Why Efforts to Motivate Medical Practice Staff are Misguided

Motivating staff is a popular topic, especially for medical practices.  The focus is misplaced, however, because it is not possible to motivate anyone.  What is possible is to remove de-motivating factors and use incentives to encourage employees to try new behaviors.

Motivation is an intrinsic quality.  If a person has no motivation, there is nothing you can do to instill it.  That is why it is so important for job interviews to address personality and attitudes.  Does the candidate display curiosity, energy, and an open mind?  If not, keep looking no matter how desperate you are or how good the candidate's credentials and experience.  While it is true that potential stars can interview poorly and real duds can be stunning for a short time, the odds are that what you see is what you will get.

Motivation can be squelched.  The most common motivation killer is fear.  If an employee does not know what is expected and right, she may be brave and show initiative.  The first or second time she guesses wrong and is harshly chastised, she'll learn the lesson to wait for explicit instructions.  The obvious solutions are to make expectations clear, identify exceptions to the rules as soon as possible, and use mistakes as teaching opportunities.  Yes, this all takes time, but it takes much less time than firing and hiring.

Impossible tasks also kill motivation.  If the system is faulty, the most motivated, well-intentioned person will make mistakes.  Ask Deming.  If the workload is too high for the resources available, not everything will get done.  Physicians should recognize that truth from their own experiences.

An often-ignored motivation killer is tolerance of bad behavior and poor performance.  This manifests itself when bad employees are seldom disciplined and never fired, and good employees are required to take up the slack.  A rotten apple can spoil the whole barrel.  It is much better to be short-handed for a time, especially since a bad employee produces a net decrease in productivity capacity.

External incentives produce short-term results.  Office lunches tend to be seen as part of the job - either to be expected or as a way to shorten employees' lunch time.  Gift cards are appreciated, if you are lucky, until they are spent.  Extra time off yields a longer-term glow, especially if it is associated with happy memories. 

Financial incentives can be motivating in the long term, but only if they are directly tied to the employee's behavior and things he can control.  The front-desk staff can have a big impact on collecting copays and outstanding balances.  It has no control over the reimbursement schedules or costs of supplies.

Gift cards and other small incentives can be the nudge that convinces an employee to give something new a try.  An example is encouraging a scheduler to actually schedule procedures at a new facility or changing a medical assistant's routine.

Internal motivation is exceptionally productive.  Employees who feel safe and have a good understanding of the objectives of the practice perform reliably and display initiative.  They identify and suggest solutions to problems, and they are a positive influence on everyone around them.  These employees also have a low propensity to leave the practice because the job itself is rewarding.

In summary, give up on trying to motivate staff.  Focus instead on hiring motivated people and removing de-motivating factors.