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Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance

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  • Leonard, Kenneth L.
  • Masatu, Melkiory C.

Abstract

Many doctors in developing countries provide considerably lower quality care to their patients than they have been trained to provide. The gap between best possible practice and actual performance (often referred to as the know-do gap) is difficult to measure among doctors who differ in levels of training and experience and who face very different types of patients. We exploit the Hawthorne effect-in which doctors change their behavior when a researcher comes to observe their practices-to measure the gap between best and actual performance. We analyze this gap for a sample of doctors and also examine the impact of the organization for which doctors work on their performance. We find that some organizations succeed in motivating doctors to work at levels of performance that are close to their best possible practice. This paper adds to recent evidence that motivation can be as important to health care quality as training and knowledge.

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  • Leonard, Kenneth L. & Masatu, Melkiory C., 2010. "Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance," Journal of Development Economics, Elsevier, vol. 93(2), pages 226-234, November.
    • Handle: RePEc:eee:deveco:v:93:y:2010:i:2:p:226-234
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    16. Kenneth L. Leonard & Melkiory C. Masatu & Alexandre Vialou, 2007. "Getting Doctors to Do Their Best: The Roles of Ability and Motivation in Health Care Quality," Journal of Human Resources, University of Wisconsin Press, vol. 42(3).
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    5. J. Michelle Brock & Andreas Lange & Kenneth L. Leonard, 2016. "Generosity and Prosocial Behavior in Healthcare Provision: Evidence from the Laboratory and Field," Journal of Human Resources, University of Wisconsin Press, vol. 51(1), pages 133-162.
    6. Hao Xue & Jennifer Hager & Qi An & Kai Liu & Jing Zhang & Emma Auden & Bingyan Yang & Jie Yang & Hongyan Liu & Jingchun Nie & Aiqin Wang & Chengchao Zhou & Yaojiang Shi & Sean Sylvia, 2018. "The Quality of Tuberculosis Care in Urban Migrant Clinics in China," IJERPH, MDPI, vol. 15(9), pages 1-15, September.
    7. Godlonton, Susan & Okeke, Edward N., 2016. "Does a ban on informal health providers save lives? Evidence from Malawi," Journal of Development Economics, Elsevier, vol. 118(C), pages 112-132.
    8. Carolina Lopez & Anja Sautmann & Simone Schaner, 2022. "Does Patient Demand Contribute to the Overuse of Prescription Drugs?," American Economic Journal: Applied Economics, American Economic Association, vol. 14(1), pages 225-260, January.
    9. Kovacs, Roxanne & Lagarde, Mylene, 2022. "Does high workload reduce the quality of healthcare? Evidence from rural Senegal," Journal of Health Economics, Elsevier, vol. 82(C).
    10. Fuhai Hong & Tanjim Hossain & John A. List & Migiwa Tanaka, 2018. "Testing The Theory Of Multitasking: Evidence From A Natural Field Experiment In Chinese Factories," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 59(2), pages 511-536, May.
    11. Si, Yafei & Bateman, Hazel & Chen, Shu & Hanewald, Katja & Li, Bingqin & Su, Min & Zhou, Zhongliang, 2023. "Quantifying the financial impact of overuse in primary care in China: A standardised patient study," Social Science & Medicine, Elsevier, vol. 320(C).
    12. Nicholas Wilson, 2015. "Can Disease-Specific Funding Harm Health? in the Shadow of HIV/AIDS Service Expansion," Demography, Springer;Population Association of America (PAA), vol. 52(5), pages 1671-1700, October.
    13. Roland Cheo & Kainan Huang & Jingping Li, 2023. "Group cooperation of village officials in Chinese rural resettlement: A lab in the field," Contemporary Economic Policy, Western Economic Association International, vol. 41(2), pages 388-407, April.
    14. Lagarde, Mylène & Blaauw, Duane, 2022. "Overtreatment and benevolent provider moral hazard: Evidence from South African doctors," Journal of Development Economics, Elsevier, vol. 158(C).
    15. Lagarde, Mylène & Blaauw, Duane, 2022. "Overtreatment and benevolent provider moral hazard: evidence from South African doctors," LSE Research Online Documents on Economics 115383, London School of Economics and Political Science, LSE Library.
    16. Jonah S. Goldberg, 2023. "What we measure when we measure the effects of user fees: a replication, reanalysis, and extension of Tanaka, 2014," Empirical Economics, Springer, vol. 65(4), pages 1981-2009, October.
    17. Rudy Douven & Minke Remmerswaal & Robin Zoutenbier, 2015. "Do Extrinsically Motivated Mental Health Care Providers Have Better Treatment Outcomes?," CPB Discussion Paper 319.rdf, CPB Netherlands Bureau for Economic Policy Analysis.
    18. Wilbroad Mutale & Peter Godfrey-Fausset & Margaret Tembo Mwanamwenge & Nkatya Kasese & Namwinga Chintu & Dina Balabanova & Neil Spicer & Helen Ayles, 2013. "Measuring Health System Strengthening: Application of the Balanced Scorecard Approach to Rank the Baseline Performance of Three Rural Districts in Zambia," PLOS ONE, Public Library of Science, vol. 8(3), pages 1-11, March.
    19. Rudy Douven & Minke Remmerswaal & Robin Zoutenbier, 2015. "Do Extrinsically Motivated Mental Health Care Providers Have Better Treatment Outcomes?," CPB Discussion Paper 319, CPB Netherlands Bureau for Economic Policy Analysis.
    20. Renfu Luo & Grant Miller & Scott Rozelle & Sean Sylvia & Marcos Vera-Hernández, 2015. "Can Bureaucrats Really Be Paid Like CEOs? School Administrator Incentives for Anemia Reduction in Rural China," NBER Working Papers 21302, National Bureau of Economic Research, Inc.
    21. J. Michelle Brock & Andreas Lange & Kenneth L. Leonard, 2012. "Generosity norms and intrinsic motivation in health care provision: evidence from the laboratory and the field," Working Papers 147, European Bank for Reconstruction and Development, Office of the Chief Economist.
    22. Liangfei Qiu & Subodha Kumar & Arun Sen & Atish P. Sinha, 2022. "Impact of the Hospital Readmission Reduction Program on hospital readmission and mortality: An economic analysis," Production and Operations Management, Production and Operations Management Society, vol. 31(5), pages 2341-2360, May.
    23. Esther Atukunda & Anne Fitzpatrick, 2015. "An Evaluation of Factors Affecting Drug Quality: Evidence from the Antimalarial Market in Uganda," Working Papers 2015_03, University of Massachusetts Boston, Economics Department.
    24. Kovacs, Roxanne J. & Lagarde, Mylene & Cairns, John, 2022. "Can patients improve the quality of care they receive? Experimental evidence from Senegal," World Development, Elsevier, vol. 150(C).

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    More about this item

    Keywords

    Motivation Practice quality Health care Tanzania Hawthorne effect;

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • O1 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development
    • O2 - Economic Development, Innovation, Technological Change, and Growth - - Development Planning and Policy

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