16 January 2010

How to get compliance with quality initiatives

Pay for it:
Cold, Hard Cash as a Handwashing Incentive - Freakonomics Blog - NYTimes.com
we made hand hygiene rates part of the program; employees had to achieve and sustain >96 percent compliance with hand hygiene to get their full bonus. (This is a pooled bonus plan — either everyone gets it or no one gets it.) We did much better, but still not quite good enough until we hit on a second idea: we made the hand-hygiene performance part of the hospital executives’ performance bonus, even though they don’t care for patients. Magically, we have attained and sustained a rate of hand hygiene >98 percent, and won a national award for quality improvement from the Children’s Hospitals Corporation of America.

As they say in MBA school: you get the behaviors you incentivize.  Not at all coincidentally, when we renew the incentive metrics every year when renewing our contract to staff the ER, the metrics which determine our CEO's bonus wind up in our incentive structure as well.  Funny how that works.


  1. I'm a primary care MD and policy researcher.
    1) I agree totally.
    2) This is pathetic. Imagine if a personal assistant said "Oh, you want me to tell you about _all_ your messages? I would need a bonus, otherwise you'll get 70%."
    Physicians claim we're so professional that no one can look over our shoulders about anything (no utilization review, managed care, etc) but then demand support for core professional functions. Necessary, but pathetic.

  2. Maybe I'm misunderstanding your point, but this isn't an individual metric. If anyone fails, all fail. Since every group, by definition, has a laziest member who drags down your metric, you need some way of coercing that person to comply. When your metric determines the CEO's bonus, one of two things happens: people are yelled at until they comply, or they are fired. Also, the CEO stops complaining about the rate of supply use driving up costs.


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