What motivates a doctor, people or science

Personnel management: intrinsic motivation - what drives doctors - and what doesn't

Many employees feel like little cogs in a big machine that have only one job: to work! Increasing absenteeism shows that fewer and fewer employees can or want to do this.

Photo: FatCamera / istockphoto.com

After many nurses have already left the hospital, doctors are increasingly asking themselves whether they want to continue working in the current system: Is that what they studied for? Some move to a practice, others drop out completely. The figures with which the merchants control the hospitals are often criticized. It is often said that the economisation of hospitals is to blame for this development. But is that really true?

Differences between yesterday and today

Anyone who used to decide to care for sick people in hospitals when choosing a career was always aware that there are easier and more convenient tasks. Nevertheless, the choice fell on this work due to a high intrinsic motivation. It was clear to everyone that they would not have a five-day week or a plannable evening. They accepted that their work-life balance would not always work and that their partners would have to be willing to make many concessions. You knew the stresses of the job and decided to work in the hospital anyway.

The subtle difference between yesterday and today seems to be that doctors used to get more back from the hospital for their work than is the case today. What the work in the hospital gave them back for their effort and dedication must have justified the high level of personal commitment. That's why they were happier and more fulfilled there. Their efforts seemed to be worthwhile. They were ready to keep bringing it in the future. Leaving the job or profession was not an issue.

Biggest driver: meaningfulness of work

But what has changed since then, that doctors have the feeling that they are no longer receiving adequate consideration for their efforts? Is it the lack of appreciation that is repeatedly lamented? Is it the working conditions?

The biggest driver for work in the hospital is probably the meaningfulness of the task. Most of the people who work in the hospital are not doing this in order to make as much money as possible. There are easier, more convenient and faster ways. They do it because they want to help sick people. The meaningfulness of work is the decisive aspect when choosing a career, especially for the younger generations. At this point, the hospital is unlikely to have lost any of its attractiveness. The successes achieved in the hospital by curing illnesses or relieving pain, as well as the gratitude of the patients, are the “reward” for the work there. This is what the hospital is giving back. That is the consideration for which the employees make all compromises, for which all efforts are worthwhile.

Compared to the past, this situation has not changed negatively. Medicine continues to make great strides in treating and curing diseases. It is true that the demands of patients have increased significantly in recent years due to the Internet and hospital comparisons. However, their gratitude and satisfaction do not seem to have diminished.

Intrinsic versus extrinsic motivation

If there are no serious negative changes in the external relationship to the patient, the question arises as to what has changed internally, i.e. in the management of the hospital.

So that people can optimally develop their intrinsic motivation, four facets of their work must be given:

  • Competence,
  • Significance,
  • Self-determination,
  • Influence.

People are interested in thinking and living in balanced states. If the employee perceives their work as important, but the company sends different signals, this challenges the employee's sense of importance. In extreme situations, it is even conceivable that, for example, the head physician would experience high recognition and appreciation from the patient being treated because he was medically successful, but he was heavily criticized by management because his work was economically counterproductive.

Management and control systems

Therefore, the question arises whether today's management and control systems, such as target agreements and key figures, reflect the intrinsic motivation of employees and thus promote them, or whether the internal systems are based on extrinsic components that endanger or even destroy the intrinsic motivation. Since many control systems in hospitals are increasingly or almost exclusively working with economic indicators, the hospitals run the risk of not strengthening the intrinsic motivation of their employees, but of inhibiting or destroying their motivation.

Many target agreements are based on financial goals, for example budget compliance or the hospital's annual results. Is that really a motivating goal? For the economists, yes, but also for the nurse and the chief physician, who both strive for the best possible care for their patients? Are the performance documentation or securing the proceeds towards the Medical Service of the Health Insurance (MDK) tasks that promote the intrinsic motivation of the medical professionals? No, they are not. Because doctors cannot take care of their patients during this time.

Ultimately, it is about the attractiveness of hospitals as employers. It is more and more decisive for future viability, both in the competition for hospitals among each other and in competition with other industries. There is now likely to be a consensus that there is no alternative to the profitability of hospitals. But the question arises as to whether the control and incentive systems have always gone in the right direction in recent years. Both the current shortage of skilled workers in the hospital and the increasing drop-out rate raise considerable doubts that they have promoted the intrinsic motivation of the employees.

Michael Born

Managing Director Human Resources

Hannover Region Clinic

30459 Hanover

Member of the initiative group for new personnel work in hospitals (InPaK)