MODERN HEALTHCARE's July 29 cover story ("Samaritan's revolution-New pay model aims to overhaul how workers think," p. 27) about pay-for-performance is a tribute to the system's foresight and leadership. People always will and should act in their own self-interest. This universal truth can be a valuable asset or the undoing of change.
Change only succeeds when the goals of individuals and the organization are aligned. Change fails when the organization asks people to act against their own interests. It's that simple-as many re-engineering and patient-focused-care programs have learned the hard way.
To fully achieve long-term goals, organizations should recognize that this type of program is a steppingstone, albeit an important one, on the road to a "proactive, flattened, team-based" future. It remains more pay-for-skills than pay-for-results. The reality is that the link is indirect between skills and results such as "enhanced clinical quality and outcomes, improved customer satisfaction and reduced costs." As other organizations have learned, rewarding people for better skills is a gamble when these skills do not lead to desired results.
The next step is to evaluate results directly and use these results as the basis for compensation. Self-directed work teams can achieve their full potential when compensation is based on results such as clinical outcomes, satisfaction levels and even caregiver costs. The underlying challenge will be to maintain continuity with patients to the point where results are controlled by those being evaluated. This is no small challenge.
WILLIAM J. LEANDER
PFCA, Marietta, Ga.