The reasons for our actions may not be as straightforward as they seem, says Raj Persaud

The basic assumption made by those who run the country is that we do what we do in order to make money. This seems to make sense since money is something you can use to exchange for many desirable items, such as increased control over your life and more freedom.

However, recent psychological experiments have begun to cast doubt on this assumption, which lies at the very foundations of our economy. In these experiments, subjects are invited to participate in the 'ultimatum' game, which is a way of exploring and measuring co-operation between two people. Classically, the game is played between a 'proposer' and a 'responder'. The proposer is given a sum of money to divide with the responder, with the proposer's role to suggest a way of dividing the funds. The responder can decide to accept the offer or not. The key feature is that if the responder accepts, the two are allowed to split the money accordingly and keep the bounty. However, if the responder rejects the offer, neither party gets any cash.

Logically, since the responder is given no capital at all at the outset, it would make sense to accept any offer made by the proposer, no matter how inequitable. Astonishingly, the actual result when both psychologists and economists play this ultimatum game in their laboratories is that offers below 20 per cent are usually rejected by responders, even when this amounts to a substantial sum, such as the equivalent of half a day's pay.

A relatively new theory proposed by Dr Terence Burnham, an economist based at Harvard, is that the experiment demonstrates most of us are willing to suffer personal loss if that stops someone else getting ahead - particularly if it looks as though they are doing better than us.

In other words, it is not that we seek money as such, more that we seek to have more relative to others. So, if everyone else does better than us - even if we have more as well - we can end up more upset than if we hadn't gained at all.

This is relevant to NHS management even when money is not directly at stake - after all, NHS workers are not often going to make more or less money for themselves as a result of managerial decisions. But in this situation, other factors come to the fore: social comparison and dominance are still at stake, and can take the place of money in psychological transactions.

It may be that managers could go a long way to securing changes they require from staff by ensuring social comparison and respect are dealt with outside the issue causing contention. It may be staff resistance to change stems from a sense of not doing as well compared to others elsewhere in the system or even outside of the NHS.

So any manager keen to drive through difficult changes would do well directly or indirectly to find out with whom staff are comparing themselves, and what the psychological consequences are of such a comparison.

In the often fraught managerial climate of the NHS, staff can perceive a lack of respect. This can only be storing up trouble for when the organisation's own particular ultimatum game comes to be played.

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