Examining organisational responses to performance-based financial incentive systems: a case study using NHS staff influenza vaccination rates from 2012/2013 to 2019/2020.
Author
Liaqat, AdibaGallier, Suzy
Reeves, Katharine
Crothers, Hannah
Evison, Felicity
Schmidtke, Kelly
Bird, Paul
Watson, Samuel I
Khunti, Kamlesh
Lilford, Richard
Publication date
2021-09-28Subject
Health statistics
Metadata
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Objective: Financial incentives are often applied to motivate desirable performance across organisations in healthcare systems. In the 2016/2017 financial year, the National Health Service (NHS) in England set a national performance-based incentive to increase uptake of the influenza vaccination among frontline staff. Since then, the threshold levels needed for hospital trusts to achieve the incentive (ie, 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 among staff in all acute NHS hospital trusts across eight vaccination seasons (2012/2013-2019/2020). 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 4 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.Citation
Liaqat A, Gallier S, Reeves K, Crothers H, Evison F, Schmidtke K, Bird P, Watson SI, Khunti K, Lilford R. Examining organisational responses to performance-based financial incentive systems: a case study using NHS staff influenza vaccination rates from 2012/2013 to 2019/2020. BMJ Qual Saf. 2022 Sep;31(9):642-651. doi: 10.1136/bmjqs-2021-013671. Epub 2021 Sep 28Type
ArticleAdditional Links
http://qualitysafety.bmj.comPMID
34583977Journal
BMJ Quality & SafetyPublisher
BMJ Publishing Groupae974a485f413a2113503eed53cd6c53
10.1136/bmjqs-2021-013671