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One of the largest pharmacological experiments in history has been running for more than three decades, namely, the administration of drugs to athletes to enhance performance in many different kinds of sports. Notably, androgenic-anabolic steroids were used with particular success for virilization of adolescent girls and female athletes. Perhaps the most remarkable aspect of this large and still ongoing global experiment is its widely accepted clandestine nature.

Although the drug experiments involved many thousands of athletes, physicians, scientists, and sports and government officials, and although the success of these programs has been publicized through print, radio, and television, the nature of the program and its results largely have been kept inaccessible to direct scientific, medical, or judicially valid investigation. Since the mids, the use of androgenic steroids and other hormonal performance-enhancing drugs has been officially banned by sports authorities, and their usage has been controlled through analysis of urine samples taken at the time of competition, i.

In addition, in many countries the use of such drugs in sports has been declared illegal and prosecuted. But these measures have had relatively little impact. Consequently, deception is basic to doping, and athletes, coaches, physicians, and officials have frequently and emphatically denied any use of androgenic hormones, even before these drugs were officially banned. The role that scientists and physicians have played in this clandestine system is particularly sad, not only because these professionals actively contributed to the worldwide cheating, but also because they violated scientific and medical ethics.

Remarkably, only a few of the physicians involved in doping have been held accountable for their misconduct and unethical behavior. After a period of scientific controversy, it is now clear that androgenic-anabolic hormones are effective in enhancing performance in sports for reviews, see refs. Moreover, as has been demonstrated through scientific and official court documents, including secret doctoral theses and scientific reports, the positive effects of these and other hormonal drugs on muscle strength, aggressiveness, and performance in elite sports were common knowledge and had been in practice since the early s for male athletes and since for female athletes.

By far the most extensive and detailed documentation of this systematic drug abuse has come from the secret government files of one of the most successful sports nations of all times, the German Democratic Republic GDR. At the same time, some of the officials of the GDR sport system apparently took care to assure that all compromising documents were either destroyed or collected by the Sports Medical Service Sportmedizinischer Dienst; SMD. In addition, one of us W. Also found were a series of scientific reports from the FKS and the research centers of the various sports associations and a handwritten protocol book, giving the times and dosages of administration of androgenic-anabolic steroids to hundreds of male and female athletes.

These documents provide detailed information—e. We have documented this evidence in several recent publications, including an expert report published by the Bund- estag, the German parliament 10 11 Some of these classified documents of GDR doping and doping research are referenced here 6 7 8 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 GDR politicians soon discerned that athletic performance would be one of the fastest and cheapest means of obtaining international prestige for a country with a population of only 17 million.

Great efforts were made to improve athletic success, from the systematic selection of talented children for special sports schools Kinder- und Jugendsportschulen; KJS to the systematic use of illegal drugs. All of these efforts were organized efficiently and with totalitarian security measures. Success was real and obvious; from on, the small GDR was consistently in the top ranks of the medal counts, along with the US and the Soviet Union.

Most of these medals were won with the help of banned drugs used for performance enhancement.

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This steroid, a chlor-substituted version of methandrostenolone, had been introduced for clinical use in 49 ; by , it was already being abused and administered to male athletes in the GDR sports system to enhance muscle strength, aggressiveness, and performance. At that time, androgenic steroids were already in widespread use among athletes proficient in muscle strength-dependent events in many countries, notably the US see, e.

In their preparations for the Olympic Games of , however, GDR officials crossed another ethical barrier and administered androgenic hormones to female athletes. The results of the administration of Oral-Turinabol to male and female athletes during the — Olympic cycle were systematically evaluated in various kinds of events. Similarly marked effects were reported for other athletes, particularly women, and starting in , this effect was further enhanced by the administration of increasingly higher doses of the drug discontinuously in cycles of a few weeks each Fig.

In their report, these authors 13 also introduced new terminology to code the substances used. The rectangle from July 28 to October 13 shows the period of drug administration, and the numbers above each date show the number of tablets taken per week here, 14, or 10 mg per day. The curve presents the results of the specific competitions, showing the increase of strength and performance in a fully trained woman.

