The impact of changes in incentives and governance on the motivation of dental practitioners

• Published in: The International journal of health planning and management 2011-01, Vol.26 (1), p.70-88
• Main Authors: Harris, Rebecca V., Dancer, Joanna M., Montasem, Alexander
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Autonomy; Business enterprises; Clinical Governance; Conflict; Contract Services - organization & administration; Cost Control; Cost effectiveness; Dental care; Dental Health Services - organization & administration; Dentist-Patient Relations; Dentists; Dentists - psychology; Enterprises; Environmental health; Fee-for-Service Plans - organization & administration; financial constraints; general dental practice; General Practice, Dental - organization & administration; Governance; Government and politics; Health administration; Health care policy; Health Care Reform; Health Policy; health sector reform; Humans; Impact analysis; Incentives; Independent contractors; Job Satisfaction; Medical personnel; Medical service; Motivation; Patients; Payment; Payments; Practice Management, Dental; Primary care; Professional Autonomy; Quality of Health Care; Reforms; Self interest; Small business; State Dentistry - organization & administration; United Kingdom
• ISSN: 0749-6753; 1099-1751
• DOI: 10.1002/hpm.1037

Recent changes to the system of remuneration and contracting arrangements with Primary Care Trusts (PCTs) has meant that dental practitioners in the UK have experienced several types of incentive and governance arrangements. This paper uses data from a qualitative study of 20 dental practitioners to examine the influence of different systems of incentives and governance on their motivational system. Results show that a perceived reduction in autonomy was the least acceptable aspect of the health reforms. The study also suggests that conflict between self‐interested and altruistic motives may occur where medical professionals operate as independent contractors in a small business environment. Whilst dentists appeared to show altruistic motives towards their patients, priorities towards running an autonomous business enterprise meant that PCT managerial requirements, for example, to widen access were not welcomed, because of their impact on managerial autonomy. Moreover, whilst dentists' professional ethos appeared geared towards achieving technically high quality standards of work, this produced tensions against a background of cost containment in a fee‐per‐item system of remuneration. The paper raises issues such as the person–system interaction associated with professional and individual autonomy and the importance of reciprocity and fair payment. Copyright © 2010 John Wiley & Sons, Ltd.