It is important for a selling company to have a motivated sales force. The motivation and what employees is motivated by have occupied the interest of human resource researchers for decades. There has been a large amount of research within motivational psychology, which has produced several theories regarding human needs and motivation factors. This study focused on sales professionals within business-to-business (B2B) with the purpose to explore and describe sales professionals’ perceptions regarding financial incentives and their motivation. The study also answers the questions of how sales professionals perceive that financial incentive affects their motivation and how the financial incentives relate to sales professional motivation. This study utilizes a qualitative approach, where the empirical data was gathered by six semi-structured interviews. By analyzing the findings, the researchers have concluded that financial incentive can both work as a motivator and a demotivator. Financial incentives can increase stress and pressure for the sales professional especially for individuals new to the profession. The study has found that this is something that the individual have to cope with since the organization is not providing support for this. If the sales professionals can cope with the stress, it will work as a motivator. Lastly, the study presents practical and managerial implications for sales organizations. They need to be aware of the business environment to ensure that financial incentive achieves the desired effect.

MPH, Faculty of Health Sciences, University of the Witwatersrand / Poor retention rates and a lack of human resource management capacity have led to a critical shortage of nurses and serious disparities in their distribution between urban and rural areas in Zambia. The Zambian government is faced with the challenge of developing retention schemes that address the most pressing needs of nurses in rural service. The aim of the study is to contribute to the body of work in Zambia that looks at the influence of non-financial incentives on the retention of nurses in rural areas. The study also aims to show what factors nurses think would keep them in rural posting. The objectives of this study are to determine the perceptions of nurses in two rural hospitals in the Copperbelt province of Zambia about non-financial incentives that could influence retention in rural areas and to determine which factors nurses perceive to be the most important for retention. The study design was a descriptive cross-sectional study. Forty nurses were conveniently sampled. Data was collected by means of structured interviews using a questionnaire and was analysed using stata10. The majority of nurses strongly agreed that individual, institutional and local environmental factors play a significant role in retention. Factors identified as the most important for retention were motivation to work (n=26), appreciation from the community (n=33), ability to make decisions about work (n=17), satisfactory accommodation (n=32), availability of schools for children (n=26), managable distance to work (n=13), access to continuing education and iv professional development (n=26), having good relationships with colleagues (n=15) and, availability of essential equipment, tools and supplies (n=14). Factors ranked first choice according to level of importance by the majority of nurses were satisfactory accommodation (n=25), access to continuing education and professional development (n=20) and motivation to work (n=18). There are no straight forward answers to the problem of retention in rural areas. The development of appropriate strategies requires an understanding of the interaction of factors which influence nurses’ decisions to work in a rural and remote post. Successful retention strategies will require strengthening and upgrading of human resource management capacity. The response must be all inclusive, engaging relevant stakeholders, including non-health and nongovernmental group

Magister Public Health - MPH / Background: Low motivation, defined as an individual's lack of willingness to maintain and exerteffort to attain organizational goals, is a problem in Ethiopia. Its consequences are poor quality of health care or performance, lack of retention and inequity. This study explored influences on nurse motivation in Butajira Zonal Hospital (BZH), and specifically investigated the influences of financial and non-financial incentives on nurses' motivation at work. Methods: A qualitative methodology, consisting of both in-depth interview and focus group discussion (FGDs) data collection methods was adopted. The study population was all nurses working at BZH with more than two years of experience, from which a sample of fifteen nurses(representing a balance of age, gender and category) was purposefully selected. Following informed consent, these fifteen nurses were interviewed by the investigator, and were followed in a second stage by three focus group discussions; with six participants each (total eighteen). Both the interviews and the discussions were conducted mostly in Amharic and tape recorded, transcribed and translated by the researcher. The data was analysed using thematic analysis. After reading, transcriptions were coded in informants' own words and phrases. These were examined, categorised and consistent themes identified and then coded with keywords to represent the content,which were considered to constitute the 'emerging themes'. Findings: In both the FGDs and interviews, a number of key themes were identified relating to both nurses' self-reported motivation and the factors influencing this at BZH. Altruism and professional pride ('love of the profession') as a source of intrinsic motivation emerged as a key theme, counterbalanced by a perception of nursing as having significant job risks (e.g. contracting infections from patients). With respect to financial incentives, salaries too low to meet living costs, unfair taxation on overtime payments, and the absence of a salary grading system for nurses was all raised as negative influences on motivation. While team spirit and solidarity amongst nurses was a positive feature of the work environment, relationships between doctors and nurses were described as poor, aggravated by large salary differentials, and perceived indifference of management to nurses. Other non-financial incentives– training, recognition systems, supervision and workplace conditions– had mixed influences on motivation at BZH. Finally, personal factors, such as age, gender and origin or married in the region,influenced reported motivation. Conclusions and Recommendations: The Ethiopian health system has paid great attention to increasing numbers, expanding training of, and creating specializations for, nurses. However, less attention has been given to their working conditions and the appropriate package of financial and non-financial incentives that will sustain performance and retention. These need to be addressed at the hospital itself, at higher levels of the system and at a broader policy level. Managing motivation requires keeping a broad perspective and innovative approaches that address the range of influences identified in the study. Solutions should be context based and sensitive to influences beyond the commonly understood sources of motivation.

