Money Talks. The Dog Barks. Motivation and Vocation

A few days ago the British Government published a Review on Antimicrobial Resistance . It described the growing resistance of bacteria to over-prescribed antibiotics and suggested that by 2050 a death from hitherto treatable bacterial infections might occur every three seconds, unless new drugs are discovered. It also urged huge investment in research, including the offering of large prizes (a billion US dollars) to pharmaceutical companies  for every new antibiotic they discover. But these vast prizes are insignificant compared to the cost of medicine being thrown back into the dark ages by recalcitrant bacteria.

It is pointless, as some do, to rail against the rapacious selfishness of pharmaceutical companies and expect them to undertake difficult and commercially risky research without incentives.

The report also urged doctors to prescribe fewer antibiotics, and to avoid prescribing antibiotics for infections that are viral. (Here in the Czech Republic there’s a tendency (admittedly now declining) to prescribe antibiotics as a precaution, to prevent a viral cold from turning into a bacterial cough.)

For many years (perhaps even decades) GPs in the UK have been asked to prescribe fewer antibiotics but are understandably upset when patient satisfaction declines. Nevertheless, data from the NHS were published yesterday that showed that doctors had prescribed 7%fewer antibiotics in the last year than during the preceding year.

How was this achieved? Through financial incentives. Some doctors’ practices were awarded 20,000 GBP bonuses, in effect for doing less.

greedydoctor

Money talks. Or as the Hungarians say – Money Talks, the Dog Barks.

We don’t like to think that financial incentives play an important role in motivating practitioners of vocational professions. The decisions of doctors, nurses, teachers and priests are not, we like to suppose, influenced by personal financial gain.  Decisions must always be made on the merits of each case.

But we know that the priest will do us a better wedding or baptation, the nurse’s hands will be softer and the doctor will see us sooner if we oil the wheels a little.

Here in Eastern Europe from 1948 until 1989 society was inspired by the utopian ideal that each of us would eagerly give ‘according to his ability to each according to his need.’ It didn’t work.

We have to accept that money motivates. If you’re managing a company, you must take account of dozens of factors when deciding how to motivate your staff, but if the money is insufficient, none of the other tricks will work – whether you’re juggling with job title, benefits (such as a company car), training, or responsibility. Even if staff say that the ‘money doesn’t really matter,’ they’ll still agree that money is a kind of recognition, whatever uses it’s put to.

You’ve got to accept that money is an incentive, and when you’re devising your incentives you’ve got to be careful. The NHS in the UK, I believe, will reward doctors for diagnosing and prescribing pills for blood pressure, and reward them for not prescribing antibiotics. The rules of the game have got to be sophisticated enough to achieve the right result but not so complex as to confuse,  or be beyond efficient measurement. And there are always the unintended, unanticipated effects of motivation that solve one problem and create another.

But sometimes incentives go too far. My mother is currently  being hounded by her young GP (probably recently married with a kid to support), who claims she’s diabetic, and, judging by the frequency with which she tells me this, it has disturbed her peace of mind.  She’s used a home-diagnostic kit to prove him wrong. Very likely he’d collect a bonus for adding her to the list of Type-2 diabetics, but he’s not going to get away with it.

Money talks. The dog barks. It will always be so. And if it reduces the risk that antibiotics will fail, who cares?

 

 

 

 

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The Art of Following – Being open about what you want

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I’ve written two posts about following in the hope of redressing the balance on LinkedIn that’s currently vastly in favour of tips on leadership. Followers make up the majority of our human population and the professional population LinkedIn addresses, though sometimes in some contexts we lead and in others we follow.

The Art of Following

The Art of Following – Obedience

I’ve suggested that in following we don’t always have to do what we’re told. Even in the military, and even in war, there are limits to obedience. But how we deal with uncongenial demands is important. A good follower criticises constructively, but is capable of compromise and compliance when led reasonably and openly. Sulking, sullen non-compliance is an unwise strategy. Better, if compliance is impossible, to get out of the situation entirely.

I’ve led two companies for more than twenty years – LLP Group, a regional consultancy and software reseller in Central and Eastern Europe, and systems@work, a software author specialising in professional services and expense management systems. If there is one thing I’ve learned about management it is that there aren’t any failsafe formulas.

I’ve worked extensively for international companies as a consultant and I’ve been impressed by how methodical they are in what they do – in marketing, finance, HR, and operations. When they arrived in Central and Eastern Europe in the early 1990s they brought their procedures and manuals with them. And to some extent these work, but they must always be interpreted rather than blindly followed. Standard procedures must be adapted to local contexts and cultures.

If there is one area where I’ve always seen procedures fail it is in the are of motivation. What works in Manhattan doesn’t always work in Moscow.

motivation

In my experience you must understand each of your followers individually if you’re to motivate them well. Some staff need constant attention and reassurance, even, in some cases the kind of micro-management that others abhor. Some want to belong to a well defined team, whether it’s the whole of or only part of a company, and love team-building activities, and other kinds of company jolly. Others want to be left alone and have no interest in the ‘group’. Some need public recognition, through a job title, others want more money. Some must be allowed to be creative, others just want to do what they’re told. The variations are as many as there are human beings in the world.

Leaders must be sensitive and percipient. Followers must be open both about what they want and what they don’t want. A good follower can help his or her leader by saying or showing what he or she needs. Nothing is worse than hidden resentment. Resentments so often end with terminal crises.

Some years ago I visited one of our subsidiaries and spoke to everyone in the company. There was a feeling that morale was low and I wanted to understand what was wrong. What I found was that our employees didn’t feel appreciated, and that in many cases rewards had been promised but not delivered – a car, a salary rise, a more generous bonus, a promotion. But everyone wanted something different.

If you’re a follower, think about what you want, and make it clear. Don’t demand. Ask nicely! And if something has been promised to you and not delivered, remind your leader gently. He or she may, albeit unforgivably, have simply forgotten.