Salud Mesoamerica Initiative, Inter-American Development Bank, N.W., Washington, DC, United States of America.
Cornell University, Ithaca, New York, United States of America.
PLoS One. 2023 Aug 18;18(8):e0290457. doi: 10.1371/journal.pone.0290457. eCollection 2023.
There is a sparsity of knowledge of the specific mechanisms through which financial and non-financial incentives impact the performance of health teams. This study aims to address this knowledge gap by examining an in-kind incentives program for healthcare teams implemented in three districts in Belize (2012-2022) as part of the Salud Mesoamerica Initiative, which aimed to improve healthcare quality.
We performed a qualitative study to understand the mechanisms through which the in-kind incentive program supported quality improvement in Belize. We conducted key informant interviews (April-June 2021) remotely on a sample of former and current healthcare workers from Belize's Ministry of Health and Wellness familiar with the program. We analyzed responses using qualitative content analysis. We used open coding to identify patterns and themes.
We conducted eight key informant interviews from a pool of thirty potential informants. Our analysis of the interviews yielded a total of 11 major themes with 27 subthemes. Most informants reported that in-kind incentives were not the primary motivation for improving their performance, though they did acknowledge that incentives had increased their attention on the quality of care provided. Conversely, we found that quarterly measurements and supportive supervision by national level authorities offered an external validation mechanism and instilled frontline staff with a sense of shared responsibility towards improving their performance. The majority of informants conveyed positive opinions about the in-kind incentives program.
Our study contributes to the understanding of how in-kind incentives can enhance performance. We found that in-kind incentives created extrinsic motivation, leading to an increased focus on quality. Standardized measurements and supportive supervision improved intrinsic motivation and formed a stronger commitment to quality of care. Rather than focusing on tangible incentives, explicitly incorporating standardized measurements and supportive supervision in the routine work of the Ministry of Health could have longer lasting effects on quality improvement.
关于财务和非财务激励如何影响医疗团队绩效的具体机制，人们知之甚少。本研究旨在通过考察 2012 年至 2022 年期间在伯利兹三个地区实施的医疗团队实物激励计划来填补这一知识空白，该计划是中美洲健康倡议的一部分，旨在提高医疗质量。
我们进行了一项定性研究，以了解实物激励计划支持伯利兹改善医疗质量的机制。我们对伯利兹卫生部熟悉该计划的前和现任医疗工作者进行了远程关键知情人访谈（2021 年 4 月至 6 月）。我们使用定性内容分析对受访者的回答进行了分析。我们使用开放式编码来识别模式和主题。
我们从三十名潜在知情人中进行了八次关键知情人访谈。我们对访谈的分析共产生了 11 个主要主题和 27 个子主题。大多数知情人表示，实物激励并不是提高绩效的主要动机，但他们确实承认激励措施增加了他们对提供的护理质量的关注。相反，我们发现，国家一级当局的季度衡量和支持性监督提供了一个外部验证机制，并向一线工作人员灌输了对改善绩效的共同责任感。大多数知情人对实物激励计划表示了积极的看法。
我们的研究有助于理解实物激励如何增强绩效。我们发现，实物激励创造了外在动机，使人们更加关注质量。标准化衡量和支持性监督提高了内在动机，并形成了对护理质量更强的承诺。与其关注有形激励，不如在卫生部的日常工作中明确纳入标准化衡量和支持性监督，可能会对质量改进产生更持久的影响。
