04.04.2016

Why nothing happens?

Do you find yourself often in a situation wondering why the treatment models that you and even clinical trials and health economics have found to be the best are not realised in healthcare units?

Have you sometimes pondered what on earth could be done about it?

Have you time and time again asked whether there is a need for change and got an affirmative answer, “as soon as we get the process going”.

And then you wait for the process to start. And you wait some more.

For your comfort, I can assure you that you are not alone. We are all witnessing one of the most common dilemmas in economics (and behavioural economics); principal-agent problem.

Pekka Männistö, Medaffcon Oy – miksi mitään ei tapahdu?

Text: Pekka Männistö

Principal and agent?

Despite the sensational name, the problem does not include any plotting or secrecy but happens every day in our lives. The starting point of the problem is that in many situations, individuals have a conflict of interest between their interests and the interests of the employee or owners.

In such situations, the individual usually aims at solving the situation in accordance with their own interests, especially if the interests of the community are, for some reason, less tempting.

And this is often the case in healthcare. Change processes are demanding and hard, often come on top of the basic work and the reward is almost exceptionally of an intrinsic nature, i.e. rests on professional proud and feeling of success. The use of extrinsic motivators (money, other fees and rewards) in healthcare is rare, although often the intensification of processes leads to large savings.

By no means am I saying that much more extrinsic motivators should be used in healthcare. Behavioural research demonstrates well that intrinsic motivators are always significantly more effective and long-term than extrinsic.

But I want to raise discussion on what we should do to get people moving? Why intrinsic motivators are often weaker than the selfish optimisation of the principal-agent theory?

Culture and the difficulty of change

According to my view and experience, the largest problem is the culture prevailing in healthcare. If improvement does not reward, why improve? Why give more than necessary of yourself?  Why assume the risk of failure always inherent in a change?

If developing one’s action does not benefit oneself, but the work and the risk of failure is left at the actor and the benefit is gained by a faceless owner (i.e. the society), why throw oneself in and take responsibility?

In such a situation, willingness to change is often hidden under the surface, you do what you are expected and go home.

Along the years, I have observed that almost every person working in healthcare has interest for change, some closer to the surface while others deeper inside. People working in healthcare are not lazy or lacking will, although you sometimes hear that, quite the opposite. The prevailing modes of operation in healthcare have just taken away their opportunity and will to develop their work.

Can anything be done about this? Yes. A lot.

Human and the imperatives of change

Our response to this dilemma is packed under the slightly clichéd title of “Healthcare Consulting”.

In most cases that we have witnessed along the road, change processes need an active catalyst that can launch the reaction. And such catalyst that keeps the change going so long that the new operational mode is rooted deep enough to survive without catalysing.

Almost without exception, people need change but they lack the last impetus to start off. Usually, the courage is found when they have been provided with an operational mode, which has been judged effective clinically and health economically and which improves their personal well-being at work.

It is also extremely important that they are assisted in the implementation in order to purport the feeling that they are not left alone with the change and the work it requires.

To put it shortly, they need:

  1. A rational reason for change
  2. An emotional reason for change
  3. A clear change process and someone to help them in the process

Many of you can surely observe that there is nothing scientifically new and mystic.

These imperatives of the change process have perhaps been most clearly presented by the Professor in Organisational Psychology at Stanford University, Chip Heath, in his research and book “Switch: How to Change When Change Is Hard”. His and his brother Dan Heath’s model about an elephant, rider and a path has become as one of the classics in organisational psychology, in good and bad.

But it works.

WIIFU (What’s In It For Us)?

We at Medaffcon want to help the change processes in healthcare with this methodology that has been found to function.

If you again find yourself wondering about the questions presented in the beginning of the post, please contact me. We are happy to help you, together with healthcare actors, build such a model and a change process that will draw people to change, and we make sure that the change is also implemented.

In this process, everybody wins, especially patients and people working in healthcare.

The most important issue is that we achieve correctly-targeted movement. Join us in the change!

Pekka Männistö
Sales Director
pekka.mannisto@medaffcon.fi
+358 50 4478 297