Incentive Systems

Tangible and/or intangible incentives and rewards and/or disincentives and punishments support implementation and delivery of the innovation.

The original CFIR described “incentives and rewards” that include extrinsic incentives such as goal-sharing awards, performance reviews, promotions, and raises in salary as well as less tangible incentives such as increased stature or respect (Helfrich, Weiner, et al., 2007; Klein et al., 2001). Tangible and/or intangible incentives and rewards, disincentives and punishments, or performance feedback can help to support implementation and delivery of the innovation (Balliet et al., 2011; Clark & Wilson, 1961; Helfrich, Weiner, et al., 2007; Klein et al., 2001) and is affirmed by more recent literature (Tagliabue et al., 2020).

Financial incentives and performance evaluations are important for reinforcing beliefs that behavior will lead to desirable results (Gustafson et al., 2003; Leeman et al., 2007). Strong incentives were found to be positively associated with implementation effectiveness (Helfrich, Weiner, et al., 2007; Klein et al., 2001). Well-designed incentives can bolster the degree to which new behaviors are positively or negatively valued, which heightens intention to change, a precursor to actual change (Gershon et al., 2004). A four-item “reward system” subscale is included as part of the Competing Values Framework measure of culture, and it was found that the number of different types of compensation incentives used is positively associated with comprehensiveness of the use of best practices by healthcare organizations (Shortell et al., 2001).

Qualitative coding guidelines that are aligned with the Updated CFIR will be added in the future.

Inclusion Criteria

Include statements related to whether incentive systems are in place to foster (or hinder) implementation, e.g., rewards or disincentives for staff engaging in the innovation.

  • “We have a goal-sharing team doing it. They each get $500 if they succeed in making it happen.”
  • “I’m really hoping this project succeeds because this is a way to show that I’m ready to be promoted at my next evaluation.”

Regarding quantitative measurement of this construct: In a systematic review of quantitative measures related to implementation, Powell et al. identified three measures (Powell et al., 2021). Using PAPERS criteria of measurement quality with an aggregate scale ranging from -9 to +36 (Lewis, Mettert, Stanick, et al., 2021), only one measure was assessed with a score of 5. Results indicate the need for continued development of high-quality measures.

As we become aware of measures, we will post them here. Please contact us with updates.

Balliet, D., Mulder, L. B., & Van Lange, P. A. M. (2011). Reward, punishment, and cooperation: A meta-analysis. Psychological Bulletin, 137(4), 594–615.

Clark, P. B., & Wilson, J. Q. (1961). Incentive Systems: A Theory of Organizations. Administrative Science Quarterly, 6(2), 129.

Gershon, R., Stone, P. W., Bakken, S., & Larson, E. (2004). Measurement of Organizational Culture and Climate in Healthcare. Journal of Nursing Administration, 34(1), 33–40.

Gustafson, D. H., Sainfort, F., Eichler, M., Adams, L., Bisognano, M., & Steudel, H. (2003). Developing and testing a model to predict outcomes of organizational change. Health Serv Res, 38(2), 751–776.

Helfrich, C. D., Weiner, B. J., McKinney, M. M., & Minasian, L. (2007). Determinants of implementation effectiveness: Adapting a framework for complex innovations. Med Care Res Rev, 64(3), 279–303.

Klein, K. J., Conn, A. B., & Sorra, J. S. (2001). Implementing computerized technology: An organizational analysis. Journal of Applied Psychology, 86(5), 811–824.

Leeman, J., Baernholdt, M., & Sandelowski, M. (2007). Developing a theory-based taxonomy of methods for implementing change in practice. J Adv Nurs, 58(2), 191–200.

Lewis, C. C., Mettert, K. D., Stanick, C. F., Halko, H. M., Nolen, E. A., Powell, B. J., & Weiner, B. J. (2021). The psychometric and pragmatic evidence rating scale (PAPERS) for measure development and evaluation. Implementation Research and Practice, 2, 263348952110373.

Powell, B. J., Mettert, K. D., Dorsey, C. N., Weiner, B. J., Stanick, C. F., Lengnick-Hall, R., Ehrhart, M. G., Aarons, G. A., Barwick, M. A., Damschroder, L. J., & Lewis, C. C. (2021). Measures of organizational culture, organizational climate, and implementation climate in behavioral health: A systematic review. Implementation Research and Practice, 2, 263348952110188.

Shortell, S. M., Zazzali, J. L., Burns, L. R., Alexander, J. A., Gillies, R. R., Budetti, P. P., Waters, T. M., & Zuckerman, H. S. (2001). Implementing evidence-based medicine: The role of market pressures, compensation incentives, and culture in physician organizations. Medical Care, 39(7 Suppl 1), I62-78.

Tagliabue, M., Sigurjonsdottir, S. S., & Sandaker, I. (2020). The effects of performance feedback on organizational citizenship behaviour: A systematic review and meta-analysis. European Journal of Work and Organizational Psychology, 29(6), 841–861.