Aligning incentives and motivations in health care: the case of earned autonomy

Delegating greater authority and decision making power to front line organisations, including devolution of control through the system of 'Earned Autonomy' is a key component of the UK Government's modernisation agenda for the public services. The principle of Earned Autonomy is that the highest performing organisations are subject to less central control and allowed increased operating freedoms. This paper explores the implementation of Earned Autonomy in the English NHS and addresses the question of whether the incentives implicit within Earned Autonomy are both sufficiently powered and aligned to the motivations of senior hospital managers to secure the desired improvements in organisational performance.