Managerial strategies to make incentives meaningful and motivating

Abstract

PurposePolicy makers are applying market-inspired competition and financial incentives to drive efficiency in healthcare. However, a lack of knowledge exists about the process whereby incentives are filtered through organizations to influence staff motivation, and the key role of managers is often overlooked. The purpose of this paper is to explore the strategies managers use as intermediaries between financial incentives and the individual motivation of staff. The authors use empirical data from a local case in Swedish specialized care.Design/methodology/approachThe authors conducted an exploratory qualitative case study of a patient-choice reform, including financial incentives, in specialized orthopedics in Sweden. In total, 17 interviews were conducted with professionals in managerial positions, representing six healthcare providers. A hypo-deductive, thematic approach was used to analyze the data.FindingsThe results show that managers applied alignment strategies to make the incentive model motivating for staff. The managers’ strategies are characterized by attempts to align external rewards with professional values based on their contextual and practical knowledge. Managers occasionally overruled the financial logic of the model to safeguard patient needs and expressed an interest in having a closer dialogue with policy makers about improvements.Originality/valueExternally imposed incentives do not automatically motivate healthcare staff. Managers in healthcare play key roles as intermediaries by aligning external rewards with professional values. Managers’ multiple perspectives on healthcare practices and professional culture can also be utilized to improve policy and as a source of knowledge in partnership with policy makers.

Exploring staff experience of economic efficiency requirements in health care: A mixed method study

“…The qualitative data provide interesting insights on how staff perceives the role of managers in relation to economic efficiency requirements, which partly contradicts the literature describing managers as key intermediaries between externally imposed requirements and staff. 16,18,19 The findings suggest that managers act as intermediaries in some aspects, making sense of the system by providing guidelines on how to manage resources and providing guidance and support when needed. Yet, based on our findings, respondents seem to make clear-sighted and sophisticated analyses of different aspects of economic governance across the vertical organization of the hospital as well as horizontally, across different stakeholders.…”

“…The qualitative data provide interesting insights on how staff perceives the role of managers in relation to economic efficiency requirements, which partly contradicts the literature describing managers as key intermediaries between externally imposed requirements and staff . The findings suggest that managers act as intermediaries in some aspects, making sense of the system by providing guidelines on how to manage resources and providing guidance and support when needed.…”

“…Concurrently, empirical studies have identified medically informed managers who function as a “hybrid,” successfully bringing professionalism and managerialism together . However, this has mainly been studied with hybrid managers in focus, exploring their abilities to articulate economic efficiency requirements in relation to clinical work and to adapt communication to professional culture . Clinical competence at top management and board level is related to improved quality of providers and the involvement of clinical managers in budgetary work has been shown to contribute to improved financial performance at the organizational level .…”

Financial incentives linked to quality improvement projects in Swedish primary care: a model for improving quality of care

“…Characteristics, such as leadership, direction, organisational culture, training, resources and practical support, have been shown to be important factors 33. The balance between assessment (in relation to requirements for funding) and general support in an allowing atmosphere can be a delicate task 34. However, there could be a similar effect in other regions in Sweden or in other countries.…”

Motivators for medical staff with a high gap in healthcare efficiency: Comparative research from Poland and Ukraine

“…As Korlén et al 14 wrote, 'motivation is a multidimensional phenomenon defined as the energy and intention behind an action'. Considering the theory of motivation, it has to be noted that Herzberg et al 15 called the motivators the intrinsics that satisfy people by what they do, and the hygiens the extrinsics (environment) of the job that can satisfy or dissatisfy people.…”