Understanding incentive preferences of community health workers using discrete choice experiments: a multicountry protocol for Kenya, Uganda, Bangladesh and Haiti.

INTRODUCTION: There is a renewed global interest in improving community health worker (CHW) programmes. For CHW programmes to be effective, key intervention design factors which contribute to the performance of CHWs need to be identified. The recent WHO guidelines recommends the combination of financial and non-financial incentives to improve CHW performance. However, evidence gaps remain as to what package of incentives will improve their performance in different country contexts. This study aims to evaluate CHW incentive preferences to improve performance and retention which will strengthen CHW programmes and help governments leverage limited resources appropriately. METHODS AND ANALYSIS: A discrete choice experiment (DCE) will be conducted with CHWs in Bangladesh, Haiti, Kenya and Uganda with different levels of maturity of CHWs programmes. This will be carried out in two phases. Phase 1 will involve preliminary qualitative research including focus group discussions (FGDs) and key informant interviews to develop the DCE design which will include attributes relevant to the CHW country settings. Phase 2 will involve a DCE survey with CHWs, presenting them with a series of job choices with varying attribute levels. An orthogonal design will be used to generate the choice sets for the surveys. The surveys will be administered in locally-appropriate languages to at least 150 CHWs from each of the cadres in each country. Conditional and mixed multinomial logit (MMNL) models will be used for the estimation of stated preferences. ETHICS AND DISSEMINATION: This study has been reviewed and approved by the Population Council's Institutional Review Board in New York, and appropriate ethics review boards in Kenya, Uganda, Bangladesh and Haiti. The results of the study will be disseminated through in-country dissemination workshops, meetings with country-level stakeholders and policy working groups, print media, online blogs and peer-reviewed journals.

On Voluntariness in Wellness: Considering Organizational Health Contingent Incentives.

Some would argue that if taking an examination to receive an incentive is not mandatory, it's voluntary no matter the size of the monetary reward. Others have concerns with how often employers use the word "required" when communicating how employees can earn an incentive. This in spite of clear rules that indicate "health contingent" incentive designs (those based on health measures rather than on completing activities) are an either/or proposition. That is, you can either earn (this amount) by (achieving a clinical standard) or by (participating in or attaining an alternative standard). This editorial examines the merits and demerits of organizational health contingent use of incentives. It is posited that employers can best satisfy a voluntariness standard in their use of financial incentives in wellness programs when the use of incentives are well integrated into a measurably robust, organizational culture that visibly values health; and when all employees are well versed in the meaning of, and opportunities for, reasonable alternatives for earning an incentive. Concerns about the administrative burden behind this idea and other potential unintended consequences of including measures of a culture of health to meet a voluntariness standard are also presented.

Leadership Intellectual Stimulation and Team Learning: the Mediating Role of Team Positive Affect / Estimulación intelectual del líder y aprendizaje del equipo: El rol mediador del afecto positivo del equipo

Abstract This study investigates how leadership intellectual stimulation relates to team positive affect and team learning. We explore the role of positive affect as mediator between leadership intellectual stimulation and team learning. Using a cross-sectional sample of 562 employees, nested within 130 teams from 44 small- and medium-size organizations, we implemented Structural Equation Model analysis at the team level. Results provide evidence of the strong relationship that intellectual stimulation has on team learning and team positive affect, as well as the potential of positive affect for stimulating team learning. Team positive affect serves as a partial mediator between intellectual stimulation and team learning, contributing to explain significant additional variance. Leadership intellectual stimulation is a relevant team social resource that provides support for team learning. Also, positive affect contributes significantly to improve learning among teams. This suggests the importance of developing leadership behaviors that encourage learning and team positive affect, which contributes to team learning and hence, performance.

