Using the Hawthorne Effect to Examine the Gap Between a Doctor's Best Possible Practice and Actual Performance

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.motivation, practice quality, health care, Tanzania, Hawthorne effect, Health Economics and Policy, Institutional and Behavioral Economics, International Development, I1, O1, O2,

Sexual practices among unmarried adolescents in Tanzania

\ud Sexual activities are increasingly changing from the cultural point of view what they used to be. Knowledge of these practices among adolescents may be a basis to create awareness among adolescents on practices that involve risks. This study aims to assess sexual practices among unmarried adolescents in Tanzania. A cross-sectional survey was conducted among in-school and out-of-school but unmarried adolescents aged 10 to 19 in five locations in Tanzania. A questionnaire was used to collect information and to characterize sexual practices among these adolescents. About 32% of adolescents reported being sexually active; a higher proportion being males than females. The only inquired and reported sexual practices include vaginal sex, masturbation, oral and anal sex. About 15% of sexually active adolescents reported having multiple sexual partners. Significantly more males reported having multiple partners than females. Nearly 42% of sexually active adolescents reported having used a condom during most recent sexual act. Females reported older partners at first sexual act. Adolescents experience several sexual practices that include penetrative and non-penetrative. More males reported being sexually active than females. Despite adolescents reporting having multiple sexual partners, reported condom use during the most recent sexual act was low. We advocate for a more enhanced approach of reproductive health education that includes safer sex to adolescents without forgetting those in-schools.\u

PROVISION OF HEALTH INFORMATION AND ADVICE TO ADOLESCENT PATIENTS BY CLINICIANS IN ARUSHA, TANZANIA.

Objectives: To determine the extent to which clinicians provide health information and advice about prevention of STDs/HIV, pregnancy and substance use to adolescent patients; and investigate if clinicians' demographic and practice-related factors are associated with provision of such information and advice. Methods: Administration of questionnaire to 197 practicing clinicians in health facilities within two districts of Arusha region, Tanzania; investigating provision of health information and advice on STDs/HIV, pregnancy, and substance abuse to adolescent patients in the preceding 3 months. Demographic and practice-related information was collected from respondents. Logistic regression was used to assess if demographic and practice related factors were associated with providing information and advice. Results: Sixty-four percent of clinicians regularly provided information and advice to adolescent patients about STDs/HIV, 49% about pregnancy and 45% about substance use prevention. Having often attended adolescents with STDs was positively associated with regular provision of information and advice about STDs/HIV, as well as regular provision of information and advice about pregnancy. Being a clinical assistant and having often attended adolescents with cigarette/alcohol-related problems were positively associated with regular provision of information and advice about substance use. Conclusion: A substantial proportion of clinicians miss important opportunities to prevent disease and promote health of their adolescent patients. Future research should explore barriers to provision of health information and advice to adolescent patients who seek health care services

Moving from the lab to the field: Exploring scrutiny and duration effects in lab experiments

The most important issue facing experimental economists is the generalizability of lab results. This letter examines more than 1200 doctor/patient consultations, in which scrutiny and duration of treatment were varied. We show that scrutiny has an important but short-lived effect.

Outpatient process quality evaluation and the Hawthorne Effect

We examine the evidence that the behavior of clinicians is impacted by the fact that they are being observed by a research team. Data on the quality of care provided by clinicians in Arusha region of Tanzania show a marked fall in quality over time as new patients are consulted. By conducting detailed interviews with patients who consulted both before and after our research team arrived we are able to show strong evidence of the Hawthorne effect. Patient-reported quality is steady before we arrive, rises significantly (by 13 percentage points) at the moment we arrive and then falls steadily thereafter. We show that quality after we arrive begins to look similar to quality before we arrived between the 10th and 15th consultations. Implications for quality measurement and policy are discussed.Tanzania Hawthorne effect Out patient department quality evaluation Audit and feedback

Using the Hawthorne Effect to Examine the Gap Between a Doctor's Best Possible Practice and Actual Performance

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

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

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.Motivation Practice quality Health care Tanzania Hawthorne effect

Professionalism, Latent Professionalism and Organizational Demands for Health Care Quality in a Developing Country

Medicine is a professional pursuit, and even in developing countries professionalism should lead at least some practitioners to care for their patients despite the absence of direct incentives to do so. Even if practitioners do not behave as professionals, what is the extent of latent professionalism, in which socialization in the profession conditions health workers to respond to a demand for professionalism even if they do not normally act as professionals? How many health care workers in developing countries act as professionals all the time and what will happen if health services turn toward remuneration schemes in which health workers are paid by the output or outcome? We examine the behavior of 80 practitioners from Arusha region of Tanzania for evidence of latent professionalism, professionalism and responsiveness to extrinsic incentives in the form of organizational demands for high quality care. We show that about 20% of these practitioners act like professionals and almost half of these practice in the public sector. Professional health care workers provide high quality care even when they work in an environment that does not reward this effort, a finding that has important implications for the use of performance–based incentives