Why Don't Underpaid Workers Advocate for Commission-Based Compensation?

SlavOz on 05/06/2022 - 21:06

The people who most often claim to be underpaid always say that they are of immeasurable importance to society and they work so hard and make such a significant impact in the world.

If they really believed that, wouldn't it make more sense to advocate for a commission pay structure? They would stand to make way more than just a flat X% increase on their salaries.

Eg - pay nurses based on patiens triaged/meds administered/lives saved/satisfaction of patients. Pay teachers based on test scores and future success of their pupils. Pay the police per life saved etc.

In other words, we hold them to their word and ask them to walk the walk. Thoughts?

Poll Options

  • 17
    Yes, switch to a commission pay for "underpaid" workers
  • 218
    No, keep them on their current structure
Education & Work

Comments

  • [Deactivated] on 05/06/2022 - 21:11
    +66

    Hi there, Onion Peeler

    Why do you diss nurses so much considering you need to avail yourself of their services so much every time you go to hospital?

      • [Deactivated] on 05/06/2022 - 21:44
        +51

        Compensation pay ……..

        Looks like nurses treating you would need to receive 'compensation pay' in excess of their salary.

      • MontyMacaw on 06/06/2022 - 08:12
        +73

        Funny that. My experience with nurses is the exact opposite. Maybe the problem isn’t them.

        • Poor Ass on 06/06/2022 - 13:49
          +4

          probably because they now know the secrets of winning roulette

          • Scrooge McDuck on 06/06/2022 - 15:46
            +2

            @Poor Ass: OzBargain commenters should be paid based on Popular Comment badges.

            • Poor Ass on 06/06/2022 - 15:58

              @Scrooge McDuck: maybe paid by discounts

            • smartazz104 on 07/06/2022 - 10:52

              @Scrooge McDuck: As long it's proportional to the total number of comments made, so certain people don't game the system by commenting on everything…

        • Caped Baldy on 07/06/2022 - 21:38
          +2

          Now, that might be because you're not a gigantic misogynist unlike OP.

      • moar bargains on 06/06/2022 - 12:58
        +11

        Compensation pay would reward the good ones and weed out the bad ones.

        Hey Slav, plot twist. They have compensation pay already, and the people who suck get cases like you.

        • SF3 on 06/06/2022 - 13:47
          +4

          reward the good ones and weed out the bad ones.
          They're rude, inconsiderate, and often make some pretty worrying mistakes

          Won't be targeted to the workers, it'll be be applied to the patients (case in point), students, etc… i.e. the customer.

          Peeling back the layers of the onion, what OP is saying is, weed out all the bad customers, then you'll have a workforce with a fantastic KPI.

          • moar bargains on 06/06/2022 - 14:05
            +5

            @SF3: "Sorry Slav my lad, I reckon that's the end of your subsidised healthcare."

            If his propensity to start (and keep trying to win, even when un-winable) arguments with people online carries over at all into IRL (and I wouldn't bet against it), he's a goner.

            • SF3 on 06/06/2022 - 14:22
              +2

              @moar bargains: There could be a correlation between wanting smooth experiences (by weeding out the undesirables) and a smooth brain?

      • Icecold5000 on 07/06/2022 - 12:26

        One thing you learn in any customer or client facing role is that people generally react positively to people who treat them with respect and who are polite and vice versa. It’s clearly obvious that give their response to you that they are simply reacting to you treat them.

      • sandman87 on 14/06/2022 - 12:01

        Ever thought that the common denominator in those situations was you?

  • AdosHouse on 05/06/2022 - 21:12

    In your example, oncology nurses are really getting the raw end of the stick. Do all the different specialty nurses have to meet the same criteria?

    All the different cops? GD has completely different job to a Stock Squad cop. Same with CIB.

      • Kangal on 06/06/2022 - 20:33
        +2

        Ey bruh, when did you get unsuspended?
        We've been missing out on your posts here for a while.

      • druex on 07/06/2022 - 17:35
        -1

        Who decides and then monitors all these new metrics? Sounds like a lot of hassle to make different goal posts, and probably make services worse overall. Good job.

  • dust on 05/06/2022 - 21:13
    +31

    Pay the police per life saved etc.

    It's not always so easy to calculate performance metrics like this. It might also create situations where police put people in dangerous/life saving circumstances so they can get a bigger pay check.

    • whatwasherproblem on 05/06/2022 - 21:25
      +44

      Yep. Or if you pay doctors per medication dispensed, then guess what? All of a sudden your case of the "slight sniffles" now requires a 3-month course of antibiotics and multiple follow-up appointments.

