Our organization does bonuses based on first the amount of revenue that we make over budgeted amount. Then from this amount we have performance incentives that are measured such as handwashing compliance of 92% or greater. Patient satisfaction scores are also usually one of the incentives. These are items that even the lowest level of employee can take part in. Usually we have 3 incentives and each area is worth 2% to a maximum of 6% of the employees base income. In years past there were times when only 2% was reached and others where 6%. We have found that the employees come to depend on this though. Especially this year with economics being what they are and hospitals feeling the impact just like everyone else. My fear is that those employees which are usually the lowest level who bank on the bonus to give their families Christmas will be disppointed. Hope this helps.

When I worked at a rehabilitation hospital years ago, our incentive package was based on revenue and how low we bring our account receiveables. Lower levels of employee worked in the patient accounts and this was the measure for their bonus package. For the professional staff like Physicians, our incentive was based on productivity. I think different criteria should be used for different departments based generally on productivity and patient satisfaction. That way, everyone is included when bonuses are shared out.

Our organizations splits net revenue that exceeds $1 million over the budgeted net revenue into a 50/50 pool. Provided that JCAHO accreditation as well as patient satisfaction scores superceed their targets for the year this excess earning pool will then be allocated out to all staff on a prorated share per their base annual earnings. It has worked well in financially sucessful times and not so well in more economic challenging times that we have found ourselves in over the past couple of years. Yes folks loose sight of it as an incentive and unfortunately have grown to expect it as part of their traditional earnings.

I agree that all employees should have an incentive to improve patient care. Monetary incentives have been proven to not work as well as nonmonetary incentives for improving work ethic and retaining employees. Employees are more likely to stay at an organization and enjoy their work when they feel valued. This can be accomplished by a simple "good job today when you explained that procedure to Mr. Smith. You really know how to make a patient feel more at ease." Monetary incentives are great, but often budgets do not allow for this and often, as mentioned previously, employees become dependent on these incentives and when the goal is not met and the bonus is not received the incentive to improve turns into the opposite effect where employees have a noncaring attitude. There are many ways to reward employees that do not involve money. Even if an organization is financially able to give bonus' the nonmonetary rewards should also be used to improve employee satisfaction which inturn improves patient satisfaction.

our organization just this year allowed me to recognize the performance of a group of nursing staff in the Operating room. The group (with me as facilitator) developed a list of goals (in conjunction with the physician users of this particular service- General Surgery). the goals were related to Staff retention and decreased use of sick time, physician satisfaction, throughput measure such as turnover time and on-time case starts, quality indicators, etc. We used a "balanced scorecard" to measure monthly progres.. it was a huge success, so much so that it allowed for 100 more cases to be performed in 9 months, completely paying for the incentive. I was allowed to reward staff performance. after much thought we decided to use a percentage on base salary (same percentage for both nurses and techs, just applied to a different base) and then multiplied by worked hours. it was really a delight to hand envelopes out to some of the lower paid staff in the organization and has caught the attention of many other groups. I would say it is most likely to be effective in areas who have a direct impact on revenue generation

My organization has an "Employee Incentive Program" which is based upon the balanced scorecard. If the organization as a whole meets the financial target, the books are opened for each department. The units must at least meet target for at least two out of the four quadrants in order to receive the minimum bonus of $200. The employee could receive up to a maximum of $600. This program has created a teamwork approach to obtaining an incentive.

Incentive bonuses should be handled with care. My organization gave an incentive bonus that ended up creating the us against them environment. I support incentive bonus for team efforts rather than individual efforts. This kind of bonus is more likely to improve team spirit and encourage collaboration.

As related to incentives that are monetarily driven, in our organization, we have goal and performance based bonuses for management and discretionary bonsuses for employees.

Goals are set above and beyond one's role and duties. Each mangement level has a potential to X% of their salary as additional compensation. For employees, it is up to the performance of the individual and budget and can range as flat dollars or % of salary.

The healthcare system that I work for recently standardized its "bonus" program. We are located over 3 different states with 7 hospitals. Each region came up with targets that had were given a percentage value equaling to 100%. Each employee has an affect on the targets - for example hand hygiene...everyone must wash their hands, these targets were measured/monitored. At the end of the fiscal year each region balanced its books and had to have reached their targeted EBITA. The healthcare system also had to have reached the targeted EBITA for all employees to receive the bonus check. The targets were measured all year, and if a region only met 75% of the target that is part of how much of the final dollar allotment is calculated.

We have offered our Emergency Room nurses a unique bonus. Each month we look at their statistics and offer a bonus based on the percentage of patients that Leave With Out Treatment. If the nurse is able to have an LWOT percentage less than 2% they receive $100. We also have offered ER nurses a bonus if the average time that it takes for them to assess their patient is performed within 15 minutes of the patient walking through the door.

In addition to bonus incentive programs offered to operations managers, my organization does offer incentives to non-operations managers and lower levels of staff employees. For example, registration staff in the ambulatory clinics have the opportunity to participate in what is called a QA contract where staff can earn up to an additional $500 per quarter (and their supervisor has opportunity to earn up to $750 per quarter). Earning the maximum incentive is based upon specific individual performance in several areas such as minimum errors in posting charges, timely providing information in claims denials, meeting low wait time standards in patient calls, etc. Meeting team goals is also required if earning the maximum incentive...examples of this include meeting benchmarks for patient satisfaction and overall clinic benchmarks in minimizing denial trends. Employees are disqualified for the quarter if their error rates exceed the allowable standards; also if they are under any kind of disciplinary action. Another example of a special monetary reward is a program called KEIP (key employee incentive program) that is only available to employees who are not eligible to receive operational bonuses. Employees must be nominated by a manager to receive these rewards that range between $500 - $2500 and they are earned by going over & above the norm in one or more of our 6 pillars of service excellence.

Our system seems to be similar to many that you have outlined above. We have four tiers. One is for System Leadership Team and is considered at risk compensation and is based on the health system goals and have varying percentages of annual income for threshold, target and maximum. We then have a Management Incentive Program for department leaders that is a 0-6% of annual income and is paid out base on three of the health system's goals for the year (financial, employee satisfaction, and quality indicators). The third level is for front line managers and is a flat $900 based on the financial outcomes of the organization at the end of the fiscal year. If we achieve budgeted operating margin, they receive payout. If we do not, they do not. The final tier is for all remaining staff not covered in a plan above, and theirs is the same as front line leaders, at the rate of $300 and is also based upon the financial success of the organization. We tie this to the end of the fiscal year (Sept 30th) and Finance strives to pay it out as soon as possible so our employees tie it to the fiscal year end results, and do not see it as a "christmas bonus" as few people mentioned above. The above described system has been in place for 4 years at my organization.

Since we work in a Nursing union environment, we have not been able to utilize incentive plans for bedside nurses, and therefore have not rolled them out to other direct care providers either.