| Course | HLTH 4100 Healthcare Organization Theory and Behavior |
|---|---|
| Week | Week 5 |
| Paper type | Discussion post with two peer replies |
| Length | About 580 words, 4 pages |
| Format | Discussion post, APA 7 citations |
| School | Walden University |
| Program | BS in Healthcare Administration |
| Updated | October 2026 |
Free sample paper for HLTH 4100 Week 5
Week 5 Discussion: Initial Post
A Bonus for Discharges Before Noon, Read Through Expectancy Theory: Why Orders Moved Earlier and Patients Did Not
The incentive I chose is one my hospital introduced last year: a quarterly bonus for medical-surgical nurse managers whose units reach a target of 35% of discharges before noon. The idea was that earlier discharges would free beds for emergency department patients waiting upstairs. I set it against expectancy theory, which holds that people put effort into a behavior when they believe the effort will lead to performance, that performance will lead to a reward and that the reward is worth having (Vroom, 1964).
What the theory predicts. For the bonus to change behavior, managers needed to believe three things: that they could raise noon discharges by working harder; that reaching 35% would actually produce the bonus; and that the bonus mattered to them. The second and third links were strong. The first was weak, because most of what delays a discharge, such as physician rounding times, transport, family availability and pharmacy, is outside a nurse manager's control.
What actually happened. The metric was measured by the time the discharge order was entered, not the time the patient left. Within two quarters, three units reached the target. But when the quality department checked actual departure times, almost nothing had changed; patients still left in mid-afternoon. The managers had found the part of the measure they could control, persuading hospitalists to enter orders during morning rounds, and moved it. Expectancy theory explains this well: when the effort-to-performance link is weak for the intended behavior but strong for a nearby one that also counts, people choose the one they can move. Fifty years ago, Kerr (1975) warned that organizations routinely pay for one thing and then act surprised when they get it instead of what they wanted.
What I would change. Hospitals that have raised early discharges for real did it by changing work across disciplines, such as earlier rounds and discharge planning the day before, not by paying one role (Wertheimer et al., 2014). So I would measure actual departure time, and give managers some control over the steps that delay it, such as authority to schedule transport and to arrange pharmacy delivery to the bedside.
My reading: the bonus did motivate, just not the behavior its designers pictured, because the measure rewarded order times that managers could move rather than departures they could not. Did your incentive's measure match the behavior it was meant to change?
Reply to Elena
Elena, your example of a recognition program for hand hygiene, where staff received certificates for high observed compliance, sounds like it ran into a similar problem: compliance rose when observers were visible and fell when they were not. Through expectancy theory, the reward was attached to being observed complying rather than to complying. I wonder whether using anonymous observers would change the effort-to-reward link, since staff could not tell which moments counted.
Reply to Ibrahim
Ibrahim, you argued that the managers acted unethically by gaming the measure. I see it differently. They did exactly what the incentive paid for, and the designers chose the measure. Kerr (1975) argued that when organizations reward the wrong behavior, they should not be surprised to get it. I would hold the design responsible before the managers. That said, I agree that once the gap between orders and departures was visible, managers had some duty to point it out, and two of them did.
References
Kerr, S. (1975). On the folly of rewarding A, while hoping for B. Academy of Management Journal, 18(4), 769-783. https://doi.org/10.2307/255378
Vroom, V. H. (1964). Work and motivation. Wiley.
Wertheimer, B., Jacobs, R. E. A., Bailey, M., Holstein, S., Chatfield, S., Ohta, B., Horrocks, A., & Hochman, K. (2014). Discharge before noon: An achievable hospital goal. Journal of Hospital Medicine, 9(4), 210-214. https://doi.org/10.1002/jhm.2154
Reading the HLTH 4100 Week 5 instructions
Threads on motivation at this point typically ask you to test one theory against one real incentive. Describe the incentive precisely: what it rewards, how performance is measured and who receives the reward. Lay out the theory's main components and use them to predict how people would respond. Then report what actually happened and explain it with the same theory. Pay attention to the measure, since people often respond to what is counted rather than to what is intended. Suggest changes that follow from the theory. In replies, apply the same lens to classmates' examples, and engage objections about blame by considering who designed the incentive.
Inside the HLTH 4100 Week 5 example
The opening describes the 35% bonus and introduces Vroom's three links. The prediction paragraph finds the effort-to-performance link weak. The outcome paragraph reports three units meeting the target through earlier order entry while departures did not change, and cites Kerr. A paragraph proposes measuring departures and giving managers control over transport and pharmacy, citing Wertheimer and colleagues on cross-disciplinary redesign. A highlighted line summarizes the reading. The reply to Elena applies expectancy theory to a hand hygiene program rewarding observed compliance. The reply to Ibrahim argues the design, not the managers, should be held responsible, while noting some managers reported the gap. Both replies stay short and each ends by asking the classmate one question that pushes the theory further.
Where the marks sit in the HLTH 4100 Week 5 rubric
Instructors in this thread reward posts that use a motivation theory to make a prediction and then test it against what happened. Naming the components of the theory and applying each to the specific incentive shows understanding beyond definitions. The measure deserves close attention, because the gap between what is counted and what is wanted is usually where incentives go wrong. Changes proposed should follow from the theory, not from general preference. Replies earn credit by applying the same lens to a classmate's case or by engaging an ethical objection with reasoning. A post that stays within the thread's length, uses sources accurately and cites them correctly meets the remaining expectations.
HLTH 4100 Week 5 help: mistakes that cost marks
Motivation posts often describe an incentive and conclude that people were or were not motivated, without explaining why. Others apply a theory loosely, naming it without using its parts. Some treat gaming as a moral failure without asking what the incentive rewarded. Write down exactly what the incentive measures and pays for. Then ask, for each person affected, whether they believe effort will change that measure and whether the reward matters to them. Compare that with what they did. We can draft an incentive post that walks Vroom's three links through your own workplace bonus or recognition program and predicts what it will really change.
Get a HLTH 4100 Week 5 example written to your instructions
Drop in the Week 5 thread prompt, its posting rubric and the incentive or program your section is working with, and a model thread contribution arrives with one motivation theory applied end to end, plus two replies that take different angles. The first custom sample is free, it is back in 24 to 48 hours, and it follows your classroom's posting rules.
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HLTH 4100 Week 5 questions, answered
Where can I find a free HLTH 4100 Week 5 sample paper?
The post on the discharge-before-noon bonus and both replies are shown above, free to read in full.
Which theory does the HLTH 4100 Week 5 post use?
Expectancy theory, which says people act when they believe effort leads to performance, performance leads to a reward and the reward is worth having.
What happened after the bonus was introduced?
Discharge orders moved earlier and three units met the target, but patients' actual departure times barely changed.
Why did the bonus produce that result?
The measure counted order times, which managers could move, rather than departures, which depended on factors outside their control.
What change does the post propose?
Measuring actual departure times and giving managers control over steps such as transport and pharmacy delivery.