This is a bimonthly column by Les Jebson, administrator of the Orthopedics and Sports Medicine Institute at Prisma Health. This is the second installment.
Incentivizing perioperative surgical teams with additional compensation tied to performance milestones has the potential to improve quality, efficiency and accountability across the outpatient surgical continuum. Preoperative and postoperative care teams, perioperative scrub teams and turnover teams might benefit from participation in separate or collective incentive models. Financial incentives can align individual and team behaviors with facility or broader corporate goals such as reducing surgical site infections, improving on-time starts, decreasing length of stay or enhancing patient satisfaction. Well-designed, milestone-based compensation can promote collaboration among surgeons, nurses, and ancillary staff by reinforcing shared ownership of outcomes rather than siloed responsibilities. Incentives may also boost morale and engagement, particularly in high-stress perioperative environments, by recognizing excellence and reinforcing a culture of continuous improvement.
However, performance-based compensation models carry notable risks and limitations. Poorly chosen metrics may incentivize “teaching to the test” — encouraging teams to focus narrowly on measured outcomes while neglecting unmeasured, but equally important, aspects of care, such as communication, education or complex case management. There is also a risk of unintended consequences, including avoidance of more clinically complex patients who could negatively affect performance metrics, or tension among team members if contributions are perceived as unequal. Additionally, attributing outcomes to a multidisciplinary team can be challenging, as perioperative results are often influenced by factors outside the team’s direct control, such as patient comorbidities or post-discharge care. An incentive model that is quarterly, semi-annual or annual depending on the overall financial performance of the respective ASC at any given time can also have significant morale problems if they are reduced or even eliminated.
Ultimately, the effectiveness of incentivizing perioperative teams depends on thoughtful program design. Milestones must be evidence-based, risk-adjusted, transparent and achievable, with safeguards to protect patient-centered decision-making and equity. Non-financial motivators — such as professional recognition, feedback and opportunities for development — should complement monetary incentives. Without careful implementation and ongoing evaluation, compensation-based incentives may undermine trust and intrinsic motivation, but when aligned with clinical values, they can serve as a meaningful lever for improving perioperative performance and outcomes.
It is also prudent to note that incentive-based compensation can have a mixed effect on employee burnout, depending largely on how milestones are structured and perceived. On the positive side, well-designed incentives may even reduce burnout by validating effort in a high-pressure environment. When ASC teams feel that their hard work, efficiency, and quality improvements are recognized and rewarded, incentives can increase a sense of control, fairness and professional value. Team-based milestones — rather than individual ones — may also foster mutual support and shared problem-solving, which can buffer against emotional exhaustion.
Conversely, poorly implemented incentive models can exacerbate turnout and contribute to turnover in particularly scarce roles such as surgical technologist or perioperative nurse.
Burnout risks are especially pronounced when incentives fail to account for emotional labor and cognitive load, which are substantial in perioperative care but difficult to quantify. Staff may feel compelled to prioritize speed or throughput over recovery time, teaching, or psychological safety, leading to sustained stress and reduced resilience. Additionally, if financial incentives become expected rather than exceptional, their motivating effect diminishes while performance pressure remains.
To mitigate burnout, incentive programs should include realistic, well-defined risk-adjusted milestones. Incentive programs that incorporate measures of team well-being and allow for time flexibility during periods of high strain. Transparent communication, frontline staff involvement in metric selection and pairing financial incentives with wellness resources and protected recovery time are critical. When incentives support — not replace — a broader culture of support and respect, they are more likely to enhance engagement without contributing to burnout.
