Table 2.

MA-Reported Mechanisms Whereby Financial Incentives May Improve Organizational Performance

MechanismIllustrative Quotations
    Increased employee effort Consistent performance“Definitely different work ethics amongst all MAs, yes. You can be on top of it like OCD/type A or you could just exist I guess.” (MA 5, FG 7)
Thorough follow-up in gathering outside records“We have [a] standard where when it’s slow, we’re supposed to create folders, but some people don’t follow up. Some people delete the whole thing when you’re not supposed to. You’re supposed to keep it for at least a month or 3.” (MA 2, FG 5)
“I send messages to myself. I call myself on my phone…Because I’ll be home and I’ll remember something I forgot to do so I call myself.” (MA 2, FG 9)
    Equivalent population health care for non-panel patientsExpectations vary across clinics and institutions for whether MAs work to close population health gaps for patients not on their physicians’ panel. (Field notes)
Signaling of organization priorities“We just had a report run on us last week about our blood pressure … everyone’s name was on there … we just passed it around in the huddle and you could see those ones that don’t do standard work … they only double-checked it [blood pressure] 1 time. This has been embedded in our heads for 2 months. ‘Why can’t you do your job?’” (MA 1, FG 5)
  • FG = focus group; MA = medical assistant; OCD = obsessive-compulsive disorder.