A key strategy to motivate proenvironmental behavior (PEB) involves the promise of monetary rewards. Financial incentives are intuitively appealing because they can increase an individual's expected benefits for engaging in the PEB; however, there is concern that incentives can transform motivations for the PEB. The purpose of this study was to examine the role of financial incentives on behavior across time. Specifically, I used an experimental design to examine the immediate effects payments on litter-removal effort (Phase 1) followed by effort after payments were no longer available (Phase 2). Undergraduate students were recruited for a trail evaluation study and randomly assigned to a control treatment or a financial incentive treatment. In Phase 1 I asked students to pick up discarded litter during their trail evaluation (PEB). The incentive condition offered students $0.25 for each of the possible 16 items of trash planted along the trail. The control condition simply asked students to help by picking up trash. Students were again asked to collect trash in Phase 2 but the financial incentive condition was not offered a payment. In accordance with self-determination theory I expected payments to increase effort in the short term and suppress effort when the incentive was no longer provided. Although there was an overall decrease in effort between phases within both conditions, the results of a repeated-measures ANOVA indicated no difference between the control and incentive condition in either phase. Given the lack of a statistically significant finding, it is possible that there are conditions under which payments provide no greater inducement than a simple request for help. This idea is supported by a meta-analysis, which identifies a consistent lack of effect for easily-performed tasks. Additional research is needed to further understand the conditions under which financial incentives can motivate and sustain PEBs. / Master of Science

Magister Public Health - MPH / Background: Adequate human resources for health play a crucial role in improving access to services and quality of care. Human resources for health are often inequitably distributed between rural and urban areas within countries. In Rwanda, almost 88% of physicians and 58% of nurses in the country work in urban areas, despite the fact that 82% of the population lives in rural areas. Kabaya is located in a remote rural area in Ngororero District; its health facilities consist of one hospital and four health centers. Living and working conditions are poor for health workers. This results in constant migration out of health workers, which has negative impacts on service delivery and quality of care provided to the population. Aim and Objectives: This study aimed to assess factors that influence the intention to stay in Kabaya amongst health workers currently in Kabaya's health facilities. The specific objectives were to analyze the associations between the following factors and intention to stay among health workers in Kabaya: socio-demographic and job characteristics; working and living conditions; and financial and non-financial incentives. Study design: An analytical, cross-sectional survey of all health workers from five facilities in Kabaya was conducted. Methods: A self-administered questionnaire, adapted from one used in a study in Uganda (Hagopian, Zuyderduin, Kyobutungi & Yunkella, 2006), was used to collect data. Data were entered in Epi- Info 3.4 and analyzed using SPSS 16.0. Descriptive analyses and inferential statistics (Chisquare,Fisher‟s Exact) were done to test for associations with the main outcome, intention to stay. Results Out of 155 employees working in Kabaya‟s health facilities, 111 (72%) accepted to participate in the study. Of the 111 respondents, 34 (31%) indicated they intended to stay working in Kabaya indefinitely. Intention to stay (bivariate analysis) was associated with:  employment category (p=0.001) and age (p<0.001);  rural background - born in Kabaya (p<0.001); and born (p=0.001), grew up (p=0.001) and studied in a rural area (p<0.001); good quality supervision - encouraging employee development (p=0.029), caring for the employee as a person (p=0.011), and competent and committed facility managers(p=0.039);  presence of workplace friends (p<0.001);  conducive work and living environments - manageable workloads (p<0.001); good infrastructure (p<0.001); access to safe and clean water at work (p<0.001); adequate housing at home (p<0.001); having time to take lunch at work (p=0.001); access to adequate transportation to work (p=0.004); adequate shopping and entertainment(p=0.001);  adequate incentives - sufficient salary (p<0.001); recognition for doing a good work(p<0.001); and adequate training (p<0.001). The small study sample precluded multi-variate analyses and it was therefore not possible to control for potential confounders such as age, sex and profession in the analysis of workplace factors. Conclusions: Intention to stay in Kabaya appears to be influenced by a complex set of factors that include: individual (age, profession, rural background), workplace, human, social, career and salaryrelated factors. Promoting retention in Kabaya‟s health facilities requires multi-faceted interventions, without which the majority of the employees are likely to continue to migrate away from the area.

