Motivating health professionals through control mechanisms: A review of empirical evidence

Abstract

This paper summarizes the findings of the literature on the levers used in the health care sector to motivate workers, with a particular focus on the impact of management control tools (such as Performance Measurement Systems (PMS) and Pay for Performance) on motivation. A review of the literature was carried out using the ISI Web of Knowledge, Pubmed and JSTOR search engines on the topic of motivation of health care workers, including, if possible, all the involved categories of employees. The research focused on empirical studies published in Europe, North America and Oceania from 1990 to 2015. Developing countries were intentionally excluded because of their specific needs and motivation perspectives that mainly focus on recruitment or retention strategies to ensure services provision. Studies on motivation generally focus on three main perspectives: (1) Employees’ satisfaction and emotions; (2) Retention; (3) Motivation or attitudes to carry out specific tasks or to behave appropriately. A few studies considered compensation strategies and monetary rewards as a driver of health care workers’ motivation. These studies did not report the crowding out effect of external locus of causality on motivation. On the contrary, most of the studies highlighted the importance of the relationship with patients and colleagues as a crucial factor affecting workers’ motivation, in particular referring to job satisfaction. Despite the large number of articles on the topic of employee motivation, there have been very few studies on the impact of the most popular managerial mechanisms introduced since the mid 1990s in health care systems.