October 2, 2018 | Marcus Miller

3 Secrets of a Strong Incentive Plan (Part I)

Many health care organizations try to achieve compliance to desired behaviors and outcomes through an incentive program. The positive outcomes they are looking for may be in patient safety, quality improvement or even in the bottom line. Change is tough to manage but one tool that helps unify management and frontline staff is a good incentive program. A good incentive program can help organizations go beyond just getting compliance to new policy and procedures for desired outcomes. It can get your team energized and proactive in making desired outcomes happen. Isn’t it great when the team takes the initiative to identify and overcome roadblocks themselves?

There are two principles that TapRooT® teaches to fix the root causes of problems. I’ll address the first principle in this blog post and circle back to address the second principle in our next newsletter.  

The first principle is understanding that the method in which the incentive is given determines how staff reacts to that incentive. Naturally you want the incentive program to motivate staff into self-compliance to the correct behaviors that achieve the outcomes desired. How you deliver the incentive will be key in achieving these outcomes. Some incentive programs can unintentionally create more roadblocks then they overcome. I’ve seen many incentives plans not get the desired results because of the way the incentive is given. So, let’s go over the secrets of a strong incentive plan.

(Secret one) Timing matters. The quicker people receive their incentive, the more impact it will have. Late incentives are not as motivating. Our bodies are wired to seek immediate gratification. When we achieve what we desire, our body immediately releases hormones, like Dopamine, to give us that feeling of happiness. A good incentive program incentivizes staff quickly. Waiting 3 months to give the incentive makes the incentive harder to connect to the specific behavior or the outcome you are trying to achieve resulting in inconsistent compliance.  

(Secret two) Consistency matters. If the incentive is certain, then staff will have confidence that there is a consequence to the behavior or outcome. If the incentive is uncertain, then staff will find reasons not to be compliant if there is a path of lesser resistance. Consequences and incentives have to be certain to be effective.

(Secret three) Positive and Negative incentives may not matter as much as you think. Although today’s culture focuses on positivity, many studies show negative incentives work just as well as positive reinforcement if not better. Sigmund Freud said people will do more to avoid pain than to seek pleasure. The Pleasure-Pain Principle was founded in modern times by Freud but referenced as far back as Aristotle. The bottom line is both positive and negative incentives are effective. Culturally though, most of us would feel better rewarding staff for desired behaviors and outcomes rather than punishing them for non-compliance. TapRooT® recommends using both. A positive, timely, and consistent incentive for compliance to the correct behaviors that lead to intended outcomes is an excellent start. But in addition, we recommend non-compliance has crystal clear consequences for staff. That is usually the organization’s progressive disciplinary process. Although disciplinary process is negative, it is effective if it’s certain and timely. Having both positive and negative incentives will increase the effectiveness of your incentive program.  

Here’s an example that illustrates the principle: Why do so many people choose to speed when driving? Knowing the secrets to incentive makes the answer easy. The negative incentive of paying a ticket when caught is very uncertain and delayed. Drivers are caught speeding only a very small percentage of the time. When they do get caught, they have a quite a bit of time to pay their ticket.  The consequences of not complying with the speed limit law is uncertain and not timely.  Imagine if they got caught every time they decided to speed and had to pay the ticket directly to the officer who pulled them over. The certainty of getting caught and the negative, quick punishment of the fine would certainly change behaviors. They wouldn’t be happy about it, but you would get reluctant compliance.  Now think about why people decide to speed in the first place. The incentive is positive, immediate and certain. They get where they are going faster saving them time and effort.  

One other real-life example I witnessed in my health care career also illustrates this principle. A health care organization had a problem with patients falling and getting injured when transferring or ambulating in their facility. The management team went to work and discovered compliance with nurses’ aides using gait belts when transferring patients was poor. We all know nurse aides have a tremendous workload. They are routinely backed up and needed by several patients at the same time. Call lights don’t wait until they are finished with their current patient. It does take time to use a gait belt appropriately so when they got in a hurry, they decided to take a short-cut and not take the time to follow the gait belt policy. That decision made it possible to help the next patient quicker. 99 out of 100 times the transfers would go smooth which further reinforced the non-compliance to the policy. But that one time the patient was groggy, had elevated blood pressure, or just slipped on the floor and fell, the non-compliance to the policy created a very costly incident in time, money and reputation. The incentive to NOT use the gait belt was mostly certain and timely. They got their work done quicker, helped more patients, and stayed out of trouble. They didn’t have an incentive for using the gait belt except for the threat of something uncertain and negative may happen. They only got caught and punished for not using a gait belt when a patient fell or was injured. No one paid attention to the compliance when there wasn’t an issue with a patient.  

An incentive program was created by management that was basic but very effective. It was timely, certain and positive. When a member of the management team witnessed a nurse aide using the gait belt correctly, they handed the nurse aide a raffle ticket. The chance to win a prize each week was perceived as an immediate reward. A raffle was held weekly with a nominal prize compared to the cost of a patient being injured because the facility didn’t follow one of their policies. It was also certain. I saw the nurse aides get a raffle ticket every time a member of the management team did their unscheduled rounds. It was also very positive which helped ensure the nurse aides went to their supervisors to ask for help when they hit road blocks like too many call lights where on at a given time or a gait belt was unavailable for their use.   

When you look to build or evaluate your own incentive program, make sure you consider the timeliness of the incentive, that the certainty of the incentive, and that you incorporate both positive and negative incentives to help elicit the desired behaviors from your team.  

Up next, I’ll discuss the second principle to effective incentive programs.  Stay tuned…

Human Performance, Operational Excellence, Patient Safety & Healthcare
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