Why do we do what we do, when we can be so much more?

I know it sounds like a lyric from Gerry and the Pacemakers but I was thinking about motivation this week.

Daniel Pink in his excellent book "Drive" outlines some of the science behind motivation and draws some lessons for how we manage and motivate. I must admit his work did resonate with some facets of how medicine is currently configured.

No medic starts out with the ambition of being mediocre, avaricious or dangerous, yet some of us become exactly that. Extrapolating the theories outlined in Drive in to the current NHS it would seem that many doctors, regardless of area of practice, are being subjected to rewards based on action which saps their intrinsic drive, their willingness to just be the best they can be, and replaces it with a financial focus on activity.

I would argue that this applies equally to GPs in carrying out QOF and hospital doctors in warning of "destabilisation" if activity levels change in outpatients.

How then can we take the lessons of "Drive" and apply them to the NHS?
Developing a payment mechanism that remunerates fairly without some form of performance measurement is pure fantasy in our current structures.
If however we were able to reward systems that perform well, with all parties in each health economy receiving some benefit for their innovation, economies and creativity, then we might find ourselves in a virtuous circle.

This circle would see patients, primary and secondary care all looking out for each other, offering challenge to unhelpful behaviour and being part of a system that strives for excellence, driven by the intrinsic motivation in each of us.

Simply put-the reward is being the right thing, not doing the right thing.