Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study
Impact of financial incentives on clinical autonomy and internal motivation in primary care: ethnographic study
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DOI：
10.1136/bmj.39238.890810.be
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发表时间：
2007-06-30
影响因子：
105.7
通讯作者：
Roland, Martin
中科院分区：
文献类型：
--
作者：
McDonald, Ruth;Harrison, Stephen;Roland, Martin
目的 探讨护理质量财务激励对初级保健医生和护士的执业组织、临床自主性和内部动机的影响。设计人种学案例研究。设置两个英国全科诊所。参与者 12 名全科医生、9 名护士、4 名医疗助理和 4 名行政人员。主要结果指标 2004 年全科医生合同中引入护理质量财务激励措施后五个月内的实践观察。引入质量激励后的结果和结果框架越来越多地使用模板来收集护理质量数据。采用了新的监测方案，临床医生被视为“追逐者”或“被追逐者”，具体取决于他们实现质量目标的个人责任。人们对合同的态度基本上是积极的，尽管对更严格的监测方案的实践的不满情绪更高。护士比医生更关心临床实践的变化，但也很高兴被赋予实现特定疾病领域目标的责任。大多数医生并没有质疑当时存在的质量目标或目标对他们自己的临床自主权的影响。结论实施护理质量财政激励似乎并没有损害所研究的全科医生的内在动机，尽管护士表达了更多的担忧。
Objective To explore the impact of financial incentives for quality of care on practice organisation, clinical autonomy, and internal motivation of doctors and nurses working in primary care.Design Ethnographic case study.Setting Two English general practices.Participants 12 general practitioners, nine nurses, four healthcare assistants, and four administrative staff.Main outcome measure Observation of practices over a five month period after the introduction of financial incentives for quality of care introduced in the 2004 general practitioner contract.Results After the introduction of the quality and outcomes framework there was an increase in the use of templates to collect data on quality of care. New regimens of surveillance were adopted, with clinicians seen as "chasers" or the "chased," depending on their individual responsibility for delivering quality targets. Attitudes towards the contract were largely positive, although discontent was higher in the practice with a more intensive surveillance regimen. Nurses expressed more concern than doctors about changes to their clinical practice but also appreciated being given responsibility for delivering on targets in particular disease areas. Most doctors did not question the quality targets that existed at the time or the implications of the targets for their own clinical autonomy.Conclusions Implementation of financial incentives for quality of care did not seem to have damaged the internal motivation of the general practitioners studied, although more concern was expressed by nurses.