Performance Feedback in Health Care

The Southeast Permanente Medical Group (TSPMG) at Kaiser Permanente Georgia provides performance feedback to its providers. The performance feedback designs can vary and change over time in terms of targets, summary statistics, included measures, and frequency of delivery. The TSPMG health services research group seek to compare different performance feedback designs to identify which are most effective at contributing to performance improvement.

The research team will randomly assign providers into different performance feedback conditions, as specified in the protocol. Providers will receive performance feedback through the standard mechanism in which it is conveyed by their supervisor.

The objective is to investigate how to design performance feedback for providers to best motivate and support them in improving performance along with existing strategic priorities for care delivery.

The reserach team will test alternative designs of performance feedback that vary on the following dimension:

1) targets for comparison of one's own performance

Study Overview

• Status: Completed
• Conditions: Influenza
• Intervention / Treatment: Behavioral: The Impact of Performance Feedback and Variable Goal Setting on Flu Vaccination Success Rates of Providers

Detailed Description

The Southeast Permanente Medical Group (TSPMG) provides performance feedback to its providers. The performance feedback designs can vary and change over time in terms of targets, summary statistics, included measures, and frequency of delivery. The TSPMG health services research team will seek to compare different performance feedback designs to identify which are most effective at contributing to performance improvement. .

The research team will randomly assign providers into different performance feedback conditions, as specified in the protocol. Providers will receive performance feedback through the standard mechanism in which it is conveyed by their supervisor.

The objective is to investigate how to design performance feedback for providers to best motivate and support them in improving performance along with existing strategic priorities for care delivery.

The research team will test alternative designs of performance feedback that vary on the following dimension:

1) targets for comparison of one's own performance

The research team will provide feedback on performance by measures that the organization already tracks internally and uses for performance improvement. These include a provider's utilization of opportunities to provide flu vaccinations.

The study will randomly assign different designs of feedback to providers. In order to understand which designs of feedback have the best effects on performance, the research team will test the following hypotheses:

1. Displaying the next-highest quartile will motivate improvement more than display of all quartiles.

   Theory: The next-highest quartile will serve as an injunctive norm, or suggested target, to repeatedly lift an individual's performance to the suggested level.

2. The positive effect of displaying the next-highest quartile, relative to displaying all quartiles, will be most pronounced for initially low performers.

   Theory: The next highest quartile averts upward social comparison to a much higher level of peer performance, which can be discouraging and so negatively affect performance

3. The positive effect of displaying the next-highest quartile, relative to displaying all quartiles, will diminish over time.

   Theory: Individuals may become worn out as they see a target ratchet higher when their performance improves.

4. Displaying team relative performance along with individual relative performance will be more effective than displaying either type of information alone.

• Study Type: Interventional
• Enrollment (Actual): 595
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Georgia
    • Atlanta, Georgia, United States, 30305
      • Kaiser Permanente Georgia Regional Offices

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

A healthcare provider practicing at The Southeast Permanente Medical Group in a specialty for which the performance measure being studied is relevant.

Health care providers include:

Physicians, Nurse Practitioner, Certified Nurse Midwife, Psych Nurse Specialist, Optometrist, Podiatrist, and Physician Assistant

Exclusion Criteria:

Non-Physicians: Registered Nurses excluding nurse practitioners

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Organizational Target; Providers are shown the flu success performance rate of their team (a "pod," or group of providers who practice together), in comparison to their own, and with the organizational target. These updates and targets are sent bi-weekly.	Behavioral: The Impact of Performance Feedback and Variable Goal Setting on Flu Vaccination Success Rates of Providers; A given provider will be involved in the study for a maximum of 6 months. This will involve, at the most frequent, the delivery of weekly performance feedback. The performance feedback will be delivered using standard approaches already in place in the organization and there will not be a period of seeking out participants for enrollment. Providers will receive performance feedback bi-weekly for the duration of the study period.
Experimental: Achievable Target; Providers are shown the flu success performance rate of their team (a "pod," or group of providers who practice together), in comparison to their own. They will receive a static and achievable target based on their previous year's flu vaccination success rate.	Behavioral: The Impact of Performance Feedback and Variable Goal Setting on Flu Vaccination Success Rates of Providers; A given provider will be involved in the study for a maximum of 6 months. This will involve, at the most frequent, the delivery of weekly performance feedback. The performance feedback will be delivered using standard approaches already in place in the organization and there will not be a period of seeking out participants for enrollment. Providers will receive performance feedback bi-weekly for the duration of the study period.
Experimental: Variable; Providers are shown the flu success performance rate of their team (a "pod," or group of providers who practice together), in comparison to their own. They will receive a variable target that will fluctuate bi-weekly, based on their previous bi-weekly flu vaccination success rate.	Behavioral: The Impact of Performance Feedback and Variable Goal Setting on Flu Vaccination Success Rates of Providers; A given provider will be involved in the study for a maximum of 6 months. This will involve, at the most frequent, the delivery of weekly performance feedback. The performance feedback will be delivered using standard approaches already in place in the organization and there will not be a period of seeking out participants for enrollment. Providers will receive performance feedback bi-weekly for the duration of the study period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Flu Vaccination Administered During Encounter	Whether or not the providers succeeded in administering flu vaccination during flu vaccination opportunity	10 Weeks

Collaborators and Investigators

• Sponsor: Kaiser Permanente
• Collaborators: London School of Economics and Political Science

Study record dates

Study Major Dates

• Study Start (Actual): September 23, 2019
• Primary Completion (Actual): December 31, 2019
• Study Completion (Actual): December 31, 2019

Study Registration Dates

• First Submitted: September 9, 2020
• First Submitted That Met QC Criteria: October 1, 2020
• First Posted (Actual): October 8, 2020

Study Record Updates

• Last Update Posted (Actual): October 8, 2020
• Last Update Submitted That Met QC Criteria: October 1, 2020
• Last Verified: October 1, 2020

More Information

Terms related to this study

• Keywords: Health Care Providers; Flu Vaccination Provision; Performance Feedback; Variable Goal Setting; Flu Vaccination Success Rate
• Other Study ID Numbers: 1535959-1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No