Applying Medical Staff Quality Incentives

Patient Safety Monitor Insider

February 27, 2006

Last month, I wrote on the topic of providing quality incentives for physicians as part of a medical staff quality program. As I indicated in that article, the reason for selecting that topic was in response to a question from a medical staff leader regarding whether it was feasible to even consider providing incentives.

I did receive a very thoughtful response from a reader questioning whether using such incentives is in keeping with best practices from Deming and other performance experts regarding motivation of individuals within an organization. While there can be differing views as to whether the practice will be effective, I want to emphasize that the article was really focused on how physician incentives have be done, rather than whether it was the best way to motivate physicians regarding quality.

As I mentioned in the last month's article, this month I will discuss some specific quality issues to which you may wish to apply these principles. Just for review, there were four principles that were outlined:

  1. Establish eligibility pool criteria that are not volume based.
  2. Make the incentive based on a random drawing from the eligibility pool.
  3. Have a reasonable frequency of the awards.
  4. Using multiple smaller awards may be better than having one big winner.

So what aspects of quality might you want create quality incentives? From a practical standpoint, first you need to decide which quality areas do you have good data at a physician specific level. Unless you already have reliable data, or can easily obtain it, it will take a while to get the process going.

An important issue to decide is whether you will base the award on outcomes or process measures. My recommendation is to focus more on process measures at first, since outcome data is more controversial at this time, particularly when it comes to physician attribution.

Second, determine where performance needs improvement. It may seem obvious, but if you already have good or excellence performance, why bother with an incentive. This doesn't mean performance needs to be poor before you consider using an incentive. If your organization is seeking to move from good to excellent, then an incentive may be useful.

Third, you should decide how much it is worth to the organization to use the incentive method to gain improvements. If it is used for trivial issues, it may lack the impact it needs when you try to apply it to more important issues.

I hope this discussion is helpful to you in considering how to motivate your medical staff. Please let me know if you have tried these approaches and the result of your effort.

Regards,

Bob Marder, MD
Practice Director, Quality and Patient Safety
The Greeley Company