Unbiased Analysis of Today's Healthcare Issues

Using the Hawthorne Effect to explain Patient Satisfaction and Quality:

Written By: Jason Shafrin - Apr• 10•08

“When regulators or policy makers succeed in improving the quality of care provided by some doctors, do patients even notice and/or care?” This is the question which Kenneth L. Leonard attempts to answer. Davies and Ware (1988) do state that patient satisfaction is correlated with average quality levels. One problem with most studies is that quality improvements take place over a long period of time. It is possible that as quality improves, patient expectations also increase and thus overall reported patient satisfaction may be unaffected.

How does a researcher get an exogenous change in quality? Leonard uses the Hawthorne Effect. The Hawthorne effect states that quality will improve whenever there is a change in environment. In this study, doctors are observed by researchers. The study finds that objective measures of quality improve immediately after researchers arrive, but the quality improvement slowly decays over time until after about 10 observations, the doctor returns to their original quality level.

So, do patients actually notice this quality improvement? Leonard find that:

Patient do, in fact, recognize and value quality care. A 1% increase in protocol adherence (from an average adherence of about 53%) is associated with about a 0.40% increase in the probability that a patient will declare the consultation to have been “very good” (from an average level of about 12%).

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  1. Ian Furst says:

    I absolutely disagree with the conclusions you’ve connected Jason. In the first sentence you speak of “regulators and policy makers improving the quality of care”. By this I assume you mean outcomes and partly service. In the study cited the effect was to improve the tangibles of consultations with the doctor – namely the attitude/service from the doctor. It’s well proven that patient satisfaction is largely dervied not from expectations or clinical outcomes but the tangibles of the experience. It therefore stands to reason that applying the Hawthorne effect would have a positive influence on patient satisfaction. But I believe you’ve made a massive leep of faith to state that based on this study patients will notice a public policy level change in health care quality.