Why Paying Health Providers for Improved Data Quality Won’t Work

What if we began to educate health providers, and the public, that health providers that capture high quality data are actually delivering the best quality care?  What if we helped people to understand that clinical documentation and the capture of high quality data is a clinical task, not an administrative task?  What if doctors in hospitals stopped delegating completion of the medical record to the most junior clinician in the room, and began to take pride in recording clinical information with a high degree of accuracy, completeness and in a timely fashion.  And what if we began to encourage health consumers to avoid health providers who don’t want to do this, and are stuck in the old world of “data capture is an administrative task”?

 

As I go about my work, consulting with many healthcare organisations on their adoption of digital health technologies into new models of care, I am seeing a growing recognition that data is the lifeblood of our future health systems.  This is encouraging.

Improved data quality will undoubtedly support the following outcomes:

  • Improved clinical safety
  • Reduced numbers of medical errors
  • Reduced duplication of testing
  • Improved service planning and targeting
  • Better population health
  • More efficient transitions of care across service boundaries

In my experience very few people disagree that we need better data quality from our health systems.  Where we disagree is in how to achieve this.

A recent report from the Grattan Institute in Australia, Building better foundations for primary care (May 2017), contained the following recommendation:

Recommendation 1: Pay for better data – We need more information about what happens in general practice. Without data, there is no sound basis for system reform. Better data will enable realistic targets to be set for improvement in primary care. The lifting of the Medicare rebate freeze should be taken as an opportunity to make a new payment to general practices for gathering and supplying the necessary data.

 

Whilst we all want improved quality data, I strongly disagree that paying health providers for better data will have the desired effect.  Let me explain…

In Australia we have a history of paying health providers for various things.  It doesn’t usually go that well.  For example, our Practice Incentive Payment (PIP) schemes in General Practice have tended to result in lowest common denominator behaviours, such as the first eHealth practice incentive, which paid GPs to obtain the infrastructure to communicate with Australia’s national Electronic Health Record, the My Health Record.  Under this incentive, GPs did acquire the capability to talk to the My Health Record.  They just didn’t use it.  Because they weren’t paid to.  Put simply, if you pay people to do something, the vast majority of them will do the bare minimum required to get paid.

The reason for this is because paying for a behaviour is an extrinsic motivator.  Extrinsic motivation can be defined as:

Extrinsic motivation refers to behaviour that is driven by external rewards such as money, fame, grades, and praise.  This type of motivation arises from outside the individual, as opposed to intrinsic motivation, which originates inside of the individual.

 

This can be contrasted with intrinsic motivation, which can be defined as:

Intrinsic motivation refers to behaviour that is driven by internal rewards. In other words, the motivation to engage in a behaviour arises from within the individual because it is naturally satisfying to you. This contrasts with extrinsic motivation, which involves engaging in a behaviour in order to earn external rewards or avoid punishment.

 

Everything we know about motivation says that intrinsic motivation is more powerful than extrinsic motivation and achieves longer lasting results.  Remove an external (extrinsic) reward and the required behaviours are likely to stop.  Once you’ve created an internal (intrinsic) motivation then good luck trying to change it.

So let’s think about applying this idea to the Grattan Institute’s recommendation of paying health providers for better data.  Why aim for behaviour modification through extrinsic motivation (i.e. payment) when this is the inferior mechanism?  Why can’t we seek more fundamental change by harnessing intrinsic motivators to improve the quality of data captured by health providers?  This would seek to cause through behavioural change through pride in what it means to be a good clinician.

What if we began to educate health providers, and the public, that health providers that capture high quality data are actually delivering the best quality care?  What if we helped people to understand that clinical documentation and the capture of high quality data is a clinical task, not an administrative task?  What if doctors in hospitals stopped delegating completion of the medical record to the most junior clinician in the room, and began to take pride in recording clinical information with a high degree of accuracy, completeness and in a timely fashion.  And what if we began to encourage health consumers to avoid health providers who don’t want to do this, and are stuck in the old world of “data capture is an administrative task”?

This is what an intrinsic motivation for higher quality data from health providers would look like.  If we want to achieve real and lasting change, this is the path that we need to take.  Paying health providers for improved data quality won’t work.

 

2 Responses to“Why Paying Health Providers for Improved Data Quality Won’t Work”

  1. April 7, 2018 at 1:37 pm #

    So how do you do that in a way that brings about change evenly? Incenting behavior through remuneration may have the lowest-common-denominator effect you mention, I agree, but it also has other kinds of benefits: coordination, consistency, and getting a group to move more or less in unison.

  2. Karina Gajewska
    April 23, 2018 at 1:01 pm #

    We’ve been trying here in NHS for years, looking at levers and incentives, but it’s been really hard as we can’t give data back to providers and commissioners quickly enough. Aiming for small incremental changes rather than revolution, but IT/Digital world needs to move fast(er)!

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