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Examining organisational responses to performance-based financial incentive systems : a case study using NHS staff influenza vaccination rates from 2012/13 to 2019/20
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Liaqat, Adiba, Gallier, Suzy, Reeves, Katharine, Crothers, Hannah, Evison, Felicity, Schmidtke, Kelly, Watson, Samuel I, Khunti, Kamlesh, Lilford, Richard and Bird, Paul (2022) Examining organisational responses to performance-based financial incentive systems : a case study using NHS staff influenza vaccination rates from 2012/13 to 2019/20. BMJ Quality and Safety, 31 (9). pp. 623-626. doi:10.1136/bmjqs-2021-013671 ISSN 2044-5423.
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Official URL: http://dx.doi.org/10.1136/bmjqs-2021-013671
Abstract
Objective: Financial incentives are often applied to motivate desirable performance across organisations in healthcare systems. In the 2016/17 financial year, the National Health Service (NHS) in England set a national performance-based incentive to increase uptake of the influenza vaccination amongst front-line staff. Since then, the threshold levels needed for hospital trusts to achieve the incentive (i.e., the targets) have ranged from 70% to 80%. The present study examines the impact of this financial incentive across eight vaccination seasons.
Design: A retrospective observational study examining routinely recorded rates of influenza vaccination amongst staff in all acute NHS hospital trusts across eight vaccination seasons (2012/13-2019/20). The number of trusts included varied per year, from 127 to 137, due to organisational changes. McCrary’s density test is conducted to determine if the number of hospital trusts narrowly achieving the target by the end of each season is higher than would be expected in the absence of any responsiveness to the target. We refer to this bunching above the target threshold as a “threshold effect”.
Results: In the years before a national incentive was set, 9%-31% of NHS Trusts reported achieving the target, compared with 43%-74% in the four years after. Threshold effects did not emerge before the national incentive for payment was set; however, since then, threshold effects have appeared every year. Some trusts report narrowly achieving the target each year, both as the target rises and falls. Threshold effects were not apparent at targets for partial payments.
Conclusions: We provide compelling evidence that performance-based financial incentives produced threshold effects. Policymakers who set such incentives are encouraged to track threshold effects since they contain information on how organisations are responding to an incentive, what enquiries they may wish to make, how the incentive may be improved and what unintended effects it may be having.
Item Type: | Journal Article | |||||||||
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Subjects: | R Medicine > RA Public aspects of medicine | |||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Medical care, Cost of -- Great Britain, Medical economics -- Great Britain, Wages and labor productivity -- Great Britain, Bonuses (Employee fringe benefits), Medical policy -- Research, Health care reform -- Great Britain, Compensation management | |||||||||
Journal or Publication Title: | BMJ Quality and Safety | |||||||||
Publisher: | BMJ Group | |||||||||
ISSN: | 2044-5423 | |||||||||
Official Date: | 11 February 2022 | |||||||||
Dates: |
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Volume: | 31 | |||||||||
Number: | 9 | |||||||||
Page Range: | pp. 623-626 | |||||||||
DOI: | 10.1136/bmjqs-2021-013671 | |||||||||
Status: | Peer Reviewed | |||||||||
Publication Status: | Published | |||||||||
Reuse Statement (publisher, data, author rights): | This article has been accepted for publication in BMJ Quality and Safety, 2021 following peer review, and the Version of Record can be accessed online at [insert full DOI eg. http://dx.doi.org/10.1136/xxxxx]. © Authors (or their employer(s)) OR “© BMJ Publishing Group Ltd” (for assignments of BMJ Case Reports) 2021 | |||||||||
Access rights to Published version: | Restricted or Subscription Access | |||||||||
Date of first compliant deposit: | 2 September 2021 | |||||||||
Date of first compliant Open Access: | 1 October 2021 | |||||||||
Funder: | The National Institute for Health Research: Applied Research Collaboration-West Midlands grant number NIHR200165. The funders had no role in the design of the workshop or interpretation of data and in writing the manuscript. | |||||||||
RIOXX Funder/Project Grant: |
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