ABSTRACT
Behavioral economics seeks to define how humans respond to incentives, how to maximize desired behavioral change, and how to avoid perverse negative impacts on work effort. Relatively new in their application to physician behavior, behavioral economic principles have primarily been used to construct optimized financial incentives. This review introduces and evaluates the essential components of building successful financial incentive programs for physicians, adhering to the principles of behavioral economics. Referencing conceptual publications, observational studies, and the relatively sparse controlled studies, the authors offer physician leaders, healthcare administrators, and practicing anesthesiologists the issues to consider when designing physician incentive programs to maximize effectiveness and minimize unintended consequences.
Subject(s)
Economics, Behavioral , Motivation , Physicians/economics , Reimbursement, Incentive/economics , HumansABSTRACT
Our goal was to measure the quality of care provided in the Pediatric Intensive Care Unit (PICU) during Therapeutic Apheresis (TA). We described the care as a step by step process. We designed a flow chart to carefully document each step of the process. We then defined each step with a unique clinical indictor (CI) that represented the exact task we felt provided quality care. These CIs were studied and modified for 1 year. We measured our performance in this process by the number of times we accomplished the CI vs. the total number of CIs that were to be performed. The degree of compliance, with these clinical indicators, was analyzed and used as a metric for quality by calculating how close the process is running exactly as planned or "in control." The Apheresis Process was in control (compliance) for 47% of the indicators, as measured in the aggregate for the first observational year. We then applied the theory of Total Quality Management (TQM) through our Design, Measure, Analyze, Improve, and Control (DMAIC) model. We were able to improve the process and bring it into control by increasing the compliance to > 99.74%, in the aggregate, for the third and fourth quarter of the second year. We have implemented TQM to increase compliance, thus control, of a highly complex and multidisciplinary Pediatric Intensive Care therapy. We have shown a reproducible and scalable measure of quality for a complex clinical process in the PICU, without additional capital expenditure.
Subject(s)
Blood Component Removal/methods , Blood Component Removal/standards , Critical Care/methods , Algorithms , Family Health , Humans , Intensive Care Units, Pediatric , Outcome and Process Assessment, Health Care , Patient Education as Topic , Quality Indicators, Health Care , Quality of Health Care , Reproducibility of Results , Total Quality ManagementABSTRACT
Para permanecer dentro de la competencia, tanto doméstica como internacionalmente, las compañías deben mejorar e innovar la calidad de sus procedimientos, producto y muestra cómo desarrollar planes para mejorar la calidad siguiendo los lineamientos de la filosofía de Deming y cómo aumentar la productividad, la moral de los empleados y las ganancias. Al usar las siete herramientas administrativas usted podrá hacer planes, en forma real y duradera, para mejoras e innovaciones