At the time of the first drug application in , the athlete had been well trained for almost 14 years. Under the influence of the drug, however, she gained unprecedented muscle strength and improved her records dramatically within a few weeks. The steroid was given in three cycles and at various dosages, from 7 to 21 tablets per week i.

Without the drug, she could not reach 18 m but when taking the drug, she improved her world record once more, to She took even more of the androgenic hormone, with daily dosages of up to 7 tablets per day 35 mg , in four cycles, for a total androgenic load of mg for the year.

This led to her top performances in the winter indoor season left curve as well as in the summer right curve and another personal best Note the much lower performance at times off the drug or after only short periods of androgenization. The effects of the treatment with androgenic hormones were so spectacular, particularly in female athletes in strength-dependent events, that few competitors not using the drugs had a chance of winning.

In the GDR of the s, the use of this and other androgenic hormones became customary among athletes, including minors. For a talented female athlete, it was a no-win situation: They could either take it the drug or leave it give up competitive sports. The dosages were also drastically increased, at least until the late s, when some of the damaging side effects became so overt that in the swimming events of the Olympic Games in Montreal , where the GDR won 11 out of 13 events, journalists were inquiring about the strangely deep-sounding voices of the broad-shouldered GDR female swimmers.

At present anabolic steroids are applied in all Olympic sporting events, with the exception of sailing and gymnastics female 2 , … and by all national teams.

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The application takes place according to approved basic plans, in which special situations of individual athletes are also considered. The positive value of anabolic steroids for the development of a top performance is undoubted. Here are a few examples… Performances could be improved with the support of these drugs within four years as follows: Shot-put men 2. From our experiences made so far it can be concluded that women have the greatest advantage from treatments with anabolic hormones with respect to their performance in sports….

Especially high is the performance-supporting effect following the first administration of anabolic hormones, especially with junior athletes. Since the early s many athletes of the GDR, notably females, were given not only oral androgenic steroids but also injections with androgenic hormones, including nandrolone esters or, most frequently, testosterone esters. The strong virilizing side effects of injectable testosterone esters were accepted by most female athletes, but some refused to participate in this additional testosterone injection program.

Moreover, several other classes of doping drugs, from stimulants e. Thus, the women with natural ambiguity of sex characteristics, who had played a significant role in female sports until the introduction of sex test controls in the late s, were soon followed by the pharmacologically induced ambiguous sex characteristics. The androgenic changes in phenotype were obvious in at the Olympic Games in Mexico City, and one of us B. For international discussion, see also ref.

This alarming prediction and the proposed solution were met with hostile silence and were not adopted for almost two decades. Major doping substances used in high-performance sport of the GDR. This decrease since has further continued until today.

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In , for example, no woman put the shot beyond 21 m, only two reached 20 m, and the average of the 10 best is now only In , many athletes were 2 m or more below their personal best from previous years. In the discus throw, no woman in , including the Olympic champion, threw beyond 70 m, well short of the junior record of This abrupt decline in performances after the introduction of random out-of-competition testing has been passed over in painful silence, even in scientific journals see, e.

For example, the best result of the Olympic gold medal winner of the shot-put in Atlanta, GDR-derived athlete Astrid Kumbernuss, would have finished only in sixth place at the Olympic Games in Moscow, almost 2 m behind the GDR winner at that time, who tossed for In , GDR sport officials and the government faced an emerging dilemma. On the other hand, the GDR, which, like most other countries, had officially denied the administration of such drugs and repeatedly pledged to fight against doping, was now being exposed to the problem of drug testing for androgenic-anabolic steroids at major international competitions.

In fact, analyses of urine samples for androgenic steroids were announced for the European Athletic Championships in Rome, but no positive results were published. Therefore, a general strategy and a centrally organized system were developed to secure both efficient hormonal doping and evasion of detection.

Because of the political importance of the problem, a crucial decision was taken at the governmental level, i. Great care apparently was taken that all copies of the 9-page bill and the original protocol of the session were destroyed; ironically, however, a single copy made a few days before by the MfS survived in the Stasi files and now provides evidence that the final decisions were made at the highest governmental level and enacted by government order.

