Exploring the motivation of providers, professionals and patients

Differences in the motivation of providers

▸ A paper in Social Science and Medicine explores the motivations of managers and doctors in UK hospitals. It highlights a lack of homogeneity among managerial motivations, but also some commonality between those working closest to service provision. The literature review showed that doctors and managers are key actors in hospitals and that “much of the organisational change within the UK ... has been an attempt to redefine the balance of power [between them], i.e. to strengthen the role of management and to encourage participation by doctors in management”.

The researchers constructed four hypotheses for empirical testing “based on the premise that doctors and managers have different sets of objectives in accordance with their incentives structures and professional duties”:

• Doctors aim to expand their service.

• Managers aim to work within the financial regime by meeting the break even constraint.

• In “good times” [as financially defined] these objectives will converge to form a Trust objective of service expansion subject to a break even constraint.

• In “bad times” the objectives of doctors and managers will diverge.

The paper draws on a survey of 1500 consultants (including chairs of directorates and those on the board) and managers (CEOs, board members, service managers and clinical professionals). Three main questions in the survey assessed motivation.

1. To what extent does your own career depend on the following factors (responses included financial success, speciality success, your individual reputation, the reputation of the hospital, the standard of R&D, and continued provision of your clinical service)?

2. Within the trust, how would …