National Health Service (NHS)
Placement: Harvard T.H. Chan School of Public Health
Mentor: Sara Singer, Ph.D., M.B.A. (Professor of Health Care Management and Policy, Harvard T.H. Chan School of Public Health)
Co-Mentor: Thomas Lee, M.D. (Chief Medical Officer, Press Ganey Associates, Inc.)
Project Title: Assessing Physician Motivation and Engagement: The Missing Piece of the Incentives Puzzle
Partha Das, M.B.B.S., M.R.C.P, M.Sc., is a 2016-17 U.K. Harkness Fellow in Health Care Policy and Practice. He completed his training in nephrology in 2015 and has been working as a consultant nephrologist in Brighton, England. He has previously worked alongside the National Clinical Director for Kidney Care with the UK Department of Health and the quality improvement organization National Health Service Kidney Care on initiatives to boost the standard of care delivered to people suffering from kidney disease. Das has been a National Institute for Health and Care Excellence Scholar, examining how the relationship and interactions between primary and secondary care professionals affect the management of chronic kidney disease. He has been chairperson of the UK and Ireland Nephrology SpR Club which represents all doctors training in renal medicine in the UK. He holds a first class degree in Neuroscience, received his medical degree from Guy’s, King’s & St Thomas’ Hospitals School of Medicine, holds membership of the Royal College of Physicians with specialization in nephrology (M.R.C.P.Neph.), and most recently obtained a M.Sc. in Health Policy, Planning and Financing from the London School of Hygiene and Tropical Medicine and the London School of Economics and Political Science.
Pay for performance mechanisms in healthcare systems across the world have not provided the large, sustainable gains in quality and efficiency of care that they might have initially promised. Insights from behavioral economics and psychology suggest that financial incentives can have negative repercussions by crowding out physician intrinsic motivation, which often leads to job dissatisfaction and burnout and correlates with poor patient outcomes and experiences.
The relationships that physicians foster with their peers and other healthcare professionals have the potential to influence motivation, and yet the importance of the healthcare ‘team’ and its impact on physician behavior is not well understood. It may be that these factors have a far greater effect on physician motivation than financial incentives and, if so, quality improvement initiatives should focus at least partially on this aspect of healthcare provision. Unlike in other industries, formal measurements of motivation are only used sporadically among physicians in the U.S., are not uniformly implemented, and lack external validation.
This study will attempt to elucidate the factors that drive physician motivation and engagement with their work and organization, how these might differ depending on the nature of the team on which a physician practices, and how they are affected by the use of performance adjusted financial instruments. It is hoped that the study will provide insight into why payment mechanisms that involve financial rewards alone and ignore other drivers of positive behavior may only have a modest influence on delivering better value healthcare and may actually have deleterious effects.