The bill of provided, among other things, that the administration of doping substances, notably androgenic steroids, to male and female athletes should:. The ZDKL was of increasing political importance, being primarily used not to detect drug abuse but to avoid the detection of drug abuse by GDR athletes in international doping controls. Therefore, after the positive doping case of shot-put star Ilona Slupianek in , 3 every GDR athlete was required to provide a urine sample a few days before departing to an international competition at which doping controls would be performed; these precompetition samples were taken by a special delivery system to the ZDKL and analyzed.

All hormone-treated athletes, including minors, and the physicians and coaches involved were sworn to keep the state secret. Remarkably, the secrecy was, by and large, maintained, despite the large numbers of athletes, physicians, scientists, coaches, and officials involved. A detailed conception for drug administration is then worked out by the team physician in a written form and sent, via the classified document office of the FKS, to Dr.

From the central SMD office in Berlin the individual sports medical district advisory offices of the SMD in the individual counties are informed which athlete shall participate in the drug program. A selected sports doctor is then nominated as the responsible MD for all doping drug [UM] problems in each of these county offices. The sports doctors will then hand out the weekly doses to the specific coach who in turn will give the drugs to the athlete.

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This conception is controlled at all levels by random checks of the amounts of drugs distributed, consumed, and left-over. In the DGV, the athletes usually know that the drugs they receive are anabolic steroids. Here the special problem exists that so many athletes, i. The drug dosages of the DGV weightlifters were very high, sometimes exceeding, in the upper weight categories, 10 g per year.

In , for example, one GDR weightlifter took Altogether, the specific drug consumption of GDR athletes is now well documented, including numerous world-record holders and medal winners at Olympic Games and World and European Championships for details, see refs. These athletes included most GDR gold medal winners in the swimming events since the Olympic Games see also the next section and all GDR gold medal winners in the throwing events of the Games.

The androgenization of girls and young women was a most effective part of the GDR doping program. The doses given were surprisingly high, and many of the top women in track and field events and in swimming took amounts of androgenic steroids that were higher than the doses taken by male athletes in the same or comparable events. For example, several female gold medal sprinters took higher amounts of male hormone than did the male GDR sprinters. The leading female athlete in one track event sprint was given a maximum annual dosage of mg, more than double the dosage recorded for the leading male GDR athlete in the same event.

In the s, special work was devoted by the GDR sports physicians and scientists to the basic problem of increased tolerance, i. Therefore, they tried to determine the minimal dosage necessary for an optimal effect on performance in young athletes. The evaluations presented in Fig. Examples of the analyses of the performance-enhancing effects of the first-time administration of the androgenic-anabolic steroid Oral-Turinabol OT , alone or together with mestanolone STS , in two junior athletes: a female long jumper W 61, left panels and a decathlete MK 12, right panels.

The middle panel presents in a histogram the annual dosages of androgenic steroids mg OT: additional STS doses shown in dotted bars. The bottom panel presents the corresponding curves of the developments of certain test performances such as maximal muscle strength MK , speed power SK , sprint speed S , and endurance at high speed SA at different intensities I.

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This is a direct photograph of Fig. Her example was presented by these authors to show that in young girls relatively low drug dosages can be effective for top achievements in the jumping events. Mestanolone, which was available only as an experimental preparation from the research institute ZIMET, was also given to female gymnasts and handball and volleyball players e. However, the person responsible for the illegal use of STS and other steroids, a pharmacology professor, was even honored for his supportive role in the GDR doping system The treatment of young girls with androgenic hormones was especially rewarding in the medal-rich swimming events, where it secured consistent international success e.

Although most of the physicians involved were aware of and documented see below the damaging side effects of the drugs, and even found this treatment unethical as they reported to the Stasi , they were subservient to the political system. Consequently, the treatment of talented swimmers in the mids with androgens started usually at age 14, with a total annual dosage of mg given in three cycles with maximal daily doses of 10 mg see refs.

The driving force behind these efforts to obtain doping drugs through illegal sources was the importance attributed to success in sports in the GDR society, which provided increased salaries and privileges such as travel abroad for both the athlete and the coach.

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  4. The Chief Physician of the DGV 28 29 30 repeatedly complained about the craving of the coaches for more and more steroids. Testosterone esters played, and still play, a significant role in Olympic sports. Before , such drugs were primarily used as merely another group of anabolic-androgenic steroid preparations. Consequently, after ceasing administration of the readily detectable synthetic steroids, athletes of both sexes were routinely injected with testosterone esters of various fatty acid chain lengths.

