If you've read Daniel Pink's work, you know that monetary incentives can backfire. Incentives will not consistently lead to desired outcomes. If a task is a simple type of an activity then financial incentives may be successful. When a task requires thinking and a financial incentive is included, the size of the incentive matters. Too much of an incentive leads to a breakdown in the ability to think and perform effectively and efficiently.
Incentivizing quality... I have mixed feelings about this. In the Selena "world," everyone does their best. Everyone cares. At times, reality is hard for me to accept. How can organizations and teams be motivated to provide top-notch quality of care? Although some payment models define quality and are focused on paying for higher quality, I wonder what organizational processes will ensure long term success. To set the record straight, I'm truly speaking about models that really look at quality versus reporting quality metrics. I'm speaking about the real change that happens through the course of a continuum of care or at least over an episode of care.
When thinking about quality, I would like to think an organization's goal is a long-term performance goal. It isn't a one time achievement. Quality is a quarterly to quarterly performance goal. Quarters add up to one year and continue on from year to year. That means there has to be consistent achievement of the determined level of quality.
Alternative payment models base payments to an organization on the level of quality of care. The organization is made up of people. What I wonder about is whether is it helpful or unhelpful to spread the financial gains earned via providing quality to those providing the care.
The reason I am curious has to do with some of Daniel Pink's work along with an article I read in Harvard Business Review. Peer pressure had longer lasting behavioral change compared to a financial incentive. Hospital employees were granted financial incentives for hand washing. The twist: physicians were not employees and were not allowed to be included in the financial incentive package. The desired hand washing target goal was for all who were working with patients in the hospital setting. In order for the employees to attain the financial incentive, the physicians had to improve their hand washing behavior also. Employees engaged with the physicians via public praise, note writing and creative ways to encourage the physicians to do better. The incentive was a one time bonus of $1,200 to the employees if the targeted level of hand washing was achieved.
At the end of the 90 days, the goal had been met. What was interesting: after the goal was met, the employees went back to their old ways while the physicians maintained the desired behavioral change (at least for the next 2 quarters after the incentive program).
When is it appropriate to use financial incentives to reward desired behaviors? And, when I think of FOTO scorecards, and what I've read about sharing individual clinical performance, maybe it is better to be completely transparent with individual performance. I wonder if it would be better to set organizational quality standards using scorecard data? If peer pressure can lead to desired targeted goals, then maybe peer pressure should be harnessed. Not only that, if peer pressure can create change, maybe clinical dialogue between top performers and low performers, peer to peer, may lead to even better performance for the low performers. Most organizations typically keep scorecard information private. I wonder if it would be more powerful to actually post scorecard results for all clinicians to see?