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I have a very long and difficult relationship with the gym. When it good, it’s good, but when it’s bad it’s almost like we never even knew each other. It’s a relationship built on mutual understanding but one that has often resulted in us arguing over how often we see each other, hurting each other (mainly me and my back) or ultimately going our separate ways. I know that I should try harder and make myself go more often but the motivation is often lacking and the draw of the sofa is often too overwhelming. Motivation and how to use it is a complex science, motivating yourself is hard, motivating others is even harder. When trying to make improvements in the NHS we need to think carefully about how we motivate our staff to bring about change and improve patient outcomes.

The numbers visiting A&E have risen by over 40% in the past 13 years. NHS services are struggling and can’t see how they could make improvements in an already overstretched and challenging environment. Financial pressures, workforce issues and increasing demand on healthcare services makes day to day working in the NHS increasingly challenging. As a nation we are passionate about the NHS, the opening ceremony at the London 2012 Olympics and the tribute to the NHS clearly shows us that. So how can we develop our staff in the NHS to bring about change and improvements in patient care?

We give rewards thinking that it will increase a person’s motivation and drive but it also has the effect of undermining someone’s intrinsic motivation to undertake that task

A common misconception is that to get people involved in an activity we must reward them for their participation, whether that be a bonus or a promotion. However, this isn’t the case. A recent BBC article shows that the number of parents hit by financial penalties for children not attending school regularly, rose 93%. In a further step, some schools have decided to penalise parents who bring their kids into school late, they implement a fine in an attempt to reduce the number of late attenders. But their plans may not have the desired effect. Rather than reducing the number of late attenders, the number will probably increase. The effect of money will change the mindsets of the parents from an intrinsic mindset of “I want to maintain a good relationship with my child’s teacher” to a transaction extrinsic motivation, “I can buy more time”.

The essence of improvement is about collaboration and working together to make things better. It builds, constructs and grows services and feeds on the intrinsic values of participants.

Whilst we might feel like extra £££ in our bank account would be great, our engagement and passion for an activity diminishes. We give rewards thinking that it will increase a person’s motivation and drive but it also has the effect of undermining someone’s intrinsic motivation to under take that task. Look at the difference between blood donations around the world. In the UK and New Zealand, people give blood donations altruistically with no financial reward but rather leave with the knowledge that they have done something good. In the USA, Russia and China, giving blood earns you between $20-$50 and demand is currently far outrunning supply in these countries. The WHO have come out to say that blood donation should be voluntary as the safest blood donors are non-remunerated donors from low-risk populations. So how can we tap into this altruistic motivation within our NHS workforce?

Well, the good news is that everyone I have ever met in the NHS is there because they care. Through their belief in the concept of free health service, their love of the NHS, or the dedication to give the best possible treatment for their patients; they all care. We want to deliver the best possible service that we can and we want to motivate ourselves to deliver it. Improvement is a tool that enables all staff to get involved and motivate us to make a change. The essence of improvement is about collaboration and working together to make things better. It builds, constructs and grows services and feeds on the intrinsic values of participants. It is much easier to go to the gym when you have a friend by your side to encourage you to go and motivate you to attend. There are ways and means to get involved in all kinds of improvement activities within the NHS, whether you are a staff member or a patient. The key to improvement is to be curious and to get involved, so check out improvement going on in your local area. Be curious, be proactive and get motivated!

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