Performance Feedback in Health Care

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.