      SlavOz didn't think this one through.

      • SF3 on 05/06/2022 - 21:34
        +15

        SlavOz didn't think this one through.

        Anecdotally I think it’s ~100%

        • whatwasherproblem on 05/06/2022 - 21:41
          +4

          Okay, I giggled at that one. Nicely done SlavOzzy.

        • FezMonkey on 07/06/2022 - 10:52
          +4

          All of a sudden your case of the "slight sniffles" now requires a 3-month course of a vaccine

          Vaccines are preventative measures. Not treatments for existing conditions.

        • greatlamp on 07/06/2022 - 22:36

          'Slight sniffles' with a 1% fatality rate.

    • SydStrand on 06/06/2022 - 01:00
      +38

      It might also create situations where police put people in dangerous/life saving circumstances so they can get a bigger pay check.

      SlavOz is too stupid to recognise the potential of perverse incentives in commission-based pay. What SlavOz is advocating, is literally what five seasons of The Wire spent thoroughly deconstructing. The second you start funding schools based on standardised tests, they'll start teaching answers. Once police are funded by % cases cleared, they'll be incentivised to prioritise low level drug busts and reclassify crimes. If firefighters were rewarded based on fires successfully fought, then fire prevention would suddenly look a lot less attractive. But sure, let's scale nurse pay based on triage rate like waiters fighting for tips, and act surprised when suddenly it's a lot more attractive to churn through freebies and ouchies at the expense of critical cases.

      • Chandler on 06/06/2022 - 10:28
        +8

        when suddenly it's a lot more attractive to churn through freebies and ouchies at the expense of critical cases

        Hmm.. do I spend hours trying to save SlavOz's life or do I go treat whatwasherproblem's family's sniffles for a greater return.

        Healthcare and money are not a good combination - have a look at the problems we have already with private healthcare.

        • Ultimate Gattai on 07/06/2022 - 10:58

          Just look at the US, that's a very money driven healthcare system taken to the extreme, let's not do that.

  • djones145 on 05/06/2022 - 21:20
    +35

    wtf dude

    • MS Paint on 05/06/2022 - 21:39
      +6

      That makes sense. Cheers

      • djones145 on 05/06/2022 - 21:53
        +3

        the world is so much cleaer now I have this

  • SF3 on 05/06/2022 - 21:21
    +12

    It’s another silver bullet solution view of the world…

    The pay is low for a reason… they have a fixed cost to hire n number of people. That same cost would just be recalibrated for a “KPI” based model, so the worker won’t be better off and work even more hours.

    • orangetrain on 06/06/2022 - 10:14
      +8

      Ironically the pay is low is probably because hospital admins get bonuses for keeping the budget spending low.

      • Kangal on 06/06/2022 - 20:36

        That is frighteningly close to the truth @_@

  • WreckTangle on 05/06/2022 - 21:29
    +21

    So teachers shouldn’t bother with pastoral care, collegiality, students that have learning difficulties, don’t speak English well or are not academically geared? Nurses shouldnt focus on patient wellbeing & happiness, just churn them out? Police shouldnt worry about public education or community policing? Jeesus.

    • whatwasherproblem on 05/06/2022 - 21:33
      +13

      That's actually a good point. If you pay teachers based on the success of their students, then surely a few enterprising educators will figure out that they can maximise their profits by ignoring the students that need them the most and instead focusing their attention on the 'talent'.

      • SF3 on 05/06/2022 - 21:36
        +8

        Sounds dystopian. I see a trend.

      • SF3 on 05/06/2022 - 21:43

        Sounds like reverse Marxism, where capitalism is taken to the extreme. OP does seems prefer a survival of the fittest society.

        • whatwasherproblem on 05/06/2022 - 21:53
          +10

          No, that's what I assumed you meant, in that they'd be compensated based on the total proportionate success of their students.

          Therein lies the problem. Even taking the totals into consideration there's a macabre arithmetic you can end up doing where it actually becomes mathematically detrimental to your personal finances for you to pay any attention to students below a given threshold. Sure, those poor students will be sh.t out of luck and probably be (profanity)-ups for life (which affects your pay, which is the most important part of course), but you take those Ls and focus the attention on the 'better' students. Doing that actually nets you a higher profit than trying to 'raise all ships'.

          At that point you're basically playing number games with people's futures, and a society that's okay with that is a society that's headed down a dark path.

          (Edit to add:
          Surreal that the two of us have basically 180'd on this, hey SlavOz? Seems like just yesterday you were the one arguing with me that we shouldn't leave poor disenfranchised peoples behind in that thread with the Aboriginals and whatnot.

