Token economy-based X-ray retakes management: resolving the principal–agent problem

This study examines the effectiveness of a token economy in managing X-ray retakes, focusing on the principal–agent problem (i.e. the discrepancy between employees’ actions and managers’ intentions) in the context of hospital resource efficiency. We introduced a combined resource usage fee and reward system during normal operations, and measured retake rate changes, token circulation, and employee perceptions via surveys and interviews. We observed token number variations and a decrease in retake rates. Employees showed increased work motivation, proactively engaged in technical improvement efforts, and sought to fulfil their intrinsic motivation and self-determination needs, aligning their interests with the final goal of department managers: reducing employee retake rate. The token economy enhanced employees’ business awareness and motivation along with their autonomy. It may help resolve information asymmetry and interest misalignment and help manage the principal–agent problem in radiology departments in hospitals.