[Leaders as intermediates between economic incentive models and professional motivation]

The application of economic incentives to providers in health care governance is debated. Advocates argue that it drives efficiency and improvement, opponents claim that it leads to unintended consequences for patients and professionals. Research shows that incentives can increase well-defined activities and targets, but there is a lack of substantial evidence that applications in health care lead to desired outcomes. The motivational literature acknowledges internal sources of motivation as important determinants of behavior, and the literature about professions suggests that professional values of serving patient needs is a key motivator. The management literature identifies the important role of leaders in aligning external demands and rewards to staff preferences, using their own management and leadership skills. Findings in health services research confirm the vital role of leaders for successful implementation and improvement work. In sum, internal motivators and the role of leaders are important to acknowledge also when understanding how economic governance models are put into practice.Our recently published qualitative case study provides empirical examples of how clinical leaders function as intermediaries between a local care choice model, including financial incentives, and the motivation of staff. The strategies deployed by the leaders aimed to align the economic logics of the model to the professional focus on increasing patient value. The main conclusion from these empirical examples, as well as previous research, is that health care managers play a key role in aligning economic incentive models with professional values and in translating such models in to feasible tasks related to the provision of high quality care.