A Frustrating "Reward" System

It is very evident that Kerr’s 1995 article, On the Folly of Rewarding A, While hoping for B, is completely correct and present in all forms in today’s civilian and military sectors.  The PMO 527 discussion boards on this topic were fascinating, and I was actually shocked at how prominent this problem is..... and what was more shocking, is how everyone’s post left a very deflating and defeated feel to them.  What is one supposed to do when organizations “reward A, while hoping for B”, how does this dynamic get fixed, or is there even a solution for it?  

While conducting further research online into this topic, I came across a table which provided further examples of how “A” is rewarded but the hope was for “B”.  It was actually the US Academy of Management who polled a number of senior executives on the prevalence of this folly in business today (http://www.strategicdevelopment.com/articles_details.php?articles_id=8). Those executives reported that it is alive and well. Instances they quoted are shown in the table below.

Hoping for . . .	While rewarding . . .
Teamwork and collaboration	The best team members
Innovative thinking and risk taking	Proven methods and not making mistakes
Development of people skills	Technical achievements and accomplishments
Employee involvement and empowerment	Tight control over operations and resources
High achievement	Another year’s effort

What I find most fascinating about this table is how organizations are hoping for innovative thinking and risk taking, while rewarding proven methods and not making mistakes.  I can’t help but laugh, as I have seen that happen time and time again in my military career.  It is always stressed by the chain of command that initiative and innovation is desired.... but the safe “sure thing” route is always taken.  Money is usually the reason for this, why fix something that isn’t broke, especially if extra costs could initially be present.  

For me, frustration is still the word (emotion) that surrounds this topic.  I believe people who belong to organizations with such messed up reward systems are left feeling frustrated, which naturally influences motivation.  It was William Bainbridge who stated that “leaders make a major error when they sustain reward systems that “pay off” for one behavior even though they hope clearly for something else” (http://schoolmatch.com/articles/SCMFEB94.htm).  Bainbridge could not be more correct, I believe supporting such reward systems is a devastating lack of leadership and it can actually be more detrimental to the workplace, then an actual “reward” system that it was originally meant to be.  

http://www.strategicdevelopment.com/articles_details.php?articles_id=8

http://schoolmatch.com/articles/SCMFEB94.htm

How to get the community to support the nurse/doctor substitution matter?

The most recent topic of discussion for PMO 527 was how “some have suggested that in primary care settings, well-trained nurses can do approximately 80% of the work normally completed by physicians (e.g., Scheffler et al., 2009). Moreover, in a recent review of the impact of doctor-nurse substitution in primary care on patient outcomes, process of care, and resource utilization, Laurant et al. (2007) found no appreciable differences “between doctors and nurses in health outcomes for patients, process of care, resource utilization or cost” (p. 2). The authors concluded that appropriately trained nurses can “produce as high quality care as primary care doctors and achieve as good health outcomes for patients” (Laurant et al., p. 2).  I commented on my discussion board of how I thought the doctor-nurse substitution concept was a great solution, and really assisted in providing primary care to rural areas in Northern Canada.  There is still an area I’d like to discuss though, and that is getting the community’s support for such a transition in health care.  

I keep wondering how to get the community and the patients support for the doctor-nurse substitution and/or supplementation topic.  It is evident that this matter elicits much debate from the PMO 527 class discussion boards as to the pros and cons of it.  Simply put, a pro could potentially be financial as nurses are normally paid less than physicians.  A con could potentially be patient comfort and safety from receiving primary care from a nurse instead of a doctor.  So with such a controversial matter, how do you implement a change in health care and get the community to support it?

One idea that came to mind was education and communication, the information has to be available to people in order for them to feel involved in a process change, or at the very least, information has to be available for them so that they don’t feel bombarded, offended and resistant to the change.  As there are many reasons why people are so resistant to change (http://npcanada.ca/portal/), and they do apply to changes in societal health care practices.  I know the Canadian Nurses Association launched a campaign in October 2011 to bring awareness to Canadian Nurse Practitioners.  This campaign highlighted how nurse practitioners can be the answer to more access to better health care, and in some areas in Canada, a supplement to doctors (http://npcanada.ca/portal/).  By actively providing information to the community on the roles of Nurse Practitioners, I believe that the community will be more welcoming to the change of having Nurse Practitioners providing more primary care within Canadian Communities.

http://npcanada.ca/portal/

http://www.schulersolutions.com/resistance_to_change.html