          Life comes at ya fast, hey?)

          • SlavOz on 05/06/2022 - 22:04
            -4

            @whatwasherproblem: Not really. What if they only got compensated if a set number of students attained a passing grade. Eg - at least 9/10 students need to pass. The average class probably has 2-3 no-hope students who don't want to learn. So to get the bonus, teachers need to make sure at least some of those are catered to. They can't make the bonus by just focusing on the good learners.

            Of course it's not a perfect system. Nothing is. You could pick many holes in the current way we do things as well. There is no shortage of problems there.

            • whatwasherproblem on 05/06/2022 - 22:14
              +8

              @SlavOz:

              Of course it's not a perfect system.

              Sure, but I think the point most of us are trying to make is that it introduces perverse incentives.

              e.g. in that example with the 9/10 students you've got, at some point it actually becomes financially beneficial for you to make the no-hopers go away. Maybe you're on good terms with the headmaster and you tell him you'll split the bonus his way if he shuffles some problem children into other classrooms? Maybe you specifically don't pay too much attention to their group when chaperoning on the school excursion day and "whatever happens, happens"? (Or perhaps less sinister and more mundane: maybe you just give the no-hopers the answer sheet to memorize so that they test well? Sure, they won't have actually learned anything in your classes, but why should that be your problem? You're just a humble educator, after all.)

                • Kangal on 06/06/2022 - 20:47
                  +1

                  @SlavOz: I think the answer to the question you had in your Opening Post is this:
                  better work = better pay

                  And so there should be an incentive for people to strive harder, work smarter, and make it a craft. And how we compensate these people should be as least corruptible as possible (ie Nepotism), and based in Objective Facts.

                  So what is the solution?
                  There isn't any. You can make "some" guidelines but even then you must be careful because they can have unintended consequences (cobra effect/fallacy). In general, it is difficult to come up with these.
                  …I think the best way to approach this conundrum is simply by Hiring people that are good (honest, caring, competent) and to reward that culture. And to have Bosses and Hiring Managers to also have this ethos, and to bring forth that culture. And lastly, we need better education. And I don't mean in the sense of memorising a million facts, but rather along the lines of increasing the Public Morality. This has ten-fold positive effects in things like politics, economics, crime, military, etc etc.

                • Randolph Duke on 07/06/2022 - 10:17
                  +1

                  @SlavOz: Tell me you’ve never worked closely with sales people without telling me you haven’t worked closely with sales people.

      • Krankite on 06/06/2022 - 07:22
        +3

        More likely they will figuire out that teaching kids with rich parent's pays better than trying to get students out of generational welfare.

      • orangetrain on 06/06/2022 - 10:16
        +4

        This happens already. A lot of private schools insist on the smartest of the crop because parents look at NAPLAN, state tests, etc

    • SlavOz on 05/06/2022 - 21:44
      -2

      So teachers shouldn’t bother with pastoral care, collegiality, students that have learning difficulties, don’t speak English well or are not academically geared?

      We could easily design KPIs and compensation for different types of teachers. Eg, special needs educators are usually seperate from general class teachers, so they would have a different KPI based specifically around the progress of their special needs students.

      Or we could put crazy bonuses in place for outcomes related to the success of students who are not academically geared.

      And so on. I never said we should use a single blanket criteria for every teacher.

      • SF3 on 05/06/2022 - 21:52
        +7

        I never said we should use a single blanket criteria for every teacher.

        The unified problem with many of your suggested solution is, it has to be implemented at scale, not in a controlled lab.

        When things are done at scale, standardisation has to happen… these are not boutique shops doing their own thing.

  • DemocracyManifest on 05/06/2022 - 21:44
    +1

    Well every job now has KPIs and majority are non ongoing in nature; so your reward is keeping your job and the benefactor is HR stooges. A commission based pay structure benefits the company/boss; not the worker, as it saves their arse when business is at a low/downturn. Every employment relationship benefits the boss. Award rates/EBAs are in the employees favour in the long run coupled with superannuation. We’ve already had one experiment where many employees signed up for AWAs during the WorkChoices era and they permanently stuffed their retirement and future earnings

  • p1 ama on 05/06/2022 - 21:47
    +4

    In other words, we hold them to their word and ask them to walk the walk. Thoughts?

    This sets up a perverse incentive, rather than working together with your colleagues and be united by common goals, you are now working against your colleagues. Your approach is only valid in professions which do not require teamwork by nature (e.g. sales).

