Leadership issue, introduction of motivation (incentive) scheme in University hospital
Setting up new motivation (incentive) scheme for the senior executives in University hospital – 700 beds
University non-for-profit teaching hospital, 700 beds, several thousands of employees.
The task is to set up new motivation scheme for the senior executives and chiefs of clinical wards (MDs and nurses).
This is stage no. one to start with.
Currently there is hardly difference in treatment of top performers and underperformers, so the best ones have little incentive to keep the standards high and/or to push their teams to achieve desired goals. “Many managers in the public sector may think “even if I do well, nobody cares”. Incentivising them may change this attitude.”
This new activity should avoid demoralization of top performing leaders and keeping talent within organization.
Questions:
- What should be monitored? Clinical and non-clinical goals?
- Short-term and long term goals (general hospital)?
- Types of incentives? Score cards – metrics proposal?
- How is the data collected, performance review intervals?
- Can you propose 2-3 goals in every dimension?
- Processes vs. outcomes measurement?
- Is the incentive rather individual or group-focused?
- What is in stake? I.e. monetary and non-monetary incentives to perform well.
- How is the final score calculated (measuring performance) and linked to the remuneration … i.e. bonus payments or any other benefits (please list some of them)?
- How significant is monetary incentives comparing to annual salary (%)?
- Do you have any advice on how to involve emotions when starting this project?
Thank you very much for your time invested to answer the questions outlined above.
PeterPan
What should be monitored? Clinical and non-clinical goals?
I believe that you want to have both type of goals. Complication rates are a clinical goal you can measure, length of stay is more of a mixed goal because it is not only clinical-dependent. Publications is also an interesting mixed goal
Short-term and long term goals (general hospital)?
I believe that as a minimun you need yearly goals. But some companies have found that this does not allow enough dymanic feedback and shorter term reaction to trends. So they do it on a semester basis
Types of incentives? Score cards – metrics proposal?
Waiting time above a certain threshold is a good metric that most people will accept and that really impacts patients life
How is the data collected, performance review intervals?
Build-in IT system
Can you propose 2-3 goals in every dimension?
Clinical: number of consultations, number of new patients, number of patients enrolled in clinical trials
Publications: number of peer-reviewed publications as 1st or last author, same if just co-author, and then same for publications in high impact journals (high IF can be defined as > 15 or 20 in oncology, but has to be adapted to each speciality, in stomatology 3 is high IF)
Processes vs. outcomes measurement?
Is the incentive rather individual or group-focused?
A mix is needed, individual and department performance as well as global hospital performance
What is in stake? I.e. monetary and non-monetary incentives to perform well.
Monetary is important, but you can also make expensive training (ie MHCD) an incentive
How is the final score calculated (measuring performance) and linked to the remuneration … i.e. bonus payments or any other benefits (please list some of them)?
How significant is monetary incentives comparing to annual salary (%)?
At least 10%
Do you have any advice on how to involve emotions when starting this project?
Ask people to suggest the best goals to measure and what they believe is the best methodology
Great question, and nice response by Crazybird. I especially like the idea of asking the employee to suggest the best goals and measurement methodology up front. It may not be exactly what you go with, but having their input early is important.
One major caveat: whatever you incentivize is what will be focused on, often at the peril of everything else. I have had providers that were incented to see more patients…and they did…to excess. Volume increased by 50%. But everyone was miserable…the provider, the staff and the patients. We are still trying to figure out a way to put that genie back in the bottle.
For these upper level employees, the incentives should be specific to each one. Every aspect of what you hope that employee accomplishes needs to be considered with an incentive. For example, if a clinician is incented to see more patients, they may do so at the expense of administrative responsibilities, research and even the quality of care provided. Patient satisfaction scores may go down if the provider seems rushed, and staff may become burned out due to an increase of volume. While you can’t control for every variable, the incentive should include a baseline level of performance for all areas, before excelling in one area is bonused. For example, the provider will be bonused for seeing more patients, but only if patient satisfaction scores or quality indicators remain stable.
I like the above responses! I have worked for a few organizations, and my current organization has been changing the % weight of our formal goals as to how it relates to our annual performance eval. One year our “goal grid” was 100% our performance eval. The next year it was 80% and the other 20% was leadership behavior/external contributions, and this year it is 50% with the other 50% being leadership behavior.
I’m a big fan of 50/50, with 50% being on organizational/system/department level goals, and 50% being on your personal leadership and behaviors.
We do this for all leaders, supervisors and above, and with physician leaders.
Another best practice is to tie your goals to the overall mission/goals of the organization. If patient satisfaction is a goal, everyone in a direct patient care area should have a patient satisfaction goal. If quality is one, everyone should have a quality goal. At our organization, we share goals across direct patient care areas and support areas, so that we can try to align our work throughout the year.