    This precompetition program of repeated intramuscular injections of testosterone esters had by then become a common procedure in several countries. Moreover, several male and female athletes used testosterone ester injections throughout the season, in addition to their Oral-Turinabol and mestanolone tablets. Consequently, virilizing side effects in female GDR athletes were frequent and pronounced.

    Example from hundreds of evaluations showing typical administration patterns of orally taken synthetic anabolic-androgenic steroids Oral-Turinabol, periods of application denoted by rectangles and injections of testosterone esters [ arrows, 10 mg of testosterone propionate TP ; triangles, 25 mg of TP; circles, mg of testosterone enanthate plus IU of hCG], here given to high H and long W, Weitsprung jumpers during the last 10 weeks before a major international competition in — [immediate preparation period UWV , in weeks, is indicated on the x -axis; WS, competition series preceding the UWV; the competition results in meters are shown immediately above the specific drug application symbols].

    Document directly taken from the scientific evaluation report of Nicklas et al. The code numbers represent male long jumpers W 22, W 23, and W 24 , female long jumpers W 61 and W 63 , and a high jumper H11 , identified in refs. Numerous analytical tests had shown that this pattern of administration would not be detected in the international doping controls at the competition. A symposium to face this problem was held in Leipzig on June 24, , which included six professors and a senior researcher and physician. The protocol and copies of some lectures of this and other similar meetings have been saved 42 and published in total elsewhere 10 In the ensuing years nasal spray preparations containing testosterone or androstenedione were indeed developed in collaboration with VEB Jenapharm, tested, and used in top athletes—some of whom did not like this mode of application as described by some athletes; see refs.

    In subsequent meetings, as well as in letters, other scientists were consulted e. Among the alternative methods were the use of drugs e. Dozens of research projects, all financed under the central program, State Plan Theme Already in , i. In a study on male and female athletes, Clausnitzer et al. They also determined that treatments with hCG and clomiphen did not change the T:E ratio. These and other experimental findings were considered in all further doping and precompetition bridging programs of the GDR see, e. The general procedure was that in the last weeks leading up to a drug-controlled competition only testosterone propionate should be injected and that the last injection should be given 4 or 5 days before the competition.

    To ensure the success of the deception, T:E ratios were also routinely assessed at the ZDKL laboratory shortly before the athletes were to depart to major international events Ausreisekontrollen. The predictive safety of the T:E return-to-normal-range curves was so accurate that athletes could risk loading with testosterone up to the last possible day.

    A departure control series not shown completed before the European Swimming Championships in Bonn showed that urinary test results for four female swimming superstars together representing 10 Olympic gold medals , were in the doping range, i. GDR sports medicine had an additional strategy to circumvent the doping test. Since , VEB Jenapharm had produced preparations of epitestosterone propionate, a biologically inactive compound that had no commercial value but was prepared exclusively for the governmental doping system.

    III, p. Similar supporting measures were also performed [for her] at the subsequent World championships. With this in mind one has to conclude that [her] extraordinarily positive results … will be unique and not reproducible, also not in her own best interest, as already now her facial features have virilized and her voice has changed. Nevertheless, this most-virilizing procedure of steroid doping with T:E injections was generally used in girls and women since —84 and is particularly mentioned in the reports for swimmers and rowers.

    However, the titration of the T:E value by injections of propionate esters of both testosterone and epitestosterone was such a convenient method to beat the doping controls that more and more athletes were anxious to use it, including many not among the selected elite of cadre A athletes. Consequently, an illegal black market for epitestosterone formed in the GDR, and Clausnitzer began to observe increased absolute amounts of epitestosterone in urine samples of athletes.

    In summary, the physicians responsible for the doping system had a choice of methods for avoiding detection while administering large amounts of testosterone esters. The top coaches were then instructed and thus were, and still are, adept at these procedures. Finally, however, even when an athlete of the GDR, or another socialist country, was tested at a risky moment, i.

    From the written records, it appears that, usually, one of the members of the international doping control committee was able to clear away the sample. The numerous secret reports and protocols document that, at least after , doping controls were circumvented by the GDR.

