title: Changing health care provider performance through measurement.
abstract: Can the quality of care be improved by repeated measurement? We show that measuring protocol adherence repeatedly over ten weeks leads to significant improvements in quality immediately and up to 18 months later without any additional training, equipment, supplies or material incentives. 96 clinicians took part in a study which included information, encouragement, scrutiny and repeated contact with the research team measuring quality. We examine protocol adherence over the course of the study and for 45 of the original clinicians 18 months after the conclusion of the project. Health workers change their behavior significantly over the course of the study, and even eighteen months later demonstrate a five percentage point improvement in quality. The dynamics of clinicians' reactions to this intervention suggest that quality can be improved by the repeated measurement by external peers in a way that provides reminders of expectations.
authors.affiliation: Department of Agricultural and Resource Economics, University of Maryland, College Park, MD 20740, USA. Electronic address: kleonard@arec.umd.edu.
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Leonard
authors.affiliation: Centre for Educational Health in Development, Arusha (CEDHA), PO Box 1162, Arusha, Tanzania.
authors.forename: Melkiory C
authors.initials: MC
authors.lastname: Masatu
mesh_terms: D005246:Feedback; D006282:Health Personnel / Q000523:psychology* / Q000592:standards*; D006801:Humans; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards; D011787:Quality of Health Care / Q000592:standards*; D011795:Surveys and Questionnaires; D014894:Weights and Measures; D000066477:Work Performance; D000078329:Workforce
keywords: Altruism; Low income countries; Pro-social motivation; Quality of care; Results based financing; Supportive supervision; The Hawthorne effect