Adherence to antiretroviral therapy (ART) is one of the most important issues in pediatric patients living with Human Immunodeficiency Virus (HIV). Combined with the fact that young patients face a large array of adherence barriers, interventions that can increase adherence are of great interest. Financial incentives (FIs) are a novel approach in pediatric HIV settings, and have not been studied previously in this disease for this age group. Thus, we sought to evaluate the effects FIs had in helping pediatric HIV patients achieve and maintain virologic suppression (VS). Furthermore, a post-incentive survey was administered to evaluate the self-perceived effects of FIs. In our study, FIs were not associated with achieving VS among pediatric and adolescent patients. The post-incentive survey has demonstrated many aspects of patients' and guardians' perceptions of FIs that should be considered in future FI studies. First, it was likely that patients who effectively grasped the concept of financial reward were most positively influenced by FIs. Second, the study data suggested that FIs may be contra-effective to those patients who report strong emotional responses to negative outcomes. Further and more comprehensive studies are required to fully characterize these effects.

High and equitable quality of care are core goals of the English National Health Service. Policy makers have experimented with various ways to improve quality, including use of financial incentives. The effects of these incentives on health outcomes and the distribution of care are not known. The aim of this study was to examine variations in hospital quality and outcomes at patient level under a financial incentive scheme in England. In October 2008 a financial incentive scheme under which quality of care was measured by process measures was introduced for 24 hospital Trusts in the North West of England. The process measures of care from this Advancing Quality initiative were linked at spell level to health outcomes and administrative hospital records. The data consisted of 252,284 spells between October 2008 and March 2013.First, I examined whether financially incentivised improvements in quality of care were associated with better patient outcomes. I examined how mortality and readmission were related to process measures using bivariate probit, probit, random effects and fixed effects estimations. I found that several of the incentivised process measures of care are associated with improved patient outcomes. I estimated that Advancing Quality saved 129 lives and avoided 121 readmissions over a four-and-a-half year period. Second I examined whether quality of care from a hospital incentive scheme is distributed equitably at a patient level. Multinomial and sequential logistic regressions were used to show that process measures of care overall were distributed in favour of patients from lower income score areas. Process measures of care delivered during an emergency admission were distributed in favour of patients from higher income score areas but this was driven by patient severity. Process measures based on advice appeared to be driven by capacity to benefit and were distributed in favour of patients from lower income score areas. Process measures of care for elective admissions regarding delivery of drugs were distributed equitably. Third, I examined if the quality of care was lower at the weekend. The in-hospital mortality rate is known to be higher for weekend admissions than for weekday admissions but it is not known whether this was due to lower quality of care. Using logistic regressions, incentivised quality of care was found to be consistent throughout the week. The weekend mortality effect can be explained by patient volume, which suggested that patient case mix may be different between weekdays and weekends. Overall, quality of care under an incentive scheme was found to positively impact on health outcomes, be distributed equitably, and be the same at weekends as weekdays. Further research is needed using quality of care indicators from all Trusts in the English National Health Service. Furthermore further research examining how trusts exclude patients from financial incentive schemes is also needed.

Thesis (M.M. (Strategic Marketing))--University of the Witwatersrand, Faculty of Commerce, Law and Management, Graduate School of Business Administration, 2015. / Cross-selling remains the easier and most cost effective option for companies to grow revenues and achieve profitability as compared to growing revenue by acquisition of new customers. Many firms are seeking to grow their revenue and achieve high levels of customer loyalty. These firms and industries across the world are turning to cross selling as the solution. Many factors, such as merger and takeovers, result in firms having multiple product lines and silos with sales people focused according to these product divisions. What becomes more difficult is identifying which factors will lead to more integrated teams that are motivated to engage in cross selling. This study seeks to address some of the challenges that result in lower motivations levels of sales people to engage in cross selling. Financial incentives, product knowledge and recognition are studies to determine their influence on motivation to cross sell products from other divisions in a firm. A review of literature was conducted to study the influence of financial incentive, product knowledge and personal recognition on work motivation. These three constructs were then extended into a quantitative study of how they influence sales people’s motivation to engage in cross selling. The findings uncovered that salespeople consider product knowledge as a key inhibitor for them to engage in cross selling. The results also revealed a close contest with financial incentives and personal recognition also having positive influence on their motivation to engage in cross selling. Consistent with existing literature from social studies, it cannot be overemphasised that product knowledge empowers sales people and gives them the confidence to cross sell in an industrial sales environment.

