Why do we do what we do, when we can be so much more?

I know it sounds like a lyric from Gerry and the Pacemakers but I was thinking about motivation this week.

Daniel Pink in his excellent book "Drive" outlines some of the science behind motivation and draws some lessons for how we manage and motivate. I must admit his work did resonate with some facets of how medicine is currently configured.

No medic starts out with the ambition of being mediocre, avaricious or dangerous, yet some of us become exactly that. Extrapolating the theories outlined in Drive in to the current NHS it would seem that many doctors, regardless of area of practice, are being subjected to rewards based on action which saps their intrinsic drive, their willingness to just be the best they can be, and replaces it with a financial focus on activity.

I would argue that this applies equally to GPs in carrying out QOF and hospital doctors in warning of "destabilisation" if activity levels change in outpatients.

How then can we take the lessons of "Drive" and apply them to the NHS?
Developing a payment mechanism that remunerates fairly without some form of performance measurement is pure fantasy in our current structures.
If however we were able to reward systems that perform well, with all parties in each health economy receiving some benefit for their innovation, economies and creativity, then we might find ourselves in a virtuous circle.

This circle would see patients, primary and secondary care all looking out for each other, offering challenge to unhelpful behaviour and being part of a system that strives for excellence, driven by the intrinsic motivation in each of us.

Simply put-the reward is being the right thing, not doing the right thing.

Transforming the Horse and Cart

Part of the problem in healthcare is that we don’t actively seek transformational change. We focus on being better, being safer and just working darn harder to get results. Unfortunately building a better horse and cart has inherent limitations.

Sport illustrates this quite nicely, the high jump in the early days of the Olympics was a standing jump, which became a scissor jump after a run up. Of course performance increased, and thanks to occasional falls a mat was introduced to prevent injury.

Things went on for a while with slightly better results every four years but then, the straddle jump evolved and results improved dramatically. Now everybody did the straddle jump and things were slightly improving every four years, it seemed that the straddle jump was the best way of doing it, period-until Dick Fosbury came along that is.

Once again a transformation occurred which changed the game with a quantum leap.

Of course now the NHS faces a major pressure to survive, and surprise surprise we’re squeezing efficiency out of the current systems, getting that better horse and cart. Even the potentially transformative shift to Clinical Commissioning Groups looks like it will be focussed on better pathways, again that horse and cart.

So what should the transformation be? Who is the Dick Fosbury of our NHS. I don’t know, it could be you or me. The solution is not going to come to those of us who are equine focussed in mentality. The solution will come from people who are not afraid to question the status quo, and ask the question “why not?”