    If you are an employer, your incentive should be to maximise productivity and output, which will often require (i) work to be divided up according to the strengths of your workforce, and (ii) your workforce to work together to achieve unified outcomes. If you are being paid on commission, would you want to help your colleague do their job better, or perhaps it's better for you to sabotage them so that you can come in and pick up the pieces?

    FWIW, I'm not against the idea of having performance incentives, and to some large extent this is already true in most of the professions you are listing. Whether this be through bonuses, or high performing individuals having better access to promotions…etc.

    The common thread amongst the professions you've listed (teaching, nursing, police) are that they are practically monopoly employers. If you are a nurse, you can't really just go to another employer in search of higher pay. It's a similar situation for teachers (barring private schools), and for police. The "free-market" solution IMHO is to actually open up these markets so that they are competitive. Let schools compete with each other to attract the best teachers, let hospitals compete with each other to attract the best nurses…etc.

    What you're saying makes little economic sense because you have a situation of a competitive supply side, and a monopolistic demand side. You're basically saying we should induce the supply side with performance-based incentives, but this is not a supply side problem. If anything, we should be inducing competition amongst the demand side. Rather than encouraging teachers to compete with each other for better pay, you should let schools compete with each other to offer better pay to their staff.

    • SlavOz on 05/06/2022 - 21:56
      -2

      This sets up a perverse incentive, rather than working together with your colleagues and be united by common goals, you are now working against your colleagues

      I disagree. That's only true for certain types of jobs where the instances of success are limited.

      Like sales. If a customer is shopping for a car, there's only 1 sale up for grabs. If another employee makes the sale, you miss out. So of course you want to work against your colleagues.

      But doesn't have to be true for teachers. Say we pay them a bonus for each student that gets at least 90% on a test. One student getting 90% doesn't affect anyone else. If each classroom has 10 kids each, both teachers have equal chance to score more money. In fact this might even encourage them to work together. They lend each other strategies or worksheets so they both make their bonuses.

      • p1 ama on 05/06/2022 - 22:54
        +1

        But doesn't have to be true for teachers. Say we pay them a bonus for each student that gets at least 90% on a test. One student getting 90% doesn't affect anyone else. If each classroom has 10 kids each, both teachers have equal chance to score more money. In fact this might even encourage them to work together. They lend each other strategies or worksheets so they both make their bonuses.

        This goes against the design of incentivised pay, which is that there is a bonus pool, and that bonus pool is allocated according to the relative performance of each employee. In other words, the top 10% may get 50% of the bonus pool, the next 10% may get 30%, and the next 10% may get 20% (or something like that).

        If your suggestion is that we reward absolute performance rather than relative performance, then that is practically impossible because designing objective relative KPIs are hard enough, designing objective absolute KPIs are just not practical.

        At the end of the day, my issue with your proposed system is that it's a very convoluted way of implementing a system of performance-aligned pay that is not incentive-compatible. As I stated earlier, the best way to improve pay and outcomes would be to let employers fight for the best employees and pay them the best. The fact that employers fight with each other for the best employees means that they will identify the best employees, and those best employees will be paid the best.

        My view is that you should let the market decide these things rather than concoct up some convoluted scheme that sounds like it belongs on a game show.

        • SlavOz on 05/06/2022 - 23:12
          -2

          Well, I won't argue with that. I am a huge advocate of free market self correction. As soon as the government gets involved, big corporations win big and employees become disposable sandbags rather than valued for their competitive performance.

          Alas most voters would never go for this. It'd about as unlikely as Australia abolishing all income tax. Never gonna happen. Once something is government-controlled, stripping it away is seen as a step backwards by the uninformed masses.

          • p1 ama on 06/06/2022 - 09:06

            @SlavOz:

            I am a huge advocate of free market self correction

            Says someone who was literally just proposing a huge government solution. Imagine if we made the government set prices of cars and phones with a formula based on KPIs. Not sure if you just didn't think through what you're saying or if you just want to create a dystopian "squid game" world for the sake of it?

            Once something is government-controlled, stripping it away is seen as a step backwards by the uninformed masses.

            How? We've privatised plenty of things…?

            • SlavOz on 06/06/2022 - 09:14
              -4

              @p1 ama:

              Says someone who was literally just proposing a huge government solution

              Only because this is Ozbargain, and the bootlickers here seem to think that everything is better under government control and nothing can ever go wrong. Suggesting privately operated healthcare or schooling system would just go nowhere. I used the KPI solution as a compromise.

              It's not really a massive government solution because the current system is already a government solution. It's not like I'm trying to increase government control. The government already controls healthcare. I'm just trying to change the way they do it.

