• Changing physician behavior: what works

    • Summary: This article is a meta-review of different studies focused on changing physician behaviors. It strives to answer the question, "In surgical and general practice, through what methods are clinical research results, as well as guidelines, best implemented to change physician practice patterns?"
    • Takeaway: Active forms of continuing medical education and multifaceted interventions were found to be the most effective methods for implementing guidelines into general practice.
    • Citation: Mostofian, Fargol, et al. "Changing physician behavior: what works." Am J Manag Care 21.1 (2015): 75-84.

  • Will Financial incentives stimulate quality improvement? reactions from frontline physicians.

    • Summary: This study interviews physicians who took part in a financial incentive program in California to understand the barriers to success for the program. Among other things, "Physicians expressed the need for accurate and timely data, peer comparisons, and more patient time, staff support, and consultations with colleagues to successfully monitor and deliver quality care.”
    • Takeaway: Physicians expressed the need for accurate and timely data, peer comparisons, and more patient time, staff support, and consultations with colleagues to successfully monitor and deliver quality care. Many support increased pay for delivering high-quality care, but question measurement accuracy, bonus payment financing, and health plan involvement.
    • Citation: Teleki, Stephanie S., et al. "Will financial incentives stimulate quality improvement? Reactions from frontline physicians." American Journal of Medical Quality 21.6 (2006): 367-374.

  • Physician peer comparisons as a nonfinancial strategy to improve the value of care

    • Summary: This article discusses peer comparisons for physicians. It outlines the history of peer comparisons, challenges with implementing them, the different types of peer comparisons, the limitations of peer comparisons, and the need for an evidence base to guide implementation.
    • Takeaway: Regardless of past experience, new policies such as the Medicare Access and CHIP Reauthorization Act of 2015 and the Oncology Care Model are embedding peer comparisons in the future of medical practice.
    • Citation: Navathe, Amol S., and Ezekiel J. Emanuel. "Physician peer comparisons as a nonfinancial strategy to improve the value of care." JAMA 316.17 (2016): 1759-1760.

  • Increasing the value of social comparisons of physician performance using norms.

    • Summary: This article discusses the policies that aid in making peer comparisons effective in changing physician behavior. The article recognizes that there are unintended consequences when implementing peer comparisons, but with the right policies, those consequences can be avoided.
    • Takeaway: Social comparisons represent a potentially powerful method for influencing physician behavior.
    • Citation: Liao, Joshua M., Lee A. Fleisher, and Amol S. Navathe. "Increasing the value of social comparisons of physician performance using norms." JAMA 316.11 (2016): 1151-1152.

  • Effect of an automated patient dashboard using active choice and peer comparison performance feedback to physicians on statin prescribing: the PRESCRIBE cluster randomized clinical trial

    • Summary: This study evaluated the effectiveness of using peer comparisons and active choice framing to improve statin prescriptions for patients that qualify. The study found that peer comparisons and email notifications are effective in changing physician behaviors.
    • Takeaway: Compared with usual care, there was a significant increase in statin prescribing in the active choice with peer comparison arm, but not in the active choice arm.
    • Citation: Patel, Mitesh S., et al. "Effect of an automated patient dashboard using active choice and peer comparison performance feedback to physicians on statin prescribing: the PRESCRIBE cluster randomized clinical trial." JAMA network 1.3 (2018): e180818-e180818.

  • Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reports

    • Summary: This study evaluated whether unblinded peer comparisons would be effective in reducing unnecessary antibiotic prescriptions. The study results "have significant implications in combating antibiotic resistance as well as modeling physicians towards quality and safety goals.”
    • Takeaway: Provider and patient education followed by regular feedback to provider via normative comparison to their local peers through unblinded provider reports, lead to reductions in the rate of inappropriate antibiotic prescribing for ARTI and overall antibiotic prescribing rates.
    • Citation: Milani, Richard V., et al. "Reducing inappropriate outpatient antibiotic prescribing: normative comparison using unblinded provider reports." BMJ open quality 8.1 (2019): e000351.

  • Improving physician performance through peer comparison feedback

    • Summary: This study is about a project to improve physician performance in colorectal cancer screening through the use of different interventions.
    • Takeaway: The use of peer comparisons was found to be very effective in getting physicians to make lasting changes to their practice patterns (changes persisted 6-12 months after intervention).
    • Citation: Winickoff, Richard N., et al. "Improving physician performance through peer comparison feedback." Medical care (1984): 527-534.

