中文摘要
我们利用超过24万例手术的临床数据与准实验方法,考察医生如何应对绩效"成绩单"的意外公布。此类反馈干预常被用于促使医生改善绩效,但成功的证据有限。我们的研究结果表明,这些有限的效应掩盖了对反馈效价的异质性行为反应。具体而言,医生从正面反馈中的改善大于负面反馈,而负面反馈甚至会降低相当一部分患者的绩效。以普通人开展的实验重复了这些结果,并表明,通过提供与改善直接挂钩的激励,以及加入有助于个体解读过往绩效的定性信息,可以缓解负面反馈带来的困难。这些结果与行为模型相一致,后者表明认知与情感上的困难限制了个体利用负面反馈的程度。因此,医疗领域的反馈干预应经过精心设计,以缓解这些适得其反的行为反应。
Abstract
We use clinical data on more than 240,000 surgeries and quasi-experimental methods to examine how physicians respond to the surprise release of a performance “report card.” Such feedback interventions are commonly used to encourage physicians to improve performance yet show limited evidence of success. Our results show that these limited effects mask heterogeneous behavioral responses to feedback valence. In particular, physicians improve more from positive feedback than from negative feedback, with negative feedback even reducing performance for a nontrivial share of patients. Experiments with laypersons replicate these results and show that struggles with negative feedback can be mitigated by giving incentives directly tied to improvement and by adding qualitative information that helps individuals interpret past performance. These results are consistent with behavioral models that suggest cognitive and emotional difficulties limit how well individuals use negative feedback. Thus, feedback interventions in healthcare should be carefully designed to mitigate these counterproductive behavioral responses.