              • p1 ama on 06/06/2022 - 12:43
                +1

                @SlavOz:

                Suggesting privately operated healthcare or schooling system would just go nowhere. I used the KPI solution as a compromise.

                I never suggested privately operated healthcare or schooling - I suggested allowing schools to be free to set their own pay and hire their own staff, rather than doing it centrally within the DoE.

                It's not really a massive government solution because the current system is already a government solution. It's not like I'm trying to increase government control.

                You are though - you are basically mandating state control of prices, which is an extreme level of government intervention. You are basically saying that the state should set the "formula" for how teachers are paid, the state should dictate what are the performance requirements and KPI targets of each school…etc.

                FWIW, as someone who is not overly political, I find that what you're arguing for is basically exactly what I find disingenuous about the "political right" - that there is no overarching ideology, but rather, just an adherence to making the world more dystopian. When this involves less government intervention, that's the view the "right" will take, when this involves more government intervention, that's the view the "right" will take. There is no consistent or coherent ideology.

              • Randolph Duke on 07/06/2022 - 10:19

                @SlavOz: Feel free to look at the US if you want to see how shit health and education could be. Of course, that doesn’t matter to you cause you lack empathy for your fellow man - as long as you’ve got yours who cares about anyone else, right?

  • Trying2SaveABuck on 05/06/2022 - 22:08
    +1

    my guess would be a 'commission based' structure can be manipulated to 'screw' you later on

    ill give you a simple example

    you are a service provider ie ward nurse.

    you have commission based structure in which you get paid 100 bucks for each patient to look after sounds 'great' right.

    well one of two reasons why this doesnt work
    government decides 100 is too much and cuts you down to 50 all of a sudden you have to do twice the work for the same money this has happened in the past in other industries. Anything where the government is 'funding' you is no a 'given' i certainly dont trust the government to work out a fair commission structure and even if they did who is to say the next government dont change it.

    2nd issue is just straight greed lets say a nurse can only effectively look after 7 patients a day thus making 700 on a full day but said nurse decides to open her/himself up to 10 patients to ensure he is making more money at the expense of quality care thus people die or have poor outcomes and get worst thus costing the system more money in the long run….

    i can think of another 10 reasons why it wouldn't really work - if you dont believe me just look at how many people are ripping off the NDIS or how many Doctors rip off the medicare system

    it might 'work' to some extent in the education system as you can be a bit more 'objective' about student outcomes however the issue is the 'dumbest' for lack of a better word are usually the hard kids to teach

    it might not be the kids fault he might have junkie parents who dont look after him and school isnt his priority - but the teacher gets less cash even though her/she has a much more challenging cohort

    • SlavOz on 05/06/2022 - 22:15
      -2

      Every system can be rigged. I could just as easily say paying nurses a guaranteed salary regardless of their performance opens the door to them bludging and doing the least amount of work possible just to get paid. Why would they bother to work as hard as their colleagues if everyone gets the same pay?

      See how catastrophic that would be…oh wait it already happens.

      10 patients to ensure he is making more money at the expense of quality care

      Then we could have KPIs that control for the quality of care, not just the quantity. Plenty of ways to do this, theoretically.

      • Trying2SaveABuck on 05/06/2022 - 22:18

        Regardless of their performance opens the door to them bludging and doing the least amount of work possible just to get paid. Why would they bother to work as hard as their colleagues if everyone gets the same pay?

        you are correct this does happen in all government paid jobs but the 'spending' is limited

        ill add this most hospital based jobs as far as i know do have KPIs ie im pretty sure Allied health staff need to 'bill' at least 7 hours worth of patient contact time on an 8 hour day in the hospital - id assume nurses/doctors etc would be the same

        to some extent i think public professions should have a performance based 'bonus' system but it would be very hard to police and ensure those dealing with more difficult clients arent 'dis-advantaged'

        the real question is 'what is under/over/fair' pay from the 'teachers' poll i had i personally think teachers arent complaining about the money they are complaining about the conditions. There is a difference between being underpaid and having substandard conditions ie abusive parents/students/excessive red tape etc

  • Hardlyworkin on 05/06/2022 - 22:23
    +1

    Obviously never worked under KPIs! So many jobs where they simply just don't work well.

    Isn't this how the police worked in the Philippines? Still a drug problem and bodies piled on the street.

    • SlavOz on 05/06/2022 - 22:34

      I worked as a freelancer for many years before going into full time work. Recently quit my job to return to freelancing.

