK it was to be delivered free at the point of charge. The NHS was designed to give the public peace of mind that even if they fell on hard times that in regards to their health they would always have access to care.

So the reason for the existence of the NHS is to provide health care to the British public.

In my book, “Beat the Cuts – How to Improve Public Services and Easily Cut Costs” I argue that the real motivation to do good work comes from within. This motivation stems from wanting to do something meaningful, wanting to work as a team, wanting to take pride in your own work and wanting to do something for others. The last of those is particularly prevalent in the public sector. That list contrasts with extrinsic motivators such as money, prestige, power and praise.

When ministers are quoted as saying that there “is not enough incentive” I think they must be thinking of the list of extrinsic drivers. My experience in all parts of the public sector is that its staff really do want to serve and provide for the public. This is very strongly true in the NHS.

So I don’t believe that there is not enough incentive. There is. The problem is that too many people only think of motivation from outside and forget the internal motivations. The consequence of that serious oversight is that they further pile on the extrinsic motivations which actually sap the internal drivers. In addition they forget to foster intrinsic motivation in the systems of management that are set up. The irony is that their statement eventually will become true. The extrinsic motivators will cease to be effective and their over application will have crushed any intrinsic motivation so there really will be not enough incentive to care for patients.

However, I am confident that we are not there yet. But we need to be careful not to ignore pride in work or the need to help others any more.

Best,

Rob

I would like to add reason 11, which is hinted at in Glyn’s reasons 8 and 9. He cites Daniel Pink and Alfie Kohn who have written about extrinsic motivation e.g. performance related pay, and intrinsic motivation e.g. joy in work. They both talk about the fact that extrinsic motivators in the form of rewards divert attention away from the purpose of the work and toward the gaining of the award. So introducing performance related pay would encourage staff to work for the extra pay rather than doing there work better for the benefit of the public.

Here is another nice post from Glyn which dovetails nicely with this topic: Um…I can’t take that, I cheated!

Let’s hope there isn’t an increase in performance related pay because it will lead to worse performance, and some people, sadly, will cheat.

And whose fault will it be?

Best,

Rob

If you read the agenda for the 9th June 2010 cabinet that will be held this coming Wednesday, you will see it is full of things like “implement check list”, “targets for individual areas”, “make managers aware of absence costs” and “put up poster”.

Put up poster!

Nowhere is any mention of improving the work so that people feel they are doing a job with a purpose (serve the local community?) and doing it well. That is the thing that will lower the absence rate. All the other things are futile or will make the problem worse.

The most likely root of the problem is that staff are dissatisfied at what they do and at management constantly getting in the way of them doing a good job. Check lists and return to work interviews will simple antagonise the staff further and continue to reduce any motivation they may have to jump out of bed in the morning.

Give them a good job to do and they will love to come to work.

I wonder if anyone will raise this on Wednesday…

Best,

Rob

The story describes a report into the pay of NHS managers in Scotland.

The report also says that performance-related pay-outs have been “largely ineffective” in encouraging staff to achieve higher standards, and adds that “the value of the payments in relation to overall salary levels is too low to have any discernible motivational effect”.

However, the group still calls for the principle of performance-related pay to be kept.

It is nothing to do with the size of the payments. It is the fact that they exist at all that is holding down improvement.

Further down the article Labour health spokesman Jackie Baillie said

“…money is needed on the frontline of NHS Scotland, not in the pay packets of executives.

“This report recognises that the performance-related payments in the NHS do not actually encourage improved performance, but argues that they should be retained. Surely there is a contradiction here.”

There certainly is a contradiction. Extrinsic incentives such as performance related pay and bonuses do not improve performance. In fact, they drive performance down.

In a recent Lean Blog post, Mark Graban pointed out a link to a TED video from, Dan Pink, the author of Drive: The Surprising Truth About What Motivates Us. In the video Pink describes how the performance of trivial, mechanical tasks can be improved by the offer of money, but that even the slightest need for creative or lateral thinking means that extrinsic motivations will actually cause a fall in performance.

In my experience, of all the things that people find the most difficult to let go of is that bonuses don’t improve performance. It is as if they know in their hearts that they do their best work when they are interested in it, when they think they are doing something important and when they have control of the work, but that they still think that others are motivated by financial gain.

I wonder when there will come a point when the confusion will end, the bonuses will stop and the really good work will be set free.

I hope it is soon because otherwise I am going to need to more money to make it bearable.

Best,

Rob

I bet the light works in your kitchen and you don’t even think about it. Well the strip light in this kitchen hasn’t worked properly for ages. For the want of 99 pence worth of a new starter, we have both been getting up on a chair to fiddle with the old starter to make the fluorescent bulb flicker and come on and stay on. We just hadn’t quite got round to going to an electrical shop to get the starter. So up on a chair every time we wanted to turn on the kitchen light. We even took to leaving the light on all evening when we left the kitchen so that if we popped back to make some tea, we didn’t have to get on the chair again to turn the light on again. Talk about a work-around.

The thing is we got used to it. After a while, getting up on a chair to make the light come on didn’t seem so much trouble. We forgot that it was a bother. It became the way things were done.

I recall way back when, working for an investment bank as an analyst messing with dozens of Access databases and Excel spreadsheets. One day I had to add an extra calculation to the daily work which would have meant a couple of days effort to update the Access database. Instead, because the trader wanted it that day, I exported the data to Excel, wrote a quick and dirty calculation in an hour, ran the calculation and then reimported the results to the database to continue the day’s work. This extra procedure added 90 minutes to my day, every day.

I continued that extra step for months. I forgot that it was slow and cumbersome. I got used to it.

It took six months before it started to bug me and I got so bored of the extra step that I spent the two days implementing the calculation in Access. After that the calculation whizzed along in the blink of an eye. Those two days spent right at the start would have saved me 24 working days over the six months I waited. In fact the two days of work would have paid for themselves in only eleven days.

In order to implement change, big or small, you need some negative emotions. You need to be dissatisfied, bored, shocked, appalled, angry and critical. If you are tolerant, accepting, placid and content with your lot, nothing will happen. This is why change agents are always searching for the “burning platform” so they can get people to jump instead of having to push them off a “quite comfortable thank you” platform.

For an evening, the newly fixed light was a revelation. “Wow! We don’t have to climb on the chair to turn the light on! Amazing!!” How sad that we take joy in things working as they always should have done. I recall my boss at the bank giving me a pat on the back for rewriting the calculation to save that 90 minutes a day.

A vision of a better way is nice and shiny, but how about a bit of tedium and rage to get us not just to where we should be, but beyond, to where we couldn’t dream of? If only we could stop being so accepting of the messy, awful, boring, infuriating status quo.

Get moving. Get some dissatisfaction.

Best,

Rob