Resumen Este estudio examina cómo la estimulación intelectual de los líderes se relaciona con el afecto positivo y el aprendizaje de los equipos. En específico, explorarnos el rol mediador del afecto positivo entre la relación de la estimulación intelectual de los líderes y al aprendizaje a nivel de los equipos. Realizamos análisis de modelos de ecuaciones estructurales a nivel grupal utilizando una muestra transversal de 562 empleados, anidados en 130 equipos de 40 pequeñas y medianas organizaciones. Los resultados proveen evidencia de la fuerte relación entre la estimulación intelectual y el afecto positivo, así como del potencial del afecto positivo para estimular el aprendizaje del equipo. El afecto positivo sirve como un mediador parcial contribuyendo a explicar varianza adicional significativa. La estimulación intelectual de los líderes es un recurso social relevante que provee apoyo al aprendizaje en los equipos. Del mismo modo, el afecto positivo contribuye significativamente a mejorar el aprendizaje. Esto sugiere la importancia de desarrollar comportamientos de los líderes que fomenten el aprendizaje y el afecto positivo, los cuales contribuyen al aprendizaje y al desempeño a nivel grupal.

Mow to Assess, Recognize, and Reward Teamwork.

Although meaicai practice managers often know a lot about how to reward individual employee performance, they may not be as well versed in the best strategies for rewarding teamwork. However, the most effective employee recognition and rewards programs focus on both individual and team performance. This article describes strategies that practice managers can use to reward teamwork without lessening their employees' desire to perform well individually. It describes five possible goals for a team rewards program and 10 practical tips for assessing and rewarding teamwork. This article also identifies three common concerns about rewarding teamwork and strategies for overcoming those concerns. It describes three types of team rewards programs and discusses when to use continuous and intermittent rewards. This article also offers medical practice managers a reliable five-question survey to use with their employees to assess teamwork and suggests a strategy to encourage employees to recognize the teamwork they observe in one another. Finally, this article explores the importance of the medical practice manager's attitude about team recognition and rewards and suggests what to do when the manager is conflicted about the team rewards he or she must give.

How to avoid 'death by benchmarking'.

Hospitals and health systems should adopt four key principles and practices when applying benchmarks to determine physician compensation: Acknowledge that a lower percentile may be appropriate. Use the median as the all-in benchmark. Use peer benchmarks when available. Use alternative benchmarks.

Optimizing enrollment in employer health programs: a comparison of enrollment strategies in the Diabetes Health Plan.

BACKGROUND: Many health programs struggle with low enrollment rates. OBJECTIVES: To compare the characteristics of populations enrolled in a new health plan when employer groups implement voluntary versus automatic enrollment approaches. STUDY DESIGN: We analyzed enrollment rates resulting from 2 different strategies: voluntary and automatic enrollment. We used regression modeling to estimate the associations of patient characteristics with the probability of enrolling within each strategy. The subjects were 5014 eligible employees from 11 self-insured employers who had purchased the Diabetes Health Plan (DHP), which offers free or discounted copayments for diabetes related medications, testing supplies, and physician visits. Six employers used voluntary enrollment while 5 used automatic enrollment. The main outcome of interest was enrollment into the DHP. Predictors were gender, age, race/ethnicity, dependent status, household income, education level, number of comorbidities, and employer group. RESULTS: Overall, the proportion of eligible members who were enrolled within the automatic enrollment strategy was 91%, compared with 35% for voluntary enrollment. Income was a significant predictor for voluntary enrollment but not for automatic enrollment. Within automatic enrollment, covered dependents, Hispanics, and persons with 1 nondiabetes comorbidity were more likely to enroll than other subgroups. Employer group was also a significant correlate of enrollment. Notably, all demographic groups had higher DHP enrollment rates under automatic enrollment than under voluntary enrollment. CONCLUSIONS: For employer-based programs that struggle with low enrollment rates, especially among certain employee subgroups, an automatic enrollment strategy may not only increase the total number of enrollees but may also decrease some enrollment disparities.

Motivating employees through incentives: productive or a counterproductive strategy.

