I watched the webcast you linked to above. It was very interesting, I admit I would have thought that staff would have an initial negative responce to the replacement of monetary incentives with non-monetary incentives, but I was impressed to find that if done well, it can cause a sense of fairness and staff satisfaction. Thanks for sharing this!

Before making a decision on monetary or nonmonetary incentives I think it is important to ask a few questions. Are incentives necessary? Are the incentives you’re using or planning to use driving the behavior you are looking for?  It is easy to loose site of the fact that incentives drive behavior. My favorite example, that I have used many times, is that of the “Last Minute” incentive. While well intentioned, the use of “last Minute” incentives has some significant unintended consequences. We are essentially incenting our workforce to hold out to the last minute to get the best financial outcome. This can result in a cascade of unintended consequences such as unplanned over-time, fatigue and thus fatigue related errors which could in turn result in increased LOS. Incentives can be very helpful if designed and applied in a carefully thought-out way.

Incentives: Practices of our past, implications for our future?

Incentives have been used in healthcare for as long as I can remember (ok, some of you should stop laughing about my age/memory now). Does anybody remember when shift differentials, weekend differentials, etc began? These essentially were designed to reward (motivate) staff who worked on the harder to fill shifts. These were incentives. Today, as is the case with many of the incentives of old, they have become entitlements embedded within the primary wage structure; and as such our workforce along with leadership just accepts them as a fact. I'm not suggesting that they should be eliminated quite honestly its too late for that, but I do think there is a lesson here we should pay attention to.

Incentives always offered will likely lose their ability to motivate specific desired behavior. Many incentive programs that I encounter today are ones that reward a nurse for any extra shift they work. While this certainly encourages staff to provide extra shifts and goodness knows extra shifts are too often needed, is it really an effective vehicle for motivating staff to focus and align with the shifts an organization knows it has the hardest time filling? Probably not.

As leaders, stewards of the scarse resources entrusted to us (both human and fiscal), there are better ways to employ incentives so that they are mutually beneficial to both the nurse and the organization.

I believe it is very important, as indicated above, to truly understand the behavior you are trying to drive before implementing any incentive program. Competing or misstated goals will impact the outcomes and could undermine the intended results from the incentive program.

Regardless of the program implemented, it is critical to not offer more at the last minute (or closer to shift start) than is done at the beginning, or hold out behavior will be the result. Additionally, it is important to evaluate your outcomes every 3 - 6 months and redistribute your incentives, always targeting the hardest to fill shifts with the highest incentives. This will effectively eliminate the "entitlement" mentality that is so often the result of incentives being viewed as part of one's salary.

Finally, I think it's important to carefully consider whether your organization can support variable rate incentives, where the offered amount decrements with each subsequent bid. People often shy away from this approach, citing the opinion that bidding is unprofessional, but when you think of it, even without incentives attached, the minute two nurses are competing for the same shift, they are effectively "bidding." Variable rate incentives afford the ultimate choice to the employee, leverage resources across the house, and offer the organization the ability to truly target their incentives to the hardest to fill shifts (since these will have the least number of bidders).

Hi out there!  I would like to hear how some of you are managing the use of incentives when you have a last minute need due to a call in - not an open shift that remained unfilled.  What kind of impact has your approach had?

Incentives has become a hot topic again in this economy, we have seen a lot in inquires come in on the use of non-monetary incentive use and the kind of impact that can have on your financial performance within an organization. We hosted a webcast that was a Finance/Nursing Collaboration - on a facility that joined these departements to jointly tackel some of the issues that were affecting the hospitals performance. At the end of the 40 min presentation, there was a 20 min Q & A with the speakers - this has some outstanding information in it. I would recommend that anyone who is looking at thier incentive program, or looking for innovative ways to impact thier financial performance, take a look at this presentation.

Nursing/Finance Collaboration: More than Just Staffing a Vehicle for Controlled Change