Peer Comparisons Can Enhance Value

By | May 20, 2020

As the healthcare industry continues to focus on value (improved quality and service, and decreased cost), understanding the human dynamics of physician healthcare providers will enhance our ability to drive change. Incentives are foundational, however, money is not always the primary motivator.

Behavioral Science postulates that different people respond differently to similar incentives. We know there is a common perception that physicians are competitive by nature. As human beings, we tend to view rivalry as “battling” others; however, this is a narrow viewpoint. For instance, competition may also be with oneself or merely overcoming a challenging situation. Considering the journey, a physician travels to reach the destination of being a full-fledged practicing healthcare provider, it is evident that a doctor experiences all three of these components.

Though we profess to practice evidence-based medicine, merely sharing that information, unfortunately, does not change our behaviors or practices. Our present model of implementing new evidence bases the situation on a fact-based educational approach versus emotion-based incentive to adopt the new information. Psychosocial components of our being are significantly higher than our thirst for a factually based existence. It is human nature to win, not necessarily to be right.

Instead of viewing these dynamics as unfavorable, why not utilize them to transform and modify behaviors? For instance, peer comparison feedback is a method that enhances quality and value. Every day, in our consumer-driven environment, we resort to comparisons; however, healthcare tends to avoid self-comparisons internally. There is a view that if I compare providers, I am therefore classifying them as superior or inferior. In numerous ways, this premise is false. Yes, there will be a bell-shaped curve, but only if you create a model in that fashion.  Competition with one another may occur; however, the primary goal is for all to perform well. These are two distinctly, different philosophies, yet, they do not need to be. During the early competition phase, it is crucial to show the performance spread between providers. Undoubtedly, this will create an uncomfortable personal dynamic, yet at the same time, ensure a positive opportunity for transformation. The key is to allow all providers to reach a high level of performance rather than creating a situation where there are “winners and losers.”

One can envision a graphical model where there are four quadrants. The goal is to move all providers to the upper-right quadrant and celebrate that accomplishment. Doing this is in contrast to a bell-shaped curve where the goal is to be at the far right of the curve. A bell-shaped curve model requires that there is always someone on the far right, even if the curve is incredibly narrow and steep and lies entirely within a high-value domain. Once again demonstrating a right way and a wrong way.

Instead of this, let us utilize these attributes of human behavior in a positive way. Unquestionably, success is delivering high-value care to those we serve. This aspiration will require us to drive ourselves and others towards continuous improvement. Therefore, it is crucial to implement it in a manner where all can win, providers, and those we serve.