The Use of Modest Incentives to Boost Adoption of Safety Practices and Systems

Abstract

Physician adoption of quality and safety systems has been delayed due to required changes in workflow, up-front investments in training, and shifts in efficiency. Here we report on the application of novel approaches to incentive design, such as the Prospect Theory, and steps to engage leadership and staff physicians in the development of a physician quality and safety incentive program in a large employed physician group. The program couples modest financial incentives along with a broad communications campaign to foster the adoption of electronic health records, the use of electronic decision support for ordering imaging studies, e-prescribing, and department/division-specific quality and safety targets ranging from note completion times to hand hygiene practices. To date over 1,200 physicians have participated in this program, and it has generated unprecedented interest and energy in quality and safety measurement and improvement. Here we report on the impact of the program on systems adoption and meeting specific quality and safety goals, as well as the generalizable lessons learned in the development and implementation of the program.