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By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
I recently had an opportunity to visit with a client on incentive plans for her employees. "What works, what doesn’t, and why not?" she wanted to know. Big order.
Incentives should be just that: Provide the staff with an incentive to squeeze out that last smile at the end of the shift when they are dog-tired and their feet are killing them. No hate mail on this, please, but there are those staff members in many centers who don’t do that. They still are valuable employees; they just are more focused on their job function and not marketing or promoting increased good will.
Here is a dilemma for you: Should that employee — the one who just does his or her job — be rewarded less than the staff member who goes above and beyond? That employee says, "I was hired to scrub on cases, not be a goodwill ambassador for the center." He or she is right, you know. You could argue that you are not required to provide bonus pay either. But that really isn’t fair to the effective staff members who are not the bubbly "cute and perky" types who could miss out on incentive pay.
Conversely, what about the employee who has the same job description as the example here and does everything right and goes out of his or her way to promote the center to physicians or patients? How can you encourage that type of behavior but not at the expense of another?
Some examples of incentive or "bonus" plans out there that have not worked (in our experience) are plans that are too nebulous or too difficult to control, such as plans based upon patient satisfaction, days in accounts receivable, supply cost per cases, etc. Using the first criteria, if your staff have incentive pay based upon patient satisfaction responses, a real risk for not obtaining good data exists.
Most patient satisfaction plans are not effective enough to base staff bonuses on. Most patients only report negative reactions or situations. I am a good example. I fly often and only write an irate letter or make a nasty phone call to the airline when something goes wrong on my itinerary. Like many, I never comment on the flights and connections that go off without a hitch. Therefore, am I a positive and satisfied airplane client or a bad one? How can you tell? If I complained four times in the year 2000 about bad experiences with a certain airline, you would need to know how many times I flew that year to see if I complained 100% of the time or 0.001% of the time. You have no way of knowing. Therefore, unless you can legitimately quantify the response — and you really cannot — it is not fair to your employees to use this as a yardstick.
What about using the administrator or supervisor discretion comments or suggestions as to employee merit and bonus? That should work; after all, they are placed in a position to know who is contributing. My experience is that this is just too subjective. In these situations, the risk is that bonus is based upon personality and popularity. The hard-working employee who has three kids at home and a 45-minute compute back and forth to work maybe just doesn’t have the energy for that extra bit of personality at the end of the day.
So, what does work? Again, using my own experience of 18 years in these situations (yours may be different), I think the rational for bonuses need to be understood. You are attempting to elicit certain behavior from individuals and using cash or other rewards as the inducement. While that sounds somewhat clinical and sterile, it is the fact. my idea is to have a pool of funds set aside each month that is a reflection of the profitability or positive variance of the budget. Each employee has a share of that pool. The fewer number of employees in that pool, the larger the share distribution to the shareholders. This system encourages fewer staff and more sharing of the workload and more "cash" availability.
I know that there are a number of centers and departments out there that do not or cannot give "cash" to employees. You don’t have to hand out money; use that "pool" to purchase cash equivalents or other goods and services for your staff such as movie tickets, vacations, paid parking, etc. Whatever you do for one, do for all. Some of you also will argue that bonuses should not be expected or given in our business; however, the fact is that your competition is giving them, so you should also.
The bottom line is that all staff members contribute to the success of the department or center. Some employees have different personalities from others.
The "perky" type will always be "perky," while the silent, efficient staff member probably will always be silent and efficient. Money will never change character or personality long term.
If you have an employee who does not live up to the standards of the department or the facility, then cull him or her out of the operations.
Care needs to be taken to screen new hires for positive traits that enhance the overall success of the day-to-day operations. An efficient scrub nurse who does everything well for the patient and the surgeon but has a flat personality is just as effective as the bubbly staff member who opens the car door for the patient and hugs the family member and wishes them luck. Reward them both.
(Readers are invited to submit examples of good and bad incentives. Earnhart can be reached at 5905 Tree Shadow Place, Suite 1200, Dallas, TX 75252. E-mail: email@example.com. Web: www.earnhart.com. Earnhart and Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management.)