The disparity between human resource in health and provision of health services is a growing concern worldwide. Many developing countries are facing this crisis and therefore human resource in health is considered a high priority on their agenda.This imbalance between supplies of human resource is exacerbated by migration of health workers in many countries. Understanding the motivational factor is an important aspect to retain the migrating health workforce. This paper analyses the role of financial and non financial incentives in motivating the health work force. A review of available literature was conducted to understand the role of motivational factor in retaining health workforce. A review of current literature found that an incentive plays a key role in motivating a health worker. Financial incentives are useful in improving the compliance to standard policies and procedures. Comprehensive integrated incentive system approach should be established to develop a sustainable health workforce with required skill. Likewise monetary incentives should be linked to adherence to provincial and national guidelines and procedures. Sustainability could be ensured by commitment of government, political will and involvement of key stakeholders and decision makers.

Effect of a novel financial incentive program on operating room efficiency.

IMPORTANCE: Operating room (OR) turnaround times (TATs) and on-time first-case starts (FCSs) are commonly used measures of OR efficiency. Prolonged TATs and late FCSs occur frequently at academic medical centers. OBJECTIVE: To test the hypothesis that establishing a financial incentive program (FIP) for OR teams would improve efficiency, leading to decreased TATs and improved on-time FCSs. DESIGN, SETTING, AND PARTICIPANTS: Prospective study to evaluate the effect of an FIP on OR efficiency between March 1, 2013, and December 31, 2013, at a freestanding academic trauma hospital. Participants were all OR team members and included anesthesiologists, certified registered nurse anesthetists, nurses, and technicians. INTERVENTIONS: Operating room efficiency awareness education was conducted before FIP implementation beginning in February 2013. Each eligible OR team member achieving a TAT of 60 minutes or less or an on-time FCS was awarded 1 point. Reports listing individual performances were posted. Pay bonuses were awarded for achieving 1 of 3 progressive point totals in any month. MAIN OUTCOMES AND MEASURES: Outcomeswere TAT, whichwas defined as "wheels out" to "wheels in," and on-time FCS, which was defined as "wheels in" within 6 minutes of the scheduled start time. RESULTS: Before FIP implementation, the mean TAT varied between 77 and 83 minutes, with only 18%to 26%of TATs being 60 minutes or less; on-time FCSs averaged 29% to 34%. After FIP implementation, on-time FCSs improved from 31% to 64%(P < .001), and TATs of 60 minutes or less increased from 24%to 52%(P < .001). The cost of a 2-month FIP was $8340. We saved 13 minutes per TAT, for an estimated savings of $177 000.We estimate an additional savings of $33 000 for on-time FCSs, for a total hospital savings of $210 000. CONCLUSIONS AND RELEVANCE: A novel FIP improved OR efficiency. Given the small amount of money involved, it seems unlikely that financial incentives were solely responsible. Effectively communicating the importance of TATs and on-time FCSs and publishing individual results more likely increased staff awareness. Teamwork created by linking assignment of points to a team result likely contributed to success.

Wellness incentives in the workplace: cost savings through cost shifting to unhealthy workers.

The Affordable Care Act encourages workplace wellness programs, chiefly by promoting programs that reward employees for changing health-related behavior or improving measurable health outcomes. Recognizing the risk that unhealthy employees might be punished rather than helped by such programs, the act also forbids health-based discrimination. We reviewed results of randomized controlled trials and identified challenges for workplace wellness programs to function as the act intends. For example, research results raise doubts that employees with health risk factors, such as obesity and tobacco use, spend more on medical care than others. Such groups may not be especially promising targets for financial incentives meant to save costs through health improvement. Although there may be other valid reasons, beyond lowering costs, to institute workplace wellness programs, we found little evidence that such programs can easily save costs through health improvement without being discriminatory. Our evidence suggests that savings to employers may come from cost shifting, with the most vulnerable employees--those from lower socioeconomic strata with the most health risks--probably bearing greater costs that in effect subsidize their healthier colleagues.