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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 levels of quality to their patients than they have been trained to provide. The gap between best practice and actual performance is difficult to measure for individual 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, examining the impact of the organization for which doctors work on the performance of doctors, after controlling for their ability. 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 is at least as important to health care quality as training and knowledge.

Suggested Citation

  • Leonard, Kenneth L. & Masatu, Melkiory C., 2008. "Using the Hawthorne Effect to Examine the Gap Between a Doctor's Best Possible Practice and Actual Performance," Working Papers 36693, University of Maryland, Department of Agricultural and Resource Economics.
    • Handle: RePEc:ags:umdrwp:36693
    DOI: 10.22004/ag.econ.36693
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    1. Nazmul Chaudhury & Jeffrey S. Hammer, 2004. "Ghost Doctors: Absenteeism in Rural Bangladeshi Health Facilities," The World Bank Economic Review, World Bank, vol. 18(3), pages 423-441.
    2. Leonard, Kenneth L. & Masatu, Melkiory C., 2008. "Moving from the lab to the field: Exploring scrutiny and duration effects in lab experiments," Economics Letters, Elsevier, vol. 100(2), pages 284-287, August.
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    9. Leonard, Kenneth L., 2008. "Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect," Journal of Health Economics, Elsevier, vol. 27(2), pages 444-459, March.
    10. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
    11. Das, Jishnu & Hammer, Jeffrey, 2007. "Money for nothing: The dire straits of medical practice in Delhi, India," Journal of Development Economics, Elsevier, vol. 83(1), pages 1-36, May.
    12. 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).
    13. Leonard, Kenneth & Masatu, Melkiory C., 2006. "Outpatient process quality evaluation and the Hawthorne Effect," Social Science & Medicine, Elsevier, vol. 63(9), pages 2330-2340, November.
    14. Chaudhury, Nazmul & Hammer, Jeffrey S., 2003. "Ghost doctors - absenteeism in Bangladeshi health facilities," Policy Research Working Paper Series 3065, The World Bank.
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    16. Das, Jishnu & Hammer, Jeffrey, 2005. "Which doctor? Combining vignettes and item response to measure clinical competence," Journal of Development Economics, Elsevier, vol. 78(2), pages 348-383, December.
    17. Steven D. Levitt & John A. List, 2007. "What Do Laboratory Experiments Measuring Social Preferences Reveal About the Real World?," Journal of Economic Perspectives, American Economic Association, vol. 21(2), pages 153-174, Spring.
    18. Abhijit Banerjee & Angus Deaton & Esther Duflo, 2004. "Health care delivery in rural rajasthan," Framed Field Experiments 00120, The Field Experiments Website.
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    Cited by:

    1. Simons, Andrew M. & Beltramo, Theresa & Blalock, Garrick & Levine, David I., 2017. "Using unobtrusive sensors to measure and minimize Hawthorne effects: Evidence from cookstoves," Journal of Environmental Economics and Management, Elsevier, vol. 86(C), pages 68-80.
    2. Barbara McPake & Anthony Scott & Ijeoma Edoka, 2014. "Analyzing Markets for Health Workers : Insights from Labor and Health Economics," World Bank Publications - Books, The World Bank Group, number 18780.
    3. 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.
    4. 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.
    5. 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.
    6. 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).
    7. 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).
    8. 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.
    9. 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.
    10. 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.
    11. 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.
    12. Anja Sautmann & Samuel Brown & Mark Dean, 2016. "Subsidies, Information, and the Timing of Childrenís Health Care in Mali," Working Papers 2016-2, Brown University, Department of Economics.
    13. Lagarde, Mylène & Blaauw, Duane, 2022. "Overtreatment and benevolent provider moral hazard: Evidence from South African doctors," Journal of Development Economics, Elsevier, vol. 158(C).
    14. 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.
    15. 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.
    16. 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.
    17. 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.
    18. 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.
    19. Anna Popova & David K Evans & Mary E Breeding & Violeta Arancibia, 2022. "Teacher Professional Development around the World: The Gap between Evidence and Practice [Training to Teach Science: Experimental Evidence from Argentina]," The World Bank Research Observer, World Bank, vol. 37(1), pages 107-136.
    20. Timothy Powell-Jackson & Jessica J C King & Christina Makungu & Matthew Quaife & Catherine Goodman, 2023. "Management Practices and Quality of Care: Evidence from the Private Health Care Sector in Tanzania," The Economic Journal, Royal Economic Society, vol. 134(657), pages 436-456.
    21. 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.
    22. 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.
    23. 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.
    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).
    25. 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.

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    More about this item

    Keywords

    Health Economics and Policy; Institutional and Behavioral Economics; International Development;
    All these keywords.

    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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