Lost in motivation? The case of a Norwegian community healthcare project on ethical reflection

Innovations are needed to meet increasing challenges in public healthcare, and type of motivation has been identified as a pivotal factor for the success of an innovation. New public management crowd out the intrinsic motivation of employees which has resulted in a quest for more self-reliant service providers. This paper takes the opposite point of departure asking if intrinsic motivation can be at the cost of the public purpose of innovations. This paper is a case study of 180 municipalities whom chose to participate in the largest healthcare project on ethical reflection in Norway. Thousands of community health-care workers performed innovative activities by establishing ethical reflection on a regular basis. We have investigated if the municipalities' type of motivation is of importance for the type of results of the project, and how the results correspond with the policy signals on the very purpose of establishing ethical reflection in health care. We find that intrinsic motivation of enhanced competence crowds out the extrinsic motivation and public value of patient satisfaction. The link in the program theory between objective and purpose is too weak to induce a better fulfilment of the purpose.