在同行比较后临床医生的工作满意度反:随机临床试验的二次分析
Jason N Doctor1, Noah J Goldstein2, Craig R Fox2
1Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles.
JAMA network open
|June 8, 2023
概括
在一项随机试验中,将临床医生的表现与同行进行比较的社会规范反并没有降低工作满意度. 这种干预可以提高绩效,而不会对临床医生的士气产生负面影响或导致营业额增加.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 医学教育 医学教育
- 医疗保健管理的管理
背景情况:
- 旨在通过反提高临床医生的表现的干预措施至关重要.
- 重要的是,这些干预措施不会对临床医生的工作满意度产生负面影响,也不会导致员工流动.
- 衡量工作满意度可以帮助识别可能导致不良后果的反干预.
研究的目的:
- 评估社会规范反 (同行比较) 是否与没有反相比,显著降低了临床医生的工作满意度.
- 为了确定接受同行比较反的临床医生中平均工作满意度是否低于预定义的临床意义边际.
主要方法:
- 一个二次的,预注册的,一个集群随机试验的非劣势分析,具有2×2×2的因数设计.
- 该研究包括来自43家诊所的201名临床医生,数据收集于2011年11月1日至2014年4月1日之间.
- 干预涉及每月发送电子邮件,提供反,比较个人临床医生的表现与表现最佳的同行.
主要成果:
- 两组平均工作满意度的临床集群差异在统计学上并不显著 (β = 0.11;95% CI, -0.19至0.42;P = .46).
- 否定了同行比较导致工作满意度显著下降的零假设.
- 在随机分配给社会规范反的临床医生中,工作满意度保持相似,在控制其他试验干预时没有显著变化.
结论:
- 实施的同行比较反并没有导致临床医生对工作的满意度下降.
- 潜在地减轻不满的因素包括临床医生对绩效指标的代理权,个人数据的隐私以及所有临床医生实现最高绩效的可能性.
- 这表明,可以设计性能反干预措施以提高实践,而不会损害临床医生的福祉.
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