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Opinion: Remember the ‘why’ in health care

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Economist John Maynard Keynes once wrote, “The government should pay people to dig holes in the ground and then fill them up.” 

The idea was people would make money, which they would spend, ultimately helping out the economy even if the work itself is pointless. I read about a study at a university where they tried it out. They paid a group of workers a fair wage to dig a large hole. After lunch, they told them to fill in the hole. When workers asked why, they were told to “just do it” and “it pays the same.” At the end of the shift, the workers were told to return the next day for the same work, but this time their pay would be increased significantly. Fewer than 25% of people came back the next day.

Why did this happen? On the first day, the workers were willing to work for a fair wage.  However, when they found out their work was pointless, they refused to do the same work for a much higher wage. It turns out, people perform better when they know why they do what they do and they get to see a result. When the work is seen as pointless or when the outcome is hidden from the employee, motivation and worker performance drop.

Providing health care for an individual is hardly the same as having them dig a ditch and fill it back in. Helping someone to get through a difficult time in their life is an incredibly powerful “why.” In fact, this is why so many people get into the difficult field of health care. However, a lot of health care practices fail to take advantage of this powerful “why.” There is often a disconnect between what front-line health care workers do and the outcomes they provide.

A nurse at a hospital may spend an entire shift caring for a group of patients. At the end of the shift, the nurse goes home. When they return, they might be caring for another group of patients without ever learning what happened to the first patient.

A doctor spends a typical day bouncing from patient to patient without getting the time to get to know the people they are treating or hearing the impact they are making on their lives. Sometimes, the inability to spend time with a patient removes the possibility of a doctor helping a patient to identify an underlying condition or change a lifestyle that is creating the illness in the first place. 

Hospitals and medical practices have incredibly complex financial models. It is one of the few businesses in the world where the providers of the service often have no idea what the price is for their customers. Reimbursements often lag the care provided, significantly clouding the “line of sight” between what health care workers do and the success of the health network.

Depending on how you look at it, this is either a major problem or a significant opportunity.

Burnout has always been a problem with health care workers, and this problem was particularly impacted by the COVID-19 pandemic. When a health care worker starts to experience burnout, their patient service suffers, and they are more likely to make mistakes. This has a direct impact on two key metrics for any medical practice: patient outcomes and patient satisfaction. Both metrics directly impact reimbursements. 

Innovative health care practices are working hard to repair the disconnect between what health care workers do and the outcomes. They are starting to engage front-line workers to help them to understand the key drivers that impact the end results. Furthermore, they are creating places where front-line workers can discuss and implement ways to improve service to their patients. Many of these improvement efforts are aimed at opening communication between departments that normally don’t collaborate. This also impacts everyone because it helps the workers to feel like they are part of something bigger, which is a big part of understanding the “why.”

Practices that get this are seeing strange and powerful results. While many health care organizations are struggling to find talent, one hospital my firm works with that has focused on the “why” is actually making a talent grab. They are getting lots of applicants for new positions because their employees find the work to be rewarding and they tell others.

While health care technology continues to advance at a rapid pace, we are learning that one of the biggest opportunities to improve patient outcomes and patient satisfaction is to tap into the power of the “health care why” to give their workers the energy and drive they need to perform their duties every day.

Don Harkey is the owner and CEO of People Centric Consulting Group. He can be reached at


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