Can external interventions crowd in intrinsic motivation? A cluster randomised field experiment on mandatory accreditation of general practice in Denmark

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

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)224-233
Number of pages10
JournalSocial Science and Medicine
Volume211
DOIs
StatePublished - Aug 1 2018

Fingerprint

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

Keywords

  • Accreditation
  • Crowding in
  • Crowding out
  • Denmark
  • External interventions
  • General practice
  • Intrinsic motivation

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science

Cite this

Can external interventions crowd in intrinsic motivation? A cluster randomised field experiment on mandatory accreditation of general practice in Denmark. / Pedersen, Line Bjørnskov; Andersen, Merethe Kirstine Kousgaard; Jensen, Ulrich; Waldorff, Frans Boch; Jacobsen, Christian Bøtcher.

In: Social Science and Medicine, Vol. 211, 01.08.2018, p. 224-233.

Research output: Contribution to journalArticle

Pedersen, Line Bjørnskov ; Andersen, Merethe Kirstine Kousgaard ; Jensen, Ulrich ; Waldorff, Frans Boch ; Jacobsen, Christian Bøtcher. / Can external interventions crowd in intrinsic motivation? A cluster randomised field experiment on mandatory accreditation of general practice in Denmark. In: Social Science and Medicine. 2018 ; Vol. 211. pp. 224-233.
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