Peer Feedback in Clinical High-Volume Activities

Peer feedback has strongly been advocated by medical professional societies as a key non-monetary strategy to improve the quality of care. Currently, if at all, clinical leader often provide feedback on key quality indicators in a rather pragmatic way. Systematic evidence on how to design peer feedback is scarce. The authors study how physicians' medical service provision is causally affected by peer feedback. Using a behavioral experiment, which mimics high-volume activity in a clinical setting, they systematically analyze how different non-anonymous ranking designs that vary in their granularity affect physician effort provision. In particular, they analyze how the heterogeneity in the physicians' abilities explains the responses to the different ranking designs. From a theoretical model of status concerns, the authors derive behavioral predictions. They report three main findings. First, peer feedback in form of rankings enhances physician performance on the aggregate compared to a non-ranking baseline. Overall, the effects tend to be stronger the more granular the ranking is. Second, the ranking design affects physician performance, and the impact of the ranking design depends on the physicians’ abilities. For an individual physician, increased granularity particularly motivates within her ability range - and may demotivate outside. Finally, the results indicate that small ranks at the tails of a ranking are salient. For clinical leaders, the results suggest that the use of rankings improves physician effort and imply that the choice of a ranking design should account for the composition of the physicians' abilities.