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Résumé: Problématique : En réponse à la prévalence accrue de la maladie du diabète et au fardeau économique important que représente cette maladie sur le système de santé international, des programmes incitatifs pour les maladies chroniques furent instaurés à travers le monde. Ces programmes visent à inciter les médecins à appliquer les lignes directrices chez leurs patients avec besoin complexe en vue d’améliorer la santé des patients et par la suite de réduire les coûts incombés par le système de santé. Les programmes incitatifs étant nombreux et différents d’un pays à l’autre, les études actuelles ne semblent pas s’entendre sur les répercussions de tels programmes sur la santé des patients atteints de diabète. L’objectif de cette étude est d’évaluer les retombées d’un incitatif financier sur le contrôle glycémique de la population atteinte de diabète du Nouveau-Brunswick, au Canada. Méthodes : Cette étude transversale répétée et de cohorte a été menée grâce à des bases de données administratives du Nouveau-Brunswick contenant des données sur dix ans pour 83 580 patients adultes atteints de diabète et 583 médecins de famille éligibles. La santé des patients a été évaluée au niveau du contrôle glycémique, en mesurant les valeurs moyennes d’A1C annuelles à l’aide de régressions linéaires multivariées. Afin d’évaluer si les médecins changeaient leur pratique avec l’implantation du programme incitatif, nous regardions au niveau de la probabilité de recours annuel à au moins deux tests d’A1C en utilisant des régressions logistiques multivariées. Résultats : La probabilité de recours annuel à au moins deux tests d’A1C était plus élevée dans quatre sous-groupes étudiés : les patients nouvellement diagnostiqués après l’implantation du programme avaient des cotes plus élevées comparées aux nouveaux patients avant l’implantation du programme (OR=1.23 [1.18-1.28]); les patients pour lesquels un médecin avait réclamé l’incitatif comparés aux patients pour lesquels aucun médecin n’avait réclamé l’incitatif (OR=2.73 [2.64-2.81]); les patients pour lesquels un médecin avait réclamé l’incitatif avaient des cotes plus élevées après l’implantation du programme comparé à avant (OR=1.89 [1.80-1.98]); et finalement, les patients suivis par un médecin de famille qui a déjà réclamé l’incitatif avaient des cotes 24% plus élevées (OR=1.24 [1.15-1.34]). Il n’y avait pas de différence dans les valeurs d’A1C annuelles entre les 4 sous-groupes étudiés. Conclusion : L’implantation du programme incitatif a démontré que les médecins ont une meilleure probabilité de prescrire au moins deux tests d’A1C, ce qui suggère une meilleure prise en charge des patients. Cependant, le manque de changement au niveau du contrôle glycémique du patient suggère que l’étude des répercussions de l’incitatif devra être poursuivie afin de voir si elle mène à une amélioration d’issues cliniques chez les patients. / Abstract: Background: Diabetes prevalence does not stop increasing with time and the economic burden this disease represents for the international health care system is unmistakable. Governments worldwide have implemented financial incentives based on guideline achievements for physicians treating people living with diabetes in hopes that these improve the health of their patients and in return lower healthcare costs. Current incentive programs implemented are different from one country to another and studies to date are inconclusive as to their repercussions on the health of diabetic patients. The objective of this study was to evaluate the influence of an incentive on glycemic control at a population level in New Brunswick, Canada. Methods: We conducted repeated cross-sectional and cohort-based analyses using administrative databases with ten years of data on 83 580 adult diabetic patients and 583 eligible family physicians. The study outcomes included patients’ glycemic control, using annual A1C means (multivariate linear regressions) and the probability of delivering at least two A1C tests annually (multivariate logistic regressions). Results: The probability of prescribing at least two A1C tests annually was greater in four sub-groups: patients newly diagnosed with diabetes after the implementation of the program compared to new patients before the implementation (OR=1.23 [1.18-1.28]); patients for whom a physician had claimed the incentive compared to patients for whom no physician claimed the incentive (OR=2.73 [2.64-2.81]); patients for whom an incentive was claimed after the implementation of the program compared to before (OR=1.89 [1.80-1.98]); and finally patients followed by a family physician who claimed the incentive at least once compared to patients followed by a family physician who never claimed the incentive (OR=1.24 [1.15-1.34]). There was no difference in mean A1C between all four sub-groups. Conclusion: Implementation of an incentive program in New Brunswick was associated with greater odds of delivering at least two A1C tests, suggesting that follow-up of care by family physicians was improved. However, as no difference between A1C means was observed, this suggests that the assessment of this incentive program needs to be evaluated further to determine if it helps improve patients’ health outcomes.