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Creating Your Own Radiological Currency to Motivate Union Technologists

May 13, 2024

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Could the principles of operant conditioning reinforce more of a simpatico relationship between radiologists and technologists?

A plea for advice came across one of the radiology social media I prowl. An interventional guy lamented his lackluster techs, who routinely fail to do basic things like setting up procedural tables or scrubbing in to assist. He saw that it would take a “massive culture shift” to correct their behavior, lest other IR guys (including future hires) quit.

Some replying rads were understandably incredulous. These are the techs’ basic responsibilities. How is it even an option for them not to do their jobs? Refusal should mean termination.

One response, unfortunately, told the tale, asking “Union?” The IR confirmed, “U know it.” Another rad shared that he had seen such things happen with the techs’ attitude being: “The CBA says I operate X-ray equipment. What you’re asking me to do is a nursing task.” If the techs’ contract runs until 2027 and administration doesn’t step in to support the rads, nothing is changing soon.

I am not about to wade into a discussion of the pros and cons of unions, or the could’ve/would’ve/should’ves of how a hospital administration might (dis)allow them to rule the roost. I am focused on what one’s options are in such an untenable mess. One might clearly see simple fixes, like firing the bad eggs and hiring good ones to replace them, but for whatever reasons, one isn’t able to execute those fixes.

When you can’t pull the levers which would correct your situation, it usually doesn’t do much good to keep reaching for them anyway, or repeatedly complain about why you can’t. My approach is to look for other levers that escaped initial detection or create some new ones.

This came up a few times in telerad entities I inhabited, initially when juggling how much to value cases. Budgets tended to be closed, fixed systems, so if you wanted to pay more for Peter-scans, you’d have to rob Paul-o-grams to do it. That sort of maneuver created winners and losers within the ranks, but no overall improvement. Similar struggles came from figuring out coverage for nights, holidays, weekends, etc.

You can of course fight to get your budget increased, but that is already a perpetual battle, and adding one more reason why you’re fighting it won’t make a difference. I suggested that, rather than vainly hope to be granted a little more of the established currency, we create our own. The same thing came to mind when I saw the post about unmotivated IR techs.

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I might have gotten the idea courtesy of my psych degree. You’ve probably heard of “operant conditioning,” where you reward behaviors you want to encourage and withhold rewards from, or punish, the behaviors you want to discourage. Levers used for this in the employment setting are time and money, such as amount of vacation, salary, and bonuses.

If, as in the IR doc’s situation, the techs’ union-negotiated contracts with the hospital make time and money unmovable levers, you can’t use those as positive or negative reinforcers.

Instead, create something of value other than a dollar which you can adjust. Call it whatever you like whether they are merits, good citizenship points, kudos, tokens, ducats. Since you’re making it up, it is nowhere to be found in any contracts, and you have a free hand to create the rules about your new currency. You can even change them as you go along if course correction is needed.

Of course, you will want to figure this out with your teammates beforehand, so everybody is on board and ready to present a united front. In the IR guy’s case, that means whatever other rads are to be working with the techs. It is probably a good idea to loop in your department’s leadership as well.

When ready, the initiative can be presented to the rank and file. Best to make it sound positive. Psych folks will tell you that reward is more effective than punishment. You want folks to see ways they will personally gain from it. It’s also a good idea to emphasize that this is a work in progress. This will preserve your right to make changes as things go along. “We’re going to try something new to reward folks who contribute to the team effort and make this department run well.”

You might then run down a list of various things that will earn people your new currency. In the IR example, for instance, a tech who preps a table might earn five points. Scrubbing in to assist with a procedure might get another five points. Volunteering to cover an extra weekend of call might get 10 points.

Whatever standard values are set, you can also empower the IR rads to reward other good behaviors as they occur or deduct points for bad stuff, but I reiterate that punishment is less psychologically effective so do this rarely if at all. It’s useful to keep a record of how many points are allocated by whom, and for what reasons, to maintain transparency. You don’t want any appearance of favoritism (Doc X is known to be generous, and thus everyone wants to work with him, or Doc Y seems to be sweet on Tech Z).

Each tech’s name and currency tally should be prominently displayed, such as on a big monitor, for constant visibility. It could be accessed elsewhere, such as online, but the main value is for everyone to routinely see the scores. People tend to be competitive or at least embarrassed over being dead last. Even without assigning any tangible benefit to the scores, they can serve as a positive reinforcement for behavior.

Of course, there should be a benefit. Otherwise, it wouldn’t be much of a currency. Some benefits could be permanently established: When it comes time to divvy holidays or call shifts, first choice goes to whoever has the highest score and then down the list. Other benefits might be situational or distributed in a spur-of-the-moment fashion. We’ve got enough in the budget to bring two techs with us to Conference X in Vegas, so the right of first refusal goes to top of the list.

You don’t want the scores to be indelible. If a tech racks up several hundred points above the rest, others might not consider it a possibility to ever catch up and stop trying. So, maybe once or twice a year, there can be a clearinghouse in which all scores are converted to dollars and paid out. Even if administration or department leadership isn’t willing to give a few hundred bucks to cover it, perhaps the IR guys who now have techs competing to be their most valuable helpers will be willing to reach into their own pockets.