    After the Slupianek case in , none of the numerous athletes loaded with anabolic steroids was ever found positive in any of the numerous international doping control analytical laboratories in any on-competition and out-of-competition test. In other words, the doping controls were useless. First-hand medical information on the negative effects of the doping drugs used in GDR sports, particularly androgenic steroids, is found in the secret doctoral theses, in some of the scientific reports, and most directly and frankly, in the Stasi reports of some sports physicians.

    Many of the sports physicians of the GDR broke patient confidentiality and professional secrecy in their reports to the security agents. Moreover, in recent years, several courageous former athletes have publicly described the damages resulting from these drugs, and some have sued the responsible persons.

    Most of the side effects and damages known from the medical literature to occur with various frequencies upon administration of androgenic steroids or of drugs stimulating testosterone synthesis have also been observed in GDR athletes, and nowhere have the GDR doctors described a novel damaging side effect not mentioned in the Western literature for reviews see 1 2 5 52 54 55 56 57 58 59 60 61 62 Some of the documented damaging side effects observed in male and female GDR athletes during treatment with anabolic-androgenic steroids, notably Oral-Turinabol.

    When she undressed, he recognized the bizarre side effects of Oral-Turinabol. II, pp. The legs including the inner parts of the thighs are strongly hirsute and the pubic hair extends already to the navel. She is forced to shave. I then talked to her several times because according to the approved program she should have been given anabolics only since last year.

    It became clear, however, that she had been given these supporting means by her coach already since she was 15 years old. Initially this was explained to her as vitamin tablets. When she, however, noticed the changes in her body she recognized that it was anabolic steroids.

    He then took compassion, talked to an official of the GDR Sports Association, and arranged, as an exception, that she could both stop her androgenic sprint career and graduate from school. Androgenic treatment of other girls, however, continued.


    One year later, one of them noticed the same and other virilizing side effects, including a deepened voice, but was not allowed to stop the androgenic medication. She consequently decided to defect from the GDR to the West under dangerous circumstances. Although her report, and a few others, were widely publicized, the sports authorities of the world, including the IOC, remained silent, a reaction that pleased the GDR officials.

    The classified records of GDR sports medicine contain numerous cases of virilization, gynecological disorders, and other problems. He repeatedly mentioned to the Stasi the case of a double gold medal winner who, because of her now-deepened voice, could not work in her profession as an interpreter. Androgen-induced amenorrhea and more severe changes such as ovarian cyst formation with recurrent inflammation were also frequent. The doping physicians of the GDR systematically recorded the damaging effects of the administration of androgens to female athletes.

    In numerous women the prevailing administration of anabolic hormones has resulted in irreversible damages, in particular in the swimming events, for example signs of virilization such as an increased growth of bodily hair hirsutism , voice changes and disturbances in libido.

    The effect on the sexual drive was relatively strong in some women. The increase of libido was so severe and unbearable for some women that they requested cessation of the hormone treatment and release from participation in elite sports. When pregnancies occurred in women taking the androgenic hormones, the teratogenic risk of the drug was as much a problem as the loss of a top athlete from international competitions. However, simultaneous intake of a alkylated androgenic steroid such as Oral-Turinabol or mestanolone with contraceptive steroid preparations increased the risk of liver dysfunctions and damages.

    The test results indicated that because of the increasing alcohol consumption by certain top athletes in combination with the intake of anabolic steroids, liver damages had appeared, including considerable increases in the size of the organ hepatomegaly. In female athletes these damaging effects are additionally promoted by contraceptive pills. This complexity can be partly explained by the fact that motivators evolve constantly along the life whereas most of the managers have been focusing on motivating employees through economic incentives Kovach , p.

    In contrast, other incentives can be more valuable motivators such as recognition, quality of working conditions and perceived fairness of promotion system. This leads to the core question: how is employee motivation developed and how can it be used to drive productivity? The first part presents an overview of the development and the implementation of ProMES in an organization.

    The second part explores how ProMES intervention can motivate employees through the application of motivational theories. In conclusion, a critical appraisal is presented based on gained experience from implementation in business. In the current economic environment, improving productivity in organizations is one of the main challenge. In the area of organizational psychology, many tools have been developed to make these improvements. Among these management systems, the Productivity Measurement and Enhancement System, has been established by Dr.

