Public Performance Metrics: Driving Physician Motivation and Performance

Abstract

Introduction: As providers transition from "fee-for-service" to "pay-for-performance" models, focus has shifted to improving performance. This trend extends to the emergency department (ED) where visits continue to increase across the United States. Our objective was to determine whether displaying public performance metrics of physician triage data could drive intangible motivators and improve triage performance in the ED. Methods: This is a single institution, time-series performance study on a physician-in-triage system. Individual physician baseline metrics-number of patients triaged and dispositioned per shift-were obtained and prominently displayed with identifiable labels during each quarterly physician group meeting. Physicians were informed that metrics would be collected and displayed quarterly and that there would be no bonuses, punishments, or required training; physicians were essentially free to do as they wished. It was made explicit that the goal was to increase the number triaged, and while the number dispositioned would also be displayed, it would not be a focus, thereby acting as this study's control. At the end of one year, we analyzed metrics. Results: The group's average number of patients triaged per shift were as follows: Q1-29.2; Q2-31.9; Q3-34.4; Q4-36.5 (Q1 vs Q4, p < 0.00001). The average numbers of patients dispositioned per shift were Q1-16.4; Q2-17.8; Q3-16.9; Q4-15.3 (Q1 vs Q4, p = 0.14). The top 25% of Q1 performers increased their average numbers triaged from Q1-36.5 to Q4-40.3 (ie, a statistically insignificant increase of 3.8 patients per shift [p = 0.07]). The bottom 25% of Q1 performers, on the other hand, increased their averages from Q1-22.4 to Q4-34.5 (ie, a statistically significant increase of 12.2 patients per shift [p = 0.0013]). Conclusion: Public performance metrics can drive intangible motivators (eg, purpose, mastery, and peer pressure), which can be an effective, low-cost strategy to improve individual performance, achieve institutional goals, and thrive in the pay-for-performance era.

Resident Perceptions of a Publicly Disclosed Daily Productivity Dashboard

“…Discomfort with comparison itself, however, does not make it unimportant or invalid, as most attending physicians will encounter at least some metric comparisons to a benchmark in their careers, and this may even be an intrinsic motivator for improvement. 1 …”

“…Discomfort with comparison itself, however, does not make it unimportant or invalid, as most attending physicians will encounter at least some metric comparisons to a benchmark in their careers, and this may even be an intrinsic motivator for improvement. 1 After comparing themselves to the mean productivity of their peers, about a third of residents revised their impressions, with fewer classifying themselves as average. While previously published findings have found that residents tend to overestimate their abilities, [16][17][18] respondents in our study were equally likely to be optimistic or pessimistic about themselves: some shifted to a higher perceived productivity, while a slightly greater number shifted to a lower perceived productivity, although there was no significant trend in either direction.…”

“…The number of patients seen per hour is a common metric used in evaluating the on-shift performance and productivity of attending emergency physicians. 1 – 4 Sharing productivity metrics can have some impact on clinician performance 5 and has been shown to increase emergency medicine (EM) resident satisfaction with their evaluation and feedback processes. 6 The productivity of EM residents at various stages in training has been previously characterized, 7 – 9 but there is little standardization in how residency programs use productivity data in resident education, what format is most useful, and how residents perceive and apply the data.…”

“…The number of patients seen per hour is a common metric used in evaluating the on-shift performance and productivity of attending emergency physicians. [1][2][3][4] Sharing productivity metrics can have some impact on clinician performance 5 and has been shown to increase emergency medicine (EM) resident satisfaction with their evaluation and feedback processes. 6 The productivity of EM residents at various Yale School of Medicine, Department of Emergency Medicine, New Haven, Connecticut Introduction: Following resident requests, we created a public metrics dashboard to inform residents of their daily productivity.…”