S1 Data -

Background
There is a sparsity of knowledge of the specific mechanisms through which financial and non-financial incentives impact the performance of health teams. This study aims to address this knowledge gap by examining an in-kind incentives program for healthcare teams implemented in three districts in Belize (2012–2022) as part of the Salud Mesoamerica Initiative, which aimed to improve healthcare quality.
Methods
We performed a qualitative study to understand the mechanisms through which the in-kind incentive program supported quality improvement in Belize. We conducted key informant interviews (April—June 2021) remotely on a sample of former and current healthcare workers from Belize’s Ministry of Health and Wellness familiar with the program. We analyzed responses using qualitative content analysis. We used open coding to identify patterns and themes.
Results
We conducted eight key informant interviews from a pool of thirty potential informants. Our analysis of the interviews yielded a total of 11 major themes with 27 subthemes. Most informants reported that in-kind incentives were not the primary motivation for improving their performance, though they did acknowledge that incentives had increased their attention on the quality of care provided. Conversely, we found that quarterly measurements and supportive supervision by national level authorities offered an external validation mechanism and instilled frontline staff with a sense of shared responsibility towards improving their performance. The majority of informants conveyed positive opinions about the in-kind incentives program.
Conclusions
Our study contributes to the understanding of how in-kind incentives can enhance performance. We found that in-kind incentives created extrinsic motivation, leading to an increased focus on quality. Standardized measurements and supportive supervision improved intrinsic motivation and formed a stronger commitment to quality of care. Rather than focusing on tangible incentives, explicitly incorporating standardized measurements and supportive supervision in the routine work of the Ministry of Health could have longer lasting effects on quality improvement.

研究背景
目前学界对财务与非财务激励影响医疗团队绩效的具体作用机制仍缺乏充分认知。本研究旨在填补这一知识空白，以伯利兹（Belize）3个辖区2012—2022年间实施的实物激励项目（in-kind incentives program）为研究样本，该项目系旨在提升医疗服务质量的《中美洲健康倡议》（Salud Mesoamerica Initiative）的组成部分。

研究方法
本研究采用质性研究范式，以剖析该实物激励项目推动伯利兹医疗质量提升的具体作用机制为目标。研究于2021年4—6月开展远程关键知情人访谈（key informant interviews），访谈对象为伯利兹卫生与福利部（Ministry of Health and Wellness）内熟悉该项目的在职与离职医护人员。研究采用质性内容分析法对访谈资料进行编码分析，通过开放编码识别访谈中的核心模式与主题。

研究结果
本研究从30名潜在受访对象中最终完成8次关键知情人访谈。对访谈资料的系统性分析共提炼出11个核心主题与27个子主题。多数受访知情人表示，实物激励并非其提升工作绩效的核心动机，但同时承认该激励项目提升了自身对所提供医疗服务质量的关注度。与之相对，研究发现国家级主管部门开展的季度考核与支持性督导，构成了外部验证机制，并使一线医护人员树立起为提升绩效共同承担责任的使命感。绝大多数受访知情人对该实物激励项目持积极评价。

研究结论
本研究深化了学界对实物激励如何提升医疗团队绩效的认知。研究表明，实物激励可激发外部动机，提升医护人员对医疗质量的关注度；而标准化考核与支持性督导则能强化内部动机，增强医护人员对医疗服务质量的职业承诺。相较于聚焦有形激励，在伯利兹卫生与福利部的日常工作中明确纳入标准化考核与支持性督导，或将对医疗质量提升产生更持久的正向影响。