Does money really make the world go around or are we motivated in a different way?

It is a hugely challenging time for the NHS.  The funding gap is estimated to be £2bn and with pay making up 70% of the costs in the NHS, substantially increasingly salaries in order to incentivise staff is not a viable option.   So how do we motivate staff to release that discretionary effort that we need to improve patient care without financial incentives and rewards?

But for to those that work in the NHS is it really about the money?

In 1964 Hertzberg revealed his motivation and hygiene theory, he hypothesed that money was hygiene factor i.e. people need to be paid a fair wage for the job they do and they appreciate a pay rise or a bonus but it doesn’t last.  It isn’t a motivator.  Fast forward to 2005 and research conducted for the Federal Research Bank of Boston by Dan Ariely et al from MIT demonstrated that financially linked reward actually reduced performance, which is completely counter intuitive https://www.bostonfed.org/economic/wp/wp2005/wp0511.pdf.  So if money doesn’t motivate or improve performance then this could actually be good news for the NHS but how is it achievable?

Daniel Pink, Al Gore’s ex speech writer, has written a fantastic book called Drive (2009), which is definitely worth a read, as he describes how to release the intrinsic motivation within people.  He cites three factors:

  • Autonomy – control over your own destiny, how you work and the ability to make decisions
  • Mastery – the ability to become extremely proficient at something
  • Purpose – doing something you believe in, that drives you and speaks to your values

People work in the public sector, and particularly the NHS, for a variety of reasons, however the majority of staff really believe in the NHS, its core values and what it achieves.  They feel their purpose links to the wider purpose of the NHS and they have the potential to love what they do.

Healthcare is a complex field and therefore it has very bright and very skilled people who work in it making life and death decisions to help millions of people every day.  It is also a fast moving sector as technological advancements mean that the clinicians and managers are constantly changing and adapting how they work.  Mastery and being an excellent clinician or manager in this complex environment brings with it a huge sense of pride and supporting staff within the NHS to be the best they can be will improve patient care and outcomes beyond compare.

Being valued and trusted as an employee demonstrated by having control over your own work environment and autonomy cannot be underestimated.  The predominant ‘pace setting’ leadership style (Goleman 2000) that has dominated the NHS over the last ten years as a by-product of the target culture, has meant that the autonomy of many staff has been challenged and a learned helpless prevails.

It seems to me that we may be missing a huge opportunity and one that would really benefit the NHS as a whole by considering how we support staff to develop autonomy, mastery and purpose. We need to help staff to unleash their intrinsic motivation so that they feel empowered in their day to day work and as a direct result improve patient care.

For Daniel Pink’s TED talk http://www.ted.com/talks/dan_pink_on_motivation#t-589324


6 thoughts on “Does money really make the world go around or are we motivated in a different way?

  1. Richard P says:

    Thought-provoking stuff Sarah, I’ll certainly look up the other work around this subject and reconsider my own management style.

  2. Tony says:

    Hi Sarah,
    I have worked in the NHS for 30 years and have witnessed the systematic destruction of professionalism. Griffiths thought that the NHS could be run like a supermarket, he completely ignored the theory to which you elude. You are right he was wrong! It is impossible find the financial reward which will motivate as much as Autonomy Mastery and Purpose. Discretionary effort can be as much as 75% of the whole. The question is not that this can and will work but rather can our current leaders shed the dogma of 30 years and have the confidence and courage to make the change. I hope so. David Marquet (Turn the ship around) has shown that it can be done.
    All the best

  3. Charlie says:

    I’ve recently taken a promotion Band 7 to Band 8b – which has involved a pay increase but a loss of protected earnings of about £6K
    the reasons
    More Autonomy – i’m in control over my destiny, how I work and the ability to make decisions
    More Mastery – the ability to become extremely proficient at something
    A better sense of purpose – doing something I believe in, that drives me and speaks my proffesional values

    • Congratulations on your recent promotion Charlie. Having a role that speaks to your values and sense of purpose is vital. Good luck with growing and developing in your new role.

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