Hospital Impact: What it looks like to replace incentives with true patient-centered care

Doctor
Do we really want a healthcare system driven by financial rewards rather than an enduring commitment to quality and safety by people who truly care? A recently observed interaction between a doctor and a non-English-speaking patient offers a very clear answer.
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Is there a direct connection between improved patient satisfaction—which is often linked with financial incentives—and improved care quality? Some research says no.

“Higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall healthcare and prescription drug expenditures, and increased mortality,” a 2012 study published in JAMA internal Medicine concludes.

And yet we continue to financially incentivize (or as Rebekah Bernard, M.D., stated in a blog post), “punish” physicians based on patient satisfaction.

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The connection between patient satisfaction and care quality in and of itself creates great opportunity for discussion, but for now I will focus specifically on the incentivizing aspect of this important topic.

You may recall my piece from earlier this year, in which I explain the troubling aspects of financial incentives in healthcare. It cited the following from a Harvard Business Review article:

  • Rewards do not create a lasting commitment. They merely, and temporarily, change what we do.
  • People are likely to become less interested in their work, requiring extrinsic incentives before expending effort.

I also asked: Do you really want a healthcare system to be driven by financial rewards rather than an enduring commitment to quality and safety by people who truly care?

What right looks like

Recently, I was blessed to witness “what right looks like” in healthcare and how without a financial incentive, true caring is really possible.

[Note: names and other identifiers have been changed]

As I was observing rounds at a hospital in the American Midwest, an Egyptian physician entered the room of one of his new patients.

“Ms. Ebrahim, I am Dr. Saadauri. I am here to support you in your healing.”

“Thank you, doctor. My wife does not speak English.”

Dr. Saadauri then turned to Ms. Ebrahim’s husband and introduced himself as he shook his hand.

And after thanking Mr. Ebrahim, Dr. Saadauri turned back to his patient.

“Ms. Ebrahim, I understand you do not speak English.”

The conversation continued as Mr. Ebrahim continued to translate and Dr. Saadauri remained focused on his patient.

“May I pull up a chair so that I may sit nearer to you?”

And with approval, he did.

“I see you are from Iran. I am from Egypt. Perhaps there is a language we are each familiar with?”

At this point, I found it quite interesting as the three of them discussed a variety of languages they spoke but unfortunately not one in common beyond the English the husband and doctor were sharing.

Or so I thought.

Over the next 10 minutes, I witnessed a human and authentic connection between three people using the universal language of compassion, kindness, caring and love.

There were no financial incentives driving Dr. Saadauri to care.

No. In fact, just the opposite. In this room at this time there were two people afraid and in need. And there was another person reaching out, serving and caring because that is who he is and what he does.

Dr. Saadauri is following his calling to help others for all the right reasons. Not because he is being incentivized to do so.

So the next time you think about your loved one nervous—in pain and afraid of what comes next—think about whether you want someone in that hospital room with them because they are financially incentivized to do so or because they truly care.

I know my answer. 

Thomas H. Dahlborg, M.S.H.S.M., is an industry voice for relationship-centered compassionate care and servant leadership. He is a keynote speaker, author, consultant and adviser and is the president of the Dahlborg Healthcare Leadership Group.

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