  • More than money: motivating physician behavior change in accountable care organizations

    • Summary: This study examines the need to change physician behaviors for accountable care organizations (ACOs) to be successful. 
    • Takeaway: There is a lack of motivators for behavior change being deployed at ACOs. Peer comparisons and data transparency at the physician level are extremely important for motivating physician behavior change.
    • Citation: Phipps-Taylor, Madeline., and Stephen M. Shortell. "More than money: motivating physician behavior change in accountable care organizations." The Milbank Quarterly 94.4 (2016): 832-861.

  • To Get Doctors to Do the Right Thing, Try Comparing Them to Their Peers

  • Want to Change Physician Behavior? Follow These Five Tips

    • Summary: This Daily Briefing from the Advisory Board details Robert Pearl's, CEO of the Permanente Medical Group, 5 tips for getting physicians to change their behavior.
    • Takeaway: The five tips are: 1) Use influence, not authority. 2) Engage doctors emotionally. 3) Explicitly define change — and let doctors track their performance. 4) Build trust. 5) Stick with what works.
    • Citation: “Want to Change Physician Behavior? Follow These Five Tips.” Advisory Board, Daily Briefing, 26 Jan. 2016, https://www.advisory.com/daily-briefing/2016/01/26/want-to-change-physician-behavior-follow-these-five-tips#ABCtake.

  • It’s Time To Rethink The Anatomy Of Physician Behavior

    • Summary: This article from Health Affairs explains why physicians might tend to behave in certain ways, and suggests different strategies for approaching physician behavior change. One of their recommendations is a physician report card that focuses on their intrinsic motivations.
    • Takeaway: Financial incentives are only a fractional determinant of overall practice patterns. Greater discussion of the multiple determinants of physician behavior, and how these factors can be leveraged to improve care, is needed to spark behavior change.
    • Citation: Rotenstein, Lisa S., and Anupam B. Jena. “It’s Time To Rethink The Anatomy Of Physician Behavior.” Health Affairs, Health Affairs Forefront, 22 June 2018, https://www.healthaffairs.org/do/10.1377/forefront.20180618.721948/full/.

  • Stop Trying to Change Physician Behavior

  • Introducing the Physician Communication Toolkit

    • Summary: This toolkit created by the Advisory Board Physician Executive Council explains the best ways to communicate with physicians.
    • Takeaway: They outline 4 imperatives for communication and advocate for strategies that remedy common communication problems that many hospital executives experience: 1) Build a scalable communication platform. 2) Curate physician-centered content. 3) Deliver attention-grabbing messages 4) Facilitate forums for meaningful dialogue.
    • Citation: “Introducing the Physician Communication Toolkit.” Advisory Board, Physician Executive Council, https://docplayer.net/86546186-Introducing-the-physician-communication-toolkit.html.

  • Daniel Pink's Theory

    • Summary: While this article is not specifically about healthcare behavior change, Daniel Pink describes a strategy for motivating professionals through self-determination.
    • Takeaway: Pink recommends that organizations harness this natural drive and use it to their advantage to get employees to behave autonomously, purposefully, and with mastery.
    • Citation: Akay, Esin. “Daniel Pink's Theory.” L.I.F.E., 6 Apr. 2015, https://esinakay.wordpress.com/tag/daniel-pinks-theory/.

  • Doctors are competitive: use that to improve care delivery

    • Summary: This article, published in Healthcare Financial Management, strongly urges physician leaders to go public with their physician behavior data (at a local level).
    • Takeaway: Physicians don't like being told what to do, and would rather make self-determined changes encouraged by public data, due to their competitive nature.
    • Citation: Dhaliwal, Gurpreet. "Doctors are competitive: use that to improve care delivery." Healthcare Financial Management, vol. 68, no. 6, June 2014, p. 152. Accessed 28 Apr. 2022.
      DhaliwalQuote-GreatestPhysicianLeaderChallenge

  • Physician perceptions of performance feedback in a quality improvement activity

    • Summary: This study aimed to understand how physicians feel about performance feedback, one aspect of which was peer comparisons. 
    • Takeaway: The study "found that physicians desire and value feedback, and have substantive suggestions on ways to improve feedback reports to make them more useful, meaningful, and actionable to improve patient care."
    • Citation: Eden, Aimee R., et al. "Physician perceptions of performance feedback in a quality improvement activity." American Journal of Medical Quality 33.3 (2018): 283-290.