Public Performance Metrics: Driving Physician Motivation and Performance

Area of Science:

• Healthcare Management
• Medical Economics
• Public Health

Background:

• Healthcare systems are shifting from fee-for-service to pay-for-performance models.
• Emergency department (ED) visits are increasing nationwide.
• Improving ED performance is a key objective.

Purpose of the Study:

• To determine if public display of physician triage performance metrics could enhance intangible motivators.
• To assess the impact of visible performance data on ED triage efficiency.

Main Methods:

• A time-series study was conducted on a physician-in-triage system at a single institution.
• Individual physician triage and disposition metrics were collected and displayed quarterly.
• Physicians were informed of the data display but faced no direct consequences or incentives.

Main Results:

• The overall average number of patients triaged per shift significantly increased from Q1 (29.2) to Q4 (36.5) (p < 0.00001).
• The number of patients dispositioned per shift showed no significant change (p = 0.14).
• The bottom 25% of performers showed a significant increase in average patients triaged per shift (12.2 patients, p = 0.0013).

Conclusions:

• Public performance metrics can effectively drive intangible motivators such as purpose, mastery, and peer pressure.
• This strategy offers a low-cost method to improve individual performance and achieve institutional goals.
• Visible performance data can be a valuable tool for enhancing efficiency in the pay-for-performance healthcare environment.