Some Executives are scared of clinicians, and doctors in particular, who have a reputation of being ‘difficult’. However, you will have much more success if your change initiative ‘fits’ with medical culture.
- Don’t hide behind General Managers. By this I mean, don’t expect relatively junior managers to do your work for you
- List benefits and risks, (just like getting informed consent for an operation!). Doctors are bright people and can understand most complex situations if you take time to explain it to them
- Be honest, especially about likely problems. Don’t spout propaganda
- Stress your personal commitment
- Provide resources for ample training
- For doctors, show where the personal financial benefits might be
This last point is often avoided. Doctors are distinctly ‘calculative’ in their perspective. This means, they need to know the answer to the question, ‘what’s in it for me?’ Obviously, this isn’t always direct financial reward (though it often is), but the benefits should be made explicit.
The NHS has a poor record of incentivising personnel to perform, which is bizarre as we know it works. Notwithstanding, there are usually ways to link productivity to reward if you try. I think it’s time that medical leaders acknowledged this and lobbied for clinicians to be allowed to reap productivity rewards within the NHS. At present, we often push the highest performing doctors into the private sector, simply because of this public sector ‘productivity paradox’. For instance, I could be the best anaesthetist in the NHS, or the worst, and it wouldn’t matter, I get paid the same. Worse still, if I’m a surgeon and don’t perform very much, I will soon be offered ‘incentive lists’ (extra work at hugely enhanced rates) to do more. Thus, I get paid more for performing poorly! You do the maths! Doctors aren’t daft; if they drag their feet, deliberately or not, they will earn more money.
As a famous Economist once said, “Economics can be summed in the the phrase, ‘people respond to incentives’. All else is comment”!