Montessorians don’t always agree about everything but one of the many things we are all agreed on is that rewards don’t work. Back in the Summer of 2011, my regular column in Montessori International ’Research Watch’ featured some research, mainly from the USA, in the field of healthcare which reflected the inefficacy of rewards in that area.  Now a major study from the universities of York, Manchester and Michigan in the USA have shown that the £1 billion a year Quality and Outcomes Framework (QOF) has had no significant effect over the rates of mortality.  The authors checked the death rates from 1994 (10 years before QOF started) up to 2010 from the UK and 26 other countries with comparable health care systems and found that not only had mortality rates for the targeted diseases (e.g. diabetes, cancer & heart disease) been unaffected but rates had actually risen in other diseases which were not targeted.  The authors comment, remarkably mildly, “Our findings have implications for the probable effects of similar programmes.”  Surely there is also a lesson here for educationalists too.  Too many mainstream teachers are totally wedded to rewards as a means of motivating children.  There is a better way!


Ryan, A.M. et al. (2016). Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: a population study.  The Lancet (in press) published online DOI:


For those readers of this blog who do not have access to Montessori Interational, the relevant paragraphs are as follows…

Who can have missed the newspaper coverage of the subject of bankers’ bonuses recently?  Or have been appalled and repulsed by the obscene size of them – especially as it was the banking sector which brought us so near to financial meltdown.   And still the bonuses are being paid!   Admittedly they are smaller percentages, but most banks have quietly doubled basic salaries to compensate.   The effects of such bonuses (rewards) are well publicised.   They lead to short-term thinking (boosting immediate profits to maximise the next bonus), sometimes actual dishonesty, insider trading and market manipulation by spreading false rumours, stifling of creativity and collaboration with colleagues, lavish & unnecessary entertainment of clients (whose feedback helps determine bonus size) and reckless gambling.   And yet despite all this, the efficacy of rewarding executives to boost motivation goes unquestioned.

 It is 40 years since Edward Deci’s ground-breaking research with undergraduates, followed up 2 years later in 1973 by Mark Lepper’s well-known study with preschoolers, which established not only that rewards are ineffective but that they actually de-motivate.   Both found that rewards make children less likely to choose an activity once the reward was withdrawn.   Dr. Deci – a professor of Social Science at Rochester University, Michigan, who has made a lifetime study of human motivation enlightened by Self-Determination Theory – subsequently carried out a meta-analysis (a survey and combination of 128 other research studies) which strongly confirmed the earlier findings. (Deci, E. L., Koestner, R., & Ryan, R. M. (1999). ‘A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation’. Psychological Bulletin, 125, 627-668.) The message has not yet reached the majority of teachers though.   It is often said that it takes half a century for really novel research results to impact on everyday practice.   So long for the old-timers to have moved on!   Incidentally, an excellent and very readable introduction to Deci’s ideas is his 1996 Penguin book Why We Do What We Do: an introduction to self-motivation.

The latest research on the inefficiency of rewards comes from the field of health care.   There have been a series of studies into the topic at Baylor College of Medicine, Texas.   In the latest, a group of primary care clinics were incentivised (i.e. given bonuses) to increase the uptake of immunisation and smear tests.   They did show an increase, but then the researchers found that giving no bonus at all had exactly the same effect.   (Gavagan T.F. et al. (2010) ‘Effect of Financial Incentives on Improvement in Medical Quality Indicators for Primary Care’ Journal of the American Board of Family Medicine 23 (5): 622-631)   This was a follow up to an earlier meta-study  by Laura Peterson (Petersen L. et al. (2006) ‘Does Pay-for-Performance Improve the Quality of Health Care?’ Annals of Internal Medicine vol. 145 no. 4 265-272)  She found that the evidence was really quite weak (only one study found a strong effect for bonuses) but also there were unwanted side effects – like the existence of bonuses making doctors less willing to take on difficult cases!

These studies confirmed work based on a large-scale survey carried out at the University of Nottingham, UK, by Brian Serumaga and his colleagues.   They surveyed 470,000 hypertension patients both before and after the introduction of an NHS bonus scheme.   They found no discernible improvement in patient outcomes whatsoever.   Serumaga commented “Having spent three years looking at the evidence of payment-for-performance, I am astonished at how weak the evidence is.”


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