      My current income is basically 100% tied to work produced and client satisfaction. If I don't meet my own personal KPIs, I don't eat. And no petrol for my V8 Mustang :(

      • [Deactivated] on 05/06/2022 - 22:39
        +6

        Did you quit because of your ex-employer's vaccine mandate?

        • SlavOz on 05/06/2022 - 22:58
          -1

          No, left to pursue personal goals. Pretty sure only a handful of large, public-facing brands issued vax mandates. Eg Coles, banks etc.

          Small businesses ain't going to risk the legal drama or staff turnover.

      • Hardlyworkin on 05/06/2022 - 22:46
        +1

        That KPIs may work perfectly well in your industry doesn't mean they are good for other industries.

        As important as I'm sure your client's satisfaction is, the success of teachers, nurses and police isn't just about keeping people happy.

      • Cheaplikethebird on 06/06/2022 - 08:53
        +7

        And here we get to the crux of the argument. SlavOz is just jerking himself off on some sort of fantasy that he's a wolf among sheep because he freelances.

        • Quantumcat on 06/06/2022 - 09:10
          +12

          He probably freelances because nobody can put up with him in an office.

          • moar bargains on 06/06/2022 - 12:20
            +2

            @Quantumcat: Perhaps he was "encouraged to pursue other opportunities" so he has decided his "personal goals" are close enough

            • SF3 on 06/06/2022 - 13:16
              +2

              @moar bargains: When you read an office memo saying someone is leaving because of "personal goals", you know it's BS.

  • pao2x on 05/06/2022 - 22:52
    +2

    That’s right! I agree lets make it completely market and commission based!
    Lets also let them choose what jobs they should do shall we?
    Like reserve the right not to help or treat douchebags or dropkicks. Also only people with money welcome, Get your bank card ready before calling 000. Thanks for the suggestion /s

    Also patient satisfaction as a metric is almost equally dumb as an idea as pay based on lives saved

    • SlavOz on 05/06/2022 - 23:00

      Like reserve the right not to help or treat douchebags or dropkicks. Also only people with money welcome, Get your bank card ready before calling 000. Thanks for the suggestion /s

      I am more than happy for them to do this as long as they are willing to give up their government funding.

      If you take taxpayer money, you must serve the taxpayer.

      • pao2x on 05/06/2022 - 23:02
        +3

        If the cops shoot more criminals is that a pay rise or a pay cut? Also will judges need to become accountants to determine how much money each criminal is worth as well as to find out if they are really crims? Shoot first ask for commission later?

        • Lord Fart Bucket on 06/06/2022 - 16:33

          Worked very well in the Philippines. Cops given targets to reach, resulting in many innocent people being framed and now in jail, awaiting trial. Some are there on remand for years.

  • bobbified on 05/06/2022 - 22:56
    +5

    Where do you come up with ideas for these threads?

    There's a reason why the trust level for the people in commission-based jobs is so low. Like real estate agents and other salespeople.

    Eg - pay nurses based on patiens triaged/meds administered/lives saved/satisfaction of patients.

    Now, imagine nursing really was commission-based. Would you really want nurses to be paid according to how much medicine they administer? Or how many patients they have to care for? Some patients need more care than others. Would you want the nurse to do a rush job so that they can move to the next patient to get paid more?

    • SlavOz on 05/06/2022 - 23:04
      -1

      Most of those situations would lead to quantifiably worse outcomes. Eg - if a nurse rushes a job just to get her patient count up, the neglected patient would report lower satisfaction or potentially even suffer complications due to poor care. So the nurse would ultimately achieve lower scores and be paid less.

      It just depends on how you design the KPIs. Not all of them are bad.

      • bobbified on 06/06/2022 - 09:02
        +2

        ..the neglected patient would report lower satisfaction or potentially even suffer complications due to poor care.

        So you'll be the one to go into the morgue to ask the "patient" for their feedback?

        It just depends on how you design the KPIs. Not all of them are bad.

        KPIs are consistent. The care that patients require differs from one patient to the next.

      • moar bargains on 06/06/2022 - 12:41
        +1

        Ok, to continue to point out the myriad problems with your proposal, how do you incentivise ICU nurses? Their patients are statistically much more likely to die so is it reasonable that they get paid less because of that? And so then they all leave and become maternity ward nurses/midwives (where people buzzed up on oxytocin give them high scores and so they rake it in), and there are now no more ICU nurses. But that's ok, because the acute stroke\cardiac arrest victims who are gonna be wheeled out in a coffin can't give bad ratings.

