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

School of Dentistry, University of Liverpool, UK.
International Journal of Health Planning and Management (Impact Factor: 0.97). 01/2011; 26(1):70-88. DOI: 10.1002/hpm.1037
Source: PubMed


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.

Download full-text


Available from: Rebecca Vera Harris
  • Source
    • "The premises and facilities of UK dental practices are owned by the principal dentist(s) who is also responsible for the payment of staff and overheads [21]. The owner's income is generated by the difference between practice income and expenditure (Fig. 1). "
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate how changes to the dental remuneration system have translated into disincentives to delegate to dental therapists in dental practices. A purposive sample of nine practices was identified incorporating a mix of small, medium and large practices, both with and without dental therapists (DTs). Semi-structured interviews were carried out with 48 principal dentists, associate dentists, DTs, practice managers and dental hygienists. Interview transcripts were analysed using a general inductive approach to identify themes and sub-themes. Four themes were identified: practice finances, productivity, lack of management information relating to the use of DTs, and fairness. DTs were often seen as a 'cost' to the team, rather than part of the team as a whole, within a system where contributions were evaluated according to a cost-volume-profit business model. Thus DTs were expected to be 'self-financing'. The fairness of deducting the salary costs of the DT from associate dentists' income was an issue. The study reveals that the financial risk sharing model which predominates in dental practice significantly influences how the remuneration system translates into establishing delegation incentives. New organisational forms or a shift in practitioner worldviews of team-working are needed in order for DTs to be fully integrated into dental practice teams.
    Full-text · Article · Dec 2011 · Health Policy
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the study was to better understand the associations between work factors and professional support among dentists (Collegial Support) as well as the sense of being part of a work community characterized by trust (Community with Trust). A questionnaire was sent to 1835 general dental practitioners, randomly selected from the members of dental associations in Sweden and Denmark in 2008. The response rate was 68%. Two models with the outcome variables Collegial Support and being part of a Community with Trust were built using multiple hierarchical linear regression. Demographic background factors, work factors, managerial factors and factors relating to objectives and to values characterizing climate of the practice were all introduced as blocks into the models. A different pattern emerged for Collegial Support than for Community with Trust, indicating different underlying mechanisms. The main results were: (I) Female, married/cohabitant, collegial network outside the practice, common breaks, formalized managerial education of leader and a climate characterized by professional values, which were positively associated with Collegial Support, while number of years as a dentist and being managerially responsible were negatively associated. (II) Common breaks, decision authority and a climate characterized by professional values were positively associated with Community with Trust. A professionally-oriented practice climate and having common breaks at work were strongly associated with both outcome variables. The study underlined the importance of managing dentistry in a way which respects the professional ethos of dentists.
    Full-text · Article · Mar 2011 · Acta odontologica Scandinavica
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Efficiency is concerned with producing maximum output with the minimum input, although what constitutes inputs and outputs within an organization is not always clear. Labour substitution is one method of achieving efficiency gains, although cost savings are found to be context dependent and may not be achieved in some situations. Because dental therapists (DTs) in England are permitted to work in dental practices, we set out to investigate how efficiency with respect to the use of DTs is conceptualized by practitioners to deepen our understanding of the potential for substitution to realize efficiency gains in dental practice. Nine dental practices were selected using a purposive sampling methodology to give a range of practice size and DT employment arrangements. Semi-structured interviews were held with 26 dentists. Transcripts were coded and analysed thematically. Efficiency was perceived as optimum use of surgery time to generate intermediate outputs of (i) managing patient flow to give patient satisfaction and business cash flow and (ii) volume of work (procedures and numbers of patients). DT efficiency gains were evaluated according to whether lower labour costs were offset by a slower working pace and higher rate of failed appointments. Patient need and demand, and whether the practice had health improvement goals, influenced whether DTs were deemed to improve efficiency. Findings are in accord with skill mix reviews in wider health care that substitution may be effective in improving efficiency but this may be limited to particular situations where conditions are conducive. More studies are needed to explore these issues further in other dental practice contexts and with other groups of dental auxiliary.
    Full-text · Article · Feb 2012 · Community Dentistry And Oral Epidemiology
Show more