Can External Interventions Crowd In Intrinsic Motivation?

A Cluster Randomized Field Experiment on Mandatory Accreditation of General Practice in Denmark

Line Bjørnskov Pedersen, Merethe Kirstine Kousgaard Andersen, Ulrich Thy Jensen, Frans Boch Waldorff, Christian Bøtcher Jacobsen

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Resumé

Motivation crowding studies have demonstrated that external interventions can harm effort and performance through crowding out of intrinsic motivation, when interventions are perceived as lack of trust. However, motivation crowding theory also presents a much less investigated crowding in effect, which occurs when external interventions increase intrinsic motivation. This study empirically tests the motivational effect of a specific external intervention and its associations with the perception of the intervention. We draw on a cluster randomised stepwise introduction of a mandatory accreditation system in general practice in Denmark combined with baseline and follow-up questionnaires of 1146 GPs. Based on a series of mixed effects multilevel models, we find no evidence of motivation crowding out among surveyed GPs, although most GPs perceived accreditation as a tool for external control prior to its implementation. Rather, our results indicate that being accredited crowds in intrinsic motivation. This is especially the case when GPs perceive accreditation as an instrument for quality improvement. External interventions can therefore, at least in some cases, foster intrinsic motivation of health care professionals.

OriginalsprogEngelsk
TidsskriftSocial Science & Medicine
Vol/bind211
Sider (fra-til)224-233
ISSN0277-9536
DOI
StatusUdgivet - aug. 2018

Fingeraftryk

Accreditation
intrinsic motivation
Denmark
accreditation
General Practice
Crowding
experiment
crowding out
Crowds
Intrinsic Motivation
Experiment
health care
questionnaire
Delivery of Health Care
lack
performance
evidence

Citer dette

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abstract = "Motivation crowding studies have demonstrated that external interventions can harm effort and performance through crowding out of intrinsic motivation, when interventions are perceived as lack of trust. However, motivation crowding theory also presents a much less investigated crowding in effect, which occurs when external interventions increase intrinsic motivation. This study empirically tests the motivational effect of a specific external intervention and its associations with the perception of the intervention. We draw on a cluster randomised stepwise introduction of a mandatory accreditation system in general practice in Denmark combined with baseline and follow-up questionnaires of 1146 GPs. Based on a series of mixed effects multilevel models, we find no evidence of motivation crowding out among surveyed GPs, although most GPs perceived accreditation as a tool for external control prior to its implementation. Rather, our results indicate that being accredited crowds in intrinsic motivation. This is especially the case when GPs perceive accreditation as an instrument for quality improvement. External interventions can therefore, at least in some cases, foster intrinsic motivation of health care professionals.",
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