Skin the Game - Reward staff for success


Currently, the overwhelming majority of staff in the health department, from the Minister through to the most junior staff, are paid without reference to how well they perform their job. This creates a systemic problem that the care givers have no skin in the game - there are insufficient rewards for our wonderful people who do so much wonderful work.

This could be fixed in a few different ways:

a) Teams could have various metrics (eg, GPs could be rewarded for providing high quality care to many paitents)

b) Individuals could have various metrics (eg, hospital cleaners could be rewarded for having a particularly low level of bacteria in their cleaned spaces)

c) The whole department could have various metrics (eg, a bonus to all health department staff when the Isle of Man life expectancy reaches or exceeds the UK life expectancy according to the World Bank - )

Why the contribution is important

The seminal book by Nassim Nicholas Taleb identifies a number of areas in society where rewards do not link to the desired outcomes - and the penalties that we suffer as a result.

by MichaelJosem on July 10, 2018 at 12:02PM

Current Rating

Average score : 3.0
Based on : 2 votes


  • Posted by Nab July 10, 2018 at 20:18

    I dont agree with the examples given but I do agree that staff/services should be reviewed against targets/service standards to ensure the Department is performing efficiently.
  • Posted by castlearcher July 11, 2018 at 09:17

    GPs have had performance related pay for at least the last 14 years - approx 25% of their funding was historically linked to a Quality and Outcome Framework. Interestingly, the evidence shows that “QOF” improved organization and monitoring e.g. disease registers but did not improve hard outcomes such as morbidity and premature mortality.
  • Posted by castlearcher July 11, 2018 at 09:23

    I would also argue that doctors already have a stake in their patients care - professional pride and reputation, accountability to the GMC, (with potential loss of license and livelihood), ability to be sued for negligence( GPs now pay £10k pa in malpractice insurance) or even face imprisonment for gross negligence manslaughter.
  • Posted by ManxMog August 06, 2018 at 09:18

    Think all should just do the job they are paid to do.
    If they cant, there are HR procedures in place, if used correctly.
    Every health professional will have a job description, job specification and salary.
    Always nice to get recognition, a thank you or well done from your boss though.
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