Chris Lancelot: NHS bodies need to adopt a more motivational approach

One of my relatives is a gifted salesman and an excellent poker player. He also regularly makes money on the stock market, easily outperforming established stockbrokers.

How does he do this? And what connects these three apparently separate abilities? It's because he is exceptionally good at personal psychology. He has no formal training, but from sheer experience can work out in a trice what others are thinking or planning - in short, what motivates them.

I often think of him when contemplating the latest complicated mess the NHS has got itself into, because the cause of the problem usually emanates from the opposite attitude - not taking personal motivation into account.

Take the recent suggestion that all nurses should sign a document promising to put patients' interests first. How utterly insulting. Did it not occur to the politicians how personally undermining this suggestion was? And that patient neglect mostly occurs when nurses (who would dearly love to put patients' needs first) have been given far too much to do - usually ticking boxes and filling out forms?

The same is true for primary care. Every time I see the headline 'GPs should do more for ...' I want to vomit. (Or weep. Or leave.)

Motivation is the key to everything we do. When presented with a new NHS project, one of the first questions we ask ourselves is: 'How does this affect me?' And if the answer is: 'It will give me more work and responsibility without assisting with my existing duties,' or if it belittles our sense of self-worth, no wonder if it falls flat.

Motivational psychology tells us that people respond better to carrots than sticks. Yet how much of what the NHS does are actually sticks (or sticks in disguise)? Traffic light ratings, league tables of practices, Care Quality Commission inspections and the grandaddy of them all, revalidation?

NHS organisations need to adopt the motivational approach, learning to see plans and opportunities through others' eyes. They should give carrots to aim for, rather than sticks to avoid. Above all, their plans should honour and respect doctors and nurses for our commitment to our patients: the deepest and most sensitive motivational driver of all.

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