Can Peer Competition Provide a Motivational Lift in the Absence of Traditional Incentives in Radiology?

I have shared my home with pooches for the past eight years or so. I would have started much earlier but logistics weren’t conducive.

One of our routines is keeping a tub of treats (they like desiccated liver) near the door to the backyard. Every time they come back in, they are rewarded with a tasty morsel. It serves as one of several reinforcements to return to the house. The treats are oversized for that purpose, so we break them into fragments. We don’t hide this. Sometimes, we snap a piece in half right in front of our two eager mutts and feed one with each hand.

If they were humans, they might grouse a bit. Just imagine giving a pair of Halloween trick-or-treaters a single candy bar and telling them to share. Fortunately, as a couple of folks savvy with dog training have quipped, “Dogs don’t do fractions.” A positive reinforcement is a positive reinforcement. Rewarding treats, petting or verbal praise will encourage more of whatever behavior you are targeting.

Lest we get too pleased with our sophisticated intellect, humans aren’t so far above that level. Token reinforcements work on us as well.

For instance, what motivates most of us to work? Money or equivalents thereof (insurance, retirement plans, etc). Vacation and holidays count if you consider time = money and that your time off is being paid by salary or “baked in” to your per-click rate. Ask a dissatisfied individual how to make his or her job better, and increases in pay or time off are almost always the knee-jerk responses, even if folks are wise enough not to say so.

Such things aren’t eagerly handed out by any employing entity with finite resources. I recall one of the partners in my initial post-training job trying to convince me to stay beyond my first year. With a straight face, he invited me to ask him for anything other than more money or vacay.

So how is one to motivate employees or other teammates without giving them their big motivators? The next best thing is a motivator-adjacent item. In other words, it may be something which, in the individual’s mind, is associated with what he or she really wants or something you teach the person to associate with it.

This can be seen with canines. Verbal praise, for instance, doesn’t initially work However, if you couple it with treats or scratches behind the ear, belly rubs, etc., eventually the verbal praise becomes a reward all by itself.

Again, we humans aren’t so far removed from that world. If I am on a partnership track, and the managing partner who might eventually give me a thumbs up periodically tells me when I am doing a good job, I am probably going to do more of whatever got his praise.

Positive reinforcement isn’t the only tool in this box. Folks are motivated by the threat of losing reinforcements they might otherwise receive. One reason many rads have negative sentiments toward QA is that it represents a constant low-level threat to their livelihood. Get enough negative marks on your record and you might lose access to reading certain types of cases (for instance, high-value neuro MRI), privileges with certain facilities, or even your entire current job.

With this in mind, it is not all that difficult to create your own system of incentives and disincentives that doesn’t directly cost a dime or require fiddling around with contracts. I have developed a couple of these and found myself thinking about them recently.

Two entirely separate venues caught my attention in this regard. One of them was a pattern of scans from certain techs always seeming deficient in some regard (missing MPRs, priors not uploaded for comparison, no sono worksheets). Another was a mid-level management friend whose employees were exhibiting a range of undesirable behaviors: lateness, bare-minimum efforts, bad attitudes, etc.

One can try talking to the problematic individuals or relevant supervisors if any exist. But that often results in bruised egos or otherwise negative sentiments, and the best you get is the equivalent of “I will try to do better” which goes nowhere.

From a psychological perspective, you want a much more immediate and impactful response to the behaviors that need shaping, and rewarding good behavior is usually of better yield than punishing bad stuff. When a poor performer sees peers get recognition or other benefits for better work, the laggard has a way of stepping up his or her game.

Consider this extremely simple example. Every worker gets a periodic score, either from the supervisor or others at the receiving end of his or her output (for instance, rads might anonymously rate the techs whose scans they read). There is a 1-5 scale with 1 just for showing up, 3 for doing the bare minimum without any major screw-ups, and 4 for a visibly good job. Achieving a 5 is rare. This is for folks who really went above and beyond, including cleaning up messes left by lackluster teammates.

The running tallies of everyone’s scores are displayed for all to see. It could be via whiteboard on the department’s webpage, etc. Everyone knows who is doing well and who is not. The points become their own currency: Having a lot can be a source of pride.

It doesn’t stop there though. Even without spelling out details, you make it known that, down the line, those points will count for something. If promotions are being considered, the guy with the most points will probably get it before the one with the least. Maybe prizes are given out to the top ranking workers at year’s end (who says only partners get bonuses?). Intermittently, you can surprise everyone with point-related perks.

By keeping things a little unpredictable, you inject extra excitement into the affair. You also avoid anyone sizing up the points-related perks and thinking, “I’m not interested in any of that,” thus immunizing themselves from the motivating effects. Let their imaginations run wild with all of the good things that just might happen to them if they make the effort and score 4s and 5s rather than 2s and 3s.