Data transparency is one of the most effective mechanisms for incentivizing physician behavior change, but one of the first reactions to unveiling physicians’ performance among their peers usually is to question the validity and source of the data, says Kelly Tiberio, manager of GE Healthcare Camden Group, a consulting company based in Los Angeles.
“In my experience, if physicians don’t trust the data being presented, you’ve already lost your ability to engage them in a meaningful discussion,” Tiberio says. “A well-designed dashboard with clear methodological assumptions will keep the discussion factual and objective.”
Quality professionals will have better luck with physician acceptance if they involve physicians early on in the performance measure selection and definition process, Tiberio says. Compliance measures that physicians have not bought into will likely not be effective measures of success.
Tiberio says there are two schools of thought on providing performance data to physicians, and both are valid. One option is to rip off the Band-Aid and embrace the potential political strife that ensues. The other is ease the physicians into the data first with blinded performance dashboards, allowing them time to digest the data in a neutral state. When there is acceptance of the methods used and understanding of individual performance related to peers, with some window of time for improvement, hospital leadership can transition the report to an unblinded one.
Defensive Reaction Expected
When confronted with evidence that they seem to be underperforming — especially when that evidence is also seen by their peers — it is a natural reaction for physicians to become defensive. In many cases, their reaction is warranted, Tiberio notes.
For instance, perhaps they deal with higher acuity patients than their peers and the best practices against which they are being evaluated don’t account for the complexity of all patient care situations.
“While standardization of care is typically its purpose, a physician compliance plan must also incorporate enough flexibility such that physicians aren’t penalized for complex patient exceptions,” she says. “Ideally, the measure being tracked can be adjusted to evaluate and adjust for patient acuity.”
When the data is presented effectively, it can bring out the best in physicians. Tiberio recently worked with a health system in the Northeast that presented a physician performance report to its orthopedic medical staff and saw a sudden increase in collaboration. While the spirit of competitiveness can motivate behavior change, Tiberio says physicians ultimately want to provide excellent patient care and are driven by evidence-based medicine and best practice. Presented with the right data in the right way, the result may be more collaboration than competition, she says.
“Variation in compliance rates stimulates valuable discussion among physicians who fall on either end of the performance spectrum, helping them to understand and adopt new care delivery practices that will ultimately benefit their patients,” she says.
Financial incentives, such as shared savings programs, are another means to incentivize behavior change, but Tiberio says that in her experience, quality of care and patient outcomes need to be the drivers of an incentive program in order for it to be sustainable and patient-centric.
Support from C-suite executives is crucial to the development, dissemination, and messaging of physician-level dashboards, Tiberio notes. There also should be a physician leader who will be a champion for physician engagement and performance improvement.
“At a minimum, this individual should act as a liaison between the medical staff and hospital administration, emphasizing important strategic imperatives on behalf of the hospital while advocating for physicians’ interests,” Tiberio says.
- Kelly Tiberio, Manager, GE Healthcare Camden Group, Los Angeles. Telephone: (310) 320-3990.