Outpatient process quality evaluation and the Hawthorne Effect
Social Science and Medicine
Department of Agricultural Economics, University of Maryland, 2200 Symons Hall, College Park, MD 20742, United States; Centre for Educational Development in Health, Arusha, Tanzania
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. © 2006 Elsevier Ltd. All rights reserved.
health care; psychology; research work; analytical research; article; consultation; Hawthorne effect; health care quality; human; interview; medical audit; outpatient; outpatient department; policy; Tanzania; Ambulatory Care; Behavior; Effect Modifiers (Epidemiology); Health Personnel; Humans; Observation; Quality of Health Care; Questionnaires; Tanzania; Africa; Arusha [Tanzania]; East Africa; Sub-Saharan Africa; Tanzania