        And don't say "you just need to set up the structure right", because that is going to create more bureaucracy, not less, and health departments which are already stretched in providing care for patients will have to divert more funds for reporting and monitoring these additional KPIs (on top of the ones they already monitor and report) rather than actually providing care. Can you perceive that this might possibly make the problem worse, not better?

  • Eeples on 05/06/2022 - 23:15

    How would the bonuses work for teachers?

    If a teacher gets a graded high performance class with students that top the state they get more money? (Did that teacher do much, really?) But what about the teacher who only has lower ability classes?….. somehow those students are evaluated on ‘value added’ or something?

    These measures would seem very hard to impossible to codify.

    • AustriaBargain on 05/06/2022 - 23:20
      +3

      If you gave teachers more money for students getting higher grades then it will mean teachers of students who struggle or live in low income areas will get paid less, and teachers of students in high income areas and of selective schools will get paid more. When really it should be the other way around, students who struggle need even more resources, more contact time with teachers.

      • SlavOz on 06/06/2022 - 09:09
        -6

        Really not that hard to set KPIs based on the average pupil success of a school or council area, so lower-scoring schools would be adjusted.

        Honestly, this is one of the worst arguments in the thread. You're just slightly behind the guy who suggested that KPIs for high-scoring students would incentivise teachers to kill or "accidentally" lose their low achievers.

        It's hard to tell what's troll and what's legit anymore.

        • AustriaBargain on 06/06/2022 - 09:40
          +2

          So then schools would start not accepting special needs students or students who just need extra help. Private schools would go out of their way to expel such students if they manage to enrol. It's a stupid idea and they tried it in America with tying funding to standardised testing and it failed.

        • SydStrand on 06/06/2022 - 09:55
          +2

          Really not that hard to set KPIs based on the average pupil success of a school or council area, so lower-scoring schools would be adjusted.

          Clearly not someone adjusted to the real world. There's debate every single year about the methodology the Department of Education uses to micro-adjust individual school scaling in the HSC.

          But now you think there's a magic formula that not only does this, but also perfectly calculates the appropriate handicap of low scoring schools, to pay their teachers, oh and this won't be controversial at all.

        • whatwasherproblem on 06/06/2022 - 12:46
          +1

          It's hard to tell what's troll and what's legit anymore.

          If you have to ask then you're doing this "Internet" thing wrong.

        • Lord Fart Bucket on 06/06/2022 - 16:35

          It's hard to tell what's troll and what's legit anymore

          It's easy for most of us. If posted by SlavOz, it's trolling.

  • star-ggg on 05/06/2022 - 23:38
    +7

    Lots of historical examples where trying to whittle down complex systems into a few metrics result in systems that are then optimised to meet the metrics rather than the original function of having the system:

    https://en.wikipedia.org/wiki/Perverse_incentive#The_origina…

    https://en.wikipedia.org/wiki/Campbell%27s_law

    https://en.wikipedia.org/wiki/McNamara_fallacy

    Realistically, the cost of maintaining a bureaucracy to design, maintain, assess and innovate (to prevent optimisation of static metrics) these metrics will be so high you might as well have paid the money to people currently employed in the professions.

    • SF3 on 05/06/2022 - 23:47
      +4

      Thanks! TIL.

      cobra effect
      the British government, concerned about the number of venomous cobras in Delhi, offered a bounty for every dead cobra.
      Initially, this was a successful strategy; large numbers of snakes were killed for the reward. Eventually, however, enterprising people began to breed cobras for the income.

      Now for the kicker.

      When the government became aware of this, the reward program was scrapped. When cobra breeders set their now-worthless snakes free, the wild cobra population further increased.

      I think CEO OP would have claimed their bonus with the silver bullet solution, before it falls apart, moved into another role and let someone else hold the bag

    • Chandler on 06/06/2022 - 11:49

      Realistically, the cost of maintaining a bureaucracy to design, maintain, assess and innovate (to prevent optimisation of static metrics) these metrics will be so high you might as well have paid the money to people currently employed in the professions.

      Makes you wonder why some government's don't implement it - think of all the money for PWC, NDY, et al

  • miwahni on 05/06/2022 - 23:48
    +1

    This is an interesting question. I would very much like to know how you'd assess teachers who are -to quote OP - paid on the future success of their pupils. Are you suggesting teachers have to wait years for compensation? And how do you measure a life saved?

    There are some good arguments for incentivising outcomes. The problems though lie in the ability to rort the system. As soon as you incentivise something monetarily then you can see an increase in that behaviour even if it's not legit.