    Robert D. Pritchard and firstly published in Pritchard In this context, Pritchard defined productivity as how effectively an organization uses its resources to achieve its goals. The main purpose of the management system is to increase productivity by changing the behavior of organizational members. In this regard, one of the key elements in ProMES is feedback: giving feedback on the measured productivity indicators, which are directly linked to certain behavior of the workers, should influence their behavior, so work performance will be more effective and efficient.

    The development of the measurement system starts with the identification of the organizational objectives. Once the measurement system is implemented, the results linked to each objective are evaluated and a feedback is regularly given to employees and management in the form of formal feedback reports. Based on the performance assessment, feedback discussions involving both workers and managers lead to changes in order to increase productivity and thus to achieve organizational objectives.

    Similar in terms of goal to other performance management systems such as Balanced Scorecard or Dashboards, the steps of ProMES yet differ. Pritchard described the ProMES process as a bottom- up approach: the implementation is approved by higher management whereas the development itself is handled by the lower levels of the organizational hierarchy Pritchard , p.

    The motivation process can be broken down into a series of components, as shown in Figure 2. Appendix C further explains these determinants and gives an example to illustrate the motivation process. In the workplace, one of the most basic and important needs is to perform well on the job Schmerling , p. Furthermore, ProMES management system is aimed at affecting the productivity of the organization by influencing the behavior and motivation of the employees.

    Accordingly, ProMES operationalizes key features of the motivation theory as illustrated by Figure 3. Indicators are the operationalization of results while contingencies operationalize the results-to- evaluations connections. The action-to-results connections can be considered as the work strategies which determine how effort should be allocated across actions. Note: The center column shows the components of the motivation process The effects of developing the ProMES measurement system are shown on the left side of the figure, and the effects of implementing feedback are shown on the right side.

    On the other hand, feedback meetings focus on developing better work strategies a more optimal set of action-to-results connections. In other words, the feedback system is designed to help the employees to allocate their efforts to the tasks which deliver the most valuable results for the organization, resulting in higher outcomes and thus maximizing the satisfaction of the needs. In conclusion, ProMES aims at increasing productivity through motivation by strengthening each component of the motivation process.

    Team work is an important factor to motivate the employees, which is reflected in modern motivation theories. The two latter ones can only be demonstrated in groups. Furthermore, respect within a group is positioned at high level within the Maslow needs pyramid Maslow , p. Concepts such as brainstorming and problem solving within a team lead to creativity and self-actualization of the members, which both are strong motivational needs according to Maslow.

    To work effectively in team, the team members have to clarify the objectives, work closely together and meet regularly to review the performance and how it could be improved West and Sacramento , p. ProMES aims at operationalizing these three team characteristics through a participative setting of the objectives and regular feedback meetings.

    However, organizational case studies have shown that team work can result in decreasing motivation depending on the population of the group. Personal achievement can lead to conflicts within the team and dominant members can prevent others from speaking resulting in lower recognition. Furthermore, it requires a lot of commitment and effort from the team members to implement the system and once installed, constant efforts are needed to keep the system ongoing Janssen et al. In conclusion, motivational aspect arising from the team work strongly depends on the group population and its willingness to commit to ProMES.

    Participation on issues which are important to employees can have positive effects on performance and attitudes, especially acceptance, and it also enhances perceptions of fairness Cawley et al. Furthermore, Herzberg stated that hygiene factors such as company policy and working organization can lead to dissatisfaction if not applied well Herzberg , p. Participation improves the role perception as well as clarification on perceived value of reward, which are important factors in Porter and Lawyers motivational theory Lawler and Suttle , pp.

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    7. Participation is operationalized in ProMES through the involvement of workers into the definition of objectives and indicators of the unit as well as into the determination of the contingency functions. Moreover, the design team develops the feedback system and the entire team participates in the feedback meetings. The participation is a key part of ProMES: it ensures the overall acceptance of the program by creating a sense of ownership and it increases the perception of fairness. Whereas the members of the design team are encouraged to discuss the development process with those not on the design team, these latter are not involved, leading to lower motivation.