    I speak from experience. In my previous life, working for a fairly major bank, as soon as something was incentivised then yes, there would be a huge lift in outcome. But so much of it was not legitimate. (Except for the time we were advised that if we waived fees, that fee waiver would come off our bonus. Amazing how the number of waived fees dropped). I've seen lenders write insurance policies for construction loans, for example, or sales staff write bogus policies for people who simply asked for a quote.

    I think paying a decent wage to attract the best staff is far more important. Commission should be reserved for sales people where it is easily measured against outcome.

    • SlavOz on 06/06/2022 - 09:06
      -2

      The problems though lie in the ability to rort the system

      The current system can be rorted too. If nurses get paid a guaranteed salary, then who's to stop them from just budging and waiting in the toilets until the end of their shift?

      • Quantumcat on 06/06/2022 - 09:36
        +11

        Maybe because people become nurses because they care about other people? A totally foreign concept to you I'll admit.

      • SydStrand on 06/06/2022 - 09:49
        +3

        Only a mean, cynical, small-minded person would assume this. In SlavOz World, there's no point to your job unless you're paid a fat commission.

  • morse on 06/06/2022 - 00:11
    +4

    pay nurses based on patiens…. lives saved

    lol - triage would certainly get interesting when the nurses just skip over the really sick ones as they’ve got a higher chance of dying and they won’t get their commission for saving a life.

    Or they just clock off as they’ve already made enough commission for one day and then there’s no staff left at the hospital.

    🤣🤣🤣 I’ve had a fairly average day/evening - this post made me laugh, thank you.

    • SlavOz on 06/06/2022 - 09:19
      -2

      lol - triage would certainly get interesting when the nurses just skip over the really sick ones as they’ve got a higher chance of dying and they won’t get their commission for saving a life.

      If they only admit healthy or low-risk patients, they wouldn't get the life saving bonus either, because those patients would never be in a fatal situation.

      Easiest argument ever to debunk. Time for the next one.

      Or they just clock off as they’ve already made enough commission for one day

      Literally never said this and its something you just made up. Most jobs with commission still have minimum hour requirements and shift times. You can't just come and and go as you please if you work at a car dealership. Second easiest argument ever to debunk.

      • SydStrand on 06/06/2022 - 09:45
        +3

        If they only admit healthy or low-risk patients, they wouldn't get the life saving bonus either, because those patients would never be in a fatal situation.

        What convoluted stupidity is this? A 'life saving bonus?' You realise that critical conditions aren't planned or predictable? So a nurse who is doing their job but doesn't get life-threatening walk ins during their shift, is suddenly making less, because their whole pay structure is now based on commissions. That's just great.

        And how do you determine what gets the 'life saving bonus?' You do realise there is ambiguity in medicine, right? What if there's no definitive diagnosis? You're now introducing opportunities to juke the stats by reclassifying diagnoses, changing DNRs to CPRs, etc.

        Instead of this unnecessarily complicated and pointless plan to treat nurses like salespeople and waiters, just pay them a fair wage and trust them to do their job.

        • Quantumcat on 06/06/2022 - 10:07

          Not to mention there is no way to tell what would have happened had the nurse done something else - by applying a bandage correctly maybe they saved the patient from getting an infection and then septicaemia and then death. Anything a nurse does could be life-saving even if it seems totally routine.

        • SlavOz on 06/06/2022 - 10:08
          -2

          So a nurse who is doing their job but doesn't get life-threatening conditions walking in their shift, is suddenly making less,

          Life threatening conditions happen often enough for it to aggregate reasonably across different shifts. Of course you might get a lucky night, other times it will be dead quiet. It balances out.

          You triage someone with a burst appendix, they get surgery which saves their life, you get a bonus. You know how common a burst appendix is? Severe infections which induce life threatening symptoms? Heart complications make up the bulk of our healthcare system. No shortage of opportunities for someone to experience a heart attack or some other abnormality that requires urgent attention.

          Heck, given our collective hysteria over COVID, you could've easily argued that administering vaccines was a life-saving intervention. Wouldn't surprise me at all.

          You do realise it's only very sick people in hospitals right? All of them could experience complications any moment. You could even get a patient that goes into cardiac arrest multiple times over a few days, spanning many different shifts.

          just pay them a fair wage and trust them to do their job.

          We tried that already. It's in place now.

          Didn't work.

          • SydStrand on 06/06/2022 - 10:30
            +5

            @SlavOz: Hear that, everyone? SlavOz feels a nurse was rude, so clearly the system 'didn't work.' Let's pack up this experiment and start paying nurses like Harvey Norman floor staff.

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